Advocating for Yourself in Therapy

Column by Amy Marschall, Psy.D.

Going to therapy can be intimidating and confusing. Even though your therapist is there to help you, they are in a position of authority. Every licensed therapist is required to follow an ethics code that includes requirements for competency, education, and practice.

It is always my goal to provide quality care for each of my clients, but what happens if your therapist does something that harms you? How do you know if a therapist’s behavior is unethical, and what are your options as a client?

I called a therapist, and they would not treat me.

As much as I wish I could help everyone, there are a finite number of hours in each day. The COVID-19 pandemic has increased the need for mental health services, and many therapists have full caseloads. One of our ethical obligations as therapists is to care for our own needs and not drive ourselves to the point of burnout, which means we have to stop taking new clients when we are full.

There are also times when I get a referral that I do not have the competency to treat. For example, I do not have the training to complete custody evaluations, so if someone calls to request one of these, I cannot provide the service they are asking for. In that case, it would be unethical for me to take the case.

Mental health professionals can opt not to take a referral, but we have an obligation to give you referral information to someone who would be able to help you. If you call a therapist and they cannot see you, ask them for referral information.

My therapist approached me in public and identified me as their client.

Although the Health Insurance Portability and Accountability Act (HIPAA) does not prevent colleges or businesses from asking about things like your vaccination status, your therapist has the obligation to protect your healthcare information, including the fact that you are their client. You have the right to share information about your therapy with whomever you choose, but your therapist is required to keep this information confidential.

Since I work primarily with children, I occasionally have a client approach me in public to say hello. I let them know that this is fine, but I cannot approach them first. I let clients know in my office, “If I see you out in the world, I will treat you like someone I do not know unless you indicate that you know me.”

If your therapist approaches you and identifies you as their client, this is a breach of your confidentiality and an ethical violation.

My therapist invited me to spend time with them socially.

Although your therapist cares about you, a therapeutic relationship is not a friendship. Healthy boundaries are essential for both you and your therapist, and because of that, we therapists have to avoid what is known as dual relationships. A dual relationship refers to when a therapist has a secondary relationship to a client outside of therapy.

There are times when a dual relationship is not avoidable. For example, I completed my predoctoral internship in a small town, and the private practice where I worked was the only psychologist for about fifty miles. My supervisor often got referrals from people who shared teachers with his children, went to his church, or had another connection to his family. There were times when the dual relationship made it impossible for him to have an appropriate professional relationship, and he had to refer to another provider. When it is not reasonable to refer someone out, a dual relationship that does not harm the client can be permitted.

Even in cases when a dual relationship is unavoidable, therapists still have to maintain appropriate boundaries. It is generally unethical for a therapist to try to spend time with you socially, and it is never appropriate for a therapist to express romantic or sexual interest in you.

My therapist committed a microaggression against me.

As a therapist, I have an ethical obligation to be culturally competent for my clients and to have the training and expertise to help the populations I work with. Therapy is meant to be a space where you can feel safe and be yourself, and you should not have to worry about your therapist’s cultural competency. It is completely unacceptable for a therapist to commit a microaggression.

Okay, I think my therapist committed an ethical violation. What can I do?

Sometimes, a client will disclose an interaction with a previous therapist that sounds unethical or inappropriate. Because of HIPAA and confidentiality laws, I cannot report what happened unless the incident involves abuse of a child or vulnerable adult, but I can make them aware of their options.

All licensed therapists have a board that oversees their license. Different types of therapists have different licenses (psychologist, licensed professional counselor, licensed clinical social worker, et cetera), and each state has its own board. Your therapist should have their licensing information in their office and on their website, and you can usually do an internet search for someone’s credentials. The board will have information on their website about how to file a complaint.

What happens after I file a complaint?

Licensing boards take complaints seriously and are supposed to investigate all claims. Unfortunately, sometimes the results of these investigations are kept private if the complaint does not lead to the therapist’s license getting revoked. For example, if a therapist is required to take additional education to improve their competency, it will look on the outside like nothing happened. In addition, boards keep records, so if one complaint does not lead to disciplinary action but then more clients come forward, the board will act based on that pattern.

Like any profession, there are therapists who are not good at their jobs. Even good therapists can make mistakes. If you had a bad experience, I hope that you can find a therapist who can meet your needs and provide the help and care that you deserve. If you feel comfortable, you have the right to have your voice heard about your experience.

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