Therapy Ethics According To A Facebook Ad

Recently, Facebook showed me a series of ads from a law firm encouraging me to sue my therapist. I read the article linked in the ad and had some Thoughts that I decided to share with all of you. I want to preface this article by reminding everyone that I am not a lawyer or legal expert, and nothing I say is legal or medical advice. This is just my reaction to an article about suing your therapist.

I also want to acknowledge that many people have experienced harm at the hands of their therapist. Fairly recently, a therapist in a jurisdiction where I practice lost their license for inappropriate sexual conduct – and frankly, that’s just the easiest ethical violation to prove. You were either sexual with a client, or you weren’t. Emotional abuse and manipulation are much more difficult to conceptualize and prove, so “I couldn’t prove it” does not mean “It did not happen.”

Even if you get a gut feeling that is difficult to articulate, it is okay to switch therapists for any reason or for no reason. You deserve to feel comfortable and safe in your treatment.

crop asian judge working on laptop in office
Photo by Sora Shimazaki on

Ethics are seldom all-or-nothing, so many things can be a “gray area” when it comes to “appropriate behavior.” Many things might be generally unacceptable with some rare exceptions. For example, in an ethics seminar in graduate school I was asked to role play how I would respond if a client invited me to their birthday party. The (fictional) client in question was a foster child who had never had a birthday party before and wanted Miss Amy to come to the party because “You helped me so much.”

After I tried to gently say no, the “child” began sobbing and promising to do better in therapy if I would just go to his birthday party, and my professor broke in to say, “In this case, it would not be unethical to attend the birthday party.”

So, according to some lawyer, here are things that indicate that your therapist is abusive, and my reaction as a therapist.

If they offer services for free or at a very low cost.

Therapists offer reduced cost services all the time. The organization I used to work for had an entire clinic to offer low-cost or free therapy for uninsured folks or those with really high insurance deductibles. In fact, Principle B of my ethics code states, “Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.” So actually I am supposed to offer free or low cost services to clients who need them.

If they schedule your appointment last in the day or after clinic business hours.

Based on my understanding of how schedules work, any therapist who sees any number of clients will have a last client of the day, so…we are choosing one client to abuse every day? As far as after hours sessions, that can be a boundaries issue if the therapist is not protecting their own balance and time off, but that is not automatically abusive to the client. The day I wrote this post, a friend actually mentioned a time that their therapist fitting them in “after hours” to accommodate a personal crisis, which they found really helpful and possibly prevented the crisis from getting worse.

Fictitious billing of insurance for non-existence treatments or sessions.

I wrote this word-for-word as it appeared in the article, but grammatical issues aside, this is correct. We should not bill for sessions that did not happen. That’s called fraud.

Therapy sessions run over time.

Again, this can be a boundary issue for the therapist, who may have another client waiting. However, it is not automatically abusive. This is a therapy Catch-22 – I have seen folks argue that therapists who insist on ending sessions on time are abusive, but so are therapists who are late for their next client. Apparently the only fully ethical therapists are Time Lords.

Practitioner seems aloof or not paying attention, or they check their phone in sessions.

Yes, your therapist should be attentive to you in sessions. Barring some type of emergency, they should not be checking their phone for things unrelated to the session.

Therapists invite clients to outside events such as a show or movie.

This is correct. Your therapist should not be inviting you to socialize. This would be a dual relationship, conflict of interest, and unethical. Some therapies involve going to a location for the treatment itself, like exposures for CBT, but your therapist should not be trying to be your friend outside of their role as your therapist.

Attending social events such as parties where the practitioner was.

I feel like I have to be misreading this. If a client goes to a social event where I happen to be, that makes me abusive? I am allowed to leave my house and have a life outside of my job. Again, I should not be inviting clients to social events, but if we happen to be in the same place, that’s just existing in a society. Imagine not being allowed to run into someone. Tell me you have never heard of a small town without telling me.

Offers rides home after sessions.

I have never given a client a ride home. When I took my ethics course, we were given an example of an extreme situation where there was a snowstorm, they had no cell phone, and they had an infant with them. I think this was meant to teach us there are no absolutes or something like that. I will say that an abusive person might use offering a ride home to test boundaries, so generally this may be an accurate statement.

Being invited to sleep over at the practitioner’s home.

Yes, this is not okay. Don’t invite your clients for sleepovers at your house.

Practitioner offers alcoholic drinks during or after sessions.

Unless there is a consideration I am missing, yes, this is also accurate. Your therapist should not drink with you or offer you alcohol.

Practitioner mentions that you have friends in the same circles.

Again, tell me you have never heard of a small town without telling me. No, I do not spend my clients’ sessions socializing or talking about friends we have in common. However, if the client mentions something that brings it to my attention that we may have a social connection, I disclose this to them. I don’t want them to be surprised if we happen to end up at a social event together, and depending on the nature of the connection, I might have to refer them out due to a dual relationship. They get to know if that is my reason for referring out.

Practitioner has offered to be friends when treatment is finished.

We are not friends with our clients, and there are rules about having social relationships after therapy has ended. So this is correct.

Have attended professional or social meetings together outside of sessions.

Do they mean attending together like going together on purpose? Again, professionally, this could be part of a CBT treatment protocol. If they mean you are not allowed to be at a meeting where a client might be, I will again say that therapists are allowed to exist as humans when we are off the clock. Therapists have our own therapists, and providers who work with other therapists might run into clients at conferences. They need their continuing education also. Therapists might participate in groups or organizations outside of work, which clients might also attend. Expecting me to never run into a client in another context is unrealistic.

If you are keeping score, a generous interpretation of these “red flags” was correct seven out of 13 times. That’s a failing grade. My conclusion here is that I will not dispense legal advice, and maybe this law firm shouldn’t be dispensing advice about therapists.

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. She completed her internship at the National Psychology Training Consortium with specializations in assessment and rural mental health. Currently, she specializes in trauma-informed and neurodiversity-affirming care, and she is certified in telemental health. Dr. Marschall runs a private practice, RMH Therapy, where she provides individual and family therapy as well as psychological assessments across the lifespan. Dr. Amy Marschall is an author and professional speaker.

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