Coping with Complaints: Stress & Impact on Mental Health Professionals

Complaint procedures are essential for protecting the public and maintaining professional standards. Patients deserve an avenue to voice concerns if they feel harmed or misunderstood. And yes, very unfortunately, there are clinicians who do cross boundaries, act out inappropriately with clients, and otherwise do not offer competent services. However, for clinicians who have acted ethically and competently, being the subject of a complaint—or even living with the fear of one—can take a significant emotional toll.

Complaints in Mental Health: A Higher Burden

Mental health professionals appear to be disproportionately affected by complaints. A large Australian study analyzing more than 19,000 cases found that psychiatrists had more than double the risk of complaints compared to physicians in other specialties, with psychologists also significantly overrepresented. Issues often included confidentiality, record keeping, communication, and even the clinician’s own mental health (Spittal et al., 2019).

But not all complaints arise from clinical misconduct. Some are rooted in misunderstandings, family disputes, or third-party grievances. For example, a therapist may be targeted by a patient’s angry spouse or parent, even when the patient themselves is satisfied with treatment. In some unfortunate cases, third-party complaints may also be used in a weaponized manner to interfere with or otherwise negatively impact a patient’s valued therapy and relationship with their therapist. These complaints are often dismissed in the end, but the stress of the investigation process remains profound.

The Emotional Toll: Anxiety, Depression, and Self-Harm

The psychological consequences of complaints can be severe. A landmark UK study of more than 7,900 doctors found that:

• 26% under investigation reported moderate to severe depression
• 22% reported moderate to severe anxiety
• 15% had thoughts of self-harm

(Bourne et al., 2015).

The BMJ reported similar findings: being the subject of a complaint doubled the risk of depression and anxiety among clinicians (BMJ, 2015). Although these studies focused on physicians, the parallels for mental health practitioners are clear.

Living in Fear of a Complaint

Even when no complaint has been made, the anticipatory fear can weigh heavily. Research suggests that 8–23% of psychotherapists continually worry about malpractice or licensing board complaints, a phenomenon sometimes called litigaphobia (Woody, 1988).

This fear may lead to defensive practice: avoiding higher-risk clients, becoming overly cautious, or over-documenting sessions. Over time, such self-protective strategies can reduce authenticity, flexibility, and presence in therapy.

Once a clinician has actually experienced a complaint and been through a complaint investigation, this anticipatory fear is only further exacerbated. Sadly, some clinicians, even when a complaint has been dismissed, chose to leave the profession all together as they feel they can no longer practice in an authentic and helpful manner.

Lack of Support and Isolation

The sense of isolation compounds the stress. A UK survey of more than 10,900 doctors found that among those who had faced complaints, 42% reported significant emotional distress, and nearly one-third reported receiving no support at all during the process (Bourne et al., 2016).

For mental health professionals—whose work is already emotionally demanding—this lack of support can deepen feelings of shame, fear, and burnout.

Compounding Stress: Burnout and Secondary Trauma

Complaints don’t occur in isolation. Many therapists already struggle with high rates of burnout, which is highly prevalent among psychological therapists worldwide (Morse et al., 2022).

In addition, clinicians are at risk of secondary traumatic stress and vicarious trauma from empathic exposure to clients’ suffering, which can intensify the distress of facing a complaint (Bride, 2007).

Practical Self-Care Strategies for Clinicians

While systemic change is necessary, there are also steps individual clinicians can take to care for themselves during the stress of a complaint:

• Seek supervision or consultation: Trusted supervisors and consultants can provide perspective, normalize the experience, and help separate clinical realities from emotional fears.
• Lean on peer support: Talking with colleagues who understand the demands of clinical work can reduce isolation and restore a sense of belonging.
• Access personal therapy: Processing the anxiety and shame with a therapist can help prevent symptoms from escalating into burnout or depression.
• Engage in grounding self-care practices: Regular exercise, mindfulness, journaling, and time in nature can buffer stress and regulate nervous system responses.
• Set boundaries around rumination: Create limits on how much time you spend thinking or worrying about the complaint; this can prevent the process from overtaking your entire sense of self.
• Stay informed but not over-immersed: Understand the regulatory process and your rights, but avoid constant re-reading of documents or worst-case thinking.
• Maintain professional identity: Remember that a complaint—even if painful—is only one chapter in a larger career built on competence, compassion, and care.

These strategies cannot erase the stress of a complaint, but they can help clinicians maintain balance, reduce the risk of burnout, and preserve the integrity of their practice.

Important: If you or a colleague are experiencing suicidal intentions, please seek immediate support. In Canada, you can dial or text 988 to connect with the Suicide Crisis Helpline. In the United States, call or text 988 for the Suicide & Crisis Lifeline. If you are elsewhere, please contact your local emergency number or crisis service right away.

Toward a More Balanced System

Protecting patients and supporting clinicians are not mutually exclusive. Steps toward balance include:

• Providing emotional support for clinicians under investigation, including peer consultation, counseling, and initiatives such as Doctors in Distress.
• Improving fairness and transparency in the complaint process, with timely communication to reduce uncertainty.
• Acknowledging third-party or misunderstanding-driven complaints as a real source of harm, even when they are ultimately dismissed.
• Encouraging open dialogue in the profession, so clinicians feel less alone and stigmatized when facing complaints.

Complaints are an essential safeguard for the public, but the evidence shows they can exact a heavy emotional cost on clinicians—even when unfounded or arising from misunderstandings. Depression, anxiety, self-harm ideation, burnout, and defensive practice are all well-documented consequences.

Acknowledging these realities and creating more supportive, transparent systems strengthens—not weakens—public protection. When clinicians are less fearful and better supported, they are free to focus on what matters most: providing safe, effective, and compassionate care.

References

BMJ (News Article)
Wong, S. (2015, January 15). Complaints procedures faced by doctors risk harming mental health. BMJ, 350, h244.

Bourne et al. (2015)
Bourne, T., De Cock, B., Wynants, L., Peters, M., Van Audenhove, C., Timmerman, D., & Van Calster, B. (2015). Doctors’ experiences and their perception of the most stressful aspects of complaints processes in the UK: An analysis of qualitative survey data. BMJ Open, 5(1), e006687.

Bourne et al. (2016)
Bourne, T., Wynants, L., Peters, M., Van Audenhove, C., Timmerman, D., Van Calster, B., & De Cock, B. (2016). Doctors’ experiences and their perception of the most stressful aspects of complaints processes in the UK: An analysis of qualitative survey data. BMJ Open, 6(7), e011711.

Bride (2007)
Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63–70.

Morse et al. (2012)
Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341–352.

Spittal et al. (2019)
Spittal, M. J., Bismark, M. M., Studdert, D. M., & Morris, J. (2019). Risk of complaints in mental health practitioners compared with other health practitioners: An Australian national study. BMJ Open, 9(1), e025712.

Thomas (2005)
Thomas, J. T. (2005). Licensing board complaints: Minimizing the impact on the psychologist’s defense and clinical practice. Professional Psychology: Research and Practice, 36(4), 426–433.

Woody (1988)
Woody, R. H. (1988). Protecting your mental health practice: How to minimize legal and financial risk. Jossey-Bass.

Patricia C. Baldwin, Ph.D.

Clinical Psychologist

President of

Note Designer Inc.