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?

One of my first jobs was at an “autism treatment center” as tutor in a preschool and then kindergarten/first grade classroom. As part our our “treatment,“ we used aversive consequences on children as young as 18 months, including but not limited to taste aversions (vinegar spray, cayenne pepper, etc), making kids stand up and sit down up to 100 times in a row, screaming at them, putting them in padded rooms for periods of time, physical restraints, spraying water in their face, etc. That was just the obvious abuse… which of course was signed off on by parents and a “human rights committee.” The psychological abuse was much more prevalent, nuanced, and frightening.

I’m not saying that therapy is bad or that no one should ever get therapy. Therapy is incredibly helpful for some people.

But there are also major problems with the way therapy culture sees boundaries, and the way therapists are taught to relate to seriously atypical people.

The problems are especially bad for people who have developmental disabilities, brain damage, or severe mental illness.

For instance, a white able bodied person is likely to be able to find someone who can help them treat their depression and still respect their boundaries and treat them like a person, especially if their depression responds well to medication.

Likewise, it’s usually possible for white women to find a therapist who will help them learn how to have boundaries women are often socialized not to have. 

It’s a lot harder for a developmentally disabled person to find a therapist who will help them learn how to have boundaries they were socialized not to have. And it’s very easy to end up with a therapist who will make matters worse.

It’s not just a matter of there being some bad people in therapy the same way there are in any other spaces. There are actual problems. And, while therapy can be very helpful, it can also be very dangerous.

That’s something that people in therapy or considering therapy need to know.