|Clinical Excellence Narcissistic Clients William Doherty Mary Jo Barrett Mindfulness Attachment Great Attachment Debate Etienne Wenger Couples Therapy Diets Alan Sroufe CE Comments The Future of Psychotherapy Trauma Ethics Symposium 2012 Mind/Body Brain Science Couples David Schnarch Challenging Cases Attachment Theory Linda Bacon Men in Therapy Anxiety Future of Psychotherapy Wendy Behary Clinical Mastery Community of Excellence Gender Issues|
When Does a Rule Become a Straightjacket
by Jenny Newsome
When I was young and only three years out of graduate school, one of my first private clients came into a session carrying a small package simply wrapped in brown paper and string. The memory of that package and how I reacted to it haunts me still.
The client--Katy--was a businesswoman who had come to me six months earlier, dumbfounded by a depression so deep that she was fighting the impulse to drive her car off a bridge. In cognitive-behavioral therapy, she'd improved steadily, returning to activities she had previously enjoyed and finding the strength to let go of unfixable situations she'd badly wanted to fix.
She was dressing more casually, laughing easily and entertaining ways to broaden her already full life. She'd decided to leave her present employer, expand her private consulting business and enroll in a Ph.D. program. Even though her depression was resolved, she had continued in therapy in order to solidify her changes and stay in touch with her long-term goals. All in all, I couldn't have been more pleased about the progress of her therapy.
Then came the fall day when, much to my surprise and horror, Katy came into her session and gave me the little brown-paper package. I unwrapped it and found a small, black velvet box. Inside, was a necklace, and not just any necklace: a gold chain with a diamond pendant that she had designed herself, worth about $500.
I took a breath. I was out of my depth.
Katy knew that giving a gift to one's psychologist could be tricky, so she was also armed with a persuasive list of reasons why I should not refuse her gift. She told me earnestly that it gave her great joy to thank me in a special way. Given her high income, the necklace was comparable to a holiday box of chocolates from a middle-class patient she insisted. She wanted to celebrate her therapy success, and this was a way of making it tangible. The choice of a diamond held great significance: it was analogous to her experience of the transformative power of therapy. The earth, she explained, takes a dark substance (carbon) and subjects it to great pressures that make it clearer and better than it was before.
Being young and new and the good ethical psychologist that I was trained to be, I did just what she feared: I refused her gift. I thanked her for the thought and said it was against my professional code of ethics to accept.
Katy looked pale and shaken and said she felt dizzy. I had to suggest she take some deep breaths. I tried other cognitive-behavioral strategies, but this was not a simple panic attack.
I asked her if this was a transference issue in which she was confusing aspects of our relationship with other significant people and events from her past? No. Was she trying to bribe me into having a non-therapy relationship? No again. Did she have trouble receiving help without reciprocating? She said that although she liked to reciprocate kindnesses, she did not feel "driven" to do so.
Then she told me she felt insulted that ethical rules designed to protect vulnerable patients were being applied to her, even though her depression was in remission. Would she now always be classified in such a way that her own judgment could be questioned? Didn't I trust her to make good decisions? And isn't a cigar sometimes just a cigar?
Finally, terrified and exhausted, I told her flatly that accepting something so expensive was against the ethical rules of my profession and I did not want to place myself at legal risk. Katy got so upset that, again, I thought she might faint. I agreed to hold onto the necklace for 10 days and talk about it again at our next session.
I put the black velvet box in my desk drawer.
Meanwhile, I talked to close colleagues, called the American Psychological Association ethics board, my state ethics board and a lawyer-psychologist who specialized in ethics law. I took the train to Philadelphia and New York to consult with two of my mentors, one of whom had supervised me in graduate school. (In the end, I spent more money on consultations than the dollar value of the necklace.)
My mentors told me I was running the risk of dehumanizing Katy and jeopardizing our therapy relationship by being so scared and rigid. The ethics boards and lawyer both told me that it was in Katy's interest that I accept her gift.
But that was not the reaction I got closer to home. One of my closest colleagues suggested that Katy must be a "borderline" and secretly in love with me. Another recommended I accept the gift but never talk about it.
With much anguish, after 10 days, I accepted the necklace, thanked Katy and brought the black velvet box home. Katy and I continued therapy for several more months before terminating, but something had changed. The sense of a "dirty little secret" had leaked into our sessions.
I had consulted with everybody I could think of and tried to please them all. Losing touch with my own best instincts, I'd gotten enmeshed in our profession's confusion over how to respond to a client's gratitude while safeguarding her from exploitation. In the process, the beautiful necklace Katy had given me had become tainted--not the celebration of growth and gratitude she had meant it to be. I'd allowed other voices into the sanctuary of our therapy and once they were there, I couldn't get them out.