Therapist Safety Should Not Come Second
The recent murder of a therapist in Orange County has shaken many in the mental health community. For some of us, the response hasn’t been panic, but a quiet recognition: this tragedy exposed vulnerabilities that already exist in our field.
Therapists are trained to prioritize client safety. This is essential and non-negotiable. But when therapist safety is consistently treated as secondary—or left unspoken—it creates conditions that ultimately undermine the work we are trying to do.
The Reality of Risk in Clinical Work
Most therapy is safe. Most clients are not dangerous. Both of these things are true.
And it is also true that therapists work closely with people in crisis, emotional dysregulation, trauma, addiction, and sometimes profound despair or rage. Risk in therapy is not constant, but it is real.
Despite this, many therapists—especially in private practice—work in settings with minimal safety measures. We may see clients alone, without staff nearby, without controlled building access, and without clear protocols for responding to threats or escalating behavior. We are expected to manage risk largely through clinical skill and judgment.
Clinical skill matters. But it cannot replace structural support.
Working With Limited Information
Therapists often make important safety decisions with incomplete information. We rely primarily on what clients share with us. We generally do not have access to criminal histories, prior incidents of violence, or restraining orders unless a client chooses to disclose them.
Confidentiality protects clients, and it should. But the current system leaves therapists holding responsibility for safety without access to the full picture. This imbalance becomes especially concerning when clinicians are blamed or scrutinized after harm occurs, despite having worked within ethical and legal limits.
When Client Safety Is Prioritized Without Attending to Clinician Safety
Ethical guidelines focus heavily on protecting clients and third parties. There is far less clarity around how therapists are meant to protect themselves.
When clinicians express fear or discomfort, it is often framed as something to process internally rather than something that might require external support or concrete action. Over time, this teaches therapists to doubt their instincts and minimize their own safety needs.
A profession built on awareness and attunement should not ask clinicians to ignore their own nervous systems.
Referral as One Necessary Safety Boundary
Referral is one of the ways therapists maintain ethical practice. When a client’s needs exceed a therapist’s scope, training, or capacity to safely hold the work, referring out is appropriate and responsible.
At the same time, referral can be emotionally activating for some clients. For individuals with histories of trauma, rejection, or abandonment, being referred out may feel deeply painful. In rare cases, this pain turns into anger directed at the therapist.
Clinicians are not often prepared for how intense these reactions can be, nor are they consistently supported when ethical decisions provoke strong responses. This can lead therapists to hesitate, delay, or question referrals—even when they are clinically indicated.
This hesitation does not serve clients or therapists.
Why Therapist Safety Matters for the Work
When therapists do not feel safe, it affects clinical judgment, boundaries, and presence. Fear—especially when unacknowledged—shapes decisions in subtle ways. Over time, this contributes to burnout, withdrawal from complex work, and clinicians leaving the profession.
Therapist safety is not a separate issue from quality care. It is a condition for it.
Moving Toward a More Balanced Approach
Client safety and therapist safety are not competing priorities. Both are essential to ethical, effective therapy.
A more balanced approach would include:
Normalizing conversations about therapist safety
Supporting consultation and referring out without shame
Developing clearer safety protocols in outpatient settings
Designing practice environments with safety in mind
Trusting therapists when they say they do not feel safe
These steps are not about fear or defensiveness. They are about sustainability and integrity.
For Clients Reading This
If you are a client, it may be hard to imagine the vulnerability therapists carry. Please know that when boundaries are set or referrals are made, it is usually done with great care and thoughtfulness—not dismissal.
Your safety matters.
And so does ours.
Closing
The loss of a therapist’s life is devastating. Honoring that loss means looking honestly at the systems we work within and asking what needs to change.
Therapists should not have to choose between compassion and safety.
The work is too important—and the cost too high—to pretend otherwise.