Ethics Part 1

Hi and welcome back to your presentation on ethics. This is part one of a multi part series brought to you by allce.com today, or at least in this hour, we're going to review different types of ethics, discuss different ethical decision making models, examine issues of transference, countertransference and therapeutic neutrality. There are lots of different definitions today, so just kind of bear with me, it's not going to be the most exciting class. And discuss warning signs of impairment. Moving on. So, codes of ethics. Most codes of ethics are broad and general rather than precise and specific. What does that mean? That means they give you kind of broad strokes about what's supposed to happen. But as clinicians, as responsible professionals, we have to take that and look at our specific situation and figure out how it applies. Ethical awareness and problem solving skills will determine how you translate general guidelines into professional behavior. So being aware of what is ethically expected and your problem solving skills, how you're going to deal with this particular issue. Now, one issue that comes up a lot that has legal and ethical implications is, is reporting of child abuse and neglect. At what point is it crossing that line? Where it's a reportable offense? If the child hears the abuse? If the child sees the abuse? If the child is abused? Well, obviously the last one, yes. And so in different places, you may have to work with your local department of children and families or whatever it's called, and your supervisor and your legal counsel to decide exactly what that threshold is, where you think it is necessary and mandatory and ethical to make a report. That is only one of many issues that we confront on a day to day basis. So ethics are designed to fulfill three objectives. We want to educate professionals about sound ethical conduct. We want to provide a mechanism for professional accountability. Now, ethics don't always work and we'll talk about that in a little while. Where we have to conform to the law and most closely conform to ethics. But it gives you a framework from which to look at things and look through things or think through things. And ethics act as a catalyst for improving practice. How could I do this better? How could I have done this in a way that was more beneficial to the client? You know, we leave counseling, grad school and we know that saying above all, do no harm, well that's wonderful, but there's a lot more to ethics than doing no harm. We actually want to look to help the client improve their quality of life. The primary purpose of codes of ethics is to do all of the safeguard the welfare of clients by providing for what is in their best Interest. Now, for each individual client, an ethical guideline is not going to say you need to do this, that and the other for Jane Doe. But it gives us broad strokes about what is and is not in their best interest. What is in their best interest? Being available, the counselor should be emotionally and physically present. The counselor should not cheat, exploit, or in any way engage in sexual relationships with the clients. Pretty self explanatory. But the ethical guidelines set up this framework in order to help people understand what they can expect when they come to counseling. It guides professionals in their work and it also safeguards professionals by providing guidelines for behavior. Now, since we know that a lot of people, no matter how many times we say it, have difficulty refraining from engaging in relationships with their clients, ethical guidelines are out there saying you shouldn't engage in sexual relationships or dual relationships when at all possible with your clients. Now we'll talk about this a little bit more later because evidently we still need to go down this road. But ethically, the duration between discharging a client and engaging in some sort of other relationship may only be as short as two years after discharge. But in some states, if you read your licensure or certification laws, it may say in perpetuity, which means forever. Once they're a client, they're always a client. And you can never engage in a dual relationship or heaven forbid, a sexual relationship with that person. So be aware of both your ethical guidelines and your legal guidelines. So community standards are what professionals actually do. Now, we would love to live in a perfect world, but we don't. So community standards are what we do in the face of certain situations on a day to day basis. How do you handle when a client starts to decompensate? Well, in a perfect world, you have a psychiatrist on staff that would do an assessment. That doesn't happen. A lot of us who are in private practice, we don't happen to have a psychiatrist right next door that we can knock on the door and go, hey, Dr. Jim Bob, I need you to do an assessment. So what do we do? Well, the next best thing is to get an immediate assessment. In real life, does it happen in certain places, you have to call out a team that will send someone out to do an assessment for an involuntary commitment that can take up to 8 or 12 hours to get the person out there. Is that ideal? No. Is it the community standard? Yes. So you need to know how to function within that community standard. What are you going to do with this client who's decompensating or who is suicidal? For that period of time? And at what point do you need to involve law enforcement or emergency service personnel? Because it's gone past the bounds of what is reasonably able to be handled in an outpatient office setting? Laws define a minimum standard society will tolerate and are enforced by the government. So there are a lot of things and it's really important to read your laws and your codes for licensure or certification in your state, because there are laws and codes that pertain to what titles that you can use, what you are expected to do, what you're not allowed to do under your current licensure. It also talks about things like whether you are able to to report to a partner the threat of harm if one of your clients is HIV positive and engaging in risky practices. It defines how long between discharge. Some of them define how long between discharge and the time that you can engage in a dual relationship. Again, like I said earlier, sometimes it's never. We're going to keep coming back to that same theme. You need to be aware of the legal ramifications as well as the ethical guidelines before you act. The American Psychological association indicates psychologists should seek to resolve conflict in a way that complies with the law and most nearly conforms with ethics. Sometimes what you have to do for legal reasons isn't what you would necessarily really want to do in the ideal world, but you have to. So you need to try to merge the two as best as you can. Values pertain to beliefs and attitudes that the clinician has that provide direction in everyday living. What are your values? Ethics pertain to the beliefs we hold about what constitutes correct and moral conduct. And I'll talk later about the mom test. And you know, you can put whatever figure in there that you want to, whether it's your mom or your higher power or whomever, but if that person found out what you did, would you be okay with it? Can you go up to that person and say, well, obviously, without breaching confidentiality, please don't do this with your mother, but if they found out that you handled a situation in a particular way, could you hold your head high and go, yes, I did that, or are you going to be ashamed? That's a pretty good drop back and punt. Quick test. If you've got to make a snap decision now, that is not the best course of action for ethical decision making. There's a whole process, but it gives you an idea if you are behaving ethically or not. Ethical decision making involves an evaluation of actions on the basis of a broader cultural Context. Remember I said ethics are broad and you've got to take information from the environment. What's going on with that particular patient, that particular patient's culture, what's going on with you, what you're able to do at that particular point in time in order to most ethically provide treatment to that patient. Ethical conduct is that behavior that results from a combination of knowledge of the ethics and a clear conception of the philosophical principles that underlie the ethics code. There's the words the blah, blah, blah, blah, blah. But what is the spirit? What are we getting at? Do no harm, thinking, fidelity, beneficence. You know, we'll go through those in a little while. What do those mean? And what do those mean to you and to your patients? So we talked a little earlier about community standards. They often become the ultimate legal criteria for determining whether practitioners are liable for damages. They often define what is considered reasonable behavior. If you put six clinicians from your community in the same room and gave them the same scenario, would they have done the same thing? Mandatory ethics describes a level of ethical functioning wherein counselors are merely acting in compliance with minimal standards. This is pretty much legal behavior. You are doing the bare minimum of what you have to do to be considered in compliance with laws and ethics. Aspirational ethics describes the highest standards of conduct to which professional counselors can aspire. So what's the difference? Aspirational ethics. I would love to be 100% of the time on my ethical game and able to be beneficent and non mal, maleficent, non malfeasant, whatever. I can never pronounce that word. Do no harm. Help our clients improve their quality of life, empower them and engage in all those other ethical principles. But sometimes we can't because we're constrained by other factors, usually the law, but not always. We're human. We make mistakes, but we need to learn from them. Principal ethics is a set of obligations that focuses on a moral issue with the goals of solving a particular dilemma and establishing a framework to guide future ethical thinking and behavior. We talked about abuse reporting, so this is one of those particular dilemmas on which we would look at the principles that were charged with upholding and go through a process to decide what the most ethical course of action would be in a particular circumstance. Virtue ethics focuses on the character traits of the counselor and non obligatory ideals rather than on solving specific ethical dilemmas. So let's talk about virtues a little bit. We're talking about all these sort of vague words with ethics and principles and morals and now virtues, characteristics of virtuous professionals. They're motivated to do what is right for the right reasons, because it's the right thing to do, not because I avoid getting in trouble, although if it's the right thing to do, you're probably going to avoid getting in trouble, but because it's the right thing to do. For the patient, they have discernment. They can sort through and see the forest, for the trees and in complicated situations. And they can be sensitive to nuances. They have compassion that involves regard for the welfare of others and a sensitivity to the suffering of others. So I really, I don't want to see people suffering and I want to help them achieve their highest quality of life. So I'm going to meet them where they are and try to help them get to however they define that. One of the issues that comes up sometimes is when you're working with persons who are homeless. Some people who are homeless are making a conscious choice to be homeless and forcing them to try to get a job and live in a house with a white picket fence is going against that particular person's wishes, desires and values. So we do need to be compassionate and help them live a high quality of life as they define it. And we need a virtuous professional is self aware and has the capacity for self observation. They're aware of those times. You know, we've all had clients, or most of us have at times where we've just, we've wanted to caretake them, we've wanted to nurture them more like a mother or father than like a clinician. And that's when your spidey senses go, whoa. So what's going on here? What is it about this client that is triggering this reaction? The reaction itself is not necessarily the problem as long as you figure out what it's about and keep it in check. Because that's not your role. Your role is not to be parent. Your role is to be a counselor. So we need to exercise prudence, be prudent in your actions, think first, be cautious, be intelligent, exercise integrity, do what you say you're going to do and uphold those things that you say you do. If you say you're going to be honest, well then be honest. And benevolence. Doing the right thing for the right reasons. Basic moral principles guiding ethical decision making are autonomy. We want to encourage our clients to be autonomous, not to be dependent on us. Now, autonomy, again is one of those things that's kind of gray. And because not all cultures prize individuality and independence, Some cultures really look toward the family unit or towards interdependence. So autonomy has to be defined within the confines of that client's culture. Beneficence. Doing what's right for the right reasons. Justice. Helping clients. Being an advocate, helping them achieve their highest quality of life, helping them achieve their goals and helping them try to right the wrongs that are keeping them stuck. Fidelity. Being faithful to your client. If you say you're going to do something, do it. One of the fastest ways to get a client to decompensate is to say you're going to do something and and then not do it. The next fastest way, or I think they're tied, is to double book. If you tell a client they're going to have an appointment at 10 o', clock, don't schedule somebody else for 1015 unless you're just taking their vitals. That's not fair. That's not being faithful to your client and doing what you say you're going to do. If you say you're going to see them at 10, see him at 10 and block that hour out for them or 45 minutes, or however you do your scheduling. Veracity. Be tenacious, don't be apathetic, just alright, you're here for your hour. Why don't you go ahead and just talk and be off in la la land somewhere. You want to be there, you want to be on, you want to be what your client expects you to be and then some be all that you can be. No, it's not the army and non malfeasance above all, do no harm. Sometimes you'll wake up in the morning and you'll be like, I really don't want to cancel my appointments today, but I cannot be emotionally present and cognitively present for my clients because I feel awful or I have this crisis going on in my world and I need to tend to that and I'm not going to be able to focus. Well, you have to weigh the options of canceling your appointments or being there, but kind of not being there. What's more fair to your clients? Probably canceling your appointment if you have the ability to refer them to somebody else for crisis counseling. Fabulous. That's actually recommended as one of those community standards. If you can't see them, make sure there's some sort of drop back and punt option in case they happen to also be in crisis. Okay, so I keep talking about these decision making models and we're going to look at two of them. The feminist model, pretty simple. It says recognize the Problem. Choose your solutions. There's usually at least an A or a B. Report or not report, refer or not refer. Choose the solution, review the process with the client and re choose solutions as needed. Now, sometimes you don't have the luxury of doing this if you need to make an emergency call. But when possible, go over your thought process with the client and help them understand, this is what I'm doing. This is why I think it needs to be done. What are your thoughts on it? Implement and evaluate the solution. Put it into action. 80% of the time you're going to put it into action and it's not going to go 100% as planned. That's okay. Evaluate the solution and continue to reflect. If you put it into action and it's going great, even if it's not 100% the way you expected, wonderful. If not, re evaluate and adjust as needed. Always try, when appropriate, to keep the client involved in this process because it is their treatment and it is their life. Now, the social constructivist model is a little bit more detailed. You identify the problem, you review the relevant ethics codes, you review the applicable laws and regulations. It's kind of assumed in the feminist model that you have those present in your mind. You obtain consultation, which they didn't talk about so much. In the feminist model, consider the possible and probable courses of action. If we did this, it could go this way or it could go this way. Enumerate the consequences of your various decisions. What are the positive possible outcomes? What are the potential catastrophic outcomes? And decide on what appears to be the best course of action. It is prudent to make sure that you have someone, some other colleague, a supervisor, a former professor, someone with whom you can consult and bounce ideas off of that is familiar with and or guided by the same code of ethics. An attorney is also helpful. If you have an attorney on staff and you're faced with an ethical dilemma, it's always helpful to bounce it off the attorney. They're obviously going to look at it from the legal standpoint and may not be familiar with all the nuances of our ethical codes. But it's another point of view, self awareness. Professionals who work with others have a personal responsibility to be committed to awareness of their own life issues. Okay, I want you to digest that for a second. Committed to awareness of your own life issues. And that could be your. We have foster animals and last week one of our fosters sprained his wrist and I was just so worried about him because I wasn't for sure whether he had dislocated his wrist or sprained it. I knew there was no bone damage. So, you know, the little mother in me was all worried about this kitten. Wasn't as focused throughout the week as I would have hoped to be. Now, I wasn't seeing any clients last week, so it wasn't a big deal. But that's one of the things you need to be aware of if you know that there are certain things that may throw you for a proverbial loop. Be aware of what those are. If you wake up and you're feeling under the weather, know how much under the weather you can participate and actually be present for clients. Know how medication affects you. Whether it be medication because you went to the dentist and got a root canal or medication decongestants. I know cold medication makes me loopy as I'll get out. So I'm probably best to not interact with clients if I'm sick enough that I'm actually having to take medication. It's up to you what your life issues are. Without a high level of self awareness, counselors are in great danger of obstructing the progress of their clients by shifting the focus of of therapy from meeting the client's needs to meeting their needs. Another good example is if you're worried about something in your life, maybe you've got family coming soon and you're concerned about how that visit's going to go, and you start turning the session around and asking your client for advice, that's not good. Okay, there's self disclosure and then there's turning the session around so you actually become the one in therapy. Not fair to the client and not ethical by any means. To the degree to which we're unaware of our needs and personal dynamics, we will probably use our work to satisfy our own unmet needs. If you need to be needed and you're unaware of that, then you may use your work as a means of surrounding yourself with people who need you. Unfortunately, if you surround yourself with people who need you all the time, you're going to burn out. We'll talk about that in a minute. And. Or you may steer clients away from exploring conflicts that you yourself are unwilling to acknowledge. So if you're dealing with issues of addiction or depression or marital problems and you just really don't want to go there with your clients, you need to look at why. This is one of the reasons that using videotapes is so wonderful. By videotaping your sessions and reviewing them yourself and then destroying them or whatever you do, it helps you see if there Are particular times or particular topics that your clients bring up that you hear and you just do a turn really fast that gives you a clue that you've got some issue there and that you may need to deal with. The critical point is not whether you happen to be struggling, but how you're struggling. We all have stuff. We don't live in a bubble. It's whether it's going to impair your functioning with that client. Transference is the process in which the client projects onto the therapist feelings or attitudes they have towards significant people in their lives. For a lot of my clients, I'm about the same age as their mother, so, you know, I get a lot of mommy issues. Transference is the process which the client projects onto the therapist feelings or attitudes they have towards significant people in their lives. Now, for some clients, this can be a very useful therapeutic tool. If they have issues with relationships with the opposite sex and their therapist is of the opposite sex, they may be able to put some transference things, put that transference out there and work through those issues that they have relating to the opposite sex. And again, this is not forming relationship. This is communicating and appropriately communicating with people of the other gender or the same gender, whatever it is. Transference is not necessarily just about gender. It could be your age, it could be your hair color, it could be the perfume you wear, it could be how you dress. It's hard to tell exactly what's going to prompt a transference reaction. It's also very important to recognize that transference does not explain every feeling a client expresses with or toward you. Saying that the client got angry as a transference reaction may be true, but it could be the client was angry at you. So you do need to reflect and look and say, hmm, was this toward me, or was this toward this other issue? And work through it with the client. If they're angry at you, you've got to help them work through that, because this may be their first and only healthy relationship that they've had to date. So help them learn how to work through that anger. Apologize if necessary. Identify the issues that are present. But remember, you need to own your own behaviors. So if you deserved to have somebody get angry at you, own it and say, yep, I screwed up, you're right, that was inappropriate or rude or whatever. Countertransference is the opposite way. Any projection by a therapist that can get in the way of helping a client. Remember I talked about earlier, A lot of us have had clients at one point or another that we just kind of wanted to Nurture. We need to look at that and go, why am I wanting to mother this person? You know, obviously me being female, I want to mother them. Why do I want to parent this particular person instead of help them become fully autonomous, self actualized beings? In what ways do I think that I could be better in that role? Look at why they're bringing that out in you. Doesn't mean again that you can't work with them. But you need to keep that in check and make sure that you are operating from the standpoint of a clinician in an equal relationship. Helping the client become autonomous and all they can be. The following are examples that come out of countertransference. Being overprotective of the client. Treating the client in benign ways to avoid their anger. Needing constant reinforcement and approval from the client. So if you grew up in a household that was abusive and you try to avoid at all costs having the client get angry, that's your own issue. Getting in there. Anger is a very normal emotion. We need to help our clients learn how to experience it and how to deal with it. Seeing yourself in your client's shoes, constantly remembering how you used to be in the other seat, or seeing how you and that client have a whole lot in common, and focusing on that sexual or romantic feelings toward the client. You know, we talked about that already. Compulsively giving advice, not eliciting suggestions from the client, not leading them down the path, but telling them what to do and desiring a sexual relationship with clients. All of these can be in part because of countertransference. They can also be in part of a lot of other issues too. But be aware when these come up, because these are not healthy behaviors for us to be exhibiting in treatment. So we move on to therapeutic neutrality. If we're not supposed to do all those things, what are we supposed to do? Be neutral. You may not agree with the values of your clients, but it's essential that you respect the right of your clients and to hold a different set of values. Not everybody holds the same values, so you need to figure out what your clients believe instead of putting yours out there and having them go, no. Start from the very beginning, saying, help me understand how you would look at that. Let's talk about your values. What is important to you about this situation? Let the client tell you what's important to them. Inform your client of any areas in which you think you cannot be neutral. There are some things that you may not be able to be neutral about, so be aware of those things going into it. If you know this client is presenting with issues surrounding something that you can't be neutral about, probably best to really consult with the client and a supervisor or peer or something about whether this would be a good relationship to get into. Because if you can't be neutral, then once you get into the relationship, it's going to be a lot harder to make a referral. Your job is not to approve or disapprove of your client's values, but to help them explore their values and apply them to solving their problems. When you experience a value conflict, seek consultation before considering referral. What does it communicate to a client? When we reach a value impasse and we go, no, I can't do that, you need to go over there. Well, in healthy clients, they'll kind of look at you like, what's your deal? But most of our clients are coming to us because they don't have that sense of self that can say, well, fine, if you don't like it, I'll go talk to somebody else. It communicates to them that something might be wrong with you. It communicates to them rejection. That's not what we want to communicate. It also means in many cases, if we're referring out, that they've got to start all over again, and that's not fair. So we need to be aware, going into the relationship, the issues that may come up, which is why screening and assessment are so important. We need to be up front with clients about any issues that we see in the assessment that we may not be able to be neutral about and let them know at the get go. So impairment, we've kind of touched on this throughout the hour. But impairment presents as a lack of presence. You're either cognitively or emotionally not present with your client. You're physically there, but that's about it. You're absent a lot now. Being absent once in a while because you've got a cold, that's one thing, but two, three times a week, that's something else. Or regularly calling in sick to avoid seeing a client, that's a problem too. Very unethical apathy. If he comes, he comes. If he doesn't, he doesn't. He didn't show up. Oh, well, that's not okay. If your client doesn't show up, you need to follow up. Being apathetic about whether they improve or not, that's also not okay. You need to be hopeful. You need to have faith that the process works, and you need to communicate that energy addiction, well, that doesn't need any explanation. If you're starting to become addicted to anything, you probably need to look at how that's impacting your work. Being stressed out or burned out all the time. Again, impairment can be evidenced by sexual involvement with clients or having inappropriate boundaries. Too much touching, too much self disclosure, too much sitting in the room and talking like you're friends instead of having a goal oriented discussion. Client dependence may contribute to or be caused by counselor impairment. If you are available for your clients 24 hours a day for any reason that fosters client dependence, if you offer quick solutions, it could delay the client developing their own problem solving processes or, and this is one of my pet peeves, delaying client termination. Now, some schools of thought, some therapeutic issues this doesn't apply to. But the majority of people should not be in therapy for two, three, four years. If you're delaying client termination just because this is a client that's easy to work with, they show up every week and their insurance pays. That's not a reason to keep them in treatment. The effects of creating client dependence communicates to the client that they're unable to function without you. Now again, that goes back to impairment and ethics and solving your own problems through your work. It prevents many clients from experiencing a successful relationship termination. Clients. A lot of clients are really good at starting relationships and then they either drop out or are abandoned. And if you replay that in the therapeutic environment or you just drag them along the whole time, they don't have the ability to see what a proper relationship termination looks like. It prevents them from learning how to self regulate. It hinders the development of a social support system. If they can call you at 2 in the morning because they're feeling really, really anxious, they're not learning to use any of those tools that you're talking about in session. And they're not developing other people on whom they can rely when they're not in counseling anymore. And client dependence may lead to clinicians exploiting the client financially and or emotionally. Again, having the client come and pay for sessions long after they're not getting any benefit anymore. Attitudes that cause impairment. And I look at these, when I was writing this PowerPoint, I was like, you know, if my client came in and said these things to me, we'd be having a long hard talk about rational thinking. I should always, okay, there's the clue. Work at my peak level of enthusiasm and confidence. Should and always. I don't like either one of those words. I want to try to work at my peak level of enthusiasm and confidence. Okay, the next one. I must be Able to cope with any client emergency that arises. That's why we have consultation. We're not expected. We're humans. We're not expected to be able to deal with everything that life ever throws our way by ourselves. Have policies, have procedures, have backup plans. I'm expected to be a model of mental health. Well, you know, even. Well, I shouldn't say the healthiest person doesn't get sick. But we all have times when we're feeling depressed. We all have times when we're having a grouchy day. What we need to model is how we deal with those ups and downs. There is no normal, there is no perfect model of mental health. If you see somebody who's happy and just on all the time, I wonder about them. So we need to model normality. Yeah, I'm having a bad day. No, it's got nothing to do with you. And I have good boundaries. Here are my emotional boundaries and this is how I handle it. A client's needs always come before my own again. Always is in there again. We do need to put a client's needs out there. However, we also need to make sure that we are modeling appropriate boundaries. Especially if you're working with a client who has borderline personality disorder or impulse control issues. Sometimes they think they want to have or they must have everything yesterday and you're going to exhaust yourself trying to keep up with that client. So we need to try to help them figure out how they can meet their needs. It's not our job to rescue them all the time. Every once in a while you may have to, but we need to help them become autonomous. I am responsible for my client's behavior. If you even have to think about this one, I'm concerned. We need to be aware of our clients behavior. Ultimately, our clients are still responsible for our own, for their own behavior. That's why we have that whole duty to warn. But we have a duty to warn. We're responsible for our behavior. We don't want to provoke a client. We don't want to fail to warn. We don't want to fail to take necessary precautions. But ultimately the client chooses his or her own behavior. So prevent impairment through continued education. If you work with clients who have addictions or borderline personality disorder or some other personality disorder, it's really important that you stay up to date on the most common treatment methods that are working. Communicate with others in your field who work with that same population. It'll help prevent burnout. Personal therapy, periodic supervision, even if it's a professional group that meets once a week and you bounce ideas off and you talk about certain cases that that are going on in order to help you maintain some distance and get some perspective on cases that seem to be going really well, as well as cases that are challenging. Remember those cases that seem to be going super easy. You may be missing something, you may not. You may be fabulous. It can't hurt to have a discussion among other professionals and get their ideas. Ensure you've got peer interaction. Ensure you've got interaction with people who aren't peers. At a certain point you gotta put the therapy hour aside and engage with people doing fun stuff and maintain vitality. That means exercise, eat right, get enough sleep. All the things we tell our patients to do, we need to model it. So we've talked some about supervision and consultation and there are two different types of supervision. There's your pre licensure supervision that you have to get every single week. And then there's post licensure supervision consultation that we were just talking about that is really still ideal to keep going in order to keep that therapeutic perspective working with your clients. It helps enhance the skills and knowledge of the supervisee. I learn things from my peers all the time. It ensures the welfare of the supervisee's clients. We're ensuring that we're not having any blind spots doesn't mean that we're not good therapists. It means we're human. It serves a datekeeping function for the profession. So we can identify whether you've had 3,000 hours of supervision. Now after you get your license, it's not so much datekeeping anymore. And it is recommended even after licensure. You'll find after licensure it's not so stressful and it's actually pretty fun. Or at least I do, but maybe that's just me. As a supervisee, you have a right to sessions free from interruptions and distractions. And this includes post licensure supervision consultation. If you're talking to your friend Sally, who also happens to be licensed, and you're putting this important issue on the table, then you have the right to expect that she's not going to be playing on Facebook. To be fully informed about the supervisor's approach to supervision, well, you probably choose your supervisor, so you do need to know their approach. You have the right to confidentiality with regard to supervisees disclosure as well as that of clients, except as mandated by law. So you have the right to confidentiality of anything that you tell them about your thought process, what you did, but as well as you have the right to confidentiality in what the client said. Now, most of the time when I talk about clients with other professionals, I don't use identifying information. There's no need. All of my male clients are Jim Bob and all my female clients are Sally Sue. And that's just the way it is. That's the safe way to go. That's the best way to go if there's not a need to breach confidentiality for some reason. But still, it's important to know that the person you're working with is going to uphold the same standards of confidentiality and professionalism. And you have the right to access any records maintained during supervision. Pre licensure supervision. Your supervisor should be keeping weekly records. Post licensure supervision. Wow. That's not necessarily the case. But if somebody is keeping records, it's very important that you have access to those. If you are consulting on a case where someone may be decompensating or you may be unsure of a diagnosis or whatever, it's always prudent to document that you consulted with another professional on that case, because that's good, sound clinical practice, not thinking that we know everything. You have the right to offer feedback to the supervisor concerning the helpfulness of supervision. If it was really helpful, that's always good to say. If not so much, then maybe you need to talk about what you were hoping to get out of the session. You have the right to receive timely feedback, assessment and evaluation. Again, that applies more to pre licensure than post licensure. But if you're working with a colleague, you may be giving each other timely feedback. And you have the right to seek consultation from other professionals if necessary. Just because you usually talk to Jane Smith, it doesn't mean that you can't go talk to John Doe. If you have a case that pertains more to something in his area of expertise, or you think a male perspective might be helpful, or he practices a different type of therapy or whatever. If we start getting territorial. Well, why didn't you come talk to me about that? Again, check your motivations, supervisors, roles and responsibilities. We have the responsibility to provide training and supervised experiences that will enable supervisees to deliver ethical and effective services to ensure the safety of the supervisee's clients. Even if you're dealing with another licensed professional. Licensed Sally Smith comes to talk to you about her client and you hear some of the stuff that she's doing with her client and you're like, whoa, you know, we got a problem here. You are ethically obligated to do something about it. To maintain records pertaining to work with trainees. Like trainees being pre licensure or pre certification, you have the responsibility to educate supervisees on state specific objectives of supervision. Again, this is more pre licensure to negotiate mutual decisions. When we're going to meet, how long we're going to meet for, yada yada, yada, and to clarify the supervisory role. Now this is another one of my pets. Supervision is not counseling. As a supervisor, I will help my supervisees understand or take a look at how their past is influencing their work with their clients. For the better, for the worse, whatever. Counseling helps them figure out how to deal with those issues. I'm just saying this is an elephant in the room and we need to figure out how to get it into its elephant environment. So it's important to not cross over from, from this is how your issues are impacting this client or this treatment into. Let's talk about you. Another kind of consultation is organizational, where a big company or hey organization, go figure, will call you in and say, you know, we're having morale problems or we're having a lot of problem with turnover and we really want to increase the longevity of employees. Well, all right, that gives me somewhere to start. The consultant provides indirect service to the client by providing direct service to staff. So your client is the CEO or the director of human resources, but you're providing services to staff. You're going down and going what's going on? Help me understand what the turnover is about or what's killing morale or what could help morale. And you're trying to figure all that out because you're trying to improve the work environment for them which will help the superior achieve his or her goals. Participation and consultation is voluntary by all parties. Okay, that's important. You don't want to have anybody forced into this consultation thing if they don't want to participate. You know, staff have the freedom to decide what they will do with the suggestions and recommendations of the consultant. Now, depending on who the client is, and generally we identify the client as the person who hired you, being the management, you will give them your suggestions and they will decide how to use it down there. Very rarely will you be working directly with the staff. You'll evaluate, make a plan, put it up here to management to decide how to disseminate it. Very rarely will a consultant actually implement the plan. Not to say that it doesn't happen, but oftentimes they'll bring in somebody else to implement the day to day goings on. Consultants take on A variety of roles depending on the nature of the consultation and the desired outcomes. Sometimes you'll be doing small groups where you'll be talking to groups of people about what's going wrong, what's going right, where they see the company going. In five years, who knows? Focus groups. That's the word I was looking for. Sometimes you will be meeting with individuals, sometimes, sometimes he'll be walking around and observing processes. One thing that's important is before you even set foot on the floor, you want to make sure that you have a contract that clearly specifies the work to be completed. What is it you want me to do? You want me to interview staff and make recommendations? You want me to interview staff and write up a 20 page plan on how to make this happen? What is my final product supposed to look like and what is my time frame? Identify any work products expected. Identify lines of authority and the person to whom the consultant is responsible. So if you were hired by the director of hr, are you reporting to that person? Are you reporting to the VP of hr? Or what happens if the CEO comes down and starts talking to you? Is it okay to have an open and frank discussion with him? Or should you have a group meeting? Establish compensation arrangements including the method of payment in advance. So don't wait till the end and go, oh well, I needed a money order or the day that you show up at the facility and say, oh, I expected 50% up front, have it all written out ahead of time and agreed to and specify any special arrangement agreed upon by the parties. So if they agree to pay your room and board and this, that, whatever, have it all in writing. That way nothing comes back as a surprise. One thing to do is to talk with somebody who, you know, who's meta consultant and see a copy of their contracts. Because we learn as we go through that, oh, maybe I should have put that in there too. Oh yeah, I need to add that before long. What seems like a simple one page contract is like four pages. Useful guidelines. Carefully identify the real clients prior to beginning the consultation. Who's calling you in and what's the purpose? Identify the cultural context in which the consultation occurs. If you're walking into a hornet's nest, know that if you're walking in ahead of time before a huge merger or company takeover, know that there are a lot of things you need to be aware of. Even though the optimal consultative relationship is an equal one, the potential for dual relationships exists. I don't live in a huge town, but I live in a pretty sizable town. And if I went down to one of the larger organizations and I did a consultation. Chances are I would know at least one person that was working there. So there's a potential for a dual relationship. How you handle that, you need to know ahead of time. And it's imperative to investigate the goals of an agency before agreeing upon a contract for consultation. What are you hoping to get out of this? If they already know what they want you to say, that's not a consultation, that's writing a report. Be aware of what you're comfortable with so you don't go in there and they expect you to be a hired gun that's going to say what they want you to say and, and then you give them something they're not expecting. What are the goals? Finally, inform the consultees about the goals and purpose of the consultation and again, make sure the management that hired you knows that you're going to be open about the consultation, the limits of confidentiality, the potential benefits and risks and potential outcomes of the intervention. So when you go in there at a prudent time and at the beginning is not always prudent, sometimes you have to tell them sort of towards the end. But it's important to have them make sure that they're informed about what your purpose was for being there and what you hope to gather and what you're hoping it's going to look like. And licensure protects the public by setting minimum standards of competence. Remember I said earlier, licensure rules and your regulations are often going to specify different types of things that you can and cannot do with the particular title you're using. And it may specify certain titles that you cannot use. It is very important to understand those different laws. It allows professionals to take on the values of the group. So you can say, I am a fill in the blank, lcsw, lmhc, psychologist, psychiatrist, what have you. It gives you a shorthand to say, this is me, this is what I do, and these are the values that I hold. It improves accessibility to affordable mental health care and increasing the numbers of practitioners reimbursed by third parties. That's kind of a pie in the sky dream because a lot of provider panels are closed, but theoretically licensed providers. By having licensed providers, you can get on provider panels, which makes mental health care more affordable because more clinicians out there are licensed. It allows for the profession to define for itself what it will and will not do, and it promotes a sense of professional identity. So in summary, laws, minimal standards, ethics, what you aspire to, reality somewhere in between, hopefully on the higher side. There are a variety of ethical decision making models. You need to choose which one works best for you and use it. All are based on core principles, including non malfeasance. Clinicians are advised to be aware of their values and how they may impact therapeutic neutrality. What you believe is the right thing to do, what you believe somebody should do is not necessarily what their values tell them is the right thing to do. Licensure is designed to set and uphold a minimum standard. Supervision and consultation is recommended even after licensure, to help us avoid having blind spots and best serve our clients. An organizational consultation is another way of serving clients, but you need to make sure you're careful about defining who the client is that you're working for, which is generally, again, management, and you're indirectly serving the line staff. All right, thank you for attending today and I hope you have a wonderful rest of your day.