Positive Ethics for Mental Health Professionals. Sharon K. Anderson
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We are not suggesting feeling guilty or ashamed of being a White person or having other points of privilege (Spanierman et al., 2009). Rather, we are encouraging you to be aware and to develop understanding about racism and other isms, the cycles of socialization and systems of oppression, and cultural humility . Cultural humility is an attitude and a “way of being” with diverse clients that values the presence and importance of cultural factors (Owen et al., 2011, p. 274) and works toward genuine respect and understanding persons as cultural beings. We might suggest that cultural humility also includes being aware of our privilege and acting to dismantle the systems of oppression in which we have been participating.
Discrimination and Oppression
Discrimination refers to behaviors that usually stem from prejudiced feelings or thoughts and “which denies individuals or groups of people equality of treatment” (Blumenfeld & Raymond, 2000, p. 22). In our opening story, two women of color were both targets of discrimination (not being acknowledged or seen—treated as if they were invisible and denied service) while the White person just behind them was acknowledged and treated respectfully.
The following example is something that happened in Sharon’s family some years ago when her children were young and interacted with neighborhood families. The experience addresses another type of privilege and discrimination:
Bobby (9 years old at the time) said to me (Sharon), “Mom, when we (he and his sister Taya, 8 years old at the time) go over to the neighbor’s house to see if Kenny can play, Gene always says, ‘Bobby’s at the door.’ He doesn’t say anything about Taya.” I asked Bobby why he thought Gene didn’t mention Taya when he announced who was at the door. He said he thought it was that Gene didn’t like Taya. I responded, “That might be true. It might also be that he doesn’t see Taya as ‘counting’ or deserving notice.” The assumption might be that Taya is “invisible” to Gene because of her gender. Whether or not that is Gene’s intent, the covert message to Taya may be, “Bobby, you’re visible and important to recognize (male privilege) and Taya, you’re female; therefore, invisible and don’t count.”
In all three experiences, the harm was overt and personal. All three individuals were made aware of their “invisibility” by another individual. If we’re honest here, there was also some indirect or covert harm that Sharon participated in as she listened to her friend talk about the experience of being invisible at the fast-food restaurant. Sharon initially didn’t believe that such a thing could happen—internally discounting her friend’s experience of discrimination. Sharon couldn’t see her friend’s experience of invisibility because of her own unexamined White privilege and resulting participation in systems of oppression. When discrimination takes place on a larger scale, we talk about oppression, which refers to “the systematic, institutionalized mistreatment of one group of people by another” (Lustig & Koester, 1999, p. 159). There is a relationship among discrimination, oppression, and privilege. The equation might look like this: discrimination + privilege (social power) = oppression.
When we become aware of our own points of privilege, we may be able more fully to really hear, empathize with, and respect some of our clients’ experiences of discrimination and oppression and thereby acknowledge, rather than discount, their experience (Furman, 2005; Sue et al., 2019; Tuason, 2005).
Journal Entry: Don’t Judge a Book by Its Cover
Think of a time when you or a person close to you was ignored, devalued, or prejudged because of age, gender, disability, beliefs (spiritual or political), language or speech, or choice of partner (same gender, skin color difference, another issue of difference). Who was doing the ignoring, devaluing, prejudging? How did it feel? What were the resulting behaviors?
Social Justice
The moral and ethical obligations we have to treat individual people (clients, co-workers, employees, friends, etc.) fairly become more evident with awareness. McIntosh (1990) states it this way: “Describing … privilege makes one newly accountable. As we in women’s studies work to reveal male privilege and ask men to give up some of their power, so one who writes about having white privilege must ask, ‘Having described it, what will I do to lessen or end it?’” (p. 31).
Recognizing discrimination and our overt or covert participation in oppression because of our points of privilege leads us to considerations of social responsibility and promoting social justice in the profession. Social responsibility has to do with our ethical obligations to help society treat individuals in moral ways—it is a “duty owed to society at large” (Clark, 1993, p. 307) and includes a duty to question and oppose community standards that work against promoting human welfare. Social responsibility means recognizing that societal issues and contexts influence the work in counseling (Sue et al., 2019). With this recognition or understanding, our ethical next step is to social justice counseling/therapy. To provide social justice counseling/therapy might be an opportunity to stretch our core, moral self. There may be clients whose values are very different from ours and our initial thought might be, how can I possibly do good work with someone whose worldview is 180 degrees opposite to mine? Through the lens of social justice, our position is to serve these clients to our best ability (i.e., competence) with respect. We may not agree with them on personal values, needs, and motivations but our position is one of focusing on the client’s goals and needs—not what we disagree with from our worldview. Sue et al. (2019) provide us the following definition of social justice counseling/therapy:
Social justice counseling/therapy is an active philosophy and approach aimed at producing conditions that allow for equal access and opportunity; reducing or eliminating disparities in education, health care, employment, and other areas that lower the quality of life for affected populations; encouraging mental health professionals to consider micro, meso, and macro levels in the assessment, diagnosis, and treatment of clients and client systems. (p. 488)
Hailes et al. (2020) use three domains of justice (interactional, distributive, and procedural) to offer guidelines under each of the domains for us to consider as ways to implement social justice work. The guidelines under interactional justice translate into (a) understanding the relational power dynamics, (b) mitigating those power dynamics, and (c) using approaches that focus on client empowerment and strengths. Power dynamics are inherent in the therapist/client relationship and are complicated by the “intersection of multiple co-occurring identities” that present different amounts of privilege (Hailes et al., p. 3). As psychotherapists we need to be aware of how our identities and interactions within the relationship might reconstruct past experiences of oppression and injustice that our clients from marginalized populations have experienced from others in roles of power and representing institutional power. Among the actions we can take are to (a) elevate collaboration and co-create with clients the goals for therapy, (b) be open to direct communication about perceived assumptions and biases we hold, and (c) draw upon strengths-based approaches which empower clients to “develop their self-advocacy skills, strategies, and resources to be agents of change in their own lives” (p. 4).
Distributive justice focuses on fairness and provision for all, in particular those who have traditionally not received provisions. The specific guidelines include (a) using our energy and resources to serve the main concerns of communities who are marginalized and (b) using our efforts and time to focus on preventive work. Actionable steps could include offering services on a sliding scale, taking on consultant roles in the community for little to no fee, prioritizing preventive or pre-emptive care to lessen the mental health problems of oppressed groups, and advocacy work to change mental health policies for the better of marginalized populations.
The last domain, procedural justice, includes the last two guidelines: (a) engaging with social systems and (b) raising awareness about system impacts