we become a professional, or simply start the process, many of our close relationships change. For example, your friends might expect to get expert knowledge from you and you just want to be their friend like before! However, you now have some new knowledge and you know it could be beneficial. You might even be wondering about your language. You may begin to see that you use more open-ended questions in conversations. Maybe you use more eye contact and share what you hear in a reflective manner. At some point, you might start to think, “Am I moving from giving advice, as any friend would, to giving professional opinions? Am I being a friend or a counselor when I ask a question like that? Should I even be using reflection of feeling with my friends? It seems like such a powerful tool.”
Another sense in which the personal and professional need to be balanced is within our therapy relationships. Our students say things like, “You tell me to use my personality as part of treatment and yet you also say to be professional in the relationship and not just go by my personal experience.” Indeed, helping people is much more than common sense or relying on your own experience. At the same time, without understanding your own tendencies, habits, and perceptions—and using your personality—psychotherapy becomes merely a mechanical process in which you risk displaying too much neutrality and objectivity and not enough compassion and genuineness. We think it is ethical to be you in the session but with a professional sense of self at the fore. Easier said than done!
The notion of technical knowledge and skill leads us to another balancing act: between humility and competence. Psychotherapists need to know an amazing amount of information about human behavior and to develop many skills to apply that knowledge. At the same time, psychotherapists need to know that they cannot help everybody and they will never know everything. Thus, they need to cultivate the virtue of humility and appreciate the limits of their competence—which is determined by their levels of knowledge and skills. However, the extremes of this balance—feeling like you know everything or feeling like you know nothing—can lead to poor practice, burnout, and ethical infractions.
As a student or practitioner exploring ethical issues, you will face yet another balancing act: between being certain and embracing ambiguity. As you initially study the ethics codes of your discipline, you will find that the codes often read like a long list of “don’ts” that should be followed blindly. Upon closer inspection, however, you will find that most of the rules are not that definite, or they contradict each other. They are often difficult to implement in simple ways. It seems like there is always “it depends” as part of the final answer. How are we supposed to behave ethically when the rules are neither clear nor absolute, or when ethical principles conflict? Answering this question takes careful study, long practice, and an open mind. We urge you to become familiar with the ethics codes of your profession, and perhaps of a few related professions. You can find links to over 100 codes or sets of guidelines at kspope.com/ethcodes/index.php. We also encourage you to draw upon your humility and seek consultation. Professionals not directly involved in a situation can often see things—like tripping points—with greater clarity. They can also be a source of accountability.
Another balance that has important ethical implications is between responsibility and respect. “They tell me I am responsible for how therapy goes,” new therapists might say, “and yet they tell me that the client is in control.” As psychotherapists, we must be responsible for the methods we use to help our clients, but we must also recognize that clients retain the ultimate responsibility for their own lives. Not appreciating this fact might lead us to blur the boundaries of the psychotherapeutic relationship as we take too much responsibility for clients’ lives, push clients into unwise or premature choices, or impose our own values. At the same time, the spheres of responsibility are not always that clearly defined. Many of the ethical issues we explore later in the book will revolve around this issue.
Boundaries are one of the most important balancing acts that we as therapists need to master. There is a complex tension between the intimacy involved in psychotherapy and the boundaries of that intimacy. Put another way: The emotional intimacy involved in therapy exists in a very restricted range. For example, clients disclose many personal details in the relationship, but therapists typically do not. Another quality of therapeutic intimacy is that it should never be transformed into a romantic or sexual relationship, a business relationship, or even a close friendship. Respecting the boundaries of the therapy relationship is a key to effective practice (we talk more about this in Chapter 5). This balancing act is one of the most important to monitor and about which to be open to seeking supervision or consultation. It can be one of the parts of the staircase that needs additional support.
A final balancing act is between personal autonomy and professional obligations. Put simply: When are you not a psychotherapist? Are you ever off the clock? You are always a psychotherapist because it is part of you now—you live in the mansion! You are off the clock when your therapy day is done; however, your role (and the perception of some others) as a psychotherapist is still part of you. Even with our personal autonomy, we have an obligation to uphold professional responsibilities and commitments—both on and off the clock. As an analogy, think of a marriage. As a married person, when we are out with friends doing friend things, we are still married—still have obligations to that role even when our spouse is absent and we’re not doing things specifically for them.
With all this conversation about tripping points, balancing acts, and developing a professional ethical identity, you might be tempted to throw up your hands and say one of these two statements: “I didn’t sign up for a big mansion and climbing a spiral staircase and all that comes with it. I just want to help people.” Or, “Ok, this is all interesting but I don’t have the slightest clue how to explore and articulate this core of my identity, adapt to this new professional culture, or think about, let alone maneuver ethically through, all of these real-world issues and balancing acts in psychotherapy.” In either scenario, you may be tempted to start walking back down the staircase. If these thoughts ring true for you, take a deep breath and let it out slowly. Relax a little and let yourself gather the strength for the next steps. We are with you on this journey and our next topic, self-care, is important to discuss.
Self-Care: The Basics
Clearly there are immense rewards for being a therapist and many find it a truly noble way to make a living. At the same time, psychotherapy is taxing and emotionally draining; authors have used phrases like “significantly stressful” (Cottone & Tarvydas, 2007, p. 123) and “inherently stressful” (Welfel, 2006, p. 58). We work with people who are unhappy, ineffective, dissatisfied, angry, anxious, and/or lonely, and who sometimes really want to stay unhappy, ineffective, dissatisfied, angry, anxious, and lonely. Under these conditions, they challenge us to be that person in their lives who brings hope, a point of connection, stability, and caring confrontation. The increments of change we may see during the therapy process are often very small. In addition, we rarely know of the positive outcomes for clients that happen long after termination. Thus, we often do not fully collect on the promise of good feelings after a job well done.
These conditions and other factors that may be out of our control (e.g., reimbursement from insurance carriers) constitute a recipe for emotional exhaustion. We need self-care strategies to prevent the harmful effects of these stresses and to help ourselves when we start to feel detached, overwhelmed, and burned out (Jevne & Williams, 1998). We need to be on guard for the telltale signs of such stress, like fleeting hopes that our clients call to cancel their appointments, impatience with our clients, and musing between sessions about going back to school to study geology or taxidermy. You need to be your own best friend and make a strong commitment to take care of yourself. Those who need your help—your clients—won’t be asking you if you are getting good rest at night, taking periodic vacations, exercising regularly, or are involved in healthy personal relationships. You need to be checking in on yourself and seeking assistance from colleagues. Ask yourself questions such as these: How do you know when you are
