Human Services Club

The Anatomy of a Clinician

Counselor Connection

Bonus Content/Counselor Connection Newsletter

How do you make ethical decisions? Do you follow your heart, do you focus on your brain, do you listen to the whispers of advice coming to your ears or do you trust your intuition (your gut)? You are going to want to say “all parts of me, of course!” But typically we have a part of our body that is a stronger advisor than others, so I want you to answer this honestly, after giving it some thought. Some of us are strongly swayed by our emotions, and find our heart often dictates our decisions. Others direct our decisions based on what feels right in our gut, using our intuitive sense. Some of us prefer to dampen those influences and listen to what our head is guiding us to do, making a rational decision based on facts and influenced by our training and education. Others trust advisors the most, and therefore use their ears (and the advise they hear) as the strongest guiding force. What about you? Let’s illustrate.


Peter is a clinician in a residential setting who has worked closely with his client, Jackson, for eight months. Jackson, despite adhering to his recovery plan for a year, relapses while on a weekend pass. He calls Peter immediately after relapsing to notify him, and returns back to the house begging to be allowed to continue treatment, despite the strict program policy of immediate discharge upon relapse. If it matters to you, reader, let’s say his relapse consisted of two drinks and Jackson did not hurt anyone, or engage in any illegal or risky behavior during his relapse. He drank alone, and called Peter immediately. He has a long talk with Peter, in which he both pleads his case and works to identify his relapse triggers in an attempt to strengthen his recovery plan. He acknowledges the areas that require his attention and makes a healthy plan to address them. The next morning, the program staff meet to discuss Jackson’s actions. The program director asks Peter for his thoughts on the relapse and what consequences he advises.


Before we discuss, consider what you would advise if you were Peter. Or if you have been in this clinical situation, what course of action did you take? Did you discharge the client because of the relapse or did you keep the client in treatment? What is the rationale for your decision? Now ask yourself, am I being swayed by my heart, my brain, my ears or my gut? Got your answer? Okay good, now consider whether certain altered details would change your decision and your anatomical influence. For example, if Jackson can’t recognize what part of his recovery plan needs strengthening, or if he has had several other infractions since being in treatment, or if this is the first client relapse the treatment facility has experienced in a long time. Would any of these changes influence you to make a different decision? Is there any detail that would lead you to a different decision? Armed with your own beliefs and preferences, let’s discuss the clinician’s anatomy and potential outcomes.


The Heart


If Peter is strongly influenced by his heart, perhaps he would be swayed by the pleading of his client. Perhaps he would see how hard the client had worked in the past and feel frustrated and disappointed for him that a relapse has the potential to affect his placement. Perhaps you will feel your own emotional repercussions from working hard with a client and facing an abrupt end to your clinical goals. Perhaps you will feel fearful of what will happen to Jackson if he has to vacate the program. These examples are thoughts that stem from Peter’s emotions.


A clinician’s heart is helpful in making ethical decisions because emotions are the pulse in a human. We connect to people through our emotions, and they serve as a significant guidepost in ensuring we act humanely and with empathy, which are clinical requirements. However, a clinician’s heart can also put us at risk for making ethical errors. We can sway too far into our emotions without listening to our rational brain, or the advice of others, or our nagging gut. Listening to your heart can help you understand your client, put yourself in their shoes, and advocate for them. But it can also bias you to your client’s needs and prevent you from considering alternative actions.


The Brain


If Peter is strongly influenced by his brain, perhaps he would be swayed by the policies of the program. Perhaps he would see the necessity of creating and maintaining rules that protect the program itself, as well as the clients in it. In this case, Peter might see that while discharging Jackson may seem unfair or inappropriate for Jackson individually, the policy is in place to protect all of the residents, ensuring each that the house is a safe place, intolerant of drug use. The policy also protects the agency as a whole, because it promotes a standard of operation. If staff only makes individual rules for each client, the program is at risk without a set of standard policies and procedures. Perhaps Peter’s brain is rationalizing that because Jackson relapsed, no matter how brief, he should be in a different level of care and that a discharge with appropriate referral is the best option for both Jackson and the program.


A clinician’s brain is helpful in making ethical decisions because it is the hub of all our education and training, and holds our ability to reason through a situation, examining more than one angle. However, a clinician’s brain can also only tell part of a story. Making a rational, practical decision without taking other opinions into account can lead to rigid thinking. Keeping decisions emotion-free can also make the clinician miss an important point: sometimes situations call for special circumstances that are informed by your heart.


The Ears


Now let’s imagine Peter is strongly influenced by his ears and the advice he hears from others. Perhaps Peter would be swayed by what his supervisor thinks he should do, or his program director, or his colleagues, or Jackson’s family, or Jackson’s probation officer. All of these are potentially excellent sources for guidance. A clinician’s ears can be helpful in making ethical decisions because these sources may make suggestions Peter would not otherwise consider—suggestions that may be superior to his own ideas. Even if the sources agree with what Peter had in mind, he will be bolstered in his decision. It is vital that a clinician considers as many possible avenues as possible, and collects any relevant opinions to ensure he or she is making the best choice. A clinician also does not want to make a tough ethical decision alone, but rather make one that is supported by trusted advisors.


However, a clinician’s ears can also lead a clinician astray. It is possible to be swayed by someone else’s agenda that pushes a clinician to make a faulty or inferior choice. If a clinician only listens to others, without considering his or her own thoughts and feelings, that clinician is undermining his or her own expertise and abilities. That clinician may actually be the most knowledgeable person in the situation and may have the best course of action in mind. Ignoring your own ideas can lead you down the wrong path.


The Gut


Finally, let’s look at clinician intuition, what we like to call the “gut.” If Peter is strongly influenced by his gut, perhaps he would feel something more was going on with Jackson. Perhaps he would feel that even though Jackson appears remorseful and seems to have a good plan in place, Peter still feels he is not as treatment-adherent as he seems. Perhaps Peter has a feeling that Jackson is still in relapse mode. Similarly, Peter may intuitively feel that the program has some other agenda for wanting to discharge Jackson. No matter what that intuition is suggesting, it is an important tool for a clinician. Clinician intuition can be helpful because it lead the clinician to ask questions, investigate a bit more, and challenge him- or herself not to jump to conclusions based on available evidence.


However, a clinician’s gut can also lead a clinician to either the wrong move or can stunt them into inaction when action is needed. Let’s be clear, no clinician should ever operate solely on his or her gut, because intuition is not based on fact. You don’t want to decide an ethical course of action based on a feeling you have, particularly if you haven’t checked with your other body parts. Listening to your gut is very important because it can lead you to the best answer, but it is not, in itself, the best answer. In this example, if Peter feels Jackson is not being completely honest, he can ask additional questions or confront the client with his concerns. Peter will likely either become more at ease with Jackson’s claims, or will uncover some clinically important information that will allow him to give the client what he needs. Contrarily, it can also push him down a rabbit hole with no end or no help, and can lead him to make a faulty decision. This happens if Peter only listens to that intuition and does not consider outside opinions, what his emotions suggest, and what his brain can discern of the evidence. Which leads us to the best case scenario for Peter, and the rest of us.


The Whole Picture


The most ethical clinician is one that uses all of his or her parts, as the whole body is strongest when the parts work together. Ignore one part and your body may still work, but it likely won’t work as efficiently. Clinicians who ignore one or more of their ethical influences are at risk of making inferior decisions. When faced with making a decision, ask yourself, “What would my heart advise me to do? How about my head? What advice are my ears hearing? What is my gut saying?” If you want to ensure you are not missing a potential path to ethical greatness, check with every part of your clinical anatomy. You’ll be glad you did.


The best course for Peter is to consider how he feels about Jackson’s progress and what Jackson thinks should occur. He should check with his gut in case further investigation is needed, he should weigh all the possible evidence and angles and make a rational plan, then check all of this with his trusted advisors to ensure he is making the best ethical decision by Jackson. In this case it is important to abide by the rules of the program, yet there are situations where exceptions are warranted. There needs to be a clearly stated argument why an exception is appropriate and it should be a team decision. If Peter can successfully listen to all his parts, he can feel confident that he is making the best decision with the information he has at the time, and can move on to the next ethical question to cross his path.

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