Psychotherapy and Social Work: Ethics, Judgement calls, and Supervision
The ethics of workers in the helping profession are continuously under the radar.
Help seekers, colleagues and other professions in vastly different fields continue to question therapists and other helping professionals’ ethics, values and intentions, understanding this suspicion aimed directly at therapists.
As a help seeker and a social worker bound by a written code of ethics, the stakes are even higher for ethical rigor when practicing. This writer’s experience practicing psychotherapy grows simultaneously with his professional and ethical wellspring for producing good outcomes at work.
Indeed, we therapists have learned a compelling set of skills when it comes to our ability to intervene with our client’s affective state and, even more potentially dangerous, their cognition. This same set of skills that have the power to soothe, de-escalate, and dig underneath psychological trauma and years of unhealthy thinking have 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 very paranoid, I have personally questioned workers assigned to treatment. Paranoid from working at cross purposes with a therapist in the past regarding care coordination with a clinic. Even go as far as saying I have been at odds with therapists to provide personal clinical mental health treatment and therapy.
I wonder: why is this the case? There have been times when this writer has personally experienced mistreatment and felt the fall out of bad judgment calls by therapists and wondered: why is this happening?
As a therapist practicing in an Article 31 clinic, the answer is more straightforward with its regulations and code for practicing psychotherapy. Sure, with rising caseloads and no show policies regarding client attendance, who has not experienced the pushback from supervisors and directors who need to balance the numbers?
When it comes to keeping the clinic’s doors open, ethics sometimes become blurred when they should be as clear as day.
I am talking about something entirely different, however. To be candid, triggering clients intentionally and not for any so-called therapeutic probing and identifying a client’s distress tolerance or intolerance, but the vile digging into wounds without regard. The wanton and willful neglect of signs of self-harm or harm to others (HI/SI-homicidal and suicidal ideation) for whatever reason, and the subsequent improper documentation or missing documentation of it all to hide the crimes inflicted upon the client.
Sure, horrible and tragic mistreatment happens in hospitals, clinics, nursing homes, adult homes and any treatment setting run and operated people with unsound ethics and questionable values. Therapists, especially social workers, must write essays and documents in writing their stance on the NASW Code of Ethics.
This ethical code written by social workers outlines social workers’ general and specific stance on a litany of essential value-points and provides guidance, with little ambiguous language, where the line is when harboring biases, judgments and client contact when practicing social work. Indeed, we social workers but get to know our values, biases and vast intersections of power, privilege and judgments that impact client care. All of these personal and professional reflective opportunities are important, but are these academic measures enough?
As our clients’ chronicity increases and the intensity of their symptoms spike without fail, who has not felt the transference and countertransference issues in their practice? I will never forget speaking with the clinical supervisor years back when she first started.
I said to her: “Transfer this client, it is not going to work, and someone will get hurt.” I pleaded to the supervisor. The supervisor was new to her position, eager to troubleshoot clinical problems and make it work.
I was not the person who was going to help this client. To be even more precise, knowing this person needed help, but I could not help. Firmly believing that there are people we cannot help as individuals and when charged with their care, providers must ethically make immediate provisions for their discharge and transfer to someone that can help. In this case, it was not an issue of choosing the right treatment fit, per se, but instead, moving this client through the system into space where the right clinician could intervene.
One day on the way to work, I got a text message from this client’s mother. The client, the same one I requested be transferred, attempted suicide the night before. I will never forget reading that message, and pulling over to the road, pained, hurt, angry, and all the emotions that come with the request not taken seriously. When the time finally came, and the client finally attempted suicide. Even this ethical problem does not speak of the willful and intentional breach I am gesturing towards, which happens all the time, just shy of physical and psychological terrorism inflicted upon this vulnerable population worldwide.
To be sincere. There have been times when this writer’s professional shortcomings were made visible and evident by the clients I have worked with without success. There have been times when the impulse to lash out at the client has crossed this mind in session. Call it lack of faith in recovery, term it transference or countertransference, or unprofessionalism and questionable values. Ever feel this impulse? I have a first hand in the field, in the clinic, and even in the documentation.
Even while writing and documenting cases, this writer has felt the urge to go ahead and use language to trigger, hurt and shame others to get the message across at all costs because the client’s life depended on that even if it meant taking the risk of de-stabilizing a client’s emotional state.
Of course, like the therapist who triggers his or her clients in a controlled environment, to map-out their clients distress tolerance skills, would only use language to de-stabilize for the purpose and aim to bring the reader to a more profound truth and insight into the world and their knowledge of where they stand in its ever-changing and rolling landscape of psychological land mines and personal plight.
Ultimately, 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 impulse I have to do good by any means necessary? Does this any means necessary idea of “help” genuinely helping? Where does the pendulum swing on the scales of good versus evil for this therapist and colleagues?