unconventional versus unethical

I started therapy with someone new about 2 months ago. The one I saw before - for 6 months so so - seemed kind of awkward and simplistic, and not on the same page as me, in too many ways.

This second therapist was not recommended by anyone but I saw his profile etc on the internet and many of the things he has a special interest in are central to my own issues. I was however, shocked when I first saw him as he was emaciated and feeble. Unlike other therapists, however, he zoned in on the most central and profound problems I have in the very first appointment. I found myself opening up remarkably fast and his insights bewilderingly on target.

Hi appearance made me very anxious though as a therapist I was seeing for 8 years died very unexpectedly and this one already looked so unwell. Despite being so gaunt, etc, he is only in his late 50s (I asked). I also asked about his health and he said he has been very stressed; his mother sick and had financial difficulties. At that time also severe insomnia and suffered from migraines.

In our further conversations he said he was aware that due to my own pathology I would be trying to tap into his needs and that we needed to keep a watch on that.

When I was on holiday in December I did message him at some point when I was having a hard time and his responses were very helpful. He indicated that he was himself a lot better. I thought this was fair because I don't want to be seeing someone who is desperately ill. Only last year someone I was very close to died...
So, his health is/was a concern for me. HOWEVER, in this message conversation he also said something about how he didn't think it would be fair to burden me with his inner pain. I found this really uncomfortable.

In our last session we were discussing how a mother's early response to the infant shapes ones perception of self. My mother has NPD and he was explaining how even beyond ordinary care-taking behavior, the infant absorbs the mother's likes/dislikes - even from physiological cues like pupil size. Clearly I have internalized a very averse and negative sense of self. He also told me that his own mother was a narcissist but that her response to him had been at the other extreme and had given him an equally problematic sense of narcissism. That he had spent much of his youth this way, but had ultimately crashed because he was unable to maintain true intimacy and had had to finally confront his own distorted sense of self.

On the one hand, I think that because he is this open with me there isn't that power disparity that there usually is with therapy. We interact as equals, etc. On the other hand, I am concerned about boundary issues. I am also concerned about the extent to which he has resolved all his own issues...

A therapist I was seeing for many years before passed away in April last year and I'm still quite devastated. I so miss his solidity

Any advice (especially from professionals in mental health care) would be much appreciated.

Just to add - the last therapist I had (who passed away) seemed to have many attributes that I desperately wanted - especially that relaxed confidence, and centeredness. How much of that was an image I don't know.

The only part that sounds a bit questionable to me is him sharing his mothers NPD and the impact on him, because it's made you question whether he's resolved his own stuff and you don't need to protect, worry about or care for your T in that way. The other stuff sounds like him being open and building rapport with you, and being open about not wanting to feed an unhelpful dynamic where you look after him.

The difference for me between unconventional and unethical is when whatever unconventional "thing" benefits the T in some way, e.g. by fostering a dependence meaning a client "can't" leave thereby meaning the T continues to make money from a vulnerable client, or where the T meets their own relationship needs, sexual needs, need for intimacy in the therapeutic relationship. Finally, not working within a clear ethical framework or not keeping to the terms of that framework - so fur example, in the UK if the T isn't in regular, monthly supervision, no matter how good their practice might be, in my eyes they're being unethical.

I agree with what Merecat said above.

Merecat and MobiusPsyche, thanks for the feedback! I have been in therapy quite a while and seen a handful of therapists and none have confided this much in me. Consequently I regarded this as unconventional (as in unusual). The therapist I saw for the longest period was almost entirely opaque regarding his own psychological history - when I asked him he said he had been depressed once long ago and that it had been sustained but that ultimately he had got through it without needing medication. He considered himself as having mild OCD which explained why he did certain things so carefully - fold his sleeves, etc. I had the sense that he did not experience significant distress or anxiety at all, though he was empathetic and could still grasp my own quite extreme states. It was an equanimity I desperately wanted myself!

As a result it was fairly shocking to hear a T to mention his own inner pain, and I was concerned that bringing up his own history could introduce some kind of enmeshment. It did seem as though the issue he raised - about his mother's NPD and its affect on him had been resolved. However, his depleted frame and various other things mentioned (like his having vivid dreams with lots of 'material') still seems to indicate problems? Perhaps these would not make him any less good a therapist...

My marriage counselor has talked about the fact that he has an anxiety disorder, which made me feel more able to trust him, since I do, too. He's talked sort of vaguely about some issues with his father, but nothing too specific. And he's talked about his children dealing with anxiety. Along with many other anecdotes from his life, but those were probably the most relevant to what you're asking about, in terms of what he told us.

My T shares little about herself, and I recently said I just assumed she'd had this perfect life and was totally pulled together. She just laughed and said her husband would be amused to hear that. It took me longer to trust her, so I think MC's self-disclosure helped me. Though it also contributed to the strong (mostly paternal) transference I have for him, so there's that, too...

Thanks LonesomeTonight, there is clearly much more variation on how much Ts are willing to disclose than I had thought. I guess that is quite reassuring as it seemed so strange at the time.

I've had ts share quite a lot of personal information. Often it has been something that directly relates to what we are talking about. As an example, t1 shared that his son had done prison time during a time when I was facing that my brother might be imprisoned. T1 definitely doesn't share that with everybody, but it was helpful in that context. T2 shared some stuff about her marriage that was pertinent to what we were discussing. I think that kind of disclosure is helpful.

On the other hand, t1 shared that he found a snake in the basement of a house he is rehabbing. And that there was actually a nest of them in the drain. I could have lived without knowing that. I don't think there was any context to that.

No!!!! That's terrifying. I am phobic - would not have dealt well!

A little self-disclosure on my part: what you've told about your t's self-disclosure reminded me how my last t behaved. Sounds very similar. For a long time nothing "unconventional" was happening except his regular self-disclosure that was rather excessive and unnecessary. But at the time it felt great and I felt it was very helpful to me because it created a more equal, egalitarian relationship by comparison with my previous therapists. As time went by, it was becoming more and more "unconventional" in the way that feelings started getting expressed on my and his part, and, while such expressions on my part, as a patient, were normal, on his part, as a professional, they were certainly inappropriate to say the least. At the time, again, not only I didn't think that there was nothing wrong with it but I thought it was amazing that my t was so unconventional and was treating me as equal because that's what I needed from previous ts and never got. Unfortunately, the "unconventional" strategy went too far. There were serious boundary violations and, to make long story short, the therapist was eventually disciplined by the board and rightfully so.

As a client, I was caught up in transference, attachment and dependency and was in no position to make a sound judgment for a long time. He, as a therapist, was supposed to make professional judgments about how his words and actions were affecting me.

The word "equal" can be understood differently depending on the context. In the context of therapy, treating client as equal means respecting their adult self despite the fact that they may often show their vulnerable child self due to traumatic history and the nature of therapy work. It means that therapist intentionally interacts with client's adult self no matter how much client may regress and how much their child self may show. This is how I understand treating client as equal - it is simply dealing with their adult part while trying to understand and explain their child part. That's how therapist shows respect to client and treats them as equal. Treating client as equal doesn't mean that therapist forgets about their professional responsibilities and gives in to the temptation to share more than it's necessary for client's benefit.

Generally speaking, self-disclosure may be helpful when therapist feels it could illustrate his or her point. Beyond that it has no therapeutic value. For therapeutic purposes, self-disclosure doesn't have to get specific and elaborate, but this is what I think happened in your therapy. So, while I can't say at this point that your t's self-disclosure was unethical as opposed to being just an "unconventional" method, to me it is certainly a slippery slope and a warning sign for you to watch out. On top of that, your t sounds like quite an emotional mess to do the work at this time due to his current circumstances and may be other unresolved issues. He sounds very traumatized and it doesn't seem like he is getting help with that. Dealing with such stress and being in the state of what looks like mental and physical exhaustion, it's his professional responsibility to you AND to himself to stop working at this time and not to return to work until he pulls himself together and regains his emotional balance. But he is not doing it and this is my concern. He hasn't done anything outright unethical yet, but I am not confident that his emotional state is stable enough to continue to maintain healthy boundaries. There has been statistics collected on what type of therapists tend to violate professional boundaries more often and the overwhelming majority were therapists who were under a lot of stress at the time the violations took place.

I am sorry if this comment doesn't make you feel good but I had to be honest. Feel free to PM me if you have questions. I visit this board randomly now so I don't know when I'll come next time.

Thank you so much. I think I did remember something of what you said of boundary violations sometimes being less obvious than one might think and this may be what has concerned me... I have PM'd you!

Ididitmyway expressed my thoughts on this beautifully. I would personally run in the opposite direction if a therapist told me such things. Maybe not unethical, but I would consider it highly unprofessional and unnecessary. For me, it would not have the effect of feeling like an equal because professionalism is important to me. I do like when a therapist shares things about himself and his experiences as they relate to mine, but for me this would feel excessive, self absorbed and yes, a bit narcissistic in an "untreated" way. I had a T who puts a lot of his vulnerabilities on the internet for everyone to see and it was quite appealing to me at first, I did buy into what he called authenticity about himself (which was a red flag on it's own). As a therapist, he turned out excessively self-centered and self-referential and while the negative transference reactions I had to him were interesting and enlightening, he was not very helpful and actually made my issues worse and therapy a mess. He was also constantly projecting his stuff upon me that did not achieve an effect of familiarity and feeling close at all, quite the opposite. He was very insecure and for me that is not attractive in a professional, ethical or not.

Thanks Xynesthesia. It does make it feel more equal to me because when someone knows extremely personal things about me, and about what makes me tick, and I only know some superficial things about them, it feels (for me) like there is a vast power differential. I tend to assume the other person is really well-adjusted and normal, etc etc. It's easy for me then to idealize them.

That being said - there have been some other things which have concerned me - like there have been times we have had a WhatsApp conversation late at night, usually beginning in response to something I had watsapped. But his responses are not of the kind other therapists have given me. Previous therapists would communicate just enough to get me through the crisis and tide me over. He puts a lot of thoughts into his responses and they end up generating quite abstract conversations. At some point he will say that the issue needs to be talked about in person, as too easy to misunderstand each other but only after quite some time.

Obviously I like the longer conversations and the fact he is putting so much thought in, etc. On the other hand it makes me feel uneasy - like what is happening here...

I do get how someone interactive generates that sense of equality and closeness. Probably his obvious difficulties also make it feel more real than someone very self-controlled would... My last therapist was very interactive in session and I loved it, but it was carefully managed and kept mostly for the meetings. He let me message him as much as I wanted and usually addressed the important bits of my emails in session, but was quite minimalistic with between-sessions interactions and that ended up one of the most helpful elements of my therapy (I had an issue with obsessive virtual interactions).

I would ask myself, is it helpful the way he approaches it beyond it's being pleasant? When therapists are overly open about themselves and unnecessarily responsive, it makes me feel I am paying to talk with a friend... and the therapy aspect loses its efficacy without the structure. I personally never saw my therapists as authority figures and I do want to work with someone who feels like an equal, but at the same time I want them to represent health, certain standards and improvement even if what goes on in reality for them is different.

When you mentioned that he self identifies with narcissism, it really reminded me of my first T, who did the same and even used a modality that is built around narcissistic disturbances, called "modern psychoanalysis". Narcissism includes having issues with managing boundaries in appropriate ways. My ex-T's approach actually calls this building a "narcissistic transference" with the client on purpose, to create a sense of familiarity and unity, which will then be used for therapeutic purposes. I get that, but I think my T mostly used it for self gratification. And later when I started seeing through it, he became extremely defensive, authoritarian, angry and very messy with everything, blaming me etc. He was very unstable and I often felt our roles were switched towards the end as my therapy became more about his projections than mine. I hope yours will not take that direction but it's good to be cautious as you are. It sounds like your instincts are telling you something potentially important.

This is a tough one as you've said he 'got you' more than any other ones i the past. I think it's good he is upfront about his health problems as long as he doesn't go into detail. He probably picked up on your sensitivity and wants you to know that his related behaviors have nothing to do with you. Or to show you that he isn't his 'normal' self right now because of health issues as opposed to disappointing you in the future. Allowing you to adjust your expectations accordingly.

Can you ask him if he's been in therapy--what type and for how long? There is a school of thought that considers anyone who had a really narcissistic mother to have an impaired sense of self. I tend to agree with that, and so from that perspective, he's no different than the other zillion therapists who had that issue but who didn't disclose it. The main difference would be--did he have years of his own therapy? Even so, I don't think these issues are ever fully resolved in a sense, but what's important is that he has had his own depth therapy, does self-analysis and has insight, and sees you as a separate person. I think a lot of therapists have this issue and just don't say it. I'd run if I knew the therapist did not do his own depth therapy. Other than that...

It does seem a bit extreme to get into the mechanics of therapy like that. My thoughts are to watch this and assess his patterns as well as your comfort levels. Maybe he just wanted to identify with you to let you know he has experience working with such issues. Xynesthesia mentioned the type of therapy that promotes the twinship...I've never done that type of therapy, but if that is what he is doing, I don't think it works this way. I'm not totally sure, but I think it's supposed to be identifying with the client, not the other way around. Also, what he's doing might prevent an idealizing transference, as he's showing you his weaknesses. I never heard of therapists getting in the way of that. If he is doing that type of psychoanalytic therapy, he'd go with your transference whether it be idealizing or twinship, rather than shape the transference himself. Hmm.

I would not be ok with someone who did this all the time. I do think the health problems are a different thing altogether, and disclosure surrounding that can be important. Do you see him doing this often, or is it too soon to tell? I think it would be generally acceptable if he only disclosed about himself from time to time, maybe once in a blue moon. It's not clear from this thread if this is something he'd be doing regularly or not, as disclosing once in a while does not in itself indicate an unconventional or a bad therapist.

Of course what's acceptable to you is what's important. I'd keep an eye on it and see how it goes. If they are just rare instances, it might give you material to work on (eg why it feels so unsettling-do you need him to be strong? etc).

Just being open-minded here because you said he was really helpful. I once had a therapist who talked too much-every other session, he'd tell me stories in his life or about others in response to my disclosures. After a few months, I told him I didn't find it helpful and wished he wouldn't do it. He graciously evaluated my feedback, quit the behavior, and ended up being an extremely helpful therapist. We did a lot of good work together and I am really glad I stayed with him.

My current therapist is the opposite, doesn't disclose his emotional issues at all (except for one time, he told me people might say he has an 'angry edge'). With him, I did (and still do) a lot of projecting--seeing him as my mother. And I've gotten a lot from this therapy, including things that didn't surface in my last therapy because of a therapist's disclosures. This way of working has gotten dangerous in the past, where I have had near-psychotic episodes due to re-experiencing trauma of an 'empty' mother and other things i won't go into detail about. It makes therapy so much more difficult because it allows a huge amount of space; it makes transference more powerful, especially the level of idealization. So there are other reasons to disclose from time to time--to make therapy more tolerable. In my case, I got the best of both worlds with two long-term therapists who worked in quite opposite ways. I find ways to benefit from the qualities of therapists I like, and both have been very helpful and rewarding despite being so different.

Anyway, I suggest to give it some time. And tell him your concerns. And find out the details about his personal experience in therapy. I didn't read all the responses, so I apologize if I'm being repetitive in terms of other responses. Hope things go well for you.

Thanks Xynesthesia and Skies! And no repetition, Skies, despite you not reading all responses

He does fairly often talk of theorists - in our first session it was Kohut, but since, Alice Miller, Andreas Salome, Lacan and others. It seems as though I speak and he applies insights from this array of theorists. In abstract this doesn't sound very helpful, but actually the points he brings up are often incisive and revealing. Of the theorists mentioned the only one I don't find unbearably abstruse (when reading myself) is Alice Miller. I can't read the others at all, as textual opacity drives me up the wall.

I appreciate that he doesn't seem to be following some strategy unbeknownst to me.

The therapist I saw before specialized in CBT but I saw him for many years so he certainly wasn't following some limited paradigm of it. In contrast he had a very common sense approach and he certainly didn't see EVERY detail of my memories or experience as psychologically significant. In many ways this was reassuring and helpful. In contrast, every detail now leads into a labyrinthine complex.

"... Every detail now leads into a labyrinthine complex." This struck a chord for me. Could it be that he's getting his own needs met here rather than yours...? His own need to see an "interesting" client? His own need to share his vast knowledge with someone who can understand and appreciate it?

Discussing theorists in a limited way can be helpful to the client if it reassures the client that the therapy is not just blundering along. Or if the therapist suggests the client read a particular book or theorist to further the therapy, I see nothing particularly wrong with that.

But getting "into the weeds" about numerous theorists the way he is seems...questionable. Perhaps it's more about his own intellectual stimulation than about meeting your needs.

That probably explains at least some of it as Kohut is the king of self-psychology.

What Xynesthesia said about modality seems to fit. I have no experience working with therapists who use that approach, just was surprised because it doesn't match my understanding of that approach.

I know what you mean--the writing is really thick. It can be mentally taxing.

I think a critical problem is that the asymmetry does not feel safe or natural for a lot of people, so when a therapist does disclose, it has a normalizing effect and this brings relief. But of course a therapist can't scratch their nose without first running it through some convoluted filter. And what pops out is usually based on absurd theories and techniques that wouldn't hold up to even the slightest scrutiny.

Even a genuine revelation given in the flow of conversation can become a "problem". OMG, he mentioned something personal, what a monster! I personally do not enjoy having a relationship with a secretive voyeur.

I found it exhausting trying to unpack therapist behavior as you are having to do Snowqueen. It was like breaking down a pile of rocks in a prison camp. Mostly served no purpose, but to perpetuate the process itself. And the more I looked at it the less coherent and intelligible it became.

Budfox - I saw a therapist for 8 years and I didn't feel like I needed to unpack anything so I don't think this is the norm. I did have a lot of anxiety regarding what that T really felt about me - and that is exactly what will happen for me in a therapeutic relationship in which there is no disclosure from T. Kind of a lose-lose situation...

Hmm, a large percentage of the threads on this forum have to do with rumination on questions like: does my therapist really care, what are they thinking, what did this response mean, who are they really, etc. And then there's the ubiquitous googling.

I meant unpack as in trying to figure the therapist out, whether in the case of limited and possibly cryptic disclosure, or no disclosure and the resulting anxiety, rumination, fixation this can generate.

Yes, I guess this is the issue of a) non-disclosure and b) people seeking therapy often have trauma and attachment issues.

and c) the relationship is contrived and convoluted and highly ambiguous.

Yeah - I would say that a) is part of c) though. The non-disclosure element is a large part of what separates if from more 'natural' relationships; and it certainly causes ambiguity!