I had an experience recently that I thought I’d write about. These days I often receive requests from various media sources wanting to interview me about something trauma related. Terrific, I typically think! Another type of opportunity to raise awareness and educate. Of course I am well aware that not all media is created equal; to the best of my ability I want to participate in ways that destigmatize and demystify mental health issues.
Recently I received one such request, a sort of fact finding, information gathering mission, from an organization purporting to be planning to make a documentary about dissociative identity disorder (DID). The stated goal was to present a more realistic view as compared to the over the top portrayals we are used to seeing. The call cited my writing on this topic, particularly my article United States of Tara Controversy where I address concerns about sensationalism of DID by the media.
Sounds good, right?
Unfortunately, it quickly became clear that what was really wanted was for me to serve up access to a DID client or clients who could perform on cue, perhaps with the therapist present to facilitate the process. How disappointing! This just sounds like more of the same. I’ve previously written about the negative impact of depicting only the “Tara” or “Sybil” extremes of DID as the norm. This experience also got me thinking about what, in my clinical opinion, is wrong with therapists participating in such endeavors. (In case you were wondering, I declined to participate any further).
A situation like this brings up issues for me related to confidentiality, dual relationships and the potential for exploitation of the client. Whose needs are being given priority in this situation? When I have seen shows like this in the past I have felt very ill at ease. I have wondered how the therapy was compromised by this extra-therapy activity and what the motives of the therapist were. His/her own fame? Increasing awareness and education? The best interests of this particular client?
And what of the therapy relationship? It is of course illegal and unethical for therapists to violate confidentiality, so in no way would I introduce a client to a documentary maker without their consent. But wouldn’t even raising this as a possibility alter the therapy relationship? Would a client feel compelled to say yes to please the therapist? Honored to be asked? Is it really possible to give informed consent when it may be difficult to anticipate exactly how such an activity might impact you and help or hinder your ongoing healing?
As a psychologist I agree to operate within my profession’s code of ethics. This involves engaging in a thoughtful, decision-making process, weighing whether extra-therapy activities constitute a dual relationship, and if so is there potential for harm? An excerpt from the American Psychological Association‘s Ethical Principles of Psychologists and Code of Conduct states:
A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
Would taking part in a documentary with a client be reasonably expected to do any of the above? Too likely for my comfort!
In closing, I share with you the opinion of the International Society for Study of Dissociation. They have included a section specifically addressing “Publications and Interactions with the Media” in their Guidelines for Treating Dissociative Identity Disorder in Adults:
The media and the public have a long fascination with DID, going back to the 19th century. Also, when doing a story, media reporters commonly want an individual to be the focus of the “human interest” aspect of the story. Thus, clinicians working with DID may find themselves targeted by the media asking to do a story on DID, usually with the request that the clinician provide a patient to be the story’s focus. In all interactions with the media concerning DID, the therapist’s primary responsibility remains the welfare of his/her. Thus, the therapist must maintain the highest ethical and legal standards of confidentiality with respect to clinical material. Appearances by patients in public settings with or without their therapists, especially when patients are encouraged to demonstrate DID
phenomena such as switching, may consciously or unconsciously exploit the patient and can interfere with ongoing therapy. Therefore, it is generally not appropriate for a therapist actively to encourage patients to “go public” with their condition or history. Patients who ignore this advice rarely have a positive experience and often wind up feeling violated and traumatized.
My gut reaction to not get involved was immediate. This was exactly the sort of media representation of any mental health issue that I want to see us move away from. I am glad there are resources like those I’ve quoted from above to help clinicians make informed choices when the decision does not seem clear.