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NCA Associates is excited to enter the world of blogging with its first blog Navigating Professional Boundaries: The Issue of Trust. I look forward to your comments!
From my archive of newspaper clippings comes this headline, “Plastic surgery scandal rocks France” (Globe & Mail Dec 2011). The article goes on to say, “Tens of thousands of women complain that their lives are a living hell after being given faulty, cheap implants made not from medical silicone but industrial silicone normally used for computer parts or the electronic industry.” In addition the article states that the company in question saved an estimated €1-billion a year by doing so. Needless to say, horrific and started me on this chain of thought.
There is an increased dynamic tension between the professional and their client when the professional applies their skills and expertise in a for-profit environment. For there is an inherent conflict of interest or two “competing” interests – that of the client’s assessed needs and dollars. As such, the professional’s ethical obligation to ensure that their client’s needs come first is exceptionally high, and their recognition, understanding and acceptance of their ethical obligation and the reasons for it critical.
Obviously many professionals who work in the for-profit environment consistently manage this dynamic tension exceedingly well. Whether they are functioning as individual practitioners or are the owner/operator of an organization. This is not to say that they may not struggle from time to time however. And needless to say, there may be a few who are not fully aware of the “competing” interests before them at all and unfortunately, a very few who are aware and choose to ignore their ethical obligation to their clients in favour of profit.
So what tools are there to help manage this delicate balance? While by no means exhaustive, here are a few.
Education to increase awareness of the issues,
The use of examples /scenarios that relate to and reflect day to day experiences so that theory is married to practice,
Education on the applicable regulatory authority’s standards, guidelines addressing conflict of interest as example,
Development of a conflict of interest policy and corresponding procedures,
On-going discussions to keep the professional’s ethical obligations and reasons for it explicit in day to day thinking and actions using such forums as supervision, team discussions, brown bag lunches and so forth,
Consultation for professionals in private practice with no or limited access to supervision,
Self-directed “study” for professionals in private practice,
Consistent application of a decision-making framework to address real, potential or perceived conflicts of interest.
Whether working in a for-profit or not-for-profit environment, we need to be fully aware of our professional code of ethics and obligations. And in the for-profit world, I suggest that we need to be hyper alert to our ethical responsibilities given the inherent conflict of interest between protection of the public interest and profit.
From my archive of newspaper clippings comes this headline; “Panel criticizes judges for failure to hand out predictable punishments untainted by personal views” (Globe & Mail Dec 2010). While admittedly it is nearly impossible to be completely neutral or unbiased, the headline underscores the potential consequences that may follow when our personal bias of what we consider to be right, good, fair or just seeps into the professional/client relationship. And whether this occurs innocently, inadvertently or purposefully, by doing so we shape or begin to shape our client’s outcome.
Framing these concepts within our professional obligations both to protect the public interest and to ensure that our client’s needs are primary in the professional/client relationship, the introduction of our personal biases into that relationship becomes problematic. For when this occurs, our clients’ needs are no longer front and centre.
In fact, it is our personal interests that take centre stage. And whether our personal biases take centre stage for the duration of our professional relationship with the client or for only a brief moment in time, the focus is now all about us. Unfortunately, the consequence of this shift may be potential harm to our client.
So what could personal bias look like? As example, it could be shortening treatment time so you get to go home early, not addressing an issue with a “difficult” client so you do not have to deal with the resulting behaviour, influencing a client’s decision to the option that you feel is best, going along with a client’s request because you don’t want to hurt their feelings or because you don’t know how to say “no”, not agreeing with a particular organizational policy or standard or part of the policy or standard and doing what you think is more appropriate or abusing your clients for financial, emotional or physical self-gain.
And what could be the harm caused? As example, the client does not receive the amount of professional time “promised” resulting in lengthened recovery, the unaddressed issue becomes a bigger issue with increased impact on client/family members/community, the influenced decision not yielding the results that the client expected or anticipated and the upset/angry client or family’s response being “but you said…”, or agreeing to a client’s request by stepping outside your professional strengths/skill sets with inadvertent harm caused because you are operating from a position of professional weakness.
Ultimately, we need to be aware that from time to time our personal biases may leak into our relationships with our clients. We may be tired, in a rush, have a difficult client, simply want to “help” a particular client for whom we feel sorry or we have strongly held religious, political, or other beliefs that interferes with our ability to be professionally neutral, as example.
So how will we know if this occurs? The following series of questions encourages critical reflection and can be used in a self-reflective mode or in discussion with supervisors and/or colleagues. The first is “Whose needs are coming first, mine or my client’s?” Getting to the root of this question requires amongst other things a strong self-awareness of our personal values and beliefs in addition to our professional strengths and weakness. It requires an honest assessment of our professional actions, behaviours and communication. In other words is there a professional rationale for what we said or did that is grounded in theory and practice or are we attempting to justify what we said or did in an attempt to “get ourselves off the hook”. For one of the questions that we are trying to answer is, “What did I or what will I gain at my client’s expense, if anything?” And the final critical question we need to ask is, “If I have gained or will gain personally, at what cost to my client?” In other words, what is the harm caused?
Can you think of a time in your own practice or area of work that your personal bias leaked into your professional/client relationship? What happened as a result? And what did you do?
While going through my file of newspaper clippings I came across this comment, “We can legislate ethics, but not integrity” (Globe & Mail April 2010). This recalled an observation made by a workshop participant who lamented that boundary violations occur despite clearly articulated codes of ethics, standards of practice and policies.
Both statements underscore a hard core reality in the professional/client relationship. That expected professional behaviours are articulated by laws, statues, regulatory bodies and organizations and the interpretation of these articulated professional boundaries are filtered through the professional applying them.
The expected professional behaviours could be the manner in which informed consent is obtained, the requirement to maintain confidentiality of client information and what limits, if any, there are to that confidentiality; defining what constitutes conflict of interest such as receiving gifts from clients, how and what constitutes documentation of the professional/client interaction and so forth.
So you may have one professional who follows “the rules”, one who may not know that particular “rule”, one who may like most of “rule” but not all of it, one who in a lapse of judgment inadvertently or purposefully ignores or forgets “the rule” or one who purposefully chooses not to follow ”the rules” for their own particular reasons.
In other words, some element of who the professional is as a human being will have some impact on their interpretation of “the rules” that guide their professional behaviour. The degree of “leakage” of who the professional is as a person on the professional decisions that they make will vary; and may vary from time to time with the same professional dependent upon their fatigue, stress and any number of other factors. As a result and dependent upon the professional, the professional boundary may or may not be maintained to the degree expected or required. The “leakage” of personal views into the professional/client relationship introduces the boundary concept of personal bias. (More on this in a future blog!)
Breaking it down a bit further, consider these human factors that come into play at any given point in any given professional/client relationship.
§ As the professional, do we know “the rules”?
§ Do we understand “the rules”,
§ Do we accept “the rules”?
§ Do we abide by “the rules”?
A weakness in any one or more of the four factors may compromise the application of the rule and therefore may compromise the professional boundary itself. And of course the other factors that come into play are;
§ As the professional, do we recognize the times that we need assistance?
§ Do we feel comfortable in seeking that assistance?
§ And from time to time when we feel that “the rule” does not work well in practice, do we speak up in an appropriate manner to the appropriate person or body, if this is at all feasible?
Occasionally, we may feel that there are too many “rules”. And from time to time even, we may forget their purpose. This too is the human element.
However, as professionals our prime mandate is to protect the public interest. In other words, to ensure that there is a safe connection between us and our clients and to ensure that this safe connection pivots around the clients’ needs not our own. And we need to maintain the public trust that we are in fact keeping their needs primary. (See June blog on the issue of trust). Therefore, we need to know ourselves and how our own human factor comes into play when it intersects with directives and guidelines that govern our professional behaviours.
© NCA Associates 2011
Tagged codes of ethics, Expected professional behaviours, Maintaining the public trust, professional behaviour, professional boundaries, professional boundary violations, professional decisions, professional rules, professional/client relationship, protect the public interest, standards of practice and policies
Reading the paper recently, I came across an article on the sentencing of a retired priest for sexual abuse. (The Ottawa Citizen 20 April 2011) Most powerful were the excerpts from the victim’s impact statement. Poignant and central to the statement was the betrayal of and absolute loss of trust in a professional held in the highest esteem. A professional trusted by individuals and the community to “do good and not cause harm”.
I speak, write and provide training on professional boundaries and have done for a number of years. The article prompted the writing of this blog as I do not believe that we talk enough about the issue of trust in any professional/client relationship. Yet trust is fundamental to that relationship. Regardless of profession; whether you are a priest, physician, lawyer, allied health professional, teacher, firefighter or police as example.
Trust is an interesting dynamic. For one, it is usually implicit. Generally, a client assumes that the professional is trustworthy by virtue of the position that they hold. And generally, there is an assumption that the professional will “do good and not cause harm” in the services that they provide.
However, trust is fluid as it is relational. So that we, the professional can have trust; we can lose trust; we can damage trust. And once lost, trust is difficult sometimes impossible to regain. Trust can be lost as the result of grievous acts such as sexual abuse; and trust can be lost or damaged in the course of seeming simple day to day interactions with clients. Can you think of a time where you said or thought; “But I didn’t mean that” as a result of a client comment?
Having trust; losing trust or damaging the trust can be broken down into a simple chain of events;
Our Intentions (our purpose, aim or objective) Our Act (what it is we do, say or imply) the Consequence to our client (impact, result or effect)
The difficult aspect of this fluid and relational nature of trust is that the intent of our actions and the impact experienced by our client may be very different.
And real, potential or perceived, the impact experienced by the client becomes their reality. And from this interpretation of our intent, the client will like what we did or said; be upset by what we did or said; be shaken, devastated or angry by what we did or said, or be neutral or indifferent about what we did or said. Some may choose to complain about our actions. Some may not. Some may at a later point. Some may behave differently. Some may stop coming altogether. And we may never know why and as a result, we are unable to address; clarify; apologize or “fix”.
That being said, I believe that we need to take the implicit nature of trust and make it explicit in our professional thoughts. In other words, we should be cautious about assumptions of trust. Rather we should keep foremost in our professional thinking that clients give or place their trust in us. Their trust that we will “do good”; their trust that we will not cause harm; and the trust that we will keep their needs primary in the services we provide. And we need to remain vigilant in our actions and our words that we maintain that trust.
© NCA Associates 2011
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