An interview with a counseling professional on the use of assessments

For a class assignment in Assessment Technique in Clinical Mental Health Counseling at University of San Diego.

Within the counseling profession, there are a variety of clinical settings and various levels of clinical competency that affect decisions regarding the use assessment tools. I had a recent conversation with the program director of an outpatient alcohol and drug treatment program within a community medical clinic setting to find out what assessments they use. Through our conversation, I learned a great deal about how substance abuse counselors use various types of assessments in their work.

The program director operates several different programs for his agency, most of which are funded by federal and state programs through contracts with the County of San Diego. Accordingly, there are numerous federal, state, and local regulations, guidelines, and company policies that must be followed. The clinic that I visited offers a wide range of health services from primary medical care to outpatient substance use recovery to disease prevention. The clientele includes many mandated individuals who are court-ordered under the California Substance Abuse and Crime Prevention Act of 2000 (known as Prop 36) to receive treatment and substance abuse recovery services are part of their criminal sentence. Because the community clinic’s mission is to provide cost-effective medical care with a special commitment to those who are medically underserved, most program participants are unemployed and uninsured or under insured. Many have co-occurring disorders and receive separate mental health services through other agencies or departments. Because this agency is known as a leading provider of HIV-related services, a significant number of the clientele are members of the LGBTQ community. When clients participate in other agency programs, their medical charts or counseling files are not shared with others outside of the Alcohol and Drug Services Department to comply with privacy regulation including the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  Similarly, staff in the program I visited do not usually access records or charts from other providers with mutual clients because the clients’ anonymity.

The program is divided into three phases and normally spans a period of 6 weeks to three months, to be flexible in meeting client’s needs and program requirements. Clients are mostly drug offenders convicted of nonviolent crimes; completing this program is designed to efficiently rehabilitate the clients and avoid further criminal involvement and relapse with substance use. To this end, clients are expected to participate in a 12-Step program which includes regular attendance at recovery meetings, meeting with a sponsor, personal reflection, and ongoing psychoeducational presentations about the harmful effects of substance use and addiction. Clients may select groups based on Narcotics Anonymous or SMART Recovery.

Intakes are conducted weekly on Tuesday mornings; often group intakes are conducted whenever more there is more than one client in a given week. Clients complete a 4-page intake to on their own in either English or Spanish; if help is needed, the receptionist provides limited assistance. The form is fairly generic, asking essentially the same basic questions as on the examples we reviewed in class. Once the intake data is collected, a substance abuse counselor facilitates a group orientation where the appropriate informed consent and release of information forms are explained and signed. Counselors review program expectations and explain the co-payment structure. The agency accepts a sliding scale for services. Even clients who are homeless with no source of income are asked to contribute something towards their treatment.

Following the group orientation, clients meet one on one with the substance abuse counselors where a more thorough assessment of the client’s substance abuse history and needs for recovery as completed. County of San Diego requirements proscribe use of the Addiction Severity Index (ASI - Lite) with all clients. The purpose of the ASI is to determine how best to determine treatment to meet client needs as well as provide data for outcome efficacy. The substance abuse counselors also rely on the Transtheoretical Model for the Stages of Change and employ Motivational Interviewing techniques. Most of the substance abuse counselors are in recovery themselves and have been through NA or AA in their personal history. Agency requirements specify that any applicants for this position who have a substance use history be in recovery for a minimum of three years to qualify for this position.  

When asked about the idea of designing better assessment for use in this setting, the program director thought for a moment and then stated that the chief weakness of the assessment tools they currently use rely too heavily on self-report measures. Because alcohol and drug addicts, perhaps notoriously, develop behavior patterns that are manipulative or untruthful to hide their addictions, it takes a highly skilled counselor to evaluate clients successfully. “Too bad we can’t administer a polygraph,” he quipped.

Substance use workers are familiar with the ACA code of ethics but are most likely to employ the Uniform Code of Conduct of the California Certified Alcohol and Other Drug Counselors. The program director reports no major areas of ethical concern regarding their use of assessments, but did state that the state places moratoria on training for new staff due to the cyclical budget crisis. This creates a dearth of qualified staff for his program which constrains his ability meet the demand of his services efficiently. 

Working Out: Personal and Professional Considerations For Self-Disclosing Sexual Orientation with Clients

Paper submitted for Ethics and Leadership class at University of San Diego

Working Out: Personal and Professional Considerations

For Self-Disclosing Sexual Orientation with Clients

David Johnson, MA Candidate

University of San Diego

School of Leadership and Education Sciences

December 8, 2012 

Introduction and background

The decision of an LGBT person to “come out” is an individual choice that is made not once but many times over the lifetime in a variety of contexts including personal and professional. Coming out is the “process in which one acknowledges and accepts one's own sexual orientation. It also encompasses the process in which one discloses one's sexual orientation to others. In contrast, the term closeted refers to a state of secrecy or cautious privacy regarding one's sexual orientation” (American Psychological Association, 2012). Historically, employment discrimination has presented a major barrier for LGBT professionals coming out at work, however thirty states now offer varying levels of legal protections to LGBT individuals (American Civil Liberties Union, 2011). In the private sector, over 85% of Fortune 500 companies now have protective policies for LGBT employees, up 35% from just a decade ago (Hewlett & Sumburg, 2011). Although these trends signify increasing acceptance of LGBT individuals, coming out remains a sensitive topic in the workplace; thus, many LGBT individuals choose to remain closeted to some degree while at work.

Coming out may be an especially complex decision for those in the helping professions because the decision involves several overlapping layers of ethical and moral considerations. This is particularly true for clinical mental health counselors because they often work within the context of an established therapeutic alliance with clients; in most cases the efficacy of counseling is directly related to the quality of trust between clients and counselors (Yalom, 2002). Professional literature on the topic of counselor self-disclosure is limited, and there is little consensus addressing the appropriateness of professionals coming out to clients. Therefore individual counselors must determine whether and how to discuss their sexual orientation with clients. This paper discusses moral and ethical considerations involved in the decision to self-disclose sexual orientation with clients from the perspective of a beginning counselor facing this decision.

For me personally, I adopted a commitment to honesty and transparency with regard to sexual orientation during early adulthood as expression of courage and to fight against the prejudice and discrimination experienced by members of the LGBT community. Cass (1979) described this as “Identity Pride,” the penultimate stage in sexual identity development. Today as I move into “Identity Synthesis,” the final stage, I seek greater balance where sexuality is no longer the dominant aspect of my identity, but rather one of many aspects. The formation of professional identity is a developmental process that represents a dynamic merging of personal with professional sense of self in one’s chosen field (Smith & Robinson, 1995).  As I assume a new professional identity as a beginning counselor, I uphold professional codes of ethics and therefore must exercise caution that any disclosure of my sexual orientation does not harm, disrespect the dignity of, or impose my values upon others (American Counseling Association, 2005, A1a).

In this context, I hold the position that it is morally permissible to disclose my sexual orientation to clients for therapeutic purposes, except when doing so would present an unacceptable risk of harm or other violation of professional ethics). I hold this position: (a) to maintain my personal commitment to honesty and transparency, as noted above, (b) to optimize the counseling experience for my clients through therapeutic alliances based on trust, (c) to strive for a balanced integrity regarding different aspects of my identity, specifically personal and professional, and finally (d) to remain closeted with clients is incompatible with honesty and transparency, creates barriers to trust, and interferes with balanced integrity. Considering the potential benefits to my clients and myself against the potential harm of remaining closeted, it is morally permissible to self-disclose my sexual orientation with clients.

A Counterargument must be also considered as part of a comprehensive moral decision-making strategy. By examine the following counterargument, I can scrutinize my own position for defecits: It would not be morally permissible to disclose sexual orientation to clients because: (a) disclosure risks burdening the client with my issues rather than focusing attention on the client’s needs, (b) sexual orientation is a private matter, and sharing creates a false sense of intimacy incompatible with the therapeutic alliance, (c) speaking openly about my sexual orientation leaves me vulnerable to being stigmatized, misunderstood, or exposed by clients whose behavior, relationships, and emotions may decompensate at any time, (d) effective counselors should attempt to become like a “blank slate” onto which clients project subconscious ideas and assumptions through a process called transference. Thus, considering the benefits of being a blank slate and the risk associated with self-disclosure, it would not be morally permissible to self-disclose my sexual orientation with clients.

Discernment and Analysis

It is possible to further develop arguments for and against the issue by applying several different moral theories and moral decision-making frameworks. I will consider implications from nonconsequentialist theories of Kant and Aristotle, Anthony Weston’s practical tools for solving ethical problems, Richard Gulla’s elements for forming a moral conscience, considerations of self-in-relationship to others, and Craig Johnson’s notions of light and shadow as they affect leadership and followership.

Major ethical theories: Kant and Aristotle

First I will consider a theory of moral duty proposed by Immanuel Kant. At the heart of Kant’s theory is the categorical imperative, a universal unconditional principle that expresses a moral duty that must be followed in all circumstances regardless of the outcome (Vaughn, 2010, p. 101). According to Kant, one can test whether an action is morally permissible by determining if it can be universalized and that we must always treat people not as a means to an end, rather as an end in themselves (Vaughn, 2010, p. 103).  

The position in support of disclosure could best be articulated by the maxim “be who you are.” This imperative represents an existentialist embrace of individual authenticity; when applied to the issue of self-disclosure, being who I am means self-acceptance and rejection of inauthentic ways of being. This maxim is universalizable because everyone can and does follow it, one can note that human development is the gradual process of becoming who one is; the purpose of counseling is to assist in this process. Secondly, considering the ends-means principle, the decision for self-disclosure in the context of a therapeutic alliance passes this second test so long as the decision is made because it helps the client become who he or she is. In other words, it would only be appropriate to discuss my sexual orientation with clients in cases where doing so relates to the client’s therapeutic goals. To bring up the topic because I want them to know, would violate the ends-means principle.

In the argument against disclosure, I might select a different maxim “do no harm.” This principle is universalizable in all of the helping professions and takes primacy among professional standards; sometimes called nonmalfeasance, by this principle, counselors are expected to “respect the dignity and promote the welfare of clients” (American Counseling Association, 2005, A1a). Whether I would be willing to allow this principle stand in all circumstances, regardless of outcome, I can again answer “yes” because promoting dignity and promoting welfare of others  is aligned with my personal mission statement. Applying this principle to disclosure, it becomes possible to imagine specific circumstances where a client’s knowledge of my LGBT status may present barriers to establishment of a therapeutic alliance, such as a client with anti-LGBT prejudices. Operating on the principle of “do no harm,” I must therefore limit the practice of self-disclosure to cases where doing so will only benefit the client and refrain from doing so in cases where disclosure would harm the client. In essence, the principle of “do no harm” necessarily supersedes the principle of “be who you are,” in professional situations.

Both of these maxims are related to ultimate goal of human flourishing, which brings us to Aristotle’s Virtue Ethics. Standing in contrast to Kant’s deontological theory, Aristotle places an emphasis on the character of an individual, rather than on duty or rules. Aristotle saw all life as striving towards flourishing, and virtue is the “disposition to act and feel according to an ideal or model of excellence” (Vaughn, 2010, p. 134-135). Applying virtue to the question of disclosure, I value honesty and transparency and strive towards flourishing by maintaining integrity in my personal and professional identity. Therefore, I seek to act consistently and avoid the extremes of sharing too much about myself, which could lead to harm for clients, and too little, which would fail to nourish a therapeutic alliance with clients. Acting within this golden mean, I can promote the well being of my clients because I am free of the problems connected with dishonesty, unapproachability, inconsiderateness, or egocentric behaviors. By maintaining habits of integrity, I can relate to people with greater openness, genuineness, and consistency. As an adolescent, I attempted to conceal my sexual orientation from some people and not others; I found myself frequently entangled in moral problems such as being dishonest, inapproachable, and egocentric. Thus I experienced emotional strain as a result of these moral failures. Since coming out to family, friends, and peers, I have been empowered to develop a strong commitment to integrity and have experienced greater human flourishing as a result.

The argument against self-disclosure from the Aristotelian perspective would be that one’s sexual orientation is a private matter, and any discussion of one’s sexual orientation with clients in a professional context, no matter how well-intended, falls too far on the extreme side of sharing too much, potentially leading to harm for clients, or at the very least, depriving clients of valuable session time they need to discuss their own issues. This is an important point to consider. As a counselor, I must be sensitive to the client’s needs and respect their time. In keeping with the rule of the golden mean, it is necessary to keep any attention focused on the counselor as brief as possible.

Tools to solve ethical issues

So far, it is possible to see that the arguments for and against self-disclosure have certain values in common, even if the actual positions disagree. For example, both sides place a primacy on client welfare, acknowledge the benefits of the therapeutic alliance, and both sides would agree on establishing clear boundaries that protect both the client and counselor. Therefore, it can be possible to nuance each position in such a way as to establish common ground. By establishing common ground, each side is able to frame it’s desires and concerns in a way that is more acceptable to both sides, creating a win-win. Anthony Weston referred to these techniques as focusing on interests rather than positions and working from common ground (Weston, 2008).

Ethics and Self

As I move towards a solution that incorporates the best ideas on both sides of the issue, it is important to be sure I am discerning a decision in good conscience. Father Richard Gula (1997) defines conscience as a “whole person’s commitment to value and the judgment that one makes in light of that commitment of who one ought to be and what one ought to do or not do.” Acting from conscience is contrasted from acting from the superego which looks to narrow references such as authority, self-comfort, and individual acts as opposed to values, orientation to the other, and general ways of being (Gula, 1977). Applied to the decision for disclosure, the values I want to honor are honesty, transparency, service, and integrity. In light of my commitment to these values, I can develop a moral checklist for myself to consider whether I am acting in good conscience or not. I act good conscience whenever I join with my clients in a therapeutic alliance based on trust, when each interaction respects their dignity and promotes well being, when I strive to have integrity and practice honesty and transparency always – not just at work, when I make proactive decisions in line with values rather than a response to given circumstances. Such a checklist, reviewed regularly, can help process moral decisions as they become apparent.

Ethics and self-in-relationship

Beyond just myself, there are other stakeholders who are affected by my decision to self-disclose my sexual orientation. For example, my family and loved ones, the local LGBT community, and colleagues in the mental health profession are all affected by how I approach this decision or the consequences of my decision. My family and loved ones look up to me and depend on me for support. Although no one would ever mistake me for a wealthy man, I anticipate the career I am preparing to enter will afford me more financial freedom than I have ever enjoyed. Completing a master’s degree would also place me as one of the most highly educated members of my family. Therefore, I need to be sure I develop decision-making habits and avoid any risks that could place my career at risk to avoid disappointing my family or becoming a financial burden to them.

Secondly, I have many ties to the local LGBT community, and my participation in it is a substantial source of my overall civic contribution. The LGBT community is also a special population I am preparing to serve as a professional counselor, a networking source for colleagues and potential clients. This of course carries risks and benefits. On one hand, my participation in LGBT public events, political activism, and advocacy for justice are all positive contributions to my community and aspects of my social life that in effect develop a public sense of sexual identity within the LGBT community. On the other hand, it is likely will encounter LGBT clients and potential clients participating in the same community or on social networking websites. Thus, my membership and participation in this subculture constitutes an “unavoidable disclosure” of my LGBT status as defined by Ofur Zur (2011). In a sense, one might compare coming out of the closet to toothpaste in a tube: once out, it can never be put back in. Similarly, my decision to participate and develop a public identity closely associated with the LGBT community limits my options to selectively disclose my sexual orientation. It is important to consider however, many counselors who practice in small communities, such as rural areas, face similar situations without compromising personal commitments to integrity or ethical obligations.

Finally, I have a responsibility to my colleagues and members of my profession. LGBT issues in counseling is an emerging issue among professional counselors with great need for current research. As already noted, it is becoming increasingly common for individuals to come out, but the profession is lagging in developing competencies for providing proper evidence-based support to LGBT clients. Accordingly, I will have opportunities to advance my field by developing a thoroughly responsive practice with regard to LGBT issues and transferring my knowledge to colleagues through writing, researching, and teaching. For example, according to the National Alliance on Mental Illness (2007), lesbians and gay men are more likely than heterosexuals in similar demographics to experience major depression, generalized anxiety disorder, and substance use issues; LGBT youth are 3.4 times more likely to attempt suicide than their straight classmates (American Association on Suicidology, 2010). Whether deliberate or unavoidable, disclosure of my sexual orientation to clients and potential clients as part of this process will impact my overall professional identity and practice.

Light and shadow in leadership

            Craig Johnson (2012) describes how leaders effectiveness using metaphors of light and shadow. According to Johnson, ignoring one’s “dark side” is a main contributing factor in leadership failures in business, politics, clergy, and other areas of leadership. To aid leaders in improving their awareness of shadow-casters such as unhealthy motivations, faulty decision-making, lack of expertise, and contextual pressures, Johnson offers a variety of self-assessments to help pinpoint the areas for growth. These examples helped me to look critically at my moral sensitivity and moral character in particular. For example, although I believe I tend to be an empathetic person, the self-assessments help me identify situations where others likely perceived me as unconcerned or too self-involved. Also, I found that I sometimes struggle for balance between acting independently, and admitting that I need help or seeking consultation appropriately. Finally, Johnson’s principles also helped me become aware of situations where I acted swiftly and decisively as a leader, when a more reasoned thought-out process was called for and would have resulted in a better outcome. I believe the sources of these shadows are related to feelings of insecurity about my ability to take on new responsibilities, mistaken assumptions about others, and an overall lack of expertise in my role.

            Some of the ways I can cast light on these areas as a leader are by improving supportive relationships with peers and authorities. By accepting my limitations and being realistic about the expectations others may place on me. Finally, although I am confident in my ability to reason through a complex moral decision using various decision-making strategies, I know I will improve my sensitivity to situations where moral decisions must be more carefully considered before I decide to act. I can add light to these circumstances by initiating consultation with more experienced counselors, allowing adequate time reach decisions,

Light and shadow in followership

As a follower, my greatest vulnerability lies in the challenge of obedience. While I can respect my duty to follow directions and adhere to policy, I have a particularly difficult time accepting the leadership of poor leaders who cast shadows by abusing power, infringing upon the rights of subordinates, or hiding decision-making behind a veil of secrecy. Sometimes I failed in my role as a follower by not speaking up; other times I expressed disagreement in ways that were not helpful or welcome in the situation and suffered consequences as a result. Even though I may arrive at a well-discerned decision about when and how I will choose to self-disclose my sexual orientation, I must recognize I may have to consider leaders who may disagree with me. I may be forced to choose between acting in conscience and accepting employment from an organization or person with whom I have a disagreement. Until I have the job security to be my own boss, my decisions will be subject to review by bosses, and I may have to accept a compromise.

Evil and leadership

Also important to understand is the presence of evil in the world. Johnson (2012) defines evil as “a destructive influence… that inflicts pain and suffering, deprives innocent people of their humanity, and creates feelings of hopelessness and despair… the ultimate product of evil is death. Evil destroys self-esteem, physical and emotional well being, relationships, communities, and nations.” Unfortunately, it is too simplistic to brand individuals as either good or evil, because each person may have capacity for both good and evil. In fact, evildoers tend to believe their intentions and actions are good, or at least neutral. Thus, evil is to be found in actions or inactions, rather than in people.

            One of the first steps in identifying the presence of evil as it may relate to my work is to accept that it exists in reality and to be mindful of conditions where evil can exist, such as schadenfreude, the taking of pleasure in the misfortune of others, chronic boredom, narcissism, administrative evil, the dehumanization of others, and the maintaining of unjust systems which perpetuate these evils (Johnson, 2012, p.119-125). Considering the specific issue of self-disclosure, I must be particularly aware that my desire to assist or advocate for clients serves their interest, rather than my own interest. Also, I must be mindful of my issues that may arise from working within the human services system such as administrative evil, and dehumanization experiences.

            Thus, I plan to combat evil by committing to treating each client as a holistic individual not simply a diagnosis or a number. As a counselor, I am always interested efficacy of the counseling experience for my clients and I will routinely seek for their feedback to assist with any shadow or blind spots that I might not have noticed. For example, I can ask a client how knowing my sexual orientation does/does not contribute to a successful therapeutic alliance.

Evil and followership       

As a follower, I remain committed to the welfare of my clients and to upholding the mission of the organization I work for. I will develop positive working relationships with employers and coworkers based on collaboration and mutual respect. I will endeavor to perform my duties and follow all policies in a diligent thorough manner and find helpful ways to address any risks, problems, or potential for harm that I encounter. I will use consultation, professional networking, and ongoing research to inform my decision-making practice and engage in healthy self-care so that I remain solidly grounded in my core values such as honesty, transparency, and integrity.

            I will guard against evil as a follower by practicing forgiveness, by communicating openness to feedback from others, and by developing habits that foster continued personal balance and professional development.

Moral argument

I have considered several different moral theories and moral decision-making frameworks, in analyzing the question of whether it is morally permissible to self-disclose my sexual orientation to clients in the context of a therapeutic alliance, except when doing so may reasonably cause harm to client. Self-disclosure is permissible in that it supports the maxim “be who you are,” however I must balance that against the maxim “do no harm.” Because integrity is a virtue to which I aspire, I will promote actions and choices for honesty and transparency because they contribute my flourishing and the flourishing of my future clients. I consider carefully the merits of a counterargument which seeks to protect clients; because that is also a value I share, I can allow myself the flexibility to recognize that in some cases, self-disclosure of my LGBT status may be harmful and I agree to refrain from self-disclosure in those cases. As a professional, I remain committed to developing a mature conscience, and avoid decision-making that is based in the needs of the superego, rather than conscience. I consider how the consequences of my actions may affect others such as family, the LGBT community, and professional colleagues. To some extent, my individual participation in the LGBT community and my decision to serve clients from the same community will lead to unavoidable disclosures, and I conclude the benefits outweigh the risks. Finally, I reflected upon how my decision casts shadow and how I can shed light as both a leader and a follower; I am human and have particular vulnerabilities, my awareness of which better prepared me to address these issues. I further reflected on the problems of evil and acknowledged my capacity for being an occasion of evil, but also resolved to remain vigilant to combat evil as a leader and as a follower.

In this context, I hold the position that it is morally permissible to disclose my sexual orientation to clients for therapeutic purposes, except when doing so would present an unacceptable risk of harm or other violation of professional ethics. I hold this position: (a) to maintain my personal commitment to honesty and transparency, as noted above, (b) to optimize the counseling experience for my clients through therapeutic alliances based on trust, (c) to strive for a balanced integrity regarding different aspects of my identity, specifically personal and professional, and finally (d) to remain closeted with clients is incompatible with honesty and transparency, creates barriers to trust, and interferes with balanced integrity. Considering the potential benefits to my clients and myself against the potential harm of remaining closeted, it is morally permissible to self-disclose my sexual orientation with clients.

Proposed solution

            Since I have drawn the conclusion that it is morally permissible to self-disclose my LGBT status with clients, I have developed an individual policy to set parameters around this practice. First, I will choose to not disclose in circumstances where there is a risk of harm to a client, or where disclosure so may interfere with the dignity or well being of the client. I will consider this question when introducing myself to each new client I serve. Secondly, I will continue to responsibly manage my participation in the LGBT community and social networking. For example, I will place a well-defined boundary around personal data such as my relationship status, HIV status, family members, personal finances, etc. and be assertive about protecting my personal information. Similarly, I will define the information I am willing to share with clients such as coming out experience, professional training, and interpersonal successes and failures that may be relevant to the client’s particular issues and goals in counseling. When encountering any complex moral or ethical decision, I will seek consultation with more experienced counselors, give myself adequate time to reach a decision, and develop habits of empathy with clients to ward off any patterns which could facilitate dehumanization with clients. I will employ an ethical decision-making model for processing decisions. Finally, I will practice prevention by committing to virtues such as integrity, honesty, and transparency and I will shed light on opportunities for colleagues to do so as well.

Action Plan

            I anticipate accepting employment in the near future with a counseling organization. My action plan will be to create a document that specifically outlines information I will and will not disclose with clients. I will file this document with my mission statement and review them monthly, beginning with the start date of next job. I have already adjusted privacy settings on my social networking applications to manage my online profile, I will continue to be aware of security features. Upon obtaining a job, I will carefully read the employee handbook and familiarize myself with all policies, taking into consideration how I might prepare myself for the experience of evil. I will participate in a spiritual community in my religious tradition and take advantage of periodic rituals of reconciliation for example liturgical seasons of lent and advent. These are opportunities for the Examination of Conscience.

Reflection

            The process of engaging in this exercise has been at different moments, challenging and refreshing. I have been challenged to confront issues of shadow and light in an academic environment. This has been a new experience for me and brought me out of my comfort zone in a good way. To publicly make a commitment to honesty, transparency, or integrity raises the bar for making sound decisions. Through most of my working life, most of my actions on the job have been those of a follower who neither bore nor accepted responsibility for making moral decisions. I had grown comfortable in relying on emotion to make decisions. However since beginning graduate school, I have been challenged to think more critically, to push beyond what was easy and to accept responsibly for my part in shaping reality.

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On The Ethical Use of Psychological Assessments

Posted to an online discussion forum for Assessment Techniques in Clinical Mental Health Counseling at University of San Diego:

 

Before choosing to come to USD, I was a seminarian and lived in a religious order of Catholic priests and brothers (I was a brother). Because taking vows of poverty, celibacy, and obedience is a serious lifelong commitment, the priests and brothers in charge of my religious formation asked me to complete a series of assessments and participate in counseling to be sure it was what I truly wanted. As part of the process, I took many of the tests we will discuss in class: the MMPI, Myers-Briggs, WAIS III, Rorsharch ink blot, Beck, TAT, and others. They really put me through the mill!

Every test showed that I was cognitively and emotioanlly healthy and a good fit for life in a religious community. Taking advantage of counseling for the first time ever, I gained much self-knowledge. In fact, that is where the seeds of my decision to become a mental health clinical counselor were planted.

To the best of my knowledge the tests were administered accurately and professionally according to the appropriate ethical standards. Between all of the assessment data, multitudes of required reflective papers, and ministry volunteer duties, the order had perhaps the most detailed portrait of me anyone had ever cared to assemble. Yet, something was still very wrong.

One particular brother had an intense personal dislike for me and made it known that he was actively trying to prevent me from making "perpetual vows," that is, taking the final step of formally entering the order. I will never know exactly why he chose to oppose me, but I kept faith that everything would work out for the best and I kept trying my hardest.

In previous dealings, this particular brother had demonstrated a pattern of taking my words and writings out of context and misrepresenting them to portray me in a negative light. Thus, I felt very threatened by this individual; I suspected he was motivated not by the interests of the order (which even today is in desperate need of new members), but by his own prejudices.  This brother argued his way onto the formation committee, and thus he was going to be privy to the test data in my files. I could tell this was not going to end well.

The testing had probed into the deepest most intimate details of my life; I had disclosed things with the psychologists I had never expressed to anyone before. I felt vulnerable and naked, having such a huge pile of my secrets in a fat manilla envelope. The thought of allowing someone who had only hatred and spite for me to access that data became unbearable. It literally caused me nightmares. So when it came time to release the confidential information, I signed the release of information to the provincial father only, specifically excluding the mean brother from my file. That decision, an act of disobedience, was what ultimately led to my decision to leave the order. It was a heartbreaking choice, because I had formed strong fraternal bonds with the other priests and brothers who knew nothing of the conflicted relationship I had with the mean brother.

My concern was that the extensive testing had significantly invaded my privacy. Although I initially agreed, on the understanding this is what the order required of its entering members; I changed my mind when I felt threatened by the mean brother who was far from qualified to objectively evaluate the data on me. I expressed my concerns in writing about the potential for misuse of my file; the the fact of my disobedience had already spoken for itself. If was was unprepared to suffer the spite of a bitter old brother, albeit one in a powerful position, I was unlikely to have the stomach for papal degrees and decisions of the USCCB.

I didn't know it at the time, but I was the victim of something known as spiritual malpractice. Unfortunately, there are no disciplinary review boards for mean brothers, no codes of ethics for religious, and no court that will ever hear my case. Even so, I left the order with some dignity still in tact. Now, as a counseling professional, I understand that a strong therapeutic alliance is necessary for conducting assessments. I understand the vulnerability that accompanies taking psychological tests. Thus in my own practice, I will be sensitive to clients concerns about use of tests, maintaining confidentiality, and being very cautious about release of information.  My prayers were eventually answered, and everything has turned out ok (so far).