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CAPA SI 2003-06-June

Ethics

Pages: 12-14
Year: 2003
Dr. Ida Rolf Institute

Structural Integration: The Journal of the Rolf Institute – June 2003 – Vol 31 Nº 02

Volume: 31

The hallmark of a profession is the recognition that the work its member: perform influences, sometimes in an extremely direct, profound, and immediate way, the lives of their clients. The powerful nature of this influence makes the ordinary rules of the marketplace (based on the principle of “buyer be ware”) inadequate. Society asks the members of the given profession to agree to be held accountable. At it,, heart, this code calls for the profession to protect and promote the welfare of clients, and to avoid letting the professional’s self interest place the client at the risk of negative influence and harm. In addition to the fundamental code of ethics, there may be s code or statement of the rights of the clients.

Perhaps because society would never pull complete trust in professions to enforce their own standards (remember the Enron and subsequent corporate ethics violations in the news recently), and perhaps because the professions have demonstrated that they, at least occasionally, are less than vigorous, scrupulous, and effective in governing their own behavior, society has established additional means for attempting to ensure that professions meet minimal standards for their work and that those who are served by the professionals are protected from the iatrogenic (helper-caused problems) harm that can result from incompetent, negligent, unscrupulous, or otherwise arrogant and ignorant practitioners.1′

Three mechanisms hold Rolfers, as I see it (and other unlicensed professional helpers who touch their clients), formally accountable to an explicit set of professional standards: The Rolf Institute’s® ethics process (which in our case is a mechanism to protect the Institute, as I was recently told, and then to help negotiate ethics violations before they get out of hand); civil court (malpractice); and criminal court.

When I did my Basic Rolfing® practitioner training in 1985, ethics education was and more than anecdotal stories; there was and formal ethics training as I remember or professional orientation to speak of as there is today (Rolfing Instructor Tessy Brungardi says that there is currently an ethics portion to the training). And so I bumbled into the world with those values and morals which I had absorbed from the world I grew up in, and from what wisdom I had assimilated from life experiences, and began pursuing the work of Rolfing. Most of us have done the same, ‘and each one of us has his or her own life values and experiences which are varyingly based on ethnic background, spiritual indoctrination or not, class, education, financial situation, regional upbringing, etc. There are multi-leveled interpretations of any Code of Ethics; this is the reality in the diverse culture that we have the great fortune to live in.

In my training for licensing as a psychotherapist at Regis University in Denver, professional ethics is suddenly in my face at a whole new level. I also completed the State of Colorado Jurisprudence Training in order to legally practice psychotherapy in a mental health facility during my internship. While I have been studying, researching, and writing numerous papers and reports on the topic of ethics and professional orientation, I have had an eye towards passing along some of what I have discovered about professional ethics as it relates to the counseling world. I now believe the Rolfing community needs to develop our knowledge of ethics to a higher level than we have in the past, and incorporate it into our training and ongoing membership education.

This article is only an introductory one; my intention is to put onto the table some key areas which I hope might stimulate further process within the Rolfing community and perhaps assist some of us in our daily practices.

“As Rolfers, we believe in the dignity and worth of the individual human being” is the first sentence to the preamble of the Rolf Institute Code of Ethics. It is typical for a code of ethics to aspire to the highest of ideals, though there is often a gap between what we aspire to and how we actually behave. It goes on: “While pursuing this endeavor, we protect the welfare of any person who may seek our services, we do not use the professional relationship, nor do we knowingly permit our services to be used by others for purposes inconsistent with these values While demanding for ourselves freedom of inquiry and communication, we accept the responsibility this freedom confers, for competence where we claim it, for objectivity in the report of our findings, and for consideration of the best interest of our clients, our colleagues, and our society.”2

INFORMED CONSENT

The process of informed consent provides both client and therapist with an opportunity to make sure that they adequately understand their shared venture. It is a process of communication and clarification. Each of us has our own approach, and it might not be adequate in this litigious society. Does the practitioner possess at least the sufficient understanding of why the client is seeking help? Does the practitioner know what the patient expects, or hopes, or fears from the Rolfing process? Does the client adequately understand the approach the practitioner will be using to assess or address their body? What are the goals of the treatment, the possible consequences, and the limits of practice (will the Rolfer work inside one of a few body cavities at some future moment?). What are the risks? What are the benefits? How much time will treatment take, how much will each session cost and how will it be paid for, what are the consequences of the missed sessions, and what recourse does the client have if he/she feels a violation? You get the idea.

In my own case, I was very timid when I came to receive the work, and my Rolfer gave me the standard Rolfing waiver to read and sign. There was little other discussion. And so I did not know what to expect or what was the norm or what I would do if I had a problem. I behaved similarly when I became a Rolfer until I began to learn, through some intense and difficult experiences, that I needed to better prepare the client for the process and establish grounds for the relationship.

Informed consent is an attempt to ensure that the trust of the client is truly justified, that the power of the Rolfer is not abused intentionally or inadvertently and that the caring of the Rolfer is expressed in ways that the client clearly understands and desires. Case law has, I believe, provided a clear analysis of the basis and working of informed consent. Much of this case law has concerned medical practice, but the relevance of the principles to what we do is inferred because if any one of us ended up with charges from some client that made its way to a court of law, it is entirely likely that we would be treated like any other medical worker or counselor. And here is where I’d like to say that although we might see ourselves as “educators” primarily, the legal world will in all likelihood not. I suggest that we would be held to the same standards as the medical and mental health professional or at least we need to cautiously orient toward that possibility.

Historically, the health care professional took a fairly arrogant and authoritarian position in regard to what the patient needed. A landmark in the shift away from an authoritarian approach appeared in a New York case. In 1914, Judge Benjamin Cardozo wrote: “Every human being of adult years and sound mind has a right to determine what shall be done with his own body.”3 No professional can any longer afford to be seen as arrogant or authoritarian and this is why we need to have clearer informed consent. This informed consent might need to go as far as stating, for instance, that sexual intimacy is not ethical and even illegal, and direct the client to the authority they need to contact if such a situation occurs. This is the law in Colorado; the mental health worker must include this and other essentials about the client’s rights in their disclosure statement.

CONFIDENTIALITY

Confidentiality is exactly what it says: the client has the right to confidentiality from the professional. Each practitioner should have a sense of their particular local and state law, whether licensed or not regarding this area. If a client shares something with you, and you share it with another person, unless you have their permission (it should be in writing), you have breached confidentiality and theoretically could be liable for that mistake.

BOUNDARY MANAGEMENT

This topic is rich in its breadth and width. Boundaries are not black and white, are often difficult to know exactly, and need to be constantly reevaluated and renegotiated in the physical, emotional, intellectual, and spiritual (identity) realms, depending on the individuals involved. What may be appropriate for one person will not be for the next. When boundaries are crossed, respect may be lost for your professional status, the client’s rights may be violated, and your effectiveness and that of your work will be weakened. The goal of helping the client must always be the primary focus.

During the 1980’s, sexual relationships between therapists and clients received considerable attention – perhaps an outcome of the freedom experienced in the 1970’s. As is stated in the Code of Ethics, sexual relationships are clearly unethical because the practitioner’s needs are now part of the equation. It states: “We protect the welfare of any person who may seek our services. We do not use our professional position or relationship for purposes inconsistent with our values. We do not attempt to transfer the authority of the teaching relationship inherent in Rolfing to other associations with our clients, realizing that sexual relations or the imposition of opinions, prejudices, or personal preferences of any kind is detrimental to the welfare of our clients.4″‘

As the practitioner, we carry the power whether we like it or not. If we are experiencing sexual intimacy with our client, we are no longer caring for their needs; we are satisfying our own. And Austin, Moline, and Williams reviewed relevant court cases and came to the conclusion that therapists who engage in sex with their clients had few arguments they could use in court. Courts have rejected the idea of consent by clients, mainly because of the vulnerability of clients and the power of the transference relationship.5′

In the transference relationship, it is proposed, unresolved issues that have been stored in the psyche/ body come to the surface for the client and are transferred to the practitioner (an internal process gets projected outward onto someone else). Here the practitioner experiences counter transference, which can be a therapeutic tool if there is an awareness of it as such. But at times, the practitioner is unable to separate the therapeutic relationship from their own personal needs and feelings surrounding the client.

It is interesting to note that male therapists are the biggest percentage of offenders in all the studies that I looked at in establishing sexual relationships with their clients. The power differential between practitioner and client should be considered soberly, as touching often elicits different feelings in men than it does in women6’

In Issues and Ethics in the Helping Professions, Corey feels that training programs have a responsibility to help students identify and openly discuss their concerns pertaining to sexual dilemmas in practice. Prevention of sexual misconduct, he says, is a better path than remediating. He feels that students should receive explicit instruction on the ethical, legal, and practice issues pertaining to sexual abuses. And ignoring this subject in our training of students sends a message that the subject should not be talked about, which will inhibit a practitioners willingness to seek consultation when they encounter sexual dilemmas in their practice?7

According to Pope, Sonne, and Holroyd, the tendency to treat sexual feelings as if they were taboo has made it difficult for helpers to acknowledge and accept attractions to clients. They found the most common reactions of helpers to sexual feelings in therapy were these:

-Startle, surprise, and shock

-Guilt

-Anxiety about unresolved personal problems

-Fear of losing control

-Fear of being criticized

-Frustration at not being able to speak openly or at not being to make sexual contact

-Confusion about tasks

-Confusion about boundaries and roles

-Confusion about action

-Anger at the client’s sexuality

-Fear or discomfort at frustrating the client’s demands

They note also that there is a difference between finding the client sexually attractive and being preoccupied with the attraction, a very important distinction.8

Included here are suggestions for self-processing sexual attractions that are a very normal and human reaction for the hormonal and biological creatures that we are:

-Acknowledge the feelings of attraction to yourself

-Explore the reasons you are attracted to a client

-Never act out these feelings of attraction – you have lost objectivity

-Seek out an experienced colleague, supervisor, or personal therapist who might help you decide what course of action to take

-Seek personal counseling, if necessary, to help understand your feelings about this client and to uncover the issues in your life that may be triggering them

-Monitor boundaries by setting clear limits on physical contact, self-disclosure, and client requests for personal information

-If you are unable to resolve your feelings appropriately, terminate the professional relationship and refer the client to another practitioner. Be sure to make it your problem, not your client’s problem9

Sexual misconduct is considered to be one of the more serious ethical violations and is also one of the most common allegations in malpractice suits. It is also perhaps a bigger problem when a student ends up in a sexual relationship with their instructor or supervisor, and can have long lasting negative effects on the student.

CONCLUSION

I have intended to open a discussion here about our informed consent and our ethics process and ethics education process in general. At present, our ethics process appears to be a way to protect the Institute. Historically, the chairperson has also taken on the role of mediator between the Rolfer and the client who placed the complaint. We need to re-evaluate our overall thinking, take greater responsibility for the clients who are attracted to the Rolfing process, and insure that our informed consent process is sufficient to protect their rights, beyond our weakness, ignorance, blindness, and as Les Kertay, former Chair of the Ethics Committee calls it, “just plain stupidity.” If the client understands her/his rights, it is shown that it strengthens the effectiveness of the work.

NOTES

1. Pope and Vasquez. Ethics in Psychotherapy and Counseling. Jossey-Bass, Inc., 1998. p. 20.

2. The Rolf Institute of Structural Integration Code of Ethics. Rolf Institute, 1997. p. 1.

3. Pope & Vasquez, op. cit., p. 128.

4. Rolf Institute, op. cit., loc. cit.

5. Corey, G., Corey, M.S. and Callahan, P. Issues and Ethics in the Helping Professions. 2003, p. 284.

6. Ibid., p. 272.

7. Ibid., p. 267.

8. Ibid., p. 270.

9. Ibid., p. 269.

David Delaney is a Masters candidate at Regis University in Denver in psychotherapy toward practice as a Licensed Professional Counselor, which 39 states now license. He is also the newest member of the Rolf Institute Ethics Committee.

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