Ethical Challenges Call for Additional Support

Even practitioners who are well versed on the nuts and bolts of legal requirements, ethics and risk management in their work can find themselves facing ethical dilemmas on occasion, says Kate Mahoney, executive director for the Naomi Ruth Cohen Institute for Mental Health Education at the Chicago School of Professional Psychology.

“A good example that happens a lot in addiction treatment is people that are mandated by the criminal justice system or the child welfare system,” Mahoney says. “Sometimes you have an external referral source or partner with a set of expectations. Those may not fit with the client’s current needs. How to balance those issues, it’s more than just knowing confidentiality laws or what your mandated reporting requirements are, but how do you balance those issues of a parole officer or child welfare worker who wants information about the progress someone is—or isn’t—making in treatment? Your job is to engage the client and help them to achieve better health in whatever way they are ready to do so.”

Mahoney, a licensed clinical social worker with more than 30 years of experience, will provide attendees at Freud Meets Buddha: An NCAD Meeting with tools and tips for dealing with these situations. She spoke with Addiction Professional about best practices in facing ethical dilemmas and some of the common mistakes practitioners make.

Editor’s note: This interview has been edited for length and clarity.

Is there a set of steps a clinician should follow when faced with an ethical dilemma, or does this vary on a case-by-case basis?

There are many models you can use for decision making in these cases. I use a seven-step approach that helps people go through a step-by-step process, and then some basic principles. To me, one of the core principles when you feel like you are facing an ethical dilemma is to never go it alone. Always seek clinical supervision, consultation or peer support so that if you’re feeling stuck, you’re helping to get an outside perspective or another person’s opinion on what you’re able to present. … Almost always, doing something in the dark when you’re trying to make a decision on your own is one of the riskiest times in terms of making a bad decision or not being able to see all the sides or factors you should be taking into consideration.

Really, [it’s about] helping people look at and identify the situation, what their agency’s policy is, and what they feel is the best choice in the moment. How do they reconcile those if they are different? Do they talk to a clinical supervisor or organizational leader? Do they need to seek an outside consultation with an attorney or the ethics board that they adhere to? [Another aspect is] helping people realize they have resources and to think about what to do and do their best to not feel like they are being pressured to make a decision quickly. On occasion, you have to make a quick decision, but sometimes we just do it out of habit without allowing ourselves time to think it through and get a little assistance.

What are some other common mistakes you see practitioners making?

One of the biggest issues is when there are boundary violations. Sometimes deciding ourselves that we think we need to disclose something we may not have been authorized to disclose, or people getting too close to a client without realizing they’ve crossed over from a clinical relationship to a sponsor relationship. Other dilemmas are when people in the field are in recovery themselves or have had close relationships—family, friends—with people who are also in recovery or are still struggling with a substance use disorder. When we get into a mode of thinking there is one right way for someone to enter into recovery and work their recovery plan. Like with other health issues, we realize there is a variety of treatment plan options. We can’t get into a cookie cutter, one size fits all [mind set], and we especially can’t say, ‘This is what worked for me.’ It’s great that that worked for you, but for the person sitting in the room today, that may not be the best strategy for them. So, we need to make sure we are actively engaging clients in true patient-centered care where they’re at.

The other thing in our field that we struggle with in general is self-care. How do we make sure we are taking care good enough care of ourselves so that we’re not depleted when we are doing this vital, important work?

Often too, people work a full-time job and they have a private practice, or a full-time job and a part-time job because they feel like they have to do that to make ends meet. But the work is pretty heavy doing it full time, let alone time and a half. Sadly, I think we’ve built a lot of our field on that—people working, working, working, and they feel like they are running on a treadmill.

Freud Meets Buddha: An NCAD Meeting, March 6-9 in Chicago, explores the intersection of traditional psychotherapeutic techniques with Eastern concepts such as mindfulness to provide patients with an evidence-based, holistic approach to addressing their mental health needs.