Therapeutic Ethics: A Sacred Bond of Trust
As a licensed Social Worker (MSW, LSW), I am required to take an ethics class every two years as part of my continuing education. These guidelines were established by the National Association of Social Workers (NASW), for the purpose of framing behavior that is both beneficial to our clients and does no harm to them.
Each time I sit in the classroom and go over scenarios and structure, the take home message is, if it breaks confidentiality, don’t do it. If it puts the client in a lesser position and takes away their personal agency and decision making, don’t do it. If it creates a dual relationship (business or interpersonal) or if it is of additional financial benefit to the therapist beyond the established or insurance contracted fee, don’t do it. If it even slightly resembles taking advantage don’t do it. Conscience is an equally important therapeutic skill.
My favorite parts of the training are the “what would you do?” scenarios.
Since I live and work in the same community, I am clear with clients that our paths may cross in public places and social settings. I assure them that I will not identify them as my client (they are welcome to do so if they choose) and will not discuss their therapeutic issues with them in those venues. Most shrug it off and say they don’t care. Some have even asked if we could be friends. I have kindly declined, letting them know that as a licensed professional, I can’t engage in “dual relationships“ with them since it involves a power differential. On a few occasions, I have run into some in supermarkets, faith communities, local events and a few parties. I have said hello and moved on.
Consider why you became a therapist. Hopefully, it is because you want to be of service and you have the wherewithal to do it. Although I hadn’t set out to sit opposite someone and listen to their stories, assisting them in sorting through sometimes dog eared and torn pages, it is where I now find myself after nearly four decades in the field. I attended school, studied diligently and earned my degrees — not to mention the “alphabet soup” letters those degrees permit me to tack onto the end of my name.
I put in my time, in previous years, in excess of 14 hours a day. A series of health crises and the desire to remain vertical, had me cutting back to a “normal” schedule. In that way, I am also able to offer clients my best. I incorporate my formal training and “seat of the pants” interventions as needed. There are times when I leave the office, and symbolically carry clients with me as I am contemplating interventions.
Potential pitfalls of such choices include compassion fatigue and burnout. Another risk is vicarious traumatization, which can happen when you spend so much time hearing about violence, abuse, neglect and suicidality that you begin to feel affected by these traumas yourself.
These stresses accumulate and show themselves in therapists through emotional and physical exhaustion, anxiety and depression, apathy toward clients, feelings of distance from loved ones, absence from work and feeling overwhelmed with the enormity of others’ needs — to the extent that some clinicians get lax about their service, may make ill-advised decisions or leave the field. To me, these are ethical issues as well. It would be equivalent to being an impaired professional. There was a time when I needed to step back from my practice, so I could again find my balance.
Therapists, teachers, and clergy have a sacred bond of trust with those they serve. I am in all three categories, since I also teach adults and children and I am an interfaith minister. I don’t take those roles and the responsibilities they entail for granted. People come to us at some of the most vulnerable times in their lives, at the loss of loved ones, illness, financial crises, unemployment, and after experiencing trauma. They want to believe that we will create a safe container for them to unpack their emotional baggage. Some they have been carrying for decades, some newly arrived with a ferocity that knocks the stuffing out of them and has them wondering if they will ever stand again. I am in awe of the resilience they embody as well as the vulnerability they are willing to expose in our presence.
Trigger warning: That is part of what appalls me about the recent revelations of widespread clergy abuse in my home state of Pennsylvania. Those who were assaulted, and their families faced and continue to face betrayal by those they were told they could trust. Like most predators, they groomed their victims by befriending them and their families who believed these men were above reproach because of their status in the church. Their actions not only caused physical and emotional damage, but a spiritual rift. It is difficult for some to experience a demarcation between their faith and those who are stand-ins for the divine. I wonder if clergy are expected to take ethics trainings. What also puzzles me is those who covered it up would be considered mandated reporters. They are in breach of both moral and civil laws. Wondering if there are repercussions for not revealing identities of abusers.
It is essential that we hold ourselves and our colleagues to impeccably high standards and treat those we serve the way we would want to be cared for or would want those we love to be cared for.
Establishing and maintain a moral compass seems like a necessary therapeutic skill.
Weinstein, E. (2018). Therapeutic Ethics: A Sacred Bond of Trust. Psych Central. Retrieved on April 1, 2020, from https://psychcentral.com/blog/therapeutic-ethics-a-sacred-bond-of-trust/