7.7.1 Journal Prompts

1. What ethical challenges do you see staff navigating, or have navigated yourself, at your placement site?
2. What have been some ethical challenges for you in the past? How did you resolve them?
3. How can equity play a part both in these dilemmas and in the proposed solutions?

7.7.2 Self-Care Activity

1. Using Meditation as an Ethical Support and Safeguard: Nelly Kaufer LPC is a licensed professional counselor and psychotherapist in private practice who integrates Buddhist psychology into her clinical orientation. She has been teaching continuing education workshops integrating meditation and mindfulness to mental health professionals for about twenty-five years. She has pioneered continuing education workshops for clinical professionals exploring the role meditation can play in helping mental health professionals avoid ethical pitfalls. Ms. Kaufer bases her training on the idea that we are likely to be more mindful in our work if we are mindful in our life outside of work. By not being mindful and present in our work, we might find ourselves tempted to shortcut processes or settle for easy answers that may not be the most ethical choice. The basis for this mindfulness is a practice of reflective meditation. Developing your own reflective meditation practice can be an excellent source of self-care nourishment. The instructions below have been provided by Nelly Kaufer LPC and Pine Street Sangha, Portland, Oregon.

These basic meditation instructions can be helpful for beginning meditators. If you already have a meditation practice, you can try these instructions, or you can meditate in the ways that you are accustomed.

In an open, unstructured meditation approach there are many ways to meditate. You’ll find your way and over time it will change. By reflecting upon your meditative process, you become aware of how you’re meditating and how meditation supports and informs you. Here are some initial suggestions to get started.

7.7.2.1 Finding Structure

• Choose a comfortable position, maybe with the support of a chair or cushion. It’s easier to settle when you are comfortable.
• Find a quiet place where you’re likely not to be disturbed.
• Choose a length of time to meditate. Consider starting with 10-30 minutes. Don’t stress yourself trying to meditate for too long. Using a timer can help.

7.7.2.2 Moving Around

• Let your thoughts, feelings, emotions and attention move around. Whatever arises in meditation is okay: nothing is inherently taboo. Let your attention go where it is drawn. This might not feel like “meditation”, though consider that this is another kind of meditation with different benefits.
• Try to keep your body still. If you become uncomfortable, move slowly and carefully into a more comfortable posture. Stillness in meditation develops with practice over time.

7.7.2.3 Settling In

• At times you may want to ground your attention, especially if things become chaotic or overwhelming. You need not stay for long, though sometimes you will settle for a while.
• You can experiment with perching on the still point where your body touches the earth; where the feet touch the ground, or the body touches the chair, couch or cushion.
• If you have a meditation practice, use a focus object that comes easily to you such as the breath, awareness of the body or a mantra.
• No need to settle on a perch when something else is calling for your attention.

7.7.2.4 After Meditating

• Take time to reflect upon your meditative experiences; this is how you’ll develop more meditative insight.
• Journaling can support awareness and memory.

1. Write down what is easiest to remember first. Then fill in more as you remember it.
2. Describe your experience in your own words.
3. Try and stick with what happened in the meditation. If you add interpretation or associations, put these thoughts in parenthesis or some other notation. This helps discern what happened in the meditation from what followed from it.

• Consider the content of your thoughts, the tone of your emotions, your relationship to your experience. Did you hear sounds, feel sensations, hear thoughts, see visuals? How did you relate to what happened?
• Whatever you remember will be enough. Don’t be concerned with remembering all of it: it’s not necessary or possible.

7.7.3 Class Discussion Topics

In this chapter we have discussed just a few of the ethical dilemmas that you might face when working in the field. Hopefully this chapter has introduced you to not just what to look for, but has provided some information on resolving ethical problems. The following case studies will give you a chance to talk over these situations with classmates.

Here are some things to keep in mind:

• These are dilemmas–there is usually not one clear “correct” answer.
• Refer to the NOHS Ethical Standards to help you decide what the ethical issues are that are involved.
• Keep issues of equity and culture in mind as you review proposed responses.

We suggest dividing up into small groups, and either each group go over a specific case study or review all of them.

7.7.3.1 Case Study #1

You are interning at a substance use treatment program, assisting with client intakes and running group sessions. One of the agency counselors you frequently work with has complimented your knowledge and skill with clients, and often requests that you help them run groups. A few months into your internship, the counselor asks you if you want to go out to coffee and debrief a recent group session. At coffee, they make it clear that they are interested in pursuing a personal relationship with you. You are currently single and attracted to this person. What should you do?

7.7.3.2 Case Study #2

Your internship is at a residential youth facility for court-involved teens aged 13-17. You are often told you look like a teenager yourself, which has helped you gain rapport with the residents. The residents state they like you because you are “one of us” and tend to be more open and honest with you. One very quiet resident opens up to you one day because he feels “he can trust you like one of us” and tells you that other residents are bullying him daily and that he is thinking of running away. How do you respond?

7.7.3.3 Case Study #3

Your agency provides support to new mothers of premature babies. You are conducting a routine home visit with a new mom to check in and deliver some preemie diapers. During your visit, the client mentions that the family loves labradoodles and is hoping to adopt one in the coming year. You happen to mention that your sister raises labradoodles. Two months later, the client asks for your sister’s contact information to see about getting one of her puppies. What do you do?

7.7.3.4 Case Study #4

Your internship involves helping immigrants with documentation issues. You are shadowing a caseworker who gets called out of the office on an emergency home visit to a newly arrived Vietnamese family. When you both arrive, you notice the shelf of shoes next to the door and observe the caseworker remove their shoes. In your hurry to get ready this morning, you tore an enormous hole in your sock which will clearly show if you remove your shoe. The family notices your hesitancy and quickly states you don’t need to remove your footwear. What do you do? (Note–this actually happened to one of the authors!)

7.7.3.5 Case Study #5

You have been working with older adults for a loneliness prevention program in a rural area. You are nearing the end of your internship, and have let your clients know that this will be your last week. You have several clients who want to give you a going away gift to thank you for your help. Here is a list of possible gifts to consider. Which ones (if any) would be ethical to accept? What about the situation impacts your decision? If you don’t think you should accept it, how will you respond to the client?

1. A package of homemade desserts
2. Gold jewelry with a Christian cross on it
3. A $50 gift card to a local restaurant
4. A $5 Starbucks card
5. A handmade quilt made especially for you
6. An antique clock that you had admired previously
7. A card you are asked not to open. When you open it later, it contains $100 cash