Creating A Safe, Therapeutic Space
Some people—especially those who’ve never been in therapy—insist that the therapist is nothing more than a kind of paid friend. After all, isn’t therapy just a regularly scheduled conversation in which Party A listens sympathetically, making encouraging or consoling little noises, while Party B feels free to share the most intimate details of her life? But of course it’s a rare friendship that could tolerate such open-ended, one-sided “sharing” of our most private concerns, not to mention our uncensored thoughts and feelings.
In fact, the hallmark of the therapeutic encounter is that the therapist is an expert, trained in a particular skill-set to conduct a rather odd, rarified conversation, while the client most definitely is not. Although both therapist and client enter equally and freely into an association, it’s understood that for the duration of treatment, the relationship—however “collaborative”—will also be hierarchical: the therapist will be the guide, leader, advisor, teacher, whatever, e.g., the one in charge. In effect, the client agrees, however grudgingly and fitfully, to at least attempt to unilaterally disarm and expose his vulnerability, neediness, flaws, and failings to someone who’s in no sense obliged or expected to reciprocate.
What keeps this arrangement from being hugely dangerous for the client—what makes it even possible, let alone healing—isn’t just the therapist’s skill, but the nature of the ethical contract underlying the therapeutic relationship itself. It’s precisely the client’s deep-seated knowledge that this relationship is defined and bound all around by firm ethical rules of conduct that frees him from the ordinary internal and social strictures that often make emotional healing impossible.
We may like to think that as good-hearted, moral, upright, caring people, we don’t really need formal codes of ethics. After all, we aren’t going to rob our clients, sleep with them, gossip about them, manipulate them for our own advantage. In fact, we’d never hurt anybody . . . intentionally. But there’s the rub. Nowadays, personal and social boundaries have become so loose and blurry that it’s possible to transgress them without even realizing it. In the salad days of psychoanalysis, professional ethics—particularly those having to do with boundaries, dual relationships, confidentiality, and so forth—were largely in synch with the times. Even up into the 1960s and ’70s, we lived in a relatively buttoned-up culture in which clear demarcations between the personal, the social, and the professional were the norm. Today, all those old notions have pretty much gone out the window.
The seductive informality of our times has transformed even our most basic ideas of when our “office” hours end and where therapy takes place. A few months ago, attending a psychotherapy conference held at a seaside resort town, I was hanging out by the pool with an old therapist buddy who refused a second glass of wine because he said he had to get on the phone for a therapy session. Indeed, therapy now takes place regularly via Skype, cell phone, e-mail, and even in little therapy smidgens via texting. Do I hear the sound of Freud & Co. collectively rolling over in their graves?
In the rebroadcast of our acclaimed webcast, Handling Today’s Hidden Ethical Dilemmas, starting September 17, six of our field’s clearest thinkers demonstrate that formal codes of ethics are far more than an antiquated set of rules, periodically reviewed in mind-numbing CE trainings so we can meet our licensing requirements. Instead, they are what makes psychotherapy as we know it possible. In fact, it might be said that whenever we conduct a therapy session, whether in person, on the phone, or in cyberspace, those rules are always implicitly present—our tacit ally and cotherapist—insuring that whatever therapeutic space is being created is truly a safe haven in a world in which circles of emotional safety and protection are in exceedingly short supply.
Looking for quick CEs? Take the online magazine quiz, “Ethics In The Digital Age”.