Ch 3 Ethical Issues in Counselling Practice

• Mandatory: involves a level of ethical functioning at the minimum level of professional practice
• Aspirational ethics: focuses on doing what is in the best interests of clients.
• positive ethics: an approach taken by practitioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble.

• Ethically, we must become aware of our own needs, areas of unfinished business, potential personal problems, and sources of countertransference.
• We need to realise how such factors could interfere with effectively and ethically serving our clients.
• Frequently ask "whose needs are being met in this relationship, my client's or my own?"
• An ethical problem exists when we meet our needs, at the expense of our client's needs.
• If we are aware of our personal problems and are willing to work through them, there is less chance that we will project them onto clients.

Must also examine other, less obviously harmful personal needs that can et in the way of creating growth-producing relationships such as the need for control and power; the inordinate need to be nurturing; need to change other in the direction of our own values; the need for feeling adequate, and the need to be respected and appreciated.

• You will have to apply the ethic codes of your profession to the problems you face.
• Professionals expected to exercise prudent judgement when it comes to interpreting and applying ethical principles to specific situations.
• Can consult with colleagues

• Professional codes of ethics serve a number of purposes:
• They educate counselling practitioners and the general public about the responsibilities of the profession.
• They provide a basis for accountability and protect clients from unethical practices.
• Ethics codes provide a basis for reflecting on and improving your professional practice.
• Best ways to prevent being sued for malpractice is to demonstrate respect for clients, keep client welfare as a central concern, and practice within the framework of professional codes.

• 1. Identify the problem or dilemma. Gather info that will shed light on the nature of the problem.
• this will help you decide whether the problem is mainly ethical, legal, professional, clinical or moral.
• 2. Identify the potential issues: evaluate the rights, responsibilities, and welfare of all those who are involved in the situation.
• 3. Look at the relevant ethics codes for general guidance on the matter. Consider whether your own values and ethics are consistent with or in conflict with the relevant guidelines.
• 4. Consider the applicable laws and regulations and determine how they may have a bearing on an ethical dilemma.
• 5. Seek consultation from more than one source to obtain various perspectives on the dilemma, and document in the client's record the suggestions you received from this consultation.
• 6. Brainstorm various possible courses of action. Include client in process of considering options for action
• 7. Enumerate the consequences of various decisions, and reflect on the implications of each course of action for your client
• 8. decide on what appears to be the best possible course of action. Once implemented, follow up to evaluate the outcomes and to determine whether further action is necessary. Document the reasons for the actions you took as well as your evaluation measures.

• Involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it.
• An ethical and legal requirement that is an integral part of the therapeutic process.
• By providing clients with info they need to make informed choices, promotes the active cooperation, empowering them and building a trusting relationship.

• Some aspects of IC process include the general goals of counselling, responsibilities of client and counsellor, limitations of and exceptions of confidentiality, fees, length of process, risks, benefits.
• Can be provided written form, orally, combination.

An ethical concept, legal duty of most therapists not to disclose information about a client.

• A legal concept that protects clients from having their confidential communications revealed in court without their permission.
• Generally doesn't apply to group counselling, family therapy, child and adolescent therapy, or whenever there are more than two people in the room.
• Basis of trust

• Must consider requirements of the law, the institution in which they work, and the clientele they serve.
• Legal requirement to break in cases involving child abuse, abuse of the elderly, abuse of dependent adults, and danger to self or others. 
• When the therapist believes a client under the age of 16 is the victim of incest, rape, child abuse or some other crime.
• When the therapist determines that the client needs hospitalisation
• When information is made an issue in a court action
• When clients request that their records be released to them or to a third party

• Current theories can be and need to be expanded to include a multicultural perspective. 
• To be relevant to a multicultural society, they must incorporate an interactive person-in-the-environment focus- individuals are best understood by taking into consideration salient cultural and environmental variables.

• Historically relied on western therapeutic models to guide practice and conceptualise problems.
• Some writes assert that theories of counselling and psychotherapy represent worldviews, each with its own values, biases and assumption about human behaviour.

• Both are often viewed as essential for planning treatment
• Rationale for assessment is that specific counselling goals cannot be formulated and appropriate treatment strategies cannot be designed until a client's past and present functioning is understood.
• Assessment is generally ongoing and subject to revision as clinician gathers further data during therapy sessions.

• Assessment: consists of evaluating the relevant factors in a client's life to identify themes for further exploration in the counselling process.
• Diagnosis: sometimes part of the assessment process, consists of identifying a specific mental disorder based on a pattern of symptoms.
• May include an explanation of the causes of the client's difficulties, an account of how these problems developed over time, a specification of preferred treatment procedure, and an estimate of the chances for a successful resolution.
• Diagnosis provides a working hypothesis

Both can be understood as providing direction for the treatment process.

• Danger of diagnostic approach is the possible failure of counsellors to consider ethnic and cultural factors in patterns of behaviour.
• Certain behaviours and personality styles may be labeled neurotic or deviant simply because they are not characteristic of the dominant culture.

• Cognitive behavioural approaches and the medical model place heavy emphasis on the role of assessment as a prelude to the treatment process.
• The rationale is that specific therapy goals cannot be designed until a clear picture emerges of the client's past and present functioning.
• + change, improvement or success may be difficult to evaluate without initial assessment.

• Counsellors with relationship-oriented approaches tend to view the process of assessment and diagnosis as external to the immediacy of the client-counsellor relationship, impeding their understanding of the subjective world of the client. 
• Feminist therapists contend that traditional diagnostic practices are often oppressive and that such practices are based on white, male-centred, western notion of mental health and mental illness.

• Most consider it a continuing process that focuses on understanding the client.
• A clinical, legal, and ethical obligation of therapists to screen clients for life-threatening problems such as organic disorders, schizophrenia, bipolar disorder, and suicidal types of depression.

• The use of specific interventions for specific problems or diagnoses based on empirically supported treatments.
• Central aim is to require psychotherapists to base their practice on techniques that have empirical evidence to support their efficacy.
• Many believe this approach is mechanistic and does not take into full consideration the relational dimensions of the psychotherapy process and individual variability.

• Dual or multiple relationships: occur when counsellors assume two (or more) roles simultaneously or sequentially with a client.
• Many forms of nonprofessional interactions (additional relationships with clients other than sexual ones) pose a challenge.
• Eg. combining teacher and therapist, supervisor and therapist, borrowing money from client, therapy to a friend, employee or relative, social relationship with client, accepting gift.
• Becoming emotionally or sexually involved with a current client is clearly unethical, unprofessional, and illegal. Sexual involvement with a former client is unwise, can be exploitative, and is generally considered unethical.

Although multiple relationships do carry inherent risks, it is a mistake to conclude that these relationships are always unethical and necessarily lead to harm and exploitation.

• Against: potential for misusing power, exploiting the client and impairing objectivity
• They are pervasive, difficult to recognise, unavoidable at times, potentially harmful, can be beneficial.
• multiple relationships are inevitable and unavoidable in some situations and that a global prohibition is not a realistic answer.
• Sexual intimacy is unethical.
• When multiple relationships exploit clients, or have significant potential to harm clients, they are unethical.
• Current focus of ethics codes is to remain alert to possibilities of harm to clients and to develop safeguard to protect clients.

• When determining whether to proceed, need to consider whether the potential benefit to the client of such a relationship outweighs its potential harm.
• Your responsibility to develop safeguards aimed at reducing the potential for negative consequences.

• Set healthy boundaries early in the therapeutic relationship.
• Involve clients in ongoing discussions and in the decision-making process, and document your discussions. Discuss with your client what you expect of them and what they can expect of you.
• Consult with fellow professionals as a way to maintain objectivity and identify unanticipated difficulties.
• When multiple relationships are potentially problematic or when the risk for har is high, wise to work under supervision. Document
• Self monitoring: ask yourself whose needs are being met and examine your motivations for considering becoming involved in a multiple relationship.

• Establishing and maintaining consistent yet flexible boundaries is necessary if you are to effectively counsel clients.
• One important aspect of maintaining appropriate professional boundaries is to recognise boundary crossings and prevent them from becoming boundary violations.
• Boundary crossing: a departure from a commonly accepted practice that could potentially benefit a client.
• Boundary violation: a serious breach that harms the client and is therefore unethical.
• Some boundary crossings pose no ethical problems and may enhance the counselling relationship.
• Other boundary crossings may lead to a pattern of blurred professional roles and become problematic.

• Limit what is shared online.
• Include clear and through social networking policies as part of the informed consent process.
• Regularly update protective settings because social media providers often change privacy rules.

Knowing and following your profession's code of ethics is part of being an ethical practitioner, but these codes do not make decisions for you.