When Contradictions in Care Leave Clients Unsafe: Why Termination Was the Only Option

As counselors, our first responsibility is always the well-being of the client. That commitment can sometimes place us in uncomfortable positions, especially when another clinician is already working with the same client. Ideally, collaboration should follow. Two professionals should be able to communicate respectfully, share insights, and ensure the client receives safe, integrated treatment.

But what happens when that collaboration reveals contradictions, dismissiveness, and a lack of safety planning? What happens when the words of another clinician don’t match their practice, leaving the client caught in the middle?

That’s exactly the situation I found myself in recently. A client who had just begun work with me was also engaged with a therapist overseas who uses EFT/TFT (“tapping”) as their primary trauma modality. That therapist had referred the client to me specifically for anxiety treatment. But from the start, I was concerned. Trauma and anxiety are intertwined; one cannot ethically be treated in isolation while the other is being “processed” in another country without safety protocols.

Wanting clarity, I asked questions. In retrospect, I see that I could have framed those questions differently. But the response I received not only failed to reassure me, it confirmed my fears.

The Questions I Asked

Here are the three questions I posed, which I sent through the client:

1. Care and Safety: “Piper has concerns regarding tapping and trauma work. How am I cared for if emotions or physical symptoms become severe and you’re in [another country]?”

2. Approach to Treatment: “Piper works with trauma and suggests [it as] a first-line treatment. With tapping and increase in anxiety, neural networks are connected how does [the clinician] work to process trauma and lessen anxiety?”

3. Ethical Responsibility: “Piper has concerns regarding ethical responsibility for my care. She cannot just do manualised CBT for anxiety if anxiety is being increased due to trauma/tapping.”

   
   

Looking back, I realize these questions may have landed more confrontational than intended. Instead of saying “Piper has concerns” I could have softened the language: “Can you help clarify how you approach…” or “Could you share how you manage…”. A collaborative tone might have invited a more open dialogue.

Still, the substance of the questions was important. Trauma work without crisis planning, unclear boundaries between trauma and anxiety treatment, and overlapping care across borders are all legitimate concerns.

The Response I Received

The clinician’s reply was long, several pages of explanations, statements, and counter-questions. At times it directly quoted my concerns; at other times it redirected or dismissed them. The tone was framed as “non-condescending,” but the words often said otherwise.

Here are some excerpts:

• “What does Piper do — sit on call 24/7 if there is an emergency?”

• “Talking is only soothing, it doesn’t resolve trauma.”

• “I don’t ‘lessen anxiety’ in a person: I guide them through the tapping to heal the cause of it, and the anxiety disappears.”

• “With EMDR you HAVE TO remember a trauma to process it; with EFT, you don’t have to even remember a trauma in order to heal it.”

• “Now, I assume that Piper has studied the brain enough to understand how it works (no condescending tone here on my part, I assure you).”

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Instead of building bridges, these responses raised red flags. The contradictions, the defensiveness, and the dismissive undertones made one thing clear: this was not going to be a safe, collaborative partnership.

1. Crisis care isn’t about being “on call 24/7.” It’s about having a real plan.

The other clinician wrote, essentially: “What does Piper do—sit on call 24/7 if there is an emergency? I assume she, like me, teaches clients to use techniques themselves.” The problem with this framing is that it misunderstands the question I asked and misrepresents how ethical crisis planning works.

First, the client is in Georgia. She has access to local supports and Georgia-based crisis resources. The question I posed was not whether the client had any coping tools. I routinely teach self-regulation from day one i.e., vagal activation, grounding, paced breathing, orienting, and other stabilizers are foundational in my approach. I also supply an emergency form to every client that spells out: who to call, what to do, and where to go (local ER/urgent care), plus 24/7 hotlines and community resources. Skills are essential, but skills are not a crisis plan.

Second, when you provide distance care, especially from another country, ethical standards require more than “I gave her tools.” The ACA Code of Ethics is explicit that distance counseling informed consent must include “emergency procedures to follow when the counselor is not available,” as well as time-zone differences and legal limitations across borders (Section H.2.a; H.1.b). In short: if you’re practicing from another country with a client in Georgia, you must disclose limits, identify backup plans, and operationalize what happens if the client destabilizes when you are asleep or otherwise unavailable. www.counseling.org

Third, ethics also require continuity and appropriateness of care. Under Georgia’s Telemental Health rule (135-11), clinicians must obtain informed consent specific to tele, assess whether a client is appropriate for telemental services, and if they’re not a good fit for tele, they “should be treated in person, or else… properly terminated with appropriate referrals.” That is, the duty isn’t to hand someone a list of soothing techniques; the duty is to ensure the mode of care is safe and workable—or to transition them to care that is. Georgia Rules and RegulationsGeorgia Rules and Regulations

Fourth, Georgia’s Code of Ethics (135-7-.01) begins: “A licensee’s primary professional responsibility is to the client,” including obtaining informed consent and making reasonable efforts to ensure services are used appropriately. If distance care across borders cannot meet safety needs (e.g., no local coverage, no viable after-hours plan, significant time-zone delays), continuing as-is conflicts with the counselor’s duty to promote the client’s welfare. Legal Information Institute

Fifth, the ACA Code also addresses clients served by others. When we learn a client is working with another mental health professional, we should seek a release and “strive to establish positive and collaborative professional relationships.” Collaboration is not rhetorical questions or minimizing another provider’s competence; it’s clarifying roles, sharing safety plans, and coordinating so the client isn’t stranded between models. www.counseling.org

To be crystal clear: this was never about finger-pointing or refusing to teach coping. I absolutely teach soothing and nervous-system regulation; it’s the first layer of my work. The question I posed was the ethical one: “You are in another country. Beyond skills, how are you following through on your duty of care if trauma work triggers a crisis at 3 a.m. in Georgia?” Ethics require a plan, not a promise.

The standards above spell out that difference.

2. On Anxiety and Tapping

Her words: “I don’t ‘lessen anxiety’ in a person: I guide them through the tapping to heal the cause of it, and the anxiety disappears. Anxiety is not something to manage or lessen… once the underlying issue is addressed, the anxiety disappears.”

This was not a debate about a modality. My question was specific: what happens when anxiety spikes during trauma work? She stated that tapping does not increase anxiety. But if that is true, then how do we explain the reported increase of distress after processing that trauma in sessions?

That was my concern: not to dismiss a modality, but to understand how the clinician accounts for the immediate distress that occurs during trauma processing. Trauma activation itself does elevate anxiety before it can be resolved, and that elevation matters for safety planning. Ignoring that contradiction, “it doesn’t increase anxiety” vs “the client says she feels increased anxiety” leaves a serious gap in care.

3. On “Talking is Only Soothing”

Her words: “Talking is only soothing, it doesn’t resolve trauma.”

This wasn’t a fully articulated thought, and it didn’t answer my actual concern. If she had taken the time to understand my work, she would know that I don’t practice “manualized” CBT that only targets thoughts and behaviors. My approach is third-wave CBT; integrative, holistic, and tailored to the whole individual. I combine cognitive strategies with mindfulness, grounding, somatic awareness, and EMDR-informed bilateral stimulation.

It’s true there is debate around CBT. Some clinicians rely heavily on a rigid, manualized model that can feel dismissive of the client’s lived experience. That’s not how I practice. I don’t “just talk” or simply restructure thoughts. I help clients build nervous system stability, challenge distortions, and integrate both cognitive and somatic healing strategies.

The red flag in her response wasn’t that she prefers tapping over CBT. Clinicians can and should have different orientations. The red flag was that she attacked CBT as a modality when no one had questioned her trauma-processing methods in the first place. The actual question was about care for the client during and after destabilization, and that question remained unanswered.

4. On EMDR vs. EFT/TFT

Her words: “With standard EMDR you HAVE TO remember a trauma to process it; with EFT, you don’t have to even remember a trauma in order to heal it.”

This is where the exchange drifted off course. I wasn’t raising questions about the effectiveness of EFT or comparing it to EMDR. I wasn’t asking her to justify her modality or defend it against mine. I was asking something much more basic: if a client destabilizes during trauma work, what is your approach to care for her?

Instead of addressing that, the response reframed my question into a debate about whether EMDR or EFT is “better.” That was never the point. This wasn’t about pitting one method against another. It was about assessing the opportunity for collaboration and continuity of care.

As the primary trauma clinician, she holds responsibility for the client’s safety. My role, which she herself defined by outsourcing the anxiety work to me, could only be secondary. In that position, I needed to understand how she provides containment if the client is triggered and distressed. Those are clinical and ethical questions, not theoretical ones.

To deflect by questioning my knowledge of trauma modalities was not only unhelpful, it was inappropriate. The issue was not whether EFT or EMDR “works.” The issue was how the clinician, as the one leading trauma processing, ensures her client is safe when distress inevitably arises.

5. On Questioning Integrity and Effectiveness

Her words: “Now, I assume that Piper has studied the brain enough to understand how it works (no condescending tone here on my part, I assure you)…”

This section of her response revealed something more concerning than professional disagreement. Instead of answering my question about how she works with this specific client if she destabilizes, she shifted into defending herself and her résumé. She cited the kinds of populations she has worked with and the breadth of EFT applications, but that was never what I asked.

My question was not: “Is EFT effective in humanitarian contexts?” It was: “How do you support this client in Georgia if trauma work causes destabilization?”

By introducing CBT, EMDR, and her own track record with EFT, she created straw man arguments that no one had raised. I wasn’t questioning whether she was effective in her work with other populations. I wasn’t dismissing EFT. I was asking about continuity of care for this client.

The condescension in her phrasing, “I assume Piper has studied the brain enough,” speaks for itself. That tone was not collaborative; it was defensive. And defensiveness is a red flag, especially when it overshadows any real expression of concern for the client’s safety.

Reading her email, the emphasis seemed to be on protecting and elevating her modality, rather than addressing a colleague’s reasonable concern for a client’s welfare. That shift away from the client and toward professional defensiveness is what troubled me most.

Why Termination Was the Only Answer

Ending this client relationship was not easy. It was, in fact, one of the more difficult decisions I’ve had to make. The individual herself is remarkable; thoughtful, resilient, and deserving of excellent care. My decision was never about her. It was about the context in which she was being treated.

I cannot ethically provide treatment when the primary clinician is practicing in a framework I do not work within, and where there was no posture of collaboration or ethically grounded safety measures. Trauma work was being conducted from overseas with no clear crisis plan. Anxiety treatment was outsourced despite claims that tapping “heals” it. And when I asked the most basic, ethically necessary questions, I received no clear answer.

Termination may not appear kind on the surface, but in this situation, it was the kindest action: ethical, responsible, and professional. Does that mean I have a responsibility to keep addressing the other clinician?

No.

I believe she genuinely seeks to serve her clients. My hope, however, is that this dialogue will help highlight some of the gaps, particularly the lack of protective safety mechanisms, and that she recognizes how a defensive posture only perpetuates the idea that one approach is superior to all others.

Do I prefer my approach? Yes. She may prefer hers. But preference is not the point. The point is care of the client: recognizing blind spots, refusing to outsource without continuity, and expanding one’s framework to ensure safety and containment. And if that expansion isn’t possible, the professional and ethical step is to terminate and refer out, not to keep one foot in, one foot out, while lobbing criticism across an ocean.

Closing Reflection

I chose to write about this because it highlights a deeper frustration within our field. There are no central standards that hold all clinicians equally accountable for how they deliver care, especially when practicing across borders. This lack of consistency leaves clients vulnerable and places other professionals in impossible positions.

I don’t share this to disparage another therapist or her approach. I share it because these contradictions and defensive postures reflect a broader problem: when we stop centering the client and start defending our modality, we lose sight of what matters most.

This experience reinforced for me that sometimes the most caring decision is also the hardest: to step back, to terminate, and to refuse to participate in unsafe or incoherent care. Until our profession demands stronger, shared standards, these situations will continue to arise. My commitment, and my call to others, is to put the client’s safety first, even when it means making the uncomfortable choice.