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Ethical dilemmas are a not so rare occurrence in mental health counseling. Counselor’s are constantly faced with deciding how to resolve conflicts related to professionalism, ethics, and obeying laws. A major consideration in resolving an ethical dilemma are counselor values. A counselor has both specific personal values and professional values which impact decisions in the counseling room. This paper will utilize the Counselor Values-Based Conflict Model (CVCM) to address dual relationship boundaries (Kocet & Herlihy, 2014).
In a clinical setting, for the last three months, the counselor has been working with a post-release convicted sex offender who spent six years in prison. He is seeking counseling to rebuild his life and re-integrate into society. He struggles to be truthful with his girlfriend about his past legal issues, and his inability to keep a job. The client also steals money from his girlfriend to go out for drinks with his friends. One weekend, the counselor attends a party hosted by her sister to meet her boyfriend for the first time. It turns out, the counselor’s sister is dating her client, and they are considering marriage. The ethical dilemma presented in this scenario is couched in the context of relationship boundaries specifically dual relationships (ACA Code of Ethics, 2014). The counselor has unknowingly counseled her sister’s boyfriend for the past three months. As a result, the counselor is privy to information concerning the client’s past and is bound by professional ethics to maintain all client confidences, unless there is a threat of serious foreseeable harm to the client or another individual (ACA Code of Ethics, 2014). Additionally, the counselor’s personal values may cause conflict because she has personal knowledge of her client’s past concerning his legal issues and stealing from her sister.
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In surveying this scenario from a Counselor’s Value-Based Conflict Model (CVCM) there are five steps to aid in the decision-making process (Kocet & Herlihy, 2014). The first step is determining whether the nature of the conflict is personal, professional or both. Step two involves exploring core issues and obstacles that impede the counselor’s ability to provide standard care to the client. Step three postulates, a counselor should seek support from knowledgeable others regarding the practice of appropriate care. The fifth step requires the counselor to evaluate possible courses of action and decide how to remedy the issue. The goal of step five is to ensure selected actions promote client welfare (Kocet & Herlihy, 2014). Each of these steps are useful in developing counselor competence for identifying biases which may disrupt competent care (Grunhaus, Tuazon, Gonzalez, & Wagner, 2018).
Individual Position- Sharell
This case brings up several feelings. I would feel pulled to tell my sister about her boyfriend, including his legal trouble, unstable work patterns, and his stealing from her to go out with friends. Their consideration of marriage would cause great concern. Knowing that he is financially unstable, the urge to encourage my sister not to marry him would be substantial. On the other side, considering to initiate a conversation with my sister is in direct conflict with client confidentiality. I love my sister however; I also value my career. Thinking about my future in terms of being able to retain my professional license is another important factor. My sister and my client could join together, upset by my choice to divulge private information to seek punitive remediation.
There are several stakeholders involved in the presented ethical scenario. The counselor must consider several concerns from differing perspectives including personal life, potential ethical and professional violations, supervisory relationship, relationship with client, and the sibling bond. Counselor’s have their own personal values just like everyone else. At times this profession requires mental health professionals to bracket their own beliefs to effectively work with clients in a clinical setting (Grunhaus, Tuazon, Gonzalez, & Wagner, 2018). In some situations, the counselor may feel like their values conflict with established professional guidelines. When an ethical dilemma involves a family member, it may be difficult to separate values from professional standards. Establishing and adhering to ethical guidelines is essential as clients work toward wellness (ACA Code of Ethics, 2014). Direct violation of ethical codes has many consequences including licensing board restrictions which may include probation, continuing education requirements, or loss of license (24 NC Code § 90-340). A mental health counselor’s failure to adhere to ethical standards reflects a lack of professional development. Professionalism is an aspect covered among counselor and supervisor. As such, counselors are advised to seek support from supervisory staff for assistance (Wheeler & Bertram, 2015). Should the counselor choose to act before engaging in a conversation with their supervisor, it is damaging to the counselor, supervisor, and the profession. The supervisor entrusts the counselor to bring challenging situations for discussion to reduce the risk of damaging decisions. When situations are too complex for the counselor and supervisor to work through together, the profession has other supports available including licensing boards and ethics committees. An ethical cornerstone involves not harming clients during the therapeutic process (ACA Code of Ethics, 2014). In the presented scenario, the client must be considered. If the counselor choses to tell her sister about her boyfriend, the client’s emotional well-being could be at risk, if he finds out the counselor released his personal information. The impact on the counselor/sister relationship is also a concern. If their personal values are similar in terms of feeling the need to protect, support, and not keep important, potentially harmful information from each other, deciding not to inform could lead to loss of relationship or decrease in closeness.
Particularly prevalent complaints to licensing boards include confidentiality and boundary dilemmas (Wheeler & Bertram, 2015). Licensing boards have a stake in this ethical situation, because they are charged with the duty of ensuring that licensed mental health professionals adhere to board regulations. When a complaint is filed, the board must investigate the complaint. If substantiated, several options are considered to help the counselor learn from their mistake. The counselor may be required to partake in additional supervision or counselor education (Wheeler & Bertram, 2015).
North Carolina State Laws Applicable to Duel Relationships
In article 24: protection of the public, North Carolina expressly states its coherence with the ACA. However, it is important to note section nine under this statue list an exemption per the following; when an ethical code is inconsistent and conflicts with the provisions outlined in this article, the provisions of the article shall control. Per this article, counselor who violate any provision or rules adopted by the board through immoral, dishonorable, unprofessional, unethical, or exploitative conduct will face board or legal sanctions (24 NC Code § 90-340). Ethical code A.6. posits managing professional boundaries is necessary for maintaining professional boundaries. Additional exploration of dual relationships is considered in statue A.6.b., involving the extension of counseling boundaries. This section notes the importance of considering risks and consequences that could surface when professional boundaries are extended outside the clinical realm. Specific to the ethical dilemma described in this paper, ethical standard A.4.b ascertains, counselors should avoid imposing their own values, attitudes and maintain high level of respect for diversity (Code of Ethics, 2014).
My consultation was conducted with a Licensed professional counselor, referred by my site supervisor. The purpose of this consultation involved discussing confidentiality and professional boundaries. Counselor explained important regulations for private practice counselors related to confidentiality and releasing information without consent. She provided information regarding the correlation between boundary violations, confidentiality and board complaints. It was noted that the best way to avoid confidentiality violations is to never give out information of any kind, until you double check release consents, even if you are pretty sure, go back and check before disclosing anything. Counselor stated it can be difficult in our town to avoid dual relationships. Especially, if you have children who play community sports. however, in her opinion, it is best practice to maintain separate professional and personal relationships. One important reason is it limits the chance of being asked to do things that are not related the client-counselor relationship. Consider making schedule changes, if necessary. She also stated the importance of being very clear and thorough in explaining your professional guidelines during the consent phase.
Course of Actions
As the counselor considers the best course of action, the five foundational principles should be utilized. The principles are autonomy, justice, beneficence, nonmaleficence, and fidelity (Forester-Miller & Davis, 2016). Autonomy is concerned with allowing every individual freedom of choice in life. Client’s should be encouraged to make their own decisions based upon personal thoughts and values. In fostering autonomy, the counselor should assess the client’s ability to make competent decisions, and help the client understand how their decisions could be perceived by society (Forester-Miller & Davis, 2016). In the presented scenario, consider the client immediately breaks up his girlfriend (his counselor’s sister) and informs the counselor that he will no longer see her sister because he needs to continue counseling. The counselor could choose to continue seeing her client, if she feels she can adhere to professional requirements. From this perspective, the counselor could work with the client helping him recognize the importance of being honest with individuals he cares about, hoping inspiring him to reveal to his ex-girlfriend, past inconsistences and deceit during their relationship. A potential consequence of the client initiating a conversation with the counselor’s sister again, could rekindle their previous relationship, leaving the counselor at risk of a dual relationship.
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The second foundation is justice, which involves treating others according to their physical and emotional needs, remaining compliant with ethical and legal guidelines. In essence, it means being fair to all clients (Forester-Miller & Davis, 2016). Following ethical code A.4.a., counselors should seek to not harm, reduce or limit harm to clients (ACA Code of Ethics¸ 2014). In this situation, if the client and the counselor’s sister maintain their relationship, the counselor should terminate and refer to another counselor. The rationale for this includes the counselor’s intimate knowledge of the existing relationship between her client and her sister. Also, it would be nearly impossible to avoid her sister’s husband, should they get married. If the counselor continued counseling her sister’s husband, it would be a violation of ethical code A.5.d which prohibits counselor from providing professional services to friends and family (ACA Code of Ethics, 2014). Consequences include suspension of license, probation, remedial education, and formal reprimand (24 § NC Code 90-340).
Third, beneficence presents the idea of counselors support their client’s movement toward well-being (Forester-Miller & Davis, 2016). The promotion of goodness brings about the postulation; should well-being of the client be pursued at all cost? Here, strong personal values and commitment to family (Fulmer, 2014), could lead the counselor to divulge client information, encourage her sister to ask her boyfriend specific questions, or encourage her sister to pay close attention to her finances. This is not a recommended course of action, rather, it is an illustration of how the counselor’s values and beliefs could influence choice. This choice could result in a licensing board or ethical complain from the client (Wheeler & Bertram, 2015), if he feels his counselor has violated confidentiality.
Nonmaleficence is the fourth consideration (Forester-Miller & Davis, 2016). This foundation also directly connects counselor actions to the ACA code of ethics principle A.4.a, avoiding harm (ACA Code of Ethics, 2014). In the given dilemma, the counselor should seek supervision and consultation for help identifying what a reasonable counselor would do (Wheeler & Bertram, 2015). If the counselor follows recommendations and confers with their mental health attorney, there should be minimal consequences, if any.
The last foundational entity is fidelity. Fidelity is concerned with the counselor’s ability to remain loyal and trusting in upholding counselor-client relationships (Forester-Miller & Davis, 2016). This allows clients to work toward an authentic relationship with his counselor (Sharf, 2014). Consider again, the client immediately ends his relationship with the counselor’s sister to preserve the therapeutic relationship, this would be a good time to revisit counseling consent to allow the counselor to re-affirm her commitment to the counseling process and the client’s right to confidentiality (Wheeler & Bertram, 2015). One consequence could include the client secretly resuming his relationship with the counselor’s sister, placing the counselor’s career and licensure in jeopardy.
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