Chapter 5 discusses ethics in the human services setting. It is likely that the topic and importance of ethics were mentioned in several of your classes. The internship involves working with other people who are being offered a service of one type or another, so ethical principles and practices must be a focus of the experience. It is your responsibility as a human services intern to uphold them in everything you do and say.
- Code of Ethics: A group of principles that guide an individual or organization and their practices. The principles act as guidelines or rules based on the values of an organization or individual that set the limits for such things as how to identify conflict, how to avoid, or how to deal with problems.
- Competence: Possessing the skills, knowledge, or abilities necessary to successfully or efficiently form various tasks associated with a discipline or position.
- Conflict of Interest: A relationship or situation where one’s own activities or interests can be advanced at the expense of another who has less power, authority, or resources. Often associated with an imbalance of equity.
- Cultural Diversity/Multiculturalism: The variety of different values, preferences, practices, and behaviors that exist between groups. Multiculturalism is an alternative, more inclusive term.
- Dual Relationship: A relationship between a human services worker and another person or group that involves a conflict of interest. Common examples include dating a client or using a client for the clinician’s own personal or financial gain.
- Ethics: A system of moral principles to guide behavior
- Ethnocentric: A conscious or unconscious belief that one’s own ethnic group or culture is inherently superior to another. An inclination toward viewing others from one’s own cultural or ethnic perspective. Extreme forms include such things believing that one’s own group is better than others and acting on this position, such as in the case of racism.
Ethics and Laws
Ethics are the rules of conduct. Often, they are recognized as the best practices based on the underlying principles of a given profession. Ethics are not laws, which are actual regulations one must comply with because they are established by an authority with judicial responsibility and the power of enforcement. In the most basic sense, ethics are principles, and laws are requirements.
At many internship sites, one may see dedicated people working in ways that are consistent with a code of ethics that they take seriously. Typically, their mission is to ensure that people are treated fairly, equally, and respectfully. It is easy to understand how ethics and laws, such as licensing laws, protect clients as they help ensure clients of reasonable treatment.
However, it is almost equally important to realize that ethics and laws also protect the workers. They provide rules that may be helpful in guiding us through difficult or risky professional situations. In addition, new circumstances are constantly emerging and must be examined by the professions and courts, sometimes resulting in revised or new codes of conduct, laws, and regulations. Understanding these issues ensures the clients’ safety and keeps a worker out of future legal trouble. Staying up to date and adhering to the standards of practice might be the only defense from a lawsuit. Most professions will offer classes or continuing education that focus on existing ethics and laws, particularly those that require credentialing. Students should ask instructors and supervisors about the practices that apply to their profession and their placement site and what the laws are and why they are in place. Moreover, the instructors and supervisors should advise students on how to handle ethical issues when the students encounter them.
Codes of Ethics and Human Services
Each human services discipline has its own code of ethics and some of them have licensing laws as well. Ethics are usually specified by the profession and based on professional values while laws are made by states, although there is often overlap between the two. For instance, the National Association of Social Workers (National Association of Social Workers, 2019) offers a code of ethics summarizing ethical principles that reflect the profession’s core values and uses them to establish a set of specific standards that should be used to guide social work practice based on the identified value. Some examples include:
- Value: Service
Ethical Principle: A social worker’s primary goal is to help people in need and to address social problems.
- Value: Social Justice
Ethical Principle: A social worker challenges social injustice.
- Value: Dignity and Worth of the Person
Ethical Principle: A social worker respects the inherent dignity and worth of the person. Again, each discipline will have its own professional code of ethics that embodies the values the discipline embraces and includes a set of behavioral guidelines as well. They can be found in counseling, criminal justice, psychology, social work, as well as in other areas. It is incumbent upon the intern to know about them. Your instructor and supervisor should make a point of helping you know where to look.
Ethical codes and licensing laws are intended to protect the client, the practitioner, and the agency by ensuring that clients receive the best treatment within a set of behavioral boundaries. Sometimes the ethics of two professions or agencies may conflict. For example, Catholic Charities offers behavioral and mental health services that do not include abortion, while Planned Parenthood provides women’s wellness programs that emphasize choice. If you find that the views of an agency conflict with yours, it is important to think seriously about those conflicts, perhaps even re-evaluate the selection of that site if the conflicts seem to be insurmountable. In general, if you agree to be an intern at a site, you have also agreed to act in ways that do not contradict its prevailing values and standards unless they are illegal. Should you decide you cannot do that, then you should discuss the problem with your supervisor. If a compromise is not possible, then the ethical path for all concerned may be for you to consider another type of agency.
Personal Codes of Ethics
In addition to having a thorough understanding of the ethical code in your profession and the facility in which you work, it is important to become aware of and develop your personal code of ethics. Professionally, a major reason for this general rule is that, in practice, your ethical principles might be challenged or come into play, often quite unexpectedly.
The more you know about what you believe and value in advance, the better prepared you may be when this time arises. Consequently, self-awareness is helpful in these situations. After all, people are rarely simple, and a client’s behavior may evoke conscious or unconscious feelings or reactions based on your experiences and background. Though this process is mostly an introspective one, it is often helpful to discuss these issues with others, such as your colleagues, instructor, and supervisor. Taking the time to develop a clear and reasonably articulate ethical foundation will help you face challenging situations in the future, and often will provide a sense of direction. Having a firm grasp of your personal beliefs may also be of value when making rapid decisions, such as in a critical relational moment or when dealing with a crisis.
You are a social worker at your local agency and someone you dislike walks through the door looking for help. Perhaps you are a criminal justice major who has just found out that you will be dealing with someone you grew up with but have not seen in years. Maybe you are a case manager driving a client to their medication appointment and you think you smell marijuana coming out of the apartment when the individual opens the door. Perhaps your next client is accused of child, spousal, or elder abuse. All these situations are examples that are likely to stir up conscious and unconscious reactions that challenge your ability to conduct yourself in a professional manner. The more you know about your personal values and ethics, the better able you will be to conduct yourself in accordance with your professional ethics and obligations without being overly judgmental or jumping to premature conclusions.
General Ethical Guidelines
There are many ethical concerns when it comes to clients. A few things to keep in mind are listed below:
- Be committed to helping people at the site, regardless of your personal preferences, no matter who the client may be. It may be helpful to keep in mind Carl Roger’s notion of unconditional positive regard, which means that you value everyone’s essential humanity, though you may not necessarily agree with or approve of their behavior.
- Having cultural awareness is necessary. Always remember that every culture handles situations differently. Educate yourself on the different cultures that the agency will be working with as that type of information will give you better insight, understanding, and direction on how to proceed with a client. Similarly, educating yourself about a client’s respective culture before meeting with them can help you achieve a rapport with the client and avoid creating unnecessary obstacles in your work.
- Conflicts can and will arise. Some of them might be unethical or even illegal to engage in. If a situation presents itself and you begin feeling uncertain, make sure to inform a supervisor and instructor as soon as you can to examine possible responses before making any decisions.
- Always be as proper and respectful as possible. Choose your written and oral words responsibly. Be aware of facial expressions and other non-verbal signals you may be conveying to your client. If non-verbal signals do not match what and how you are saying something, it may be more difficult for the client to believe what you are saying is true.
- Pay attention to ethical and legal mandates. Most human services professionals are mandated-reporter occupations. States have laws concerning when and under what circumstances situations need to be reported. Suspicions can be based on circumstances that would cause a reasonable person in a similar position to suspect that a client has suffered or faces a threat of physical or mental harm. This practice is especially necessary if the situation involves a child under the age of 18 or an intellectually challenged, developmentally disabled, or physically impaired person under the age of 21. It also may apply to suspected spousal or elder abuse. Suicidality and homicidality are other possibilities to be aware of. If such situations arise at the site, they must be taken seriously and should be discussed immediately with your supervisor.
- A good ethical and professional guideline is to remember The Golden Rule: Treat others the way you would want to be treated.
Practicing Ethics at the Site
Maintaining professional ethics is not always easy. For example, it is important to remember that although you may not agree with all your workplace’s codes, you are usually obliged to abide by them. Learning how to integrate the ethics of the workplace and profession with your own is helpful and could enhance your professional image. For instance, you can fulfill your corporate social responsibility by recycling goods on site. Embodying ethics in this way may also serve as a role model for clients, especially children, who often look to you for guidance.
Part of a professional code of ethics and law that can cause people considerable trouble concerns avoiding dual relationships, especially if one is living or working in a small town. Dual or multiple relationships occur when a professional has more than one type of relationship with a client. More specifically, the relationship must be such that there is an unequal distribution of influence or power between the provider and the recipient of the services. For example, having a friendship is usually based on an equal distribution of influence, but having a professional relationship with a friend is not. What makes dual or multiple relationships unethical is the chance that the client might be exploited, and, as a result, potentially harmed. One clear violation of the code of ethics in most disciplines is that a provider and a recipient of services cannot have a sexual or financial relationship with one another.
Countertransference, or the professional’s conscious and especially unconscious reactions to the client, should be something you learned about in other classes or coursework related to your major. Risks of countertransference are especially high when the clinician projects their unresolved conflicts and interpersonal issues onto the client. At times, for instance, a client might remind you of a person who you are close to, such as a parent, sibling, partner or ex-partner. Depending on your degree of self-awareness, sometimes you might not even be aware of it as the process often happens unconsciously. That is what makes the situation especially difficult or even dangerous. Self-awareness helps spot these possibilities before they become a problem, but general awareness of them helps too. One way to increase this ability to spot these problems is to ask yourself if the person you are working with reminds you of anyone else in your earlier or current life. If the answer is “yes,” then countertransference is likely to be a part of the situation. As you continue the internship, keep in mind that your job is to help the client in an appropriate way, with the emphasis on appropriate.
Even though you may believe you have a clear understanding of what countertransference is and how it works, it remains tricky because countertransference always happens in our psychological blind spots. While working with the elderly, for example, it is very easy to find yourself responding too much to a client, until you realize that they remind you of your own grandparent. Once again, if someone really irritates you, it may help to ask yourself who else have you responded to in this way from your childhood or from a current relationship. While such self-awareness might seem simple, it is difficult to achieve when countertransference is occurring.
An older person you are working with reminds you of someone you once knew and always makes you smile. They seem so “nice” and need a little money for rent or medications. You think nothing of offering to “lend” them some or even pay for it because you are supposed to help those in trouble, and, after all, it isn’t that much money. To do so, of course, would cross ethical lines. Once that happens, it is easy to form an attachment that could lead to other things, such as dependency, unrealistic expectations, and problematic behaviors that compromise your position when your behavior becomes known to others. In this way, a well-intentioned, but ill-considered action may lead to an ethical mess.
Confidentiality, as most interns know, is a key ethical responsibility. There are many dimensions to this issue, such as keeping client and staff information confidential, as well as conversations and observations made at the site and in classroom discussions. Another dimension of confidentiality to consider is outside of your work and academic environments.
Most people have a natural desire to talk about their experiences, particularly meaningful ones, with others. Always check with the supervisor to find out the limitations as to what can and cannot be discussed within and outside of the workplace. Keep in mind that when talking outside of the workplace, a person’s real name and identifying information (information that can be used to identify someone such as gender, age, physical characteristics, behavioral history, place of residence, occupation, and so on) should never be used. The same rules apply to journals, notes, and, of course, social media. In fact, it is probably best not to even think about “discussing” anything from your practicum using social media as that record never goes away.
You are in your practicum class and say, “I was taken by surprise at my internship site when Suzie, my best friend from high school, came out of the therapist’s office who treats only opioid addicts.” It may seem like you have “permission” to share this information at your classroom meeting because there are many Suzies in the world, and you did not mention a last name.
However, that would be a mistake because you have revealed what is called personally identifying information, in fact, quite a bit of it. For example, you identified the person as having a common name. Furthermore, you also specified a location and a relationship. Together, these three bits of information are more than enough to identify someone. In this case, someone in the class may have known a Suzie in your high school and that she had a best friend who had your first name! Or, perhaps the school’s social media pages showed a picture of you and Suzie together at an event.
HIPPA regulations concerning client confidentiality often apply to human services settings, too. HIPAA is an acronym for the Health Insurance Portability and Accountability Act that Congress passed in 1996 and is a compliance requirement for any health professional or setting. Most human services professionals talk about these requirements when discussing ethics, but it is also the law, which makes honoring these rules more than just an ethical obligation. These rules apply to all forms of information, including paper, oral, and electronic forms. Furthermore, only the minimum health information necessary to conduct business is to be used or shared. Criminal justice settings may have different rules concerning confidentiality because some records are open to the public for the asking, such as crime reports, so it is always advisable to discuss the rules with your supervisor early in your internship.
Dependency vs. Empowerment
One of the more challenging ethical issues that many interns in the helping professions face is the tendency or inclination to do too much for clients. In the extreme form, such practices involve going far beyond what is required to help the individual such that the client becomes dependent on you and expects you to do the work for them. This is a common ethical dilemma because the helping profession tends to hire workers who genuinely want to help the lives of others, and the clients generally do need help. However, crossing this line may lead to major problems, such as loaning people money, buying them things, and, on rare occasions, even taking them home, which usually leads to people being fired!
One way of preventing this type of ethical dilemma is to constantly involve the clients in the helping process as active participants so that they may learn to help themselves. For instance, if a client is looking for housing, you can involve them in the process of finding a home, which includes learning how to find advertisements, make calls, get references in order, have a bank account, and so forth. The proverbial Biblical story that discusses the difference between giving a person a fish and teaching them how to fish comes to mind here: “Give a man a fish and you feed him for a day. Teach him how to fish and you feed him for life.” Even though well intended, doing too much for a client is unethical or at least detrimental.
If you find yourself in a situation where the client has become dependent, then appropriate action needs to be taken. You can help the client to recognize and rely on their own strengths thereby fostering their independence. Encouraging clients to develop their own plans, getting them to identify goals, and directing them to the appropriate resources is a win-win for both of you in the long run.
Sometimes you and your client will disagree on a plan, goal, or resource. Try to be professional when these situations come up and remember that often people learn by making mistakes. If they are small ones, you can think about stepping back a bit and allowing the client to figure out what happened in order to avoid the error in the future. Small mistakes can be used as learning tools and build up confidence, if you continue to be supportive. Supervisors, of course, may sometimes take the same approach with you!
Sometimes you may encounter a client who seems unwilling to help themselves. This situation may be especially frustrating to interns because we all want to demonstrate that we do care, are competent, and can do the work. Before doing anything, be sure to reflect on whether there is a cultural issue involved. It may be that the client is doing what they think they should be doing from their cultural perspective. For instance, most Americans expect eye contact and plenty of dialogue to occur when interacting with other people. However, in another culture, maintaining eye contact with a person in authority or speaking up is considered impolite or even rude. So, if an American is dealing with someone from that culture who appears politely reserved, we might regard them as depressed, bored, or resistant when they are not. Cultural competence is important in the human services field because we deal with human diversity all the time in our work.
However, sometimes the client is just not prepared for change or really does not know how to start the process. It is important to do your best in these situations and offer support and guidance to the individual even though the person may not accept it until later. Of course, there are other types of resistance, some of which concern personality conflicts, differences in individual styles, and mental health issues, all of which should be brought up to your supervisor when they occur.
Sometimes referring the client to a different case manager or specialist is what the client may need. For instance, if you are working in the area of domestic violence and find that a client is an alcoholic, it helps to refer the individual to someone who specializes in doing therapy with people who suffer from addictions. There are several other reasons a referral may be necessary, such as having to end the internship experience before the client’s needs are completely met, a therapist changing jobs, or taking Family and Medical Leave Act (FMLA) leaves, to name a few.
One of the most delicate situations is when you and the client come to an impasse. Massive transference or countertransference problems, a lack of training and skills in an area that must be addressed in order to move forward, or a client’s resistance to change all create special problems in treatment. In general, it is important to realize that the client should never be abandoned. Instead, you, the supervisor, or the site should set up an alternative pathway to get clients the help they need and deserve.
Sometimes clients may also ask to be referred to someone else. Try not to be offended if that happens. There are plenty of reasons why a client may ask to be referred to another professional and not many of them have to do with you or your style, though that can happen, too. Be sure to discuss the issue with your supervisor. That way you may be able to find out what went wrong, if anything, and gain knowledge.
Asking for Help
If you ever find yourself in a position that you are not sure how to handle, ask the supervisor or your instructor for guidance. If you are at the site and the supervisor is not available, it may be possible to check with one of the other staff members. If no one is available and you must act quickly, you will probably have to make the best decision you can based on your training and individual principles. These situations may be intimidating, but they can also be great learning opportunities. Afterward, you should process the experience with the supervisor and ask questions. Although there may be dumb questions somewhere in the universe, it is not during the internship.
Documentation, or an approved way to record events and transactions with a client(s) is extremely important in most human services settings. From mental health to criminal justice settings, documentation is valuable in at least two ways. First, it lets others know what transpired if you are not available. Imagine what being in a hospital would be like for nurses if there were no charts on the patients to turn to as you come on your shift! Second, documentation often has legal standing. It is a record of what you saw and did in response to a client. Good documentation not only protects the well-being of the client, but it protects you as well, as it can show that you followed appropriate procedures in your work with the individual.
Some people like to say, “If it is not on paper, then it didn’t happen.” Although that may be an exaggeration, the concept is a good one. Always follow agency policy on taking detailed notes and on documentation. Also, if a situation with a client occurs, or if you are injured in any way, tell the supervisor, and keep clear documentation of the incident. These are standards of practice at most agencies. Your internship site and your role there will determine such things as how to record information, what to write, how detailed it should be, and which format to use. Be sure to ask about these things if you are not told about them.
Depending on the agency, you should be cautious about signing documentation. After all, if you do sign something, it can be understood to mean that you agree with what is written. Therefore, if you must sign a document, make sure that it is accurate or that you agree with it. If you do not agree, it is important to see your supervisor and discuss this problem with them before signing.
Identifying and Dealing with Dilemmas
Being able to identify legal or ethical dilemmas is the first step toward properly handling them. Most likely you have already heard of some potential issues and some examples which have occurred with other interns or professionals. You should expect to experience dilemmas as well. One of the more common ones occurs when witnessing someone else doing something that you feel is wrong. Like it or not, once you have knowledge of the issue, an ethical burden lands on your shoulders. Since these situations are often difficult, it might be a good idea to spend some time considering how you might handle them in advance. For example, you may want to explore ethical dilemmas in the classroom component of the internship. It is also possible to review some hypothetical situations with your supervisor at the site. Such “imaginal variation,” as it is called, may help you handle yourself in a professional manner when such situations arise.
If something like this does come up, remember to pause and take a deep breath before responding to a situation. Self-monitoring is important, as sometimes the first thing out of one’s mouth does not necessarily come out as intended. It is also always important to protect the interests of the client. While you never want to act without thinking things through, choosing to do nothing is still a choice. Failure to act is a decision, and, like all decisions, it has its own consequences.
Critical Thinking and Decision Making
Knowledge of ethical standards only goes so far. Sometimes, you will have to rely on your own ability to deal with dilemmas that are not always clear-cut. Making an ethical decision is complex and difficult, but sometimes it simply must be done. As with any type of problem-solving, it is a good idea to view it from multiple perspectives because different points of view reflect different interests and priorities. Ideally, of course, you should discuss the situation with your supervisor or coworkers and take time to come up with the best solution. Keep in mind, though, that there will be times when you must act immediately and use your best judgment.
As discussed earlier, reflecting on your own code of ethics as well as knowing those of the agency and profession in advance helps. Staying calm is usually beneficial in these situations as well. Having a realistic view of yourself will help, too, as well as being aware of such factors as tone of voice, timing, non-verbal expression, and word choice. Once you successfully face a few of these situations, your confidence in your professional decision-making process is likely to increase.
After the Decision
It is not unusual to dwell on a difficult decision you made after the event is over. Having a good working alliance with your supervisor, colleagues, and instructor are especially helpful. These relationships can allow you to talk through issues and gain different perspectives on them. You may receive some constructive criticism about your decisions from time to time. After all, no one is perfect; otherwise, if you were, why would you even be in an internship? Try to understand this feedback as a part of the learning process that is concerned with helping you become better prepared for future situations. Learning this way may also help reduce second guessing yourself. While difficult, partial successes and failures can be the most valuable parts of an internship because they show you some of the more complicated facets of working with human experiences before you are accountable in the way that a full-time employee would be.
Self-care is essential in all helping professions due to the possibility of burnout. Burnout is a type of exhaustion that has a negative impact on physical, mental, and emotional health because it saps your energies in all three areas. It is easier to fall prey to burnout if you are not routinely trying to take care of yourself in these ways. Luckily, the reality of burnout is becoming more and more recognized every day, but you still must be active in identifying your own vulnerabilities. Though you may feel that you are “just an intern,” the need for self-care is still essential because your clients depend on you, and this level of responsibility should be treated respectfully. Also, interns are regularly juggling many demands while serving internships, such as class, family, and job obligations.
Ethics and Continuing Education
From social work to police work, human services usually require professionals to stay informed about up-to-date practices in order to deliver better service. Though each career has its own standards, keep in mind that it is your responsibility to understand and fulfill requirements and that those requirements frequently change. That is the reason that most human services professions, as a rule, offer and require continuing education credit. Most internship sites will have some of these professional educational opportunities, and it is a good idea to at least sit in on them. Another advantage is that sometimes sites offer access to high-level seminars, workshops, and programs. All can add to your growth and knowledge as a human services professional.
Some of these events may include the opportunity to learn from outstanding experts in your field. If your agency is offering one of these events or sending people to a regional or national convention or workshop, try to be included. Sometimes training certifications are awarded, and each one of the higher-level events can become a resume item, not to mention a wonderful networking opportunity.
Challenges Along the Way
Asking for and Giving Help
It is important to remember that while at your practicum site, you can be an asset to the team. First, remember to always ask for help if you need it. This could be asking for help from your supervisor, coworkers, or any colleagues with whom you have worked. Second, remember you are at your site to gain knowledge and experience as a helping professional. Third, try to move toward increasing degrees of reasonable independence as your internship progresses. Finally, take advantage of any downtime to do or learn something new. Nonprofit internship sites always have work that needs to be done and showing initiative in this way is usually a win-win for all concerned.
Tools for Chapter 5
Activity 1: What Would You Do?
In the helping professions, you will often face problems without clear-cut solutions. Consider the following scenario:
Funding sources have recently changed at the non-profit organization where you are employed. You are the one responsible for telling a few fellow employees that if they wish to continue in their positions, they must accept a significant pay cut. You are close with these individuals and you know some have families and that others are already struggling financially. There are four courses of action you can take:
- Look into transferring the employees. (The closest opening is 100 miles away).
- Ask for additional funding. (Grant writing takes time and is usually competitive)
- Choose who goes and who stays.
- Hold a staff meeting to discuss funding cuts.
Now, what do you do? Why? With your classmates, discuss all the options provided. Did you or any classmates include standards for ethical practice?
Activity 2: Caring for Your Most Valuable "Tool"
Believe it or not, you are your most valuable tool in any human services field because all of them require that you rely on your ability to understand people and respond to them appropriately. Just like any other tool that is important for your work, you must take advantage of it, which is why self-care is important. It is also different for everyone and what works for you can change day to day. Here are some practical strategies you can use to reduce stress:
- Recognize stress: Identify those situations that make you most vulnerable to stress so that you may minimize them or at least anticipate them and act to lessen any negative impact.
- Try to get more or better sleep: It is no secret that as you try to juggle your personal and professional life, you will find yourself growing busier by the second, so getting enough sleep is key for overall work productivity.
- Talk it out: Your site supervisor and professor overseeing your internship are also valuable tools for you. Good mentors will understand your stress and be patient with it. Also, remember that asking for assistance when you are struggling is not a setback, but a way to be better in the future.
- Try mindfulness meditation: A lot of research supports the idea that mindfulness meditation (Kabat-Zinn, 2019), when done on a regular basis, is a low-cost and effective way of reducing or at least managing stress. There are many online videos and phone applications to guide you through 10- to 15-minute sessions of mindfulness meditation. Mindfulness meditation is simple yet powerful. The more you practice it the more effective it is at reducing stress.
Activity 3: Exploring Ethics
Make a list of your personal ethics. Next, compare them with the standards offered by your profession or internship site. Note any similarities and discrepancies. The similarities may help give you more confidence when dealing with an ethical dilemma, and the discrepancies will give you something to think more about. Either way, you gain something.