When Worldviews Collide | Ethics & Managing Therapist Burnout

Hey there everybody and welcome to today's presentation on when world views collide ethics boundaries and cultural sensitivity. I'm your host Dr. Donnisee Snipes. Today we're going to define worldview and discuss the importance of validating a client's worldview and beliefs even if you disagree in order to maintain an environment of safety. We'll explore how to maintain authenticity without violating a client's boundaries or dismissing their beliefs and discuss strategies for managing your own distress. Start out at the beginning. What is a worldview? A worldview is a person's comprehensive way of understanding and interpreting reality. It's the lens through which they see the world, make sense of it, and decide how to act. Our world view is shaped by our prior learning brought by our experiences. That includes our culture and anything and potentially everything that's happened to us up until now. All of that gets stored in our experiential vault. how people respond to us, whether people are trustworthy, what we can expect in certain situations. If we'd encountered those in situations before, or if we've even seen or learned about those situations before, then we've probably got some schema stored in our experiential vault that will help us anticipate what's coming next. And it helps us to synthesize these experiences to create our world view and how we understand what's going on around us. Respecting a client's beliefs and worldview is just one way we help create a safe, non-judgmental environment for growth. A lot of times clients are coming to us and they're talking with us about things that they're not going to talk about with anybody else in their life because they're afraid they're going to be criticized, ridiculed, rejected, fill in the blank. We need to make sure that the environment is safe so the client does not feel that they have to keep secrets. In counseling, we contend with several different types of boundaries. And respecting a person's boundaries, every single type of them, is essential to ensuring they feel safe. Now, boundaries, as I've explained in a lot of other places, maintaining boundaries doesn't mean you have to take on that person's thoughts, feelings, beliefs, practices, whatever. Doesn't mean that. It means they are telling you this is what's appropriate for them. This is what they think. This is what they believe. This is what's meaningful to them and this is what's important to them. They're putting their cards on the table. And you can tell them, you know, in terms of boundaries, this is where mine are. Once you both have your boundaries out there, then you can learn to respect each other's boundaries. If you're living in a neighborhood, for example, and you live really close together and you have a fence line separating you and your neighbor, you know, that's a boundary. And maybe your neighbor hates roses, but you love roses and you've got them planted all along your fence line. But unfortunately, you planted them close enough to the fence that they keep nudging over into your neighbor's yard. Well, your neighbor may cut him down because he doesn't want the thorns over there. Respecting your neighbor's boundaries ideally would mean planting the rose bush far enough away it's not going to encroach on your neighbor's yard. But if you did, then respecting your neighbor's right to cut off the limbs of your rose bush that come into their yard. That's respecting their boundaries. You're not saying you have to like roses or you have to let my my rose bush encroach on on your side of the fence. No, you're saying I love roses. I have my rose bush here. I'm going to keep it. You can do with your side of the fence whatever works best for you. This is where your space ends and my space begins. Imagine that. So, back to regular boundaries, physical boundaries, these are the ones we talk about a lot. Touch, hugs, eye contact, even non-verbals. In some cultures, extended eye contact is a boundary violation. That's considered too personal. In some cultures, they are very touchy. They hug, they kiss, they do that kind of thing. Other cultures are more standoffish. We want to respect that when our client is crying, when our client's in distress, do they want us to pat them on the shoulder or not? When our client comes into the office, do they want us to shake their hand or not? Um, it's important to keep that dialogue open. Interpersonally, these are the rules and understanding of the relationship and power dynamics. In counseling, you know, we start out by saying, "This is an egalitarian relationship." But then if we change the rules and start saying, "Ah, maybe it's not so equal. Maybe I'm going to tell you what to think. Maybe I'm going to make sure that you understand that your thoughts and feelings are wrong." It's changing the dynamic. It's you're no longer supporting, you're controlling. That's a boundary violation and a violation of your fidelity to your promises to the client. Emotionally, how you feel about something cognitively, how what your beliefs are about something. You have your thoughts and beliefs and feelings. And your client may have different feelings, beliefs, and thoughts. It doesn't mean either one of you is wrong. It means from your worldview, from your experience, from your understanding of what's going on, you have different perspectives. Environmental boundaries are really important. And these days, especially when we talk about counseling, most of what we're talking about is social media and the client um trying to find you online or you trying to find your client online. Um that is an invasion of privacy. That's an invasion of their their safe space. They did not invite you into into their safe space. And even if they did, it's unethical to do it anyway. And spiritually, what gives them a sense of connectedness and meaning may be different than what gives you a sense of connectedness and meaning. Doesn't mean you're wrong. It just means you derive your sense of connectedness and meaning in different ways. Why am I bringing this up right now? Because when our worldviews collide, it is important to get back to boundaries and recognize that our job as clinicians is to be there for the client. Not to impose our values, our beliefs, our feelings, our thoughts. not to control them, but to provide a safe environment to help them explore what they're going through and grow. Think of times when your worldview or belief about the right choice has been completely different than your client or a significant other. We've all had that. I've been married for over 30 years. My husband and I have had some significant differences in our belief about the right way to handle something. Okay. Does it mean he's a bad person? Absolutely not. Mean I'm a bad person? Absolutely not. It means we were raised differently. We have different perceptions on things and different ways of handling things. How did you and when you had this difference, how did you respect their boundaries and autonomy? Um, for me when my husband and I had a disagreement about something, um, I respected as that's the way you were raised. I can see where you might feel like that is the right choice. It's not something that works for me. It's not something that I'm going to do. But, you know, you are an individual and you can make the choices that you think are best. and we left it at that. Um because we were clearly not going to agree. My mother was just vehemently against homeschooling. There was a difference there. How did I respect her boundaries? I didn't tell her she was wrong. I didn't tell her that she was jumping to conclusions or whatever else. I heard what she had to say. I respected the fact that she didn't think that I was capable of providing adequate education to my children, but it didn't change how I parented my children. It didn't change whether I was going to homeschool or not. We homeschooled because we had our reasons. We had our reasons to do it. and she respected our autonomy by not interfering. I mean, she had her her say, but she was authentically stating her point of view. She didn't do anything to meddle in it. When you had this disagreement in what the right choice was, what did you do to also ensure fida fidelity and non-malfcence? That is what did you do to ensure that you were keeping your promises and not doing harm to the other person? When you disagree with a client, is it always appropriate or even when you disagree with a significant other, is it always appropriate to share your perspectives or beliefs? And I can't answer that for you. That's one of those things that you've got to answer for yourself based on your worldview. My personal opinion is that it's not always appropriate or necessary. Sometimes I have an opinion or a belief that isn't going to really make that much of a difference. It's just me wanting to try to oneup somebody or something. There's no point. It's better to keep my mouth shut. Um or the person didn't ask. They don't care about what my perspective is on something. They want help with XYZ. Okay. If you believed that the person you were dealing with was lacking information, how did you share that without violating their boundaries, without telling them, well, you're wrong. Maybe they are, maybe they aren't, but you don't know. based on their perspective, their experiences, that may be their truth. So, how do you provide additional information in a way that's non-threatening? In counseling, I work hard to validate, you know, I hear you don't think you've got a problem with your drinking, for example. Um, and let's take a look at what your uh medical report shows. Shows a history of pancreatitis, cerosis, you've had three DUIs. Um, that indicates to me that there might be a problem. What do you think it indicates? So, I'm providing some information or I may say, you know, I hear you've got very valid points and you feel very strongly about this. Before you make your final decision, here's some additional information I'd like you to consider. Take what's useful, leave the rest. If you feel that that is necessary and Rotary Club has a pneummonic that they use called think. Is what you're getting ready to say or offer, is it truthful? Got to make sure it's truthful first. Are you saying it or providing the information in a way that's inspirational or are you being critical? Is what you're offering, is it necessary? Is this going to help the person at all? Um or is it just you putting in your own two cents? If it's not necessary, maybe not worth worth saying. Um truthful, inspirational, necessary. um helpful. Is what you're getting ready to ask uh offer helpful? And are you can you say it in the kindest way possible? Not I don't think you have all the information. Why don't you read over this? That's critical. That is not inspirational. That's not helpful. Um I want to help you make sure that you're making the decision that's right for you. So, here's some additional information. Look it over. If it's useful, great. If not, put it in the trash. You're not going to hurt my feelings. That's how I handle those situations where I think a person may be not fully aware of all the information. I had one client that was getting ready to leave residential. Well, actually four clients, but the one that came and talked to me um said that he was getting ready to leave residential and he was moving in uh with three other people that were leaving residential at the same time. Now, if you've worked in addictions treatment, you know that this is a very bad idea. People that are only 30 days clean um are at high risk of relapse. And if one person in the group relapses, the chances are the other three are going to relapse as well. And I told my client this. I said, "I hear you feel very strongly about this and I understand your rationale because, you know, it's a lot more affordable if you've got three roommates. This is my concern." And you know, do with it what you will, but my experience over 20 years and and the research has shown that this is a really high-risk choice that you're getting ready to make and I just want to make sure that you're aware and you have a safety plan in place. And the client was like, "Yeah, it's it's what we need to do. It's the only option I have. It's the only option I have to go somewhere else besides back to the same druginfested unsafe place that I came from when I came to treatment. And I'm like, well, okay. You know, I can kind of see how that makes sense that this is still better. Is it high risk? Yes. But at least at the beginning, he knew that his other three roommates were going to be clean and sober and trying to stay clean and sober. Um, so do do with that what you will, but those are a couple of my experiences where a client was getting ready to make a choice that I believed was probably not in their best interest. It wasn't that it conflicted with my values. It was just, you know, objectively this seems kind of risky. I'm not telling them what to think. I'm not telling them what to do. I'm providing them a little bit of additional information just to make sure they have it but making sure to validate their autonomy and the fact that you know after we talked about it for a while and he told me what he told me I was like okay well that makes perfect sense it's cheaper and it's still safer than your alternative okay um which is when we moved into creating a safety plan. If one of your roommates relapses, what are you going to do? If you refuse to process issues with a client because they conflict with your values, how does it cause harm? I've worked with clients before uh or clinicians before who have refused to work with clients who were going to have an abortion or who were of a different religion. You know, there are a variety of different issues that come up that are, you know, hot button topics for the client and they were unable to set those boundaries and recognize these are my beliefs, these are my values, this is my personal stuff, check that at the door and go in to the therapy session and be present for the client. When we refuse to process issues with the client, it creates an environment of conditional positive regard where we're telling them there are only some topics that are safe. There are only some topics I'm willing to discuss with you. The rest of them are so distasteful to me that I'm not going to discuss them. Wow. I mean, how is a client supposed to react to that? um getting shut down by your therapist. That's a serious rejection, a serious violation. It violates their interpersonal, emotional, and cognitive boundaries because essentially you're saying, "I'm controlling what we actually can talk about in this relationship." So, I'm taking the power position and I'm telling you how you should think and feel about this particular issue. And if you don't, then I'm not going to discuss it with you. Wow. And for obvious reasons, this can lead to feelings of abandonment. The client can feel like, hey, I've opened myself up. I've shared all this stuff. I got the courage to share this other issue with you, and as soon as I did, you dropped me like a hot potato. You know, that's an ethical violation in a big way. I do want to note that there is a difference between not having the skills to address a particular issue and refusal to address a particular issue. Special skills are required to work with people who have severe autism to you implement EMDR to help people explore their se sexual orientation and the coming out process. If you're not trained in those, then you don't want to just wing it. It is important if you run into something with a client that you don't feel competent to handle. This is very different than a values issue. If you don't feel confident to handle it, let the client know, hey, this is a really important step in your growth and I want to be here to support you, but I'm not sure that I have all the skills necessary. Here are the options. you c I can refer you to somebody who specializes in this or in in some cases I can continue to work with you and I will seek supervision. Um, ultimately we want to make sure that the client has the power to decide either I'm not going to we don't need to process this issue right now or I want to see somebody else or I want to continue to see you but you need to figure out how to help me [clears throat] and then we can go from there. It's important um if you're not willing to continue to see the client and get supervision, if that's just something you hear and you're like, I'm not going to do that uh for anybody for any reason. Okay. Well, make sure the client knows that at the outset. There are certain things that I'm trained to work with, but there are certain things that I don't have the training to work with. And if we encounter some of those, then I may make a referral. Some EMDR therapists will basically do a handoff with you where you're either both seeing the client, you're doing everything but the trauma processing and they're working on their trauma issues with the EMDR therapist or you suspend treatment with them while they're seeing the therapist for EMDR. When they've processed that trauma and they've resolved that issue, then they will leave that therapist and come back to you. Have an open dialogue with your fellow clinicians in order to make sure that the resources and services clients need are available to them in a way that is meaningful for everybody. So, let's talk about some areas where worldviews may collide. faith-based understanding and interventions versus secular understanding and interventions. Some people um who are more secular in nature, whether they're agnostic or atheist or whatever label they ascribe to um don't believe that prayer is an effective intervention. Um, and there are other things that come up in faith-based interventions that they may not believe is helpful. Okay. If I am a faith-based therapist and I'm working with somebody, I'm in a a regular clinic and I offer faith-based services, but I also offer secular services. Then secular it is. I'm not going to start talking to you about reading scripture or what John 2 uh verse 23 says or whatever. That's not going to be an appropriate thing. Even if it gives meaning to me, even if it helps me find comfort, that's not your thing. My best friend is an atheist and if I started citing scripture or told him to pray on it, he'd probably hang up on me. Okay. Um, [laughter] that's okay because that would be in some ways violating his boundaries. He would feel like I was telling him to handle the is the issue the way I would handle the issue. And it can go the other way for a secular therapist that completely ignores the faith-based interventions, the power of prayer, what's written in scripture. For somebody who has a very strong faith, it is not being culturally responsive, not being responsive to the individual. When we're working with clients from different cultures, some cultures are individualistic. They put a premium on doing what's best for the individual. And some cultures are collectivistic. They put a premium on doing what's best for the family, for the collective, for the community. And using individualistic interventions, even if you think they're appropriate for somebody who comes from a collectivistic culture, is not going to be appropriate. um the example of a couple who is in a really bad marriage and you're looking at it going, "Ugh, you know, I don't see how this can resolve anyway but divorce." Okay, well, you're not going to say that to them. And if they're from a collectivistic culture, divorce may not be an option. And putting that out there, saying, "Well, it seems like the only option for you is divorce." that is not appropriate. Um, if you're working with somebody who's in a violent relationship, obviously every fiber of our being wants them to get to safety, but it is not our decision to make. Um if they are from a collectivistic society um or culture, they may believe that they need to stay as mother to their children. They need to stay in this relationship because it's their responsibility. Um, and at that point you've got to pivot and figure out, okay, what interventions are available to help keep the individual as well as the family safe? And of course, do any abuse reports need to be made? whatever sexual orientation. Trying to tell somebody that um heterosexuality is the only appropriate response is just painful. I I hope nobody even would utter those words anymore. But there are people who do believe, hopefully not counselors, but there are people, especially those who are highly religious, that do believe that anything else is unacceptable. And okay, so how do we handle that? If we have a client come to us and want help with processing their sexual orientation and coming out, but we don't believe that that is an acceptable option. It's not a choice. It's not a choice. And don't get me wrong, we don't believe it's an acceptable option to be authentic about who they are. Then how do we handle that in counseling? How do we handle that as a professional? Same thing with abortion. Somebody comes in, they want to talk with you, they're in this crisis, they found out they're pregnant, they don't want to be pregnant. um for whatever reason they've decided or they think they've decided that they're going to have an abortion or they had an abortion and they're dealing with the aftermath of it, but you are strongly pro-life and you have a hard time empathizing or having compassion for somebody who is thinking about or who has had an abortion. How do you handle that when worlds collide? Um, some people, unfortunately, it happens, will secretly cause a pregnancy. And this happens on both sides of the aisle. Men, uh, may want to secretly cause a pregnancy because they want a child and they want the woman to stay with them. A woman may secretly cause a pregnancy because she wants the guy to stay with her. Unfortunately, children, especially fetuses, are often used as pawns. And secretly causing a pregnancy is one way that some people um manipulate another person. Now, if your client comes to you and says, "Well, I'm planning on doing this and I don't want Tom to leave. I'm worried that he's going that he's having an affair with somebody else. I want to keep him with me. So, I think the best way to do that, if I got pregnant, he would have to stay. And the client is actively telling you that they're planning on causing a pregnancy. Um, obviously, that's not something you're going to break confidentiality for. How do you handle that? If you believe that it is the wrong choice, how how can you look from the client's perspective and try to understand where they're coming from and how this seems like the best choice for them. Gender roles. There are certain people who are in traditional male-led relationships, tradives, whatever we're calling it now. Some people are extremely happy with that setup. Other people are completely appalled by it. What happens if you have a person come into your office, your client who is in a traditional relationship but unhappy with some of the ways things are going. Your personal viewpoint is that traditional relationships are misogynistic and oppressive. How do you support that client's desire to stay in a traditional relationship while still resolving their issues even though you feel that that relationship is that relationship style is oppressive and misogynistic? You know, we have to balance these. It's going to happen. You're going to have at least one of these things come up sometime during your career. Sometimes you can have people that are in equal um they're equal in the relationship. Everybody thinks that's great, right? No. Some people think that it should be maleled or femaleled, which takes us to FLR, femaleled relationships. These relationships can run the gamut. On the more extreme end, the female in the relationship controls the male's, fun, finances, food, friends, and fornication. The five Fs. You may think that's just the greatest thing than sliced bread. Or you may think that that is completely unnatural and not healthy in a relationship because it's not one of equals or it's not traditional. It's not what you think is the appropriate relationship style. How do you support your client in the relationship structure that they have chosen as best for themselves? How do you keep yourself from trying to convince them that your relationship structure is the better one? porn use. Oh gosh. And I know this is going to be a hot button topic for a lot of you. You're going to be like, uh, no, that's never okay. Not true. Research has actually shown that when couples watch porn together, sometimes it can enhance intimate conversations and improve uh improve intimacy in some ways. porn use to the extreme, porn use instead of with a human being can be problematic. U some research has been done on couples in which one partner is has a much higher sex drive than the other partner. And instead of having affairs, they watch porn. And that's okay with their partner. Their partner's like, "Okay, you know, you're keeping it in the house. You're keeping it at home. I'm okay with that. And it's respecting my boundaries because I don't have the same sexual appetite you do." Many clinicians have an implicit bias against porn and and I caution you against that. Porn comes in many forms. It's not just what you find on Pornhub. There is erotic novels, which a lot of women actually gravitate towards erotic novels. Those are porn. Um, there is erotic art. There is, you know, erotic videos, of course, you know, varying in quality from, you know, high to high to low. But there's a lot of porn out there and recognizing that some people may use it for what they see as valid and healthy reasons. And you don't have to like it. Um, and it's important not to attribute, for example, some of their beliefs or behaviors. assume that those developed as a result of watching porn. They may have developed as a result of the actions in their family of origin and porn has nothing to do with it. So, we don't want to assume. We don't want to impose our values on our clients. If they reveal to us that they're using porn and they want to cut down or stop, okay, you know, it's not. We need to make sure that we are being non-judgmental about what's going on with them. Family or relationship structures, another issue that's this is a more a newer issue uh probably the past two decades that's really come out where we've started to see an upsurgence of polyamory, open relationships or relationship anarchy. Um polyamory is when there is uh there are multiple people they are in commit a committed relationship with each other. Open relationships the each partner in the relationship may have relationships with other people. That's okay too if it works for them. And if you're not aware of what the terms mean, it's important to ask the person, "What does polyamory mean? Explain to me what this looks like in your relationship and how it works for you." Not, "Oh my god, how can you do that?" But help me understand um how this works for you. Sexuality is another place where clinicians may hear things from clients that make them go no. But I caution you to not impose your own values. BDSM is one of those areas. Um when Fifty Shades of Gray came out, I think it's almost been two decades now, that was the big gasp that we heard. Since then, um, fetish and BDSM culture has blossomed and there are a lot of people that practice BDSM. Some practice it as a lifestyle, others practice it as part of sexual play. Okay? you know, understanding how BDSM plays into the life of your client is important. Not automatically freaking out. If you have a client who is a submissive, for example, who comes in and has a bruise, okay, sometimes they'll get bruises. safe, sane, and consensual are the buzzwords for BDSM. And that doesn't mean there will never be some injury. It happens occasionally. It doesn't mean it's domestic violence. If both partners were actively consensually participating, that's not domestic violence. The understanding of mental illness is another place where people may diverge. I've had clients come into my office who've watched way too much YouTube and have this laundry list of pip pop psychology diagnosis that don't exist in the DSM5 TR or any version of the DSM for that matter. Um, what's important for me to understand is they're trying to find a way to understand what they're feeling and what they're experiencing. So, it's not for me to contradict them and say, "Okay, that's all a bunch of hoie." It's for me to say, "Okay, I hear you're trying to put labels on this so you can understand what it is and how to fix it. Let's start talking about that. People find meaning in suffering in different ways. Some people struggle to find meaning when they're suffering. Other people will sit with it for a while and they find it helps them grow. Everybody has their right to grieve and to suffer in a way that is meaningful for them. And finally, politics. Oh my gosh. Um this is a hot button issue and it's only going to get worse over the next couple of months as we are approaching the midterms. Um if people are in and I was looking at research the other day and I think it was like 20% of households are mixed marriages. That is one person is a Republican, one person's a Democrat. Um the number goes up higher if you include independents where one person's an independent and the other person is either a Republican or a Democrat which means there is a lot of conflict in a lot of households right now because politics has become so um nasty and polarized and name calling and and I think it's really important that when we hear politics of some sort that we step back and we say, "Help me understand." If somebody says that they come into your office and they say that I think Trump is the greatest president ever and you disagree, then you might instead of saying, "Are you absolutely crazy? No wonder you're in counseling." That would not be the appropriate response. The appropriate response is tell me a little bit about what he's done that makes you think he is the best president. Um, obviously you're only going to do that if that's a treatment issue because maybe they're disagreeing with their partner about it. But um recognizing that there are a lot of people even if their partner is on the same wavelength as they are, their friends may not be or the place they work may be not supportive of their political beliefs. And for a lot of people, they've learned to just keep their mouth shut about it. But many people when they feel like they're not allowed to disclose their beliefs and what they think is right um feel like they're living an in inauthentic life and that is stunting their growth and their ability to form meaningful authentic connections. So politics does come into the therapy room periodically. Um there are a lot of people who will who uh regularly complain online. Uh my my husband watches a lot of these videos of 20 and 30somes talking about how bad dating is right now. I guess to remind him why he's glad he's been married for 30 years, but whatever. Um but apparently there is it's almost almost essential. It's almost every person says you know I'm looking for this this and this and you have to have this political belief or I don't want to talk to you. Okay. Well, um or you can have all these wonderful things, but if you like this particular person for president, don't bother. Which makes people feel like, you know, nothing else matters. Unless I conform, unless I believe the exact same things that they do, I'm not acceptable. So that creates a situation of conditional positive regard. But it also creates a really frustrating bleak place for a lot of people who are trying to make a meaningful connection who may happen to share or have the unpopular political belief. How can we maintain authenticity using the care model? And yes, there are two Rs in this. This is the care model of cultural sensitivity. This is not one of my pneummonics. Uh show curiosity about the client, their goals and their beliefs and their worldview. What's important to you? And [clears throat] okay, you see you went through this experience, the same experience that I did. You're elated about how it turned out and me I'm kind of devastated. Help me understand your perspective. you know, help me see through the lens that you're seeing and arriving at such a different conclusion. Be attentive to the client as well as to personal beliefs, biases, and professional identity and how all of those things impact interpretation of the client's experience. We are interpreting the client's experience. The client is interpreting their experience. And it's important that we recognize the client as the expert on themselves. They may not understand, for example, why this particular person or this particular activity rubs them the wrong way. And that's where we can help them figure out what memories is that triggering. But it's not for us to tell them that their perception of something is wrong. We need to respect the client's worldview and experiences if they believe. My husband was in law enforcement for 20 years and there are a lot of people that believe that law enforcement is a bunch of corrupt crooks. Okay. Well, if that's been your experience, then that's of course how you're going to perceive it. That hasn't been my experience. But for me to tell somebody, "Oh, no, they're not. There's just a few bad apples." That invalidates what they've experienced up until now, they've experienced something completely different than I have. Their reality is completely different than mine is. It's not for me to tell them how to perceive something. It's for me to try to understand why do they perceive it differently than I do. We need to be responsive to aid the client in achieving their goals, not our goals. You know, their goals. What is the best course of action to help you move toward what's important in your rich and meaningful life? A lot of times your goals and what's important in your rich and meaningful life may be very different than what's is for your clients. my mother-in-law, sweetest woman you could ever hope to meet. And she was perfectly happy being a stay-at-home mom. She didn't work. Well, she worked when the when they were first married, but then when they had the kids, she didn't work. She stayed at home, and she was your very traditional tradife. Um, and that gave her life meaning and that was what she needed. She didn't have a desire to go work and be a CEO and do all that kind of stuff. I did. And she didn't tell me I was wrong for working outside the house, just like I didn't tell her she was wrong for not working outside the house. We had different things that gave our life meaning and different things that were important for both of us. Raising happy, healthy kids was important. We just went about it a different way. And embodiment. We need to align our emotions, facial expression, posture, voice, and actions with the values of cultural humility and care. Translation: Wipe that nasty look off your face. Don't be looking at the client like you have got to be kidding me or oh my gosh you know we need to provide a an accepting non-judgmental environment. Yeah we may not agree. Okay, we don't agree, but it's not our life and it's not our choice in terms of managing your distress because there are times where you're going to work with a client who [clears throat] actively engages and plans to continue actively engaging in BDSM or polyamory or they're going to have an abortion or do something that you have strong feelings against but it's not our choice. So how do we manage that? First identify the difference between caring for understanding and affirm affirming a person's dignity. They are a person first and they are worth love and respect. We may not agree with their choices but they probably don't agree with all of ours either. We want to understand, affirm, and care for their dignity as a human. doesn't mean we endorse their choices. In what ways does the client see whatever this choice they're getting ready to make as the best choice or approach in the context of their life? Staying in a an unhappy marriage, staying in a relationship that is objectively dysfunctional. um having an abortion, choosing to vote for X, Y, or Z. In what way is this the best choice in in the context of your life? Help me understand. Just educate me. When clients have to educate us, they're talking it through. They're processing it. And along the way, they may think, well, you know, maybe I missed something, or they may not, but at least we're starting to understand their point of view. If you were struggling with an issue that your therapist deeply disagreed with, how would you want them to respond? Would you want them to tell you you were wrong? Would you want them to tell you that, you know, your way is not going to work or that you won't even discuss it? What uh what would you how would you want them to respond to you? And we really want to reflect on that when we're working with clients. The ABCs. Uh, cognitive behavioral therapy 101. Activating event. The client comes in and engages in a behavior or is getting ready to make a choice or decision that you disagree with. What are your beliefs? So, the B stands for your automatic beliefs about what's going on. What are your automatic beliefs about the issue? Um, what are your clients beliefs about the issue? That's important so you can understand where each of you is coming from. Are you merging acceptance of a person with acceptance of their behaviors or beliefs? Remember, we want to affirm their dignity as an individual. It doesn't mean we're endorsing their behaviors. What are your beliefs about the client if they make the choice you disagree with? Do you think they're a bad person? Do you you What are your beliefs about the client? If you make this choice, it you know, fill in the blank. What are your beliefs about yourself? If you support a client in making a choice you disagree with, maybe you disagree with um polyamory and your client is in a polyamorous relationship and maybe they're having some difficulties, but they still want to keep the family together. if you support them in working through that and working toward a meaningful improvement in their relationship. Uh what are your beliefs about yourself if you don't think that that is an acceptable relationship structure? And then the consequences activating event beliefs and consequences. What are the consequences to you the therapist if you support the client? Well, ultimately those are probably going to be pretty good because you are maintaining fidelity. Um, you are supporting autonomy. You're acting ethically. You're supporting the client in exploring the issue and making the best decision to help them move toward what's important in their life. What are the consequences to you if you refuse to support the client? And we need to think this through clearly. If we refuse to discuss the issue, if we refuse to support the client um in making the choice that they think is best for them, what are the potential consequences to you as a therapist? What are the consequences to the client if you support them? Ultimately, those are probably going to be pretty good. If you support them in exploring what's going on and making the best choice, then you're helping them move toward what's important in their rich and meaningful life. And what are the consequences to the client if you refuse to support them? Those can tend to be much more damaging because they may feel rejected. They may lose faith in count the counseling process. They may lose hope that things can get better when you support a client in making a choice that conflicts with your values. How do you process the inner conflict? And I want those of you who are parents, I want you to reflect or maybe all of us were children at one point and I think we all made decisions that our parents were just like, "Oh my gosh, I can't believe you just did that." Um, [laughter] [gasps] but hey, you did. Um, or like when I went into psychology, my parents were dead set against it. They're like, "There's no money in it. There's no jobs. you're going to have to go and at least get a master's, so your bachelor's is useless. All that's true, but it was important to me in my rich and meaningful life. It gave my life meaning. It was something I was good at. Um, my parents told me their point of view, but then they supported me in my journey once I said, "Well, I hear what you're saying, but it's my life." Uh then they said, "Okay, well, we've raised you for 20 years. We have imparted our wisdom. We've let you know our opinions. So, at this point, it's up to you to make the right choice because, you know, at a certain point, you got to adult." My children did the same thing. Um they both of them made decisions that I'm not fond of, I wasn't fond of, but thank God they have all worked out. And you know, I wasn't sure they were going to, but they have. And it was important for them at that point to individuate and make these decisions that they had thought through. And one of them, you know, it worked out great and there's been no assistance needed. Thank you. And the other one didn't work out so well. We were there to help him put things back together and he got back on the right track and is doing great. Now, what was important was we didn't try to control them. We didn't say, "We don't love you. You can't come home if we said, "All right, [snorts] wouldn't be our choice, but you're an adult, so you know, you're you're able to make that make that decision." And when we put it in terms of either our children or try to think back to when we were doing things that our parents vehemently disagreed with, you know, sometimes we look back and go, "Hey, you know, maybe they were they were a lot more right than we realized, but we made that decision and we learned from it. We grew from it." Um, and that was important for our for our autonomy, for our self-esteem to be able to make these decisions. And yes, I appreciate I appreciated my parents saying, "Okay, I hear you want to do this. These are the concerns we have, just like I did with my clients. You I hear that you want to do this. These are the current concerns that I have. Take what's useful, leave the rest. In terms of the ethics of respecting people's worldview, there's a lot of them. Beneficence means engaging in actions to promote client health and well-being. It doesn't mean telling them what they have to do or telling them that they shouldn't or can't make a decision if we don't think it's the best decision. Um, but we want to educate them, provide information to them so they can make an informed decision. And sometimes we need to advocate for clients if they are needing assistance. Non-malfins do no harm. If we tell clients what to do or we set conditions on worth or what we're willing to talk about or what we're willing to accept in terms of their choices for their life, then we're causing harm. we're not supporting autonomy. Um, and we're potentially creating a dependency and squashing the client's ability to live authentically. Fidelity. When we pay attention to our boundaries and we respect the clients, we're keeping our word to show unconditional positive regard, creating a safe, supportive environment. By doing this and respecting worldview, we're ensuring all people get the quality of treatment, even if they disagree with us, we're not only giving good treatment to people who think the way we do. We are giving good treatment to everybody, and that's justice. And finally, autonomy. We support the client in making the best choice for themselves based on what's important in their rich and meaningful life. We help them get all the information that they need to make a good decision. We help them process that information, but ultimately the decision is up to them. People's worldviews are formed by their culture and their experiences as well as their interpretation of those experiences. Their actions and decisions are based on that worldview. If you think that pitbulls are dangerous, which most of them are very sweet, but some of them have been not trained appropriately. But anyway, if you think pitbulls are scary and dangerous, then you're going to act a certain way. Your worldview about and your assumptions about pitbulls is going to cause you to act a certain way around them. whereas you may act differently around a labradoodle. Um, just a little aside here. I know we're running long, but there was an incident when uh when we lived in Florida that unfortunately one of the people at the sheriff's office had passed away and the sheriff went to visit the widow and they had two Chihuahua. And the sheriff was a big guy, you know, he was 6'2, something [clears throat] like that, big guy. And he was all dressed up in his share of duds and everything. and he went in to visit the widow. Those Chihuahua tore his ankles up. And you know, I think of Chihuahua as these sweet little dogs, but those Chihuahua were vicious. Um, so recognizing our implicit assumptions about things um, and how our worldview can potentially be wrong [clears throat] is important. And, uh, but anyway, I digress. Failing to understand the client's point of view and help them work toward their goals risks violating multiple ethical principles. Provided the client's choices are not illegal or would not cause imminent harm to self or others. In most cases, therapists must help clients process their motivations, beliefs, feelings, and knowledge about the situations and make the decision that is they believe is in their best interest at that time.