Tag Archives: Voice of Experience

Voice of Experience: Confidentiality – The core of ethics

By Gregory K. Moffatt September 17, 2019

As my colleague and I chatted casually in the copy room about life’s odds and ends, she mentioned a client I had referred to her some months earlier.

“Thomas [not the client’s real name] is doing so well,” she commented absentmindedly. “Thank you for the referral.”

Nobody was around to hear us, but I couldn’t believe my ears. My colleague had just used a client’s name. Even though I had referred the client to her and I knew she was seeing him, I was shocked she had identified him so casually.

When we study counseling ethics, we often use phrases such as “do no harm” or “what is in the best interest of the client” as general landmarks for ethical dilemmas. In the 2014 ACA Code of Ethics, nearly all of the ethical standards, from Section A through Section I, in some way or another relate back to protecting the client from harm.

Although I use these benchmarks myself and often mention them to my supervisees and interns, I would suggest that confidentiality comes in at a close second place for the core of our ethical conduct.

Our informed consent, release of information documents, and testimony in court are all centered around the importance of maintaining the confidentiality of our clients. We don’t leave client files lying about on our desks or open on our computer screens.

Current common practice in office construction is to have windows in all office doors. The attorney for the university where I teach loves this practice. But this approach creates an ethical problem for us as counselors. We cannot maintain the confidentiality of our clients’ identities if passersby can easily glance in the window and see them.

When the Health Insurance Portability and Accountability Act (HIPAA) was first introduced to us, I resented it as another governmental intrusion into my work, but I came to realize its power to protect the confidential information of our clients — the very thing I am advocating here. While I don’t necessarily “love” HIPAA, I value it highly and comply with all of its requirements. I pay heed to HIPAA not simply to keep from getting into trouble, but rather to protect my clients.

The very words in this article model my respect for client confidentiality. I have changed the name of the client and a few of the specifics regarding the interaction between my colleague and me. If either of them happened across this article, there is little chance that they would recognize themselves. The gist of the story is true, but some details were changed to protect both the client and my colleague.

I drill a high regard for confidentiality into the minds of my clinicians. I want to ensure that they are so sensitized to this part of our ethics that even the smallest breach will scream at them.

While I certainly appreciate a word of thanks from a colleague if I refer a client, I don’t want to hear, “Thanks for referring Thomas to me …” Even the simple use of a client’s first name in a private conversation between colleagues is a big deal. If we allow that, what other slips will we allow?

I couldn’t let the situation pass. According to Standard D.1.d. of the 2014 ACA Code of Ethics, it is my duty to address ethical lapses within the field. This provision says that if we perceive an ethical violation, we should first approach colleagues directly to resolve it.

As awkward as it was, I gently told my friend it made me uncomfortable that she had used the client’s name. I had scarcely finished the sentence before her mouth dropped open and she quickly covered it with her hand upon the realization of what she had done. She apologized and said she knew better. Somewhat to my surprise, she also thanked me for modeling ethical conduct and for respectfully calling this out to her. She won’t make that mistake again, and I’m glad I did the right thing.

Thomas will never know what happened. But this isn’t just about Thomas. It is about a way of behaving that protects all of our clients, regardless of whether they will ever find out.

Basketball legend John Wooden has been credited with saying, “Character is how you behave when no one is watching.” Ethical behavior, including confidentiality, is perhaps most clearly reflected when no one is watching.

 

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Giving away power

By Gregory K. Moffatt July 11, 2019

“Are you Dr. Moffatt?” a soft voice said as Antoine (not his real name) stepped into my office.

I nodded. He was a 20-something African American male. He explained that he had been arrested for assault. His court requirements included completing 12 counseling sessions for anger management. I quickly perused the copy of the court mandate Antoine had brought with him as he stood by respectfully.

“So, let me get the picture,” I said. “You got in a fight. A white guy arrested you. A white guy represented you in court, and a white guy sentenced you and sent you to see a white guy for 12 weeks. Is that about right?”

Antoine tried to stifle a smile but failed. “Yeah, that’s pretty much it,” he acknowledged.

“Well,” I said, “according to this court document, the only mandate is that we have to meet for 12 weeks. We can do whatever you want. We can talk about life, sports, or stare at the wall. Whatever you like. At the end of 12 weeks, assuming you show up, I’ll sign off. Or, if you like, we can work on what might have led to your arrest. If we do, then maybe I can learn something about you, and you can learn something about yourself and hopefully never see a jail cell again.”

When I tell that story to new clinicians, they argue that it would have been unethical to see Antoine for 12 weeks but not do therapy. We would have done therapy, but that isn’t the issue. The mandate didn’t require that I show progress or that the client cooperate. The document only required him to attend.

I’m not playing word games. Alcoholics Anonymous has done this since its inception. Individuals can attend, not say a word, be resistant, and they can show little or no progress or even relapse. Showing up is a giant step on the long road to recovery.

Predictably, mandated clients bring resistance with them. We have no power to force any of our clients to change. The wording of the court mandate allowed me to give away power from the get-go by stating the obvious: I couldn’t force Antoine to change or engage in therapy. (Be aware that some court mandates do require growth.)

I also gave Antoine power by stating something else that was obvious. He was nonwhite, and I was just another white man in a system in which he had no power. I gave him permission (power) not to trust me, and in so doing, ironically, I began to earn his trust.

Mandated counseling makes giving power to our clients especially challenging, and resistance is predictable. Because I’m white, I was pretty sure Antoine assumed that I wouldn’t understand him or his culture. He had no reason to trust me. If I had been in his shoes, I wouldn’t have trusted me either.

Giving away power is one of the things in our therapeutic tool boxes that can help us earn trust very quickly. My technique worked. Within minutes, Antoine was at least willing to give me a chance.

I do something similar with child clients because children are also mandated in a way. Guardians bring them to me — a stranger — often without even asking these children their thoughts about it.

But like Antoine, young children learn to trust me almost as soon as they cross my office threshold. I meet them at the door, welcome them in and say, “You can do about anything you want in here. If there is something you can’t do, I’ll tell you.”

Some children test me with a question such as, “Can I break something?”

“If you feel like you need to,” I reply.

I often watch them as they roam around my playroom, shooting occasional glances at me, seemingly waiting for me tell to them what they can’t do. Saying “no” is rarely necessary.

Antoine turned out to be one of my favorite adult clients. If I hadn’t given him power from the start, he probably still would have shown up and been respectful and cooperative. But growth may not have happened.

Instead, over our 12 weeks, he was fully engaged — starting with our very first session — and he grew tremendously. Several times I saw his eyes light up as he had epiphanies about his decision-making processes. He gained insight into his behavior and developed numerous coping and problem-solving strategies that make it unlikely he will ever see the inside of a courtroom again, at least as a defendant.

I still think about Antoine and his sly smile during our first meeting. Witnessing his growth was satisfying, and that is why I became a counselor in the first place. I doubt I would have ever earned his trust without giving him power from the beginning.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Invisible people, Part 3: The homeless

By Gregory K. Moffatt June 3, 2019

He was the only student in my class who didn’t turn his papers in on time. He was constantly late and regularly fell asleep in class. I felt insulted by his seeming lack of respect for my classroom, for me and for our discipline. If I could have dropped him from the class, I would have. I almost resented the days he showed up.

But he wasn’t truly lazy, and he wasn’t intentionally disrespectful. Instead, he was a struggling member of the third group of invisible people I am highlighting in this series. It had never occurred to me that this student might be homeless, but a conversation with one of my colleagues opened my eyes to his situation. What I learned totally changed the way I saw him. I had been so blind.

The student was the eldest of three siblings who had been living with their mother in a homeless shelter. Mom had married young and had no job skills. When her husband left her, she had no money to pay the rent for their meager apartment. After months of eviction notices, the movers came in and swept everything in the apartment to the curb in less than an hour.

His mother spent the rest of that morning trying to find a place for them to stay. In the meantime, thieves helped themselves to their unsecured possessions on the curb. An afternoon rain had soaked their clothes, bedding and personal belongings. Much of what they owned was ruined. When my student and his siblings came home from school, they found their mother sitting on a broken dresser — dropped by a member of the eviction team — guarding what possessions they had left.

My student slept on a cot in a large room with several other families in the shelter. There was no place to store things other than under their cots, and things put there were often pilfered by other residents. Even an old pair of shoes might be better than those someone was already wearing.

Common bathrooms meant lines, especially in the mornings as my student tried to ready himself, wearing one set of clothes one day and his second set the next. Like others in the shelter, he washed out what he could in the sink, hoping the clothes would dry on the end of his cot by the next day.

This family was homeless because of divorce and a thoughtless ex-husband. Divorce happens to almost half of the U.S. population, so there was nothing unusual in that circumstance alone. My attitude toward my student made it clear I hadn’t even considered that there might be much more to his story.

Many of the people who are homeless in our nation struggle with addiction. Others are seriously mentally ill. To save money many years ago, my home state decided to get out of the mental health business. Mental health patients who were deemed not to be a risk to self or others were sent home or let out on the street, and the facilities closed. Some families couldn’t care for their family members who were mentally ill, and these individuals became nomads.

But there are also many people who are homeless who have merely fallen on hard times. Some men and women travel from one state to the next in search of job opportunities that might enable them to settle down with their families. They spend their nights in shelters, doorways, alleys or their cars.

Those who want to pull themselves out of the abyss of homelessness are met with barriers at every turn. Businesses don’t want them warming themselves in their shops. Cynical pedestrians cross the street to avoid saying, “I don’t have any money for you.” Esteem is further eroded by words such as, “You’ll just spend it on drugs.”

Services for those who are homeless are often inaccessible. For example, in Atlanta, the labor pool (where men and women go to find work) was many blocks away from where most shelters were located. It was smarter to sleep under a nearby bridge, thus possibly being first in line the next morning. Better that than to sleep in a shelter and not being allowed to leave until 7 a.m., thus risking being at the end of long lines and having less chance of securing a job for the day.

People who are homeless can also be stalled by people like me — a college professor and professional counselor who should have known better. My student had no place to study at the shelter, no place to keep his homework, and no money to buy his books. With limited transportation options, he was perpetually tardy. And he was exhausted all of the time from caring for his family, working when and where he could, and getting insufficient sleep in the crowded shelter.

Our clients who are homeless need transportation, food, clothing and jobs. I know that we aren’t social workers, but those who work with the homeless have to think pragmatically.

I’m glad that I learned about this student’s story — which has a happy ending. He and his family got back on their feet, he graduated from college, and life is better. It frightens me to think how many other people I might not have seen clearly, however, because of my cultural blindness.

 

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Dear readers: I would value hearing from you if you found this series on cultural awareness (invisible people) helpful. My primary writing goal is always to help us do our jobs better. You help me do that with your comments, questions and ideas.

Previous articles in this series:

Voice of Experience: Invisible people, Part 1: Native Americans

Voice of Experience: Invisible people, Part 2: The incarcerated

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Invisible people, Part 2: The incarcerated

By Gregory K. Moffatt May 6, 2019

In the 1980s, the head of the department of corrections in my home state removed the exercise equipment from the state prisons. “They aren’t here on holiday,” he proclaimed in his no-nonsense tone.

I remember feeling a sense satisfaction at those words. “Yeah!” I thought to myself. “They deserve to be miserable. It’s prison, not a health club.”

In the years since, I’ve been inside prisons many times in the course of my work, and I now realize how thoughtless I was. Beyond my work, I have visited prison most often to see a friend. His incarceration was an experience that taught me the most about this invisible population.

Any politician running on a platform of prison reform would risk the accusation of being soft on crime. Although chain gangs and hard labor camps are, thankfully, part of history, for the most part, people don’t really care about what happens to prisoners. Like Native Americans (see the first article in my three-part series on “invisible people”), prisoners are often simply ignored.

In my experience as an investigator, a friend and a counselor of prisoners, most prisoners want to mind their own business, serve their time and get on with their lives following release. Many of these individuals are good men and women who readily admit their mistakes and are trying to put their lives back together.

I once wrote a similar thought in a newspaper column and received angry responses from readers. “My mother was killed. … Prisoners should be punished.” You get the idea.

I am not denying that there are some very bad people in prison. In fact, whenever I leave a prison, I’m glad that those iron doors lock behind me. Certain people need to be there, and they need to be there for a very long time. But just as there are many people in the general population who should be in prison — they just haven’t been caught yet — there are many individuals in prison who are very good people. Many of the men I’ve counseled could have been let out the front doors at any point and the community wouldn’t have been in any greater jeopardy whatsoever. People make mistakes, and sometimes those mistakes land people in the judicial system.

It is hard to describe the public humiliation of being arrested, tried, and sent to prison. And that humiliation is shared by family members. If someone asks where your father/son/brother is and you say “prison,” there will almost certainly be an awkward silence.

Once in the system, no matter how humane, prisoners are treated more like animals than like people. They are told what to wear, where to stand, when to eat and when to sleep. They are locked in crowded cages, and events they look forward to all week — visitation, a welding class, an appointment with the prison counselor — are often snatched away from them without notice because of the behavior of others. It can be total lockdown because of one guy doing something stupid.

Prisoners can be transferred without warning. Loved ones might travel four or five hours to see them only to discover that they have been moved, and it may take days or weeks to find out where they are. In such cases, the fragile lives that inmates have built in their prison world are erased, and they have to start over.

They are numbers in a system, not names. And they are identified by their crimes by probation officers, future potential employers and others. I would hate to be identified by my mistakes rather than by my character.

One inmate told me just after sentencing, “I know that no matter how many good things I’ve done in life, I’ll only be remembered for this one thing.” I couldn’t tell him he was wrong.

People entering the system can’t trust their fellow inmates — not because they are necessarily unworthy of trust, but because these new inmates just don’t know who they can trust. It is literally every man for himself. Sadly, neither can they trust the police, their lawyers or judges. I’m not suggesting at all that these people are unethical. I’m only stating the fact that at the end of the day, none of them see the accused as their friend. They see the person in relation to the charge and the process. If you don’t believe me, you’ve never been exposed to the system.

The consequences of the near-sighted policy of the former director of prisons in my home state were easily foreseen. Instead of occupying their time with exercise, inmates had little to do. Consequently, they filled their time with disruptive behaviors. The equipment was eventually returned — as it should have been.

If you want to experience real cultural diversity as a counselor, volunteer to work with prisoners in the system. It will open your eyes to what you (like me in my earlier days) have probably been unable to see.

 

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For a more detailed perspective of the prison system, see the book I co-authored with W.A. Murphy, Handcuffed: A Friendship of Endurance.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Invisible people, Part 1: Native Americans

By Gregory K. Moffatt March 18, 2019

The little girl sitting next to me was no more than 5. Her bony little body was draped in clothes that appeared to have been worn for several days. Unmistakably Apache, she looked up at me and smiled from her seat on the school bus in which we were riding. As is sadly common among children on the sprawling Apache reservation in Arizona, her teeth were rotted off at the gum line.

“Does your daddy hurt you?” she asked me matter-of-factly. After four years of working with these children, I was still shocked at how rampant the ills of society were among these populations. Child abuse, suicide, domestic violence, addiction, unemployment, substandard education, truancy/dropout and, yes, poor dental hygiene are just a few of the problems that are so disproportionately part of the experience of Native Americans who live on reservations.

In traveling the world, I have encountered cultures so vastly different from my own that it is hard to describe them to my friends and family members. You don’t have to leave the United States to have that experience, however. My heart breaks for the lovely people I have met — Apache, Hopi, Navajo — on reservations located within our borders.

Native Americans on reservations are among three groups that I will be addressing in a series of monthly columns on “invisible people.” One or more of these groups may be within walking distance of our counseling offices without our even knowing it.

I live in Georgia, the home of the Cherokee Nation, but many in our state have no idea that the Cherokee people are here. They know the Cherokee only from movies or perhaps because they have seen someone on the roadside in the north Georgia mountains dressed in traditional clothing and offering to pose for a photograph with tourists who are willing to pay a few dollars.

Sadly, the mention of “Cherokee Nation” likely causes many people to think of a sports mascot and not the literal nation of the Cherokee. I sometimes wonder if the average person realizes how many of our states, roads, rivers, cities and towns are named after one tribe or another or are otherwise derived from Native American words. Yet the heritage of these people gets lost in the blur of movie stereotypes, school mascots and advertising caricatures. It’s heartbreaking.

Because Native Americans are often “invisible,” so are their struggles. I suspect the typical American knows more about Middle Eastern culture than about the rich and beautiful cultural heritage of their Native American neighbors who may live only doors away. Native Americans who live on reservations are often inaccessible to those who might try to understand them, and those who live off the reservations possess a heritage that is largely misunderstood by nearly everyone.

Do you know the difference between a Seminole and a Blackfoot, an Apache and a Hopi, or a Cheyenne and a Tonkawa? Did you even know that the Karuk, Wichita, Koi and Kaw are tribes? Seeing all Native Americans as the same is as insulting as assuming that all Spanish speakers are from Mexico.

Misunderstandings abound. For example, for some tribes, feathers are indeed a part of the honor of a headdress. What you probably don’t know is that many tribes would never use a feather as decoration because it is part of what is dead, and that is sacred — not to be worn as jewelry or adornment.

It is next to impossible for tribes to perpetuate their traditions, religions, languages and cultural values as a subset of mainstream American culture. So, they are relegated either to abandoning these things or to moving onto a reservation, where life options for themselves and their children are significantly limited. What a bitter choice to make.

But even in 2019, in a culture in which we have removed cartoons such as the “Frito Bandito” from advertising, some Native Americans are still forced to look at caricatures of themselves in sports team mascots and advertising. If you think that I’m being overly dramatic, watch the documentary In Whose Honor. Only a cold-hearted viewer would not be moved.

I worked for years with Apache and Navajo parents, teens and children on a reservation, but in general, most of them never grew to trust me. I was a white man, so there was no reasonable cause for them to trust me. As we have all been taught in other arenas, distrust is to be expected when you represent the population in power. I have found that it is sometimes easier these days to practice with other minority groups, but not so much with Native Americans.

Unless you have gone out of your way to learn about Native Americans, my guess is that this article has opened some eyes. We pride ourselves on cultural diversity as counselors, but I’m not confident that the blinders we wear allow us to really see how much we don’t see — at least when it comes to the three groups of “invisible people” I am addressing in this series. I hope this first column on invisible people will open counselors’ eyes to what we might be missing.

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Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.