private list of negative reactions by completing the following sentences, as many ways as possible, with complete honesty and without censoring ourselves:
I can’t stand it when someone …
I’d rather not be around someone who …
The worst kind of person is someone who …
The people who are responsible for more trouble in the world than anyone else are the …
The kind of person I’d hate to be seated next to on a long car trip is …
It’s not politically correct to say it, but personally …
You may not like it but there’s a good reason everyone says that all [members of some racial, ethnic, religious, or other group] are [name of some characteristic, usually negative]—It’s true!
Our personal list may include negative emotional reactions evoked solely by someone’s membership in certain social categories based on
Religion
Politics
Race
Skin color
Ethnic group
Caste
Weight
Intelligence
Education
Mental health status or disorder
Country of origin or current citizenship
Immigration status
Income (or lack of it)
Occupation
Physical ability or disability
Mental ability or disability
Sexual orientation
Gender identity
Gender expression
Speech (e.g., whether the person makes grammatical errors, uses slang unfamiliar to us, speaks our language with an accent)
Age (e.g., someone who is very old)
Dress
Personal hygiene
These negative emotional reactions based solely on such categories have the potential to choke off our respect for the dignity of that person.
This chapter is a reminder that treating others with respect for their dignity is a basic ethic of our profession, one easily overlooked but facing countless challenges. None of us is perfect in this area. All of us will fall short more than once over the course of a career. It will suddenly strike us that we’ve been sitting with a patient for most of a therapy session and for most of that time our mind has been elsewhere; we’ll breathe a deep sigh of relief as we terminate a patient, realizing that we never liked the person, never invested much in the therapy, and feel joy that we’re rid of that person; a patient will say something that somehow breaks through our shell and we’ll discover that some time ago we’d lost our sense of shared humanity with someone who’d started to seem like a stranger. The Golden Rule is useful here, no less so for being a cliché: We must strive to treat our patients and others with the same respect for their dignity that we wish to receive from others.
Chapter 5 TRUST, POWER, CARING, AND HEALING
Psychotherapy is a remarkable venture. It harnesses three forces—trust, power, and caring—to help people heal. In our work, we face the ethical challenge of understanding, respecting, and handling carefully all three.
TRUST
When we apply to states and provinces for professional status via licensure and certification, we accept the responsibility that comes with that status. Society expects us to be trustworthy, to avoid abusing the trust that people place in us. Society depends on us to fulfill that trust for the good of our clients as well as society. Ethical dilemmas can arise from the clash between the client’s interests and society’s interests, or between the client’s interests and the therapist’s interests. In return for assuming a role in which the safety, well-being, and ultimate good of clients is to be held as a sacred trust, we are entitled to the roles, privileges, and power that governments and society entrust to professionals.
This concept of trust is key to understanding the context in which clients enter into a working relationship with us. Clients expect or desperately hope that they can trust us. Many fear we might betray their trust. Some agonize over trust issues. Others find barriers to trust almost insurmountable. And others, like Black, Indigenous People of Color (BIPOC) clients come to therapy knowing that the profession we represent has violated their trust many times throughout history. Still others come to therapy unaware of how their problems trusting others have made it hard for them to love, work, and enjoy life.
Trust is at the core of therapy and clinicians put it to good use. In therapy we expect clients to walk into the consulting room of an absolute stranger and say things that they would say to no one else. We therapists may ask questions that would get us slapped, punched, or sued if we asked them outside of therapy. What patients tell us in confidence carries potential to be therapeutic or harmful depending how we use that information and/or, whether we violate the client’s trust by breaking the sacredness of confidentiality. This potential to help or hurt has led virtually all states and provinces to recognize some form of professional confidentiality and therapist–patient privilege. Laws prevent therapists, with some specific exceptions, from talking to others about what clients share with them during therapy.
Therapy, like surgery, relies on trust. Surgery patients allow themselves to be physically opened up in the hope that their condition will improve. They trust or may reluctantly trust surgeons not to take advantage of their vulnerability to harm or exploit them. Therapy patients undergo a process of psychological opening up in the hope that their condition will improve. They trust us or want to trust us not to harm or exploit them. Freud (1952) noticed this similarity. He wrote that the newly developed “talking therapy” was “comparable to a surgical operation” (p. 467) and emphasized that “the transference especially … is a dangerous instrument … If a knife will not cut, neither will it serve a surgeon” (p. 471). Recognizing and respecting the potential harm that could result from psychotherapy was, according to Freud (1963), essential:
It is grossly to undervalue both the origins and the practical significance of the psychoneuroses to suppose that these disorders are to be removed by pottering about with a few harmless remedies … Psychoanalysis … is not afraid to handle the most dangerous forces in the mind and set them to work for the benefit of the patient.
As patients, only if we trust the therapist and their intentions are we likely to speak truthfully about—or even disclose at all—events and topics that make us feel fear, shame, guilt, anxiety, or all the other forms of discomfort and apprehension. Research by Farber et al. (2019) found that trust played a “role for clients concealing depression symptoms;
