One Therapist’s Memoir: A Violation of Ethics?

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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13 Responses to “One Therapist’s Memoir: A Violation of Ethics?”

  1. Tam says:

    I agree with you about soliticing from clients or former clients, and I think that their lack of objection to it doesn’t say much. People often don’t object to situations that exploit them.
    I’d have a hard time refusing a favor to my therapist, and might even enjoy the warm feeling of being able to do him a good turn. That doesn’t make it unproblematic.

  2. Cassandra says:

    I have a friend whose husband buys his lady therapist’s art photography. Needless to say, their marriage is rocky at best. Nonetheless, her husband’s purchases make her uncomfortable, and she knows it crosses the dual relationship line. Both the husband and the therapist are either clueless or just don’t care. CREEPY!!!

  3. Yasmin says:

    Interesting. The rules for attorneys are much less strict – but then, we only get involved in very narrow aspects of our clients’ lives and (usually) in a much less personal manner. I hear from my family law friends, though, that they feel like they should have gotten training in counseling!

  4. Eric says:

    My understand is you’re concerned that the therapeutic relationship is still ongoing even after 2 years, in that Haynes’ clients may want to return to her for therapy. Is this always true though? If a client got another therapist then they wouldn’t come back to their old one, so after 2 years no therapeutic relationship exists anymore. Or are you saying that one has to assume the relationship is life long on the off-chance old clients might ever need you again?
    Dr. Rob: It is, of course, not always true, and very often clients will find another therapist. But the therapist’s responsibility is to err on the side of caution b/c it can be more than an off-chance.

  5. RB says:

    I agree with you. If my therapist actually asked me to allow her to write about something I told her during therapy, I would definitely feel forced and betrayed, but I would never tell her so. If a journalist later on asked me about this, I hardly imagine telling them that it bothers me.

  6. Even if I disguise potentially revealing information about my clients, I am highly reluctant to describe case scenerios and clinical details for fear the client would still recognize herself based on whatever cluster of symptoms and situations provided.
    If a client agreed, after two years, to some form of solicitation, I think the psychologist should make clear that participation may require future therapy be sought elsewhere (due to the changed nature of the relationship, as you discussed). But yes, in general I believe the rule of thumb should be no solicitation or only in rare instances or in instances of scientific study.

  7. The Edge says:

    I’d be pretty interested to see what my shrink has to say about me (rather than *to* me). But as for the non-shrink community, I wouldn’t be comfortable holding myself up to the judgment of readers and literary critics until this chapter of my life is over and the relevant issues are addressed and resolved.

  8. Tam says:

    Oh, man, now that I’ve thought about it, if my shrink wrote a book and I wasn’t in it I’d be crushed! I’d read the whole book cover to cover instantly looking for myself.
    OK, that’s sick. Should I bring this up in therapy? 😉

  9. DUI Lawyer says:

    I chanced upon your site via a comment from another blog and am happy I did. Great stuff you’ve got here…not sure if it’s a bug or not but the sidebar seems a little out of sync in Chrome. Bah – I should use IE and stop complaining. Cheers!

  10. TPG says:

    Actually, the APA ethics code 10.08 mandates a two year for sexual contact with former patients, and even then in unusual circumstances. As far as friendships, working partnerships, etc. with former patients that are not sexual? No ethical violation.

  11. Rob Dobrenski says:

    @TPG: true, but she isn’t part of APA or its mandates. And solicitation runs across the lifespan for the reasons I describe above. Whether you could squeeze past APA on something like this (“no harm, no foul”) is irrelevant.

  12. Kymberly says:

    Good post but I was wanting to know if you could write a litte more on this topic? I’d be very grateful if you could elaborate a little bit more. Kudos!

  13. MJ says:

    I have recently terminated the intimate relationship that existed for a short time between my former therapist and myself. I am now seeking the help of another therapist to work t through and process the damage I’ve done to myself by consenting to this relationship. Though she never utilized it, she was always in a position of control over me. I found myself conceding on matters that I would normally stand firm on. It is now very difficult for me to unplug from this woman. Though I have remained resolute in my stance of seperation, I find ii t impossible to cease thinking about her. I just have to say this for me: the multiple-relationship dynamic within the therapeutic arena should be avoided by both professionals and their clients. No long-term good can come of it.