10 Myths Or Faulty Beliefs In Psychotherapy And Counseling
By Ofer Zur, Ph.D.
Our profession is inundated with all kinds of unquestioned faulty beliefs regarding what is always right, ethical, legal, or what one must do or not do in certain situations. Many such unfounded urban legends that haunt therapists are often fueled by fear and rigid risk management ideology.
Following is a short list of the ten most common, faulty beliefs.
Please, forward to colleagues and let us know if you think there are other faulty beliefs we have missed and forward this email to colleagues.
Myth #1: If a client drops out of therapy, we must follow up with a registered letter and make a referral.
Fact: Clients have the right to terminate therapy any time they wish. While sometimes a follow up letter expressing our concern and offering to give referrals is appropriate, many other times it may not be necessary or appropriate. Be flexible and remember that different situations require different responses. One intervention does not fit all.
Resources on Termination:
Free Article on Termination Guidelines
Online course on Termination
Myth #2: Outgoing answering machine messages must mention 911.
Fact: There are neither laws, nor ethics codes, nor acceptable standards that mandate putting a 911 statement on a therapist's outgoing phone message. In fact, having the statement, "If this is an emergency, go to the nearest emergency room or call 911," may harm a therapist's practice if potential clients assume that your clinical focus is on suicidal or very unstable clients. As a result, therapists are likely to miss out on healthy people who seek counseling to discuss issues of health, love, or spirituality. Additionally, calling 911 is not always helpful, it could be the wrong intervention for some people in certain situations.
Resources on Risk Management:
Free Article on Risk of Risk Management
Online course on Risk Management
Myth #3: Dual relationships are always unethical.
Fact: This myth is not only incorrect but can inhibit a therapist from providing the highest level of care. Dual or multiple relationships are mandated in the military and in many correctional settings. They are unavoidable and are a normal, healthy part of life in rural and small, interconnected communities. They can also be helpful in other settings. Almost all codes of ethics do not consider all dual relationships as unethical.
>Resources on Dual Relationships:
Free Article on Dual Relationships Guidelines
Free Article on Key Concepts
Online course on Dual Relationships
Myth #4: The DSM is a scientific and valid document.
Fact: Like it predecessor, DSM-5 is a document that has been developed, primarily, in service to the psychopharmacological and psychiatric industries. It is a political document, which reflects decisions made by lobbying and majority votes rather than by scientific research and principles. The DSM pathologizes many normal behaviors, women, spirited-creative children and minorities.
Resources on DSM:
Free Article on DSM Critique
Online course on DSM-5: Diagnosing For Status and Money
Myth #5: Touching a client is likely to lead to sex.
Fact: This myth evolved from a paranoid and illogical concept of the 'slippery slope', which claims that boundary crossing inevitably leads to boundary violation. Sexualizing most forms of touch is a sad and harmful aspect of our culture, often perpetuated by ethicists and rigid risk management 'experts.' Over 50 years of extensive research has shown that touch is one of the most important human capacities and is essential for healthy development and growth. While sexual touch of clients is always unethical, non-sexual touch is common and can be extremely therapeutic. Rigid avoidance of all forms of touch, with all clients, can be harmful.
Resources on Touch:
Free article on Touch Guidelines
Online course on Ethics of Touch
Online course on Touch-Advanced
Myth #6: There is always an "inherent power differential" between therapists and clients.
Fact: The unfounded and self-serving myth that therapists are always more powerful than their "inherently vulnerable" clients has gone unquestioned for too long. The fact is, therapists do have legitimate expertise and role power. However, some of our clients are powerful attorneys, successful CEOs of large corporations, established physicians, renowned artists, or successful fellow therapists. Not all clients are vulnerable and, definitely, not all therapists and counselors are very powerful.
Resources on Power:
Free Article on On Power
Free Article on Power in Therapy
Online course on Power in Psychotherapy (2 CE Credits)
Online course on Power in Therapy (6 CE Credits)
Myth #7: Therapists must warn potential victims and call the police when their patients present a serious danger of violence to others.
Fact: Many therapists, who assume they must always warn a potential victim and call the police when their client presents a serious danger of violence to another, often misinterpret the Tarasoff laws. The original Tarasoff ruling, and most of the subsequent rulings, did not impose a "duty to warn" but a "duty to protect." Therapists have an obligation to do what is reasonable to avert harm, which may include calling the police or warning the potential victim. However, in some situations doing that can cause harm rather that averting it. Generally, the ruling permits warning the victims but does not mandate it. Each situation is different and laws vary from state to state. Get informed about your state laws, conduct a thorough ethical decision-making procedure, and consult with experts.
Resources on Confidentiality:
Free article on Confidentiality Guidelines
Online course on Confidentiality
Myth #8: Clinicians must use DSM Diagnoses in treatment plans.
Fact: There is a myth that giving a DSM diagnosis as part of the initial assessment or treatment plan is mandated for all clients. The fact is that many family, humanistic, group, and other therapists do not find DSM diagnoses very relevant or helpful and prefer familial, spiritual, communal or existentially based assessments.
Resources on Treatment Planning:
Online course on Treatment Planning
Treatment Plan in Clinical Forms
Myth #9: Attending a client's wedding, school play, or graduation constitutes a dual relationship.
Fact: Attending a client's wedding, school play or graduation does not necessarily add a secondary social relationship. If therapists attend these events because they think it is likely to enhance therapeutic alliance, the best predictor of therapeutic outcome, this would be considered as part of a well thought out treatment plan rather than constituting a dual relationship.
Resources on Clinical Work Outside the Office:
Free Article on Out of Office Experiences
Online course on Out of Office Experience
Myth #10: Face-to-face therapy is superior to phone or e-therapy.
Fact: Different clients can benefit from different interventions. Phone therapy has been known to be very effective in suicide prevention and in the treatment of many other conditions. Shy, highly technical, or clients who live in small communities may prefer e-therapy with a person they have never met and may never meet. The fact that most therapists have been primarily trained in face-to-face therapy and are low-tech does not make face-to-face superior to virtual therapy.
Resources on Telehealth (E-Therapy):
Online course on Telehealth
In summary, this clinical update invites you to dare to re-think some of the unquestionable myths in your professional life by employing critical thinking and thorough ethical decision-making (see Ethical Decision-Making course). Rather than blindly following some unfounded myths, follow the principles of do no harm, do good, treat people with respect and fairness, be honest, thoughtful and responsible and do your best to help your clients.
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