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I started writing this blog to get something out of my head and onto a screen where I could look at it from the outside. My therapist thought it would provide some closure for me to get it all out. That was the only goal at first. But as I wrote, it became clear that the account had a function beyond my own recovery. When I was in the thick of those three months, I looked around the internet for stories from people who had gone through what I was going through, but I didn’t find anything from a patient’s perspective, little that could tell me what was going on in my life at that time. Some stories about patients whose therapists sexually abused them, but that hadn’t happened to me (I thought). So I want to close with what I’ve learned, not as a clinician or a lawyer, but as someone who went through it and came out the other side.
What I Wish I’d Known Then
Warning signs are cumulative, not isolated. No single thing Sam did would have been an obvious red flag on its own. A personal anecdote, an extension of a session, a word choice that seemed charged. Each one could be explained away—and she explained each one away when I asked. It was the pattern that mattered. I couldn’t see the pattern while I was inside it. If your therapist’s behavior frequently confuses you, or their explanations get really jargony really quickly, that pattern is a warning.
Your therapist’s feelings are not your responsibility. If you find yourself worrying about how your therapist is doing, comforting them, managing their reactions, or feeling guilty about their emotional state, something has gone structurally wrong. That’s role reversal, and it’s a boundary violation regardless of whether your therapist calls it “authenticity.”
The impulse to record is itself a signal. If you feel like you need external evidence to trust your own perception of what happened in a session, your perception is probably correct.
“More harm in leaving than staying” is almost never true. A therapist who tells you this while you’re being harmed by the therapy is not protecting you. To be sure, therapy can be uncomfortable. You’re working through potentially a lot of trauma and releasing or acknowledging a lot of upsetting feelings. But if the nexus of those feelings is the therapy or the therapist, that is not “the work” and they are not protecting you or helping you.
What I Think Should Change
Licensing boards need to take non-sexual violations seriously. The clinical literature is unambiguous: non-physical boundary violations can cause harm equivalent to sexual ones. My hospitalization and PTSD diagnosis are documented outcomes. But when my complaint was filed with recordings, a lawyer’s detailed account, and evidence of falsified notes, the board found “insufficient evidence.” When a system set up to protect patients produces that result with that evidence, the system is broken.
Therapists’ notes should be subject to verification. Sam’s notes were either blank or fiction. There is no check on their accuracy. Without my recordings, her notes would have been the only record, and they told a story that didn’t happen. I don’t know how to make that happen. AI is now available to automatically take notes, but to do that it makes recordings that many patients would like not to be made and which the patient does not control. The idea of a repository somewhere of every intimate thing you’ve ever said is a privacy nightmare, but a dishonest, ass-covering therapist creating a false record is a nightmare too. I’m going to cop out and say the profession must solve this, because it’s not the patient’s job to, but I am left with no faith that this profession can or will police itself.
Patients need to know their rights. I didn’t know what a boundary violation was in any formal sense. Though I was educated and interested, nobody explains clearly what the norms are that one should expect in therapy, at least not beyond the superficial. Informed consent covers payment and cancellation. It should also set expectations on the therapist’s responsibilities and cover what to do if you believe you’re being harmed.
Supervision needs to actually supervise. Sam told me I’d come up in her supervision “a gazillion times.” Whatever happened in that supervision didn’t prevent or correct any of what I’ve described. At some point, “I discussed it in supervision” stops being evidence of diligence and starts being evidence of a system that makes therapists go through some motions but doesn’t have the authority to enforce standards of care.
For Therapists Reading This
I’m not anti-therapy. Therapy healed me after Sam harmed me. The therapists I’ve worked with since have been careful, boundaried, and effective, and the contrast between their approach and Sam’s is itself evidence that what she did was not standard practice.
If you recognize something in this story—a patient you’ve become too invested in, a session where you said more than you should have, a relationship that feels “special” in a way that makes you reluctant to bring it to supervision—the literature says that reluctance is itself the diagnostic. Gabbard, Gutheil, everyone who studies this says the same thing—the moment you feel you shouldn’t seek extra supervision when a client has told you they have been damaged by their relationship with you is the moment you most need to.
I don’t think Sam set out to hurt me. I think she had unresolved needs that I activated in some way. At least, I hope that this behavior was specific to me and that this is not how she handled every patient. I believe Sam didn’t have the self-awareness or the supervisory support or the humility to manage what she did with me. The fact that I understand that it wasn’t willful doesn’t make it ok. She more than once excused herself by saying she’s only human and sometimes struggles and makes mistakes. Fair enough, but not an excuse for making the same mistakes repeatedly and leaving someone with years of recovery ahead for a trauma that needn’t have happened.
Where I Am Now
It took me two and a half more years of therapy to get myself back. Two and a half years to lose the rumination and the PTSD. It was hard work, but I’m better now.
The therapists who followed Sam did their jobs. But it wasn’t only them maintaining good boundaries. I did too, and I probably overcompensated. I didn’t want to know a single thing about them. If anything personal started to come up, I pushed back. I recognized their role better than I had with Sam, and I held that line with a tenacity that probably wasn’t as helpful as I wanted it to be but which felt necessary.
There was one occasion where Facebook somehow suggested my therapist as a person I might know. I saw a picture of him on a bike with a young daughter. I literally yelped in frustration—because now I knew things about him I didn’t want to know. He wore a cycling kit. His daughter was surprisingly young for a man clearly a few years older than me. I told him I’d seen the picture and that it had upset me—not blaming him but reinforcing how strongly I felt about not knowing his details. That’s what Sam had done to me. She’d made the slightest glimpse of my therapist’s personal life feel like a violation.
When eventually we agreed that I no longer needed therapy, he said—no doubt with pure and meaningful intent—that in another context he’d see me as friend material. I gently scolded him. But I invited him to wait a couple of years and give me a ring if he still felt like that. I was never going to reach out for that purpose. It’s been fourteen months. I’m not counting on it.
I do like to ride bikes, though.
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Boundary Violations in Psychotherapy - A Personal Case Study 