ETHICAL ISSUES IN TREATMENT

1. ETHICAL ISSUES IN TREATMENT Presented by: Neva Chauppette, Psy.D P.O. Box 6234, Woodland Hills, CA 91365 818-439-7080 cell / 818-703-1854 fax CA License PSY14524 nchauppett@aol.com

2. ETHICS • Ethical principle establishes a higher standard of conduct than is required by law; a mental health and/or drug treatment provider must meet a higher ethical standard. • In all areas of life, ethics comprise the principles of morality, including both the concepts of what is “right” or “good.” • Ethics codes say that “we will give and not take.”

3. ETHICS • Primary purpose of a code of ethics is to guide professionals in helping clients and families while behaving in a fair, respectable, objective, and humane way.

4. ETHICAL PRINCIPLES • Personal values that guide moral conduct appropriate for work setting (telling the truth even when consequences may be personal and/or professional) • Understanding the connection between law and ethics and feeling a responsibility to integrate both appropriately

5. ETHICAL PRINCIPLES • Understanding your agencies policies and procedures for client services (consistent collaboration with others, conflict of interest) • Awareness of personal needs/issues relevant to the provision of mental health care/drug treatment services to others (divorce, death, personal relapse)

6. ETHICAL PRINCIPLES • Understanding that the passage of time is necessary, but not solely sufficient when evaluating client relationships • Principle of “doing no harm” or “preventing harm” • Relevant prior education and training for your position and/or agency (credentials match job duties)

7. ETHICAL PRINCIPLES • Appropriately seeking supervision and/or consultation when needed. • Continuing education relevant to your profession, including connection to other mental health and drug treatment professionals (i.e., co-workers, supervisors, knowledgeable people in your field, etc.).

8. PROFESSIONAL BOUNDARIES • They are the line that separates where the provider ends and the client begins. • They are the emotional and physical space that gives our clients room to focus on their own healing and not on us. • They are limits that control the professional’s power so that clients are not hurt.

9. PROFESSIONALBOUNDARIES • They dictate our interactions with clients. • They are fluid limits that change depending on the client’s vulnerability and our role. • They are parameters that keep the professional as objective as possible.

10. PROFESSIONALBOUNDARIES • It is the provider’s responsibility to maintain professional boundaries where she/he can: • Maintain proper limits (using ethical standards) • Keep treatment focused • Be aware of thoughts/feelings generated about the client

11. PROFESSIONALBOUNDARIES • Know what to do about these thoughts/feelings • Know how to handle personal needs for gratification without inappropriately involving the client

12. PROFESSIONAL BOUNDARIES • When considering boundary dilemmas, consider whether you are: • Currently providing treatment for the client • Have previously provided treatment for the client

13. PROFESSIONAL BOUNDARIES • Dual or Multiple Relationships: A situation where the professional (provider) functions in more than one role with the client.

14. PROFESSIONAL BOUNDARIES • Social / Friendships: A situation where the professional (provider) decides that it is acceptable to see a client (or former client) in a social context or decides that it is acceptable to now “be friends” with the client.

15. PROFESSIONAL BOUNDARIES • Romantic / Sexual: A situation where the professional (provider) begins to view the client as a potential romantic partner, fantasizes about the client, thinks about terminating treatment so that the relationship can “deepen”; engaging in a sexual relationship with client/other staff person.

16. PROFESSIONAL BOUNDARIES • Never engage in any form of sexual contact with a client. • Sexual contact can include: • intercourse, anal or oral sex, fondling, and any other kind of sexual touching. • nudity, kissing, spanking, verbal suggestions, innuendoes, or advances. • This kind of behavior is considered exploitation by the health care provider.

17. PROFESSIONAL BOUNDARIES • Important issues in this kind of sexual boundary violation: • Provider: • Relying on a vulnerable client to meet your sexual needs • Convincing the client to isolate him/herself from others (family, friends, other professionals) because you are the only/best person to help – or on some level you know that the kind of relationship you have with the client is inappropriate

18. PROFESSIONAL BOUNDARIES • Important issues in this kind of sexual boundary violation: • Provider: • Loss of objectivity to provide appropriate treatment or exercise appropriate judgment • Ethics code for helping professions – unprofessional conduct, unethical, illegal

19. PROFESSIONAL BOUNDARIES • Important issues in this kind of sexual boundary violation: • Client: • Damage to the client’s mental health • Loss of trust in the helping professions • Could end up with more focus on you than on him/herself

20. PROFESSIONAL BOUNDARIES • Important issues in this kind of sexual boundary violation: • Client: • May become confused about motivations to change (e.g., having sex with you --- to keep the relationship going---- to avoid the feelings associated with loss/abandonment)

21. PROFESSIONAL BOUNDARIES • Business / Bartering: A situation where the professional (provider) engages in a business relationship or trading services (counseling) with a client who either cannot afford treatment or has a particular skill that you could benefit from.

22. PROFESSIONAL BOUNDARIES • Counseling to family or friends: A situation where the professional (provider): • a) agrees to “talk” with a family member or friend (on a regular basis) who really needs treatment but can’t or won’t seek it out; or

23. PROFESSIONAL BOUNDARIES • b) agrees to provide treatment in a situation where the family member or friend does want treatment, but would rather “talk” to her/him because she/he trusts you already (and you know a lot of the surrounding details that she/he won’t have to explain to a stranger), or

24. PROFESSIONAL BOUNDARIES • c) you agree to provide the treatment (be the individual or group counselor) for your friend who is ambivalent about going into treatment.

25. PROFESSIONAL BOUNDARIES • Confidentiality: A situation where the professional (provider) conveys (either verbal or written) confidential information about a client to someone else (including other agencies) without explicit consent (written when the client is rational and sober) to do so.

26. PROFESSIONAL BOUNDARIES • Gift Giving: A situation where a counselor is appreciated for what she/he does. Normally gratitude is expressed with a written note, verbal expression of thanks, or some small material token. • Most counselors feel that refusing such gifts would reject or insult the client. However, any type of gift giving should be carefully considered in advance.

27. SELF-DISCLOSURE • Can the client gain the same benefit without self-disclosure? • Will self-disclosure shift the focus onto you (and your needs being met) vs. keeping the focus on your client? • Should you self-disclose when the therapeutic relationship has been harmed in some way? • Should you answer a client’s personal question (about your past/present history with __) or is it more appropriate to address the client’s concern behind the question?