Ethical behaviour as it relates to the Counselling and Consulting Psychologist is a matter of “life and death”. Good ethical decisions lead to life, vibrancy and growth of the psychological practice. On the other hand, if a psychologist continues to make unethical decisions, especially where the right choice is evident and fairly easy to make, it is almost certain that his practice will not continue for very long. The psychologist will often be faced with situations that require sound ethical decision making ability. Arriving at the appropriate course of action to take when facing an ethical dilemma, however, can be a real challenge. The American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct to assist the psychologist when faced with such dilemmas. The psychologist must ensure that the power and authority that comes with the profession are not misused, nor abused. It is also up to him/her to maintain boundaries and professional distance. Ensuring ethical behaviour is the responsibility of the psychologist, although he will not be alone in this venture, as psychologists seek to spur each other on to ethical behaviour.
Suppose that as a psychologist during psychotherapy, a client disclosed that he was planning to kill a woman who had refused his advances. What should you do? This is clearly an ethical dilemma that you would be faced with. On one hand, you are well aware that the information a client supplies in therapy should be confidential, that is, the information is strictly between therapist and client, and should not be disclosed to anyone else. On the other hand, you also know this person well enough to worry that he might actually murder the woman in question. (Baron, 2001) What to do?
Dictionary.com defines ethics as “the rules of conduct recognized in respect to a particular class of human actions or a particular group, culture, etc.”; hence the terms medical ethics, Christian ethics and professional ethics. Ethics span every arena of our lives, whether we are in the helping professions or not, and at some point, we will all face an ethical dilemma. An ethical dilemma is a situation in which there is mental conflict about a decision to be made, because obeying one imperative may lead to transgressing another.
When one becomes engaged in a discipline, an organization, or a job, he/she usually seeks to find out what the parameters are for operating within the particular group – what the boundaries are, what the expectations are. In other words, what the ethical guidelines are for performing the given task. The American Psychological Association (APA) has established an Ethical Principles of Psychologists and Code of Conduct, also referred to as the ‘Code of Ethics’, which serves as an ethical guide to members of the helping professions, especially psychologists. The Jamaica Psychological Society in its effort to “advance psychology as a discipline and profession” (Jamaica Psychological Society, 2007) has adopted this code with a few minor modifications.
The APA Code of Ethics for psychologists is based on five general principles, from which all the standards are developed. The first principle is beneficence and nonmaleficence. This means that the psychologist’s aim is to benefit the persons with whom they work, while, in the process, does no harm to them. The psychologist needs to always be mindful of the client’s needs. In essence, their job is to put the client’s needs above their own. According to Corey (2005), “our professional relationships with our clients exist for their benefit” (p. 37), and so the Code of Ethics encourages the counsellor to strive to be aware of any possible effect that their mental and physical state may have on his/her ability to help the client, and take the appropriate steps to ‘take care of themselves’.
The second principle of the Code of ethics is fidelity and responsibility. Fidelity speaks to the fact that the psychologist seeks to establish a trusting relationship with the clients, whether the client is an individual, a group or an organization. To this end, the counsellor is well aware that the information shared by the client in therapy is strictly confidential. Confidentiality is central to developing a trusting and productive therapeutic relationship, according to Corey (2005). He notes also that it is both an ethical and a legal issue. No meaningful therapy can occur without the client’s trust in the privacy of their disclosures to their counsellors, and so professionals are responsible to define and determine the degree of confidentiality that can be promised. The therapist has an ethical responsibility to discuss with the client the nature and purpose of confidentiality early in the counselling process. The client should also be made aware that the counsellor may discuss certain aspects of the relationship with a counsellor or colleague.
The counsellor would also be aware that confidentiality must be broken when it becomes evident that the client might do serious harm to either himself or others, and of course, the client would be so informed. This is what happened in the true case used to open this paper. The therapist chose to break confidence and inform his supervisor of the client’s revelations. The client was arrested. However, after promising to stay away from the woman in question, he was released. Two months later, he stabbed the woman to death. The parents of the woman sued the therapist and the university where he worked for failing to protect their daughter. This was clearly a complex issue involving confidentiality. Here, ethics and the law were “walking a thin line”.
Corey (2005) also notes that “there is a legal requirement to break confidentiality in cases involving child abuse, abuse of the elderly and of dependent adults.” (p. 41)
Fidelity also speaks to the right of informed consent, which is also an ethical and legal requirement, and is an integral part of the therapeutic process. Providing individuals with necessary information so that they can make informed choices can lead to greater cooperation on the part of the client. Because the therapist takes the time to educate the client about his/her rights and responsibilities, the client is empowered while a trusting relationship is being built. Corey (2005) identifies some aspects included in the process of informed consent as
the general goals of counselling; the responsibilities of the counsellor toward the client; the responsibilities of the client; limitations and expectations to confidentiality; legal and ethical parameters that could define the relationship, the qualifications and background of the practitioner; the fees involved; the services the client can expect; and the approximate length of the therapeutic process (p. 40).
The psychologist is responsible, not only for himself or herself as a professional, but also for colleagues. As such, psychologists are concerned about their colleagues’ compliance with ethical standards as well. The practicing psychologist is mindful of his/her professional responsibility to the organization and community in which he/she works, and accepts responsibility for behaviour.
Principle number three of the Code of Ethics stresses integrity. The code encourages the psychologist to do everything in his/her power “to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology” (APA, 2010). The psychologist should not attempt to cheat, defraud or be dishonest in any way, especially if such behaviour may lead to the client being harmed.
The fourth principle on which the Code of Ethics is based is that of justice. In other words, ‘fairness is the name of the game’. Kitchener (1984) points out that the formal meaning of justice is “treating equals equally and unequals unequally but in proportion to their relevant differences” (p.49). This means that if someone is treated differently by the psychologist, it is because there is a clear and appropriate reason for that treatment. For example, if a client is determined to be unable to make certain decisions as it relates to their therapy because of some mental challenge, then the psychologist would treat this client somewhat differently from how someone who is fully able to make such decisions is treated.
In addition to treating clients fairly, the psychologist is also cognizant of the fact that everyone is entitled to access and benefit from psychology and its contributions o the society. According to the code of ethics, psychologists also ensure that they are just as it relates to their own limitations of expertise and their competence. They are not to portray themselves, or allow themselves to be portrayed as a specialist in areas that they are not.
The psychologist must also be non-exploitative. There are many ways that a client may be exploited, but I think in particular now of sexual misconduct. Ethics codes do not condone this activity in any form. There are many reasons for this, including the fact that if the therapist surrenders to sexual attraction with the client, he/ she is making the needs of the client secondary to their own; the therapist who engages in such a relationship can no longer remain objective in making therapeutic judgments about the client; and some clients might not be able to make sound decisions about forming intimate relationships (Baron, 2001).
The final principle underpinning the Code of Ethics is respect for people’s rights and dignity. This underscores the justice principle and recognizes the humanness of each person regardless of gender, race, social status and such other distinguishing factors. The psychologist is careful not to allow personal biases to impair his treatment as it relates to such persons. The psychologist is also responsible to be aware of, and respect cultural, individual and role differences, and treat individuals accordingly, where required, based on the group of which they are a part.
The whole matter of ethics for the counselling and consulting psychologist includes a vast array of subtopics and little areas that sometimes may not even be thought of until they arise within the client-therapist relationship. In all honesty, while I sat in Professional Ethics class for the weekend of June 25-27, 2010, I was introduced to, and thought of, so many ways that a therapist can make mistakes and ‘slip up’ in the profession. It appeared to me that the psychologist is required to be almost a perfect person and so much is demanded of this individual, because at every turn, he/she must be cognizant of how their behaviour can affect the client and the community in which they work. It appeared to me that there are so many instances in which the counsellor, if not very sensitive, can behave unethically. More than one lecturer mentioned that they have been to social events where they have been in the company of clients. The lecturer/psychologist felt that it would be safer for her to leave the social event rather than have the client be uncomfortable. One lecturer was careful to note, however, that it is not always possible to excuse oneself from such events. In such cases, if the therapist thinks that the client might need a reassuring word that although they are familiar with the same persons, there will be no discussion of the client’s issues, then they would find some private time to talk with the client.
I noted with interest, too, that in the Code of Ethics, under section one (1) that deals with ‘Resolving Ethical Issues’, the first loyalty of the psychologist lies with the code. For example, Section 1.02a Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority, the code states that:
If psychologists’ ethical responsibilities conflict with law, regulations, other governing legal authority, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority. (p.4)
It would appear that the grounds on which most lawsuits are brought against psychologists is as it concerns unethical behaviour. This further underscores the point that the counselling and consulting psychologist needs to clarify his values, and take the ethical guidelines for both his organization and profession very seriously.
The counselor will find that interpreting the ethical guidelines of the professional organization and applying them to particular situations demand the utmost ethical sensitivity (Corey, 2005). There will be times when the decision to be made is clear and easy; but there will be times when the decision is difficult, and has implications for further actions, and even for the counsellor, as in the mentioned case. The counsellor will struggle sometimes to decide how to act in ways that will further the best interests of the client. However, the psychologist is not operating, and should not operate in a vacuum. The psychologist has the option of consulting with other colleagues, and with supervisors. Corey (2005) notes that the counsellor should also “keep â€¦ informed about laws affecting your practice, keep up-to-date in your specialty field, stay abreast of developments in ethical practice, reflect on the impact your values have on your practice and be willing to engage in honest self-examination.” (p. 37)
Various authors have posited ethical decision making models to assist the counsellor when faced with an ethical dilemma [e.g. Van Hoose and Paradise (1979), Kitchener (1984),
Stadler (1986), Haas and Malouf (1989), Forester-Miller and Rubenstein (1992), Sileo and Kopala (1993) and Corey, Corey and Callanan, (2003)]. The steps to follow are generally the same and are listed below.
Identify the problem or dilemma.
Identify the potential issues surrounding the dilemma, e.g. legal issues
Consult the relevant Codes of Ethics for guidance on the matter.
Determine the nature and dimensions of the dilemma. This includes considering the general principles of the APA code of Ethics, reviewing relevant professional literature, consulting with experienced colleagues or supervisors and consulting your professional Board or Association.
Generate potential courses of action.
Consider the potential consequences of all options for both therapist and client.
Choose what seems to be the best course of action, implement it, and follow up the outcomes and determine if further action is necessary.
This all important matter of making sound ethical decisions in the counselling and consulting practice is not to be taken lightly by the psychologist. At every point along the practice, the counsellor is making some ethical decision. Consulting with the code of ethics and with colleagues and supervisors can help the psychologist to ‘stay on track’ as he/she continues in the practice of helping.
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