This episode had been a long time coming. But as with most things, in the psychological realm everything worth doing, exploring, investigating, takes time. We are complex as all hell. 

I have spoken quite a bit on the podcast about how I think the field of psychology has not done a very good job making the hard science of mental health friendly and accessible. And I’m not exactly sure why. Perhaps it has something to do with the fact that most therapist offices are stuck in 1984. I mean seriously. Let’s update that shit. If I am going to share my innermost thoughts with someone, they better have a clean couch and an updated selection of magazines. At least subscribe to the Atlantic, please. Whether the field has chosen to acknowledge it or not, appearances matter. It sucks, but we know this. And appearances are leading the trust of the public into the hands of people that are just plain sexier. And sometimes unqualified. And this is not good. 

In the world of licensed mental health clinicians there is a strict code of ethics. Ethics in clinical work are not just a set of loosely agreed upon rules, but a set of determined best practices tied to our licensure that act in the interest of protecting our patients. 

Ethics are why psychotherapists never take on a friend or family member as a patient, or the child of a friend or family member. A former teacher, boss, employee, next door neighbor. There just isn’t enough unweighted perspective to do the job as intended. Therapists are people too and when it comes to our own lives and loves, our perspective can get clouded. 

An ethical code is why you won’t hear many licensed professionals comment on the mental health of a public figure. Be it a president, a celebrity or an athlete. We do not evaluate or diagnose those who are not within our caseload. We do not know the whole story and in clinical work, the whole story means a lot. A whole lot. We do not diagnose who we do not see as a patient. And when the person is a patient, we don’t share that information either. Confidentiality is another crucial part of the clinical ethical code. 

Additionally, and in my mind most importantly, the clinical code of ethics requires that we do not work outside of our area of expertise. In other words, we stay in our fucking wheelhouse. This is stressed and taken very seriously in training. Here’s what that looks like in the real world. Let’s go back in time to when I was in private practice. While in practice, my area of expertise was adolescents in acute crisis. This means I knew more about treating adolescents in acute crisis than anything else. I kept up on research, treatments, and new discoveries in the field. And most of my continuing education revolved around treating adolescents. This is not to say that I didn't have a very broad spectrum of clinical knowledge and experience or that I didn’t see patients with other issues. It simply means that I found a facet of psychology that really interested me and I put more focus on that area of study and treatment than anything else. So, imagine I receive a phone call from a parent who’s teenage child is struggling with an eating disorder. They reached out to me because when they googled child therapists in their area my practice popped up. Now you might imagine that in all of my concentration on treating adolescents, eating disorders must have been a part of my training. And yes, definitely true. However, when it comes to ethics an honest self evaluation of my area of expertise would lead me to conclude that while I do treat adolescents in crisis, eating disorders lie outside my area of expertise. Do I know about them, yes. Do I specialize in them, no. And let’s go even further. Let’s say I suffered from an eating disorder when I was a teenager. Surely this positions me as an expert in the field of eating disorders, right?  Wrong. Big wrong. Sharing a struggle or a diagnosis does not make an expert. Should I say that one more time? Sharing a struggle, diagnosis, even an experience, does not make an expert. Not when it comes to treatment. For this scenario to work, and to see the patient with an eating disorder, I would still have to have the specific training to make treatment of eating disorders well within my area of expertise. I would also have to do a lot of internal work to make sure that my own experience was not clouding my ability to help my patients. And that internal work would be an ethical requirement and overseen by a qualified consultant in the field. And would take a very long time and probably be ongoing while I had an active caseload in order to protect my patients from any loss of perspective on my part. 

So why do I bring this up? Well, first, as I mentioned before, I think a general lack of friendliness, approachability and outreach about exactly what therapy is and can do, has led people to seek help elsewhere. And help is good. I love help and I want anyone who wants help to be able to get it. But help alone is different than treatment. And that is a really important distinction to make. There are many things that help and support our mental health. Buzzfeed articles that boast 5 tips to banish anxiety, the influencer who shares their breathing techniques when they experience anxiety, the beautifully packaged essential oils Gwynth places on her temples when she needs to feel grounded. All helpful. All supportive. But not treatment. Will these things make you feel better? Sure. I am for all the things. But quick tips, strategies, pretty smelling things - I have them all but the way- these are supportive and do not replace treatment. And what is treatment? Treatment, no matter the modality, is an individualized level of care provided by a skilled practitioner with deep learning and years of practice. And depending upon the symptoms, this practitioner can be a psychotherapist,  physician, dentist, acupuncturist, shaman, reiki master, etc. The list goes on and on. In my case, I’m a licensed clinician with a code of ethics. And that’s why clinicians like myself, and most other practitioners constantly evaluate their area of expertise. 

I suppose helpful strategies might concern me because a lot of the time they are touted by individuals who share an experience, or struggle but have no expertise in treatment. Whether treatment to you is classic psychotherapy, acupuncture, chiropractic work, nutrition, shamanism, massage, reiki, and the like. I think ya’ll know by now I’ve tried all the things. And it’s good to try all the things to see what works for you. But whatever you choose, treatment involves a qualified professional. What concerns me greatly is that the confusion between helpful/supportive and treatment might be leading people to feelings of hopelessness about their struggles. And that’s concerning. Imagine experiencing anxiety and relying on influencers, Buzzfeed clickbait, and let’s include podcast hosts here, to provide tips that promise to get rid of your anxiety. There’s a red flag right there. Banish, get rid of, control. Those words are a little dicey. What about understand, manage, and navigate? Much better.  These are words that qualified clinicians use. 

You’ve tried everything and maybe these quick tips work for a while, and they might. Support goes a long way. But then plateau. And you are left wondering why after working so hard, things are still not improved. There must be something wrong with you. You didn’t try hard enough. You didn't buy the right candle, you bought the less expensive weighted blanket. I call bullshit. You were simply looking for help. And utilized what was right in front of you. What was friendly, pretty, and made much nicer promises than a serious commitment over a long period of time. And in the end, that’s a choice we all get to make. For better or worse. But let it be a conscious choice. Decide not to do the work, not to seek treatment. That’s fine. No one is saying you have to. But if you are seeking change make sure the help you are receiving is well within the givers wheelhouse. Ask questions. Do research. Know whether the strategies you choose are advice, or treatment. And always consider ethics. 

Thanks for being here. 

Listen to this episode of JOY IS NOW here. 

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