Thinking for Yourself About What’s Ethical
Following rules does not make a person ethical. Becoming ethical requires thinking for yourself.
As a counselor, you need to be an ethical free thinker. That means you need have a grasp of three things:
- the difference between defensive and proactive ethics
- the stage of moral development in which ethical thinking occurs
- some cognitive tools to help you solve ethical problems as they arise in the course of your work
Here’s your crash course in all of the above.
Defensive Or Proactive?
How do you feel about touching people? In the United States, people touch each other far less than in most parts of the world, and since the reign of Sigmund Freud, physical contact between counselors and clients has been heavily discouraged. Combine a low-touch culture with a touch-phobic profession, and you wind up with a lot of confusion about people touching one another in the context of counseling. In fact, there is a common misconception that professional counselors are prohibited from touching their clients. When such confusion abounds, it’s time to start doing your own thinking about what’s right. So, how do you feel about touching people, and how do those feelings play out in your counseling relationships? Touch is a hot topic in counseling ethics. Let’s make use of it to explore how you can come to your own conclusions about what is and is not ethical.
Somatic, or body-oriented, innovations in counseling have incorporated essential aspects of the human experience such as the felt sense, movement impulses, breathing, posture, non-verbal communication of all kinds, and of course, the giving and receiving of touch. As a result, one might think that an organization like the United States Association for Body Psychotherapy (USABP) would be a good place to look for an enlightened perspective on touch in counseling relationships. Peruse their ethics code, however, and you’ll find a viewpoint that makes the simple act of touching seem incredibly risky, only to be engaged in after systematic consideration of anything that could go wrong, requiring thorough training, and accompanied by elaborate informed consent and record keeping. The USABP ethics code regarding touch is a perfect example of defensive ethics in action.
The distinction between defensive and proactive ethics comes from the work of social psychologist and counselor Cath Byrne. Defensive ethics, at their best, are “do no harm” ethics, designed to minimize potential negative outcomes for your clients. At their worst, defensive ethics become “cover your ass” ethics, put in place to protect you from law suits and other hassles. Once you’re in “cover your ass” territory, you have stopped being concerned with what is best for your clients, instead prioritizing the kinds of things that insurance companies and litigation attorneys think will mitigate professional risk. These two aspects of defensive ethics, “do no harm” and “cover your ass,” are often thoroughly intermixed in counseling-related ethics codes.
In contrast to “do no harm,” proactive ethics are about trying to “do some good,” concerned with whatever will most help your clients get where they’re trying to go. A proactive approach may require you to go out of your way to do what’s right, even when doing so requires mustering up all your counseling courage and taking personal risks.
A story told by Ofer Zur, a psychologist dedicated to making ethics codes more ethical, illustrates the difference between defensive and proactive ethics when it comes to touch in counseling. A woman he worked with had, some years earlier, lost her infant son in a car accident. She secured an emergency session with a psychiatrist, during which she implored him to hold her while she cried, but the psychiatrist refused. Such a refusal is not surprising. People in the mental health field are trained to be very circumspect about touch. Touching clients is believed to be dangerous. It collapses professional distance for those who believe it to be integral in counseling relationships, commits the psychoanalytic sin of entertaining “infantile transference,” makes clients particularly vulnerable, runs the risk of triggering unresolved injuries, such as sexual abuse, in which touch was used in acts of violence, and, so it is feared, may lead down a road toward inappropriate and damaging sexual contact between counselors and clients. In Zur’s story, the psychiatrist, rather than incurring such risks, prescribed valium to the grieving mother, a drug she became addicted to for many years thereafter. At this point in the story, Zur comes in. He works with the mother until she is ready for them to visit her baby’s gravestone, for the first time, where they hold each other and cry together about the depth of her loss. Zur is able to do this because his ethics with regard to touch are proactive ones, recognizing the basic human need for touch, its healing power, and the degree to which many people are isolated and deprived of the touch they need to survive and to thrive. Zur’s point is that, while it may be unethical in some circumstances to touch the people you’re counseling, in other circumstances it is at least as unethical to deprive your clients of touch.
Defensive ethics would have you consider all the risks involved in touching and work to minimize them. Proactive ethics would have you consider all the potential benefits of touch and act to realize them. Both are important, but because defensive ethics dominates most ethics codes and discussions of ethics, most of us are not practiced in proactive ethical thinking. In many situations, taking a proactive stance means relinquishing a defensive one.
We’ll come back in a moment to the question of touch, and to how you can decide for yourself what you believe to be most ethical when it comes to touching your clients. First, however, we need to look at the failure of rule-following to provide you any real guidance in the quest to balance defensive and proactive ethics.
Why Following Rules Is Never Enough
In a highly structured, hierarchical workplace, rule-following may be all you need to address day-to-day workplace challenges, such as safety regulations on the factory floor, or practices for managing the cash in a register drawer. If you’re a counselor, however, no such structures exist when you are alone in a room with your clients. Instead, you need to solve complex relational problems, often in the immediacy of the moment, with no one but yourself to guide you.
Taking some guidance from Lawrence Kohlberg’s theory of moral development, our relationship with rules progresses through three basic stages. Before we become full members of society, we are not yet rule followers. Becoming fully integrated into our communities requires that we come to appreciate the value of rules. But rules have their limits, and a more complete moral development is only possible once we transcend rules. Consider these three stages when it comes to ethics for counselors.
Nobody starts out following rules. Part of the process of socializing young humans into members of their cultural communities involves conditioning them to conform to rules, laws, and cultural norms. As part of this conditioning, our earliest relationship with rules tends to be about not getting in trouble. We comply with rules so we don’t get punished for not complying. When it comes to ethical codes in counseling, professional associations and institutional boards often appeal to this earliest stage of moral development, threatening us with consequences to get us to follow the rules. This stage, however, is pre-ethical. If you’re following rules to keep from getting in trouble, you’re not acting ethically. Instead, you’re likely to do what you’re told out of self-preservation, even when doing so runs counter to proactive ethics.
Until we begin to respect the value of shared rules, we can’t be complete members of our communities. Eventually the motivation to avoid punishment must give way to the motivation to cooperate with our fellow community members by participating in the social order that was established before we arrived. At this stage in moral development, we want to do the right thing, and we recognize that those who came before us have done the best they could to codify what’s right and what’s wrong. We can take advantage of their wisdom by working within the guidelines set forth for us. The problem counselors at this stage face is not about questioning whether the existing rules are the best possible rules. The problem is that even if the most ethically-minded person came up with the best set of guidelines they could imagine, counselors would still face countless situations not covered by those guidelines, where the interpretation of the guidelines is ambiguous, or where adhering to one guideline means breaking another. The only way to handle such subtleties is to transcend rule-following.
As moral development proceeds, rules stop becoming the basis for determining what’s right and what’s wrong. Instead, higher principles are used as guides, and systems of rules are only respected so long as they fall in line with higher principles. As is the case when ethical codes are defined by “cover your ass” defensive ethics, the social forces that determine ethical codes are often counter-ethical. As a result, there is no substitute for thinking for yourself. When you come across an ethics guideline, you have to ask yourself whether it serves the principles that lead you to want to help people. Will the guideline allow you to love your clients in the ways they most need? Will it promote healing, help the people you’re working with to grow, facilitate their liberation and empowerment? Will following the guideline help you create a world more like the world you most wish to live in?
The World You Most Wish To Live In
I assume that you are someone who has reached the stage in your moral development where rules are valuable only so far as they serve the higher principles that guide you. I also assume that you want to be ethically proactive, doing what will promote the most good rather than just being concerned about preventing potential harm. If both of these assumptions are correct, it’s time for you to imagine the world you most wish to live in.
Our long-dead philosopher friend, Immanuel Kant, proposed a thought experiment he calls the “categorical imperative” you can use as a way of evaluating you think is right. If you consider a morally ambiguous act that you might want to commit, such as lying about something important, you first want to ask yourself what it would be like to live in a world where everyone told such lies. You might imagine that, in such a world, it would be hard to ever trust anyone, since everyone would be lying about important things whenever it was convenient for them. If you would prefer not to live in such a world, then don’t tell the lie. If, on the other hand, it’s just a white lie, you might decide that living in a world where everyone told white lies, you would be perfectly happy, since such things have little impact anyway. If so, go ahead and tell your white lie. If everyone in the world does the thing you’re contemplating doing, does it make the world better or worse?
Let’s apply this thought experiment to the question of touch in counseling. To do so, first consider why touching people matters.
A young child experiences something frightful, or painful. There she is crying. Do you keep your distance and attempt to discuss the experience with her? Probably not. I suspect you reach out and embrace her, holding her close, or perhaps you put a hand on her back, or stroke her head to comfort her. Touch like that does something talk alone can’t do. We are embodied organisms, and touch is integral to how we experience our own bodies, how we regulate our nervous systems, how we form attachments to others and a sense of belonging, how we heal when we’ve been hurt. Without touch, infants fail to thrive, and people older than infants may fail to develop somatic resources they need to achieve their goals as clients.
So, here’s the Kantian question. Would you prefer to live in a world where no one touches one another? I suspect not, so perhaps we need to narrow the question. Would you prefer to live in a world where only infants and small children receive comforting and supportive touch? Still too broad? Perhaps this question is really about counseling relationships, but we want don’t want to make the mistake of defining counseling relationships merely in professional terms. Would you prefer to live in a world where the people we turn to for support when we are in greatest need systematically deprive us of touch?
I don’t know about you, but it’s hard for me to imagine such a world. So why would anyone have imagined such a world in the first place? Touch, of course, comes in many forms, and some of them are damaging rather than beneficial. Consider a problematic aspect of touch, and another thought experiment.
On the problematic side of touch, the phrase “non-sexual touch” is often used in the ethics literature, as if touch is so closely related to sexual contact that we have to qualify it rather than simply use the word, “touch”. By contrast, no one uses the phrase “non-sexual talk,” because there’s no such assumption that if a counselor is talking to a client, there’s a good chance they’re “talking dirty,” making explicit sexual come-ons, or seducing the client with their words. In a low-touch culture, however, so many touch-deprived people get touched in caring ways primarily within sexual encounters that we conflate the two, sexualizing the nature of touch. There are two reasons this is problematic. First, clients with a history of sexual violation may be unable to assert boundaries for themselves around what kind of touch they want or don’t want, and they may find touch frightening or confusing, causing a re-experiencing of old, unresolved experiences of violation. Second, counselors may also harbor confusion about touch and may as a result fail to maintain a boundary around sexual contact. Debates about touch seem particularly concerned with this possibility, that touch of any kind will lead to sex.
Because some clients, and some counselors, are more vulnerable to these problematic aspects of touch than others, we need an additional thought experiment. This one comes from political philosopher John Rawls. Imagine that all people in our society, including you, are somehow reset to be totally equal: stripped of our positions in society, our internal and external resources, and our personal preferences. Then, behind a “veil of ignorance” that prevents us from knowing how things will turn out, each person is randomly assigned a position in society, a set of resources, and a set of preferences. Since you don’t know what you’ll end up with after the veil is lifted, you want to create a set of social arrangements that will be as desirable to you as possible, no matter who you wind up being.
Really, this is a deep exercise in perspective-taking. Think about it. When the veil is lifted, you might be the counselor, or you might be the client. You might be a client with a history of sexual abuse who is afraid of touch, prone to give up your power, and easily influenced, or you might be a client who is well-resourced, can tell the difference between the past and the present, but who still needs a lot of support and help in healing. You might be a counselor who has always struggled to get your interpersonal needs met and who is vulnerable to mixing up their own needs with the needs of their clients, or you might be a counselor who has training in bodywork and is well-practiced in the uses of therapeutic touch. When asked what kinds of ethical principles would best serve all these different types of people, you would probably want to find a way to protect the most vulnerable clients and least experienced counselors, without being so conservative that you deprive everyone else of the potential power of touch in healing relationships. What balance do you strike? Do you draw primarily on defensive ethics to protect against damage, or do you give a proactive answer, trying to determine what best serves all these people’s needs as they collaborate to help each other heal and grow and become free?
Maybe you’re hoping I’m about to give you the answers, but, for better or worse, I can’t. I can share with you some of my own conclusions, but I can’t do the thought experiments for you.
Many of the ethical sticking points that dominate discussions of ethics in counseling are holdovers from the history of psychotherapy. Discouraging you from touching the people you counsel, from sharing with them about yourself, from developing friendships with them: all these come from a belief that counselors, rather than being real people in real relationships with their clients, should be experts who keep professional distance and maintain a role that masks much of their humanity. I believe such a culture of professionalism hinders the important work of counseling, work best served by people being real people accompanying each other on the journey of healing, growth, and liberation. When I conduct my ethical thought experiments, I wish for a world where everyone counsels one another as part of their daily lives and everyday relationships, and so my ethics fall in line with that vision.
But that’s just me. Whatever my biases are, I’m not here to ask you to share them. I’m here to ask you to think for yourself, because that’s the only way to become truly ethical. So, what do you think?