This intellectually stimulating and highly practical 2-part seminar with Kathy Steele starts by first exploring the intersection of our own and professional ethics and how we can reconcile the differences between them. With the help of case vignettes, we address a number of questions and clinical conundrums:

• What are the factors that impact the development of our ethical positions? How do we manage when our morality or legal restrictions conflict with our professional ethics?
  • We will explore many clinical issues that involve mindful ethical decision-making, including reporting issues when our clients have the potential to abuse others, or when they continue to be abused in the present, and confidentiality issues when family members, friends, or others outside the mental health field are involved in helping our clients.
• What ethical dilemmas are we confronted with when clients engage in chronic self-harm or suicidality?
• What are effective and ethical ways to use the therapeutic relationship to help our clients without being caretaking or withdrawn?
• What is our responsibility to be aware of our own countertransferences and manage subtle attitudes and actions toward our clients?
• What are the ethics of continuing to see clients that we are not helping?

Specifically, we will explore ethical dilemmas in the following areas of work:

• Revictimization, self-harm, and suicidality:
  • The therapist is often in a dilemma about how to help patients who continue to be abused but are unable or unwilling to stop contact.
  • We will explore how to manage our countertransference tendency to rescue, and to help the patient develop agency. We will also explore the dilemmas of ongoing self-harm and chronic suicidality and how we can respond rationally.
• Boundary and dependency:
  • Dependency is often a problem in therapy with highly traumatized individuals.
  • We will explore ways to ethically maintain boundaries while supporting the client to gain more self-agency and utilize available supports, while taking care of ourselves as therapists.
• Sense of Separateness of Parts, for DID Clients:
  • Is the whole person responsible for what one part does?
  • We will discuss a rational approach to treating DID as a whole person with responsibility for his/her own behaviour, while still acknowledging a sense of separateness.
• Intense re-enactments and countertransference:
  • The most intense countertransference – both positive and negative – can occur in therapists who treat highly traumatized individuals.
  • We will learn how to identify re-enactments and ways to address them ethically and therapeutically.
• Differences in short- and long-term therapy:
  • The therapist has an ethical obligation not to open up issues that cannot be treated with a time-limited frame.
  • We will explore how and what to address in shorter-term therapies for highly complex clients.
• Reporting and confidentiality:
  • Traumatized clients often present us with highly complex situations that involve grey areas of reporting.
  • When do we need to report a patient’s mistreatment of his/her own children? How does that impact the therapeutic relationship?
  • How do we manage the complicated requests for us to speak or intervene with partners, children, friends, clergy, and management at the patient’s work?
  • What do we do if the client refuses for us to contact other treatment providers?

© nscience 2021 / 22