Why Can’t Any Random Person Offer Therapy? It’s a Matter of Ethics
In the wake of Sushant Singh Rajput’s suicide, there has been an uptick in people trying to reach out to their friends and acquaintances, offering themselves up as sounding boards, as people who are ‘there for you.’ This behaviour has also been amplified by influencers who are asking thousands of their followers to trust them, talk to them, ask for advice, in return for positive affirmations, ‘love and light,’ and ‘healing energy’ — the last of which was recently offered up by fashion blogger Santoshi Shetty who asked her followers to reach out to her for a chat, for the nominal fee of Rs. 1,500.
This behavior has understandably received backlash by mental health advocates who see the complicated process of talk therapy being reduced to the exchange of positive vibes and energy. This approach, where any random person can be ‘there for you,’ also blurs the ethics of mental health therapy, an area that is already fraught with transgressions in India. Understanding the ethics and the need for boundaries in a mental health therapy setting, then, can perhaps help people limit their pseudo-therapist selves, and finally fathom the complexities of therapy that they are not qualified to traverse.
First stop: competence. It’s the first element of a universal code of conduct for therapists, adopted by both the American Psychological Association (APA) and the Indian Association of Clinical Psychologists. It mandates therapists offering talk therapy to provide their services or teach and conduct research only in areas in which they are competent, which is informed by their education, training, supervised experience, study, or professional experience. If a therapist encounters a client whose needs go beyond their level of expertise, they’re required to refer their client to another trained professional.
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The importance of this ethical element is self-explanatory — if a therapist helps someone deal with issues they have no experience, expertise, or training with, they run the risk of harming their client, possibly engendering faulty beliefs or actions in them. In a similar vein, random people on the Internet, who have no expertise, training and experience with handling someone else’s mental health, cannot be helpful, only dangerous, when they offer up their ‘services.’
Second up: boundaries. Ethical codes of conduct, almost universally, warn therapists against dual or multiple relationships with their clients. That is, a therapist is advised against taking up a client they already know, such as their friend or colleague, and is also discouraged from establishing close relationships outside of the realm of client-doctor therapy, such as a sexual involvement. The APA says why this is problematic — “A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.”
In a client-therapist dynamic, where one person struggling with an issue has sought the help of an expert, and where most often money is changing hands, a power dynamic is established. This is intensified when clients open up, are vulnerable, and often dependent upon their therapists, but this vulnerability is precisely why ethics are so important. Transgressions of those ethical boundaries can cloud both the therapists’ and clients’ view of themselves and each other, essentially proving a detriment to the process of therapy. The process of seeking help is already fraught with the risks associated with vulnerability and trust. Entrusting an acquaintance, or an influencer, with this responsibility can be dangerous in the context of boundaries and multiple relationships we have with the people we know and follow. Think: an influencer that a person looks up to, who gives them fashion goals, body goals, makeup goals, cannot be someone who helps them through their mental health issues — who knows, maybe the influencer’s Instagram lifestyle is what is compounding the person’s issues of self-esteem, or other insecurities.
Next on the list is consent — therapists are required to obtain informed consent from their clients, using language that is clear, providing information that clarifies efficacy and risk factors and any and all methods of treatment they might employ. This goes hand-in-hand with another ethical aspect of mental health therapy: confidentiality, which requires therapists not to disclose their clients’ personal information to third parties, and be clear to their clients about the limits of confidentiality. Both of these practices are rooted in exercising trust between the therapist and the client, which can foster better communication and therefore progress in the relationship. Without it, the relationship is broken, and the client is put at unnecessary risk.
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Needless to say, these complicated exercises in consent and confidentiality cannot be undertaken by influencers, or even friends and acquanitances, with whom social contracts are often unspoken, implied and understood, and not detailed like with a trained professional.
Understanding the concepts of consent, confidentiality, boundaries and efficacy are also important in trying to create more accessible, affordable options for mental health therapy, such as community health care. Right now, there is a gap in mental health care, one that unfortunately untrained influencers often try to fill with positive affirmations. With a majority of people in India unable to access expensive, time-consuming therapy, alternative methods of mental health care need to be developed and made available on a large scale, hopefully imbibing the same principles that drive ethical practices in formalized therapy.