Therapist Ethics Is Not About Following Rules
Real ethics requires understanding how and why psychotherapy works.
Most of what therapists think of as professional ethics is not really about ethics.
It’s actually about competence: understanding how psychotherapy works and the conditions necessary for it to happen.
We maintain confidentiality not because it’s an ethics rule, but because no one will open up to us unless they know that what’s said in therapy stays in therapy. Without confidentiality, the conditions necessary for psychotherapy do not exist.
We avoid dual relationships not because the rules say so, but because we understand that entangled roles impair our ability to think psychologically, recognize relational patterns, and respond effectively in our role as psychotherapist.
We don’t promise cures, make exaggerated claims, or traffic in hype because psychotherapy works only when words mean something.
We’re transparent about our credentials and training because a therapy relationship is built on trust. If we spin the truth, how can our patients believe anything else we say?
“The rules” are just attempts to codify the minimal conditions necessary for psychotherapy to happen.
We maintain therapy boundaries because we understand the raw power of transference and countertransference. We know boundaries create the safety to unclench. The more secure the boundaries, the deeper the work can go.
We don’t diagnose or give clinical advice outside a professional relationship because we know that real psychological understanding requires comprehensive, in-depth assessment that can happen only in a clinical context.
Most of professional ethics is actually about clinical knowledge and understanding. “The rules” are just attempts to codify the minimal conditions necessary for psychotherapy to happen.
Related Essays
Getting Started in Psychotherapy: A Guide for Patients (and Their Therapists) (September 3, 2025)
Much of What Is Called Therapy Is Not Psychotherapy (February 23, 2026)
What Is Therapy For? (April 20, 2026)
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Simple and so relevant. This is what writing as a therapist is about and I forget this sometimes when working online as a private practice owner has different expectations online.
This read was grounding in how it gently and succinctly deconstructs the 'whys'. It cuts through the noise and is straightforward.
Thank you for this read.
Jonathan Shedler raises such an important point about ethics in therapy: rule compliance is not the issue. Particularly with confidentiality, psychotherapy creates an unusual, even unique, relationship in which one person can trust another to keep their deep and often dark secrets. In therapy, healing often occurs partly because, in speaking hidden truth, the person seeking care gains psychological mastery and power over that part of the self that tends toward self-destructive behavior. This is why our legal tradition recognizes patient-psychotherapist legal privilege - and courts tend to avoid ordering therapists to break the seal of secrecy even when it might help with a prosecution. Give that up, and rest assured government would eventually find a way to force therapists to snitch on their clients for even minor lawbreaking such as possession of controlled substances.
Shedler's point is especially important now, because tech wants to insert itself into the private therapy relationship in devastating ways, including so-called ambient listening, where sessions are recorded and transcribed by corporate algorithms. The therapist gets the convenience of a note written when the session ends, by an algorithm. The tech company that controls the algorithm becomes an Orwellian Big Brother, with all the power that implies. Too many people naively trust Big Brother, because they are introduced by a therapist they already trust. And too many therapists are trusting Big Brother because they don't understand technology companies and the sociopathy of leadership in most of the largest ones. The legal doctrine of privilege tends to be absolute, and any penetration of the veil of secrecy destroys the client's right to keep their communications out of legal matters. It remains to be seen whether courts will hold that once a client consents to ambient listening, they have given up the legal privilege to keep their communications with their therapist away from any of their future legal enganglements.
If you resonate with Shedler's words here, consider the broad impact tech can have on the ethical foundation of therapy that Shedler describes. Tech is attacking this unique healing relationship on all sides. Patients and advocates can do a lot here by noticing the ways the ideal Shedler has laid out so eloquently gets eroded when therapy moves online, to cloud-based platforms, performed by therapists with minimal training through online degree programs in many cases (because they work for low wages). Clients can seek therapists who embody what Shedler lays out, and reject therapies and therapists who fail to live up to this standard. Only by diligent collective action can our grand tradition of deep, relationship based healing continue. But in general, you will not find the ethical and therapeutic relationship Shedler describes in newer corporatized treatment options, such as online therapy platforms. Investors are using these vehicles monetize our growing need for carefully curated healing relationships built on trust and respectful of a long tradition of apprenticship training in this important work. The need grows more urgent every day specifically because of the incursions of inhumane tech in every nook and cranny of human life.