self-care ethics code ethical violation

In last week’s blog post, we discussed a novel in which a psychologist enters into a sexual relationship with her client, a decision that is portrayed by the author as a woman finally following her heart  (Melissa Foster’s Sisters in Love, 2014).   As disturbing as this minimization of harm is, even more alarming is the public acclaim for the novel, with the vast majority of raters and reviewers seeing it positively.

Dr. Danica Snow is described as an intensely responsible practitioner, dedicated to her patients and her profession to the detriment of her own happiness.  Because of the “sacrifices” she has made, her involvement with her client Blake is presented as something akin to her due.

Although easy to overlook in the context of the damaging sexual relationship, Danica also manages to breach client confidentiality in the space of a few short weeks.  She tells her sister that Blake has just come to her office, then coyly insists that she can’t reveal why.  On another occasion, Danica places a stack of client files directly in front of her sister, only moving them when she realizes she wants to protect Blake.

In addition, the descriptions of Danica before she met Blake merit scrutiny.  Of the many problems with these depictions, it bears emphasizing that “responsible” Danica was in fact already committing an ethical breach- in her total neglect of self-care.  Readers are told:

“Danica had spent their evenings out looking over her shoulder for her clients instead of loosening up.  Now she wondered if she’d given herself a fair shot at a social life.”

“She lived in the shadow of her profession, worried that someone would find out if she had a sordid one-night stand.”

“She’d lived her life carefully, always putting work and professionalism before her own needs…”

Danica appears to be profoundly isolated in both her professional and personal life.  If a therapist were genuinely so afraid of running into a client that he or she was unable to go out in public with friends, this fear would seem to demand professional consultation at a minimum.  Yet in this novel it is heralded as an indicator of what a good and devoted therapist she is.  So instead of being shown an ongoing pattern of ethical violations (lack of self-care followed by sexual involvement with a client), readers are given an impression that Danica somehow “deserved” the romantic connection because of her prolonged loneliness and self-denial.

Of course, therapists, in fiction as in life, are not required to be perfect human beings with perfect lives who never stumble or make mistakes.  But when fictionalized accounts portray significant problems as minor (or as virtues), this can create misleading and negative treatment expectations for potential help-seekers.

In Caroline Eriksson’s The Missing (2016), a deeply troubled woman named Greta visits a lake with her partner and daughter, only to have her loved ones vanish.  It turns out that Greta’s memories are unreliable and her denial mechanisms so potent that her beliefs about what is happening may bear little relation to reality.  As she struggles to make sense of events, Greta recalls different therapists she has had throughout her life, including one psychologist who seemed particularly passionate about helping her.  Though she is mentioned earlier, this psychologist’s major contribution to the plot comes quite late in the book.  Now, the ethics codes are silent on what to do if you track down your husband’s extramarital lover with the intent of doing her violence, only to discover that she is a former patient.  But it is difficult to see how public perceptions of therapy or therapists would be negatively influenced by this plotline; Eriksson does not write misleading depictions of the therapeutic process itself.  It is those types of depictions that need scrutiny and challenge.