Ethics is a Team Sport!!

This is a handout developed by Madeline Stein & James Cole Abrams © in conjunction with their presentation ‘Ethics is a Team Sport!’

It’s never ‘the thing’—it’s how you look at it!!

It’s very common for ethical practice to be thought of as objective. When in fact, it’s incredibly subjective. What you think of as ethical conduct is informed by your identities, the culture you were raised in, the education you received, your life experiences, and your scope of practice. Determining ethical conduct is actually a combination of your subjective reality and the thought process that landed you at your conclusion (i.e., the determination that a given action is either right or wrong).

Broaching is a practice— letting clients (and colleagues!) know what identities you hold and how those identities could influence your perspective! For example,

Madeline: I’m white, cis-gender (which to me means that sex I was assigned at birth based off of my genitals correlates to how I express my gender) female. I come from a middle-class socioeconomic status, english is my first language, I don’t have any physical disabilities, I do have orthographic processing differences, I live in a somewhat liberal city, and am in private practice.

James: I’m white, mostly cis-gender, male although that location has never felt quite right for me.  I was raised middle class and highly educated, am able-bodied but do have significant executive functioning disabilities.  For the most part, my social locations have taught me that authority figures are there for my protection, which absolutely influences my attitude towards ethics and creates blind spots in my assessment.  While I work to address these, I welcome any support in calling me out.

We mention these identities because they inform how we view the world, morality, and ethical conduct.

Ethical practice is about doing right by your client but ALSO about doing right by yourself - don’t set yourself up to go looking for a third career! We’re not here to say what is right and wrong— make sure you know the ethical codes relevant to your profession. State law trumps ethics—know the ins and outs of the laws in your state.

Three pro-tips to hang on your corkboard:

1. Ethics is a team sport: don’t go at it alone!!

2. Have an ethics buddy!

3. When in doubt, document it out!

What’s an ethics team? Who should be you ethics buddy?

Sometimes your team is your school and training

• We often meet people who tell us something like “I went to school for social work and had one class called “Mental Health” that also covered ethics.”  If you find yourself in a similar situation where you don’t feel confident in your training, please get more!

  Sometimes your team is a colleague or colleagues

• This can be especially true in a group practice or agency.  Also, it can be especially untrue if there are colleagues there that you don’t trust for one reason or another.

• Have your go-to person or persons

  • Likely you already have these: friends and mentors you trust to talk it out informally and bounce ideas off of

  • It’s cool because you trust them to call you on your shit without throwing a tantrum

Sometimes your team is more formal, like a supervisor or consultation group

• These are so good y’all.  Bounce ideas off of lots of people with different trainings.

  • Be wary about running into big egos in these scenarios, sometimes people can be on your team who maybe shouldn’t be

Sometimes your team is a lawyer

• It’s likely you have this and don’t know it.  If you have malpractice insurance, you may have access to a lawyer through your insurance company.  On the other hand, if you have a lawyer through your agency or agency-provided insurance, be aware that those lawyers have to serve the best interests of the company ahead of you; you may become a sacrificial lamb in a difficult legal scenario.

AN IMPORTANT NOTE: Don’t meet with board investigators without legal representation! Ever! 

• Seriously not ever, not for a chat or a “just thought I’d pop in to clear something up”

• It’s very easy for boards to revoke a license based on mistakes therapists made during interviews they gave without a lawyer present, regardless of what happened between the therapist and the client

 Supervision vs. consultation

Supervision and consultation are two different things. They are NOT SYNONYMS (I’m looking at you modern analysts), different legal connotations. Supervisors get details on ethical quandaries, consultants don’t. 

What makes for a good consultation group?

• Know what kind of group it is.  Is this for serious consultation on cases exploring countertransference, or is this something more casual/supportive?

• You don’t have to have rules or structure, but you should all be on the same page about whatever is decided.  Some people like structure a lot - these kinds of groups can often be very difficult, as you’re showing up at your worst when you bring ethical quandaries.

  • If you want boundaries, here’s some I’ve seen work well:

    • Time limits on case presentation.  It’s very easy to spend 90 minutes accidentally ripping someone to shreds

    • Case presenters can bow out of feedback whenever they like and don’t have to explain why they’re doing so!

    • Does this group have a formal leader?  Does this group have an informal leader?  Does this group have both?

    • Though it’s outside the scope of this presentation, there are specific models of group consultation out there, such as those presented by David Altfeld and Bobby Moore.  If you’re interested, they’re actually really thoughtful and interesting, check them out!

• Ethical Values of the ACA (there is some overlap with the APA and ASCW)!

• Autonomy is the principle that addresses respect for independence, and self-determination. The essence of this principle is allowing an individual the freedom of choice and action. 

• Beneficence reflects the counselor’s responsibility to contribute to the welfare of the client. Simply stated, it means to do good, to be proactive, and also to prevent harm when possible

• Nonmaleficence is the concept of not causing harm to others. Often explained as “above all, do no harm,” this principle reflects both the idea of not inflicting intentional harm, and not engaging in actions that risk harming others

• Justice is “treating equals equally and unequals unequally but in proportion to their relevant differences” (p. 49). Justice does not mean treating all individuals the same. If an individual is to be treated differently, the counselor needs to be able to offer a rationale that explains the necessity and appropriateness of treating the individual differently

• Fidelity involves the notions of loyalty, faithfulness, and honoring commitments. Clients must be able to trust the counselor and have faith in the therapeutic relationship if growth is to occur

• Veracity is dealing truthfully with other individuals that you come into professional contact with

Top four reasons therapists get grieved (per ACA 2019, January):

• Don’t do CEUs

• Dual relationship as business partner

• Dual relationship as sexual relationship

• Misrepresent themselves, usually in court (give an eval in a divorce case that they’re not qualified to give)

Diversity and Bias in Group, Ethical Considerations, and Practice

• Consider structure! Personally I’m not a huge structure guy, but I also come from the culture that developed psychotherapy so it’s likely I experience a lot less anticipatory anxiety than people from other cultures.  This is to say that for me, or someone like me, even an unstructured group benefits from the internal scaffolding of culture that I bring with myself everywhere I go. Groups remind me of places I’m welcome.

• “Local clinical scientist” - if you would like to make an intervention actually within the confines of the group, try thinking of yourself this way.  So much research about groups is done on homogeneous groups, which means practice recommendations often don’t work the way they’re expected to in real-life groups.  Pay attention to your group and be willing to modify your practice on the fly based on the new research you’re doing in the moment (Chen, Kakkad, Balzano, 2008).

Deontology 101 

Virtue Ethics 101

Consequentialism 101

Follow up source that may be of interest!

White Supremacy Culture (and the values that it propagates)

ACA Governing Council. (2014). 2014 ACA code of ethics: as approved by the ACA governing council. American Counseling Association. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010 and January 1, 2017). Retrieved from http://www.apa.org/ethics/code/index.aspx

Chen, E. C., Kakkad, D., & Balzano, J. (2008). Multicultural competence and evidence-based practice in group therapy. Journal of Clinical Psychology, 64(11), 1261–1278. doi: 10.1002/jclp.20533

Even, T., Robinson, C. (2013). The impact of CACREP accreditation: a multiway frequency analysis of ethics violations and sanctions, Journal of Counseling and Development, 91, 1, (26-34).

Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev. ed.). Retrieved from https://www.counseling.org/docs/default-source/ethics/practioner-39-s-guide-to-ethical-decision-making.pdf?sfvrsn=10

Thomas, K., Weinrach S. (1993). The National Board for Certified Counselors: The Good, the Bad, and the Ugly. American Counseling Association, 72, 105-109.