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!

Monkey Mind, Monkey Run

I’ve been thinking all week about external validation, beyond the likes and blog comments and more into  (what I used to believe was) my non-digital life. Most days I struggle to walk away from my keyboard. After all, that’s where my livelihood (such as it currently is) resides—writing, school, job applications. To counteract all of this screen time, I’ve been trying to push away and spend at least an hour each day running. I was on the massage table the other day, telling my massage therapist about my last blog, recounting for her how I thought that running so much these past two months had significantly calmed my annoying physical symptoms of the past year. I told her how good it was for me to spend that hour each day away from the computer screen and out of my head. Then I mentioned in that offhanded manner that so often carries the weight of truth that I run with my iPhone because my phone is where my Nike app lives along with my running music and my Fitbit app.

“So, you’re not really getting away from the external validation,” she noted.

“I don’t answer the phone and I don’t check my blog stats when I run,” I said, a little miffed, before adding, “Usually.” Slowly I began to see her point.

As I run through the miles, my iPhone via the Nike app, tells me how far I’ve run and at what pace.  My Fitbit vibrates when I hit 10,000 steps for the day (generally by the time I’m done with my daily run). I listen to a playlist of music and when Florence and the Machine comes on with Dog Days, I know that I’m nearing the two mile mark and that about 20 minutes—give or take half a minute—have gone by. I know then I have about 30 minutes left. I know the first of the Lady Gaga songs come on around mile four, and I know that if I’m still running when The Band starts playing that I’m closing in on mile five. I know if I’m running better than I did the day before. Hell, I even know if I’m running better (or worse) than the average of my last seven runs. On good days when I’ve finished running and before I stretch, I’ll even post my run results to Facebook with a comment along the lines of “nailed it bitches!”

“What would happen if you ran without your phone?” the massage therapist asked me and then answered her own question. “You’d be able to hear the birds.”

“I’d just hear myself huffing and wheezing,” I countered. “And I’d lose miles. My averages would plummet.” As soon as I uttered those words I knew I had a problem, or, in the parlance of the mindful and aware, I knew I had something I might want to pay attention to, something to look at.

She laughed when I said I’d lose miles. Absurd, right? Of course I wouldn’t be losing the miles—my body, my health would still benefit, clearly. But would I be able to tolerate not documenting my progress? Would I be able to derive the same pleasure from running if I couldn’t compare today’s run with yesterday’s?  And how would it be to run without music? Would I be faster or slower? Could I stand to listen to just my own heavy breathing? I’m not sure I can. I’m not even sure if I want to, but I’m interested in taking a closer look at the whys of the situation. I’m interested in noticing.

I’m interested in noticing because when I pay attention, I can begin to make more conscious choices about this one life I’ve been allotted. On the surface these choices seem trivial: whether I run with or without music, with or without digital feedback on my performance, with or without compiling and parsing each mile. But are they really insignificant or are they indicative of a larger problem? Even as I type this piece I can’t refrain from flipping back to the Internet, to Facebook, to my email. I cannot focus just on this bit of writing for any sustained period. I don’t know if my monkey mind is getting worse or I’m just noticing it more, but I’m beginning to worry that I’m not paying close enough attention in other areas of my life, that being easily distracted could be taking a toll on my relationship and my career (or lack thereof), on my desire to be a writer. Is this inability to focus on just one thing at a time without soliciting feedback and validation getting in my way?

For one of the psychology classes I’m taking this quarter, I had to read about and then write a page and a half paper on BF Skinner—I had to pick out my favorite theory of his, write a paragraph on said theory and then find a related online source to write about that had to do with my favorite Skinner theory. I started this exercise thinking I wasn’t a big fan of Skinner—I think (or used to think) that behaviorism was reductionist and limiting. After all, behavior modification techniques did not work at all when I tried to use them on my kids. My kids could give a flying fuck if they got a gold star on a refrigerator chart. I came out of my active parenting years with the firm belief that nature will always triumph over nurture. But, a funny thing happened on the way to writing my Skinner paper—I started connecting the dots. Duh. I remembered a book I had purchased but only partially read a few years ago, Nicholas Carr’s The Shallows: What the Internet is Doing to Our Brains. I looked Mr. Carr up on youtube and listened to him read from and discuss his book at the Harvard University bookstore.

If Carr is correct (and I do believe he is), the Internet really is changing the way our brains work. My brain has been changed to actually need to push the levers at Twitter and Facebook, to peck away at my email icon. All of this screen time is rewiring my grey matter, new neural pathways are being formed based on Skinner’s Operant Conditioning theory. I have been trained to push the levers just like the lab rats. Nike and Fitbit, Apple, Facebook, Twitter, WordPress, Google are delivering enough random little doses of oxytocin to keep me coming back for more.

Now that I have this awareness, what am I to do? Initially, I’ve decided to just be aware, to simply notice (is it obvious yet that I’m taking a mindfulness class?). When do I press the levers? What distracts me? Do I feel better or worse if I stop writing and check an empty inbox? What do those Facebook likes and new Twitter followers mean to me? Does my self worth rise and fall with my stats? Why? And maybe most importantly, am I engaged in meaningful and purposeful relationships outside of these places? Am I moving forward, toward my goals for the next year, the next five years?

This afternoon I thought briefly about leaving my phone and earbuds behind when I headed out for my run. After all, I knew the run from my front door to Boulevard Park and back again is just over five miles. I don’t need iTunes to mark my distance. But, I do know that I seem to be in a running groove right now that works for me. I am aware enough to know I don’t want to fix something that’s not broken. I’m getting fit. My pants are getting looser. My body feels great. I LIKE having Macklemore, JayZ, and Rhianna in my head. Screw the birds–S & M motivates me. Today I chose to run with the technology in place. Tomorrow I may decide differently. Tonight I will decide if I want to read a book or spend my time before sleep anxiously checking online stats. I’m leaning toward the book. I’ll let you know what actually happens.

My Drug and My Vice

Feedback hits my veins
Smack for my ego, mainlined
I close my eyes, sigh

I wrote this haiku over the weekend, fueled as I was then by a steady stream of positive feedback for my writing and after a really great response to the Whatcom Writes reading on Sunday. But like any good addict knows, that euphoric feeling fades fast without a continual infusion.

I managed to ride the wave for most of the week, getting by on a steady stream of Facebook likes and occasional comments, but on Friday I hit bottom.  Two months ago I sent out some queries to a handful of agents and within days one agent requested I send sample chapters of my memoir. This is it, I thought. I’m golden. I worked feverishly for a week to put some high polish on a few of the better chapters and sent them off into the ether. I tried hard to stay in the moment but really, who among us writers doesn’t live at least part of the time on that fantasy book tour? On the bestseller list in our own heads? I’m a legend, if only in my own little monkey mind.

Things came crashing back to earth for me on Friday when the agent got back to me with a kind and generous email indicating that perhaps my pages aren’t quite ready for primetime. Honestly, I can’t say that I wasn’t expecting this—I know the odds. We all do, when we sit down and dare to think we have a hope of seeing our words in print. The statistics are depressing, but still, we dream.

This crash, this bursting of my ego and the view from down here at the bottom set me to thinking about how fortunate we are now, though, as writers. We have an audience if we want one. We don’t have to toil in obscurity—relative obscurity, maybe, but not completely. We have communities that welcome our imperfect work, places where we can get our hits and fixes, venues even if they are of our own making.

I started wondering, though. What was it like as a writer to wait months and months for feedback on a piece of writing? Or to not get any at all? Imagine—writing something, spending a few hours, or weeks, months, years, on a piece and then just . . . doing what with it, exactly? Sending it to an agent or publisher and then waiting for a single letter to come by post. No instant gratification. No thumbs up or down within minutes. I suppose after a week or so trips to the mailbox might become something like obsessively checking Facebook within a few minutes of posting a particularly witty comment or status update. The worn path to the mailbox might have been a little like the iPhone-shaped silhouette on my back pocket—there because I want easy access to my inbox, the ability to quickly check my blog stats. My self-esteem rises and falls with the number of hits I get.

All of which leads me to ponder just how healthy it is, this continual trickle of sporadic feedback and my incessant need to check in on it. On the one hand, when the stream dries up a bit, we can just post something new. On the other hand, why? What’s my motivation? To continue the high or to hone my craft? I’ve been reading about B.F. Skinner and the behaviorists, operant conditioning—the key to operant conditioning is the immediate reinforcement of a response. Suffice it to say, I’ve been thoroughly conditioned by variable reinforcement. I feel a bit like a used lab rat, and the unpredictable rewards are messing with my monkey mind.  One day there might be these beautiful little gifts waiting when I press that lever, other days there’s nothing. Does the nothing keep me from pressing the lever? No it does not. The nothing makes me press the lever even more—there must be some mistake! Where’s my feedback? My next hit? I need my fix!

So. I enroll in a mindfulness class. I employ hypnotherapy and guided imagery. I run. I run and run and run. They say the endorphins produce a natural high. It doesn’t really compare, but there are 30, 40, 50 minutes a day where I’m away from the lever at least. And I’m getting healthier as a side benefit. I’m not sure I want to give up the drug, the high, the next hit long term, but I’m trying to get better at living in the moment and focusing on writing just because.

Oh hell. No I’m not. If I were, I’d not be posting this damn blog.  Hit me baby. Just one more time.

Tired of the Hate

Is it me or are we already done with the season of love and peace? The first two things I read online this morning have upset my delicate sensibilities, Dear Reader. First, a tweet from @JoeMyGod about a group of people who are boycotting the Rose Parade because a wedding float will feature a gay couple. The second, the comments section following an article on komonews.com about the Catholic school vice principal fired for his same sex marriage.
I clicked through to the Facebook link on the Rose Parade—evidently a gay couple won the Dreams Come True contest and the prize is getting married on the giant cake-shaped float in the venerated parade. More details can be found here. I found a page filled with hateful, ignorant comments about how witnessing two men getting married would irreparably harm children. I have to say I was stunned. I mean, yes, I know that not everyone is thrilled with same sex marriage, but I have been living in a bit of a bubble, I guess. The hate and fear and ignorance, the vitriol and anger shocked me. I posted a comment on the page, just a few words letting them know that I was sure Jesus would be so proud of their hate and bile. I think we all need to visit the site and show them that hate won’t win.
That small act made me feel a tiny bit better but for a moment I was beset by anxiety and dread, that feeling of futility that I often get spread across my chest. I then realized that my FB picture is of The Little Woman and me holding our marriage license and I had to smile. I fought back my urge to delete my comment, to not make waves.
I poured myself a cup of coffee and settled myself in front of the Pin Stripe Bowl, picked up my laptop and logged on to www.komonews.com to catch up on local news. My eyes caught the headline announcing that the vice principal of Eastside Catholic High School was fired and had not resigned as the church said last week. I clicked. Call me a sucker for the obvious. The article confirmed what I’d already suspected—Mark Zmuda had been forced out for marrying his male partner. The article was benign enough, but the comments section . . . why oh why did I feel the need to read the comments? More hate and ignorance.
I understand that Mr. Zmuda worked at a Catholic school and that his being gay flies in the face of some Catholic teachings, but the hypocrisy is killing me. How many Catholic school teachers live “in sin” with their heterosexual lovers? How many Catholic school teachers use birth control? How many Catholic school teachers have had abortions? How many of these teachers have been forced out of their jobs? And lets not forget the hundreds or thousands of priests who continued in their positions in spite of having sexually molested thousands of children. Mr. Zmuda’s being gay has absolutely no bearing whatsoever on his ability to do his job, to teach math. Mr. Zmuda did nothing wrong, he committed no crime. He simply let down his guard and maybe forgot that he worked for a homophobic organization. I can understand his mistake—lots of people who work for the church are decent folks. But the organization itself is not so benign (see my earlier blog here)
Let’s not forget that the Catholic church operates without paying any taxes. It does not pay into unemployment insurance, it does not pay any income tax. As an institution, it collects gazillions of dollars and not one cent of it (except what its employees pay in income tax) goes into the public coffers. Hundreds of non-Catholics and non-believers work for the church, and I’m guessing lots of those workers belong to the LGBTQ community. It seems to me, and call me crazy, that an institution that doesn’t pay taxes should have no right whatsoever to contradict the laws of the land. Same sex marriage is legal. Don’t like it? Tough shit.

We’ve (and by we I mean all LGBQT people) have lived too long in fear of god’s wrath, in fear of other people’s judgment, in fear that we will lose not just our jobs but our very lives. We’ve stood by and watched as heterosexuals celebrated their love in some of the gaudiest and most offensive ways imaginable. We have been marginalized by religious institutions, shunned by those that claim a loving Jesus and god as their masters. It’s a bit hyperbolic that these people believe a single float in the Rose Parade or the same sex marriage of a Catholic math teacher signal the end of civilization, don’t you think? On the other hand, maybe we need an end to this sort of civilization—maybe the end of civilization as we know it is not a bad thing at all.