The Ethics of Multiple Roles in Small Communities

Goals Identify multiple types of small community Identify possible dual/multiple roles that are common Identify the difference between absolute boundary violations and realistic gray areas

Small Communities Physical boundaries Spiritual/Philosophical Boundaries Ethnic/Racial Boundaries Language Boundaries Not barriers as this may be due to language preference Sexual Orientation

Show of Hands Real quick, what small communities do you personally belong to that you would be willing to share?

NAADAC Code of Ethics I. The Counseling Relationship- It is the responsibility of the addiction professional to safeguard the integrity of the counseling relationship and to ensure that the client is provided with beneficial services. The client will be provided access to effective treatment and referral giving considera­tion to individual educational, legal and financial needs.... The addiction professional shall provide the client and/or guardian with accurate and complete information regarding the extent of the professional relationship. In all areas of function, the addiction professional is likely to encounter individuals who are vulnerable and exploitable. In such relationships he or she seeks to nurture and support the development of a relationship of equals rather than to take unfair advantage. IV. Professional Responsibility- The addiction professional espouses objectivity and integrity and maintains the highest standards in the services provided. The ad­ diction professional recognizes that effectiveness in his or her profession is based on the ability to be worthy of trust... Further, the addiction professional recognizes that those who assume the role of assisting others to live a more responsible life take on the ethical accountability of living responsibly. The addiction professional recognizes that even in a life well­lived, harm might be done to others by words and actions.

Other Codes Social workers, Professional Counselors, Psychologists, as well as Marriage and Family Counselors all have their own ethical codes. In some cases, a profession will have two competing codes (NBCC and ACA for counselors). Each code, with different wording, addresses similar concerns.

Standard Rural Issues Small Community due to physical boundaries Lack of resources If rural, likely other towns are some distance away You may be the only therapist in town

Faith Communities Some religious groups are small compared to others, even when in a larger city Some of these groups are distrustful of people outside of the community They want a treatment provider that is within their community There may be fears that outsiders will not treat their faith with respect Quakers Mennonites Orthodox Jews

Ethnic/Racial Communities Often boundaries are created through language Some larger cities have small neighborhoods that are overwhelmingly one ethnic group At times these groups are also unified as a faith community Many groups have historical antagonism to institutionalized intervention. People of Color access mental health and substance abuse treatment far less than their white counterparts. There can be fears that “outsiders” won’t understand the nuances of culture.

Sexual Orientation Issues of “Family of Choice”, at times community is created due to rejection from other communities may have membership The “LGBT” community is not a unified subculture. The most common issue is transgendered individuals being “represented” in talk, but not integrated into the community. There can be concerns heterosexual treatment providers will be rejecting at worse and heterocentric at best. This community more than most others, eskews traditional gender roles which may become a point of subtle conflict

Problem Solving model

Ethical Principles Core ethical principles that are effected is the idea that we Not Harm our client and that we Help our client. This becomes the key litmus test when looking at a dual role. Does this cause harm, and could it potentially cause harm Does failing to take on the dual role fail to offer appropriate help What are additional options or resources

Discussion Prohibited Activities Treatment of individuals that you have been in a romantic/sexual relationship with or their children What are others? Gray Area Treating individuals you know from other social groups, church, etc. What are others for the group to discuss?

Story Time You tell us, what have you encountered? What did you do to resolve this? What questions do you have? “This one time at the Mennonite Church…” “I know the family and have had drinks with him and friends at the bar, and we serve on a Board together...” “They don’t have a lot of money, and the next provider is an hour away. I am the only provider in this area, but we are in the same small town. Same church, same stores, same community…”

Contact Information Mathew T. Mejia, Psy.D. Licensed Clinical Psychologist Licensed Professional Counselor Clinical Director Steel City Consultants Pueblo, CO James R. Ward, MSW Licensed Clinical Social Worker Licensed Addictions Counselor AcuDetox Specalest Director of Substance Abuse Treatment Steel City Consultants Pueblo, CO