It’s great that we’re holding therapists accountable for their actions. Being a therapist is an extremely important job and doing it poorly can have devastating implications with regard to the lives of patients.

Still, the system is out of balance. We’re investigating therapists in record numbers – and often finding that the complaints against them to be spurious, at best- but we’re not considering the risks that therapists take in caring for the most wounded and disturbed members of our population.

No-one is protecting the therapists from the occupational hazards of their jobs.

In order to do a good job on behalf of our patients, we therapists have to challenge their beliefs, attitudes and expectations. We have to question their habitual patterns of behavior and shake them out of their comfort zones. We need to risk annoying our patients for their own benefit.

Being a good therapist means being accepting, kind and respectful to our patients but not necessarily being “nice.”

Our goal should be less that they like us and more that they trust us and feel safe with us. We need to worry less about how they feel about us and more about whether we’re being helpful to them, so that we’re free to confront them in ways that might sometimes cause them to become angry with us.

To challenge a person’s most cherished, but false and self-destructive beliefs is often seen as an affront to their already fragile sense of self. It’s anxiety-provoking at best and infuriating at worst. Still, they need to let go of this counter-productive self-concept if they’re going to be free to live a better life.

It’s not uncommon for the most wounded patients to become become enraged at their therapists when the therapist causes them to question the way they look at, and respond to, themselves, others and the world.

At the best of times, we therapists can build a therapeutic alliance with a patient which creates a “safe space” for them to do their work of healing and growth. Unfortunately, not every patient is capable of entering easily into such an alliance. They’re so wounded that they find it extremely difficult to trust any sort of “authority figure,” even one whose job it is to help them.

These individuals can’t help but project their abusive, abandoning or crazy-making parents (or other adults from their past) onto us therapists, and despite our best attempts to explore this negative transference, they may initially insist upon seeing our therapeutic interventions as hurtful and disrespectful to them.

With such a patient, the more we attempt to help them, the more we’re seen as hurting them. Frequently, such an individual can be brought around to see that the therapist is on their side, but paradoxically, these efforts on the part of the therapist require a degree of ruthless compassion, or “tough love.”

We have to strongly challenge their false beliefs and expectations, set very clear limits and be the loving but firm-boundaried parent-figures they never experienced in the past.

The patient might then see that the therapist is there to help them and stop resisting their therapeutic interventions. On the other hand, it’s also possible that this ruthless compassion approach might make them even more annoyed.

I know of many therapists who will choose to back off with these most wounded of patients, because they don’t want to risk the possible consequences of angering them. These therapists are extremely “nice” and supportive and won’t challenge these patients around their highly dysfunctional attitudes or behaviors.

In such situations, the therapist takes minimal risks and the patient has virtually no chance of experiencing any meaningful change.

It’s true that the risks to a therapist are great, when dealing with disturbed individuals. These types of patients can become so convinced that the therapist is “abusing” or “disrespecting” them that they can begin to stalk the therapist, or they can report the therapist to their governing body.

When a patient begins to show up at the therapists place of work (or even their home) without an appointment, it can be a very threatening experience. The patient, however, often has more rights than the therapist, so it’s a legal and ethical morass, protecting oneself from such a patient.

In terms of patients making formal complaints against their therapist, the vast majority of these complaints are demonstrated to be without merit. Even so, it’s a humiliating and highly stressful experience for the therapist to go through, and one which will certainly make them hesitate to take on the care of another such wounded individual in the future.

I know of many therapists who simply choose not to work with the very disturbed.

Paradoxically, these patients are the members of society who are suffering the most, and who need the most help. They often have PTSD from severe childhood abuse; their lives are often chaotic and they’re frequently isolated and alienated from others.

These extremely wounded individuals usually have few or no friends, sparse employment and chronic problems with their physical health. They place an enormous burden on society due to their inability to function in a productive manner.

They’re often seen in the ER for mental and physical complaints; they receive Welfare or (public or private) disability payments; they create a havoc in their interpersonal interactions, whether at family gatherings, in the grocery store check-out line, with the bank teller or at any government offices where they’re awaiting services.

When we therapists aren’t protected from the possibility of abusive, punitive, or inappropriate behaviors on the part of our patients, it’s like our hands are tied behind our backs and as a result, we can’t do our jobs.

When we live in fear of being harassed or complained about, we hesitate to confront our patients in the ways that would be most beneficial to them, or we make the choice not to work with people like this at all.

When our governing bodies fail to protect the therapists, it’s the patients who suffer.

When therapists are afraid to do their jobs, the patients receive substandard care or no care at all, and society has to bear the financial and social burden of these untreated or inadequately treated individuals.

Protecting the therapists, then, is a win-win. We’ll be free to practice ruthless compassion with our patients, and the most wounded among them will have the best chances of becoming well.

When we aren’t worrying about the risk of receiving unsubstantiated complaints by disturbed individuals and when we have legal recourse when being harassed by such people, we’ll feel empowered to do our best to help them.

Society will benefit from these individuals finally being able to receive optimal treatment. Perhaps, even, there will be fewer such wounded individuals in future generations, as the people we treat will go on to be better, more loving parents to their own children.

I’m not advocating for an unregulated practice of psychotherapy. This profession needs its checks and balances. However, for there to be real balance, and for patients to receive the best possible treatment- treatment they desperately need and truly deserve- the system must also be in balance.

By all means, hold us therapists accountable. Hold us up to the highest possible standards. But don’t fail to protect us from the misguided anger of those whom we’re trying to help.