Ron beats his wife when he loses his temper and has no intention of stopping. Mark samples every new pill or powder his teen-age friends offer him at parties. Cynthia has decided to end her pregnancy through abortion.
When confronted with such problems, parents might criticize and friends might be encouraging. But how do -- and how should -- clinical psychologists react when faced with a client's behavior that they find morally repugnant?
Local clinical psychologists interviewed said moral issues such as drug use, abortion, sexual deviations, and abuse arise frequently in their practices. Although counselors agreed that in general moralizing detracts from a clinical psychologist's effectiveness, nearly all of the dozen psychologists interviewed said that occasionally they will take a moral stand with a client.
"When you moralize, it's like saying I'm right and you're wrong," said Carolyn Payton, dean of Howard University's counseling service. "It keeps you from operating on a neutral stance.
"But when it comes to spouse or child abuse something inside me is triggered," Payton said. "I cannot tolerate that and would have to let the person know."
"I'm not saying [moralizing] is necessarily helpful" to the client, Payton said, "but it's a recognition of my own limitations. A psychologist or psychiatrist cannot rid himself of his own limitations."
Sylvan Kaplan, a private Chevy Chase clinical psychologist, said he could cope professionally with physical abuse, but would "raise all kinds of social and moral issues" about a young client's drug use.
Payton, on the other hand, said that although she does not condone drug use, she "is more understanding of drugs as part of ghetto life."
Another District psychologist, Mary Ellen Bou, said that when it comes to counseling, she keeps her personal views to herself. "If a client wanted morality they would go to a religious counselor," she said. But she said she would not hesitate to talk a client out of suicide and also would "stress with clients the negative value of drugs or criminal behavior."
"I would give them books and discuss the effects to help them see another side," Bou said. "But I don't see that as moralizing. Some of the teenagers I see are still on drugs but I don't reject them. That would be destructive.
"The term 'moral' implies good and evil," Bou said, "and I wouldn't counsel against drugs because it's sinful, but because it's self-destructive."
Many counselors interviewed said that although they oppose abortion they would never counsel a woman against abortion.
"I would explore what the different options would mean to her," said the Rev. Fletcher Swink, a United Methodist minister who has been a counselor for the last 10 years with the Washington Pastoral Counseling Service. "But I would recognize that she has to reach and live with that decision herself."
Another counselor, Sister Rachel Callahan, represents a faith that vehemently opposes abortion. However, if a client told her she planned to have an abortion, Callahan said she would try to make sure the woman was not pressured into the abortion. "I usually share my own position with a person," said Callahan. "But I wouldn't talk someone into anything. I feel just as strongly that everybody has the right to make his own decisions."
Callahan, who has a private practice and teaches at Loyola College, said she finds herself "much more in conflict with the contemporary value of consumerism."
Being a clergyman as well as a counselor sometimes presents special problems, Swink said.
"Some people come to a pastoral counselor [a counselor who is also a clergyman] expecting and hoping the counselor will take a moral stand," Swink said. These clients sometimes want a counselor to tell them what to do, he said. "In other words to take responsibility for their decisions."
Swink said he's reluctant to make clients' moral choices, "because individuals must decide for themselves what actions they can live with."
Morality and guilt, however, are not taboo to Stanton Samenow, an Alexandria clinical psychologist and coauthor of books on the criminal personality.
After working with patients at St. Elizabeths Hospital for eight years, Samenow has come to the conclusion that on occasions a dose of morality and guilt is the most effective cure for certain kinds of antisocial behavior.
Samenow likes to explain his theory on the value of guilt with the example of a teen-age youth he once counseled in a detention center after the youth's alleged involvement in drug abuse, theft and tampering with an auto. When Samenow left the center after the first session the youth was in tears. Upon his second visit, the center guard told Samenow, "When that boy got here he was feeling pretty good about himself but after you left, he was crying like a baby. How many more times are you going to come?"
"That boy had no business feeling good about himself," said Samenow, who has been appointed to President-elect Reagan's task force on law enforcement. "Guilt and self-disgust was an appropriate emotion in that situation," said Samenow. "It's doubtful he would change until he got good and fed up with his behavior."
Guilt trips are not for everyone. Samenow said. In fact, he is working with patients now who are trying to overcome the emotionally crippling effects of "unwarranted guilt."
Several counselors said they could see how guilt can be productive in some very limited circumstances. But most strongly disagreed with Samenow.
"I would never purposely try to make someone feel guilty," Payton said. "It is not an effective emotion."
"A person usually already has gotten a load of guilt dumped on him," Swink said. "We usually spend more time trying to get people to feel unguilty."
People usually already know what is right and what is wrong, said Swink and Callahan. "That's why they end up here," Swink said.