The technology-driven world we live in presents a number of different challenges and dilemmas both for therapists and clients, to the ones that existed twenty or thirty years ago. The internet, social media, and blogging, all give rise to their own set of questions. How much should a therapist reveal online, and how much ‘googling’ should a client do? How does a therapist’s online presence or their writing, affect their own clients, or indeed other people’s clients? What are the boundaries around online interactions, and the potential ethical implications?
I am a therapy client and I blog about my experiences of therapy and of mental health difficulties. I recently received an email (via my blog) which I found very unsettling; it was from a therapist (outside the UK) who is also a client. She was struggling during her therapy break and wanted to reach out to someone who ‘gets in’ (her own words). She told me some very personal details about her past, and she ‘confessed’ to repeated behaviour that violated her therapist’s privacy. She clearly felt guilty, and the aspects of her therapist’s life that she was witnessing, caused her a great deal of pain. She also made reference to alcohol abuse, and I suspected that she had been drinking when she emailed me.
I know that therapists are human, fallible, and struggle as much as anyone. But they are also in a position of responsibility in which they deal almost daily with vulnerable people. There is an inevitable and necessary imbalance within the therapeutic relationship, but I would argue that that exists also in a general sense between any therapist and any client. Similarly to the medical profession, I believe therapists have a responsibility to act with integrity and in a way that upholds the public’s trust in this area of work. Additionally, when it comes to therapy, both our past and our present selves are invested, as clients, and in some senses we need to be able to trust therapists in the way that a child needs to be able to trust parental figures.
Though I have received similar emails from therapy clients in the past, I was shaken this time, precisely because this client was also a therapist. My therapist called it an ‘attack’ on me - not because the content was malicious, but because it showed no consideration for the potential impact on me and on my therapy. After weeks of struggling, I had just made important progress in my sessions, and this email intruded into that ‘flow’ and into the process of analysis. My therapist is helping me to heal from the wounds of an intrusive, anxious, and un-boundaried mother, who focused more on her own feelings than on mine. And yet here was another therapist behaving not in a thoughtful and healing way, but in a way that felt as though it replicated some of the wounding that I had received as a child. That in itself felt deeply disturbing.
The email also left me with the ethical dilemma of what to do next. She described herself as a successful therapist, but her lack of insight and boundaries, and the risk she was taking in emailing me, made me concerned for her clients, as well as for her therapist whose privacy was being invaded. Yet it was clear to me I couldn’t break her confidentiality. I asked her not to contact me again, as I needed to protect my own therapy; but I also tried to confront her with the self-destructive nature of her behaviour and the impact on her own therapy, suggesting that by making different choices and working things through, she could be of greater benefit to her own clients.
I was far more direct (and directive) than I would ever normally be – but this was a very unusual situation and under the circumstances, I felt it was the best and only thing I could do for her, and for the benefit of those who cared for her and who she had in her care. Like a therapist who ends with a client, I will need to sit with the discomfort of not knowing what happens next. Yet I didn’t ask to be put in that role; just as I didn’t ask, as a child, to become the grown-up in the face of my mother’s anxieties.
Whenever I interact with other clients in the blogging world, I try and hold the sanctity of their therapeutic relationship at the forefront of my mind, and that influences the comments I make. I feel privileged to also be in touch with a number of therapist bloggers who are very respectful of my position as a client and who act in a way that upholds my own therapy. Equally, I hope that I manage to approach them in a way that respects their boundaries and their position as therapists (by, for example, not treating them as if they were my therapist)! To me, they represent some of the joys and benefits that online interactions in the therapy/client world have to offer; but this recent incident has been a valuable demonstration of the significant potential pitfalls and dilemmas involved. I think it is a reminder of the responsibility of all therapists and clients with a presence in this online world, to approach ourselves with insight and self-care, so that we are able to maintain ethical interactions online that uphold the nature of therapy and the therapeutic relationship in its broadest sense.