Elements of Healthy and Ethical Therapy


The spirit of collaborative therapy is perhaps best described by Albert Schweitzer when he wrote that “each patient carries his own doctor inside him. We are at our best when we give the doctor who resides within each patient a chance to go to work.” Collaborative mental health therapy is when a therapist encourages a client to become a co-therapist. In this way therapists trust clients to know themselves better than anyone else and to access their own wisdom. It puts them in the driver’s seat of therapy. Collaboration is not directionless; rather, it combines the client’s wisdom of self with the therapist’s objectivity, insight and implementation of evidence-based interventions.


Therapists who empower clients maintain the belief that they have the capacity for change. They also maintain the belief that their clients are equipped with the inner resources to do so. Empowering mental health therapy is based on the belief that clients can heal if they desire change. It is also based on the belief that they are able to contribute to their own process of growth. This is opposed to a deficit-based approach which views them as fundamentally flawed. When a therapist views a client as flawed or incapable of change, the client is more likely to feel flawed. When a therapist can see beyond flaws, the client is more likely to discover their strengths and make healthy changes.


Beyond technique and theory is relationship: the ongoing interpersonal connection that provides the foundation for change. Without this, change is unlikely. The therapeutic relationship is the mechanism that allows a client to more fully and completely feel emotionally safe while in the presence of the therapist and during the difficult process of change. A therapist who provides unconditional positive regard regardless of whatever the client may be experiencing nurtures the therapeutic relationship. This increases the likelihood of change.


Viewing a person as greater than their problems is the hallmark of strengths-based therapy. It does not mean problems do not exist. Instead, it means the therapy process does not view a client’s problems as the focal point of therapy. Working from a strengths-based perspective requires a shift in both the understanding and approach to pathology.

Most of the issues people go to mental health therapy for are not static problems but process-oriented problems. They are the result of a client doing the best they can to integrate difficult life experiences. This process of adaptation prevents the client from getting hurt again. A strengths-based approach is sensitive to the adaptive mechanisms that keeps clients safe but understands that these adaptations now contribute to symptoms and there remain inner strengths a client can access to realize change. Problems that are static in etiology such as psychosis, mood disorders and other biophysical conditions still require a strengths-based approach if therapy is to be effective. This signifies a departure from nomenclature such as “disorder” which can provoke feelings of shame and inadequacy.

When a therapist focuses on getting rid of a symptom instead of exploring its origin as a natural response they are overlooking the client’s opportunity to heal. It is important that a therapist remember that behind the layers of protection, no matter how self-destructive or maladaptive a client’s thinking and behaviors have become, there is a human being at the very core. A strengths-based approach is supportive of the process of change and focuses on a client’s assets.


Therapists value working with people and tend to be empathic and seek authenticity. Providing psychotherapy can be gratifying and rewarding. Therapists work through some of the most difficult life experiences with clients. However they can be rewarded by being present with them during some of their greatest self-discoveries and transformations. Maintaining a focus on addressing the client’s needs and not the therapist’s is the emphasis of healthy and ethical therapy.

Client’s needs vary but come from the same themes that many of us, including therapists, have struggled with. They want to feel appreciated, loved, seen and in control. Therapists who have done their own mental health therapy and have identified their own personal reasons for entering the helping profession and are aware of, have tended to, and continue to tend to their own wounds are less likely to depend on their clients to feel good about themselves and are less likely to cause harm. Addressing the client’s needs and not the therapist’s is the emphasis of healthy mental health therapy.


Mental health therapy requires a vulnerable and inwardly explorative process that I call the downward arrow. A client may initially identify a symptom, or even source of a symptom. But if they continue to dig deeper into their life experiences and narratives, a process that requires trust and relationship with the therapist, clients can begin to realize the significance of sentinel life events that have led to negative cognitive schemas that feed symptoms

In the field of mental health, a distinction has developed between types of therapy that emphasize cognitive solutions versus those that emphasize emotional or body-oriented healing. Both are important and should be used at various stages of the therapy process, defined as an eclectic approach. But healing takes more than insight about a problem, cognitive reframing and behavioral change. To heal, we must explore the depth of the wounds that fuel extreme beliefs, feelings and behaviors. As opposed to countering and turning away from difficult experiences and emotions, healing requires moving downward to the root experience, negative schema and core belief about oneself. Many of these beliefs, feelings, and behaviors are maintained as a result of an effort to survive and avoid painful wounds and burdens. Healthy mental health therapy helps clients process whatever wounds they have harbored.

Without the downward arrow process clients are more likely to remain symptomatic and healing is stalled. Addressing the source of pain is not always easy but it is essential for change.


Therapists are limited. We greet clients with great hope. We have spent countless hours studying our trade, doing our own inner work, mastering our technique, and learning to truly attend to clients who seek our services. Therapists want to do good work and are compelled to help others release burdens and cope with suffering. However, there are times we cannot help. A good therapist never gives up hope that a client can heal, but also recognizes that they may not be the one to facilitate change. The time may not be right or the client may not be ready to do the work we envision them doing. Healthy and ethical therapy means letting go of expectations and outcomes we may foresee for our clients, without giving up hope that they can realize the change they desire, even if at another time and with another therapist.

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