A Moral Basis for the Helping Professions
The issue of morality in the helping professions is much discussed at present. Most recently, it has come up in connection with issues involving the abuse of trust in relationships of unequal psychological and emotional power. It is a good thing to raise these issues. From the clergy accused of abusing young people to therapists taking advantage of their positions to sexually or emotionally abuse their clients, actions which were formerly concealed through the vulnerability of the client and the authority of the professional need no longer be kept secret. However, this, along with issues such as involuntary incarceration and the use of mind-altering drugs, has helped form the impression that moral issues in the helping professions have mainly to do with addressing specific issues rather than a more basic general view. This is not so; the helping professions require a general moral framework, a recommendation for ways of being that help people deal with the issues and resist the temptations that naturally arise from holding a powerful position, and develop into the sorts of people who would not misuse the power that is so freely given, through tradition, the law, and cultural value and emotional attachment.
When we ask ourselves about moral issues in the helping professions, it is tempting to suggest that people who take up the helping professions ought to be as "normal" as possible. There should be few personal difficulties, minimal moral struggle, to muddy the view of the helping professional, who can then see more clearly the disturbances and problems presented. However, when one considers the qualities necessary for any helping professional, from doctors to counsellors to clergy, one might take a different view.
The helping professional works almost exclusively with the distressed and vulnerable. S/he is constantly presented with a situation in which s/he has more emotional power, and indeed is given more emotional power through transference, than the client. The temptations are considerable, and as we know to our sorrow, many do not resist. In the past few years, helping professionals have been forced to face the fact that there is a great deal more abuse of various kinds in the professions than was ever admitted. Because they are the sorts of professions that involve a great deal of temptation, the person who enters them needs some special qualities. The helping professional needs to be someone who has a strong respect for persons, a steady regard for the autonomy and reality of others. In addition, she/he needs to be capable of insight, understanding and compassion without losing boundaries, to be exceptionally reliable , trustworthy, and discreet, able to put her/his own interests and concerns aside in the presence of clients (patients, parishioners) and at bottom have some affection for one's fellow human beings. A certain amount of realistic self-confidence and a sense of humour are essential. Finally, the helping professional needs to have the capacity for objectivity, for confronting difficult questions, for telling the truth even when it's not what people want to hear. When we look at this list, we can see that for helping professionals the actions and motives required are not just those of ordinary decent behavior. To be a helping professional, one must have sufficient self-knowledge, self-discipline and what might generally be called character to manifest the above qualities under stress and when faced with nearly overwhelming temptation to behave otherwise. In other words, the helping professional is required to perform an unusually large number of superorogatory acts. From this point of view, the values look more like the requirements for sainthood than being an ordinary decent person. Furthermore, they are qualities that are usually only achievable through considerable personal struggle and growth.
However, another comparison comes to mind to supplement that of sainthood, and one which brings another arena of personal struggle and growth. It is the comparison of being a good helping professional to being a good parent.
It is uncontroversial that being a good parent requires one to perform a large number of supererogatory actions. Comparing good parenting to being a good helping professional, it seems plausible that they require the same psychological and emotional qualities. The major difference lies in the level of emotional involvement. Parents are expected to love their children with a singularity and devotion not required and indeed not even desirable for helping professionals. Nevertheless, some sort of emotional connection is required between helping professional and client, and it seems to resemble parental love more than other forms of emotional connection because it is necessary for it to be relatively selfless love. Thus even though the attachment of helping professionals to clients ought not to be the sort of passionate devotion that characterizes a great deal of parental love, it shares some important features.
In many respects, the qualities necessary for helping professionals resemble the virtues that Sarah Ruddick suggests inform maternal practice. In her paper,"Maternal Thinking," she argues that there are specific virtues involved in mothering, virtues that support maternal practice. In general, she characterizes these virtues as being involved in what she calls preservative love: "By 'preservative love' I do not mean a feeling. Mothers' feelings toward their children vary from hour to hour, year to year. A single day can encompass fury, infatuation, boredom, and simple dislike without being in any way atypical. Preservative love is an activity of caring or treasuring creatures whose well-being is at risk." (1) Preservative love is also complex. First, mothers try to preserve the life of the child, taking an attitude she calls "holding"
"...governed by the priority of keeping over acquiring, of conserving the fragile, of maintaining whatever is at hand and necessary to the child's life." (2)
Mothers are also forced to come to terms with reality, with the fragility of life and with the fact that a great deal in life, including the person one's child turns out to be, is out of one's control.
"Humility that emerges from maternal practices accepts not only the facts of damage and death, but also the facts of the independent and uncontrollable, developing and increasingly separate existences of the lives it seeks to preserve." (3)
Ruddick is helpful because she captures both the essential sense of responsibility that is involved in being a parent and the limits of that responsibility. She presents the situation in all its poignancy: one feels deeply responsible for something many aspects of which are out of one's control. One may do one's best, but natural causes, human brutality, the requirements of the culture itself (e.g. the draft), take the outcome out of one's control. The ideal is, of course, that the mother is the sort of person who does act for the good of the child when she says she does, really does have a strong sense of responsibility that does not immediately turn into the desire for control.
Perhaps the most important virtue that Ruddick discusses is the capacity for attentive love. Drawing upon the work of Simone Weil and Iris Murdoch, Ruddick's notion of attentive love involves the capacities for objectivity, generous attentiveness, and reflectiveness. Attentive love involves our wanting to see the reality of the other person, not just our own fantasies and projections. In this sense, it is a form of unselfishness, especially when we consider the difficulty of doing this. Fantasy is a powerful force in the heart and soul:
"Fantasy according to their (Weil and Murdoch) original conception, is intellectual and imaginative activity in the service of consolation, domination, anxiety, and aggrandizement. It is reverie designed to protect the psyche from pain, self-induced blindness designed to protect it from insight." (4) The requirements for parenthood and sainthood coincide in the capacity for attentive love. It is this sort of unselfish, insightful, interested and reflective love the characterizes the love of the deeply spiritual for their fellow human beings. It is this sort of love that allows people to be truly good parents. And it is this sort of love that would enable helping professionals to behave in a virtuous way and resist the inevitable temptations of what is basically an extremely intimate relationship.
All this is particularly important because there is something special about the situation of helping professionals that is not the case for other professionals.
In general, people who plan to become lawyers, academics, and corporation executives, are not expected to be any particular sort of person. Of course it's useful if lawyers are patient and helpful and care about their clients, but it is not considered disqualifying if they are not. It is quite possible to be an obnoxious, overbearing, know-it-all and still be an excellent and thoroughly successful lawyer. However, though there may be overbearing know-it-alls who are doctors and nurses, psychotherapists, social workers and clergy, this would be not be considered irrelevant. The whole process of psychological and spiritual development is undermined by the lack of respect shown, by the failure to "hold" , the failure of preservative love, in Ruddick's terms. Therefore, ethics in the helping professions turn out to be more complex than ethics in some others. One must not only follow a set of principles--respect for persons, confidentiality, non-exploitation of power--but also become a certain kind of person, since the person one is has a profound effect on the success of the psychotherapy and counselling of any kind.( These qualities seem less essential for non-psychiatric physicians. It is possible to be thoroughly unpleasant and overbearing and still be an excellent surgeon in the technical sense. However, there would still be something lacking in her/his relation with patients, and it does not seem far-fetched to say that this bears on the healing process.) There are, of course, morally irrelevant factors present in the kind of person someone is. For example, aesthetic preferences and intellectual interests might make some people prefer one therapist or psychiatrist to another-a fellow opera lover might add to one's sense of being understood. But there is no particular set of idiosyncratic personal qualities that makes someone intrinsically better qualified for the helping professions than others. The moral qualities that must be present are available to every sort of person and well-described by Ruddick's description of maternal virtues.
If it's true that these qualities and capacities are essential for becoming a helping professional, this means that being a helping professional is a different kind of task than, e.g., becoming a good lawyer. In addition to hard knowledge of particular professional areas, the helping professional must have developed a high level of psychological, moral and spiritual development, which will involve self-knowledge, self-understanding, what psychoanalysts would call a commitment to consciousness, and spiritual directors might describe as putting aside one's own attachments and allowing the transcendent to come through. (5) They must have the unselfish commitment to the well-being of others that Ruddick describes, which is enhanced by the sort of self-knowledge and objectivity that comes having undergone some extended form of self-examination such psychoanalysis and/or spiritual direction. That some branches of the helping professions believe this to be necessary can be seen is the requirement of extensive analysis for psychoanalysts and the requirement of spiritual direction for many clergy.
When we consider all this, we may ask ourselves how it could inform our moral practice. Could the professional associations with which helping professionals are generally registered require their members to be in a certain inner states before registration? The answer seems clearly to be no. Furthermore, the difficulty of seeing oneself, of knowing when one's own interpretations and wishes are entering into one's relation with the client are such that one is bound to make mistakes. It is unambiguous to say "Don't sleep with your clients.", and whether or not one is doing this is easy to tell. However, the states of being and consciousness that make it possible to sleep with clients without being overwhelmed with guilt can be morally slippery and fall victim to self-deception, and it is here that the trouble really begins. The best we seem to be able to do is know whether we are committed to awareness of ourselves and responsibility for our actions or to being thoughtlessly comfortable where we are. It might be helpful to be on the lookout for certain qualities , such as defensiveness, that indicate a propensity to self-deception.
All this makes promoting and monitoring ethics in the helping professions a difficult business. While we can specify particular practices, recommend the development of spiritual, psychological and moral capacities, some of the most important determinants of behavior are not immediately accessible to the will. To become a person capable of preservative love requires a strong desire to do so and a willingness to do what is necessary to develop into the sort of person who can manifest preservative love. We cannot become unselfish, humble and attentive in the same way that we can decide to follow a moral rule. We require both education in virtue and transforming self-knowledge.
(1) Sarah Ruddick, "Maternal Thinking" in Mothering: Essays in Feminist Theory, ed. Joyce Trebilcot ( Rowan and Allanheld, Totowa, New Jersey, 1983) p. 240.
(2) Ruddick, op.cit., p.213
(3) Ruddick, op.cit., p. 217
(4) Ruddick, op.cit., p. 223
(5) See Bonnelle Strickling, "Self-Abnegation" in Feminist Perspectives: Philosopohical Essays on Method and Morals, ed. L. Code, S. Mullet and C. Overall (University of Toronto, 1983).