For those who have been commenting lately on my therapy drama, this may add some perspective on my side and what I have been trying to bring to therapy, in some cases unsuccessfully. These are the two emails I sent to my therapist post-rupture when she first took away outside contact. She has implied I have become aggressive and she has currently moved our therapy toward working on my boundaries but, honestly, I feel like I’ve expressed myself pretty assertively and stated my needs really clearly. Maybe they’re unrealistic needs, I don’t know. The letters are long and I repeat myself often because I haven’t been feeling heard. I do get wordy, so I bolded the important parts for skimability.
I’m writing this now in case I lose my nerve when I’m in front of you. I feel like you abused my trust. It isn’t going to be easy for us to move past this, rather, for me to move past it. I don’t see how I can count on you to mean what you say, if what you say can change at any moment. I feel like you should have known that stability and consistency were important for me. I know I haven’t talked about any of the things I’ve been through but you have the stupid intake paperwork. You know it’s a lot, like “yes” to everything. Because I stupidly keep putting myself in situations that lead to the same kinds of hurt and I’m afraid that I’m doing that with you now. I think if we are to move past this then I need you to be just as willing to accept the possibility that alternatives are true. I think that is the only way I will be able to come around to keeping my mind open that you actually care. You want me to always accept that maybe the evidence I see means something else, to accept that maybe my perception isn’t absolute truth, so then I need that from you, too.
I need you to be open to the possibility that maybe this is the wrong decision, that maybe you can’t completely standardize communication when it comes to the mental health field because according to the ACA’s code of ethics, “Counselors [must] communicate information in ways that are both developmentally and culturally appropriate.” Texting is a part of culture, maybe that seems like a stretch to you, but if culture effects the ways in which people communicate then… doesn’t that mean that technology is a part of culture? Not to mention that texting offers a means for me to step outside myself when I am feeling triggered and needing to cut. It helps me to get in touch with the part of myself that’s able to say, “wait, maybe this isn’t what I want.” And it helps to have you remind me of the alternatives we’ve talked about. Except you haven’t done that in a while anyway. It’s just none of it feels fair or right. We aren’t moving at my pace. We aren’t working with my needs. How is this a joint operation?
And, back to the notion of standardized care, how is that judicious, making changes across the board? Isn’t it about “Treating equals equally and unequals unequally but in proportion to their relevant differences.” Shouldn’t that mean meeting each of us where we are at in the process and in our lives? You wouldn’t treat someone with ADHD and an otherwise privileged (in the well adapted, had needs met way) life the same way you would treat someone with Complex PTSD and an entire life of trauma, would you?
Can you be open to the idea that maybe setting up the precedence for that outside support and then taking it away was cruel and emotionally negligent? It wouldn’t have been so bad if you started out by not allowing texts, if I had never had the opportunity to express need in that way, but you kept telling me you’re glad I texted, that you’re glad I reached out, that reaching out is a big step in the right direction, etc. You knew how much trouble I had accepting that as okay. You knew that I was afraid of overstepping boundaries and having you withdraw because of it. I told you, over and over. My life has been riddled with caretakers and partners offering warmth or support in one moment and then taking it away the next. I thought this was the one place that I could count on those things not being taken away. You knew my pain could possibly be made worse by having been encouraged to express needs, by having been told that reaching out is part of the process, by being reassured of the safety in what I was doing, only to have it revoked. And yet, you persist. How am I supposed to accept that as evidence of care? You insist on this change which I feel denies me the autonomy of participating in the choice of how we communicate. I know that we were working toward getting away from electronic communication and I do know that you cutting me off from that forces me to talk in session if I want to accomplish anything but it still feels wrong. Regardless of truth, I feel like this is because of my actions. I feel like I was bad and therefore, something good was taken away.
I need you to be open to how punitive that feels. How personal. And not personal in the “it affects me” way. I mean personal in the, “maybe she is resentful because I took when she offered and that interfered in her personal life, in her self-care time.” Personal in the “my needs, having them and expressing them, landed me in this position again” kind of way. Maybe we haven’t talked a lot about this issue, this feeling I have that whenever I was a disappointment or I was bad love would be taken away. I’d get the silent treatment. I’d get letters asserting new boundaries, boundaries I just had to accept because I was the child. I guess if I never told you, then you couldn’t know that all of that would just amplify the awfulness of this change. But, still, I think it is fair for me to expect that my therapist be consistent, that her boundaries not change on a whim. I mean even that is in one of the codes of ethics. It says, “a licensee shall set and maintain professional boundaries.” MAINTAIN being the operative word, “cause or enable to continue.” You set boundaries and then you failed to maintain them, you changed them, you discontinued the service. You can say that you didn’t actually discontinue it because it’s still available but how is someone like me supposed to see that as a realistically affordable option? Now that the savings has been depleted I’ll be lucky to have 5% to 10% of my monthly income left for me to use after therapy is budgeted for and after bills are paid (if we keep going at the rate we are, that’s without factoring in any outside contact at an additional cost to me).
I just can’t wrap my head around how, in this change, the potential benefit outweighs the harm it has caused. In many ways, I feel like I am worse off now than I was when I first came to see you. And, I was doing well. I was taking healthy risks, meeting new people, expanding my social circle, going longer without cutting. It wasn’t like the outside communication was a detriment to my progress. It maybe was just a detriment to your social life. This change feels self-serving. Most of what I have read regarding texting in therapeutic relationships goes something like this, “I see my job as forming an alliance with [clients]” and those therapists see texting as part of that alliance because it is what the client needs in that moment; they acknowledge that texting is how the client best communicates at that point in the process. Given that, this change doesn’t feel like you had the needs of your clients in mind, or at least you definitely put mine secondary to your own.
On that note, it feels like you did this because you needed more time or money for your social relationships, for your travel, for your self-care. It feels like you made a boundary before that you personally couldn’t keep, so you’re hiding behind ethics in order to have your needs met now, in order to justify the harm you knowingly caused. That isn’t ethical. In fact, the code of ethics says, “A licensee shall not engage in activities for the licensee’s personal gain at the expense of a client.” Doing something which you know will trigger a client, causing them immense pain, probably causing them to harm themselves, is not ethical, especially when it appears that it is done so for monetary or personal gain (hide behind the safety of the ethical, professional relationship all you like but the ethics haven’t changed on that in many years). This move for monetary gain and tighter boundaries is most especially not ethical based on a model that encourages beneficence (be proactive, prevent harm where possible), non-maleficence (do no harm), and fidelity (taking care not to threaten the therapeutic relationship, being loyal, faithful, and consistent). You’ve taken advantage of the inherent power differential of the therapeutic relationship. If you needed more control in your life, then you should have found it elsewhere.
I can’t help but wonder if any of this has to do with the times you’ve come frustrated or
annoyed to my sessions, or the time you were clearly disgruntled during our most recent phone session (while you were in California). Or, if it has something to do with what caused your suddenly changed plans. Some part of me says that maybe my persistent need contributed to part of that, at least the California part, and that maybe I really am suffering the consequences of that fallout (whether permanent or temporary). What I know is that you opened yourself up to availability during your vacation even though it seemed to have caused problems. I was grateful, of course. I accepted your openness and availability at the time because I needed it and you offered. But, that blinded me to the fact that maybe that wasn’t right. Maybe we both should have had more respect for your time away. Maybe I should have had more respect for your need for time to disconnect from clients in general. Because, to me, it feels like something happened which has maybe left you feeling less in control of your personal life. I would guess that this might not be something you’ve really given any thought. And, anyway, you often discredit my inner detective. Sometimes the detective does good work though. It’s hard to know when she is or isn’t right; she makes a convincing argument.
Regardless, I think you genuinely think you are doing this to “enhance treatment services” for your clients. Except that motivation seems to deny the fact that this isn’t the only change you’ve made recently in terms of separating personal from professional, exerting control where you know you have it, consequences be damned. More hiding behind ethics. Speaking of which, one thing I never did bring up, if we are hiding behind ethics, what are the “corresponding ethical guidelines regarding contact outside of sessions?” Where does it say that a professional relationship requires the counselor to charge clients for outside communication? Where does it say that a professional relationship does not allow for outside contact? The therapeutic frame exists as it has been co-created. And, as we co-created it, that included outside contact. Now, you want to change the frame saying that it aligns with “continued updates from the State Board of Examiners”? How is that a justifiable reason? You included the 2011 code of ethics. The code changed most recently in July of 2017 (I just finished my ethics class in December). And, when comparing the two codes, there were no changes in codes involving the professional relationship or communication outside of sessions or regarding the use of technology. In fact, reference to the use of technology in the counseling relationship says, “Technological means of communication may be used to facilitate the therapeutic counseling process.” I would interpret that as sanctioning the use of technology (i.e. texting or email). Of course, with the proper attention paid to confidentiality. But, we have already discussed the risks involved with that. So, again, it seems to me that ethics isn’t on your side. The detective still feels like this is personal.
I mean, maybe it just boils down to my having to accept that when using the model for
ethical decision making, you and I just have come to different conclusions. I will admit that, given I am the “case study” being analyzed, I can’t be objective. My feelings are undeniably hurt. But, I’ve sure got a heap of knowledge in this brain that makes a damn good case for the part of me that fears trust. For instance, according to Van Hoose and Paradise in Ethics in counseling and psychotherapy, a counselor “is probably acting in an ethically responsible way concerning a client if (1) he or she has maintained personal and professional honesty, coupled with (2) the best interests of the client, (3) without malice or personal gain, and (4) can justify his or her actions as the best judgment of what should be done based upon the current state of the profession.” Given that, can you say with certainty that you put my best interests at the forefront of this decision? Can you say that your need for personal gain (whether monetary or social) is not outweighing my need for consistency and a certain medium of communication? Why not just saying, “we can only text between this time and this time and only when you have this need or that need”? Setting those guidelines and boundaries would also have protected the professional nature of the relationship, wouldn’t they? And, in regard to your need for compensation (which further proves this is a personally driven decision), you could have just made your session fee even greater for those clients who intend to use outside technological services (i.e. 135 for clients who do not use text/email and 170 for clients who do intend to use these services). Yes, it comes with an additional monetary fee but it wouldn’t have felt like something that was going to grow astronomically out of control. It would have felt more manageable.
I get that while texting might feel intrusive for you, it helps me to feel more secure. Taking it away has just made me feel even needier and clingier (not sure what part of me gets to decide that impulse, ugh). I know I always tried to be mindful of when I sent texts though. I never sent them at unreasonable times. I realized quickly that if I was suicidal you weren’t the person to reach out to, that you would just tell me to call 911 or a hotline, so I respected that boundary (even though that meant that if I ever found myself in that place again I was just going to kill myself and not try to reach out to anyone). I made sure that I waited patiently for you to respond and didn’t get anxious or act on anxiety before a response came. I never sent multiple texts in rapid succession. I never tried to demand a response. Whenever you told me you wouldn’t have your phone or wouldn’t be able to respond, I respected that and stopped texting immediately after. I thought I was being respectful of your boundaries. I feel like if you felt like you were getting the respect you needed then your boundaries wouldn’t have had to change. I feel like you should have talked to me about this before the change occurred.
It isn’t so much that your boundaries changed, it is how they changed, that they changed in what feels like a huge way. I’d say that it also felt like it was all of the sudden but that
wouldn’t be the truth. I saw this coming. You alluded to it that weekend session after one of our other misunderstandings or ruptures. I journaled about it. I’ve journaled about a lot of this. The detective, as you say, was onto some things. I was insightful despite feeling like I was encouraged to question my insights. But, they proved true in this case. I’m just lost and heartbroken now because I feel like we’re at an impasse. How can I trust that this is a secure, professional relationship when you just change things on a whim? You introduced an unnecessary kind of unpredictability into this relationship. That is the last thing I need. I had that my entire life. I don’t expect for things to never change just that when they are going to change, I am asked how that is going to feel beforehand. That maybe I’m treated like a human being who might have feelings and opinions about a change that is going to significantly impact a part of my life.