Episode 10: When the Work Gets Complicated: Sexual Harassment in the Therapy Room

In this episode, Kari says she wants to shine light on an uncomfortable but very real issue in the mental health field: sexual harassment toward therapists. She explains that although it’s shockingly common, therapists rarely receive training on how to talk about it, which leaves many clinicians feeling isolated, ashamed, or unsure of how to respond. Kari says she was inspired to record this episode after seeing a TikTok where a therapist blamed herself for being harassed during a video consult.

Kari shares a personal story from early in her private practice, describing an “accidental” sexual text a client sent her and how being alone in an office made her feel especially vulnerable. She notes how gender shaped the feedback she received from colleagues—female colleagues naming the inappropriateness, male colleagues minimizing it as “normal guy talk.” Kari says these experiences made her rethink safety, boundaries, and the emotional burden therapists carry.

She then outlines three categories of sexualized behavior therapists may encounter:

1. Accidental or clinically meaningful, where transference or attachment wounds may be explored therapeutically.
2. Boundary-pushing, involving repeated flirtation, fantasies, or testing behaviors that require firm limit-setting, documentation, and consultation.
3. Harassment or threatening behavior, such as explicit messages or exposure, where Kari says therapists should respond immediately, end the session, terminate care, and consider legal or safety steps.

Kari explains why these situations happen—trauma histories, unmet relational needs, blurred lines in emotional intimacy, telehealth disinhibition, and power dynamics that shift back and forth between client and therapist. She emphasizes the importance of therapist safety plans, supervision, and policies, and says clinicians often minimize their discomfort because they’re trained to put clients first.

Kari also discusses the aftermath: the freeze response, the shame spiral, and the subtle trauma therapists carry. She says it’s vital for clinicians to acknowledge these experiences instead of downplaying them. She offers a gentle PSA to the public: therapists are people with bodies, boundaries, and histories, and harassment deeply impacts their ability to help.

Kari closes with validation—therapists are not dramatic, not responsible for harassment, and are allowed to feel shaken or angry. Ending therapy in these cases isn’t a failure but an ethical success. She says relief comes from naming what therapists were trained to keep quiet, and she encourages clinicians to seek consultation, talk openly with peers, and reinforce boundaries before issues escalate.

Transcript

0:01

Welcome to both sides of the couch. I'm Carrie, a therapist who also happens to be a human navigating chronic illness, which means I see life from both sides. This is where I share honest stories, lessons, and little reminders that you don't have to have it all figured out to keep showing up. Let's get into today's episode. Today we're on episode 10 when the work gets complicated sexual harassment in the therapy room. So trigger warning, if this is something that may bother you or be too hard to listen to, you might wanna skip this episode. This is one of those episodes that therapists whisper about to each other, but nobody really teaches us how to talk about, I think. That sexual harassment towards providers is actually shockingly common, and it's not a sign of incompetence on the therapist part, I was inspired to make this episode because I saw a TikTok where a therapist was sharing her story about a video consult call her experience being targeted with sexual harassment and her reaction, and a lot of her. Statements were blaming herself, you know, a lot of, I should have this, I should have that. And I love the support in the comments of people saying, one, me too. This has happened to me too. And also you didn't do anything wrong and your reaction was totally normal. So I'll talk a little bit more about the type of reactions that we tend to have, um, and some examples of situations that pop up. So I'll start with a personal story. The first time in private practice that I remember this standing out because in previous positions I worked with a bunch of other therapists and a supervisor In private practice, I was all by myself. Which definitely plays a role in the sexual harassment I have experienced. You know, being all alone makes you feel a bit more vulnerable, but also when you're consulting. About, Hey, how should I handle this situation? In private practice, especially solo private practice, you don't have a lot of colleagues to lean on in an immediate sense to talk about that. So the first time I remember in private practice, um, that stands out in my mind was I was messaging a client and letting them know I was free. An hour sooner than we had originally scheduled because I knew they got outta work at a certain time and kind of just waited around until our session before they drove home. So I was letting them know,'cause I figured they would want to come earlier so they could get home earlier. So I sent the message and then I received a message back that looked like it was an accidental text. Like it wasn't meant to be sent to me. It looked like it was meant to be sent to, I'm guessing a friend. And it was kind of like, Hey, I can't meet up because my therapist wants to meet sooner, and then made a comment about me describing a sexual act they wish they could do, and said the words if she would let me. That was important to me because if she would let me did indicate consent was. Wished in this fantasy. Yeah, it was a tough situation. I read it and just froze. Like, I was like, oh gosh, like this person's on their way. Now I have to address it via text and in person, and I can't remember, this was so long ago. I can't remember if they realized the mistake and said, oh, I'm so sorry. I shouldn't have sent that to you. Or I said, oh, I think you sent me the wrong. Message. I think this is what happened. I think I said, I think you sent this to the wrong person. Let's talk about this in session. And they responded with, is it even okay if I still come? I'm really sorry. And I was like, yeah, let's talk about it, because I thought that was the professional, appropriate therapeutic thing to do, right? Like, I have to talk to this person face to face and we have to address it. And I didn't feel like I had any right to express my reactions or how it made me feel. And so I didn't have a lot of time before this client arrived at my office. And I think I reached out to a couple of my therapist colleagues I'd worked with before and was like, Hey, real quick if you have time, even if this is after I've seen the client, if you can just give me your opinion. And it was, I found it interesting'cause my female colleagues were like, oh, this is so inappropriate. I'm so sorry that you were put in this situation. I don't think this text was an accident. I think it was a test. I think. It was intentionally sent to you making it look like an accident to test the waters. So be very careful about how you address this with the client. You know, give some tips on how we could process why they would say things like that and how it wasn't appropriate in the therapy room and boundaries, et cetera. My male colleagues. And I told them, I told them this. Um, my response to'em was basically like, you're gross too, and this isn't okay. They were like, oh, that's like typical guy talk. I, I could definitely see myself sending this text to one of my buddies. I'm like, Ew, really? About your therapist? Like, I find that very bizarre. I don't know. I'm not a man though. I don't, I certainly wouldn't talk to my friends this way, but they. Seemed to think that it was an accidental text and that all I really had to do was make some comment that it was inappropriate. So I, you know, we talked about it, the client was dismissive, like they really didn't wanna talk about it. Um, when I, when they came to my office, I was like, Hey, let's talk about the text. And there was a lot of apologies and shame of like, I really don't think that I am one of those. Dirty old man types, but this isn't helping my case. And I was like, well, it's okay to have these feelings, you know, that's really normal, but it's not appropriate to say those things to people, you know? I know that it was an accident, but blah, blah. Anyways, so it was just kind of like pushed away and then for another reason, unrelated, the client never ended up. Coming back again. So I always wondered if that text had anything to do with the reason they terminated with me. But that was like the first moment I think I realized like, it is not safe to be by yourself in your office. And in that particular office, there weren't many people that shared space and worked there at all. None of them were therapists. But in the evenings, like by five o'clock, everybody was gone and I would see clients in the evening. So my clients knew I was alone. Like there were no other cars in the parking lot, the building was silent. So yeah, that started kind of me thinking about safety and concerns. So I also had this, I mean, I've had, it's. Disheartening.'cause when I was thinking about this episode, I had a lot of examples of this happening. Even pre private practice, but in private practice. Another one that I think is really common that we tend to experience is getting emails from potential clients. I have received sexually explicit photos and I have had potential clients reach out asking about sex therapy. And do you have sex with your therapist when you do sex therapy? This, this happens, I don't know if this happens to male therapists, but this happens a lot to female therapists, people pretending they're seeking therapy, but really they're just trying to expose themselves or get off on saying certain things to a woman. And. We tend to get stuck. I think this is a common reaction of like, oh, what if this is a potential client? Like the what if this is legit, somebody that is trying to seek help, I wouldn't wanna push them away or abandon them or shame them. It's like we don't think that we have the right to have a boundary to be like, this makes me feel uncomfortable. Here are some referrals. And maybe ultimately that's what we do. But I think the longer that I've been in business. I am less likely to respond at all to these types of inquiries and emails. And sometimes there's some that are borderline where I'm like, are they testing the waters? I'm gonna reply really professionally and if I get something similar in return, I'm no longer gonna speak, or I'm gonna say, this is not appropriate and just leave it at that. But I would say probably like several times a year I get an email like this and the therapist whose TikTok I saw. They got an email. I don't know that it said anything specific in the email, but she did get like vibes. Something was off and they did a video consult and he exposed himself masturbating on the call. And it caught her really off guard. I could, that hasn't specifically happened to me, but I could see that like really catching me off guard and what I would, the way it would respond in my personal life would not be my therapist response. And I think that I would struggle there of like, oh, I can't have my genuine response. I have to be like professional and therapeutic. But looking at it from an outsider, no, someone who I almost think that like. It blurs the lines past sexual harassment to like sexual assault, and I don't think you owe anybody professional, calm, rational tones when somebody's assaulting you. I think it's completely appropriate to not speak in a nice tone and hang up on the person. And in some cases I think it would even be appropriate to press charges depending on the situation. Therapists often downplay or internalize the discomfort instead of addressing how it's making them feel. But that's how we're trained as therapists. We're supposed to put ourselves last. So I wanna talk about why maybe this happens more than people think. I think that. Clients when they're in distress, sometimes they can sexualize connection due to trauma, unmet attachment needs poor boundaries, or transference, transference is really common. You're maybe talking to a person in a way that you've never had anybody show up for you before. Like a lot of my clients don't have a lot of relationships in their life where they can openly talk about their feelings and have somebody. Truly hear them and validate their experience and care about them, and that can make the lines blurry, like it feels like more than a professional relationship when you feel this steep emotional connection with someone. Those are the times I think it's much more understandable and therapeutically appropriate to work through in sessions. At least try to, and try to repair the relationship with the client. But then there are times where it's not clinical and it's simply just inappropriate behavior. It's unacceptable. We are especially vulnerable, like I mentioned before, we're alone in a room with somebody or sometimes multiple somebodies, and we are trained to be compassionate even when clients share things with us that don't align with our personal morals. And there are gender dynamics here, of course. I think when I reflect on all the examples I've experienced personally, it's all from male clients, not from female clients. And not to say that this doesn't happen to male therapists, but it's less common for male therapists to experience sexual harassment from their clients. Although I can think of some examples I have seen recently. And then when we do remote therapy, we're doing telehealth. It removes some social cues. I also think there's like a braveness that some people have over the computer that they wouldn't have in person, and there's a power difference working both ways in a therapeutic relationship. Like at times, I think the therapists. Appears to have more power'cause we're the helper, but the client is the person paying for the services and kind of driving the bus, so to say. So I think at times they can play that role of like, I have the power here, like you're working for me, type things. So I wanna get into a little more about like what I think there's our, there's three categories of this behavior and kind of how you would want to. Address them if this happens to you as a therapist. The first one that I kind of talked about or originally was like the accidental or clinically meaningful experience the client making embarrassing comments or poorly worded compliments towards the therapists or accidental disclosures. I think transference there too, right? The clinically meaningful stuff. So indicators that this may be happening is the client is startled when it comes out. Like they look surprised that they've said this thing or done this thing. They show shame or they correct themselves immediately before the therapist has a chance to respond. Or we see that it's linked to like trauma attachment, or relational patterns. So as a therapist, my suggestion is how you respond is kind of like pointed out. So say, oh, I'm gonna pause you a minute. What's happening between us right now? What's happening for you right now? Um, I'm sensing something about our relationship, you know, kind of exploring that in an open way. And I always think it's important to normalize unless it's clearly crossed the line, right? We're talking about this clinically meaningful category to normalize that it is normal for people to have. Romantic or sexual feelings towards their therapists called transference. It happens very often. That's why it's so important for therapists to have boundaries and why all of our ethical codes tell us that we can't have dual relationships with our clients and then redirect it. So this is how we address this. It's normal that you have these feelings, but this isn't appropriate and here's how we can mend. And you provide some insight for the client without shaming them. And depending on the situation, there's a lot of things that you would do absolutely recommend under any of these categories that you seek, supervision or consultation with some peers. The second category I notice is boundary pushing to the point where you're not yet at termination, but it's starting to get close, or is crossing that line where the client is flirting with the therapist. They've given repeated compliments to the therapist. Maybe they're sharing sexualized fantasies about the therapist to them in session or written like, Hey, I had this dream about you. This is what happened. Um, or probing for personal details about the therapist. So these indicators, what you're gonna notice is there's a pattern that's emerging. It's not a one time thing that's happened in session, but this is the classic testing the waters where a little thing happens and then a little more happens, and then something more obvious happens. The client has awareness that this is happening, but continues the testing and you and yourself notice like dread discomfort or hypervigilance in your body. You know that gut feeling where you're like, Ooh, something feels icky. Like you'll feel that when your client is pushing the boundaries. So how I would respond with this repeated behavior is you're gonna wanna make more clear and direct boundary statements. Instead of exploring, you're gonna say, this is not appropriate. This is impacting our relationship. We've addressed this several times. And talk about these patterns, maybe even their avoidance or the power dynamics between you two. And definitely I think for all of these, you wanna make sure you're documenting, documenting, and documenting all of the stuff that's happening just in case you need evidence or have to pursue this beyond the therapy room. Call a peer for consultation or it, it could be great even to seek a supervisor, even if you're independent. Don't need supervision anymore. Lots of therapists still provide supervision. On a one-off basis. So if you are working with a special population maybe say for example, your client's struggling with addiction. You could meet with a supervisor that specializes in clients with addiction and talk about this boundary crossing and get some feedback from their experience or how you should appropriately address this. And then you also wanna make sure that you create a safety plan for yourself and not just the client. So if you are meeting alone with this client in the evenings when they know no one else is in the office, I would switch to appointment time and I would tell the client too, like, since, you know, you are pushing boundaries, I don't feel comfortable seeing you in the evenings anymore. So I, I'd love to continue our relationship, but it needs to be during daytime hours. And it depends on you and it depends on the client how you wanna word that. But I have said that to clients before where, Hey, I'm not really comfortable meeting alone with you, so I'm not gonna go on the walk that we used to go on. This was in residential because for part of that walk, there's nobody around us and I wanna be close to people, so I feel more comfortable. And then the last category, I think is just that clear, blatant harassment or threatening. Behavior where therapy cannot continue or cannot start when you get those emails from potential clients. This is unwanted sexual comments, masturbating during session, explicit messages and pictures, propositions, stalking any boundary violation. So this behavior shows intent or disregard. They do not have any remorse. It can escalate despite the boundary setting. And your safety as a clinician is compromised. So this is really important how you respond in this one. This is not one that you wanna let slide or be a little too clinical. You wanna respond immediately with firm interruptions. This behavior is not acceptable. You need to end the session. If that's warranted, if they're pushing and pushing despite you setting that boundary, click the end button. If you're on telehealth or open your door and say, we're ending the session right now, and walk them out you can always terminate with your clients for any reason. I think some therapists get stuck on the ethics of, oh, if I know they won't be able to find another therapist easily, I don't think it's ethical for me to terminate with them. It is technically ethical. We just have to provide referrals. So when we send them a termination letter, however you do that, um, you wanna make sure you're providing referrals and resources for them. And we always say a minimum of three. I try to provide as much as possible and some other things too, not just therapists that they can see, but maybe like a residential program or support group or something too. And then if required, or you feel like you need to report it. And I would definitely consult with my malpractice insurance. I believe all of our malpractice insurers offer free lawyer consults included in your premium fees, so take advantage of that. When you have a question, they'll set you up a consult call with a lawyer, and you can talk about what happened, and they can give you advice on what you should be doing legally and ethically. And then, um, I definitely think you should consider security protocols at this point too. Like if you've terminated with a client and you're worried they may retaliate, um, making sure that. The door to your building is secure in some way. You have security cameras. When I worked in office, we had security cameras that didn't record, but were playing live, so we could see who was coming and going at all times. And we actually ended up putting the code on the door. The clients got the code. If the code was compromised. We had to tell all our clients that there was a new co code. Worst case scenario, you call me, um, when you're waiting outside and I'll come let you in if the code hasn't been given to you or it's not working. And even telehealth, there's safety protocols that you can follow too. I think that's like more of just like a hangup situation to end things and obviously don't contact, don't allow video sessions or phone calls from that client anymore. So the aftermath I think of dealing with situations like this is probably one of the harder pieces for therapists because we have like that personal. Reaction and impact to it. And then there's the professional side. Like that therapist I saw on TikTok when she was like, oh, was this my fault because I didn't do these things? That's a shame spiral. Like, I caused this. I was too friendly. I should have caught it sooner. Why didn't I listen to my gut? It's not your fault. Absolutely. We are trained to have the responses that we do. We are trained to put others' needs before ours, and we're trained to not pay attention to our feelings and gut responses when we're working with a client. So it's common for us to freeze our nervous system. Doesn't care that we have a master's degree and that we're licensed therapists. It just knows that we feel really icky and we don't know what to do. So fight or flight kicks in and we turn into freeze. This is subtle trauma that we're carrying, I think a lot of times without acknowledging it. And I do think for me personally, this has had some impact on my relationships personally, outside of being a therapist. And I think that there really is a danger of us minimizing these experiences for the sake of professionalism. The more we minimize it, the more it's gonna happen to us. I liked to see that therapist sharing her story on TikTok'cause it's not something that I feel like I've talked to other clinicians about. Outside of like seeking consultation, I've definitely not talked to clients about this unless they have been a client that's harassed me. So I think. My general PSA to the public, like maybe what other clients don't realize is that therapists are people too, with our own bodies and limits. A lot of therapists have trauma histories themselves. Some of that trauma stems from the therapy room. With these examples, I mean, there's a lot of things that happen. Some therapists, witness clients, physically harm their child or their partner or a family member in a family session. Having clients harm themselves in front of you if you've worked in residential before, you know, you see a lot of really traumatic stuff, but you also don't know, like if a therapist has been, sexually assaulted in their personal life and they're being sexually harassed at work, like there's so much more dynamic going on here. And really like at the end of the day, harassment impacts our ability to help. We can't help these clients if they're gonna cross boundaries and be inappropriate. Boundaries are there to keep therapy safe. Both of us, the client and the therapists. They're not to make the relationship cold, but when transference happens. That's the scary part if your therapist does not have firm boundaries set up, that transference can turn into counter transference, and that can start leading to dual relationships and crossing boundaries. I have seen this happen with colleagues before, so luckily though, I think that most clients never cross the line, but the ones that do really do affect us deeply, like I would love, and of course I do, I would love to remember only the clients. That have had positive impacts, but I definitely remember the clients who've had negative impacts against me, like the sexual harassment. It's clear in my mind, like I can feel the way I felt that day, even though the example I shared was probably from like 10 years ago. So I just wanna remind. The therapist, if you're listening in that you're not the only one that's experienced this, you're not being dramatic. You definitely are not responsible for the behavior. You're allowed to feel shaken up, gross or confused or angry, and ending therapy is not a clinical failure. Sometimes it's an ethical success and you're not necessarily. Abandoning that client. Maybe the boundary you set helps them with the next therapist to not repeat that behavior. And you can reclaim your sense of safety and authority in the room. So I think relief comes from naming the things we were trained to keep quiet. I hope that other people share their stories. Um, even if you're not gonna share it in a public way, I hope that you talk to a colleague and reflect on some of these things. And I think when this stuff comes up in session, we can invite our clients to understand the relational container more deeply by talking about it. So don't wait until somebody's made a clear boundary crossing. It's good to check in because even if it's not, it's an early reminder for the client about the boundaries in the relationship. So thanks for listening today. I know this was a heavy topic, but I hope that it was helpful and I encourage everyone to engage in some self care after listening to this. Reach out for consultation if needed, band together with your fellow therapist and I promise next episode will be something lighter. Thanks for joining me on both sides of the couch. If something you heard today resonated, share this episode with someone who might need it. And if you'd like to support the show or find more of my work, check the links in the show notes. Until next time, take care of yourself on both sides of the couch.