What's the ethical issue here?
March 12, 2018 3:06 AM   Subscribe

I'm trying to access therapy via my EAP right now, and during the referral process the person I'm in contact with stated that after the eight free sessions my employer provides, I'd need to take a three-month break before resuming a therapeutic relationship with the provider I get matched with (assuming I want to). Why is this?

I asked about this during the intake process because the issues I'm seeking therapy for (mostly abusive-childhood-legacy stuff, C-PTSD feels like an increasingly good fit for the symptoms I'm experiencing) aren't necessarily easy to resolve with an eight-week course of structured counselling.

The intake person who works for my EAP also mentioned concerns about this, at one point implying I might be too traumatised for the type of counselling they're offering. I still want to pursue therapy via the EAP as I think it's one of the better immediate options I have right now (they can hook me up with someone in 2-3 days and I don't have to worry about researching/choosing the therapist or paying for it, both of which are significant bonuses for me right now) and they've agreed that I can use their service as long as the focus is on practical steps for managing symptoms and moving past the abuse (which is also what I want to get out of therapy this time round).

I was already struggling not to process this as a rejection (ok, so, what, I'm too traumatised for the free therapy, is that implying that past a certain point of trauma you ought to be paying for it yourself?) and accessing the EAP in the first place felt like a bit of a risk as I've been very self-reliant when it comes to accessing services in the past.

As part of answering their concerns about whether or not I was too traumatised for the therapy they were offering, I asked if it would be possible to continue a private relationship with the therapist once the free sessions were completed. Their response was: "we want to ensure that we are working in the most ethically appropriate way, we would therefore ask for you to have a 3 month gap before starting a private relationship with the counsellor."

I'm really struggling to understand the ethical issue here. Is it the fact that my employer is paying for short-term targeted therapy aimed at solving a specific problem, and if I then use those sessions to segue into a longer-term therapeutic relationship, I'm somehow taking advantage of the counselling my employer provides via the EAP? Other than that, I can't see what the ethical problem might be, but I don't know very much about how EAPs etc. are meant to work.

From my perspective, I have multiple chronic mental and physical illnesses and my employer gets the best, freshest and most pain-free forty hours I have each week; I feel no qualms about using the benefits they offer, even if the way I use them isn't quite how they were intended to be used.

I'm concerned now that I'm going to start processing some difficult stuff and then have to take a three-month break for "ethical" reasons right in the middle of it. But equally I'm already in the middle of the process with the EAP and I'm not sure I have the wherewithal right now to seek out private therapy. "Too traumatised for free therapy" sounds too much like "worthless and not deserving of treatment" in my head, which is already a feeling I struggle enough with.

I definitely plan to bring this up with the therapist once the therapy begins, but I don't feel comfortable asking the EAP contact about it given that I already feel vaguely-rejected by the interactions we've had so far. In the meantime, I'm really curious - what's the ethical concern here?
posted by terretu to Health & Fitness (11 answers total)
I'm going to guess that what the EAP is lining you up for is eight weeks of CBT. That may or may not be an effective intervention, only you can tell.

My guess at the "ethical" issue is that the EAP provider doesn't want to encourage clients going direct to therapists & making their own arrangements - and vice-versa. Like a kind of non-compete agreement, whereby the EAP stays in the middle of any contact.

After giving it due consideration, I turned down the offer of x weeks therapy through my own EAP, around this time last year. I wanted to maintain a little bit more control over the process than it looked like I'd be getting.
posted by rd45 at 3:33 AM on March 12, 2018 [1 favorite]

The ethical issue is that the counselor has a contract with your employer that they will only treat patients for free under the EAP for 8 sessions. “Ethical” is a bad choice of words on that person’s part - it’s almost certainly a financial, contractual issue. You should not take this personally.
posted by something something at 4:46 AM on March 12, 2018 [14 favorites]

Expanding on something something's answer, I guess it could be seen as an ethical issue for the counselor. An unscrupulous therapist could, presumably, half-ass the 8 free sessions so that you're more likely to continue seeing them at a higher rate.
posted by A Robot Ninja at 5:17 AM on March 12, 2018 [5 favorites]

The insurance company wants some mental health coverage if you need it, but does not want you to be in regular therapy that they have to pay for. In order to make sure that the therapist/counselor use this as a bridge to a long term relationship, they set up that 3-month restriction. If the therapist thinks you need more help they can refer you to someone else, but they don't get the money from continuing with you.

It's part cynical, part sensible. EAP is suppose to provide short term counseling to help with specific issues or life events. It's not meant to be used as "First thirty days free!" promotion.
posted by Garm at 5:33 AM on March 12, 2018 [17 favorites]

The ethical consideration is likely concern about whether the therapist is behaving ethically, not about you. A therapist working within an eight-session framework needs to work differently than a therapist working without a deadline; they need to be more solution-focused (and more focused in general) and do almost no depth-work, because it can be harmful for a client to open up major wounds without having the opportunity to resolve them (exactly as you've intuited). By telling their therapists that they cannot just parlay the EAP clients into long-term clients, the EAP is forcing the therapists to stick within established ethical guidelines for short-term care, for the benefit of the client.

Basically, they're trying to avoid harming clients, or having therapists coerce clients into paying out of pocket once the eight sessions are over.
posted by lazuli at 6:24 AM on March 12, 2018 [5 favorites]

I would also say that ethical guidelines for therapists are sometimes confusing and the person you talked to may not have actually understood why it was an ethical issue, which may be why it came across as accusatory.
posted by lazuli at 6:26 AM on March 12, 2018

EAP is suppose to provide short term counseling to help with specific issues or life events.

This. If you have serious issues, it's not that you don't deserve help, it's just that the way employers set up help for more serious ongoing mental health problems is to go through the mental health benefits provided under your health insurance, not your EAP. It's sort of like--I can go to the health services office at my company whenever I want to get an icepack or a band-aid for free, but they provide these things to prevent people from needing to leave work early for a transient health issue, not to replace having a primary care provider. The point isn't that you're too traumatized for free therapy--it's that the free therapy exists primarily to keep people from calling off of work because of stress about marital issues and such, not to be serious mental health care, and a band-aid is only going to do so much good if you've really got a serious wound. They have not budgeted for this as more than a band-aid kind of solution.

As mentioned, the ethical issue here is that the therapist is supposed to providing deadline-oriented care and not getting this person with minor personal issues into an ongoing and expensive care relationship. Because you're using this for something that's so far outside of what the EAP is really for, you probably do need ongoing help, but you have to remember that these rules are not made based on your situation. I would suggest that you be really cautious about this generally--they may not be referring you to someone who is actually good with your sorts of issues.
posted by Sequence at 6:28 AM on March 12, 2018 [15 favorites]

I'm concerned now that I'm going to start processing some difficult stuff and then have to take a three-month break for "ethical" reasons right in the middle of it.

Also, this would be a big concern for me, too, and I think that's why the EAP is being hesitant here. EAP sessions are generally more for focusing on short-term, concrete problems, or maybe on some coping skills for longer-term problems. They're not really designed to be the same as long-term therapy. If I were the therapist in this scenario, I would not have you be doing any processing of the past in those eight sessions. We would be focusing on coping skills coping skills coping skills.
posted by lazuli at 6:31 AM on March 12, 2018 [1 favorite]

Thanks for the advice everyone - I had enough of a weird feeling about this that I've put the EAP referral on hold (I'd forgotten CBT was a thing but it makes sense that that's what the EAP counselling would be and I know I don't want that kind of therapy right now) and I'm looking for a new private therapist in the meantime.

For the record, this is all in the UK, so while I do get private medical insurance, it doesn't cover any pre-existing conditions and all my mental health stuff is pre-existing. My options are EAP, NHS or private therapy, and given that the majority of my interactions with the NHS for mental health have been more traumatising than helpful, private therapy looks like the way to go right now.
posted by terretu at 6:53 AM on March 12, 2018 [1 favorite]

This is totally normal in the UK - if you got counselling through the NHS via your GP then you'd get the standard "six sessions of CBT" (or whatever the default is now) and after that the counsellor you saw would not be permitted to solicit further paid sessions from you.

(They would be able to refer you to other counsellors who take paid referrals however.)
posted by pharm at 8:06 AM on March 12, 2018

Just chiming in to say that 8 sessions of CBT would be quite short of recommended doses- that would be pretty atypical except for some very specific conditions (like insomnia). CBT is usually 12-16 sessions when it's used to treat conditions like PTSD, anxiety, and depression. I would guess you'd be getting something more like problem-solving therapy or a crisis intervention type therapy, neither of which are meant to treat posttraumatic stress.
posted by quiet coyote at 8:47 AM on March 12, 2018 [2 favorites]

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