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Case Vignette1: Jessica Jessica is sixteen years old, and is sent to the school counselor following concerns from her year level coordinator. Jessica is finding it difficult to concentrate in class, is continuously late to school, and often arrives to school disheveled and unkempt. The coordinator is concerned about what may be happening at home with Jessica, and that she may be getting involved in a notoriously bad circle of friends in the area known for drug taking and other delinquent activities.
Although reluctant during the first few sessions to disclose anything much, Jessica begins to trust the counselor and opens up about her frequent drug use. She says she used to only smoke marijuana, but that now this had increased to weekly party hits of Cocaine and speed. She tells the counselor that the effects of these drugs is beginning to diminish and that she feels like she has to try something harder like heroin, to gain the same effect. That week the counselor receives a call from Jessica’s parents wanting to know what is going on with their daughter. What should she do?
Ethical standard involved: The issue here is of sharing confidential information divulged by a minor during therapy with the parents. The following points from the Singapore Association for Counselling, Australian Counselling Association and American Counseling Association pertain to this issue: Singapore Association for Counselling (SAC)’s Code of Ethics: Section B point number 3, which states ‘Members discuss with clients as early as feasible in the therapeutic relationship appropriate issues such as the nature and anticipated course of counseling, fees and confidentiality’.
Australian Counselling Association (ACA)’s Code of Conduct: Code of Ethics section, point number five which states, ‘as members of the ACA we will: offer a promise of confidentiality and explain the limits of duty of care’. Also the following points in the Code of Practice section: 2. 1 Issues of Responsibility 2. 1. 6. 1 Counsellors must take all reasonable steps to be aware of current law as it applies to their counselling practice. 2. 3 Confidentiality 2. 3. 4 Exceptional Circumstances 2. 3. 4. Any disclosure of confidential information should be restricted to relevant information, conveyed only to appropriate people and for appropriate reasons likely to alleviate the exceptional circumstances. The ethical considerations include achieving a balance between acting in the best interests of the client and the counsellor’s responsibilities to the wider community. 2. 3. 4. 3 Counsellors hold different views about the grounds for breaking confidentiality, such as potential self-harm, suicide, and harm to others.
Counsellors must consider their own views, as they will affect their practice and communicate them to clients and significant others e. g. supervisor, agency. American Counseling Association (ACA)’s Code of Ethics: Section A: The Counseling relationship A. 1 Welfare of Those Served by Counselors A. 1. d. Support Network Involvement Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (for e. g. , religious/ spiritual/ community leaders, family members, and friends) as positive resources, when appropriate, with client consent.
A. 2. Informed Consent in the Counseling Relationship A. 2. d. Inability to Give Consent When counseling minors or persons unable to give voluntary consent, counselors seek the assent of clients to services and include them in decision making as appropriate. Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf. Section B: Confidentiality, Privileged Communication and Privacy B. . Clients Lacking Capacity to Give Informed Consent B. 5. b. Responsibility to Parents and Legal Guardians Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/ guardians over the welfare of their children/ charges according to law. Counsellors work to establish, as appropriate, collaborative relationships with parents/ guardians to best serve clients.
Ethical trap possibilities: There being not enough information about the counselor in the case, to ascertain the possibility of a values or objectivity trap. Circumstantiality: Jessica is a minor but she is 16, which is a bit of a grey area between being a child and adult and depending on Jessica’s psychological development, the counsellor may fall into a Circumstantiality trap and procrastinate about informing her parents. Preliminary response: Jessica is a minor and her parents are stake holders in her well-being.
Drug abuse is a major clinical and life issue and her parents deserve to be informed. Having said that, the counselor should discuss it with Jessica first and sensitively deal with her inevitable resistance. The counselor should inform her of her duty to take the parents into confidence and draw her attention to the limits of confidentiality and also the informed consent process that she must have gone through at the beginning of the therapy. How to deal with this disclosure depends on her own state of mind and her family situation.
Does she recognize that she has a problem and is she looking for a way to come out of it? Or is she unapologetic about her drug abuse and wants to keep going down that path? Then the counselor should try to understand by discussing with Jessica how she thinks her parents will react. Her family background could be complicated. In that event the counselor’s accurate judgment of the level of support the parent/s can offer is vital to the disclosure process. If the parents are up to their necks with their own problems relationship or work issues etc. t is very likely they won’t be in a position to offer much support and on the contrary may even resent her for adding to their list of problems. In such a scenario the counselor can either recommend family therapy if she thinks it will help Jessica and her family come to terms with her drug abuse and any other issues they may be facing. If however, the counselor either from Jessica’s account or from an actual meeting feels that Jessica’s family will not be able to offer the needed support then they will have to explore other ossibilities like support networks for drug abusers etc If on the other hand, Jessica’s family comes across as supportive and wanting to be with her as she tries to come out of the drug habit, the counselor can then make the most of their involvement and seek their help and understanding and complementing Jessica’s therapy. Ideally Jessica informing them herself would be the best option. The counselor can offer her office as a neutral venue for them to meet and discuss, can also offer to be there to facilitate the conversation.
As a last resort if Jessica cannot bring herself to tell her parents, the counsellor can offer to do it for her. There is also the legal aspect to be considered. Drug abuse is a serious offence in Singapore, however there is no mandatory reporting per se and it really depends on the counsellor whether and at what stage she wants to involve the police or Ministry of Community Development, Youth and Sports (MCYS). She could choose to delay that decision and explore how Jessica benefits from the therapy before she reports.
The counsellor could also take a consultative approach with Jessica’s parents and involve them in this decision. Having said that, if Jessica is defiant about her drug abuse and does not make any correctional efforts the counsellor may be left with no choice, and may have to report her case to the MCYS. Possible Consequences of adopting this response: When the counselor shares with Jessica her duty to inform the parents about her drug problem, more likely than not, she will try to dissuade her from involving her parents.
The counselor will have to be firm in her stand and not get carried away by Jessica’s pleas. When Jessica realizes that her pleas are not working, she might retreat into herself either by physically not coming to therapy or if she is forced to by the school to attend her therapy sessions, she may not cooperate. That is where the counselor will have to talk it out with her, explain her professional duty to inform her parents because they are stakeholders in her well being, all the while stressing that she will not be left alone to deal with it herself.
The parents on being informed may react in a way that is counter-productive to Jessica’s progress and inadvertently harm her prospects of recovery. The counsellor will have to collaborate with the parents and try to minimize the negative effects of their involvement if possible. Ethical Resolution: The counselor must discuss the matter sensitively and in detail with Jessica and explain to her why it is unavoidable for her to inform the parents. Then she must deal with (to whatever extent possible) Jessica’s reservations with regard to it.
Having worked with Jessica to prepare her for what is coming, the counselor must then initiate the process of informing her parents. Reassuring Jessica that the counsellor will work with her as she battles with her drug problem and also to deal with the repercussions of informing her parents is a vital part of this process. Depending on the parent’s reaction, the counselor must judge how they can support Jessica and contribute to her progress and make the most of their involvement or on the other hand minimize the negative effect they could inadvertently have on her therapy because of their reactions.
Based on the progress Jessica is making in therapy and also maybe after considering her parent’s opinion or maybe consulting with a supervisor, the counsellor can decide whether and when to inform the police or the MCYS. Which aspects of this dilemma do I anticipate would be the most challenging for me to deal with? Why? In my case I think, as the mother of a daughter I would have to focus hard not to get carried away, and not to lose my objectivity with Jessica.
Also though it would probably be alright to sympathize with her parents, it will be important for me to keep in mind that Jessica is my primary client and understanding her point of view should be my main concern and I should not be swayed from that. Case Vignette 2: Alex Alex works as a counselor at a local agency. He is also the president of the local right to life organization. During lunch and tea breaks, Alex tries to convince staff of the importance of saving lives and the need to oppose abortion.
He is very open about his views and is known as an anti abortion activist by the locals. Alex is also very opposed to contraception. During a recent conversation Alex expressed his belief that abortion is murder and contraception is sinful and unacceptable. Many of the clients that come to this agency are single females with issues around family planning. As a counselor at the same agency what should I do? Ethical standard involved: The issues in this case are mainly of imposition of values, competence of the herapist and maximizing freedom of choice and self determination of the client. The following points from the Singapore Association for Counselling, Australian Counselling Association and American Counseling Association pertain to this issue: Singapore Association for Counselling (SAC)’s Code of Ethics: Section A, point number nine which, that states ‘in their work-related activities, members respect the rights of others to hold values, attitudes, and opinions that differ from their own’.
Australian Counselling Association (ACA)’s Code of Conduct: Code of Ethics section, point number one which states as follows, ‘Members will offer a non-judgmental professional service, free from discrimination, honouring the individuality of the client. ‘ Point number two ‘Members will establish the helping relationship in order to maintain the integrity and empowerment of the client without offering advice. ‘ Point number nine ‘Members will be responsive the needs of peers and provide a supportive environment for their professional development’. The following points from the Code of Practice: 2. Issues of Responsibility 2. 1. 3 Responsibility to the client Client Self-determination 2. 1. 3. 4 In counselling the balance of power is unequal and counsellors must take care not to abuse their power. 2. 1. 3. 6 Counsellors do not normally give advice. 2. 1. 4 Responsibilities to other counsellors 2. 1. 4. 2 A counselor who suspects misconduct by another counselor which cannot be resolved or remedied after discussion with the counselor concerned, should implement the Complaints Procedure, doing so without breaches of confidentiality other than those necessary for investigating the complaint. . 1. 7 Resolving conflicts between Ethical Priorities 2. 1. 7. 1 Counsellors may find themselves caught between conflicting ethical principles, which could involve issues of public interest. In these circumstances, they are urged to consider the particular situation in which they find themselves and to discuss the situation with their counselling supervisor and/or other experienced counsellors. Even after conscientious consideration of the salient issues some ethical dilemmas cannot be resolved easily or wholly satisfactorily. 2. Anti-Discriminatory Practice 2. 2. 2 Client Autonomy Counsellors are responsible for working in ways that respect and promote the clients ability to make decisions in the light of his/her beliefs, values and context. 2. 4 Contracts 2. 4. 3 Contracting with Clients 2. 4. 3. 3 Counsellors must avoid conflicts of interest wherever possible. Any conflicts of interest that do occur must be discussed in counselling supervision and where appropriate with the client. 2. 6 Competence 2. 6. 1 Counsellor Competence and Education 2. 6. 1. Competence includes being able to recognize when it is appropriate to refer a client elsewhere. 2. 6. 1. 5 Counsellors should take reasonable steps to seek out peer supervision to evaluate their efficiency as counsellors from time to time. American Counseling Association (ACA)’s Code of Ethics: Section A: The Counseling Relationship A. 1. Welfare of Those Served by Counselors A. 1. a. Primary Responsibility The primary responsibility of counselors is to respect the dignity and to promote the welfare of clients. A. 4. Avoiding Harm and Imposing Values A. 4. b. Personal Values
Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants. Section C: Professional Responsibility C. 2. Professional Competence C. 2. d. Monitor Effectiveness Counselors continually monitor their effectiveness as professionals and take steps to improve when necessary. Counselors in private practice, take reasonable steps to seek peer supervision as needed to evaluate their efficacy as counselors.
C. 2. g. Impairment Counselors are alert to the signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others. They seek assistance for problems that reach the level of professional impairment and, if necessary, they limit, suspend, or terminate their professional responsibilities until such time it is determined that they may safely resume their work.
Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients. Section D: Relationships with Other Professionals D. 1 Relationships with Colleagues, Employers, and Employees D. 1. h Negative conditions Counselors alert their employers of inappropriate policies and practices.
They attempt to effect changes in such policies or procedures through constructive action within the organization. When such policies are potentially disruptive or damaging to clients or may limit the effectiveness of services provided and change cannot be affected, counselors take appropriate further action. Such action may include referral to appropriate certification, accreditation, or state licensure organizations, or voluntary termination of employment. Section H: Resolving Ethical Issues H. 1. Standards and the Law H. 1. a. Knowledge
Counselors understand the ACA Code of Ethics and other applicable ethics codes from other professional organizations or from certification and licensure bodies of which they are members. Lack of knowledge or misunderstanding of an ethical responsibility is not a defense against a charge of unethical conduct. H. 2. Suspected Violations H. 2. a. Ethical Behavior Expected Counselors expect colleagues to adhere to the ACA Code of Ethics. When counselors posses knowledge that raises doubt as to whether another counselor is acting in an ethical manner, they take appropriate action. H. 2. b.
Informal Resolution When counselors have reason to believe that another counselor is violating or has violated an ethical standard, they attempt first to resolve the issue informally with the other counselor if feasible, provided such action does not violate confidentiality rights that may be involved. H. 2. c. Reporting Ethical Violations If an apparent violation had substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution or is not resolved properly, counselors take further action appropriate to the situation.
Such action might include referral to state or national committees on professional ethics, voluntary national certification bodies, state licensing boards, or to the appropriate institutional authorities. This standard does not apply when an intervention would violate confidentiality rights or when counselors have been retained to review the work of another counselor whose professional conduct is in question. Ethical Trap Possibilities: This is a Values trap if Alex is influencing his clients and urging them to adopt solutions that are consistent with his values without regard to their value system.
Preliminary Response: Alex has very strong values in the areas of contraception and abortion and based on the information in the case study, makes no secret about it. He is also trying to propagate his views by talking to other staff members about the need to save lives and oppose abortion. Therefore it appears that he is not the ideal therapist for single female clients with issues relating to family planning because of his ‘contraception is sinful and abortion is murder’ views.
Also he might have a conflict of interest between being a therapist and the President of the local right to life organization. Although there is no clear information on whether he is indeed imposing his values during therapy on clients; as a colleague I should be concerned on various points: Is he respecting the client’s autonomy and right to self-determination? Is he abusing the power of the counselor’s position? How would he deal with a single female client who is in a sexual relationship?
Would he ‘advise’ her against contraception? Or with a client that is pregnant and does not want the pregnancy? Would he try to convince her that ‘abortion is murder? ‘ Having observed Alex’s behavior and had concerns about how it is affecting his clients, it becomes a part of my ethical duty as a counselor to discuss the issue with Alex. How do I go about it? Taking a higher moral position or accusing him of unethical practice outright will alienate him and that will not serve my purpose.
I should probably try to initiate an open discussion with him about whether he feels that his values conflict with his work specially when working with the kind of clients that frequent our agency and how he deals with it. Maybe I could involve another colleague to get a second opinion, but taking care not to create an unfavorable opinion about him in the agency or indulge in rumor mongering. Possible Consequences of adopting this response: When we have this discussion Alex may open up to me and share that he has been feeling the same way.
It may be that his views are not actually as fanatical as they appear to be. If that is the case I should support him, in whatever ways he feels will be useful. I could also encourage him to seek supervision from senior counselors (if he has not already contemplated it) so that there is third party expert validation of his efficiency as a counselor and also of the fact that he has recognized that there is a problem and is trying to address it. On the other hand, he might be completely blind to his problem.
In that case, I will have to sensitively draw his attention to how it appears to an observer that he has a serious conflict of values with his clients. Another option could be that after discussing with him I get the feeling that he is consciously abusing his position as a counselor and imposing his values and using his professional position to propagate his values. Something like that would probably call for more serious action like bringing indiscriminately unethical practice to the notice of the agency by initiating a complaint procedure.
Ethical Resolution: I should definitely bring up the matter with Alex. Ignoring the issue would mean I am failing in my ethical duty. Depending on his reaction to our discussion, I should support him as he tries to deal with the issue by offering suggestions and feedback. I should encourage him to seek supervision. I should also try to get a second opinion and see if others feel the same way as me.
If it turns out that Alex is either not ready to change or worse is abusing his power as a counselor to propagate his values, it is my ethical duty to report him to the agency. Last but not least if I then observe that the agency is turning a blind eye to Alex’s behavior in spite of drawing their attention to it & I see his clients’ welfare suffering as a result of his unethical practice, as an ethical counselor it behooves me to pursue the matter and further take it up with the regulating body.
Which aspects of this dilemma do I anticipate would be the most challenging for me to deal with? Why? If I were Alex’s colleague in this situation, my pro-choice views would directly clash with his pro-life stance and I would be alert to this fact and leave it out during our discussions lest it becomes a personal issue between me and him.