Doing No Harm....

"Do no Harm" is the crux of the Hippocratic Oath and something to which most of us aspire to. It's also not terribly practical or realistic in our profession.

I'm reminded of a session early in my career where I'm convinced I did do some harm... The client spent an hour blaming her weeping daughters for her alcoholism and the behavior that corresponded with it. I was afraid of the consequences of confronting this strong, angry woman (whom I had met only a few minutes before the session) so I let her be offensive to her daughters. I tried to reason with her for far to long; I should have said "Stop it. These girls have nothing to do with your staying in bed for days at a time and for you to blame them is ridiculous. You will stop or the session will end."

What I hadn't learned yet - and still sometimes struggle with in my personal life - is that it's vitally important that we remember to measure harm based on our own perceptions, rather than those of someone else. There's a difference between something being painful vs. something being harmful.

A family is in my office because something is not working in their life and that means that sometimes I am required to bring that to their attention in ways that feel "harmful" (though really they're just painful) to them. If there's an alcoholic family in my office and I fail to model good boundaries by confronting offensive behavior (in a respectful, but firm fashion), fail in speaking the truth as I see it (in a respectful, but firm fashion) of fail in modeling boundaries about the behavior I will and will not accept in the future, I am doing harm to the family members of the addict. This behavior will be perceived as harmful by someone who is still pre-contemplative.

Disillusion is at the root of almost all pain - pain is what happens when perception and reality clash. A successful therapist brings truth to their clients (which is often intensely painful) in a loving way and at at time when they're able to accept it.

So that's the first thought I have on doing no harm. The second is to realize that at some point in your career (probably daily at first) you're going to make the wrong decision. I encourage folks to realize that Doing No Harm in this profession is an aspirational (rather than practical) ethical goal. I've adopted a "do not harm on purpose" philosophy and I make sure I apologize if I realize I did harm.

These two things are valuable tools when it comes to abrogating the fear of doing harm.