Professional Ethics and Law in California, 2nd Edition _ ____________________________________________
THE THERAPEUTIC RELATIONSHIP The relationship between the clinician and client sets the course for providing ethical treatment. Although many issues concerning this topic will be addressed throughout this course, the initial contact with the potential client sets the tone for treatment. For example, the first communication with the client can convey an atmosphere of support that sets the foundation for building trust. Professionals must also carefully consider that when ser- vices begin, the professional relationship should proceed with cultural sensitivity. During the course of treatment, an effort must be made to revisit informed consent issues as the treat- ment plan evolves, as well as consult with other professionals to avoid the risk of potential ethical conflicts. Professionals need to take reasonable steps to ensure that clients understand the implications of any diagnosis, assess- ments, treatment, methods, Health Insurance Portability and Accountability Act (HIPAA) precautions, fees, and billing arrangements. ETHICAL DILEMMAS Not every issue of ethics can be covered by published standards or by codes of ethics. Social workers may find themselves confused about whether a situation borders on an ethical violation because the issue may not be clearly defined by the code. There also may not be an obvious violation or the social worker may not know how to proceed. These situ- ations represent ethical dilemmas that are likely to occur in every social work practice. Barsky (2014) defines an ethical dilemma as a situation that creates some tension. He explains that in a true dilemma, there is no clear, single answer that satisfies all of the different ethical and legal imperatives that apply to the case. This situation may occur when: • There are two ethical standards or rules that conflict . • There are conflicts between the values of the social worker and those of the client . • A conflict occurs between the obligations to an agency, versus the obligations to a client . • Conflicts occur due to religious, cultural, or political beliefs . • No clear answer is apparent to meet the obligations or the ethical and the legal directives of the profession . One example of a common dilemma involves issues in decision making in end-of-life situations. An individual in an end-of-life stage may claim the right to terminate his or her own life. The laws vary concerning these issues throughout the United States.
Given her strong belief in client self-determination, the client’s belief in her ability to assist, and her willingness to read the literature and consult the Internet on protocol, Mary agreed to revise their plan of treatment and proceed. Example 2: Joaquin, a licensed clinical social worker, and his client, a young man with schizophrenia, have successfully worked together to achieve stability in symptom management and independent living. Joaquin and his client are close in age, have many interests in common and consequently have achieved a strong rapport and mutual trust. Now Joaquin is transferring to a supervisory position, which will effectively end his professional relationship with the client. His client wishes to continue their relationship as friends and Joaquin is tempted to do so. In these two examples, each mental health practitioner demonstrates both a compassion for and commitment to their respective clients. They are at a crossroads in their relationship with their clients. When deciding what to do next, they must consider various issues that include what is in the best interest of the client and the client’s right to self-determination. THE PRIMARY REASON FOR ACTION What is easiest, most comfortable, and/or desired by these mental health practitioners should never be the primary rea- son for action. If the needs of the client versus mental health therapist were the only considerations, decision-making would be easy. However, the mental health worker must also consider the ethical guidelines established by various government agen- cies and national mental health professional associations, as well as the law. In the first scenario, Mary must balance both her and her client’s desire to continue what appears to be a comfortable and trusting therapeutic relationship with the need to provide the most effective service for the client. Clearly Mary is not quali- fied to provide the service this client needs. Is her plan for a crash course in transgendered treatment adequate? Should she make a referral to a more competent therapist? Should she work with the client to overcome the financial barriers he is facing? If Mary makes the wrong decision, she might either violate ethical guidelines or the law, or both. She may be committing a medical error and putting her client at risk of harm. Her actions may also result in Mary being sued and/or censured. Joaquin must ask himself the question, “Am I considering crossing the boundaries of our professional relationship for my own needs or for those of my client?” Clearly both Joaquin and his client value a friendship, but what potential harmful impact could this have on one or both of them? Ethical decision-making is a complex process, requiring mental health practitioners to look at not just the immediate impact but also the long-term and future consequences of their actions.
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