As therapy becomes more widespread and society more informal, some of the ethical guidelines have become increasingly ambiguous. As the general public has come to regard therapists as just another kind of service provider, rather than a potential Svengali, the relative power of therapist and client has shifted, as well as the role of professional boundaries.
Presumably, the great majority of us recognizes the importance of behaving ethically with our clients, and wouldn’t engage in unethical behavior. We intuitively know we can’t do good therapy unless we’re trustworthy and dependable, respect our clients’ confidentiality, and maintain decent professional boundaries between ourselves and them.
The central ethical concern in therapy is professional boundaries. I began to understand this 21 years ago when I began a regular program of exit interviews with terminating clients, systematically asking them what they thought had been most helpful about their experience in treatment.
Thousands of interviews later, the answer was overwhelmingly clear: Regardless of why these clients had sought treatment, what they valued and remembered most was feeling “safe” in therapy.
The essential factor for clients to benefit from therapy was the sense that they’d entered a secure haven, which provided a time and space set off from the tumult and emotional confusion of their “regular” lives.
There they could concentrate on doing the reflective, difficult work they needed to do to make the changes they desired for themselves. They required a guide who was empathically on their side, hopeful about their future, and open to their free expression of thoughts and feelings, but detached enough not to be sucked into their emotional morass.
They absolutely needed to believe that what happened in therapy would stay in therapy, and that included the therapist. This meant the therapist wouldn’t regularly pop up in their daily life, and they might allow themselves the illusion that the therapist never left the office and was always there waiting for them when needed.
In short, this therapeutic safe house was built on a foundation of unambiguous professional boundaries, confidentiality, and hopefulness, conveyed by a trustworthy expert in a collaborative engagement suspended from ordinary life.
These features of the therapeutic process emerge precisely from those boring old ethical rules and regulations that were established with the specific purpose of safeguarding clients’ interests.
Mary Jo Barrett
Mary Jo Barrett, MSW, is the founder and director of Contextual Change and coauthor of Treating Complex Trauma: A Relational Blueprint for Collaboration and Change and The Systemic Treatment of Incest.