Outpatient therapy requires stability. When a new client presents with severe symptoms, high PHQ-9 or GAD-7 scores, safety concerns, or significant functional impairment, the ethical response is referral, not treatment initiation. That may include psychiatry, higher levels of care, or crisis resources like 988. If a client destabilizes during treatment, we adjust. But starting outpatient therapy without stabilization risks client safety and your license. Ethical care means matching clients to th