The therapeutic relationship, whether with a man, woman or child is an intimate one. Behind a closed door, the therapist intently and warmly listens while the client discloses aspects of one’s life that have likely never been revealed to anyone else before. If the work is to be fruitful a deep connection is formed. This is shaky ethical ground. In such a private and supportive setting, the appropriate professional boundaries can be easily misjudged. Indeed, some of the most common ethical violations made by therapists are sexual and therefore rules and guidelines are provided and enforced by state licensing boards and national associations. The question I would like to pose is: Are therapists doing enough to prevent and protect themselves and their clients from acts of misconduct? In the private, secluded environment that we work, are we taking sufficient precautionary measures to make sure that professional boundaries are maintained? Is there an elephant in the therapy room?
A recent article in the forward that weighed in on the Harvey Weinstein scandal suggests that the beginnings of a solution to reduce sexual misconduct are preventative and may be found in the Talmudic laws of yichud that place restrictions on who is and is not allowed to be alone in private together. The author suggests that given the #metoo, Harvey Weinsteinesque reality of our society, awareness of where you are, who you are with and what it could lead to, is wise. Like the author, I blame only the perpetrator of these crimes. The victim is not at fault regardless of what she is wearing and yet taking preventative measures in an imperfect world seems like sound advice.
Let’s return to the therapy room. What measures can be taken to prevent the likelihood of misconduct between therapist and client? In my mind, the most simple and obvious is to place video cameras in the therapy room. The camera would not record audio and it would be placed in a location where lips could not be read, maintaining confidentiality. Further, the video itself need not be high quality, just enough of a grainy picture to ensure that everyone is where they should be and conducting themselves appropriately. Further, when a therapist is seeing a child or adolescent alone, a parent or guardian could be given remote access to the video to ensure the child’s (and therapist’s) security and safety.
I don’t believe that mental health ethical codes require video monitoring, nor in my experience is it standard practice in the field. In a profession that is entirely devoted to reducing pain and suffering, this simple preventative measure seems not only justifiable but necessary. Let’s recognize the reality: Everyday therapists are in situations that are private and personal. Things can and do go wrong, often. Right now we can begin to reduce the likelihood of intense hurt and sadness emerging from the therapy room. Let’s work for the health and healing of all our clients and make the simple solution of video monitoring a reality.