CONTENT WARNING: This article includes examples of exploitation by therapists towards clients.

Introduction

One of the joys of being a therapist is the opportunity to connect professionally with other therapists, and most of my connections over the years have been extremely positive. I like to think that there is a certain like-mindedness amongst therapists that relates to a genuine desire to help others, and personally, I like people who are kind to others.

I don’t have statistics to report on how common client exploitation by therapists is, but anecdotally, I’d say that extreme cases of client exploitation are rare and less severe incidents, less rare, but not common. Unfortunately, in my 24 years of social work counselling practice, I have heard reports of both.

Admittedly this is a dark topic and I understand if you choose to not read further. If you would like to educate yourself more about this topic through this article, please do so at your own pace and seek support from a loved one, or a trusted health professional, if you feel you need it.

In a 2014 article I wrote, Why Your Counsellor Is Not Your Friend, where I touch on the area of boundaries in the counselling relationship, first referenced in a 2013 post, Your Counselling Bill of Rights. More recently, I wrote an article on dual relationships. These articles are related to what I’m going to talk about here, but I’d like to more fully expand on recognizing possible forms of client exploitation by therapists, and what to do about it if you find yourself in this situation.

As some of you know, I am a Registered Clinical Social Worker (RCSW) with the British Columbia College of Social Workers and a Registered Social Worker (RSW) with the Ontario College of Social Workers and Social Service Workers and as such, I write from the social work perspective. As I have said many times in previous articles, counselling is not regulated in British Columbia so be sure that your therapist is registered with a professional body which has a code of ethics and standards of practice (which exist for the protection of the public).

The Code of Ethics from the Canadian Association of Social Workers clearly states:

“A social worker shall not exploit the relationship with a client for personal benefit, gain or gratification.”

British Columbia’s Code of Ethics and Standards of Practice for social workers goes on to elaborate that when working with clients, the needs of the client must remain paramount at all times and that social workers must be adept at recognizing and getting their own needs out of the way, so as not to harm clients or negatively influence the service provided.

Why is this level of diligence important? At the core of the matter, therapists are in a position of power, trust and influence, and clients seeking therapy are vulnerable, both because they do not have equal power in the relationship with the therapist, and also because of the emotional pain and challenging personal circumstances that generally accompanies attendance in counselling.

A Shadow Problem?

It can be difficult to spot exploitation when you’re a counselling client. There are a number of reasons for this, which could include:

• You feel a good, or even great, rapport with your therapist and couldn’t fathom them ever exploiting you.
• You have a history of trauma which has included exploitation or abuse of power.
• You struggle with assertiveness.
• You have been taught, or believe, in a “doctors as experts”/medical model where the authority of your health professional should not be questioned.
• You have been gaslit by people in your life and you struggle with self-doubt.
• You are emotionally vulnerable—hence why you are seeking counselling—and you are distracted by the intensity of your emotional suffering.

Identifying Client Exploitation

Exploitation can take many forms, from mild to severe, and while this is not an exhaustive list, let’s look at some of the more well-known forms:

Expertise-seeking

The therapist is looking for your expertise on matters not related to your counselling. There may be times when you discuss your expertise within a counselling session, but this should be for your therapeutic benefit, such as feeling more understood, increasing your self-confidence, or seeing how your expertise in one area could be applied to other therapeutic goals. I was once mined for my counselling business knowledge by a one-time therapist and it was, uhh, gross. Not the reason I was attending counselling.

Emotional

Your therapist over-discloses their feelings with you in a way that makes you feel uncomfortable. There are times when therapists—who are not robots—disclose their feelings about what is being discussed in counselling, however this is to benefit the client, not the therapist.

Legitimate therapist expressions of emotion could include:

• The client feeling validated
• As a therapist’s expression of genuine human connection, which builds trust and rapport in the counselling relationship
• Therapists identifying client risk or concern through their emotional response

Illegitimate expression of emotion could include:

• Therapists using the client for emotional support or gratification
• Therapists burdening the client with their emotional problems/implying the client should solve them
• Therapists upselling the client as “wise” and owing the therapist emotional support
• Emotional abuse (degradation, humiliation, gaslighting, shaming, manipulation, subjugation , threats, secrecy requests, etc.)

Anything that gives you an emotional “ick” feeling is a bad sign. A caveat of note is if you have a history of emotionally rescuing others, whether or not this has been requested. This history could either make you more vulnerable to emotional exploitation (so it is important to acknowledge this),  or conversely you may jump-in reflexively, even if not requested or hinted at, and end up feeling unsettled and upset or “used.”

Social

This refers to situations where client boundaries are crossed socially by the therapist. This could include:

• Therapists frequenting social groups or settings that the client has identified in therapy
• Encouraging clients to join their therapists’ social circles
• Asking clients for access to social settings that the therapist otherwise does not have access to
• Inviting clients to participate in social contact together outside of the therapy (e.g. going out for coffee, drinks, to the therapist’s home if they don’t have a home office)
• Initiating a friendship with clients outside of therapy
• Calling or messaging clients outside of therapy for reasons not related to their therapy.

Ethical therapists avoid conflicts of interest with clients or “dual relationships”, whenever possible. It should be mentioned that there are some caveats to the above including the fact that social cross-over is often completely unavoidable in small towns (these possibilities should be discussed in advance with clients including a plan of action) and that there will be times in large cities where clients and therapists will inadvertently run into one another in social settings. Also, some social settings are very public by their nature and do not “belong” to client or therapist so both may have ‘rights’ around accessing this space. In such coincidences, therapists must be rigorous to maintain the clients’ confidentiality.

Financial

This can take several forms including:

• Raising clients’ fees without telling them or without sufficient warning
• Raising fees dramatically/beyond what is expected in the field
• Charging clients for sessions which have not occurred
• Not disclosing therapy fees at the outset of counselling
• Charging clients’ credit cards fraudulently
• Asking clients to participate in insurance fraud
• Therapists independently committing insurance fraud using client information
• Bartering counselling for goods/services from clients
• Using therapist privilege to sell products to a client not related to their therapy
• Accepting clients that cannot afford their therapy services/do not have 3rd party financial help
• Insisting that clients continue paying for therapy when they cannot afford it or don’t need it
• Entering into business or other financial arrangements with clients

Most counselling codes of ethics are clear and prohibit therapists from entering into financial arrangements with clients, and stipulate that the therapist must act with honesty and integrity in their financial dealings.

Physical (non-sexual)

Any physical, non-sexual touch from a therapist should only be done if the therapy method involves it and that the client has consented to it. For example, a client may be seeking cognitive-behavioural therapy for anxiety related to job interviews, and has a fear about shaking hands. A therapist may choose to offer the client the opportunity to shake hands as part of a practice script; the client decides in advance whether they want to consent to this.

For in-person sessions, clients also have the right to sit where they want in a therapy office, unless the therapist must use a designated chair (usually for postural support). Most couches are three-seaters, allowing the client to moderate their distance from their therapist.

The issue of platonic hugs in therapy is controversial. It’s my belief that therapists should not initiate hugging their clients and hug requests from clients should be treated with careful consideration, particularly if it could lead to confusion in the therapeutic relationship.

Sexual

Counselling professionals do not have sex with their clients under any circumstances. In fact, the social work Standards of Practice stipulates that social workers who have provided counselling or psychotherapy to a client have a lifetime ban on any sexual contact whatsoever with previous clients.

Further, therapists should never:

• Commit sexual assault or touch a client sexually
• Make sexualized or harassing comments or “jokes” towards clients
• Discuss aspects of the therapist’s personal sex life to clients; make gratuitous inquiries about clients’ sex life not related to their therapy
• Expose clients to sexual images, inappropriate sexual information (not legitimate sexual health information)

What To Do If You Have Concerns About Exploitation By A Therapist

My strongest recommendation is to reach out to someone for support because the trauma from these situations can become compounded if you try to deal with it alone. How you seek support depends on a number of things including urgency, severity, comfort level, options in your circle of support and resource availability.

• Honour your feelings – If something isn’t sitting right with you, don’t write off this feeling but instead, investigate further, by either talking to someone you trust, writing it out, meditating on it, or what other form of reflection makes sense to you.
• Talk to someone you trust – to help with perspective, get a trustworthy person’s opinion who is outside of the situation. Does their response make sense to you? If not, try someone else.
• Talk to a health professional – If you have a family doctor, getting their perspective is often a great place to start. Another idea is to talk to a different registered mental health professional or call Wellness Together Canada and speak to one of they professional therapists.
• If you feel that the incident has left you puzzled and is in the league of a misunderstanding and not abuse or exploitation, talk to your therapist and see how they react. Do you feel satisfied after the discussion, or worse?
• Access Crisis Support – Reach out to an anti-violence helpline for support, particularly if you are in crisis or overwhelmed and don’t know what to do.
• Contact the therapist’s professional college or association (if they have one). They will listen to your complaint, investigate it and, if a violation has occurred, the professional you are working with will be disciplined. This may include consequences such as the therapist being barred from practicing or mandated to receive supervision or additional training. There may also be additional support resources available to you through the college or association.

Seeking therapy again after exploitation by a therapist can be tough, if not impossible. If you are open to trying again, check to ensure that the therapist is registered with a college or association. Friends or family may also be able to refer you to someone who helped them feel comfortable and respected. Going off of online reviews can be dicey as reviews can be fake, the reviewers’ backgrounds and needs can be very different than yours and therapists are very limited in how they can respond online as doing so can compromise a clients’ confidentiality.