Risk of Risk Management — Re-Thinking Care
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So-called risk management 'experts' have in effect hijacked parts of the fields of general medicine, including mental health, by inducing exaggerated fears of lawsuit. Some of risk management's standard, yet unfounded, instructions in psychotherapy have been: Never touch a client, don't self-disclose, don't leave the office with a client, and don't engage in any form of dual relationship. These overly cautious 'defensive medicine' practices, often perpetuated by purported risk management experts and attorneys, can actually hurt clients, as they in effect deny them adequate focus on effective patient care. In my article on the Risk of Risk Management I document how, even though the healing benefits of touch, therapist self-disclosure, or meeting clients where they feel most comfortable or safe have been scientifically documented in the last 50+ years, many poorly trained and frightened psychotherapists regularly avoid doing what is therapeutically right and helpful out of regulatory fear.
One of my clients was a gentle, pleasant older man in his 50's, suffering from paranoid schizophrenia, with whom I worked in the East Coast. As part of therapy, I was continually in touch with his parents, his three children and sisters, as well as his landlord, employer, psychiatrist, and everyone else involved in his life. He happened to be a Starsky and Hutch TV show 'junky' who closely identify with the show and even drove a car that mimicked the signature car of the show. My curly dark hair reminded him of Starsky—in fact, at times, he confused me with the character. So it came to be that his car was the 'office space' where we met for most of our weekly therapy sessions. He never liked my office—being there made him nervous, frightened, paranoid and withdrawn—but he felt relaxed, engaged, and receptive while tooling around town with me in his signature car. As we cruised, like in the TV series we checked out the hotspots, all the while talking about the client's relationships, dreams, fears, and work. He felt safe going into the stores to do basic shopping, knowing that Starsky was 'backing him up' from the car. As I described in my Ethical Eye article, several ethicists and attorneys warned me of the dangers of leaving the office or being involved in what they labeled as a dual relationship. After consulting with several 'true' experts, I decided to continue my approach to therapy with this client, for the simple reason that it was effective. At all times I reminded myself that I was being paid to help him, not to practice defensive medicine.