It’s impossible to do this sort of work without encountering situations where it’s not always clear what the right thing to do is and sometimes you find yourself choosing between two similarly good actions, and sometimes the more challenging one is where their isn’t an obvious good action and you’re trying to identify which is the least worst way to respond. But the really important thing is to realise that it’s ok not to know what to do for the best and recognising that is so much better than blundering on regardless.
When we face these dilemmas and we all will, this is where the opportunity to talk to trusted colleagues or to take the issue to supervision is so valuable that it creates, just sometimes voicing it just as we know as clients or from a client sometimes putting things into words brings a bit of clarity, but also it allows us to step back and to start to access where the balance of the potential harms or goods lies. Ethics is very much a discipline which helps us to sort these issues out. Sometimes we’ll need specialist advice from lawyers or from other specialists and the techniques that we are trying to use or the approach that we are using in our work.
There are also some very useful tests we can use to test whether we think we’ve got the best possible solution to our ethical dilemma and these are set out within the Ethical Framework. One is the test of Universality, would we be happy if someone else took the same approach as we are proposing to take? Would we recommend it to somebody else?
Publicity, would we be happy if it became known that this was what we were doing? Would we be happy seeing an account of it in a professional journal or in the local press for example?
And justice, would we recommend this as an outcome for a client regardless of how rich or how poor they are or how powerful they are in their lives or in their relationship with us? BACP has developed a set of resources to support us in resolving ethical dilemmas and identifying what is good practice, so there’s a Good Practice in Action series which is available on the web to members of BACP, which covers many of the issues that do throw up ethical dilemmas and issues.
Q1: What are the common ethical dilemmas that I might encounter as a practitioner?
A: The common ethical dilemmas often relate to confidentiality or to boundary management. So, a typical dilemma in the area of confidentiality is where a clients telling you something or communicating something to you which you feel you may have an obligation to communicate to a third party, or it may be ethically the best thing to do, but you suspect the client will not want you to do it and so that’s clearly a dilemma, what’s the right thing to do? Do you protect your client’s confidence or do you make the communication?
In terms of boundaries these can occur in all sorts of ways, but the most common ones are, for example, where you meet a client in a public space and the client wants to talk to you about the last session, for example, and you maybe thinking is this appropriate or is it not? Or there can be situations where clients come in to your space as it were, perhaps they unexpectedly turn up at a party you’re attending. But there may also be situations where you have clients who deliberately seek to intrude upon your life, perhaps they stalk you in the real world or online and it becomes clear to you that they are intruding your space, what is the appropriate thing to do in those circumstances? And that’s an increasing issue for all practitioners as our practice moves online, how do we separate our personal life from our online presence? And how do we mark a boundary between the personal and the professional presence?
Q2: If it stays unclear what is the best ethical practice after trying ethical problem-solving – because the choices are so evenly balanced – would it be appropriate to involve the client in choosing the best option?
A: It would certainly be consistent with the Ethical Framework and putting clients first to involve them in deciding any ethical dilemma. I mean clearly if you can resolve a dilemma in say in supervision and it becomes clear what is the right thing to try, you then have a separate decision to make in, do I involve the client in this? Do I explain why I am doing what I am doing, or do I present the client with choices? But generally speaking, and providing it’s within the therapeutic model you’re using, I think there’s a lot to be said for involving clients in the choices being made and both to help them understand what the dilemma is, but also to hear their response to that dilemma and taking account any preferences that they have.