Jun 15 2014

Victories, A Men’s Personal Growth Program: Ethics & Transparency Progress

The Victories Board of Directors took a very positive step forward in creating and publishing its Ethics policy.

The key element of their new Ethics policy is as follows:

“Service Personnel who are mental health professionals shall avoid dual relationships involving their clients and Victories of the Heart unless they can be assured that (1) the relationship does not violate the code of conduct applicable to their profession and (2) the  relationship will not adversely affect their client. In particular, this means that no mental health professional will invite a client to a weekend, which he is attending as staff or participant, without full disclosure to the client of the potential change in the therapeutic relationship that may occur as a result of attending the weekend together. If more than one such client accepts the invitation, the professional must (1) disclose to each client the fact that other clients from his therapy practice will be in attendance and (2) fully discuss the therapeutic and confidentiality implications of the situation.”

Up until this new policy was implemented, it was commonplace for the therapist leaders and staff to encourage their clients to attend a weekend, preferably, the therapist’s own weekend. There were notable exceptions to this rule, particularly among the programs founders and other board members who had robust private practices and often referred their clients to other leader’s weekends.

When I was a leader myself, I both encouraged my clients to attend my weekends, other weekends, and was the recipient of many referrals from other principals in Victories. I noted in fact it was generally easier for me to help clients step beyond their comfort zone to attend a weekend if they were going to join me. This speaks to the very powerful attachment clients have with their therapist, making them at risk of harm in the creation of a dual relationship and why this new ethics policy has important value.

Like all ethics guidelines or codes, the new Victories policy underscores the need to protect the complex and powerful relationship of therapist and client. Victories built itself on the backs of the clients who were referred by either the therapist leaders or therapists from the community. I know from own experience and witness to others in Victories how dual relationships can be damaging. I began my involvement with Victories in about 1990 as a result of a referral to one of the Victories’ (Men’s Room at the time) principals. What began as a request for therapy, quickly became an encouragement to engage in the principal’s personal growth weekend, the first of multiple, dual relationship problems.

Ethical thinking and analysis is a great process and only good things can come from an effort of this sort. While this new ethics policy is a very positive step forward, here are some of my concerns offered in the spirit of transparent dialogue being a good thing.

First, let’s consider the “wiggle room.” The new policy states the importance of preventing dual relationships between therapist and client, but then waivers, and gives the therapist permission under certain circumstances to invite their client to their weekend.

In creating a policy of preventing dual relationships, then allowing them, Victories falls into the logic trap of both/and.  Both/and logic suggests that there are no contradictions and diverging concepts can be seen as compatible. This is the problem with this aspect of the new ethics policy.  Is it possible that both dual relationships have a negative impact and should be avoided and dual relationships can have a positive impact and should be encouraged?

Having lived through this dilemma myself as a client and staff leader, I do not think both concepts are compatible. Dual relationships in the context of “men’s work” has no place and should be have  a strict prohibition.

The problems with the wiggle room in this policy suggest the culture within Victories is not yet ready to let go of older beliefs, such as clients attending their therapists’ weekend is a net positive. What may lie beneath this optimistic beleif could be the fear that if therapists can not recruit their clients to their weekends, the weekend may fail. I think Victories misses an opportunity to create healthier relationship boundaries among all involved and therefore a more transparent and healthier organization.

Second, the idea a therapist can manage the dual/multiple relationships of client/clients attending their weekend, through informed consent presents other ethical problems.

A key question here is if the therapist has a good therapeutic relationship with their client, why would they want it to change? Who does that really benefit? Also, how does the therapist describe how their relationship will change after a shared weekend experience?

There are several flaws in this thinking, including therapists are not able to see the future, both therapist and client are biased in how they report their experience, and importantly, the previous individual relationship with the therapist has morphed into a group relationship experience. The client now has access to other therapists and staff from the weekend, each with their own favorite leader and opinions about other leaders.I remember the not-so-subtle attempts by other therapist leaders to compete with the therapist with whom I worked. How can knowledgeable therapists ever think this would be a good idea?

The therapist has more influence by the nature of the therapeutic relationship, so just in the asking, even if subtle, the client will feel some pressure to participate. Even if good initially for the client, his therapeutic relationship will be forever changed, usually in ways not able to be predicted. Just the suggestion “the therapy relationship can change” may be enough to create a block in the development of the therapy relationship, preventing growth, disclosure and healing on the part of the client.

Also, the idea of informing clients that other clients will also be attending a shared weekend raises questions about confidentiality as well. The therapist is saying, “I will have other clients at the weekend” reveals other men to be in therapy with the therapist leader. Does this disclosure that other clients will be present represent a complicated breach of confidentiality? And in a situation of unequal power, how can a client say no or even be able to make an informed consent decision?

Both/and logic is a way of rationalizing a dilemma so it does not have to be resolved. Victories sets out to create a clear ethics policy, yet allows it to remain murky, such as it was for over 25 years.

There is extensive ethics literature on dual relationships. It may be one of the most discussed and written about aspects of various ethical codes. In looking at the literature, there is some leeway when it comes to dual relationships. There is mention of various exceptions, such as therapists in rural areas who might be required to help someone they might know in another setting. The exceptions to the “avoid dual relationships” rule have clear rationale. In Victories programs, there are many other opportunities for a therapist/lleader/staff person to have his clients attend another weekend where he will NOT be present.

Third, the ethics guideline specifically addresses the dual relationship possibility of VOH personnel engaging in business and sexual relationships with participants. The guideline states:

“Specifically, for a period of two years following the completion of a man’s participation in a Victories’ weekend or other program, no Service Person who attends or leads that weekend or program shall become engaged in any new financial, business, or therapeutic relationship with that individual. In the case of a new sexual relationship, this prohibition shall be in effect for five years.”

The two and five year prohibitions again offer wiggle room, weakening the intent to create clarity as to right/wrong actions within the organization. If dual relationships can be avoided permanently, why not do so? In hindsight, I would have preferred not being a participant at my therapist’s weekend and then being recruited to volunteer and become involved in the development process of the organization.

The late, Buddy Portugal, Bob Mark, and the other leaders were tremendously charismatic, dynamic men, but needy too. There was a lot of competition, most of it hidden, between leaders. The dyadic leader structure encouraged this competition by preventing cross-collaboration and cooperation. The hidden competition was a significant cause of organizational malaise, a stumbling block to development.

I also am critical of the permission after a five year prohibition on the development of sexual relationships. This element of the ethics policy needs much greater clarification. It uses language from other professional ethics codes which govern the relationship between a therapist and their client. Suggesting 5 years is an adequate amount of time to lapse between a therapist working actively with a client is debatable enough, but the Victories policy addresses a more complicated system of relationships.

Unlike the therapist who terminates their professional relationship with their client, waits 5 years and then begins a personal, sexual relationship with their former client, the Victories policy suggests there can be an ongoing relationship of some kind, then after five years, this relationship can become sexual. What does sexual mean in this context? Does sexual not include erotic emotional relationships?

Also, much of the relationship language during weekends during the first 20 years was biased towards hetero-sexism, even though sensitive observers during weekends could see men struggling to with same-sex (male) attractions. I could see how these weekend experiences did not offer these men, some of them feeling trapped in straight marriages, a safe place to address their sexual orientation issues.

This aspect of the ethics policy, without more clarification, seems to offer too much wiggle room for leaders, staff  or participants who may be interested in pursuing a sexual relationship with someone from within the program. A program whose mission it is to encourage health and healing to men and their families should create a more clear rule about right/wrong sexual behavior within the organization. Seeing anyone else within the organization as a potential sexual partner seems to me to be part of the damage men can bring to relationships.

Having worked as a straight therapist in a variety of contexts, including a MR/VOH volunteer and leader, I can verify same sex attractions can and do surface on a regular basis. VOH should do an anonymous research project to explore what individuals have experienced in this area. I saw and heard plenty in my own experience and think the organization would get enough confidential feedback to encourage them to create more strict and clear right/wrong ethical standards in this area. Even the stress on a dyadic leader team can create multiple meanings for multiple people. How much do the leaders really love each other? It needs to be clear to create safety.

If I had still been involved, I would have encouraged a strict prohibition on any business or non-business relationship/sexual relationships. If two men wanted to develop a closer business or sexual relationship, they could withdraw from any formal organizational role. The relationship would not need to be prohibited. Those two men could make their own choices, so long as no Victories staff or volunteer was abusing their authority or power to exploit the other man.

Finally, there are many, many other areas for ethical thinking within the overall organization.  VOH would benefit from adapting another professional organizations’ ethical code (NASW or Illinois Counseling Association) to develop a more comprehensive and integrated approach to ethical decision-making.  The published VOH ethical standards are very important, but there is much missing that could offer guidance when the right/wrong decisions have to be made. For example, there are claims the programs are based on science, but there is little to no specific research offered. There is a private site “for professionals” which can only be accessed with permission.

I reviewed that site imagining I would find some of the latest neuroscience research which offers clear rationale for some of the body centered work of weekends, like psychodrama. I was also curious to review any research cited to support the shadow weekend, of which I had grown to become very critical. In this private section, I was shocked to find limited reading resources. Nothing was found directly substantiating any of the processes on any of the weekends.

The amusing part of this story is originally, I had been asked to provide the  reading list for the graduate class I was teaching at the University of Chicago School of Social Service Administration. This list was used for many years.  You can view the VOH list here and my current list here to evaluate which you think are more extensive.

I will also note I was the only clinician involved with Victories who published anything in a peer reviewed publication. The founders wrote a book, but it was not peer reviewed and offered no citations. I wrote a brief article on a body-centered exercise we used extensively in my program related work. I assume there is some rationale for this article to not be mentioned, but ask the ethical question about proper attribution to colleagues for professional work. I should have been included in this professional resources section.

A question still remains as to how this ethics policy is managed internally. When I was involved, Kurt Schultz and I discussed the creation of an “ethics committee”, a committee within the larger organization whose purpose was to review relevant matters. Ideally, this group would have some autonomy and even an outside consultant with ethics expertise.

Having an ethics committee function in this way can be invaluable to the development of effective and impactful programs.  Ethical dilemmas are commonplace in organizations of every size and should be explored and studied. Is someone having an inappropriate sexual relationship with a person with lesser power is something heard all the time. Even Victories decided to address this issue in this ethics policy.

However, there are many other areas of ethical concern Victories could address, such as the role of specific processes on weekends, how applicants are screened prior to participating in programs, how confidentiality is managed after a weekend program (everything is confidential is not an adequate standard), the power relationship between program leaders and volunteer staff, the adequacy of the claim all programs are based on research and evaluated by outside consultants, transparency among other issues.

Victories is limited, of course, by being an organization mostly led by volunteers. How much time can they devote to the organization before they neglect themselves and their own personal and family obligations.

While creating ethical standards is a very positive effort by newer leaders, it seems like the old guard still wields influence. This has served to muddle the effort to create a clear right/wrong way of thinking and acting in an organization which has claimed it’s superiority due to professionals being in charge.

Ethical thinking and the development of standards is an ongoing process. Hopefully, more clarification will come down the road and we in the public will learn about a more robust ethical process in VOH, including a free-standing committee whose role is to explore and adjudicate ethical complaints. This will enhance the power of VOH version 3.0.

There is no doubt these standards represent a huge and historic step forward and the Board members creating these standards deserve a lot of credit. Kudos to them and I hope they keep up the good work.

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