Ethics can be a difficult topic to talk about. Frankly, people not following ethical guidelines drives me nuts. Ethics are guidelines that all professionals must follow. In the field of mental health, each discipline (social work, counseling, marriage and family therapy, psychologist) have our own Code of Ethics. Any time a therapist potentially violates a code, a formal complaint can be filed with the state board. Many client’s experience ethical violations but never say a word. I have experienced this with clients, as they have disclosed clear ethical concerns. When it comes to a violation, the professional gets to defend themselves as well. Which is appropriate as there may have been miscommunication, or some distortion of what happened. Companies have ethical guidelines to follow as well, along with other policies…and sometimes these are not in the best interests of the client. I have personally experienced these type of situations, as have a few close colleagues, in various states as well. When it comes to business ethics there is a fine line between profitable services and the best interest of the client. Businesses are made to make money, but sometimes, at what costs? The well-being of the client? Sometimes….probably more than not.
Often in large comprehensive care companies, the company runs as a single system, thus bouncing from therapist to therapist is norm; every time causing disruption in the healing process. Most often new therapists start off in comprehensive care systems; thus the quality of care is not at the experienced level. Often clinicians are overwork with very high case loads due to the turnover rate. However, these clinicians can get a lot of trainings and a wide range of clinical experience. All states are different; all counties are different. One thing I experienced in comp care, is when clients are challenged or progress is being made (fear from change), a simple request to change clinicians is all it takes, rather than openly discussing the issue with the current provider. This is not how the process is supposed to be; it is supposed to be a team decision.
More and more private companies are popping up as billing insurances has expanded. With this can come more experienced level clinicians, and more consistency in treatment. Sometimes the ethics in these type of companies can become blurred as well. Ideally there is accountability among the system. Then we have individuals in private practice often have little outside connect to other colleagues outside of trainings. If a therapist has always been in private practice there may not be that wide range of training that is seen with comprehensive care. This can be limiting for professional development, however their commitment to learning is what to look for.
SO with that being said..There are EFFECTIVE (not “good”) therapists everywhere. One should look at the therapist’s individual characteristics. Does the therapist connect well with you and your child(ren)? Does the therapist invest their time in education and learning? Does your therapist honor your culture? If you disagree or misunderstand something, can you address these with your provider? Even if your therapist is inexperienced that does not mean they are not a good fit, we all start somewhere.
These are important things to think about when working with a provider. Providers are human. We make mistakes. I once said “shit” in front of a child in the heat of the moment. (Unfortunately this was a word they have heard before.) I handled the situation, talked with my supervisor, guardian, and learned. I learned that my emotions were getting the best of me in that context; I needed to take my frustration and move it into something productive; not reactive. I was able to model that I was human, that I make mistakes too, that I took responsibility. Did this damage my relationship with my client, no. But it could have.
Mental health is a tricky business. This is the business of helping people. For me, working in a larger system was not working. I noticed too many unethical things go unresolved. I prefer to work alone. That does not mean I am alone. I have many colleagues and my husband that I communicate with constantly about professional development. I am apart of the Sandtray Suite- this is a group that is focused on the development/training of sand tray therapy. I am a part of a few different play therapy facebook groups. I am required to complete professional education for my LMFT and separately for my RPT. So I stay busy just keeping up to date!
If you are looking for a provider it is okay to ask these questions. Know your rights.