Ethics of Therapists who Are Mentally Ill

Hi lil bit,
I think you just said the same thing I said earlier.

And who in this world has a "clean mental state?" I don't know ANYONE who meets that definition!

Okie

Well, I know many who have a clean mental state.

What is Severe mental illness? What is a mental illness that someone is automatically competent to treat patients while coping? Is cutting oneself, a coping mechanism, allowable? What are they coping with? While depression is a medical illness, and can be caused by medical issues, it's still depression. It still affects people the same ways, whether they are homeless or a PsyD. It still skews thinking, and hope. Someone mentioned Freud; his depression greatly affected his work.

As I said, it used to be for psychologists to be licensed they had to be free of mental defect for the 5 years previous to their application to the APA. If it was possible then, why not now?

IDK I've continued on this too long I think. But I know I wouldn't want to be in therapy week in and week out with someone who didn't have their own mental health in order. That just isn't right. There are other helping professions that don't require the accurate thought processes in an emergency and that don't cause the situations that the mentally ill person would mold into stress and act out from, and that don't have other people's lives at stake.... guess that makes me biased.

I know many that have a clean mental slate or HAVE WORKED to get a "healthly mental slate."

Many years ago, I was severely ED. One of the first things I asked my soon-to-be therapist, was "Do you currently have unresolved issues surrounding food?" Why? Because the power that behaviors and symptoms like this have over one's life are very strong and no way in hell was I going to put my needs for help in the hands of someone who was out of control and not healthy. I needed healthy modeling and someone who had a healthy relationship with food to work with me.

Notice I did not ask about her entire life. I asked about her current behavior while she was working as a therapist treating people with ED.

The power T's have over our lives is amazing. Look at the posts about how people love their T's, worship their T's, etc. We do not say this about other medical personnsel, but yet, they are held to higher standards of care when it comes to patients.

I have a yearly drug test and if I fail it, I lose my job immediately. Irregardless of how many children I have helped or worked with. There is a No tolerance policy. There are also random tests....Why? Because if I were an addict, I could be affecting the kids I work with, perhaps not all of them, but lets say my mood sucks one day and I am less tolerant than normal, guess what, I probably negatively impact one of the kids.

T's that work in private practice have nothing like this. So, you could have a current addict working. Is that healthy? How honest is that in the therapeutic realtionship? It is a lie. The T is not healthy.

T's have such an incredible impact on lives of people ~ and when one is not healthy, it is somehow going to impact the relationship.

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_Sky said:
Part of the problem on this, I think, is that other therapists enable the unfit therapist to continue working.

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I agree with this statement. As a professional T's should understand that it is their responsibility to maintain and enforce the standards of practice. If a T become aware that a colleague is in violation of those standards, he/she has a duty to act. I would hope that if a T sees a patient that has been harmed by the unethical practice of another T, that he/she would feel compelled report the misconduct.Too often people want to be paid like a professional but not take on all the responsibilities that come with the title.

As a patient I now feel as though I trust my T and value her insight. However, I have not and never plan to surrender control of my life to her. Patient's need to see their T's as being simply human and therefore susceptible to all the things everyone else is (i.e. greed, jealously, power, lust).

I like earthmama's post.. I also don't know about my T's personal life. I am sure she has her own struggles and does not walk on water. However when I am in her office, she is doing her best to help me.

the trouble with is the behaviour of the T... not the issue they struggle with. A T who is seeking to control their issues, seeking help.. why can't they model that?

just how or why a client would know a T was puking in the bathroom?

why a T would disclose their own struggles... how, how much, why... The oncologist who gets lung cancer because they were unknowingly exposed to asbestos? It doesn't seem to be the illness but the behaviour you object to.. yes?

a T who is a good T can still be a good T, because as such they know when they cannot perform their job... and they, as a population, are subject to the same chances as the rest of us of becoming ill - from anything, including mental illness.. they don't have immunity. A friend of mine out west has been hospitalized just about once a year on average due to bipolar I.. but she has been a practicing PhD psychologist for years.. and a decent one from what i know of her.

a T who has battled an ED may have a special understanding of the struggle than a T who is 100% healthy... speaking of which, where is the cut-off point? And who decides? i mean.. how much disorder or defect or bad judegment would be ok? How little? who exactly IS 100% healthy 100% of the time?

how do you divide these things?

some people think my T expressing frustration is terrible... unethical maybe.. but i dont worry one fig.. what we have works so very well, and yes, even in my times of struggle and doubt. How do i know or not know that his frustration isn't the result of a gambling addiction or something else? Maybe he does puke in the bathroom between sessions.. it can make a person stressed or grumpy. It isn't any different than anyone else i run into, one never knows who is dealing with what.

i would say a T is a fraud if they pass on fake caring... or actively lie with the intent to mislead or cause damage.. or with disregard for damage. And honestly, such a T would cause pain and suffering regardless of their mental health status.

It is interesting that this thread comes up after I posted a couple threads about being a therapist, but not taking care of myself so well.

I find it very narrow minded that one would think that a therapist who is battling a personality disorder (a lifelong condition) or self-harm cannot completely dedicate him/herself to patients during the appropriate times.

I have been very actively dealing with a mental ilness while giving therapy. I give myself completely to my patients. I have been nothing but commended by both my supervisors and my own thearpist as to my competence as a therapist.

You ask how a therapist can serve as a model for self-care if he/she cannot do it on their own? Well, as a therapist I know that I am not a model. Likewise, I don't look at my therapist to "model" self care skills. I look for deep empathy and understanding. I look for someone who is not afraid to allow me to express myself and bring all parts of myself, no matter how raw, into that room-- and accept me for all that I am. I offer the same to my patients. My goal is much deeper than that of "modeling." In addition, I am not presenting or talking about my symptoms to my patients-- so my practices (or lack) of self care would not come into play, nor is it their business.

This is not a black and white issue.

Also, as far as PC being intellectual vs. supportive-- We can't always be all touchy/feeling huggy supportive. I find that unrealisitc. Sometimes you just have to be real and say what you have to say without being rude. We are intelligent people. I would hope that we can handle more than just hugs and "it will be okay."

I wouldn't give up what I have gone through or what I am going through for anything. I can say that I would like to work on a lot of symptoms, not because it is screwing me over as as a therapist, but because I would not want them to interfere with my ability to be exactly where I am supposed to be. The way that I am makes me stand out as a clinician. My honesty helped me get into doctoral school. I do not harm patients because I struggle with my own illness. I am sorry that you generalize and find it "frightening."

My therapist admitted a great deal of countertransferece to me because he stated that he has such great confidence and pride in me as a therapist. He reminded me that despite my illness, that would NEVER take away from the fact that I am a good clinican and it is what I was meant to do.

To all of the doctors, therapists, psychiatrists, therapists, whatevers, out there who are battling illnesses-- I will never take away from the true goodness of what you do. Will it interrupt sometimes for some people? Sure. Just be careful to know what you can handle. Do your patients all the good in the world. If it gets too much, then take some time for yourself.

I think part of this issue is whether the clinician is self-aware or not about their functioning and how it might affect clients. It's one thing to have a mental illness, to be actively working to cope with and improve the problems associated with it, and another to be in denial or just plain ignorant about one's problems. I had a supervisor who was beginning to have some memory problems. Fortunately, he no longer saw clients, but still, it was a problem for me and for my clients when he didn't remember important, serious conversations we'd had about a client and what we decided, and then would chastise me for doing what we had agreed was the proper course of action. He didn't even remember the conversation after reading the note for that session or when I talked to him about it again and tried to refresh his memory. Should this man continue to have an effect on clients via his interactions with and authority over trainees? I tell you what, it scared me enough that I let the person at my school who was in charge of fieldwork placements about it.

And from my own experience as someone with a mental disorder or two, just as my depression and ADHD symptoms are better at times and worse at times in everyday life, so it also was when I was at a placement. It was up to me to monitor how I was doing, pay attention to cues from supervision and from my clients, and ask myself if I doing okay. Perhaps I took more days off over the course of a year than someone without chronic mental (or physical) disorders did, but it was always for a very good reason and in order to stay as well as I can.

At any rate, a therapist with self-awareness, good resources for support and assistance, and I'd say a strong enough ego to be able to question their actions and thinking honestly and critically without damaging their self-esteem.

Oh, and for the love of Dog, it's not a PhD/PsyD issue.

gg

I have to say I am sick of seeing the T bashing threads that come up from time to time.

Have you any idea what a T has to go through in order to practice?

At least 6 years of studying and training for a start! During that time the T learns how to manage stress effectively so that they can truly help patients/clients.

All T's within the British Psychological Society have to adhere to a strict code of conduct, rules, regulations and ethics. That includes being fit to practice and maintaining good health and self-care. I would think that the APA has a similar system.

All T's are police checked,have medicals and HAVE to have regular supervision to make sure they are dealing with any issues that come up, not only that but all T's have to do huge amounts of CPD, continuous training and continuous reflection.

If you have a worry about your own therapist, I suggest you report them.

Pink - Right the F on!

s

I just started reading this thread and find it very interesting. Many well-thought-out posts, I think. I have had issues with my T and have posted here about it before. I hope that is not found to be simple T-bashing. I also like to post ideas here and do not like the feeling that only "support" is appropriate to Psych Central.

I like self-awareness. I think maybe that is because I suffered as a child from its virtual absence in my mother. Self-awareness does not mean to me that one is without blemish. (Is that possible?) It does mean one is as much as possible aware of what may be going on.

"I like self awareness. I think maybe that is because I suffered as a child from its virtual absense in my mother"
(for me)

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MzJelloFluff said:
the trouble with is the behaviour of the T... It doesn't seem to be the illness but the behaviour you object to.. yes?


i would say a T is a fraud if they pass on fake caring... or actively lie with the intent to mislead or cause damage.. or with disregard for damage. And honestly, such a T would cause pain and suffering regardless of their mental health status.

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Yes, but the behaviors are a sign of an illness that is not controlled. I do not have a problem with illness that is controlled or has been dealt with, I have a problem with behaviors that are indicative of an illness that is not controlled.

IMO, a T who is actively engaging in behavior that is harmful or self-destructive is lying to themselves and clients. I feel the same for my collegues who smoke and treat lung cancer. They are lying.

Many people that T's see have low opinions about themselves, are self-harming and self-hating, and look to the T for an example of self care and improvement in the self. The relationship between a T having a current ED and and ED client would be a lie because the T can't even use their knowledge and skills to help his/herself. The T is presenting a false front.

I'm working on my PsyD. I'll get you later for saying Phd>PsyD. :P

Health Care workers are a very interesting field of people. I hope that one day I'm able to fill the role of therapist for therapists! In the subsection of psychology it becomes even more interesting.

You have a therapist with an eating disorder; counseling you on an eating disorder. It would make sense that if they know so much about eating disorders they could clearly see they are also suffering.

But, even with years of education in psychology they are still unable to do recognize their own symptoms. My point is they may have to go through the same process to realize their illness.

I don't really know who should decide if the person gets to counsel or not. Mental illness is a very broad category. It seems like a very slippery slope to have other mental health professionals disqualifying their colleagues from practicing.

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pinksoil said:
It is interesting that this thread comes up after I posted a couple threads about being a therapist, but not taking care of myself so well.

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Pink, many of your posts in the past couple of months have been about you not being able to take care of yourself, hence this is not directed at you.</font>

I find it very narrow minded that one would think that a therapist who is battling a personality disorder (a lifelong condition) or self-harm cannot completely dedicate him/herself to patients during the appropriate times.

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I never said that they could not dedicate themselves to their clients. I said is it ethical? Clients come to therapists looking for help in many areas, but most are dealing with low self-esteem, dislike of the self, and perhaps self-abuse. It does not matter if a T can actively work with a client, the point is, a T who has not dealt or controlled their issues is presenting a false front to those clients. If a T can not take care of themselves correctly, is it not ridiculous to think that they should be helping others try and battle their demons. I again go back to the obese physician telling patients to lose weight.

Self-harm is extremely serious in any form and it is clearly a symptom of out-of-control mental illness. I am not at all saying that T's should not have their problems, because we all do. But when a T engages in behaviors that are dangerous, harmful, and self-hating, how can that T tell a client not to do it? It's a falsehood and a lie in the relationship.

And yes, personality disorder are life-long battles, but therapy can make them a whole lot more controlled. Take BPD for instance. It is estimated that within 2-5 years of therapy, a borderline can be "cured," of most of the negative behaviors.
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You ask how a therapist can serve as a model for self-care if he/she cannot do it on their own? Well, as a therapist I know that I am not a model. Likewise, I don't look at my therapist to "model" self care skills. I look for deep empathy and understanding. I look for someone who is not afraid to allow me to express myself and bring all parts of myself, no matter how raw, into that room-- and accept me for all that I am. I offer the same to my patients. My goal is much deeper than that of "modeling."

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A T is a model to a patient. A model of behavior and a model of self-acceptance. Read any textbook and it talks about modeling. Especially if you are dealing with people who come from abusive or backgrounds where life was difficult. Clients like this may not have had self-care EVER modelled to them by their families. T's model behavior, boundaries and self-care all the time.
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To all of the doctors, therapists, psychiatrists, therapists, whatevers, out there who are battling illnesses-- I will never take away from the true goodness of what you do. Will it interrupt sometimes for some people? Sure. Just be careful to know what you can handle. Do your patients all the good in the world. If it gets too much, then take some time for yourself.
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You just said it. Will it interrupt sometimes for some people. Sure.
That's the point. How much interruption will you allow?</font>

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pegasus said:

I have to say I am sick of seeing the T bashing threads that come up from time to time.

<font color="blue"> Ah, this is DEFINITELY not a T bashing thread. There are more T bashing threads here everyday ie "My T is a *****," "My T did not give me what I wanted." etc.
This is a thread about ethics and perhaps what clients deserve.
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Have you any idea what a T has to go through in order to practice?

At least 6 years of studying and training for a start! During that time the T learns how to manage stress effectively so that they can truly help patients/clients.

<font color="blue"> Are you asking me? I am very well aware of what a PhD T goes through. Lower levels, I am not really sure as my interest is not so much there. But, all the training in the world DOES NOT remove the importance of T's having therapy to deal with their own issues so they can practice ethically."
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All T's are police checked,have medicals and HAVE to have regular supervision to make sure they are dealing with any issues that come up, not only that but all T's have to do huge amounts of CPD, continuous training and continuous reflection.

<font color="blue"> Not all T's have supervision. Students, early-career T's have supervision. Perhaps older T's if they are good still meet with supervision groups, etc. In private practice, they are not continusouly checked. After a couple of years, a T could open a practice and do whatever they want. The APA has guidelines, but they are NOT an enforcement organization. So, you could definitely have T's with their own major issues affecting the health and well-being of their clients.</font>

If you have a worry about your own therapist, I suggest you report them.

<font color="blue"> I don't. T has had therapy. T does not have the issue I need assistance with. And T is extremely educated and continues to belong to groups to discuss clients, even though T has been practicing for 20 years. </font>

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gardenergirl said:

Oh, and for the love of Dog, it's not a PhD/PsyD issue.

gg

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Well, perhaps it could be. See, and again THIS IS NOT A BASH, but a factual point.

As I pointed out in another thread, the PsyD degree is a secondary degree to the clinical PhD. The training is less and PsyD's tend to match at lower percentages and into lower level internship positions.
(Please review the APPIC reports for data)

Lower-level internships = lower level supervision, less opportunity for diversity, etc. And those that do not match to APA approved internships work in internships that are NOT governed by any standards that the APA sets for training.

So, you may have less training in PsyDs and lower quality.

But, the major issue I see is one whether a T has enough ethics to work on his/her issues before working with clients. And that those issues are well-controlled.
Unfortunately, most programs today require VERY LITTLE personal therapy, so it is up to the T to do what is right. Some don't, some do.

First of all I need to point this out to you, this is not a debating forum. It is a support forum.

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This is, first and foremost, a self-help support community. That means if your message (post or PM) isn't about offering support to another person or asking for it, it's potentially not appropriate for our community. Written by DocJohn, community guidelines.

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Secondly, I can assure you that in The British Psychological Society, ALL clinical psychologists receive supervision/personal therapy on a regular basis. It is part of the code of ethics!

I don't see it as a therapist bashing idea.

I see it as an acknowledgment of the power a therapist has over their clients or patients. And the ability of patients to "see" a therapist far more than therapists perhaps realize or acknowledge to themselves.

My therapist's normal everyday nonpathological moods and experiences influence me as a client. If he's angry or upset, I know it, and I tend to think it has to do with me. If he's happy I know it. It's not a question of boundaries. It's that he can either be emotionally present and therefore visible to a perceptive and intuitive client, or he can be emotionally unavailable. I don't want the latter.

I think a therapist who has overcome severe mood instability, and cutting, and eating disorders, and just about anything there is, can be an excellent therapist. Maybe even better than one who hasn't. Since my therapist is totally unable to understand cutting, and why someone might do it, I think I'd like someone to be able to look at me and tell me they understand why I do it, and that there are better choices out there, and that they can help me find them. If I then found out that my therapist hadn't yet found them, it would seriously undermine my desire to try.

My therapist and who he is are so monumentally important to me that I don't see how I could be unaffected if he were currently undergoing severe mood instability, canceling sessions, or being emotionally unavailable.

I don't think my thinking this is being disrespectful of therapists at all. It's being respectful of the enormous power they have over clients. And it's being respectful of the perceptiveness and intuitiveness of clients. It's taking the profession seriously enough to expect that there are standards and that they should be met. In all professions, there are standards. In therapy, as in no other profession, the therapist's own being is part of the performance of the job.

I don't think degree should matter at all. Therapists have the same power over clients no matter what their degree.

Or at least these are my thoughts, based on my own experiences. I am aware that there are clients who don't vibrate like a tuning fork to their therapist's internal moods.

I agree with Dinah, I didnt see anything unsupportive of damaging said in Riptides original post. I would have no problem with a therapist having had issues but I certainly cannot see how one still struggling with those issues is doing her/himself justice nor the client. I had a therapist that had not worked through her issues completely and unconsiously was setting me up to caretake her. It wasn't healthy for me or her. I wish all those that enter that career well, but I also believe the client deserves the best someone can give them. For to long a lot of clients have had to play the role to a wounded other, please dont let the theraputic relationship become an extention of that.

ok, then, I'll tell you this... I'm a raging maniac, a loonatic with no self-confidence at all but somehow I fooled everyone and I'm now a clinical psychologist trying to make everyone as evil as I am! Yes, I have to have therapy once a week because I'm soooooooo ill. I fooled the doctors and the police and my employers by never taking a day off, but if you look carefully you'll see my fangs covered in blood. I'm so uneducated that I have to study until 2am every night but that's just one of the requirements of being a clinical psychologist, so that's ok!

I don't think you are going to find any "perfect" therapists out there, Rip. Illnesses are illnesses and aren't always "cureable". Therapists can model behavior for a client but that's not their #1 job and many types of therapist don't disclose any/much about themselves so there's no way to know what their issues may be so they can't very well model anything at all. They are supposed to be there with us as we grapple with our problems, a human interaction, someone who cares and wants healing for us. Therapy is for us, not the therapist, presumably they go to their own therapist if they have problems.

Last time I checked, this was a support community, not a place to judge others or engage in ethics debates about what makes a good therapist or bad one.

And before you get on your soapbox to criticize a therapist based upon their *degree* from heaven's sakes, you might want to look at the outcome research literature on whether it makes a difference in the real world based upon real client outcomes.

Please take a note of this for future postings. This is *not* the place to debate professional ethics and such. You might find the SDN forums a better place for such discussions.

John