I've recently been back through the ACA and AAMFT codes and the ACES supervision guidelines. I said on the latest Got Therapy? what any honest clinician would: "there's so much to know and to learn." Dr. Dan Rose's reply has stayed with me. He didn't say the codes were wrong. He said "it's a little like reading a manual on how to play guitar."
Here is the position: our profession teaches ethics as a list to memorize, and it should teach ethics as a practiced capacity, something done in the room with another person and supervised there, the way we supervise every other clinical skill.
Dan's description of how we teach it is accurate: "You have this big long list and you're supposed to memorize them." Beginning clinicians, trying hard to follow that list, can end up hiding behind it. In his words, the code "suddenly keeps you from being able to listen to what's going on inside of you or the person across from you in a way that could generate a therapeutic moment as well as an ethical one."
That last phrase is the argument. In the room, a therapeutic moment and an ethical moment aren't separate events. A rule applied without listening can be technically compliant and still clinically harmful. A rule applied with listening can be both.
Dan's alternative comes from an unlikely source: Epicurus, the philosopher of pleasure. His working title is meant to provoke: "If It Feels Good, Do It." But the pleasure Epicurus meant is ataraxia, peace of mind, which Dan calls "the midpoint in the euthymic window." The goal, he says, is to "render the epistemological ontological," so that ethics is "written on our hearts" and "in our bones." We'd be ethical not because someone told us to, "but we're ethical because this is the nature of who we are."
Some will hear that as soft, but I hear it as more demanding. A code you've memorized only asks for recall. A code you live asks for attention, self-knowledge and judgment in real time, under pressure, with a real person in front of you. Dan put it plainly: "it makes an ethical code more than just a code. It becomes a way of being."
It also keeps the clinician in the picture. "You have to be aware of everyone else's peace of mind as well as yours," I said on the show. Dan named both sides: self-care and "other care."
So keep the codes. Teach them, test them and cite them. But don't stop at the manual. Put the guitar in their hands and supervise the playing.
"Until you pick up the guitar," I said. That's where ethics is learned.
Michael Baltimore co-hosts Got Therapy? with Dan Rose Psy.D. on Columbus Television.