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This paper will describe and marries the interview, including my reaction to the interview, my inner dialogue, what I learned in the interview process and how my expectations regarding ethical practice have been influenced or changed by the interview process. My interview began by asking about how clinical ethics affects the normal day to day work of a therapist. The therapist, Tom, responded by saying that clinical ethics permeates virtually every part of the therapists work day, the actions they make and their decision making processes for treatment.
For example, it is important that the linen be involved in the treatment plan development, not only for their own benefit of success but also as part of the informed consent process. If the approach is not a good fit for the client and is not modified, the chances for success diminish greatly. Also, clients who feel involved in their own treatment are far more likely to put effort into their success. As I heard this, I began to think of what was discussed in my class lecture and how the material coincided with real time practice. My internal dialogue was, “that makes sense” and “this is all coming together now’.
Confidentiality Another aspect we discussed was the importance of informing the client of the limits of confidentiality. Tom stated that many clients have a preconceived notion that anything that is said during therapy remains confidential; which is not the case. The client must be made aware that any threat of harm to oneself or another must be reported. He said that as clinicians, we are mandated reporters and are required by law to report this information. I asked about how a therapist would deal with a client who made statements of self-injury or suicide.
Tom said that as a beginning therapist, one should rely heavily on supervisory guidance. As a therapist becomes more experienced, it becomes easier to identify whether a client truly has intent to commit suicide or if the statements reflect something else. Tom stated that it is usually best to side with caution and act on the information than to dismiss it and risk a worse outcome. My immediate internal dialogue to this was, “I’m really worried about facing this dilemma”, “l hope I make the right decision”. Another aspect of confidentiality we discussed was the risk of seeing a client in public and how to respond.
While a large city is not as problematic, Tom stated that in a small rural own where everyone knows everyone, it can be difficult. Tom stated that it is usually best to address this issue in the beginning so that the client is not surprised by my response. I thought, “l will have to be mindful of this when I begin practicing. Boundaries I asked Tom what difficulties he might have encountered with clients when it comes to time and place of sessions, and fees. He stated that time can sometimes be a factor when the client wants to “run over” on the session time.
He said that part of the art of counseling is cueing the client in advance to let them know that the session ill be ending soon. If you don’t, it can disrupt the rest of your day scheduled sessions; it’s also unfair to your other clients. Another aspect of time, Tom said, is that it is important that your client know to arrive on time for their session. If it becomes a problem, a client can sign a contract with the therapist agreeing to arrive on time; it is a meaningful symbol of the client / therapist relationship as well as professional boundaries.
After hearing this, I thought, “that makes sense” and “l have to set these boundaries or my clients’ will take advantage of me”. Tom also mentioned the topic f dual relationships. He said that non-sexual dual relationships are not unethical or illegal but can be problematic if clear boundaries are not set. In fact, he said, “some theoretical approaches such as humanistic and cognitive behavioral therapy consider dual relationships to be an important and integral part of the treatment plan.
He said that in his experience, setting these boundaries at the start of the relationship sets a good precedent and can be reviewed later if difficulties arise. Dual relationships cannot always be avoided so it is best to be prepared in the event this arises. Tom dated that if you are not comfortable with a particular client with regards to a dual relationship, it is usually a good idea to discuss it with a supervisor. A more experienced clinician can usually put the problem into perspective before you decide to refer the client.
My initial thoughts were, “l would seek a referral” but later, my internal dialogue was “talking to someone would be a better idea than Just reacting”. Therapeutic Relationship I asked how ethics played a role in the therapeutic relationship. This question prompted a discussion on the beneficence, competency, and the balancing of risk ND harm. In order to be able to practice with beneficence, Tom said, the therapist must use a holistic approach. A practitioner who can only deal with patients on anything other than a physical level cannot be a ‘good’ practitioner.
My internal dialogue was, “the therapeutic process involves treatment on many levels”. Tom stated that a therapist has an ethical responsibility to maintain competency in order to effectively treat their client. This concept ties in with the practice of beneficence. It is not enough though to have the technical skills of a therapist. A good therapist can apply more innate skills including empathy, compassion, humility, a strong sense of self and a high level of self-awareness. I thought, “these are skills I can only gain through practice”.
The balancing of risk and harm is something that every therapist thinks about, Tom said. Treatment decisions involve a careful balancing of risks and benefits. The best way to make that decision is to involve the client in the decision making process and to use empirically sound methods in one’s treatment. The ethical importance of this concept is that we don’t let our ego blind us from providing retirement that is the most beneficial and least harmful to the client. My internal dialogue was, “I will always try to remember that the client’s needs come first”.
Safety Concerns On the topic of safety concerns, Tom stated that the ethical piece of safety comes from our responsibility to inform the client of our obligation to their safety and the safety of others. This includes waiving some client’s right to confidentiality in order to contact family members or persons who may be the target of harm. It might also be necessary to notify the police or state agency as well. In the event that the police are ladled, he said that only information relevant to threat should be disclosed.
He stated that it is important that when a situation arises which might compromise confidentiality; a clinician must also alert and confer with their supervisor to insure that imminent danger exists. Tom stated that it is important to be familiar with the Code of Ethics and the state law which regulates breach of confidentiality. It is also important to insure that proper documentation of the event is recorded should the need to go to court, arises. My internal dialogue during this conversation was, “this is tremendous responsibility’ and “I’m surprised that there are still limits to confidentiality when such a danger exists”.
Mandated Reporting I’m familiar with this term as a direct care provider. My ethical responsibility is to insure the safety and welfare of the clients I serve. I asked what the ethical responsibilities were as a therapist since the role of a therapist is different. Tom stated that as a mandated reporter, we are required to report any cases of abuse or neglect. I asked who that applied to and he responded, basically anyone who does not have the ability to protect themselves from abuse or neglect. He cited examples such as children, elderly persons or someone who was considered special needs or developmentally challenged.
I asked what, if any, ethical dilemmas existed for these types of reporting. He stated that the difficulty is in making sure that we have enough reliable information before we make a phone call. I asked how one would do that. He stated that it is important to ask questions objectively and avoid any leading questions. The clinician should also be familiar with the state law since laws are different in each state and also include how soon you are required to report the abuse or neglect. The information that is passed on to the state agency should be limited to the reported abuse or neglect and not include peripheral information.
My internal dialogue was, “making the wrong call of abuse could ruin the family’. I also thought, “l think I will be deferring to my supervisor and colleagues for advice”, “this is a tremendously complex topic”. Informed Consent On this topic, we both agreed that that ethics related to informed consent was a very comprehensive subject and that we would discuss those areas encountered most frequently in the clinical setting. Tom stated that informed consent is an ongoing recess in the therapeutic relationship. The client becomes part of the process which in turn improves the likelihood of a successful outcome.
He said that all therapists that he knows practice informed consent but not all do so in the same way. He said that because most clients cannot remember all of the facets of informed consent. It is more practical to inform the client at different phases of treatment or when it becomes necessary, such as safety and confidentiality. It can be more damaging at the onset of treatment to prolong needed help in lieu of signing large stacks of paper. He said the reason is because the therapist is in the early stages of forming the relationship and developing trust.
Signing large stacks of informed consent documents distances the therapist from the client and sends the wrong message to the client; that the client’s needs are being ignored. Tom stated that the therapist must balance the need for informed consent with the need to be sensitive to the client. Informed consent, he said, can also become ethically challenging when a client’s disorder prevents them from cognitively have an understanding what their sights are. I asked what a therapist would do in such a situation. He stated that you just have to do your best to explain informed consent to the client in the best way they can understand.
It is also helpful to ask the client if they have a legal guardian that can give permission for them. The most important thing to remember is that as clinicians, it is our responsibility to protect the client’s rights and welfare. My internal dialogue was, “l can appreciate the importance of protecting the client’s rights”, and “the client should know what is going on”. Therapist Self-Care The last topic we discussed was the ethics of therapist self-care. Tom stated that therapists that do not have a healthy outlet are very likely to burn out quickly.
They are also doing an injustice for both themselves and their client’s. He said that therapists have to listen to a wide range of problems and challenges and it is important that they have an outlet at the end of the day. Part of the importance of self-care can be attributed to the PAP preamble which states that a therapist should do no harm. A therapist has a duty to be mentally fit in order to effectively serve their linen. My internal dialogue was, “l will need to find a hobby’ and “l realize how important it is to take care of ourselves”.
Summary Throughout this interview, I learned about a broad range of ethical topics as it applied to the clinical setting. For me, since the field of psychology is an informal science, it is critical that the concepts and practice of ethics be applied to this field to protect the public as well as maintain its legitimacy in the industry. I also feel that the moment we begin to falter in the practice of ethics, the greater the likelihood that buses of clients’ rights will occur and the substantive value of treatment will suffer.
The information I received from my questions told me that the concepts we have learned about in class are being practiced in the industry. This is important to me because I wanted to know if the information I am learning about is being actively practiced. My inner dialogue throughout this interview was “this is great information I am getting from a practicing clinician”. This interview put the concepts of ethics into perspective for me. I was able to hear how a therapist applies the concepts of ethics n the clinical setting.
I think the topic of informed consent is probably one of the most important of ethical concepts because of its important role in the therapeutic dynamic. I feel that a client has an absolute right to be fully informed of the treatment they will receive as well as the benefits and risks they may experience. As a therapist, I would insure that my clients’ are informed and that their input plays a role in the development of their treatment plan and goals. The interview process itself was an enjoyable experience however I wish I could have referred my questions.
In retrospect, I feel that the questions I asked were too general and I would have asked more specific questions and examples. Also, I didn’t feel that thirty minutes were ample time to obtain all the information I needed. In order to complete the interview on time, explanations to questions had to be shortened. Overall though, the interview process was very interesting and I enjoyed the opportunity to speak with a professional in the field. My perception of ethical practice in the field was not altered a great deal by the interview. I think that the reason for this is because of my GE and work experience in the field.
I also found that many of the concepts of psychology in clinical practice overlap in many areas such as confidentiality, informed consent and mandated reporting. I had certain notions before the interview that I believed that perhaps therapists did not necessarily practice ethics at the same standard as we learned in our lecture. I was elated to hear that my notions were wrong and that ethical practice is actively practiced in the field. I feel that the Code of Ethics plays an important role for all counselors and maintains a professional standard that we can all strive towards.