Therapist's Responsibility and Ethical Considerations When a Client with Alternates Leaves a Session in an Emergency

Dealing with clients who have alters, often associated with Dissociative Identity Disorder (DID), requires a nuanced approach. Safeguarding the client's and others' well-being is paramount in the therapeutic setting. This article explores what a therapist would do if a client with alters runs out of the building during an emergency, and the ethical considerations involved.

Understanding the Client's Experience

Therapists who work with clients presenting with alters, or multiple personalities, must be particularly mindful of their client's unique experiences. These individuals often face complex circumstances that require a sensitive and supportive environment. Understanding the client's alarm or distress during a session is crucial in determining the best course of action.

Staying Ethical

Maintaining ethical standards is non-negotiable in the therapeutic relationship. It is never appropriate for a therapist to chase after or pursue a client who has left the session. Every choice made in therapy is a deliberate decision. If a client decides to leave, they have every right to make that choice. However, if prior to leaving, the client expresses that their life or another person's life is at risk, the therapist has a duty to alert emergency services immediately.

Emergency Situations Involving Multiple Personalities

During the therapy session, it is possible that one alter may dominate the interaction while others are present and experiencing distress. If an alter decides to leave in a state of panic or if the client experiences a sudden and dramatic shift in personality, the therapist must act swiftly but ethically.

Follow-Up and Responsibility

After a client with alters leaves under distressing circumstances, the therapist should:

Reassess the client's safety and well-being. Consider reaching out to the client to check on them and provide support. Document the incident in the client's record, detailing the actions taken and the next steps. Discuss the situation with the client during a subsequent session, if appropriate and safe to do so.

Contacting Emergency Services

In certain situations, it may be necessary for the therapist to contact law enforcement. This should be a last resort and only if there is clear evidence that the client or someone else is in immediate danger. The therapist must have a concrete, undeniable reason to believe that running after and stopping the client would be beneficial and positive. For example, if the client had previously made threats to themselves or others, or if their sudden departure indicates a critical safety risk.

Guarding Against Coercive Behavior

Going after a client is manipulative and coercive behavior that undermines the therapeutic relationship. It can also escalate the situation and create additional harm. Coercing a client into staying or returning to a therapy session is unethical and could lead to a breakdown in the trusting relationship that is essential for effective therapy.

Safeguarding Minors in Therapy

There is a special consideration when dealing with a child client. If a child is left in a therapist's care until a parent arrives, and the child decides to leave, the therapist must act to ensure the child's safety. In such cases, it would fall under safeguarding measures, where the therapist would need to contact the appropriate authorities or ensure someone suitable is available to look after the child.

Conclusion

Therapists working with clients who have alters must prioritize ethical behavior and the client's well-being. Chasing after a client is never appropriate, as it is an invasive and unethical action. Therapists should document and address emergencies in a responsible manner, ensuring that any actions taken are in the best interest of the client and do not compel the client to make unwanted returns to the therapy setting.

Ultimately, a therapist's role is to provide a safe and supportive environment, while respecting the client's autonomy. By adhering to these principles, therapists can navigate complex situations ethically and effectively.