The Psych Central Report
The Patient-Therapist Relationship,
Part 2: Professionalism
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Editor's Note: This is Part 2 in a series of three articles on the patient-therapist relationship. The first part deals with specific kinds of therapists and mental health professionals available. The second part looks at how to determine and find quality mental health professionals. The third part discusses knowing when to end a patient-therapist relationship.
In the last issue, Part 1 explained the different kinds of therapists, including what the initials after their name means. Part 2 discusses an essential part of the patient-therapist relationship, and that is how professional the therapist is.
An important quality to look for is the professionalism and ethical behavior of the therapist. He or she might have a significant amount of credentials and experiences, but may not behave in a professional or ethical manner. Under the Preamble section of The Principles of Medical Ethics - with Annotations Especially Applicable to Psychiatry (2001 with 2003 updates) by the American Psychiatric Association, it says "A physician shall, while caring for a patient, regard responsibility to the patient as paramount (Section 8)." Section 9 adds, "A physician shall support all access to medical care for all people."
Under Heading Principles with Annotations, it states that "A psychiatrist shall not gratify his or her own needs by exploiting the patient. The psychiatrist shall be ever vigilant about the impact that his/her conduct has upon the boundaries of the [patient-doctor] relationship . (Section 1)"
Although the information came from the American Psychiatric Association, there are similar provisions within the associations the therapist belongs to. Bearing the above ethical principles in mind, it is time to take them into consideration and apply them to the current therapist. Some signs are more obvious than others.
- Does the therapist explain the 'procedures' such as setting a fee at the beginning of the first session?
- Let the patient explain why he or she needs to see a therapist so that appropriate number of appointments can be made (i.e., once or twice a week to start, then reevaluate)
- Is the therapist on time or is he or she consistently late or even cancels the session? It is also the patient's time and money and that is important. It means respect.
- The therapist who has been chosen should have the education and experience to help the patient. He or she must also respect the patient and maintain strict confidentiality (unless the patient is a threat to him- or herself or to others, at which time authorities must be notified).
- A good therapist will focus on the patient at all times. Too much revealing of the therapist's personal life or other patients' stories may be a sign to change therapists.
Power (Use of therapist's authority and knowledge)
- The patient should be the focus of attention in the session, not the therapist. The patient should do most of the talking.
- The therapist lets the patient learn how to deal with his or her life his or her way (as long as it's healthy). Any or all sources of positive change are promoted, and the therapist supports and encourages the patient's self-esteem and lets him or her choose his or her own life path.
- Problems arise when the therapist enforces his or her own belief that one type of therapy is the only answer. Various methods should be explored and the method that has the most chance of working should be used. Sometimes a combination may be needed. It is often difficult to know which treatments are going to be the most effective for the patient. So here is a question to think about, "Is the patient's decision based on giving-in to the therapy process (which is ok) or, giving-in personally to the therapist (which is not ok)?"
- It is unethical for the therapist to insist that the patient needs more therapy (when he or she really does not), just to maintain the continuing income generated by the patient. It is sometimes difficult for the patient to know if he or she needs more therapy, so the patient must ask him- or herself, "Do I really need more help?" If the answer is no, then termination with the therapist should begin.
- Unfortunately, some therapists abuse their power by violating their patient's trust. One such violation is obtaining sexual favours from their patients. This is not only unethical, but it is also illegal. Although it will be difficult, reporting the therapist to the police and state licensing authorities is appropriate. This will not only start the healing, but it will also help any other victims.
- Good therapy means that the patient is treated with respect, care, and dignity.
- The feelings and thoughts of both the patient and therapist are discussed professionally and freely, not coerced or silenced.
- The patient and therapist should talk about how feelings can be safely discussed and understood rather than acted upon.
- If the therapist suggests anything that makes the patient uncomfortable, especially if the suggestion doesn't feel 'right' and is ethically questionable, that should make the patient consider whether to continue with the therapist.
- Any obviously inappropriate comments or actions by the therapist justifies ending the relationship as soon as possible.
Part 3 will talk about the ending the patient-therapist relationship.