When Business Gets in the Way: Rifts in the Therapeutic Relationship

Being a good therapist involves juggling three aspects of the job, even when these aspects—ethics, business, and relationships—sometimes seem to butt heads. Adhering to ethical codes and enforcing business policies are vital to doing good work and running a successful practice. But what happens when following ethical guidelines and enforcing policies creates conflict in the relationship between therapist and client?

My work as a therapist, supervisor, and peer consultant constantly highlights this balancing act and demonstrates it’s not always easy to stick to the guidelines and procedures amid the genuine desire to be empathic and helpful. Being a good therapist involves mastering the art of maintaining clear boundaries with the people we work with while ensuring they experience our genuine sense of compassion and care. Unfortunately, it’s sometimes impossible to follow the rules without being perceived as unsupportive or insensitive.

The response to my article Why I Charge for Late Cancellations and No-Shows to Therapy underscores how delicate the balancing act between enforcing business policies and maintaining an amicable therapeutic relationship can be. As a reliable client, it’s hard to incur a no-show charge for a session you forgot about for valid reasons. And as a therapist, it’s hard to charge someone for a missed session when just last week you supported the person through tremendous grief or hardship.

It’s equally difficult to feel obligated to break confidentiality and risk losing a client’s trust, as therapists are sometimes forced to do because of mandated reporting laws. My colleagues and I often discuss the challenges related to wanting to support and protect the people we work with while being required to act ethically, maintain boundaries, and uphold business policies.

The bottom line is that sometimes therapists unintentionally and involuntarily cause the people they work with to feel uneasy about an interaction in the work or the relationship. There is much gray area and a lot of difficult decisions to be made when it comes to navigating the various aspects of working as a therapist. And there are times when things, for whatever reason, don’t go smoothly and someone’s feathers get ruffled.

Whether it’s feeling bitter about incurring a no-show charge for a missed session, feeling betrayed by a therapist about their duty to report, or being frustrated by something the therapist said or did, people receiving therapy services can sometimes feel hurt, slighted, or misunderstood by their therapist. And this rupture can pose a threat to the trust and rapport that are vital in therapy. It can halt the therapy altogether because when negative experiences or perceived slights occur, people seeking help may feel reluctant to continue.

But let’s face it: No therapist is perfect. At some point, every therapist makes a mistake, whether it’s an inaccurate assumption, saying the wrong thing, or failing to communicate in the most appropriate and ideal manner. Simultaneously, people in therapy can sometimes be so caught up in their challenges and struggles they may lack the ability to see the broader picture behind certain actions or inaction by their therapist.

Let’s face it: No therapist is perfect. At some point, every therapist makes a mistake, whether it’s an inaccurate assumption, saying the wrong thing, or failing to communicate in the most appropriate and ideal manner. Simultaneously, people in therapy can sometimes be so caught up in their challenges and struggles they may lack the ability to see the broader picture behind certain actions or inaction by their therapist.

While most therapists are in their line of work out of a genuine desire to help, they are running businesses, potentially supporting families with their income, and are required to follow certain laws and state regulations. Sometimes, the need to protect licensure, follow moral and ethical codes, and run a reputable and successful business can be perceived as clashing with a desire to maintain sincere and amicable relationships.

Therapy is all about the client, and sessions are a time for people in therapy to focus inward—to reflect on their life, process their struggles, and gain insight that helps them move forward. They open up about some of their most challenging experiences and share their vulnerabilities, so it makes sense people in therapy may feel offended or betrayed when their therapist acts in a manner that seems to miss the mark or feel punitive.

Therapists need to navigate their obligation to adhere to ethical codes and their commitment to running successful businesses with consideration to the impact their actions have on the people they work with. Therapy is a strange thing in that clients share very personal stories and can develop a strong bond with their therapist, yet, at the end of the day, it is a professional relationship and there may be instances where the business side of the work causes friction.

I encourage therapists and clients alike to see therapy as a collaborative process where there is room for open and honest communication about feelings that come up regarding the work or any administrative aspects that impact the relationship. If someone in therapy feels hurt or upset regarding an action or comment made by their therapist, it would be advisable to initiate a conversation about the issue during a session, where feelings can be shared and processed. While confronting conflict is hard, it’s an opportunity to work on things like standing up for yourself, expressing your feelings, and practicing assertiveness skills—things that many people in therapy are working toward.

Therapists need to know the impact they have and should be challenged to look at how they might improve their communication and ways of handling the balancing of their roles. For less seasoned therapists especially, sometimes personal anxiety and the need to ensure things are done “by the book” overshadow the ability to put the therapeutic relationship first. It’s okay for therapists to be real with clients—to receive feedback, to admit to being wrong, and to say, “I messed up” or “I didn’t handle this very well.” If a therapist makes a mistake, they should own it. Doing so can be a chance for both parties to learn and grow.

It’s important to recognize that some of the greatest transformation may come from conflicts and challenges that are acknowledged and addressed. Although rifts in the relationship can occur and threaten the work, these experiences can also be catalysts for growth and change if the therapist and person in therapy are able to confront and process the experience together.

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