Rupture, Mistake or Misconduct? They Aren’t the Same Thing
There will probably be moments in your counselling career when you leave a session knowing that something did not go particularly well.
Perhaps you interrupted at exactly the wrong moment, misunderstood something important, became too directive, forgot something the client had told you, or pushed a little harder than you should have. A client may become angry with you or tell you directly that something you said was hurtful.
Sometimes, you will have made an actual mistake.
I certainly have!
Some of my mistakes have been small. There are also things I have done in my career that, looking back with the experience I have now, I would handle very differently. I think anyone who has practised for long enough and reflects seriously on their work will accumulate a collection of these moments.
They can be painful to think about.
One of the difficulties for counsellors, particularly early in their careers, is working out what kind of problem they are actually dealing with. A therapeutic rupture, a clinical mistake and professional misconduct can all involve a distressed client and an uncomfortable therapist. They are not equivalent.
Understanding the difference helps us respond proportionately, take responsibility where responsibility belongs, and learn without turning every imperfect session into a judgement on our competence.
Therapeutic ruptures are part of therapy
A therapeutic rupture is a deterioration or strain in the therapeutic alliance. It might involve disagreement about the goals of therapy, difficulty collaborating on what happens in therapy, or a disruption in the emotional connection between therapist and client (Eubanks et al., 2018).
Some ruptures are obvious.
A client might say:
“I don't think you're listening to me.”
“You keep trying to make this about my mother.”
“I felt judged by what you said.”
Others are much harder to see.
The client becomes unusually agreeable. They stop bringing meaningful material. They change the subject. They withdraw emotionally. They start saying that everything is fine. They cancel the next appointment. They ghost you.
Safran and Muran's work on therapeutic alliance ruptures has been particularly influential in helping therapists recognise that ruptures are not unusual aberrations in otherwise perfect therapeutic relationships. They arise within relationships, including good therapeutic relationships (Safran & Muran, 2003).
A rupture also does not automatically mean that the therapist has done something wrong.
A rupture can happen when a client and therapist disagree about where therapy is going, or when the client feels misunderstood by something the therapist says or does. An intervention we offer with care may feel dismissive or intrusive to the person receiving it. Differences in cultural background or expectations of relationships can contribute to these misunderstandings, as can a client’s previous experiences. Sometimes the therapist has made a mistake and the mistake creates the rupture.
Understanding what happened means being willing to hear how the client experienced the interaction and to acknowledge our part in it. Working through a rupture together can strengthen the therapy, although this depends on how we respond when something has gone wrong. A meta-analysis by Eubanks et al. (2018), involving 11 studies and 1,314 clients, found a moderate association between successful rupture resolution and better therapy outcomes.
That does not mean we should go around causing ruptures for everyone's personal growth. It does suggest that a difficult moment in the therapeutic relationship needn’t spell disaster. However, repair matters.
Sometimes you actually made a mistake
This is so much harder! For me, anyway …
Counsellors make mistakes because counsellors are human beings making complicated clinical decisions while another human being sits in front of them.
You might:
misunderstand what a client is communicating
make an intervention at the wrong time
forget an important piece of information
fail to follow something up
speak more bluntly than you intended
disclose something and later realise it was not helpful
miss the significance of something the client told you
make an administrative error
make an incorrect assumption
fail to recognise your own countertransference until afterwards.
Some mistakes have very little consequence while others can genuinely hurt someone.
Our responsibility increases with the seriousness and consequences of the mistake.
This is where I think the idea that therapists should simply “trust the process” can become dangerous. Reflection requires more than finding a therapeutic explanation for everything that goes wrong.
Sometimes the client is angry because we behaved poorly. And the feedback stings because it contains something we need to hear.
Professional maturity includes developing enough tolerance for shame, embarrassment and uncertainty that we can seriously consider this possibility.
A complaint does not automatically mean misconduct
Clients have a right to raise concerns about their care and to have those concerns taken seriously. Both the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA) have ethical standards and processes for considering complaints about practitioners (Australian Counselling Association [ACA], 2022; Psychotherapy and Counselling Federation of Australia [PACFA], 2017). These processes allow concerns to be examined fairly before conclusions are drawn about whether a practitioner has engaged in professional misconduct.
Every complaint deserves serious consideration because it concerns someone’s experience of our care.
It is not, however, itself proof of professional misconduct.
Australian research examining complaints about regulated mental health practitioners found that professional conduct issues represented a substantial proportion of complaints, but only a minority of complaints ultimately resulted in formal regulatory action. The pattern differed across professions: 7.8% of complaints about psychiatrists and 23.9% of complaints about psychologists resulted in outcomes such as cautions, reprimands, conditions or suspension (Veness et al., 2019).
We need to be careful applying research about psychologists and psychiatrists directly to counsellors because they operate within different regulatory frameworks. It does, however, demonstrate something useful: the existence of a complaint and a finding of professional wrongdoing are different things.
There is also a substantial healthcare literature examining what people complain about.
A systematic review examining 59 studies and more than 88,000 patient complaints found concerns clustered broadly around clinical care, healthcare management, and relationships between patients and healthcare staff. Treatment and communication were particularly prominent concerns (Reader et al., 2014).
Some complaints identify genuine failures. Some involve misunderstandings, unmet expectations, communication problems, differences in perspective, systemic problems or combinations of these.
So if a client complains about you, curiosity is useful before either defensiveness or self-condemnation takes over.
What are they telling me about their experience of me?
That question is absolutely worth asking (even if you ultimately disagree with aspects of the complaint).
Misconduct is different
There are behaviours that move beyond ordinary therapeutic difficulty or clinical error.
Professional codes exist partly because counsellors occupy positions of considerable trust and power.
The ACA Code of Ethics and Practice applies ethical expectations across counselling practice and related professional activities, while PACFA's Code of Ethics similarly establishes standards intended to protect clients and support ethical practice (ACA, 2022; PACFA, 2017).
Serious boundary violations, exploitation, sexual relationships with clients, serious breaches of confidentiality, dishonest professional representations, practising significantly outside competence without appropriate safeguards, and other substantial departures from professional standards cannot sensibly be described as ordinary “ruptures”.
Calling misconduct a rupture can minimise harm.
Calling every mistake misconduct creates a different problem. It can produce frightened practitioners who become more concerned with avoiding errors than thinking openly about their work.
We need language capable of holding the difference.
So which one is it?
When something has gone wrong, try separating the questions.
1. What actually happened?
Describe the event as concretely as possible.
Not:
“The whole session was terrible.”
Instead:
“The client was talking about her relationship with her mother. I interpreted what she was describing as avoidance. She became visibly withdrawn and said I was making assumptions about her.”
Concrete descriptions make reflection possible.
2. What was the impact on the client?
Intent matters, but impact matters too.
You may have been trying to help.
The client may still have experienced you as dismissive, intrusive, judgemental or unsafe.
You do not have to agree with every interpretation a client makes of you to become interested in their experience.
3. Did I depart from an ethical or professional obligation?
Now move beyond the relational question.
Was confidentiality compromised? Was there a boundary issue? Was informed consent inadequate? Were you practising beyond your competence? Was there a risk issue requiring action? Does your professional code, workplace policy or legislation create an obligation?
If you are unsure, this is exactly the point at which consultation becomes important.
4. Is there continuing risk?
Ask whether anybody remains at risk because of what happened.
If so, the immediate priority may be risk management rather than relational repair.
Depending on the situation, appropriate consultation might include your supervisor, professional association, employer, insurer or legal adviser.
PACFA, for example, explicitly recommends supervision as one source of support when practitioners face ethical dilemmas and also identifies its ethics resources, insurers and legal services as possible sources of advice (PACFA, 2017).
5. Can something be repaired?
Sometimes the next clinical step is surprisingly ordinary.
You talk about it.
You might say:
“I've been thinking about what happened last week. I got the sense that something changed between us after I said that. How was that for you?”
Or:
“I've thought about what you said, and I think you were right that I made an assumption there. I'm sorry. I'd like to understand what that was like for you.”
An apology does not need to become a dramatic performance of therapist guilt - your client should not have to reassure you.
A useful apology identifies what you are taking responsibility for and leaves room for the client's experience.
Bring the uncomfortable version to supervision
Supervision is particularly important here, but only if we actually tell our supervisors what happened.
There is not much value in saying:
“The client became really dysregulated when I challenged them.”
when the fuller version is:
“I was frustrated because we'd been going around the same issue for several sessions. I think I became impatient and challenged them much harder than I normally would.”
Those are different supervision conversations.
A good supervisor should help you resist two temptations.
The first is collapse:
“I hurt a client. I'm terrible at this. I shouldn't be a counsellor.”
The second is defensiveness:
“They were projecting.”
“They weren't ready for therapy.”
“They misunderstood me.”
“They have attachment issues.”
Any of those explanations could contain some truth. They can also become sophisticated ways of avoiding responsibility.
A supervisor can help slow the process down.
What happened?
What were you feeling?
What did you notice in the client?
What did you miss?
What were you trying to accomplish?
What happened immediately afterwards?
What might the client have experienced?
Was an ethical obligation involved?
What needs to happen now?
And perhaps most importantly:
What can you learn from this that changes what you do next time?
Shame is a poor clinical supervisor
Mistakes can generate enormous shame in therapists.
That makes so much sense! Most counsellors care deeply about doing this work well. Our professional identity can become tangled up with seeing ourselves as safe, competent and helpful people. Evidence that we have hurt somebody can therefore land heavily. It feels painful.
But shame tends to narrow our attention towards ourselves.
What does this say about me?
Reflective practice asks a more useful set of questions.
What happened? What was my contribution? What does the client need now? What are my responsibilities? What do I need to learn?
We can regret something, deeply, without making our own distress the centre of the story.
We can also forgive ourselves without pretending nothing happened.
A mistake-free practice is not a realistic aim
I would be deeply suspicious of a therapist who told me they had never made a mistake with a client.
Perhaps they have achieved a level of clinical perfection unavailable to the rest of us!
More likely, they have not noticed all of them.
Competence develops partly through getting things wrong, recognising what happened, seeking feedback, repairing what can be repaired and allowing experience to change how we practise.
Some difficult moments will turn out to be ordinary therapeutic ruptures.
And some will reveal mistakes.
A much smaller number may involve genuine ethical or professional misconduct requiring formal action.
We need to know how to tell the difference.
And when you cannot work out which one you are looking at, take it to supervision.
You do not need a supervisor who automatically tells you that you did nothing wrong.
You need one you feel safe enough to look closely enough to find out and learn, together.
We’d love to support you and your practice! Check out our supervisors here.
References
Australian Counselling Association. (2022). Code of ethics and practice (Version 16). Australian Counselling Association.
Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. https://doi.org/10.1037/pst0000185
Psychotherapy and Counselling Federation of Australia. (2017). PACFA code of ethics. PACFA.
Reader, T. W., Gillespie, A., & Roberts, J. (2014). Patient complaints in healthcare systems: A systematic review and coding taxonomy. BMJ Quality & Safety, 23(8), 678–689. https://doi.org/10.1136/bmjqs-2013-002437
Safran, J. D., & Muran, J. C. (2003). Negotiating the therapeutic alliance: A relational treatment guide. Guilford Press.
Veness, B. G., Tibble, H., Grenyer, B. F. S., Morris, J. M., Spittal, M. J., Nash, L., Studdert, D. M., & Bismark, M. M. (2019). Complaint risk among mental health practitioners compared with physical health practitioners: A retrospective cohort study of complaints to health regulators in Australia. BMJ Open, 9(12), Article e030525. https://doi.org/10.1136/bmjopen-2019-030525