The Internal and External Policing of Therapists by Therapists

The mental health profession is heavily regulated. We are regulated by a web of licensures, registrations, state boards and laws, national boards, and other bodies and systems.

Most therapists are afraid of making a “misstep” or “mistake” and losing their ability to practice or ending up in a lawsuit. Therapists frequently absorb this fear, and it rumbles within them throughout their career.

Nobody likes the feeling of fear. It means we’re not safe. It means something is wrong or a threat is present. We do everything we can to ensure we are safe, protected, and unharmed. Internally, we are constantly concerned that we’re doing it “right” or know the exact way to apply the rules, regulations, and laws. We self-monitor ourselves relentlessly.

Why do we do this?

It’s what we’re taught to do. In graduate school for mental health, we are taught to not harm anyone and continuously look at ethics and our behaviors. These ethics and self-monitoring behaviors are reinforced in our internships, jobs, and overall field.

While it is a beneficial thing to live with a code of ethics and the ability to self-monitor, it becomes harmful when taken to extremes. The extremes are easily reached when we have to fear our livelihood being yanked from us. Our governing boards have the right to revoke our ability to work in a field that we’ve invested years of education and thousands of dollars into.

It’s no wonder we police ourselves internally. We become hyper-focused on being perfectly ethical, “doing it right,” and not harming anyone ever. Internalized policing can cause therapists to ruminate over the quality of their work (wondering if they’re ever good enough), their previous sessions and current clients, and any perceived mistakes.

Internalized policing can also cause therapists to live small and not take professional risks (such as opening a private practice), fearing they might make unintentional mistakes that cost them their license. A therapist wanting more safety, control, order, predictability, can easily fall into internal policing, hoping it will give them the things they seek.

"In the Seat of Judgment" Collage by Jackie Schuld

This policing behavior can also manifest externally. Therapists police each other relentlessly. They tell other therapists what they can and cannot do. They weaponize “ethics” to reinforce their arguments. They “educate” and offer unsolicited advice. They police other therapists as if it is their deepest responsibility to ensure every other therapist is doing it “right.”

For example, I once heard an art therapist in a consultation meeting tell another art therapist that it was illegal for her to see a client in another state. That therapist was actually wrong. I know art therapy regulations and had recently researched the laws of the state in question. I explained the laws and how it was legal for that art therapist. The criticizing therapist then expounded on how she was also a mental health counselor and within that profession you cannot cross state lines and that we should follow similar rules as art therapists.

She extrapolated from one regulated profession to another. She misrepresented her extrapolation as “law” by saying it was “illegal” for that therapist to see the client. I’ve seen this happen over and over again. Therapists who take their opinions and present them as the law or the one ethical “right” way. It robs other therapists of clear information and the autonomy to discern their own choices within a complicated system.

How did a profession founded on mental health become so ruthless?

Again, it’s what we’re taught to do.

We’re taught to be the bastions of mental health and stand up for the under-served, under-resourced, and ill-equipped. Essentially, it’s white saviorism, elitism, and patriarchy. We’re taught that we “know better” and therefor must act on that knowledge for the betterment of everyone else.

We’re also taught within a system that reinforces monitoring others. In graduate school, we have professors that oversee our work. In our internships, we have supervisors who are required to monitor us and ensure we are behaving legally and ethically. Once we graduate, we are required to be supervised by supervisors who are also required to monitor our behavior. Thus, the necessary system for us to become credentialed relies on being monitored and monitoring others.

Again, a beneficial system can quickly become negative when it becomes too extreme. It is harmful when our monitoring behavior extends into policing other therapists. It is harmful when our focus shifts to ensuring others are doing it “right.”

Doing it “right” relies on some false assumptions:

• There is always a right/wrong way to do things

• We can avoid all harm

• The most ethical action is always clear

The mental health field is multi-layered and complex. There are not always simple, clear answers. Furthermore, the standards, expectations, regulations, and laws are constantly changing.

I believe the majority of therapists are simply trying to do their best in a challenging system. We do not need to make it even more challenging by policing ourselves. When we police other therapists, it implies, “I do not trust you to make the right decision.” This horizontal violence and gaslighting leads to harm. It stamps out self-trust, creativity, flexibility, and the very things that can enhance our mental health systems and the well-being of therapists

I want us to take the energy poured into policing and pour it into supporting each other, creating new systems, and dismantling the things that get in our way.

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