Ethics and therapy (specific example and general issues)

[ClinPsycMasters]

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I only have my masters so I don't know if I can pass judgment on a licensed psychologist. With that in mind, here are my views on a certain therapist.

There is this psychologist, who shall remain nameless, on a non-American TV station. I have watched him on at least ten different occasions with an international student who told me about him. She watches him religiously. He uses a dominant and paternalistic style of interaction with the viewers who call in, being forceful with his opinions and so forth. He comes across as somewhat disrespectful, cutting them off, and speaking in a somewhat condescending manner.

The viewers speak only an average of 5-10 minutes before he jumps in telling them what's wrong with them and how to deal with the situation, and just to cover his own ass, always concludes by suggesting the person see a therapist. He does constantly advertise for his own CDs (on anxiety, developmental issues, divorce, etc) which are surprisingly expensive. He also has a private practice.

What bothers me the most about this guy is that his style of interaction with his callers, most of whom seem to have very low self-esteem, seems somewhat akin to abuser/victim interactions in those who have experienced abuse (and BPD patients). He does provide some general information on mental health issues, which is a bit dated, but useful nonetheless. This complicates the situation.

I truly doubt that this guy doesn't know any better and is letting his own issues get in the way of his work. I wonder if he knows exactly what he is doing. Perhaps he knows his viewers so well that his emotional blackmail of the vulnerable viewers is part of his "business acumen."

There are two kinds of ethical issues that are of concern to me. One is therapists who do more harm than good, those who know better but let their own needs for prestige, money, sex, etc, get in the way of delivering helpful treatments. The above was an example of that, and again this is again my judgment based on my limited knowledge.

The other has to do with proper use of psychological findings in business, military, politics, etc.

I can think of good examples of misuse of psychology in military and politics, but I want to stay clear of contentious issues. Suffice to say that power can corrupt even the most decent people, and generally it is not the most compassionate and philanthropic folks who are drawn to these areas. Of course many soldiers have the best intentions in joining the army and many politicians are idealistic at heart. Yet these very people are not immune to social pressures nor can resist their own basic needs.

Let me use an example from business. I had a discussion with someone online about obesity in US. He felt that overweight folks had no willpower and were weak. He said they had no right to blame fast food restaurants or advertisers. I disagreed. There is a reason that advertising industry spends hundreds of millions of dollars each year on commercials and ads. Advertising is effective.

Isn't a person's weight his own responsibility? Sure. To see oneself as being victimized by advertisers is as bad as blaming the person for their own weight issues. There are both conscious and subconscious factors at work, not to mention genetics. People have the power to change. However, other factors are relevant too. Advertisements for cheap unhealthy food, the availability of organic and healthy food, upbringing, present environment, financial situation, mental illness...they all play a role.

If I'm a therapist on TV talking about weight issues, I should think twice about the commercials I run during the break. At the same time, I have my own needs so I have to make a living. How I balance that reflects my own values and needs. However, I need to be aware of these issues. That's the first step.

 

[teo3099]

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[Psy01]

I only have my masters so I don't know if I can pass judgment on a licensed psychologist.

Dude, who cares if he's "a licensed psychologist" and you "only" have a master's? You're close to falling prey to the "argument from authority" fallacy.

Always question claims and practices, no matter who does them. Nobody is immune to error.

Let me use an example from business. I had a discussion with someone online about obesity in US. He felt that overweight folks had no willpower and were weak. He said they had no right to blame fast food restaurants or advertisers. I disagreed. There is a reason that advertising industry spends hundreds of millions of dollars each year on commercials and ads. Advertising is effective.

He's wrong and you're right. I'm not well-acquainted with the literature, but I've heard of lots of studies that demonstrate the addictive qualities of foods, etc.

Plus I've even seen footage of a great study in which children where exposed to either fruits or a rock with stickers on it (like SpongeBob). The kids tended to prefer the rock. To eat. Advertising is not just effective, it starts to have an effect early.

 

[Therapist4Chnge]

Maybe the kids were mineral deficient?

😀

 

[ClinPsycMasters]

Oh, so many topics. I'll just add my two cents on one for now.

I can't speak for this therapist on TV (haven't seen him), but I do believe that there are many approaches one can take to therapy and some of those *look* harsh, but may be what people need. I don't feel that my personal style is particularly confrontational, but I knew a therapist who was very pragmatic and behaviorally oriented and he got results using what would be considered abrasive methods. Still, he seemed to get results.

I honestly think that some people need to be quietly listened to and others need to be smacked around a bit, so to speak.

I think essentially we are in agreement but your post has got me thinking so I want to further clarify my views regarding that psychologist.

My criticisms:

Respect is number one for me. You need to speak in the utmost respectful manner with the patient/client no matter how the person talks, or feels, or what he has done. If you need to cut people off, you do it very respectfully. If you need to end the call, you do it very respectfully. I don't care if this therapist and his viewers come from a country where many people have difficulty meeting their most basic needs and that, compounded by poverty and political unrest, has led to social interactions that are not exactly civil. Regardless of technique, therapy needs to take place in a humanistic framework, and one of respect and equality, as we are not dealing with defective/sick/stupid/lazy people but human beings (no less valuable than the therapist) facing problems of living.

For me, the ends do not justify the means. The process of therapy is not akin to a surgical incision with the patient completely vulnerable and put under. Confrontation at the right time is perfectly fine. Too early and it disrupts rapport, and now you have to regain the person's trust and though that can be done (with exceptions), it's just a waste of time. However, if I'm dealing with a person with borderline traits, someone who is the "victim" all the time, I may be tempted to take on the abuser role. I may get immediate results. But should I? I would never! But this psychologist does. When a person calls in and is in a total "victim" mode, as if the whole world is against him, he berates him for being weak, saying the person wants to hurt himself.

There are certain psychodynamic techniques that are confrontational. Even RET/REBT can come across as confrontational at time. For the right person and at the right time, that is fine. The first step, however, is sympathy, sympathy, and sympathy. The feelings need to be validated. Too many people have not had their feelings validated. They think they are not allowed to exist even. They don't need to be scolded even if the psychologist is very very tempted to do so. Should he want to tell someone, stuck in victim state, that he must want to hurt himself, it may be fine but only later in therapy. Calling them weak though? And all these confrontations must come after you sympathize with them, and you actually know the root of the problem, not in the first ten minutes.

Lastly, one can not diagnose someone nor suggest treatments in 15-20 minutes, and based on a phone call. You need to do a full personal, family, medical/psychiatric, legal, occupational...history. You need to consider lifetime stressful events, make some behavioral observations, do mental status assessment....

She says he's a genius, that he has great intuition, and cuts people off because he knows what their problem is (I tell her that an educated therapist will try to falsify not validate his views; I tell her about viewers lying or agreeing with him out of shame or confusion). She says lots of people can't afford psychologists so hearing him give general advice or talk about others with similar problems can be helpful to her (I tell her little knowledge can be a dangerous thing, and that these callers might in fact benefit from self-help books.)

This frustrates me but I know I can only do so much and I leave the rest up to the people who listen to him and other so-called therapists who know better but whose narcissistic needs seem to act like gravitational force around a black hole, distorting and bending the current of therapy.

Dude, who cares if he's "a licensed psychologist" and you "only" have a master's? You're close to falling prey to the "argument from authority" fallacy.

Always question claims and practices, no matter who does them. Nobody is immune to error.

Thanks for the vote of confidence. This person I mentioned, the dedicated viewer, used this fallacy to quieten my criticism. I mentioned my opinion a few times but that's it. She has the right to do what she wants. However, I am not going to put up with her constantly comparing my views to that therapist or asking me to justify my views. I have very little respect for that psychologist and his methods, and I let her know exactly why, and that's that.

 

[Therapist4Chnge]

One person's "rude and disrespectful interjections*" are another person's healthy and therapeutic interventions. People often knock REBT and Ellis because he could be more confrontational at times, but sometimes that is what is needed with particularly difficult patients.

*This was said to me after I asked a clarifying question of a patient I treated who exhibited severe narcassistic tendancies. They believed that they should be able to talk at length, on any topic, and only after they made their side perfectly clear was anyone else allowed to respond. It was an interesting few months.

 

[FadedC]

Well it sounds like the ethical problem is not so much that he is confrontational and more that he is telling people who to do with their lives after only talking to them for 5 minutes. That seems pretty irresponsible.

However he's a tv psychologist. He's limited by time and he needs to make his therpay "exciting" enough that people watch it. He's probably more concerned with good ratings then with ethics and helping people.

 

[Psy01]

This person I mentioned, the dedicated viewer, used this fallacy to quieten my criticism.

How do you mean?

 

[ClinPsycMasters]

How do you mean?

That I as someone who only has his masters is in no position to judge a licensed clinical psychologist.

 

[ClinPsycMasters]

One person's "rude and disrespectful interjections*" are another person's healthy and therapeutic interventions. People often knock REBT and Ellis because he could be more confrontational at times, but sometimes that is what is needed with particularly difficult patients.

*This was said to me after I asked a clarifying question of a patient I treated who exhibited severe narcassistic tendancies. They believed that they should be able to talk at length, on any topic, and only after they made their side perfectly clear was anyone else allowed to respond. It was an interesting few months.

I know what you're saying. In such cases, I would be very clear from the get-go how the therapy works and what sort of style of interaction we should aim for, and what consequences there are for deviating from that. I would say all of that in a very respectful manner of course, and provide justifications when necessary. If the person is insistent on perfectly clarifying his view before I am permitted to talk, I would use that as an opportunity to talk about resistance and power struggles. I would also point out that we could have accomplished more during the session but we didn't because of that. This is purely hypothetical of course as I have no knowledge of that patient in particular, but I do think that most people make adjustments in their behavior when things are explained to them in a sympathetic and respectful manner, justified when necessary, with consequences delineated in a clear manner. The key is persistence.

Of course, T4C's patient appears to have been amongst the few that truly test one's patience. 🙂

 

[Psy01]

That I as someone who only has his masters is in no position to judge a licensed clinical psychologist.

I was trying to clarify: you're saying that you criticized the psychologist, and somebody else quieted you down by saying you were committing the aforementioned fallacy?

Thanks for the vote of confidence.

And was this sarcastic here?

I'm trying to clarify all this bc I've been on message boards for a long time and seen tons of nonsense, and lots of misunderstanding. Thus, I often try to clarify just to be sure.

 

[ClinPsycMasters]

I'm not sure what the misunderstanding is and I don't know what you mean by the "nonsense" reference. How are you interpreting what I'm saying?

I am not being sarcastic (though I do have a tendency to kid around 🙂 which you can see in some other threads). I have some free time now so let me explain this again:

This particular psychologist on TV has such a major following that initially, after speaking to this particular girl who really believed in him, I felt vulnerable to the fallacy above. In other words, the girl told me that I was in no position to judge this psychologist, also mentioning that a number of professional folks (doctor, engineers, etc) call in to his show and ask for his opinion for various problems they're having.

Why would I have such doubts? In addition to the degree issue mentioned above, there is the whole cultural thing. The viewer and the TV psychologist are from a culture and country where a more confrontational and, what I in Canada would consider, "abrasive" style of interaction is more common and "normal." Hence, my doubts about some aspects of my criticisms of him.

From time to time I hear of guru-like therapists, ones who are charismatic and very influential, whose influence on the patients perhaps have less to do with particular therapeutic technique and more to do with their charm and unique powers of persuasion. I still do not believe that one can diagnose patients from afar and in 10-15 minutes, nor approve of his rather harsh method, but there is no denying that a few therapists are fantastic as persuading patients, even in a very shorty time, and that they can be idolized rather than listened to.

 

[Therapist4Chnge]

...I would be very clear from the get-go how the therapy works and what sort of style of interaction we should aim for, and what consequences there are for deviating from that. I would say all of that in a very respectful manner of course, and provide justifications when necessary. If the person is insistent on perfectly clarifying his view before I am permitted to talk, I would use that as an opportunity to talk about resistance and power struggles. I would also point out that we could have accomplished more during the session but we didn't because of that.

The key is persistence.

Working successfully with people who have strong Axis-II traits can be both rewarding and challenging. Some of my favorite Dx's are in that group, so I learned early on how to handle it. I don't want to get into shop talk, but suffice to say it takes a lot of patience and consistency.

 

[Psy01]

I'm not sure what the misunderstanding is and I don't know what you mean by the "nonsense" reference. How are you interpreting what I'm saying?

I am not being sarcastic (though I do have a tendency to kid around

There wasn't a misunderstanding. I was simply trying to clarify so I knew I wasn't misunderstanding, bc I could immediately see two different slants to some of what you wrote. This is largely due to all the things I've seen online, the "nonsense" I was referring to. This reference wasn't directed specifically at you. I was simply commenting in general that I've seen all kinds of stuff online, and so I'm never quite sure now about the kind of person I'm talking to and if I'm understanding them the way they wanted to be understood.

This particular psychologist on TV has such a major following that initially, after speaking to this particular girl who really believed in him, I felt vulnerable to the fallacy above.

Okay, this was something I wasn't sure about. I wasn't sure whether you actually were operating under that kind of mentality (one that would think an argument from authority is above criticism) or not.

In other words, the girl told me that I was in no position to judge this psychologist, also mentioning that a number of professional folks (doctor, engineers, etc) call in to his show and ask for his opinion for various problems they're having.

That was my read of it.

Why would I have such doubts? In addition to the degree issue mentioned above, there is the whole cultural thing. The viewer and the TV psychologist are from a culture and country where a more confrontational and, what I in Canada would consider, "abrasive" style of interaction is more common and "normal." Hence, my doubts about some aspects of my criticisms of him.

Addressing this on the merits now, this would get into the whole "cultural relativism" thing, such that many would argue you aren't in a position to criticize.

I would argue that, while cultural systems should be taken into account, inter-cultural criticism is as fair game as criticizing somebody at a higher degree level.

 

[ClinPsycMasters]

Addressing this on the merits now, this would get into the whole "cultural relativism" thing, such that many would argue you aren't in a position to criticize.

I would argue that, while cultural systems should be taken into account, inter-cultural criticism is as fair game as criticizing somebody at a higher degree level.

Yes, I agree with you.

In my view, human rights are (or should be) universal. We all deserve to be treated with respect. Of course some disagree. Why? Perhaps they define abuse in a different manner. Hostility and abuse may be nearly ubiquitous and feel "normal" to them even if unpleasant. Or maybe they think they deserve the abuse and that a different way of relating to others feels wrong. Or that relating with others in a more caring manner would deprive them of power, of meeting some of their own needs by mistreating others.

Of course I'm just speculating here within a humanistic psychological framework of meaning-making. There are other value and meaning-making systems (e.g. religion, tradition, other sciences like sociology). I can not convince everybody nor myself that humanistic views or psychological explanations are unquestionably superior to others. Yet I can not sit by and watch people abuse each other and explain it away using "cultural relativism" and such.