Do No Harm

Do no harm is a common phrase in the mental health profession. It is understood to mean, at the very least, don’t hurt anyone. The Hippocratic Oath in medicine essentially states the same. Of course, it is also expected that we in both professions will do much more—that we will help people in significant ways.

This is the most basic, simple statement of ethics and to most of us, seems like a no-brainer. We are in a helping profession. To do contrary would be the antithesis of our entire purpose.

And yet, we are human beings—fallible and far from perfect. We make mistakes. Sometimes we do so unwittingly, without malice or forethought. We make ethical miscalculations. Or do we know and forget? i.e. leaving confidential information out on our desks or entering into a dual relationship by participating in a lengthy conversation with a client in a grocery store? These are the mistakes or ethical dilemmas we encounter, especially as young professionals. Hopefully we catch these faux pas before it’s too late.

That’s what HIPPA and our Code of Ethics are there for, to keep us aware of and accountable to not engaging in such behaviors. Rules are good; they tend to keep us out of trouble. But I believe there is more for us to consider.

For me, it is even more important, not in place of, but in addition to such rules, to be ever cognizant of the quality and tenor of the relationships we have with our clients. What do really offer to them? My hope is that we offer our most genuine concern, compassion and respect.

In our current culture, it seems as though the concepts of compassion and respect have greatly diminished. As we learn more and more about the scope of sexual harassment and abuse, racial violence and mass killings, not to mention increased marginalization of the poor and disabled, it becomes even more pressing that these basic values of humanity are restored and maintained. As therapists, our opportunities to contribute to this end are particularly abundant. My greatest hope is that we rise to this calling. To do no harm and bring respect back into our world.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Navigating the Holidays Therapeutically

We know that the clinical data and real life clinical experience clearly support the unfortunate truth that these seasonal holidays bring many clients heightened anxiety, depression, and thoughts and actions of harm to self and others. This phenomenon has been occurring regularly for decades, if not centuries. While we know that some is related to the nature of the actual season itself (i.e. the shorter days of daylight), it is thought that the holidays themselves also contribute to this rough period of time experienced by so many. The expectations of joy and giving often becomes burdensome to those who feel limited on material funds or sources of happiness in their personal lives.

Another area that creates tension for many is the interpersonal context of the season, or more specifically, family. The holidays bring with them some Hollywood, picture-perfect ideals of family get-togethers and, as we know all too well, they’re not always that way. Conflicts and feuds, old and new collectively, intensify and heighten the probability and noted occurrences of domestic violence in the midst of attempted festivities. Illness, physical or mental, or losses, such as divorce or death of a loved one, in the family can produce clouds of sadness and despair. Many do not have any family at all. So trying to create joy around these real life situations are increasingly challenging, if not seemingly impossible, depending on the freshness and intensity of the circumstances.

So therapists have a greater responsibility during these times. It rests upon us to have keener awareness to the possibilities of more difficult and, perhaps, more dangerous times for our clients. We need to more diligently assess for suicidal and/or violent ideations and be prepared to intervene swiftly and effectively as needed. Obviously, this season can and does also cause more stress for us as healers. Therefore our wellbeing is even more vitally significant than usual. As we teach our clients how to be more kind and gentle to themselves and those they love, so should we carefully listen to our own words of wisdom. May this season bring all of us peace and calm reassurance that we are valued.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

The Continuum of Violence

Over and over again, in the last few weeks, months, years and decades we continue to be overwhelmed by the news of horrible acts of violence. Most recently, in a small, quiet town in rural Texas, where “you would least expect it,” it happened again: a mass murder in an unassuming country Baptist church. More than fifty people were killed in cold blood, including children and the elderly. An unfathomable act for most of us trying to process such terror, even as it becomes more and more a part of the norm.

While many are asking why and debating the gun control issue, therapists realize that these news stories that are becoming much too frequent are really only the tip of the iceberg. We see in our practices the wider spectrum of violent acts, including spousal and child abuse, which are physical, sexual and verbal in nature. We see victims of trauma routinely who present complex, long term symptoms of anguish and pain, sometimes leading into generations of further pain and maladaptive behavior.

It seems as though there may be no end to this stream of inhumane behavior. This may indeed be true, that violence prevails no matter what interventions are attempted. But I believe that as a therapist I have a duty to try to intervene, even if only on a case-by-case basis.

With over four decades in this field, I can’t help but notice the continuum of aggressive and violent behavior. On one end it seems small, almost trivial, maybe “teasing,” or passive-aggressive in nature. Like bugging someone about wearing their favorite baseball cap or the way they wear their hair or calling them names just to be funny. This can grow into more full-fledged bullying, like playground bullying, cyberbullying or workplace bullying. There is a distinction between bullying and abuse, the latter crosses the line into physical harm and violence, but I would contend that this wider range of behaviors can be considered to be those of disrespect and ultimately harmful to some degree or another.

My point here is not to exaggerate the lesser of these acts into major problems on their own, but to recognize the larger picture so that we can more completely study and begin to understand this phenomenon of violence in our culture, our neighborhoods, our families and ourselves. I believe that the lack of respect, or disrespect, can behave like a cancer and grow to become a devastating story, sometimes told on the news. Therapists have an opportunity to intersect and intervene in these stories in a way that few do. I believe it’s our responsibility as professionals and human beings to do so with as much respectful clarity as possible.

Over the next weeks and months I will be returning to this topic of understanding and intervening violence and welcome your input into this discussion.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Transpersonal Respect, Multicultural Understanding & Social Justice

Creating ground for transpersonal or universal respect is about taking tangible respect, that for self and those close by, to incrementally larger and larger circles (such as trust in nuclear families expanding to extended families. Taking action to this end can then expand into communities, nations, and ultimately grow to universal respect for all of humankind, such that the abstract “Other”—stranger or enemy—no longer exists in a way that poses a threat. To respect means moving past fear in order to embrace humanity with curiosity and confidence. Recognizing this as ideal vs. the ongoing real life situations of sometimes severely disrespectful patterns among families, communities, political factions, religions, tribes, sects, and nations (which too often lead to oppression, violent conflicts, and war), makes the case for the urgency for respect to grow.

When we consider all of the possible differences and combinations of differences there are in humanity, it can be quite overwhelming. Everything from genetics to personality traits, philosophies, beliefs, cultural mores, family backgrounds, physical and psychological attributes as well as socioeconomic and life experiences, all contribute to the vast array of differences there are between us. And yet, there remains the common thread of being human. How we approach our differences is very much up to us.

RFT postulates that we are each capable of reaching past our differences in order to fully celebrate our common humanness. Though it bears more poignantly for therapists to focus our respect most directly on our clients, it is also our obligation, as I see it, to exercise this broader scope of transpersonal respect, so that we can also demonstrate in our work a sense of multicultural understanding and social justice.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Texas Clinical Supervision Conference 2017

On November 3, at 1:30 PM, I have the honor of presenting at the Texas Clinical Supervision Conference at The University of Texas at Austin, Thompson Conference Center.

My topic will be Helping Supervisees Work with Highly Complex Clients Using Respect-Focused Therapy.

Related Articles: Preparing for Difficult Clients

Texas Clinical Supervision Conference PowerPoint November 3 2017

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Integrity and Self-Forgiveness

Integrity is that part of ourselves which holds us accountable to our core beliefs and is at the heart of respecting who we really can be. This accountability includes a standard in human behavioral values, but should not be so rigid as to make that standard humanly unachievable. No one is above making mistakes or bad choices. Our sense of well-established integrity, therefore, necessarily includes compassion, forgiveness and grace.

The pathway to achieving such a balance of moral integrity, and the ability to genuinely forgive one’s perceived shortcomings, is frequently interrupted or broken by trauma and the resulting life experiences, such as PTSD, addiction, depression or other mental impairments. Integrity may seem as if it is unattainable or out of one’s reach even if it is already there. Shame often becomes a dominant source of blockage around the trauma(s), and the resulting experiences or behaviors by the traumatized or impaired, because it frequently becomes the way we interpret those negative events in our lives. We tend to internalize those events and cast blame on ourselves.

Therefore, self-forgiveness becomes key to repairing the psychological damage done by shame. This process of self-forgiveness, then, is not about making excuses for one’s behavior, but truly acknowledging wrongdoings with grace, letting go self-imposed penalties, self regret, hatred or other forms of disregard. It is also about being able and willing to make amends and correcting hurtful behavior where and when possible in context of relating to others.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Dealing with sexual trauma in therapy

We have reminded in the news once more that sexual harassment and abuse are very prominent issues in today’s society. The latest controversy around a famous movie producer for decades of sexual harassment and assault only adds to a long list of known cases of people using their positions of power to abuse others.

Of course, what we also know is this horrific phenomenon is not restricted to the rich and famous. Many therapists see the results of sexual trauma play out in our practices on a fairly regular basis. The range in behavior is vast, but the overreaching message of disrespect for another human being is resoundingly the same. In a therapeutic context, the victims of sexual misconduct are wounded deeply, mainly because of the serious lack of regard for their innermost sanctity and personhood.

This goes far beyond the physical acts themselves. It is the robbery of emotional and spiritual safety. It is the denigration of personal value. The damage done is ultimately repairable, but not before the pain is fully recognized and experienced.

Therapy is about this very process. It is the full recognition of what has been taken away without self blame or shame. Most often, the healing process involves self-forgiveness for being broken by the event, even though there is really nothing internally to forgive. A violation occurred externally, but struck so privately and personally that it frequently feels like a stain on one’s soul or psyche. With this understanding, it then makes perfect sense that coming forward by the victims may be indeterminately delayed, for fear of being seen with such a stain and/or having to endure more disgrace and humiliation because of it.

Cleansing and healing the wound made by someone else’s invasive or attacking behavior is the task that therapists are asked to assist with. Respect-Focused Therapy suggests that the best, most effective way we can do that is by concentrating our full energy and focus on truly respecting a person’s pain as well as the whole person completely. With the experience of receiving such depth of genuine respect, it is hoped that these individuals will have the platform on which to begin building, once again, their own self-respect as well as respect for others around them.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Exploring Beneath Addiction

In the last several years it has become more and more clear in the media as well as within the mental health profession that addiction has become an out-of-control epidemic, especially addictions to meth, opioids, and heroin.

I supervise post-grad interns who work with this population (addicts of all substances), many of whom are homeless and/or ex-incarcerated. Most of these clients have years, if not decades, of addictive patterns of behavior well established, such as lying, cheating, and portraying some level of aggression or passive-aggressive behavior. Many are dually diagnosed with other mental illnesses and have suffered various traumas during the course of their lives.

These entrenched behaviors often become like masks or shields for the people living inside of them, seemingly impenetrable to those working with them. So many layers of harm from others, self harm, and harm done to others are woven into the horrific disease of addiction, that it seems extremely difficult to unravel and find the human being strangling inside.

Exploring beneath this quagmire of addiction requires the willingness to suspend judgment and presumptions about the limitations of hope placed on or by this person. Societal norms and personal records of misconduct have put boxes of low expectations on addicts. To find the real people hiding in these boxes is the primary challenge of therapy, as I see it. As we go about the careful process of doing so, we need to help that person exposed learn to not be afraid of who he or she really is, but to have the courage to heal and embrace the broken goodness within.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Intersecting Therapy and Religion

Research on the interrelatedness of psychotherapy and religion or spirituality has been relatively sparse historically, but in the last decade or so, it has received greater interest, particularly as it relates to multiculturalism. In a study conducted by Post & Wade (2009), several interesting findings about the differences between therapists and their clients were found. First, most therapists overall were found to have significantly less personal identification with being religious or spiritual than their clients and had very little training in counseling around spiritual issues, yet for the most part, they saw their clients’ religious beliefs or practices as a positive addition to their mental health. However, the belief systems outside of the more traditional western religions, i.e. the Judeo-Christian tradition, were more often seen as being tied to some pathology. Eastern religions, Islam and Native American faiths would be typical examples of such misunderstandings.

As this study continues to point out, the pluralistic approach, that is, the broader willingness to be open to and accepting of all faiths, even those unknown to us, is perhaps the most effective and ethical stance we can have with clients. The key danger in not taking such a position is to fall into the trap of trying, consciously or subconsciously, to make clients become more like ourselves. It is not wise, particularly in therapy, to impose our beliefs on someone else, especially to those who are more vulnerable.

There are those counselors who identify themselves as Christian counselors (or other faiths), who use such spiritual tools as scripture readings and prayers within the context of doing therapy. If this is understood and agreed to by the client prior to implementing these practices, it can be a powerful tool, which may reach into the deeper spiritual needs of the client. If handled with care and respect for the client’s perspective, without judgment, this can truly be an enriching process.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Working with People with Disabilities

Disabilities primarily fall into three main categories—physical, intellectual, and the ones we in the mental health profession are most acquainted with, mental or emotional disorders. This is not to say that these disabilities don’t overlap. They frequently do, however, it’s important to clearly understand the differences and the unique qualities and psychosocial impact of each category. It’s imperative to point out here that any and all disabilities bring with them stigma and prejudgment, not unlike racial and ethnic stereotyping. Some common responses to people with disabilities include talking down to them, avoiding them, bullying, and other abusive behavior.

Disabilities come in all shapes and sizes. Many are quite visible, like people in wheelchairs who use walkers and people who are blind. And there are others without visible disabilities, like deaf people or those with heart or respiratory issues. Some disabilities are developmental, meaning that they are existent from birth or early childhood, like cerebral palsy or spinal-bifida, but others are traumatic, with later onset, such as spinal cord injuries, traumatic brain injuries, or amputees. People with physical disabilities are often misunderstood to have other intellectual or mental disabilities and are often judged unfairly to be incapable of being functioning social, adults.

Intellectual disabilities, or as it used to be called, mental retardation, can be related to a number of different causes, i.e. Down’s Syndrome, cerebral palsy or brain injury. People with these related disabilities have the most stereotypes put upon them in terms of being social outcasts, weirdos, or freaks.

Mental illness clearly carries with it plenty of stereotypic biases as well. People with bipolar disorder, schizophrenia, or personality or identity disorders, have tremendous social alienation issues to deal with as well. But those of us in the mental health field have greater familiarity with this particular population, and are, hopefully more accustomed and comfortable interacting respectfully with them than perhaps with those with other disabilities. This is largely due to the level of exposure to and education about these various disabilities.

I have been a psychotherapist for forty years, and I have had cerebral palsy all my life and have used a wheelchair for most of it. My life experiences have brought with them the dichotomy of being the stereotyped disabled person, with all the biases and social prejudice that comes with it—and as an educated, professional healer. The combined awareness brings me the opportunity to deepen my senses around human variation and my desire to broaden my respect for all.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.