Ethics Consult: The Client Who Wouldn’t Leave

Dear Ethics Consult,

A few days ago I had a frightening experience that left me wondering how to prevent it from happening again. My client—I’ll call him Dave, and yes, I’m changing some details here—wouldn’t leave my office at the end of his session. He wasn’t outwardly threatening. He just stared me down from his spot on the couch at the end of our session. Even when I got up and put my hand on the doorknob (a pretty strong signal, I think) he just sat there.

To be fair, the session hadn’t gone well. I confronted him, probably too much, about a habit of his that is driving friends and family away. I like Dave as a client and as a person, I think—or at least I thought I did. Now I’m not so sure. I’m a small woman, he’s a large man, and no one else was in the office. I shudder to think of what might have happened if things got ugly.

After a couple of minutes that felt like an hour, he got up and walked out without saying a word. Just shaking his head. I haven’t heard from him since then. Do I apologize? I wasn’t the greatest therapist, but he was the one who was stoking fear.

—Him or Me

Dear Him or Me,

Let’s focus on what you did right here: you didn’t escalate the situation further. You’re trying to figure out what happened and how to repair your therapeutic relationship—while also being mindful of your safety.

Client physical attacks on therapists are thankfully rare, but they do happen—sometimes with tragic results. Therapists report both that this situation is something they fear happening to them, and that they don’t feel that their training or education addressed what to do if it does. 

So we should be discussing therapist safety in direct and practical terms. There’s a benefit to keeping an emergency call button within reach at all times. If you need to call police to remove a client who’s threatening you or refusing to leave, you can typically do so without violating confidentiality—just don’t explain why the person was in your office in the first place.

As far as your work with this specific client goes, should you apologize? I’m not sure it’s owed, necessarily. But apologies can serve lots of purposes, and they go beyond just settling a moral debt. An apology here might open up a discussion that ultimately repairs your relationship. You can apologize for what you see as a therapeutic mistake without absolving him from responsibility for his behavior. Hopefully he takes the social cue, is also interested in repairing your relationship as well, and apologizes too.

For now, I would give your client Dave the benefit of the doubt, and hope that he was simply unaware of the gender dynamics at work in that moment. Perhaps he was intending just to show his frustration, or to exercise some small degree of power. But regardless of his intention, you began to fear for your safety—and reasonably so.

If you continue to experience your session with Dave as dangerous or threatening going forward, you likely have no legal or ethical obligation to continue treatment. (I say “likely” just to account for rare exceptions.) The ethical principle of non-abandonment doesn’t mean you’re stuck with a client who poses a safety risk. It just means you should work to ensure any crisis needs are addressed and that you provide appropriate referrals. You should never have to choose between confidentiality and personal safety.

Good luck and stay safe,
Ben