Groupthink

In his paper, Why I Do Not Attend Case Conferences Dr. Paul Meehl, psychotherapist and former APA president, pointed out that:

In one respect the clinical case conference is no different from other academic group phenomena such as committee meetings, in that many intelligent, educated, sane, rational persons seem to undergo a kind of intellectual deterioration when they gather around a table in one room.

He identified a groupthink process by which [t]he most inane remark is received with joy and open arms. Unfortunately but not surprisingly, this phenomena is not limited to psychiatric case conferences and appears to extend to any time a group of people get together, including in mailing lists, social functions, and professional get togethers. In many such groups a form of reinforcement occurs, negative opinions are not tolerated, and if the group leaned a certain way before getting together, they will lean more strongly in that direction after leaving the group.

According to Ethics in Psychotherapy and Counseling, based on Janis and Mann's A psychological analysis of conflict, choice, and commitment: Groups where groupthink is taking place have a tendency to pressure group members who dissent or challenge the groups collective beliefs; they will deny or dismiss or rationalize away evidence that is contrary to the way they already lean; and they will tend to develop a firm belief in their own ethical standing. Some members of the group may also take the role of mindguard--members who protect the group from adverse information that might shatter their shared complacency about the effectiveness and morality of their decisions.

Application

Evidence of these and other problems is not difficult to find in Neopagan circles. In larger groups, statements such as don't rock the boat are very common and tolerance can--ironically--become a buzzword for putting down dissent or enforcing the group's own ethical standards to the exclusion of others. It is not uncommon to see groups cast out, shun, or ridicule those who make statements that might be perfectly acceptable--if perhaps disagreed with--by any individual member independent of the group dynamic.

This group reinforcement mechanism is one of the ways in which group mythology can come about. Where people organically grow a set of beliefs about themselves and their group, simply as a function of people reinforcing each other without any form of an outside sanity check. Combine with a little UPG which may or may not be valid, and some interesting consequences can fall out of this.

This can also lead to individuals developing very particular views about the nature of what they do that may not extend to others doing similar work, but who are not a member of that group. Even if none of the issues of groupthink exist, there is a strong possibility of selection bias.

As spirit workers who deal extensively with UPG and spirits on the behalf of others this poses a particular problem for us, since it affects our ability to validate our experiences. The concept of Peer Corroborated Personal Gnosis (PCPG) is particularly susceptible to this, since it is affected not only by cultural biases but by group dynamics of that particular group of spirit workers. A message from a deity or a spirit to an individual can take an entirely different timbre if there is a form of group reinforcement going on, and the potential for boundary violations goes up tremendously.

Guards

Combatting this is not easy, as groups serve numerous useful purposes. They form support networks, resources for ideas, and can provide sanity checks of their own. In a small community as Pagans or Spirit Workers, groups provide a great means of socialization, finding romantic partners, and finding clients.

How can one work with and exist within groups, while at the same time avoiding succumbing to groupthink? I do not have any solid answers here, but here are some possible things that can help, (adapted and influenced by Janis's work, but not taken directly from that):

• Encourage dissent and actively solicit people's objections and doubts. Allow them to air such thoughts without censure. Let people finish their thoughts before objecting to them.
  
• Keep conversation civil. People who disagree are not the enemy, they simply have a disagreement and may be operating from different, and still valid, premise.
  
• Engage in critical thinking and analysis of your own ethical structures. The specific ethics that you follow tend not to be as important as that you are actively considering them.
  
• Avoid generalizing statements such as "all" or even "most" without empirical evidence when talking about people (or spirits, for that matter).
  
• Don't assume you are right about anything.
  
• If asking for confirmation, don't tell the individual what you concluded.
  

The last point, in particular, is especially important. It is easy to introduce confirmation bias into a situation without intending to, simply by telling someone what you found before asking them to confirm it.

None of this can cure it, and the problem of groupthink is notoriously tricky in governments, businesses, and organizations all over the world. At the same time, it is something we need to be talking about, so that we can be better aware of it when it does come up.

Further Reading

• The Shaman and the Spirit Worker
  
• Amazon: Guys, Put the Torches Down
  
• Ethics in Psychotherapy and Counseling, by Kenneth S. Pope and Melba J. T. Vasquez
  

Stigmas on Mental Disorders

There is a huge stigma on mental illness and on mental health professionals in much of the western world, which gets in the way of honest discourse and helping people who are suffering from mental disorders. There is the attitude that psychology is an attempt to justify, rather than understand, and that mental disorders are a sign of an underlying character flaw, as opposed to a disorder or disease.

As Darryl Cunningham indicates: If someone gets diagnosed with cancer, their friends and family rally around them to support them. If they get diagnosed with paranoid schizophrenia, they tend to lose those support networks just as they are starting to need them most.

In the military you can get passed up for promotion or lose your security clearance if you get diagnosed with a mental illness. Doctors are also pressured by the military not to diagnose PTSD. Many mental illnesses are treated as something you just have to "man up" about, "get over," or are treated as "not real illnesses." Recently the JAG Tom Kenniff called vicarious traumatization psychobabble.

You can tell your friends you are going to the doctor to get treated for heart disease, or in most crowds a chiropractor for back pain. The response is dramatically different if you tell them you are going for treatment of your bipolar disorder, let alone paranoid schizophrenia or narcissistic personality disorder. There are taboos around these things, and these taboos make it significantly more difficult to get treatment.

This is further not helped by certain individuals, even (especially?) doctors who should know better, seeming to classify everything and the kitchen sink as being treatable exclusively or predominantly with chemicals, many of which have ugly side effects (my own personal definition of hell includes anterograde amnesia, which is a potential side effect of many anti-anxiety medications). Many others who seem to be of the opinion that everything is actually depression, even if it is, in fact, fibromyalgia or a thyroid condition.

Then we get into problems that therapists themselves run into thanks to malpractice, professional codes, and legal systems. Where we can look in retrospect and say "they misdiagnosed/misevaluated" or any number of other statements, but therapists who evaluate the situation will also say "There, but for the grace of God, go I." Treating real humans is enormously complex, and the legal framework surround it is almost as complex. The situation puts tremendous strain on therapists, who may find themselves in a position of being unable to predict the future, and then being blamed for not being able to at a later point.

So what we get is a situation where a lot of people in this country have undiagnosed PTSD, major depression, anxiety disorders, paranoid schizophrenia, and a thousand other things. At a minimum, these impact their quality of life and some of them may get more serious without treatment (or, depending on the nature of the treatment, with treatment) They are unable (quite possibly because of insurance) or unwilling (possibly quite rationally so, depending on their situation) to visit mental health professionals and get an actual diagnosis. If they have dissociative identity disorder they may have amnesia blanks over periods of time where they self-sabotage, and they may have a fight with a lover only to not remember even having a conversation with them later. They may spend years blaming themselves or burning out, may try self-help which may or may not make the situation better (or worse), and spend a lot of energy hiding these illnesses and differences from others.

These things are so heavily stigmatized in our society, that the stigmas themselves make it more difficult to function independent of that the disorder itself makes it more difficult to function. This can and does make the situation significantly worse. This is something to pay attention to, because it isn't something you can prevent by pretending it is "all in your head": it really could be you or a loved one who starts to suffer in silence, do poorly in relationships at school, or their job, and feel there is no way out as a result.

Further Reading

• Anything in Darryl Cunningham's Psychiatric Tales, but especially the one on schizophrenia (also linked above) and this one on mental disorders in general.
  
• Mental health: Overcoming the stigma of mental illness from the Mayo Clinic
  
• National Association of Mental Disorders
  

[Admin Note] Sick

I've been sick for the past few weeks (word of advice: don't get the flu), but have several essays in the works for when I get better.

Dual Relationships: Romantic Relationships with Clients

Paying attention to other ethics codes and looking at the reasons why, the answer to the sex/romantic dual relationship with clients issue can be summarized with a single word: Don't.

The problems with this are not abstract or theoretical. After studying the subject relatively extensively in the late 60's and early 70's, William Masters and Virginia Johnson put forth the statement that:

We feel that when sexual seduction of patients can be firmly established by due legal process, regardless of whether the seduction was initiated by the patient or the therapist, the therapist should be sued for rape rather than malpractice, i.e., the legal process should be criminal rather than civil.

Kenneth Pope and Valerie Vetter conducted research on the subject and found some tragic--and sadly unsurprising--results. Around 90% of patients who have had sex with a previous therapist have been harmed by it, and around 80% are harmed even when the relationship doesn't begin until after the therapeutic relationship ended.

Of course, reality is more interesting and nuanced than can be summarized in a single word, and as spirit workers we are faced with some unique challenges in this department. However, even if everything else I say about professionalism for spirit workers is ignored, this is the one thing I adamantly believe should not be. The risk for harm, unintentional abuse, and boundary violations are simply too great.

What Others Say

This is one of the older creeds among healing professions going back to the Nigerian Healing Arts. It is also found, though indirectly, among numerous shamanic cultures. Here are some general statements from other helping professions throughout the centuries:

Psychologists do not engage in sexual intimacies with current therapy clients/patients. -- APA 2002 Ethics Code

Sexual or romantic counselor–client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. -- ACA 2005 Ethics Code

Sexual intimacy with patients/clients is unethical. -- AGPA (American Group Psychotherapy Association) and NRCGP (National Registry of Certified Group Psychotherapists) Guidelines for Ethics

Massage therapists shall [...] Refrain from engaging in any sexual conduct or sexual activities involving their clients.-- AMTA (American Massage Therapy Association) Code of Ethics

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. -- Hippocratic Oath

You should not tell what you have learned from the time you enter a woman's room, and, moreover, you should not have obscene or immoral feelings when examining a woman. -- Seventeen Rules of Enjuin

The details, of course, vary. The ACA bans romantic or sexual counselor-client relationships for a period of five years following the end of the counseling relationship. The APA puts the number at two years. Both state that the therapist/counselor should document whether the relationship could then be viewed as exploitive or whether there is a potential of harm to the client.

I personally feel that two years makes a good absolute minimum, and that five years is a safer number.

Doing Work For Significant Others

While the statement don't sleep with your clients is relatively uncontroversial, one of the subtle ways this can be come a problem is in doing work for someone who you already have a preexisting romantic relationship with. Because surely there's no problem with helping them ward their home, right?

Of course there is. Just because the romantic relationship started first, doesn't mean that the situation won't compromise your ability to heal and cause long-term trust issues in the romantic relationship.

This is where we get into what constitutes a low powered relationship. It is one thing for me to offer friendly advice, to help ward someone's house, to have them help me ward my house, to receive help from the spirits on the behalf of someone else in an emergency situation, and another for me to enter into a professional, deeper or longer term relationship with a client who I am seeing romantically. The former are lower-power and usually single shot and do not require an intimate, healing relationship with the individual. It is also best even if these lower power relationships are kept professional in attitude and demeanor while they are taking place, just to establish that sense of space while the work is taking place.

It is also a good idea to document when such things happen, and to talk about it with a Teacher or another spirit worker, just to make sure that everything stays above board. Do not be afraid to refer them to another individual if the situation starts to get too high powered or if the boundary lines start to blur.

To do otherwise, to make them your client, creates an unstable situation where the position of trust you share in one domain will cause conflicts in the other. It can make a relationship unintentionally abusive, and your focus cannot be entirely on healing them as your client.

To illustrate, consider what happens if there are problems in the relationship, or even if you break up? Will they lose their spirit worker while simultaneously losing their significant other, should they? What if during a journey on their behalf you find out that you caused the problem that you are trying to help them with. What if it turns out that, as described in Sandra Ingerman's Soul Retrieval, you--entirely accidentally--steal part of their soul.

While all of these are manageable situations overall if the spirit worker and the romantic partner are different people, they can and do cause endless problems and are rife with potential unintentional abuses--let alone if either parties intentions are not entirely honorable.

In short, you can be their lover, you can be their spirit worker, but you cannot be both.

Conclusion

Although the prohibition against sex with patients reaches back beyond Freud, beyond the Hippocratic Oath, and at least as far as the code of the Nigerian Healing Arts, it was only with systematic research that began in the 1950s that the profession began to understand the depth, pervasiveness, and persistence of the harm that can result when therapists abuse their license, role, power, and trust. -- Kenneth S. Pope

The more we learn about shamanic practice and its links with psychology, especially now that our techniques are being used in psychological healing, the more it looks like the boundaries set by these other healing organizations--especially groups like the APA and ACA--are appropriate for us as spirit workers as well. We are members of a healing profession and our role as spirit workers is to help others, it only makes sense that we build our code of ethics off of others who are trying to do similar things.

Romantic relationships with clients are one of the most clear-cut areas in the domain of dual relationships. Fortunately, where professional and social relationships can be unavoidable in the communities we frequent, romantic entanglements are almost always entirely avoidable with existent clients, as is becoming the spirit worker for your current romantic partner.

Further Reading

• Dual Relationships and Ethics
  
• Professionalism
  
• Boundaries (II, III, IV)
  

Dual Relationships and Ethics

As members of a healing profession we frequently run into one of the pitfalls of other healing professions: having more than one kind of relationship concurrent with, prior to, or subsequent to our professional relationship as spirit workers, occultists, or clergy. This relationship may be professional (e.g., someone comes to you for a soul retrieval who also happens to be your dentist), social, or financial in nature.

Many helping professions--from counselors and psychotherapists to clergy to doctors--have struggled with professional and emotional boundaries as they relate to dual relationships. As spirit workers our difficulties are not that different from counselors or psychotherapists, as we deal with many of the same forces in our client's lives.

Even so, we are faced with a variety of problems that make certain classes of dual relationships nearly unavoidable, and as spirit workers we operate in a realm with relatively undeveloped codes of professional ethics. Ellen C. Friedman, writing on the topic of the ethics of dual relationships and Wiccan clergy, states:

The lack of professional training for Wiccan clergy and the adolescent development of Wiccan ethics is a considerable problem. Wicca is a young religion and has yet to develop in these areas to the extent found in older religions.

In truth these problems are not unique to Wicca, and we could substitute Neopagan for Wiccan and be very accurate for most of the available trads and clergy out there. This is not to demean those who are out there and who are operating relatively in the dark, and there are some great programs, such as Cherry Hill Seminary out there, but there are very few good, comprehensive analysis of dual relationships in a pastoral setting.

I personally believe that it would serve us well to follow a similar code of ethics to that employed by counselors, psychotherapists, and pastoral counselors, or at least to use their practice as a starting point.

Dual Relationships Defined

The American Counseling Association's (ACA) 2005 Code of Ethics gives a great deal of guidance around relationships with clients, but--in a departure from previous versions of the guide--does not actually use the term dual relationships. This wasn't because the concept is no longer important, but rather because the term itself was problematic. To quote Dr. Rocco Cottone, who was on the ACA Ethical Code Revision Task Force:

When you sit down and analyze the concept of dual relationships, you will find that it relates to three different types of relationships: sexual/romantic relationships, nonprofessional relationships and professional role change. The first category, sexual and romantic relationships with current clients, is banned by the code of ethics because we have evidence of the damage that results. The second type of relationship, nonprofessional relationships, encompasses those activities where you might have contact or active involvement with a client outside of the counseling context. The third type of relationship that the old dual relationship term encompassed is a professional role change. An example is when you shift from individual counseling to couples counseling. Moving from one type of counseling to another with one client can be really confusing and ethically compromising.

So, in the end, moving away from the concept of dual relationships was really about the analysis of what the dual relationship term meant and the confusion it caused because of multiple meanings. The new ethics code addresses all three types of roles and relationships with clients.

Despite the split into three separate categories, there lacks an effective term--other than dual relationship--that covers all three under some other heading, and the term is still in common use among other therapeutic organizations. For example, the American Association of Pastoral Counselor's Code of Ethics echoes previous versions of the ACA's ethics codes, and states outright:

We recognize the trust placed in and unique power of the therapeutic relationship. While acknowledging the complexity of some pastoral relationships, we avoid exploiting the trust and dependency of clients. We avoid those dual relationships with clients (e.g., business or close personal relationships) which could impair our professional judgement, compromise the integrity of the treatment, and/or use the relationship for our own gain.

Due to the widespread nature and lack of a better term, I will continue to use the term in this blog to refer to all three categories mentioned by Rocco Cottone, without attaching any specific stigma to properly conducted dual relationships. These may, in fact, be beneficial or even necessary and this should be recognized where appropriate to do so. I will also break them down into separate categories where appropriate, so that each may be better addressed separately.

Separation and Boundaries in Pagan Society

One of the challenges that face modern day spirit workers is that it is difficult--if not impossible--to maintain strict separation from our clients. First, it is not uncommon for our client-base to come from within our chosen families, and for the groups that we teach or work for to be our close friends as well.

Some shamans live on the outskirts of the society they are part of for various spiritual or practical reasons, which can help provide this separation. For those of us who are not in that position, however, this poses quite a problem.

Friedman, speaking of Wiccan psychotherapists, says that:

Wiccan clergy psychotherapists appear particularly vulnerable to ethical dilemmas caused by dual relationships. Complications unique to Wicca include the intimacy required of its clergy within the ritual context and within their covens. Covens serve not only as congregation, but also as seminaries and in some instances as family of choice.

She then goes on to offer four alternatives: Avoid clients within the community, practice low-power relationships, negotiate each relationship on a case-by-case basis, and use established best-practices that involve consultations with others.

For spirit workers the first two options are clearly untenable since we tend to serve the communities that we are part of, and while we can occasionally do low-powered work for clients some of what we do (e.g., soul retrieval, serving as a medium to the gods) is much deeper and requires relations that are closer to that of a therapist.

What I suggest is that we approach things with a hybrid of the last two. This means:

• Adopting our own ethics guidelines and best practices from those of other helping organizations, such as the ACA.
  
• Document our agreements and the dual relationships that we have.
  
• Consider how our dual relationships might be unintentionally exploitive or otherwise harmful to our clients.
  
• Openly discuss--and negotiate--our boundaries with our clients, both from their perspective and ours, documenting the results.
  
• Use lower powered but still professional relationships where appropriate--keeping with all of the above points--and not being afraid to refer people to others when we feel that our position compromises our relationship in some way.
  

Conclusion

This is merely scratching the surface. I am going to go more into each of the three types of dual relationship (social, sexual/romantic, and professional) and the challenges and guidelines for each of them in the upcoming posts. Feedback or suggestions, as always, are welcome.

Further Reading

• American Counseling Association's Code of Ethics
  
• American Psychological Association's Code of Ethics
  
• American Association of Pastoral Counselor's Code of Ethics
  
• Spiritual Direction
  
• Boundaries (II, III, IV)
  
• Professionalism