by Kelly and Michele O’Donnell
How boards provide member care is as significant as the service.
Member care is a basic, though often underemphasized, aspect of mission strategy. It ranks in importance with prefieid preparation, language acquisition, and church planting strategies. Member care services, such as in-service training, re-entry orientation, and pastoral counseling, promote staff health for greater effectiveness.
It makes sense for mission agencies to provide such services.
Member care, however, is also an ethical necessity. The biblical command to care for the flock with which we have been entrusted (John 21:16, Acts 20:28,1 Peter 5:2) applies to mission agencies as well as to churches. This biblical theme reflects the heart of member care: to faithfully pursue the growth and well-being of our missionaries.
THE RELEVANCE OF ETHICS
The way we do this is as significant as the services themselves. Each mission agency should periodically examine the appropriateness, or ethical quality of its services. By "ethical" we mean in accordance with recognized standards, for example the ethical guidelines for counseling developed by the American Association of Pastoral Counselors.
Most mission agencies do not have well-defined, formal standards. Despite their good intentions, mission agencies can still encounter some perplexing ethical issues, and resolving them may not be easy.
Consider, for example, the missionary who informally counsels a couple and then prays with his wife about some of the couple’s struggles. Is this an ethical way to handle confidential information?
Or, take the experienced consultant who makes recommendations to a mission agency based in another culture, even though he is not familiar with that culture. Is he acting competently?
Finally, think about the mission agency that shortens a family’s field preparation so that the husband can take over a crucial and vacant overseas position. To what extent is the organization being responsible and ethical?
Many other ethical issues get stirred up in mission settings. We believe it is important for mission agencies to anticipate and discuss such issues. We also believe it is important to carefully develop clear, written guidelines about how member care services will be provided. Mission staff need to be aware of and understand these guidelines.
THE CASE OF JEAN-LE-FIDELE
One useful way to explore the relevance of ethics in member care is to use a case study approach. The following fictitious case includes at least 25 unethical, or potentially unethical, practices. Read through this study and try to identify as many of them as possible.
The remainder of the article discusses this case in light of five ethical principles-organizational responsibility, confidentiality, counselor/consultant competence, the use of testing, and personal values/legal standards. These principles can be used as a helpful reference point for mission agencies to explore their own set of ethical and member care issues.
The Fidele family: Jean and Anne (parents); and Angela and Jerome (children).
Jean is a 28-year-old member of a European mission agency. He works nine- to 10-hour days and is almost always available to help out. He doesn’t say No to those over him, sometimes at the expense of his own needs. He often uses part of his vacation for ministry abroad.
Jean was raised in France and went to a university in England for two years, where he met his wife, Anne. He married at age 24 and has two healthy children, Angela, three, and Jerome, six months. They live in Vienna and minister in Eastern Europe.
During the last three months Jean, who is usually very friendly, has become increasingly irritable with his colleagues and somewhat withdrawn within his family. His supervisor noticed these changes and talked to Jean’s wife Anne about what he viewed as "pride and independence" in Jean. She confided that they both feel apathetic and that she has little energy to take care of her home and work responsibilities. The supervisor shares some Scripture with her. He then encourages her to talk with Jean about taking some time off to "get back into work shape" and also to talk to someone about his problems. She follows his advice.
Jean was too busy to take time off, but he did agree to contact the director of training, Ms. Bartell, for counseling. She is an American woman who has taken some counseling courses at a Christian university and is recognized within the mission for her ability to listen and offer appropriate advice. She also counsels Christians from some of the local churches to supplement her income.
Ms. Bartell works on a fund-raising committee with Jean. Jean approaches her after a meeting and schedules a time with her to talk and pray about his problems. She also begins to pray regularly for Jean with the pastoral care committee.
Ms. Bartell obtained Jean’s files from the temporary secretary in the Personnel Department to better acquaint herself with his background. Jean had taken a personality test as part of the screening to be accepted on staff. He scored high on the "depression" scale, so she wondered if he had tendencies towards a serious emotional disorder.
Ms. Bartell also decided to speak to Jean’s wife and supervisor. The supervisor recommended that Ms. Bartell borrow a "temperament analysis" test and administer it to Jean. She administered the test and then spoke with the supervisor, recommending that Jean be placed in a department where he would have less paperwork and more people contact.
Jean and Ms. Bartell met for four counseling sessions. They spent most of their time talking about the challenges of raising his two children, his past relationship with his father, and his fear of talking openly about his work frustrations with his leaders. Ms. Bartell listened for what might be the "root" of his problems, and subsequently advised him to work fewer hours, spend more time with his family, and be more assertive with his colleagues.
After the fourth session, Ms. Bartell told Jean that she felt led to send him to a mission leader who had come to Vienna to give two weeks of seminars. She felt this person could encourage him and possibly give him more insights into his current situation. Jean gave her a small honorarium for her services, and a few days later approached the mission leader.
1. Perhaps the central ethical issue in this case is that the mission seemed to have no set policy, or protocol, to which the supervisor or Jean could refer. Rather, it appeared to take a reactive hit-or-miss approach, with little prevention emphasis.
2. The organization also had a responsibility to the Fidele family during the selection process. Did it adequately assess Jean’s emotional stability, family well-being, work style, and motivation? Psychological assessment can be an important preventive measure and a stimulus for personal growth.
3. The supervisor avoided his responsibility to confront and talk with Jean directly. Instead, he spoke to Jean’s wife and then referred him out. The supervisor, though, wisely avoided taking on the dual roles of supervisor and counselor, as this would probably confuse their relationship. Supervisors should be aware of the needs of staff and link them with the appropriate resources.
4. Jean’s department did not seem to have met during the last three months (and possibly longer) for regular feedback times to discuss personal and work needs. Problems just build up to the crisis point before they receive attention.
5. When and how is the mission tracking Jean’s progress in counseling and providing supportive follow-up?
Basic principle: mission agencies should acknowledge responsibility for the quality of care they provide staff.
1. This case is filled with questionable confidentiality practices. First, the supervisor talked to Jean’s wife, Anne, without his prior permission. Jean should have been consulted first about his "problems" and the supervisor should only have spoken with outside parties, including Anne, with his consent.
2. The temporary secretary had access to Jean’s files. This may or may not be appropriate, depending on the agency’s policies.
3. Ms. Bartell had access to Jean’s files without his knowledge. If counseling records are kept, it is important for him to know how they will be stored and who will own them. For instance, will they be kept in the Personnel Department files, or kept separately in Ms. Bartell’s counseling files?
4. Ms. Bartell talked with Jean’s supervisor and wife without his permission.
5. Ms. Bartell prayed with the pastoral care team about Jean. The problem here is that both the fact of counseling and the content of counseling are generally considered confidential, unless policy states otherwise. It would have been well for Ms. Bartell to have Jean’s permission to share in this team context and then to share only material relevant for prayer, while avoiding details about the case.
6. Ms. Bartell probably never discussed the legal or organizational limits of confidentiality before she rendered service. Some of these limits might include: (a) being a danger to self (suicidal), or a danger to others; (b) suspected child abuse and neglect; (c) serious moral failure in the areas of sexuality or money; and (d) serious problems that significantly affect one’s job, such as severe marital discord or chronic depression.
Basic principle: mission organization and member care workers should have clear policies based on the legal and organizational limits of confidentiality.
1. A fundamental issue in this case involves identifying where the actual problem lies. Does the real problem reside in Jean’s internal struggles, his marriage, the way his department functions, and/or the organization’s marginal member care services? So, who really has the problem after all? Furthermore, who in this organization can accurately assess and work with the problems that may exist at various levels?
2. Ms. Bartell listened and gave good advice. This is often necessary, but usually not sufficient for more serious problems. She means well, but needs to consider her limitations. Consequently, she appeared to have little direction to her intervention and no treatment plan. Ms. Bartell’s counseling strengths are probably in giving support and encouragement
3. Competence in one setting does not imply competence in another. For instance, when counseling people from a different culture, it is important to understand the limits of one’s own competence. Was Ms. Bartell familiar with French culture, or issues of cross-cultural marriages? She recommended that Jean be more "assertive" at work. Did she know how to assess or develop this skill in Jean in a culturally appropriate manner? Consultation with an experienced colleague is necessary when working outside of one’s member care expertise.
4. There is another "dual relationship" issue here. Was Ms. Bartell’s competence (objectivity and judgment) as a counselor impaired by her serving on a fund-raising committee with Jean? Personal relationships and friendships are not necessarily incompatible with counseling, but must be clarified.
Basic principle: member care workers should be dedicated to high standards of competence in the interest of the individuals and mission agencies they serve.
USE OF TESTING
1. There are many misuses of testing in this case. To begin, Ms. Bartell referred to the personality test results from the initial screening done six years ago. Are the results applicable?
2. In addition, did the personality test have norms for French or Europeans? In other words, with whom was Jean compared on the test?
3. What did the depression scale on this test actually measure and what did a high score mean? Only one test was given in the screening. Hence, Ms. Bartell’s tentative interpretation of the depression scale was accurate, although her attempt at interpretation was inappropriate.
4. Tests need to be administered, scored, and interpreted by a trained professional. Ms. Bartell’s background did not qualify her to use tests. The supervisor’s recommendation to borrow and use a temperament analysis test was also inappropriate.
5. Was the temperament analysis test valid with cross-cultural populations, given Jean’s French background? How relevant would the information be in Jean’s situation even if there were French norms?
6. Tests can help guide decisions about candidacy, promotion, and transfers. Jean, though, should have been apprised of what Ms. Bartell recommended to his supervisor and the basis for her recommendation. He should also have received feedback on the results of his temperament analysis test by a qualified person.
Basic principle: only qualified individuals should administer and interpret psychological, educational, and vocational tests.
PERSONAL VALUES AND LEGAL STANDARDS
1. There may be a "quick fix" value operating within the agency. Evidence for this is the suggestion that Jean take some time off, in trying to get at his root problem in our sessions, and in his being referred to a visiting leader. Mission agencies that rely primarily on quick approaches to change and healing (prayer, repentance, short-term counseling), may be doing their staff a disservice in cases where more intensive and lengthy care is needed.
2. Anne’s "apathy and home responsibility struggles" raise a red flag that needed to be explored by the supervisor. These symptoms may indicate depression or another serious problem. If she has a serious problem, what are the legal obligations to report suicidal potential or possible neglect of her children?
3. The supervisor seemed to value Jean’s job performance more than his adjustment and health. Perhaps Jean, too. Was this a reflection of the organizational culture? Both work effectiveness and individual well-being need to be emphasized and balanced.
4. Can Ms. Bartell legally receive payment (an "honorarium") from Jean for her services? Was the idea of payment even agreed upon in advance? In addition can she hold herself out as a counselor, or provide counseling within Austria to nationals and charge a fee?
Basic principle: member care workers and mission leaders should be aware of the values and standards set by the organization and the society in which they work. They are sensitive about how these values, as well as their own, might effect the agency and its staff. Legal regulations regarding the provision of mental health services should be understood and followed.
Providing ethical member care means applying our principles to specific cases. But many gray areas make the application far from simple. For example, what should be the balance between Jean’s responsibility for his well-being and the organization’s? Should Ms. Bartell provide services that challenge her to go beyond her competence in response to crises or the lack of more qualified professionals? How should Jean (and other missionaries) balance their pursuit of personal fulfillment and growth with the call to sacrifice and suffering?
These are some of the ambiguous ethical questions faced by mission agencies. Dealing with such concerns is best accomplished through careful reflection, through regular consultation with mission leadership and colleagues, and through reference to written policies and ethical guidelines for member care developed by the mission agency.
Additional information on member care and ethics can be found in the article "Some Suggested Ethical Guidelines for the Delivery of Mental Healthy Services in Mission Settings." It is included in Helping Missionaries Grow: Readings in Mental Health and Missions, published by William Carey Library (1988).
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