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Moral Reasoning: A Three Part Essay
Gail D. Moskowitz
Virginia Commonwealth University
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I often say that my job as a Clinical Social Worker in the role of psychotherapist is to sit with
my clients in the depth of their pain without harsh judgment or the mongering of shame and
criticism so that they can learn to sit with themselves and hear their problems anew. I am
successful at this in a seamless way. I understand humanity and have long since given up the idea
that there is much new under the sun when it comes to human behavior. Many of my clients act
in ways that society would not approve of. While these individuals are in treatment and often
also in twelve step recovery programs, it is not uncommon for a subset of those who I see to
continue acting impulsively. Much of the behavior that clients display is self-destructive; they
hurt themselves and those with who they are in relationships. Some of my clients’ behaviors are
illegal (such as going to a prostitute) but not on the list of behaviors that I need to report. I have
absolutely no difficulties continuing my work in the midst of this kind of client struggle even
when a client is not making much progress. There have been times that I felt saddened or
conflicted knowing that the spouse of a client was in the dark about awful, destructive, possibly
dangerous acting out behavior. However, even this kind of conflict is surmountable when the
only one in treatment is the acting out partner.
It is when I am treating both partners and I come to know extremely disconcerting behavior
that I have had difficulty with cognitive dissonance. It is precisely this kind of moral dilemma
that I proffer for the purpose of this essay. I shall summarize the case and the moral dilemma it
posed. The names will be changed and the facts altered for the sake of confidentiality. I will then
analyze the conflict by identifying the deeply held moral values by which I live and practice my
profession. The essay will then explicate that even as an individual who is crystal clear about the
moral underpinnings from which I navigate life’s decisions, those values can come into conflict
with one another and with the happenstance of life. By focusing on the value’s conflict
generated from the moral dilemma described I will be able to offer an expanded view of possible
solutions and what the effect or conflict each solution might engender. In order to take an even
more rigorous look at the principles of my choices, the paper will take the reader through another
evaluation of the material using the four framework approach of ethical decision making
articulated by Starret (1991).
The Dilemma
In January of 2011 I began seeing Jacob, who was motivated to seek treatment after his wife,
Dell, discovered that Jacob was having an affair with a friend who was also married. Jacob had
been caught previously by Dell viewing pornography and engaging in other inappropriate
behavior but the affair was her breaking point. Jacob moved out of the family home, broke off all
contact with the affair partner and became active in a twelve step program for Sexual Addiction.
Dell stated that Jacob could come home if he agreed to go to individual and couples’ therapy.
Their couples’ counselor referred Jacob to me. I began working with Jacob on a weekly basis.
The difficulties in his life were deeply rooted. The most significant of which was his having been
pulled into a sex-game by a male babysitter when Jacob was nine years old after which the
babysitter manipulated Jacob into pulling his younger brother in as well.
Jacob worked in therapy with me in an effort to manage the panoply of sexual acting out
behaviors that included men and women and long term and short lived contacts. He also
struggled with internet pornography and anonymous hook-ups. Jacob was in treatment with me
for one year and was getting better every week. He was taking responsibility for his actions and
how they affected his loved ones. He became a more involved father and faithfully attended a 12
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step program when he suddenly dropped out of treatment. One year later Jacob returned. He was
involved in another long term affair. He was back to blaming everyone else for his problems.
After several unproductive months of treatment, his refusal to return to a 12 step program or
to enter an extended stay rehab we discussed the pain of the duality of his day to day life. We
then collectively decided to ask Dell to enter into joint therapy with Jacob so he could use the
time to get honest with her. She readily agreed. We began the first session confirming that the
ultimate goal of the couple’s work was for Jacob to speak honestly to Dell. We agreed she
deserved to know. She assured him she was in it for the long haul if they could reconnect and
find a new way to be in a real relationship. He asked if we could spend some time just getting
comfortable with Dell as a part of his sessions. This also was agreed to.
Jacob and Dell came to see me nine times over a period of four months. Dell believed that
Jacob was clean and sober. She believed that much of what he wanted to reveal was in the past.
They had not at this time seen their couples’ counselor for more than a year. Jacob immediately
began to use the time in our joint sessions to highlight the marital issues between himself and
Dell. Dell was always willing to take her share of the blame for the day to day discord. Jacob
wanted to talk about their lack of passionate love making. Dell was earnest in her attempt to
understand and address their collective issues. Individually Jacob indicated he was not ready to
disclose the acting out in which he was engaged. In joint sessions Jacob would become angry or
he would pull away and shut down every time Dell would attempt to get emotionally vulnerable
with him.
I knew that Jacob was continuing to act out sexually and I began to feel ethically and morally
confused about what to do next! I struggled with the knowledge that Dell was earnestly in
couples’ counseling with Jacob who was not willing to be honest with himself or his wife. He
was doing morally unspeakable things. His behavior was putting his wife at risk physically and
financially. I now also had a therapeutic relationship with Dell as well and I began to feel that I
was in collusion with Jacob while we spent time working on mundane issues of married life. I
knew I could not disclose Jacob’s behavior and I seemed to be unable to encourage Jacob to do
so. I even met with Jacob individually to discuss his reticence at which time he stated he was no
longer sure he wanted to be honest and if he did he was not sure how far he wanted to go. I did
not want to abandon either Jacob or Dell but I sincerely wondered if I needed to end my joint
work with them. I was at a crossroad; what would best serve my clients’ individual needs
without sacrificing my ethical responsibility for confidentiality or sound mental health care?
Analysis of Dilemma
The Values in Conflict
In my line of business confidentiality must head and always head the list of values from
which I practice. It is fundamental to the therapeutic alliance. It almost always sets the stage for
clients to be honest, which is the second most important value on my list. Confidentiality is
needed to establish an environment of safety which in turn will promote honesty and hope for the
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client to sort out problems. Clients, especially those who suffer from addiction are routinely “bad
reporters.” Again, this is not a dilemma for me. I believe deeply that we are all personally
responsible for our lives and the decisions made. I hope that my clients will become more
capable of honesty as they get less afraid of letting go of their current maladaptive modes of
coping.
Yet, when I am working with a couple I am accountable to both clients. Generally when I
begin work with a couple I am upfront with them about secrets and how together we will handle
the information. If I am working individually with a client who has a life of many hidden stories,
even if I see their spouse collaterally during a few sessions, I am not stricken with any
discomfort. The dilemma described was a unique; I allowed the situation to sneak up on me.
This again brings me discomfort with another value I hold dear in my practice, working for
continued competency. This leads me to the most explosive part of the value’s conflict. Honesty
is fundamental to both healing from addictive behavior and making and maintaining emotional
and physical intimacy in a couple’s relationship. I knew Jacob was withholding information and
therefore lying. I could see Dell’s life plan was being based on a house of cards and I had
tremendous empathy for her. I also felt Jacob’s pain and fear about disclosure.
Is it just Values or something Deeper?
Central to solving any problem is clarity about all aspects of the dilemma. So if honesty is an
important value then I had to begin with self-examination. While I have trained myself to
steadfastly accept that other people’s problems are their own, I was beginning to believe that I
had inadvertently conspired with Jacob and I was upset with myself. I also had to admit that I
was disappointed with Jacob; I thought he was ready to do the hard work to make change in his
relationships and his life. Two other values etched in my moral code are sexual and financial
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fidelity. While he had broken off the affair I began to realize that he was now withholding his
acting out behaviors from me as well because he knew I was also in a therapeutic relationship
with Dell. I clearly was not feeling competent. The greatest conflict planted itself to grow in
between my most important moral values. I was legally, ethically and interpersonally bound to
keep Jacob’s behavior confidential and by doing so I was participating in lying to Dell. These
lies kept her from having the information she deserved in order to develop a path for her future.
In order for me to make good choices about helping Jacob and Dell, getting personally honest
was a very important first step and managing my own emotional response was the second.
Looking at All the Options
As previously stated I could not tell Dell the information that Jacob was now withholding.
One possible option would be to state to Jacob and Dell that Jacob’s original thoughts about
disclosing to Dell was causing him much difficulty and perhaps it would be best to end the
couple’s work and if Dell wanted to I could refer her to another therapist. I feared that the effects
of this would be that Dell would feel tossed-out as she had already made a therapeutic alliance
with me. Jacob might also feel negatively about this disruption. He, after all, was taking the
opportunity each week to talk about his frustration with Dell and making it emotionally difficult
for Dell to do much of anything except accommodate. Another consideration was to ask Dell
directly how she felt about Jacob avoiding the work he started out to do. I did not think that
Jacob could handle this. In a subtle way I knew he would feel abandoned by me. I felt
responsible to both of them.
An additional possibility was to continue my work with the couple trying to minimize his
aggression and help her to find her voice. If Dell encouraged more transparency and Jacob was
unwilling to provide it then it was really her responsibility to decide how she wanted to proceed
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in her own life. If he believed that honesty was going to drive her away, even though she stated
many times that it wouldn’t, then perhaps he would begin to see that withholding honesty would
actually be the wedge between them. I wholeheartedly believe in forgiveness but I think it is
difficult to forgive someone who does not acknowledge the wrong doing. I had been his support
for so long and now it appeared that this work would be the undoing of their marriage and if
Jacob perceived my divided loyalties it could very well unbalance his already tenuous mental
health. I felt compassion for both. I could consider asking Jacob to meet with me individually
again. I would help him articulate his current frustration and inability to follow through on his
plan. I would also want to ask him how he intended to proceed. The difficulty in my meeting him
and asking these questions would be that Dell was also my client and it seemed unfair to allow
Jacob to have the driver’s seat. I knew that Jacob would not tolerate my meeting individually
with Dell as well. Since fairness was another of my values solving this dilemma seemed to have
an unending effect on my sense of moral justice. Therefore I knew that if I did not choose to
change the status quo of work I was doing with Jacob and Dell, I would only be prolonging the
problem and perhaps causing harm.
A Choice to Make and to Live By
After carefully weighing the options about how to continue with this couple I knew I had to
be 100% honest with myself. My current work with this couple was no longer helping. My sense
of obligation may have been misplaced as I began to work with Dell and knew what Jacob was
withholding. I had to have a frank talk with myself, and consultation with my ongoing
supervision group. Dell is married to Jacob who is a very broken man and I had to go back to my
deeply held belief that she is responsible for her own life and her own decisions. I also had to
admit to myself that in my hope of providing real and lasting change for this couple I allowed the
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joint sessions to linger way past the point at which it was therapeutic. Jacob’s behavior was
devolving. He continued to put up an angry shield at any mention of his part of their difficulties.
I knew he was regressing and I had made a mistake. My choice is to begin to explain and then
discuss with Jacob and Dell that Jacob did not at this time have the psychological health to
follow through on his proposed idea about disclosing to Dell. Further I will be honest about my
own misjudgment. I will strongly encourage Dell to seek individual treatment and continue
working in her own twelve step support group. I will invite Jacob to come back to work with me
individually. I will allow them both to express their feelings to me and I will manage my own
disappointments through the healthy mechanisms I have established in order to do the work of
therapy.
Moral Rule and Moral Judgment
I am happy with this conclusion while it may not be easy to pick up the pieces. My moral rule
is that I am responsible to model emotional honesty in my relationships with my loved ones and
my clients. My moral judgment is that continuing to collude with Jacob’s lying was destructive.
One Page Attachment
Statement of dilemma: I was at a crossroad; what would best serve my clients’ individual needs
without sacrificing my ethical responsibility for confidentiality or sound mental health care?
A.
1.
2.
3.
4.
List of values discussed in my paper:
Confidentiality
Honesty
Safety
Accountability-clearly if I am accountable to each I feel a deep sense of conflict as he
acted as if he were going to be honest by he is withholding information. This makes him
the most powerful and ultimately destructive person in the room.
5. Acting ethically-The NASW code of ethics and the Virginia Board of Social Work would
consider it a serious breach of ethics for me to reveal confidential information even from
one spouse to another.
6. Responsibility-Yet, I am 100% responsible to both.
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7. Secrets are destructive
8. Protecting the rights of others
9. Empathy
10. Self-respect
11. Work for continued competency
12. Relationships
13. Respect the rights of others
14. Compassion
15. Fairness
16. Sexual and financial fidelity
17. Forgiveness
18. Approval
B. My moral rule: I am responsible to model emotional honesty in my relationships with my
loved ones and my clients.
C. My moral judgment: Continuing to collude with Jacob’s lying was destructive.
Ethical Analysis
Hopefully it can be said that each day in everything we do and in every decision we make,
consciously or not, we proceed from an ethical standard. Probably most actions are undertaken
intuitively as the majority of adults have surely integrated appropriate ways in which to act. It is
also important that individuals in any ongoing professional endeavor pause and reflect and
evaluate whether their actions are effective and made from a moral and ethical framework.
Robert J. Starratt (1991) suggests just such a structure in configuring how leaders in a school
setting can establish standards for ethical decision making. He proposes that we assess our moral
decision making and our actions through the ethics of critique, justice, care and the profession.
Critique refers to the importance of asking all the questions, not just the easy ones; keeping a
keen eye on where power lies and who it impacts. The framework of justice entreats a leader to
know the rights of the institution and the individual and to evaluate whether these rules protect
and serve all constituencies. The ethic of care asks us to understand that each person in a system
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has individual needs to be addressed. The last framework, the profession, is essential in sorting
out the larger picture. It encourages the leader to look within the context of the profession and
institutional expectations, as one must have a professional focus, when evaluating ethical
decision making. These four clear and powerful frameworks can certainly be used in any setting.
In the third section of this assignment, Moral Reasoning Essays, I will use these ethical
frameworks to justify and evaluate the analysis and choices made in solving the moral dilemma
illustrated in essays one and two.
Framework 1- Ethic of Critique
Socrates was correct in helping us to understand that conflict is best solved by daring to ask
all the questions! This should also be true when the conflict is internal. The ethic of critique
demands comprehensive and critical thinking. It suggests that one take a hard look at who has
the power to direct the flow, who benefits from how things are currently going and who chooses
the values from which to work and in turn colors the arena?
Ultimately, I identified honesty as a fundamentally important value to the work of a therapist.
It is synthesized into my moral rule, I am responsible to model emotional honesty in my
relationships with my loved ones and my clients, and my moral judgment, that continuing to
collude with Jacob’s lying was destructive. I believe I was able to do this because I was not
afraid to look critically at every aspect of my work and particularly because problems were
noted. I asked every question in regard to all the solutions so I could identify how any action
would affect every player. I was able to see that Jacob’s anger, obstinacy and fragility gave
ultimate power to the one person who was incapable of empathy. I also saw my collusion was
self-protection, that would be tantamount to abusing my power. I knew that if I were also to stay
true to my other deeply held values of keeping clients safe, being accountable and responsible to
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all with whom I work and maintaining my professional ethics I would have to change course and
bear the brunt of any emotional fallout.
Framework 2-The Ethic of Justice
Even when outcome is correct it is not always pleasant. Once I was clearly able to assess the
problem continuing the status quo became abuse and not merely a mistake. Often we want to
look for a cookbook of direction to make an assessment about how to proceed yet the nuance of
leadership does not come with a list of do’s and don’ts. Johnson (2012) highlights the work of
the 18th century philosopher, Immanuel Kant, who believed that there is only one morally correct
action and it incumbent upon all to follow that directive. Starratt in his (1991) article explains
that Kant taught that we were all individually obligated to act on the ethical imperative. Starratt’s
ethic of justice directs us to think beyond the rules and laws in an effort to ascertain if the written
guidelines are fair and if they protect the few against the many. It is essential to evaluate whether
rules are just and if they take each person into account and not just the institution or the power
holders.
The rules governing my ethical dilemma are dictated by the ethics of my profession. As stated
they include both confidentiality and the responsibility of competent service to all clients. It was
not possible to serve both of these masters from a morally grounded structure. Further, Jacob
knew that he had the rule of confidentiality on his side and he was using it to hold everyone
hostage. Another rule as a therapist is that I must be the one with the objectivity and stay out of
the emotional fracas. I cannot be effective any other way. Yet, all the rules published never
account for human behavior. I needed to regain my objectivity as this directive is paramount. My
empathy for Dell was clouding my recognition of the problem we were being lured into. I do
believe that I have an obligation for morally correct action; I just don’t think that the answers are
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always completely clear. I was able to review the rules and mandates in an effort to make a
decision that took everyone into account. The truth was that no one was being served well and
change was needed.
Framework 3-The Ethic of Care
Johnson (2012) describes care as fundamental to moral decision making. He references Carol
Gilligan, a feminist psychologist and writer, in contrasting this ethic from what she considered
the male dominated view of, “justice as fairness (p. 172).” Gilligan encourages us to remember
that connection to others ought to trump the notion that only one truth exists. Starratt (1991)
wants us to view each human being’s needs as central to moral reasoning. He cautions us that
every relationship cannot be have deep familiarity but each person is worthy of fully being cared
for. This ethic is close to my heart. It is clearly what motivates me to do the work I have chosen.
Caring for this couple and wanting them to have a chance to heal, grow up and keep their family
intact was the original motivation to invite Dell to work with Jacob in session. Caring also
ultimately informed my decision to stop the course of the treatment I was offering to Jacob and
Dell. I believe that both of them deserved a chance to get what they needed. In the short term we
all had to manage our discomfort. I had to admit my short-sightedness and risk Jacob’s wrath and
Dell’s disappointment. Jacob had to admit that he was not able to follow through with his
original goal to disclose his behavior and begin a course of refocusing on his own internal
struggles. Dell was going to be left without a therapist. I trusted that the good news would be that
she needed a better advocate than I could be at the time; I knew I was doing the right thing.
Caring, and recognizing that most dilemmas are not solved, as Kant would have us believe, from
a black and white list of moral rules, moved me to make my choice.
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Frame 4-The Ethic of Profession
I have noted over the years that when some people are asked what their profession is, they
answer with what they “do.” For example they may say, “I teach,” or “I work at the Schwartz
and McDonald Law firm.” Others answer with who they are and say, “I am a first grade teacher
or I am a tax attorney.” When I am asked what I do, I say without hesitation, “I am a clinical
social worker.” I feel tremendous pride in my association with the profession of social work. The
preamble to the code of ethics established by The National Association or Social Workers (2008)
(NASW) is shown below.
The mission of the social work profession is rooted in a set of core values. These core
values, embraced by social workers throughout the profession’s history, are the
foundation of social work’s unique purpose and perspective:






service
social justice
dignity and worth of the person
importance of human relationships
integrity
competence
This constellation of core values reflects what is unique to the social work profession.
Core values, and the principles that flow from them, must be balanced within the context
and complexity of the human experience.
Essentially my own value stance is mirrored in the associations. The above statement not only
captures the individual value beliefs explicated in this essay, it also reminds us that humanity is
infinitely complex and all work must be predicated on taking real human beings in to account.
Social Workers cannot rest only on theory or philosophy alone. Further, NASW calls for
continued competence best sought by ongoing self and case evaluation. I fully believe that my
work in this case satisfied this imperative.
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Concluding Thoughts
Mistakes Made
Perhaps it can be noted that when Jacob agreed to invite his wife to enter into couple’s work I
needed to be reestablish the boundaries I had with Jacob to include the dynamics that would arise
from integrating Dell into our work. From this it could be concluded that somewhere along the
way I lost my objectivity that is surely a part of continued competence; I would not disagree. I
do, however, try to remember that we are ALL human and vulnerable to err, not just my clients. I
know that the only way to fix a mistake is to move from it with a new plan.
One other comment can be made of the moral decision making explicated in this essay and
that is whether I compromised confidentiality by using case material. I had to think deeply about
this. I use case material when I teach and before I do so I get permission from the client. I always
change names, identifying information and content. In doing so I have to do a little creative
writing and this is true in writing up this case as well. I, as always, sought permission from the
clients modeled in this essay. To that end I feel that this exercise is scholarly and only adds to my
continued quest for excellence.
Worth the Effort
Starratt’s (1991) frameworks provide a new template to look at the ethics that inform
everyday work life. Using his writing as a tool encourages professionals to examine their actions
from a new perspective. His philosophical ideas about ethics are beautifully nuanced and
articulated. He asks the practitioner to remember what is ultimately important (in his case
educating children) when entering into the environment of politics, policy, economics and
personality. For me, Starratt’s outlook offers an opportunity to look at circumstances with a fresh
pair of eyes; surely for all of us this enhances objectively.
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References
Johnson, Craig (2012). Meeting the Ethical Challenges of Leadership: Casting Light or Shadow.
4th ed.Los Angelos: Sage Publications, 2012. Print.
Starratt, R.J.(1991).Building an ethical school: A theory for practice in educational. Educational
Administration Quarterly, 27, 185-202
The National Association of Social Workers. Code of Ethics, 2014. Web. 7 March 2014.