Ethics Consult: What to Do When Clients Speak Negatively About Prior Therapists

Dear Ethics Consult,

Most of my clients aren’t in therapy for the first time. They’re frequent fliers. 

Usually their stories about their previous therapy experience are good, or at least neutral. 

But, once in a while, my current clients tell me stories about other providers that leave me horrified—from lack of intake paperwork and informed consent to excessive provider cancellations to dual relationships and abusive-sounding interventions. 

Even though these clients are aware that what they went through in these awful therapy situations wasn’t acceptable, they typically don’t follow through with a formal complaint. 

In those cases, what can I do? I hate the idea of terrible therapists continuing to do things that are damaging to clients, or that give all of us in the profession a bad name.
Sincerely,

Concerned About Colleagues’ Bad Behavior

What Can I Do When Clients Tell Me About Previous Therapists’ Bad Behavior?

Dear Concerned,

I hear you. Over the years, a few of my clients have shared stories with me about their previous therapists that made my skin crawl. 

That said, it’s usually up to the client, and not us as their current clinicians, to decide what they want to do about it. 

Here’s the Approach I Take When My Clients Describe Their Negative Experiences With Prior Therapists

1. I Believe the Client

If a client tells me about something they experienced with their prior therapist that was hurtful or damaging or otherwise wrong, it’s not my place to ask questions like, “Are you sure?” 

I’m not an investigator. I’m a therapist. In general, I take clients at their word and operate in good faith. 

At the same time, just like with other clinical information, I don’t necessarily presume that what the client is telling me is objective truth. 

In my work with couples, I’ve seen time and time again how two people can have wildly differing experiences of the same events. 

Our memories are fallible, after all, and clients can sometimes misunderstand things that happen in therapy. So rather than treating a client’s story like courtroom evidence, I treat it as their subjective experience. 

I accept their story, and we talk about how it impacted them.

I ask clinical questions.

If they’ve lost some trust in therapy overall, I work to rebuild that trust. 

I never want the client’s sharing of their experience to become a power struggle.

2. I Consider Whether There Could Be a Benign Explanation for the Previous Therapist’s Behavior

As I said, some clients have bad feelings about prior therapy that simply result from a misunderstanding (or, less charitably, poor communication from the prior therapist). 

Operating in good faith extends to my colleagues. I’ll consider—sometimes to myself, sometimes out loud—whether there was some reasonable explanation for what the client experienced. 

Sometimes I’m able to put a client’s bad experience in context of what I think the prior therapist might have been trying to accomplish, and that can be helpful. 

After all, the overwhelming majority of therapists are well-intentioned, and we all try things clinically that sometimes don’t work the way we wish they would.

At the same time, normalizing the client’s reactions to their prior experience can be helpful too. 

Simply hearing someone acknowledge “That doesn’t sound right to me either. I can see why that would bother you” can sometimes bring visible relief to a client’s face.

3. I Educate the Client About Their Options

Clients may benefit from discussion of the differences between a treatment failure and misconduct. 

The simple fact that treatment didn’t work, or even that it didn’t end well, does not necessarily mean the prior therapist did anything improper. 

Their methods might have just been the wrong fit for the client.

If clients believe that they were impacted by a prior therapist’s bad behavior or misconduct, they typically have three options for formal responses:

• They can file a complaint with the state licensing board
• They can file a complaint with a professional association’s ethics committee
• They can file a civil lawsuit in court
  

A board complaint may result in an investigation and ultimately disciplinary action against the therapist’s license. Their license could be suspended or revoked. 

That said, the majority of consumer complaints about therapists do not result in formal discipline. If the board takes action at all, these types of complaints commonly result in probation and some required retraining for the therapist.

A complaint to an ethics committee may also result in an investigation. 

The investigation may lead to no action, but it also may lead to a formal finding of an ethics violation, a letter of censure, and/or the therapist being kicked out of the association. 

When a client has complained to both an association and a state board, the association sometimes chooses to wait until the state board has completed its own investigation before starting theirs.

A civil lawsuit for malpractice is a court process that may result in the therapist being forced to pay monetary damages to the client. It typically requires hiring an attorney and paying court fees.

Going back to your initial question, you’re right to say that many clients don’t follow through with formal complaints or lawsuits. All of these processes can have tangible outcomes in favor of the client, but they all take time. What’s more, it can be unpleasant for a client to reveal their own suffering as part of the process. 

Reluctance can also happen for a wide variety of other reasons, each one warranting a particular kind of response. 

If the client simply doesn’t know what their options are, you can provide information to them. 

Some clients will be pleasantly surprised at how easy it is to file a board complaint.

If the client doesn’t want to get the prior therapist in trouble, you can empathize, and see whether there may be something else that would bring the client relief—like reaching out to the prior therapist to request an apology. 

Sometimes that’s all a client really wants. There have been multiple episodes of the Very Bad Therapy podcast where clients who have gone through lawsuits or complaints against their former therapists have said very clearly that if they had just gotten an apology, that would have been the end of it. 

Of course, if your clients ask for an apology, they might not get one, so you would want to prepare them for that possibility. 

And for more egregious acts, it may be worth seeking to persuade the client to go ahead and report the therapist to the board and/or in a civil lawsuit, in the interest of protecting that therapist’s other clients from suffering the same harm.

If the client believes that they themselves must have done something wrong, or that the problem was unique to them, you can provide valuable reassurance. 

Legal and ethical compliance in therapy is the job of the therapist, not the client. 

And, while some therapists do make singular mistakes, it’s also common for issues around compliance to be patterns of behavior impacting multiple clients. 

Again, your client might be swayed if they consider how filing a complaint may help protect that therapist’s future clients.

4. I Consider My Own Options

Here in the U.S. state laws make a great deal of difference, and they can vary widely. 

In some states, you may be allowed or even obligated to report instances of alleged unethical or incompetent conduct of a colleague to your state licensing board. 

In other states (including California, where I practice), there are no such allowances in law, so you’re effectively prohibited from reporting a colleague yourself. 

However, I might get involved in ways that could either strengthen the client’s case should they choose to file a complaint in the future, or at least help their understanding of what the prior therapist was trying to do. 

For example, with the client’s authorization, I might request records from that prior therapist. The content and quality of those records might prove very informative.

You asked the initial question about what you can do when a client tells you of a prior therapist’s bad behavior. 

I hope the process I’ve spelled out here is useful in a practical way, but it’s perhaps equally important to consider what you’re wanting to accomplish. 

You want your client to feel safe in therapy. You want them to feel heard and understood. 

You want them to know that, regardless of whether their prior experience was misconduct, a misunderstanding, a treatment failure, or something else, that therapy can still help them. 

You want them to understand their options for reporting misconduct when it’s appropriate to do so, and you want to inform and support their choices about reporting. 

Ultimately, you don’t want the prior experience to overshadow the reasons why the client has come to therapy now. 

In my experience, the steps above are one way of holding good faith for all involved, addressing the client’s previous experience in therapy without their past overwhelming what they’re here for in the present in their sessions with you.  

Best wishes,

Ben Caldwell, PsyD

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