“The first thing you should know about me is that I’m not you. A lot more will make sense after that.”
(From a meme spotted on social media)
From the Preamble of the American Counseling Association’s Code of Ethics:
Professional values are an important way of living out an ethical commitment. The following are core professional values of the counseling profession:
1. enhancing human development throughout the lifespan;
2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts;
3. promoting social justice;
4. safeguarding the integrity of the counselor–client relationship; and
5. practicing in a competent and ethical manner.
These professional values provide a conceptual basis for the ethical principles enumerated below. These principles are the foundation for ethical behavior and decision making. The fundamental principles of professional ethical behavior are:
• autonomy, or fostering the right to control the direction of one’s life;
• nonmaleficence, or avoiding actions that cause harm;
• beneficence, or working for the good of the individual and society by promoting mental health and well-being;
• justice, or treating individuals equitably and fostering fairness and equality;
• fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and
• veracity, or dealing truthfully with individuals with whom counselors come into professional contact.
A Well-Reasoned Decision
To clarify, this is part three of a three-part series designed to help people candidly consider whether or not therapy might be useful for them at this time. If this is a decision you have already made, please forward this blog to someone who might appreciate it. Thanks!
Hold Us To It
The Code of Ethics above is one to which I am bound as a participating member and a Licensed Clinical Professional Counselor in the state of Maryland. I first committed to the ACA Code in 1996 when I began my counselor training. (It was a somewhat different version, but similar in spirit.) At the time, I was starkly aware that we were not living up to our ideals as a profession. Nearly my entire training was sourced from Eurocentric assumptions. In my research for papers and presentations, I actively sought out the work of psychology professionals who addressed the conflicts between their world-views, cultural expressions, relationship norms and social structures and what was commonly accepted in our field at that time.
They were painfully hard to find.
Unsafe
The field of psychology is historically awful. Reinforcing the idea that mental health professionals need mental health care at least as much as the next person, our field is filled with horrifying chapters where we profoundly harmed the people we said we were trying to help. We have learned a great many things the hard way, at the expense of clients.
I don’t blame anybody who looks at atrocities like the Tuskegee Experiment, the Monster Study, the Aversion Project, and so many more terrible, destructive choices in the field, and decides to steer wide and clear of mental health treatment. At the same time, it would be important to consider that many mental health professionals have also looked boldly at these horrendous pieces of our history and firmly committed ourselves to something much finer.
Personally, while I am pained that it’s taken this long, I am very encouraged that the American Counseling Association has taken seriously the need for a complete overhaul of the single-culture system and assumptions from which we came. They have spent many years actively seeking out the voices and perspectives of people who have been marginalized by ethnicity, socioeconomic strata, faith perspectives, age, gender identity and relationship preferences, and worked hard at cultivating an environment that lives up to the above quoted values expressed in the Preamble of our Code of Ethics. (The National Association of Social Workers, the American Association for Marriage and Family Therapy, and the American Psychological Association have all been doing likewise.)
In the last two years, our Association has sent members poll after poll to seek out places where we need to change our policies and procedures so that all perspectives are honored and considered in the governance of our association, in the training of our people, and in the work that we do with clients. As recently as last week, the ACA came out strongly against the current wave of anti-LGBTQIA+ legislation being enacted around the country. We have a long way to go, but at the same time, we have come a mighty long way.
Subtleties
Often the risk in therapy is not as stark as the historic travesties mentioned above. It occurs in tone-deaf aggressions, assumptions and microaggressions on the part of the therapist as well. For example, I once had a friend who was seeing one of my former colleagues for therapy. At one point, my friend described an incident to her therapist where she had been so angry that she threw a shoe at her husband. While she was abundantly clear that this is not the healthiest response she might have had, both she and I concurred she could have chosen a whole lot worse!
This isn’t great, but it isn’t really out of the pale in this friend’s cultural context. The therapist, however, comes from a culture where such an action would be considered quite extreme. The therapist, apparently unaware of her biases, was adamant that my friend needed to be evaluated for medication post haste.
I’m not quite sure how this therapist missed the continual charge in our training to understand each client in their own framework without imposing our own assumptions, but she clearly did. Her shocked and vehement reaction, loaded with centuries of intergenerational trauma caused by a dominant culture’s demands that all other cultures comply with its norms by any means necessary, damaged their therapeutic relationship beyond repair.
Fortunately, taking a stand and refusing to play along with the therapist’s oblivious prejudice was a powerfully positive self-statement for my friend. I wish she hadn’t experienced it this way, but I’m glad she was able to use the whole ordeal to strongly support her self-advocacy and clarity around who is and is not qualified to be her therapist.
Empathy, Empathy, Empathy
As mentioned in last week’s blog, a therapist who stays attenuated to their own biases and continually seeks to understand clients in their own context can have a healing effect for clients. I mentioned that my former therapist, Steve, more closely resembled the perpetrators in my life than he did me. Experiencing empathy, intimate support and encouragement from the kind of face and presence that had previously harmed me was a profound experience.
Finding the person that is qualified for that work can be challenging, but well worth it.
Vetting
Repeating what I wrote last week, before you choose a therapist, vet them as best as you can. Ask any and all of the questions you can think of that would help you figure out where this person is coming from and what they might be like. Read their blogs, watch their reels, look for any articles they may have written. If you can, get warm referrals from people who have worked with them personally.
If you have negative feelings stemming from the way they answer or don’t answer your questions, they are not the right therapist for you. It is not only okay to decide someone isn’t the best fit; It’s imperative for you to get what you want from therapy. Trust. Your. Gut. It’s okay to err on the side of safety.
Inch By Inch
It can be helpful to offer trust incrementally with a therapist. If the therapist violates your trust in one of the lesser risks you take at first, challenge them on it. Carefully observe how the person responds. Have they disqualified? Tell them, and move on to someone else. Have they qualified? Trust them just a little bit more and keep observing what happens. If that process is moving too slowly for you, consider moving on to someone you feel safer with more quickly.
As mentioned previously, all human healing happens in the context of others, one way or another. Find the right healing relationship for you. It’s worth its weight in gold.