Don't Let "Risk Management" Undermine Your Professional Approach
The best form of risk management for your practice may be doing what you think is right.
Let's End the Conspiracy of Silence About Ethical Dilemas
One way or another, all therapists face similar questions about therapeutic boundaries: Should we accept the gift? How much do we self-disclose? What do we do when a dual relationship can't be avoided? How do we safely negotiate the currents of sexuality? Moved by our best instincts, our weaknesses or simply by the sheer ambiguity of the situation, we can often find ourselves striking out on our own and coloring outside the lines.
Letting Go of Our Inscrutable Facade
There is a basic inequality built into the therapy contract—we ask clients to disclose their vulnerabilities, while we hide behind a facade of unflappability, presumably floating above ordinary human foibles, untouched by the jolts and discouragements of life. While preaching congruence, who among us has never pretended fondness for a client we actually disliked, didn't understand, and didn't trust? But on at least two occasions, with a minimum of strategic deliberation, I opted to step out from behind my own well-cultivated facade of inscrutability to tell clients the unvarnished truth—with surprising results.
A Therapist Caught in the Act of Being Herself
After the incident, I came to a decision to consciously bring some of the wisdom and skill of my profession into my life with my children and husband at home. And I started bringing into the office the honesty and imperfection I had once tried to sequester in my personal life.
Violating the Ultimate Therapeutic Taboo
I doubt that I would fit many people's image of a therapist who would violate sexual boundaries with a client. Before it happened, I certainly did not fit my own. On the day I first met Cara, I was a well-respected social worker at a venerable psychiatric hospital in the Midwest. I viewed myself as a caring and conscientious professional. Yet, over the course of two years, I progressed from sympathizing with Cara, to over-sympathizing with her, buying her groceries, paying her rent and, finally, sleeping with her.
Challenging Our Culture of Avoidance
Before it happened to me, I had never heard even my closest colleague talk about falling in love with a client. In our consultation group, the subject was once broached purely theoretically, and everyone became uncomfortably quiet. Nobody shared a personal experience. The message we gave each other was clear: Whatever you do, don't talk about having a crush on a client! And that may be why I would rather write about being seen naked by a client at the health club, or dealing with anti-Semitic remarks in session, than describe to you what happened.
When Does a Rule Become a Straightjacket
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.
Sometimes It's Okay to Trust Your Instincts
We therapists tend to worry a lot about boundaries, sometimes to the point that we forget that sharing our humanity can be a gift, not a distortion.
From Client to Friend to Client
The blanket disapproval of "dual relationships" in some circles draws no distinction between "boundary violations," which can harm a client, and "boundary crossings," which produce no harm and may even enhance the therapeutic connection.
There Are Few Secrets in a Small Town
When my wife and I moved to a place in the Yukon so small that when someone sneezed at one end of town, someone at the other end reached for the Kleenex, I quickly found that practicing therapy could get pretty tricky. Not only did everyone know everyone else's business, everyone was in everyone else's business.
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