Do No Harm…Do Good
I think one of the biggest challenges facing the mental health profession as it relates to ethics, treatment, and even professional relationships is the intersection between personal values and professional values.
As professionals many of our ethical guidelines are based on principles like the following:
- Non-Malfeasance – Do no harm.
- Beneficence – Do good.
Valuing People
Fortunately this aligns with many of our personal values. I think it is safe to say that the vast majority of mental health professionals entered the profession with a desire to assist people with alleviating emotional and mental pain.
We also enter the profession with the hopes of supporting people in cultivating lives where they are as healthy and whole as possible.
While there may be a few among our group (mental health professionals) who appear to not really like people and actively have difficulty connecting with them…. I think that is a minority; most of us “like” or at least “value” people individually. We may have preferred populations, but by and large we have the innate skill or the cultivated skill of building rapport.
It is also widely surmised that many of us join the field in order to better understand ourselves and our families.
- We want to know “why” certain things happened as they did and how to heal from those injuries.
- We want to know how to avoid or limit that legacy put upon us in both the present and the future.
Professional Identity & Personal Values
As a psycho-dynamic, interpersonal, existential, positive psychology and systemically based psychotherapist, I believe that we are shaped by our family of origin and our prior relationships.
I believe that what we learned and experienced from our earliest and most significant relationships play a major role in who we are, which includes what we value.
Our personal values are reflected in how we live our lives in countless ways:
- how and whether or not we worship;
- who or what we support in politics;
- what we believe about authority and its role in our lives;
- our ideas about gender roles;
- our perceptions about aging and the role of young people and elders in society;
- what we think about substance use (alcohol, marijuana, prescription medications etc…)
- what we think about race (and whether we think about race);
- how we relate to money;
and so many more areas.
Professional Values
Our professional values have some themes that are so universal that we don’t always recognize them as values.
- We value life as it relates to people who are self harming or considering suicide.
- Privacy (protecting clients rights to it).
- We believe that talking about things can help people feel better.
- We generally think that feelings are important indicators of our well-being and should be explored.
- We believe that what the client wants out of therapy is just as important or more important than what we think they should want (self determination).
As a result of our values around “self determination,” we as a group generally hold the value that we should not impose our “personal” values on our clients.
However, lately there is a ripple in our generally widely held and accepted professional values. It seems to stem from what has grown out of the multicultural movement in therapy and what it challenges us to do or be.
Multicultural Factors
Just like ethics…multicultural factors are now viewed as an important competency that is essential to practice. This means we need to factor in things like:
- gender;
- age;
- sexual orientation;
- race;
- religion;
- ethnicity,
- country of origin;
- economic status…
and many other “identifying” factors in the context of our understanding our clients.
As a result of a bigger focus on understanding clients’ worldviews based on their subjective experience and their experiences within the larger culture, therapists are increasingly challenged to work with clients who they perhaps in the past would have referred out or avoided because they didn’t feel “qualified” or “comfortable” working with them.
The discomfort in some cases is based on a lack of exposure to the population. Please note that I am not talking about “niche” areas of practice like working with substance abuse or sex offenders etc…
I am talking about the basic characteristics that are the underpinning of our identities.
Us and Them…not Us vs. Them
Because we are of course human ourselves, we (therapists) have identifiers in all of the above categories as well. Within those identities are our histories and closely held commonalities with others in our identified groups. At times it can seem as if identifying with one’s cultural groups means excluding or being at odds with others.
Of course we know that this does not have to be the case. This is why as a profession we are trained to know and acknowledge our values, yet be cautious not to assume that the clients we work with believe or value the same things that we do. Beyond not assuming that clients value what we value, we are charged with learning more about our clients multicultural identities and how they are impacted.
Thus multicultural competence takes time to develop; in fact it is always under development.
We risk doing harm when we place our values based on our identifiers and cultural norms above the client. This is often done when an identity factor like sexual orientation is mis-categorized as a “value” in and of itself.
For example, we do not reference being white or being black (race) as a “lifestyle.” While we do know that there may be some shared culture experiences within group based on race and other factors, we think of race as being something someone “is” and not something that they are “practicing.”
This is where many who have religious based objections to people who are same sex oriented may struggle. They struggle because their beliefs, their faith (identity/identifier) says…“You are asking me to believe something that I don’t believe,” therefore, “my rights are at risk.” The issue or implication seems to be “Why are the clients’ rights/values/identifiers more important than mine?”
“Why should I compromise my beliefs?” and “This is a violation of my religious freedom” and so on. I am not interested in trampling on anyone’s religious freedom. Not the therapists and not the clients. I am only and primarily interested in the core conditions of therapy, which involve setting the structure for “doing good” – creating a safe place for clients to address their emotional and mental health concerns.
It is okay for therapists to be in a struggle between their personal values and their professional values. My hope is that “doing no harm” is a professional value that will prevail while personal values are being confronted by putting someone to whom we have pledged ourselves professionally first.
Copyright © 2016 Ruby Blow. All rights reserved.
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