Friday Challenge: Too Much Information?

Happy Friday, ethical gods and goddesses. This week’s challenge is borrowed from ethical with a few alterations. As always, please send in your answers to add to our discussion next week of this challenge. Get your thinking caps on!
Dr. Smith is a psychologist who has worked with a young woman for about 9 months. The patient presents with a history of rejection and abandonment as well as persons of power misusing her. She recently received an offer to become a sales representative for a pharmaceutical company. The psychologist and patient discussed the type of job she was entering because she may experience rejection from doctors, nurses, and other office personnel.
After her 6 weeks of training, the company assigns her to a regional director that the psychologist knows personally. She reports an increase of her anxiety related symptoms. Dr. Smith knows her new boss, Mr. Biggy (they dine together with their wives several times a year), and seeks to reassure the patient that “he is a really a good guy” that seems bright, friendly, and fair. He indicates that Mr. Biggy is a good “family man”. The patient is reassured, and reported less anxiety.
Several weeks later, your patient reports that Mr. Biggy has been spending more time with her, complimenting her on the way she looks and her ability to make the sale. She begins to feel uncomfortable as she feels like they are spending too much time together and Mr. Biggy is asking questions that are more personal, forwards her “funny” emails, and texts some inappropriate remarks to her, mainly about her alluring power that helps make sales. Two days later, Mr. Biggy and Dr. Smith meet in an unplanned social venue. Mr. Biggy pulls Dr. Smith aside and explains how he has become very attracted to a new sales representative. He thinks that she is young and impressionable. He confides that he would like to have an affair with her.
Dr. Smith politely explains that he feels uncomfortable with them discussing his more personal marital issues. Mr. Biggy indicates that he wants to talk more about his feelings. Dr. Smith suggests a referral to a psychologist, but Mr. Biggy states that he feels more comfortable talking with Dr. Smith. After some other small talk, Dr. Smith leaves to mingle with other friends. Dr. Smith is now worried about the entire situation.
In hindsight, think about what triggered some possible difficulties in this situation?

Friday Challenge: Lie by omission?

Happy Friday, ethics enthusiasts!
Today marks the inaugural Friday Challenge. Are you at the edge of your seat with anticipation? Do you like to be challenged? Play games? Ponder life’s mysteries? Well ok then, join in the fun!
Here’s how it works: I post an ethical challenge, some unbearable uncomfortable professional ethical dilemma. You read it and squirm. After an appropriate squirming, your brain then starts to churn. “What would I do?” you ask yourself… and then you answer. In writing. In the email form listed below. Then I read it and publish a few. Sound like fun? Are you ready? Set? Begin.
The following challenge was actually first posted exactly 5 years ago to the day! Originally published on 9/27/14 as the inaugural challenge of the first incarnation of this blog. Because of the date sympatico, we are publishing this as our first this year. We will post current responses and those sent in 5 years ago, in honor of the past and in celebration of the present. Here goes.
John is a client you have worked with for the better part of a year. He came in with several goals, related to the depressive symptoms he couldn’t shake on his own. Prior to coming into your office, John had successfully ceased his methamphetamine abuse and had developed a solid foundation in recovery.  As he works with you, he continues to build on this foundation, getting active in the 12-step community, avoiding negative relationships and anyone who actively uses drugs. He surrounds himself with supportive, healthy people, and creates a balanced life filled with healthy activities.
Yet despite this success, John had consistently struggled with crippling depression even after he had managed to quit the methamphetamine. Thus, he found himself in your office, asking for help in coping with the symptoms. You worked for months, understanding his symptoms, applying all the treatment techniques at your disposal, developing coping skills and tools for John, evaluating them, throwing out the failing tools, and sticking with the helpful ones. The two of you had a good professional run, and met the goals you set together to the best of your ability. One of the things you both learned is that John was incredibly fearful of living alone. He worried that after becoming stabilized, he would unravel if living alone. You both decide that a supportive living program would be ideal as a stepping stone for John. He is excited and grateful for the opportunity.
And you are feeling lucky, because there is a wonderful supportive living facility in John’s community, which will allow him to continue to access the sober network he has worked to develop.  You call them up, and discover there is a bed available. What good luck! The referral paperwork is faxed to you and you start filling it out…and then hit a snag. The paperwork clearly states that the program requires no substance use diagnosis, as it is aimed at serving clients with mental health issues, not those dually diagnosed with a mental and substance use disorder. The program is perfect for John, and you suspect he will do well and use it for all it has to offer him, just as he did with your program. You also worry about his well being, and his ability to keep the depressive symptoms managed, if he does not access this level of support. You also think about the fact that John no longer meets criteria for an active substance use disorder because of the length of time in recovery. At this point, he would be classified as “methamphetamine use, in full sustained remission.”
So you wonder… should you send in the referral paperwork, omitting the substance use (in remission) diagnosis, or should you tell John the referral can’t be made?

Welcome to the NEW Clinical Ethics Blog!

Well Howdy Ethical Clinicians!

Welcome the new and improved Clinical Ethics Blog. We started this blog way back in 2014, but it has been in hibernation for the last two years. We are excited to roll it out again, with some improvements. Welcome!

Some of you may be wondering why this blog has been created. Isn’t it pretty clear what is and isn’t ethical behavior in our profession? Can’t we just look at our Code of Ethics and Scope of Practice to figure out the best ethical action in clinical situations? If we aren’t sure what to do, shouldn’t we just go to our supervisors and ask for guidance? What can this blog give that you can’t get anywhere else? Well, a lot actually. 

The major issue is that Ethics is not taught, at least not in the traditional format. But it needs to be. It’s ironic that the one topic we have to rigorously repeat in our training is ethics, yet it is the one topic that is not typically taught. We attend ethics trainings at least every 2 years, sure, but those trainings typically use the water-cooler technique, rather than a traditional teaching format.

The water-cooler technique of teaching uses inductive reasoning, meaning we create principles based on our experiences. We get into ethical dilemmas or we observe them in others, and then wonder what we should have done differently, or what principle could have helped to guide us to an ethical action. We meet our colleagues at the proverbial water-cooler and discuss the event AFTER it has occurred. The trainings we attend are filled with vignettes and attendees are asked to contribute vignettes of things that have happened to them. Don’t get me wrong, vignettes are wonderful tools that I use often, but they should be used to illustrate an existing principle or point, rather than to BE the principle or point.

Think about it. If ethics truly were innate, and if all we needed was some practice and clinical vignettes to bring to life what we already knew inside, then one would find a significant decline in the amount of ethical violations the longer a clinician is in the profession. Yet there is no evidence that longevity in the profession is correlated with few or decreased level of ethical violations. In fact, the opposite is true. In other words, if we are not becoming more ethical as we professionally age, then there is something wrong with how we are being taught.

What I am promoting is a different way of learning ethics, a more traditional way of teaching that is utilized with other topics in our field. It’s pretty simple, really. The idea is to teach someone to be an ethical clinician, so that they are prepared BEFORE an ethical dilemma enters their practice. Of course, dilemmas will occur, no education can completely omit them, but the number will be greatly reduced if clinicians can learn to strengthen their ethical practice before it is tested. Clinicians will also learn to detect red flags early and what to do and where to go for help before the dilemma becomes disaster.

This is how we wrote Ethics for Addiction Professionals (2014) and this blog will unveil the specifics in building an ethical practice. So welcome! And read on…