Description:
For your discussion:
Read the Case of Candy in Chapter 3 of your textbook:Examine the responses and determine which would be your top two courses of action and why? What moral principles does your decision illustrate?
Introduction to
Professional Ethics
Chapter One
Codes of Ethics
Ethics codes are usually broad and
general
◼ Codes often lack clarity and precision
◼ Some issues cannot be handled only by
relying on ethics codes
◼
Ethical Limitations
All ethical codes are not uniform
◼ Your personal values may conflict with an
ethical code standard
◼ Codes may conflict with institutional rules
◼
Ethical Limitations
Codes may not align with state laws
◼ Ethical codes must be adapted to specific
cultures
◼
Using Codes of Ethics
The primary purpose of a a code of
ethics is to safeguard the welfare of
clients
◼ Ethics codes do not remove all need
for judgment and ethical reasoning
◼
Objective of Ethical Codes
Educate
◼ Provide accountability
◼ Improving practice
◼
Ethical Codes and the Law
Ethics: the standards that govern
the conduct of its professional
members
◼ Law: the body of rules that govern
the affairs of people within a
community, state, or country
◼
Ethics Codes and the Law
Laws and ethics codes are usually
put into place based on what has
occurred
◼ Common places for conflicts
between ethics codes and the law
include: advertising, confidentiality,
counseling minors, and clients’
rights of access to their own files
◼
Example of Legal & Ethical Conflict:
HIV and “The Duty to Warn”
ACA standard to report
◼ CA’s state statute against reporting
◼
Evolution of Ethics Codes
Codes are revised periodically
◼ Some professional organizations
also provide casebooks which
interpret and explain various ethical
standards found in the code
◼
◼
These casebooks can never replace the
informed judgment and goodwill of the
individual counselor
Emerging Issues
Cultural considerations and the role
of diversity
◼ Influence of technology
◼ Impaired professional
◼
The Stages of an Ethical Complaint
to Professional Organizations
Investigation and deliberation
◼ Disposition
◼
◼
◼
dismissal
sanctions
Types of Sanctions
Reprimand
◼ Probation or suspension
◼ Recommendation of expulsion or
remedial action
◼
Key Terms in Ethical
Decision Making
◼
◼
◼
Values: beliefs and attitudes that
provide direction to everyday living
Ethics: beliefs we hold about what
constitutes right conduct
Morality: concerned with perspectives
of right and proper conduct and involves
an evaluation of actions on the basis of
some broader cultural context or religious
standard
Key Terms
Community Standards: vary on
an interdisciplinary, theoretical, and
geographical basis (generally less
rigorous than ethical standard)
◼ Reasonableness: the care that is
ordinarily exercised by others
practicing within that specialty in the
professional community
◼
Key Terms
◼
Professionalism: behaving in a
professional manner with clients,
other professionals in the field, and
whoever else one comes into contact
with
◼
It is possible to act unprofessionally
and still not act unethically (such as not
returning a client’s phone calls
promptly, provided it is not a crisis)
Levels of Ethical Practice
Mandatory Ethics: counselors act
in compliance with minimal
standards
◼ Aspirational Ethics: the highest
standards of thinking and conduct
professional counselors seek
◼
Core Virtues in Making
Ethical Decisions
Prudence
◼ Integrity
◼ Respectfulness
◼ Benevolence
◼
Five Characteristics of
VIRTUOUS professionals
◼
◼
◼
◼
◼
Do what is right because it is right
Rely on vision and discernment
Have compassion and sensitivity
Self-aware
Understand the importance of community
in moral decision making, policy setting,
and character development
Moral Principles to
Guide Decision Making
Autonomy
◼ Nonmaleficence
◼ Beneficence
◼ Justice
◼ Fidelity
◼ Veracity
◼
Autonomy
◼
Autonomy: the promotion of selfdetermination, or the freedom of
clients to choose their own direction
Nonmaleficence & Beneficence
◼
◼
Nonmaleficence: avoiding doing harm,
which includes refraining from actions
that risk hurting clients
Beneficence: promoting good for others
Justice, Fidelity, and Veracity
Justice: to be fair by giving equally
to others
◼ Fidelity: means that professionals
make promises and keep these
promises
◼ Veracity: truthfulness
◼
Steps in Making
Ethical Decisions
Recognize a problem
◼ Define the problem
◼ Develop solutions
◼ Choose a solution
◼ Review the process and rechoose
◼ Implement and evaluate
◼ Continue reflection
◼
Ethical Decision
Making Process
◼
Identify the problem or dilemma
◼
Consultation with your client begins
here and continues throughout the
process
Identify the potential issues involved
◼ Review the relevant ethics codes
◼ Know the applicable laws and
regulations
◼
Ethical Decision
Making Process
Obtain consultation
◼ Consider possible and probable
courses of action
◼ Enumerate the consequences of
various decisions
◼ Decide on what appears to be the
best course of action
◼
Deciding on the Best
Course of Action
◼
Evaluate your course of action by asking
these questions:
• How does my action fit with my
profession’s code of ethics?
• To what degree does the action taken
consider the cultural values and
experiences of the client?
• How have my own values been affirmed or
challenged?
• How might others evaluate my action?
• What did I learn from dealing with this
ethical dilemma?
Suspected Unethical
Behavior of Colleagues
◼
Most professional organizations
place the responsibility for
confronting recognized violations on
members of their profession
(National Organization of Human
Services Ethics Code – Standard
#21)
Values and the
Helping Relationship
Chapter Three
Introduction
Counselors’ values influence every
phase of the therapeutic process
◼ Neither possible nor desirable for
counselors to be completely neutral
◼
Clarifying your Values
and Their Role in Your Work
Even though you may not agree you
must respect clients values
◼ Counseling is not synonymous with
preaching, persuasion, or instruction
◼ Personal reactions and values do not
have to be hidden from clients
◼
The Ethics of Imposing
Your Values on Clients
Value Imposition: directly
attempting to influence a client to
adopt certain values, attitudes, beliefs,
and behaviors (e.g.
countertransference)
◼ The message of values are sent many
ways
(National Organization of Human
Services Ethics Code – Standard
#7)
◼
View Video
◼
MindTap: Respecting Your Clients’
Values and Identifying Angela’s
Values.
Value Conflicts:
To Refer or Not to Refer
You will inevitably have value
conflicts with your clients
◼ Before making a referral, examine
yourself
◼ If a referral is decided upon, HOW it
is done is crucial
◼
Value Conflicts
Pertaining to Abortion
◼
Legally, mental health practitioners
are expected to exercise “reasonable
care” with clients exploring abortion
Value Conflicts
Pertaining to Abortion
◼
Counselors can be charged with
negligence if they (a) do not act
with skill and withhold relevant
information or provide inaccurate
information; (b) do not refer a
client; or (c) make an inadequate
referral
Ethical Decisions
and Abortion
Examine your own moral and ethical
views on abortion
◼ Determine when your own personal
ethics would become an issue
◼ Be prepared to refer clients to other
professionals when it is appropriate
◼
Counseling Minors Who Are
Considering an Abortion
Parental consent varies from state
to state
◼ If working in a school, check the
School Board’s policy PRIOR to
discussing this topic with a student
◼
Shared Life Experiences
and Values
You CAN help clients with problems
that you have not experienced
◼ When you and the client connect at
a certain level differences can be
overcome
Referral CAVEATS
We should question the ethics of
resorting to a referral in all cases
where we experience discomfort
◼ We need to work on being more
open to diverse viewpoints
◼
Spiritual & Religious
Values in Counseling
◼
◼
Growing awareness and willingness to
explore spiritual and religious matters
within the context of counseling
Since the 1970s, spirituality and religion
have become more prominent in the
counseling literature
Spiritual & Religious
Values in Counseling
◼
◼
◼
◼
Religion entails a set of codified beliefs
that connect us to a God or gods and that
influence our daily life
Spirituality can entail embracing a religion
It is not our role as a helper to prescribe
a particular pathway toward fulfilling
spiritual needs
It is the client’s place to determine what
specific values to retain
Spiritual & Religious
Values in Counseling
The spiritual domain may offer
clients in crisis solace when all else
fails
◼ Become knowledgeable about
members of the religious community
that we can refer when appropriate
◼
Cautions about Spirituality
Be aware of the potential for
countertransference
◼ Guard against making decisions for
clients
◼ Strive to not impose our values on
the client
◼
End-of-Life Decisions
◼
Decisions have become increasingly
controversial since the Death with
Dignity Act became law in Oregon in
1997 which allows physician assisted
deaths for those terminally ill and
will die in 6 months
End-of-Life Decisions
◼
Role as a counselor is to assist clients in
making the best decision in the context
of:
•their own values
•applicable laws
•ethical guidelines
Suicide: A Free
and Rational Choice?
You need to be willing to discuss
end-of-life decisions when clients
bring such concerns to you
◼ If you are closed to doing this, you
may interrupt dialogue, cut off your
clients’ exploration of their feelings,
or try to provide clients with your
own solutions based on your values
and beliefs
◼
Helping Clients with
End-of-Life Choices
You should explore a client’s
decision to refuse treatment to
make sure it is not based on
misinformation or misunderstanding
◼ Realize that clients who are near
death often need help coping with
their psychological pain as well as
their physical suffering
◼
Policy Statement on
End-of-Life Decisions
◼
◼
◼
◼
The American Psychiatric Association and
the American Medical Association have
opposed physician-assisted suicide
The National Association of Social
Workers developed a statement based on
the principle of client self-determination
The American Counseling Association
addresses end-of-life care in its revised
Code of Ethics (2005)
Few other professional organizations have
addressed this issue
A Counselor’s
Responsibilities
If your values do not allow for a
hastened death for a client, you
should not be obligated to provide
professional services
◼ You can refer this client out
◼
A Counselor’s
Responsibilities
There are legal prohibitions
regarding assisted suicide in every
state except for Oregon
◼ You may not have to deal with
assisted suicide, but you still may be
involved in end-of-life decisions
◼
Multicultural
Perspectives and
Diversity Issues
Chapter Four
The Need for a
Multicultural Emphasis
Helping professionals can not ignore
issues involving serving culturally
diverse populations
◼ All counseling can be thought of as
multicultural if culture is broadly
defined to include not only race,
ethnicity, and nationality, but also
gender, age, social class, sexual
orientation, and disability
◼
Multicultural Terminology
Ethnicity: a sense of identity that
stems from common ancestry,
history, nationality, religion, and race
◼ Ethnic Minority Group: a group of
people who have been singled out for
differential and unequal treatment
and who regard themselves as
objects of collective discrimination
◼
Multicultural Terminology
Multiculturalism: a generic term
that indicates any relationship
between and within two or more
diverse groups
◼ Cultural diversity: the spectrum
of differences that exists among
groups of people with definable and
unique cultural backgrounds
◼
Multicultural Terminology
◼
◼
Multicultural counseling:
helping role and process that uses
approaches and defines goals consistent
with the life experiences and cultural
values of clients
Diversity-sensitive counseling:
concept that includes age, culture,
disability, education level, ethnicity,
gender, language, physique, race, religion,
residential location, sexual orientation,
socioeconomic situation, and trauma
Multicultural Terminology
Cultural empathy: awareness of
clients’ worldviews, which are
acknowledged in relation to
therapists’ awareness of their own
personal biases
◼ Stereotypes: oversimplified and
uncritical generalizations about
individuals who are identified as
belonging to a specific group
◼
Multicultural Terminology
◼
Racism: any pattern of behavior
that, solely because of race or
culture, denies access to
opportunities or privileges to
members of one racial or cultural
group while perpetuating access to
opportunities and privileges to
members of another racial or
cultural group
Multicultural Terminology
Unintentional racism: racism that
is subtle, indirect, and outside our
conscious awareness
◼ Cultural racism: the belief that
one group’s history, way of life,
religion, values, and traditions are
superior to others
◼
View Video
◼
MindTap: Cultural Identity and
Emotion.
The Problem of
Cultural Tunnel Vision
Many ONLY know their own culture
◼ Possess cultural tunnel vision – a
perception of reality based on a very
limited set of cultural experiences
◼
Characteristics of Those
“Culturally Encapsulated”
Defines reality according to one set
of cultural assumptions
◼ Fails to evaluate other viewpoints
and makes little attempt to
accommodate others’ behavior
◼
Learning to Address
“Cultural Pluralism”
Cultural pluralism: a perspective
that recognizes the complexity of
cultures and values the diversity of
beliefs and values
◼ Self-exploration makes learning
about the race, cultures, and
experiences of clients a manageable
process
◼
(National Organization of Human
Services Ethics Code – Standard #34)
Challenges of Reaching
Diverse Client Populations
Providers should identify resources in
the client’s family and the larger
community and use them in
delivering culturally sensitive services
◼ Due to psychology being based on
Western assumptions, the influence
and impact of racial and cultural
socialization has not always been
considered
◼
Challenges of Reaching
Diverse Client Populations
◼
Culturally encapsulated helpers
often incorrectly assume that a lack
of assertiveness is a sign of
dysfunctional behavior
Ethics Codes from a
Diversity Perspective
Should try to uncover and respect
cultural and experiential differences
◼ Should become aware of counselor’s
own attitudes and biases that can
interfere with cultural competence
◼ Counselors, social workers, etc. are
prohibited from discriminating
(National Organization of Human
Services Ethics Code – Standard
#10, 11, 14, 16)
◼
Challenging Professionals’
Stereotypical Beliefs
◼
◼
Practitioners who counsel ethnic and racial
minority clients without an awareness of
their own stereotypical beliefs can easily
cause harm to their clients
Failure to change does not necessarily
mean a lack of motivation, but could be
due to limited choices due to their
environment
Assumptions about
Self-Disclosure based
on Western Values
Helpers often assume that selfdisclosure is essential for the
therapeutic process to work
◼ It is not acceptable to share
personal problems in some cultures
because this will make the family
look bad
◼
Assumptions about
Self-Disclosure
In many cultures a dance,
circumlocutions, and certain rituals
may precede intimate disclosures
◼ If your techniques are not working
with a client, you must learn other
ways of connecting with this client
◼
Assumptions about
Assertiveness
Many helpers assume that it is
better to be assertive than to be
nonassertive
◼ Asian Americans are often viewed as
nonassertive and passive, but this
assumption has not been supported
by research
◼
Assumptions:Self-Actualization
& Trusting Relationships
◼
◼
◼
Many assume that it is important for the
client to become a fully functioning
person
Mainstream Americans readily talk about
their personal lives
Many Asian Americans, Hispanics, and
Native Americans have been brought up
not to speak until spoken to, especially
with the elderly or with authority figures
Assumptions about
Nonverbal Behavior
Direct eye contact, physical gestures,
and probing personal questions may
be seen as offensively intrusive by
clients from another culture
◼ Silence may be a sign of respect and
politeness in some cultures
◼
Assumptions about
Directness and Respect
Western approaches tend to stress
directness
◼ Some cultures prefer to deal with
problems indirectly
◼ Deference is often a sign of respect
in cultures outside America
◼
Addressing Sexual
Orientation
In 1973, the American Psychiatric
Association stopped labeling
homosexuality as a form of mental
illness
◼ In 1975, the mental health system
finally began to treat the problems
of gay and lesbian people rather
than treating them as a problem
◼
Addressing Sexual
Orientation
◼
Mental health professionals who
have negative reactions to
homosexuality are likely to impose
their own values and attitudes, or at
least to convey strong disapproval
Court Case about Refusal
to Counsel Gay Clients
◼
◼
◼
Employee fired for her refusal to “counsel
anyone on any subject that went against
her religion”
She was offered several other job
opportunities within the agency and she
turned them down
The courts eventually found that the
company made reasonable attempts to
accommodate her religious beliefs and she
was properly dismissed
The “Bruff” Case
In a counseling relationship, it is
NOT the client’s place to adjust to
the therapist’s values
◼ Counseling is NOT about the
counselor, but about the client’s
needs and values
◼
The “Bruff” Case
◼
The question is whether the
employee should have had a position
in a public counseling agency given
her inexperience and ineffectiveness
working with diverse client
populations
View Video
◼
MindTap: Diversity/Multicultural:
Transgender.
Matching Client and Counselor
Clients belong to multiple groups
that influence their perceptions,
belief, attitudes, and behavior
◼ Counselors become too analytical
about what they say and do when
they are overly self-conscious about
their ability to work with diverse
client populations
◼
Matching Client and Counselor
The more differences between the
client and the therapist, the stronger
the need to collaboratively find
meaning and understanding
◼ Most clients will not initiate this type
of conversation, so it is up to the
counselor to directly address
◼
Matching Client and Counselor
You can be your own best teacher
by paying attention to the voices
within you and within your clients
◼ Unintentional racists can be more
dangerous than those who are more
open with their prejudices
◼
How to increase the likelihood
of FAILING as a counselor!!
Be afraid to face the differences
between you and your clients
◼ Perceive these differences are
problematic
◼ Be uncomfortable working out these
differences
◼
How to Learn to Work with
Clients that Differ from Us!!
◼
◼
◼
Be trained in multicultural perspectives,
both academic and experiential
Be open to being challenged and tested
Be aware of your own value systems, of
potential stereotyping and any traces of
prejudice, and of your cultural
countertransference
Characteristics of the
Culturally Skilled Counselor
Checks his/her attitudes and beliefs
about race, culture, ethnicity, gender,
and sexual orientation
◼ Is knowledgeable and understanding
of his or her own worldview
◼ Develops proper skills, intervention
techniques, and strategies necessary
in serving diverse client groups
◼
Culturally Skilled Counselor
Critical to immerse yourself with
knowledge and approaches specific
to the group with which you are
working
◼ Open yourself to people in other
cultures through reading and travel
◼
Client Rights and
Counselor
Responsibilities
Chapter Five
Introduction
This chapter gives special attention
to the role of informed consent as
well as ethical and legal issues that
arise when therapists fail to provide
for consent
◼ Part of ethical practice is talking with
clients about their rights
◼
Introduction
Some counselors are more focused
on protecting themselves than on
helping their clients
◼ Don’t become so involved in legalities
that you cease being primarily
interested in the ethical and clinical
implications of what you do
◼
The Client’s Right to
Give Informed Consent
Informed consent involves the right of
clients to be informed about their
therapy and to make autonomous
decisions pertaining to it
◼ Mental health professionals are
required by their ethics codes to
disclose to clients the risks, benefits,
and alternatives to proposed treatment
◼ (National Organization of Human
Services Ethics Code – Standard
#2)
◼
The Client’s Right to
Give Informed Consent
◼
It is a mistake to overwhelm clients
with too much detailed information,
but it is also a mistake to withhold
important information that clients
need to make wise choices
Legal Aspects of
Informed Consent
◼
The three basic aspects of informed
consent are capacity, comprehension of
information, and voluntariness
◼
◼
◼
Capacity: client has the ability to make rational
decisions
Comprehension of information: therapists
must give clients information in a clear way and
check to see that they understand it
Voluntariness: person giving consent is acting
freely in the decision-making process and is
legally and psychologically able to give consent
Legal Aspects of
Informed Consent
◼
The therapist should explain to
clients they are free to withdraw
their consent at any time for any
reason, except those ordered by the
court to undergo evaluation or
treatment
Educating Clients
about Informed Consent
Clients should be viewed as partners,
involved as fully as possible in each
aspect of their therapy
◼ Education about the therapeutic
process begins at the intake session
and continues to the termination
phase
◼
Educating Clients
about Informed Consent
◼
◼
Informed consent can serve as an outline
of the rights and responsibilities of the
client in the therapeutic process
Clinicians are expected to provide
prospective clients with clear information
about the benefits to which they are
entitled and the limits of treatment
Educating Clients
about Informed Consent
◼
◼
Clients have the right to specific
information regarding their treatment
under managed care and the limitations
of their treatment packages
Managed care contracts often have “gag
clauses” that prohibit practitioners from
sharing any negative information about
managed care policies, including options
not covered by the plan
Informed Consent:
1) The Therapeutic Process
Clients should be told that
counseling might open up levels of
awareness that could cause pain and
anxiety
◼ Clients in need of long-term therapy
should be told that they may
experience changes that could
produce disruptions and turmoil in
their lives
◼
The Therapeutic Process
It is appropriate to use the initial
sessions for a frank discussion of
how change happens
◼ Clients need to know that they can
terminate therapy when they decide
to
(National Organization of Human
Services Ethics Code – Standard
#2)
◼
2) Therapist Background
◼
◼
Therapists might tell clients about their
training and education, their credentials,
licenses, any specialized skills, their
theoretical orientation, the types of client
and problems in which they have
competence, and the types of problems
that they cannot work with effectively
It is critical to disclose to potential clients
in advance certain values you hold,
especially those that might make it
difficult for you to maintain objectivity
3) Costs Involved in Therapy
It is essential to provide information
about all costs, including methods of
payment
◼ Some professional codes of ethics
recommend a sliding fee standard
◼
4) The Length of Therapy
and Termination
It is important for clients to be
prepared for a termination phase
◼ Under a managed care system,
clients are often limited to 6
sessions or a specified amount for a
given year and the limited number
of sessions needs to be brought to
their attention more than once
◼
The Length of Therapy
and Termination
In order to avoid being accused of
abandoning your client, your clinical
records should give evidence that
they were not terminated
inappropriately
◼ The decision to terminate should
rest with the client
◼
5) Consultation with
Colleagues
◼
Even though it is ethical for
clinicians to discuss their cases with
other professionals, it is wise to
routinely let clients know about this
6) Interruptions in Therapy
It is best to explain at the first
contact with clients the possibilities
for both expected and unexpected
interruptions in therapy and how
they might best be handled
◼ When practitioners plan vacations,
ethical practice entails providing
clients with another therapist in case
of need
◼
7) Benefits & Risks
of Treatment
• Clients need to know that no
promises can be made about specific
outcomes
• Ethical practitioners avoid giving
guarantees of cures to clients
8) Alternatives to
Traditional Therapy
◼
◼
According to many ethics codes, clients
need to know about alternative helping
systems
Some alternatives to psychotherapy include
self-help programs, stress management,
programs for personal-effectiveness
training, peer self-help groups, indigenous
healing practices, bibliotherapy, 12-step
programs, support groups, and crisisintervention centers
9) Tape-Recording or
Videotaping Sessions
It is important that clients
understand why the recordings are
made, how they will be used, who
will have access to them, and how
they will be stored
◼ It is essential for counselors to
secure the permission of clients
before making any kind of electronic
recording
◼
10) Clients’ Right of
Access to Their Files
Clients have a legal right to inspect
and obtain copies of records kept on
their behalf by professionals
◼ A professional should write about a
client in descriptive and
nonjudgmental ways
◼
Clients’ Right of
Access to Their Files
◼
Rather than automatically providing
clients access to what is written in
their files, some therapists give
clients an explanation of their
diagnosis and generally what kind of
information they record
11) Rights Pertaining to
Diagnostic Classifying
◼
Ethical practice involves informing
clients that a diagnosis can become
a permanent part of their file
◼
Such a diagnosis can have ramifications
in terms of costs of insurance, longterm insurability, and employment
12) The Nature and
Purpose of Confidentiality
◼
◼
Expected to inform clients of the
limitations of confidentiality from the
outset of the professional relationship
(National Organization of Human
Services Ethics Code – Standard #3)
Clients in managed care programs need
to be told that the confidentiality of their
communications will be compromised to
some extent and that the managed care
organization has the power to limit
reimbursement for services
The Nature and Purpose
of Confidentiality
◼
Therapists are required to secure
written consent from clients for any
disclosure made to an insurance
company
Professional Responsibilities
in Record Keeping
Clinically, record keeping provides a
history that a therapist can use in
reviewing the course of treatment
◼ Legally, state or federal law may require
keeping a record, and many practitioners
believe that accurate and detailed clinical
records can provide an excellent defense
against malpractice claims
(National Organization of Human
Services Ethics Code – Standard #8)
◼
Record Keeping from a
Clinical Perspective
Progress notes are a basic part of
the clinical records
◼ They are behavioral in nature and
address what people say and do
◼
◼
These notes contain information on
diagnosis, functional status, symptoms,
treatment plan, consequences,
alternative treatments, and client
progress
Record Keeping from a
Clinical Perspective
◼
Process notes deal with client
reactions such as transference and
the therapist’s subjective
impressions of a client
◼
These notes may include intimate
details about the client; details of
dreams or fantasies; sensitive
information about a client’s personal
life; and a therapist’s own thoughts,
feelings, and reactions to clients
Record Keeping from a
Clinical Perspective
The law requires clinicians to keep
separate progress notes on all
clients
◼ The law does NOT require keeping
process notes.
◼ If a therapist does keep process
notes, they must be kept separately
from the individual’s clinical record
◼
Record Keeping from a
Legal Perspective
◼
◼
◼
It is wise for counselors to document their
actions in crisis situations such as cases
involving potential danger of harm to
oneself, others, or physical property
In some states, it is unethical and illegal
for mental health professionals to fail to
keep clinical records
Keeping records is perhaps the least
expensive and most effective form of
liability insurance as well
Record Keeping
from a Legal Perspective
It is important to enter notes into a
client’s record as soon as possible
after a therapy session, and sign
and date the entry
◼ Case notes should NEVER be altered
or tampered with after they have
been entered into the client’s record
◼
Ethical Issues
in Online Counseling
Behavioral telehealth: electronic
consultation between consumers and
mental health providers
◼ The APA ethics code states that
psychologists who offer services via
electronic transmission inform
clients/patients of the risks to privacy
and limits of confidentiality (Section
4.02)
◼
Advantages of Counseling
via the Internet
There is a potential for greater
numbers of people to receive
services
◼ Online groups enable men to be less
constrained by masculine
stereotypes by offering a more
anonymous context for expressing
their personal concerns
◼
Disadvantages of Counseling
via the Internet
Ethical problems incur when dealing
with a serious crisis, a psychotic
individual, or even someone who
needs more than a behavioral
intervention
◼ Insurance companies have not
recognized online counseling for
reimbursement
◼
Legal Issues & Regulation
of Online Counseling
Most pressing issue is whether it is
legal for a mental health practitioner
who is licensed in one state to treat a
client in another state by telephone or
over the Internet
◼ No state legislature has yet addressed
Internet counseling, although some
states have begun restricting
physician practice across state line
◼
Authors’ Perspective
on Online Counseling
◼
◼
◼
Online counseling should not be used as
an exclusive or primary means of
delivering services, but it can have value
if it is used as a supplement to face-toface counseling
The effectiveness of online counseling for
clients with deeply personal concerns or
interpersonal issues are questionable
Some fields, such as career counseling
and educational counseling, seem better
suited for online work than others
Children & Adolescents:
The Right to Treatment
It is necessary to have informed
parental consent or for counseling to
be court ordered for a minor to
enter into a counseling relationship
◼ The general rule is a parent is
entitled to general information from
the counselor about the child’s
progress in counseling
◼
Children & Adolescents:
The Right to Treatment
◼
Informed consent of parents or
guardians may not be legally
required when a minor is seeking
counseling for:
dangerous drugs or narcotics
◼ sexually transmitted diseases
◼ pregnancy and birth control
◼ examination following alleged sexual
assault of a minor over 12 years of age
◼
Children & Adolescents:
The Right to Treatment
In the case of school counselors, it is
not necessary to obtain parental
consent unless a state statute
requires this
◼ Parents who object to their child’s
participation in counseling probably
have a legal right to do so
◼
Informed Consent of Minors
◼
Minors are not always able to give
informed consent so whenever
possible counselors should involve
the parents in the initial meeting
with their child to arrive at a clear,
mutual agreement regarding the
nature and extent of information
that will be provided
Informed Consent of Minors
◼
◼
Although minor clients have an ethical
right to privacy and confidentiality in the
counseling relationship, the law still favors
the rights of parents over their children
Information that will or will not be
disclosed to parents or guardians must be
discussed at the outset of therapy with
both the minor and the parent
Specialized Training for
Counseling Children/Adolescents
◼
Practitioners who want to counsel
children:
◼
◼
◼
◼
May have to acquire supervised clinical
experience in play therapy, art and music
therapy, and recreational therapy
Must have a knowledge of developmental
issues pertaining to children
Need to become familiar with laws relating to
minors
Need to know when and how to make
appropriate referrals
What is Malpractice?
◼
◼
Malpractice is the failure to render
professional services or to exercise the
degree of skill that is ordinarily expected of
other professionals in a similar situation
Professional negligence can result from
unjustified departure from usual practice
or from failing to exercise due care in
fulfilling one’s responsibilities
What is Malpractice?
The primary problem in a negligence
suit is determining which standards of
care to apply to determine whether a
clinician has breached a duty to a
client
◼ The burden of proof that harm
actually took place is the client’s, and
must demonstrate that all four
elements of malpractice occurred
◼
Four Elements of
Malpractice
◼
◼
◼
◼
(1) Duty – existence and nature of a
special relationship
(2) Breach of duty – the practitioner failed
to provide the appropriate standard of care
(3) Injury – the client was harmed
physically, relationally,or psychologically
and actual injuries were sustained
(4) Causation – the practitioner’s breach of
duty was the proximate cause of the injury
they suffered
Areas Practitioners Have
Been Sued for Malpractice
◼
1) Failing to obtain or document
informed consent
2) Client Abandonment
◼
Courts have determined that the following
acts may constitute abandonment:
◼
◼
◼
◼
failure to follow up with a client who has been
hospitalized
consistently not being able to be reached
between appointments
failure to respond to a request for emergency
treatment
failure to provide for a substitute therapist
during vacation times
Client Abandonment
Under managed care plans, therapists
may be accused of abandonment
when they terminate a client based
on the allocated number of sessions
rather than on the therapeutic needs
of the client
◼ The codes of ethics apply to
practitioners, not to managed care
systems
◼
3) Marked Departures from
Established Practice
◼
Counselors that employ unusual
therapy procedures put themselves
at risk for malpractice
4) Practicing Beyond the
Scope of Competency
◼
Accepting a case beyond the scope of
a counselor’s education and training
can result in a malpractice suit
5) Misdiagnosis
◼
Giving a diagnosis that the therapist
is not qualified or licensed to render
could leave the practitioner
vulnerable to an allegation of
malpractice
6) Repressed or False
Memory
Therapists have been sued and
found guilty of induced memories
◼ The style in which a therapist
questions a client can influence
memories, particularly for young
children
◼
7) Unhealthy Transference
Relationships
The mere existence of
countertransference feeling is NOT
an ethical and legal issue
◼ If a therapist’s personal reactions to
a client cannot be managed
effectively, an abuse of power is
likely, and this can have both ethical
and legal ramifications
◼
Unhealthy Transference
Relationships
◼
When a client cannot be served in a
professional manner due to a
practitioner’s personal feelings, it is
the THERAPIST’S responsibility to
seek consultation, undergo personal
therapy, and if necessary, to refer
the client to another counselor
8) Sexual Misconduct
with a Client
NEVER appropriate for therapists to
become sexually and intimately
involved with clients
◼ Even in the case of sex between a
therapist and a former client, courts
do NOT easily accept the view that
therapy has ended
(National Organization of Human
Services Ethics Code – Standard
#6)
◼
9) Failure to Control
a Dangerous Client
Negligence lies in the therapist’s
failure to warn a third party who is
threatened by imminent danger, not
in the failure to predict violence
◼ Liability for failing to anticipate
suicide or assaultive acts is relatively
uncommon since the courts recognize
that such acts are difficult to predict
◼
Risk Management
Risk management is the practice of
focusing on the identification,
evaluation, and treatment of
problems that may injure clients, lead
to filing of an ethics complaint, or
lead to a malpractice action
◼ Exhaustive list of recommendations
for improving risk management can
be found in the text
◼
Risk Management
◼
Increased use of the legal system may
lead to excessive caution on the part of
therapists because of their concern about
being sued
◼
◼
Due to the encroachment of malpractice issues
into ethical thinking, there is increasing
emphasis on doing what is safest for the
therapist rather than what is best for the client
Unfortunately, reasonable risk
management strategies may not prevent
false accusations
Confidentiality:
Ethical and Legal
Issues
Chapter Six
Introduction
◼
You cannot make a blanket promise
to your clients that everything they
talk about will always remain
confidential
Confidentiality
As a general rule, psychotherapists are
prohibited from disclosing confidential
communications to any third party unless
mandated or permitted by law to do so
◼ Therapists are advised to err on the side
of being overly cautious in protecting the
confidentiality of their clients, unless
faced with a mandatory exception to
confidentiality such as reporting child
abuse or elder abuse
(National Organization of Human
Services Ethics Code – Standard #3)
◼
Confidentiality
◼
Counselors MUST obtain client
consent before engaging in
advocacy on behalf of an identifiable
client
Privileged Communication
Privileged communication – legal
concept that generally bars the
disclosure of confidential
communications in a legal proceeding
◼ All states have enacted into law some
form of psychotherapist-client
privilege
◼
Privileged Communication
Generally speaking, this legal
concept does NOT apply to group
counseling, couples counseling,
marital and family therapy, or child
and adolescent therapy
◼ No clear judicial trend has emerged
for communications that are made in
the presence of third persons
◼
Privacy
◼
◼
Privacy, as a matter of law, refers to the
constitutional right of an individual to
decide the time, place, manner, and extent
of sharing oneself with others
You must not reveal identifying information
about clients, orally or in writing, or even
the fact that they consult you, without
their formal consent
Privacy Issue with
Telecommunication Devices
◼
◼
It is the counselor’s responsibility to
make sure fax and email transmissions
arrive in a secured environment to
protect confidential information
The courts have ruled that email sent or
received on computers used by
employees is considered to be the
property of the company, and therefore,
privacy and confidentiality do not exist
Confidentiality and
Privileged Communication
No genuine therapy can occur unless
clients trust that what they say is
confidential
◼ When it is necessary to break
confidentiality, it is a good practice
to inform the client of the intention
to take this action and also to invite
the client to participate in the
process
◼
Exceptions to Confidentiality
and Privileged Communication
◼
◼
Mandatory reporting is designed to
encourage reporting of any suspected
cases of child, elder, or dependent-adult
abuse
All of the major professional organizations
have taken the position that practitioners
must reveal certain information when
there is clear and imminent danger to an
individual or to society
Exceptions to Confidentiality
and Privileged Communication
◼
It is the responsibility of the
therapists to clarify the ethical and
legal restrictions on confidentiality
The Duty to Warn
and to Protect
◼
Those in the counseling profession often
have to weigh these conflicting principles:
◼ The client’s right to privacy versus the
therapist’s responsibility to protect
society
◼ The client’s right to die versus the
therapist’s obligation to save lives
The Duty to Protect
Potential Victims
◼
◼
◼
Practitioners are not generally legally liable
for their failure to render perfect
predictions of violent behavior of a client
Most states permit (if not require)
therapists to breach confidentiality to warn
or protect victims
Many states grant therapists protection
from being sued for breaching
confidentiality if the therapist can show
that he or she acted in good faith to
protect third parties
The Tarasoff Case
◼
◼
◼
The California Supreme Court ruled that a
failure to warn an intended victim was
professionally irresponsible
The court held that simply notifying the
police was insufficient to protect the
identifiable victim
Negligence lies in the practitioner’s failure
to warn a third party of imminent danger
The Tarasoff Case
According to this decision, “the
protective privilege ends where the
public peril begins”
◼ Psychotherapists need only follow
reasonable standards in predicting
violence
◼
◼
Therapists should not become intimidated
by every idle fantasy, for every impulsive
threat is not evidence of imminent
danger
The Tarasoff Case
◼
Not all states have embraced the
Tarasoff doctrine
◼
In 1999, the members of the Texas
Supreme court unanimously rejected
the Tarasoff duty
Other Court Cases
The Bradley case illustrates the duty
not to negligently release a
dangerous client
◼ The Jablonski case underscores the
duty to commit a dangerous
individual and that failure to obtain
a dangerous patient’s prior medical
history can constitute malpractice
◼
Other Court Cases
◼
The Jaffee case found that
communications between licensed
psychotherapists and their clients
are privileged and therefore
protected from forced disclosure in
cases arising under federal law
Applies only in federal cases
◼ Does not appear to cover couples,
family, and group therapy
◼
Duty to Warn and to Protect
for School Counselors
Courts have uniformly held that
school personnel have a duty to
protect students from foreseeable
harm
◼ School officials may be held
accountable if a student’s writing
assignments contain evidence of
premeditated violence
◼
Guidelines for Dealing
with Dangerous Clients
◼
◼
◼
Most counseling centers and community
mental health agencies now have
guidelines regarding the duty to warn and
protect when the welfare of others is at
stake
In most cases, therapists will not have
advanced warning that a client is
dangerous
Under NO circumstances should clinicians
alter client records
The Duty to Protect
Suicidal Clients
Therapists have a legal duty to
protect suicidal clients
◼ Counselors can be accused of
malpractice for neglecting to take
action to prevent harm when a client
is likely to commit suicide
◼
Court Cases and
School Settings
Courts have found a special
relationship between school
personnel and students
◼ Even if the risk of the student
actually committing suicide is remote,
the possibility may be enough to
establish a duty to contact the
parents and to inform them of the
potential for suicidal behavior
◼
Guidelines for Assessing
Suicidal Behavior
◼
◼
In an assessment interview, focus should
be placed on evaluating depression, suicide
ideation, suicide intention, and suicide
plans
Once it is determined that a client is at
risk, the professional is legally required to
break confidentiality and take appropriate
action
Guidelines for Assessing
Suicidal Behavior
Consultation and documentation
offer safeguards against malpractice
liability
◼ The final decision about the degree
of suicidal risk is a subjective one
that demands professional judgment
◼
View Video
◼
MindTap: Dealing with Confidential
Issues and An Ethical Issue –
Confidentiality
Concluding Thoughts
on Suicide
◼
There is no Tarasoff duty to report
when a client is threatening suicide.
Protecting Children, Elderly,
and Dependent Adults
◼
◼
Privileged communication does not apply
in cases of child abuse and neglect, nor
does it apply in cases of elder and
dependent adult abuse
Mandatory reporting laws differ from
state to state
AIDS-Related Cases
Courts have not applied the duty to
warn to cases involving HIV infection,
and therapists’ legal responsibility in
protecting sexual partners of HIVpositive clients remains unclear
◼ The ACA ethics code states that
counselors “may be justified” in
disclosing information to a third party
who is at risk
◼
AIDS-Related Cases
◼
California state law places the
practitioner who divulges this
confidential information at risk for
fines, civil penalties, incarceration,
and loss of license
Duty to Protect
vs. Confidentiality
◼
◼
◼
State laws differ regarding HIV and the
limits of confidentiality
Two-thirds of the states have enacted
legislation specifying limits to
confidentiality regarding an individual’s
HIV status
Very few states (just Montana and Texas)
offer legal protection against liability for
practitioners who break client
confidentiality to warn third parties at risk
Do Tarasoff Principles Apply in
AIDS-Related Psychotherapy?
Therapists should be extremely
cautious regarding breaching
confidentiality and should first
consider less intrusive measures
◼ Therapists should be aware that
some state laws prohibit warning
identifiable third parties of partners
who are HIV-positive
◼
Do Tarasoff Principles Apply in
AIDS-Related Psychotherapy?
◼
Therapists have a duty to protect when the
following three conditions are met:
◼
◼
◼
◼
There must be a “special client-therapist
relationship”
“Clear and imminent danger” must exist
There must be an “identifiable victim”
If an HIV-infected individual is engaging in
high-risk behavior with an identifiable,
unsuspecting partner, then it appears that
the three criteria under the Tarasoff
decision may be met
View Video
◼
MindTap: Beginning a Group –
Setting the Appropriate Tone and
Rules of Confidentiality.
Managing Boundaries
and Multiple
Relationships
Chapter Seven
Introduction
◼
◼
Ethics codes of most professional
organizations stress thinking of the best
interests of clients when considering
boundary issues
A multiple relationship exists when a
practitioner is in a professional role with a
person in addition to another role with
that same individual, or with another
person who is close to that individual
Introduction
◼
Dual relationships may involve:
Assuming more than one professional
role or blending a professional and
nonprofessional relationship
◼ Providing therapy to a relative or a
friend’s relative
◼ Socializing with clients
◼ Becoming emotionally or sexually
involved with a client or former client
◼
Introduction
◼
Dual relationships may involve:
Combining the roles of supervisor and
therapist
◼ Having a business relationship with a
client
◼ Borrowing money from a client
◼ Loaning money to a client
◼
Dual and Multiple
Relationships
Codes of ethics caution professionals
against any involvement with clients
that might impair their judgment and
objectivity, affect their ability to
render effective services, or result in
harm or exploitation to clients
◼ The law does NOT specifically address
dual relationships, except for sex with
clients
◼
Differing Perspectives
Dual relationships tend to impair the
therapist’s judgment, increasing the
potential for conflicts of interest,
exploitation of the client, and blurred
boundaries that distort the
professional nature of the therapeutic
relationship
(National Organization of Human
Services Ethics Code – Standard
#5)
◼
Differing Perspectives
◼
None of the codes of ethics of any of
the professional organizations state
that nonsexual dual relationships are
unethical
Differing Perspectives
Not all nonsexual dual relationships
can be avoided, nor are they
necessarily harmful
◼ The mentoring relationship is a
personal one, in which both mentor
and mentee may benefit from
knowing the other personally and
professionally
◼
Entering into a Multiple
Relationship
◼
◼
Practitioners need to address several
questions to make sound decisions about
multiple relationships
◼ Please see these questions in your text
If the dual relationship is judged to be
appropriate and acceptable, the therapist
should document the entire process,
including having the client sign an
informed consent form
Boundary Issues
◼
There is a difference between
boundary crossings and boundary
violations
Boundary crossing: departure from
commonly accepted practices that
could potentially benefits clients
◼ Boundary violation: serious breach
that results in harm to clients
◼
Managing Multiple Relationships
in Small Communities
Practitioners who work in small
communities often have to blend
several professional roles and
functions
◼ APA ethics code offers three helpful
criteria in making decisions about
multiple relationships: risk of
exploitation, loss of therapist
objectivity, and harm to the
professional relationship
◼
Bartering for
Professional Services
Bartering involves exchanging
services in lieu of paying a fee
◼ Bartering is not prohibited by ethics
or law, but most legal experts frown
on the practice
◼
Making a Decision
about Bartering
If you decide to barter with a client,
you would need to report the
bartered services or goods as
income to the Internal Revenue
Service
◼ You should also create a written
contract that specifies hours spent
by each party and all particulars of
the agreement
◼
Giving or Receiving Gifts
◼
◼
◼
Few professional codes of ethics
specifically address the topic of giving or
receiving gifts in the therapeutic
relationship
Each situation should be evaluated on a
case-by-case basis
It is more problematic to accept a gift at
an early stage of a counseling relationship
because doing so may be a forerunner to
creating lax boundaries
Social Relationships
with Clients
◼
◼
Few professional ethics codes specifically
mention social relationships with clients
Here are some reasons for discouraging
the practice of accepting friends as clients
or of becoming socially involved with
clients:
◼
◼
Therapists may not be as challenging as they
need to be with clients they know socially
Counselors’ own needs to be liked and
accepted may lead them to be less
challenging, lest the friendship or social
relationship be jeopardized
Social Relationships
with Clients
Counselors’ own needs may be
enmeshed with those of their clients to
the point that objectivity is lost
◼ Counselors are at greater risk of
exploiting clients because of the power
differential in the therapeutic
relationship
◼
Cultural Considerations
◼
◼
◼
Western ethical standards that discourage
dual and multiple relationships can prove
to be an obstacle or hindrance in
counseling African clients
In some Asian cultures it is believed that
personal matters are best discussed with a
relative or a friend
Clients from many cultural groups prefer to
receive advice and suggestions from an
expert
Forming Relationships
with Former Clients
Mental health professionals are not
legally or ethically prohibited from
entering into a nonsexual relationship
with a client after the termination of
therapy
◼ Although forming friendships with
former clients may not be unethical
or illegal, the practice could be
unwise
◼
Socializing with Current
or Former Clients
◼
◼
◼
Factors to be considered include whether
the social involvement was initiated by a
client or was instigated by a therapist,
whether the social contact is ongoing or
occasional, and the degree of intimacy
If you are psychoanalytically oriented,
you are likely to adopt stricter boundaries
If you are a behavior therapist helping a
client to stop smoking, it may be possible
to have social contact at some point
Suggestions for Dealing
with Sexual Attractions
Several recommendations to
minimize the likelihood of sexual
transgressions by clinicians can be
found in the text
◼ Terminate the therapeutic
relationship when sexual feelings
obscure objectivity
◼
Sexual Contact with Clients
Most states have declared sexual
relationships between therapists and
clients to be a violation of the law
◼ Existing ethics codes do not, and
maybe cannot, define some of the
more subtle ways that sexuality may
be a part of professional relationships
(National Organization of Human
Services Ethics Code – Standard
#6)
◼
The Scope of the Problem
◼
◼
Sexual misconduct played a role in 53% of
the complaints opened by the APA, and all
of these sexual dual relationships involved
male-psychologist-female client complaints
The majority of the sexual boundary
violations occurred after the professional
relationship had ended (50% after therapy,
100% after supervision, and 54% after
teaching)
At-Risk Therapists
◼
In a study of professionals who
engaged in sexual boundary
violations, respondents cited
concurrent dissatisfaction in their
own lives as a risk factor leading to
sexual misconduct
At-Risk Therapists
◼
High-risk clinicians should:
Avoid the isolation of private practice
◼ Closely monitor their boundaries with
clients
◼ Obtain ongoing professional supervision
and
◼ Seek their own therapy to address any
remaining abuse-related issues
◼
Harmful Effects of Sexual
Contact with Clients
◼
Studies continue to demonstrate
that clients who are the victims of
sexual misconduct suffer dire
consequences
Harmful Effects of Sexual
Contact with Clients
◼
The harmful effects of sexual boundary
violations include:
◼
◼
◼
◼
◼
◼
◼
◼
distrust of the opposite sex
distrust for therapists and the therapeutic
process
Guilt
Depression
Anger
Feeling of rejection
Suicidal ideation
Low self-esteem
Legal Sanctions
Against Sexual Violators
◼
Consequences include being
convicted of a felony, having their
license revoked or suspended by the
state, being expelled from
professional organizations, losing
their insurance coverage, and losing
their jobs
Legal Sanctions
Against Sexual Violators
◼
A number of states have enacted
legal sanctions in cases of sexual
misconduct in the therapeutic
relationship, making it a criminal
offense
◼
These states include California, Colorado,
Florida, Georgia, Idaho, Maine, Michigan,
Minnesota, Missouri, New Hampshire, New
Mexico, North Dakota, Rhode Island, Texas,
Washington, and Wisconsin
View Video
◼
MindTap: My Way of Saying Thanks
and Boundary Issues: Dating a
Client.
Assisting Victims in the
Complaint Process
◼
◼
◼
Although the number of complaints of
sexual misconduct against therapists has
increased, individuals are still reluctant to
file complaints for disciplinary action
against their therapists, educators, or
supervisors
Clients can file an ethical complaint with a
professional association or with the
therapist’s licensing board
Legal alternatives include civil suits or
criminal actions
Sexual Relationships
with Former Clients
Most professional organizations prohibit
their members from engaging in sexual
relationships with former clients
because of the potential for harm
◼ The burden of demonstrating that there
has been no exploitation clearly rests
with the therapist
(National Organization of Human
Services Ethics Code – Standard
#6)
◼
Nonerotic Physical
Contact with Clients
◼
◼
Although acting on sexual feelings and
engaging in erotic contact with clients is
unethical, nonerotic contact is often
appropriate and can have significant
therapeutic value
Due to the current attention being given to
sexual harassment and lawsuits over
sexual misconduct in professional
relationships, some counselors are likely to
decide that it is not worth the risk of
touching clients at all, lest their intentions
be misinterpreted
Nonerotic Physical
Contact with Clients
◼
◼
It may be safer for a hug to occur in
group therapy rather than in individual
counseling because there are witnesses to
the context of the touching, leaving less
room for misinterpretation
Practitioners need to formulate clear
guidelines and consider appropriate
boundaries, but touch can be a
therapeutic means to healing
Issues in Supervision
and Consultation
Chapter Nine
Introduction
◼
◼
Supervision is perhaps the most important
component in the development of a
competent practitioner
The four goals of supervision are:
◼
◼
◼
◼
(1) to promote supervisee growth and
development;
(2) to protect the welfare of the client;
(3) to monitor supervisee performance and to
serve as a gatekeeper for the profession; and
(4) to empower the supervisee to self-supervise
and carry out these goals as an independent
professional
The Supervisor’s Roles
and Responsibilities
◼
◼
◼
◼
Supervisors are both ethically and legally
responsible for the actions of their
trainees
Supervisors should maintain records
pertaining to their work with trainees
Supervisors need to be careful not to
misuse the inherent power in the
supervisor-supervisee relationship
The clients’ welfare comes first, followed
by that of the supervisees
Methods of Supervision
Supervisors need to create a
collaborative relationship that
encourages trainees to reflect on
what they are doing
◼ Verbal exchange and direct
observation are the most commonly
used forms of supervision
◼
Methods of Supervision
◼
◼
◼
Self-report is one of the most widely used
methods, but it may be the least useful
Process notes build on the self-report by
adding a written record explaining the
content of the session and the
interactional processes
Audiotapes are a widely used procedure
that yields direct and useful information
about the supervisee
Methods of Supervision
Videotape recording allows for an
assessment of the subtleties of the
interaction between the supervisee
and the client
◼ Live supervision provides the most
accurate information about the
therapy session
◼
Ethical Practices of
Clinical Supervisors
◼
51% of the 151 supervisees
sampled reported what they
considered to be at least one ethical
violation by their supervisors
◼
The ethical guidelines most frequently
violated involved adequate
performance evaluation, confidentiality
issues relevant to supervision, and
ability to work with alternative
perspectives
Survey Results
◼
◼
◼
33% perceived that their supervisors did
not provide adequate evaluations of their
counseling sessions
18% reported that confidentiality issues
were not handled appropriately by their
supervisors
18% reported that their supervisors were
not receptive to theoretical approaches
other than their own
Survey Results
◼
◼
◼
13% reported that their supervisors did
not ensure adequate session conditions or
respect
9% said that their supervisors never
explained the roles and responsibilities of
the supervisee and the supervisor
9% viewed their supervisors as lacking
competence regarding the clients the
supervisees were treating
Survey Results
◼
◼
◼
8% reported that their supervisors did not
address the issue of how they were to
disclose their student status to clients
8% reported that supervisors did not
model ethical behavior or respond to
ethical concerns
7% contended that crisis procedures and
policies were not explained to them by
supervisors or by the agency where they
were doing their fieldwork
Survey Results
7% reported that their supervisors
were multiculturally insensitive
◼ 6% reported ethical violations
pertaining to dual roles
◼ 5% believed their supervisors did
not handle these issues
appropriately
◼
Survey Results
5% believed that their supervisor
failed to adhere to the ethical
guideline of referring a client when a
supervisee has personal problems
that interferes with care
◼ 1% of the supervisees reported that
their supervisors were inappropriate
regarding sexual or romantic issues
in the supervisory relationship
◼
Legal Aspects
of Supervision
◼
◼
Three legal considerations in the
supervisory relationship are informed
consent, confidentiality and its limits, and
liability
Supervisors must make sure that both
supervisees and their clients are fully
informed about the limits of
confidentiality, including those situations
in which supervisors have a duty to warn
or to protect
Legal Aspects
of Supervision
◼
◼
The following areas should be addressed
in a written informed consent document:
purpose of supervision, professional
disclosure statement, practical issues,
supervision process, administrative
issues, ethical and legal issues, and
statement of purpose.
Supervisors are both ethically and legally
vulnerable to the work performed by
those they are supervising (vicarious
liability)
Legal Aspects
of Supervision
◼
Direct liability can be incurred if
supervisors are derelict in the supervision
of their trainees, if they give trainees
inappropriate advice about treatment, or
if they give tasks to trainees that exceed
their competence
Multicultural Issues
in Supervision
The ACA’s code of ethics states that
“Counseling supervisors are aware
of and address the role of
multiculturalism/diversity in the
supervisory relationship”
◼ Multicultural supervision includes
race, ethnicity, socioeconomic
status, sexual orientation, religion,
gender, and age
◼
Multiculturally
Effective Supervision
◼
◼
◼
◼
Have supervisors initiate discussion of
multicultural issues as a basic part of
supervision
Provide increased training for supervisors
in working with multicultural issues
Provide more supervisors with
multicultural experience
Involve all personnel within an agency in
multicultural training
Ethical Issues in Combining
Supervision & Counseling
There is a lack of consensus and clarity
about the degree to which supervisors
can ethically deal with the personal
issues of supervisees
◼ Although discussing a trainee’s
personal issues may appear to be
similar to therapy, the purpose is to
facilitate the trainee’s ability to work
successfully with clients
◼
Ethical Issues in Combining
Supervision & Counseling
◼
The ACA guideline says if
supervisees request counseling,
supervisors should provide them
with acceptable referrals
View Videos
◼
MindTap: The Role of a Supervisor
and Challenges of Being a
Supervisor.
Special Issues
in Consultation
◼
Consultation: process in which a
human service professional assists a
consultee with a work-related (or
caretaking-related) problem with a
client system
Special Issues
in Consultation
◼
Dougherty found general agreement
on these common characteristics of
consultation:
The consultant provides indirect service
to the client by providing direct service
to consultees to better serve their own
clients
◼ Consultees have the freedom to decide
what they will do with the suggestions
and recommendations of the consultant
◼
The Need for Ethical
Standards for Consultants
◼
The ethics codes of most of the
mental health professional
associations do not sufficiently
address the complexity of ethical
issues consultants encounter
Values Issues
in Consultation
◼
◼
◼
Ethical practice demands that consultants
investigate the goals of an agency before
agreeing to offer consultation services
Value conflicts can arise at any stage of
the consultation process
It is critical that difficult choices be made
with consultees rather than for them by
the consultant acting alone
Competence & Training
in Consultation
Consultants are ethically bound to
assume responsibility for keeping
abreast of theoretical and technical
developments in their field
◼ Consultants should present their
professional qualifications to avoid
misrepresenting themselves
◼
Relationship Issues
in Consultation
The consultee’s interests and needs
are paramount
◼ Consultants are expected to
establish a clear contract with welldefined limits, to respect their
contract, and to communicate the
terms of the contract to all those
participating in consulting activities
◼
Rights of Consultees
◼
Ethical practice requires that consultants
inform their consultees about the:
◼
◼
◼
◼
◼
◼
goals and purpose of consultation
limits to confidentiality
potential benefits
potential risks
potential outcomes of intervention
freedom to decline to participate in the
consultation process
Ethical Issues in
Couples and Family
Therapy
Chapter Eleven
Ethical Standards in Couples
and Family Therapy
◼
◼
Marriage and family therapists advance the
welfare of families and individuals
Therapists respect and guard confidences
of each individual client
◼
◼
Some treat all information they receive from a
family member just as if the person were in
individual therapy
Others refuse to see any member of the family
separately, claiming that doing so fosters
unproductive alliances and promotes the
keeping of secrets
Ethical Standards in Couples
and Family Therapy
◼
The principle of professional competence
and integrity implies that clinicians keep
abreast of developments in the field
through continuing education and clinical
experiences
Ethical Standards in Couples
and Family Therapy
◼
Regarding financial arrangements:
Couples and family therapists do not
accept payment for making referrals
and do not exploit clients financially for
services
◼ Ethical practice dictates a disclosure of
fee policies at the onset of therapy
◼
Ethical Standards in Couples
and Family Therapy
◼
Regarding advertising:
◼
Ethical practice dictates that
practitioners accurately represent their
competence, education, training, and
experience in couples and family
therapy
Special Considerations
Therapists need to consider that the
status of one partner or family
member does not improve at the
expense of the other partner or
another family member
◼ Therapists who function as an
advocate of the system avoid
becoming an agent of any one
partner or family member
◼
Values in Couples
and Family Therapy
◼
Values pertaining to marriage, the
preservation of the family, divorce,
traditional and nontraditional
lifestyles, gender roles and the
division of responsibility in the
family, child rearing, and
extramarital affairs can all influence
therapists’ interventions
Values in Couples
and Family Therapy
◼
The value system of the therapist
has a crucial influence on the
formulation and definition of the
problems the therapist sees in a
family, the goals and plans for
therapy, and the direction the
therapy takes
Values in Couples
and Family Therapy
◼
The role of the therapist is:
To help family members see more
clearly what they are doing
◼ To help them make an honest
evaluation of how well their present
patterns are working for them
◼ To help and encourage them to make
necessary changes
◼
A Nonsexist Perspective
on Family Therapy
◼
It is critical that family therapists
take whatever steps are necessary
to account for gender issues in their
practice and to become nonsexist
family therapists
A Nonsexist Perspective
on Family Therapy
◼
Family therapists are particularly
vulnerable to the following biases:
(1) assuming that remaining married
would be the best choice for a woman
◼ (2) demonstrating less interest in a
woman’s career than in a man’s career
◼ (3) encouraging couples to accept the
belief that child rearing is solely the
responsibility of the mother
◼
A Nonsexist Perspective
on Family Therapy
◼
Family therapists are particularly
vulnerable to the following biases:
(4) showing a different reaction to a a
wife’s affair than to a husband’s
◼ (5) giving more importance to
satisfying the husband’s needs than to
satisfying the wife’s needs
◼
Responsibilities of Couples
and Family Therapists
◼
Legal obligations may require
therapists to put the welfare of an
individual over that of a relationship
◼
The law requires family therapists to
inform authorities if they suspect child
neglect or abuse or become aware of it
during the course of therapy
Responsibilities of Couples
and Family Therapists
◼
In the case of domestic violence,
clinicians agree that conducting
couples therapy while there is
ongoing domestic violence presents
a potential danger to the abused
and is unethical
View Videos
◼
MindTap: A Leader without Skills, A
Leader with Skills and The Case of
Carl.
Ethical Issues in
Group Work
Chapter Twelve
Confidentiality in Groups
◼
The legal concept of privileged
communication generally does not
apply in a group setting, unless
there has been a statutory exception
Exceptions to
Confidentiality
◼
◼
If members pose a danger to themselves
or to others, the group leader would be
ethically and legally obliged to breach
confidentiality
All states have had mandatory child
abuse reporting laws since 1967 and
several states have mandatory elder
abuse and dependent adult abuse
reporting laws
Ethical Issues in
Community Work
Chapter Thirteen
Introduction
◼
◼
◼
There is an ethical concern if community
workers ignore community needs
The traditional approach to understanding
and treating human problems focuses on
resolution of internal conflicts as a
pathway to individual change
The community approach focuses on
ways of changing the environmental
factors causing individual problems
Ethical Practice in
Community Work
It is left to community workers to
identify strategies for becoming more
responsive to the community
◼ The ethical principles for social workers
outlined in the code of ethics do not
begin to cover many of the practical
situations community workers
encounter
◼
(National Organization of Human Services
Ethics Code – Standard #11, 12, 13-16)
Influencing Policymakers
One way community workers can
initiate change and be a change
agent is by organizing within an
agency or even several agencies and
developing a collective voice
◼ Practitioners can empower a
community to organize political action
to influence the state and national
government to fulfill their
responsibilities
◼
Case Management
in a Community Setting
◼
◼
◼
Case management involves planning and
coordinating approaches to treatment
The overall goal of case management is
to promote, restore, or maintain the
independent functioning of clients in the
least-restrictive community environment
It is important that the case manager
NOT ignore client advocacy
responsibilities in the interest of time and
job security
Case Management
in a Community Setting
◼
A particularly challenging issue
involves the level of cooperation and
collaboration between human
service agencies
Working Within a System
◼
Working in a system can put an
added strain on the counselor due to
several factors:
The amount of paperwork required to
justify continued funding
◼ High caseloads
◼ A multitude of policy directives
◼
Working Within a System
◼
Another source of strain is the
counselor’s relationships with those
who administer the agency or
institution, who may have long
forgotten the practicalities involved
in providing direct services to clients
but must contend with managing
and funding programs
Relationships between
Community Worker & Agency
Human service workers need to
learn how to best deal with the rules
and regulations of their agency
◼ Correcting an abuse that may be
systemwide demands the willingness
of those involved in the system to
practice aspirational ethics and take
action
◼
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