When Doing “No Harm” Isn’t Good Enough: Bringing beneficence to your clients
Curt and Katie chat about ethics again. We look at how therapists decide what is beneficial for clients. We also contrast the concept of “beneficence” (doing good) versus “nonmaleficence” (doing no harm). We specifically explore how to identify when something is in the therapist’s interest versus the client’s interest as well as what therapists can do when clients hold harmful, untrue beliefs. This is a law and ethics continuing education podcourse.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we talk about how therapists do good, beyond “do no harm”
Therapist healthcare ethics are often taught from the perspective that the professional’s role is to “do no harm” when providing treatment to clients. Lost in the teachings is that therapists have other obligations to address when providing treatment. This workshop focuses on examples of bringing the principle healthcare ethic of beneficence to therapy to help determine “doing good” for the client’s benefit.
What is beneficence in the context of psychotherapy?
- Do what is good for the client and for treatment
- “For the benefit if the client”
- Comparing this with the idea of non-maleficence (“do no harm”) which is don’t do bad things, but also try to prevent bad things from happening
How do therapists decide what is “good” for their client?
“I see this sometimes in the EMDR consultations I do, particularly with the people who are first practicing EMDR, first using it with clients. Where sometimes there’s a tendency… when clients are starting to seem overwhelmed, to rescue clients from those difficult feelings… [however] one of the underlying principles of [EMDR] is, the way to get through the feelings is to go through the feelings… it’s hard to see people going through this, but it’s beneficial [for the client] based on what the research base of [EMDR] is. ” – Curt Widhalm, LMFT
- Assessing the risk of overtaking client autonomy and becoming paternal or parental
- Balancing all of the core ethical principles and putting them in context for the unique situation for each client
- Looking at whether therapist self-disclosure is in the benefit of the client
- Identifying what is therapeutic and beneficial
- Making sure that therapists move beyond what is comfortable (and not “harmful”) to something that may be less comfortable (and more beneficial)
- Looking at who therapists choose to work with, balancing therapist self-care and self-protection with what is beneficial to the client and society
What are specific concerns to consider when deciding whether a therapist is working for the benefit of the client?
“[When deciding whether to self-disclose to a client], I feel like I’m constantly assessing, will this benefit the client or not? Will this benefit our therapeutic relationship or not? And what will the client do with this information if they have it?” – Katie Vernoy, LMFT
- Therapy dogs (are they certified and registered, is it in the treatment plan)
- Contact between sessions initiated by the therapist (who is the contact for? What does the treatment model say about this type of contact?)
- Have a thought process and document that thought process when deciding what to do as a therapist
What can therapists do when clients hold distorted beliefs?
- Identify: Do the distorted beliefs that the client holds cause (or could cause) harm?
- Understand: What laws or ethics are relevant to whether the distorted belief should be addressed?
- Get client consent (or not) to talk about the distorted belief and potentially change the course of therapy
- Is it necessary to discuss the belief at this time?
- What countertransference issues could impact the efficacy of the conversation with the client?
- Will the conversation be helpful and potentially change the client’s view?
- How will the conversation change the course of therapy?
- Does the therapist have appropriate expertise and training to address the distorted belief?
Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide
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Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.
You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/courses/when-doing-no-harm-isnt-good-enough-bringing-beneficence-to-your-clients/
Continuing Education Approvals:
When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information including grievance and refund policies.
CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.
Resources for Modern Therapists mentioned in this Podcast Episode:
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References mentioned in this continuing education podcast:
Avasthi, A., Grover, S., & Nischal, A. Ethical and Legal Issues in Psychotherapy. Indian Journal of Psychiatry 64(Suppl 1):p S47-S61, March 2022. | DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_50_21
Bhattacharya, Ishita, Avinash Desousa, and Prosenjit Ghosh. “Ethical Issues in Psychotherapy with Suicidal Clients.” Indian Journal of Private Psychiatry 17.2 (2023): 53-54.
Brookfield, S. (2024). Choosing not to help: The ethical challenge of beneficence for clinicians conducting ethnographic research. Ethnography, 14661381241237407.
Conlin, W. E., & Boness, C. L. (2019). Ethical considerations for addressing distorted beliefs in psychotherapy. Psychotherapy, 56(4), 449.
Geppert, C. M., Brendel, R. W., & Trachsel, M. (2021). Ethics in psychiatry and psychotherapy. Frontiers in Psychiatry, 12, 742218.
Gerger, H., Nascimento, A. F., Locher, C., Gaab, J., & Trachsel, M. (2020). What are the key characteristics of a ‘good’psychotherapy? Calling for ethical patient involvement. Frontiers in psychiatry, 11, 517444.
*The full reference list can be found in the course on our learning platform.
Relevant Episodes of MTSG Podcast:
It’s the Lack of Thought That Counts: Ethical Decision Making in Dual Relationships
Dual Relationships – Pros and Cons
How Much Autonomy Do Therapy Clients Deserve? Balancing client autonomy with therapist skill
Therapists Are Not Robots: How We Can Show Humanity in the Room
REPLAY – Therapists Are Not Robots: How We Can Show Humanity in the Room
REPLAY – Structuring Self-Care
Conspiracy Theories in Your Office
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:15
Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, where you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.
Katie Vernoy 0:47
Once again, hop over to moderntherapistcommunity.com For one CE once you’ve listened.
Curt Widhalm 0:55
Welcome back modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about the things that go on in our practices, things that go on in our profession, and the ways that we go about them. And this is another one of our CE eligible episodes. And we were talking before we started recording about when we do law and ethics episodes, the general response that we get from people is just kind of like, more law and ethics? And then people listen to our episodes. And then they’re like, That was surprisingly above the very low bar that I had set for how entertaining that episode would be. So hopefully, this is another one that you find beneficial. And on that transition, we are talking about beneficence today. This is one of the principal ethics that sits in all of our ethical codes. And I think it’s one that is kind of glossed over just a little bit. And I admit that even when I teach the introductory law and ethics courses that I have taught in the past and talking about the four principles ethics of autonomy, justice, beneficence and nonmaleficence, that there have been times where I stood in front of first year graduate students and just being like, beneficence, that means do good, like, like, do things that are good. So now moving on to nonmaleficence, where there are plenty of evidence of people doing bad. Let’s focus a lot on nonmaleficence. And we had some stuff come across our, our emails, our social medias that made us look at some things that was like, whose benefit is this stuff for any way. And in our ensuing discussions, both with each other and with people in our modern therapists community, we started to boil down that: not a lot of people are taught really well about beneficence. So Katie, I always kind of transition something over to you at the beginning of these episodes. And you’ve been my longtime partner here on the podcast. But what was your understanding of beneficence before we even started getting into this, like early part of your career? Go back to young therapist Katie, what did you understand beneficence to be?
Katie Vernoy 3:23
My mind is what a whole bunch of places. I know, I knew that you were going to ask me some question. I didn’t know what it was. So, this is me talking off the cuff, I think. But when I first started, the closest thing to beneficence that I think was talked about in a supervision session was in talking about how to work with teenagers. And all of us were complaining teenagers just want to talk about their friends and all of the stuff. And so obviously, nonmaleficence is like don’t do horrible things to them. But the beneficence element of it, it was like we’re not doing anything in therapy, we’re not doing good in therapy. And my supervisor was like, trust that your teenager is going to talk about what they need to talk about and you’ll find something that’s really relevant to their treatment goals before the end of the session, and make sure to do good for about 15 minutes a session. Like focus in on doing some some sort of positive intervention, some sort of active work in therapy for 15 minutes. You do that and you’ve done good work with with teenagers. So, that’s kind of where my mind went. But I think in truth, that’s me framing it as a discussion of beneficence. Now, it wasn’t discussed as beneficence. It was discussed as like, here’s how you don’t do crappy work with teenagers. I think I had the same kind of understanding of it. It was just do good. And don’t do bad. Like I don’t think there was a big conversation about beneficence as I was a young therapist.
Curt Widhalm 5:01
So I think that we probably need to talk very, very briefly about just the differences between beneficence and non-maleficence. Just to help clarify some things real quick, this is not the focus of the episode. So we’re not going to spend a ton of time on this. But beneficence is, do what is good, do what is good for people, do what is good for the clients, and hopefully within the context of the therapeutic treatment. Nonmaleficence is not only don’t do harm, but it’s also take active steps to help prevent harm from happening. So if clients are engaging in things that are harmful, this is where, you know, like in residential treatment centers, like people will be put on like level systems to prevent them from engaging in opportunities that could lead to harm. I’m thinking of like eating disorder centers that might not allow people to be at a level where they’re able to be a little bit more physically active. So that is nonmaleficence. It’s also preventing clients from doing harmful things. I think we tend to focus a lot more on when people violate nonmaleficence. And just because law and ethics is all about creating anxiety and scaring people into good behavior that we tend to not really focus in on what is the decision making process around beneficence. Like what how do we determine what is actively good. And I think that we sometimes try to do that within our theoretical models, or we do that within our theoretical goals for clients. As far as like, oh, we are helping you learn and attain new skills. We are helping you to be able to show progress towards goals that we have theoretically worked on together as evidence that we are doing things that fall under the category of beneficence. However, we look at things like applied behavior analysis as an example where we can push somebody towards goals, we can get them to do things. But if practices are used that are abusive in the process, is that actually something that falls under the category of beneficence? So, this is a little bit more of where the focus of our episode is going is, how do we determine what is actually good, where we as a field currently stand when it comes to our principle ethics as not only beneficence and nonmaleficence, but within the ideas of also autonomy and justice as how we make our decision making process. Why we need to think about this actively more in thinking about it as examples, like you said, of being active participants towards doing good beyond just getting to an arbitrary treatment goal.
Katie Vernoy 7:57
Sure, sure. I think that there’s so much there. And I want to kind of preface the episode with some of the thoughts that we’re planning to go into more deeply. The most obvious beneficence versus something else oftentimes is client is therapist self interest. Like, is it in your benefit, or is it is for the benefit of the client, we’ll go into that deeply. We’re also going to talk about, I think, a deeper concept around addressing clients distorted beliefs, things they believe that are wrong, and are harmful to themselves or other people. So we have some, I think, some really deep conversations that we’re going to have around making those decisions. But when we’re talking about the core principles to kind of finish out this philosophical part of what beneficence is, I think it makes sense to look a little bit about beyond beneficence versus nonmaleficence. But into this idea of client autonomy. Now we have a whole episode about client autonomy. So we’re not going to go a long time there. We’ll link to the client autonomy episode in the show notes over at mtsgpodcast.com. But you started talking about kind of this idea of what’s good for the client, and us pushing goals. And from what we’ve read, and there’s a great article you sent over about the just sort of beliefs that we’ll get into later that mentioned this. But this idea of beneficence, if we’re pushing what we think is best for the client moves into paternalism or parentalism, however you want to describe it. That means that we’re rolling, you know, steamrolling our clients into what we think is best for them. And so client autonomy in that regard is something that has to be balanced when we’re thinking about doing what’s good for the client or good for society.
Curt Widhalm 9:54
So, I’m going to start with an article. This is from the Indian Journal of Private Psychiatry 2023 I’m hoping that I’m at least somewhat respectfully pronouncing the author’s names on this. This is by Bhattacharya, Desousa, and Ghosh, and they are talking about some of the aspects around suicidality as it comes to looking at some of the core principle ethics here. And I think for a lot of us who were trained, I will just say 15 plus years ago that a lot of the core principles of ethics that we were taught first and foremost: Is first and foremost, do no harm.
Katie Vernoy 10:39
Yeah, nonmaleficence.
Curt Widhalm 10:40
Nonmaleficence, you are correct. They said, The American Psychological Associations Ethical Principles and Code of Conduct laid out ethical principles that are meant to nurture an understanding and desire for having an ethically sound relationship. This text is based on the primary principles of beneficence and nonmaleficence, fidelity and responsibility, integrity, justice and respect for people’s rights and dignity. Historically, the principle of beneficence and nonmaleficence took precedent over other principles and was considered the goal of not only mental health professionals, but physicians, on average, to the extent that these principles were often given more importance than the wishes of the client. However, autonomy has overtaken beneficence as the primary principle of medical ethics over the course of the last 25 years, and has become extremely intertwined with the concept of beneficence. Now, I take this to say and see in kind of practice in the way that we talk about clients, and particularly with the way that I see earlier career clinicians talking about ethical decision making is this idea that autonomy should be respected above all else, and therefore, what is autonomous is beneficial. And I don’t necessarily agree with that. That’s our whole previous episode on like…
Katie Vernoy 12:06
Yeah.
Curt Widhalm 12:06
…as therapists, we actually have to do something. We actually have to have an opinion on things. So, it still comes into which of the core principles are really the primary ones to start with. And this, I think, is really the core of this episode with: none of them are first and foremost, they all are first and foremost. And part of our decision making is which ones apply in which situations.
Katie Vernoy 12:38
Which makes the decision harder, right? Like…
Curt Widhalm 12:40
Oh no, we have to make hard decisions!
Katie Vernoy 12:44
Well, I think I just want to comment on that. Because when we’re looking at nonmaleficence, it feels like triaging, that would be the worst thing. To do something harmful, feels like it would be the worst thing. And I think that the other elements of these core principles, I think, really do raise to a level that we need to look at them, if not all at the same time, because I feel like triage, we, you know, don’t sleep with your clients. And then you can look at kind of the lower level, nonmaleficence, in line with the other beneficence, justice and autonomy. But to me, I feel like these decisions, while difficult, often feel very intuitive in the room. And so I think when I was reading through some of that, through the article that you sent over to me “Ethical considerations for addressing distorted beliefs in psychotherapy” by Conlin and Boness, 2019. I was thinking, Yes, this is kind of what I do, but it’s laid out really well here. And so, to me, I feel like some of this is going to feel intuitive. And I think some of it is not going to feel intuitive. And so I want it to just acknowledge that although this makes the decision more difficult, because you have to hold these four principles at the same time. Some of it just makes common sense.
Curt Widhalm 14:08
It makes common sense to those who think about it. And I think that this is maybe the the starting point is what kind of sparked all of this in the first place is we came across a social media post of a pre-licensed therapist who had taken a BeReal picture. And for those of you who are not familiar with the app BeReal, it gives you a prompt once a day to take a picture of what you’re doing and it takes a picture from both your front facing camera and your selfie facing camera at nearly the same time. There’s a small opportunity to be able to kind of change positions but it is meant to be kind of the anti-Instagram like here’s a lot of people who have boring lives and it’s not all like glammed up and gussied sorts of things. Now, what had happened in this particular BeReal is a therapist had taken a picture during session. And they had blocked out the the client sitting on the couch with their hand. So it was obvious that there was somebody sitting on the therapeutic couch. But there was some sort of you know description on it that was like protecting HIPAA, obviously taken with client consent. And the immediate reaction amongst the social media therapists online was, this is really bad.
Katie Vernoy 15:35
Yeah.
Curt Widhalm 15:37
And it led to some discussions around okay, the therapist is saying, I asked the client, the client gave some consent. And what is it about this particular situation that makes it to where this is still not good? I mean, clients can consent to all kinds of things. We have all kinds of dual relationship kinds of things. But where do we actually have any laws or ethics around saying, don’t take blocked out pictures of your clients from sessions and post them on your social media?
Katie Vernoy 16:15
When we had a long conversation about like, is this actually harm? You know, is the client losing their confidentiality without really understanding it? Like, yes, the face is blocked, but you can see like the arm, arms out doing a peace sign, and there’s a water bottle. I don’t know how common it is. Like there’s there’s clues, potentially, that might reach confidentiality, but there’s not a lot there. It’s, it looks like a white woman, most likely in therapy, which is, you know, pretty much most people in therapy. Not all thank, thank goodness, but it’s it’s pretty, pretty not there’s there’s the breach of confidentiality, if it is at all is fairly low. So, the part that I think is really hard is we don’t know the relationship the therapist has with this client. We don’t know what the conversation was. We don’t know what the therapeutic treatment goals are. So, we’re making a lot of assumptions here. But if we’re looking at the power differential, we’re looking at what was happening in the session, like why did the session become about that? Like, how long did that take? How much discussion was part of it? You know, like, it seems like, although there may not have been bad harm, I don’t see how it was doing good. And that’s kind of where we came to with the beneficence episode was like, we got to talk about this, because it’s that this therapist whether the client was like, Oh, sure, that’ll be fun, took part of the session to do something for themselves, that did not help the client, as far as we know, who knows, maybe there’s a therapeutic goal, I can’t think of one that was served by that. And maybe it served the relationship in some way, I don’t know. But it is something where I can’t see how that benefited the client.
Curt Widhalm 18:04
So, even within your response to what I just said, and I don’t listeners, I promise you, we did not gear this up for Katie to go through all of the core principle ethics, in what your response was. So, you’ve done a great job of hanging around us therapy ethicists enough to be able to be like, You covered justice: Is the client informed on what this is? They gave their consent. That also falls into autonomy: Is this doing harm? Doesn’t seem like it. But…
Katie Vernoy 18:38
Well, if it is, it’s minor.
Curt Widhalm 18:40
But you wrapped it up nicely with like, but still, where is this good for the client? Where is this action good for the client? And this is where we still need to look at the interplay of all of these core principles when making decisions. Any one of the points that you had made up to that is a point that I often see some of these ethical discussions stopping. Well, the client gave consent. Okay, that’s justice. That’s autonomy. They made some sort of informed decision, theoretically, that there was a discussion on what it meant. It didn’t do harm. Okay, that is only within the nonmaleficence part of the discussion. You get your gold stars out of the day, hitting also on the beneficence aspect of it.
Katie Vernoy 19:28
Yeah.
Curt Widhalm 19:29
Now, this is not just this one instance, as far as how we kind of talk about beneficence as a field. And a lot of times I think this also comes under pretty good advice that is also like stuff that we violate all the time. And what I’m talking about here is we often are given the advice, especially in grad school, but throughout our careers that don’t self disclose unless it’s for the benefit of the client.
Katie Vernoy 19:59
Sure.
Curt Widhalm 20:00
How do you determine what that beneficial aspects to the client is? Because I know that you and I self disclose all the time in our sessions.
Katie Vernoy 20:12
And we have a podcast that where we disclose a lot, so our clients can hear a whole bunch about our lives and what we think.
Curt Widhalm 20:21
And so a lot of the parts of being more public therapists is that information is available out there. But when it comes to actually sitting in sessions with clients…
Katie Vernoy 20:33
Yeah.
Curt Widhalm 20:34
…there’s all kinds of reasons to be able to make self disclosures about things. That for my practice, it’s a lot of teenagers, or a lot of people who might have a trauma background, where just like getting into like, Alright, here’s what negative cognitive beliefs are. And that just is like, presented in a way that is less than stimulating, and it’s very hard to retain. Sometimes…
Katie Vernoy 21:04
It’s just boring is what you’re saying.
Curt Widhalm 21:06
I, it’s only boring if it comes from the boring region of France, I like to consider mine sparkling under simulation.
Katie Vernoy 21:14
Okay, all right.
Curt Widhalm 21:17
But I, I self disclose a lot to be able to be here are concrete examples of the principle that is being discussed here. This is what this skill looks like in action. Sometimes it’s about me, sometimes it’s other stories that I hear, read online, other kinds of successes, that makes it to where, all right, here’s what this skill looks like in practice.
Katie Vernoy 21:44
Yeah.
… 21:50
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Katie Vernoy 21:45
Yeah, I, I think I self disclose is for a different reason, which I think makes it harder to figure out if it’s for my benefit, or for the clients benefit.
Curt Widhalm 21:54
Well, and so tell me more about that, because that’s the kind of stuff that we’re trying to comb through here in a discussion about beneficence.
Katie Vernoy 22:04
Well, I think for me, I have a lot of my clients are executives who have impostor syndrome, or neurodivergent folks who are just figuring it out, or some folks with trauma, a lot of folks that have a lot of attachment wounds. And so a lot of the times I self disclose, it’s to humanize myself, to normalize certain situation, to strengthen the relationship. And so there’s times when all disclose what I’m doing on vacation, or why I’m taking time off, so that clients understand a little bit more about how I make decisions. Sometimes it’s about telling my clients that I’m in therapy, and potentially that I’m have been in therapy longer than they have. So it’s not that bad. I think there’s, there’s a lot of pieces to this, where there are times when it feels to me very connecting, but I have to definitely watch and pay attention to how the, how the client responds to it. But there’s times when I feel like it could be me trying to make excuses like, hey, you know, I’m taking time off again, but it’s medical, this time, I promise, I’m okay. It’s, you know, so I think it’s, it’s something where I feel like I’m constantly assessing, will this benefit the client or not? Will this benefit our therapeutic relationship or not? And what will the client do with this information if they have it? And so I don’t think I always get perfectly, you know, I don’t always perfectly do that. I think that I, I pass the low bar of I don’t cause harm by what I disclose. But as far as is it beneficial? I think that’s the part where, you know, kind of sorting through, is it beneficial to them or not? I think that’s something where I feel like I can strengthen that even more by you know, kind of thinking through the things that we’re talking about in this episode.
Curt Widhalm 24:14
I like the you’re talking about this in a way that is not just like, I sit down and make the exact same decision every single time for every single client. And this allows for us to make this more than a one size fits all approach for the work that we end up doing. Because a lot of the discussions that I see on how we should approach situations, how we should approach certain clients, I think we’ve mentioned this on the podcast several times before is that there are not one size fits all answers. There are reasons to treat different clients differently and to be based in some kind of principled decision making of how you come to those conclusions is really what makes that necessary, or what makes that work. But it’s doing what you’re describing thoughtfully, because it is really more of a dynamic process that is okay, while doing no harm and doing good, am I also taking into account that I am practicing within the principles of good therapeutic work? People, for example, taking one of the things that you’re saying; people, for example, that might be doing self disclosure in order to benefit the relationship, if that is the sole aspect of why they’re sharing, that’s not therapy. That’s sharing about your life to hopefully just build rapport, but it doesn’t necessarily speak to the fidelity of good psychotherapeutic treatment. If that was the case, then we’d all be, you know, just therapeutic helpers on social media being like, here’s my life story.
Katie Vernoy 26:01
Well, it’s paid friends, right. And I think, to clarify what I meant by kind of strengthening the relationship, it’s making sure that they see my humanity in a way that is connecting, and helps them to further their own insight. And even me modeling some vulnerability, because a lot of my clients don’t know how to do it in a boundaried way. And so some of it is, here’s a skill, it’s more meta than like, let me give you an example of a skill, it’s like, let me be in this relationship with you, and show you how I do that with you. Right?
Curt Widhalm 26:35
Right. And so sometimes that decision making is also going to change as new evidence is provided.
Katie Vernoy 26:45
Sure.
Curt Widhalm 26:45
I have had situations in the past where I’ve had clients come in to work on things like dissociation. And to be able to not only get to trauma, work with them, but to also be able to give skills to kind of work through dissociation, so that way, we could work on trauma, we would do things that would help to bring more attention, more mindfulness to things. And it might take the form of like, here is very specific grounding exercises that help us to be able to, you know, notice exactly where we’re at within our window of tolerance. But depending on the clients, it might be wrapped into a game that’s just like, here’s how to be able to kind of sit and focus on something that doesn’t necessarily look therapeutic. But it’s something that is therapeutic by its nature. And I recently had a client be like, it seems like we just played games for like, 20 minutes. And I was like,alright…
Katie Vernoy 27:45
And it’s a game you like, so you’re having fun over there.
Curt Widhalm 27:49
I would have liked it a lot more if I was winning, but beneficence for the client. But when I pointed out, hey, based on this measure of dissociation, how are you feeling now compared to before the game? And the client responded with, I’m actually feeling a lot more within kind of my, my grounding, my pertinent to the client language that we’re going to veer off here for a second. But and so when I was talking with a client, I’m like, this is the beneficial aspect of sometimes we have to do things to be able to kind of stay within our distress tolerance, and to be able to practice that. And sometimes that means that we’re going to actively focus on something else to be able to continue to operate here. If we were going into this with just like active trauma treatment, you would have, you would have been out of the building, you would have been across the street and out while still physically being here. So, it’s sometimes being able to say, I’ve got tools that can help, it may not be the thing that you’re directly asking for, kind of going to that autonomy question, but within the scope of everything that we’re working on, these are some of the things that we can do for your benefit.
Katie Vernoy 29:17
So, sticking kind of with it, the treatment element of beneficence. I think that, you know, if were looking at kind of therapist self interest is kind of a first range of of beneficence topics. I feel like there are a lot of therapy clients that I’ve gotten, who want a more direct approach because they’ve been in therapy before with a therapist that wouldn’t approach certain topics. And so, to me, and maybe we can make sure that we’re we’re still in the realm of beneficence versus nonmaleficence; therapists will stick with comfortable topics, they’ll stick with comfortable interventions versus going that extra more uncomfortable mile, so to speak, to do something good. So, they’re not harming the client. But they’re not actually helping the client.
Curt Widhalm 30:13
I see this sometimes in the EMDR consultations I do, particularly with the people who are first practicing EMDR, or first using it with clients. Where sometimes there’s a tendency within other treatment informed models to when clients are starting to seem overwhelmed to rescue clients from those difficult feelings.
Katie Vernoy 30:37
Yeah.
Curt Widhalm 30:38
Now, at least within the model of EMDR that I was taught, that I consult on is one of the underlying principles of it is, the way to get through the feelings is to go through the feelings.
Katie Vernoy 30:52
Yeah.
Curt Widhalm 30:53
And so when practitioners doing EMDR are talking about this in consultation of like, oh, they were starting to talk to a pivoted to a close out or a grounding technique. And I find myself talking with them about like, is the client asking you to stop? Like, it’s really hard for them in those really big feelings. And unless they’re giving signs that they’re having a bad reaction an ab-reaction to this, they’re starting to dissociate or something like that. If they’re not telling you to stop, if you’ve given them the permission at the beginning of treatment to be like, hey, I need to stop. The model says, continue doing what you’re doing, because that’s what’s actually working there. This is, it’s hard to see people going through this, but it’s beneficial based on what the research base of it is.
Katie Vernoy 31:48
I think that’s a great example. Because I think it’s such a specific thing within a model that is really hard for therapists, you know, this, this idea of rescuing clients from their emotions. I know, it’s probably something I’ve done, especially as a younger clinician, because it is something where it’s like, I want them to feel better. Right?
Curt Widhalm 32:07
Right.
Katie Vernoy 32:08
And that’s my own discomfort. It’s not theirs. And so I think, I think there’s an argument here that that potentially could be a doing harm, because you’re actively pulling them out of something that would be helpful for them and stalling their treatment. But I think it goes more towards the beneficence. You’re not doing something helpful. And so to me, when I was originally thinking about this part of the topic, I was thinking about therapists that just won’t talk about really hard stuff, because their clients don’t want to.
Curt Widhalm 32:38
Right.
Katie Vernoy 32:39
But, but this idea of rescuing clients from their emotions, I think, is a strong one. And I think that that’s, that’s a good, I think that’s a good example. And so I want to I want to make sure we get through the other types of therapist self interest as we’re going along. We have a whole episode on this. So I’m just going to mention it so people can go look at it. You mentioned who you choose to work with and who you don’t work with as a therapist self interest that is not following beneficence.
Curt Widhalm 33:10
And so a lot of the ways that I see this, and we’re not going to rehash this argument, but a lot of the ways that I see this is particularly around female presenting therapists and their choice to work with male clients or male presenting clients. If we’re making choices that are only for our own self interest in our own self beneficent, then we’re not actually doing the good for the public that our licenses say that we can do.
Katie Vernoy 33:43
We have a couple of episodes on that. I think one is a shorter episode called: Is it discrimination? And we have another one that’s like a CE version of that, I believe. And it leads to the other part of this argument, which is therapist self care, and therapist self protection. I think that’s a, you know, we have a whole conversation on it around discrimination. But I think going beyond who we work with, I think there’s that element of, we’re allowed to take care of ourselves, we’re allowed to protect ourselves. And so how do we make a decision there? Because I know how I do it. But I’m wondering if you have ideas around: when do we go beyond: this is my self care, this is my self protection? To okay, this I have to do this for the benefit of the client.
Curt Widhalm 34:32
There’s going to be different answers depending on different contexts of this. For many of the people that I see making this decision, they’re running their own practices, they’re the ones who are setting their hours, setting who they work with, setting their marketing, but this might not be a choice as much in working in agencies where you’re assigned clients. And so again, trying not to be like there is a one size fits all rule that unites our field. What unites her field is the ability to think, ethically and intelligently given the contextual variables. And there’s a bunch of contextual factors that may even change during the course of one week to the next. That without making kind of a contextual decision based in every single one, you’re falling short of the thoughtful process that licensure actually tells the public that we make in these kinds of decisions.
Katie Vernoy 35:32
In the self protection, we actually have an episode, it was therapist danger, or or I don’t remember what it was, it was after a shooting. And we actually went through kind of making that decision around therapist protection. Because there are times when some therapists will think I have to stay here because this client is suicidal. And or this client has this thing or that thing going on. And there are times when it is perfectly ethical and legal to just leave because of their own danger. And so to me, that’s has to be for your benefit, if if your life or or well being is at great risk. And that’s a hard decision to make when things are much smaller, and what people call violence has shifted over the years. And so I think it is an individualized decision. But I think self protection, there are certain almost absolutes, like if you stay and you will get killed, you can leave. That is an absolute. I think this the therapist self care and we also have, you know, discussions around this with our systems of self care, we have other things like that. But I think there are times when we make choices around: Am I too sick to work? Am I able to do an evening appointment? Can I take this client on because they have high support needs, and I don’t have the space for them? And so I’ll link to episodes where we’ve gone into some of those self care versus client care conversations, because I think that they are pretty challenging for both folks who are imagining this, you know, 12 caseload with very low need clients, where they spend the rest of the time sitting on the beach and doing yoga or whatever it is, right. And so I think that there are responsibilities beyond what we’ve said as our our kind of ideal practice, but there are abilities to take care of yourself beyond, Well, I only can do this if unless if it’s in the benefit of the client. Does that all line up for you, Curt?
Curt Widhalm 37:50
I think it does. And I think that it makes the same danger that we had talked about earlier of only looking at one of the core principles at a time. But if we were to only look at this as: I am solely going to set out after listening to this wonderful episode with the intention of only doing beneficence for the people that I serve, you will run into the situations that you’re talking about. Yeah, but this is another emphasis on you have to look at all of the principles together and to make the decision that sometimes beneficence is the most important one. It’s not the least prioritized one.
Katie Vernoy 38:32
Yeah.
Curt Widhalm 38:33
But it has to be a part of the conversation.
Katie Vernoy 38:35
Absolutely. Absolutely. So there’s a couple other things we put kind of on our list of therapists self interests that we probably should go through quickly so we can get to the last segment before we run out of time: having a therapy dog.
Curt Widhalm 38:50
Is the dog registered?
Katie Vernoy 38:52
I think that’s step one. But I think there’s some folks that kind of bring it along after therapy has begun. And so I think the quick answer is it needs to be part of the treatment plan and there needs to be client consent. Informed client consent.
Curt Widhalm 39:10
Informed client consent. I don’t remember if we’ve done an episode on this in the past, but several years ago in California, there was a therapist who had brought their dog in and was kind of considered the therapy practice dog and the dog ended up biting a child client. Like the it was a small child and the kid kind of like reached up and grabbed onto it with both hands. The dog nips the child’s ear and caused the kid to bleed and I think there were stitches involved, like there was there was substantial injury. And part of the California BBS case around it was that it wasn’t a registered therapy dog. It wasn’t something that there was any kind of consent around the benefits and dangers of having a dog in and around the practice. And while the dog had been well behaved, or seemingly 99.9% of the rest of the time, this was not something where true informed consent was to be able to be there. Now, this is one of the dangers out of, well, it seems to work, therefore, it’s good; is not really part of the thought process. And while, I know that it’s very expensive to run through all of the certifications, and everything else to get a dog trained as an actual therapy dog is something that is distinctly different than bringing your very nice pet into the practice that is therapeutic. But it’s not a therapy dog.
Katie Vernoy 40:43
Yeah. Yeah. So, I think that’s good for that one, then the other one that I want to make sure we get to is out of, you know, between session out of session contact. So, I’ve had a lot of different responses and reactions to this. Obviously, you hear therapists or clients talk about therapists that that manage it differently than you do. And I know for myself, when I something’s happened in session, and I’ve thought about it, and whether it’s like, I want to share something quickly, or I want to make sure the clients okay, because it was a difficult confrontation, or there was a misstep or that kind of stuff. I know that there are times when I use my own anxiety reducing coping strategies to wait for session, because I recognize that reaching out to the client between sessions will help my anxiety, it is not a benefit to them. There are other times I’ve made the choice to contact clients, because I feel like there was a repair needed and it was appropriate. But like, it’s something where reaching out to a client between sessions may be not harmful. But if the benefits for me, I think I have a harder time justifying reaching, reaching out between sessions.
… 42:02
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Curt Widhalm 42:05
So again, not necessarily creating one size fits all…
Katie Vernoy 42:09
Absolutely not.
Curt Widhalm 42:09
…kinds of responses.
Katie Vernoy 42:11
For sure.
Curt Widhalm 42:11
And part of helping you to be able to make some of these decisions is, if I was going to have to explain this to a licensing board or an ethics committee of why I’m reaching out to a client at a particular time in between sessions, there better be pretty good reasons for why this is the client benefit. For the day that we’re recording this right outside my office, there is road construction happening that is very much affecting people’s ability to park and get into my building. I am sending messages to all of my clients out of the day, that is, hey, here’s the situation, give yourself, you know, a little bit more time both to enter and to leave the building because this situation is not part of the normal. I think I can pretty much be like that is entirely for the benefit of the clients. And maybe there’s some secondary like, then they’re not frustrated with me when they actually get here, that I’ve given them at least some knowledge that here’s what you’re walking into today.
Katie Vernoy 43:19
And also, they won’t be late. So you’ll be waiting around like there is some benefit to you.
Curt Widhalm 43:23
Yeah, exactly.
Katie Vernoy 43:24
But it’s primarily benefit for the client. So I think that’s that that makes tons of sense.
Curt Widhalm 43:29
Now, in things like DBT, I know that sometimes some extension of what is happening in sessions is sometimes encouraged as far as like helping people to be able to be like, there are people who are thinking about you in between sessions. And here’s something that might just brighten your day, just a little bit within, you know, very difficult parts of treatment to be like, here’s something that just kind of is neutral or fun just to be like, hey, hope you’re doing well. Here’s a gift of some cats. Like…
Katie Vernoy 44:05
That’s kind of cool. I haven’t done that. But that’s, I like that within that treatment model. It makes sense because there’s already the opening for coaching calls. I think when the the initiation of texting by the therapist is primary versus the client needing or seeking some of that additional support, I get really worried about it.
Curt Widhalm 44:28
This is where having your thought process and for all of the people who may need this, your attorneys telling you, and documenting the thought process, is really what backs it up. Like if I’m texting clients like hey, here’s a recipe that I made. It made me think of you. That is entirely for my benefit.
Katie Vernoy 44:52
Sure.
Curt Widhalm 44:53
It should not be allowed and why I don’t do it.
Katie Vernoy 44:56
All right. All right. So I think for the most part, we covered what we had wanted to about therapist self interest, we’ve got probably about 15 minutes left. And so I think it’s time we switch over to addressing distorted beliefs. With a great article that we will link in the show notes, because I think it’s an easy read. And it has really good tools around like a decision tree and questions to ask yourself. I think it goes beyond addressing distorted beliefs. I think the decision tree and the the questions you can ask, but I think the idea around distorted beliefs is much more nuanced. And I think especially relevant in the coming months with all of the political and other worldly things that are happening in the world, where it gives us an idea of what do we do about this? So I’ll let you start off on this topic.
Curt Widhalm 45:47
This does come again to kind of that ethical decision making around what is beneficial? What is harmful? And what is truly autonomous? And kind of looking at the interplay between all of these is, how do you do this when the clients beliefs are incorrect, and have the potential for harm. So, this is not just a beneficence discussion, this is also has very much the underpinnings of nonmaleficence; helping prevent harm from happening when it’s based in things that are scientifically not accurate. We are trying to frame this episode as Hey, beneficence. But we keep coming into its beneficence as part of a decision making. And this article you had mentioned earlier, this is by Conlin and Boness. And once again, its “Ethical considerations for addressing distorted beliefs in psychotherapy.” And the decision making tree that they put in you here helps to kind of organize some of the stuff that you were referring to earlier as things that you just kind of pick up and you’re able to do. But a lot of times when it comes to anything that we can kind of think ahead and to be able to have our decision making plan for us. So that way, we’re not stuck in trying to come up with this stuff in the moment.
Katie Vernoy 47:16
We’re trying to prove ourselves right.
Curt Widhalm 47:18
Right. It’s it’s practicing like fire drills, like we do fire drills so that way when there’s a fire, we know what to do.
Katie Vernoy 47:27
Sure.
Curt Widhalm 47:28
And being able to have some of these decision making models already laid out for us really helps. So in this article, what they talked about is in working with distorted beliefs, this helps us to consider whether and how to address a distorted belief. So that way, we can still arrive at what is beneficial, or what is at least preventing harm when it comes to clients with this. And honestly, it’s a decision making model that when people are going to do consultations with me and they are basing information about their practices around things that they are factually wrong to start with. I’m probably going to use this model with them as well.
Katie Vernoy 48:18
Sounds good. So just to clarify, the distorted beliefs are not like cognitive distortions or irrational beliefs. These are things that are objectively incorrect based on the current scientific evidence base, and are causing harm to the client or others. And what they have a vignette in here about a young man who is potentially sexually assaulting women, and believing that it’s, well, they really want it they’re just playing hard to get or whatever it is. And so it’s an interesting article, but there is, you know, some conversations about do you address this with this this young man or not. Now when it says objectively incorrect based on the current scientific evidence base, I feel like even in the vignette, they move away from like, should, are vaccines healthy and and safe like that there’s an objective scientific evidence base to almost going into, like, political opinions and those types of things. And so, I feel like there is a little bit of a, an assessment on the objectively incorrect based on the current scientific evidence base, that one will have to make given how politically divided we are, how people are, you know, kind of alternative facts, all of these things. I think that the first decision: is this a distorted belief or is this somebody that disagrees with me is an important one that they kind of skirt over because they assume that all therapists are going to be able to assess the objectivity and the current scientific evidence base. And so I believe that we mostly can. But I think that there are some things that feel very, very true and very, very objective that are really our own beliefs. So I think that that is one addition I’d like to make before we jump into the rest of these things.
Curt Widhalm 50:20
Part of what I like about this model is it makes us have to kind of deal with our own feelings, because the questions around countertransference are not at the top of this model, they’re in the middle of it. Because that does inform our decision making about this. And it makes us to not have to completely put ourselves to the side, but have to be able to examine difficult topics from all different viewpoints in order to be able to arrive at what is in fact beneficial to the client. For example, anybody who has worked with distorted beliefs knows that arguing back with your client about what is factually correct often is not productive for therapy. That you can provide all kinds of evidence, but if it was just as easy to change people’s belief says, Hey, here’s some contradictory evidence that proves you wrong. We would live in a much different society and the internet would be a much different and nicer place where we’re all agreeable with people. But in dealing with how the world really works, we know not to do that. And so kind of in response to our beliefs, factually correct or incorrect, part of this model ends up looking at is this a harmful belief? Is this a client who is talking about having delusions that lead to big feelings of anxiety that lead to suicidal thoughts? That is something that is harmful, as opposed to a client who’s coming in and being like, I believe that seeded grapes are money laundering front for the mafia, that…
Katie Vernoy 52:05
One of Curt’s things seeded grapes.
Curt Widhalm 52:07
Right, one of those is harmful. One of them is: All right. That’s a belief.
Katie Vernoy 52:14
Yes.
Curt Widhalm 52:14
And that helps us to be able to make our decisions as far as do we need to actively intervene with this? Or is this just an amusing anecdote or made up story?
Katie Vernoy 52:27
Yeah.
Curt Widhalm 52:29
If it’s something that we actively have to engage in, or…
Katie Vernoy 52:34
Like abuse, neglect, duty warn that kind of stuff.
Curt Widhalm 52:37
So, there’s laws to follow. And the decision making is follow the law?
Katie Vernoy 52:42
Yes.
Curt Widhalm 52:43
But then it becomes something where now we get into the interplay of some of the other ethical principles that come in. Does the client want to discuss this?
Katie Vernoy 52:54
So, this is client autonomy?
Curt Widhalm 52:56
Yes, exactly. So if they want to discuss it, discuss the belief that is beneficial.
Katie Vernoy 53:05
Done and done.
Curt Widhalm 53:07
But if they don’t, then you are faced with further decisions. And this is sometimes where it gets into some of the uncomfortability of you actually having to act like a professional and do professional job kinds of things, which is, if it’s necessary, then you get into some of the well how do I feel about this? What informs my decisions? And this might…
Katie Vernoy 53:32
Before we go to that, I just want to comment, like, if you determine it’s not necessary to discuss the belief, and I’m not sure the reasons why you would if it was harmful, and was leading to harmful actions, but if there was some reason that you decided it was not necessary to discuss the belief, you don’t address it at that time. But if you do, then you go into your own beliefs, but I just wanted to comment on that. There is a there is a an escape hatch there around is it necessary to discuss the belief.
Curt Widhalm 53:32
Well, so I have maybe an example of where it may not be necessary to discuss the belief at the time. For somebody who’s experiencing, let’s say, something like delusional disorder where it does lead to based on the conclusions of the delusion that they end up having very strong anxiety and very strong, suicidal feelings based on that anxiety. If it’s something where you can treat the anxiety without necessarily discussing the belief at that point in treatment, then it may not be necessary to discuss the belief while working on practical anxiety reduction skills.
Katie Vernoy 54:45
Sure, okay. That makes sense. So, like if the if if it’s harmful, but the client doesn’t want to talk about it, you may be able to mitigate the other impacts of it.
Curt Widhalm 54:53
Yeah.
Katie Vernoy 54:53
Okay. Cool. All right. But let’s say it is necessary to discuss the belief. Moving on.
Curt Widhalm 54:57
Then you need to kind of examine your responsiveness. Are you having countertransference? Is it particularly salient to you? Sometimes I hear, you know, some of my colleagues that are working with anti-semitic clients, but the therapist themselves comes from a Jewish background. But that is particularly salient. Is it an empathic failure? Is it something that I can’t, as the clinician come across in a way that is caring about this to be able to help work through clients? And the result of any of those kinds of questions, there is get consultation on how to work through this, because just because you’re having feelings doesn’t necessarily mean that you can’t be beneficial.
Katie Vernoy 55:45
Yeah, yeah, I think the thing that I was thinking about with the empathic failure, is there are times when, you know, I’ve got a lot of male clients, and there’s times when there’s a flavor of what is popularly called toxic masculinity. And there are times when I have difficulty with empathy there. And so I, you know, at times, I’ll consult with you or consult with other colleagues, but I feel like I’ve gotten a pretty pretty, you know, good shell around it. But it is something where I in the past, it was a belief that was personally salient, there was some countertranference I was experiencing. And it was an empathic failure, until I started kind of digging deeper looking at what where is this coming from? Why is this where this whether this, this person is going to? You know, and so I was able to kind of get back into, okay, now I’m understanding this person a lot better. And so it was easier for me to deal with it. But I did have to go through this process of like, Can I sit here with someone who’s watching the, you know, crazy guys on YouTube, or TikTok, or whatever they’re saying stuff that are absolutely completely diametrically opposed to what I believe about women, and sit with this person and be helpful to them. And so I think this is a tough one. And I think it’s a really good process for getting yourself to a place where you can work with more folks more effectively.
Curt Widhalm 57:07
And so after doing your consultation, you come to the question: Is even after examining my role in things, is there a possibility that, that discussing the distorted belief, even at this point, will discussing it change with the clients view is? Now I’m using delusional disorder as kind of a really good example, to help work through this model here, because even if it’s something where you as the clinician are now, okay, I’ve wrapped my feelings around things, I can kind of get to the nuanced layers of things. If you’ve ever worked with somebody with delusional disorder, you still know the same thing that I said at the very beginning of this decision tree, which is presenting them with factual evidence otherwise does not work whatsoever. But if there is a more nuanced conversation that you’re able to have about things, your decision at this point is: okay, if it’s still not going to be helpful, don’t address the belief.
Katie Vernoy 58:04
Sure.
Curt Widhalm 58:05
If it does have the potential to change the client’s view, this is where you start to bring in some of this discussion with the idea that it could alter the course of therapy, and that could be a good alteration, or it could be something that pushes the client out of therapy altogether.
Katie Vernoy 58:24
Sure.
Curt Widhalm 58:25
So on that, and again, coming back to autonomy, with the goal of beneficence is, is the client willing to engage in something that might alter the course of therapy? So looking again, at autonomy here, and the way that this might sound in sessions is, hey, you’ve got this thing that contributes to your anxiety and I know that you’ve been told by other people that what your belief is is not true. Are you willing to talk about that belief knowing that we might not agree on it? And that might really affect the way that our relationship ends up going. We have done beneficial work up to here by reducing your anxiety. But it seems like this is a step that often leads to that anxiety, and there might be some beneficial aspects out of getting to the core of your anxiety rather than just managing it.
Katie Vernoy 59:23
And then the client makes the decision.
Curt Widhalm 59:24
Exactly.
Katie Vernoy 59:25
And if they say, No, you don’t address it. But if they say yes, then you start moving in the direction of addressing it but then you go to: do I have sufficient training and education in this area, because sometimes it could be something that isn’t your area of expertise, isn’t something that you know a lot about, and so then you looks like, can I get sufficiently educated? And if so, go for it. If you can’t, then you may have to refer out.
Curt Widhalm 59:51
Some of the aspects on this is can you get that training in a way that is open and fast enough? Is it something that you’re able to have a strong enough therapeutic alliance to be able to continue working through it while you’re getting that training and background.
Katie Vernoy 1:00:08
Yeah.
Curt Widhalm 1:00:09
And some of this stuff is going to be a lot more difficult than others. If the therapeutic alliance is kind of shaky, you know, as much as all of our modern therapists, I believe that you are fantastic at building strong therapeutic alliances with clients, from the very getgo, I admit, probably doesn’t happen in every single situation. Because sometimes what might come up in these distorted beliefs is tension in that therapeutic relationship. Even if the client is making the informed autonomous decision, yes, I’m willing to go there with you. And you’ve got conflicting feelings that might be present in that alliance. That is something that you have to continue to tend to and continue to talk about it while you get whatever training is necessary. Otherwise, this might be the point where you make referrals.
Katie Vernoy 1:01:06
Sure.
Curt Widhalm 1:01:07
So, within this, even if it comes back to the question that you were posing earlier, as far as things like, therapeutic safety, I think that there’s the point around like, is this based on just trying to skip through an entire decision making model and arriving at an outcome that justifies our feelings? Rather than going through step by step like: Is there things that I can do to manage this. It’s the same kind of things that we do that are going to be for the beneficence of clients.
Katie Vernoy 1:01:41
And so to finish out the model a little bit that if you decide not to address the belief at this time, for whatever reason, there was a lot of different ways we got there, then you ask yourself, can I still provide quality services? And if the answer is yes, you continue with therapy. But if the answer is no, you’ve decided not to address it, and you don’t believe you can provide quality services. This is another reason that you would refer the client to an appropriate provider. And there’s a lot of different reasons, and we’re really short on time. So, I want to make sure that we are able to close out. But this model is really quite, I think, impactful and can also be how do I decide what to talk about, you know, when there’s something that’s coming up? I mean, we it’s, what are my feelings about it? Do I have the training on it? Is a client on board? Like there’s a lot of really good questions here. So, I would highly recommend reading this article for both of beneficence element of it, but also in some clinical decision making around working with a client because it’s, it feels very simple and intuitive, but I think it gives a really good basis for that decision making.
Curt Widhalm 1:02:47
You can find our show notes over at mtsgpodcast.com. Listen at the beginning and the end of the episode for information on how to get CE credit for this. And follow us on our social media, continue the conversation over in our Facebook group, the Modern Therapists Group, and until next time, I’m Curt Widhalm, with Katie Vernoy.
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Katie Vernoy 1:03:07
Just a quick reminder, if you’d like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.
Curt Widhalm 1:03:22
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