Professional Relationships – an oxymoron?
It is Thursday, the 14th of January, 2016. For many years I facilitated workshops or hosted continuing education classes at professional conferences for licensed professional counselors and certified addiction counselors. Many of the workshops and classes also had social workers in attendance. In addition, I have been and remain in West Virginia an approved supervisor for those on the path to becoming a licensed professional counselor and those wanting to be certified as an addiction counselor.
Over the years I and many others have noticed some trends. These include:
An increasing emphasis on accountability or ensuring that one is working with clients on measurable, attainable goals.
The code of ethics for the National Association for Alcohol and Drug Abuse Counselors, The Association for Addiction Professionals, The National Association of Social Workers, and the state and national associations for professional counselors keep increasing in length and complexity (list of behaviors one should not do).
We expect clients to prove/show that they want help and are willing to do the work necessary to get well or to manage their diagnosed illness more effectively.
Clinicians with and for whom I have worked (supervised clinically) have often complained that they are spending an increasing amount of time on paperwork which is demanded by their agency, the insurance company, and/or their professional organization.
It was not surprising to hear Ms. Hilary Cottam claim in a Ted Talk that she found that in England, social workers were spending an average of 86% of their time serving the system. I am sure that someone has done a similar study in the United States although a cursory internet search did not reveal that data. I strongly suspect that it is an equal amount of time. I know that when I was in private practice and billing insurance companies or when I was briefly working as a counselor for a treatment center here in Florida, a great deal of my time was spent justifying the work that I was doing.
A review of the counseling ethics codes, the addiction professional ethics code, and the social work ethics code is an arduous task. The Ethics Code of the American Counseling Association waxes on for 18 pages and the social workers’ code patiently outlines a code of conduct for 24 pages. With the advent of increased electronic communication between professionals and clients, there are many additions to the ethical “guidelines.” When I attend a workshop or a lecture on ethical conduct for counselors or addition professionals, I have heard in recent years:
Do not do telephone counseling. One never knows who is in the room or can hear the conversation.
Be wary of email communication. It can be hacked or subpoenaed in court.
Do not skype or face time.
Do not see colleagues or have other dual relationships.
Do not accept gifts from clients.
Do not attend weddings, funerals, or other events which are significant to client.
Do not touch clients.
Do not speak to client in public unless he/she speaks to you.
Do not text clients.
Do not have sex with clients or see someone as a client with whom one has had sex.
It is not my intention to herein copy or elaborate on all 19 or 24 pages of ethical guidelines. My point is that we have morphed into a defensive relationship with our clients. We often function from a position of fear – fear of the possibility that a client will sue us or fear that we will not get paid by the third party such as an insurance company, Medicare, or Medicaid. Our primary relationship is with the rules or the agency making the rules and not the client(s).
Ms. Hillary Cottam and some of her colleagues have been exploring an innovative but old fashion approach. She stays in her Ted Talk:
“But today, we need to bring people and their communities back into the heart of the way we design new systems and new services, in an approach that I call "Relational Welfare." We need to leave behind these old, transactional, unsuitable, outdated models, and we need to adopt instead the shared collective relational responses that can support a family like Ella's, that can address an issue like loneliness, that can support people into work and up the skills curve in a modern labor market, that can also address challenges of education, of health care systems, and so many more of those problems that are pressing on our societies. It is all about relationships. Relationships are the critical resource we have.”
Her approach echoes what I have found to be helpful and rewarding. As is true for most who enter a service profession I did so because I care about people and want to be helpful. I did not enter the field to become rich or to spend most of my time worrying about being sued or justifying the work that I do. What is it I do not do or have? Consider:
I often do not have measurable goals. If I text or email someone good morning (currently I text or email good morning to about 30 so-called “clients” as well as several other friends. My goal is simple: Let them know that I am thinking about them.
I often see my colleagues as clients. They know and trust me and may not have the time or money to travel to a community to see a stranger.
I use email, texting, skyping, face time, letters and even face-to-face time with clients. I do tell clients that if they cannot protect the internet or telephone systems at the Pentagon or White House I certainly cannot guarantee confidentiality but will do what I can to insure a secure system. I also tell them that in my 45 years of working as counselor, I have yet to hear a unique story.
I let clients know that hugs are free and available. If they are uncomfortable with touch I will do my best to remember and honor that. Admittedly there are times when I have done or said something which was misinterpreted. I am liberal with my sincere apologies.
I do not do anything which I am unwilling to put in the official chart along with the reason I made the decision to do or say what I did. If I am uncomfortable or a client is uncomfortable with something I did or said, I share it with a clinical supervisor or other trusted colleague and listen carefully to their feedback.
I share personal information when asked to if the request is because of a genuine interest and does not seem like an attempt to sabotage the relationship.
I will not recommend or ask the client to do anything I have not done or am not willing to do.
I ask the client if they think that what WE are doing is helpful.
First and foremost, therapy is a relationship between two people of equal worth and value. One is not less than or more important than.
I remind myself that when I am meeting or talking with another human that this might be the last hour for one of us to live. I must leave a legacy of love. Nothing else is important or lasts.
This is essentially my code of ethics which guides me in interaction with people – some of whom are clients and some of whom are not. It is not 19 or 24 pages long. Admittedly, the goals are not often measurable. Love is not always measurable. Honesty is not always measurable. One of my goals is to be honest with myself and with the client. I do my best, but, on occasion, I find that I was not as honest as I thought I was. Someone may question me or point out to me that I might want look at such and such. Sometimes I am surprised and perhaps even a little embarrassed by what I find out about myself. I, too, am on a journey.
Is what I do cost effective? Clients say that it is. Certainly, spending 80% or more of my time on serving the system rather than the client is not cost effective. Are there colleagues who are not healthy enough to be effective or trusted by clients? Certainly. Given the opportunity, clients will self-select the ones who are. Are there clients who are self-sabotaging or who I simply do not seem to help? Certainly. I have had client such as K who announced during his first visit that he had sabotaged the relationships with every previous therapist. Eight years later we were still working on trust. Was the insurance company happy about this limited achievement? No, but it was the first time he had sustained a relationship. Worthwhile? We as a culture and as social scientists will have to decide the long term value of we humans learning to trust and love each other.
Written January 14, 2016x
It is Thursday, the 14th of January, 2016. For many years I facilitated workshops or hosted continuing education classes at professional conferences for licensed professional counselors and certified addiction counselors. Many of the workshops and classes also had social workers in attendance. In addition, I have been and remain in West Virginia an approved supervisor for those on the path to becoming a licensed professional counselor and those wanting to be certified as an addiction counselor.
Over the years I and many others have noticed some trends. These include:
An increasing emphasis on accountability or ensuring that one is working with clients on measurable, attainable goals.
The code of ethics for the National Association for Alcohol and Drug Abuse Counselors, The Association for Addiction Professionals, The National Association of Social Workers, and the state and national associations for professional counselors keep increasing in length and complexity (list of behaviors one should not do).
We expect clients to prove/show that they want help and are willing to do the work necessary to get well or to manage their diagnosed illness more effectively.
Clinicians with and for whom I have worked (supervised clinically) have often complained that they are spending an increasing amount of time on paperwork which is demanded by their agency, the insurance company, and/or their professional organization.
It was not surprising to hear Ms. Hilary Cottam claim in a Ted Talk that she found that in England, social workers were spending an average of 86% of their time serving the system. I am sure that someone has done a similar study in the United States although a cursory internet search did not reveal that data. I strongly suspect that it is an equal amount of time. I know that when I was in private practice and billing insurance companies or when I was briefly working as a counselor for a treatment center here in Florida, a great deal of my time was spent justifying the work that I was doing.
A review of the counseling ethics codes, the addiction professional ethics code, and the social work ethics code is an arduous task. The Ethics Code of the American Counseling Association waxes on for 18 pages and the social workers’ code patiently outlines a code of conduct for 24 pages. With the advent of increased electronic communication between professionals and clients, there are many additions to the ethical “guidelines.” When I attend a workshop or a lecture on ethical conduct for counselors or addition professionals, I have heard in recent years:
Do not do telephone counseling. One never knows who is in the room or can hear the conversation.
Be wary of email communication. It can be hacked or subpoenaed in court.
Do not skype or face time.
Do not see colleagues or have other dual relationships.
Do not accept gifts from clients.
Do not attend weddings, funerals, or other events which are significant to client.
Do not touch clients.
Do not speak to client in public unless he/she speaks to you.
Do not text clients.
Do not have sex with clients or see someone as a client with whom one has had sex.
It is not my intention to herein copy or elaborate on all 19 or 24 pages of ethical guidelines. My point is that we have morphed into a defensive relationship with our clients. We often function from a position of fear – fear of the possibility that a client will sue us or fear that we will not get paid by the third party such as an insurance company, Medicare, or Medicaid. Our primary relationship is with the rules or the agency making the rules and not the client(s).
Ms. Hillary Cottam and some of her colleagues have been exploring an innovative but old fashion approach. She stays in her Ted Talk:
“But today, we need to bring people and their communities back into the heart of the way we design new systems and new services, in an approach that I call "Relational Welfare." We need to leave behind these old, transactional, unsuitable, outdated models, and we need to adopt instead the shared collective relational responses that can support a family like Ella's, that can address an issue like loneliness, that can support people into work and up the skills curve in a modern labor market, that can also address challenges of education, of health care systems, and so many more of those problems that are pressing on our societies. It is all about relationships. Relationships are the critical resource we have.”
Her approach echoes what I have found to be helpful and rewarding. As is true for most who enter a service profession I did so because I care about people and want to be helpful. I did not enter the field to become rich or to spend most of my time worrying about being sued or justifying the work that I do. What is it I do not do or have? Consider:
I often do not have measurable goals. If I text or email someone good morning (currently I text or email good morning to about 30 so-called “clients” as well as several other friends. My goal is simple: Let them know that I am thinking about them.
I often see my colleagues as clients. They know and trust me and may not have the time or money to travel to a community to see a stranger.
I use email, texting, skyping, face time, letters and even face-to-face time with clients. I do tell clients that if they cannot protect the internet or telephone systems at the Pentagon or White House I certainly cannot guarantee confidentiality but will do what I can to insure a secure system. I also tell them that in my 45 years of working as counselor, I have yet to hear a unique story.
I let clients know that hugs are free and available. If they are uncomfortable with touch I will do my best to remember and honor that. Admittedly there are times when I have done or said something which was misinterpreted. I am liberal with my sincere apologies.
I do not do anything which I am unwilling to put in the official chart along with the reason I made the decision to do or say what I did. If I am uncomfortable or a client is uncomfortable with something I did or said, I share it with a clinical supervisor or other trusted colleague and listen carefully to their feedback.
I share personal information when asked to if the request is because of a genuine interest and does not seem like an attempt to sabotage the relationship.
I will not recommend or ask the client to do anything I have not done or am not willing to do.
I ask the client if they think that what WE are doing is helpful.
First and foremost, therapy is a relationship between two people of equal worth and value. One is not less than or more important than.
I remind myself that when I am meeting or talking with another human that this might be the last hour for one of us to live. I must leave a legacy of love. Nothing else is important or lasts.
This is essentially my code of ethics which guides me in interaction with people – some of whom are clients and some of whom are not. It is not 19 or 24 pages long. Admittedly, the goals are not often measurable. Love is not always measurable. Honesty is not always measurable. One of my goals is to be honest with myself and with the client. I do my best, but, on occasion, I find that I was not as honest as I thought I was. Someone may question me or point out to me that I might want look at such and such. Sometimes I am surprised and perhaps even a little embarrassed by what I find out about myself. I, too, am on a journey.
Is what I do cost effective? Clients say that it is. Certainly, spending 80% or more of my time on serving the system rather than the client is not cost effective. Are there colleagues who are not healthy enough to be effective or trusted by clients? Certainly. Given the opportunity, clients will self-select the ones who are. Are there clients who are self-sabotaging or who I simply do not seem to help? Certainly. I have had client such as K who announced during his first visit that he had sabotaged the relationships with every previous therapist. Eight years later we were still working on trust. Was the insurance company happy about this limited achievement? No, but it was the first time he had sustained a relationship. Worthwhile? We as a culture and as social scientists will have to decide the long term value of we humans learning to trust and love each other.
Written January 14, 2016x
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