Group finds few easy answers to common ethical dilemmas

Can clinicians in small towns avoid dual relationships when they likely will run into patients frequently in the community?

When is it valuable for a counselor to self-disclose a personal history of addiction and recovery?

How do professional relationships change when a peer service worker transitions to a clinical role?

A highly interactive breakout session at the National Conference on Addiction Disorders (NCAD) on Aug. 20 spurred a discussion that revealed few easy answers to these ethics questions. Mark R. Shields, LPC, director of the Access to Recovery initiative for the Missouri Department of Mental Health, led a session in which participants could easily relate startling ethics violations that they have encountered in their professional lives, but often struggled to make conclusive statements about more basic everyday challenges.

This is the kind of exercise Shields believes all addiction treatment programs should encourage in their workplaces. “In your organization you have to make it OK to talk about it,” he said. “And you have to continue to talk about it.”

Interaction of roles

Shields emphasized that the emergence of new professional roles in the addiction field, such as that of peer specialist, has created challenges around role confusion and boundaries among members of the treatment team. The title of his ethics presentation was “Playing Together in the Sandbox.”

One audience member also pointed out that not only do these multiple roles exist, but in some small communities there are professionals who find themselves forced to fill more than one role.

When another session participant questioned why a 12-Step mindset of “we're all in this together” has to give way to concern about dual relationships when a person in recovery becomes a professional in the field, another participant remarked, “All these regulations are written in blood.” In essence, he said, they had to be created because innocent people were being hurt by inappropriate actions by some professionals.

Shields added that clinical professionals need to find colleagues who will give them objective feedback about their actions because “we have an amazing potential for self-deception.” He suggested that too few supervisors give staff members leeway to make honest mistakes, saying that only one supervisor in his career “made it OK not to be perfect.”