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One Therapist's Memoir: A Violation of Ethics?

Posted Apr 23 2009 4:19pm

A British psychotherapist, Jane Haynes, recently published a memoir revealing, in great detail, many horrors of not only her own life, but those of her patients as well. Strangely enough, some of those patients helped her to write it. You can read about her award-nominated work here.

A few ShrinkTalk readers have written in to me about this book. Is she allowed to write about her own life in such a way? Is she violating confidentiality? What about any other ethical violations? Do these issues relate to the book you're writing. I'll address these points now.

If you're a regular reader of this site you know that I periodically meet resistance from colleagues because I talk about my own life, issues, flaws, idiosyncrasies, as well as times that I engage in raging idiocy. I've revealed the reasons for this self-disclosure here. If you're a Freudian analyst this poses a problem, as the practice involves you being a tabula raza, or blank slate. Since I don't practice in this way it's less of an issue for me and I haven't found anyone's care negatively impacted because I reveal some of my inner workings on the web. I'm confident Ms. Haynes feels the same way.

Simply put, the author is not violating confidentiality because she is disguising any revealing information about the people involved. I go to great lengths to accomplish this and I hope she did as well. As discussed here psychology textbooks regularly use clinical vignettes to demonstrate important material that are based on real people. Details are altered to protect clients' rights but the principle is no different than what I or Ms. Haynes does. Our work will simply draw more attention because the material is not in a traditional, academic format.

In other words, Ms Haynes is not in violation of confidentiality, nor are her personal accounts of her life unacceptable. With the disclaimer that I am not familiar with the laws that govern British psychotherapy practices, however, there are problems with this book. They relate to both dual relationships and solicitation [1].

Psychologists' ethics state that practitioners must allow a two-year grace period before having any non-professional contact with patients. This rule is in place to protect clients from any deliberate or subtle exploitation on the part of the therapist. However, and I've discussed this point previously, any new relationships are based on a "guilty until proven innocent" model within the field. It's not acceptable to simply wait things out for two years, become a former client's friend, lover, business partner or co-author and then assume that you two have wiped the slate clean. The therapeutic relationship is a one-sided affair with an inherent power dynamic. That doesn't simply disappear after 730 days and so it is assumed that the client may suffer because of it [2]. Therefore the onus is now on the therapist to prove that no damage has occurred. And, of course, the question that might be considered low-hanging fruit comes to mind: what if the client ever wants to return to therapy? You've altered the relationship (again) by now making it a non-therapeutic one and any attempts to return to its original status will prove to be difficult. Ms. Haynes waited the requisite two years before having any non-therapeutic contact with former patients [3], but she needs to demonstrate not only a "no harm, no foul" outcome, but also that every one of those former clients will not need her services again. Impossible to show? Exactly.

The other inherent problem is that, unless her patients read about this upcoming tome in an interview or heard about it on the streets, she must have contacted them to ask for their permission or involvement. She likely sought them out. I've addressed this point but the rule needs to be stated again: Do not solicit from clients. Both past and present. It puts them at an immediate disadvantage. Again, this is especially true if they ever needed to come back to see you. What if I say no to her request? Will she be angry with me? Will she still give me therapy? Will the quality of the treatment be as good because I've rejected her? These are questions that clients shouldn't have to ask.

Based on the article it seems as if her former clients are perfectly fine with the situation as it is. If so, the author was extremely selective, very lucky or both. But that doesn't change the fact that she went against some extremely important rules in protecting those she worked with.

So no, these issues will not be relevant regarding my book. As much as I make light of psychology, therapy, shrinks and so on, there is a fine line between entertainment and following the rules. If my book is less of a thrill ride than hers because of this then so be it. But Ms. Haynes definitely showed some irresponsibility, and that needs to be known.


[1] Criticisms are based on the practice of psychology/psychotherapy by Licensed Psychologists in the United States.

[2] This is how your good friend and mine, Dr. Phil, got himself into hot water.

[3] Strangely, she doesn't seem overly confident with her knowledge of the code: "I think there has to be a reasonable period, at least two years, before one can have [further] contact with a patient."

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