Third-Party Interference
I’ve been challenged with a recurring issue in my practice — to cater to the demands of outsiders who want to influence client treatment or to allow the person sitting in front of me to make their best decisions about their lives.
The issue is most prominent when I’m working with minors. Oftentimes, parents want their children to think and act in accordance with their own parental beliefs and behaviors. This, of course, makes sense based on the family culture; each household has a set way of being within their contained environment. Individuality, especially behaviors or traits that contribute to discord in the house, are identified as threatening to the household dynamic. Parents commonly want their way of life to be reinforced outside of the home and have some choices when it comes to schools, extracurriculars, and other social settings. I am often enlisted as authoritative backup to bolster the family’s belief systems.
I hear similar arguments about conformity from spouses, adult siblings, and caregivers too. “Make [client] change!” is the demand. The unspoken part of the sentence is “to accommodate ME because they’re clearly the problem!” The latter assessment may or may not be true. There is a problem, but who and where is it? When/If I do not corroborate with the outsider, as determined by clinical assessment, client’s sometimes receive consequences, for example, an ultimatum — either therapy with Rashida or us (family). This is what happens when the client does not happily and expeditiously conform to their family’s wishes.
Coercive, controlling ultimatums sadden me. The ideal is to work through conflict towards mutuality. While determining treatment plans and co-creating outcomes works with adults, minors don’t always have choices. But I do. When third party interference begins to dictate the course of treatment, I ask the client if they choose to align with the external demands. If that is their choice, we move in that direction. If that is not their choice, we move in a different direction. If undecided, we explore options. If the client decides to move in a specific direction and then changes direction, I need to know so that I can also pivot.
Ultimately I will ALWAYS ask the person seated across from me what THEY want. Am I also a third party? Yes, although I try to remain as neutral or impartial as possible, asking questions to align myself with my client’s culture, i.e. way of thinking and being. It’s not always effective to maintain neutrality, but I check myself often. Why is that necessary?
For me, allowing external forces, such as parents or politicians, as in the recent Supreme Court conversion therapy case, to control the messaging within my therapy practice is the actual harm.
First, it violates ethics. I don’t care who is paying for treatment. I’m not an employee! I’m a service-provider and I am bound by a set of ethical standards and guidelines established by professional organizations (National Association of Social Workers, Board of Behavioral Sciences, and American Psychological Association, specifically) that emphasize the importance of autonomy, confidentiality, and the well-being of clients. I cannot allow external influences to determine the messaging in my practice that violates these ethical principles.
Second, and maybe even more important than the first, client autonomy and informed consent are the foundation of my practice! I respect my clients and insist that they have the freedom to make their own decisions about their mental health and well-being. If their decisions are harmful to self and/or others, I am ethically and legally obligated to intervene. (Safety first.) If it’s a behavioral issue, as is most often the reason for therapy with children, then I use best practices, not scare tactics or trending fads. If I assess the family as the issue and the child with the symptoms, I note that the family’s emotionally violent, conformist agenda violates the child’s basic human rights and advocate for the child. While laws may change, ethics are much slower to do so. Imposing external messages without the informed consent of clients, adult or minor, compromises their ability to make choices aligned with their values and needs.
Let me be clear here too: I don’t always share my adult client’s values and needs. My PERSONAL life, what I think and how I feel, often differs from my clients. Example: I’m in recovery and proud of my sobriety. I have seen more avoidable death and preventable trauma due to substance use than I want to remember. I know the ways that alcohol and other drugs affect mental, physical, and emotional health. (I also know how easy it is to create data and publish studies.) However, many of my clients use substances and even work in the alcohol and drug industries. Their decisions are not my decisions. They make their own choices and they trust me to help them make choices wisely with and about them. I don’t force my PERSONAL beliefs onto them. That’s what makes therapy with me a safe space.
Which brings me to the third reason that I am resistant to outsider persuasion. Therapeutic effectiveness relies on the establishment of a trusting and authentic therapeutic relationship. True, compliance with privacy laws and professional standards is essential to avoid legal consequences. Also, if clients perceive that external influences are shaping the therapeutic messaging, it undermines the trust they have in the therapeutic process. In me! This damages the effectiveness of treatment and then what is the point?!
Let me go back to a crucial piece, which is confidentiality. Since the therapeutic process is predicated on trust, what would it mean if anyone outside of the therapy office has enough information on what goes on inside the therapy office to control the therapist? It means someone is disclosing confidential information and someone is being puppetered. Would YOU be willing to share sensitive information if you feared that it could be relayed to external parties who have a vested interest in shaping the therapeutic narrative? Exactly.
I feel lucky to live in California where politics haven’t (yet) intruded into my therapy office. In this state, there are legal and regulatory implications for allowing external parties to control messaging within a therapeutic practice. Also in this state, to achieve and maintain licensure, therapists have to provide evidence-based and client-centered care. Allowing external forces to dictate messaging dilutes the professional identity of therapists and compromises the integrity of the therapeutic process.
Lastly, and it might need to go without saying, but I’ve already said a lot, so I’ll say this too. Violating client’s ethics hurts me. If I allow myself to succumb to external pressure to control messaging within my practice, I experience ethical conflicts, burnout, and moral distress. Therefore, I must maintain my professional integrity and adhere to ethical standards to protect my own well-being. My own mental health. There’s no way I’ll ever compromise that for myself, so why would I do that to anyone else?
While this post may have been born from feelings that arose after I read Vox’s SCOTUS conversion therapy article, it’s nonetheless an important declaration. I’ll make it bold for emphasis:
I will not allow external forces to control the messaging within my therapy practice.
I will not compromise ethical standards, client autonomy, and the overall quality of treatment to accommodate third parties.
I will uphold professional principles, prioritize client well-being, and ensure the integrity of the therapeutic relationship.
