Ethics and Sex, Part 2

Part 1 of this topic touched upon the reasons why sexual contact between therapist and patient is harmful, and covered the standards in the Code of Ethics that dictate proper sexual behavior between therapist and patient.

There are additional guidelines for sexual contact with colleagues:  

The Code prohibits sexual contact with a colleague who is your supervisee, student, trainee, or anyone else over whom you have authority (standard 2.07[a]). 

It’s advised against having a sexual relationship with other colleagues if there is any potential for conflict of interest (standard 2.07[b]). 

Sexual harassment between colleagues is also prohibited (standard 2.08).

How should you go about answering exam questions about sexual content?

If there is a question on the exam about you as the therapist having romantic or sexual feelings for a client, obviously don’t select answers that involve you acting on your feelings. 

However, the correct answer usually isn’t to terminate immediately, either.  You can’t realistically terminate everyone to whom you feel attraction.  

Sometimes the best answer on the test includes talking about the sexual/romantic attraction with the client.  However, the “best-best” answer usually involves seeking consultation with a colleague to process your feelings.

Specifically for California test-takers, if you learn someone has previously had a sexual relationship with their therapist, you should give them the booklet entitled Professional Therapy Never Includes Sex.

Also important to note -- If you learn that a minor client has had sexual contact with their therapist, that is a mandated report of child abuse.

The booklet states that “A national study revealed that probably fewer than 10 percent of all therapists have had sexual contact with their patients,” though it does not give a citation for that study.  Anyone know it? 

Regardless, any number of therapists having sexual contact with clients is too many, and up to 10% is an astonishingly large number.  So although this topic may seem obvious, it bears reminding – don’t do it!

Ethics and Sex, Part 1

Focusing in on ethics for the short-term.  One common topic on both the ASWB Clinical exam and the BBS Law & Ethics exam is sex.

The very first thing discussed in the Code of Ethics is that we as social workers have a “primary responsibility to promote the well-being of clients” (standard 1.01). 

Engaging in a sexual relationship with a client is unethical because it gets in the way of promoting that very well-being.  For a pretty thorough description of the ways clients can be harmed via sexual contact with their therapist, check out Kenneth S. Pope’s article, “Sex Between Therapists and Clients.”

Image Credit Kate McHugh Akbar

The Code of Ethics spells it out pretty clearly.  Paraphrased below:

Don’t have a sexual relationship with current client, either consensual or nonconsensual (standard 1.09[a]).

Don’t have a sexual relationship with clients’ relatives or friends when there is a risk of exploitation/potential harm to the client.  This type of relationship could be harmful to the client and difficult for the social worker to maintain appropriate professional boundaries (standard 1.09[b]).

Don’t have a sexual relationship with a former client.  Again, even though the therapeutic relationship has been terminated, there is remaining potential for a sexual relationship to be emotionally harmful to the client (standard 1.09[c]).

You also shouldn’t treat people with whom you used to have a sexual relationship.   Even though the therapy is in the past, same reasons: It can be harmful to them and hard to maintain appropriate professional boundaries (standard 1.09[d]). 

Also, don’t terminate with a client in order to pursue a sexual relationship (standard 1.16[d]).

Related—don’t sexually harass clients (standard 1.11). 

Be careful about physical contact—don’t do it when there’s potential for harm, and it’s the social worker’s responsibility to discuss appropriate boundaries (standard 1.10).

Part 2 of this topic will cover a few more standards relating to sexual contact between colleagues, and also discuss how to answer questions about sexual relationships on the exam.

Why Social Work?

March is Social Work Month, and World Social Work Day 2016 is on March 15th.  So yes, that means that today is basically the most social work-y day of the year.  To celebrate that, let’s continue the discussion from yesterday and reflect: why did we choose social work?

While in college, I discovered an Intro to Psychological Services class, read the course description about different services in the mental health field, and knew that this class (and the accompanying major) was the right one for me. 

Encouraged by my major advisor, I began volunteering at the local domestic violence shelter.  What started as one volunteer shift per week operating the shelter’s hotline evolved into a part-time job my last year of college in which I worked 12-hour overnight shifts at the shelter. 

I also had a practicum internship at an adoption agency where I was able to observe counselors working with pregnant mothers as well as potential adoptive families, and I myself got some direct experience answering the expectant parent hotline.

Those experiences enabled me to confirm my desire to be a part of the social services field.  At that point, however, I was undecided between a graduate program for counseling or social work so after college I sought work experience that would help me decide.   

Image Credit Kate McHugh Akbar

I spent two years working as a sexual assault prevention/intervention counselor at a rape crisis center.  I really enjoyed the work, which included providing individual peer counseling to survivors as well as being an advocate for survivors going through the forensic medical, criminal justice, and legal process.  It felt extremely rewarding to be present for someone undergoing a lot of trauma and pain, and to be able to make an impact during one of the most challenging parts of their lives.

We also provided very comprehensive prevention services to youth in schools as well as the general community.  Prevention was about education: talking about gender role socialization as well as the societal issues that correlate with abuse and assault, with the ultimate goal being to change attitudes. We taught that sexual assault is a crime motivated by power and control, where sex is used as the weapon. 

During this time, I compared counseling and social work grad programs.  I went to several academic open houses and spoke to dozens of current students and graduates of different programs.  I also re-read Reviving Ophelia, 11 years after I read it the first time.

Through this process, I realized that in addition to being fascinated by the counseling case studies, now I also had a desire to study the issues affecting young women from the prevention and policy viewpoint.  I wanted to be engaged holistically in the lives of the people that I worked with: seeing them as individuals, as a part of the whole community, and by looking at the community’s practices and issues as well.

Professionally, I felt the best when I was not only assisting survivors after the assault, through counseling, medical advocacy, and legal advocacy, but also engaging in the social environment to try to change attitudes and possibly decrease future instances of sexual assault.  

That is how I knew social work was the best career choice for me—it would set me up to be able to continue to do a variety of different types of fulfilling, empowering work.  I’m now five years post-masters and continue to feel satisfied being in the social work field.

Image Credit Kate McHugh Akbar

Happy Social Work Month – and Happy World Social Work Day!

My Early Interest in Mental Health

Let's say that you just failed to pass a licensing exam and will need to retake it.  You might be feeling discouraged and in need of a little extra motivation.  One way to pump yourself up is to go waaaaaay back and explore why you became interested in this field to begin with.

Mid-1990s, Chicago suburbs: My interest in the mental health field began in junior high school.  I read Reviving Ophelia, a book by Dr. Mary Pipher, which discusses her work counseling adolescent girls who are struggling to thrive in our culture and society.  As an adolescent girl myself, I was fascinated by the case studies.  

I loved reading about the girls’ lives and issues like sexual assault, substance use, family divorces, and eating disorders.  Dr. Pipher’s book inspired me to begin wanting to do similar work as an adult.  I realized today that I have kept this book on all my different bookshelves for the past 20 years.

Still on my bookshelf after 20 years.  (Image credit Kate McHugh Akbar.  Reviving Ophelia and all other books pictured credit to authors.)

Because of this book, I sought to learn more about mental health.  I found an old college psychology textbook at a church rummage sale and bought it for $.50.  To this day, I can still recall reading about Harry Harlow and seeing the image of the rhesus monkey clinging to the soft terrycloth “mother” instead of the wire mother-figure that provided milk.  

I also made use of the library to feed my interest.  I remember borrowing books about arachnophobia to try and understand why I felt the way I did about spiders.

In 8^th grade we wrote a big research paper, topic of our choosing.  My paper discussed if individuals suffering from multiple personality disorder (now called dissociative identity disorder) should be held responsible for crimes committed by their alter personalities.  I found this paper in my parent’s house several years ago and it’s hilarious.

At age 14, in the yearbook, my classmates predicted that I would become a women’s activist, while I predicted for myself that I would grow up to be a psychologist or a clinical social worker.  I completely forgot about this until I rediscovered the yearbook in my 20s!  If that isn’t motivation to keep studying for the clinical social work exams, I don’t know what is.  

Come on self, let’s make 1998 Katie’s dreams come true.

That's my story, what about you?  Please share!

You’ve learned about my initial interest in the mental health field.  Come back tomorrow in honor of World Social Work Day to read more about why I specifically chose to become a social worker.