Ethics in Counseling

Powerpoint Study Guide on Corey and Corey First Chapters

Ethical Decision Making: Key Terms

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Values Morality Law Community Standards Mandatory Ethics Virtue Ethics Professionalism


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Ethics Ethical Conduct Ethics Aspirational Ethics Principle Ethics Standards of Practice

Issues and Ethics - Chapter 1 (1)

Definitions: Key Terms

Law

Ethics

defines the minimum standards society will tolerate and is enforced by government represents the ideal standards set and is enforced by professional associations refer to the highest professional standards of conduct to which counselors can aspire focuses on moral issues with the goal of solving a particular dilemma

Aspirational Ethics

Principle Ethics

Virtue Ethics
Issues and Ethics - Chapter 1 (2)

focuses on character traits of the counselor and nonobligatory ideals

Basic Moral Principles to Guide Decision Making

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Autonomy Beneficence Nonmaleficence Justice Fidelity Veracity

Issues and Ethics - Chapter 1 (3)

Steps in Making Ethical Decisions

The authors’ approach to thinking through ethical dilemmas:
1. Identify the problem or dilemma 2. Identify the potential issues involved 3. Review the relevant ethics codes 4. Know the applicable laws and regulations 5. Obtain consultation 6. Consider possible and probable courses of action 7. Enumerate the consequences of various decisions 8. Decide on what appears to be the best course of Issues and Ethics - Chapter 1 (4) action

Social Constructivism Model of Ethical Decision Making

Redefines ethical decision making process as an interactive one This model involves negotiating when there is disagreement If consensus is not possible, further negotiating and interactive reflection need to occur

Issues and Ethics - Chapter 1 (5)

The Counselor as a Person and as a Professional

Counselors must be aware of the influence of their own personality and needs Personal needs of counselors based on unresolved personal conflicts:

a need to tell people what to do  a desire to take away all pain from clients  a need to have all the answers and to be perfect  a need to be recognized and appreciated  a tendency to assume too much responsibility for the changes of clients Issues and Ethics - Chapter 2 (1)  a fear of doing harm, however inadvertently

Transference

Transference is the process whereby clients project onto their therapists past feelings or attitudes they had toward significant people in their lives Transference: the “unreal” relationship in therapy

Counselors need to be aware of their personal reactions to a client’s transference  All reactions of clients to a therapist are not to be considered as transference  Ethical issue is dealing appropriately with Issues and Ethics - Chapter 2 (2) transference

Countertransference
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Countertransference is the counselor’s reaction to the client’s transference response Examples:

being overprotective with a client  treating clients in benign ways  rejecting a client  needing constant reinforcement and approval  seeing yourself in your clients  developing sexual or romantic feelings for a client  giving advice compulsively  desiring a social relationship with clients Issues and Ethics - Chapter 2 (3)

Stress in the Counseling Profession

Counseling can be a hazardous profession Some sources of stress for counselors are:

Feeling they are not helping their clients The tendency to accept full responsibility for clients’ progress Feeling a pressure to quickly solve the problems of clients Having extremely high personal goals and perfectionistic strivings

Issues and Ethics - Chapter 2 (4)

Counselor Impairment

Impaired counselors have lost the ability to resolve stressful events and are not able to function professionally Shared characteristics of impaired counselors:
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fragile self-esteem difficulty establishing intimacy in one’s personal life professional isolation a need to rescue clients a need for reassurance about one’s attractiveness substance abuse

Issues and Ethics - Chapter 2 (5)

Maintaining Vitality as a Counselor
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Counselors are often not prepared to maintain their vitality Sustaining the personal self is an ethical obligation Personal vitality is a prerequisite to functioning in a professional role Main challenge is to create a balanced life in these areas:  Spirituality  Self-direction  Work and leisure  Friendship  Love

Issues and Ethics - Chapter 2 (6)

Values and the Helping Relationship

Value conflicts:
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To refer or not to refer Referrals appropriate when moral, religious, or political values are centrally involved in a client’s presenting problems and when:


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therapist’s boundaries of competence have been reached therapist has extreme discomfort with a client’s values therapist is unable to maintain objectivity therapist has grave concerns about imposing his or her values on the client

Issues and Ethics - Chapter 3 (1)

Values

Development of value systems are influenced by:
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Family Peer group Culture Media Religion Education Politics

Issues and Ethics - Chapter 3 (2)

Value Areas

Education/New
Knowledge Money/Possessions Religion/Morals Helping Others

Health—Emotional
and Physical Love/Affection Achievement/Recogni tion Marriage/Family Security

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Friendships
Work/Career

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Issues and Ethics - Chapter 3 (3)

Leisure

Role of Spiritual and Religious Values in Counseling

Spirituality refers to:

general sensitivity to moral, ethical, humanitarian, and existential issues without reference to any particular religious doctrine the way people express their devotion to a deity or an ultimate reality

Religion refers to:

Key issues:

Can the counselor understand the religious beliefs of the client?  Can the counselor work within the framework of Issues and Ethics - Chapter 3 (4) the client?

Policy on End-of-Life Decisions

Various continuing care or treatment options exist, such as:

aggressive treatment of the medical condition(s)
medical intervention intended to alleviate suffering (but not to cure) withdrawing life-sustaining treatment voluntary active euthanasia physician-assisted suicide

life-sustaining treatment

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Issues and Ethics - Chapter 3 (5)

Values Pertaining to Sexuality

Counselors need to know their attitude toward:

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the belief that sex should be reserved for marriage only sex as an expression of love and commitment casual sex group sex extramarital sex premarital sex homosexuality teenage sex

Issues and Ethics - Chapter 3 (6)

Need for Multicultural Emphasis

Key Terms:

Ethnicity  Minority group  Multiculturalism (cross-cultural, transcultural, intercultural, similar meanings)  Multicultural counseling  Diversity-sensitive counseling  Racism  Stereotypes  Culturally encapsulated counselor Issues and Ethics - Chapter 4 (1)

Multicultural Competence

Recognizing our limitations
Manifested in our willingness to:

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seek consultation
seek continuing education make referrals

Issues and Ethics - Chapter 4 (2)

Counselor Attitudes in Working with Culturally Diverse Clients

Issues and Ethics - Chapter 4 (3)

Overt racist  overtly hostile, homophobic, racist, ageist, sexist, judgmental (should stay out of the field) Covert prejudice  tries to hide negative, stereotyped opinions but client picks up cues Culturally ignorant  lack of knowledge based on homogeneous background (need to learn about other cultures before working with them)

Counselor Attitudes in Working with Culturally Diverse Clients

Color blind

denies differences: "I don’t recognize differences; I treat everyone the same." recognize, appreciate, and celebrate cultural differences; strives for freedom from judgments of diverse clients

Culturally liberated

Issues and Ethics - Chapter 4 (4)

Examining Common Assumptions

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Assumptions about self-disclosure About assertiveness About self-actualization and trusting relationships About nonverbal behavior About directness

Issues and Ethics - Chapter 4 (5)

Cultural Issues in Counseling

Counselors will encounter diversity in areas such as:  gender  race  culture  socioeconomic background  physical ability  age  sexual orientation

Issues and Ethics - Chapter 4 (6)

Cultural Issues in Counseling

In dealing with diversity, counselors need to:  acquire academic and experiential multicultural training  develop working therapeutic relationships  be flexible in applying theories  be open to being challenged and tested  be aware of their own value systems, potential stereotyping, and any traces of prejudice

Issues and Ethics - Chapter 4 (7)

Guidelines for Addressing Sexual Orientation

In order to change therapeutic strategies, one must be open to changing assumptions about sexual orientation Counselors need to become conscious of their own faulty assumptions Counselors are challenged to confront their personal fears, myths, and stereotypes regarding sexual orientation

Issues and Ethics - Chapter 4 (8)

Counseling Gays and Lesbians

Exemplary practice includes:

not attempting to change sexual orientation without evidence that client desires change recognizing that gay and lesbian individuals can live happy and fulfilled lives recognizing the importance of educating others about gay and lesbian issues recognizing ways in which social prejudices and discrimination create problems for clients

Issues and Ethics - Chapter 4 (9)

Gay and Lesbian Myths
Gay people can be identified by their mannerisms or physical characteristics  Most gay people could be cured by having a good sexual experience with a member of the opposite sex  The majority of child molesters are gay  Gay people have made a conscious decision to be gay  Gay adults will try to convert youth to their lifestyle  Homosexuality is a psychological disorder that can be cured by appropriate psychotherapy  In gay relationships, one partner usually plays the “husband/butch” role and the other plays the “wife/femme” role  Homosexuality is caused by a defective gene Issues and Ethics - Chapter 4 (10)  Homosexuality is unnatural, since it does not exist in

Asian Americans

I. Family structure patterns:
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traditional gender roles honor parents, listen to words of wisdom that come with age extended family rules—especially within the first few generations

Issues and Ethics - Chapter 4 (11)

Asian Americans

II. Values and attitudes:
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education is the ladder to success persevere, don’t give up self-denial is the secret to success respect traditions and culture of forefathers don’t be ostentatious, forward, brash austerity and renunciation valued duty to family and country spiritual evolution sought

Issues and Ethics - Chapter 4 (12)

Checklist for Informed Consent

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Issues and Ethics - Chapter 5 (1)

Voluntary participation Client involvement Counselor involvement No guarantees Risks associated with counseling Confidentiality and privilege Exceptions to confidentiality and privilege Counseling approach or theory Counseling and financial records Ethical guidelines

Checklist for Informed Consent

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Issues and Ethics - Chapter 5 (2)

Licensing regulations Credentials Fees and charges Insurance reimbursement Responsibility for payment Disputes and complaints Cancellation policy Affiliation membership Supervisory relationship Colleague consultation

Content of Informed Consent

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Issues and Ethics - Chapter 5 (3)

The therapeutic process Background of therapist Costs involved in therapy The length of therapy and termination Consultation with colleagues Interruptions in therapy Clients’ right of access to their files Rights pertaining to diagnostic labeling The nature and purpose of confidentiality Benefits and risks of treatment Alternatives to traditional therapy Tape-recording or videotaping sessions

Ethical Issues in Online Counseling

It is the counselor’s responsibility to examine the ethical, legal, and clinical issues related to online counseling
Providing counseling services online is controversial There are potential legal issues that must be addressed, a few of which include:
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Competence of practitioner in providing online counseling
Informing client of limits and expectations of the relationship Developing a plan for how emergencies can be addressed

Issues and Ethics - Chapter 5 (4)

Some Advantages of Online Counseling

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Issues and Ethics - Chapter 5 (5)

Reaching clients who may not participate in face-to-face therapy Improving client access in rural areas Increasing flexibility in scheduling Facilitating assigning and completing of client homework Augmenting a problem-solving approach Improving an orientation to the counseling process Enhancing the provision of referral services

Some Disadvantages of Online Counseling
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Danger of making an inaccurate diagnosis Compromising of confidentiality and privacy Problems involved in being able to protect suicidal clients Difficulties in attending to clients who are in crisis situations Absence of traditional client-therapist relationship Inability to address a range of more complex psychological problems Inability to deal with interpersonal concerns in the therapy process

Issues and Ethics - Chapter 5 (6)

Reasons for Malpractice Suits

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Failure to obtain or document informed consent Client abandonment Marked departures from established therapeutic practices Practicing beyond the scope of competency Misdiagnosis Crisis intervention Repressed or false memory Unhealthy transference relationships Sexual abuse of client Failure to control a dangerous client Managed care and malpractice

Issues and Ethics - Chapter 5 (7)

Signs of Child Abuse
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Wary of physical contact with adults Apparent fear of parents or going home Inappropriate reaction to injury Lack of reaction to frightening events Apprehensive when other children cry Acting-out behavior to get attention Fearful, withdrawal behavior Short attention span or learning difficulties Regression into earlier stages of development Sudden change in behavior Fearful reaction to questions about injury

Issues and Ethics - Chapter 5 (8)

Key terms

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Confidentiality
Privileged communication Privacy

Issues and Ethics - Chapter 6 (1)

Limits of Confidentiality

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When clerical assistants handle confidential information When counselor consults When counselor is being supervised When client has given consent When client poses danger to self or others When client discloses intention to commit a crime When counselor suspects abuse or neglect of a child or vulnerable adult When a court orders counselor to make records available

Issues and Ethics - Chapter 6 (2)

Duty to Protect Potential Victims

Identify clients who are likely to do physical harm to third parties Protect third parties from clients judged potentially to be dangerous Treat those clients who are dangerous

Issues and Ethics - Chapter 6 (3)

Liability for Civil Damages When Practitioners Neglect Duty by:


Failing to diagnose or predict dangerousness Failing to warn potential victims of violent behavior Failing to commit dangerous individuals Prematurely discharging dangerous clients from a hospital

Issues and Ethics - Chapter 6 (4)

Legal Precedents

Tarasoff Case
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Bradley Case

duty to warn of harm to self or others duty to protect

Jablonski Case Hedlund Case

duty not to negligently release a dangerous client
duty to commit a dangerous individual

Jaffee Case

extends duty to warn to anyone who might be near the intended victim and who might also be in danger
communications between licensed psychotherapists and their clients are privileged and therefore protected from forced disclosure in cases arising under federal law

Issues and Ethics - Chapter 6 (5)

Guidelines for Implementing Duty to Warn Requirements

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Get informed consent Plan ahead through consultation Develop contingency plans Obtain professional liability insurance Involve the client Obtain a detailed history Document in writing Implement procedures to warn

Issues and Ethics - Chapter 6 (6)

Guidelines for Assessing Suicidal Behavior
Take direct verbal warnings seriously  Pay attention to previous suicide attempts  Identify clients suffering from depression  Be alert for feelings of hopelessness and helplessness  Monitor severe anxiety and panic attacks  Determine whether individual has a plan  Identify clients who have a history of severe alcohol or drug abuse  Be alert to client behaviors (e.g. giving prized possessions away, finalizing business affairs, or revising wills)  Determine history of psychiatric treatment Issues and Ethics - Chapter 6 (7)

Ethical Guidelines for Disclosure of a Client’s HIV Status

Issues and Ethics - Chapter 6 (8)

Sufficient factual grounds for high risk of harm to third party Third party is at risk of death or substantial bodily harm Harm to the third party is not likely to be prevented unless counselor makes disclosure Third party cannot reasonably be expected to foresee or comprehend high risk of harm to self

Recommendations in Counseling HIV Clients

All limits to confidentiality should be discussed with the client at the outset of treatment Therapists must be aware of state laws regarding their professional interactions with HIV-positive clients Therapists need to keep current with regard to relevant medical information Therapists need to know which sexual practices are safe

Issues and Ethics - Chapter 6 (9)

Dual and Multiple Relationships

Identify measures aimed at minimizing the risks:


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set healthy boundaries from the outset secure informed consent of clients discuss both potential risks and benefits consult with other professionals to resolve any dilemmas seek supervision when needed document in clinical case notes examine your own motivations refer when necessary

Issues and Ethics - Chapter 7 (1)

Accepting Gifts

Questions to consider in making a decision of whether or not to accept gifts from the client

What is the monetary value of the gift? What are the clinical implications of accepting or rejecting the gift? When in the therapy process is the offering of a gift occurring? What are the therapist’s motivations for accepting or rejecting a client’s gift? What are the cultural implications of offering a gift?

Issues and Ethics - Chapter 7 (2)

Recommendations Concerning Bartering Relationship

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Evaluate whether it puts you at risk of impaired professional judgment Determine the value of goods or services in a collaborative fashion Determine the appropriate length of time for arrangement Document the arrangement Consult with experienced colleagues or supervisors

Issues and Ethics - Chapter 7 (3)

Bartering

Additional guidelines to clarify bartering arrangements
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Minimize unique financial arrangements If bartering is used, it is better to exchange goods rather than services Both therapist and client should have a written agreement for the compensation by bartering

Issues and Ethics - Chapter 7 (4)

Signs of Unhealthy Professional Boundaries

I. Intimacy distortions
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not noticing boundary invasion  over-responsible for client  over-involvement with client  over-identification with client  role confusion/reversal  inappropriate touch  being manipulated by client’s unreasonable demands  responding to inappropriate personal questions Issues and  acting on sexual attraction Ethics - Chapter 7 (5)

II. Inadequate boundaries

falling in love with client parentification of client

Types of Sexual Abuse in Psychotherapy

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Sexual touch as therapy “Learning to love” as therapy Exploring sexual identity Becoming romantically involved Brief loss of control “Bonding” and other types of closeness

Issues and Ethics - Chapter 7 (6)

Suggestions on Dealing with Sexual Attraction to Clients

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Acknowledge the feelings Explore the reasons for attraction Never act on feelings Seek out experienced colleague or supervisor for consultation Seek personal counseling if necessary Monitor boundaries by setting clear limits If unable to resolve feelings, terminate the relationship and refer

Issues and Ethics - Chapter 7 (7)

Continuum of Sexual Contact Between Counselor and Client

Psychological abuse

The client is put in the position of becoming caretaker of counselor’s needs. The counselor intrudes into client’s intimacy boundaries by sexual hugging, professional voyeurism, sexual gazes, overattention to client’s dress and appearance, or seductive behavior Counselor initiates or allows sexual remarks, passionate kissing, fondling, sexual intercourse, oral or anal sex, or sexual penetration with objects

Covert abuse

Overt forms of sexual misconduct

Issues and Ethics - Chapter 7 (8)

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