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By: Loretta J. Bradley, Ph.D.
Paul Whitfield Horn Professor &
Coordinator, Counselor Education
Texas Tech University
C. Bret Hendricks, Ed.D.
Assistant Professor
Counselor Education
Texas Tech University
Available through permission of the American Association of State Counseling Boards (AASCB).
Copyrights, American Association of State Counseling Boards (AASCB)
Abstract
This manuscript presents ways to solve ethical dilemmas encountered by counselors. In the manuscript, information is provided about at-risk behaviors that can produce unethical practice. Attention is focused on cases which provide examples of ways that counselors can utilize an ethics code and an ethical decision-making model to enhance ethical behavior and decision-making.
As early as 1980, Losito (1980) and Van Hoose (1980) posited that ethics is the foundation for virtually everything that a counselor does. Now 25 years later, ethics has emerged as a salient area of concern for counselors. Many researchers (Bradley, Kottler & Lehrman-Watterman, 2001; Chae, Kelly, Brown & Bolden, 2004; Corey, Corey & Callanan, 2003; Cottone & Tarvydas, 1998; Herlihy & Corey, 1996; Kitchener, 1984; Remley & Herlihy, 2005; Urafsky & Sowa, 2004; Welfel, 2002) have concluded that there is no area of study more relevant to the counseling practice than ethics for counselors who are confronted with ethical issues on a daily and sometimes hourly basis.
Several years ago, ethics was defined as standards of conduct within the profession (Levy, 1972), and that basic definition has remained intact for several years although the practice of ethics has expanded over the years. Remley & Herlihy (2005) state that ethics is concerned with human conduct and moral decision-making. In this manuscript, we use the term ethics to refer to those standards adopted by and expected by the counseling profession as “what is right” for a counselor to do. In essence, ethics mandates that the counselors do the “right” thing that is in the best interest of the client. Further, good ethical conduct is grounded in sound moral principles and involves implementing professional ethical codes and understanding how to do “what is right.”
Ethical codes adopted by professional associations (e.g., the American Counseling Association (ACA)) and laws regulate the work of counselors. Although the terms “ethical” and “legal” are sometimes used interchangeably and while they do have commonalities, these terms are different. As defined by Remley & Herlihy (2005), we will use the term ‘ethics’ to refer to the belief of a group of professionals about what is “right” practice for a given professional. In contrast, we use the term “law” to refer to the minimum standards of behavior that culture and society will tolerate. In recent years, ethical issues faced by counselors have increased with many of the ethical issues resulting in legal issues (Austin, Moline & Williams, 1990; Benke, 1998; Corey, Corey & Callanan, 2004; Cottone & Claus, 2000; Hansen & Goldberg, 1999; Remley, Herman & Huey, 2003). Given the rapid increase in ethical and legal issues, this manuscript is written to (1) call attention to the ethical issues encountered by counselors, (2) provide a framework for helping counselors to solve ethical issues, and (3) help counselors avoid ethical and legal problems.
Ethical Issues
In this manuscript, we will present three cases which provide examples of ethical situations that counselors may encounter. While these cases are fictitious, they are based upon cases with which the authors are familiar. We will use the American Counseling Association (ACA) Code of Ethics and Standards of Practice (2005) as our cornerstone. In the last case, we will present a case that in addition to implementing the ACA Code, we will also need to implement an ethical decision-making model. We will use the decision-making model developed by Forester-Miller and Davis (1996), a model endorsed by the American Counseling Association to assist counselors in making ethical decisions when the ethics code does not address the specific ethical problem.
Case One: Sheila Jones and James Tyson
Sheila Jones wants to obtain career counseling. After consulting a list of providers endorsed by her insurance plan, she contacts James Tyson, M.Ed., NCC, LPC, for counseling because he is a “designated provider” for her insurance plan. Mr. Tyson proceeds to work with Ms. Jones on career issues and developmental issues as they pertain to career and resume development. He administers four career/interest instruments to the client. After eight sessions, Ms. Jones reports to Mr. Tyson that she is very satisfied with counseling, and Mr. Tyson agrees that termination should occur. After the final session, Mr. Tyson, who has billed only for the initial session, writes a final report to the insurance company for billing. In the report, he states that Ms. Jones was depressed at the beginning of the counseling process, and he assigns Ms. Jones a diagnosis of depression. He has frequently diagnosed depression in other cases because he knows that the insurance company is more likely to pay for treatment related to depression than for career assessment. “After all,” Mr. Tyson tells himself, “She appeared to be depressed at the beginning of counseling. Ms. Jones was having sleep disturbances, and she was more irritable than usual.” Additionally, he rationalizes, “She might not have been able to obtain counseling if I did not report one of the ‘target diagnoses’ to the insurance company.” He also contends that the career instruments he administered indicated that she was not in a field of work in which she was really interested; therefore, depression could be the result.
Discussion:
While Ms. Jones and Mr. Tyson are fictitious characters, this sort of scenario occurs all too often. The ACA Code of Ethics and Standards of Practice (2005) in Section E.5. speaks clearly about proper diagnosis of mental disorders. Section E.5. states that counselors should take special care to provide proper diagnosis of mental disorders and should “select assessments and techniques that are carefully selected and appropriately used.” In this example, it is obvious that Mr. Tyson did not utilize appropriate assessments to determine the diagnosis of depression nor did he use techniques related to the treatment of depression. His assignment of diagnosis was unwarranted. Additionally, Mr. Tyson violated Section E.2.d. of the ACA Code of Ethics and Standards of Practice (2005), which states “counselors provide accurate information and avoid making false claims or misconceptions when making statements about assessment instruments or techniques.” Mr. Tyson stated that Ms. Jones’ assessment results indicated that she was not in a good career fit. While this could provide valuable information for career counseling, this does nothing to indicate depression. Although Mr. Tyson never assessed formally for depression, he generalized the results of the career instruments to an area that is not applicable, namely depression. This is a clear violation of ethical standards. Mr. Tyson used possible nonreimbursement of services to rationalize his actions. Further, Mr. Tyson did not inform his client about the parameters of payment as defined by the client’s insurance company, and this action did not allow the client to make the choice of whether to proceed with counseling with the knowledge that reimbursement might be disallowed by the payer.
Case Two: Mary Manes and Joanna Wright
Mary Manes wants to file for divorce; however, friends and family tell her that she should obtain counseling before she proceeds further. Mary has discussed counseling with her husband, and he refuses to go to counseling. While she wishes that he would participate, he plainly states that he does not want to go to counseling and would prefer to proceed with the divorce. Mary and James live in a small town in a rural area, and when Mary decides to look for a counselor she finds that there are only two counselors in town, a male and a female. Since Mary prefers to see a female counselor, she schedules an appointment to see Joanna Wright, M.S., LPC, whose name sounds vaguely familiar. When she sees Ms. Wright for the initial counseling session, Mary recognizes her as being a neighbor.
In the initial session, after recognizing and acknowledging that Mary is her neighbor, Ms. Wright warmly greets Mary. At first, Mary is a bit uncomfortable about entering counseling with someone with whom she might have future social contacts. She mentions this concern to Ms. Wright, who dismisses this concern and tells Mary, “This is a small town and this sort of thing happens all the time. Why if I did not counsel people that I see everyday in town, I wouldn’t have any clients.” This makes sense to Mary, and she proceeds with the initial session during which she completes paper work related to rights of privacy and payment. Mary also reads Ms. Wright’s credentials along with her professional memberships. While Mary does not understand all of these, they certainly seem impressive, and she decides that she will continue counseling. In the ensuing sessions, Mary is very pleased with the counseling. Because Mary does not have access to third party payers, she pays Ms. Wright in cash after each session.
Mary and Ms. Wright have completed six sessions. Suddenly, on the day of Mary’s scheduled counseling session with Ms. Wright, Mary must meet with her attorney at the same time that her counseling is scheduled. She calls Ms. Wright and requests to reschedule her appointment, and with an apology that her schedule is very busy, she says that she can only see her early the next morning. The two agree that this time, while inconvenient, is acceptable. The next morning, Ms. Wright, who may be late for the appointment, calls Mary, who suggests that the two meet at Ms. Wright’s house “since it is so close by.” Ms. Wright agrees that this would be more convenient. In the next couple of weeks, the two decide to meet at each other’s homes for every session because “it is so much easier.” Furthermore, they decide to attend some social activities in the neighborhood together. “After all,” Ms. Wright says to Mary, “We do need to increase your social connections and practice your social skills.” During these sessions, Ms. Wright continues to charge Mary for counseling time, including time that is spent “practicing social skills” while the two are engaged in social activities in the neighborhood. When Mary states that she cannot pay after a session, Ms. Wright tells her that it’s “all right” and she will “bill her later.” She does not say when she will bill her.
Discussion:
The relationship that has evolved between Mary and Ms. Wright is a violation of the ACA Code of the Ethics and Standards of Practice (2005). Specifically, Section A.6. states “Counselors are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of clients that could impair professional judgment or increase the risk of harm to the clients.” Not only is Ms. Wright promoting a dual relationship, but she is also compromising Mary’s right to privacy of the counseling relationship. This is referred to in Section B.1. of the ACA Code of Ethics and Standards of Practice (2005). That is, Mary has not given Ms. Wright written authorization to implicitly or explicitly disclose their counseling relationship in a social situation, and Mary’s friends, some of whom recommended that Mary see Ms. Wright, are well aware that Ms. Wright is providing counseling to Mary. The friends become curious about the social relationship that they see developing, and this curiosity leads them to speculate about the nature of the relationship. Thus, Mary is exposed to unnecessary social stress because of her relationship with Ms. Wright. Also Ms. Wright is charging Mary for time that is not counseling. Section A.10. addresses this action by stating, “Counselors clearly explain to clients, prior to entering the counseling relationship, all financial arrangements related to professional services including the use of collection agencies or legal measures for nonpayment.”
Case Three: Jane Smith and Jose Mara
A high school counselor, Jose Mara, M.Ed., NCC, LPC, School Counselor, has been approached by a teacher who is concerned about one of her students, Jane Smith. Jane is a 16 year-old female who is progressively doing less and less work in class. Additionally, Jane, who usually procrastinates about turning in her work, is not turning in any work without personal help and attention. Mr. Mara agrees that he should see Jane to assess the situation. Mr. Mara approaches Jane and asks if he can meet with her after school, and she agrees. Following the initial counseling session, Mr. Mara begins seeing Jane for counseling each week. During this time, Jane begins to talk to Mr. Mara about more personal things in her life. She reveals that she has a two year history of alcohol dependence, although she was admitted to eight weeks of treatment during the previous summer, and she has not had alcohol since. She also tells Mr. Mara that her mother is drug dependent and does not work. She says that her mother has different men over every night, and she seldom gets to talk to her mother.
Discussion:
In this case, Mr. Mara has done nothing to violate an ethics code; however, he is presented with a dilemma. The dilemma centers on whether Jane is being exposed to dangerous situations and/or neglect. When Mr. Mara refers to the ACA Code of Ethics and Standards of Practice (2005), he finds that while the Code speaks to various issues pertaining to client welfare and safety (Sections A.1., A.2., A.3.), it tends to be broad, thus not providing adequate information to deal with this particular situation. Realizing there is an ethical dilemma not completely covered by the code, Mr. Mara utilizes an ethical decision-making model developed by Forester-Miller and Davis (1996) and adopted by the American Counseling Association. This model, as well as other ethical decision-making models (Cottone & Claus, 2000), is designed for situations in which the ethics code is silent and/or does not provide enough information on the ethical issue. The Forester-Miller Model contains seven steps as follows:
Mr. Mara finds that this model provides a means for him to reflect on both the counseling process and the ethical dilemma, thereby minimizing the likelihood of an arbitrary decision which might not be in the best interest of the client. Following the model, in Step 1, Mr. Mara determines that the problem centers around his determination of the extent to which the client is being exposed to abuse. In Step 2, he sees that the ACA Code of Ethics and Standards of Practice (2005) does not specifically speak to this question. Step 3 leads him to determine that the nature of the dilemma is whether he should or should not report Jane’s situation to the local Children’s Protection Agency, a report that could compromise Jane’s right to privacy and possibly create conflict with Jane. When Mr. Mara attempts to define potential courses of action in Step 4, he realizes that he can either report or not report and do further evaluation. Mr. Mara then moves to Step 5, which states that he should evaluate the courses of action and their consequences. In regard to consequences of reporting, he surmises that there are two major consequences which may result from his reporting. First, the relationship between himself and Jane might be damaged because of the client’s perceived breach of trust, and further, Jane could decide to discontinue counseling. Second, he might be compromising Jane’s right to privacy if he reports the situation to the agency. However, Mr. Mara also knows that he has previously explained to students and obtained in writing that he might disclose cases of supposed abuse if these became apparent in counseling. He also knows that there are legal consequences related to failing to report suspected cases of abuse. Namely, if he does not report, he could possibly leave the client open to further abuse and expose himself to legal action for not reporting the situation. In the last step (step 7), Mr. Mara implements the course of action that he has chosen by making a report about Jane to the Child Protection Agency.
Summary
While there is no absolute blueprint for solving ethical issues encountered by counselors, this article presented cases about at-risk behaviors that can result in unethical behaviors. These cases were followed by discussions of the counselors’ behaviors and references to pertinent sections of the ACA Code of Ethics and Standards of Practice (2005). Additionally, a case was presented in which there was no clear answer provided by the ethics code, thus presenting a dilemma in which the counselor was faced with various possible courses of action. In response to this dilemma, the authors illustrated how the counselor should implement an ethical decision-making model. This article focused on the decision-making model developed by Forester-Miller and Davis (1996). This decision-making model can help the counselor implement a more “standardized” model for solving ethical issues. In conclusion, this article stressed the importance of counselors implementing sound ethical decisions by following ethical codes and procedures that ensure the welfare of the client and provide “best practices” in the field of counseling.
References