Can I... in therapy?
If you’re starting therapy for the first time, you might have a lot of questions about what to expect. You’ve possibly heard stories from friends who have gone to therapy, and one of them says their therapist will hug them and another says their therapist would NEVER. You might wonder if you can ask about your bill ahead of time, or if you are allowed to give your therapist a Christmas gift.
Therapy is a unique space. The relationship between you and your therapist is real, and can often feel very intimate. At the same time you might sense there are some “rules” or boundaries that might be different from other relationships outside of therapy.
Feeling unsure and confused about what’s normal in therapy might leave you anxious. It’s completely normal to not know the answers to some of these questions and to feel intimidated about asking. While it’s never a bad idea to just talk directly to your therapist, let’s take a look at some common situations together so you feel like you have a place to start.
Let’s explore three general categories — “should always,” “should NEVER,” and “may or may not.”
There are some things that your therapist should absolutely do, especially if you ask. As the client of a therapist, you have basic rights that should be respected and are legally protected. There are other things that a therapist should NEVER do and if your therapist is doing these things it’s a very big red flag. There are ethical boundaries in therapy that all therapists must respect. Of course, there are also some things that fall in a gray areas— the answers are case dependent or therapists may have different preferences.
Let’s take a look.
First, let’s look at a few things you “should always” expect from your therapist.
Good Faith Estimate: One thing that your therapist is legally obligated to do is make sure you know exactly what to expect to be charged for your session BEFORE you meet with them for the first time. In January of 2022 the “No Surprises Act” was enacted, which obligates all medical professionals (therapists included) to give what’s called a Good Faith Estimate. This is an estimate of what to expect to pay for the services provided (barring emergency situations). This is documentation your therapist should give you – when you receive it, save it for your records and if your therapist overcharges you by $400 or more you may not have to pay the difference.
They Answer Questions About Their Credentials: Your therapist should answer any questions you have about their training, education, and treatment approach. It would be a major red flag if a therapist did not answer your questions about their credentials or licensure or could not articulate why they are taking a certain approach to your treatment. You are allowed to make choices about your treatment, so it’s absolutely your business to be able to ask things like, “Are you trained in DBT?” ; “Are you licensed or are you still being supervised?”; “Have you worked with other clients who have my diagnosis?” etc. They should answer these questions openly and non-defensively.
Provide Appropriate Documentation for Sessions: If you ask for documentation related to your session payment (e.g. an invoice or superbill) your therapist should provide this to you. Not all therapists will accept insurance or provide out of network courtesy billing, so that responsibility might fall on you, but you are entitled to a receipt for your payments. No therapist should deny you this.
Now let’s look at a few things your therapist “should NEVER” do.
Make Sexual Advances or Sexual Harassment: If you are seeing a therapist for therapy, there are absolutely no circumstances in which a therapist should ask you out on a date or make any kind of sexual advances towards you. Therapists are prohibited from having sexual relationships with clients, even if it’s the client’s idea. Having a sexual relationship with a therapist has been proven harmful to the client and treatment. It is against all therapists’ ethical codes. You have a right to report your therapist if they have ever made sexual advances or harassed you in any way.
Not Report Abuse: Your therapist should never agree to keep child/elder/dependent adult abuse that is currently occurring a secret. Specific laws vary state to state, but at minimum, therapists are legally mandated to report ongoing abuse. They cannot keep that information confidential if someone is currently being harmed, and a promise to do so would be a major red flag.
Employ You or Ask You for Favors: Your therapist should never hire you or ask you for professional advice. Therapy is a space that is supposed to be for you and your treatment. It would be a major red flag if your therapist asked you to babysit their kids, give them investment or tax advice, asked you to pick up their dry cleaning, etc.
Finally, let’s look at some things your therapist “may or may not” do.
Attend Your Events: Your therapist may or may not attend a graduation, wedding, or other public event (poetry reading, concert, etc.) that you are involved in. Different therapists will approach these situations differently depending on their style, the situation, and your relationship. This is definitely something you can talk about with your therapist, and see what makes the most sense in your unique circumstances.
Hug: Your therapist may or may not hug you. There is no ethical prohibition against a therapist giving their client a hug, but different therapists may have different perspectives about whether or not they are open to hugging their clients. You and your therapist might talk about how hugs impact your treatment and what treatment boundaries work best. Your therapist should never assume or imply that you must hug them – you should always feel free to say no to physical contact. It should never be forced.
Accept Small Gifts: Your therapist may or may not accept a small gift from you. Different therapists follow different ethical codes depending on their license (and may work in workplaces that have specific rules about gift receiving). There may even be a different dollar amount they they are ethically permitted to receive and cannot go over. Therapists are not allowed to accept expensive gifts from clients (a designer bag or a car would be the type of gift your therapist would have to return to you), but something small like cookies, a memento, picture frame, homemade craft, etc. may be okay.
“You have basic rights that should be respected and are legally protected.”
These lists are not comprehensive, they’re just a place to start. You should never feel embarrassed to ask your therapist about what to expect in therapy, no question is too silly. You don’t have other relationships with therapists outside of therapy, so it’s totally normal to be in a process of figuring out the ways therapy is the same and different from other spaces. You’re essentially asking about the boundaries of therapy, and that is completely acceptable.
A good therapist should respond well to these questions. If they don’t, you should feel empowered to seek out a relationship with another therapist who provides answers to these questions that give you clarity and create an environment of safety.