The ethics of the helping profession and helping professionals are constantly under the radar. Help seekers, colleagues, and other professions in vastly different fields continue to question the ethics, values, and intentions of therapists and other helping professionals. I understand this suspicion aimed directly at therapists. As a help seeker, myself, I understand this disbelief. As a social worker bound by a written code of ethics, this disbelief becomes even more clear as my experience practicing psychotherapy grows and my professional ethical wellspring and history with clients deepens.
Indeed, we therapists have learned a set of skills that is very powerful when it comes to our ability to intervene with our clients affective state and even more potentially dangerous, their cognition. This same set of skills that has the power to soothe, de-escalate, and dig underneath psychological trauma, and years of unhealthy thinking has a dark side, too, and vastly dangerous potential to hurt and do collateral damage with little time, energy, or assets expended on behalf of therapist.
As a person carrying a schizophrenia diagnosis who can be at times very paranoid, I can tell you I have personally questioned the ethics my workers, therapists, psychiatrists, and members of my treatment teams. Indeed, when I am at cross purposes with my therapist, or have been at odds with my therapist, in terms of the provision of care my personal mental health treatment, I wonder: why is this the case? There have been times when I have personally experienced mistreatment and felt the fall out of bad judgement calls by therapists in my own care and treatment and again, wondered: why is this happening? As a therapist in an Article 31 clinic, with its regulations and code for practicing psychotherapy, the answers to my questions are little more clear. Sure, with rising caseloads and no show policies regarding client attendance, I have experienced the pushback myself from supervisors and directors who need to balance the numbers, worker productivity, and billable hours when it comes to keeping the doors of the clinic open.
I am talking about something entirely different though. To be candid, I am speaking of triggering clients intentionally, and not for the purpose of any so called therapeutic probing and identification a client’s distress tolerance or intolerance, but the vile digging into wounds without regard. I am also talking about the wanton and willful neglect of signs of self-harm or harm to others (HI/SI-homicidal & suicidal ideation) for whatever reason, and the subsequent mis-documentation or missing documentation of it all to hide the crimes inflicted upon the client. Sure, horrible and tragic mistreatment happens all the time in hospitals, clinics, nursing homes, adult homes, and any treatment setting run and operated people with unsound ethics and questionable values.
Therapists, specially social workers, are required to write essays and document in writing their stance on the NASW Code of Ethics. This ethical code written by social workers outlines the general and specific stance of social workers on a litany of important value-points, and provides guidance, with little ambiguous language, on where the line is drawn when it comes to harboring biases, judgements, and client contact when practicing social work. Indeed, we social workers but get to know our values, our biases, and all the vast intersections of power, privilege, and judgements that impact client care. All of these personal and professional reflective opportunities are important but are these academic measures really enough?
Indeed, as the chronicity of our clients diagnoses increase, and the intensity of their symptoms spike without fail, who hasn’t felt the transference and countertransference issues in their practice? I will never forget speaking with my clinical supervisor years back when she first started. I said to her:
“Transfer this client, its not going to work, and someone is going to get hurt”
She was new to her position, eager to troubleshoot clinical problems, and make it work. I knew better though. I knew that I wasn’t the person who was going to help this client. To be even more clear, I knew this person needed help, but I was not capable to helping. I firmly believe, to this day, there are people we cannot help as individuals, and, when charged with the provision of their care, must ethically make immediate provisions for their discharge, and transfer to someone that can help. In this case it wasn’t an issue of choosing the right treatment fit, per se, but instead, moving this client through the system into a space in which the right clinician could intervene.
In the end, I was right. One day on the way to work I got a text message from this client’s mother. My client, the same one I requested to be transferred, attempted suicide the night before. I will never forget reading that message, and pulling over to the side of the road, pained, hurt, angry, and all the emotions that come with my request not being taken seriously when the time finally came and the client finally attempted suicide. Even this ethical problem doesn’t speak of the type of willful and intentional breach I am gesturing towards which happen all the time just shy of physical and psychological terrorism inflicted upon this vulnerable population around the world.
I will be completely honest. There have been times when my own professional short comings were made visible and evident by the clients I have worked with in the past whom I have not been able to help. There have even been times when I felt the impulse to lash out, at the client, at myself, and at the world. Call it lack of faith in recovery, term it transference or countertransference, or unprofessionalism and questionable values. But I have felt the impulse first hand in the field, in the clinic, and even in my writing.
Even in my writing I have felt the urge to go ahead and use language to trigger, to hurt, to shame others just to get my own point across even if it meant taking a risk in de-stabilizing the emotional state of my reader. Of course, like the therapist who triggers his or her clients in a controlled environment, to map-out their clients distress tolerance skills, I too would only use my language to de-stabilize for the purpose and aim to bring my reader to a deeper truth and insight into the world and their own knowledge of where they stand in its ever changing and rolling landscape of psychological land mines and personal plight.
Ultimately, I still wonder: Are there others out there who feel the same way I do? Are their other therapists, psychologists, psychiatrists, and peer professionals who have felt the same evil impulse I have to do good by any means necessary? Does this any means necessary will to help even helping? Where does the pendulum swing on the scales of good versus evil for this therapist, or for you and your colleagues?
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