Exposing ‘Ethical Taboos’ in Counselling and Human Services

1. Exposing ‘Ethical Taboos’ in Counselling and Human Services Associate Professor Donna McAuliffe School of Human Services and Social Work Griffith University (Logan) Queensland. d.mcauliffe@griffith.edu.au

2. Agenda • 8.45-9.15 Coffee and welcome • 9.15-9.45 Setting the scene • 9.45-11.00 Ethical Taboos 1,2,3 • 11.00-11.20 Morning Tea • 11.20-12.50 Ethical Taboos 4,5 • 12.50-1.00 Conclusion and evaluation

3. A starting point… • Ethical issues, problems and dilemmas are a part of life in counselling and human service practice – escaping them is simply not an option • There is increasing professional education and training in the management of ethical issues – however this is largely within a risk management framework with a focus on organisational liability • Many ethical codes, standards of practice/conduct, and laws guide professional practice in the diverse array of fields in human services – so many that confusion often reigns supreme!

4. What we know about counselling practice and ethics Counsellors clearly acknowledge that practice is very dependent on context – this is a defining feature of what we do Ethics education and training has been increasing over past decade and is now commonplace in university education and CPE Codes of ethics seem to be documents that more practitioners are becoming familiar with and using more as a tool – (eg recent review of the social work Code of Ethics engaged over 500 in discussion about areas for inclusion) Continuing confusion about the interface between ethics and legal issues Practitioners are taking the issue of professional supervision more seriously Currently ongoing work on the issue of ‘unregulated professions’.

5. What governs counselling practice? • Relevant codes of ethics • Practice Standards and competency documents • Mission, value statements specific to agencies • Codes of conduct, standards/policies (for staff) • Law

6. Opening up ethics conversations: some things we talk about and some things we don’t • ‘Ethical talkfest topics’ = those topics that are commonly on agendas at staff meetings and often the subject of training/professional development • ‘Ethical taboos’ = risky topics related to standards of conduct that are often (informally) banned from discussion in workplaces

7. Ethical talkfest topics • Documentation and client records – what should be written in client records, how, when, by whom • Confidentiality, privacy and disclosure – limits of these in relation to duty of care/duty to warn, issues relating to minors, impaired capacity, discussions with colleagues • Client autonomy, self-determination, informed consent and engagement in decision-making – who is the client? • Technical aspects of practice – how we do assessments, interventions, techniques and skills

8. ‘Ethical taboos’: what are they? • Issues of intimacy in relationships (boundaries, conflicts of interest) • Issues of personal gain (gifts, fraud) • Issues of practice competence (lack of knowledge & skill, ‘non-traditional’ interventions) • Issues of imposition of values or experiences (spiritual/religious/political; personal disclosures) • Issues of personal mastery (impaired practice, stress, burnout, vicarious trauma)

9. Have you done any of the following: • Develop a friendship with an ex-client? • Accept a hand-made gift from a client? • Accept a client’s invitation to a party or special event? • Hug or embrace a client? • Discuss your religious beliefs with a client? • Share personal information with a client? • Provide home telephone number to a client? • Work when too distressed to be effective? • Discuss clients with friends without using names?

10. Who do I tell? • Supervisors? • Colleagues? • Family/friends? • External others?

11. Intimate relations… • Golden rule – ‘do no harm’ • Accepted across all professions that no justification for a professional entering into a sexual relationship with a person with whom they are engaged in a therapeutic relationship • More questions around non-sexual dual relationships • When is a client a ‘former client’? – the question of timeframes? • What happens in rural contexts? • The critical importance of supervision

12. Case scenario • Gaby is working in a rural community and is contacted at work by her ex-partner Rick. Rick and Gaby lived together for 3 years but separated 5 years ago. Their separation was amicable and Rick and Gaby still run into each other at parties and in town. Rick reports that he is currently going through a divorce and his wife is taking him to court over custody of his 2 small children. Rick needs Gaby to do a family report to help him dispute his wife’s claims that he had physically abused his children. Rick feels that Gaby is the only person who knows him well enough to give a balanced and supportive family report. There was never any physical violence in Rick and Gaby’s relationship and there are few counsellors qualified to produce a family report working in the small town. Should Gaby take this referral?

13. Differences between personal and professional relationships (from Beddoe & Maidment 2009, p. 93) • Professional • Paid • Time-limited • Structured • Power over other • Greater responsibility • Responsibility to other stakeholders • Involvement requires preparation & training • Contractual agreement within timeframes • Can I work with this person? • Personal • Voluntary • Forever • Spontaneous • More equal power • Equal responsibility • Responsibility to family or community as citizen • No preparation required • Personal choice and natural processes • Do I like this person?

14. Personal gain • Clarification around gift-giving and receiving of gifts – nature of relationship, value/cost, cultural considerations, symbolic meaning • Policies and procedures? • Gaining in other ways – unanticipated benefits • Questions of fraud

15. Case scenario • Erin is a community health worker visiting Lily to provide emotional support following the death of her husband of 60 years. Lily has been teary and depressed, but after several months of visits she is starting to take an interest in life and has started baking again. Now, Lily insists that Erin take home one of her baked goods each time she visits and Erin has so far provided her family with scones, apple pie and a carrot cake. On Erin’s visit today, Lily has remembered her mentioning that her birthday was in the beginning of the month and has wrapped up an antique vase she had admired on one of her previous visits. Lily is adamant that Erin accept her gift as appreciation for all the support and assistance she has provided over the last few months. Should Erin accept the gift?

16. Practice competence • Knowledge and skill – playing the ‘bluffing game’ • Misuse of power – excessive claims of expertise • Things that happen behind closed doors – what are non-traditional interventions?

17. Case scenario • Julie is working as a counsellor in a men’s prison. Her supervisor approaches her and informs her that there is a higher position being advertised in the weekend paper which she thinks Julie would be well suited for. Julie has been working in her current position for 5 years and is keen to move into a different area of the prison, with additional responsibilities. Julie and her husband have also just bought their first home and are struggling with the mortgage repayments and an increase in pay would really help them manage their finances. When Julies reads the position description, she realises that the advertised position is for a sexual offenders program starting in the prison in the near future. Julie has not worked on any sexual offender programs to date as she has a lot of anger towards these men as her sister was molested as a young child. Julie is aware that she would struggle to work with these inmates but really needs the extra money the position would bring. Should Julie apply for this position in a sexual offenders program given her past experiences and current feelings towards these inmates?

18. Imposition of Self • ‘Use of self’ an acknowledged therapeutic skill – ‘imposition of self’ requires caution • Is there a difference between the personal and the professional – matters of congruence and integrity • The pros and cons of self-disclosure

19. Case scenario • Judy was working in a counselling service. One of her clients, Helena, was living in an abusive relationship and reported low self esteem. Helena believed that she would fail at any new goal she decided upon and felt that she was worthless. Several years ago, Judy had been in an abusive relationship, was hospitalised as a result of injuries, spent some time in a refuge with her children, and could relate to a lot of the issues that Helena was experiencing. Judy wanted to share her personal experiences with Helena in their counselling sessions, feeling that it would really help Helena to see that things do get better and it is possible to get through. Should Judy disclose her personal experiences?

20. Staying in control • Impaired practice – who is responsible? • Dealing with a tough job – sustainability and self-care

21. Case scenario • Elizabeth is a counsellor who works part-time in private practice and part-time in a women’s health centre. She has struggled with anxiety and depression for all of her adult life, but manages this well most of the time. She has had a series of personal problems including a relationship breakdown, and become more depressed of late, and has begun to cancel some appointments with more difficult clients. She has not told her employers that she is struggling with her work, although some of her colleagues have begun to notice that Elizabeth seems more withdrawn and irritable with administrative staff. She is often late for work, and her normally very tidy office is a mess. One client has made a complaint that several appointments have been cancelled at short notice. What ethical responsibilities does Elizabeth have? What ethical responsibilities do her colleagues have? What ethical responsibilities do the employers have? Who is responsible for clients in the private practice setting?

22. Implications of a healthy ‘taboo-free’ workplace • Better ethical decision-making – the important role of consultation and critical reflective practice • Less ‘nasty surprises’ – less threat to reputation, quality of service, fewer complaints • Strong collegial relationships most effective in forming a buffer against work-related stress

23. Practice strategies - formal • Implement an ethics audit of policies and procedures • Engage in research activities around ethics • Incorporate ethics into supervision • Create opportunities for ethics education and training – needs analysis • Develop ethics resource materials • Engage ethics expertise

24. Practice strategies - informal • Encourage consultation and provide safe space for discussion • Build trusting relationships – team-building, support • Challenge unethical or inappropriate conduct – role modelling • Find ways to always keep ethics on the agenda

25. Resources • Chenoweth, L. & McAuliffe, D. 2011. The Road to Social Work and Human Service Practice, Cengage. (Chapters 3 & 4). • Corey, G., Corey, M.S. & Callanan, P. (2007) Issues and Ethics in the Helping Professions, Brookes/Cole, Belmont. • Freegard, H. (Ed) 2006. Ethical Practice for Health Professionals’, Thomson. • Morrissey, S. & Reddy, P. (2006) Ethics and Professional Practice for Psychologists, Thomson. • Ethics and Social Welfare Journal (UK) • Journal of Social Work Values and Ethics (US)