Due to the intimate nature of the therapist-client relationship, it is easy for it to go off track and become unhealthy. However, if this happens then keep in mind that it is not your fault. It is the therapist’s responsibility to maintain appropriate boundaries. If your therapist tries to shut you off from others in your life, spend time with you outside the therapy session, or share more about themselves than you do about yourself, they might be engaging in incompetent behavior. You can also spot an unethical therapist by looking at their billing practices. An unethical therapist might not be licensed to practice in your area, or be unclear or misleading about the costs of treatment. Finally, if your therapist is not helping you or is instead actually re-traumatizing you, you’ve spotted an unethical therapist.
EditSteps
EditExamining the Nature of the Patient-Therapist Relationship
- Look for a therapist whose relationship to you extends beyond the office. In order to provide the best care possible, therapists are expected to maintain appropriate boundaries by limiting contact with their clients outside of regular appointments.[1] This includes, phone calls, emails, texts, and social media. If a therapist does not respond to your messages outside of work hours, then they are maintaining healthy boundaries. If you and your therapist spend time together outside of your scheduled appointments, such as going bowling together, then they are violating their code of conduct.[2]
- If you are, for instance, in a relationship with your therapist, they are definitely in violation of ethical codes.
- Check for a dependent relationship. If you feel that you could not function without your therapy sessions, or if you feel that your therapist is causing you to have a dependent relationship with them, they are behaving unethically. For instance, if your therapist suggests that you stop spending time with all your friends and family and suggests that they are the only one who can help you, they might be engaging in manipulative and unethical behavior.[3]
- There are certain cases in which a therapist will recommend that you stop spending time with someone. Listen to your therapist’s reasoning in each case to determine if the person they encourage you to stop spending time with is truly harmful to your physical or emotional well-being.
- Identify a lack of clarity in the therapist’s role. It should never be unclear for whom the therapist is working. For instance, if your therapist is hired by your employer to evaluate your fitness for a job, they should let you know that (and should also let you know if they will be providing information about you to your employer). Alternately, if a therapist is a witness in a court case, they should make it clear whether or not they are advocating for (or were hired by) one side or the other.[4]
- Listen for oversharing. During the course of therapy, you will get to know your therapist – their likes and dislikes, their personality, and other personal details that tend to crop up naturally in conversation over time. But overall, when you seek therapy, the therapist should focus on you. If your therapist seems to emphasize themselves, their life, and their problems, seek treatment elsewhere.[5]
- Sometimes this isn't an ethical issue, but just a sign of a bad match.
- Look for breaches of confidentiality. When you see a therapist, you should expect that the information you share with them will remain confidential. If the therapist shares information about you with third parties – insurance companies, teachers, or spouses, for instance – they are in violation of their professional role as confidantes.[6]
- In some cases, the therapist must turn information over to third parties such as law enforcement. For instance, if you’ve committed a crime or if you are the victim of a crime and there is an eminent threat to yourself or others, your therapist might be required to turn that information over to the authorities.
- When you begin working with a therapist, they should lay out the limits of their confidentiality and disclosure practices, including how their records are stored.
- If your therapist does not share this information with you, you should not seek counseling with them.
- It is important to make sure that you understand the confidentiality agreement between you and your therapist, and recognize that this has certain limits. For example, if you express a desire to harm yourself or others, then your therapist is mandated to report this. Otherwise, everything you discuss should remain confidential.
EditQuestioning Qualifications and Business Practices
- Be wary of a therapist who has no qualifications. Depending on what state you are in, your therapist should hold specific degree and license requirements. You may see a M.A, PsyD, or PhD that is licensed according to the specifications required in their locality. Each nation has its own board or organization that grants licenses and certifications. Certain states or provinces have their own licensing requirements, too.[7]
- You’ll probably see a psychologist, but if you’re working with a psychiatrist rather than a psychologist, they should have a medical degree (M.D.).[8]
- There is no such thing as an unlicensed therapist. However, sometimes, you will be referred to a therapist in training, who is still being supervised and working under a licensed professional. If this occurs, the trainee should let you know as soon as you begin seeing them.[9]
- Look for a therapist who oversteps their areas of expertise. Every therapist focuses on a particular subset of therapeutic practice. For instance, some therapists practice marriage counseling, others are specialists in the area of child psychiatry, and so on. Ask your therapist what their areas of specialty are before signing up for treatment with them. If they insist they are qualified to treat you instead of referring you to an appropriate specialist, you should consider this an indication that they are unethical.[10]
- For example, if you have a heart problem, you don't go to your foot doctor to treat it, you go to a cardiologist. The same type of specialty classifications apply to psychologists. If a psychologist says that they "do everything," then this is a sign of an unethical practice.
- Consider how much the therapist knows about the conditions they specialize in. For example, if a therapist can train an autistic child to hug on command but doesn't really understand autism or autistic people, that is a problem.
- Note any inappropriate secretive behavior. While psychologists shouldn't share much personal information, you should be able to get some information about their business practices. For instance, if your therapist will not answer basic questions pertaining to their business practices, then they might be trying to hide something.[11]
- Withholding psychological testing results from you is another example of unacceptable secretive behavior.
- Look for sketchy billing practices. If your therapist does not inform you of the fees and billing practices associated with treatment, their behavior might constitute an ethical violation. Your therapist or a representative of their office should answer all billing questions in a direct and easy-to-understand way.[12]
- Your therapist should address billing schedules and practices at the beginning of your treatment.
- If you are confused about a bill or have questions about how your bill is calculated, do not hesitate to ask your therapist.
- Watch out for a therapist that milks you for every penny. If you have a hard time paying your therapy bill, let your therapist know. They should refer you to a community therapist or work with you to develop a sliding payment scale.[13]
EditDetermining Outcomes
- Watch out for therapists that do not offer realistic treatment plans. When you begin therapy, you and your therapist should have a conversation and develop a treatment plan that addresses the problem or problems you’re interested in working on. These will be different for each individual. Using your input, your therapist will identify a set of criteria to determine when your treatment can be considered complete, a point beyond which you no longer benefit from therapy.[14]
- Both you and your therapist should be on the same page about your needs and develop a plan – open to later amendment – that can help.
- An unclear or inadequate treatment plan would be one in which your therapist continues to suggest or provide therapy even after you stop benefiting from it.
- Alternately, an inappropriate treatment plan might inappropriately end your treatment before providing adequate help.
- It is impossible to say how long a treatment plan should last. Everyone has different emotional needs. The length of your treatment plan should be based on the depth of your particular emotional needs or issues.
- A questionable treatment plan is one that offers guarantees.[15] For instance, if your therapist says, “You’ll be guilt-free in 90 days, guaranteed,” you should assume they are unethical.
- Note a lack of improvement. If your therapist insists that you are getting better but you express that you do not feel better, or have not found an improvement in your situation, your therapist is – at the very least – a poor listener, which makes them essentially unqualified to continue treating you. At the worst, their continued insistence that you are getting better could be an unethical ploy intended to get you to keep opening your wallet.[16]
- Improvement depends on the reason or reasons that prompted you to seek treatment.
- If you sought therapy because you were struggling with depression, for instance, a more positive mood or outlook on life might qualify as improvement.
- If you're in therapy for a lifelong condition (e.g. autism), consider if you're gaining any skills or coping mechanisms. Your condition may be permanent, but you should be learning better ways to handle things.
- Be cautious with a therapist who focuses on the negative. Part of successful therapeutic treatment is learning how to identify and reframe negative thoughts and feelings. You’ll never totally dismiss or forget about negative feelings, but they will take an appropriate place alongside positive thoughts. However, if your therapist constantly brings up your failures or negative aspects of your personality without helping you reframe your thoughts in a supportive, healthy way, they are engaging in unethical behavior.[17]
- For instance, a good therapist might hear you say, “I don’t think I have anything to offer” and suggest that your friends and family surely disagree.
- An unethical therapist, on the other hand, might hear you say “I don’t think I have anything to offer” and agree, “You’re right, you don’t seem to be very intelligent or kind.”
- If you often leave your therapy session feeling worse than when you started, that should be a red flag that your therapist is not right for you.[18]
EditRelated wikiHows
- Find a Supportive Therapist if You Are Lesbian, Gay, Bisexual or Transgender
- Tell if an Autism ABA Therapy Is Harmful
- Choose a Therapist
- Choose a Mental Health Counselor or Psychotherapist
- Talk to a Therapist
- Prepare for a Session With a Therapist
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