I am a therapist who believes in clinically appropriate self-disclosure in sessions. Further, I am open about my own struggles with mental health and addiction, coming out very publicly as a professional living with dissociative identities in 2018. Because of my leadership in this area, many people have consulted me over the years about the logistics of self-disclosure and being fully “out” as a professional living with a major diagnosis. And not just “out” in the, “Well, I dealt with this disorder at one point but I recovered and it’s now a thing of my past” kind of way. For me, recovery from both addiction and a dissociative disorder is ongoing. I do not run from the fact that I am a system who has chosen the path of cooperation and communication for my parts in order to heal in a sustainable, long-term fashion. While many in my field admire me for living out loud, many others have labeled me unethical for existing as I do in this profession and in the public forum.
Our field is rife with people calling things that they don’t like unethical as a way of blaming and shaming others. And this tactic often works because no therapist wants to get a reputation as being unethical. Worse yet, getting a complaint to a board or another professional organization for unethical behavior can feel like the end of the world, or the end of one’s career.
For the record, I am not anti-ethics. I believe the ethical codes of our professionals and our licensing boards exist to keep the people that we serve safe from harm, or to at least get us as professionals to think twice about what constitutes harm. I believe that there are some non-negotiables in the arena of therapeutic ethics, such as not having an exploitative relationship with one’s client, whether that be sexual, emotional, or financial. Yet so much of what others in our field will accuse others of doing as “unethical” do not appear in these codes, either directly or indirectly. And that leaves us to do the hard work of recognizing that, like many things in our professions, most ethical decisions are not binary, and they are open to interpretation. How we interpret them, and how we may attack others with our interpretations, is revelatory.
One of the reasons that I put together a course called Navigating Self-Disclosure: A Course for Human Services Professionals is that so many of my fellow therapists have been taught that it is “unethical” to self-disclose to clients. Therapists engaged in advocacy are being similarly attacked with accusations that they are being “unethical” by sharing so much of themselves on social media or online. Yet when you actually look at the ethical codes of the major clinical professions in the United States, minimal direct guidance exists. Or with the guidance that is there, you need to read between the lines quite a bit. Students in my classes are often shocked when they actually look up the guidance on self-disclosure in the codes, only to find that there is very little there. And then that look of recognition comes over their face: When an old professor or colleague of theirs declared with conviction that using self-disclosure is “unethical,” that was really just that person spouting off their opinion. When we put the word “unethical” in our opinion, people tend to pay more attention because of the shock and awe it can elicit.
And that, as I see it, is the main problem: couching our opinion in the ethics argument. I’ve written before that in the EMDR Therapy community where I’ve spent many years, everyone has an opinion. And our community has a major problem with consultants and teachers passing off their opinions as facts. I jokingly teach that on any major hot button issue within EMDR, like how long you should keep a person in Phase 2 Preparation or how much screening you ought to do for dissociation, you can get 10 different approved consultants around a table and get 10 different opinions. On the Phase 2 issues, I’ve heard people in both camps of the polar arguments use ethics to call attention to their position…
“It’s unethical to keep a person in Phase 2 for too long!”
“It’s unethical to take a person, especially if they have complex trauma or dissociation, into the reprocessing phases unless you’ve done enough preparation and given every inventory and have taken every precaution possible!”
Candidly, I sigh with a bit of exasperation when I hear either argument (especially when the E-word gets brought in) because I believe that the truth is somewhere in the middle and must be navigated on a case-by-case basis. What one person or system needs for preparation will vary drastically from what another person or system needs. This position is informed by my more artistic approach to trauma therapy that is person-centered over technique-centered. That is also the lens through which I interpret my ethical obligations to the people I serve. And research does not impress me if it does not connect to the lived experience of the person I am serving in my office.
Any issues around the treatment of dissociative disorders, either with or without EMDR Therapy, can also bring up many different opinions based on perspective. Having the perspective I do as a person with lived experience who has worked for years to depathologize dissociation, I see much of what my colleagues do as creating unnecessary fear and shame around dissociation that exacerbates professionals’ fear in working with it. Naturally, many of my colleagues see my approach as too careless and not sufficiently based in technique or research. Even though I disagree heartily with the way that many people teach and work with dissociation, I still believe that most of these colleagues are ethical therapists who are doing what they believe is best to mitigate harm. My hope remains that people coming for services will find themselves with the right fit of therapist to validate their dissociative experiences and work with them in a safe way that empowers rather than shames.
I am not going to bring this opinion piece to a grand conclusion bringing in the classical ethicists like Aristotle, Plato, Socrates, Emmanuel Kant, and John Stuart Mill to consider what they would make of ethics in the world of modern psychotherapy. Although if you are an ethics buff and would find this useful, I’d be delighted to see what you come up with! As the language nerd that I am, I believe it’s important to consider the origin of this word that we can throw around so readily. We get the English world ethics from both the Latin and Greek ethos. The Latin meaning refers more to character and the portrayal of character, whereas the Greek meaning refers to custom, habit, and disposition of character. Ethics, according to my language dive on the matter, are largely shaped by culture and community values, as in, “What is the ethos of our community here?”
In considering those questions, I believe that most psychotherapists of varying backgrounds can agree on the big ones. Don’t have sex with your client. Don’t exploit your client. Don’t break your client’s confidentiality except for instances where there is a legal duty to report. Yet so much of the rest of what we talk about as ethics exists in varying shades of grey. We must promote a culture where we can have difficult, nuanced conversations about those shades of grey and how they translate into the care we offer to specific therapy participants and systems. Because the community of psychotherapy is not a monolith. And shaming people with a “That’s unethical!” accusation, in my experience, is the surest way to shut down conversation and the level of discussions that are needed in this work.
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