Ethical dilemmas are something that we as clinicians face on a regular basis. In our work with people often there are no clear cut answers as to which way to advise our client. We walk a fine line with our commitment to see our clients improve their lives in positive and healthy ways, while always knowing in the back of our minds of the liability we face with each and every recommendation we make.
As a Treatment Coordinator, more often than not I am placing people in residential treatment facilities rather than with outpatient therapists, at least as the first step. Here are a couple of the ethical scenarios illustrating the situations I face quite often:
A client who has survived extensive abuse has significant PTSD symptomology, which has made it very difficult to function in his/her home environment. Due to the level of anxiety, depression and intrusive images, amongst other things, they are unable to work and thus, financially unable to pay for the treatment they need. Often there is no insurance or if any, it is state Medicaid. The family of origin is wealthy. . . paying for treatment would not be a financial hardship for them. The problem is that the family member who has the financial resources is also the offender. It causes such an increase in the anxiety level of the client to even consider asking for money from the perpetrator them he or she spirals back into a collapsed state, reinforcing the need for residential treatment. What do you do? Continue to work with the client on an outpatient basis, knowing this level of care is insufficient to offer them the 24 hour support he or she really needs to do the trauma work? Or encourage the client to put himself/herself in a very triggering situation by asking the person who harmed them to now help them? How best to reliably convey to the client the understanding that once they enter treatment, they will be able to resolve those triggers?
Another common ethical dilemma I see is when, within a marriage, there is emotional, psychological and physical abuse. The spouse is again unable to function in a healthy way and is getting triggered into a PTSD state every time he or she is home. This person has turned to alcohol and prescription drug use to self medicate. The prognosis for the client’s recovery is very poor without a residential level of care. The client, however, has small children at home and leaving them for 30 days with the abusive parent so that he or she can go to treatment is not in the best interest of the children. You have an ethical obligation to make the best recommendations for your client; however, the welfare of the children needs to be considered as well.
One other issue I have faced frequently in the past 2 years since starting this business is working with clients who have issues and disorders that I have limited or no experience working with. I get a lot of requests to help assess and find placement for clients with chronic mental illnesses, such as schizoaffective disorder and schizophrenia.
Aiding our clients in their recovery is rarely, if ever cut and dry. I have come to rely heavily on my colleagues to collaborate with—to bounce ideas off, to voice my concerns over the welfare of my clients and to come up with creative, realistic ideas for treatment planning that often times requires thinking out of the box.