Psychology Primer: Ethics

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Psychology Primer By Cyndi Lupo, BA Psych Introduction Tutorial 1: Theory The Definition of Psychology Psychoanalytic Theory Behaviorism and Cogn... Humanistic Psychology The modern movement... Tutorial 2: Application Introduction Role of a Ship's Counselor? Sim Strategies Ethics Counseling Styles Etiquette Preparation Counselor (Duty Post) Counseling Duty Post Forums Edit this nav Ethics in Counseling Before we get too far into a discussion about counseling there are some very important ethical guidelines that you need to be aware of and comply with while IC in the role. Confidentiality The first and foremost ethical consideration is confidentiality. Never under any circumstances should you ever share with other members of the crew things that have been discussed in the counseling session. There are a few exceptions to this rule, however none of them must ever be conducted in public forums such as the officer’s lounge, or any other place where those without a need to know are present and may “overhear” the information divulged. When to Share Information In cases where you have been directed to evaluate a crewmember due to some concern on the part of the command staff or for the purposes of yearly crew evaluations, your findings may be shared with the First Officer or Commanding Officer. At times, it may be necessary to discuss a particular condition or psychiatric issue with the CMO in order to rule out a medical diagnosis for the particular problem. Regardless of the situation, each and every person having access to this information is also bound by the same confidentiality agreement. Additionally, there must be a purpose for the exchange of information beyond mere curiosity; a need to know as it were. While there have been examples on TNG of Counselor Troi and Commander Riker discussing crew evaluations in Ten Forward it should be noted that they were far enough away from other crew members and talking quietly enough that the writers probably felt it was okay for them to do so. I would assert that unless you can establish that you are alone with no chance of someone entering the “scene” being able to overhear what you are saying, that you leave the conversation to another time. Quick updates within the turbolift may be acceptable, provided that there are no other persons present, however never at any time should the conversation be continued while walking the corridors of the ship. It is important to remember, that once posted, sims are fair game for others to sim around, if they can establish a plausible explanation for their IC knowledge of what’s being said. Obviously, what is shared in counseling sims is going to be known by the rest of the crew, but they cannot act on the information. Do not give them an opportunity to have access to sensitive information, because it not only violates the trust between the counselor and client, it could cost you your “license” to counsel. Confidentiality Exception to Prevent Harm Another exception to the confidentiality rule involves notifying Security personnel regarding confessions of desires to harm other persons, or the client indicating suicidal or self-injurious thoughts. Confessions of certain crimes, such as homicide may be shared as well, but petty crimes such as taking PADD’s or sleeping on duty may not rise to the same level, and are often indicative of a psychological or behavioral issue better handled by the counselor. Of course whenever you notify Security, you should speak with the senior officer and must notify the command staff as well immediately. Additionally, you must remind the Security staff members that they are bound to confidentiality as well and may not discuss the situation with anyone who does not have a need to know. Threats Made Against a Specific Person If a threat has been made towards a specific person you are required to notify that person immediately but only about the specific threat and the steps being taken to safeguard their well being. While they may choose to disclose to their friends or colleagues their distress over the situation, they are not necessarily bound to keep the information confidential, however they should be encouraged to do so anyway. It would be entirely in character for you to offer your services to the threatened person as a safe alternative to sharing the information with friends or colleagues. In some cases, while confidentiality is not the key issue, the command staff may order the aggrieved person to not discuss it outside of your office. This would still constitute a lawful order, regardless of confidentiality laws and must be obeyed by the subordinate crewmember. Professional Objectivity The next most important issue ethically speaking, with regards to the counselor position would be professional objectivity. Although it may seem counterintuitive, given the desire to help the client, it is important that we as counselors maintain a professional distance from the client and their issues. In order to provide the most beneficial services possible, the counselor/ client relationship must be kept professional. The counselor’s office is a place of implied intimacy, and the conversations that take place there can be highly charged emotionally. One of the things that we as counselors must guard against is becoming “enmeshed” with our clients emotionally. We are not there to help them because we “care”, we are there to help them because they need our help, we are trained to help them and most importantly it's our job. Maintaining Boundaries What does this mean? It means that we have to maintain boundaries. The ability to help others often can generate a strong feeling of attachment or bonding between counselor and client. While this is a normal reaction on the part of the client, it must never be encouraged or reciprocated by the counselor. The reason for this is that while the client may feel better having the ability to share their innermost secrets with you, if you allow the relationship to become personal you can actually be detrimental to the success of their therapeutic outcome. If the client becomes emotionally involved with you and you reciprocate, your ability to make objective observations or confront the client’s maladaptive perceptions becomes compromised. Empathy vs Sympathy It is important to note that while empathy for your client is required, sympathy is absolutely to be avoided. What does this mean? It has been said that empathy allows you to acknowledge your understanding or more importantly lack of understanding of what it must be like to be in their shoes, metaphorically speaking. Sympathy, it has been said, is you taking the shoes off of their feet and walking around in them. While it is perfectly acceptable to tell the client that you are concerned for their well being and that you desire for them to be well adjusted, productive members of the crew, this is entirely different from telling the client that you care for them, or care deeply about their situation. For this reason, you as a ship’s counselor should never have your character provide counsel to another character that your character is emotionally or romantically involved with. In the RL world, a counselor would provide a referral to another colleague for such services. In the simming situation, this is an excellent opportunity for you to make use of the ACH program, another player's counselor PC or NPC, or your own second counselor NPC (perhaps an assistant counselor for instance). Inappropriate Relations with Clients Now, some may say, what if the counselor and client begin to have and acknowledge feelings for each other, can they pursue the relationship after the counseling sessions are concluded? The answer ethically is an emphatic “no”. The problem is, once you allow for feelings to creep in, your effectiveness is compromised by the fact that both you and the client will be motivated to complete the therapy sessions not out of a desire to reach the appropriate outcome, but by the desire to pursue the relationship. This can cause you as a counselor to make poor judgements in assessments or rationalize that a client is actually doing better than they really are. More disastrous is the tendency for you to try to “rescue” the client, to mitigate the necessary discomfort or pain that they may have to go through to make a breakthrough. This in turn leads to a deepening of the client’s reliance on you as their “savior” rather than taking the responsibility to “save themselves”. On the part of the client, this can lead to superficial “progress” which is often the client adapting their responses to what they think the counselor wants to hear. It is not your job to fix the client. It is your job to help the clients become aware of the obstacles that are blocking them from achieving their emotional or psychological well being, and provide them with the tools to do the work themselves. It is an old joke, but a profound one: “How many psychologists does it take to change a light bulb?” The answer is “One, but the light bulb really has to want to change.” Inappropriate Attachment Of course, in the real world, such laudable ethical rules are often bent or broken outright. If you manage to keep your professional distance, and have successfully discouraged any romantic transference on the part of the client towards you as the counselor, then after a period of maybe three or more sim adventures have played themselves out, perhaps you can explore a romantic relationship. If, however, the first step in that exploration comes in the form of the former client telling you that they feel close to you because “you were there” for them, or “you were the only one who believed” in them, or they are attracted to you because you are such a caring person, and they greatly benefited from your help, you must immediately recognize that they still have an inappropriate attachment, and you cannot encourage it or reciprocate it. Furthermore you must inform the client that any progress that they have made, they made themselves, and while it may seem somewhat mean spirited to do so, you must observe to them that maybe they haven’t progressed as far as they should have given their failure to understand this very basic point. It would be entirely appropriate for you to refer them for continued counseling, but you must make it clear that they will have to see someone else, because of their inappropriate attachment to you. Likewise, if you feel yourself drawn to this character out of sympathy for all that they’ve gone through then you have succumbed to counter-transference and a red flag should go up in your mind. At this point it would be entirely appropriate, and ethically necessary for you to seek counseling for this lapse in judgement. In the parlance of modern twelve step programs, you have assumed the role of the co-dependent enabler at this point, and that is never beneficial to either party. Guarding Against Bias Another issue related to professional objectivity is guarding against bias, in your dealings with clients. It is a fact that some people are more or less likable than others. You cannot afford to let your personal feelings about this person sway your judgement. You are not there in the counseling session to be their buddy, nor their judge, jury and executioner. As has been explained before, this can lead to transference or countertransference issues in the therapeutic relationship. When addressing behavior you must avoid making personal judgements about behavior in favor of observations about behavior. An example would be telling someone that what they did was evil, or that you are disappointed with them, as opposed to observing that what they did was wrong, and giving rationales based in policy, procedure, law, or bringing to light how it violated someone else’s right to be respected, or free from harassment, or violence, etc. Always get in the habit of providing rationales for expected behaviors as well as rationales for prohibitive or maladaptive behaviors. It is perfectly acceptable to ask the client to put themselves in the reverse situation and ask them how it would make them feel if they were put upon in the way that they put upon that person. This is an important step in developing empathy, which can open the client up to genuine feelings of remorse, which are beneficial to change, whereas guilt is not. Cultural Biases It is important to recognize that you may not agree with the client’s lifestyle or cultural moiré’s, but you must be careful not to let that influence your objectivity. Additionally, you should try to understand something about the client’s background and ethnobiology. Klingons are notoriously confrontational, however unless you understand their cultural obsession with honor and their aversion to ever showing weakness, you will at best be putting a Band-Aid on a psychological sucking chest wound if you try to modify this behavioral trait without due consideration. Ferengi are often typecast as duplicitous and shady, but once you understand their culture and morality you can be of better use in helping them to adapt to Starfleet. In all cases, culture or ethnobiology do not excuse socially maladaptive or sociopathic behaviors. You would do well in acknowledging the client’s background and your understanding of their world view, but in the same instance point out that they have chosen to serve within Starfleet voluntarily, and in so doing have taken an oath to abide by the rules and strictures of not only Starfleet regulations, but Federation principles as well. This once again puts the onus back on the client to modify their own behavior, or face the consequences of their actions. Self-Disclosure The next ethical question I will address in this section is the question of self-disclosure. Simply put, self-disclosure is telling the client things about yourself that may or may not relate to the issues at hand. To address the co-dependent issue once again, if you are finding yourself “opening up” to the client in an effort to show them that you really do understand where they are coming from you had better be hearing “Red Alert” going off in the back of your mind. The client is the focus, not you. The Illusion of Intimacy This is often one of the first signs that a transference/countertransference dynamic has entered your counseling sessions. This two sided sharing creates the illusion of intimacy within the counseling session. Furthermore, the client can often use it against you in efforts to prevaricate, or deflect attention away from their behavior. It’s like a parent telling their child not to drink while underage, but confessing that they themselves did it and then relating some horror stories to make their point. The only thing the teenager is going to hear most likely is, “Dad did it and he turned out okay”, after which they will most likely throw that observation in their father’s face. While the father may have the trump card in saying, yeah, but you still better not or you are going to have this and that consequence, and be able to back it up, you as a counselor might not be able to salvage the situation quite so cleanly. Instead your client may prevaricate by questioning your ability or right to judge their behavior based upon what you revealed about your own. On the flip side, if you reveal, hypothetically, that you were victimized in some way similar to or worse than the client that can be problematic for even more reasons. The first of which has been documented to death in the above paragraphs about objectivity sabotaging behaviors leading to an inappropriate enmeshment between client and counselor. This can sabotage the efforts of other counselors in the future because the client may come to believe that they are not as able to help the client as you were because of your shared experiences. The second consideration is that the client may feel that their concerns or issues are somehow given less weight because they may not have been as bad as the issues you expressed. Maintaining Perspective The final ethical consideration is one of maintaining your perspective. It is a sad but true fact that many counselors working in the field actually find themselves working out their own issues at the client’s expense, and the above examples of self-disclosure are one of the most common explanations for how it begins. In the case of two friends commiserating over a couple of cold beers, a bond can develop which is not inappropriate, given that there is an equal “power sharing” within the relationship. The Counselor/ Client relationship, however is designed to be one sided, and therefore the counselor has the implied power over the relationship by virtue of the fact that they are the one who makes the determination as to whether or not the person is “cured” of their condition. Even without inappropriate self disclosure, the counselor must be aware of this dynamic cropping up. While a counselor has every right to take pride in their work, they must guard against the tendency to personalize their response to successes or failures, as this is a sign of the counselor pursuing their own issues of self worth at the expense of the client. This in turn is evidence of a loss of perspective on the part of the counselor, which can lead to bias or transference/ counter-transference. If you as a counselor find yourself looking forward to a particular client each week, or dreading another one, you need to ask yourself whose needs are being served. If you find yourself engaging in self-disclosure, you need to ask yourself, is this really for the client’s benefit or my own. If you find yourself frustrated or elated at a client’s failure or success, you need to ask yourself why you are having such a personalized response to the sessions, and reassess your perspective as being objective or impaired. Final Considerations With regards to simming, ethical conundrums and internal strife are excellent fodder for your character’s journeys. Nobody is perfect, and if you keep this in mind, you can provide many opportunities to create very dramatic sims for your character in which they struggle with and overcome such lapses in judgement or counter the attempts of characters to derail you into inappropriate avenues of the therapeutic relationship. Such measures can create tension, sexual or otherwise between characters, and from a dramatic standpoint make for excellent storylines.