The ethics and application of our values in the helping profession are constantly under the microscope. Help seekers, colleagues, and other professionals in vastly different fields continue to question the intentions of therapists and other helping professionals. As a social worker bound by a written code of ethics, the scepticism surrounding the integrity of clinicians has increased through my years of practising psychotherapy.
Indeed, therapists have learned skill sets that are very powerful in terms of the capacity to intervene with our clients. We intervene, sometimes, in challenging situations in which our patient’s affective state is elevated to a potentially dangerous level. Without this code of ethics, the very same set of skills that has the power to soothe, de-escalate, and dig underneath psychological trauma, years of unhealthy thinking has a dark side.
These are skills mobilised for justice that have a vastly dangerous potential to hurt with a small degree of energy invested, but, have a large potential for unethical and overtly intentional collateral damage by rogue or burnt-out therapists.
As a person carrying a schizophrenia diagnosis who can be at times very paranoid, I can tell you I have personally questioned the ethics of workers, therapists, psychiatrists, and members of my treatment teams. I sometimes wonder why this is the case.
Maybe this is due to experiences in which I was mistreated and felt the fallout of bad judgement calls by therapists. In these cases, I often wondered: Why is this happening? As a therapist in an Article 31 clinic, with its regulations and code for practising psychotherapy, the answers to my questions are a little more clear. Sure, with rising caseloads and no-show policies regarding client attendance, I have experienced the pushback myself from supervisors and directors who need to balance the numbers, worker productivity, and billable hours when it comes to keeping the doors of the clinic open.
Therapists can dig into wounds. They do so to unearth either a broader understanding of our mental status or are applying an intervention incorrectly and stir up unwanted and uncontrollable negative emotions. I am also talking about the wanton and wilful neglect of signs of self-harm or harm to others, for whatever reason, and the subsequent mis-documentation or missing documentation of it all to hide the crimes inflicted upon the client to avoid legal action.
Therapists, especially social workers, are required to write essays and document in writing their stance on the NASW Code of Ethics. This ethical code, written by social workers, outlines the general and specific stance of social workers on a litany of important value points and provides guidance, with little ambiguous language, on where the line is drawn when it comes to harbouring biases, judgements, and client contact when practising social work.
Indeed, we social workers get to know our values, our biases, and all the vast intersections of power, privilege, and judgements that impact client care. All of these personal and professional reflective opportunities are important, but are these academic measures really enough? Indeed, as the chronicity of our clients’ diagnoses increase, and the intensity of their symptoms spike without fail, who hasn’t felt the transference and countertransference issues in their practice?
I will never forget speaking with my clinical supervisor years back when she first started. I said to her: ‘Transfer this client, it’s not going to work, and someone is going to get hurt.’ But she was new to her position, eager to troubleshoot clinical problems and make it work. I knew better though. I knew that I wasn’t the person who was going to help this client. To be even more clear, I knew this person needed help, but I was not capable of helping.
In the end, I was right. One day, on the way to work, I got a text message from this client’s mother. My client, the same one I requested to be transferred, attempted suicide the night before. I will never forget reading that message, and pulling over to the side of the road, pained, hurt, angry, and all the emotions that came with my request not being taken seriously, when the time finally came and the client attempted suicide.
I firmly believe, to this day, there are people we cannot help as individuals and when charged with the provision of their care, must ethically make immediate provisions for their discharge, and transfer to someone that can help. In this case, it wasn’t an issue of choosing the right treatment fit, per se, but instead, moving this client through the system into a space in which the right clinician could intervene.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.