In my first column for A&U in August 2002, I wrote about how everybody is a therapist these days – from massage therapy to aromatherapy. I wrote then about how the term “therapist,” as I use it, refers specifically to professional providers of counseling and psychotherapy, who are appropriately trained and licensed by the states in which they practice. By having objective credentialing standards and standards of care, consumers of mental health services are protected from the modern-day equivalent of snake-oil, cure-all hucksters.
Beyond this, however, is another concern that affects far too many consumers of mental health services. These are the licensed therapists, state-registered associates, or graduate student interns who violate the legal and ethical codes that govern therapists throughout the country. While the specific state laws vary, there are certain things that a therapist should never do, and other things that a therapist should probably never do, to stay within legal and ethical guidelines. These kinds of behaviors are very rare, and you should still have confidence in the mental health field in general, but just in case you’re one of the unlucky ones, some words of advice:
First, your therapist should never have sex with you or even suggest it. This is probably the most prevalent issue over which therapists lose their license to practice. This is because you’re there to be helped, and becoming sexually involved with your therapist has tremendous potential to harm you emotionally at a time when you’re going through a lot already. Another ethical violation is when therapists are too consumed with their own problems to help you – whether it’s personal, health, substance abuse, or even their own mental health status. Other problems can arise if a therapist is too distracted by his or her own feelings about your issues to really help you, which I have observed from time to time when therapists are dealing with their own feelings about HIV/AIDS or homosexuality. In some cases, their own religious convictions or lack of education about human sexuality, HIV, substances, or other “controversial” topics can impair their judgment or cause them to be too judgmental to remain impartial, which is critical for successful treatment. If you suspect your therapist is impaired in your sessions by these issues, appears intoxicated, or even just falls asleep, you have a right to complain. Attempt to discuss and work these issues out first, before terminating your treatment.
A therapist should not treat you differently based on discrimination – whether it is gender, race, ethnicity, religion, sexual orientation, national origin, or disability. Unless the therapist is a pastoral counselor (for which there are also guidelines and ethics), a therapist should not use “spiritual” cures on you. They should not try to coerce you in ways like trying to get you to “change” your sexual orientation, or direct you to get married, divorce, break up, have an abortion, not have an abortion, or any other major life decision that only you should be making for yourself.
Therapists should avoid having any other relationship with you other than the therapy – not hiring you, being employed by you, socializing with you, or borrowing/lending money. They should be able to answer questions you have about their experience, education, credentials, and theoretical orientation of the psychotherapy techniques they use. Your therapy and patient records are confidential; your therapist can’t talk to anyone about them without your written consent unless it’s an emergency (such as your intending to harm yourself or other people), or when suspected child/elder abuse is involved, or when involved in a legal action (and even then it’s limited to what is absolutely necessary).
While some negative feelings toward your therapist are normal and to be expected doing the hard work of therapy (such as frustration, anger, or impatience), some other feelings, like being afraid, exploited, or threatened are not. Whatever you’re feeling, it’s important to talk about your feelings with your therapist first. If you’re not satisfied, or if you feel that you are being exploited or harassed instead of being helped, you have a right to consult a state government regulatory board and ask questions or even file a complaint.
Fortunately, the number of therapists who seriously violate the laws and codes of ethics of the profession is extremely small, compared with the number who are dedicated, skillful, and compassionate. But if you are one of the unlucky ones who have experienced some of the things I’ve mentioned here at the hands of your therapist, know that you are not alone, you are not helpless, and you are not “crazy.” Getting the help you need means getting it from someone who is truly qualified and deserving of the privilege of the opportunity to help you.