Why Therapy Should Be Outside the Organization
As part of meetings with prospects, I am often asked why we insist that mental health professionals delivering wellbeing services should be provided outside the organization.
Many of our BPO customers recognize the importance of any therapy solution sitting outside their operation. In many cases, the end client also insists on this arrangement. Our direct customers understand the necessity of clearly defining the therapist’s role and ensuring protection on both sides.
For any organization that wants to provide a valuable psychotherapy service, therapists should be employed by a separate company, and session notes and calendars are not held on internal systems.
Stigma and the Need for Confidentiality
A new poll commissioned by NAMI, surveying over 2,000 working adults in the United States found that nearly three-quarters (74%) of employees indicated that it is appropriate to discuss mental health concerns at work, but only 58% say they would personally feel comfortable doing so.
The stigma surrounding mental health issues at work remains strong, with a high proportion of people genuinely concerned that if they talk about depression or anxiety, it will be held against them in some way.
We need to ensure that they can access services without worrying about potential repercussions from managers or peers, especially with Content Moderators, where the role is recognized to be deeply challenging and may lead to or worsen mental health care concerns.
Simplifying Access to Mental Health Support
Encouraging people to access therapeutic services will help ensure that their wellbeing is protected both in the short and long term.
Psychological safety – the shared belief that it is acceptable to take risks, admit mistakes, express ideas and concerns, and speak up with questions without being penalized – plays a huge role in the willingness to engage in mental health services at work.
Having external professionals deliver these services will enhance this feeling among Content Moderators to seek support without fear of judgment.
How Dual Relationships Affect Therapeutic Boundaries
While it may not always be possible to avoid dual relationships and conflicts of interest, mitigating this risk by sourcing external therapists is an intelligent and feasible solution that will better serve your employees in the long run.
Challenges with Internal Therapists in the Workplace
The main reason therapists and clients (your employees) don’t work for the same company is to avoid conflict of interest. Internal therapists may have pre-existing relationships with employees or management, such as friendships or professional connections.
When these relationships overlap with their therapeutic role, these are considered dual relationships and can create conflicts of interest.
For example, an internal therapist who provides regular consultation to a manager about their team may find it more difficult to maintain impartiality when providing counseling to that manager’s subordinates.
Risk of Bias in Therapist-Employee Relationships
In organizations with clear hierarchies, internal therapists may feel pressured to prioritize the interests of senior management or executives over those of lower-level employees. After all, their jobs may also be on the line.
This can compromise their ability to provide fair and equitable treatment to all individuals within the organization. For instance, an internal therapist may hesitate to address issues of workplace bullying or harassment involving a high-ranking executive for fear of repercussions.
Issues of Confidentiality
Internal therapists may face challenges with the limits of confidentiality, particularly when ethical considerations arise related to their dual role. In contrast, external therapists are free from these conflicts, allowing them to focus solely on the wellbeing of the individual.
It’s important to note that clinically sound practitioners follow clear professional and ethical guidelines for mental health in the workplace. The water can be muddied much more easily when therapists work for the same company as their clients.
For example, if an employee discloses unethical behavior or legal violations during therapy sessions, the therapist may feel conflicted about whether to report this information to management, potentially breaching confidentiality.
Code of Ethics
Governing bodies often outline practices related to conflict of interest to minimize these concerns. For example, under section 4.4 Conflicts of Interest and Exploitation from the Psychological Society of Ireland’s Code of Professional Ethics, it is stated that practitioners should:
Be acutely aware of the problematic nature of dual relationships (with, for example, students, employees, or clients) and recognize that it is not always possible to avoid them (for example, when offering services in a small community or engaging in person-centered teaching or training).
Where it is possible, psychologists shall avoid such relationships; where it is not, they take active steps to safeguard the students’, employees’, or clients’ interests (p. 18).
5 Key Factors Beyond Conflicts of Interest
Conflict of interest is the main concern, but there are other factors to consider.
-
Privacy
Employees may feel more comfortable sharing sensitive thoughts and feelings with an external mental health provider.
Knowing they have the right to privacy and their discussions won’t impact their careers can facilitate more open and honest communication, leading to more effective therapy outcomes.
-
Objective Perspective
Internal politics, biases, or preconceptions do not influence external therapists. They can provide an unbiased perspective on organizational issues and individual challenges without being swayed by internal dynamics.
-
Neutrality
External therapists can maintain neutrality in situations where there are interpersonal conflicts or organizational tensions. Their impartiality can help facilitate conflict resolution and mediation processes more effectively.
-
Fresh Perspective
External therapists can introduce new ideas, techniques, and approaches that may not be readily available within the organization.
For instance, promoting employee work-life balance can enhance workplace culture and individual satisfaction. Their fresh perspective can stimulate innovation and growth in the therapeutic process.
-
Crisis Intervention
In times of crisis or organizational change, external therapists can provide timely support and intervention without being directly affected by the situation.
Their external viewpoint can help them navigate through turbulent times more effectively. For example, when redundancies occur, internal therapists may be concerned about their own roles, whereas external therapists remain unaffected.
The Zevo Way
Zevo’s experience over the years has demonstrated that any customer employee can become a therapy client at any stage. Therefore, it is essential to minimize dual relationships to avoid conflicts of interest.
Boundary-Setting and Dual Relationships
One of the most important aspects of our Wellbeing Specialist is setting boundaries. We highlight the potential harms of engaging in dual relationships and provide clear guidance on how to handle any such cases.
For example, if a new Wellbeing Specialist realizes that they have a pre-existing relationship with a customer employee, such as being childhood friends, they are instructed to redirect this employee to another Wellbeing Specialist for support to avoid any potential conflict of interest.
Social Boundaries and Client Interaction
We also discourage Wellbeing Specialists from “hanging out” socially with any of our customer’s employees in the office environment.
While we support friendly interactions to support effective therapeutic relationship building and service engagement, we train specialists to redirect any personal disclosures to ensure confidentiality and protect the anonymity of clients.
If our Wellbeing Specialists see customer employees outside the office environment, we follow the rule of thumb to allow the customer employee to “make the first move.” We also advise against accepting social media invitations, as the online space reflects our physical space.
Confidential Information and Session Notes
Finally, on the topic of session notes, we have heard some horror stories where highly confidential notes from sessions were accessible on internal customer systems, putting sensitive information at risk.
Considering what is disclosed in a counseling session or group intervention space, this is deeply personal and highly sensitive data that needs to be protected.
External therapists will have dedicated devices and separate case management systems. This ensures that client confidentiality is upheld and that employees understand the goals of therapy.
Independent Therapeutic Services as a Workplace Essential
Therapeutic services should be delivered by a separate supplier, whether moderation work is handled internally or through an outsourced BPO.
Establishing this separation signals a commitment to ethical practices, ensuring mental health solutions are impartial, effective, and aligned with both employee and organizational needs.
