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 clients 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 therapists 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

• Dont 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- matching

• 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.

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
Ericksons 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 clients 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 clients 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 Cont

• 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.