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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Dinah on October 7, 2003, at 18:23:32
I haven't any credentials so what I say doesn't carry as much weight as someone who is speaking as a professional mental health professional. I would ask my therapist to sign on the board to correct misinformation, but I'd rather have my fingernails pulled out than have him see this board. Would you object to my posting a general appeal on Behavior Online for any professional who is willing to do so to post their opinion on a topic?
Posted by Dinah on October 7, 2003, at 23:31:14
In reply to On another note - Dr. Bob, posted by Dinah on October 7, 2003, at 18:23:32
If you object, I guess you'll have to contact that forum. And I'm thinking of other places I might post the question too.
Posted by Dinah on October 7, 2003, at 23:52:45
In reply to Re: Hope it's ok. Did it., posted by Dinah on October 7, 2003, at 23:31:14
Since it is on your very own forum that one of two posters is handing out very bad information indeed, that you might want to comment on your views of a client telling their therapist about their feelings for him or her.
Does telling a therapist about your strong feelings for him mean that your therapist is honor-bound by ethics to terminate with you?
Is it bad advice for me to suggest to my fellow posters that they should disclose their feelings for their therapist, and that a trained therapist will handle them with empathy and without rejection?
Posted by Dr. Bob on October 8, 2003, at 10:29:09
In reply to Re: And just maybe, Dr. Bob, posted by Dinah on October 7, 2003, at 23:52:45
> Would you object to my posting a general appeal on Behavior Online for any professional who is willing to do so to post their opinion on a topic?
Not at all, the more input, the better...
> Since it is on your very own forum that one of two posters is handing out very bad information indeed
Sorry, I'm not sure what you're referring to, I've been tied up lately. This is on Psychological Babble? I'll take a look as soon as I can...
Bob
Posted by Dr. Bob on October 8, 2003, at 18:17:17
In reply to Re: opinions on topics, posted by Dr. Bob on October 8, 2003, at 10:29:09
> > Since it is on your very own forum that one of two posters is handing out very bad information indeed
>
> I'll take a look as soon as I can...OK, regarding:
http://www.dr-bob.org/babble/psycho/20030925/msgs/266267.html
Questionable information is being rebutted with good information. This happens with medication-related issues, too. I know it can be frustrating, and anxiety-provoking, but I think in the end this system does work...
Bob
Posted by jay on October 9, 2003, at 3:10:45
In reply to Re: questionable information, posted by Dr. Bob on October 8, 2003, at 18:17:17
> > > Since it is on your very own forum that one of two posters is handing out very bad information indeed
> >
> > I'll take a look as soon as I can...
>
> OK, regarding:
>
> http://www.dr-bob.org/babble/psycho/20030925/msgs/266267.html
>
> Questionable information is being rebutted with good information. This happens with medication-related issues, too. I know it can be frustrating, and anxiety-provoking, but I think in the end this system does work...
>
> BobWhy are people talking behind my back? I am a registered social worker in Ontario and Canada, as well as am working on my MSW. I used evidence-based material to make a point, not to squander any others opinion. I don't like this "you are absolutely wrong" tone, as I am a very open individual. I can post 100's of pages from everyone such as the Center for Mental Health and Addictions on the topic (transference), as well as McMaster Medical Research online regarding ethics of handling transference. I have even brought this up in a staff meeting, as well as with other fellow social workers around the world. I have absolutely no problem someone disagreeing with me, but I have a major problem with someone who completely ignores and invalidates my concerns. I am serious..I'll post the whole darn NASW, CASW, and International Federation of social worker's ethical guidelines. My opinion on this matter is one of great specialty, and I think I deserve a little respect, rather than being attacked, and told outright I was *wrong*, etc. I've been practicing for over 12 years now, and am very, very darn good at what I do and in my knowledge in the field.
One last point. One of the main reason to keeping transference and counter-tranference low is because this can lead to strong damage in people who are many people sexually abused kids/people.
Jay
Posted by Dr. Bob on October 9, 2003, at 5:16:05
In reply to Re: questionable information » Dr. Bob, posted by jay on October 9, 2003, at 3:10:45
> I don't like this "you are absolutely wrong" tone... I have absolutely no problem someone disagreeing with me, but I have a major problem with someone who completely ignores and invalidates my concerns... I think I deserve a little respect...
>
> One of the main reason to keeping transference and counter-tranference low is because this can lead to strong damage in people who are many people sexually abused kids/people.IMO, it hasn't been absolute, complete disagreement; others have acknowledged that transference and countertransference can lead to serious damage. And I agree, in some cases it's important not to stimulate it.
Bob
Posted by Dinah on October 9, 2003, at 8:36:10
In reply to Re: questionable information » Dr. Bob, posted by jay on October 9, 2003, at 3:10:45
To be clear, Jay. I wasn't talking behind your back. I was talking to your face. Perhaps if you weren't dismissing me and my fellow posters with
"think Dinah doesn't exactly know what I mean. (I mean that in a nice way.)"
"I honestly think folks don't quite understand the intricacies of therapy. The line between a casual relationship and a professional one is quite distinct for those who have practiced social work."
you would have heard what I was saying to your face.
In fact I told you that I was going to send links to your posts to your licensing agency and to any professionals I could beg to comment on your comments. Because you are dismissing my comments because they come from a layperson, and others may as well. Others who will be terrified to bring up their feelings for their therapists.
Incidentally, perhaps sexual abuse survivors may be hurt by their feelings and harmed if their therapist exploits them. But they'll also be harmed by their therapist telling them their feelings are unacceptable to hear and reason for abandonmnent. If telling someone you love them or are attracted to them is reason for termination, how can that possibly be therapeutic to anyone.
So I am linking the posts that contain the following information from you citing your social worker credentials:
> Another important factor, which others seem to agree on, is what I have come up against in counselling, and that is transference. It can make even the most comfortable of therapists uneasy. It actually feels like "teeth-pulling" to a therapist, especially how vulnerable to lawsuits, malpractice, etc, they are. Just a suggestion, but you may want to try to find a good counsellor who specializes in helping you build your own walls to keep separation and understanding of the different types of 'roles' and actions we should use when dealing with various people. (i.e. how you act around a partner compared to a stranger and/or a therapist.)
> I have noticed a number of folks who mention extensive attraction to their therapist, which is with no mistake, transference. What you must realize is that this is one of the ultimate *sins* in counselling. Therapists are usually obligated to terminate the client-patient relationship if this occurs. Therapists can face criminal charges and lose their license to practice if they operate outside the boundaries of a client-patient relationship at all.
> Yes, the NASW code of ethics is identical the Ontario/Canadian Social Work one. (I am legally bound, also, because I am a member...and I pay 400 bucks a year for such!..hehee) I am not saying that your own transference issues, as long as they don't interfere with the professional relationship, are not 'fine'. Should this leave the clients mind and enter into the communication between the two, then the SW has an obligation to terminate. A good therapist can pick this up quite easily.
> I understand what you are saying...and the smallest amount of attraction should only be able to be picked up if you where a psychic. I don't mean to be arrogant or whatever, but I have plenty of first-hand experience, twice with me and numerous with other colleagues. The two times with me involved slightly covert, but suspicious questions about *me* as a person, and my personal life.(VERY blatent questions.) Most counsellors who find this is an issue will discuss it with colleagues first.
> Again, I am not trying to say that clients, in their minds, should not harbour any feelings towards a therapist. That would be humanly impossible. But, when that line is crossed and feelings turn into words, or an inappropriate gesture, the common practice is to terminate.
> My main point being, is besides counsellors, clients must take some responsibility for how their actions could affect the professional/client relationship. This is not just an ethical argument, but a legal one also. It differs in many places, but a counsellor can be charged for appearing to any way 'entice' the client. Plus, especially for sexual abuse survivors, this can be deeply dangerous ground. There is plenty of time to socialize out in public or at a bar, but a professional is being paid good money to utilize very complex and intricate skill.
And you are using these words to describe the "sin" of a client merely mentioning his/her feelings for their therapist. Not stalking, not attacking, just mentioning their feelings. I think that is not only mistaken but potentially harmful to clients.
Since you appear to discount anything anyone without a license has to say, I am planning to use those links to contact every professional organization, every school, every group of professionals I can find, to find anyone with a license who will come and challenge you.
If you want to brandish your professional credentials on this board, you must be prepared to be held to professional standards.
Posted by Dinah on October 9, 2003, at 8:55:47
In reply to Re: questionable information » Dr. Bob, posted by jay on October 9, 2003, at 3:10:45
I am a participant on an online mental health board. A poster, giving his credentials as a Canadian licensed social worker, has made a series of posts saying that it is a social worker's ethical obligation to terminate with a client who admits feeling strong feelings for him or her. That it's ok for a client to feel things for a therapist, but that when the client crosses the line into showing or mentioning those feelings that the therapist is bound by ethics to terminate with that client.
I have spent my last many months on this bulletin board trying to help fellow clients see their feelings for their therapists as being something that's fairly common and certainly not shameful. And that their therapists will be familiar with transference, and will want them to bring it up with them. I am always recommending the book "In Session" by Deborah Lott. Now I don't think I'm wrong in saying those things. I've done a fair amount of reading, and it is my understanding that a client is supposed to bring up their feelings for a therapist, not hide them for fear of abandonment.
But the poster making the claim that disclosing a tranference, particularly an erotic tranference, is grounds for termination, that the therapist is in fact required to terminate, is pulling out his professional credential card. And I fear that the weight of his professional authority will scare vulnerable clients into silence, whatever this layperson might say.
And so I am appealing to professionals. If I am wrong in the advice I am giving my fellow clients, please let me know. If the other poster is giving out information that you, as a professional would disagree with, would you please also comment on that, either to me or on the board in question, for the sake of the clients.Here are some excerpts from the posts:
"Another important factor, which others seem to agree on, is what I have come up against in counselling, and that is transference. It can make even the most comfortable of therapists uneasy. It actually feels like "teeth-pulling" to a therapist, especially how vulnerable to lawsuits, malpractice, etc, they are. Just a suggestion, but you may want to try to find a good counsellor who specializes in helping you build your own walls to keep separation and understanding of the different types of 'roles' and actions we should use when dealing with various people. (i.e. how you act around a partner compared to a stranger and/or a therapist.)"
"I have noticed a number of folks who mention extensive attraction to their therapist, which is with no mistake, transference. What you must realize is that this is one of the ultimate *sins* in counselling. Therapists are usually obligated to terminate the client-patient relationship if this occurs. Therapists can face criminal charges and lose their license to practice if they operate outside the boundaries of a client-patient relationship at all."
"Yes, the NASW code of ethics is identical the Ontario/Canadian Social Work one. (I am legally bound, also, because I am a member...and I pay 400 bucks a year for such!..hehee) I am not saying that your own transference issues, as long as they don't interfere with the professional relationship, are not 'fine'. Should this leave the clients mind and enter into the communication between the two, then the SW has an obligation to terminate. A good therapist can pick this up quite easily."
"I understand what you are saying...and the smallest amount of attraction should only be able to be picked up if you where a psychic. I don't mean to be arrogant or whatever, but I have plenty of first-hand experience, twice with me and numerous with other colleagues. The two times with me involved slightly covert, but suspicious questions about *me* as a person, and my personal life.(VERY blatent questions.) Most counsellors who find this is an issue will discuss it with colleagues first."
"Again, I am not trying to say that clients, in their minds, should not harbour any feelings towards a therapist. That would be humanly impossible. But, when that line is crossed and feelings turn into words, or an inappropriate gesture, the common practice is to terminate."
"My main point being, is besides counsellors, clients must take some responsibility for how their actions could affect the professional/client relationship. This is not just an ethical argument, but a legal one also. It differs in many places, but a counsellor can be charged for appearing to any way 'entice' the client. Plus, especially for sexual abuse survivors, this can be deeply dangerous ground. There is plenty of time to socialize out in public or at a bar, but a professional is being paid good money to utilize very complex and intricate skill."
And here are the links:
Http://www.dr-bob.org/babble/social/20031002/msgs/267152.html
Http://www.dr-bob.org/babble/psycho/20030925/msgs/266267.html
Http://www.dr-bob.org/babble/psycho/20030925/msgs/266313.html
Http://www.dr-bob.org/babble/psycho/20030925/msgs/266338.html
Http://www.dr-bob.org/babble/psycho/20030925/msgs/266597.html
Posted by Penny on October 9, 2003, at 10:17:54
In reply to Re: questionable information » Dr. Bob, posted by jay on October 9, 2003, at 3:10:45
>I am serious..I'll post the whole darn NASW, CASW, and International Federation of social worker's ethical guidelines.
Jay,
I have already posted a link to the ethical guidelines for the NASW and the APA - and, after having read both, I have *yet* to see where they recommend terminating a patient who is experiencing transference, even when the patient expresses those feelings to the therapist. Even in what you have posted, the only person I see saying that a therapist *will* terminate a patient based on the mere voicing of transference is YOU.
As I posted on psychological babble - I spoke with my therapist about this - she holds a Ph.D. from an esteemed university and has many years of experience - and her answer was that a therapist DOES NOT terminate a therapy relationship based on the voicing of transference!!!! Not to mention that I spoke with my former therapist - a clinical social worker who is quite involved at the regional level with the NASW - extensively on the topic of MY transference toward her, and NEVER ONCE did she EVER mention that she had even CONSIDERED terminating me!!! EVEN when I researched her online and then told her what I knew about her, ashamed as I was and afraid as I was, and EVEN when she admitted being upset by my doing that - her response was that she would get over it, and she used the experience to help me work through many of my feelings regarding her and her pregnancy/maternity leave. It was never a question of her terminating me - which would have been paramount to abandonment in my eyes - and which would have made things that much worse regarding my trust issues. In fact, her comment to me was that this was a good opportunity for me to learn that someone could be angry with me WITHOUT LEAVING ME.
On the other hand, my current therapist did say that if the countertransference feelings the therapist was experiencing became too much for the therapist to handle, where it was interfering with the therapy and the best interest of the client, then it was the therapist's obligation to refer the client to another practitioner. That's IF the feelings became too much for the therapist to handle, and that's the THERAPIST'S feelings, NOT the client's feelings.
I think what has upset me, and others, is that you are actually saying something that would cause a therapy client to withhold information from his or her therapist, and I cannot see how that would ever be a good thing. Most of the people I know who are in therapy experience some form of transference, and for those people to keep those feelings, especially when they can be painful, to themselves and to not process them with the therapist, well, I fail to see how that benefits either the patient or the therapist.
Here's what the code of ethics for the APA says about terminating therapy:
10.10 Terminating Therapy
(a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.(b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.
(c) Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.
In this case, I would think that termination due to transference would have to fall under (a), and that would be limited to situations where the transference was causing HARM. Or, in (b), if the transference led to unacceptible behaviors, such as stalking. But general transference - as I would imagine occurs in most cases of therapy - wouldn't fall under either of these. A client feeling love, whether mother-child or romantic love, for a therapist doesn't automatically constitute harm, especially if the therapist uses those feelings to help the client.The NASW code of ethics says the following:
1.16 Termination of Services
(a) Social workers should terminate services to clients and professional relationships with them when such services and relationships are no longer required or no longer serve the clients' needs or interests.(b) Social workers should take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary.
(c) Social workers in fee-for-service settings may terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client.
(d) Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client.
(e) Social workers who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral, or continuation of services in relation to the clients' needs and preferences.
(f) Social workers who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.
Again - no mention of terminating therapy based solely on transference. In fact, except in unusual circumstances (which, of course, is subjective), it appears to be considered unethical for a social worker to withdraw services when the client is still paying, can still benefit from therapy, and there are no other extenuating circumstances preventing therapy from continuing.I suppose one could consider any transference-related situation as being of potential harm to the client, but having been in therapy myself and having experienced transference first-hand, I can certainly say that that is not the case in my experience. So ALL transference is not bad, and transference in the hands of a skilled practitioner gives much to work with in a therapy setting.
Again, for those who would like to read the codes of ethics in entirety for themselves:
American Psychological Association (APA): http://www.apa.org/ethics/code2002.htmlNational Association of Social Workers (U.S.):
http://www.socialworkers.org/pubs/code/code.aspAlso, the APA has a video available on its website that addresses the issue of patient sexual interest in the practitioner, and how the therapist can deal with it:
http://www.apa.org/videos/4310570.html?CFID=2493388&CFTOKEN=89863392I found this page interesting b/c in the video description, there is a statement about client fears regarding expressing such feelings for the therapist:
Moreover, patients and potential patients frequently misunderstand the probable consequences of their expression of sexual interest in the therapist. In one study of 265 potential patients (Bram, 1997), nearly one-quarter indicated that their therapist would have pursued the sexual interest and another 16% indicated that the therapist would have likely referred him or her to another therapist.
The point, of course, being that therapists most likely will NOT either pursue a sexual interest regarding a patient OR refer that patient to another therapist. The description does address the lack of training in this area for practitioners - hence the video. But the idea behind the video is not to tell therapists to terminate therapy with a client who expresses a sexual interest, but rather to instruct the therapist on the best ways of working with such feelings/information.What I have seen frequently is encouragement for the therapist to take care of him or herself, recognize when transference is becoming a problem, be aware of his or her own feelings and how they are affecting the therapy, and find ways of dealing with those situations should they become difficult - therapy for the therapist, supervision, consultation with another therapist, etc. I feel sure that a competent professional who found him or herself unable to deal with transference issues after attempting to (through the afore mentioned methods, if not others) would THEN, and only then, consider terminating the client.
P
Posted by Dinah on October 9, 2003, at 10:19:29
In reply to Re: questionable information » jay, posted by Dinah on October 9, 2003, at 8:36:10
Of course, I have no idea if Jay was dismissing me and my fellow posters. I'm sorry for writing that he did.
It would be more accurate to say.
I felt dismissed, and less worthy of consideration due to my lack of professional credentials, by the statement:
"I honestly think folks don't quite understand the intricacies of therapy. The line between a casual relationship and a professional one is quite distinct for those who have practiced social work."
Posted by Dinah on October 9, 2003, at 10:28:56
In reply to Re: questionable information (looonnnggg) » jay, posted by Penny on October 9, 2003, at 10:17:54
It is very very informative.
Posted by Tabitha on October 9, 2003, at 14:45:11
In reply to Re: questionable information » Dr. Bob, posted by jay on October 9, 2003, at 3:10:45
Dear Jay, I looked at my post in that thread, and realized I did word it more strongly than I would normally do. I'm sorry if you felt personally attacked. I did not mean to call *you* wrong, but to call a couple of your ideas wrong. Which I think is perfectly acceptable here under the terms of the site.
One of the reasons I put my disagreement so strongly was that I got the impression you were trying to suggest that your ideas were more right because of your professional credentials. That just makes me feel I have to argue harder when I disagree. The other reason I was so blunt is that I think the information you're giving might harm clients who are reading it by interfering with their therapy, or even making them afraid to seek therapy.
Then when I read what you posted here on Admin, it almost sounds like you're saying people should not argue with you because after all you're a professional. You must realize this isn't the kind of site where people accept the word of 'experts' and don't debate. Presenting yourself as an 'expert' is probably likely to get you more vociferous objection.
Posted by Tabitha on October 9, 2003, at 19:27:36
In reply to Re: questionable information » jay, posted by Tabitha on October 9, 2003, at 14:45:11
not very kind, even if 'civil'. Sorry jay I got caught up in battling
Posted by jay on October 12, 2003, at 16:10:51
In reply to Re: opinions on topics, posted by Dr. Bob on October 8, 2003, at 10:29:09
This is the end of the thread.
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