Dear Inadequate Graduate,
I am currently treating a patient who is engaging in activities that I view as emotionally and developmentally inappropriate. Frankly, he’s too young to be doing what he is doing, and while I’m trying to be empathic to his experience, I don’t feel I can get past my personal disapproval of his behavior. Do you have any advice on how to be supportive and helpful to him while still being true to my own values?
I cannot tell you how many times I’ve encountered this scenario, be it with someone half or twice my age. One of our main goals as mental health providers is to help a patient in the way that he/she/they perceive as helpful, and because of this, I try keep in mind the APA Ethics Code: Principle A of Beneficence and Non-Maleficence, aka “First, do no harm.” Still, ethical guidelines are often more nebulous than clear cut, and dilemmas such as yours can feel like navigating murky waters in a sea of complex psychological dynamics, which often just leads to more confusion.
I get it. I’ve been there.
Despite our best intention of ‘helping,’ there are times when we providers are mandated to act in a way that the patient or client perceives as hurtful, intrusive, or a betrayal, such as when reporting suicidality, homicidally, or instances of child abuse. These instances included, I often seek to understand the patient’s internal world and reasons as to why he/she/they engage in behaviors I do not condone. The same can be said of ideology. I’ve worked with patients whose views vastly different from my own, and I’ve found that if I can understand one’s unique perspective regarding a specific person, experience, or entity, I sometimes find compassion or understanding for behaviors I might deem problematic. It doesn’t mean I then agree with something I consider to be unhealthy or inappropriate, but I’ve gained a tremendous amount of insight and education by working with patients who challenge my personal values as this process has also challenged me to reexamine my own internal world. Ultimately, the patient is the expert of his/her/their experience, and our role is to to understand that experience in order to help guide the individual on a path that is in his/her/their best interest given their circumstances and capabilities.
Of course, there might be times you reach an impasse that feels like a standstill, or you could encounter a client that you simply find off-putting. If you’re feeling stuck, the patient probably is, too. Dynamics happening inside of therapy are a often reflective of the patient’s experience with others outside of therapy. During instances such as these, I encourage you to consider the reason why your patient’s behavior (or ideas or…) affects you in this particular way. In your example, is it possible the patient is telling you about worrisome behavior so that you will respond like a parent and he feels cared for or protected? Could you be colluding with the patient in not confronting unhealthy habits? Is he pulling for rejection so that you react like everyone else has and he will not get attached? While we forever dance between personal and professional conflicts on the path to helping our patients, I encourage you to discuss this concern at length with your supervisor and/or therapist. Remember that whatever you chose,
You. Are. Enough.
The Inadequate Graduate