Ethics in Psychotherapy and Counseling. Kenneth S. Pope
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heavily tattooed teenager gang member with an accent, dressed in baggy pants that fall underneath his buttocks.
A Black woman who is richer, more professionally successful, and personally happier that you ever hoped you could be and whose minor problem, which brought her to seek therapy, is one you’ve had for a long time and have been unable to overcome no matter what you tried.
A member of US Immigration and Customs Enforcement (ICE) who comes dressed in uniform.
A leader of the anti-choice movement who is deeply religious.
A man who owns a string of “massage” parlors, which are occasionally raided by the police, resulting in the arrest of the young women who work there (but not their customers).
A very successful political operative who opposes your most cherished values in the areas of social justice, human rights, and human well-being.
Someone who uses racial slurs in therapy and sees that as freedom of speech and authenticity of self-expression.
A gay-rights activist.
A migrant worker who speaks English with an accent that is difficult for you to understand.
A famous movie star.
A man who has not bathed in a while because he lost his job and his water was cut off for nonpayment. He has an extremely strong body odor.
A man under court order to seek therapy because he beats his wife.
An animal-rights activist who breaks into research labs to free the animals.
A physician whose specialty is performing abortions.
A gun rights activist who carries a gun where open-carry laws allow but who also has a permit to carry a concealed weapon—He’s coming to you because others keep telling him he has an anger problem and poor impulse control.
A therapist who specializes in conversion or reparative therapy,
An orthodox Jew
A wealthy White woman who has had several plastic surgery procedures on her face who wants you to change all of your other appointments to accommodate her busy schedule.
A Catholic priest.
A devout Muslim woman who wears a full burka.
A medical researcher whose experiments on dogs involve inducing disabling pathologies, painful surgeries, and death within a matter of months.
Someone who believes in the intellectual, cultural, and moral superiority of their race.
A Black academician who is seeking mental health services to address the racism he experiences at work.
A gender expansive Filipino who uses they pronouns.
How did you do? Turn up any potential challenges to competence? Achieving awareness of these challenges puts us in a better position to handle them carefully, knowledgeably, and ethically, and to approach each situation with humility.
Our own values and experiences as members of different groups contribute to our biases, blind spots, and other limitations. Our ethical awareness depends on us becoming aware of these limitations. Despite our best efforts to spot problem areas, some of these challenges may stay hidden from our awareness for quite a while yet manifenst themselves in our moment to moment interactions with our patients, supervisees, mentees, and colleagues. We may pride ourselves on our lack of biases toward certain groups and yet our behaviors may seem somehow “off.” Others may view what we say or do in regard to members of that group as avoidant, passive-aggressive, subtly hostile (words and behaviors sometimes termed “microaggressions”), or more openly biased—all of which may escape our attention. In addition, we may be well aware of the biases and prejudices that we have toward particular groups, but we may excuse them or view them as valid.
One tipoff that we may need to examine our competence to work with a particular group is if we talk about members of that group differently when they are present than when they are not within earshot. This difference in behavior, depending on whether members of a group are present, can be much more subtle than simply telling certain jokes, imitating accents, making generalizations about the group, and the like.
The theme of blind spots and biases affecting our competence on the individual level runs throughout this book and is a focus of Chapters 7 and 23—but a parallel theme is the way they affect the competence of organizations. For example, think of the different clinics, hospitals, and other agencies you’ve been to. Imagine the array of patients listed above each entering that agency, walking to the reception desk, and asking about getting help there. To what extent do you think each person would actually feel welcomed and get the help they need?
The opening chapters of this book rejected views of ethics as rigid rule following and presented an approach in which professional codes, administrative directives, legislative requirements, and other givens mark the start of a process of creative questioning and critical thinking. We search for the most ethical and positive way to respond to each unique patient with unique needs and resources in a unique context.
We carry on this creative questioning and critical thinking with a sense of humility as fallible human beings, vulnerable to fatigue, discouragement, frustration, anger, fear, and feeling overwhelmed. Our work depends on not just intellectual competence (knowing about and knowing how) but also what might be called emotional competence for therapy (Pope & Brown, 1996).
COMPETENCE AS AN ETHICAL AND LEGAL RESPONSIBILITY
Competence is hard to define. Licensing boards and civil courts sometimes specify defining criteria for areas of practice. More often, they require only that in whatever area of therapy and counseling the clinician is practicing, they should possess demonstrable competence. Demonstrable competence requires clinicians to produce evidence of their abilities. Usually this evidence comes from formal education, professional training, and supervised experience, followed by continuing education.
A competence requirement often appears in ethical, legal, and professional standards. Here are some examples:
Section 1396, of California Title 16 states: “A psychologist shall not function outside his or her particular field or fields of competence as established by his or her education, training and experience.”
Ethical Standard 2.01a of the APA’s “Ethical Principles of Psychologists and Code of Conduct” (2017a) states: “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.”
The Canadian Code of Ethics for Psychologists (CPA, 2017a) states that “psychologists recognize the need for competence and self-knowledge. They consider incompetent action to be unethical in itself, as it is unlikely to be of benefit and likely to be harmful. They engage only in those activities in which they have competence or for which they are receiving supervision, and they perform their activities as competently as possible” (p. 18).
The American Counseling Association (2014) ACA Code of Ethics states: “Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” (p. 8). It also states that “multicultural counseling competency is required across all counseling specialties” and that “counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population” (p. 8).
APA’s (2017a) Multicultural Guidelines: An Ecological Approach to Context,