This is a really interesting and useful conversation, actually. I have been angry lately at the health care industry as a whole after recently being harmed by primary care (less angry with therapy than other areas), so i like to talk about things that need improving and feel it is ok to express anger, too.

The case study was a really stupid example to begin with. But it was posted, so let's look at it from a different angle.

The patient was suicidal, showed excessive anger. The chair really made the case study, didn't it; great that that was thrown in there like that... Anyway, so-this therapist decided he felt so ineffective after just 8 sessions? He couldn't work through this with her under supervision to see if things improved? See if it passed? How can you simply decide the outcome in that amount of time. What if she simply sought help for her first manic episode and simply needed a mood stablizer? He can't really know in just 8 sessions. So the argument is that he is CBT, not positioned for complex clients. Ok, fine.

But then there is this: how many conditions include the possibility of suicidal feelings? Do people think it's ok for therapists to take on clients, but then drop them when they became suicidal? I mean, that would affect many clients. And how can a profession aimed at helping those with mental illness just drop people when they need help the most-when they become suicidal? I mean, how can the profession treat clients with mental illness, most getting paid by insurance to do that, than not treat them for mental illness--suicidal thoughts?

If not, then maybe this guy isn't cut out for treating patients with diagnoses of depression, bipolar, attachment disorders, and many others that might include suicidal feelings. They guy should probably have been a life coach! And if he could only treat the most simplistic of patients, then fine, but then he should have screened for these things up front. So the article should have mentioned at least some of the mistakes this therapist made to begin with. Actually, the article is just a really poor example; unrealistic as someone else said.

It can sometimes take a long time to get an accurate diagnosis, but he should have known sooner that he didn't have the skills simply by asking her a few questions about her history. And therapists do have screenings to decide if they will take a patient or not (psychoanalysts). So that exists, maybe the rest of the profession could look at adopting those methods?

A more real life example would have changed things, and reflected a truly ethical situation that is colored grey and not black and white. That's usually how case studies are done-so people can discuss all the many points to learn ethical decision making. (one reason why i thought the article was very stupid). And again, the biggest issue i have is that the article is framed more from a legal standpoint than an ethical one. If you look at APAs code of ethics, it's to protect the patient. This article and author focus more on the therapist, not the patient's welfare. And that this guy is the Director of Ethics at APA. That's what got me.