Blogging on Good Therapy

A GoodTherapy.org Featured Column written by Cedar Barstow, M.Ed., C.H.T.

Click here to contact Cedar and/or see her GoodTherapy.org Profile

What a pleasure to go to the site here at GoodTherapy.org and find responses to the Ethics Column from Sam and Sally and Meg and Rob. I want to appreciate you for your interest in ethics and for your thoughtful and thought-generating words.

Grief and the Sensitivity Cycle

Both Meg and Rob were thinking about grief. So a bit more about that. Grief, of course, has it’s own rhythm and pace, and is a process….neither to be rushed nor clung to. I’m reminded of the Sensitivity Cycle from the Hakomi Method. The Sensitivity Cycle describes the process of becoming more and more sensitive and effective. It has four phases: clarity, effectiveness, satisfaction, and relaxation. All four phases need attention and organically move on to the next. In thinking of grief, for example, first you need to be clear about what you’re grieving, then take some kind of effective action, then find and integrate some satisfaction from the action you took, and then relax and let go—so that you will have made space for a new cycle. It is easy to get stuck at each phase and with grief it seems that the most common place to get stuck is in letting go. Getting unstuck and letting go when it is time seems to involves having a “gut” sense of the timing. It also involves trusting that letting go of the process of grieving for a person, thing, or event, doesn’t mean letting go of it all, but rather knowing that you have integrated it, or the learning from it, within you.

In responding to Sally who is looking for some more depth, I’d like to say something about two kinds of ethical decision-making edited from pages 59-61 of my book: Right Use of Power: The Heart of Ethics. I find that we as professionals most often think of ethical decision-making simply and solely as the second kind I describe as complex decision-making without putting conscious attention toward ordinary moment, every day kind of ethical decision-making.

Ordinary moments—ethical attention.

The basic ethical question is: Is what I am doing in the best interest of my client? With this question in mind, the preponderance of ethical decisions are made moment to moment in the ordinary process of sessions with your clients. Commitment to the best interests of your clients is the often unnamed and yet constant foundation that guides your interventions. Everyday ethical decisions involve both personal integrity and professional responsibility. For example, supporting your client’s accurate self-assessment of progress, conveying compassion for suffering, holding hope when your client has lost their hope, making sure you complete a session in a timely way. Ethical decision making is deeply embedded in your professional relationships. Moment to moment decisions create trust.

Ordinary Moment Ethical Decision-making

Let’s break this down a little further. When being ethically sensitive and aware, there are two kinds of ethical decision-making. The first arises in everyday, ordinary service moments. These require tracking subtle energetic cues, attitudes of integrity, and attunement to being in right relationship. Here are some everyday, normal instances using client questions:

•How often should I be coming to see you?
•Will you write a recommendation for me?
•Can we go later today?
•Can I pay at a reduced rate?
•Would you meet me for coffee to talk about a business idea?
•Is this situation I’m in a healthy one?
•Tell me about your marriage.

Decision-making Using Ethical Codes & Power Spiral

Far less frequently, you are called to make complex ethical decisions that require time to think through your response, consulting with your supervisor, referring to your Ethical Code, and/or using the Power Spiral model in the Right Use of Power book. Examples of such ethical challenges might be:

•deciding how to manage an inevitable dual role relationship
•making a DSM4 diagnosis and considering the ramifications
•reporting impending or actual harm effectively and skillfully
•confidentiality exceptions
•deciding whether your client is being re-traumatized
•making appropriate referrals
•responding and adapting to cultural diversity
•use of touch
•self-disclosure
•handling sexual issues
•dealing with possible unethical behavior by colleagues.

In these non-ordinary complex situations, there are many forces and influences to consider. Some of these include: regional laws, ethical code, clinical assessment, gut intuition, standards of practice, transference, supervisor recommendations, cultural norms, risk to client and/or caregiver, employer policies, client wishes, client’s life circumstances, and your personal issues and feelings.

I hope you will find it useful to think in terms of these two different categories of ethical decision-making. I look forward to hearing from you if you wish to respond.

Cedar Barstow

For more information about Right Use of Power see www.rightuseofpower.com

©Copyright 2007 Cedar Barstow, M.Ed., C.H.T. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Cedar and/or see her GoodTherapy.org Profile

This entry was posted on Friday, February 15th, 2008 at 12:18 pm and is filed under Ethics, Right Use of Power. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.