Psychology- Counselling Techniques

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CHAPTER 3

Ethical Issues in Counseling Practice

Adopted from Gery Corey by Jo-Anne D. Petrie, M.Ed.

Spring 2021

Learning Objectives 1. Understand mandatory, aspirational, and positive ethics. 2. Identify characteristics and procedural steps of ethical decision making. 3. Understand the right of informed consent. 4. Articulate the dimensions of confidentiality (privacy, privileged communications, and exceptions). 5. Become familiar with the ethical and legal aspects of using technology. 6. Identify the major exceptions to confidentiality. 7. Understand ethical issues from a multicultural perspective. 8. Recognize when it is necessary to modify techniques with diverse clients. 9. Identify some key ethical issues in assessment and diagnosis. 10. Understand how ethnic and cultural factors can influence assessment and diagnosis. 11. Compare arguments for and against evidence-based practice. 12. Describe ethical issues related to multiple relationships in counseling practice. 13. Understand various perspectives on multiple relationships. 14. Explain the differences between a boundary crossing and a boundary violation. 15. Understand how to manage boundaries and risks associated with using social media. 16. Explain what is involved in becoming an ethical counselor.

Vocabulary Aspirational ethics: A higher level of ethical practice that addresses doing what is in the best interests of clients. Assessment: Evaluating the relevant factors in a client’s life to identify themes for further exploration in the counseling process. Boundary crossing: A departure from a commonly accepted practice that could potentially benefit a client (for example, attending a client’s wedding). Boundary violation: A boundary crossing that takes the practitioner out of the professional role, which generally involves exploitation. It is a serious breach that harms the client and is therefore unethical. Confidentiality: This is an ethical concept, and in most states therapists also have a legal duty not to disclose information about a client. Diagnosis: The analysis and explanation of a client’s problems. It may include an explanation of the causes of the client’s difficulties, an account of how these problems developed over time, a classification of any disorders, a specification of preferred treatment procedure, and an estimate of the chances for a successful resolution.

Dual or multiple relationships: A counselor assumes two (or more) roles simultaneously or sequentially with a client. This may involve assuming more than one professional role or combining professional and nonprofessional roles.

Ethical decisions: To make ethical decisions, consult with colleagues, keep yourself informed about laws affecting your practice, keep up to date in your specialty field, stay abreast of developments in ethical practice, reflect on the impact your values have on your practice, and be willing to engage in honest self-examination.

Evidence-based practice (EBP): Psychotherapists are required to base their practice on techniques that have empirical evidence to support their efficacy. Informed consent: The right of clients to be informed about their therapy and to make autonomous decisions pertaining to it.

Mandatory ethics: The view of ethical practice that deals with the minimum level of professional practice. Nonprofessional interactions: Additional relationships with clients other than sexual ones.

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. Practice-based evidence: Using data generated during treatment to inform the process and outcome of treatment.

Privileged communication: A legal concept that generally bars the disclosure of confidential communications in a legal proceeding. Clients are protected from having their confidential communications revealed in court without their permission

Introduction

Ethical principles and issues will be a basic part of professional practice.

Balancing clients’ needs against your own needs, ways of making good ethical decisions, educating clients about their rights, parameters of confidentiality, etc.

Being an ethical practitioner is far more complex than a set of rules.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Types of Ethics

Mandatory Ethics deals with the minimum level of professional practice.

Aspirational Ethics involves the highest standards of thinking and conduct.

Positive Ethics is an approach taken by practitioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Putting Clients’ Needs Before Your Own

Aware of our own needs, areas of unfinished business, potential personal problems, and especially our sources of countertransference.

Professional relationships with clients exist for benefit.

Examine your personal needs that can create growth-producing relationships.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Decision Making

Ethics codes are a fundamental component of effective counseling:

They are guidelines that outline professional standards of behavior and responsible practice.

Counselors must interpret and apply ethical principles to their decision making.

Codes do not make decisions for counselors.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Decision Making

The principles that underlie our professional codes:

benefit others, do no harm, respect other’s autonomy, and be just, fair and faithful.

The following is the role of ethical codes:

They educate us about responsibilities, are a basis for accountability and improving professional practice, and protect clients.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Decision Making

The following are the steps in making ethical decisions:

Identify the problem, look at the relevant ethics codes and laws, seek consultation, brainstorm various possible courses of action, list consequences, decide, and document the reasons for your actions.

To the degree it is possible, include the client in all phases of your ethical decision-making process.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

The Right of Informed Consent

Providing clients with information they need to make informed choices

Educating clients about their rights and responsibilities

Empowering clients and building a trusting relationship with them

Addressing privacy issues with clients, including the implications of using technology to communicate

Theory and Practice of Counseling and Psychotherapy - Chapter 3

The Right of Informed Consent

Some aspects of informed consent process include the following:

Therapeutic procedures and goals

Responsibilities of clients

Limitations of and exceptions to confidentiality

Legal and ethical parameters

Qualifications and background of the practitioner

Fees involved

Approximate length of the therapeutic process

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Dimensions of Confidentiality

Confidentiality is essential but not absolute.

Privileged communication is a legal concept that protects clients from having their confidential communications.

Confidentiality is developing a trusting and productive client–therapist relationship.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Dimensions of Confidentiality

Ethical Concerns with the Use of Technology

Confidentiality and privacy can become more complicated when technology is involved.

ACA Code of Ethics( American Counseling Association) (2014) contains a new set of standards with regard to the use of technology, computer-mediated communication, and social media as a delivery platform.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Dimensions of Confidentiality

Exceptions to Confidentiality and Privileged Communication

Client poses a danger to self or others.

Clients who are children/minors, dependent adults, or older adults are victims of abuse.

Client needs to be hospitalized.

Information is made an issue in a court action.

Client requests a release of record.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Issues From a Multicultural Perspective

Current theories can be, and need to be, expanded to include a multicultural perspective.

Assumptions made about mental health, optimum human development, and the nature of effective treatment may have little relevance for some clients.

Theories should incorporate an interactive person-in-the-environment focus.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Issues From a Multicultural Perspective

Counselors must be mindful of diversity and social justice issues to practice ethically and effectively.

A counselor or therapist should facilitate social action that leads to change within the client’s community rather than merely increasing the individual’s insight.

An adequate theory of counseling does deal with the social and cultural factors of an individual’s problems.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Issues in the Assessment Process

Assessment is an ongoing process designed to help the counselor evaluate key elements of a client’s psychological functioning.

Influenced by the therapist’s theoretical orientation

Requires cultural sensitivity

Can be helpful in treatment planning

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Issues in the Assessment Process

Diagnosis is the process of identifying a pattern of symptoms that fit the criteria for a specific mental disorder defined in the DSM-5.

Requires cultural sensitivity

Practitioners debate whether a diagnosis is necessary

Can be helpful in treatment planning

If used only for insurance purposes, can lead to ethical dilemmas

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Aspects of Evidence-Based Practice (EBP) Evidence-based research means that the information you use to make decisions about patient care is based on sound research, not opinion. This means you must search several sources (published articles in medical journals or in electronic form) for data, results and conclusions of valid, reputable studies

Treatments have been validated by empirical research

Empirical research is based on observed and measured phenomena and derives knowledge from actual experience rather than from theory or belief.

Treatments are usually brief and standardized-out of pocket copays are not discriminatory

Are preferred by many insurance companies

Enhance the effectiveness of client services and to improve public health

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Ethical Aspects of Evidence-Based Practice (EBP)

Empirically analyze the most effective and efficient treatments

Mechanistic and do not take into full consideration the relational dimensions of the psychotherapy process and individual variability

Existential concerns that do not fit with any diagnostic category because they are heavily based on client responsibility and freedom.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Managing Multiple Relationships in Counseling Practice

Either sexual or nonsexual, occur when counselors assume roles sequentially with a client

Multiple relationship is often used instead of dual relationship because of the complexities involved

Dual or multiple relationships are combining the roles of teacher and therapist or of supervisor and therapist.

Nonprofessional relationships

Nonprofessional interactions or nonsexual multiple relationships pose a challenge to practitioner

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Managing Multiple Relationships in Counseling Practice

ACA Code of Ethics (ACA, 2014) teaches how to manage multiple roles and responsibilities in an ethical way.

Inherent in counseling relationships and training relationships, balancing boundary issues, addressing nonprofessional relationships, etc.

Boundaries in Psychotherapy: Ethical and Clinical Explorations (Zur, 2007) is an excellent resource.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Managing Multiple Relationships in Counseling Practice

For helping professionals who are using social media, a host of ethical concerns about boundaries, dual relationships, confidentiality, and privacy are raised.

Practitioners should maintain the following:

Limit what is shared online.

Include social networking policies as part of informed consent.

Regularly update protective settings, because privacy rules change.

Theory and Practice of Counseling and Psychotherapy - Chapter 3

Becoming an Ethical Counselor

Knowing and following your profession’s code of ethics

Interpreting the ethical guidelines of your professional organization and applying them to particular situations

Seeking consultation from trusted colleagues and supervisors

Ethical decision making is an evolutionary process that requires to be continually open and self-reflective

Theory and Practice of Counseling and Psychotherapy - Chapter 3

. Let’s watch the case of Gwen Informed Consent https://ng.cengage.com/static/nb/ui/evo/index.html?eISBN=9780357435830&id=1032955763&snapshotId=2152968&

Food For Thought:

Why is it essential that counselors follow ethical guidelines? What are these guidelines intended to do? What do you imagine the practice of counseling would be like without the use of ethical guidelines?

What ethical considerations are relevant in a multicultural counseling arena? In what way might our current “Westernized” ethical guidelines facilitate or impede the process of multicultural counseling? How might you as a therapist go about working within existing ethical parameters in a multicultural counseling setting?

What does the informed consent process involve? What information must be presented to clients? Why is this important in counseling?

Next Class

Chapter 1 take home quiz due 2 11 by 11:59pm Journal 2 assigned. What professional and ethical issues do you see as obstacles for you as a therapist and why? Class 2/17 fully remote two guest speakers Spirituality and Self Care