Springfield College Psychology Discussion

Description

Question # 1: Discussing your thoughts and concerns about ethics in counseling and human services. 150 words
Question # 2: In a 2-3 paragraph minimum, write about your awareness of professional ethics at the start of this course.
Question # 3: Identify one specific value that you are likely to push or promote, or an area where you expect to struggle because of a value conflict with a given client or a given value system. Or — identify one of your core values and show how this value could either enhance or inhibit the effectiveness of counseling. Demonstrate how you might proceed to lessen the chances that you would impose your values on this client. How might you resolve a value conflict and use a referral as a last option? Keep this to no more than one page in length.

Issues and Ethics in the
Helping Professions
Eighth Edition
Gerald Corey
California State University, Fullerton
Diplomate in Counseling Psychology
American Board of Professional Psychology
Marianne Schneider Corey
Consultant
Patrick Callanan
Private Practice
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Issues and Ethics in the Helping Professions,
Eighth Edition
Gerald Corey, Marianne Schneider Corey,
Patrick Callanan
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Dedicated to the friends, clients, students, and colleagues
who opened our eyes to the complexities and subtleties
of ethical thinking and practice.
Gerald Corey
is Professor Emeritus of
Human Services at California State University at Fullerton. He received his doctorate in
counseling from the University of Southern
California. He is a Diplomate in Counseling Psychology, American Board of Professional Psychology; a licensed psychologist; a
National Certiﬁed Counselor; a Fellow of the
American Psychological Association (Counseling Psychology); a Fellow of the American Counseling Association; and a Fellow of the Association for Specialists in
Group Work. Jerry received the Eminent Career Award from ASGW in 2001
and the Outstanding Professor of the Year Award from California State University at Fullerton in 1991. He regularly teaches both undergraduate and graduate courses in group counseling and ethics in counseling. He is the author or
co-author of 16 textbooks in counseling currently in print, along with numerous journal articles. His book, Theory and Practice of Counseling and Psychotherapy, has been translated into Arabic, Indonesian, Portuguese, Turkish, Korean,
and Chinese. Theory and Practice of Group Counseling has been translated into
Korean, Chinese, Spanish, and Russian. Issues and Ethics in the Helping Professions has been translated into Korean, Japanese, and Chinese.
Along with his wife, Marianne Schneider Corey, Jerry often presents workshops in group counseling. In the past 30 years the Coreys have conducted group
counseling training workshops for mental health professionals at many universities in the United States as well as in Canada, Mexico, China, Hong Kong, Korea,
Germany, Belgium, Scotland, England, and Ireland. In his leisure time, Jerry likes
to travel, hike and bicycle in the mountains, and drive his 1931 Model A Ford.
He holds memberships in the American Counseling Association; the American Psychological Association; the Association for Specialists in Group Work;
the American Group Psychotherapy Association; the Association for Spiritual,
Ethical, and Religious Values in Counseling; the Association for Counselor Education and Supervision; and the Western Association for Counselor Education
and Supervision.
iv
About the Authors
Recent publications by Jerry Corey, all with Brooks/Cole, Cengage Learning, include:
Becoming a Helper, Sixth Edition (2011, with Marianne
Schneider Corey)
Groups: Process and Practice, Eighth Edition (2010,
with Marianne Schneider Corey and Cindy Corey)
I Never Knew I Had a Choice, Ninth Edition (2010,
with Marianne Schneider Corey)
Theory and Practice of Counseling and Psychotherapy,
Eighth Edition (and Manual) (2009)
Case Approach to Counseling and Psychotherapy,
Seventh Edition (2009)
The Art of Integrative Counseling, Second Edition (2009)
Theory and Practice of Group Counseling, Seventh Edition
(and Manual) (2008)
Group Techniques, Third Edition (2004, with Marianne
Schneider Corey, Patrick Callanan, and J. Michael Russell)
Jerry is co-author (with Barbara Herlihy) of Boundary Issues in Counseling:
Multiple Roles and Responsibilities, Second Edition (2006) and ACA Ethical Standards Casebook, Sixth Edition (2006); he is also co-author (with Robert Haynes,
Patrice Moulton, and Michelle Muratori) of Clinical Supervision in the Helping Professions: A Practical Guide, Second Edition (2010); and is the author of
Creating Your Professional Path: Lessons from My Journey (2010), all four of which
are published by the American Counseling Association.
He has also made several educational video programs on various aspects
of counseling practice: (1) Theory in Practice: The Case of Stan—DVD and Online
Program (2009); (2) Groups in Action: Evolution and Challenges—DVD and Workbook (2006, with Marianne Schneider Corey and Robert Haynes); (3) CD-ROM
for Integrative Counseling (2005, with Robert Haynes); and (4) Ethics in Action:
CD-ROM (2003, with Marianne Schneider Corey and Robert Haynes). All of
these programs are available through Brooks/Cole, Cengage Learning.
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Marianne Schneider Corey is a licensed
marriage and family therapist in California
and is a National Certiﬁed Counselor. She
received her master’s degree in marriage,
family, and child counseling from Chapman College. She is a Fellow of the Association for Specialists in Group Work and was
the recipient of this organization’s Eminent
Career Award in 2001. She also holds memberships in the American Counseling Association; the Association for Specialists in Group Work; the American
Group Psychotherapy Association; the Association for Spiritual, Ethical, and
Religious Values in Counseling; the Association for Counselor Education
and Supervision; and the Western Association for Counselor Education and
Supervision.
Marianne has been involved in leading groups for different populations,
providing training and supervision workshops in group process, facilitating
self-exploration groups for graduate students in counseling, and co-facilitating
training groups for group counselors and weeklong residential workshops in
personal growth. With her husband, Jerry, Marianne has conducted training
workshops, continuing education seminars, and personal growth groups in
the United States, Germany, Ireland, Belgium, Mexico, Hong Kong, China,
and Korea. She sees groups as the most effective format in which to work
with clients and ﬁnds it the most rewarding for her personally.
Marianne has co-authored following books with Brooks/Cole, Cengage
Learning:
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Issues and Ethics in the Helping Professions, Eighth Edition
(2011, with Gerald Corey and Patrick Callanan)
[Translated into Japanese and Chinese]
Becoming a Helper, Sixth Edition (2011,
with Gerald Corey) [Translated into Korean and Japanese]
About the Authors
Groups: Process and Practice, Eighth Edition
(2010, with Gerald Corey and Cindy Corey)
[Translated into Korean, Chinese, and Polish]
I Never Knew I Had a Choice, Ninth Edition
(2010, with Gerald Corey) [Translated into Chinese]
Group Techniques, Third Edition (2004, with Gerald Corey,
Patrick Callanan, and Michael Russell) [Translated into
Portuguese, Korean, Japanese, and Czech]
Marianne has made educational video programs (with accompanying student workbooks) for Brooks/Cole, Cengage Learning: Groups in Action: Evolution and Challenges—DVD and Workbook (2006, with Gerald Corey and Robert
Haynes); and Ethics in Action: CD-ROM (2003, with Gerald Corey and Robert
Haynes).
Marianne and Jerry have been married since 1964. They have two adult
daughters and three grandchildren. Marianne grew up in Germany and has
kept in close contact with her family and friends there. In her free time, she
enjoys traveling, reading, visiting with friends, bike riding, and hiking.
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Patrick Callanan is a licensed marriage
and family therapist in private practice in
Santa Ana, California. In 1973 he graduated
with a bachelor’s degree in human services
from California State University at Fullerton, and he received his master’s degree in
professional psychology from United States
International University in 1976. He has had
a private practice for more than 30 years, working with individuals, couples,
families, and groups.
Patrick is a part-time faculty member in the Human Services Program at
California State University at Fullerton, where he regularly teaches an internship course. He also donates his time each year to the university to assist
in training and supervising group leaders and co-teaches a graduate course
on ethical and professional issues in counseling. Along with Marianne Schneider Corey and Gerald Corey, he received an Award for Contributions to
the Field of Professional Ethics by the Association for Spiritual, Ethical, and
Religious Values in Counseling in 1986.
Patrick co-authored Group Techniques, Third Edition (2004). In his free time,
Patrick enjoys reading, walking, and playing golf. Each year he returns to the
land of his birth in Ireland for refreshment.
viii
Contents
Preface
1
xvii
Introduction
to Professional Ethics
The Focus of This Book
2
Some Suggestions for Using This Book
Professional Codes of Ethics
Ethical Decision Making
2
3
5
14
Steps in Making Ethical Decisions
22
Dealing With Suspected Unethical Behavior of Colleagues
27
Self-Assessment: An Inventory of Your Attitudes
and Beliefs About Ethical and Professional Issues
Chapter Summary
Suggested Activities
2
38
38
The Counselor as a Person
and as a Professional
Pre-Chapter Self-Inventory
Introduction
28
42
42
43
Self-Awareness and the Inﬂuence
of the Therapist’s Personality and Needs
44
ix
x
Contents
Personal Therapy for Counselors
47
Transference and Countertransference
Client Dependence
54
63
Stress in the Counseling Profession
67
Counselor Burnout and Impairment
69
Maintaining Vitality Through Self-Care
Chapter Summary
Suggested Activities
3
71
73
74
Values and the Helping
Relationship
Pre-Chapter Self-Inventory
Introduction
76
76
77
Clarifying Your Values and Their Role in Your Work
The Ethics of Imposing Your Values on Clients
78
80
Value Conﬂicts Regarding Sexual Attitudes and Behavior
Value Conﬂicts Pertaining to Abortion
87
Case Studies of Other Possible Value Conﬂicts
90
The Role of Spiritual and Religious Values in Counseling
Value Conﬂicts Regarding End-of-Life Decisions
Chapter Summary
Suggested Activities
4
84
93
100
109
110
Multicultural Perspectives
and Diversity Issues
Pre-Chapter Self-Inventory
Introduction
112
112
114
The Problem of Cultural Tunnel Vision
117
The Challenges of Reaching Diverse Client Populations
Ethics Codes From a Diversity Perspective
Cultural Values and Assumptions in Therapy
Addressing Sexual Orientation
Matching Client and Counselor
120
123
132
141
Multicultural Training for Mental Health Workers
Chapter Summary
Suggested Activities
152
153
146
118
Contents
5
Client Rights and
Counselor Responsibilities
Pre-Chapter Self-Inventory
Introduction
156
156
158
The Client’s Right to Give Informed Consent
The Content of Informed Consent
160
165
The Professional’s Responsibilities in Record Keeping
Ethical Issues in Online Counseling
186
Involuntary Commitment and Human Rights
194
Malpractice Liability in the Helping Professions
Chapter Summary
Suggested Activities
172
180
Working With Children and Adolescents
6
195
205
206
Conﬁdentiality:
Ethical and Legal Issues
Pre-Chapter Self-Inventory
Introduction
xi
208
208
210
Conﬁdentiality, Privileged Communication, and Privacy
Privacy Issues With Telecommunication Devices
226
Implications of HIPAA for Mental Health Providers
The Duty to Warn and to Protect
210
227
230
Protecting Children, the Elderly,
and Dependent Adults From Harm
250
Conﬁdentiality and HIV/AIDS-Related Issues
Chapter Summary
Suggested Activities
7
257
264
264
Managing Boundaries
and Multiple Relationships
Pre-Chapter Self-Inventory
Introduction
266
268
The Ethics of Multiple Relationships
Controversies on Boundary Issues
269
279
266
xii
Contents
Managing Multiple Relationships in a Small
Community
283
Bartering for Professional Services
Giving or Receiving Gifts
287
294
Social Relationships With Clients
298
Sexual Attractions in the Client–Therapist Relationship
301
Sexual Relationships in Therapy: Ethical and Legal Issues
Sexual Relationships With Former Clients
311
A Special Case: Nonerotic Touching With Clients
Chapter Summary
Suggested Activities
8
306
315
318
319
Professional Competence
and Training
Pre-Chapter Self-Inventory
Introduction
322
322
323
Therapist Competence: Ethical and Legal Aspects
Ethical Issues in Training Therapists
324
331
Evaluating Knowledge, Skills, and Personal Functioning
Gatekeeper Role of Faculty in Promoting Competence
Dismissing Students for Nonacademic Reasons
Professional Licensing and Credentialing
337
341
344
353
Continuing Professional Education and Demonstration
of Competence
356
Review, Consultation, and Supervision by Peers
Chapter Summary
Suggested Activities
9
360
361
Issues in Supervision
and Consultation
Pre-Chapter Self-Inventory
Introduction
359
364
364
366
Ethical Issues in Clinical Supervision
367
The Supervisor’s Roles and Responsibilities
370
Contents
Ethical and Effective Practices of Clinical Supervisors
Competence of Supervisors
xiii
375
375
Legal Aspects of Supervision
379
Special Issues in Supervision for School Counselors
Multicultural Issues in Supervision
381
383
Multiple Roles and Relationships in the Supervisory
Process
386
Ethical Issues in Consultation
Chapter Summary
405
Suggested Activities
10
398
405
Issues in Theory
and Practice
Pre-Chapter Self-Inventory
Introduction
408
408
410
Developing a Counseling Style
410
The Division of Responsibility in Therapy
Deciding on the Goals of Counseling
413
The Use of Techniques in Counseling
415
412
Assessment and Diagnosis as Professional Issues
Using Tests in Counseling
Counseling in a Managed Care Environment
Evidence-Based Therapy Practice
Chapter Summary
435
442
445
Suggested Activities
11
416
433
446
Ethical Issues in Couples
and Family Therapy
Pre-Chapter Self-Inventory
Introduction
448
448
449
Ethical Standards in Couples and Family Therapy
451
Special Ethical Considerations in Working With Couples
and Families
454
Contemporary Professional Issues
455
xiv
Contents
Values in Couples and Family Therapy
458
Gender-Sensitive Couples and Family Therapy
463
Responsibilities of Couples and Family Therapists
Conﬁdentiality in Couples and Family Therapy
468
469
Informed Consent in Couples and Family Therapy
Chapter Summary
Suggested Activities
12
473
475
476
Ethical Issues
in Group Work
478
Pre-Chapter Self-Inventory
Introduction
478
479
Ethical Issues in Training and Supervision of Group
Leaders
480
Ethical Issues in the Diversity Training of Group
Workers
484
Ethical Considerations in Co-Leadership
487
Ethical Issues in Forming and Managing Groups
Conﬁdentiality in Groups
495
Values in Group Counseling
500
Ethics in the Use of Group Techniques
Ethics in the Consultation Process
Suggested Activities
13
501
502
Ethical Issues Concerning Termination
Chapter Summary
503
505
506
Ethical Issues
in Community Work
Pre-Chapter Self-Inventory
Introduction
488
508
508
510
Ethical Practice in Community Work
512
The Community Mental Health Orientation
Social Justice Perspective
515
Advocacy Competencies
519
513
Contents
Roles of Helpers Working in the Community
Promoting Change in the Community
Working Within a System
Chapter Summary
Suggested Activities
xv
521
527
529
535
536
Authors’ Concluding Commentary
538
References and Suggested Readings
Name Index
Subject Index
539
574
583
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Preface
I
ssues and Ethics in the Helping Professions is written for both graduate and
undergraduate students in the helping professions. This book is suitable
for courses in counseling, human services, couples and family therapy, counseling and clinical psychology, school counseling, rehabilitation counseling,
addiction counseling, and social work. It can be used as a core textbook in
courses such as practicum, ﬁeldwork, internship, and ethical and professional issues or as a supplementary text in courses dealing with skills or theory. Because the issues we discuss are likely to be encountered throughout
one’s professional career, we have tried to use language and concepts that
will be meaningful both to students doing their ﬁeldwork and to professionals interested in keeping abreast of developments in ethical, professional,
and legal matters pertaining to therapeutic practice.
In this book, we want to involve our readers in learning to deal with the
ethical and professional issues that most affect the actual practice of counseling and related helping professions. We address questions such as the following: How do your values and life experiences affect the therapeutic process?
What are the rights and responsibilities of both the client and the counselor?
How can you determine your level of competence? How can you provide
quality services for culturally diverse populations? What major ethical issues
might you encounter in couples and family therapy? in group work? in community agencies? in the school setting? in private practice? Our goal is both to
provide a body of information and to teach you a process for thinking about
and resolving the basic issues you will face throughout your career. For most
of the issues we raise, we present various viewpoints to stimulate discussion
and reﬂection. We also present our personal views and commentaries, when
appropriate, and challenge you to develop your own position.
The ethics codes of various professional organizations offer some guidance
for practice. However, these guidelines leave many questions unanswered.
We believe that as a student or a professional you will ultimately struggle
with the issues of responsible practice, deciding how accepted ethical principles apply in the speciﬁc cases you encounter.
xvii
xviii
Preface
Throughout this book, we take you on a journey that will involve you in an
active and meaningful way. To this end we provide many opportunities for
you to respond to our discussions. Each chapter begins with a self-inventory
designed to help you focus on the key topics to be discussed in the chapter. Within the chapters we frequently ask you to think about how the issues
apply to you. There are open-ended cases and situations designed to stimulate thought and discussion. Readers are encouraged to apply the codes
of ethics of the various mental health professions to the case illustrations.
Reﬂecting on the questions following each of the case examples will help
readers determine which of the therapist responses are ethically sound and
which are not. We offer our commentaries after each case to guide readers
in the process of determining sound ethical decisions. We also cite related
literature when exploring ethical, legal, and professional issues. This book
combines the advantages of both the textbook and a workbook. Instructors
will ﬁnd an abundance of material and suggested activities, surely more than
can be covered in a single course.
An Instructor’s Resource Manual is available that contains chapter outlines, suggestions for teaching an ethics course, test items, additional exercises and activities, a list of Power Point slides, and study guide questions.
An electronic version of the Instructor’s Resource Manual is available for all
platforms.
A supplementary resource for this edition is a premium website available to students who are using Issues and Ethics in the Helping Professions. The
website contains integrated multimedia elements and learning modules and
includes quizzes, cases for discussion and analysis, glossary of key terms,
video clips depicting key ethical issues, a study guide for each chapter, links
to websites, and other supplementary features. For faculty who use a course
management system like Blackboard, the premium website content is also
available as a WebTutor e-pack that will load directly into your course for
easily assigning homework.
The codes of ethics of the various helping professions are discussed in
Chapter 1, and the full text of each code is available in a booklet titled Codes
of Ethics for the Helping Professions (4th ed., 2011), which can be packaged with
the text for a nominal price.
An integrated learning package entitled Ethics in Action CD-ROM is
available to enhance the eighth edition of Issues and Ethics in the Helping
Professions. The Ethics in Action CD-ROM is designed to bring to life the
ethical issues and dilemmas counselors often encounter and to provide
ample opportunity for discussion, self-exploration, and problem solving of
these issues and dilemmas. The vignettes on the CD-ROM are based on a
weekend workshop co-led by Marianne Schneider Corey and Gerald Corey
for a group of counseling students, which included challenging questions
and lively discussion, role plays to bring the issues to life, and comments
from the students and the Coreys. Additional material on the CD-ROM is
designed to provide a self-study guide for students who are also reading
this book. This educational program is divided into three segments: ethical
Preface
xix
decision making, values and the helping relationship, and boundary issues
and multiple relationships in counseling. At the end of several chapters in
this book are suggested activities and guidelines for integrating the CDROM with this textbook.
What’s New in the Eighth Edition
of Issues and Ethics
For the eighth edition, each chapter has been carefully reviewed and updated
to present the current thinking, research, and trends in practice. The following chapter-by-chapter list of highlights outlines some material that has been
added, updated, expanded, and revised for the eighth edition.
Chapter 1: Introduction to Professional Ethics
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Citation of updated ethics codes whenever available
New material on similar themes in various ethics codes
Updated information on the relationship between law and ethics, and
on the discussion of potential conﬂicts between law and ethics
Expanded discussion of ethical and legal monitoring of practice
Revision of the steps in ethical decision making
Inclusion of ethics codes for addictions counseling
Revision of dealing with unethical behavior of colleagues
Chapter 2: The Counselor as a Person and as a Professional
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Revised section on personal problems and conﬂicts of counselors
Updated and expanded discussion of the role of personal therapy in
training programs and ongoing therapy for practitioners
Inclusion of recent studies on personal therapy for psychotherapists
New material on the CACREP (2009) standards pertaining to personal
counseling for students
New commentaries after each of the case examples
Updated discussion of transference and countertransference
Added discussion of countertransference issues in addictions counseling
Revised material on how stress affects practitioners
New discussion of empathy fatigue
Updated and expanded discussion of self-care for professionals
Updated and expanded discussions of burnout, practitioner impairment, and maintaining vitality
xx
Preface
Chapter 3: Values and the Helping Relationship
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Revised and expanded section on the role of spirituality and religion in
counseling
Updated discussion of training counselors to deal with spiritual and
religious concerns
Addition of spirituality competencies
Inclusion of ethical issues in spirituality and addictions treatment
Revised and updated section on end-of-life decisions
Literature on recent trends in addressing end-of-life matters in therapy
New commentaries after each of the case examples
Chapter 4: Multicultural Perspectives and Diversity Issues
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New literature on multicultural and diversity perspectives
New commentaries after each of the case examples
Expanded discussion of cultural encapsulation
Updated and expanded coverage of examining cultural biases and cultural assumptions
Revised discussion of issues pertaining to sexual orientation and inclusion of competencies in working with lesbian, gay, bisexual, and transgendered individuals
Updated discussion of training students in multicultural competence
Chapter 5: Client Rights and Counselor Responsibilities
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Revised and expanded section on informed consent
Recent literature on trends in informed consent procedures in psychotherapy
Updated and expanded discussion on record keeping guidelines
Additional cases and case commentaries
Revised discussion of the ethical issues in online counseling
New study assessing ethical practices for online counseling websites
New material on weighing the beneﬁts and risks of distance counseling
Inclusion of recent ethics codes on the applications of technology
Expanded and updated coverage of ethical and legal perspectives in
working with children and adolescents
Updating discussion of balancing a minor’s right to privacy and a parent’s right to information about a minor client
New material on ethical issues in working with minors who engage in
self-injurious behaviors
Preface
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xxi
Updated discussion of reasons for malpractice suits
Expanded treatment of client abandonment and premature termination
Revised and expanded treatment of risk management strategies
Chapter 6: Conﬁdentiality: Ethical and Legal Issues
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Revised material on ethics regarding conﬁdentiality and privileged communication
New discussion of an ethical practice model for protecting clients’ conﬁdentiality
New material on balancing privacy rights of clients against the broader
needs of protecting the public
Addition of new commentaries to most cases
Revised section on the implications of HIPAA for mental health
providers
Revised material and new studies on the duty to warn and protect
Expansion of risk management strategies in dealing with duty to protect
situations
Revised section on protecting children, older persons, and dependent
adults from harm
Revised discussion of conﬁdentiality and HIV/AIDS-related issues
Chapter 7: Managing Boundaries and Multiple
Relationships
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New material on changing perspectives on nonsexual multiple relationships
New material on factors to consider before entering into multiple relationships
Increased coverage of boundary crossings versus boundary violations
Revised section on managing multiple relationships in rural practice and
in small communities
New commentaries after each of the case examples
Expanded treatment of the need for ﬂexibility in establishing professional boundaries
Expanded discussion of giving and receiving gifts in therapeutic relationships
Revised section on dealing with sexual attractions in therapy
Updated and expanded coverage of the use of nonsexual touch in
therapy
xxii
Preface
Chapter 8: Professional Competence and Training
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New discussion of competence and its assessment
New material on formative assessment and summary assessment
Revised discussion of psychological ﬁtness in selecting counselor trainees
More emphasis on the importance of self-care and wellness in counselor
education programs
Revised section on evaluating knowledge, skills, and personal functioning
Inclusion of CACREP (2009) standards on core curriculum for all counseling programs and standards for retention and dismissal of students
Revision of discussion on policies and procedures of training programs
to evaluate students in personal and interpersonal ﬁtness
Updated and expanded discussion on dismissing students for nonacademic reasons
Revised and expanded section on continuing professional education
Chapter 9: Issues in Supervision and Consultation
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Increased and updated coverage of informed consent in clinical
supervision
Recent literature on ethical and effective practice of clinical supervision
New material on the roles and responsibilities of supervisors
More emphasis on self-care needs of supervisees
Revised material on legal aspects of supervision
Recent research dealing with impaired supervisees
Updated material on risk management practices for supervisors
Recent literature and expanded discussion on diversity-effective
supervision
Revised section on attending to spiritual issues in supervision
Updated and expanded discussion of multiple relationships in supervision
Recommendations for effectively dealing with multiple relationships in
supervision
Revised and updated section on ethical issues in consultation
New section on crisis and disaster consultation
Chapter 10: Issues in Theory and Practice
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Revised material on how theory is an ethical issue
Revised and updated section on assessment and diagnosis
New material on the case for diagnosis and the limitations of diagnosis
Preface
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xxiii
Expanded coverage of cultural issues in diagnosis and assessment
Revised section on the use of testing
Revised and updated discussion of ethical issues in managed care
Revised and expanded section on evidence-based practices
Chapter 11: Ethical Issues in Couples and Family Therapy
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New discussion of the family systems perspective
Increased attention to the scope of informed consent in couples and family therapy
More attention to how therapists’ values inﬂuence interventions with
couples and families
Revised and expanded section on conﬁdentiality in couples and family
therapy
Increased attention in dealing with secrets in couples and family therapy
Additional cases and case commentaries
Chapter 12: Ethical Issues in Group Work
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Updated research on the effectiveness of group counseling
Additional cases and case commentaries
New literature on training and supervision of group leaders
Revised and expanded section on ethical issues in diversity training of
group leaders
Revised and expanded section on ethical considerations in co-leadership
New material on informed consent in group work
Revised section on conﬁdentiality in group work
Increased attention on the role of leaders in preventing negative group
experiences
Updated and expanded discussion of termination issues in a group
Chapter 13: Ethical Issues in Community Work
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Updated and expanded discussion of the community mental health
perspective
New section on the social justice perspective
New section on advocacy competencies
Additional cases and case commentaries
Revised discussion on building strengths within a community
xxiv
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Preface
New section on school counselors as cultural mediators
New discussion of a developmental versus a service approach to community work
Increased coverage on the multiple and alternative roles of counselors
working in the community
Revised discussion of the tasks of community counseling
Increased emphasis on addressing the needs of underserved communities and the delivery of services in nontraditional settings
Acknowledgments
We would like to express our appreciation for the suggestions given to us
by reviewers, associates, students, and readers. The reviewers of this eighth
edition have been instrumental in making signiﬁcant changes from the earlier editions, as have the combined responses of 70 people who participated
in a web survey for Issues and Ethics in the Helping Professions. We especially
recognize the following people who reviewed the revised manuscript and
offered ideas that were incorporated into this edition:
Virginia Allen, Idaho State University
Rebecca Farrell, Morehead State University
Perry Francis, Eastern Michigan State University
Robert Haynes, Borderline Productions
Louis Jenkins, Loma Linda University
Brad Johnson, United States Naval Academy
Maureen Kenny, Florida International University
Wayne Kistner, Saddleback Community College
Margaret Miller, Boise State University
Beverly Palmer, California State University, Dominguez Hills
Terence Patterson, University of San Francisco
Mark Stebnicki, East Carolina University
We are especially grateful to those reviewers who did a follow-up review
and provided many insightful suggestions that we incorporated into the
case commentaries for all the chapters. Thank you to Brad Johnson, Maureen
Kenny, Rebecca Farrell, Mark Stebnicki, and Beverly Palmer.
We appreciate the feedback from the following people on selected chapters in this edition, based on their areas of special interest:
Chapter 3: on the role of spiritual and religious values in counseling, we thank Craig S. Cashwell and J. Scott Young, both of University
of North Carolina at Greensboro; and Allen Weber, St. Bonaventure
University. On end-of-life decisions, James L. Werth Jr. provided
commentary and critique.
Chapter 4: on ethical issues in multicultural counseling, we appreciate the contributions of Paul Pedersen, University of Hawaii; and of
Carlos P. Zalaquett, University of South Florida.
Preface
xxv
Chapters 5 and 6: we thank these three attorneys who reviewed the
material from a legal perspective: Mary Hermann, Virginia Commonwealth University; Anne Marie “Nancy” Wheeler, attorney in private
practice and consultant for the ACA Insurance Trust Risk Management Helpline; and Lisa Quinn, California State University at Fullerton. Nancy Wheeler also reviewed sections of Chapter 3.
Chapter 9: on the topic of ethical issues in consultation, we appreciate the contributions of A. Michael Dougherty, Western Carolina
University.
Chapter 10, on the topic of ethical issues in diagnosis, we acknowledge Frank Dattilio, Harvard Medical School and University of Pennsylvania School of Medicine; Barbara Herlihy, University of New
Orleans; Michael Nystul, New Mexico State University; and Carlos P.
Zalaquett, University of South Florida.
Chapter 11: on ethical issues in couples and family counseling, we
recognize Jim Bitter, East Tennessee State University; David Kleist,
Idaho State University; and Frank Dattilio, Harvard Medical School
and University of Pennsylvania School of Medicine.
Chapter 13: on ethical issues in community work, our thanks to Mark
Homan, consultant, Tucson, Arizona; Hugh Crethar, Oklahoma State
University; Chris Faiver, John Carroll University, Cleveland, Ohio;
and Carlos P. Zalaquett, University of South Florida.
We wish to recognize the following six individuals who work in the ﬁeld
of addictions treatment and who consulted with us on ethical issues in treatment of people with addictions: Betty Collins, Sally Diane, David Gafford,
Alan Massey, Mary Gordon, and Toni Wallace. They each offered valuable
perspectives on a range of ethical dimensions in addictions work that we
included in this edition.
We appreciate the members of the Brooks/Cole, Cengage Learning team
who continue to offer support for our projects. These people include Seth
Dobrin, acquisitions editor of counseling, social work, and human services;
Julie Martinez, developmental editor, who monitored the review process; Caryl
Gorska, for her work on the interior design and cover of this book; Arwen Petty,
assistant editor, for her work on the supplemental materials for the book; Trent
Whatcott, senior marketing manager; and Rita Jaramillo, project manager.
We thank Ben Kolstad of Glyph International, who coordinated the production of this book, and Kay Mikel, the manuscript editor of this edition, whose
exceptional editorial talents continue to keep this book reader friendly. We
appreciate the careful work of Susan Cunningham in preparing the index. The
efforts and dedication of these people certainly contribute to the quality of this
edition.
Gerald Corey
Marianne Schneider Corey
Patrick Callanan
Chapter
1
The Focus of This Book
Working both independently and together over the years, the three of us
have confronted a variety of professional and ethical issues that have no
clear-cut solutions. Conversations with students and colleagues describe
similar struggles. Exchanging ideas helps us deal with these issues. We are
convinced that students in the helping professions must anticipate and
be prepared for these kinds of problems before their ﬁrst ﬁeldwork experience, and certainly before they begin practicing.
We have discovered that many of the issues relevant to beginning professionals resurface and take on different meanings at various stages in a professional’s life. We try to avoid dispensing prescriptions or providing simple
solutions to complex situations. Our main purpose is to establish a basis for
you to develop a personal perspective on ethical practice within the broad
limits of professional codes and divergent theoretical positions. We raise what
we consider to be central issues, present a range of views on these issues, discuss our position, and provide you with many opportunities to reﬁne your
thinking and actively develop your own position.
As you read this book, it will be apparent that we have certain biases and
viewpoints about ethical behavior. We try to identify and clarify these stances
as our perspective rather than as universal truths. We state our position not
to sway you to adopt our views, but to help you develop your own position on
a variety of ethical and professional issues.
Identifying our own personal misconduct is far more challenging than
pointing out the misconduct of our colleagues, yet it is incumbent on each of
us to continually reﬂect on what we are doing personally and professionally.
In the end, you are responsible for your own ethical practice. Codes of ethics provide general standards, but these are not sufﬁciently explicit to deal
with every situation. It is often difﬁcult to interpret ethics codes, and opinions
differ over how to apply them in speciﬁc cases. In all cases, the welfare of the
2
Introduction
to Professional Ethics
client demands that you become familiar with the guiding principles of the
ethics codes and accepted standards of practice of your profession. You will
encounter many situations that demand the exercise of sound judgment to
further the best interests of your clients, and we recommend that you begin
to consider these issues now.
The various mental health professions have developed codes of ethics that
are binding on their members. As a professional, you are expected to know
the ethics code of your specialty and to be aware of the consequences of
practicing in ways that are not sanctioned by your professional organization.
Responsible practice requires that you use informed, sound, and responsible
judgment. It is essential to demonstrate a willingness to consult with colleagues, to keep yourself up to date through reading and continuing education, and to continually monitor your behavior.
Be prepared to reexamine many of the issues that are raised in this book
throughout your professional life. Even when you resolve some of these
ethical and professional issues at the initial stage of your development as a
counselor, these topics are likely to take on new dimensions as you gain experience. Many students think they should resolve all possible issues before
they begin to practice; this is an impossible task. The deﬁnition and reﬁnement of such concerns is an evolutionary process that requires an open mind
and continual reexamination.
Some Suggestions for Using This Book
In this book we cover the central professional and ethical issues you are likely
to encounter in your work. Our goal is to provide you with a ﬂexible framework and a direction for working through ethical dilemmas.
We frequently imagine ourselves in conversations with you, our students.
We state our own thinking and offer a commentary on how we arrived at the
3
4
Chapter 1
positions we hold. We hope you will try to integrate your own thoughts and
experiences with the positions and ethical dilemmas we raise for consideration. In this way you will absorb information, deepen your understanding,
and develop an ethical way of thinking.
We offer speciﬁc suggestions for getting the most from this book and from
your course. Many of these ideas have come from students in our classes. In
general, you will get from this book and course whatever you are willing to
invest of yourself, so it is important to clarify your goals and to think about
ways of becoming actively involved. Here are some suggestions that can help
you become an active learner.
Be prepared. You can best prepare yourself to become active in your
class by spending time reading and thinking about the questions we pose.
Completing the exercises and responding to the questions and open-ended
cases will help you focus on where you stand on controversial issues.
■
Identify your expectations. Students often have unrealistic expectations
of themselves. If you have limited experience in counseling clients, you can
think about situations in which friends sought your help and how you dealt
with them. You can also reﬂect on the times when you were experiencing conﬂicts and needed someone to help you gain clarity. This is a way to relate the
material to events in your own life.
■
Complete the self-assessment survey. The multiple-choice survey at the
end of this chapter is designed to help you discover your attitudes concerning most of the issues we deal with in the book. Take this inventory before you
read the book to determine where you stand on these issues at this time. We
suggest that you take the inventory again after you complete the book. You
can then compare your responses to see what changes, if any, have occurred
in your thinking.
■
Identify your viewpoint by reviewing the self-inventories. Each chapter begins
with an inventory designed to encourage reﬂection on the issues to be explored
in the chapter. Bring your responses to class and discuss your views with those
of fellow students. You can retake the inventory after you ﬁnish reading the
chapter to see if your views have changed.
■
Think about the examples, cases, commentaries, and questions. Many examples in this book are drawn from actual counseling practice in various settings with different types of clients. (Elements of these cases have been
changed to protect conﬁdentiality.) We ask you to consider how you might
have worked with a given client or what you might have done in a particular counseling situation. We provide our commentary on each of the cases to
guide you in clarifying the speciﬁc issues involved and in helping you think
about the course of action you might take for each case presented. We also
provide illustrations of possible therapist responses to the various ethical
dilemmas in the cases, not all of which are ethical or appropriate. Reﬂect on
our commentaries and the questions raised as you respond to the cases in
each chapter.
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Introduction to Professional Ethics
5
Terminology. In the wide variety of mental health professions covered
in this book, professional mental health workers are designated by a variety of terms: mental health professional, practitioner, therapist, counselor, social
worker, school counselor, rehabilitation counselor, addictions counselor, community worker, couples and family therapist, helper, and clinician. Throughout
this book, we generally use these terms interchangeably, reﬂecting the
differing nomenclature of the various professions. Substitute your own
profession’s terminology in speciﬁc cases to make the information more
meaningful to you.
■
Do the end-of-chapter suggested activities. Each chapter ends with suggested activities intended to help you integrate and apply what you have
learned. These exercises challenge you to be active both in class and on your
own, and they give you a chance to apply your ideas about the issues to various situations.
■
Involve yourself in thinking about the issues we raise. Focus on the questions, cases, commentaries, and activities that have the most meaning for
you at this time, and remain open to new issues as they assume importance for you. Strive to develop your thoughts and positions on the ethical dilemmas presented. As you become actively involved in your ethics
course, you will discover additional ways to look at the process of ethical
decision making.
Professional Codes of Ethics
Various professional organizations (counseling, social work, psychiatry,
psychology, marriage and family therapy, human services) have established
codes of ethics that provide broad guidelines for mental health practitioners. (A box at the end of the chapter titled “Professional Organizations
and Codes of Ethics” lists 17 professional organizations with links to their
websites.) The codes of these national professional organizations have similarities, and they also have differences. In addition, national certiﬁcation
boards, other professional associations, specialty areas within the counseling
profession, and state regulatory boards all have their own ethics or professional practice documents. Specialty guidelines are available to cover
areas not adequately addressed by the general ethics codes. For example,
the American Psychological Association (APA) has some of the following
specialty guidelines:
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Guidelines for providers of psychological services to ethnic, linguistic,
and culturally diverse populations (APA, 1993)
Guidelines for psychotherapy with lesbian, gay, and bisexual clients
(APA, 2000)
Guidelines on multicultural education, training, research, practice, and
organizational change for psychologists (APA, 2003a)
6
Chapter 1
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Guidelines for psychological practice with older adults (APA, 2004)
Evidence-based practice in psychology (APA Presidential Task Force, 2006)
Record keeping guidelines (APA, 2007)
The National Association of Social Workers (NASW) also has developed
some practice guidelines, two of which are especially helpful in the area of
end-of-life care:
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Client self-determination in end-of-life decisions (NASW, 2003)
NASW standards for social work practice in palliative and end-of-life
care (NASW, 2004)
Publications by the various professional organizations contain many
resources to help you understand the issues underlying the ethical decisions
you will be making in your professional life.
Common Themes of Codes of Ethics
Each major mental health professional organization has its own code of
ethics, and we strongly recommend that you obtain a copy of the ethics code
of the profession you are planning to enter and familiarize yourself with their
basic standards for ethical practice. Pleading ignorance of the speciﬁcs of the
ethics code of one’s profession is not an excuse when engaging in unethical behavior. The ethics codes offered by most professional organizations are
broad and general, rather than precise and speciﬁc. These codes do not provide speciﬁc answers to the ethical dilemmas you will encounter, but they do
offer general guidance. Although there are speciﬁc differences among the
ethics codes of the various professional organization, Koocher and KeithSpiegel (2008) note a number of similar themes:
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Promoting the welfare of consumers
Practicing within the scope of one’s competence
Doing no harm
Protecting client’s conﬁdentiality and privacy
Acting ethically and responsibly
Avoiding exploitation
Upholding the integrity of the profession by striving for aspirational
practice
Limitations of Codes of Ethics
Your own ethical awareness and problem-solving skills will determine how
you translate the various ethics codes into professional behavior. As Welfel
(2010) indicates, codes of ethics are not cookbooks for responsible professional
behavior; they do not provide recipes for healthy ethical decision making. Indeed, ethics codes offer unmistakably clear guidance for only a few
Introduction to Professional Ethics
7
problems. For example, the APA’s (2002) ethics code is quite clear that it
neither provides all the answers nor speciﬁcally addresses every dilemma
that may confront a practitioner. In short, ethics codes are necessary, but
not sufﬁcient, for exercising ethical responsibility. It is essential that you be
aware of the limitations of such codes (see Herlihy & Corey, 2006a; Herlihy &
Remley, 1995; Pope & Vasquez, 2007). Here are some limitations and problems
you might encounter as you strive to be ethically responsible:
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Some issues cannot be handled solely by relying on ethics codes.
Some codes lack clarity and precision, which makes assessment of an
ethical dilemma unclear.
Simply learning the ethics codes and practice guidelines will not necessarily make for ethical practice.
Conﬂicts sometimes emerge within ethics codes as well as among various organizations’ codes.
Practitioners who belong to multiple professional associations, are
licensed by their state, and hold national certiﬁcations may be responsible to practice within the framework of numerous codes of ethics, yet
these codes may not be uniform.
Ethics codes tend to be reactive rather than proactive.
A practitioner’s personal values may conﬂict with a speciﬁc standard
within an ethics code.
Codes may conﬂict with institutional policies and practices.
Ethics codes need to be understood within a cultural framework; therefore, they must be adapted to speciﬁc cultures.
Codes may not align with state laws or regulations regarding reporting
requirements.
Because of the diverse viewpoints within any professional organization, not
all members will agree with all elements of an organization’s ethics code.
In the Code of Ethics of the National Association of Social Workers (2008), the
limits of the code are succinctly described:
Text not available due to copyright restrictions
The code of ethics for the Canadian Counselling Association (2007) makes
it clear that professionals are challenged to make sound decisions based on
their own values:
Although a Code of Ethics is essential to the maintenance of ethical integrity
and accountability, it cannot be a substitute for the active process of ethical
8
Chapter 1
decision-making. Members increasingly confront challenging ethical demands
and dilemmas in a complex and dynamic society to which a simple and direct
application of this code may not be possible. Also, reasonable differences of
opinion can and do exist among members with respect to how ethical principles
and values should be rank-ordered when they are in conﬂict. Therefore, members must develop the ability and the courage to exercise a high level of ethical
judgement. (Preamble.)
Using Ethics Codes as Guides
Ethics codes are not intended to be blueprints for resolving every ethical
dilemma; nor do they remove all need for judgment and ethical reasoning.
Formal ethical principles can never be substituted for an active, deliberative,
and creative approach to meeting ethical responsibilities (Pope & Vasquez,
2007). Ethics codes cannot be applied in a rote manner because each client’s
situation is unique and calls for a different solution. When practitioners
weigh multiple and often competing demands and goals, they must use
their professional judgment (Barnett, Behnke, Rosenthal, & Koocher, 2007).
Handelsman, Gottlieb, and Knapp (2005) remind us that becoming an ethical practitioner is a more complex process than simply following a set of
rules. Becoming a professional is somewhat like learning to adjust to a different culture, and both students and professionals experience an ethical
acculturation process. Handelsman and colleagues recommend that ethics
courses provide opportunities for students to explore their acculturation
and begin to develop an ethical identity. Handelsman and colleagues add
that “ethics is the study of right and wrong but is often taught as the study
of wrong. Many ethics courses are devoted to laws, disciplinary codes, and
risk management strategies and do not focus on best practices” (p. 59). From
our perspective, practitioners are faced with assuming the responsibility of
making ethical decisions and ultimately taking responsibility for the outcomes. This process takes time, and it should include consultation.
Herlihy and Corey (2006a) suggest that codes of ethics fulﬁll three objectives.
The ﬁrst objective is to educate professionals about sound ethical conduct. Reading
and reﬂecting on the standards can help practitioners expand their awareness
and clarify their values in dealing with the challenges of their work. Second, ethical standards provide a mechanism for professional accountability. Practitioners are
obliged not only to monitor their own behavior, but also to encourage ethical
conduct in their colleagues. One of the best ways for practitioners to guard the
welfare of their clients or students and to protect themselves from malpractice
suits is to practice within the spirit of the ethics codes. Third, codes of ethics serve
as catalysts for improving practice. When practitioners must interpret and apply
the codes in their own practices, the questions raised help to clarify their positions on dilemmas that do not have simple or absolute answers.You can imagine
the chaos if people were to practice without guidelines so that the resolution of
ethical dilemmas rested solely with the individual clinician.
Introduction to Professional Ethics
9
We must never forget that the primary purpose of a code of ethics is to
safeguard the welfare of clients by providing what is in their best interest.
Ethics codes are also designed to safeguard the public and to guide professionals in their work so that they can provide the best service possible. The
community standard (what professionals actually do) is generally less rigorous
than the ethical standard (what professionals should do). It is important to be
knowledgeable of what others in your local area and subspecialties are doing
in their practices.
Bersoff (2003a) makes a distinction between the ideal and realistic purpose
of a code of ethics. Ideally, ethics codes provide guidance in resolving moral
problems encountered by members of the profession:
Realistically, however, what a code of ethics does is validate the most recent
views of a majority of professionals empowered by their colleagues to make
decisions about ethical issues. Thus, a code of ethics is, inevitably, anachronistic,
conservative, ethnocentric, and the product of political compromise. But recognition of that reality should not inhibit the creation of a document that fully
realizes and expresses fundamental moral principles. (p. 1)
At this point, what do you think it takes to be an ethical professional? Is it
primarily knowing and following the ethics code of your profession? What
else does it take to be an ethical practitioner? You may ﬁnd that you answer
differently depending on the situation.
Ethics Codes and the Law
Ethical issues in the mental health professions are regulated by both laws
and professional codes. The Committee on Professional Practice and Standards (2003) of the American Psychological Association differentiates between
ethics and law as follows: Ethics pertains to the standards that govern the
conduct of its professional members; law is the body of rules that govern the
affairs of people within a community, state, or country. Laws deﬁne the minimum standards society will tolerate, which are enforced by government. An
example of a minimum standard is the legal obligation mental health professionals have to report suspected child abuse. All of the codes of ethics state
that practitioners are obligated to act in accordance with relevant federal and
state statutes and government regulations. It is essential that practitioners be
able to identify legal problems as they arise in their work, because many of
the situations they encounter that involve ethical and professional judgment
will also have legal implications.
Remley and Herlihy (2010) note that counselors sometimes have difﬁculty determining when there is a legal problem, or what to do with a legal
issue once it has been identiﬁed. To clarify whether a legal issue is involved,
Remley and Herlihy suggest assessing the situation to determine if any of
the following apply: (a) legal proceedings have been initiated, (b) lawyers
10
Chapter 1
are involved, or (c) the practitioner is in danger of having a complaint ﬁled
against him or her for misconduct. When confronted with a legal issue, it is
important to consult a lawyer to determine which course of action to take.
Remley and Herlihy do not advise consulting with counselor colleagues
about how to deal with legal problems, because counselors do not have
expertise in legal matters.
One of the reviewers of this book, Mary Hermann, an attorney and counselor educator, teaches a course in legal and ethical issues in counseling.
She ﬁnds that her students get frustrated because they expect her to provide them with concrete answers to legal problems. Hermann believes that
much of the time even legal scholars can only speculate about the answers to
these questions. Stating this reality immediately helps to get students thinking about their options and making the best choices they can make under the
circumstances rather than searching for some mythical “right answer” to a
legal issue (personal communication, January 30, 2009).
To avoid legal ambiguities, some professionals increasingly limit their
scope of practice and the range of clients they will work with to reduce
their fear of a possible lawsuit. This raises a potential ethical issue of delivering less than effective services, especially if this narrowing of available
options to clients is not clearly expressed during the initial interview. In
situations such as this, “high-risk clients” may not have access to services
they need.
Laws and ethics codes tend to emerge from what has occurred rather than
from anticipating what may occur. Limiting your scope of practice to obeying statutes and following ethical standards is inadequate. It is important to
acquire an ethical sense of striving for the highest level of functioning at the
beginning of your professional program. It is well to remember that the basic
purpose of practicing ethically is to further the welfare of your clients (you
will hear this many times throughout this book).
At times you may encounter conﬂicts between the law and ethical principles, or competing ethical standards may appear to require incompatible
courses of action (Barnett & Johnson, 2010). In these cases the values of the
counselor come into play. Conﬂict between ethics codes and the law may
arise in areas such as advertising, conﬁdentiality, and clients’ rights of access
to their own ﬁles. The APA’s Committee on Professional Practice and Standards (2003) suggests that if obeying one’s professional code of ethics would
result in disobeying the law, it is essential to seek legal advice. A licensed
mental health professional might also contact his or her state licensing board
for consultation. On this point, the National Association of Social Workers
(2008) guideline is clear:
Text not available due to copyright restrictions
Introduction to Professional Ethics
11
When laws and ethics collide, Knapp, Gottlieb, Berman, and Handelsman
(2007) state that practitioners need ﬁrst to verify what the law requires and
determine the nature of their ethical obligations. At times, practitioners do
not understand their legal requirements and may assume a conﬂict exists
between the law and ethics when there is no such conﬂict. If there is a real
conﬂict between the law and ethics, and if the conﬂict cannot be avoided,
“psychologists should either obey the law in a manner that minimizes harm
to their ethical values or adhere to their ethical values in a manner that
minimizes the violation of the law” (p. 55). They add that apparent conﬂicts
between the law and ethics can often be avoided if clinicians anticipate problems in advance and take proactive measures.
One example of a potential conﬂict between legal and ethical standards
involves counseling minors. This is especially true as it pertains to counseling children or adolescents in school settings. Counselors may be committed to following ethical standards in maintaining the conﬁdentiality of
the sessions with a minor, yet at times parents/legal guardians may have
a legal right to information that is disclosed in these sessions. Practitioners will often struggle between doing what they believe to be ethically
appropriate for their client and their legal responsibilities to parents/legal
guardians.
In ethical dilemmas involving legal issues, it is imperative to seek advice
from legal counsel and discuss the issues with colleagues familiar with
the law (Remley, 1996). In those cases where neither the law nor an ethics
code resolves an issue, therapists are advised to consider other professional
and community standards and their own conscience as well. This subject is
addressed more fully in Chapters 5 and 6.
Evolution of Ethics Codes
Codes of ethics are established by professional groups for the purpose
of protecting consumers, providing guidelines for practitioners, and clarifying the professional stance of the organizations. As such, these codes do
not convey ultimate truth, nor do they provide ready-made answers for
the ethical dilemmas practitioners must face. Ethics codes undergo periodic revisions. For instance, the current American Counseling Association (ACA) (2005) and APA (2002) ethics codes replace codes from 10 years
earlier.
In addition to codes of ethics, some professional organizations also
provide casebooks, which interpret and explain various ethical standards
contained with the code. Three examples are A Guide to the 2002 Revision
of the American Psychological Association’s Ethics Code (Knapp & VandeCreek,
2003a), The Social Work Ethics Casebook: Cases and Commentary (Reamer, 2008),
and ACA Ethical Standards Casebook (Herlihy & Corey, 2006a). Two excellent
desk reference manuals are also available: Ethics Desk Reference for Psychologists (Barnett & Johnson, 2008), which interprets the APA code and provides
12
Chapter 1
guidelines for ethical and effective practice; and Ethics Desk Reference for
Counselors (Barnett & Johnson, 2010), which interprets the ACA code and
offers recommendations for preventing ethical problems. However useful
these casebooks and desk reference manuals may be, they can never
replace the informed judgment and goodwill of the individual counselor.
We emphasize again the need for a level of ethical functioning higher than
merely following the letter of the law or the code. For instance, you might
avoid a lawsuit or professional censure by ignoring cultural diversity, but
many of your ethnically diverse clients would likely suffer from your insensitive professional behavior.
Walden, Herlihy, and Ashton (2003) surveyed ACA Ethics Committee
chairs in addressing the evolution of ethics codes. One trend emerging as
a future issue in the ﬁeld of counseling ethics relates to cultural considerations and a continued emphasis on the role of diversity in counseling
practice. The ethics chairs surveyed predicted the development of a culturally competent code of ethics, increased globalization of counseling, and
health care models that take into account the place of diversity in counseling. Other emerging issues that were perceived as necessary to consider
in revising ethics codes included the inﬂuence of technology on counseling and proactively addressing the impaired professional. Walden and her
colleagues concluded that it is important that codes of ethics be evolving
documents that are responsive to the needs of counselors, the clients they
serve, and society in general.
Professional Monitoring of Practice
The legal and ethical practice of most mental health professionals is regulated in all 50 states. State licensing laws establish the scope of practice of
professionals and how these laws will be enforced by licensing boards. State
licensing boards have the task of monitoring the conduct of professionals
they have licensed (Koocher & Keith-Spiegel, 2008). Some psychotherapy professions are regulated through registration and certiﬁcation; others, such as
social workers, marriage and family therapists, professional counselors, and
psychologists, are regulated through licensure. The major duties of regulating boards are (1) to determine standards for admission into the profession,
(2) to screen applicants applying for certiﬁcation or licensure, (3) to regulate
the practice of psychotherapy for the public good, and (4) to conduct disciplinary proceedings involving violations of standards of professional conduct
as deﬁned by law. Mental health professionals can lose their certiﬁcation or
license if their state regulating board ﬁnds that they have engaged in unethical practice or illegal behavior.
In addition to state regulatory boards, most professional organizations
have ethics committees—elected or delegated bodies that oversee the conduct of members of the organization. The main purposes of these ethics
Introduction to Professional Ethics
13
committees are to educate the association’s membership about ethics codes
and to protect the public from unethical practices. These committees meet
regularly to process formal complaints against individual members of the
professional organization. Ethics committees also revise and update their
organization’s code of ethics.
When necessary, practitioners must explain to clients how to lodge an ethical complaint. When a complaint is lodged against a member, the committee
launches an investigation and deliberates on the case. Eventually, a disposition is reached. The complaint may be dismissed, speciﬁc charges within the
complaint may be dismissed, or the committee may ﬁnd that ethical standards have been violated and impose sanctions. Possible sanctions include
a reprimand; a recommendation that a speciﬁc course of remedial action be
taken, such as obtaining ongoing supervision or personal therapy; probation or suspension for a speciﬁed period of time; a recommendation that the
member be allowed to resign from the organization; or a recommendation
that the member be expelled.
Expulsion or suspension of a member is a major sanction. Members have
the right to appeal the committee’s decision. Once the appeals process has
been completed or the deadline for appeal has passed, the sanctions of suspension and expulsion are communicated in writing to the members of the
professional organization. Practitioners who are expelled from the association may also face the loss of their license or certiﬁcate to practice, but only
if the state board conducts an independent investigation. Cases that result in
expulsion are often serious enough to involve law enforcement and criminal
charges. Many cases also result in civil court proceedings, which are usually
published in the local press.
How effective are ethics committees of professional organizations in monitoring professional practice and protecting consumers? Koocher and KeithSpiegel (2008) question their effectiveness and identify some speciﬁc criticisms
of ethics committees:
■
■
■
■
■
■
Conﬂict of interests or bias among committee members
Lack of training and experience of ethics committee members to adequately carry out their functions
Excessive time taken to adjudicate cases, resulting in harm to consumers
Failure to follow due process
Timid procedures due to fear of lawsuits
Reactive rather than proactive stances
Mental health professionals facing ethics violations are at times not
given fair treatment, and they may take action against the ethics committee.
Koocher and Keith-Spiegel state: “Frustrated complainants are increasingly
contacting lawyers or the media when sources of redress are inefﬁcient or
reach unwelcome conclusions” (p. 50).
14
Chapter 1
Ethical Decision Making
Some Key Terms
Although values and ethics are frequently used interchangeably, the two
terms are not identical. Values pertains to beliefs and attitudes that provide
direction to everyday living, whereas ethics pertains to the beliefs we hold
about what constitutes right conduct. Ethics are moral principles adopted by
an individual or group to provide rules for right conduct. Morality is 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.
Ethics represents aspirational goals, or the maximum or ideal standards
set by the profession, and they are enforced by professional associations,
national certiﬁcation boards, and government boards that regulate professions (Remley, 1996). Codes of ethics are conceptually broad in nature
and generally subject to interpretation by practitioners. Although these
minimum and maximum standards may differ, they are not necessarily in
conﬂict.
Community standards (or mores) vary on interdisciplinary, theoretical,
and geographical bases. The standard for a counselor’s social contact with
clients may be different in a large urban area than in a rural area, or between
practitioners employing a humanistic versus a behavioral approach. Community standards often become the ultimate legal criteria for determining
whether practitioners are liable for damages. Community standards deﬁne
what is considered reasonable behavior when a case involving malpractice is litigated. Courts have consistently found that mental health care
providers have a duty to exercise a reasonable degree of skill, knowledge,
and care. Reasonableness is usually deﬁned as the care that is ordinarily exercised by others practicing within that specialty in the professional
community.
Professionalism has some relationship to ethical behavior, yet it is possible to act unprofessionally and still not act unethically. For instance, not
returning a client’s telephone calls promptly might be viewed as unprofessional, but it would probably not be considered unethical unless the client
were in crisis.
Some situations cut across these concepts. For example, sexual intimacy
between counselors and clients is considered unethical, unprofessional,
immoral, and illegal. Keep the differences in the meanings of these various
concepts in mind as you read.
Levels of Ethical Practice
One way of conceptualizing professional ethics is to contrast mandatory
ethics with aspirational ethics. Mandatory ethics describes a level of ethical
functioning wherein counselors act in compliance with minimal standards,
Introduction to Professional Ethics
15
acknowledging the basic “musts” and “must nots.” The focus is on behavioral
rules, such as providing for informed consent in professional relationships.
Aspirational ethics describes the highest standards of thinking and conduct
professional counselors seek, and it requires that counselors do more than
simply meet the letter of the ethics code. It entails an understanding of the
spirit behind the code and the principles on which the code rests. Practitioners who comply at the ﬁrst level, mandatory ethics, are generally safe from
legal action or professional censure. Courts of law and state licensure boards
now require minimal standards to which all mental health professionals will
be held accountable. At the higher level of ethical functioning, aspirational
ethics, practitioners go further and reﬂect on the effects their interventions
may have on the welfare of their clients. An example of aspirational ethics is providing services for no fees (pro bono) for those in the community
who cannot afford needed services. In the most recent revision of the ACA’s
(2005) Code of Ethics, each section begins with an introduction, which sets the
tone and addresses what counselors should aspire to with regard to ethical
practice.
When the word unethical is used, people think of extreme violations
of established codes. In reality, most violations of ethics probably happen
quite inadvertently in clinical practice. The ethics codes of most professional organizations require practitioners to engage in self-monitoring
and to take responsibility for misconduct. Welfel (2005) indicates that the
professional literature focuses on preventing misconduct and on responding
to serious ethical violations. However, the literature has not offered much
guidance regarding minor infractions committed by professionals. Welfel
states that by taking minor ethical violations seriously and by seeking
honest ways to remediate such infractions, counselors can demonstrate
their professionalism and personal commitment to beneﬁting those they
serve.
Welfel’s (2005) model progresses from awareness, through reﬂection, to a
plan of action whereby counselors can ethically repair damage when they
recognize they have violated ethics codes in minor ways. She emphasizes that
the ﬁrst step in recovering from an ethical violation is for the practitioner to
recognize that he or she has acted in a way that is likely to be ethically problematic. If a practitioner is not aware of the subtle ways his or her behavior
can adversely affect the client, such behavior can go unnoticed, and the client
will suffer. For instance, a professional who is struggling ﬁnancially in her
private practice may prolong the therapy of her clients and justify her actions
on theoretical grounds. She is likely to ignore the fact that the prolongation of
therapy is inﬂuenced by her ﬁnancial situation.
Practitioners can easily ﬁnd themselves in an ethical quagmire based on
competing role expectations. The best way to maintain a clear ethical position is to focus on your clients’ best interests. School counselors may be so
focused on academic and scheduling issues that they do not reach out to
the community and develop the network with other helping professionals needed to make productive referrals for families and students in crises.
16
Chapter 1
In school systems teachers and others sometimes label students and families
as dysfunctional or unmotivated. The counselor needs to advocate and help
others look for strengths and reframe limitations if progress is to be made.
The counselor can be an ethical model in a system where ethics is not given
much consideration.
Clients’ needs are best met when practitioners monitor their own ethics.
Ethical violations may go undetected because only the individual who committed the violation knows about it. Rather than just looking at others and
proclaiming “That’s unethical!” we encourage you to honestly examine your
own thinking and apply guidelines to your behavior by asking yourself, “Is
what I am doing in the best interests of my clients? Would the codes of my
professional organization agree?”
Principle Ethics and Virtue Ethics
Several writers have developed models for ethical decision making, including Barnett and Johnson (2008, 2010), Cottone (2001), Cottone and Claus (2000),
Cottone and Tarvydas (2007), Frame and Williams (2005), Hill, Glaser, and
Harden (1995), Jordan and Meara (1990), Kitchener (1984), Koocher and KeithSpiegel (2008), Meara, Schmidt, and Day (1996), Smith, McGuire, Abbott, and
Blau (1991), and Welfel (2010). This section is based on an amalgamation of
elements from these various models and our own views.
In a major article titled “Principles and Virtues: A Foundation for Ethical Decisions, Policies, and Character,” Meara, Schmidt, and Day (1996)
differentiate between principle ethics and virtue ethics. Principle ethics
is a set of obligations and a method that focuses on moral issues with the
goals of (a) solving a particular dilemma or set of dilemmas and (b) establishing a framework to guide future ethical thinking and behavior. Principles
typically focus on acts and choices, and they are used to facilitate the selection of socially and historically acceptable answers to the question “What
shall I do?”
A thorough grounding in principle ethics opens the way for another
important perspective, virtue ethics. Virtue ethics focuses on the character traits of the counselor and nonobligatory ideals to which professionals aspire rather than on solving speciﬁc ethical dilemmas. Simply stated,
principle ethics asks “Is this situation unethical?” whereas virtue ethics asks
“Am I doing what is best for my client?” Even in the absence of an ethical
dilemma, virtue ethics compels the professional to be conscious of ethical
behavior. Meara and her colleagues maintain that it is not a question of
subscribing to one or the other form of ethics. Rather, professional counselors should strive to integrate virtue ethics and principle ethics to reach
better ethical decisions and policies.
According to the Canadian Counselling Association (CCA, 2007), the virtue ethics approach is based on the belief that counselors are motivated to
be virtuous and caring because they believe it is the right thing to do. Virtue
Introduction to Professional Ethics
17
ethics emphasizes the counselor’s responsibility in making complex ethical decisions. The CCA ethics code suggests asking the following questions
when making virtue-based ethical decisions:
■
■
■
■
■
What emotions and intuition am I aware of as I consider this ethical
dilemma, and what are they telling me to do?
How can my values best show caring for the client in this situation?
How will my decision affect other relevant individuals in this ethical
dilemma?
What decision would I feel best about publicizing?
What decision would best deﬁne who I am as a person?
Some mental health practitioners concern themselves primarily with avoiding
malpractice suits. They tend to commit themselves to a rule-bound approach
to ethics as a way to stay out of trouble. Other professionals, although concerned with avoiding litigation, are ﬁrst and foremost interested in doing
what is best for their clients. These professionals would consider it unethical
to use techniques that might not result in the greatest beneﬁt to their clients
or to use techniques in which they were not thoroughly trained, even though
these techniques might not lead to a lawsuit.
Meara and colleagues (1996) identify four core virtues—prudence, integrity, respectfulness, and benevolence—that are appropriate for professionals
to adhere to in making ethical decisions. They also describe ﬁve characteristics of virtuous professionals, which they see as being at the heart of virtue
ethics.
■
■
■
■
■
Virtuous agents are motivated to do what is right because they judge
it to be right, not just because they feel obligated or fear the consequences.
Virtuous agents rely on vision and discernment, which involve sensitivity, judgment, and understanding that lead to decisive action.
Virtuous agents have compassion and are sensitive to the suffering of
others. They are able to take actions to reduce their clients’ pain.
Virtuous agents are self-aware. They know how their assumptions, convictions, and biases are likely to affect their interactions with others.
Virtuous agents are connected with and understand the mores of their
community and the importance of community in moral decision making, policy setting, and character development. They understand the
ideals and expectations of their community.
Virtue ethics focuses on ideals rather than obligations and on the character
of the professional rather than on the action itself. To meet the goals, ideals,
and needs of the community being served, consider both principles and
virtues because both are important elements in thinking through ethical
concerns.
18
■
Chapter 1
A Case Illustrating Virtue Ethics.
Your client, Kevin, is making good progress in his counseling with you.
Then he informs you that he has lost his job and will not be able to continue seeing you because of his inability to pay your fees. Here is how
four different therapists handled a similar situation:
Therapist A: I’m sorry but I can’t continue seeing you without payment. I’m giving you the name of a local community clinic that
provides low-cost treatment.
Therapist B: I don’t usually see people without payment, but I
appreciate the difﬁculty you ﬁnd yourself in through no fault of
your own. I’ll continue to see you, and you pay whatever portion of my fee you can afford. In addition I want you to seek out
a community agency and do volunteer work in lieu of the full
payment.
Therapist C: I suggest that you put therapy on hold until you can
ﬁnancially afford it.
Therapist D: I can’t afford to see you without payment, but I am
willing to suggest an alternative plan. Continue writing in your
journal, and once a month I will see you for half an hour to discuss your journal. You pay what you can afford for these sessions.
When your ﬁnancial situation has been corrected, we can continue
therapy as usual.
How do you react to the various therapists’ responses? Which
response appeals to you and why? Can you think of another response?
Would you be willing to see a client without payment? Why or why not?
Do you have concerns about the responses of any of these therapists?
In considering what you might do if you were the therapist in this
case, reﬂect on the standards pertaining to pro bono services found in
the ethics codes of NASW (2008), ACA (2005), and APA (2002). All three
codes encourage practitioners to contribute to society by devoting a
portion of their professional time and skills to services for which there
is no expectation of signiﬁcant ﬁnancial return.
Text not available due to copyright restrictions
Introduction to Professional Ethics
19
Text not available due to copyright restrictions
Moral Principles to Guide Decision Making
Building on the work of others, especially Kitchener (1984), Meara and
colleagues (1996) describe six basic moral principles that form the foundation of functioning at the highest ethical level as a professional: autonomy,
nonmaleﬁcence, beneﬁcence, justice, ﬁdelity, and veracity. Applying these ethical
principles and the related ethical standards is not as simple as it may seem,
especially when dealing with culturally diverse populations. (See Chapters
4 and 13 for more on this issue.) These moral principles involve a process
of striving that is never fully complete. We describe each of these six basic
moral principles, cite a speciﬁc ethical guideline from the ACA, APA, or
NASW, and provide a brief discussion of the cultural implications of using
each principle.
Autonomy refers to the promotion of self-determination, or the freedom of clients to be self-governing within their social and cultural framework. Respect for autonomy entails acknowledging the right of another to
choose and act in accordance with his or her wishes, and the professional
behaves in a way that enables this right of another person. Practitioners strive
to decrease client dependency and foster client empowerment. The ACA’s
(2005) introduction to Section A states it this way:
■
Counselors encourage client growth and development in ways that foster the
interest and welfare of clients and promote formation of healthy relationships. Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve. Counselors also explore their own cultural
identities and how these affect their values and beliefs about the counseling
process.
The helping services in the United States are typically based on traditional
Western values of individualism, independence, interdependence, selfdetermination, and making choices for oneself. It often appears as though
Western cultures promote individualism above any other cultural value.
20
Chapter 1
However, many cultures follow a different path, stressing decisions with the
welfare of the family and the community as a priority. As the ACA standard
described here implies, ethical practice involves considering the inﬂuence of
cultural variables in the counseling relationship.
We cannot apply a rigid yardstick of what is a value priority in any culture without exploring how a particular client views priorities. For instance,
what are the implications of the principle of autonomy when it is applied to
clients who do not place a high priority on the value of being autonomous?
Does it constitute an imposition of values for counselors to steer clients
toward autonomous behavior when such behavior could lead to problems
with others in their family, community, or culture? What about promoting
autonomy for those incapable of it (for example, dependent youths)?
Nonmaleficence means avoiding doing harm, which includes refraining from actions that risk hurting clients. Professionals have a responsibility
to minimize risks for exploitation and practices that cause harm or have the
potential to result in harm. The APA (2002) principle states,
■
Psychologists strive to beneﬁt those with whom they work and take care to do
no harm.
What are the cultural implications of the principle of nonmaleﬁcence? Traditional diagnostic practices can be inappropriate for certain cultural groups.
For instance, a therapist may assign a diagnostic label to a client based on a
pattern of behavior the therapist judges to be abnormal, such as inhibition of
emotional expression, hesitation to confront, being cautious about selfdisclosing, or not making direct eye contact while speaking. Yet these behaviors may be considered normal in certain cultures. Another example may be
a school counselor who inappropriately labels a boy ADHD, which may color
the perceptions of other staff members in a negative way so they pressure the
parents to put the boy on medication. Practitioners need to develop cultural
awareness and sensitivity in using assessment, diagnostic, and treatment
procedures.
Beneficence refers to doing good for others and to promoting the wellbeing of clients. Beneﬁcence also includes doing good for society. Ideally,
counseling contributes to the growth and development of clients within their
cultural context. Whatever practitioners do can be judged against this criterion. The following ACA (2005) guideline illustrates beneﬁcence:
■
The primary responsibility of counselors is to respect the dignity and to promote the welfare of clients. (A.1.a.)
Consider the possible consequences if a therapist encourages a Vietnamese client to behave more assertively toward his father. The reality of this situation may be that the father would refuse to speak again to a son who
confronted him. Even though counselors may be operating with good intentions and may think they are being beneﬁcent, they may not always be doing
what is in the best interest of the client. Is it possible for counselors to harm
Introduction to Professional Ethics
21
clients unintentionally by encouraging a course of action that has negative
consequences? How can counselors know what is in the best interest of their
clients? How can counselors determine whether their interventions will lead
to growth and development in their clients? As we have previously stated,
there are no simple answers to complex questions.
Justice means to be fair by giving equally to others and to treat others
justly. Practitioners have a responsibility to provide appropriate services to
all clients. Everyone, regardless of age, sex, race, ethnicity, disability, socioeconomic status, cultural background, religion, or sexual orientation, is entitled to equal access to mental health services. An example might be a social
worker making a home visit to a parent who cannot come to the school
because of transportation, child care matters, or poverty. NASW’s (2008)
guideline illustrates this principle:
■
Text not available due to copyright restrictions
Traditional mental health services may not be just and fair to everyone in a
culturally diverse society. If intervention strategies are not relevant to some
segments of the population, justice is being violated. How can practitioners
adapt the techniques they use to ﬁt the needs of diverse populations? How
can new helping strategies be developed that are consistent with the worldview of culturally different clients?
Fidelity means that professionals make realistic commitments and
keep these promises. This entails fulﬁlling one’s responsibilities of trust
in a relationship. ACA’s (2005) code encourages counselors to inform clients about counseling and to be faithful in keeping commitments made to
clients:
■
Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and
verbally with clients the rights and responsibilities of both the counselor and
the client. Informed consent is an ongoing part of the counseling process and
counselors appropriately document discussions of informed consent throughout the counseling relationship. (A.2.a.)
Fidelity involves creating a trusting and therapeutic relationship in which
people can search for solutions. However, what about clients whose culture
teaches them that counselors are experts whose job is to provide answers
for speciﬁc problem situations? What if a client expects the counselor to
22
Chapter 1
behave in this way? If the counselor does not meet the client’s expectations,
is trust being established?
Veracity means truthfulness, which involves the practitioner’s obligation
to deal honestly with clients. Unless practitioners are truthful with their clients,
the trust required to form a good working relationship will not develop.
An example of the principle of veracity is found in the Code of Ethics of the
Association for Addiction Professionals (NAADAC, 2008):
■
I understand that effectiveness in my profession is largely based on the ability to be worthy of trust, and I shall work to the best of my ability to act
consistently within the bounds of a known moral universe, to faithfully fulﬁll the terms of both personal and professional commitments, to safeguard
ﬁduciary relationships consistently, and to speak the truth as it is known to me.
(Principle 4.)
The six principles discussed here are a good place to start in determining
the degree to which your practice is consistent with promoting the welfare
of the clients you serve. To the list above, Barnett (2008) adds self-care, which
involves taking adequate care of ourselves so that we are able to implement
the preceding virtues. If mental health professionals fail to practice self-care,
their ability to effectively implement the other principles will be impaired
(Barnett, Johnston, & Hillard, 2006).
Steps in Making Ethical Decisions
When making ethical decisions, ask yourself these questions: “Which values
do I rely on and why? How do my values affect my work with clients?” When
making ethical decisions, the National Association of Social Workers (2008)
cautions you to be aware of your clients’ as well as your own personal values, cultural and religious beliefs, and practices. Acting responsibly implies
recognizing any conﬂicts between personal and professional values and
dealing with them effectively. The American Counseling Association’s (2005)
Code of Ethics states that when counselors encounter an ethical dilemma
they are expected to carefully consider an ethical decision-making process.
To make sound ethical decisions, it is necessary to slow down the decisionmaking process and engage in an intentional course of ethical deliberation,
consultation, and action (Barnett & Johnson, 2010). Although no one ethical
decision-making model is most effective, mental health professionals need to
be familiar with at least one of the following models or an amalgam that best
ﬁts for them.
Ethical decision making is not a purely cognitive and linear process that
follows clearly deﬁned and predictable steps. Indeed, it is crucial to acknowledge that emotions play a part in how you make ethical decisions. As a practitioner, your feelings will likely inﬂuence how you interpret both your client’s
behavior and your own behavior. Furthermore, if you are uncomfortable with
an ethical decision and do not adequately deal with this discomfort, it will
Introduction to Professional Ethics
23
certainly inﬂuence your future behavior with your client. An integral part
of recognizing and working through an ethical concern is discussing your
beliefs and values, motivations, feelings, and actions with a supervisor or a
colleague.
In the process of making the best ethical decisions, it is also important
to involve your clients whenever possible. Because you are making decisions
about what is best for the welfare of your clients, it is good to strive to discuss with them the nature of the ethical dilemma that pertains to them. The
feminist model for ethical decision making calls for maximum involvement
of the client at every stage of the process, a strategy based on the feminist
principle that power should be equalized in the therapeutic relationship
(Hill, Glaser, & Harden, 1995).
Consulting with the client fully and appropriately is an essential step in
ethical decision making, for doing so increases the chances of making the
best possible decision. Walden (2006) suggests that important therapeutic
beneﬁts can result from inclusion of the client in the ethical decision-making
process, and she offers some strategies for accomplishing this goal at both
the organizational and individual levels. When we make decisions about a
client for the client rather than with the client, Walden maintains that we rob
the client of power in the relationship. When we collaborate with clients, they
are empowered. By soliciting the client’s perspective, we stand a good chance
of achieving better counseling results and the best resolution for any ethical
questions that arise. Potential therapeutic beneﬁts can be gained by including clients in dealing with ethical concerns, and this practice represents functioning at the aspirational level. In fact, Walden questions whether it is truly
possible to attain the aspirational level of ethical functioning without including the client’s voice in ethical concerns. By adding the voice and the unique
perspective of the consumers of professional services, we indicate to the public that we as a profession are genuinely interested in protecting the rights
and welfare of those who make use of our services. Walden sees few risks in
bringing the client into ethical matters, and there are many beneﬁts to both
the client and the professional.
The social constructionist model of ethical decision making shares some
aspects with the feminist model, but focuses primarily on the social aspects
of decision making in counseling (Cottone, 2001). This model redeﬁnes the
ethical decision-making process as an interactive rather than an individual or
intrapsychic process and places the decision in the social context itself, not in
the mind of the person making the decision. This approach involves negotiating, consensualizing, and when necessary, arbitrating.
Garcia, Cartwright, Winston, and Borzuchowska (2003) describe a transcultural integrative model of ethical decision making that addresses
the need for including cultural factors in the process of resolving ethical
dilemmas. They present their model in a step-by-step format that counselors can use in dealing with ethical dilemmas in a variety of settings and
with different client populations. Frame and Williams (2005) have developed a model of ethical decision making from a multicultural perspective
24
Chapter 1
based on universalist philosophy. In this model cultural differences are recognized, but common principles such as altruism, responsibility, justice, and
caring that link cultures are emphasized.
Barnett and Johnson (2010) remind us that many of the ethical dilemmas
we will encounter do not have a readily apparent answer. Keeping in mind the
feminist model of ethical decision making, Walden’s (2006) views on including the client’s voice in ethical concerns, a social constructionist approach to
ethics, and a transcultural integrative model of ethical decision making, we
present our approach to thinking through ethical dilemmas. Following these
steps may help you think through ethical problems.
1. Identify the problem or dilemma. It is important to determine whether
a situation truly involves ethics. The distinction between unorthodox and poor professional practice may be unclear (Koocher & KeithSpiegel, 2008). To determine the nature of the problem or dilemma,
gather all the information that sheds light on the situation. Clarify
whether the conﬂict is ethical, legal, clinical, professional, or moral—or
a combination of any or all of these. The ﬁrst step toward resolving an
ethical dilemma is recognizing that a problem exists and identifying its
speciﬁc nature. Because most ethical dilemmas are complex, it is useful
to look at the problem from many perspectives. Consultation with your
client begins at this initial stage and continues throughout the process of
working toward an ethical decision, as does the process of documenting
your decisions …
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