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BERMUDA | RSS PODCAST

Rights and wrongs in the therapy room

Ethical problems in professional organisations are handled by codes and complaints, by boards of inquiry, and by consequences. Some consider such things punitive and harsh; others see them as necessary and a way to make professionals accountable. In communities ethical breaches are considered lapses of judgment, bad form, mistakes, “stupidness”, predatory, egregious, unacceptable and worthy of scorn. Professional organisations deal with violations of their codes by making people attend remedial classes, putting them under the supervision of another professional, and-or taking away their registration, certification, or licence to practise. Communities deal with ethically unacceptable behaviour by bringing legal charges against a person, shunning, or engaging in aggressive retaliation.I once had to deal with the ethical breach of a colleague, and it was not fun. In such cases there are usually blind spots in the offender, and they are the things that make it possible for him or her to exercise bad judgment (at best) and engage in bad behaviour (at worst).In matters of ethics people expect the religious guy to be first to cast a stone, and I suppose that’s justified. I once sat in a church service and watched some preacher, a guest evangelist at that, state that his mission, his “calling”, was to go around pointing out where people are wrong, where their theology is off, and where they have sinned. You might imagine how much of a winsome presence he was.There is a need to be able to discern right from wrong, but I like the emphasis of getting to know what is right so well that anything falling short is just immediately obvious and no longer attractive. It takes making one’s mission a focus on what is, as the Bible says, “…true, whatever is honourable, whatever is right, whatever is pure, whatever is lovely, whatever is of good repute...” thus anything of excellence and worthy of praise. See how different that is? The first guy likes to go through people’s garbage and stand against them by saying how much it stinks. The second approach is to stand with the people in the midst of their garbage and to find order and beauty right there as a starting point in cleaning up the mess.Dealing with someone who has crossed ethical boundaries is often made more difficult by the denying and minimising that the offender employs in the effort to deflect blame and accountability. I am currently in conversation with a friend and fellow colleague, not anyone in the country of Bermuda, who admits to a mistake. However, he focuses on the procedural processes by which his professional organisation is holding him accountable and missing what I believe are the more important matters that have to do with the therapeutic relationship and the impact that people have on one another during psychotherapy.Psychotherapists identify the experience of the therapist that is stirred up by features in the client as “counter transference”. Transference is the way the therapist reminds the client of other people in is or her life (I am keeping this simple). These are holdover terms from classic Freudian psychoanalysis, but they refer to something universally recognised influence and interpersonal experience in psychotherapy is a two-way street. So, the client can move the therapist just as the therapist can influence the client, and that is why it’s important that therapists spend some time in psychotherapy themselves so they can learn to discriminate between their “stuff” and their clients’ “stuff”.Now we come to affection and attraction. The therapy room is not a nook off any social network; it’s not a corner of society where people can meet one another and fall in love. It is a special, almost sacred place, where one person offers another person him or her self as a tool to work through some of their most troubling, most difficult, perhaps most shameful problems and problematic secrets. It’s not about getting a friend. It’s not just a confessional where the client dumps a load of guilt and is given some penance by which to expunge sins from the soul. It’s not a solution store where people can pick up a few gimmicks to make a few more bucks. Therapists enter into real relationships with their clients, but these are therapeutic in nature, and they are in the favour of the client. That is, there is an unwritten contract between therapist and client in which the therapist agrees to set his or her needs and interests largely aside so that time and energy can be devoted to the needs of the client. When that happens the therapist does all he or she can to give focused and concentrated attention to the client, and the way each therapist does that, usually providing positive regard in the process, differs. Regardless, it is a powerful thing to have someone else’s undivided attention, to feel them with you, tracking you, understanding you and feeling sympathetic to your struggles. It is deeply meaningful to “let it all out” with one’s therapist, and over time, it is normal to begin to value that therapist and to appreciate them.This level of involvement can turn into attraction and affection, and experienced therapists consider it normal at times for clients to have a fondness and affection for the person who is all there all for them. When the therapist loses track of what that is really about, they are both in trouble.It’s because affection in therapy is fairly normal that organisations like the American Psychological Association have created ethics codes to make explicit limits on relationships between therapists and clients. This is not to shame anyone, but to alert people enough so that they can avoid shaming themselves.It doesn’t always work. When it doesn’t, and a therapist has lost his or her therapeutic value in the pursuit of his or her own desire, then the kind of perspective necessary to keep the client’s needs, the client’s safety, and the client’s ongoing therapeutic gains in mind has been lost.The obligation is on the peers and colleagues of such a compromised therapist to come alongside and correct, to encourage to get help, to end the destruction, and to embark on a remedial road that might serve as a learning experience, make for a stronger and wiser therapist in the future, or lead to a career change. Above that, the code of ethics is there to protect clients, because if they are not protected, then the mistakes of the therapist mean the client loses an opportunity to ameliorate symptoms, experience personal growth, overcome unfinished business, heal wounds, prevent familiar patterns of self-destruction, and otherwise benefit from clinical work.