The core ethical principle in psychotherapy is this: The therapist's sole function in the relationship with a client is to perform psychotherapy. Therapist's silence, words, actions, inactions and policy exist solely to maintain the psychotherapeutic process.

The best therapeutic course may not always be what feels good in the moment to either the client or the therapist.

The therapist's decisions are not based on the patient's wishes or expectations, nor are they based on the therapist's feelings of discomfort when accused of coldness or selfishness. Nor are they based on the therapist's feelings of pleasure when praised by the client. Emotions inform, but do not determine therapist action.

Once a therapist is educated, trained, tested and licensed, there are five essentials to psychotherapy: time and space, money, acceptance, confidentiality and role. Each has its challenges.

Time contributes to the space boundary in which therapy occurs. The client needs to know her/his therapy solidly exists in space and time within appointment hours. As the client restructures time and priorities to keep appointments s/he develops increasing trust in self and the therapist. They both honor the time and space in which the therapy occurs. As that trust and honor increases, so does the intensity and value of the work. Plus, when the time and space boundaries are solid and reliable, the client is more able to bear stressful experiences outside of appointment times.

Money is crucial in defining the relationship. The client pays the therapist an agreed fee. In exchange the therapist provides the complex service of psychotherapy. The client does not owe the therapist gratitude, referrals, gifts, contacts, advice, adoration, friendship or anything else. Paying for psychotherapy is the total sum of the client's obligation to the therapist. This frees the client to feel and express whatever is true in the moment, unburdened by any intangible debt. It also frees the therapist from any distracting sense of entitlement.

Acceptance means no judgments. If the psychotherapist judges the patient, the possibility for understanding is diminished or voided.

Confidentiality means the psychotherapist remains unshakably silent concerning all information revealed by the client. Clients need to be confident that their personal secrets, strong opinions about others, or sensitive emotional expressions, will not go beyond the relationship with their therapist.

This creates the possibility for developing trust that is deserved. Only when confidentiality and trust are certain can the clients allow deeply surprising and previously unknown or unexpressed powerful thoughts to come to the surface to be explored and understood.

Role definitions appear simple. One person is the client. One person is the psychotherapist. If the therapist leaves the role of therapist to interact with the client in another way, there is no therapy. The person who was in the therapist role has entered a different role leaving the role of therapist vacant.

Whether the intentions are benevolent or exploitative matters not. If the therapist leaves the role of therapist the therapist has abandoned the client.

Maintaining these boundaries are part of the continuing challenge to therapy and contribute to making therapy possible.

Clients must, and continually do, challenge these boundaries. They will be with their therapists as they are with people in their lives. How could it be otherwise? Yet when the therapist responds as therapist (and not like everybody else in the client's life) the client can experience shock, rage, frustration, sorrow, insight, relief, learning and eventually fundamental change.

The responsibility for remaining in role rests with the therapist. However, sometimes pressure from the client for the therapist to behave, speak or feel like a friend, parent, lover, teacher, child or advice-giver of some sort is so great that the therapist finds it extraordinarily difficult and even impossible to remain solidly in role.

This is natural. Minor lapses, when recognizable, can actually be helpful to the therapeutic process as long as the lapse is indeed minor (anything more than a few moments is no longer minor) and recognized by the therapist. Then the lapse can be worked through with the client to increase understanding.

When a psychotherapist honors professional ethics, he or she not only protects clients from exploitation but also creates an environment in which powerful healing can take place. The conscientious client focused on personal healing may be surprised and even angry at the ethically determined structure he meets in psychotherapy. However, the client quickly grows to realize that this structure is essential to bring about his healing and allow him a life of more freedom and joy.

5/28/98

Joanna Poppink, M.F.C.C., licensed by the State of California in 1980, is a Marriage, Family, Child Counselor (License #15563). She has a private practice in Los Angeles where she works with adult individuals and couples. She specializes in working with people with eating disorders and with people who are trying to understand and help a loved on who has an eating disorder. Contact Information: 10573 West Pico Blvd. Suite 20 Los Angeles, CA 90064 (310) 474-4165 phone (310) 474-7248 fax