Client Abandonment, Malpractice, and Professional Self-Care

As mental health professionals (MHPs), our ethical codes suggest that we should prioritize our client’s welfare (ACA, 2014, s.A.1.a; NASW, 2021, s.1.01; APA, 2016, Principle B). The ethical principle of fidelity means that we keep our promises to clients, including our commitment to demonstrate respect for their dignity and worth, to honor their right to self-determination, and to act in a trustworthy manner (Barsky, 2023).

Sometimes, this means that we put our client’s interests above our own. Prioritizing the needs of our clients helps facilitate trusting work relationships with clients and protects people who may be in vulnerable situations. Although our primary professional obligation is to our clients, various professional organizations also recognize a professional obligation to engage in self-care (ACA, 2014, s.C; NASW, 2021, Purpose). This post explores the potential conflict between our ethical responsibilities to our clients and to ourselves when considering termination of work with clients to protect our psychological well-being. In particular, this post explores the risks of being held liable for malpractice when terminating work due to personal concerns experienced by MHPs.

How Malpractice Applies

Malpractice is a legal concept that defines a professional’s legal responsibility to compensate a client for harm experienced as a result of receiving substandard care from the professional. To establish malpractice in a civil lawsuit, a plaintiff must prove that:

1. The professional owed the client a duty of care.
2. The client breached the duty.
3. The breach of the duty led to particular harm experienced by the client.
4. The breach of the duty was the proximate (closely connected) cause of the harm. (Barsky, 2024; Jacobson, 2017)

When MHPs engage clients in services, they are deemed to owe the client a duty of care (satisfying the first element of malpractice). When MHPs terminate services with clients, there may be questions as to whether the manner of how services were terminated constitutes a breach of that duty, and if so, if there was a close connection between the breach of this duty and any harm experienced by the client. For the purposes of this post, we’ll focus addressing on the second point: “Did a breach of duty occur?” We will assume that any damages experienced by the client can be closely connected to the breach (the last two points).

What Constitutes a Breach of Duty of Care?

To illustrate how courts may determine whether MHPs have breached a duty of care, consider Dr. Phipps, an MHP who terminates psychotherapy with a client because she found the client to be rude and offensive. Following termination of services, the client’s mental health deteriorates to the point where he can no longer work. The client sues Dr. Phipps for malpractice, claiming lost wages as damages. The question of whether Dr. Phipps breached a duty of care would be based on whether her actions do not live up to a standard of care reasonably expected of a comparable professional, acting prudently, in analogous circumstances.

The actual determination would depend on the facts of the particular case. For instance, if the client’s rudeness was simply a failure to say please and thank you, then it is unlikely that the court would find that a reasonable MHP, acting prudently, would terminate under such circumstances. If the rudeness was a repeated pattern of sexual or racial harassment by the client despite repeated warnings about the agency’s anti-harassment policy, then a finding that the MHP acted prudently would be more likely.

The question of whether a breach of duty occurred also depends on the manner in which the MHP affects the termination. Thus, if Dr. Phipps terminated abruptly—without warning and without offering a referral or other follow-up—then it would be more likely that the court would find a breach of the duty. If Dr. Phipps repeatedly warned the client about the possibility of termination and the harassment continued, then it would be less likely that a court would find that a breach occurred. Even in such circumstances, MHPs should not abandon their clients. Prudent practitioners engage in collaborative conversations and refer them to appropriate services to ensure continuity of appropriate care (Barsky, 2023; Reamer, 2023).

This is Part I. Part II of this series explores appropriate and inappropriate reasons to terminate, and provide further suggestions for mitigating risks of malpractice when considering termination due to personal reasons.