Five wrong things therapists say about law & ethics

I am part of several online groups for psychotherapists, on Facebook and elsewhere. We talk about ethics, about theories, and sometimes about cases (without identifying details, of course, to protect confidentiality). Most of the time, when people say something that isn’t right, the collective wisdom of the group corrects the error. That’s one of many positives of social media: It allows professionals all over the world to share information and hold each other to high standards of knowledge and behavior.

Sometimes, though, a myth or misstatement is so common that the collective doesn’t effectively stop it. Here are the five misstatements about legal and ethical issues that I see most often from therapists.

Usual caveat, of course: I’m not a lawyer. This isn’t legal advice and shouldn’t be read as a substitute for a legal or ethical consultation. But, that said, each of these is demonstrably false (except #5, which is only sometimes false).

1. “There are four (or five) exceptions to confidentiality.”

Many of the therapists I know have a statement like this in their treatment contract. They usually cite the major exceptions to confidentiality: Child, elder, or dependent adult abuse; threat to self; threat to others; and legal authorization, such as a release of information (signed by the client) or a court order. Sometimes the abuse exception is split into two exceptions (child and elder/dependent adult), hence the “or five” above.

What most clients are not made aware of is that there are actually many more instances where confidentiality legally can or even must be broken by the therapist. California law offers more than 20 such exceptions. The exact number varies by state, but all states are bound by federal rules surrounding a national security investigation — where not only can a therapist be compelled to turn over records on a client, but the therapist legally cannot inform the client that their records have been disclosed.

These additional exceptions to confidentiality may be rarely triggered, but in cases where they are triggered, a client who had not been adequately warned about the possibility could rightly complain that the therapist didn’t fulfill their ethical responsibility to inform the client accurately about the limits of confidentiality. Better, I think, to include at least something in an informed consent agreement acknowledging that additional exceptions exist.

2. “Dual relationships are prohibited.”

In therapist circles, “That’s a dual relationship” is far too often treated as if it should be the end of the conversation. If you look at what our ethics codes actually say about dual relationships, it’s clear that this is only the beginning of the conversation. Dual relationships are not absolutely prohibited — some are perfectly acceptable. Only the avoidable ones that would impair clinical judgment or increase the risk of exploitation are prohibited.

If all dual relationships were prohibited, we could never take clients who came to us via word-of-mouth referral. And working in a rural area or with a more insular community would be all but impossible. Dual relationships can be challenging to manage, and they may trigger additional responsibilities for therapists. (The AAMFT Code of Ethics, for example, requires therapists choosing to enter into a dual relationship to document the precautions they take to minimize risk.) But there is not a blanket prohibition on all dual or multiple relationships.

3. “Therapists aren’t supposed to give advice.”

As the therapy world has been more heavily influenced by postmodern theories in recent years, I have heard a steadily increasing chorus of students and practitioners alike saying that they would never dream of giving their clients advice. While I quibble with the idea that you can avoid it — every question you ask, and every nonverbal cue you give, can be interpreted by the client as direction — it’s at least a position that has a theoretical basis. But the fact that a theoretical model directs you away from giving advice does not mean it is therefore unethical for another therapist to do so.

The ethical codes of the mental health professions are in agreement that therapists should not make major life decisions for their clients. But we are actively encouraged to help clients understand the likely consequences of their decisions, which, for many therapists, leads them to advise. And there are plenty of directive models of therapy where advice-giving is perfectly appropriate.

It’s fine to not give advice if your model discourages it. But that is a far cry from advice-giving being unethical. And indeed, many clients come to therapy precisely because they want to be advised by someone who has knowledge, training, and expertise that the client lacks.

4. “Other than sex, every ethical standard is subjective.”

I’ve seen this one floating around in a few online discussion groups lately, and it’s alarming. It is true that a lot of ethical issues are debatable, and lack clear answers; here’s an example. But our codes of ethics aren’t just written to be thought about. They are meant to be enforceable, and licensing boards around the country use the codes to help define the standard of care to which all therapists in a profession will be held. There are a lot of behaviors that are clearly and inarguably unethical. Licensing boards don’t tend to accept ignorance of those standards, or a (false) belief in the subjectivity of every situation, as an excuse.

5. “That’s unethical.”

While lots of behaviors actually are unethical and should be called out as such, too often I hear therapists say “that’s unethical” when what they mean is “I don’t like that.” The fact that we don’t like something, or wouldn’t do it that way ourselves, doesn’t automatically mean that it is therefore outside the bounds of acceptable professional behavior.

There are lots of things other therapists do that I don’t agree with. That’s part of what makes being a therapist so interesting! We are each part of a diverse profession, one that includes wildly differing theories and methods of treatment. Sometimes the behavior of a colleague will make you uncomfortable or even disgusted. But before you label that behavior or that colleague as unethical, make sure you can specifically cite the professional standards you believe they are violating. Erroneous accusations of unethical behavior are ultimately damaging to everyone involved, on all sides.

If you see any of the above floating around in your discussion groups, please do your part to correct them. Again, that is part of the benefit of social media: Each of us can play a role in holding our colleagues to high — and accurate — standards of professional behavior.