Therapists and responsibility

What responsibility do therapists have towards their clients and those they encounter?  I’ve often wondered this as I see an increasing number of therapists having online interactions with mental health consumers who aren’t necessarily their own clients.

I can understand, as a consumer, that there is an attraction in finding information online – you can do it at your own leisure, it may seem less scary than talking to your therapist and it helps you to feel a sense of connection or validation to find a group of people who are experiencing the same sort of things you are.  We often come to the information with a sense of hope and vulnerability – we’re desperately searching for anything that will help us to make sense of the world we find ourselves in.  This vulnerability means that the information we find has to be totally unbiased, ethical and of a superior quality – not due to issues with our intelligence, but rather with that vulnerability potentially hampering our ability to filter the information we find.  When you’re desperate to find any hint of familiarity, you are less likely to evaluate the information found for it’s worth and relevance.  If that information, or connection to a group of people, is found on a site run by a therapist, there is an intrinsic trust associated with it.  This person is a therapist, with qualifications and years of experience… surely that means they can be trusted.  But can they?

When we go to see a real life therapist, you interview them to see if they are a good fit for you, are ethical and have complaint procedures in place… how do we do this for online therapy blogs that we read? Years of teaching Information Literacy has shown me that we are more trusting of what we find online.  There seems an implicit trust in having the information online.  This can mean that if a therapist strays from ethical guidelines, we’re possibly less likely to question it, and we’re more likely to accept what they say as being fact.  There is also the issue that the therapist doesn’t have to allow questioning on their blog… any comments which question the content of the blog or their practice can be deleted at the moderation stage.  So, we can have a perfect storm scenario, where vulnerable mental health consumers are being led along a path that is dangerous and unethical, without any checks on the therapists behaviour.

This is not to say that all therapist blogs are negative… I’ve found some excellent therapist blogs which are written either for the consumer or other therapists.  But, we do need to stand back and evaluate what we are finding…  Often the intentions of the blogs are real and true… they’re wanting to help the consumer, but often the way of doing that is questionable.  The next time you read a blog – be it a therapists or a survivors, ask yourself some basic questions…

What is this person getting out of writing the blog – what is their aim and motivation?
Is it an opinion piece, or is it factual?
Are they stating opinion as fact?
If it’s portrayed as fact, where is the research supporting that fact?
Is there indications that the therapist is continuing with their own education?
What qualifications does the therapist have, and what does that qualification mean?
Can you find out more about the therapist – do they list their name and contact details?
Google the therapist and see what comes up – are there any complaint procedures filed against them?
Who does the therapist link to – research from reputable sources, or other opinion pieces?

I know this all sounds difficult, but the online world is a dangerous one at times… you need to be aware of where you are going and what you are reading. It’s easy to be caught by a case of the therapist wearing the Emperor’s New Clothes… I know I have been.

—————-
Now playing: Sarah McLachlan – Angel
via FoxyTunes

Advertisements

42 thoughts on “Therapists and responsibility

  1. I find many things on therapist blogs which seem to represent opinion as fact and I rarely find anything even resembling conclusive evidence. Even links which appear to be represented as evidence are often simply theoretical. I think people should be very careful with therapists both online and in person. Even when we have a therapist who is working out for us, not everything they offer up is going to be useful to every single individual. The same goes for practitioners who offer nutritional and supplement advice. Good post.

    • Hi Ethereal Highway,

      It’s incredibly hard when we go into a situation wanting to find answers and connection… It can cloud our judgment. We do need to be careful with any interaction we have, I’ve picked up on therapists here, but the same could be said for message boards, blogs etc.

      It’s easy to portray opinion as fact, often unknowingly… It’s up to us to question and look for what is going on, and that is difficult.

      Take care,
      CG

  2. This is such an awesome post! Thank you for sharing.

    Yes, therapists can be dangerous, both online and in real life. I enjoy reading therapist blogs – particularly ones that give me an insight into therapy or show the therapist to be human. Others, well… sometimes I wonder if the therapist is just a megalomaniac?? Clearly that’s a dangerous thing when it comes to vulnerable people.

    • Hi Kerro,

      Yes, it can be interesting to see the other side of the therapeutic relationship. I don’t know if I’d like to read my therapists view on their practice though…

      Take care,
      CG

  3. Brilliant post, really important points you make here, thankyou. Not everyone is helpful and many are damaging, it is important to keep safe and evaluate what we read/see.

    • Thanks 🙂

      It can be difficult to constantly evaluate what we find, but it has to be done to keep ourselves safe.

      Take care,
      CG

      • Am adding a disclaimer to my site as a result of this castorgirl, I think it is important for readers to know my blog is not intended for MH consumers even though I am a counsellor – is there anything you recommend I include (and are there any issues with my site as far as you are aware?)

        ta

        xx

        • Hi TheSameSky,

          Personally, I find your blog validating and inspirational… It’s obvious that it’s written about your journey through therapy and life, but has the added bonus of being informed by your studies. If you wanted to add one, a simple disclaimer would be enough. I’ve never seen you offer therapeutic advice; but rather, you document how different techniques have worked for your healing – that’s totally different from the ethical breaches that I’ve seen on the blog that prompted me to write this post.

          Take care,
          CG

          • Wow, that is really good to know castorgirl, thankyou. I’ve added a disclaimer to be safe. And I’d be totally open to hearing from you if you ever thought I did get it wrong. Thankyou,
            xx

            • I’m just another blog reader, looking for those connections to help me explain what’s happening. I’m definitely not an expert on boundaries and ethics… That you’re open to questioning and concerns shows that you are working from a good foundation.

              Take care,
              CG

  4. I agree, well said.
    I have found w/DD being such a controversial, misunderstood and relatively new dx, that there is some pretty iffy stuff out there.
    We need to be careful not to get triggered by some stuff we come across.
    Some stuff is just SO wrong. Like I made a complaint to ‘honcode’ I think it was, people, cuz they endorsed this website that had some TERRIBLE and very (to me) triggering info on that site regarding DD. I got an email back saying cuz it was verified by Dr….. they deemed it fine…..
    So beware, just cuz a site has endorsement by honcode or others, it means NOTHING. It can still be untrue/unsafe.
    Sort of how a criminal record check for people working with kids is. It means NOTHING. It does not guarantee a person is safe w/your kids.
    I am kinda glad you posted bout that desprate search for knowledge, understanding. Cuz DD is so nuts. I try and try and understand….but its just nuts.
    Thx
    Ones

    • Hi Ones,

      I’ve read some really good validating blogs about the dissociative disorders, as well as some which seem to give fodder to iatrogenic and False Memory Syndrome supporters. I recently had a comment where I questioned a therapists assumptions not published on their blog, that was the final driver for me to write this post.

      While I like the idea of the HONcode, it will probably honour the practice and online work of professionals because of their qualification. This is why it’s important for us to all learn how to discern the worth of the information we come across ourselves. Having a qualification does not necessarily mean that the person is fit to practice from an ethical and professional point of view.

      It’s a minefield…

      Take care,
      CG

  5. Thanks CG. This is really timely. I have some additional thoughts that I will write about soon. I just have to present them in a way that I am comfortable with.

    • I’d be interested in hearing your thoughts Paul. I admit to writing a very watered down version of what I was wanting to post… I didn’t want to face the venom that I’ve seen from fellow bloggers and survivors when a particular blog or therapists methodologies have been questioned in any way – let alone the potential libel allegations!

      Take care,
      CG

  6. As you probably know, my T is very involved with my healing process. I don’t often visit blogs of therapists who like to do therapy online. My therapist told me before I began blogging to be careful and to watch for a lot of what you listed above. He also told me that if a ‘successful’ therapist has time to treat online, then how successful is he or she, really? That was an eye-opener. My T also said that if a person cannot see me, see what I’m not saying, or see that an alter is out, then how can that person know enough to handle the situation. I have an alter who can be suicidal. What if, during a phone conversation with an online therapist, my 11 year old Smoke came into the mix and threatened to cut. There is no way the therapist could effectively help me.

    You are wise to know about the dangers and for posting them for others.

    • I echo these comments, Ivory. The problem is that many in the survivor community are impressionable and naive. So, when they see an online therapist pay attention to them, they connect with it. That connection, generally, is not the kind of therapeutic connection that is helpful.

      • Are we impressionable and naive, or just desperate to find a place where we belong or someone who understands us? Does that need make us impressionable and naive? I’ve seen very intelligent people get caught up in unhealthy online situations… when those early attachment needs have gone unmet, it can be amazing what you will do in order to have them met in the present. Ethical therapists with appropriate boundaries realise this, others seem to feed what becomes a frenzy…

        • Maybe I meant to say “vulnerable” as an umbrella term.

          But impressionable and naive refers to many of the people who seem to be new to healing. I have seen an effort, mainly on message forums not these blogs, by these people to gather what is very very basic information. Put those people in a position where someone who is unethical is providing the answers or advice to them, and that cannot be a good situation.

          • Sorry Paul, that last response was me smarting over being one of those who were naive when I was new to healing… I got caught up in some of the unhealthy online forums and blog environments because I was so desperate to find something that could help me explain what was going on for me. Thankfully, I also had the detached “librarian” part of me that allowed me to see fairly quickly that the information and environment wasn’t healthy.

            I agree it can’t be (and isn’t) a good situation, but how do we fix it? I tried to add comments questioning the practices that I was seeing, and my comments weren’t published by the therapist. They then went on to post even more questionable material… I’m not a client, or even in the same country, so how can I lay a complaint?

            I know that the ethical online practitioners are looking into how to lay complaints when they are crossing state and country borders; but there is nothing on the blog that I’m thinking about, where complaint procedures are listed.

            Take care,
            CG – now going back to a less defensive and bitchy mode of operating 🙂

            • I don’t have a good answer… As one of our elected officials has said: “That’s above my pay grade”. I think what you have done is best. Stay clear yourself and protect yourself. And put it out there for others to think about, even if they may not be willing now. Maybe someday they will see the wisdom of your words.

    • Hi Ivory,

      I know of some therapists who specialise in online forms of therapy, but they are very aware of what diagnoses are suitable (or not) for that online practice. They screen all clients and advise of the limitations of going into an online therapy situation – including screening for issues around suicidal behaviour and general safety. So, I think it is possible to safely practice online, but I’m not so sure that someone new to DID would be a good candidate for online therapy.

      I’ve also come across some great informational blogs by therapists – these people aren’t trying to treat anyone, they’re presenting information for the consumer or fellow therapists…

      In both instances, it’s up to us to evaluate the sort of information we find. That can be really hard when your vulnerable in any way. This is what makes me so angry about some blogs that I see… they seem to be victimising already vulnerable people with misleading or biased information. My sense of justice gets riled and this post was one way of addressing that ire – although I now realise it’s a weak one considering I have a small readership here, and those who I see as potentially being hurt won’t read what I have said. Although, even if they did read it, I’m not sure it would make a difference… what’s my word against a therapist with letters after their name? The balance of power will be in their court.

      Take care,
      CG

  7. CG, that’s an excellent post. It’s so important that we scrutinize all informations we find. I hope many people read this post and start to evaluate. Everytime when I find a blog from a therapist I’m trying to question the intention of this person. Why he/she writes a blog? It’s interesting too, that in my country no blogs are available from therapists. There are some excellent websites with good informations, some forums, but no blogs from a therapist. I’ve wondered why this difference exist…
    btw. I absolutely avoid such things like forums. It’s to unsafe. It’s important to know that even perps are in the online world.

    • Hi LostShadowChild,

      It’s interesting that there are no therapist blogs originating from your country… I wonder if it’s a cultural thing? There’s only one blog that I know of from New Zealand and it has some really interesting things from an advocacy point of view regarding the government changes that are coming in regarding the support of sexual abuse survivors. There are some local forums, but they tend to be quite negative and dysfunctional from what I’ve seen.

      I did have one good experience with a forum, but it was small and fairly quickly died out. It’s interesting that you mention perps being everywhere, as I’m sure one of the people on this blog was an abuser. They joined only briefly, but they joined with the sole purpose of getting closer to another vulnerable survivor… It was scary to watch.

      The main thing with any place we visit is to question what we see and to not accept it on face value. This can be difficult and exhausting!

      Take care,
      CG

  8. I think there ARE relatively safe places out there as far as forums. Just yes, you always have to be on guard, and i tend to keep stuff, for the most part fairly surface, and I try very hard to not give out any info that could be identifying. And if you do slip up, any decent forum will remove it for you reasonably quickly.
    But forums are filled w/people and there will be problems ocassionally of course.
    I have found a place where people are very kind, and very careful. We keep it pretty surface. There is one area where more is said, but I don’t go there. Also chat functions can be really dicey. Its too easy to say what you shouldn’t, cuz its all happeneing too fast. So I don’t generally chat.
    So I hate to see people be afraid of all forums, cuz they can be helpful, just keep your eyes open is all.
    I have gotten alot of support and kindness and learned alot from my forum.
    But ya, be alert.
    Thx Ones

    • I’m glad you found somewhere you feel safe Ones… I’ve tried forums and found them negative, but that is just my experience. I know others have found forums invaluable…

      It’s all about being careful and maintaining boundaries – something that many survivors struggle with.

      Take care,
      CG

  9. This is really one of my pet peeves — interactive therapist blogs. If a therapist feels the need to blog to provide information, there should be *no comments allowed*. If the therapist feels the need to interact with commenters, there is an immediate and irreparable ethical breach. That therapist is treating someone else’s clients. Under United States licensure, it’s a breach of ethics which, if pursued, could result in revocation of a license. I think that is rarely pursued by commenters on therapist blogs, partly because they don’t necessarily live in the same state, and filing a formal complaint would be impractical.

    But to me, the line is very, very clear. I am horrified when I see dissociative disorder blogs written by therapists who allow commenters’ child parts to comment in post threads, and to interact with adult-faceting commenters. It is incredibly irresponsible.

    It’s hard for the newly-diagnosed DID client, in particular, to moderate and self-protect. The skill isn’t there. And those therapists should know that. Shame on them.

    • It’s interesting that many of the really good therapists blogs I’ve encountered don’t seem to get many comments. This is often because of the way they write their posts – very informational and professional. So, it is possible to impart the information without compromising any ethical or moral boundaries.

      I hadn’t realised that the US licensure was so strict. Here, it’s possible to see numerous therapists, with each of the therapists not necessarily knowing about each other. It’s a rare situation, but possible… As an aside, I wonder if there are guidelines in place where LostShadowChild lives, which mean that therapists are not permitted to blog?

      I haven’t spotted any therapist blogs where child parts have obviously written, but it sounds like a potentially dangerous situation. The potential for confusion on the young ones parts is huge. This is something that the therapist should be protecting the young ones from, not encouraging…

      I hadn’t realised that there were so many people as worried about therapist activities as I am…

      Take care,
      CG

  10. As I read this, one particular blog came to my mind. I can never put my finger on exactly what it is that bugs me about that blog. Maybe it is because somehow it seems disingenuine to me, I question the motivations for her post. And David, I think that just because someone who writes a blog and then responds to comments is not really providing treatment but just a response. It seems to be a nicety or acknowledgement of the commenter. I mean not everyone who responds to posts is in therapy and therefore someone’s client! And last thing, what if the client wants to see two different people and not have them be aware of each other? How is that ownness on the therapists? I don’t mean to sound rabid but you sure seemed to have made a lot of blanket statements. Peace

    • Hi Tyley,

      My take on what David is saying is that there is more than a simple acknowledgement of the commenter occurring. I’ve seen therapeutic techniques, advice and leading assumptions been given to commenters on a blog, either in the body of the post, or in the responses to comments. In my eyes this would constitute therapeutic treatment – I’m not a lawyer or a therapist, so I could be wrong on that one.

      As for the case I cited where a client can have numerous therapists, this is a situation that can arise here in New Zealand. It isn’t an indication that the practice of having more than one therapist would lead to ethical dilemmas, but rather a statement of fact that it’s possible… Speaking as a person working with two therapists, it would be good if they knew about each other and had permission to communicate if there are any concerns… But that’s just my opinion based on what I’ve found working for me, others may find something else works for them and their therapists.

      Please remember through the post and the comments that I have stated that there are a number of excellent therapist blogs out there. This post was purely to raise awareness that we need to be careful about what we encounter online… Skills such as filtering and evaluating what we find are vital when we (as mental health consumers) come into the equation with so many questions and needs…

      Take care,
      CG

    • Tyley,

      I am referring specifically to therapists who do interact therapeutically with the commenters, making specific observations about what the commenter has said, suggesting lines of thought or a course of action.

  11. WOW,hot topic for sure.
    There is a T blog I read from time to time, but it allus made me nervous, not sure why. I wanted to get sucked into the vortex, to feel connected to this seemingly kind understanding person.
    but lucky for me, I had seen some stuff and was wary, and I got a part that very logical and smart and rational, and it realized how on earth could one person possibly cater to so many and still have any kind of life, or be consistant etc.
    and ya WHAT role this person trying to play exactly??? I found it confusing. But really , on the surface,nothing seems wrong, just my alarm bells ringing….
    Cuz this blog got some good stuff, but some stuff is major triggery.
    I never quite sure whats so off putting, but reading poeples comments here are making things more clear. I never realized, but now I know, that if I had come across that blog say 3-4 yrs ago, I probably would have got sucked in 😦
    I have occasionally reported bad stuff to places like sidran or isstd. I document and explain it as clear as I can. Mebbe if more of us do this, there will be some kind of action? If nothing else post a blurb bout what goes on out there on their site? A warning about some places that have many complaints? I dunno? What can we do? I am wiser, but there’s those who are not.
    Frustrating.
    Thx for listening.

    • Hi Ones,

      I didn’t realise what a big issue this was with people… It’s sort of taken us aback.

      I’m gald you were able to keep yourself safe… that’s a huge skill and shouldn’t be underestimated. Having been drawn into several unsafe environments online over the years, I know how much our young and needy parts are looking for that connection… it’s easy to lose sight of our boundaries and safety when we get even a hint of a connection to a group or therapist.

      I never thought of contacting Sidran or ISST-D… good thinking, when I’m feeling a bit stronger and together I’ll do that as well. My understanding is that those organisations aren’t tied to licensing bodies at all, but many dissociative survivors go to those sites for quality advice and information.

      Take care,
      CG

  12. I think that some therapists blog online in an effort to build their practice. It is a way of building credibility (I am published) and name recognition (more people will see their name).

    I cringe if I see little ones posting comments. If I recall correctly, there is a therapist who has an online forum and blog whose clients (including their little ones) post comments. I don’t know how that fits ethically, but it comes uncomfortably close to the line of open therapy for me. How does that fit with confidentiality?

    That particular therapist, although knowledgeable, is also dangerous. I know that from personal experience. I also know that she is in the process of fighting the revocation of her license.

    I have been in forums that were very helpful. A lot depends upon the setup and upon what is allowed and disallowed. Her forum was dangerous. Others I have been to were safe.

    However, having said that…I have also seen forums infiltrated. It is sad. I am always wary…no matter where I go online. I try to be careful what I post…whether openly or in “private”.

    • Hi OneSurvivor,

      There are some really good therapist blogs out there, but the sort of practices you mention are what led me to write this post. I worry about the ethics as well… engaging with little ones of the system in an open blog is scary for me. This isn’t about wanting to repress the little ones, but protect them and show where they can get that ongoing support that the system needs as a whole.

      My personal hope is that her license is revoked. I don’t wish ill on anyone, but there is a reason why there are codes of conduct and professional bodies overseeing therapists work.

      You’re right, we all have to be careful with what we post, and where. It’s sad, but a reality.

      Take care,
      CG

      • Yeah…it is definitely a reality that we need to be careful.

        All of my friends that were hurt by the person impersonating me and lying about me were gotten to through their little ones. They allowed little ones to IM and talk on the phone without having an older one who was savvy watching and listening. Little ones are easy to fool. *sigh*

        That is why I wrote an article on Safety for Survivors…both offline and online. I NEVER want to see anyone go through what my friends went through or what I went through. It was scary and dangerous.

        • Hi OneSurvivor,

          I’m so sorry you and your friends were hurt by this group of people. I’m glad you’re free of them, although I know you are still processing what happened and the pain it caused.

          If you have a copy of your article online, and are happy to share it, would you mind adding the link here? Only if you are comfortable.

          Take care,
          CG

Please leave a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s