Sunday, June 24, 2012

Ask the Doc: When a therapist breaks your trust

Q. Someone dear to me was a client of a counselor/therapist who radically broke her trust, and she's never been able to trust any counselor/therapist since. How do you learn to trust a therapist/counselor after your trust has been betrayed by one? (I asked for additional information, and was told that the therapist shared personal information about the client without permission, in order to enable the person outside the relationship to "help with the therapy).

First, before I go anywhere else with this answer, I want to express my dismay about what happened to your friend. As with any profession, there are people who don't follow the rules. I've had clients tell me about a prior therapist who fell asleep in session, or walked out to take personal phone calls. These rogue professionals are thankfully rare, but they do exist. The therapy relationship is entirely built on trust, and your friend's experience has created an injury that will be hard to overcome.

While no one can "fix" this situation, here are some things for your friend to think about while considering whether to give therapy another try. The options range from reporting the therapist to simply working on rebuilding an attitude of trust, and all are about choices that your friend can make.

One choice your friend can make is to report the therapist for a confidentiality violation. If the therapist is licensed, the state licensing board will handle the complaint. This is obviously not a choice to be made lightly, as your friend would need to continue to be involved in this traumatic situation. I always inform my clients of their rights when they feel they've been harmed by their previous therapist, and I always understand when pursuing a complaint sounds too difficult to them. I'm there to support them in whatever they choose to do. This is what you can do for your friend, as well. Let them know about their choices, and support them unconditionally.

Another choice to be made is when (and whether) to reengage in therapy. If therapy begins again, the choices are about how much to disclose, and when to disclose it. The difficulty here is that this kind of dilemma is perfect therapy fodder, and your friend is likely very resistant to therapy. Some make the choice to "get back on the horse," while others need to let time heal the wounds.

Your friend will likely need to spend some time considering her feelings, really thinking about what will be needed to rebuild a trusting relationship. When the time comes to disclose things in therapy, the process will be made easier by having thought beforehand about where the boundaries are, and what the true feelings are. A good therapist will be open to working on this process - your friend can tell the therapist that a core issue is trusting the therapist, and the work can begin there. A good, careful therapist will be willing to take as much time as needed, while at the same time knowing when to gently push a little.

As therapists, we understand that our clients have often navigated a bumpy road before ending up in our office. We get that we might have to start from scratch, maybe more than once. I hope your friend can forgive herself if she feels gun-shy, and I hope she can realize that it will be difficult to start a new therapeutic relationship. It's okay if she starts and stops before she finds someone she can trust. The therapy work is about her, not about the therapist, and it's perfectly natural for her to pick her way carefully down the path.


  1. I recall an incident from many years ago when a psychologist I saw as a teenager revealed things from my therapy to my parents. At the time, I didn't realize that there was anything necessarily wrong with this revelation, or that it caused significant damage to my willingness to trust.
    Upon reflection, I see that I was deeply affected and how difficult it has been for me to feel comfortable with any therapist since then.

  2. Daisy - One of the things that makes licensure so complicated is that every state has different laws about consent to treatment, and confidentiality. In many places, clients under a certain age (usually 16-18) don't have the right to full confidentiality. Parents are often included in the loop. Therapists, however, have the responsibility to tell their younger clients exactly what the confidentiality policies are, and how they will be used. I feel that it's just as much of a betrayal if a therapist talks to a teen's parents without disclosing to the teen when and how that will be done. No matter that it's legal - therapy is ABOUT THE CLIENT. The client needs to be in the know at all times.

    1. I think I was actually a bit younger, maybe 12 or 13. But this therapist definitely never told me that anything would be shared with my parents. My father told me some of what the therapist had said about me. Opinions and such. I really felt very violated and embarrassed.

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  4. Michael, thank you. There are big things afoot here... I'm writing a book, and the blog will undergo a huge face-lift when the book comes out this fall. Please stick around!