5320: Multidisciplinary Ethical Codes

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Chapter 2. Helper Variables–●–29

the welfare of the client leads us to attend to the client’s needs, values, and desires as these give shape to the goals of the helping encounter and the nature of each helping interaction. This client focus is most likely obvious. As professionals, we understand that our helping is a dynamic process that takes place within the context of social interaction and as such, all members involved, including the professional helper, contribute to the focus and pro- cesses encountered. While our ethics direct us to attend to the needs of our clients, what may not be obvious or expected is the role that the helper’s values, needs, beliefs, and interests play in coloring the helping process. Consider the following case illustration as it demonstrates the potential influ- ence that the helper’s personal values, needs, beliefs, and interests may exert within the helping process (Case Illustration 2.1).

Case Illustration 2.1

Michele: Maintaining Objectivity

Michele is a social worker for the Department of Human Services in a large metropolitan city. From all accounts, she is a consummate profes- sional, respected by her peers and supervisors and truly embraced by all her clients. Because of her own competence, Michele is often given some of the hardest cases to handle.

Michele and her husband of five years have, for the past two years, unsuccessfully tried to have a child. Michele has just found out that she is unable to get pregnant because of scar tissue lining her fallopian tube. This news has been very upsetting to Michele, and she is currently in counseling.

Michele has continued to go to work and has been able to main- tain an active professional calendar. Michele has just been assigned a new case. Judy is an 18-year-old single woman who is currently living in a halfway house for people progressing through a drug treatment program. The following is part of the intake interview between Michele and Judy.

Michele: Hi, Judy. Please come in and have a seat. Thanks for coming.

Judy: No problem.

Michele: As you know, I am a social worker for the Department of Human Services, and I will be your caseworker while

(Continued)

Parsons, Richard D., and Karen L. Dickinson. Ethical Practice in the Human Services : From Knowing to Being, SAGE Publications, Incorporated, 2016. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/capella/detail.action?docID=5945468. Created from capella on 2023-01-09 10:36:10.

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30–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Clearly, Michele’s personal interest in childbearing and current experi- ence of sadness and grief around her inability to conceive is making it dif- ficult for her to remain emotion ally detached as she listens to Judy’s story. Keeping her focus on the client and what is best for that client appears to be difficult for this provider. While professional boundaries are essential for ethical helping, the concept of helper detachment and total objectivity is truly a myth, one that if gone unchallenged can prove detrimental to the helping relationship.

you are at Hansen House (the halfway house). I will help you coordinate your work and therapy schedules and work with you in trying to develop a career development plan.

Judy: Yeah, I kind of know what you do. I’ve done this before.

Michele: You have?

Judy: Well, not the halfway house. The drug thing. But I had a social worker when I was 11 and another time, like at 13 or 14, living in Detroit.

Michele: So you worked with a social worker before. Could you tell me what that was like?

Judy: It was okay. I had to go ‘cause I was living on the street and I got pregnant a couple of times and tried to abort it myself.

Michele: You were pregnant?

Judy: Duh, yeah.

Michele: But you were just a kid! Just 11!

Judy: Yeah, so? I was having sex when I was like 9 or 10. I must have gotten pregnant like four times, with two abortions and two ‘’whatevers.”

Michele: Whatever? Judy, you are talking about human life here.

Judy: Whoa, cool it . . . that was then. I thought you were sup- posed to be helping me with this career thing? I don’t need another person preaching at me!

(Continued)

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Chapter 2. Helper Variables–●–31

Helpers: Detached and Objective

The fact that helpers’ biases, expectations, or values are active in the helping process may run contrary to your own belief that helpers must be totally objective, totally value free. It is neither possible nor desirable to be “scrupulously neutral with respect to values in the counseling relationship” (Corey, Corey, & Callanan, 1988, p. 67). While the idea of value neutrality is unrealistic, value imposition is possible and as noted throughout professional codes of ethicsm must be guarded against. For example, the American School Counselor Association code of ethics states that school counselors “respect students’ values, beliefs, sexual orientation, gender identification/expression and cultural background and exercise great care to avoid imposing personal beliefs or values rooted in one’s religion, culture or ethnicity (ASCA, 2016, Standard A.1.f). A similar statement can be found in the ACA Code of Ethics (ACA, 2014), which notes: “Counselors are aware of their own values, atti- tudes, beliefs and behaviors and avoid imposing values that are inconsistent with counseling goals and respect for the diversity of client” (Standard A.4.b).

The ethical and effective helper understands that his practice decisions and interactions are not value neutral. The ethical and effective helper, while recognizing the influence of his or her own values, continues to strive to assist the client in finding the direction that is most congruent with the client’s own values, needs, and goals. This is not always easy. Consider the delicate situation a practitioner may find himself or herself in when working with a client who has gone through a decision-making process and without coercion from others has decided to end his life because of extreme suffering involved with a terminal illness. Balancing the ethical value of protecting a client’s right to autonomy and self-determination with organizational policies, legal statute, and the practitio- ners own beliefs and values can be quite daunting. The potential influence of the helpers’ values, needs, beliefs, and interest within the helping relationship is a point of concern and interest for all professional organizations (Table 2.1).

While professional organizations cannot police personal values, their codes of ethics clearly highlight the ethical mandate to recognize the exis- tence of these values and to monitor the potential role they play in guiding a provider’s decisions. While our professional organizations have codified set of values to guide professional practice, one cannot simply compartmental- ize the ethics of the professional helper versus the virtue, value, and ethics of the person of the helper.

As the title of this book suggests, ethical practice demands more than knowing ethics. Ethical practice demands the development of the practitioner as an ethical person. It is imperative for all ethical helpers to increase aware- ness of their own personal values, beliefs, and expectations, along with an

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understanding of the degree to which these can and do give shape to their professional identity and the decisions and behavior they enact within the helping encounter.

Table 2.1 Ethical Principles Regarding Objectivity

Professional Organization Statement on Ethical Principles Regarding Objectivity

American Association for Marriage and Family Therapy (2015)

3.2.

Marriage and family therapists pursue appropriate consultation and training to ensure adequate knowledge of and adherence to applicable laws, ethics, and professional standards.

American Counseling Association (2014)

A.4.b.

Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

American Psychological Association (2010)

2.06. Personal problems and conflicts

a. Psychologists refrain from initiating an activity when they know or should know that there is substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.

b. When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.

National Association of Social Workers (2008)

1.06.

Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with the proper referral of the client.

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Chapter 2. Helper Variables–●–33

Helper Values and Expectations: Shaping the Helping Relationship

Many professional helpers (e.g., counselors, psychotherapists, psycholo- gists, and social workers) present themselves as totally objective, totally value free. As noted above, total objectivity is not possible. It is possible that the feelings experienced in the helping encounter or the values and expecta- tions with which the helper enters the relationship can distort the helpers’ objectivity and interfere with the effective utilization of an appropriate helping process. These feelings can oftentimes be quite subtle in their devel- opment and thus can go unrecognized until they have done their damage, a point highlighted in our previous case of Michele (see Case Illustration 2.1).

Helpers cannot always keep their own values out of the helping process. Helper value systems can influence the helper’s view of goals, strategies, and even topics discussed. However, while it is unrealistic to assume one can leave personal values outside the office doors, it is essential for the ethical practitioner to be aware of her personal motivations, values, worldviews, and biases, especially as these may impact her professional decisions and actions (Collins, Arthur, Wong-Wylie, 2010). And as much as possible, the ethical practitioner will understand how his personal values can conflict with a client’s needs and in those situations, take steps to reduce that pos- sibility. Exercise 2.1 will help illustrate the potential conflict that can exist between helper values and client needs.

Exercise 2.1

Identifying Areas of Helper Value Conflict

Directions: Part 1: Review the characteristics and experiences of each of the following helpers and assume that his or her unique experience may cause biases in a particular direction. Next, identify a type of client prob- lem for which the helper will have very strong feelings (for or against) and thus may have difficulty remaining non-judgmental and objective.

Discuss with your colleagues or classmates the impact such biases may have on the helping process.

Counselor A: A female professional who had to pay for her own college and post baccalaureate education, even as her family objected that a place for women is in the home

(Continued)

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As may be evident in the illustrations provided in Exercise 2.1, helper values and biases can interfere with effective helping and ethical practice. Our codes of ethics direct us to establish professional boundaries, to monitor and assess progress, and to engage with supervision, all as ways to reduce bias and value imposition and support ethical behavior. But even with these ethical practices, it may be necessary, when a professional’s personal values are so strong, to share those values and their potential influence with the client. A client has a right to know where the helper stands on various issues presented within in the helping process. To do less is to deprive the client of the respect due and prevents conditions necessary for the expression of client autonomy and self-determination, all values undergirding ethical practice.

Because of the potential influence that a helper’s personal values have for affecting the counseling relationship, it is important for all ethical help- ers to identify and understand the role their personal values may play in their enactment of the role as helper and to do so prior to engaging in a helping

Counselor B: A divorced professional who experienced and contin- ues to experience a bitter dispute over child custody

Counselor C: A person who was raised in a very strict, Bible-oriented religious family and who identifies herself as a Christian fundamentalist

Counselor D: An overachieving, highly successful, somewhat driven helper who has been accused of being a workaholic by his coworkers

Part 2: For each of the following clients, identify one of the counsel- ors (listed above) who may have difficulty in remaining objective and non-judgmental:

Client A: A person considering an abortion

Client B: A person considering suicide

Client C: A child abuser

Client D: A person having an extramarital affair

Client E: A person wishing to break away and become independent of her parents

(Continued)

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Chapter 2. Helper Variables–●–35

relationship. Through such heightened self-awareness, a helper may be more able to monitor the potential influence that his or her values and expectations may have in the helping relationship and even know if and when a client should be referred to another professional more capable of supporting his needs.

While you are in the early stages of your professional formation, it may be hard to determine how your values may help or hinder your effectiveness as a human service provider. Exercise 2.2 is designed to increase self-awareness of values and bias. As with each of the exercises, it is suggested that responses are shared and discussed with your colleagues or classmates.

Exercise 2.2

Areas of Personal Bias

Directions: Part 1: For each of the following, identify your belief, your attitude, or your value about the issue presented. Along with a class- mate or colleague, discuss the potential impact your position on each of these issues may have as you engage in the helping process.

Equality of genders

Fidelity in marriage

Children’s rights

The recreational use of drugs

Date rape and the responsibility of the person raped

Cheating in school

The viewpoint that one should be able to pull himself or herself up by the bootstraps

The sanctity of marriage

A women’s right to choose an abortion

Alternative lifestyles

Part 2: Through personal reflection and discussion of your responses to Part l, identify those items in Part I for which you have strong opinions, attitudes, or values. Identify the type of client problems in which these values may interfere with your ability to remain objective and non- judgmental.

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The challenge for the ethical helper is to use personal values to enhance the helping process without abusing the power of the relationship or the vulnerability of the client. While it is clear that the ethical helper will resist the temptation to become a missionary for a particular value, she or he will also attempt to be a model of health and well-being and when appropriate give voice to how his or her values serve that state of wellness.

When Values Conflict

The mutual nature of the helping process almost ensures that there will be times when the individual values, beliefs, and needs of the helper and cli- ent may conflict. While respecting the client and accepting the client’s right to choose his or her own values, a helper may not agree with or embrace those values. Consider the Case Illustration 2.2.

Case Illustration 2.2

Conflicting Values

Howard is a clinical psychologist who is married with three children, ages 9, 14, and 18. Howard married at the age of 20 and worked full-time as he finished his senior year in college and continued as a graduate student. When his wife, Lisa, became pregnant, the couple mutually decided that Lisa would stop working and would be a stay-at-home mom, at least until their children were in high school. Both Lisa and Howard value the importance of children having a full-time parent at home, especially during what Howard calls the formative years.

Howard has just received a call from a new client, Tangelique. In a brief telephone intake, Howard learns that Tangelique is 31 years old, a member of a major law firm, and on track to become a partner. Tangelique’s husband, Ralph, is a physician completing his surgical residency. Tangelique is three months pregnant and, according to Tangelique, she and Ralph are fighting a lot and having “serious mari- tal conflict.” The conflict centers on the issue of child care following delivery. Tangelique wants to return to work as soon as possible and feels that the baby can do very well receiving “good professional child care.” Ralph strongly believes that it is essential for a parent to be at home, especially during these early years. Ralph stated he would be willing to stay at home if he had completed his residency, but he has

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Chapter 2. Helper Variables–●–37

Under these conditions, the ethical helper will expose those values in conflict and then along with the client, review these areas of value conflict in order to decide how they may impact the decisions made in the helping process. When the conflict is such that it interferes with the helper’s ability to effectively assist the client, the ethical helper will pre pare the client for referral to another helper who is more able to serve that client’s needs (see Chapter 11). The direction to refer is not only good practice, it is ethical practice and responsive to clear mandates made within our various codes of ethics (see Table 2.2).

Helper Orientation: A Theoretical Agenda for Helping

In addition to having our practice decisions influenced by personal values and expectations, our view of the “reality” of the helping encounter will be shaped by the model of helping we have embraced and employ. The information presented by each client often appears somewhat disjointed and disconnected. Each helper needs to weave a thread of consistency or find a theme within the information so that she or he can understand what is “really” going on and how best to approach this situation. Most helpers find that making sense out of the information provided by the client is aided by the use of a theoretical model or framework (Parsons & Zhang, 2014a).

Theories of helping—such as behavioral theory, psychoanalytic theory, cognitive theory, systems theory, and the like—provide frameworks for understanding the meaning of a person’s actions as well as offer prescriptions for how to help the person move to a more fully functioning life. However, just as these theoretical models help us to “make sense” of the information provided by the client, we must be sensitive to the possibility that such a model can impose “sense” on the data offered (see Case Illustration 2.3) and

a year and a half to finish. He wants Tangelique to stay home for the next two years and then they can decide what to do. Tangelique is will- ing to cut back on her 60 hours a week to 30 or 40, but this is totally unacceptable to Ralph.

As Howard listens to the presenting concern, he becomes very aware of his strong feelings of agreement with Ralph, even prior to meeting the couple. Tangelique stated that she and her husband agree that professional counseling is important at this point in their relation- ship, and they would like to schedule an appointment.

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Table 2.2 The Ethics of Referral

Professional Organization Statement on Ethical Principles Regarding Objectivity

American Association for Marriage and Family Therapy (2015)

1.10. Referrals

Marriage and family therapists respectfully assist persons in obtaining appropriate therapeutic services if the therapist is unable or unwilling to provide professional help.

American Counseling Association (2014)

A.11.b. Inability to assist clients

If counselors determine an inability to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors should discontinue the relationship.

American Psychological Association (2010)

10.10. Terminating therapy

a. Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.

American Mental Health Counselors Association (2010)

5.d.

If mental health counselors determine that services are not beneficial to the client, they avoid entering or terminate immediately the counseling relationship. In such situations, appropriate referrals are made. If clients decline the suggested referral, mental health counselors discontinue the relationship.

American School Counselor Association (2016)

A.6.d.

Develop a plan for the transitioning of primary counseling services with minimal interruption of services.

National Association of Social Workers (2008)

1.06.

In some cases, protecting clients’ interests may require termination of the professional relationship with the proper referral of the client.

in fact be limited in validity and usefulness, especially when employed with those with diverse worldviews (See Chapter 4).

While it is possible that Jimmy, the client in our case illustration (Case Illustration 2.3), is having difficulty resolving issues around his own sexual- ity, his father-son relationship, and so on, and as a result acts silly in class because he is anxious, it is just as likely that Tom is simply making him

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Chapter 2. Helper Variables–●–39

laugh. Peggy’s interest in a psychoanalytic theory as well as her own limited training may be directing her to see meaning where none exists.

The ethical practitioner needs to be competent and grounded within the theory and research supporting the helping process (see Chapter 11). Beyond being able to identify the model from which one approaches the helping process, it is also imperative that as an ethical helper, one remembers that theories and models provide only tentative frameworks, not absolute directives, and our decisions, our actions, and our plans need to be tested for validity and utility in each situation. Table 2.3 provides a number of questions that can be used in reviewing the models one employs for both utility and validity for use with any one client or within any one helping relationship.

Case Illustration 2.3

Finding or Imposing Meaning?

Peggy is a recent graduate with a master’s degree in counseling. Peggy has always wanted to be a counselor and has been very taken by the psychodynamic view of helping. Peggy intends to go on for additional training and someday become a psychoanalyst.

Peggy is currently employed as a middle-school counselor. She is currently meeting with Jimmy, age 11. Jimmy was sent to her office by his health-science teacher, who is very concerned with Jimmy’s ten- dency to giggle and “act silly” during health class. When asked about his behavior in class, Jimmy describes the following:

“I sit next to Tom. He’s my best friend. But he is a goof. He is always making funny noises or saying things about what we are talking about in class, and I can’t help it, I just start to laugh. I always get caught and Tom gets away with it.”

Peggy asks Jimmy to tell her what they are studying and what types of things Tom may say.

Jimmy responds, “I don’t know . . . something to do with becom- ing a man and a woman, puberty or something like that, I don’t know.”

At this point, Peggy starts to challenge Jimmy and ask for other information about his relationship with his parents.

“Jimmy, you keep saying you don’t know. Is it that you don’t know or that you find it difficult to talk about these types of things?

“Jimmy, it would be helpful to me if you could tell me a little about your family and your relationship with you parents, especially your dad.”

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Reflecting and Validating Interpretations

Theoretical models can assist a helper to gather data, connect the infor- mation provided, and draw hypotheses and tentative conclusions about the meaning of those data. The ethical helper will keep focused on the “hypoth- esis testing” nature of this process (Parsons & Zhang, 2014b). As data are provided, the effective helper needs to hazard tentative guesses about meanings and connections to previous data. Once these hypotheses have been established, the helper needs to go about the process of finding more information to validate his or her hypotheses or revise these hypotheses as new information is revealed.

The ethical helper will not only continue to identify and articulate his or her model of helping but will remain vigilant in his or her evaluation and testing of the validity of that model.

Table 2.3 Guidelines for Reflections on Operating Model

● HELPER COMPETENCE: BEYOND KNOWLEDGE AND SKILL

The ethical helper is a competent helper. While competence implies the possession of the knowledge and skill required to practice (see Chapter 11), it also implies the ability to implement and apply that knowledge and skill. Competence goes beyond simply knowing, it requires doing. As such, help- ers need to be self-aware and self-caring (see Chapter 14) so as to provide the best care they can.

Our theoretical, operative models help give shape to how we see our clients, their problems, prognoses, goals, and pathways to those goals. It is important to check the utility and validity of our models for each of our clients and helping encounters. Questions to consider in reflecting on our operational models of helping:

• Can I explain the major assumptions and tenets of my model to a colleague?

• Is it employed by others within the field?

• Is there support (clinical, anecdotal, empirical) for this model?

• Can I demonstrate its utility and validity for understanding this current case? What are the limitations and inherent biases built into this model?

• Are there specific clients or client problems for which this model will not be effective?

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