When Should You Fire Your Therapist?
The following example of a sexual boundary violation may be disturbing to some readers.
Dear Analyst:
I’m a male in my thirties. In a recent session, I became emotional discussing my deep dark fear of never finding a partner. My therapist of four years leaned forward and asked, “Can I kiss you?” I declined and left immediately. I feel strongly that her behavior crossed a line. Should I fire my therapist?
—FC
NY
Dear FC,
Thank you for writing—and I am really sorry this happened to you. Please know that you did nothing wrong, this is not your fault. If a therapist experiences any kind of excitement or sexual feeling during a session, it’s on them to look in the mirror and reflect. Therapists are bound by professional ethics (more later) and are expected to approach the treatment situation with arm’s-length curiosity, not be drawn in by their own reactions. Even if a patient flirts and attempts to pull you in—and again you did nothing wrong here—it’s on the therapist to say no.
Your therapist’s behavior, asking for a kiss, raises ethical alarm bells. Kissing, or any form of sexual contact, is expressly forbidden by professional codes of ethics for psychotherapists. All professionals—psychoanalysts, psychologists, physicians, clinical social workers, counselors, licensed mental health workers, and psychotherapists of any clinical orientation—are bound by these codes to protect the vulnerable. (APsA’s code of ethics, for example, can be found here.)
There is an inherent power differential in the therapist-patient dyad, and the therapist has a duty not to use that power to exploit vulnerable patients. Your therapist’s overture raises concerns about abuse of power and represents a huge no-no in terms of crossing boundaries.
You left immediately. I’m guessing you felt unsafe. I’m glad you trusted your instincts. The American Psychological Association and other professional organizations don’t publish current statistics on this. However, APA reports have estimated that the incidence of erotic contact between mental health practitioners and patients ranges from 7 to 12 percent. And roughly 3 percent of ethics code complaints have involved boundary violations, including cases like you’re describing. One review stated that 7 percent of all sanctions issued by medical boards for physicians were for sexual misconduct. This is the black-and-white part. The rest is more insidious and complicated. Some people with traumatic experiences in their past cannot set limits and say no as easily as you did. In fact, some would argue patients who were victims of abuse in childhood are vulnerable to repeating the trauma, winding up in abusive relationships with therapists.
Ethics codes agree: Physical contact such as kissing or more is never OK in the treatment room. Never: no matter who proposes it, patient or therapist. You listened to your instincts and trusted yourself despite what the therapist said and proposed—good for you.
And just to be clear, if a therapist suggests working through difficult feelings raised by the interaction, in cases where that therapist is violating a sexual or physical safety boundary no amount of discussion excuses, and no words render therapeutic, any such serious boundary violation. In less serious cases, talking about pressures to the treatment frame may afford insight, progress, and healing (see below)—but this is not one of them.
So now what? For starters you might consider reporting this clinician to the local licensing board. That’s your choice. I’ll say again, I’m sorry this happened to you when you were discussing your fears, hopes, and dreams—the very dreams of partnership that your therapist was toying with. Who hasn’t come to therapy to cry it out—I’ve been there and it’s a vulnerable place. Therapists are bound to provide a safe space and put patients first.
Which brings me to your continuing treatment: Get thee to a new clinician. Run, don’t walk. Talk about what happened, how vulnerable and unsafe you felt. What it stirred up in you. What other feelings (guilt? shame?) you might have felt, and whether you want to report this practitioner. Find a professional you can talk to.
Illustration by Austin Hughes
For Therapists
Many of you reading are not just patients but practicing therapists. Let’s think about sexual feelings in treatment from your angle. I’ve written in a previous column on handling positive transference—specifically, what to do when you become aware of erotic feelings towards your clients. Three words: supervision, supervision, supervision. Talk, don’t enact. At least one study found that clinicians who spoke to supervisors had increased awareness of sexual violations as ethical and boundary issues. Consulting with your own therapist or training analyst is also crucial in this situation.
Sometimes in sessions we hear that a prior therapist has crossed a line with a patient. Whether therapists need to report violations by prior clinicians is another avenue of concern. There is no big study published on this, and as with other ethical issues incidence of reporting varies state to state.
Therapists, like other medical professionals, must avoid abusing our position of power. We as mental health professionals of every stripe, regardless of training and theoretical background, can take inspiration from our medical colleagues to “do no harm” (hat tip, Hippocrates). That’s an ancient idea that doesn’t go out of fashion.
“You’re Fired!”—or Not: When to Talk It Out
The example above might seem like a pretty obvious case of when to fire your shrink. But some cases are more borderline, and many issues can be talked through. Indeed, if no serious boundary violations have occurred, it’s helpful to speak to your therapist about challenges to the frame. Think of it as Technique 101: Deep and meaningful examination of what’s going on in the consulting room presents a chance for the dyad to learn something important about the client.
For example, when patient and therapist enact something from the patient’s or therapist’s unconscious world—by, say, chatting outside the office, which is a slight boundary crossing—something often can be learned by discussing what’s been acted upon (“I wish we were friends; I want more time with you”). Enactments are inevitable and open up new avenues for understanding. There is no harm to the patient if it’s a minor crossing and understood through analysis of feelings and thoughts.
Ponder these real-life scenarios:
Your therapist’s office is a cluttered little room covered in a thick layer of dust with a pipe protruding from the ceiling—and not in an industrial-chic “exposed brick” kind of way.
After inadvertently ending a session 15 minutes early, your therapist remains silent in sessions that follow as you share related feelings of rejection.
Your therapist tells you, “I know what you’re going through … I’ve also been involved in a messy divorce.”
If and when you embark on discussing an issue like one of these with your therapist, here’s one test to tell how big a problem you have: Can the therapist own and discuss their part in the situation?
Those of us who earn our living in a therapist’s chair should be able to own what we bring into the treatment room (Greenson’s “real relationship,” an oldie but a goodie, makes this point well). Adopting a defensive stance, as in scenario 2 where the therapist remains quiet after ending a session early, is anti-therapeutic. Silence here models a lack of communication and may constitute a replaying of old deadlocked arguments that go way back in the patient’s psyche. Recreating breakdowns in communication with a therapist is generally not helpful for patients. If discussion becomes too difficult, if there are stubborn emotional barriers to working on certain feelings in the treatment situation, whether those barriers seem to be erected by the therapist or patient or both, consulting with a different therapist makes sense.
Boundaries around space and time, along with a therapeutic alliance, make clients feel protected. A patient should not be left to wonder about subpar maintenance of a therapist’s office or premature session endings. If your therapist doesn’t raise boundary issues like office conditions or lapses in timing—and if they can’t discuss your concerns about these issues without defensiveness or denial—don’t suffer in silence and don’t wait for months on end. Find a new shrink.
What about the third scenario, where the therapist discloses information about their own divorce? Certain types of disclosures—like direct expressions of the patient’s reactions to the analyst’s statements—have been found to foster cooperative work more than disclosures involving the revelation of personal information to the patient. Therapists must weigh what Barry Farber calls the “inevitable tension within the dyad between the demands of open and honest disclosures and the equally potent countervailing forces of shame, tact, and appropriateness.” Therapists should not overburden the client with personal disclosures and should refrain from hijacking sessions by speaking about themselves. (See, e.g., Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy, published by Routledge.)
You should feel there’s a “fit” with your therapist and that you are able to engage freely in session. If disclosures or other aspects of the therapist’s style or technical approach make you feel uncomfortable, you should raise this issue.
Different clinicians may pursue conversations about these scenarios differently. Those who see the work as interpersonal with no need for regression when analyzing will try to unknot the transference, analyzing everything in the present (“When you arrive late for our sessions you piss me off”). Therapists practicing in a more traditional way might emphasize the utility of regression (“You are here after the time, perhaps you are wondering like you did with your dad growing up whether you can have an impact on me”). Here linking to people or experiences from the past helps clients understand themselves and makes different choices in the present. Still other therapists might listen for derivatives of the boundary issue (“I went to the dentist yesterday and that office was a mess!”) and connect them to what’s going on in the treatment (“Perhaps you are noticing some construction in my office?”).
How a clinician listens is generally informed by theoretical orientation and by the way their therapist or supervisor has done things. Point is everyone wins when the dyad discusses what’s going on in the treatment.
Therapeutic boundaries are there for a reason. When they are clearly violated—or can’t be addressed fruitfully—it’s time to find a new couch to cry on.
In Ask a Psychoanalyst, Stephanie Newman, PhD, responds to reader questions about therapy, relationships, and psychopathology of everyday life. Submit your questions to advice@tapmag.org. Your identity will be kept anonymous.
This column is for general educational and informational purposes only and is not a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your own therapist, physician, or other qualified health provider with any questions you may have regarding a mental health condition. Reading or submitting to this column does not create a therapist-client relationship.Published November 2025