Deliberate intentional, planned, conscious Workshop Overview - PDF document

5/28/2014 The Ethics of Self-Disclosure: Bringing Nuance to Content and Process Andy Bernstein, PhD, CPRP Zur’s Taxonomy of Self-Disclosures: What is Addressed in This Workshop • Involuntary — client-obtained information • Accidental — unplanned encounters and utterances • Unavoidable — appearance, speech, etc. • Deliberate — intentional, planned, conscious Workshop Overview • What has been our collective experience around self-disclosure — training vs. real life? • What has changed in this area of practice? • What is the difference between content and process disclosures? Are there other types? • What are the benefits and possible harms of disclosing within each of those domains? • What--if anything-- does PRA’s Code of Ethics say about self-disclosure? 1

5/28/2014 What’s In Your Training? c What do you actually do regarding self-disclosure? Evolution of Helping • Before professionals – Mutual Help – Experiential Knowledge (Thomasina Borkman) • Industrial Revolution and Class System – Formal training and purported expertise – Professional Knowledge – Accountability to third parties • society (educators, discipline certifiers, geographic entities) • payors (insurers) • professions (guild system) Evolution of Helping, p.2 • Industrial Revolution and Class System (cont’d) – techniques and the standardization of helping – objectification of helpees, and helpers – commodification of helping industry • Consumer Empowerment – naturopathic, alternatives to traditional Western medicine – whole person – self-help movement – “nothing about us without us” – questioning big pharm and big psych – recovery and psychiatric rehabilitation – consumer-providers, peer workforce • Integrated Health Care 2

5/28/2014 How has this evolution affected the ways in which deliberate self-disclosure is viewed in the field? Three Types of Disclosure • Content — facts about us or about experience we’ve had in our lives • Process — how we are thinking at the moment • Hybrid — how we think generally; our beliefs or values (attitudinal) Content Examples • This is my first year working in this setting. • I’m a student, and this is part of my training. • I’ve received mental health services in the past. • I’m in recovery myself from… • I, too, have been the parent of adolescents. • No, I’m not actually a parent. • I’ve had serious trauma in my own past. • No, I’ve never been divorced. • I once lived in __________ , also. • I grew up in a family in which …. 3

5/28/2014 Process Examples • I’m thinking that we could go in a couple of different directions at this point... • I’m thinking about asking you some questions about your family. • When you smile like that it makes me think that …. • At this point I usually ask about prior relationships, but I’m not sure that’s a good idea right now. • I’m trying to figure out how you really feel about that. • I’m having trouble remembering how you ended up in that situation. Attitudinal Examples • I usually think that when people are sitting here, there are forces acting upon them which they’re trying to understand. • Yes, I do believe in God. • I think it’s important for clients to have some sense of control over what happens here. • I generally believe that people do things for reasons that make sense to them at the time. • I’m not opposed to medication; I just think that it is only one tool among many which can be used. Why Self-Disclose? • Credibility • Role-Modeling • Connection • Perspective • Authenticity • Collaboration • Transparency • Sharing Power • Humanness • Demystification • Others? 4

5/28/2014 Additional Reasons to Self-Disclose Why NOT Disclose? • It might work against building the kind of relationship you’re trying to create. • It might make YOU uncomfortable and thus feel compromised in your ability to work well. • It might be coming out of YOUR need to share and not the needs of the person with whom you’re working. • It might be forbidden in the setting in which you work. • It might not be consistent with the way in which you work. • It might be harmful to the person you’re working with • It might be the wrong time to do so. • Others?? Additional Reasons NOT to Self-Disclose 5

5/28/2014 What does PRA’s Code of Ethics Say About Disclosure? NOTHING DIRECTLY But let’s drill down into them a bit… Principles, Standards, and Guidelines of Ethical Practice From PRA Practitioner Code of Ethics (9/28/12) • Fundamental Principles (21/5) • Fundamental Standards (24/4) • Guidelines for Principles and Standards (43/10) Principles (21) • The fundamental principles are aspirational in nature — a framework for guidance in practice. A. Ethical Behavior (2) B. Integrity (5) C. Freedom of Choice (3) D. Justice (4) E. Respect for Diversity and Culture (7) 6

5/28/2014 Standards (24) • The fundamental standards are descriptive ideals – how to implement the foundational principles; grouped into 4 sections indicating important areas for ethical practice: A. Competence (7) B. Informed Consent (6) C. Advocacy (7) D. Propriety (4) Guidelines (43) for Principles and Standards • The guidelines are prescriptive statements recommending practitioner tasks that are essential to ethical practice; grouped into 10 categories that represent areas where ethical practice may create a special challenge for practitioners: A. Promoting Ethical Behavior F. Multiple Roles and Relationships B. Practice Responsibilities (3) G. Supervision (7) C. Confidentiality (5) H. Termination (3) D. Rights Protection (3) I. Service Coordination (3) E. Individualization (2) J. Collegial Relationships (7) Guidelines Caveat • Practitioners should be aware that these guidelines do not cover every possible circumstance where ethical dilemmas may arise. • Should an ethical dilemma arise, practitioner should be able to justify their decisions and actions, including explaining how the Code of Ethics was considered and applied. 7

5/28/2014 Principles Which Might Be Related to Self-Disclosure • A. Ethical Behavior – A1. Practitioners uphold and advance the mission, principles, and ethics of the profession. • B. Integrity – B1. Practitioners act in accordance with the highest standards of professional integrity and impartiality. – B3. Practitioners are continually cognizant of their own needs, values, and of their potentially influential position, in relationship to persons receiving services. – B4. Practitioners foster the trust of persons receiving services and do not exploit them for personal gain or benefit. – B5. Practitioners act fairly and honestly in professional relationships and business practices, and do not exploit them for personal gain or benefit. Principles Which Might Be Related to Self-Disclosure p.2 • D. Justice – D3. Practitioners provide information about their professional qualifications to deliver services to people using those services. • E. Respect for Diversity and Culture – E3. Practitioners study, understand, accept, and appreciate their own culture as a basis for relating to the cultures of others. Where differences influence the practitioner’s work, the practitioner shall seek training and/or consultation. – E5. Practitioners demonstrate respect towards the cultural identities and preferences of persons using their services, and respect the right of others to hold opinions, beliefs, and values different from their own. Guidelines Which Might Be Related to Self-Disclosure • J. Collegial Relationships – 2. Practitioners are transparent in defining their ongoing professional relationship with those colleagues whom they employ, supervise, or mentor, especially when those relationships change. • G. Supervision – 5. Supervisors model and engage supervisees in objective and balanced self-assessment. – 6. Supervisors inform supervisees about performance expectations, including competencies required, standards for acceptable completion of job duties, and any rules, policies, and procedures that relate to general practice. – 7. Supervisors refrain from entering into multiple roles and relationships with supervisees. When multiple roles and relationships are unavoidable, it is the responsibility of the supervisor to conduct himself/herself in a way that does not jeopardize the integrity of the supervising relationship. 8

5/28/2014 Looking Ahead Is there anything with respect to personal disclosure which you think you might do or think about differently in the future, one way or another? Andy Bernstein, PhD, CPRP Psychologist in Independent Practice Clinical Director, UA Health and Wellness Center (Camp Wellness) Tucson, Arizona 520-396-4956 adbpsy@gmail.com andybernstein@email.arizona.edu 9