HHS 320 Cultural Awareness in the Human Services WK5-2

11 Ethical and Legal Issues

The counseling profession is guided by ethical standards established by several professional organizations including the National Board of Certified Counselors (NBCC), the American Counseling Association (ACA), and its many divisions. In addition, related professional associations such as the American Psychological Association (APA), American Association of Marriage and Family Therapists (AAMFT), and the National Association of Social Workers (NASW) also set standards of ethical practice for their members, many of which provide counseling services.

In most instances, ethical standards are guidelines that assist counselors and other professional helpers in making appropriate judgments about their services for clients and relationships with other professionals. As Helms and Cook (1999) indicated, however, sometimes preparation programs and authorities on ethical behavior present standards as absolute rules that professional helpers must follow to the letter. Such a stance creates additional dilemmas for counselors and therapists who work with diverse client populations because consideration of cultural differences is not always apparent within specific ethical standards (Pedersen, 2002). Regarding this predicament, Helms and Cook (1999) concluded, “we realized that these rules were antithetical to the cultural values of some of our clients.... Consequently, it has become necessary for us to become more flexible in our application of certain ‘tried and true’ therapy methods so that we might sustain authentic relationships with our clients” (p. 186).

This chapter presents on overview of ethical issues and laws that have significance in the practice of cross-cultural or multicultural counseling. It will present standards that specifically address helping relationships with diverse clientele as well as standards that create dilemmas for practicing counselors and other helping professionals. Cultural competencies related to ethical practice of counseling are also considered. In addition, the chapter reviews historic legislation that affected the lives of oppressed groups in the United States as well as contemporary legislation that attempts to protect civil rights. We begin with an overview of ethical standards established by NBCC and ACA that relate to counseling with diverse clients.

Ethical Standards

As noted, several different professional associations have established codes of ethical practice for the helping professions. In the following sections, we limit coverage to the ethical codes of the National Board of Certified Counselors (NBCC) and the American Counseling Association (ACA). Readers, however, are encouraged to review other codes that relate more specifically to their professional field of practice. Examples of such codes might come from one or more of the divisions of the ACA, such as the Ethical Code for the International Association of Marriage and Family Counselors (Gladding, 2002), or one of the national associations representing psychologists, social workers, or marriage and family therapists.

National Board of Certified Counselors

The preamble of the Code of Ethics for National Board of Certified Counselors (2003) states that the NBCC “certifies counselors as having met standards for the general and specialty practice of professional counseling” (p. 1). The code is divided into seven sections: (A) General, (B) Counseling Relationship, (C) Counselor Supervision, (D) Measurement and Evaluation, (E) Research and Publication, (F) Consulting, and (G) Private Practice. A review of all the standards under each section found that only a few standards address directly or indirectly counseling practice across cultural groups.

Standard A.5 indirectly relates to services provided for clients who are financially unable to afford them. It states, “In establishing fees for professional counseling services, certified counselors must consider the financial status of clients. In the event that the established fee status is inappropriate for a client, assistance must be provided in finding comparable services at acceptable costs” (NBCC, 2003, p. 2). Because clients from diverse backgrounds and cultures frequently are new immigrants or refugees to this country, they seldom have the financial resources to pay for social services or counseling sessions. Likewise, clients from historically oppressed groups might suffer similar financial burdens. General standard A.5 of the NBCC code attempts to guide professional counselors in navigating this ethical issue. Yet, the standard also raises additional issues if counselors are unable to locate “comparable services at acceptable costs.” If a counselor’s fees are inappropriate for particular clients, and the counselor or other helper is unsuccessful in referring those clients to sources they can afford, the standard provides no further guidance. The question remains, if all attempts at finding appropriate and acceptable services fail, what is the responsibility of the counselor to the client who sought assistance? This challenge would likely be the reality in rural communities that struggle to provide adequate services to citizens and other residents.

Standard A.12 more directly addresses ethical issues when working with diverse clients. It states, “Through an awareness of the impact of stereotyping and unwarranted discrimination (e.g., biases based on age, disability, ethnicity, gender, race, religion, or sexual orientation), certified counselors guard the individual rights and personal dignity of the client in the counseling relationship” (NBCC, 2003, p. 2). This standard is a general statement about protecting the rights and self-respect of clients. Implicit in the standard is the responsibility of counselors to monitor their biases and prejudices that might negatively affect the helping relationship. Although the standard does not specifically state so, the intent is that counselors are also obligated to refer clients when their biases or prejudices threaten productive relationships. For example, a professional counselor who has strong moral convictions against homosexuality probably could not begin to offer genuine empathic assistance to a young person struggling with the decision of whether to come out.

Under Measurement and Evaluation, Standard D.10 of the NBCC code advises that counselors must use caution when selecting assessment instruments and understand the limitations when interpreting test results or other measurements. In addition, counselors who use measurement instruments in the practice must “ensure that periodic review and/or retesting are made to prevent client stereotyping” (NBCC, 2003, p. 7). This standard is important when selecting ability tests, achievement batteries, job placement inventories, or other instruments that might unfairly categorize clients due to cultural differences or language barriers. Counselors have the responsibility of ensuring that the measurement instruments and procedures they use with clients are the most appropriate assessments available and that the interpretation of results are accurate considering a variety of cultural contexts.

American Counseling Association

The preamble to the American Counseling Association’s Code of Ethics (1995) includes the statement, “Association members recognize diversity in our society and embrace a cross-cultural approach in support of the worth, dignity, potential, and uniqueness of each individual” (p. 1). The code consists of eight sections, and several sections either directly or indirectly address diversity issues. The eight sections include (A) The Counseling Relationship, (B) Confidentiality, (C) Professional Responsibility, (D) Relationships with Other Professionals, (E) Evaluation, Assessment, and Interpretation, (F) Teaching, Training, and Supervision, (G) Research and Publication, and (H) Resolving Ethical Issues.

Several general and specific standards of the ACA code address counselors’ practice with diverse clients. For example, in Section A.1, Client Welfare, under the subheading Family Involvement, the code encourages counselors to recognize the important role of families in clients’ welfare and to involve families in the counseling process when appropriate to do so. Another example of a general standard is in Section E, Evaluation, Assessment, and Interpretation, under the subheading Client Welfare. It cautions counselors to use assessment techniques, results, and interpretations appropriately and to take steps to prevent their misuse by others.

More direct standards in the ACA code are found in Section A.2, Respecting Diversity. In this section, a statement on nondiscrimination warns against practices that discriminate by “age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status.” This standard is reiterated in Section C.5, Public Responsibility, which, in addition to the identity factors listed in Section A.2, includes direction for counselors not to discriminate in a manner that negatively influences the relationship “for any other reason.” A second standard in this section, titled Respecting Differences, directs counselors to understand various cultures of clients with whom they work, and to learn how the counselors’ cultural background, perceptions, values, and beliefs might influence counseling relationships.

Section C.5 mentioned above also warns against sexual harassment, “defined as sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with professional activities or roles.” Sexual harassment includes intentional behaviors of a sexual nature that are not welcomed, offensive, and create a disinviting work environment, or are intense enough to be considered harassment in the context they are expressed.

According to the ACA code, cultural sensitivity is expected when diagnosing mental disorders. Section E.5 includes statements that counselors should recognize cultural influences, socioeconomic status, and cultural experiences in describing clients’ problems and diagnosing mental disorders.

Section E.8, Diversity in Testing, specifically cautions counselors about using assessment procedures and interpreting clients’ performance when the normative group upon which the instruments were developed and standardized do not include representation of a client’s gender, culture, or ethnic or racial group. This standard again emphasizes the knowledge counselors must have about the effects that status variables related to diversity have on the administration and interpretation of test results.

National Organization for Human Service Education

Chapter 1 introduced the National Organization for Human Service Education (NOHSE, 2004a) and its ethical standards. As do the NBCC and ACA, this national organization includes ethical standards to guide human service professionals in their work with diverse clients. In the section titled, “The Human Service Professional’s Responsibility to the Community and Society,” statements #16 through #21 address issues of diversity. Statement #16, for example, guides professionals to advocate for all members of society, especially people from groups with a history of discrimination. Likewise, Statement #17 warns against discrimination or preference for clients based on all of the status variables covered in this text. Awareness about and respect for all clients are advocated in Statements #18 and #19, and sensitivity to sociopolitical issues is covered by Statement #20. The need for continuing education and preparation to meet the needs of diverse clientele is the focus of Statement #21.

The ethical standards mentioned in the previous paragraphs illustrate some specific and general guidelines for counselors and human service providers to follow. As noted earlier, these standards are guidelines. As the counseling and other helping professions have become more accepting, knowledgeable, and sensitive to cultural diversity among client populations, authorities in the multicultural arena have advocated for the use and interpretation of standards within situational and cultural contexts. Pedersen (2002), for example, observed, “Clients or counselors from different cultural backgrounds might follow the same ethical guidelines in identical situations by displaying different behaviors” (p. 13). Consequently, when following particular ethical codes while working with diverse clientele, professionals might find themselves in an ethical dilemma, feeling forced to choose between the stated standard and what the counselor believes is most appropriate within a cultural context. Such dilemmas highlight practical distinctions that professional counselors and human service providers might make in working across cultural groups.

Ethical Distinctions

Pedersen (2002) warned that the ACA code of ethics and similar professional standards (e.g., NOHSE) include presumptions that if adopted literally would culturally encapsulate counselors or other helping professionals. He pointed to serious discrepancies between the cultural context within which the code was developed and the cultural context within which it is applied by professional counselors. “These discrepancies have resulted in patterns of implicit cultural bias that may require counselors to choose between being ethical or following the codes” (Pedersen, 2002, p. 18) Finally, he asserted that the ACA code includes 16 suppositions that present cross-cultural challenges to counselors, and probably for other professional helpers:

1. An individualistic perspective is favored.

2. Dependency is a negative trait.

3. Freedom of choice is not destructive.

4. Differences are best overlooked.

5. Counselors act in the place of parents.

6. All counselors have cultural self-awareness.

7. All dual relationships are inappropriate.

8. Counselors should withdraw from conflict.

9. A universal money economy exists.

10. Privacy is a universally held value.

11. Universal guidelines for counselor competency exist.

12. Counseling is narrowly defined.

13. Quantitative data are superior to qualitative data.

14. Assessment measures do not always require validation.

15. Teachers do not learn from students.

16. Ethical guidelines are perfect. (Adapted from Pedersen, 2002, pp. 18–19)

Several authorities have questioned the absolute wording of some ACA standards in relation to work with culturally diverse clients (Helms & Cook, 1999; Pedersen, 2002; Sue, Arredondo, & McDavis, 1992). Beginning with the preamble mentioned earlier, the ACA code receives criticism because of its apparent or implicit focus on individualistic philosophy rather than respecting both collective and individualistic points of view. Pedersen (2002) stated that if the ACA code cannot embrace both philosophies, it “at least needs to make its dependence on individualistic values explicit for the benefit of those who do not share the assumption that the individual is more important than the group” (p. 16). Pederson (2002) continued to analyze several standards regarding their interpretation in a cultural context. For example, Section A.1.c of the code links counselors’ effectiveness to their ability to respect a client’s freedom in making life choices. The notion of freedom of choice may not always be compatible with collectivist views, which elevate the role of family, community, or other groups influential in a client’s life. Likewise, Section A.2.a warns counselors to avoid discriminatory behavior, which at first glance seems to be an appropriate ethical standard. However, when counseling, as noted throughout this text, many different identity factors and statuses interact and counselors might want to help their clients discriminate or differentiate among “many potentially salient cultural identities” (Pedersen, 2002, p. 16). Consequently, a standard that for all appearances intends to be culturally appropriate actually may tie the hands of counselors who work with diverse clients and understand the influence of an array of cultural identities.

Confidentiality is an important part of counseling relationships, and one that the ACA code of ethics highlights in Section B, as well as Statement #3 of the Ethical Standards of Human Service Professionals (NOHSE, 2004a). However, as some authorities have noted, the notion of personal privacy is another ideal that may have roots in individualistic values. Robinson (2005) argued that emphasis on confidentiality also promotes a middle-class value, which biases counselors. Furthermore, Pedersen (2002) explained that the ideal of personal privacy is not as highly held in many collectivistic societies as in individualistic ones because it encourages egocentric, self-interested behaviors that may be counterproductive to the goals of society. Counselors and other professional helpers who want to behave in an ethical manner interpret codes of ethical standards with the best interest of clients and communities in mind. Exercise 11.1 invites you to review several other standards of ethical practice from the ACA Code of Ethics and interpret them within a cultural context.

xercise 11.1

Practicing Ethically with All Clients

Instructions: Read each of the standards below and write a critique noting any cultural conflicts or questions raised by the standard. Share your critique in class. A sample of responses is at the end of this chapter.

1. “If it becomes apparent that counselors may be called upon to perform potentially conflicting roles, they clarify, adjust or withdraw from roles appropriately” (ACA Code, 1995, Section A.8).

Critique: _____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

2. “Counselors make every effort to avoid dual relationships with clients that could impair professional judgment or increase the risk of harm to clients” (ACA Code, 1995, Section A.6).

Critique: _____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

3. “Counselors recognize that culture affects the manner in which clients’ problems are defined. Clients’ socioeconomic and cultural experience is considered when diagnosing mental disorders.” (ACA Code, 1995, Section E.5).

Critique: _____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

As noted throughout the previous section, interpretation and use of ethical standards requires thoughtful consideration of how standards might apply within a cultural context. Applying various standards with clients across cultures and within cultures is complex and challenging. This challenge is largely due to the difficulty in establishing written standards that present appropriate boundaries for counselors while allowing them to remain flexible enough in their professional judgment when working with a broad range of clients. In particular, counselors and human service professionals must ask how a standard relates to collectivistic views and values embraced by clients and/or the cultures that influence their development and daily functioning. Being competent to adapt ethical standards appropriately for all clients is imperative for counselors and other professional helpers. In the next section, we examine some multicultural competencies established and published in recent years.

Multicultural Competency

Earlier chapters of this text have alluded to competencies and skills that successful counselors acquire and apply when assisting culturally diverse clients. Chapter 9, for example, covers the skills of the multicultural counselor, discusses appropriate assessment, diagnosis, and treatment decisions, and briefly presents group procedural issues in working with diverse populations. In addition, the “Counseling Inferences” section of each chapter has addressed some competencies in general terms. This section presents more specific information about the development of multicultural competencies.

The Professional Standards Committee of the Association for Multicultural Counseling and Development (AMCD) is credited with developing basic competencies and standards of practice for multicultural counseling (Sue, Arredondo, & McDavis, 1992). This landmark document delineated essential cultural competencies across three major categories: counselor awareness, knowledge, and skills. A few years later, Arredondo, Toporek, Brown, Jones, Locke, Sanchez, and Stadler (1996) provided further explanation about how counselors apply these competencies in practice. Specifically, they illustrated how awareness, knowledge, and skills manifest themselves in attitudes, beliefs, understanding, and interventions chosen by counselors. The following sections briefly summarize the three basic categories with a few explanations and apply them across the helping professions. Readers are encouraged to review the original references for detailed explanation and understanding of these competencies.

Competency I: Counselor’s Awareness of Own Cultural Values and Biases

Attitudes and Beliefs.

Competent counselors and human service professionals believe that self-awareness, particularly about their own culture’s influences, and sensitivity to their cultural heritage are essential. They realize the impact culture has had on their self-development, in both positive and negative ways, and are able to identify particular cultural groups, values, and beliefs that have had the most significant influence in developing their self-view and overall worldview. Furthermore, they are aware of how they translate these perceptions into common thoughts, personal feelings, and daily behavior. Exercise 11.2 asks you to explore some attitudes and beliefs that might affect your performance as a culturally effective counselor or human service professional.

Successful professional counselors and helpers are also aware of the multitude of ways that cultural background and experience might influence thought processes, decision making, and problem-solving behaviors. Identity factors such as race, religion, sexual orientation, and others are understood as significant contributors to self-development and psychological/cognitive processes for both counselors and their clients.

Exercise 11.2

My Cultural Awareness

Instructions: Complete the sentences about your racial, cultural, ethnic, sexual, and other identities. After completing each sentence, contemplate how these views and beliefs might affect your functioning as an effective helper. What might you do to increase or heighten your cultural awareness?

1. About my racial identity, I believe ________________________________________________

2. About other races, and in particular ________________, I believe _______________________

3. About my sex, I believe _________________________________________________________

4. In general, I believe members of the opposite sex _____________________________________

5. The most important person in my life has been (or is) _________________________________

6. The most important group to which I belong is _______________________________________

7. I believe that sexual orientation ___________________________________________________

8. People who have a different sexual orientation than I do _______________________________

9. What I know about my own culture ________________________________________________

10. About religion, I believe _________________________________________________________

11. My awareness of diverse religions _________________________________________________

12. People who follow no religion ____________________________________________________

13. My ethnic awareness ____________________________________________________________

14. Awareness of my family background and roots _______________________________________

15. The most influential aspects in my development have been _____________________________

Additional attitudes and beliefs associated with this first competency relate to counselors’ understanding of their professional limitations when working across cultures. Such limitations may be related to lack of knowledge, undeveloped skills, or unwavering beliefs and values that hinder the establishment of effective counseling relationships. In addition, these attitudes and beliefs might limit a helper’s effectiveness due to discomfort regarding certain differences in identity factors that exist in the relationship between the counselor and client. As examples, counselors and other therapists sometimes have difficulty with racial issues presented by clients, struggle with differences regarding religious beliefs, or are unable to overcome prejudices about particular groups that hold different views or lifestyles, such as homosexuals.

Knowledge.

Culturally competent professional helpers attain knowledge about their cultural heritage, including racial and ethnic identity, and understand how this background influences their definitions of and beliefs about normality and abnormality in counseling relationships. In addition, their knowledge includes an understanding of how racism, sexism, classism, and other forms of oppression, discrimination, and stereotypic behavior influence the effectiveness of professionals, particularly their functioning with diverse clients. Furthermore, successful counselors and therapists know how a particular racial, cultural, ethnic, or other social identity grants them certain unearned privileges. By being White, tall, male, heterosexual, physically attractive, able-bodied, or affluent, some people may receive privileges that society denies to other persons or groups that do not share these characteristics.

Self-knowledge includes an understanding by counselors and other professionals of how clients might perceive and interpret their behaviors and functions in the helping process. Knowing that certain verbal and nonverbal behaviors may be inappropriate or why selected assessment or intervention strategies might prove counterproductive with particular clients is indicative of a culturally sensitive and knowledgeable professional.

Skills.

Counselors and other professionals who are culturally aware continuously seek educational opportunities and learning experiences to expand their knowledge and capability. In addition, they willingly consult with colleagues and other professionals as appropriate to verify their understanding of particular cases and counseling practices when working with challenging situations. Similarly, they know when to refer cases to ensure that all clients receive the best possible care, and they remain informed about appropriate, culturally sensitive referral sources in their community.

Another skill related to becoming a culturally aware and sensitive helper relates to a continuous search for understanding oneself as a racial/cultural being who actively works to establish a nonracist identity and, furthermore, seeks to create a nonracist society. This skill parallels the characteristics of advocacy and social justice explored in Chapter 9 of this text. Counselors and human service professionals who use their skills to establish a nonracist identity while seeking to create nonracist societies move beyond typical counseling relationships to more proactive interventions in the larger community.

Competency II: Counselor’s Awareness of Clients’ Worldviews

Attitudes and Beliefs.

Effective helpers understand how their beliefs, including biases and prejudices, will enable or prevent them from becoming aware of how clients view themselves and the world around them. Specifically, culturally competent counselors and therapists understand how their reactions toward clients and stereotypic views might inhibit their ability to establish effective helping relationships. Genuine awareness of their biases and stereotypic thinking enables competent professionals to refer clients to more appropriate sources for assistance. As counselors and other helpers are able to move toward less judgmental positions regarding specific races, cultures, or groups, they expand the clientele they are able to serve effectively.