Chapter 3: Ethical Issues in Counseling Practice

mandatory ethics

the view of ethical practice that deals with the minimum level of professional practice

aspirational ethics

a higher level of ethical practice that addresses doing what is in the best interests of clients

positive ethics

an approach taken by practitioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble

ethics codes

- fundamental component of effective counseling
- guidelines that outline professional standards behavior and practice
- APA ethics code

Ethical decision making model

1. IDENTIFY the problem or dilemma
2. look at the relevant ETHICS CODES for general guidance
3. seek CONSULTATION from more than one source to obtain various perspectives on the problem
4. BRAINSTORM various possible courses of action
5. EVALUATE the cons

informed consent

involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it
- inform patients about everything, from type of treatment to pay

confidentiality

the legal duty of therapists not to disclose information about a client

privileged communication

the legal concept that generally bars the disclosure of confidential communications in a legal proceeding
- does not apply in group counseling, family therapy, or child and adolescent therapy

when to break confidentiality:

- child abuse
-abuse of elderly
- abuse of dependent adults
- self danger / needs hospitalization
- under 16 year old is victim of incest, rape, abuse
- needed in court

assessment

evaluating the relevant factors in a client's life to identify themes for further exploration in the counseling process

diagnosis

sometimes part of the assessment process
- consists of identifying a specific mental disorder based on a pattern of symptoms

APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

guides practitioners in making diagnostic assessments
- it represents an initial step in comprehensive evaluation

evidence based practice (EBP)

- the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences
- treatments have been validated by empirical research
- replication/ reliable , valid
- calls for accountability

Evidence based treatment (EBT)

- most powerful research method
- RCCT tells us if treatments are effective
-RCCTs use a type of experiment
- 2 or more RCCT's at different labs with same result= reliable and valid (replication is required)
- EBT are preferred in clinical psychology prog

practice-based evidence

using data generated during treatment to inform the process and outcome of treatment

criticisms of EBT

focuses on only one of these techniques in change
1. treatment technique********* (this one)
2. therapist characteristics
3. client characteristics
4. therapist client relationship
- no creativity
- impersonal, mechanical, insensitive to patient differenc

4 factors in change

1. treatment technique
2. therapist characteristics
3. client characteristics
4. therapist client relationship

T in EBT can stand for three things:

1. evidence based THEORY
2. evidence based PSYCHOLOGICAL TEST (or assessment)
3. evidence based TREATMENT or intervention

dual or multiple relationships

occurs when counselors assume two or more roles simultaneously or sequentially with a client
- either sexual or nonsexual

boundary crossing

a departure from a commonly accepted practice that could potentially benefit a claim
eg= attending the wedding of a client

boundary violation

serious breach that harms the client and unethical
eg=sexual relationship with client

Case study: Cinderella

- patient tells her therapist she loves him and wants an affair
- what should therapist do?
- say thanks but no
- therapist cares about what is best for patient and this ruins that and is harmful to her -he says that its common

Case Study: Henry Richter

- multiple or dual relationships
- therapist has affair with patient (melissa)
- both are married
- richter's wife is mentally ill
- richter says that melissa has a damaged superego (conscience) -blaming melissa
- melissa thought therapist could be both l

ethics codes related to Richter

- fidelity and responsibility
- respect for people's rights and dignity
- sexual harassment
- conflict of interest
- exploitative relationships
- interruption of psych services
- sexual intimacies with former therapy clients (wait 2 years)
- interruption

Principle A: beneficence and nonmaleficence

Richter violated this
-do not harm patients
- do what is best for patient
- avoid any harm
- also a standard

Principle B: Fidelity and responsibility

Richter violated this
- keep promises and commitments without deceit or exploitation

Standard 2.06: Personal Problems and Conflicts *

Richter violated this
- psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work- related activities in a competent man

Standard 10.05: Sexual intimacies with current therapy clients/ patients
Standard 10.08 Sexual intimacies with former therapy clients/ patients

Richter violated this
- psychologists do not engage in sexual intimacies with current therapy clients/patients even after a two year interval except in the most unusual circumstances
- psychologists who engage in such activity after the two years after th

5 general principles of the APA ethics code

A. beneficence and nonmaleficence
B. fidelity and responsibility
C. integrity
D. justice
E. respect for people's rights and dignity

dancing naked rule

if patient takes off their clothes and starts dancing and wants sex, it is NEVER okay for therapist to say yes

Steps in dealing with sexual or emotional abuse

1. criminal (against the law)
2. civil (sue the person)
3. complain to license board (person could lose license)
4. professional association (person could be kicked out)

Richter info

- could have a disorder (no empathy, no emotion)
- depressed
- isolated
- wife is in mental hospital
- works a lot

The Giving Tree

- tree: therapist
- person: client
- giving tree syndrome (burnout)
- always take care of yourself to help others

inner abundance

refers to life in its abounding fullness of joy and strength for mind, body, and soul.