Grieved: A firsthand account of enduring a client grievance as a counselor

I learned in graduate school that most counselors will experience three things in their careers: a client who dies by suicide, a client who overdoses, and a client who files a grievance. I remember hoping that I would be the exception to the rule. Throughout my career, I tried to do everything in my power to avoid that grad school prophecy. But fate had other plans: Last year, one of my clients filed a grievance against me.

Shame breeds in secrecy. In my experience, being the subject of a client grievance is one of the most shaming — and isolating — events a counselor can encounter. Those who choose to speak openly and honestly about the grievance process are often met with judgment and criticism. In an effort to help combat the silence and stigma, I’m sharing my story with the hope that it will provide guidance and support to other counselors who are going through this difficult and trying process. I want to remind others that they are not alone on this journey while also offering a road map for a way through. It will be OK.

One of the things that helped me get through the grievance process was conceptualizing it in terms of Elisabeth Kubler-Ross’ grief cycle. I tell my clients that the stages are the road map for grief. If I had a road map, then I had a direction to go, and I was not stuck or lost. I did not know when I would reach acceptance, but I knew that it was on the horizon if I just kept moving forward.

 

Denial and shock

Early last year, while checking my email in a Target parking lot, I saw a message from the Department of Regulatory Agencies (DORA) sitting in my inbox. In Colorado, DORA is the governing body that issues licenses to providers while also handling consumer grievances. My heart began beating quickly. I felt dizzy and nauseous. I walked into the store to return an item at the customer service counter, and I had to will my legs to move forward and my mouth to speak. I felt like everyone around me could see a massive letter “G” tattooed across my forehead. My hands began to shake as I drove home so that I could read the email at my desktop computer. As I read through the entire message from DORA, I started to cry.

A few weeks prior, I had taken on a new client at my practice. Interestingly, my intuition immediately suggested that this client would be challenging. The second session reinforced my sense that building a therapeutic relationship with this client was going to be a rough road. The third session didn’t happen — the client was a no-show, no-call. When I reached out to the client through a text message, she said that she did not want to schedule a future session with me, so I discharged her from therapy that afternoon. I had a feeling this would not be the last time that I heard from this client. My intuition was correct.

I received an email from the client that night, criticizing me for the way I had handled the interaction. She thanked me for helping her but asked me to explain my “side of the story.” Because I had already discharged her from therapy and felt that any potential future counselor-client relationship would be negatively impacted by the exchange, I told her that I no longer felt comfortable working with her. Again, I had a feeling this would not be the last time I heard from this particular client. My intuition was right again.

 

Bargaining

DORA was citing me for poor communication and abandonment. I immediately reached out to a friend and former colleague who had worked with an organization that completed assessments for DORA. I knew she had also been through the client grievance process a few years prior. As I prepared for our discussion, I looked up everything I could find on the internet about the grievance process, client abandonment, HIPAA, and mental health statutes. Nothing was clear, and most of the information seemed contradictory.

On the phone, I laid out the facts of the case before my friend. Like many others I would talk to along the way, she thought it likely the case would be dropped. Thankfully, the grievance was not based on a verbal exchange; resolving the case would not depend on pitting my word against the client’s. My friend advised me that I might need to seek legal counsel, and we discussed my official response to the complaint, which I typed up immediately and sat on over the weekend.

The following Monday, I gathered the client’s file and submitted it to DORA, along with my response to the grievance. I also reached out to my insurance carrier to let it know about the grievance. All the while, I was hoping the case would be dismissed so that this nightmare would end. Due to the benign nature of my case and the cost, I chose to hold off on hiring legal counsel at the beginning, but my insurance provider encouraged me to reach out to a lawyer if the case continued any further.

 

Depression

The grievance was all I could think about. It consumed me. I would fall asleep ruminating about it and wake up the next morning to a continuation of my thoughts from the night before. Or, just as often, I would wake up in the middle of the night, my anxiety quickly rising as I remembered that this was not a dream — it was really happening to me. I prayed for it all to go away. I wanted to return to a sense of normalcy. I began second-guessing myself and the image I was presenting to my clients at work. I felt on edge and afraid that something else would happen. I feared that this grievance process would not be the end of it.

I had been in the field for seven years and had never experienced an issue like this previously. I had provided services in challenging and demanding settings, including detoxes, residential treatment facilities, and jails, and I had never before had a client complain to a supervisor or another colleague about my work.

Because the personal is professional and the professional is personal in our work, it can be hard to separate the two. This makes it difficult to prevent internalization during the grievance process. I felt like a bad counselor and, thus, a bad person. At the same time, I felt confused because I had other clients telling me that I was an incredible therapist who had helped them change their lives for the better and become the best versions of themselves. I tried to hold space for all of these experiences and live in the gray, but it was tiresome and tough to do.

Fearing judgment and criticism, I was mindful of who I shared my troubles with. I was in a vulnerable place and was already attacking and beating myself up enough without someone else adding to the punishment and suffering. Like most therapists, I am attuned to nonverbal cues and underlying speech tones and was always looking for them when I told my story to fellow counselors. For the most part, I chose to keep the experience to myself and a few confidants, but I knew that wasn’t enough. I also needed the perspective and guidance of other professionals during this demanding time, so I shared with people in my therapist support groups. The majority of the people I told were empathetic, nonjudgmental and supportive, but there were a few whose faces dropped once I told them. There were still others who tried to use my story as their own personal case study, which was disappointing and disheartening.

I felt like I was in a dream, observing this entire experience happening to me from a distance. I believe that, at the time, this was a necessary coping strategy. I had to compartmentalize the experience so that I could go to work each day and meet with clients at my private practice. I likened it to being sued by your company and continuing to show up for work every day, knowing what is happening around you and within you.

I questioned myself constantly and considered what I could have done differently. I read through the mental health statutes and searched HIPAA forums, but nothing was transparent and straightforward. I tried to look up articles, podcasts and research on the grievance process but could find only one research article from the 1990s on the impact of the grievance experience on psychologists. It helped to know that my experience of the process was normal and valid, but it did not ease my fears.

 

Anger

I have two licenses in Colorado, which is advantageous in my work — except for when I going through the grievance process. My double licenses made it doubly difficult because my case had to go before both boards. The two licensing bodies can have differing opinions and sanctions, but I learned early on that once one board reaches a verdict, the other board often follows suit. I received an email informing me that the Colorado State Board of Licensed Professional Counselor Examiners would be the first to review my case, in May. I had submitted my paperwork in February, so it would be months before I would know the resolution of my case. I was learning that the grievance process is a prolonged waiting game.

Meanwhile, I was expanding my practice and interviewing contract therapists. Then, in April, I received an email from the Colorado State Board of Addiction Counselor Examiners informing me that my case had gone before its board first, without my knowledge. I was blindsided. I was in the middle of doing interviews but, thankfully, had a break, so I drove home. I made it about halfway before pulling over to the side of the road to read the rest of the email. My mind was blown. I felt like my sense of reality was crumbling.

The Board of Addiction Counselor Examiners had found me “guilty” of the allegations and was moving the case forward to Colorado’s Office of Expedited Settlement. I found a lawyer online and emailed him from the side of the road. I felt powerless and out of control and needed to find a way to regain my sense of self-agency. I knew that taking action was the way for me to do that. I didn’t want to have any regrets about what I could have or should have done, so I was finally ready to get legal assistance for this fight.

I met with the lawyers the following week and learned that they were receiving three to five grievance cases per day. In the past, they said, they had received only three to five grievance cases per month. After our meeting, I looked up the list of therapists involved in disciplinary actions through DORA’s website, and the numbers were staggering. There are approximately 26,000 counselors in Colorado, and more than 11,000 have received disciplinary action.

I was angry — with myself, with the system, with the profession, and with the client. I felt so much anger pulsating through me that I wanted to scream and to run away, both at the same time. I thought about walking away from it all — leaving the counseling profession, giving up my licenses, and moving on to a different, safer, easier path.

Mainly I thought, “Why me?” I felt myself moving into a victim mentality as I had done in the past when going through trying experiences. Because I have been victimized in my past, this is an easy role for me to assume when I am experiencing pain and suffering. I blame others and shut down.

Anger is an uncomfortable emotion, but I knew I was meant to have it in this moment because it would lead to motivation, change and movement. I could harness it or let it eat me alive. It was my choice alone.

 

Acceptance

Like many grieving people, I remained stuck for some time in the anger phase. Anger feels powerful and motivating, unlike sadness, which is exhausting and debilitating. However, I always go back to the saying that “anger is like taking a cyanide pill and hoping it will kill your enemy.” It only ends up hurting you in the end. My anger toward myself, the client, the system and the profession would not serve me. It would end up eating me alive if I allowed it to.

I was walking home from work one day when suddenly it began to rain. Completely unprepared, I had nothing to keep me dry. It was only a mild shower, however, so I said out loud, “If it keeps raining like this, then I’ll be OK.” It started raining harder. Undaunted, I said again, “If it keeps raining like this, then I’ll be OK.”

And then it began to pour. I was halfway home, caught in a storm without a raincoat. All I could do was surrender. I was broken open. The armor of anger I had been parading around in fell away as I began to cry. “I surrender,” I said aloud. “I get it. I’ll always be OK.” I started to smile as tears mingled with the raindrops running down my face. Nature has a way of asking us to let go of our resistance and surrender.

I released my anger in that moment, realizing that I’d been aiming most of it at myself. I began the slow process of forgiving myself and coming back home to the idea that we are all doing the best we can. I never meant to hurt the client, and I had no malicious intent in my actions. I had done the best I could in that moment and with the situation.

I moved into acceptance by making meaning of the experience and discovering that it was meant to realign me with my soul’s calling and purpose. I realized that I cannot veer far off my course in life before the universe pushes me back into my lane.

 

Lessons learned: Seek support, ask for help, find allies

It is difficult to share with others what it’s like to go through the grievance process, but it is also incredibly necessary. As is the case with any grief process, we need sources of support to call on to ground us and anchor us when we feel like we are floating away or losing sight of our true selves. As professional counselors, we may make mistakes, but that does not make us bad people. We need to be reminded of our goodness and wholeness.

It is essential to surround ourselves with genuine and unconditional love and to have a safe place to cry and yell without fear of judgment or criticism. When all we want is to lie on the ground and give up, our support systems can lift us up and keep us moving forward. And, finally, we need to be reminded that counseling is extremely difficult work.

My only regret about the whole process is that I did not seek legal counsel sooner. I wonder what might have happened if I had not been deterred by the nature of my case and the cost. Although I now realize that I needed to go through this process to realign my priorities and path both personally and professionally, I sometimes question whether things would have turned out differently if I had sought the assistance of a lawyer in formulating my response to the grievance originally.

Retaining attorneys earlier in the grievance process might not have helped me avoid the verdict of “guilty,” but it likely would have provided me more peace of mind. In fact, once I sought legal counsel and spoke with my lawyers, I felt a sense of ease and relief. As I mentioned, I was restless and waking up frequently during the nights, but after that initial afternoon meeting with my lawyers, I got my first full night’s sleep in two months. I am aware of how vital regaining the ability to rest was to enduring the trauma of the grievance process. Sleep heals.

Later on in the process, I connected with the Colorado Counseling Association (CCA). I remember saying to myself, “DORA protects the consumers, but who protects the counselors?” This was my answer. I went to an event sponsored by CCA and learned more about the advocacy work it does to support and help counselors. Specifically, it is fighting to change the vague and subjective language of the clause in the mental health statute of “best practices” that was cited in my case and many other cases as a catch-all category for disciplinary actions. Here were even more people on my side who were passionate about advocating for counselors and changing the system.

During the grievance process, someone had said to me that the tower I had built with all I had believed to be true was crumbling and falling, leaving behind a pile of rubble and debris. My beliefs about my career had been built on shaky and rocky ground to begin with, so it was inevitable that they would all come tumbling down eventually. Now that the collapse had ended, I had to decide what to do with the debris. I could choose to walk away from the bricks and stones in the rubble, or I could use them to build a new tower on stronger ground.

I am still in the process of rebuilding, and I know that it will be a slow and methodical project. I am fulfilling the stipulations from DORA and considering the future. I am not sure if I will ultimately want to maintain both of my licenses. For now, however, I have chosen to keep them. But I know that the choice is mine — no one else’s. I now have a solid foundation on which to build my tower.

With each placement of brick and stone, I feel stronger and more powerful than I was before this experience. My battles scars and wounds will influence how I build my tower, but they will not halt or control the construction. As Carl Jung said, “I am not what happened to me; I am what I choose to become.”

 

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Jessica Smith is a licensed professional counselor and licensed addiction counselor with a private practice, Radiance Counseling (radiancecounseling.com), in Colorado. Contact her at jsmith@radiancecounseling.com.

 

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ACA members: Facing a dilemma about ethics, business practices or risk management? Contact the ACA Ethics and Professional Standards Department at (800) 347 6647, ext. 321 or email: ethics@counseling.org

 

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