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Professional values

Where I stand, and why.

Some of my values in regards to the mental health profession and its practices — and a political statement on why I consider professional indemnity insurance unethical.

Adapted from Ofer Zur (zurinstitute.com)

Eight stances

On diagnosis, dialogue, dual roles and independence.

01

Professional differences

  • If I differ with colleagues’ ways of doing therapy I respectfully say “I disagree,” rather than claiming “it is unethical.”
  • I use critical thinking and contemplation before encouraging a client to file a complaint, just because a former practitioner had a different view of healing.
  • Short of questions concerning sex or intentional harm, I engage in respectful discourse about gifts, dual relationships, non-sexual touch, home visits, self-disclosure, bartering and other boundary considerations.
02

The “psychiatric bible”

  • I view the ICD-10 and DSM-5 through the lens of critical thinking.
  • I acknowledge that the mental health sections of these documents are at times politically and economically motivated, and at times lack scientific grounding.
  • These documents can be helpful in understanding clients and communicating with colleagues, but their truth-value is relative — all diagnoses are constructed.
  • The more any mental disorder can be marketed as treatable with medication, the more likely it is to be included; conditions treated with psychotherapy alone tend to be excluded.
03

Digital communication

  • I do my best, when appropriate, to accommodate clients who prefer to communicate via email, text, phone, chat or video.
  • I attend to populations such as adolescents and young adults, and their comfort level with texting.
04

Neurodiversity

  • I do not pathologise people with atypical neurological architecture, such as autism, and I support others to do the same.
  • For Autistic persons in my practice, I treat the presenting issues, not the autism itself.
  • I refer to Autistic people, not people “with autism,” since autism is not a disease.
  • Neurodiversity, and the variance among neurological make-ups, is normal and adaptive.
05

Custody

  • I avoid writing custody-type letters on behalf of clients I treat; I leave custody recommendations to custody evaluators.
  • While many forms of multiple relationships are unavoidable and ethical, acting as both treater and custody evaluator is highly ill-advised.
06

Risk management

  • I work without being intimidated by the fear of attorneys, licensing boards and lawsuits — operating from clinical and ethical integrity.
  • I distinguish between rigid, fear-based risk management and ethical risk management based on client care.
07

The diagnosis of children

  • I stand in protest against the inappropriate diagnosis of small children with ADHD or Bipolar disorder and their subsequent medication.
  • I require proof from longitudinal studies regarding the risk/benefit ratio of using such chemical interventions in children.
  • I do what I can to protect vulnerable children by providing parents, clinicians and the public with information about the potential harm some medications may cause.
08

Independence

  • I operate a fee-for-service private practice, not under the control of managed care companies.
  • This allows me to treat clients according to their needs and wishes, rather than the protocols of profit-motivated insurance companies.
A political statement

Why I think professional indemnity insurance is unethical.

Trust

Clients reveal a great deal of themselves in therapy, and are in a vulnerable position. They trust the therapist to respect their boundaries, act professionally, maintain confidentiality, and support their personal growth.

Responsibility

Therapy in the Gestalt style is like the relationship between a player and their coach. The coach supports, but what the player does on the field is not the total responsibility of the coach.

The problem

Indemnity insurance does not prevent harm. It provides a lawyer and a fund. It is counter-productive to ethical practice — it protects therapists from the costs of legal action rather than encouraging them to act ethically.

Five problems

Problems with the current system.

It is up to individual professionals to take a stand. If clients want more cost-accessible health care and to be treated with respect, it is necessary for them to stand up for their rights assertively — rather than resorting to suing.

  1. 01

    Adversarial

    It sets up a fight with winners and losers — not the best way of settling differences.

  2. 02

    Beneficiaries

    The main beneficiaries are the legal profession and the insurance industry.

  3. 03

    Encourages greed

    It reduces human pain and suffering to monetary value.

  4. 04

    A climate of fear

    It turns justice into a chase for money, constraining normal human consideration and trust.

  5. 05

    Spiralling costs

    Huge costs are added onto basic services and passed on to the public.

Alternatives

Other ways to pursue a problem with a therapist.

  • Raise the issue directly with the therapist.
  • Dispute mediation.
  • Contact associations of which the therapist is a member.
Ethical commitments

Codes of ethics I am committed to.

I am committed to the codes of ethics of the European Association of Gestalt Therapy and the Career Development Association of Australia. These codes emphasise respect, the welfare of the client, competence, integrity, non-exploitation, dignity, privacy, and working within the law.

If you feel I have breached any of these codes, I invite you to let me know. I am committed to working at the relationship, even when difficult, and ask my clients to use mechanisms other than adversarial law to deal with disputes.

Talk it through

Questions about these values, or how we work together?

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