E is for (what else?) Ethics

 

EDon’t have sex with your clients. Just. Don’t.

Washington State law forbids it and even goes so far as to outlaw intimate relationships with former clients. Forever. The American Counseling Association (ACA), in section A.5 of its 2014 Code of Ethics prohibits sex with current clients as well, as do all of the other professional organizations, but they don’t put a complete ban on sexual relationships with former clients forever, instead imposing a five year moratorium on sex with former clients.

And still. Therapists have the dubious distinction of being disciplined most often for violating this particular ethical code. In fact, they (we) outpace all other helping professions in this area, leaving lawyers, doctors, and even massage therapists in the dust.mother

But say your aspirational ethics around this issue are intact. Say you are really clear that you would never, ever engage in a sexual relationship with a client or former client, or with their family members. There are still a thousand different ways to violate client trust or for a counseling relationship to go off the rails.

The ACA’s code of ethics state that the primary responsibility of the counselor is to respect the dignity and promote the welfare of the clients (Section A.1). The document goes on to say that counselors must act in such a way as to avoid harming their clients (Section A.4). It’s a lot like the Hippocratic Oath: First, do no harm.

But what causes harm, exactly?

Consider the following scenario (borrowed from my Ethics textbook): You are the only counselor in a small town. Another therapist is a two-hour drive away. When you moved here, you became good friends with the school principal, and her son and your son are best friends. She asks if you would see her son professionally. His grades are slipping. He has started acting out at home. He’s defiant and surly. She doesn’t have time to drive two hours each way to take him to a different therapist. Could you just talk to him a few times? You want to help.

What to do? What to do? What could possibly go wrong?

How about this situation: You’re seeing a client who is a writer. You, too, dabble in the written arts. The client mentions his blog during a session, and as soon as he leaves you Google his name, find his blog, and settle in to read it. Your curiosity piqued, you search for him on Facebook. Research, you tell yourself. What you find out will help you understand him better. The next time he comes in you say, “Great blog! I have one too. You should check it out. And if you have any feedback on my writing, I’d love to hear it.”

ethics cartoonWhat’s wrong here? Why not bond with a client over a shared passion? Maybe trade a few sessions for a critique of the novel you’ve been working on. After all, the writer doesn’t have a surplus of cash. It would be a win-win. Right?

No. To borrow a phrase from Cheryl Strayed’s book of quotes Brave Enough: “The short answer is No. The long answer is No.”

You are the therapist. He is the client. It is a one-way street. You must consider all the ways in which your actions could possibly harm the client. You are not friends, buddies, colleagues. You are the keeper of deep secrets, a confidant, a compassionate listener, a mirror. Just in asking, you’ve violated the trust implicit in the counseling relationship. And the client is paying you for a service. Asking for a personal favor, for feedback places an extra burden on the client, a burden he did not sign up for.

Okay. One more. How about this? You are seeing a client who struggles with self-esteem, with feeling heard and being seen. She shares with you some of the poetry she has written. You tell her it is beautiful and moving and wonderful. You email her a couple of poems from your favorite poets and hope they resonate with her the way the do with you. She sends you more of her poetry. It really is beautiful, full of amazing metaphors and gorgeous imagery. You tell her as much. She should be published, you say. She glows in your effusive praise.

What? Is there a problem?

The short answer is Yes. The long answer is Yes. Now the client is seen. Now the client is heard. But by you. Instead of helping her gather her inner resources and find her intrinsic value, you’ve taken a short cut. Basically, you have given her the needle and the spoon and pushed the plunger down, mainlining self-esteem. You are now her source, her dealer, her heroin. Congratulations, you’ve created an addict.boundary issues

There are so many other things to consider here as well. What is poetry? Who sends poems? Poetry is the language of love. People in love send poetry. Poetry is metaphor—a word can have a thousand meanings in a poem. What you read and what the client meant might be vastly different.

What would an ethical counselor do in any of these situations? And why? An ethical counselor must always consider the needs of the clients first. In some respects, a therapist has to see the future and ask herself, “How will my actions and words now impact my client down the road?” “Will I be helping or hurting my client by taking this action?” “What is my motivation?” “Am I getting my own needs met or am I meeting my client’s needs?”

Instead of praising a client’s poetry, ask them what writing poetry does for them? What do they get when they create? How do they feel when they are writing? What’s their process? Explore. Ask questions. Help the client find her own meaning in her work.

I could write for days on this topic. But the bottom line is this: There is a power differential in the therapeutic relationship. The ethical therapist uses her power for the good of the client. Never for herself.

And I’d love to hear your thoughts on the scenarios I’ve presented. What could possibly go wrong in each of these situations? Let me know what you think!

7 thoughts on “E is for (what else?) Ethics

  1. Excellent examples and explanations, Pam. The sidebar cartoons are perfect. What could go wrong..indeed! Lots of fodder for plots and poetry…

    • That is very true. They tend to stay home a lot in small towns.

      “How we spend our days is, of course, how we spend our lives.” – Annie Dillard

  2. Before I left to be a freelance writer, my job was setting up laptops and multimedia for the boards in our state that disciplined medical professionals for crossing those very ethical boundaries. Therapists most often were brought in for inappropriate conduct with patients (or drugs–smoke marijuana on the weekend and you can lose your license here in Tennessee). It was always sad to hear these people having their licenses at risk…years of school and hard work out the window. Often, though, they’d just suspend them and send them through some kind of counseling.

    Stephanie
    http://stephie5741.blogspot.com

    • Fascinating! I used to work in IT doing much the same thing. Loved being a fly on the wall like that. It’s so sad to think of people losing their livelihoods.

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  3. What a fine line therapists have to walk. I often wonder how therapists handle situations where, by accident, their lives and the clients’ lives intersect. For example, the therapists friends ends up dating a client. Does the therapist advise the client they can no longer see them due this conflict or does the therapist just hand the client over to colleague?

    • Yeah, that’s a great example of there not being a clear, cut and dried answer. In a perfect world, I would hope the therapist would refer the client to a different therapist. In a small town, that might be more difficult. I think that it would be challenging to maintain a level of trust.

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