Ethical Therapy: Toby Watson
First Aired: 04-01-2012 -- 9 comments | Add comment
Can psychotherapy be a replacement for medication for psychosis and extreme states? Should therapists hospitalize suicidal clients against their will — even when they could be traumatized by the very care intended to protect them?
Dr. Toby Watson, clinical psychologist, discusses how to be an ethical therapist in an era of medications, diagnostic labels, and forced treatment.
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Can psychotherapy be a replacement for medication for psychosis and extreme states? Should therapists hospitalize suicidal clients against their will — even when they could be traumatized by the very care intended to protect them? Dr. Toby Watson, clinical psychologist, discusses how to be an ethical therapist in an era of medications, diagnostic labels, and forced treatment.
I forgot to ask one more thing. If I understood correctly, Toby Watson advocates the view that clients should be able to share anything without fear of being reported to the police or other relevant services. The example given during the discussion was battery/domestic violence.
I was wondering whether both you and Watson would extend this attitude to sexual abuse (i.e. your client admits to not being able to stop sexually abusing his child and/or partner), and the situations in which the client expresses serious murderous intent (i.e. the sort of intent that is judged to be more than just hyperbolic/bombastic language use).
Sorry for the very untimely response, but I was unaware of the chat till now. Legally and ethically, yes, one needs to report…as I am a mandated reporter and so are most, if not all, therapists in the US. Having said this, there are different ways to ensure the safety of the child or adult being sexually abused. IF a patient is coming in and states they can not stop abusing, they they are telling me this for a reason, knowing very well I have informed them about the mandated reporting guidelines. They are suffering greatly as they do not want to abuse, and thus, letting me know. The first question would be, why do you suppose you might be letting me know this. I may interpret their behavior as being a way to ask for me to call with them, to ensure their loved one is protected from themselves. I have called several times with patients to alert a protective service. I have had client threaten murder, and I was correct in that they were not serious and did not murder the individual. Every doctors threshold for what they believe to be a serious threat is different. Thus, it comes down to a practitioners belief-thoughts-cognition-faith in their patient…partnered with the therapists own ability to tolerate intense feelings, scary feelings at times.
I was just wondering whether either you or Toby Watson have ever lost a client to suicide. And if yes how did that make you feel like?
I have not Sarah. I have supervised others who have though. I have had people in my life who have committed suicide. It can be an earth-ego-emotional shattering experience. Many feel that if you have had a patient suicide, it will change how you practice. This may be true, if one believes it is their fault…however, a patient deciding to suicide is not the fault of the therapist (provided no neglect of duty)…for one can not predict very well future behavior, one can not control people over the long term, and if someone really wants to die…they will behave in that manner. When a patient calls a doctor or comes in to talk about suicide, there is part of them that wants to die and part that wants to live. The part that wants to live, make the pain go away, is letting the therapist know. Thus, there is uncertainty. It is that uncertainty that gets amplified, not repressed through control. If they are talking, they are not committing suicide. I would much rather have a patient talking about suicide with me than not talking about suicide with me…when those feelings or thoughts are occurring. Having a patient bring up suicide and then trying to control them, or break from the deep pain talk to begin a reductionistic suicide assessment is the best way to stop therapy and increase suicidal ideation. This is not to say that one should not do a detailed internal assessment of the patients risk, but the focus is different. It is less technique and more perspective and focus.
Well, I’m sure there are plenty more on this site. I am so grateful for this interview. I learned so much and have renewed my faith in psychotherapy. I appreciate Toby’s story about how he let his client take responsibility for her own life and didn’t try to stop her from committing suicide because that would have been reinforcing that she get attention by trying to commit suicide and in the end she eventually got better. Love that confidence in his ethics! Totally inspiring.
I’m thrilled to know of the resources for connecting with like-minded meds free psychotherapists as I would like to team up with them with the somatic movement work that I do.
Thank you Toby and Will for an excellent interview!
Somatic Movement Educator
Your most welcome Michelle. Here are several places I recommend:
Don’t know if anyone will see this comment/question but:
I’m really I’m struck by Toby Watson’s approach of telling his suicidal client that he wouldn’t “indulge her behavior” and could only talk for 3 minutes, not 20 minutes. I appreciate the honesty about your boundaries and about your perspective on what she was reaching for. I was surprised by this though – especially by the contrast with a lot of what I tend to take away from Madness Radio interviews and the peer movement – which is that if someone is seeking attention (not a bad thing!), it means they need something (namely: support, care, love, a listening ear). The emphasis is often on taking *time* to “be with” someone.
One example of this quite different approach is what Daniel Mackler talks about (@ 19:30 in his interview). With a suicidal person, he would suggest they come in for counseling everyday in order to work through their experience “intensively.”
So I’m interested in what people (Toby Watson, Will Hall, or anyone) think are the pros / cons of these quite different approaches. Where is the balance between working with someone very intensively without it leading to dependency?
by the way, thank you both so much for this illuminating interview and thank you Will Hall for this treasure trove of conversations! Just started a job in the MH system and so grateful to have Madness Radio and other resources to keep me on my toes and remind me not to get lost in the BS!