CRIS 302 Kanel, Chapter 2: Ethical and Professional Issues
Ethics assure the public that counselors operate with the best interest of their
clients by mindfully trying to do no harm (Hippocrates and his “oath”).
Nonmaleficence- The ethical guideline that focuses on doing no harm to clients
based on the Hippocratic oath
Even before Hippocratic oath, standards of practice and the idea of accountability
were seen in the ancient Egyptian code of Hammurabi ( ~ 2000 BC).
oContained description of physician responsibilities and the consequences
and punishments to the physician if the patient’s health did not improve
Strong ethical practice is important for crisis intervention because clients in
crisis are in a vulnerable state of disequilibrium and instability.
At onset, clients will often feel hopeless and scared and may view a counselor
who reaches out with empathy with seemingly all the answers as a hero or savior
oEthics help clients see them and their abilities realistically
Ethics – from Greek word (character), and Latin word ethos mores (customs)
Guide behaviors that are deemed good for society and each individual
Social work profession adopted a code of ethics (many revisions have been made
since by the National Association of Social Work (formed in 1960)).
Law is not the same as ethics, though the two sometimes overlap.
Law: “Standards, principles, processes, and ruled adopted, administered, and
enforced by governmental authority that regulate behaviors” (Saltzman and
Furman, 1999).
oSome laws regulate mental health practice by requiring certain education,
experience, and examination completion to receive government standing
as a professional
oOthers impose mandatory reporting practices such as child abuse
reporting
Health Insurance Portability and Accountability (HIPAA) (1996): who can use,
look at, and receive individuals’ health information, including mental health
providers.
oDHS created penalties for violations of this rule in 2009
Controversies:
Community Mental Health Act was originally intended to serve individuals
suffering from chronically mental illnesses, but soon mental health workers
began seeing healthier, less dysfunctional patients suffering from
emotional disorders (typically treated in private Psychologists’ office
previously)
oResulted in less care for chronically mental ill
Lanterman-Petris-Short Act in 1968 established more specific requirements
for the provision of mental health services in the community.
oset up the conditions of involuntary detention by peace officers or an
individual designated by the act
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oIf an individual was determined to be gravely disabled or a danger to
himself or herself or to others, that person could be taken into custody for
72 hours if this was a result of a mental disorder.
oSome see this act as vague and may lead to unfair consequences to the
poor and minorities
Moore (2000) found that at least one-third of Blacks receiving
psychiatric care in various CA facilities were given twice the dosage
of antipsychotic drugs compared to other races
His studies suggest that African Americans are
misdiagnosed and overrepresented as schizophrenic by
many mental health providers
Lenell suggests that the concept of preventive detention may raise
constitutional questions.
oIf it is to be allowed, the client being detained must be assessed by
psychiatrists as being at risk of causing serious harm.
oCertain research studies that indicate that psychiatrists consistently error
in their prediction of violence, and often individuals who are involuntarily
detained may have lost their Fourteenth Amendment right to due process
(2010)
oJackson v. Indiana: “at the least, due process requires that the nature and
duration of commitment bear some reasonable relation to the purpose for
which the individual is committed” (p. 751).
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oO’Connor v. Donaldson: States may not confine a non-dangerous
individual who is capable of surviving safely by himself or herself or with
help of others.
“Gravely disabled” does not apply if a person with a mental illness
can properly survive even if others believe his or her clothing and
food habits are not adequate.
oHumphrey v. Cady: Supreme Court decided that evidence of an
individual’s harm to others must be high and the probability of danger
must exist before confinement.
Use of Paraprofessionals:
Another controversy has to do with the use of nonprofessionals in the provision
of crisis intervention.
oSome mental health professionals may think that crisis intervention should
only be provided by counselors with at least a master’s degree or a
license.
Crisis intervention began with the use of community workers, sometimes referred
to as nonprofessionals or paraprofessionals.
ooften functioned in multidisciplinary team settings such as county agencies
and grassroots nonprofit organizations.
The use of paraprofessional crisis workers has continued to be especially
important as the world has moved into the twenty-first century.
oEconomic recession of the early 1990s plus a decided shift in
governmental policies during the beginning of the twenty-first century, and
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more recently the increasing governmental debt and the Wall Street
collapse that began soon after the wars in Iraq and Afghanistan, has led to
cutbacks in government spending on human services programs.
This has led to less or no money to pay mental health workers,
which leads to volunteers and paraprofessionals making the most
economical choice
“When immediate low-cost help is needed, using paraprofessionals makes the
community stronger by ensuring that its population is functioning and coping with
stress” (Kanel, 2018).
Ethical Issues:
Many ethical standards include issues related to boundary violations, improper
and incompetent practice and record keeping, lack of honesty, breach of
confidentiality, financial fraud, and failure to report inappropriate violations by
others.
Kitchener’s Five Guiding Moral Principles for Ethical Decision-Making (1984):
1. Autonomy—freedom of choice for the client;
2. Non-malfeasance—do no harm;
3. Beneficence—contributing to the welfare of the client and
attempting to benefit the client;
4. Justice—providing equal treatment for all clients; and
5. Fidelity—honoring commitments and guarding trust.
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Self-Awareness and Self-Monitoring:
Therapeutic self-awareness: being conscious of one’s own emotions,
values, opinions, and behavior.
oIf workers learn to deal with the most common and pressing
issues surrounding death, for example, they have a better
chance of helping a client deal with bereavement.
oalso helps counselors monitor reactions to situations that might
trigger inappropriate reactions and lead to unethical behaviors.
oWithout ongoing self-reflection and awareness, counselors can
be prone to countertransference
Countertransference: A situation in a counseling relationship that arises
from unresolved feelings experienced by a counselor in a session with a
client. These feelings come out of the counselor’s personal life and
cause him or her to act out these feelings with a client, behavior that
may cause emotional harm to the client.
o“unconsciously determined attitudinal set held by the therapist
which interferes with his work” (Singer, 1970).
ocan be worked through effectively with personal therapy, lab
sessions, and active self-exploration.
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oIf students have not worked through the crisis completely,
their feelings may interfere with their ability to remain calm,
objective, and client focused.
Dual Relationships
Dual relationship: A relationship that a counselor engages in with the
client outside the professional one—for example, a social, sexual, or
business relationship.
When counselors are providing crisis intervention to a client, they are
prohibited from being involved with that client on a personal level of any
kind.
oSexual, social, employment, or financial
Necessary because a person in crisis is often in a vulnerable state and
could be taken advantage of quite easily by a counselor (who is viewed
as an expert).
oTo avoid a dual relationship is because of the possible emotional
damage clients may sustain if they experience the counselor in a
different role and then are disillusioned or disappointed.
The most potent advice on the subject is this: Do not make friends
or lovers of your clients. It is unethical and, in some cases, illegal.
Confidentiality
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Confidentiality: An ethical standard providing the client with the right for
all disclosures in counseling to be kept private.
oConfidentiality is an explicit promise by the counselor to reveal
nothing unless the client has agreed to it.
Privileged Communication: The legal counterpart of confidentiality.
Clients may waive the right to privilege if they wish the counselor to
share certain information in court or other limited venues.
In study where clients were asked about the most important aspect of a
therapeutic relationship, feeling safe and secure and the chance to talk
to the therapist in a safe environment without fear of repercussion were
the two most critical aspects (Cullari, 2001).
Instances when confidentiality must be broken: child abuse or elder
abuse, when clients , and it may be broken are a danger to others
when clients are a danger to themselves or are gravely disabled.
oJustice Mathew O. Tobriner of the California Supreme Court,
after the court heard Tarasoff v. Regents of the University of
California created the “duty to warn mandate”
o“Privileged communication ends where public peril begins”
(Buckner & Firestone, 2000).
Elder Abuse Reporting Act:
Elder Abuse: Physical abuse, fiduciary abuse, neglect, or abandonment
of someone 65 years old or older. In many states, anyone working with
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clients over 65 years of age must report suspected cases of elder abuse
to the state’s adult protective services agency. This reporting is often
mandatory and grounds for breaching confidentiality.
Child Abuse Reporting Act:
This act provided federal funding to states in support of prevention,
assessment, investigation, prosecution, and treatment activities.
Was most recently amended and reauthorized in 2003 by the Keeping
Children and Families Safe Act (P.L. 108-36) (U.S. Department of
Health and Human Services, 2010).
Child Abuse Reporting: Reporting required of anyone working with
children as a counselor, doctor, or teacher, or in any other capacity
since the passage of the 1974 Child Abuse Prevention and Treatment
Act by Congress. These people must report any suspicions of child
abuse to the child protective services agency in their state. The
requirement is mandatory and, in many states, overrides the client’s
right to confidentiality.
In many states, child abuse must be reported within 36 hours of its
discovery to the department of social services or the police.
oSuspicion alone is enough evidence
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oIf abuse is suspected that is later proved, and it is not reported,
the person who is required to report may be fined by the state.
oOn the other hand, more and more states are ensuring immunity
from suit for false reports.
o The state of CA requires a therapist to notify the police and the
intended victim when possible if the therapist has reasonable
belief that a client is dangerous toward others (duty to warn)
(California State Case Law, 2010).
Informed consent: Permission for treatment given by a client to a
therapist after the client has been thoroughly informed about all aspects
of the treatment. Anyone entering a counseling relationship has the right
to understand the nature of therapy, give his or her consent for it,
understand that it is voluntary, and be told the limits of confidentiality.
oThree legal elements to informed consent:
1. clinicians must make sure clients have the ability to make rational
decisions and, if not, must ensure that a parent or guardian takes
responsibility for giving consent.
2. Therapists must give clients information in a clear way and check
their understanding of the risks and benefits of treatment and
alternate procedures available.
3. Clients must consent freely to treatment.
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Exceptions to these elements occur when clients are dangerous to
themselves and others or are gravely disabled.
oElectroconvulsive shock treatments and psychosurgery
(lobotomies) cannot be done without consent; however, there are
times when medication is given without client consent.
Competence:
Evidence-based practice: model to ensure clients receive the most
competent and effective service possible; considers the current state of
knowledge regarding a variety of clinical needs.
Competence is increased and monitored is the requiring of counselors
to receive appropriate supervision and training.
Unless paraprofessionals are supervised by a licensed professional,
most agencies—county, state, and nonprofit—do not let them provide
crisis intervention and counseling.
Knowing one’s limitations is essential for ethical practice.
obeing able to make an assessment for organic illnesses and
severe mental illness is especially important.
Even though making technical diagnoses is not usually
considered appropriate for paraprofessionals, knowledge
of the Diagnostic and Statistical Manual of Mental
Disorders, (American Psychiatric Association, 5th edition
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2013), is helpful in ensuring that clients receive services
from the type of professional appropriate to their needs.
Client’s Rights:
In addition to rights for privacy, a client also has the right to give consent
for treatment unless he or she is considered incompetent to refuse.
Clients must also be given information about the service so he or she
may weigh the benefits and risks of treatment.
oFee structure, the counselors’ qualifications, and termination
rights.
Virtual/e-Therapy:
May be done via email, the Internet, teleconferencing, or
videoconferencing.
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Some support this practice saying it allows people to be served who
otherwise could not, due to their living location or due to fears of stigma,
or conditions such as agoraphobia.
oAlso have some concerns such as risks to security and
confidentiality, lack of legal recourse for malpractice, and
inappropriate counseling due to lack of observation of facial
expressions.
Multicultural Competence:
Crisis workers are encouraged to be open and knowledgeable toward
subgroups that may differ from mainstream culture.
omust not personal values on clients, but instead be impose
aware of how the client’s values may be a part of the problems
that exist.
One cannot help but sometimes one’s values to expose
others, but it is considered unethical to assume that
everyone should believe and act the way counselors think
they should.
Began in the 1960s when the civil rights and affirmative action
movements emerged, and became a part of formal education in the late
1980s and 1990s.
o“Multicultural counseling refers to preparation and practices that
integrate multicultural and culture-specific awareness,
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knowledge, and skills into counseling interactions” (Arredondo
and Colleagues, 1996. P. 43)
Suggest multicultural refers to five major cultural groups in
the United States: African Americans, Asian Americans,
Caucasians, Latinos, and Native Americans.
Cultural sensitivity is an ethical mandate, and it helps to strengthen
clinical practice.
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