The Ethical Dilemmas Present in Military Behavioral Health Technicians (BHTs)
Jackson Duncan
Masters of Art in Psychology
PSYC-5311: Pro Orient: Legal/Ethic Issues
Dr. Harry Beverly & Dr. Parnell Ryan
August 10, 2023
Summary
In military life there are many occasions where war has caused trauma, separation from
family can cause depression, and looming threats of danger can cause fits of anxiety. There are a
wide range of mental disorders that plague all militant lifestyles and as a result, mental support is
needed. To combat this, the government has enlisted military behavioral health technicians
(BHTs). These BHTs are paraprofessionals supervised by a licensed provider that engage in a
wide range of clinical duties. They receive training in delivering behavioral health services,
cognitive behavioral interventions, and other methods of psychological treatment, however, they
are not licensed under any board.
Behavioral health technicians are highly beneficial to the lives of military soldiers and the
surrounding camp. They become embedded in units where their duty is to reduce stigma (marks
of disgrace) and can even provide more effective treatment to those who are reluctant to go to a
formal counselor. However, the effectiveness of their works are due to the close relationships
with their “clients”. A looming threat to the entire realm of military BHTs is multiple
relationships that cloud their supervision and merge the role between friend, and counselor.
Currently, there is a released model (created by Staal and King) where the potential for
multiple relationships can be mitigated in the BHT world. This model has 4 “factors” that assess
the entirety and severity of the relationship, those being the 1) power differential, 2) duration of
services, 3) termination and future contact, 4) role compatibility, 5) consultation, and 6) informed
consent. While this decision-making model is not an end to all means, it certainly can be when
paired with an increased training and competence amongst the military behavioral health
technicians.
Learned Knowledge
The military life has a degree of complexity to it that breeds mental instability, which
causes a complex duty for behavioral health technicians unbeknownst to most. First, these
technicians are unlicensed yet still required to follow the Code of Ethics from the American
Counseling Association as well as unique laws from whatever branch enlisted in. Typically, there
is no formal graduate level training in ethics or even guidance on how to manage multiple
relationships inside the military culture. Something that needs to be fixed for the integrity of the
client-patient boundary that is listed in the ACA guidelines.
Second, a major component to the relationships developed amongst the client patient
occur on different levels for each power ranking. For example, there is a lesser chance for an
officer to become friends or even listen to an entry level BHT. Compared to an entry level BHT
providing sound counsel to another private who has just become enlisted. Atmospheres in the
military are teeming with opportunities for relationships, whether shallow or deep, and no person
(not even BHTs) are void of their temptation for relations with another in their unit.
It is surprising to see how under prepared each of these military health workers are, and
how there is not much happening to increase awareness for the protection of their professional
boundaries. A deeper understanding of what military culture is like and a checklist to prevent
multiple relationship situations is just a small step on the path of untangling the messy
relationships of military mental health professionals and client.
Agree and Disagree
Many ethical dilemmas arise in the midst of the chaos that is the professional boundaries
of a BHT. A major component of these issues that needs to be addressed is the extent of their
training as well as the code of ethics required to follow. It is impossible to expect someone who
is engaged in the therapeutic field to be competent in ethics without a formal training. Licensure
should be required solely for the benefit of enhanced therapeutic techniques, and the increased
knowledge of ethics that follows as a result. Relationships with a patient is a slippery slope that
can turn out to be detrimental to a person’s psyche if one small component goes wrong. It should
also be required for the government to prohibit many, if not all, relationships from forming while
on duty. While the mental health of the BHT is important while serving, romantic with a fellow
soldier is a path that can become ethically unsound rapidly. For there to be any code of ethics
followed, that means that the client is placed as primary; i.e. the professional boundary is
necessary. This means that at no point should there be a romantic relationship between someone
that the BHT could be providing health care for.
Contrasting to these apparent mistakes, the current ethical guidelines and mentorship
setup, paired with the assessment for risk of merging relationships, the military has a sound
foundation for a healthy mental capacity for its soldiers. With the licensed supervisors there, it
provides an outlet of sorts for the BHTs to go to in search of guidance in their dilemmas. These
supervisors are trained and can answer any of their questions in a timely, ethical manner. It can
become tricky as any and all forms of relationship will occur at any time (friendship, romantic,
or higher rank) and the supervisor has a high sense of competency regarding navigating the
situation. Paired with the checklist for multiple relationship factors, most (if not all) potential
possibilities are accounted for. Power differential and role compatibility can cause a lack of
respect and differentiating relationships. Duration of services and length of contact provide an
adequate view of what their relationship is like. The form of consultation shows how involved
the BHT is in the entire situation. Finally, the informed consent is a clear, legal method of
clearing any sort of breaches that may occur.
Application
Applying the information is detrimental towards the pursuit of ethical therapy. When
looking at the extremist lifestyle of merging relationships in a military culture, any holes in the
therapeutic world outside become apparent. The checklist provided can be an adequate solution
for assessing the severity of breached patient-client boundaries, and can be used to determine
what steps are next. With some modifications in the factors, the form can be just as beneficial as
the military staff that it would benefit.
It is also important to examine the ethical stability of the counselor themselves and
determine whether they would be fit to be a supervisor in the military role. In the many situations
that occur, it is safe to assume that the licensed professionals in the BHT field can answer any
sort of ethical relational question that may come up; something beneficial to those who interact
with clients at all and especially in small town scenarios. Reading up on vignettes of the military
BHT world and how the supervisor interceded could be highly beneficial to the development and
prevention of any multiple relationship dilemmas.
References
Reddy, M. K., Anthony, J. R., Rehmert, K. A., Wheat, A. R., & Hoyt, T. (2023). Military
behavioral health technicians: Multiple relationship dilemmas and recommendations for
supervision. Psychological Services, 20(2), 353–362. https://doi.org/10.1037/ser0000664