When therapists don’t have an explicit way of dealing with client ethical dilemmas,
I’ve observed three main responses. (I used to do all three.)
- 1Ignore the client’s ethical language and steer back to clinical language.
Example: Client says, “I’m stressed out that if I leave my husband, I’ll damage the children.”
Therapist says, “Tell me more about how you are handling your stress right now.” - 2Focus on the client’s self-interest. “I think it’s important that you figure out what’s best for you. Your children will adjust.”
- 3Become abruptly prescriptive. “You’re right to worry about your kids. If you pick and leave with your new boyfriend, it will hurt them badly.”
The first two responses are the most common (keep it clinical or focus on just the client’s perceived needs) because they are safe for the therapist, even if not necessarily optimal for the client. Nobody in a case consultation will fault the therapist for those statements, whereas lurching into being prescriptive and judgmental is clearly something to avoid—and when it happens, the therapist is not likely to tell colleagues about it in case consultations. However, the first two responses do not engage the complexity of the client’s dilemma.