Ethics at the Intersection: Power, Identity, and Clinical Practice
“Regulatory compliance is not the same as ethical practice.”
In June’s Therapist Salon, we focused on Ethics at the Intersection: Power, Identity, and Clinical Practice. At the heart of our conversation, we explored – how does a therapist's own identity, training, and unexamined assumptions show up in the room? And what does it mean to practice ethically when the rules themselves don't always point toward what's right?
What We Discussed & Discovered
The therapist is never a neutral actor. The myth of neutrality in clinical work is itself a political stance; your culture, training, and the systemic forces that molded you inevitably influence every diagnosis, linguistic choice, and treatment priority. To suggest otherwise is a pretense that can result in genuine harm.
We explored how ethical bracketing (Kocet & Herlihy, 2014), decolonizing therapy (Mullan, 2023), and multicultural competency (Association for Multicultural Counseling and Development. 2015) can help us examine ourselves, the work, mental health and ethical practice.
The structure of therapy can replicate oppression regardless of intent. Freire's banking model (1970) maps directly onto standard clinical practice — diagnosis, treatment planning, the expert-patient hierarchy. Ethical practice means interrogating the structure itself, not just what happens within it. We dug into the uncomfortable reality that therapy's traditional structures can sometimes replicate the very dynamics of power and exclusion our clients are trying to heal from (Mullan, 2023; Freire, 1970).
Regulatory compliance is not the same as ethical practice. When a regulatory body retreats from naming racism or constrains care for vulnerable or underserved people, following the rules can itself become a form of harm. Clinicians need to know where the floor is and where it falls short.
Texas BHEC recently replaced the explicit CE requirement for "cultural diversity" training with the broader term "distinct populations competency," framed as giving clinicians more professional autonomy. But when over 80% of Texas mental health providers are white and 60% of Texans are people of color, who does that autonomy serve?
Similarly, WPATH's Standards of Care 8 names clinician bias and transphobia as ethical concerns, while Texas guidance increasingly places therapists at potential legal risk for affirming trans youth's gender identity. These aren't abstract policy debates. They show up in the room, in our bodies, in the choices we make under pressure.
The conflicts inside the regulatory system, over cultural competency, discrimination protections, who gets to define "distinct populations," and who holds accountability, are live evidence for today's mental health oppression and institutional violence per Jennifer Mullan’s work (2023), Paulo Freire (1970), and Multicultural and Social Justice Counseling Competencies framework (2015).
Documentation is valuable. Using an ethical decision making model and documenting your pathway is paramount to ethical clinical work. The latter and former of which we did not have time to dig into as much as we might have all liked or needed. This may be the topic for our next Therapist Salon. Regardless, ethics isn't a checklist. It's an ongoing, uncomfortable, and politically conscious practice.
If this resonates with you, I'd love to connect!
Whether you're a fellow therapist looking for community, an associate seeking supervision, or a person simply trying to understand what a thoughtful therapist looks like, this is the work I'm committed to. Ongoing, honest, and never finished.
References
Freire, P. (1970). Pedagogy of the oppressed. Continuum.
Mullan, Jennifer, PsyD. (2023). Decolonizing therapy: Oppression, historical trauma, and politicizing your practice. W. W. Norton & Company.
Statutes and Rules – Texas Behavioral Health Executive Council. (2026). Texas.gov. https://bhec.texas.gov/tbhec/statues-and-rules/
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066X.62.4.271
Kocet, M. M., & Herlihy, B. (2014). Values-based conflicts in counseling: Implications for professional practice and counselor education. Counselor Education and Supervision, 53(4), 284–295.
Association for Multicultural Counseling and Development. (2015). Multicultural and social justice counseling competencies. Multicultural and Social Justice Counseling Competencies
WPATH. (2022). Standards of care for the health of transgender and gender diverse people (Version 8). International Journal of Transgender Health, 23(Suppl. 1), S1–S259.
Autistic Self Advocacy Network. (n.d.). Identity-first language. Identity-First Language
