Ethical Issues in Agency Counseling

1. Ethical Issues in Agency Counseling Sabrina Dougherty Amy Haney

2. What are ethics? • Ethics “character”- what is considered good or right for specific groups of people • Purpose is to establish the criteria to label “good” and “bad” behavior and to promote the good and discourage the bad • Good, ethical decisions should be made on more than intuition

3. What motivates your ethical practice?Class discussion • Fearful motivation; fear of consequences?

4. Ethical Principles of the Therapeutic Professions (Five Golden Principles) • Autonomy- honoring the client’s right to independence and freedom as well as their decision making abilities. • Beneficence- the doing of good to others • Non-maleficence (the responsibility to avoid harm)-not doing harm through your actions • Justice- being fair and treating clients equally • Fidelity- the practice of honesty and loyalty

5. Confidentiality • Confidentiality is a therapist’s ethical obligation to keep the identify of their clients private. • Being clear with clients about the limits of confidentiality is important

6. Confidentiality can be broken ethically under many circumstances. • If the counselor believes that the client is a danger to self or others • The counselor should immediately express concerns with client and share their intentions with the client. • If they suspect the client is abusive to children, the elderly or those who are mentally challenged.

7. Professional Responsibility • It is the responsibility of the counseling professional to be aware of ethical standards, boundaries of competence, honest disclosure of credentials, and ethical practice in advertising services.

8. Professional Responsibility • It is your responsibility to clearly know and state what you can and cannot offer your clients. • You are ethically bound to evaluate realistically whether you have the competence to work with a particular client. • It is your duty to continually assess your skills and area of expertise while working to maintain them and develop new skills.

9. Relationships with other Professionals • Honor the autonomy of fellow professionals. • Avoid relationships with co-workers. • Avoid discrimination and unequal, unfair treatment of other professionals. • A sense of justice rooted in compassion can promote a healthy work environment where employees feel they are fairly compensated for their hard work and feel a sense of satisfaction.

10. Cultural Issues in Evaluation, Assessment, and Interpretation • Ethical standards require counselors to be aware of the appropriate and ethical use of the various assessment tools. Maintaining cultural awareness as you engage in assessment practices will help to meet the golden principles. • It is important to begin the process by asking: • “Who is making the assessment?” • Self-assessment (s or subjective data) • Assessment by another person (o or objective data) • Combination of the two • “What is being assessed?” • How is the client defined? • Individual, couple, family • What domain? • Affect, cognition, behavior • “What tool is being used to assess the client?” • Use “culture-fair” tests • The best way to guard against the inappropriate use of tests is to understand the norming population of the instrument and its properties.

11. Sexual Contact with Clients Don’t Do It!

12. TRUE or FALSE • Male therapists are most often the offenders and female clients most often the victims. • The sexual contact is not limited to adults and includes children. • The problem is increasing reported worldwide, not just in North America. (Welfel, 1998)

13. What do I do? • Seek counseling for yourself if feelings arise • Consult with colleague (ACA Code of Ethics, 2005) • A.5.a Current Clients “Sexual or romantic counselor-client interactions or relationships with current clients, their romantic partners, or their family members are prohibited.”

14. Working with Involuntary Clients • An involuntary client may be reluctant or resistant or both. • Resistance: “unwillingness to change” (Ritchie, 1986) • Reluctance: would not seek out services, involuntary • Required by law to attend counseling (jail or counseling) • Pressured to attend counseling by friends or family

15. What do I do? • Establish therapeutic relationship • Start where the client is • Foot-in-the-door OR Door-in-the-face • Punishment/Reinforcement

16. Techniques used with involuntary clients • The continuum moves from the least intrusive techniques, relying on persuasion methods, to the most intrusive, compliance-oriented methods. • Foot-in-the-door principle • Asking clients for a small concession increases the probability that they will agree to a larger concession • Door-in-the-face principle • Asking clients for an outrageously large concession increases the probability that they will agree to a considerably smaller one (the one you really wanted)

17. Compliance-oriented methods are designed to directly influence actions and attitudes by punishing undesirable behaviors and rewarding desirable behaviors. Common types of punishment Response cost punishment Positive punishment Negative reinforcement the use of an aversive consequence after an undesirable behavior occurs withholding reinforcements when an undesirable behavior occurs\ removal of an aversive stimuli when an unwanted behavior stops followed by the application of a positive reinforcer when the desired behavior is displayed. Compliance-oriented methods- matching

18. What does Rooney say? 1.Practice within the legal guidelines -pretherapy training 2. Keep ethical principals in mind -negotiable/nonnegotiable 3. Think about the goals of treatment -win-win situation (Rooney, 1992)

19. A.2. Informed Consent in the Counseling Relationship • A.2.a Informed Consent “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” (ACA, 2005).

20. Working with Clients with HIV or AIDSWhat does ACA say? B.2.b Contagious, Life-Threatening Diseases “When clients disclose that they have a disease commonly known to be both communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if they are known to be at demonstrable and high risk of contracting the disease. Prior to making a disclosure, counselors confirm that there is such a diagnosis and assess the intent of the clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party” (ACA Code of Ethics, 2005).

21. Justification in Breaking Confidentiality • According to Gray and Harding (1988), therapists are justified in breaking confidentiality when: • “a therapeutic relationship exists between the counselor and client” • “the client is known to have a medically verified diagnosis of HIV infection or AIDS and refuses to make contacts aware of the situation” • “the risk of other identifiable victims is (or seems) imminent.”

22. Erickson’s Idea • Initial session: tell the client about limits of confidentiality • Get permission from client to contact relevant medical personnel • Based on the assumption that the client has not agreed to safe sexual practices or other safe practices: the client is notified if he/she does not act to protect others in the client’s life, the counselor will report to the contacts or state health department (if contacts are unknown) (Erickson, 1990)

23. Therapy and Technology • If you keep case notes on a computer and your hard drive crashes, is that an ethical violation? • Are you violating confidentiality by communicating with a client or supervisee via email? • Can counseling really be done over the internet? (Cottone & Tarvydas, 1998)

24. What does the ACA Code of Ethics Say? B.3.e Transmitting Confidential Information “Counselors take precautions to ensure the confidentiality of information transmitted through the use of computers, electronic mail, facsimile machines, telephones, voicemail, answering machines, and other electronic or computer technology.”

25. Ethics and Managed Care • AHHHHHHHHHHHHH!!! • Sabin (1996) defined four principles. He states that when these principles are met, counselors can confidently provide managed care services that are solid on ethical ground.

26. Principles by Sabin (1996) • Provide services without “overtreatment” • Least costly treatment plan • Advocate • Informed consent

27. Diagnosis and Third-Party PayorsIssues • “Quick” diagnoses to justify payments for services • Issues with “over diagnosing” to receive payment

28. What do I do? Welfel (1998) suggests the following: • Does the financial agreement with the payor allow for the counselor to make independent professional judgment based on the client’s goals and needs? • Do the people conducting the utilization review have the appropriate clinical background to make informed decisions?

29. References • American Counseling Association. (2005). Code of ethics. Alexandria, VA: Author. • Cottone, R.R., & Tarvydas, V.M. (Eds.) (1998). Ethical and professional issues in counseling. Upper Saddle River, NJ: Prentice Hall. • Erickson, S.H. (1990). Counseling the irresponsible AIDS client: Guidelines for decision making. Journal of Counseling and Development, 68,454-455. • Gray, L.A., & Harding, A.K. (1988). Confidentiality limits with clients who have the AIDS virus. Journal of Counseling and Development,66, 219-223. • Ritchie, M.H. (1986). Counseling the involuntary client. Journal of Counseling and Development, 64, 516-518.

30. References Con’t • Rooney, R.H. (1992). Strategies for work with involuntary clients. New York: Columbia University Press. • Sabin, J.E. (1996). Is managed care ethical care? In A. Lazarus (Ed.) Controversies in managed mental health care, 115-128. Washington, DC: American Psychiatric Press. • Welfel, E.R. (1998). Ethics in counseling and psychotherapy: Standards, research, and emerging issues. Pacific Grove, CA: Brooks/Cole.