As with any profession, counsellors are expected to behave in a manner that is of a highly ethical standard towards their clients. Ethical issues in a counselling practice lay the foundation of a therapist in practice. Ethics are at the centre of how the counselling process functions and operates in a successful manner for the clients who seek help in such a setting. In order for the counselling profession to be ethical and uphold professional recognition, there are many facets that need to be examined and outlined to make sure all counsellors and practitioners are functioning at the highest level and withholding their duties required by the counselling profession (Bartley, 2011).
As counsellors we have an obligation to follow professional standards and apply appropriate behaviour as defined by the Psychologist and Counsellor’s code of ethics unique to each Country. In Kenya this would be the Kenya Counselling and Psychological Association (KCPA) Code of Ethics.
The purpose of this is to prevent harm to clients as well as to define our own professional values, obligations and limitations. According to West (2002) the challenge of working ethically means that practitioners will inevitably encounter situations where there are competing obligations, members are committing themselves to engaging with the challenge of striving to be ethical, even when doing so involves making difficult decisions or acting courageously.
The Concept of Ethical Dilemmas
Ethics are guidelines based on basic principles in counseling namely justice, fidelity, beneficence, nonmaleficence and autonomy. It should be noted that the ethical dilemmas are situations in which there is a choice to be made between two options, neither of which resolves the situation in an ethically acceptable fashion. In order for the counselling profession to be ethical and hold professional recognition, there are many facets that need to be examined and outlined to make sure all counsellors and practitioners are functioning at the highest level and withholding their duties required by the counselling profession (Bartley, 2011). It is with this regard that counselors need to embrace the code of ethics in addressing ethical dilemmas according to their Countries of origin.
In this paper we wish to raise particular areas of ethical dilemmas in counselling which include Confidentiality, Gifts, Culture and Religion, Dual Relationship and Abortion and address them in regards to particular code of ethics as defined by individual Countries.
Confidentiality
Confidentiality is an important part of the counseling relationship. A client must be able to trust that the personal information he or she shares with a therapist will not be revealed to other people. To protect their professional relationships, a counselor must explain the benefits and problems inherent in counseling services and clarify the limits of confidentiality to the client. Canadian Counselling Association (2007) proposes three cases were confidentiality can and sometimes should be broken. That is cases where we need to protect a child, when legal requirements force us or cases of self-harm such as suicide.
Besides that counselors are mandated to protect the confidentiality of their clients as stated in the American Psychological Association (APA), (2011).
Other circumstances were confidentiality can be broken also include supervision or in the process of referring the client. At times, counselors may be asked to disclose information that could be harmful or damaging to the relationships with the client. This brings an ethical dilemma whereby the counselor must avoid undermining confidentiality and privileged communication and on the other hand must give appropriate information to others who share concern and responsibility for a client’s welfare.
Case Study Example
Sam is a twenty years old male. He is in the third year of his university studies. He sought help by visiting the university’s counselling services after his friends insisted that he should “get some help”. Sam disclosed to the psychologist that he is a regular cannabis user for the past two years. His friends told him they were concerned for him because even when he was not under the influence of the drug he was behaving “weirdly” and “aggressively” towards others the past few weeks.
After a thorough assessment by the center’s psychologist it was obvious that Sam had a psychotic episode. When he was asked about his family’s medical and mental history it was found that one of his aunt’s had schizophrenia. The psychologist informed Sam about the results of his assessment and that further treatment both medical and psychological, would be advisable. However, Sam was not willing to engage in any treatment and refused to believe the possibility of a recurrent psychotic episode. Additionally, when the psychologist suggested that Sam should inform his parents he did not agree. Fortunately, he did not stop coming to the meetings with the psychologist but Sam gradually became more aggressive and violent towards others.
Now, the therapists is presented with the following dilemma, should she keeps confidentiality and try to deal with Sam’s symptoms only during therapy or should she inform his parents or the university about his symptoms and refusal to seek treatment?
The reason for thinking about breaking confidentiality is if Sam does not seek medical treatment and has another psychotic episode there is a chance of harming himself and others. What’s more, he is still regularly using cannabis which only worsens his current mental state and makes him more aggressive (Essay, 2017)
Ethical Dilemma
In the case of Sam the main ethical issue is whether the counsellor should break confidentiality and inform his parents about his current situation as well as his refusal to seek treatment. Or keep confidentiality and try to address these issues during the sessions.
Gifts
Gifts are presents or rewards that are given or received by a client and counselor. According to APA (2011), giving or receiving a gift is an ancient and universal way to express gratitude, appreciation, altruism and love. Appropriate gifts in therapy are ethical and enhance authentic therapeutic relationships, which is the best predictor of therapeutic outcome. However, according to Shelton (2016) although gifts may seem appropriate between a person in therapy and their therapist, receiving gifts can be a source of stress for the therapeutic relationship. It can tamper with client therapeutic progress. For example, the ACA (2014) advises counsellors to consider the therapeutic relationship, monetary value of gifts, and the motivation for accepting or declining gifts from people they serve. The APA (2010) requires that psychologists avoid personal and financial situations that could create a conflict of interest.
When a client presents a therapist with a gift, they may do so for both known and unknown reasons and may enter the interaction with anxiety regarding how the therapist will respond. How the therapist does, in fact, respond is vital to the therapy relationship and process because such gestures may stretch the therapy boundaries (Hundert, 1998). The American Counseling Association’s code recommends that in determining how to respond to client gifts, therapists consider the therapy relationship, the gift’s monetary value, the client’s motivation for giving the gift, and the therapist’s motivation for wanting to accept or refuse the gift (Knox, 2009)
Dual Relationships
Dual relationships are defined here as those where a client-therapist relationship extends, intentionally or unintentionally, to include encounters, activities or relationships outside the therapeutic one (Gabriel, 2015). Korsinek (2011) indicates that a dual relationship occurs when a therapist has a second, significantly different relationship with his or her client in addition to the traditional client-therapist one. Examples of dual relationships are when the client is also a student, friend, family member, employee or business associate of the therapist.
Even though dual relationship sometimes enhances therapy, aids treatment strategy, and promotes positive relationship between therapist and client, it also weakens the treatment process, hampers the clinician-client co-operation, and brings instant or lasting damage to the service user.
According to Corey (2009), the issue of dual relationships, involving clients and counsellors has been widely addressed by the various professional ethical guidelines. Corey continues to state that except for sexual intimacy with a client, there is not much consensus in the professional world of mental health practitioners regarding the appropriate way to deal with dual or multiple relationships.
Cultural and Religious Dilemmas
Multicultural counsellors are faced with a responsibility to advocate for individuals and groups. They have a responsibility to contribute to a just society through the reduction and elimination of unjust discriminatory practices. Counselors strive to create both a trusting relationship and a comfortable environment with all their clients so that the difficult task of healing therapy can begin. According to Ryan (2012), a lack of sensitivity to a client’s unique cultural and religious experiences can result in miscommunication, a client’s refusal to participate, and ultimately, an ineffective counseling relationship. Furthermore, counselor’s biases towards the client’s cultural and religious practices may also hinder effective counseling session. Thus, an ethical dilemma escalates whether to embrace the subjective client’s point of view or the objective view as stipulated down in code of ethics in the counseling profession.
Today, psychologists and counselors may come from different cultures, train in different countries, and practice with a diversity of clients and in a diversity of locations. When cultural beliefs appear to clash with ethical rules of conduct, ethical decision making must focus on the well-being of clients individually and collectively (Ferrero, 2012)
Case Study Example
An Asian couple has been referred to a counsellor for marriage guidance. The impact of migrating to Australia has taken its toll on their relationship. In the session, the husband seems quite controlled and reserved, whereas the wife cries often but says little. The counsellor is a novice in the area of multicultural difference, but has just completed some workshops in multicultural counselling. The counsellor has learned that in Asian cultures, restraint of strong feelings is considered to be a sign of maturity, too much talking is viewed as impolite, and the husband is usually the more dominant member of the couple (Austrailan Institute of Professional Counsellors, 1)
Ethical Dilemma
The counsellor is conscious of the cultural differences and avoids talking too much and attempts to refer to the husband for most of the exchange. The counsellor is also conscious of their silence and wishes not to be disrespectful by challenging the couple to open up further. As a result however, the counsellor feels uncomfortable and subdued, and ineffective (AIPC)
Abortion
An obstacle to abortion exists in the form of abortion 'counselling' that discourages women from terminating their pregnancies. This counselling involves providing information about the procedure that tends to create feelings of guilt, anxiety and strong emotional reactions to the recognizable form of a human fetus (Woodcock, 2011). Consequently Woodcock further explains that a dilemma arises regarding the information that one ought to provide to patients considering an abortion: on the one hand, the mere offering of certain types of information can lead to intimidation. On the other hand, withholding information that some patients would consider relevant to their decision-making is objectionably protective on any standard account of the physician-patient relationship.
Abortion has long been one of the most controversial issues in counselling sessions. The thoughts of abortion may be as a result of rape, unwanted or unplanned pregnancy. It should be noted that confidentiality is of paramount concern to abortion clients. Counselors must respect and protect their clients’ right to confidentiality (Cook, Powell & Sims, 2011). However, a therapist may be forced to disclose confidential information with the consent of the client or, unless inappropriate, the client legally appointed surrogate. Besides, therapists may also disclose confidential information as required by law or to prevent imminent, serious harm to the client or others.
Case study on Abortion
Melissa is 17 years old, and a junior in high school. While she is normally quiet and does not get into any trouble, she comes to her counselor, who she has spoken to before about unrelated matters, to ask where she might be able to get an abortion. She is two months pregnant and does not want to tell her parents about it, so she thinks it is best to get an abortion. The school counselor, Donna, tells her she wants to meet with her and talk about her options before any decision is made. Then she considers whether she will notify Melissa’s parents, because the school has a policy about notifying parents if there is an issue with a child. Donna is Catholic and does not personally believe in abortion.
Ethical Dilemma
There are three specific issues with the teen abortion case of Melissa, addressed here. The first issue is in regards to the school policy when it comes to teen wanting to get an abortion. The second is with the school counsellor providing any advice regarding abortion to a teenage student. The third is with the religious beliefs of the counsellor. These are legal and ethical concerns that have to be considered from different standpoints.
Procedures for Ethical Decision Making
Therapists are often faced with situations that require sound ethical decision-making ability. Determining the appropriate course of action to take when faced with a difficult ethical dilemma can be a challenge. To assist counsellors in meeting this challenge, this paper has developed a four-stage framework for sound ethical decision making in counselling as adopted from Hepworth et al (2006).
Stage One: Creating Ethical Sensitivity
In this first stage, the counselor should identify ethical issues arising from the counseling sessions. Relevant ethical codes and related literature should be read by the counsellor in advance. The therapist should also explore value issues arising from the counseling sessions. Lastly, the counselor should clarify and confront one’s own issues.
Stage Two: Formulating a Moral Course of Action
At this stage, counselors should identify the ethical dilemma and gather as much information as possible about the situation. The problem at hand should be clarified whether it is legal, ethical or professional and look at the problem from as many different perspectives as possible. The counselor should involve the client and identify the potential issues involved. Regarding this, three crucial questions need to be answered: what are the critical issues? What is the worst possible outcome? What would happen if nothing is done?
Stage Three: Implementing an Ethical Decision
In the third stage, the counsellor should ask themselves’ four fundamental questions. These queries include what steps need to be taken to implement the decision? What people are involved and who needs to be told what? What restraints are there so as not to implement the ethical decision? Regarding this questions, politics of the situation, protection of the client and rationalization are major issues that need to be analyzed. The last question is: what support is needed by the counselor, client and others to implement and live with the results? Therefore, evaluate the rights, responsibilities and welfare of all those who are affected by the situation.
Relevant ethical codes should be reviewed and identify completing moral principles namely veracity, fidelity, autonomy, justice, beneficence, and nonmaleficence. Also, consider whether the principles of the organization for which you work can provide a solution.
The counsellor needs to acquaint them self with the up-to-date laws that apply to the ethical dilemma. If possible, obtain consultation and bring the situation to supervision. Also, consider possible and probable courses of action and discuss with the client. Count the consequences of the various decisions and think about the implications of each course of action for the client, for others who are related to the client and for you as the counsellor. Lastly, discuss with the client the impacts so they can decide on what appears to be the best course of action.
Stage Four: Living with Ambiguities of an Ethical Decision
Lastly, counselors need to find ways of dealing with anxiety regarding the final decision. This will be realized by letting go of the situation and ethical dilemma at hand and accepting the limitations that are involved. At this stage, counselors need to communicate learning from experience and use personal and professional support to live with the consequences of the decision made. That is why according to the Kenya Counseling and Psychological Association (2015), practitioners shall strive to resolve any ethical dilemmas with direct and open communication among all parties involved and consult with colleagues and supervisors when necessary.
Conclusion
It appears it is not possible to achieve an absolute ethical position on counselling to cover all situations. What we can do is to avoid gross violations by sensitivity to the more delicate ethical suggestions of counselling practice, and to recognize the balancing act required around the ethical issues involved, with the aim of minimizing harm to the client.
Finally, professional codes of ethics are fundamental for ethical practice in counseling, however, simply knowing these codes is just the beginning. The ability to think critically and apply general ethical principles to specific situations is vital. The ethical codes of counseling offer a degree of guidance, but these guidelines do not deal with every situation nor do they answer every question. At times, interpretation and application of the codes of ethics in specific cases is difficult. Thus, therapists possess some freedom to exercise professional judgment to promote the welfare of their clients. This freedom must be embraced with informed and sound information because the professions’ codes of ethics in counseling are binding on their members. Therefore, counselors should know the ethical codes of their specialty, be aware of consequences for actions not sanctioned by their organization, and seek consultation when in doubt.
REFERENCES
American Psychological Association. (2011). Ethical principles of psychologists. Washington,
Austrailan Institute of Professional Counsellors. (1). A multicultural issue in a relationship. Counselling Dilemmas, 2007.
Bartley Writting. (2011). Ethical Issues in Group Counseling. Mental Health Ethics, Law and Practice,
Bartley Writting. (2011). Ethical Issues in Group Counseling. Mental Health Ethics, Law and Practice, 1.
Bodenhorn, N. (2012). Exploratory study of common and challenging ethical dilemmas
Burnes, T. R., Singh, A. A., Harper, A. J., & et al. (2010). American Counseling Association:
Competencies for counseling with transgender clients. Journal of LGBT Issues in Counseling, 4(3-4), 135-159.
Cook, C., Powell, A & Sims, A. (2011). Abortion and counseling. London: Gaskell.
Counseling, 3(2-3), 1-19.
DC: APA Press.
Essay UK. (2017). Ethical Dilemmas: Breaking Confidentiality. Psychology, 3.
experienced by professional school counselors. Professional School Counseling, 10(2), 195-202.
Ferrero, J. L. (2012). Ethical Dilemmas, Cultural Differences, and the Globalization of Psychology. Oxford Handbooks on line, 1.
Guilford Press.
Hepworth, N., Rooney, M., Rooney, B., Storm-Gottried, C., & Larsen, M. (2006). Ethical issues
Imperial Media Group Ltd.
in counseling. London: Oxford University Press.
Kenya Counseling and Psychological Association (KCPA) (2015). Code of Ethics. Nairobi:
Korsinek, S. (2011). Crossing boundaries and dual relationships. London: New York: The
Lynne Gabriel, D. D. (2015). The management of ethical dilemmas associated with Dual Relationships. Dual Realtionships, 3.
Ryan, T. (2012). Counselor should understand Clients’ Cultural Differences. Journal of Issues in
S, W. (2011). Abortion counselling and the informed consent dilemma. NCBI, 1.
Sarah Knox, R. D. (2009). Ethical Considerations Regarding Client Gifts. Clients' Experiences Giving Gifts to Therapists, 4.
Shelton, K. (2016). Is It Ever Appropriate to Give or Accept a Gift in Therapy. Good Therapy, 1.
West, W. (2002). Some ethical dilemmas in Counselling and Counselling Research. British Journal of Guidance & Counselling, Vol. 30, No. 3, 2002, 263.