Video summary
The core challenge in therapy arises when a client actively engages in behaviors or makes life choices, such as participating in BDSM, polyamory, having an abortion, or voting for specific candidates, that conflict with the therapist's personal values. The fundamental principle for managing this situation is to clearly distinguish between affirming a person's inherent dignity and endorsing their specific actions. Therapists must recognize that every individual deserves love, respect, and care simply by virtue of being human, regardless of whether the therapist agrees with their lifestyle or decisions. This approach requires therapists to genuinely seek to understand how a client perceives their chosen path as the best option within the unique context of their own life, rather than imposing external judgments or refusing to discuss the topic.
To navigate these conflicts effectively, therapists can apply the ABC model from cognitive behavioral therapy by examining the activating event, their automatic beliefs about the situation, and the resulting consequences. It is crucial to separate acceptance of the client as a person from acceptance of their behaviors or beliefs, ensuring that affirming dignity does not equate to validating every action. Therapists should introspectively ask themselves what they believe about the client if they make a choice the therapist disagrees with, whether they view such a choice as making the client a "bad person," and how supporting autonomy aligns with ethical standards like fidelity and non-maleficence. Conversely, refusing to support a client or setting conditions on what can be discussed causes harm by undermining the client's autonomy, creating dependency, and potentially damaging their self-esteem and faith in the counseling process.
The video illustrates this dynamic through personal anecdotes involving parents and children, highlighting that while family members may vehemently disagree with an adult child's life path, supporting that individual's right to make their own decisions is essential for individuation and growth. Just as parents eventually realize that respecting a child's autonomy allows them to learn from their experiences and build self-esteem, therapists must respect the client's worldview, which is shaped by their culture, experiences, and interpretations. The goal is not to control the client or dictate what they should do, but rather to provide accurate information, advocate when necessary, and help the client process their thoughts so they can make an informed decision that aligns with what is important in their rich and meaningful life.
Ultimately, upholding ethical principles in these scenarios ensures justice by guaranteeing that all clients receive high-quality treatment regardless of whether their values match the therapist's. By adhering to the ethics of beneficence, non-maleficence, fidelity, and autonomy, therapists create a safe environment where clients feel heard and supported even when exploring controversial topics. This approach fosters a therapeutic alliance based on unconditional positive regard, allowing clients to move toward solutions that matter most to them without fear of rejection or judgment. In doing so, therapists not only honor the client's right to self-determination but also model a respectful engagement with diverse worldviews that is essential for effective and ethical mental health practice.
Read the full video transcript
There are times where you're going to
work with a client who [clears throat]
actively engages and plans to continue
actively engaging in BDSM or polyamory
or they're going to have an abortion or
do something that
you have strong feelings against but
it's not our choice. So how do we manage
that?
First identify the difference between
caring for understanding and affirm
affirming a person's dignity. They are a
person first and they are worth love and
respect. We may not agree with their
choices but they probably don't agree
with all of ours either. We want to
understand, affirm, and care for their
dignity as a human. Doesn't mean we
endorse their choices.
In what ways does the client see
whatever this choice they're getting
ready to make as the best choice or
approach in the context of their life?
staying in a an unhappy marriage,
staying in in a relationship that is
objectively dysfunctional,
um
having an abortion,
choosing to vote for X, Y, or Z.
In what way is this the best choice
in in the context of your life? Help me
understand. Just educate me. When
clients have to educate us, they're
talking it through. They're processing
it. And along the way, they may think,
well, you know, maybe I missed
something, or they may not, but at least
we're starting to understand their point
of view.
If you were struggling with an issue
that your therapist deeply disagreed
with, how would you want them to
respond?
Would you want them to tell you you were
wrong? Would you want them to tell you
that,
you know, your way is not going to work
or that you won't even discuss it? What
uh what would you how would you want
them to respond to you? And we really
want to reflect on that when we're
working with clients.
[cough]
The ABCs.
Uh, cognitive behavioral therapy 101.
Activating event. The client comes in
and engages in a behavior or is getting
ready to make a choice or decision that
you disagree with.
What are your beliefs? So, the B stands
for your automatic beliefs about what's
going on. What are your automatic
beliefs about the issue?
Um, what are your clients beliefs about
the issue? That's important so you can
understand where each of you is coming
from.
Are you merging acceptance of a person
with acceptance of their behaviors or
beliefs? Remember, we want to affirm
their dignity as an individual. It
doesn't mean we're endorsing their
behaviors.
What are your beliefs about the client
if they make the choice you disagree
with? Do you think they're a bad person?
Do you you What are your beliefs about
the client? If you make this choice,
it you know, fill in the blank.
What are your beliefs about yourself?
If you support a client in making a
choice you disagree with, maybe you
disagree with um polyamory and your
client is in a polyamorous relationship
and maybe they're having some
difficulties, but they still want to
keep the family together.
if you support them in working through
that and working toward a meaningful
improvement in their relationship. Uh
what are your beliefs about yourself if
you don't think that that is an
acceptable relationship structure?
And then the consequences activating
event beliefs and consequences. What are
the consequences to you the therapist if
you support the client?
Well, ultimately those are probably
going to be pretty good because you are
maintaining fidelity. Um, you are
supporting autonomy. You're acting
ethically. You're supporting the client
in exploring the issue and making the
best decision to help them move toward
what's important in their life.
What are the consequences to you
[snorts] if you refuse to support the
client? And we need to think this
through clearly. If we refuse to
discuss the issue, if we refuse to
support the client um
in making the choice that they think is
best for them,
what are the potential consequences to
you as a therapist?
What are the consequences to the client
if you support them? Ultimately, those
are probably going to be pretty good. If
you support them in exploring what's
going on and making the best choice,
then you're helping them move toward
what's important in their rich and
meaningful life.
And what are the consequences to the
client if you refuse to support them?
Those can tend to be much more damaging
because they may feel rejected. They may
lose faith in count the counseling
process. They may lose hope that things
can get better
when you support a client in making a
choice that conflicts with your values.
How do you process the inner conflict?
And I want those of you who are parents,
I want you to reflect or maybe all of us
were children at one point and I think
we all made decisions that our parents
were just like, "Oh my gosh, I can't
believe you just did that." Um,
but hey, you did. Um, or like when I
went into psychology,
my parents were dead set against it.
They're like, "There's no money in it.
There's no jobs. you're going to have to
go and at least get a master's, so your
bachelor's is useless. All that's true,
but it was important to me in my rich
and meaningful life. It gave my life
meaning. It was something I was good at.
Um, my parents
told me their point of view, but then
they supported me in my journey once I
said, "Well, I hear what you're saying,
but it's my life." Uh
then they said, "Okay, well, we've
raised you for 20 years. We have
imparted our wisdom. We've let you know
our opinions. So, at this point,
it's up to you to make the right choice
because, you know, at a certain point,
you got to adult."
My children did the same thing. Um they
both of them made decisions that
I'm not fond of, I wasn't fond of, but
thank God they have all worked out. And
you know, I wasn't sure they were going
to, but they have. And
it was important for them at that point
to individuate
and
make these decisions that they had
thought through. And one of them, you
know, it worked out great and there's
been no assistance needed. Thank you.
And the other one didn't work out so
well. We were there to help him put
things back together and he got back on
the right track and is doing great. Now,
what was important was we didn't try to
control them. We didn't say, "We don't
love you. You can't come home if we
said, "All right, wouldn't be our
choice, but you're an adult, so you
know, you're you're able to make that
make that decision." And when we put it
in terms of either our children or try
to think back to when we were doing
things that our parents vehemently
disagreed with, you know, sometimes we
look back and go, "Hey, you know, maybe
they were they were a lot more right
than we realized, but we made that
decision
and we learned from it. We grew from
it." Um,
and that was important for our
for our autonomy, for our self-esteem
to be able to make these decisions. And
yes, I appreciate I appreciated my
parents saying, "Okay, I hear you want
to do this. These are the concerns we
have,
just like I did with my clients. You I
hear that you want to do this. These are
the current concerns that I have. Take
what's useful, leave the rest.
In terms of the ethics of respecting
people's worldview, there's a lot of
them. Beneficence
means engaging in actions to promote
client health and well-being. It doesn't
mean telling them what they have to do
or telling them that they shouldn't or
can't make a decision if we don't think
it's the best decision. Um, but we want
to educate them, provide information to
them so they can make an informed
decision. And sometimes we need to
advocate for clients if they are
needing assistance.
Non-malfins do no harm. If we tell
clients what to do or we set conditions
on
worth or what we're willing to talk
about or what we're willing to accept in
terms of their choices for their life,
then we're causing harm. we're not
supporting autonomy. Um, and we're
potentially creating a dependency and
squashing the client's ability to live
authentically.
Fidelity.
When we pay attention to our boundaries
and we respect the clients, we're
keeping our word to show unconditional
positive regard, creating a safe,
supportive environment.
By doing this and respecting worldview,
we're ensuring all people get the
quality of treatment, even if they
disagree with us, we're not only giving
good treatment to people who think the
way we do. We are giving good treatment
to everybody, and that's justice.
And finally, autonomy. We support the
client in making the best choice for
themselves based on what's important in
their rich and meaningful life. We help
them get all the information that they
need to make a good decision. We help
them process that information, but
ultimately the decision is up to them.
People's worldviews are formed by their
culture and their experiences as well as
their interpretation of those
experiences. Their actions and decisions
are based on that worldview.