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NO BROKEN CLIENTS
I don’t have and have ever
had any “broken” clients. No
one, no child, no teenager, no couple, and no family have come to therapy
with me broken. None of them
were other than they were… none of them were other than human.
Many, indeed most were wounded, injured, or had suffered
significant harm from intimate family members… or from bullies or toxic
peers… or from societal or institutional oppression.
Harm may have come from the actions of others or the failure of
action by others. However,
none were broken. An
individual may have lost it or were losing it, but although he or she
flipped out, this person had never experienced his or her life, was
affected, or responded in other than in some human fashion.
Nothing is broken, thus nothing needs to be fixed… and nothing
needs to be “repaired.”
Deeply harmed, a person may
have suffered intense human emotions such as anxiety, fear, doubt,
confusion, sadness, depression, loss, abandonment, or betrayal.
Trying to make sense of him or herself or of the world, the
individual often experienced emotional, intellectual, psychological, and
spiritual dissonance. Such
dissonance is often what brings an individual, a couple, or a family or
causes parents to bring a child or a teenager to therapy.
One person might want to be happy, but can’t be happy.
Another has trouble reconciling how angry he is with the person he
loves so deeply.
A young woman finds herself strongly attracted to a toxic
emotionally unavailable to emotionally abusive boyfriend… again.
Still another person holds him or herself to be a caring and loving
person, but has an intense instinctive hatred for someone different from
him or herself.
Or, wants to be a great spouse, friend, or parent but continues to
be negative or even abusive to important intimates.
Or, despite affirmations and affection from others, an individual
does not feel him or herself worthy or capable of self-love.
Or, someone may have conflict about his or her sexuality and sexual
attraction to… (Take your pick what to insert here.
You can put just about anything here, not just same or opposite sex
What do I do… how do I
respond as a therapist to my client’s dissonance… between the
discrepancy between what he or she wants and what he or she wants… to
feel, think, or do? Often, I
and other therapists enter into what has been called a “reparative
reparative relationship is NOT same thing as “reparative therapy.”
The reparative relationship is the relationship between the
therapist (or other important intimacy person) and the client (or other
harmed or wounded person). The
therapist’s care, attention, validation, and investment in the client
have a reparative effect. From
a psychodynamic perspective, the transference of the client (how the
client holds and experiences the therapist relative to older experiences
with intimate authority figures, for example) and the counter-transference
of the therapist (how the therapist holds, experiences, and interacts with
the client relative to nurturing and mentoring instincts, for example)
interact to create a restorative dynamic that heals infantile and
childhood emotional and psychological wounds.
Others and I can go on and on
about this relationship from various theoretical orientations and
therapeutic strategies, but essentially it is based on attachment
theories. Although, this
relationship has been called a “reparative relationship,” it may be
better named a “restorative relationship” or a “healing
perhaps it can be called a “growth relationship” as it addresses
developmental or formative dynamics or process that were not broken, but
were repressed, delayed, or diverted.
The responses or reaction of the individual to neglect, harm, or
trauma were fully human, and therefore not “broken” or inhuman or
non-human responses needing repair.
What makes the relationship
restorative or healing? What
about the client’s dissonance? Clearly
drawing from an humanistic orientation, I believe what makes the
therapeutic relationship restorative or healing is my and other therapists
acceptance of the absolute humanity of the client… acceptance of his or
her feelings as human… of his or her thinking (common, idiosyncratic,
culturally or societally normative or non-normative AND sometimes
problematic or illogical) as human. If
problematic, it is reflective of his or her confusion as a human being…
of confusion about his or her choices: outbursts, drinking, gambling,
toxic actions towards others, sexual behaviors, cultural behaviors… but
most importantly still about many behaviors that are human!
Some choices or behaviors may be personally (to the client)
self-injurious, harmful to others, and even destructive of the social and
cultural fabric of society and communities, but they are still most
Oh yeah, some of the choices or
behaviors may be personally appalling to you or I.
However, any dissonance the therapist experiences with the
client’s choices and behaviors (including
the client’s personal dissonance) is the individual of the therapist’s
personal responsibility to hold outside the therapeutic process.
It is the client’s dissonance within him or herself that the
therapist is in the role to address. The
therapist’s disagreement with, aversion to, disgust of, or any other
dissonance triggered by the client’s feelings, beliefs, behaviors, and
choices is the therapist’s personal/professional challenge- NOT to be
injected into the client’s therapy.
The therapist should get consultation at the very least.
When the client enters therapy
with some dissonance and presents it, the therapist’s first
responsibility should be to discover how, what, and why it exists.
To me as a psychodynamic or family of origin, developmental,
attachment oriented, AND cross-culturally (among other lenses) oriented
therapist, that means how has this client’s humanity in interaction
(including conflict) with his or her journey through childhood (and
adulthood), relationships, communities, and other environmental contexts
and influences resulted in this particular human response of dissonance.
In other words, I automatically NEVER take and agree with whatever
evaluation, complaint, self-loathing, judgment, or condemnation the client
presents about him or herself, his or her family of origin, partner, or
current family (at least, I
hope I never do or will, because if I do, I will have fundamentally failed
as a therapist).
So many of my… and your
clients come in despising and hating themselves because of the ill health,
choices, and behaviors of prior intimates.
They come in and talk about and assert they are so screwed up…
eternally condemned for not being lovable enough, worthy enough, or
important enough to be loved or valued.
This could include someone who has internal conflict about sexual
attractions. I absolutely
never grab my client’s self-hatred or dissonance and run with it
therapeutically because it coincides with or validates MY value, belief,
or spiritual system or life process, choices, or behavior.
Why not? Because it’s not MY therapy!
It’s my client’s therapy… his or her values, beliefs,
spirituality… life, behaviors, choices… and most of all his or her
version of his or her humanity. (And,
I’m not even going to argue about what is choice or what is innate.
I’ll leave that to others. For
me, it doesn’t matter as long as I as a therapist honor each person’s
individual and shared humanity).
So, I explore with the client
how, what, and why the dissonance exists.
How, what, and why his or her humanity has taken him or her on this
particular journey… to this particular junction in the journey.
I almost always have guesses about how emotional, psychological,
intellectual, spiritual (including religious), and even sometimes, sexual
dissonance occurs. I’ll
prompt the client to look in those areas, but sometimes the client goes
other directions. Sometimes,
he or she knows where to go… sometimes, it’s a distraction or
avoidance… sometimes, it happens quickly and other times it goes slowly.
And even when it we can’t somehow figure it out, I’m still
confident that my client is human… that his or her journey and who he or
she is or feels or believes comes from some logic of humanity and the
human process. NEVER will I
say, “You’re right that you’re wrong!” or “Yes, you are
deficient… somehow not human… you are somehow inhuman… wrong or
broken.” I believe that I
can hold this perspective resolutely because I do not have a personal
vested interest in having a client… any client be “wrong” or
But then what if the beliefs,
feelings, and choice or behaviors cause harm?
And we’re not talking about Tarasoff or suicidality here.
Harm to self or harm to others?
Harm to others is an obvious call.
With harm to others, therapist must activate intervention as is
ethically and legally appropriate and mandated.
(And those who feel that sexual orientation is somehow contagious,
I hardly know what to say. I’ve
interacted with, touched, hugged, breathed the same air, and shared room
and food with gays and lesbians and haven’t “caught” anything!
I guess I’m terminally straight… but who knows for sure?!
I honestly don’t.) Harm
to self? Hmmm?
Sounds like the fundamental work of therapy!
Emotional harm? Go for
it! Psychological harm?
Do it! Intellectual
harm? Well, stinkn’ thinkn’
causes emotional and psychological harm (aka as the cognitive behavioral
or rational emotive therapies)! Relational
harm? That’s precisely the
scope of practice for MFTs! Spiritual
Gets a bit dicier here… Yes, if!
But to me a big IF! If
spiritual harm causes emotional and psychological harm that causes
relationship harm… maybe OK I think.
I know this will be controversial, and a lot of therapists believe
their work to encompass spiritual health.
However, I’ll have to look again, but I do not recall the word
“spiritual” or the phrases: “spiritual health” or
“spirituality” in the legal definitions of the scope of practice for
In addition, other than
references against discriminatory practices on the basis of religion, I
don’t believe “spirituality” and “religion” in the CAMFT Ethical
Standards either. If a client
has religious conflict (arguably, a spiritual-religious conflict), the MFT
has to be very careful of practicing outside of the MFT scope of practice.
So, if the client believes and feels that he will be condemned to
hell for some beliefs, feelings, or behaviors (or other religious
consequences of not following a particular religion or set of religious
doctrines), I believe that would be clearly outside the MFT scope of
practice; and personally, for me outside of my scope of competence- I am
not trained as a theologian. It
would seem to be within the scope of pastoral counseling.
If the MFT or other licensed psychotherapist wishes to practice
psychotherapy from religious principles, tenets, and doctrine, that also
may be problematic because the legal definition of MFT practice makes no
mention of working from such foundations.
Instead, the law mentions psychotherapy, psychological principles,
The other terminologies for
“reparative therapy” are “conversion therapy” and SOCE, which
stands for Sexual Orientation Change Efforts.
Conversion has overt religious connotations throughout history.
For example, European Christian missionaries attempted to convert
indigenous peoples on several continents- a process that resulted in
religious conversions for some and oppression, death, and slavery for
others. For many people,
it was a gift they did not want or benefit from.
Without reference to religious conversion, conversion involves
changing a belief, the beliefs, or the belief system of another person.
It is not merely “sharing” a belief or belief system.
An individual may go through a personal conversion in his or her
belief system (religious or otherwise).
However, self-determination should be the core principle in belief
conversion. The Ethical
Standards admonish MFTs not to give advice or to otherwise inflict the
therapist’s beliefs on the client.
I personally find it
disingenuous for practitioners of conversion therapy to claim that they
are only offering the therapy because there are individuals who wish to
change their homosexual behaviors (and/or feelings) to heterosexual
behaviors (and/or feelings). I
find rather incomprehensible that practitioners of conversion therapy do
not strongly and completely believe that being heterosexual is not only
“normal,” desirable, but also morally and religiously superior; and
probably that homosexuality is… let’s just say, not. On
the other hand, therapists who work with domestic violence perpetrators or
pedophiles certainly do the work because clients may want the therapy
(sometimes) and it is important work.
However, it is completely plausible if not the norm, that such
therapists overtly abhor the behavior of DV perpetrators and pedophiles.
(Please don’t confuse this reference to the entirely
inappropriate comparisons of homosexuality and child molestation).
The point is that therapist tend to do the work that they believe
in, and it seems logical that practitioners of conversion despite their
claims to the contrary, that they are otherwise not accepting of
homosexuality or homosexuals not interested in “converting.”
In other words, it appears to me that such practitioners are
practicing their religious beliefs rather than practicing psychotherapy.
The ultimate points to this entire discourse is three-fold.
In my opinion, reparative therapy or conversion therapy by any name
inherently violates the principles of good therapy; practitioners of such
therapy may be disingenuous when they claim to be accepting of
homosexuality; and such therapy is unethical and may also be legally
questionable. MFTs and other
licensed psychotherapists have legal scope of practice as defined in their
licensing laws in each state. Therapist
behavior in therapy based on personal beliefs from whatever sources, no
matter how heartfelt do not preclude or exempt MFTs from the boundaries
and limitations of their scope of practice as legally defined. As
members of a professional association, said membership includes an
agreement to abide by the ethical standards or code of the association.
Included in ethical codes are references to standard accepted
professionally reviewed practices (I’m not sure if this is the exact
behavior in therapy based on personal beliefs, including religious beliefs
are not exceptions to the ethical standards.
Therapist behavior in therapy based on personal beliefs and
morality that is in conflict with legal requirements can result in legal
liability. Therapist behavior
based on personal beliefs and morality that is in conflict with ethical
requirements by virtue of membership in ones professional association can
result in ethical sanctions. The
point that many members have made is that conversion therapy, reparative
therapy, or SOCE therapy and the like are not considered appropriate or
ethical by American psychology and psychotherapy.
An individual therapist may disagree, but should remember that the
disagreement does not have professional ethical support and thus, arguably
also may not have legal support.
This is what happens when I’m
drawn to contribute to this very important discussion I’ve been
following for the past few years. Although,
my instincts and feelings about social justice, equality, and shared
humanity took me quickly to a personal (and political) perspective and
stance, I felt obligated to find the therapeutic consistency in the
perspective and stance. Although,
everyone knows what the listserve has been talking about, and everyone
should know what I’m talking about, I wanted to make sure that my
concepts and principles for therapeutic activity and responses (and
response to the listserve) would transcend this important topic and be
applicable and livable (or using a fancy businessy word- “actionable”)
for other clinical situations and client presentations.
In other words, I find reparative therapy objectionable not merely
because of its potential and past harm to members of our community, but
because its core principles are objectional because of potential harm to
any client. I believe this
will work for me as a therapist. I
hope it’s useful or at least, provocative for others.
And for those of you who may be curious of what my religion or religious
beliefs might be so that you can drop me into this group or that group…
or, accept or reject me, it’s none of your business!
Actually, I’m quite fine with letting anyone know, but it really
isn’t any of your business! That
I do or do not practice clinically with effectiveness, integrity, heart,
and ethically and legally should be sufficient.
If that’s not sufficient for you, then… oh well, what can I
I guess, I might as well take
it a step further, as a fellow MFT, I don’t really care if you are this
or that, believe in or practice this or that religion or not.
As a fellow MFT, I really only care if your practice with
effectiveness, integrity, heart, and ethically and legally.
How you come to your practice, that is, your clinical and
therapeutic behavior and actions may be interesting (and certainly,
important to you), but I also might not particularly care about that
because I don’t know most of you… perhaps, yet (and I’m not YOUR
therapist!). In lieu of
personal contact, as a fellow MFT, I essentially care about what you do
(your behavior and actions) as it affects clients and as it affects our
professional reputation. As an
individual, especially in person if I come to know you, then I’ll care
about other “stuff.” Of
course, self-disclosure (which I’m prone to do) may be useful in making
a point in the discussion, so I’m not that rigid about it.
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