Sense and Sensibility: Ethical Considerations in the Workplace

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Sense and Sensibility Ethical
Considerations in the Workplace

• Debra Guthmann, Ed.D.

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Developed by

• Debra S. Guthmann, Ed.D.
• Director of Pupil Personnel Services
• California School for the Deaf
• Fremont, CA
• Project Director, Minnesota
• Chemical Dependency Program for
• Deaf and Hard of Hearing Individuals

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What are Ethics??????
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Ethics are

• Doing the right thing because it is the right
  thing to do. (Aristotle)
• Theories or systems of moral principles that
  provide a code of conduct.
• The beliefs, standards, and values that are
  adhered to by an individual, a group, or a
  society, and which reflect a system of moral
  principles.

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Ethics are

• What ought to be in a world of what is.
• Not static they change and evolve in response to
  the changes in individuals and their societies.

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Myths about Ethics

• One must have ethical perfection to raise ethical
  issues
• Everyone knows when theyve made mistakes

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Law Versus Ethics

• Law
• Reflects the minimum standards that society will
  tolerate
• Ethics
• Represents the ideal standards set by
  professionals
• The basic purpose is to further the welfare of
  the client

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Law Versus Ethics

• WHAT HAPPENS WHEN ETHICS AND THE LAW ARE IN
  CONFLICT?????
• EXAMPLE OF SOMETHING UNETHICAL AND LEGAL
• EXAMPLE OF SOMETHING ETHICAL AND ILLEGAL

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What is a Code of Conduct?

• A formal statement of the values and business
  practices of an agency/corporation.
• A code may be a short mission statement, or it
  may be a sophisticated document that requires
  compliance with specific standards and a
  complicated enforcement mechanism.

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Code of Ethics?

• Does your Agency have a Code of Ethics??????
• What are some examples of groups of
  people/organizations that have Codes of Ethics?
• Why have a Code of Ethics?

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Self-Inventory Boundary Exercise

• On a piece of paper, write down 1-10 and the
  word by each
• statement which is most accurate for you. (None,
  Little, Average,
• Much, Always)
• 1. How much are you threatened by others whose
  moral views are different than yours? (None,
  Little, Average, Much, Always)
• 2. How much are you threatened by others whose
  political views are different from yours? (None,
  Little, Average, Much, Always)
• 3. How much are you threatened by others whose
  religious views are different from yours? (None,
  Little, Average, Much, Always)
• 4. How much do you allow others to determine your
  values for you?
• 5. How much do you allow others to set your
  priorities for you? (None, Little, Average, Much,
  Always)

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Self-Inventory Boundary Exercise

• 6. How often do you tell things about yourself to
  the wrong people? (None, Little, Average, Much,
  Always)
• 7. How much are you thrown off base by people who
  say and do inappropriate things around you?
  (None, Little, Average, Much, Always)
• 8. How much do you throw up a wall to protect
  yourself from others abuses? (None, Little,
  Average, Much, Always)
• 9. How often do you store up feelings until they
  explode and then feel you must apologize for the
  way you expressed them? (None, Little, Average,
  Much, Always)
• 10. How much do you allow yourself to become lost
  in the other persons with whom you choose to
  connect? (None, Little, Average, Much, Always)

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Self-Inventory Boundary Exercise

• An answer of none indicates a strong healthy
• boundary.
• An answer of always indicates a
• weak, unhealthy boundary or no
• boundary at all.
• Based on your answers,would you say that you
• have boundaries that are mostly excellent, good,
• fair, poor, or non-existent?

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Boundaries Quiz

• Choose the correct answer
• A. The word boundary, as used today refers to
• 1. Physical and sexual limits
• 2. Emotional and spiritual limits
• 3. Relational limits
• 4. All of the above
• B. The phrase boundary violation indicates
• 1. That ones limits have been breached
• 2. That one has expanded his or her frontiers
• 3. A minor infringement of ones defenses
• 4. A problem only to the victim of the
  violation.

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Boundaries Quiz

• Choose the correct answer
• C. A boundary violation causes
• 1. No particular consequence
• 2. An emotional shock wave
• 3. No harm to a really strong relationship
• D. Boundaries are
• 1. Usually flexible
• 2. Usually rigid
• 3. Impossible to change
• 4. Different for different people

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Boundaries Quiz

• Mark the incidents that are boundary violations
• 1. Grandpa takes little Jim fishing.
• 2. Esther tells Betty a secret Mary told her.
• 3. You are a counselor and invite a client to go
  for coffee
• 4. Your boss wants to know information about your
  personal life
• 5. Your boss cries on your shoulder about his/her
  problem.
• 6. Your counselor accepts an invitation from you
  to go to coffee
• 7. Your boss asks if youd like a hug
• 8. Your colleague makes a comment about your
  weight

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Healthy Versus Unhealthy Boundaries

• What characteristics indicate to you that a
  person may have healthy boundaries? Examples?
• What characteristics indicate to you that a
  person may have unhealthy boundaries? Examples?

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Professional Boundaries

• The line that separates where I end and where the
  client begins
• Emotional and physical space that gives our
  clients room to focus on their own development
  and not on us
• Limits that control the professionals power so
  that clients arent hurt

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Professional Boundaries

• Dictate our interactions with clients
• Fluid limits that change depending on the
  clients vulnerability and our role
• Parameters that keep the professional as
  objective as possible
• Put a limit on professionals power so clients
  arent hurt

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Signs of Unhealthy Boundaries

• Telling all
• Not noticing when someone invades your boundaries
• Touching a person without asking
• Taking as much as you can get for the sake of
  getting
• Letting others direct your life

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Issues Related to Boundaries

• Gift giving
• Touching/hugging
• Confidentiality
• Self-disclosure
• Power differential
• Boundaries between colleagues

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Boundary Scenario

• A client of your agency comes with a request to
  borrow money. She goes into details of why she
  needs the money and when you would be repaid.
  Would you always, sometimes, or never lend a
  client money?
• Rationale

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Boundary Scenario

• One of your clients is interested in earning
  some extra money and has offered to wash your
  car. Would you always, sometimes, or never ask a
  client to wash your car? Rationale

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Boundary Transgressions

• Physical Boundary Transgressions
• Emotional Boundary Transgressions
• Psychological Boundary Transgressions
• Sexual Boundary Transgressions

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Physical Boundary Transgressions

• A client comes into your office and picks up
  papers on your desk.
• You are meeting with a co-worker and a colleague
  opens the closed door, sits down, and begins
  talking about a crisis.
• Your supervisor hugs you without your permission
  after a negative performance review.

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Emotional Boundary Transgressions

• A client shares memories of sexual abuse with
  members of the support staff in a crowded program
  office.
• A staff member shares the gruesome details of his
  divorce during a staff meeting.
• A staff member acts as therapist for a supervisor.

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Psychological Boundary Transgressions

• A white client calls a black client a racist
  name.
• Your supervisor answers the phone three times
  during a meeting that you requested.
• A staff member shames a co-worker by indirect
  criticism, ridicule, or sarcasm, such as, Your
  clients sure have a lot of problems. Whats that
  say about you?

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Sexual Boundary Transgressions

• A client winks at you seductively during class.
• A staff member tells off-color stories or makes
  references to sex that make you very
  uncomfortable.
• A supervisor wants to know details about your
  students sex lives. Each time you try to
  discuss other relevant information, your
  supervisor steers the topic back to sex.

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Gift Giving Accept or Decline?

• Your agency policy states that it is okay for
  employees to accept homemade gifts from clients.
  A client gives you an ornately carved cradle that
  sells for 800 each. Would you always,
  sometimes, or never accept a gift like this from
  a client?
• Rationale

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Boundary Scenario

• A client asks you for a ride to an appointment
  since you are driving in a similar direction.
  Would you always, sometimes, or never give a
  client a ride in your car?
• Rationale

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Boundary Scenario

• A former client owns an auto repair shop and
  offers to fix your car for the same cost as any
  other shop would charge, but the client will
  take good care of your car. Would you always,
  sometimes, or never take your car to this auto
  repair shop?
• Rationale

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Boundary Scenario

• An interpreter scheduled for a meeting in your
  agency is sick and you have no coverage. Would
  you (or a colleague) always, sometimes, or never
  offer to interpret for the meeting?
• Rationale

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Dual Relationships A National Study

• 4,800 psychologists, psychiatrists and social
  workers
• were surveyed (return rate of 49) to examine
  attitudes and
• practices regarding dual relationships, social
  involvements,
• financial involvements and incidental
  involvements.
• 800 male and 800 female clinicians were
  randomly selected from the membership directory
  for American Psychological Association,
  American Psychiatric Association and the National
  Association of Social Workers
• Survey forms sent out and 1,108 individuals
  returned surveys that could be used.

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Dual Relationships A National Study
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Dual Relationships A National Study
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Dual Relationships A National Study
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Self Reported rates of Boundary-Related Behaviors

• Description
• Telling a client you are angry with him or her
• Using self-disclosure
• Hugging a client
• Accepting a clients gift worth at least 50
• Accepting a gift worth less than 5 from a client
• Accepting favors (e.g. a ride home) from clients
• Lending money to a client
• Inviting clients to a party or social event

• Reported Rate
• 42.5 responded sometimes to very often
• 69.4 responded sometimes to very often
• 41.7 responded from sometimes to very often
• 19.1 responded rarely
• 58.1 responded from sometimes to very often
• 35.7 responded rarely
• 23.9 responded rarely
• 15.4 responded rarely or sometimes

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Self Reported rates of Boundary-Related Behaviors

• Description
• Disclosed details of current personal stresses to
  a client
• Went out to eat with a client after a session
• Accepted a clients invitation to a special
  occasion

• Reported Rate
• 38.9 did this with a few other clients
• 11.6 did this with a few other clients
• 35.1 did this with a few other clients

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• What does Power Differential mean?

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Exploitation of RelationshipPower Differential

• Exploitation occurs when the professional uses
  the power of his/her position for personal gain
  from the client in some way
• Although the counseling relationship will
  end, the power differential remains
  indefinitely and affects any
  future non-therapeutic relationships

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POWER DIFFERENTIAL

• 1. The ideal - The professional is close enough
  to be emotionally involved. Clients feel
  protected and supported in their vulnerability.
  Te professional is also distant enough to allow
  clients the autonomy they need to heal.
• 2. Shrinking the boundary space - If we are
  uncomfortable with our power, we may reposition
  ourselves a buddies or peers. We come in too
  close. Clients may feel confused, angry, or
  unsafe they know that we have more power, though
  we are acting as if we dont.
• 3. Expanding the boundary space - If weve been
  too close, we might react by moving too far away.
  We forget clients vulnerability and abandon
  them. We remove ourselves from the complex
  emotional relationship and thus act outside it.
  We may begin to think of clients as walking
  diagnoses objects to be acted upon. Clients
  may feel alone, unheard, confused, unsafe.

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• POWER DIFFERENTIAL SCENARIOTHE APPOINTMENT

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POWER DIFFERENTIAL

• 1. How is The appointment similar to or
  different from what your clients experience?
• 2. Will your clients speak up directly if they
  dont like something you say or do?
• 3. Will your clients directly refuse to follow a
  recommendation?
• 4. What are examples of ways you have power over
  your clients?

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Dual Relationships in the Workplace

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Dual Relationships

• when professionals assume two roles
  simultaneously or sequentially with a person
  seeking help (Herlihy Corey)
• May occur beginning, during, or after a
  counseling relationship
• Not always problematic or unethical
• Greatest potential for harm may result from the
  power held, or perceived as being held, by the
  counselor or other professional

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What Makes Dual Relationships Problematic?

• They can be difficult to recognize
• They can be very harmful, but they are not always
  harmful
• They are the subject of conflicting views
• They are not always avoidable

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Maintaining Neutrality

• Avoid dual relationships that could impair
• the professionals judgement or objectivity
• in the manner of treatment of the case.

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Sexual Relationships

• Most professional associations agree that
  concurrent sexual and professional relationships
  are unethical (sexual relationships comprise 20
  of complaints and other kinds dual relationship
  complaints 7.)
• Even after termination, some professionals
  believe once a client, always a client

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Ethical Issues regarding Dual Relationships

• 1. Most ethical codes draw strong distinctions
  between sexual and nonsexual dual relationships.
  
• Although the codes considered here prohibit the
  counselor from having a sexual relationship with
  a current client, variation occurs in the
  prohibition of such a relationship with former
  clients and the length of time that must pass for
  such a relationship to be permissible.
• 2. Other relationships cited in the ethical
  standards include those of friendship, business
  association and supervision.
• These interactions also lie on a time line
  encompassing outside relationships that existed
  before counseling, those that develop during
• the course of counseling and those that arise
  following termination.
• 3. One variable in determining the ethical
  ramifications of a potential dual relationship is
  its avoid ability.

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Ethical Guidelines regarding Dual Relationships

• Former Clients
• Sexual dual relationships with clients are among
  the most serious of all ethical violations
• Some codes say that counselors should not engage
  in sexual relationships with former clients
  within a minimum of two years after ending the
  counseling relationship (per some licenses, two
  years recommended in other situations, some feel
  it is never appropriate) .
• THOUGHTS??????

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Ethical Guidelines Regarding Dual Relationships

• 1. Counselors make every effort to avoid dual
  relationships with clients that could impact
  professional judgement or increase the risk of
  harm to clients.
• 2. When a dual relationship cannot be avoided,
  counselors should take appropriate professional
  precautions such as informed consent,
  consultation, supervision and documentation to
  ensure that judgement is not impaired and no
  exploitation occurs.

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Recovering Counselor

• Self disclosure of personal recovery, should be
  used judiciously.

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Social RelationshipsRole Conflicts

• The roles of friend and counselor are not
  compatible
• A counselors objectivity is compromised when the
  client is also a friend
• Clients may hesitate to reveal sensitive issues
  for fear that the counselor/friend will lose
  respect for them

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Social RelationshipsRole Conflicts for Deaf
Counselors

• Clients may be former schoolmates of the
  counselor, and this can lead to conflicts in
  role.
• How the Deaf professionals social relationships
  are perceived by others is a potential problem
  area
• The social relationships that partners of Deaf
  counselors have can cause a conflict with the
  counselors professional relationships.

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Social Relationships Role Conflicts for Hearing
Counselors

• In order to gain respect and credibility, the
  hearing person must be visible in the Deaf
  community
• Some professionals prefer not to socialize within
  the Deaf community due to confidentiality and
  trust issues.
• Professionals may feel an obligation to interpret
  when no interpreter is available and the need is
  crucial.

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Social Relationships Role Conflicts for Deaf
Hearing Counselors

• It can be awkward for a professional who attends
  a friends party and finds clients there
• Consumers who discuss confidential issues at a
  social gathering are encouraged to save it for
  the office
• Some professionals indicate that they would
  accept an invitation from former clients for
  events such as weddings, graduations, etc.

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Survey Results Dual Relationships

• An obligation to interpret for consumers or Deaf
  friends when no interpreter available
• A struggle to clearly define their role and
  limitations
• Attempts at respecting the Deaf community may be
  misinterpreted as being aloof, or trying to meet
  their own financial or professional needs

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Survey Results Dual Relationships

• Jobs have multiple roles and difficult to define
  or clarify positions such as administrator,
  counselor, interpreter, friend, colleague
• Difficulties if seen at a social gathering when
  working in certain kinds of confidential
  positions
• Dilemmas related to determining when socializing
  within the Deaf community is appropriate in case
  they run into clients.

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Unavoidable Relationships

• In rural areas, professionals may play several
  roles and may find it more difficult to maintain
  clear boundaries than professionals who practice
  in more suburban or urban areas.

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Unavoidable Relationships

• Professionals who are asked to provide
  individual services to clients with close
  associations,(for example, husband and wife
  close friends or enemies) will likely feel role
  conflicts.

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Unavoidable Relationships

• There are situations in which refusing to
  provide counseling to individuals with whom one
  has another relationship, would prevent people in
  need from receiving assistance.

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Unavoidable RelationshipsInternet, E-mail
Instant Messaging

• Set clear and consistent boundaries re internet
  communication, anticipating how it could be
  abused.
• What are you agency policies around E-mail
  and confidentiality issues?

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Private Therapists E-mail Policies

• If you have already read my email policies (see
  below) and consent to the use of email as a form
  of communication, please click here.  If you are
  uncomfortable with email as a form of
  communication, please contact my office directly
  at _________.
• Thank you

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E-mail Informed Consent

• I understand that by initiating email
  correspondence and/or providing you with my email
  address, I am agreeing to use email as an
  acceptable form of communication for confidential
  information.

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Exploitation of RelationshipsBartering

• Bartering is not generally encouraged
• It may be a standard practice in certain cultures
  and communities
• It can lead to conflicts when the services being
  exchanged are not viewed by one of the parties as
  being equitable

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Potential Role Conflicts Interpreting

• May be difficult to explain why the professional
  would not interpret for them
• May be a struggle to define their role and
  limitations for those involved

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Jobs with Multiple Roles

• May be difficult at times to clarify the various
  roles (i.e. positions such as administrator,
  counselor, interpreter, friend/colleague
• Deaf counselors who have other positions in
  the Deaf Community (e.g. NAD, AAAD) may feel
  conflicted when clients join.

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Dual relationships Among Co-workers

• There are many kinds of relationships at any
  worksite. Overlapping roles with co-workers
  make boundary setting even harder.
• It can be difficult to approach a co-worker
  with a boundary concern. This becomes even more
  difficult when layers of relationships exist
  among the staff.
• We benefit by making dual relationships
  explicit.

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Dual relationships Among Co-workers

• We can decide if such relationships energize or
  deplete the staff by positively or negatively
  affecting the team and thus clients.
• Example You and a colleague play on a softball
  team after work.
• 1. How would this relationship be viewed by the
  rest of the staff?
• 2. Would your colleagues know about the
  boundary youve set? Will they trust that the
  boundary is upheld?
• 3. Even if the dual relationship is explicit,
  would colleagues feel that the relationship is
  affecting work?
• 4. Can colleagues raise their concerns?
• ARE THERE ANY EXAMPLES OF DUAL
  RELATIONSHIPS THAT OCCUR IN YOUR OFFICE?

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Dual relationships Among Co-workers

• In order to keep a system focused on client
  care, we need to monitor and maintain our
  boundaries with co-workers.
• When youre angry or upset with a colleague or
  distrust a co-worker, where is your energy going?
  
• The amount of energy we expend in self
  protection, anger, and disagreements with
  co-workers takes away from what we can give to
  our clients immediately and in the long term.
• Caring for ourselves is important so we can care
  for others. When we take care of ourselves, we
  can better take care of clients.

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Confidentiality

• Is information obtained about clients, outside of
  the agency still confidential?

• When questions are asked about clients without
  releases signed, it is important to be clear
  about roles, so that silence is not
  misinterpreted.

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Measuring Potential for Harm

• The greater the incompatibility of expectations
  in a dual role, the greater the risk of harm
• The responsibilities associated with dual roles
  diverge, the potential for divided loyalties and
  loss of objectivity increases
• Clients by virtue of their need for help, are in
  a dependent, less powerful, and more vulnerable
  position

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Safeguards to Minimize Risks

• Set healthy boundaries from the onset
• Involve the client in setting the boundaries of
  the professional relationship
• Informed consent needs to occur at the beginning
  and throughout the relationship
• Discussion and clarification needs to be an
  ongoing process

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Safeguards to Minimize Risks(continued)

• Consultation with other professionals can be
  useful in getting an objective perspective and
  identifying unanticipated difficulties
• Practitioners should work under supervision
• Documentation is an important ethical precaution

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Dual Relationship Considerations

• Recognize the complexity of therapeutic
  relationships
• Attend to self-care
• Engage in peer consultation
• Engage in ongoing self-evaluation
• Acknowledge potential for multiple relationships
  and possible harm to clients
• Use sound clinical judgment

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Dual Relationship Scenario

• Youre a program supervisor and develop a close
  friendship with one of the program staff. Its
  obvious to everyone in the office that youre
  friends. However, after a somewhat negative
  performance review, one of your other staff
  members complains that you dont treat everyone
  fairly. What would you do?
• Rationale

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Dual Relationship Scenario

• You and Keisha, a deaf woman, have been close
  friends for a long time. Keisha has recently
  moved and will become a client in your office.
  You are the only counselor in the office who
  knows sign language. Would you always,
  sometimes, or never agree to work with this
  client?
• Rationale

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Dual Relationship Scenario

• You are a VR counselor, and a client with whom
  youre working is newly in recovery from alcohol
  and other drug problems. You see this client is
  sometimes struggling with recovery, and often is
  not able to get much support. You consider
  sharing with the client that you are in recovery
  yourself.
• Rationale

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Dual Relationship Scenario

• Your community has a very limited number of
  interpreters, most of whom are children of deaf
  adults. Several of the interpreters who are
  available to work in your program are siblings or
  cousins. Is this a problem? Would you always,
  sometimes, or never agree to hire family members?

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Ethical Dilemma

• You are a rehabilitation counselor in a small
  town and, while at a social function, you see a
  client with whom you have been unsuccessful
  contacting for an appointment. You take the
  client into another room, and proceed to discuss
  her vocational plans.
• What do you see as the ethical issue(s)?
• How would you handle this situation?

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Competent Professionals

• Competent professionals have the
• knowledge, skills, and abilities necessary to
  perform the tasks relevant to that
• profession as well as
• understanding when
• it is appropriate to
• provide services or to
• refer a student.

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Competence

• Level of skill
• Objectivity
• Recognition of existing problems
• Asking for assistance
• Referrals
• Peer consultation
• Ongoing professional development

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Personal Conduct Self Care Skills

• Are you working regular overtime?
• Are your personal relationships fifty-fifty
  That is, do you get as much from these
  relationships as you give?
• Do you take all of your vacation days?
• Do you have friends who are not related to your
  work?
• Do you have friends who are not in the helping
  fields?

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Personal Conduct Self Care Skills

• Do you play as hard as you work?
• Do you really leave work at work? Are you having
  fun in your life?
• Who are your mentors? What characteristics of
  theirs do you admire?
• How do you keep your work and life separate?

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Making Ethical Decisions

• 1. Review your code of ethics and legal mandates.
• 2. Seek input from a second party.
• 3. Determine the values (motives) involved.
• 4. Evaluate the long-term effects of your choices
  on the individual.

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Steps in Making Ethical Decisions

• 1. Identify the Problem
• Gather information in a comprehensive
• manner
• No clear right or wrong..one has to deal with
  ambiguity
• 2. Identify potential issues that might be
  involved
• Collect critical issues and discard
  irrelevant ones

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Steps in Making Ethical Decisions

• 3. Review relevant ethical guidelines
• Do the guidelines, standards or principles of
  your organization or profession offer a possible
  solution?
• Consider whether your own values and ethics
  are considered or in conflict with relevant
  guidelines
• If in conflict, do you have a rationale

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Steps in Making Ethical Decisions

• 4. Obtain Consultation
• Objectivity can be difficult when on your own
• Consulting can help you think about possible
  ramifications that might otherwise be overlooked
• Allows for feedback regarding your
  justifications

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Steps in Making Ethical Decisions

• 5. Consider possible and probably
  courses of action
• Brainstorming can be useful
• Enumerate the consequences of various
  decisions
• Ponder the implications (pros and cons)
• 6. Decide best course of action
• Avoid second guessing

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Considering Ethical Principles (Kitchener)

• Respect autonomy
• Do no harm
• Benefit others
• Be just
• Be faithful