Ethical Guidelines: Do We Really Want What Is Best For Our Clients? By Howard Rosenthal, EdD on 11/28/11 - 3:05 PM

Most therapists are familiar with the affliction of Seasonal Affective Disorder (SAD). SAD impacts approximately seven million people each year in America, mainly women.

At one point in my career I shared a private practice office with a psychiatrist. She would use the office on some days and I would use it on others. When I entered the office for the first time I was struck by the fact that she had a phototherapy apparatus in the room. It was physically huge and was much larger than any commercial unit I had ever seen. Many experts believe that SAD is caused (or at least intensified) by a lack of sunlight. Hence, when the sun is not shining very often or the days get shorter depression sets in. Phototherapy devices fight the depression and emit massive amounts of full spectrum light. The phototherapy simulates or mimics the sunlight you would receive if you more spent time outdoors.
My initial reaction to this situation was beyond positive. I was elated that this psychiatrist was utilizing cutting edge technology. I thus decided to praise her and let her know in no uncertain terms that I was impressed.

The good doctor's reaction, nevertheless, was hardly what I expected. "Oh my gosh, no, I don't use it for my clients. That's fringe psychiatry. Somebody might think it was unethical. I might even be sued or reported to the Board of Healing Arts. I might be branded as a quack."

"Well what in the world is a light therapy lamp doing in your office?" I asked inquisitively.

"In the dreary short days of winter I am stuck in this office all day and I generally become extremely depressed, so I had an engineer build me a phototherapy unit that is stronger than anything you can purchase. As soon as my current patient exits the treatment room I flip on my phototherapy device. I then turn it off before the next patient enters the office."

Oh, so now I get it: It's good enough for you, but not for your patients. Go figure.

In one of my recent books, Favorite Counseling and Therapy Techniques, I share a fascinating story about a young man I treated who had such low self-esteem that he walked bent over like an ape. The kids at school thought it was hilarious and made the situation worse by calling him the Ape Man.

One reason for the young man's Ape Man posture was that he believed he was extremely ugly and could never date a nice young woman. To counter his feelings I set up a contrived situation in which a female colleague walked in the room and said, "Gosh, is that your client, he's really cute." He seemed shocked (exactly the reaction I wanted). I told him we weren't going to discuss his looks because we both knew he was an exceptionally good looking guy and there were serious issues of his we needed to work on. He walked out with the finest posture he had displayed in years. Cured, no. Improved, yes.

Unfortunately, I also point out in my book that today's ethics which stress informed consent would not permit an intervention of this ilk. The female colleague who gave him the compliment would need to be identified as part of the treatment or therapy team up front and there is a 99% chance he would have totally discounted her remarks as being staged. (The young man's mother had repeatedly told him he was a good looking guy many times to no avail.)

Along these same lines a client I shall call John came to see me who severely depressed. John's brother was a very well-known psychiatrist. Now I was aware of the fact that ethical codes frown on (or downright prohibit) dual or multiple relationships, but certainly John's brother knew another top notch psychiatrist who could help. Why was John seeking my little old services?

When I asked John why his brother did not provide a psychiatric referral John quoted his brother verbatim. "Look I give those dangerous psychiatric medicines to my patients, but I'm not going to let my family take them. You need psychotherapy."

I so I get it. It's not good enough for your family, but it's okay for your patients. Oh sorry, I think I said something similar to that that before.

I remember hearing a presentation given by Jay Haley once. He told a powerful story regarding a difficult client he had successfully treated. I raised my hand and asked if his psychotherapeutic intervention was in violation of the ethical principle of informed consent. It certainly seemed like that was the case.

Haley was silent for a moment and then grinned. "I never let ethics get in the way of good treatment."

The problem for those of us who are mere mortals is that Haley's philosophy might leave us without a therapist's license and standing in a long unemployment line.

File under: Law & Ethics, The Art of Psychotherapy