Camielle Call, LCSW

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ETHICS To Do or Not to Do. . . What An
Adventure!

• Camielle Call, LCSW
• This presentation may be reproduced with written
  consent from the presenter.

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ethics
ethical
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ETHICAL
? The discipline dealing with what is good and
bad and with moral duty and obligation ? A
set of moral principles or values ? A theory
or system of moral values ? The principles
of conduct governing an individual or a group
? A guiding philosophy
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I THINK WED BETTER GET THAT KID TO A
PSYCHOLOGIST
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SITUATION ETHICS
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SITUATION ETHICS
Yep! Its REALLY in the dictionary!
Function noun a system of ethics by which acts
are judged within their contexts instead of by
categorical principles
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Lets discuss this. . .

• Is it situational?
• Is it standard, regardless of the situation?
• To what standard will we be held?

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Boundaries Dual Relationships
Where my fist ends, your nose begins. . .
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Boundary Concepts
?Boundary issues occur when practitioners relate
to clients in more than one relationship
(professional, social, business) and can occur
simultaneously or consecutively.
?Dual or multiple relationships are not
necessarily unethical some are and some are not.
Frederick G. Reamer, PhD Tangled Relationships
Managing Boundary Issues in the Human Services
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Typology of Boundary issues
Major Themes
?Altruism
?Personal Benefit
?Intimate Relationships
?Emotional Dependency Needs
?Unavoidable Unanticipated Circumstances
? Sexual Misconduct
Frederick G. Reamer, PhD Tangled
Relationships Managing Boundary Issues in the
Human Services
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Offending Clinicians
One bad apple can spoil the whole bunch baby . .
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Do we truly have offending clinicians? That
is, those who may purposely cross boundaries?
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Gary Schoener John Gonsiorek (1990) provide a
typology of offending clinicians in
Assessment and Development of Rehabilitation
Plans for the Therapist
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• Psychotic, severe borderline, manic disorders
• Sociopathic severe narcissistic personality
  disorders (self-centered exploiters, calculating,
  deliberate)
• Impulse control disorders (including paraphilias)
• Chronic neurotic isolated (excessively needy,
  depressed, low self-esteem, poor self-confidence)
• Situational offenders (marital discord, loss of
  relationship, professional crisis)
• Naïve offenders

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Robert Simon (1995) suggests a similar typology
of the offending clinician inThe Natural
History of Therapist Sexual Misconduct
Identification and Prevention
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• Character disordered (borderline, narcissistic,
  antisocial personality disorder)
• Sexually disordered (pedophilia, paraphilia,
  sexual sadism)
• Incompetent therapist (poor training, persistent
  blind spots)
• Impaired (alcohol, drugs, mental illness)
• Situational reactors (marital discord, loss of
  relationship, professional crisis)

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Further. . .Simon gives names to these
offending clinicians
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How might boundary violations emerge?
Simon, 1999
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Simon, 1999
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What consequences might occur for the client when
a boundary violation happens?
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• Increased anxiety
• Identity confusion
• Hopelessness/depression
• Feelings of self-worth
• Mood lability
• Feelings of rejection
• Cognitive dissonance / impairment
• Feelings of abandonment

• Self-esteem issues
• Destructive dependency
• Mistrust of therapists
• Displaced anger
• Impaired relationships sexual other
• Guilt / self blame
• Substance abuse
• Isolation

Adapted from Frederick G. Reamer, PhD Tangled
Relationships Managing Boundary Issues in the
Human Services
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What emotional needs are being met when the
clinician makes choices that lead to boundary
crossings and/or violations, ultimately resulting
in unhealthy consequences?
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We clinicians have the obligation to exemplify
clear boundaries. . .
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When we do not, we have only ourselves to blame
for any resulting consequences.
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Suicidality Homicidality
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Suicidality

• In assessing liability, courts review three main
  criteria
• ? Foreseeability of the attempt
• ? Reasonability of professional judgment
• ? Thoroughness with which treatment plan was
  implemented

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Homicidality

• Duty To Warn
• Tarasoff Case

Discussion
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Risk ManagementRisk management is a process
whereby mental health practitioners make
decisions about professional practice after
analyzing the implications of these decisions for
ethical, regulatory, and legal risk and
liability.
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Risk Management Strategies
DECISIONS!!!
MIXED MESSAGES
QUESTIONS!
Self Preservation
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DECISIONS!!!
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MIXED MESSAGES
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FIRST SHE SAYS GO OUT. NOW SHE SAYS COME IN.
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QUESTIONS!
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Self Preservation
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Head-shrinkers
ON THE OTHER HAND, THE NEIGHBORS KEEP PLANTING
NICE BIG TREES NEXT TO US.
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Be Clear with Self and then . . .

• Set clear concise boundaries that are concrete
  rather than abstract.
• Evaluate the potential for dual relationships and
  / or boundary crossings
• If or when an unsure situation arises, consult
  with colleagues, check professional ethics,
  regulations, statutes.
• Remain in check by being consistent
  unambiguous.
• Determine whether any manner of dual relationship
  is warranted, or even justifiable.

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• When risk is high or questionable, seek out
  supervision.
• Sometimes it becomes necessary to refer clients
  to other clinicians in order
  to minimize risk and to prevent harm.
• Consider other potential incompatible roles such
  as supervisor/supervisee or instructor/student.
• And remember
• DOCUMENT
• DOCUMENT
• DOCUMENT

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Can we get there from here?
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In this uncertain and sometimes scary world, what
does the clinician bring to the therapeutic
environment?
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Safe place for client to feel Trust, openness,
respect Space. . .physical, emotional,
intellectual Safe for client to focus on
healing Clinician Safety Net Codes of
Ethics
Our boundaries define the type of interaction we
will have with each individual client.
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SELF-CONSIDERATIONS
Best Practice Principles Do I get the right
exercise? Mandated Expectations Am I eating
properly? Moral Value System Service Provision Do
I take time to relax breathe? Current
Legislation Do I need a vacation?
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Other Considerations
There are a number of considerations with the
current federal regulations and health care,
mental health care, and managed health care
trends.
Discussion HIPAA AOD
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The Alcohol and Other Drug (AOD) Confidentiality
Rule42 CFR Part 2
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The HIPAA Privacy Rule45 CFR Parts 160 164
Get Hip With HIPAA!
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What are my personal values and principles? Do I
have a personal creed or motto? How do I
operate in my personal life? And how do I
transfer that into my professional life?
Camielles Creed
I will attempt to help others feel better about
themselves after they have left my presence than
they felt when they came into my presence.
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Each day I remind myself that the work I do is
valuable!