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Counselling Theory and Practice

Study Guide

Topic 11 Ethical issues

MySCU | learn.scu.edu.auscu.edu.au/health

Objectives

At the end of this topic you will be able to:

Introduction

Unless the primary subject matter of the text, a discussion on ethical practice is often found in the final chapter of a book, and it not always clear whether this means it is the least or most important of the author’s concerns. Placement of this topic at the end of your study of Counselling Theory and Practice presents it as very important information, and hopefully allows you to leave your study of this unit with these vital theories and practices fresh in your memory!

As a student of the human sciences you have no doubt studied ethics in detail in other units and it is not necessary to revisit material which is probably quite familiar to you. In this topic our study of ethics is particularly applied to the practice of counselling, but a broader knowledge of ethical principles and practices will certainly assist in making appropriate decisions when presented with case studies and, indeed, in real life practice as a human services worker and/or counsellor.

Two intersecting perspectives

a. Principle ethics

Kohlberg (1981, cited in Berger & Thomson, 1998) developed a theory which categorised moral reasoning and presented the final postconventional stage as having an emphasis on moral principles. He suggested that without life experience and responsibility, people would not reach the stage of ‘social contract’ – ‘obey the rules of society because they benefit all, however these rules can be broken if they become destructive’. It is suggested that the most altruistic stage of ‘universal ethical principles’ – values determined by individual reflection (e.g. life is sacred) which may contradict the egocentric or legal principles adopted in earlier stages of moral reasoning – is not reached by many people.

Not everyone agrees with this model, stating it is based on Western patriarchal values, but it has given some examples of how we apply our moral reasoning to situations in life. By choice of vocation, counsellors have taken on a role which requires them to have a higher level of self-awareness and commitment to the positive enactment of moral principles. Society may reasonably expect this profession to exhibit behaviour in line with Kohlberg’s postconvential stage.

Discussion of moral principles has taken place since ancient times and although there may be some disagreement about which take precedence in certain circumstances, Remley & Herlihy (2007) present six principles as agreed upon for work in the counselling profession:

b. Virtue ethics

Virtue ethics takes the practice of ethics one step further, in that decisions made rest not only upon agreed moral principles, but are also influenced by the personal characteristics of the decision maker. From the beginning of this unit you have conducted exercises on self-awareness, and through your wide reading and research, you now have a clear picture of yourself, ‘warts and all’ if you like.

You are aware of your strengths and weaknesses, boundaries and biases. You know whether or not you can view all potential client groups with unconditional positive regard. You know the sorts of words, actions and components of non-verbal communication which trigger negative reactions in your psyche. You have reflected deeply on cultural issues and are aware of where more knowledge is required for you to work well with identified client groups. You have become very aware of your values, where these originated, which have changed over time, which are subject to change, and which are the same as when you were a child. You are aware of the contextual issues of counselling and the influence of social constructs on our clients and ourselves. Can you now transform all this self-knowledge into a list of virtues?

Activity (reflect and write)

Think about what virtues you bring to your professional practice of counselling. Remember that a virtue is not the same as a value or a belief. A list of positive components required for good counselling practice such as the core conditions of person-centred therapy is also not the focus of this activity. It is all about you.

It is certainly not an easy exercise to transform what we know about ourselves into virtues, and if you had difficulty putting into words your virtuous characteristics, that is not unusual. However, you will lean on these virtues and your interactions with others you trust, when making ethical decisions. Remley and Herlihy (2007) present the following characteristics of virtuous agents working in the field of mental health:

Did any of these, or similarly worded virtues, appear in your list?

Ethical decision making

There are several models of ethical decision making we can choose from in the counselling literature. One of these models suggests that you:

You may have already adopted a model you prefer, and you may include practices recommended by the Code of Conduct relevant to your employment and/or your professional association. Models for ethical decision making usually include a reference to using our own internal mechanisms and emotional reactions to ethical dilemmas as one of the sequences in the decision making process. If we are a virtuous person, then our emotion can reliably inform our judgment (Remley & Herlihy, 2007).

Activity (reflect and write)

  1. Think of a time in your working or studying life when you had to make an ethical decision without much time to think about it. Were you aware of sensations in your body? What did these sensations tell you? Did you experience fear, self-doubt, and/or overwhelming responsibility? Did you make the decision according to these emotions? When you had time to reflect and/or discuss with others, would you have made the same decision?
  2. If you have ever ‘fallen in love’ what did your body tell you about the object of your affections the first time you set eyes on him/her? Did you make a decision in line with these feelings? Did it turn out to be the correct decision?

In thinking about ethical decision making and the recommendation to tune in to our feelings, it is hoped that years of experience in seeing many clients will help us to be able to rely on the veracity of our gut reactions. Or perhaps we cannot always trust our gut reactions. We need to remember all the steps of ethical decision making, and don’t forget the client who should be involved.

The virtue of the counsellor’s interdependence within the community will usually assist when a difficult ethical decision looms. In attempting to make ethical decisions and reviewing those already made, debriefing with trusted others will provide excellent guidance. It is really quite a burden to privately carry a potential ethical decision without reference to those with whom we have interdependence. Such burdens are commonly carried, however, as the decision can be in relation to the professional conduct of a colleague or a challenging scenario where counsellors must weigh up, for example, a client’s right to confidentiality and privacy against issues of his/her safety or the safety of others.

Although it may appear to a beginning counsellor that confidentiality is the basis of all our practice, and therefore the clearest ethical tenet to uphold, it often proves to be fraught with obstacles. Jan Wiener in the following reading presents some interesting perspectives.

Reading 11.1

Wiener, J. 2001, Chapter 10 ‘The sanctum, the citadel and the souk: confidentiality and paradox’ in Barnes, F.P. & Murdin, L. eds., 2001, Values and ethics in the practice of psychotherapy and counselling, Open University Press, Buckingham.

Activity (reflect and write)

You have had several sessions with your 32-year-old female client who came to you with issues of personal identity as a result of sexual abuse by a family member when she was an adolescent. You feel that you have been making progress and your client confirms this positive assessment. The therapeutic alliance was established well, and she trusts you. She discloses that she has an asymptomatic serious venereal disease as the result of this abuse. She is getting married next month and has asked you for pre-marital counselling, but does not want her prospective husband to ever find out about the abuse or the disease. What is your response to this request?

Inappropriate responses to ethical dilemmas are usually the result of lack of sensitivity, knowledge or experience (Heppner, Kivlighan & Walmpold, 1999) and not any premeditation on the part of the counsellor. Nevertheless, such responses are not infrequent and ethical behaviour and decision making requires our constant and undivided attention.

Ethics in research

Ethics is an important part of all research. In the field of counselling and human services, research often requires more direct contact with people; therefore care must be taken to protect the participants. Where data is collected through forms, surveys and the review of client records, the concepts of confidentiality and privacy still apply (Welfel, 2006, cited in Remley & Herlihy, 2007). You will probably be aware of psychological studies where the truth of the nature of the study was withheld from the participants in order to observe and record reactions to certain stimuli, and important information of the nature of the psyche has been gathered through these types of research activities. Sometimes concealment of the goal of the research is justified as participants will usually perform in socially acceptable ways and to please the researcher – this of course impacts negatively on the validity of the results. However, contention and criticism abounds around possible harm which has accrued to participants, observers and the community at large though some studies. Can you think of some examples?

Codes of Conducts will commonly require researchers to give participants full clarification of the nature of their proposed studies, and where this is not justified, take reasonable measures to avoid causing harm. Sometimes there is no warning of possible harm before research commences. There are many, many unanticipated variables in the research process which occur throughout the study, and sometimes harm is not obvious until a period of time has elapsed after publication of the results. Researchers need to take responsibility for unintended consequences and their effect on the participants and the community (Lepper, 2001 cited in Barnes & Murdin, eds, 2001).

Ethical decisions of what is justifiable or what is not in the name of research or science, and other ethical considerations are such an important aspect of research (and a concern of the whole community), that the entire process is not only overseen by the individual research supervisor or board, but by the institution(s) concerned which must comply with legislation. Substantial protocols exist to protect participants, researchers and overseeing institutions, including severe penalties (such as removal of funding) for unethical practices. All aspects of counselling research require ethical input, some areas requiring thought are:

Narrative interviewing is a tool used by some counsellors when undertaking qualitative research. Many interesting and valuable studies have arisen from the use of participant’s stories, and although these stories will be analysed and interpreted to present the final results of the research study, the actual words of the participants often contain the most potency for the reader. Researchers have been concerned that the process of data gathering through narrative interviewing has ethical connotations. There is contention around the issues of whether the distress caused to participants by uncovering painful issues through the interview is mitigated by allowing the participants the opportunity to reflect on their lives with a ‘professional listener’. One researcher stated that she was tormented by ‘constantly opening my interviewee’s wounds and … leaving them with the pain’ (Lieblich, 1996, cited in Elliott, 2006).

Ethics and risk management

Ethical practice is not only for the benefit of the client and society at large, but also seeks to protect practitioners. The following proactive planning is a good start in responding to real or perceived impropriety or incompetence.

Case studies

Now that you have come to the end of the topics for this introductory unit in counselling, it is useful to apply your knowledge to some case studies. Although we may believe ethical principles are firmly entrenched in our hearts, the practice of those principles and application of virtue ethics in real life is seldom simplistic. Take this opportunity to reflect upon your practice and discuss your responses with a colleague, family member or friend. Remember you can still use the MySCU discussion board to discuss and clarify how other students have assessed the salient issues.

Activity (write)

Write a brief paragraph assessing the main ethical issues in the following case studies. Use a model for ethical decision making to formulate your response.

Case Study (1)

You are a human services worker in a community-based support program for people who have recently experienced a relationship breakdown. The program is funded through the local neighbourhood centre. You are employed on a sessional basis for a period of 4 months to get the group to the point of being able to operate independently. The group has 6–8 people who regularly attend the weekly session. It has taken you nearly 3 months to get the people to deal with some of the issues and share their feelings with the group. The sensitive nature of the issues and fear of people outside the group knowing what was discussed has made confidentiality a big thing in the group. You are finally getting down to the real issues when one of the group whom you have been concerned about shares with the group in a particularly aggressive way the following – ‘if I can’t have the kids then that bitch won’t either’. The person then leaves the group abruptly.

Case Study (2)

You are working in a child protection program with a large government department. The role mainly involves case work with sexually and physically abused children. The role is demanding and requires not only extra hours but also a lot of you emotionally. After working in the role for four years, you really appreciate the support and assistance of the very close team of people in your office. Your supervisor has worked with you for all of that time and you have become very close socially and professionally. Your children attend the same school and your partners also are both teachers at the local high school. Very late one afternoon and needing some information about a particular client, you see the light on in your supervisor’s office and go in to ask him for the file. When you walk in to the office you find him at the computer looking at child pornography on the internet. When he saw your shocked face, he said it was research for a particular work project.

Summary

We have understood from this topic that ethical practice is based on moral principles and virtues. We have discussed the steps to be taken when making an ethical decision. Ethics in research has been discussed and we have researched some Codes of Practices for some professional associations. We are aware of some issues for risk assessment, and have applied our knowledge of ethics to some case studies. Perhaps the most important point of this topic, is that our practice is not solitary – ethical decisions are made within the context of our profession, the needs of our client and our responsibility to the community. We have a responsibility now to investigate who will be our professional supervisors, if we do not have one already. This person is probably your first point of contact for an ethical dilemma. Remember, we are never alone – if we find ourselves alone with no-one to talk to, this is unhealthy for us and inappropriate for our clients, to whom we have the first responsibility.