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_at_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 professionals
  power so that clients are not hurt.

9
PROFESSIONAL BOUNDARIES

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

10
PROFESSIONAL BOUNDARIES

• It is the providers 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
PROFESSIONAL BOUNDARIES

• 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 clients 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 cant or wont 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 wont
  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 clients personal question
  (about your past/present history with __) or is
  it more appropriate to address the clients
  concern behind the question?