Hi Dan,
I wanted to address some of your comments about suicide where you
said:
The conflict would seem to arise in a circumstance where as facilitator you
might want to say something that you could not ethically say as a therapist.
For example, in the case of a client with suicidal feelings, a facilitator may
acknowledge the client's desire to follow someone in the system to death. This
can be voiced in a way that is accepting of that fate. A therapist, on the
other hand, is required by ethics to act to prevent that fate from being
realized.
However, being drawn towards death in the form of suicide, has many subtle
nuances. It can be a valid manoeuvre to acknowledge this in both traditional
therapy and in constellations.
First we need to consider that there are quite different situations in
constellations in which it may arise i.e..
1. for someone other than the client who might or might not have already died
2. for the suicidal client
I assume you are talking about the second situation. In that situation, the
acknowledgement and validation of the desire to die is a necessary step in
dealing with it. After all this is not a trivial feeling that a person arrives
at easily. Disavowal only leads to worsening feelings of alienation in the
client.
When a therapist accepts that fate either in constellations or therapy this is
a seemingly paradoxical step that is used to clarify the situation. It helps
the client to feel understood. It is usually only an intermediary step which
leads to the client finding a way to turn and go forth in their life. Very
occasionally the paradoxical intervention is enough and the intervention can be
stopped there. A therapist needs to be very skilled & experienced dealing with
suicidal clients to do this. I myself haven't done it for some years.
Nonetheless it is a recognised therapeutic technique.
In the setting of constellations we need to be mindful that the constellation
may have subtle unobserved acute effects. As such, we probably should ensure
that any vulnerable clients do have adequate follow up. Some may even need
assertive medical treatment. Even with this, there are no guarantees because
some psychiatric illnesses like cancer are terminal, in spite of the best
treatment. So we as therapists, need to bow to fate. That frees us to act more
skilfully.
When hold that attitude in our hearts, our clients feel better understood and
better held, which actually makes it more likely that they will want to live.
So I don't see an ethical conflict between competent therapeutic management of
these issues in the two arenas of constellations and of conventional therapy.
hasta la vista
Chris Walsh
An Australian Constellation Website:
www.constellationflow.com
----- Original Message -----
From: Daniel Booth Cohen
To: ConstellationTalk@xxxxxxxxxxxxxxx
Sent: Wednesday, 12 May 2004 12:44 PM
Subject: RE: [ConstellationTalk] Dual relationships
Libby - You are raising an important point.
The general public might think that the Code of Ethics exists to protect
clients from unethical psychologists. However, the members of professional
associations guided by these Codes understand that their primary purpose is to
protect practitioners from civil and criminal liability in situations where the
outcome of treatment is not successful, such as in the case of suicide. If a
practitioner can demonstrate that the course of therapy conformed to best
practices, as set forth in the Code, they there is no legal liability for a bad
outcome. Conversely, if the therapist's actions fall outside the boundaries
established by the Code then the courts may establish a case of malpractice.
The situation of being a therapist and facilitator raises some thorny issues.
The conflict would seem to arise in a circumstance where as facilitator you
might want to say something that you could not ethically say as a therapist.
For example, in the case of a client with suicidal feelings, a facilitator may
acknowledge the client's desire to follow someone in the system to death. This
can be voiced in a way that is accepting of that fate. A therapist, on the
other hand, is required by ethics to act to prevent that fate from being
realized.
It would seem to me that once you accept the responsibility of being a
person's therapist, you cannot shut it off for purposes of facilitating a
constellation. The responsibilities of a therapist supercede the detachment
required of the facilitator. Operationally, there are a number of ways to work
around this.
Thanks for bringing this subtle distinction up for discussion.
Dan
-----Original Message-----
From: Libby Nottle [mailto:LibbyNottle@xxxxxxxxxxx] ;
Sent: Tuesday, May 11, 2004 9:35 PM
To: ConstellationTalk@xxxxxxxxxxxxxxx
Subject: *Possible Junk Mail* [ConstellationTalk] Dual relationships
Thanks for the responses so far. I appreciate the way the definition of
therapist can be extended but I am also asking an ehtical question. As a
clarification I meant dual relationships in terms of (as the other Libby
defines)
"a professional who works in different capacities"
Part of my reason for seeking comment is that were my practice to be
questioned by a professional organisation, the organisation would take into
account what is considered appropriate practice with other practitioners in the
field ie you guys!!! (as well as my supervisor's reports of our discussions
relating to the client, Chris's, as my constellation colleague, comments about
the workshop etc)
My query is partly, and I stress only partly, prompted by a situation earlier
this year when a client of mine suicided. I had been seeing him reasonably
regularly over a two year period and he had attended a number of Chris and my
constellation workshops. The most recent was two weeks before his death. He had
had previous attempts. His family were very grateful for the support he
received from (a number of) professionals. So I did not end up before Coroner's
Court or answering a complaint to a professional body from family members. But
I could have.
This is an unusual situation. And having clients attend workshops can benefit
the therapy but if it "goes wrong" what are the justifications/processes? In
the sort of context described above arguements in addition to definition of
therapist would be useful.
Thanks
Libby
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