Thoughtful Thursday: Words Can Hurt and Ethical Considerations

Have you ever been sitting in a meeting when someone makes an off-hand comment that is directed at you that just pierces your heart and then takes over your brain for the rest of the day?

Ugh. This happens to me quite often, and it happened yesterday. An entire day of good stuff just destroyed by a snarky little comment offered in a public forum with no prior warning to me. The person who made the comment had and has no idea of the devastation that I felt when the comment was made, and I know that my reaction is above the average type of response to such a comment, but that comment increased my anxiety tenfold. I ended up just crawling into bed when I got home, feeling like a complete and total failure (emotional brain takeover - I know that I am not that failure! My rational brain knows better, but emotions tend to take over!). I had my anxiety symptoms, and I worked through them a bit, but they are back this morning.

Lately, I've been avoiding specific social media feeds because of words that are hurtful.

I made a mistake of reading a post on one of the feeds that really hurt me - the poster stated that not paying interns is an ethical violation, and that hurt. Now, this comment was not directed at me in any way, and I'm not sure that any of my interns would have felt that I used them to do things that were not part of an educational experience (I never asked them to do my errands or cover classrooms or do my duties to the school - in fact, I've protected them when others have tried to insist that they do those things!), but the thought that not paying interns is an ethical violation troubles me to my core.

Now, my program is run within the legal expectations of the Department of Labor of the United States. The internship experience is that of education, not free labor. My interns are under my direct supervision at all times. I do not ask them to do anything that is not part of their development as a music therapist. They have a syllabus, a calendar of assignments, time to engage in scholarly work, and the expectation of completing the tasks that I have to complete in my role as music therapist. They are at the facility to learn. Their presence at the facility does not financially benefit the facility (or me) at all. I do not use my interns to expand on the sessions that I can offer - they cover my caseload, they do not have their own caseloads in addition to mine. My clients do not pay for music therapy services - we are funded through educational categorical aid from the government. My facility does not get paid because there are music therapy interns. I avoid any sort of hint of a dual relationship with my interns, and I provide direct supervision of all music therapy encounters.

So, legally, I am doing what I need to do to ensure that my interns are not being used in ways that would be illegal. Ethically, there are no provisions in the AMTA Code of Ethics about paying interns other than (possibly, and only if you are getting paid for sessions that interns are running) 4.8 - Ensure that billing and business practices are accurate and reflect the nature and extent of the services provided. Interns are mentioned in principles 5.4 and 5.5, but those principles do not mention anything about payment or how internships are run.

I know that there are internship programs out there in the world that do not vigorously follow the Department of Labor indications or the ethics of our own profession. I can state that my internship is run the way it is because I am (probably) over aware of these boundaries. Not everyone is as stringent in drawing lines over what interns can and cannot do within a training program. My years on the AMTA Association Internship Approval Committee demonstrated to me that there are folks out there who do not focus on educating interns at all, but many of those folks are never brought to disciplinary action because interns do not follow the noncompliance procedures that have to be done in order to get to that evaluation and action.

I take myself into the Ethical Decision Making Model from the Markkula Center for Applied Ethics included in our AMTA Code of Ethics. I'm not going to get through this entire process this morning - I'm already a bit late with my morning routine - but here are the first two questions for consideration.

"Could this decision or situation be damaging to someone or to some group?"

Offering an internship without payment can certainly be financially damaging to music therapy interns. Following the legal requirements of this particular situation helps to ensure that interns are not being used in ways that do not correlate to their educational outcomes, so there are some considerations of damage to financial health, but there are also many opportunities to strengthen that health prior to the selection of an internship. Do personal decisions of the group that could be damaged make what is presented by another party (in this case, an internship director) unethical? 

This is where I start to get bogged down.

Ugh. Ethics is such a murky topic, but is also so very important. 

"Is this issue about more than what is legal or what is most efficient? If so, how?"

Oh dear. This issue is certainly more than what is legal and what is most efficient. There are views that include attitudes that "What I offer to clients is valuable" and "You are here to learn and are not able to do this job yet." Often, when these discussion occur, the client is not referenced at all. The argument often centers on the feeling of the intern rather than looking at the quality of music therapy service that is offered to the client. If interns are truly in an internship to learn, then there is an expectation that clients may not receive quality services during the tenure of the intern. Think about the first time you ever led a music therapy session. Did you know what you were doing based on the knowledge and experience that you have now? Of course not. Did your clients pay for their services? Do you feel that they were best served by your (and my) naive fumblings through music therapy interaction? For me, interns are NOT efficient. They take lots of time, lots of my energy, and lots of my financial benefits. I do not get any sort of recompense for being an internship director, and I pay for all of their projects, materials, instruments, and perks. I also work more hours than I get paid to work so that I can justify their schedule in an attempt to get them out of my internship as soon as I can rather than to offer the internship over nine months.

Would I pay my interns if I could?? Of course I would! I would love to endow an internship stipend for all the internship programs out there that are in my place - a not-for-profit organization offering an intensive music therapy clinical training program for clients who are typically underserved or difficult to serve. If I ever win the lottery, I know how I am spending my funds. Watch for the Landaker Music Therapy Internship Stipend Scholarship!

I only got through the very beginning of thinking about this situation and this process - there are eight more questions that I may be able to move to AFTER I finish my thoughts about the first two questions (because I am NOWHERE near finished with those first two questions - this is why ethics can consume us all!). I will never come to a definitive conclusion that will work for every single position and situation in the music therapy world, but I do think that I can come to a place where my anxiety won't take over anytime someone breathes the words, "unpaid internship," in my vicinity.

We will see. 

Comments, questions, and challenges to these thoughts are welcome!