Discussion If you were a pro-choice, mental health professional, how would you practice?

[TAW122]

So I just had an interesting thought but before I begin I will add a disclaimer just so there isn't any misunderstandings.

Disclaimer: I am not a counselor, therapist, nor mental health professional, nor a doctor. This is just a hypothetical thought that I've had and found interesting to explore for educational and philosophical purposes only. and in no way would I or have any inclination where I would see myself as one especially in the current world and its pro-life State, etc. This is just a thought I had that I found interesting.

With that said, in a hypothetical scenario, this thread is about how I would act if I was a psychotherapist or counselor in our current system while being a pro-choice champion and advocate. Again, this is for exploratory and informational purposes only. To start, here are a brief list of some of the things I would do if I were an mental health professional practicing if I had a client.

1. In the first session when a patient is meeting and introducing themselves, I would definitely set the boundary before proceeding with anything else, which will include the stating the terms and limits of confidentiality (as per dictated by legal and professional standards – a.k.a. the very minimal baseline). This allows a patient to understand the relationship and power dynamics upfront and the patient can decide whether he/she wants to proceed or not.

2. During the practice, while I may do something based on what the profession dictates, I would aim to not just parrot off things or do the things that all/most psychotherapists and mental health professionals do, and put myself in a position that I can actually be "constructively" helpful to the patient. This includes if the patient asks me for direct advice, I would give it while still maintaining the professional standards that the profession requires, which again, within boundaries.

3. If a patient crosses a line into danger to others or oneself (and as required by law in the current system (even if I personally am against it or disagree with it) and professional ethical requirements), I will do whatever I can to not have to break confidentiality or violate bodily autonomy, while still being compliant with the law (to avoid legal liabilities for myself) and professional ethics (to not lose the license or be barred from practice). By this, I would go through every hoop and steps to make sure that the patient isn't going to get me into trouble, nor be quick to rat/snitch/turn the patient in (breaking their trust or confidentiality), UNLESS it is 100% beyond a reasonable doubt. This means unless they explicitly said (and confirmed danger to self, imminent, no safety plan, and even insisted on it – leaving me with absolutely no other choice), then I would act. But merely discussing CTB or planning it (but not imminent) I would work with the patient to understand and empathize, but also gently remind the patient of the legal obligation and give every reasonable chance for the patient to either recant, come with a safety agreement (to protect from liability, legal issues), or ensure that the patient won't just go and CTB, and inform the patient of potential consequences of involuntary commitments and psych holds as well as the consequences. Of course, in a real world scenario there are many other factors and it isn't something really straightforward, granted my simple example is just that, an reductive one.

4. When interacting with the patient, I treat it more as a conversation, with constructive advice (if solicited) while also guiding the patient towards their choices (again while also reminding them of the boundaries) and not spew platitudes and what not. I will aim to be constructive and helpful, trying to be a friend rather than just do the same trite bullshit that most other mental health professionals do. Some may even claim that perhaps I'd be better being a life coach in the scenario versus a mental health professional, but I digress… I just don't want to throw labels or diagnosis, or dismiss, downplay, or even deflect and treat the patient as a me versus them dynamic.

In summary, if I was a psychotherapist or mental health professional (while being pro-choicer myself), I would do whatever I can within the limits of the system to honor the patient's bodily autonomy, dignity, and confidentiality (as well as trust). However, with all mental health professionals, if I was one, sadly, I would be still hard-bound by legal and ethical requirements to act (not because I want to but because I would be required to in very specific situations). Though I will do what I can to avoid being in a situation where I may have to act and go against my personal values. In an ideal system and one that I would always keep fighting and advocating for, of course, I would be 100% support of one that will NEVER breach confidentiality or violate bodily autonomy if the legal and ethical system changes to support that, which sadly isn't coming anytime soon. Anyways, I mainly wrote this thread and article because it was an interesting thought I had and I wanted to highlight and demonstrate what I would do if I was an MHP. What would you do if you were an MHP or someone in charge of patients, would you do the same as well or not?

 

[Namelesa]

I have to ask, what actually stops a mental health professional from not ratting out a patient that says they are going to kill themselves and not following the law? Like couldn't they just lie about the patient saying that they were going to ctb to them? I am probably being really ignorant and stupid here not knowing about some risk to this.

 

[TAW122]

Assuming I'm reading the question correctly, I suppose there are unscrupulous mental health professionals in the field too who would lie or twist words, and those are hard to prove. But generally I would think that most of them are more somewhat reasonable ones, where they would only act if it was more imminent and clear cut scenario where the patient explicitly states that they will CTB. My answer is based on the fact that I've been a patient before (ranging from social workers, psychologists and psychotherapists, as well as various other mental health professionals throughout my life), many years ago, but haven't in the past 7+ years.

I hope I answered the question that you asked, but feel free to clarify or restate if I haven't or if my answer was still too confusing...

 

[Michelstaedter]

Given my background, it's very difficult for me to try to help others just like that. In shitty countries like mine, you have to be aware of legal issues so you don't get into trouble, even if they try to do it indirectly and unfairly for something that has nothing to do with you.
I'll give a somewhat strange example that came to mind in recent months when I've definitely thought about leaving this world:
A doctor whose knowledge of my situation spans almost 20 years, who has known me and treated me for everything from a simple flu to the emotional problems I've had, has prescribed me anti-anxiety pills at more complex times in my life when I could say I really needed them. However, at least this year since my pets died, my desperation has reached the point where I would try any method to achieve my BBT. However, one of the difficulties I have is the anxiety I have about committing it, and that's where anti-anxiety pills come into play. If I were to commit such an act using anxiolytics and the (already elderly) doctor were blamed, I would feel bad for him, so I dismiss that detail and would prefer to get those anxiolytics elsewhere, even going to a psychiatric hospital so they have more to do with my CTB than the doctor whose affection and appreciation lead me to avoid even indirectly implicating him.

Being a therapist in Mexico is difficult, being a doctor is equally difficult. There are often problems in this regard, and people's ignorance and the laws make the situation even more complex.

P.S. I couldn't be both pro-choice and a mental health professional, in short. Being both pro-choice and a mental health professional is incompatible with me.