Friday, May 21, 2010

Finding a Good Therapist: Treatment Gone Wrong


". . . be wary and wise as serpents, and be innocent (harmless, guileless, and without falsity) as doves."

Matthew 10:16b Amplified Bible

Before graduate school education is complete, every mental health clinician is required to understand and is tested on the ethical guidelines of treatment. Yet, despite such training, too often you hear on the news about therapists who have abused their power. What went wrong?

The relationship between therapist and client is an unusual one in that the counselor is seen as the expert.  This leads to a relationship where most of the interpersonal power is on the therapist's side. As a result, there are opportunities for the misguided, dysfunctional, or damaged clinician to hurt clients.  Being aware of and alert to signs of treatment relationships gone wrong will enable you to protect yourself better should such a situation occur.

Due to the unique type of relationship between therapist and client there are some basic guidelines that should be maintained throughout treatment.  A therapist who shares personal information needs to be very careful.  This is a therapeutic relationship that was created for the sole purpose of healing the client. It is not to be meeting the needs of the counselor.  All personal information shared should be done for the purpose of advancing the clinical relationship.  It is not unusual for clients to ask about the therapist’s demographical information, such as does the counselor have children or is he or she married.  Knowing such answers may help strengthen the treatment relationship, but it also could accidently create barriers. For example, if your therapist doesn’t have children and you are seeking help on handling your difficult child, you may feel your counselor isn’t qualified despite his or her expertise with children. Counselors should share personal information carefully and thoughtfully, and always in the best interest of the treatment relationship.

Your counselor cannot be your friend. He or she should not be going out to lunch with you or contacting you at home to chat. Treatment sessions should maintain the focus on you and your issues, not on the counselor's hobbies or interests.  I remember one new client telling me that his last therapist spent a significant portion of each session talking about the counselor’s recent golf games instead of allowing the client to discuss his issues. If there is a sense that the sessions are primarily about meeting the social needs of the clinician, then treatment is being compromised.

Physical contact should be minimal. Many schools of thought recommend that there is no physical contact between therapist and client.  Therapists have different guidelines regarding this boundary. I generally don't touch unless it is an initial handshake with a new client, or a quick hug that is initiated by the same-sex patient at the close of a session. Substituting physical forms of comfort instead of words can dilute or change the treatment process.  Clients seek treatment to understand and work through their emotional pain. This best occurs through the use of words, not touch.

There are some strict guidelines that should never be crossed:  1.) there should be no contact between therapist and client that is flirty or sexual in nature; 2.) counselors should not be marketing or selling you product(s) that they are representing; and finally, 3.) confidentiality of your identity as a client and the content of your sessions should be strictly maintained.

What should you do if treatment is going wrong? If you see problem signs, you should first discuss your concerns and observations with your counselor.  There may have been a misunderstanding. Working it through could improve communication and strengthen the treatment relationship.  But if this does not work or if the situation continues, you should get advice or a second opinion from another counselor. Terminating the treatment relationship is another option. If you chose to do this, I would strongly encourage you to find another therapist in order to process your previous negative therapy experiences.  In extreme situations, such as sexual abuse, you should contact the disciplinary committee of your state to file a complaint. Again, get help from a reputable therapist to help you through such an emotional process of filing or reporting a complaint.

It is unfortunate when treatment goes wrong, but therapists are human.  Your best defense against such abuses is to be your own advocate.  If something isn’t feeling right about your therapy experience, trust your instincts and get another opinion.

The summer months are almost here and I will be posting articles less frequently until Labor Day. I welcome any topical suggestions for future blogs or comments about past articles.

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