When the Therapy Room Stops Feeling Safe: Understanding Client Violence Against Therapists

When the Work We Love Changes Us

We often talk about creating safety for our clients. But what happens when therapists no longer feel safe?

Client Violence Isn’t Always Physical

When people hear client violence, they often imagine physical assault. Although physical violence is a serious occupational concern, it represents only part of the picture.

Client violence can include verbal aggression, threats, intimidation, harassment, stalking, and sexual harassment, in addition to physical assault. Some experiences are overt, such as being punched, threatened, or having objects thrown during a session. Others may be less visible, including repeated belittlement, boundary violations, or threatening communications.

In our work examining Adverse Psychological Events (APEs), Khara and I distinguish between more overt forms of violence and less obvious behaviors that can still undermine a therapist’s sense of safety. Not every uncomfortable interaction constitutes violence. Therapists routinely work with anger, distress, interpersonal conflict, and dysregulation. However, being a therapist does not mean consenting to threats, harassment, or abuse. Compassion for a client’s circumstances and accountability for harmful behavior can coexist.

The Impact of Feeling Unsafe

Experiencing client violence may change how a therapist approaches their work. For example: 

• A therapist who previously felt comfortable working alone may become hypervigilant. 

• Someone who once approached difficult sessions with confidence may begin anticipating danger.

• They may question whether they missed warning signs or should have responded differently.

• Relationally, the experience can influence trust, including trust in clients, colleagues, supervisors, and organizational leadership.

• They may reconsider the populations they serve, the settings in which they practice, or whether they want to remain in the field.

Yet, many therapists minimize these experiences. They were just dysregulated. They have experienced significant trauma. I should have handled it better. Understanding the reasons behind someone's behavior does not require accepting harm.

Organizational Responses Matter

Imagine telling your supervisor that a client threatened you and hearing, “Well, what did you do to trigger that response?” Or being told to continue seeing the client without a safety assessment, additional support, or discussion of alternatives. These responses can compound an already distressing experience. 

Trauma-informed leadership means recognizing that therapists have physical and psychological safety needs, too. Organizations cannot eliminate every risk associated with clinical practice, but they can establish clear procedures, respond to threats appropriately, and support clinicians who experience violence.

Potential Strategies for Healing After Client Violence

• Reestablish safety. Begin with immediate safety needs. Depending on the situation, this may involve consultation, workplace safety planning, documentation, changes to scheduling or office procedures, or contacting appropriate authorities. Consider whether it is possible to maintain a therapeutic orientation while establishing firm limits around threatening or abusive behavior.

• Seek clinical consultation. A trusted supervisor or colleague can help differentiate clinical considerations from personal safety concerns while supporting ethical decision-making.

• Attend to the nervous system. Movement, grounding, mindfulness, and somatic approaches are some ideas. 

• Reconnect with professional confidence. One harmful encounter does not define your clinical competence. Healing may involve identifying what you did effectively, what you would change, and what additional resources you need.

A Call to Action for Leadership

If you supervise clinicians or lead a mental health organization, ask yourself: What happens when someone on your team reports feeling unsafe? Do you have a protocol? Do clinicians know how to access support? Can they raise concerns without being blamed? If you are a leader, consider:

• Establish procedures for responding to threats, harassment, and violence.

• Provide opportunities for safety planning, consultation, and follow-up.

• Consider paid leave or workload adjustments when appropriate.

• Avoid automatically framing client violence as a failure of the therapist’s clinical skills.

• Normalize conversations about workplace safety before an incident occurs.

The call to action is simple: Stop expecting therapists to sacrifice their own safety in the name of helping others. We can care about our clients while also recognizing that therapists deserve protection, support, and dignity.

This article is part of our seven-part series exploring Adverse Psychological Events from The Resilient Therapist by Khara Croswaite Brindle and Ashley Charbonneau.