Social skills for autonomous people: boundary violations in therapy


all-women-kick-ass asked realsocialskills:

do you know what particular boundary violations in therapy AREN’T considered unethical? because i am also studying to be a therapist and would very much like to avoid said boundary violations with future clients.


Something horrible one of my therapists did to me:

He told me that because I was I’m the system, I was not a real adult and never would be. And that therefore I would never be allowed to make major life choices without consulting him.

He then told me exactly how he’d manage it. He would make my choices for me. Then he would communicate to my parents such that they would make all my decisions for me.

Another thing he did was hold my sleep disorder against me. He said real adults can control their circadian rhythms and he would not let me make choices until I could sleep all night.

He and another therapist also communicated with my parents, without my permission, signed out otherwise, about me, after I reached adulthood. That’s not only wrong, it’s illegal.

My psychiatrist had a lengthy conversation with my mother that was basically about how if I didn’t take a medication for narcolepsy (after it was clear I didn’t have narcolepsy), my life would go to hell in a handbasket and I’d lose all my friends because I didn’t care enough to take care of myself.

Same shrink decided that the only valuable course my life could take, was to overcome my autism, and go on to become another Temple Grandin. He wanted me to become a psychiatrist just like him, work with autistic children, and contribute to autism research. Anything less than this and my life would be a waste.

This was combined with another huge boundary violation:  He basically every time I went along with his plans for me, he wrote that I was making progress and becoming higher functioning. If I went against his plans for me, he’d say I was regressing, becoming lower functioning, or ruining my life.

Going against his plans for me was one of the best things I ever did. It was my first step towards being able to run my own life and my life has gotten better and better since.

Mind you, he was probably my best shrink. But not realizing the power he had, he abused it without even trying.

Another shrink told me that I would never be able to think for myself. That it would probably kill me to do so.

Same one told me that he was going to get inside my brain. Create a version of himself that lived inside me. Kill off the me that lived in there. And replace me with a version of me he built himself. And then climb in there with me so I couldn’t disobey him anymore.

I don’t know what the hell he did to me but there’s still remnants nearly two decades later.

And that’s just off the top of my head. All of these things are in the category of things you should never ever do to someone.

The easiest to do accidentally are protecting your goals for your patient onto them. And then seeing moving towards those goals as progress, moving away as regression. Watch out for that.

I’d also recommend the video, the ethics of touch, by Dave Hingsburger. It’s not just about touch, it’s about boundaries in general.

I have had my sleep issue be ignored, glossed over, and have even had a therapist get angry with me because I was so desperate for sleep I wasn’t getting and they thought it didn’t matter. Literally “so?“ was said many times. Everyone thinks that my complete inability to sleep without meds/enough meds is my fault snd if I can’t sleep even with meds then it is clearly my fault bc i must be doing something wrong. This attitude coming from s therapist whom I enjoyed and trusted up until the last year I was in school, was damaging.

A lot of people I know who have sleep disorders have been emphatically told that it’s just because they’re practicing poor sleep hygiene and if they’d just try harder their problems would go away.

These stories above are bizarre, like, 60s shit. This is so far beyond ethics and legality it’s unbelievable. That should NEVER have happened and is NOT the norm or typical of ANY kind of therapy.

The Judge Rotenberg Center openly uses electric shock and food deprivation as behavior modification techniques.

Given that, which part of what youneedacat described is something you think no longer happens?

Those methods are contrary to AMA and APA guidelines and not how the typical psychiatrist acts. I don’t want to scare anyone off therapy by telling them that any of this is likely to happe nto them, because it won’t. This is NOT how psychiatrists are trained in modern universities.

Someone was unlucky to get stuck with a psychopath. Anyone can encounter a criminal, in any situation. If your psychiatrist is displaying warning signs, you don’t have to stick with them because you think the next one will be just as bad.

you really can’t say that it won’t happen because it absolutely does happen. therapy is not exempt from criticism just because it helps people.

Of course it shouldn’t be exempt from crit, I just think we should be presenting a balanced opinion to people considering going to therapy, who really need help. I’ve been in therapy for 15 years and it’s done me worlds of good. And I once had a really hideious therapist who should be disbarred or disbanded or whatever. Incarcerated for preference. 

But I don’t open the conversation with “I’ve been in therapy for 15 years and once, for a few months, I had a therapist who was awful.” Because there’s so much stigma against getting help, that most people don’t get help when they should, and stay sick, stay depressed, hurt the people in their lives, and don’t become the people they CAN be, because pop culture tells us that psychiatry is fake and wrong. 

So. Is there anyone following this thread who’d like to say that therapy helped them? That their therapist was professional, competant, helped them work out their issues and taught them helpful and adaptive skills? Because of my, like, 10 therapists across multiple offices and universities, that was the majority of my experience. 

obviously therapy helps people all the time, but this thread is specifically about boundaries and therapists breaking those boundaries and how the breaking of certain boundaries with certain patients isn’t seen as unethical for whatever reason. if you’ll notice, a lot of this thread is centered around the treatment of autistic patients, which are at a much higher risk for medical abuse.

so I don’t think this thread is adding to the stigma of getting help, I think this thread is an open and honest conversation about the abuses that are rampant in the medical field, specifically dealing with mental health, and more specifically dealing with patients that are viewed as disabled. and I think you’re derailing that conversation by saying that not all therapists/therapy is bad. we all know that. that’s not what’s being discussed here.

and sure, if you want to start a conversation about people’s positive experiences with therapy, I totally encourage that. but don’t use that to shut down this conversation, which is an important and necessary conversation for all of the people who have experienced abuse at the hands of their therapist.

Okay. I see what you’re saying. I didn’t mean to derail an important topic. I’ll stop now.

Thank you.

And I’d like to add explicitly:

I’ve seen therapy be dramatically helpful for many of my friends. Medication too. I think it’s great when those things work for people, and it’s horrible that there’s such a stigma attached to them. So many people are needlessly pressured into struggling alone.

I think it’s also horrible that the problems with therapy culture make therapy and medication unsafe for so many people who would otherwise benefit from them. I wish it was safer. I wish these things were realistic options for more people.

I also wish that people who have serious problems and address them in ways other than therapy/medication got more respect. Therapy and medication can be important tools, but they are not the only tools.

The stigma of seeking help is large, and can mess people up badly.

The stigma of having a mental illness or other serious problem and *not* going to therapy or using medication, or otherwise being noncompliant, is an order of magnitude worse.

People need to know that the risks are real. People who’ve been mistreated in therapy need to know that they are not alone.