ETHICAL ISSUES IN TREATMENT Presented by: Neva Chauppette, Psy.D P.O. Box 6234, Woodland Hills, CA cell / fax CA License PSY14524

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.”

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.

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

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)

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)

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.).

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.

PROFESSIONAL BOUNDARIES  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.

PROFESSIONAL BOUNDARIES 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

PROFESSIONAL BOUNDARIES Know what to do about these thoughts/feelings Know how to handle personal needs for gratification without inappropriately involving the client

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

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

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.

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.

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.

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

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

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

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)

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.

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

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

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.

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.

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.

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?