Ethical dilemma?

This month's BACP magazine Therapy Today includes the regular feature 'ethical dilemma' which puts a topical question in practical terms and invites practitioners to think about it. Andy Rogers, a Person Centred counsellor working in Further/Higher Education has submitted this thoughtful and poignant response:

This month’s TT dilemma: "Suzanne has worked in a primary care counselling agency for four years and has become good friends with a colleague there, Michelle. Michelle is a highly respected and well-liked member of the team. Suzanne discovered recently that Michelle has been drinking heavily, and for some time. While she appears to be sober at work, Suzanne is fearful for Michelle’s clients and her capacity to work professionally. Michelle became distressed when asked about this and begged Suzanne not to say anything to her manager – she would ‘lose [her] job and become unemployable’. Suzanne feels torn between trying to support her friend to turn things around personally, and the wellbeing of her clients, which increasingly seems to be compromised."

"Andy Rogers, counsellor in HE/FE replies: "
Many potential assumptions are piled on top of each other in this scenario and we should scrutinise them. What constitutes ‘drinking heavily’ and how has this been ‘discovered’? Is Suzanne also ‘highly respected and liked’, or not? What light or shade does this cast on her account? In what sense might the ‘wellbeing’ of Michelle’s clients be ‘compromised’? If Michelle appears sober at work, why is Suzanne fearful? What are Suzanne’s attitudes to alcohol and – more broadly – what values does she hold about how therapists should conduct themselves in their personal lives? At the crux of this dilemma is the question of what it means to ‘work professionally’ and whether our behaviour outside work can compromise our role as practitioners, even if there is no evidence of it being detrimental to our clients. What conduct, then, is unacceptable, and why? What values lie behind these judgments? Must counsellors and psychotherapists behave ‘better’? Better than whom? Must our personal lives be healthy? What does ‘health’ mean here and is it being conflated with goodness, morality and virtue? Is that desirable? Does Michelle really need to ‘turn things around personally’? Are counsellors not fallible human beings, too? Might not such imperfection be an acknowledgement of our shared existential reality and an aid to ordinary empathic engagement? 

Perhaps, when asked about her drinking, Michelle’s distress and concerns about future employment are not hints that her clients could be at risk – as Suzanne appears to take them – but rather expressions of a thoroughly realistic appraisal of the operation of power and interest in both this encounter and its organisational, professional and cultural contexts. Perhaps Michelle knows that complaints in professional organisations and in our wannabe regulator – whose aims doubtless already mould our professional discourse – are brought more often by colleagues and employers than by service users, and that many motivations will be submerged beneath the claim of ‘client protection’. Maybe she is acutely aware that the culture of her profession is becoming dominated by tendencies towards risk aversion and blame, and that fear and careerism drive these more than client interests. Perhaps she read recently of the psychologist hauled before a Health Professions Council (HPC) Fitness to Practise hearing for being drunk at a social occasion with colleagues. He was cleared of misconduct but only after the charges against him were publicised on HPC’s website and in the national media. Perhaps Michelle realises too, in the very moment Suzanne confronts her, that events are already spiralling out of her control; that sometimes organisations move against individuals, and that while her colleagues will follow procedure with (we hope) good intentions, the system nonetheless has a powerful current of its own – the energy of unacknowledged self-interest – which completes the circuit of professionalised mistrust we increasingly find buzzing around the intimate conversations of therapy. Before Suzanne does anything further, she might want to reflect in depth upon such questions. Her friend’s dilemma, after all, is as potent as her own."