Multidisciplinary Ethical Codes

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C H A P T E R 2

Helper Variables: What the Helper Brings to the Helping Relationship

Ms. Wicks: Maria, let me see if I understand what you are saying. You are sexually active and you don’t care that you are engaged in unprotected sex. The possibility of becoming pregnant or contracting a sexually transmitted disease, even AIDS, doesn’t concern you. Is that what you are saying?

M s. Wicks, the counselor in our sample case, appears to be actively listening and accurately reflecting Maria’s explicit message. However, one must wonder about the manner in which she reflects that mes-

sage. As a trained professional, Ms. Wicks is most likely attempting to remain objective as she continues her work with her client, Maria. But objectivity does not mean emotionally detached or without one’s own values and beliefs.

Ms. Wicks has feelings, expectations, biases, and values regarding adolescents engaging in unprotected sex, and while she is attempting to maintain a professional objectivity, to assume she can remain value free is naive at best and when viewed from the perspective of professional ethics, can be dangerous. Does Ms. Wicks’s tone of voice, inflection, or even body language reveal her own biases and beliefs regarding unprotected adolescent sexual behavior?

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a> Created from capella on 2021-07-12 17:04:11.

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The complexity of a helping process as a problem-solving venture, along with the potential for intense emotional reactions to be experienced by all involved, makes the helping process highly vulnerable to the influence of the needs, interests, beliefs, and expectations of both helper and client. We enter a helping relationship as we enter all relationships, full of personal expectations, biases, and values. Further, as with any of our encounters, these expectations, biases, and values cannot help but influence the nature of our exchange and the fundamental dynamic of the helping relationship, often in profound ways.

As suggested in Chapter 1, the ethical helper needs to be aware of her or his values, biases, and expectations, along with circumstances wherein these personal values, biases, and expectations may interfere with the effec- tive helping of another. It is these affective and subjective factors that the helper brings to the relationship, along with the ethical challenges that can result, that serve as the focal point for the current chapter.

● OBJECTIVES

Extending the discussion started in Chapter 1, which illustrated the role of the helper in the process of change, the current chapter will discuss the role that a helper’s values, biases, and professional models and orientation play in giving shape to the helping process and this process of change. After reading this chapter, you should be able to do the following:

• Explain the need for helpers to increase self-awareness of personal values, beliefs, and expectations.

• Describe the ethical steps to be taken when helper-client values conflict.

• Discuss the value of a helper having a theoretical model along with the ethical challenges that can arise if such a model is “imposed” with- out awareness of “best practice” procedures.

• Define what is meant by “helper competence.”

● HELPER VALUES

As human service providers, we are directed to care for those within our charge or, as noted by one organization, the American Counseling Associa- tion (ACA), our primary responsibility is “to respect the dignity and promote the welfare of clients” (2014, Principle A.1.a). This directive to promote

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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)

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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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Chapter 2. Helper Variables–●–41

Care of the Helper: Essential to Maintaining Competence

As will be discussed in greater detail in Chapter 14, working as a human service provider positions us to experience both physical and emotional exhaustion and depletion. Walking with clients who themselves share stories of trauma, emotional exhaustion, and stress-filled lives can result in our vicari- ous experience of these issues. With mounting stress, a helper’s ability to care about and care for the client can be threatened and the possibility of providing ethical, competent practice reduced. In recognition of this possible impact on helper competence, our professional organizations developed codes of ethics that address this issue of practitioner impairment (see Table 2.4)

As noted with the statements found in Table 2.4, maintaining one’s health and well-being is not just a good idea but also an ethical responsibility. It is important for all practitioners to monitor their health and well-being and engage in practices that reduce the possibility of impairment as a result of work-related stress (Zhang & Parsons, 2016; Bennett, Bryant, VandenBos, & Greenwood, 1990). There are a number of steps that all ethical helpers can do in attempting to reduce the potential negative effects of helper stress. In fact, rather than simply focusing on the identification of impairment and the introduction of effective remedial programs, the ethical helper will attempt to employ preventive steps, such as continued education, personal therapy, supervision, and peer interaction. Specific steps that may help to reduce the potential impact of stress on the functioning of the helper include

• Set realistic expectations. Ethical helpers recognize that they are not omnipotent. The healthy, ethical helper sets realistic expectations for him or herself, the client, and the outcome of any one helping relationship.

• Take care of self. It is important for helpers to eat properly, rest, and exercise. Helping is an energy-draining activity, and the ethical, healthy helper will take steps needed to ensure her or his own health is maintained.

• Organize and manage. Boundaries need to be established that not only organize your professional day but also help to distinguish the professional from the personal aspects of your life. The ethical, healthy helper will schedule variations into the day, including suf- ficient breaks to take care of paperwork, personal needs, or even to take a moment’s breather.

• Keep perspective. Helpers need to remember that helping is part of their life, not all of their life. The effective helper will also establish mechanisms for ongoing professional support (e.g., supervision,

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Table 2.4 Selected Statements on Professional Impairment

Professional Organization Statement on Professional Impairment

American Counseling Association (2014)

C.2.g.

Counselors monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsi- bilities until it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients.

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 a 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 measure 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)

4.05.b.

Social workers whose personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others.

American Association for Marriage and Family Therapy (2015)

3.3. Seek assistance

Marriage and family therapists seek appropriate professional assistance for issues that may impair work performance or clinical judgment.

personal counseling, peer involvement, continuing education) to maintain objectivity and professional distance, especially when work- ing with particularly difficult cases.

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THE ETHICS OF THERAPEUTIC CHOICE ●

Licensed and certified mental health providers are required to not only provide clients with care that an ordinary, average person should exercise under such circumstances but to provide services that compare to that of their professional peers. A mental health professional who fails to meet the relevant standard of care, when compared with that of other profes- sionals in the same community with comparable training and experience, is not only performing unethically but may also be found to be negligent in his or her duty to provide care. The evidence for such negligence will rest on the clinical correctness and efficacy of the treatment that was given, along with the practitioner’s judgment in choosing it (Bennett et al., 1990).

Ethically and legally, a practitioner needs to not only be competent and skillful in the application of her or his helping skills but needs to employ those skills and approaches that have generally been accepted within the profession as appropriate and customary. One professional organization directs its members to “use techniques/procedures/modali- ties that are grounded in theory and/or have an empirical or scientific foundation” (ACA, 2014, Principle C.7.a). This point is also echoed in the Ethical Principles of Psychologists and Code of Conduct that directs their members to employ strategies that are “based upon established scien- tific and professional knowledge of the discipline” (APA, 2010, Standard 2.04). Professionals who employ “innovative strategies” not only run the risk of malpractice based on the principle of negligence but at minimum, run the risk of failing their ethical responsibility to provide the best care possible to their client. When a practitioner engages in the use of an innovative technique, she would be wise to follow the directive offered by the ACA to “explain the potential risks, benefits, and ethical consider- ations of using such techniques/procedures/modalities. Counselors work to minimize any potential risks or harm when using these techniques/ procedures/ modalities” (ACA, 2014, Principle C.7.b).

Selecting the Appropriate Treatment

Practice decisions, including those involving methods and strategies for treatment, need to be made as reflections of those values that under- pin our ethical principles, that is, beneficence, our desire to promote the health and well-being of our clients, and nonmaleficence, the mandate to “do no harm.” The American Mental Health Counselors Association,

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for example, directs its members as part of its code of ethics to employ “individual counseling plans that offer reasonable promise of success” (AMHCA, 2010, Principle B.1.a). Similar directives can be seen across our various professional codes of conduct.

For some practitioners, their choice of treatment approach stems from a personal intuition, “gut feeling,” or simply the practitioner’s liking. The use of intuition or gut feeling as criteria for choosing and employing a treatment regimen opens the practitioner to not only poor decision- making and ineffective intervention but also to ethical violation. For the ethical practitioner, practice decision, including choice of treatment strat- egies, needs to reflect customary and accepted practice and reflect the practitioner’s critical understanding of the current state of the research guiding practice.

It is not only an ethical imperative but also a legal reality that practitio- ners must employ those strategies demonstrated to be best practice in each given situation. When techniques have some general acceptance and are not used, the practitioner runs the risk of not only performing unethically, but he or she may also be held legally accountable and found to be negligent in the professional duty to provide care. In areas for which there is not solid research to direct best practice or for which the standard of the profession is not clearly articulated, the ethical practitioner will employ those techniques for which there is a theoretical rationale and evidence that at least the local community and the ordinary, average practitioner would employ as cus- tomary practice. Awareness of the standards of practice defining accepted intervention strategies as well as familiarizing oneself with customary modes of service is essential for ethical practice. Exercise 2.3 has been designed to assist you in this process.

Exercise 2.3

Customary and Accepted Practice

Directions: For each of the presenting problems listed do the following:

• Contact a human service professional in your community and inquire into his or her general approach or strategy employed in this situation.

• Review the research in the past five years pointing to the efficacy and outcome for specific interventions when employed with this type of problem.

• Identify your own approach to this situation and include your rationale.

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Chapter 2. Helper Variables–●–45

Problem Area Human Service Professional Research Personal Approach

Depression Dr. Wicks: Employs cognitive behavior therapy (CBT) (Beck, Rush, Shaw, & Emery, 1979)

NIMH studies demonstrating effectiveness of CBT (Elkin et al., 1989)

I would use CBT plus referral for medication if warranted. Supported by research and local practice professionals.

An 11-year-old child diagnosed with ADHD

A 35-year- old woman diagnosed with agoraphobia

A 42-year-old man arrested with Driving Under the Influence; he has a longstanding history of alcoholism

A child (6 years old) who appears to have been burned (burn marks) and may continue to be abused

A hostile 28-year-old male reporting a desire to “severely hurt his boss”

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● PROFESSIONALIZATION, PROFESSIONAL ETHICS, AND PERSONAL RESPONSE

Professionalization is “the process by which an occupation, usually on the basis of a claim to special competence and a concern for the quality of its work and benefits to society, obtains the exclusive right to perform a particular kind of work, to control training criteria and access to the profession, and to determine and evaluate the way the work is to be per- formed” (Chalk, Frankel, & Chafer, 1980, p. 3). Once professionalized, an occupation develops professional associations or societies that promote the profession, safeguard the rights of their members, and facilitate the exchange of information. In professional fields, such as helping, national professional organizations develop rules for appropriate conduct for their memberships (e.g., American Counseling Association, American Psycho- logical Association, National Association of Social Workers, American Association for Marriage and Family Therapy). These codes become the standards for these groups and provide practitioners with a guide to mak- ing ethical decisions.

Codes of Ethics

These professional associations and societies also develop codes and standards of practice that are created to enhance the quality of the profes- sional work performed by their members. In the previous sections of this chapter, we have made reference to some of these specific standards, and it is these standards, these codes of ethics, as applied to the practice of helping that will serve as the basis for the remainder of this text.

Our codes of ethics not only serve as guides to professional decision- making and professional practice but also function as a covenant to those we serve (Ponton & Duba, 2009). Our ethical codes exist primarily to protect the public from unethical or incompetent professionals and to protect the profession from unethical practices by any of its members. As discussed in Chapters 3 and 7, these standards by themselves do not always provide clear direction for helpers to follow in order to avoid con- flict or to make the best decisions for all involved and maintain freedom from legal entanglement. Our codes are not recipes or step-by-step direc- tions to follow, but rather they are guidelines that require the helper’s best personal and professional judgment in selection, reflection, and applica- tion to individual situations.

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Chapter 2. Helper Variables–●–47

Moving Beyond Professional Standards to Personal Response

As mental health and human service providers, we need to have a clear understanding of professional standards along with knowledge of local, state, and federal policies that impact professional practice. Beyond this understanding and knowledge, however, the ethical practitioner needs to work to move knowledge to action by making these principles personal values and guided moral responses.

Sadly, for many practitioners, the ethics and practice guidelines that they were taught in school lose definition and impetus as they become absorbed within the experience of daily practice. The pressures of everyday life may lead practitioners to view these codes of ethics as abstract concepts that they think about only when they hear or read about an ethics violation by a colleague. Some practitioners view ethics either as rules designed to hinder practice decisions or to serve as a lever to remove colleagues who may not be as concerned about themselves, their clients, or the profession as we might be (Bennett et al., 1990, p. 7).

We need to move beyond simply seeing codes of ethics as abstract concepts, leverages, or hindrances and begin to view them as personal ethical imperatives. This is the reason for this book. It is hoped that as you proceed through the text, engaging with the case illustrations and guided exercises, you will move from simply knowing and understanding ethical principles to being ethical. Evi- dence of that transition from knowing to being takes form in your decisions and behaviors that (a) respect and support client autonomy; (b) extend and manifest a desire to place the welfare of the client above all else; and (c) ensure you do no harm while treating all your clients, regardless of presenting complaint or personal characteristics with justice and fidelity (Zhang & Parsons, 2016).

CONCLUDING CASE ILLUSTRATION ●

Returning to our ongoing case of Ms. Wicks and Maria, we can see that Ms. Wicks has identified a number of values or beliefs that are currently giving shape to Maria’s decision-making. As you continue to read the case, place yourself in the role of the helper and consider your position and reac- tions as they parallel or contrast with those exhibited by Ms. Wicks. After reading the interaction, consider the points raised in the section entitled Reflections. How might your personal reactions guide your interaction and decision-making in regard to Maria’s situation?

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Ms. Wicks: Maria, let me see if I understand what you are saying. You are sexually active and you don’t care that you are engaged in unpro- tected sex. The possibility of becoming pregnant or contracting a sexually transmitted disease, even AIDS, doesn’t concern you. Is that what you are saying?

Maria: Well, the way you are saying it . . . it sounds like I’m stupid.

Ms. Wicks: No, I apologize if that is how it sounded. I guess when I heard you say that you were engaging in unprotected sex and I assumed you were at risk of contracting AIDS, it upset me. Maybe that’s what you heard in my tone?

Maria: Not that it is any of your business, but I am sexually active. And becoming pregnant, I would like that. I would like to have his child of love!

Ms. Wicks: So you feel relatively certain that both you and your boyfriend are free of any sexually transmitted diseases and that as long as you stay monogamous that shouldn’t be a problem?

Maria: Yeah, we’ve even talked about it!

Ms. Wicks: But, I don’t quite understand your view of becoming pregnant. You seem to want that?

Maria: Hey, I’m a woman and my guy is a real man. A baby would be proof of our love, a gift from God!

Reflections

1. What is your current level of competence in regard to working with adolescent, Latina females? How might this impact your abil- ity to work with Maria? What specifically might you have difficulty with?

2. Ms. Wicks has accepted that her own values and beliefs may have influenced the tone of her response. In an attempt to share her own perspective while valuing the position of the client, she offers the clarification regarding her tone of voice. How would you have responded to Maria’s challenge that you thought she was stupid? The same as Ms. Wicks? More strongly? Not at all?

3. Maria is introducing a number of value-laden issues (e.g., adoles- cent premarital sex, out-of-wedlock pregnancy, children as evi- dence of maturity, gifts from God, etc.). How is your perspective

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Chapter 2. Helper Variables–●–49

similar? Different? How might your perspective give shape to your response?

4. What goal would you have for this encounter? How has that goal been influenced by your own values, family experience, and culture?

COOPERATIVE LEARNING EXERCISE ●

The purpose of the chapter was to familiarize you with the role that specific helper variables—such as values, theoretical orientation, competence, and cultural sensitivity—play in the formation of a helping process and to have you begin to increase your awareness of your helper variables as they may inform your professional decision-making.

Part I: Identify your own values as they impact your opinion on each of the following:

• Divorce • Abortion • Extramarital sexual affairs • Spanking • Marijuana • Sexual orientation • Children’s rights • Importance of schedules and planning • Importance of success and achievement • Spirituality

Part 2: For each of the following, identify a goal and a treatment strategy that you may employ. After identifying your own goals and strategies, share these with a supervisor, col league, or classmate and attempt to identify alternative goals and strategies that would be appropriate and helpful. Finally, identify how your own opinions, biases, values, and culture experiences may have influ- enced your selection of goals and treatment strategies for each of the following:

• A woman, age 38, who has been married for 11 years, has over the course of the past 8 months had an affair with her husband’s busi- ness partner. The affair has resulted in her becoming pregnant. She is stressed and is asking for direction as to what she should do.

• A 12-year-old has been referred to you by his parents who found “drug stuff’ in his room. The child disclosed to you that he has been smoking marijuana since the beginning of the school year (last three months) and

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has found that it makes him feel less stressed and depressed. Further, he disclosed that he is upset because he knows he is gay and doesn’t know if his parents will accept that. He has asked you NOT to tell his parents.

• You are working with a senior in high school who has been referred by his teacher. The student, while having a documented IQ of 148, is currently barely passing his classes. When confronted, he explains that he is simply placing more value and importance in getting in touch with his spiritual side and his “connectedness to all living things” and that he has decided to learn and attend to things that have personal relevance regardless of grades and class rankings.

● SUMMARY

• It is neither possible nor desirable to be neutral with respect to values in the counseling relationship, and to assume such could be ethically dangerous.

• Ethical helpers increase awareness of their own personal values, beliefs, and expectations and the role they play in giving shape to their professional identity and behavior within their role as a counselor.

• Establishing professional boundaries and maintaining professional detachment and objectivity in service of the client, while never abso- lute, remains a goal of ethical helping.

• When client and helper values conflict, 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 prepare the client for referral to another helper who is more in line with the client’s needs and values.

• A helper’s theoretical orientation and model not only provide a frame- work for understanding the information provided by the client but can also impose meaning on the data offered.

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

• The ethical helper is a competent helper. Competence goes beyond simply knowing; it requires doing. As such, helpers need to be self- aware and self-caring so as to provide the best care they can.

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• As professionals, we not only provide clients with care that an ordi- nary, average person should exercise under such circumstances, but also our service reflects our professions standard of care.

• As professional helpers, we are called to operate within a framework of ethics as defined by our specific professional organizations.

• Codes of ethics are reflections of our commitment to our clients and to one another to provide for the welfare of the clients.

• Knowing one’s code of ethics is insufficient. Being ethical, embracing those codes as personal, professional values, is necessary.

IMPORTANT TERMS ●

burnout professionalization

codes of ethics professional boundaries

competence professional objectivity

cultural sensitivity self-determination

customary practice standard of care

decision-making strategy theoretical model

hypothesis testing value free

practitioner impairment

ADDITIONAL RESOURCES ●

Consoli, A. J., Kim, B. S. K., & Meyer, D. M. (2008). Counselor’s values profile: Implications for counseling ethnic minority clients. Counseling and Values, 52, 181–197.

Granello, D. H., & Yong, M. E. (2012). Counseling today: Foundations of profes- sional identity. Upper Saddle River, NJ: Pearson.

Rogers, C. (1980). A way of being. Boston: Houghton Mifflin. Sheperis, D. S., Henning, S. L., & Kocet, M. M. (2015). Ethical decision making for

the 21st century counselor. Thousand Oaks, CA: Sage.

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Web-Based

Dobrin, A. (2012). Am I right? How to live ethically. Retrieved from http://www.scu .edu/ethics/practicing/decision/thinking.html

Josephson, M. (2014). The six pillars of character. Retrieved from http://josephson- institute.org/MED/MED-2sixpillars.html

Shallcross, L. (2010). Putting clients ahead of personal values. Counseling Today. Retrieved from http://ct.counselin.org/2010/11/putting-clients-ahead-of-personal- values

● REFERENCES

American Association for Marriage and Family Therapy. (2015). Code of ethics. Retrieved from https://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/ Code_of_Ethics.aspx

American Counseling Association. (2014). Code of ethics. Retrieved from http:// www.counseling.org/resources/aca-code-of-ethics.pdf

American Mental Health Counselors Association. (2010). American Mental Health Counselors Association code of ethics. Retrieved from http://www.amhca.org/ assets/content/AMHCA_Code_of_Ethics_11_30_09b1.pdf

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from: http://www.apa.org/ethics/code/principles.pdf

American School Counselor Association. (2016). ASCA ethical standards for school counselors. Retrieved from: http://www.schoolcounselor.org/ school-counselors-members/legal-ethical

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

Chalk, R., Frankel, M. D., & Chafer, S. B. (1980). AAAS professional ethics project. Washington, DC: American Association for the Advancement of Science.

Collins, S., Arthur, N., & Wong-Wylie, G. (2010). Enhancing reflective practice through multicultural counseling in cultural auditing. Journal of Counseling & Development, 88, 340–347.

Corey, G., Corey, M. S., & Callanan, P. (1988). Issues and ethics in the helping pro- fessions (3rd ed.). Pacific Grove, CA: Brooks/Cole.

Elkin, I., Shea, M. T., Watkins, J. T., Imbers, S. D., Sotsky, S. M., Collins, . . . Paroloff, M. D. (1989). National Institute Health treatment of depression collaborative research program: General effectiveness of treatment. Reprinted from the Archives of General Psychiatry, 46, 971–983.

National Association of Social Workers (2008). Code of ethics of the National Association of Social Workers. Retrieved from https://www.socialworkers.org/ pubs/code/code.asp

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Parsons, R. D., & Zhang, N. (2014a). Counseling theory. Thousand Oaks, CA: Sage. Parsons, R. D., & Zhang, N. (2014b). Becoming a skilled counselor. Thousand Oaks,

CA: Sage. Ponton, R. F., & Duba, J. D. (2009). The ACA code of ethics: Articulating counseling’s

professional covenant. Journal of Counseling & Development, 87, 117–121. VandenBos, G. R., & Greenwood, A. (1990). Professional liability and risk manage-

ment. Washington, DC: American Psychological Association. Zhang, N., & Parsons, R. D. (2016). Field experience: Transitioning from student to

professional. Thousand Oaks, CA: Sage.

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