What are therapists responsible for?

Serious question. What do you all think therapists are (and possibly are not) responsible for?

Doctors, for example, have an oath that says they should first do no harm. Therapists don't seem to have the same notion.

Are therapists responsible for a client's well being outside of a session? Are they responsible if a session goes badly and once the time is up the client leaves in an unstable state?

In some jurisdictions, a bar can be held responsible if they allow a patron to become overly intoxicated and then leave. But therapists don't seem to be held to that standard either.

Is a therapist responsible if a client deteriorates due to their therapy?

APA Code of Conduct

http://www.apa.org/ethics/code/principles.pdf

Answers a bit, but not all. For example, doesn't say anything about whether they're supposed to give a toss what state they leave their clients in post session. Also, this is for psychologists, so I don't think it actually even covers psychotherapists?

My T says her first rule is to do no harm, to do everything in her power to ensure I have the best care I can have either thru her and those other care providers on my team.

T won't let me leave her building if I'm unstable, and when I am stable enough to leave (she knows me well enough to know of I'm telling her the truth in this or am just saying it in order to leave) she follows up to ensure I made it home safely.

She holds herself responsible if she feels she has re-traumatized me or have gone backwards and we work together to move thru it, past it and to correct it and she does things differently to make sure that she doesn't error in that direction again.

She is very attuned to me and herself so she knows the little changes and I truly believe she has my best in her interest. That she pays attention, cares, and not inflict harm and when she does she takes responsibility to repair it.

She sounds very ethical. You have a good T!

She is and I do. I consider myself quite lucky in the T department.

My social work training taught me to 'do no harm' but, if you can't do no harm, 'do least harm to the most vulnerable' That makes sense to me. Sometimes there is a conflict of interest. If you're working with a family, for example, children and those with a disability would be 'the most vulnerable'.

Sometimes it seems to me that therapists leave their clients in a heap and don't seem to have any responsibility for it because it's 'part of therapy'. Right now I'm extremely angry at my therapist. My therapist knows this. My therapist appears to not particularly care one way or another and has not been in contact since our ridiculous session.

That makes me angrier still, because a) he's insisted how much he cares b) this isn't the first time he's left me worse for wear and c) I truly don't think he takes any responsibilities for the emotional state he leaves me in.

I guess he's not ethically bound or responsible for this. But it leaves me in a no-win situation. I feel like he triggered me in a way I wasn't triggered in his absence. I feel like he's undermined my healthy functioning. Not the therapy. Him specifically. And I feel like he doesn't feel any responsibility for the way he reacts or how the session ends.

And that makes me furious. I don't see the point in paying someone to mess with my head and leave me less functional. This isn't the first time he's done this, and what bothers me the most is that he never reaches out afterward to see if I'm okay. He just leaves it because the session is up and I'm not his problem anymore.

I've emailed him twice about this, so far no response. This is making me really frustrated and honestly, the most borderline I've ever felt. This is pretty much my worst case scenario, someone gets into a conflict with me and then just leaves and doesn't look back.

I wonder if he realizes how much this completely undermines everything we've allegedly worked on, the so called 'relationship'. It's not a relationship if one person doesn't give a damn when it's ****ed up.

I really don't get it. I've been so stable feeling lately that I really thought I was about done with therapy. And then that *** comes along and just dumps me back in my hole and wanders off and ignores my emails. I am so damn angry. And it's all completely impotent too, because I can't do anything about it apart from disengage and disconnect. Which is apparently a negative thing. But **** it, I'd rather be the jerk who doesn't care than the person who gets left feeling horrible.

Off the top of my head Id say they're responsible for showing up, listening, following professional ethics and at a minimum acting compassionately toward clients at a maximum plotting out some mass treatment plan. I think it's more art than hard science.

I feel like we should get more for our money than that. Just because it's art is no excuse for finger painting .

I suppose it's about distinguishing between professional ethics and responsibilities and personal ones. I would think most people's personal ethics would say at least an acknowledgement of receiving your email would be appropriate. However many therapists have a no between session contact policy so I don't think it's unusual in a T or against a professional ethical framework not to reach out to you. I wonder if he's feeling a conflict between a no-between-session therapy policy and a concern for you and doesn't know how to handle it?
You said it doesn't seem like he gives a toss; how did he seem in session? If he really didn't care in session I would be very concerned, though I think he should at least acknowledge your emails (does he normally answer on a weekend?)
Sorry you're going through this, I hope you can resolve it, I seem to recall you have a good relationship with him usually

Thanks for your response

He's fine with emails, though like a lot of therapists he doesn't 'do' email therapy. So it's not like he's all 'ooo, must preserve boundaries.' I did kind of slam him with a lot of content in the first email, maybe that's why no response. Or maybe it has nothing to do with me at all.

He always seems to care in general, he just doesn't seem to be concerned when things end badly. And that kind of grinds my gears because in a way it feels like he doesn't care that I'm hurting and angry just because I'm not one of the people who has SH issues or whatever.

It feels like I'm not 'bad enough' to care about in a way. Maybe I'm just projecting, maybe it's some throwback to being the good kid nobody paid attention to, but it really does feel like if I acted out more, he wouldn't be so cavalier about upsetting me. I'm not planning on doing that, it's just a thought that crossed my mind.

I've found with my own therapist that the more heavy the content of the email, the less likely he is to respond at all. It sounds like yours might be the same way.
I think the processing you've been doing is really perceptive and will be good material for the next session. I think the temptation to act out isn't unusual (I've felt that way myself)
Hopefully the next session will be a productive one and maybe even unlock new lines of communication and understanding between you both.
In the meantime I hope you are feeling better in yourself.

Yeah if he didn't respond at all, that'd be the end of it for me. One thing to have a session go badly, another thing to not be in touch after, a whole other bucket of churning fish to not even acknowledge me. If he did that, it would be out of character. I couldn't see a therapist who doesn't do between session contact. I find that demeaning and infantalizing. (No, you sit and wait until it's your turn for attention again.) I hate the power imbalance of therapy to begin with. To be essentially put on the naughty step when I'm upset and just ignored? Yeah, no. Not going to fly.

I don't appreciate being put in situations like this because they're so inorganic. Where else in life does someone get under your skin this much and yet also have such huge boundaries around contact? Never, really. Most people you can at least have it out with until you're done having it out, and even if you never speak again, at least you said your piece.

Therapy is like conversationus interruptus. You just get truncated and tossed out at the end of the hour, no matter where you were. I get that there are practical reasons for that, but it still leaves the client in a half-baked state which feels really unfair to me. To be honest, incidents like this undermine my trust and faith in him, which is tenuous anyways because that's what I bring to the table.

It especially bugs me that he sits there acting like he has no power at all, and yet he has ALL of it. He determines when we speak and for how long. He determines the very bones of therapy, and then has the gall to act like what goes on in there has nothing to do with him.

If we were doing things my way, therapy would look very different. But no, we do things his way. All the time. And I hate it. Hate it so very, very much.

But yes, I am feeling better, thank you

[QUOTE=SkyscraperMeow;4775766]Serious question. What do you all think therapists are (and possibly are not) responsible for?

Doctors, for example, have an oath that says they should first do no harm. Therapists don't seem to have the same notion.

Therapists are first and foremost expected to "do no harm". Unfortunately it's a lot easier to prove harm done by a surgeon or negligent medical doctor than by a therapist.

Are therapists responsible for a client's well being outside of a session? It depends, if a client gives no indication something is wrong and doesn't appear to be a risk to themselves or others, no. Are they responsible if a session goes badly and once the time is up the client leaves in an unstable state? They should not let a client leave in an unstable state, but there's no clause in the ethics code that specifically states this. It falls under the "do no harm" clause, that in therapy can be very subjective.

In some jurisdictions, a bar can be held responsible if they allow a patron to become overly intoxicated and then leave. But therapists don't seem to be held to that standard either. There is liability if a client is under the influence and the therapist knows this. If a client specifically states they are suicidal then a therapist needs to have a safety plan in place- a trusted family member or friend should pick them up if the client can contract that they will not hurt themselves. If a client can't do this, a T will often section a client or call an ambulance to have them taken to an ER.

Is a therapist responsible if a client deteriorates due to their therapy? Possibly, if the therapist committed an ethical violation or was extremely negligent. That needs to be able to be proven, however. Otherwise I doubt a T would be held responsible. [\QUOTE]

[QUOTE=Lauliza;4776270]Thanks for this. Seems very much like therapists get a bit of a free pass in general because unless they do something wildly obvious like sleep with a client, it's all kind of gray area. I suspect they like that.

[QUOTE=SkyscraperMeow;4776274]Honestly that's pretty true. Staying out of a personal relationship with a client is by far the most enforceable ethical violation that there is. Everything else is subjective, even the concept of "do no harm". What is upsetting and triggering to one client can be benign to another. I have come across one or two new therapists who work with kids who have been fired from jobs for incompetence. Still, their incompetence was obvious because of poor boundaries (not sexual, just getting too personally involved). And they worked with kids. When you're dealing with adults there is much less policing.

I think the therapist has the obligation to do his/her best to make sure the client is safe from self harm, specifically suicide, both inside and outside of session. That means making check-in phone calls or having client admitted to hospital or pursuing whatever method is needed to ensure client's safety. T's also are responsible for making sure you do not hurt anyone else of course. Beyond this, I can't think of anything else the therapist should actually be responsible for.

I do think if a client leaves t's office in an unstable (non-sui) state, it would be a caring gesture for the t to do something like make a follow-up phone call to client at the very least. It almost seems inhumane to me to not offer some sort of follow-up care to the distressed client, but, unless the client is suicidal I do not think the t is obligated or responsible for anything further.

As for t being responsible for a client's deterioration, that depends. I am one of those who believe "it's gonna get worse before it get's better" types when working through tough issues so some sort of temporary deterioration could be expected. If the t is just a jack*** in general, taking advantage of a client, or something unethical then of course they are responsible for a client's deterioration.

At any rate, sorry your t has agitated you once again. I know that get's to be frustrating as ****. He must think it helps you somehow? Have you ever discussed his reasons for being a provacateur with you?

I think a therapist is responsible for doing something if the person is deteriorating from therapy, but this is subjective. If the person is having a freak-out emotional overload and this is one of the presenting problems that they came with, then that's not a result of bad therapy, but something for the therapist and person to address.

Rescuing someone in distress is not necessarily helpful, but it is something the therapist should be open about discussing with the person so that she can find ways to reduce the stress of those emotions between session. I have a problem with therapists who never address this.

My therapist, for example, won't let me open up huge painful emotional wounds in session if I haven't found a way to contain them during the week. It's frustrating for me at times, but afterwards I can see her reasoning that doing so would have put me in the position you describe--sending me out the door in a heap. So that's how she handles it. We take things slowly. I almost always email during the week, to stay in touch, and she responds most times. But if I'm really despairing, she can't rescue me from it and doesn't try. It would be my responsibility to let her know if I was really unsafe. Not hers to guess.

This approach works for me. I go through my crazy stuff, she stays steady and available, but she has never led me to believe that she could or should be the one to make improve my state by doing something or preventing me from feeling awful.