Clinical Impact Statement: This article discusses ethical decision-making for emerging psychotherapists in the millennial generation. Key features of millennial culture and how these may impact the ethical practice of psychotherapy are addressed. A focus on a deliberate decision-making process is emphasized when faced with ethical dilemmas and specific recommendations are provided for millennials, and for all individuals, to practice psychotherapy ethically.
Acting in an ethical manner requires careful consideration, deliberation, consultation, and reflection (Knapp, VandeCreek, & Fingerhut, 2017). Answers to ethical dilemmas cannot be found through a quick internet search or superficially sought through queries on professional listservs. When faced with ethically ambiguous and challenging situations for which there appears to be no readily evident “right” course of action, psychotherapists and psychotherapists-in-training must take the time to consider their clients’ best interests, to seek ethical guidance from a range of sources, to consider their own values and the values of the profession, and to apply an ethical decision-making model or process to assist them to determine the most appropriate course of action in that situation (Barnett, 2017). In short, ethical practice can require considerable time, thought, and effort. In a culture that seems to continually speed up, how do we get emerging generations to slow down and engage in this deliberate process to promote ethical practice?
From “trophy kids” to “generation tech” to the more popular, “millennials,” there has been a wide variety of terms used to describe individuals born between 1980 and the early 2000s. Distinguished by both positive and negative stereotypes, the reputation of millennials seems to be a relatively controversial topic of conversation with little consensus. Research on members of this generation mainly focuses on their role in the workplace and their workplace interactions, yet there appear to be some overarching generational traits worthy of mention.
Millennial culture has been associated with greater education, multicultural and diversity awareness, and affluence (Howe & Strauss, 2009). Greater exposure to cultural diversity has led to the development of increased empathy for populations of lower socioeconomic status and increased advocacy for social justice issues (Fox, 2012). Not only does the literature describe and discuss a generation engaged in, and motivated by, social activism, millennials are argued to be more competent and comfortable when interacting with individuals from diverse cultural backgrounds (Thompson & Gregory, 2012).
In terms of personality traits, individuals in this generation are defined as being generally collaborative and achievement-oriented, having strong multitasking abilities, and as being modest and philanthropic (Howe & Strauss, 2009). Yet, despite these positive generational attributes, millennials have also been identified as being over-indulgent, self-obsessed, competitive, sleep-deprived, arrogant, and entitled—traits not limited only to millennials in the United States (Alsop, 2008). Millennials have a tendency to seek career advancement based on performance, rather than experience or seniority, and can be impatient when it comes to traditional career tracks (Ott, Blacksmith, & Royal, 2008). Poor job retention, often described in the literature as a lack of loyalty, is cited as the leading problem for employers of millennials. Millennials tend to seek early employment to develop marketable skills, or make money to support their social life, rather than to establish a career (Thompson & Gregory, 2012).
The need for ongoing and frequent positive feedback to foster confidence and feelings of security is also associated with this generation (Gursoy, Maier, & Chi, 2008). Difficulty with decision-making and in resolving ambiguous tasks are said to result from a preference for receiving explicit directions and the use of checklists (Alsop, 2008). The ability to multitask is another defining characteristic of this generation, particularly as it relates to the use of technology. Millennials prefer to engage in multiple experiences at once and are ever-connected to others through social media, smartphones, and other forms of technology, which can lead to high expectations for information exchange (Stein, 2013). In this age of technological speed and growth, millennials are frequently focused on determining the best, most efficient course of action, and time is regarded as a valuable currency that is not be wasted (Marston, 2016). Each of these qualities and characteristics have implications for how they may approach and practice psychotherapy, especially when confronted by ethical dilemmas.
Ethics and the Practice of Psychotherapy
Ethical dilemmas are those situations in which no clearly appropriate or inappropriate course of action is readily apparent. While there exist some situations and actions by psychotherapists that are clearly ethical or unethical, many of the challenges psychotherapists face in the conduct of their professional work constitute ethical dilemmas. The American Psychological Association (APA)’s Ethical Principles of Psychologists and Code of Conduct (Ethics Code; APA, 2017) sets minimal expectations in a number of areas of practice (e.g., it is never appropriate to engage in sexually intimate relations with a current client), yet the Ethics Code is not designed to tell us what to do in every situation that might arise. As the Ethics Code states in the Introduction and Applicability section, the Ethics Code is intended as one source of guidance for psychologists, and it should be utilized along with a decision-making process that includes consultation with colleagues.
When confronting an ethical dilemma, the most appropriate course of action may not be initially evident, so an immediate response or solution is not always necessary or appropriate (Barnett, 2017). In fact, quick and impulsive decision-making in these situations is generally the opposite of what will likely lead to the best possible outcome. It is important for psychotherapists to take the time needed to reflect on the situation, seek consultation, and engage in a deliberate and thoughtful decision-making process. In contrast to the preferences of many millennials that Alsop (2008) describes, there is no comprehensive checklist to consult to quickly find the appropriate course of action, and a rapid resolution that seems to be the most efficient use of time possible may not be the preferred approach to take. Ethical dilemmas are most frequently ambiguous situations, requiring careful thought and adequate time to reach the best possible decision.
When confronted with an ethical dilemma, the General Principles of the APA Ethics Code (APA, 2017) should be reviewed as an initial source of guidance. These aspirational principles form the foundation of all ethical practice and may prove helpful in shaping our approach to the dilemma (Barnett & Behnke, 2012). A first step may be reflecting on whether our considered course of action is consistent with these aspirational principles. For example, for beneficence, a psychotherapist might ask, “Will acting in this way result in benefit to my client?” Similar questions may be asked regarding each of the other General Principles of the APA Ethics Code. Of course, one should also consider the enforceable Ethics Standards in the Ethics Code to find whatever clear guidance on the matter might be in the Ethics Code. Then, we must consider our own values and how the guidance available in the Ethics Code (as well as in relevant laws and regulations) might be interpreted and applied, while keeping the client’s best interests in mind.
The next step is to engage in a thoughtful and deliberate decision-making process. A number of ethical decision-making models are available. One useful resource that describes many of them is the website of the Markkula Center for Applied Ethics, which may be accessed at https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/. Ethical decision-making models can provide psychotherapists with a systematic, step-by-step process for working through ethical dilemmas. Common steps in ethical decision-making models include: Clearly define the situation and the conflict/dilemma, determine who all will be impacted and how different decisions might impact them; review and consider available guidance or direction from relevant the laws, regulations, and guidelines; reflect on your relevant competence and countertransference; consult with trusted colleagues to obtain feedback on the plan you are considering as well as to be exposed to alternative views and perspectives; consider all reasonably available possible courses of action; identify the potential risks and benefits likely to be associated with each course of action; after careful deliberation make a decision and implement it; then monitor the impact of the decision made on the client and make any necessary modifications based on outcomes achieved (Barnett, 2017).
Consultation with trusted colleagues or mentors provides new insights or differing perspectives that might not ever have been considered otherwise (Sears, Rudisill, & Mason-Sears, 2006). Consultation can be also be useful for challenging unconscious biases or highlighting competence issues unknown to the decision-maker (Caplan & Caplan, 1993). Thus, consultation is an essential element of all ethical decision-making processes. Professional isolation and making decisions in a vacuum can be significant contributing factors to poor decision-making and further reinforces the need to consult with colleagues when addressing an ethical dilemma (Younggren & Gottlieb, 2004).
As mental health professionals, psychotherapists have a fiduciary responsibility to their clients (Jorgenson, Hirsch, & Wahl, 1997). This means that we are entrusted with our clients’ well-being and that we should not take any actions that are inconsistent with this obligation. Our clients are trusting us to do so and we have an obligation to take all reasonably available actions to achieve these objectives, only acting in ways that are consistent with our clients’ best interests.
Tying it all Together for Millennial Psychotherapists (and Others)
Further research is needed to define millennial culture and determine the potential personality traits specific to individuals in this generation. However, based on the current literature, it seems there are some common characteristics worth discussing in the context of emerging psychotherapists. A number of millennials possess some generational characteristics that could enhance the therapeutic relationship, such as greater multicultural awareness and competence, empathy for diverse populations, and affinity for philanthropic engagement. These are all crucial strengths when working with individuals in the context of a psychotherapy relationship.
However, the importance of efficiency and expediency associated with millennials could lead to an impatience for taking the necessary steps to act ethically. Ethical dilemmas tend not to have readily available answers. Following an ethical-decision making model is not as fast as asking a supervisor what to do or “Googling” for an immediate, definitive answer. As has been highlighted, ethical dilemmas have no easily identifiable correct or right courses of action. These situations are characterized by ambiguity, which is not conducive to speedy resolution, and which may present unique challenges for a group shown to have increased difficulty with decision-making and problem-solving in unclear situations.
So, should millennial psychotherapists be viewed as potentially less ethical than other generational cohorts? The answer is a clear and emphatic, “No!”: As a group, they bring valuable strengths and a unique perspective to the field. However, it may be important for millennial psychotherapists-in-training to challenge learned or reinforced values of speed and efficiency, as they contradict the values of ethical decision-making. Immediate responses to ethical dilemmas are often not needed, and may, in fact, contribute to poor decision-making. Not only can psychotherapists themselves face consequences for ethical and legal violations, such as license revocation, but they can potentially harm their clients. Failure to exercise due diligence when facing ethical dilemmas may result in neglect of fiduciary responsibilities, which in turn can weaken the individual clients’ and the community’s trust in mental health professionals. Having a step-by-step guide, such as an ethical decision-making model, seems to be a great compensatory tool for individuals of this generation to utilize to assist them in slowing down and thoughtfully determining the most appropriate course of action in the many challenging situations and ethical dilemmas that will undoubtedly arise in the practice of psychotherapy throughout their careers.
Cite This Article
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