Ethics for Tribal Vocational Rehabilitation

1. Ethics for Tribal Vocational Rehabilitation Managing Boundaries and Valuing Relationships

2. Boundary Issues in Perspective • Code of Professional Ethics for Rehabilitation Counselors • A.5 Roles and Relationships with Clients • D.5 Professional Responsibility of Rehabilitation Counselors • H.3 Professional Responsibility of Educators, Supervisors, Trainers • I.4 Professional Responsibility of Researchers • K.3 Business Practices Bartering Discouraged

3. Definitions • Dual or Multiple Relationships refer to any situation where multiple roles exist between a professional and a client. [Examples: The client is also a student, friend, family member, employee or business associate of the professional]. • Role Blending is characterized in activities that pertain to professionals playing multiple roles and having multiple responsibilities. [Example: Supervisors blend the roles of teacher, coach, evaluator, counselor, and mentor at times].

4. Definitions • A boundary crossingis a departure from commonly accepted practices that could potentially benefit clients • Example: By attending a client’s play, musical recital, or sports event, the professional can do a lot to build a relationship with a client. • A boundary violationis a serious breach that results in harm to clients and is therefore unethical. • Example: A gradual erosion of boundaries can lead to very problematic multiple relationships that bring harm to clients (e.g. sexual exploitation).

5. Managing Multiple Relationships in a Small Community • Practitioners who work in small communities often have to blend several professional roles and functions. • They have to become an integral part of the community to be accepted as a credible mental health resource. • If these practitioners isolate themselves from the surrounding community, they are likely to alienate potential clients and thus reduce their effectiveness in the settings where they work.

6. Bartering – A Case Study “ Barbara”

7. Case Study-Barbara • Barbara is 20 years old and has been receiving services from Sidney, a counselor in private practice for over a year. She has developed respect and fondness for Sidney, whom she sees as a father figure. She tells him she is thinking of discontinuing services because she has lost her job and simply has no way of paying for the sessions. She is obviously upset over the prospect of ending the relationship, but she sees no alternative. Sidney informs her that he is willing to continue services even if she is unable to pay. He suggests that as an exchange of services she can become the babysitter for his three children. She gratefully accepts this offer.

8. Case Study –Barbara- Part II • After a few months however, Barbara finds that the situation is becoming too difficult for her. Eventually, she writes a note to Sidney telling him that she cannot handle her reactions to his wife and their children. It makes her think of all the things she missed in her own family. She writes that she has found this subject difficult to bring up in her sessions, so she is planning to quit both her babysitting services and her counseling sessions. Adapted from Corey, G., Corey, M. & Callanan, P. (2011) Issues and Ethics in the Helping Professions (Eighth Edition), CA: Brooks/Cole.

9. Prior to Establishing a Bartering Relationship • Evaluate whether it puts you at risk of impaired professional judgment; • Determine the value of goods or services in a collaborative fashion; • Determine the appropriate length of time for arrangement; • Document the arrangement, and • Consult with experienced colleagues or supervisors.

10. Bartering • Additional guidelines to clarify bartering arrangements: • Minimize unique financial arrangements; • If bartering is used, it is better to exchange goods rather than services, and • Both the professional and the client should have a written agreement for the compensation due as a result of bartering.

11. Accepting Gifts-A Case Study “ Mayda”

12. Case Study- Mayda • Toward the end of her rehabilitation counseling services, Mayda presents an expensive piece of jewelry to her counselor, Joaquin. Mayda says she is grateful for all that her counselor has done for her, and that she really wants her to accept her gift, which has been in her family for many years. In a discussion with the counselor, Mayda says that giving gifts is a part of her culture. Joaquin discusses the dilemma, telling Mayda that she would like to accept the gift, but that she has a policy of not accepting gifts from clients.

13. Case Study - Mayda Part II • She reminds Mayda of this policy, which was part of the informed consent document she signed at the intake interview. Mayda is persistent and lets Joaquin know that if she does not accept her gift she will feel rejected. Mayda is extremely grateful that Joaquin helped her to get that great government job. Joaquin recalls that Mayda had told her that in her culture gifts are given with the expectation of reciprocity. A few days after the session, Joaquin received an invitation from Mayda to attend her daughter’s birthday party where her family will be present. Adapted from Corey, G., Corey, M. & Callanan, P. (2011) Issues and Ethics in the Helping Professions (Eighth Edition), CA: Brooks/Cole.

14. Accepting Gifts • Questions to consider in making a decision of whether or not to accept gifts from the client • What is the monetary value of the gift? • What are the clinical implications of accepting or rejecting the gift? • When in the counseling process is the offering of a gift occurring? • What are the counselor’s motivations for accepting or rejecting a client’s gift? • What are the cultural implications of offering a gift?

15. Dealing with Sexual Attractions - A Case Study “Cliff”

16. Case Study-Cliff • Adriana’s husband, a police officer was killed in the line of duty, leaving her with three school-age boys and having to find work to support the family. She seeks job placement assistance from Cliff, the rehabilitation counselor. She discusses her grief and other issues pertaining to one son who is acting out in school. She seems to rely on Cliff as her partner in supporting her son, who has joined the Boy Scouts troop in which Cliff is the Scout Master. After two years the son is ready to move on to middle school. She confesses to Cliff that she is finding it increasingly difficult to think of not seeing him anymore. She has grown to love him. She wonders if they could continue to see each other socially and romantically.

17. Case study- Cliff Part II • At first Cliff is taken aback. But he realizes that throughout the relationship he has come to admire and respect Adriana, and he discloses his fondness for her. He explains to her that because of their professional relationship he is bound by ethical guidelines not to become involved with clients romantically. He proposes to her that they not see each other for a year. If their feelings persist, he will then consider initiating a personal relationship. Adapted from Corey, G., Corey, M. & Callanan, P. (2011) Issues and Ethics in the Helping Professions (Eighth Edition), CA: Brooks/Cole.

18. Socializing with Current or Former Clients Potential disadvantages: • Professionals may not be as challenging as they need to be with clients they know socially because of a need to be liked and accepted by the client. • Professionals’ own needs may be enmeshed with those of their clients to the point that objectivity is lost. • Professionals are at greater risk of exploiting clients because of the power differential in the therapeutic relationship. • If you develop a friendship with a former client, then he or she is not eligible to use your professional services in the future.

19. Sexual Attractions in the Client-Counselor Relationship • Attraction to clients is a prevalent experience among both male and female counselors. • The most common reactions of counselors: • Surprise • Guilt • Anxiety about unresolved personal problems • Fear of losing control • Fear of being criticized • Confusion about boundaries and roles • Confusion about actions

20. Recommendations for Dealing with Sexual Attractions To minimize the likelihood of sexual transgressions by clinicians: • Learn to recognize sexual attractions and how to deal with these feelings constructively and therapeutically. • Seek professional support during times of personal loss or crisis. • Examine and monitor feelings and behaviors toward clients continually. • Know the difference between having sexual attraction to clients and acting on this attraction.

21. Recommendations for Dealing with Sexual Attractions - continued • Learn about the possible adverse consequences for clients and counselors who engage in sexual activity. • Establish and maintain clear boundaries when a client makes sexual advances toward you. • Terminate the therapeutic relationship when sexual feelings obscure objectivity. • Recognize that direct explicit disclosures of sexual feelings can run the risk of harming clients and may therefore be unethical.

22. Recommendations for Dealing with Sexual Attractions - continued • Rather than making any explicit communication of sexual feelings for clients, acknowledge caring and warmth within the therapeutic relationship. • Practice a risk management approach (e.g., be aware of timing and the location of scheduled appointments, non-erotic touch, and general self-disclosure). • Be open to using supervision, consultation, and personal therapy throughout your career.

23. Legal Sanctions Against Sexual Violators • Negative consequences for counselors include: • being the target of a lawsuit • being convicted of a felony • having their license revoked or suspended by the state • being expelled from professional organizations • losing their insurance coverage • losing their jobs

24. Non-sexual Touch - A Case Study “Brian”

25. Case Study - Brian • Brian is a warm and friendly counselor who routinely embraces his clients, both male and female. One of his clients, Ida, has had a hard life. She has had no success in maintaining relationships with men and is now approaching her 40th birthday. Ida has come to him because she is afraid that she will be alone forever. She misreads his friendly manner of greeting and assumes that he is giving her a personal message. At the end of one session when he gives his usual embrace, she clings to him and does not let go right away.

26. Case Study - Brian Part II • Looking at him, she says: “This is special, and I look forward to this time all week long. I so much need to be touched.” He is surprised and embarrassed. He explains to her that she has misunderstood his gesture, that this is the way he is with all of his clients, and that he is truly sorry if he has mislead her. She is crest-fallen and abruptly leaves the office. She cancels her next appointment. Adapted from Corey, G., Corey, M. & Callanan, P. (2011) Issues and Ethics in the Helping Professions (Eighth Edition), CA: Brooks/Cole.

27. Some Final Thoughts Where are you now and where will you go from here?