In a town this size⦠There is no place to hide
Inatownthissize… Thereisnoplacetohide Ethical issues in being a counselor in a small town AlaskaAnnualSchoolofAddictions andBehavioralHealth May 4‐6, 2015 Bruce Carruth, Ph.D. San Miguel de Allende, GTO, Mexico ( a very small town) Inatownthissize… JohnPrine andDeloresKeane BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane In a town this size, there is no place to hide, Everywhere you go, you meet someone you know …. BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane You can’t steal a kiss, In a place like this, How the rumors do fly, In a town this size BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane In a smoky bar, In the backseat of your car, In your own little house, Someone’s sure to find you out BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane What you do and what you think, What you eat and what you drink, If you smoke a cigarette, They’ll be talking about your breath BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane In a town this size, There is no place to hide Everywhere you go, You meet someone you know You can’t steal a kiss, In a place like this …. How the rumors do fly, In a town this size BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane Oh, I had a fight, With my girlfriend last night, And before the moon went down It was all over town BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane How he made me cry And how I said goodbye, If it’s true or not …. Doesn’t seem to count a lot BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane In a town this size, There is no place to hide, Everywhere you go, You meet someone you know BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane You can’t steal a kiss, In a place like this How the rumors do fly, In a town this size In a town this size….. In a town this size BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane And if this song had been written by a counselor …… BruceCarruth,Ph.D. Inatownthissize… In a town this size, There is no place to hide In the market frozen food row, I meet every client I know BruceCarruth,Ph.D. Inatownthissize… I can’t kiss my sis In a town like this. How the rumors do go, To my boss, I know BruceCarruth,Ph.D. Inatownthissize… Well, my dirty car Is seen outside the bar It’s assumed I’m there …. It just ain’t fair BruceCarruth,Ph.D. Inatownthissize… JohnPrine andDeloresKeane In a town this size, There is no place to hide Everywhere you go, You meet someone you know You can’t kiss your sis In a place like this …. How the rumors do fly, In a town this size BruceCarruth,Ph.D. Inatownthissize… Oh, I had a fight With my girlfriend last night Now all the couples I see, Are wondering about me BruceCarruth,Ph.D. Inatownthissize… In a town this size, There is no place to hide I think I’ll need more supervision To make this transition To a town this size ….. To a town this size BruceCarruth,Ph.D. AnAlaskageographylesson • Lowest population density in the nation • Largest state in land mass • 2/3 of the population live in two cities • Access to behavioral health care is significantly impacted by geographic distribution • Alaska has a wide variety of specific ethic/cultural/geographic groups with special needs and orientations BruceCarruth,Ph.D. • For a discussion of issues specific to Alaska, see the excellent article by Cates, Gunderson and Keim: • The Ethical Frontier: Ethical Considerations for Frontier Counselors” • The Professional Counselor magazine • http://www.westga.edu/documents/pubs/031736_591.pdf BruceCarruth,Ph.D. Notallsmallcommunitiesaresmalltowns • 12‐Step communities • Religious communities • GLBT communities • Specific socio‐cultures within a geographic community • Informal communities of counselors and therapists • College communities BruceCarruth,Ph.D. Asamplingofsomeoftheethicaldilemmasof smalltowncounselors • Crossing boundaries (for instance, socialization with clients outside of treatment setting, being in the same AA group with our clients) • Dual relationships (when your plumber becomes your client) • Confidentiality & record keeping • Privacy (visibility of coming and going from your agency) • Issues related to payment for services BruceCarruth,Ph.D. Asamplingofsomeoftheethicaldilemmasof smalltowncounselors • Information that you may know from outside of treatment about a client (and the client doesn’t know you know) • Specific information from other sources (legal & health services) that you have but aren’t authorized to share with the client • Handling explosives – big secrets BruceCarruth,Ph.D. Asamplingofsomeoftheethicaldilemmasof smalltowncounselors • Some special issues in treating other therapists/counselors/agency staff, other professionals (who may have different standards for ethical issues) • Being sought out just because you (and the prospective client) are part of the same small community • Being asked to take on situations that are beyond your competence and training because you are seen as the “most qualified” person around BruceCarruth,Ph.D. Somestandardsforhandlingethicalissues &howtheycanbeappliedinsmallercommunities 1. There rarely is a black and white answer to your problem. If there was, you wouldn’t be in the quandary. So don’t look for definitive answers. 2. Don’t tote the load alone, get information and advice. Always start with clinical supervisor, unless there is a definitive reason not to. You need the agency backup & documentation that you have consulted appropriate resources in the agency. BruceCarruth,Ph.D. Somestandardsforhandlingethicalissues &howtheycanbeappliedinsmallercommunities 3. When you do consult, focus on the ethical issue, not the details of the case 4. Consult / research professional ethical standards & even talk to experts in your professional association national office. 5. Be aware of a bias towards solutions more applicable to ethical dilemmas in urban settings BruceCarruth,Ph.D. Somegeneralrulesforstayingoutoftrouble • Be clear about boundaries / dual relationships • Privacy and confidentiality • Know your limits of training and experience • Make every effort you can to get quality clinical supervision • Wear two hats: counselor and citizen BruceCarruth,Ph.D. Somegeneralrulesforstayingoutoftrouble • Be respectful of the special role you play in your community and of the responsibilities that come with that role BruceCarruth,Ph.D. Formoreinformationorfollow‐up BruceCarruth,Ph.D. brucecarruth@gmail.com brucecarruth.com US telephone: 713‐589‐3250 MX telephone: (52) 415‐121‐1169 BruceCarruth,Ph.D. BruceCarruth,Ph.D. BruceCarruth,Ph.D. BruceCarruth,Ph.D. BruceCarruth,Ph.D. BruceCarruth,Ph.D.
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