When there is no “Ethical Framework” for “Psychological Interventions” …
By Pramudith D Rupasinghe - Consultant clinical psychologist – Program Manager –Psychosocial Support –Danish Red Cross
Interview resumption – 17th June 2009
PSS operational framework development workshop
Vavuniya.
“Ethics” are implied to almost all the professions
and they add significant value and act as an
operational framework to those who exercise those
professions. In sooth, professional ethics or in other
terminology the code of conduct deals with human
relations (interactions) at work more than with
abstract rules. Also the professionals are expected to
respect among themselves as well as with those
whom they serve. This is the key to ethical
relationship at business. The competency consists
knowledge, skills, judgment and diligence, in
serving the well-being of the others. Hence
competent professionals are expected to exercise
their area of responsibility respecting to the ethical
frameworks. When “Ethics” in counseling pr
psychological interventions are considered, the
professionals are profoundly bounded to profess in
accordance with not only the “ethical frameworks”
but also with sensitivity to social, cultural, religious
and individual diversities. As a psychological
counselor, you are not expected in diagnosing,
prescribing and treating but you are holding the
ultimate responsibility of healing your clients by
facilitating, clarifying, understanding, encouraging
and helping. Hence this process of facilitation and
assistance in healthy personal growth, adjustment
and in solving problems should be practiced with
high level of discipline and reliability.
For counseling and psychotherapy or
psychological interventions in general, there should
be clear and specific ethical framework or code of
conducts for professionals which states with clarity
the limitations and appropriate interventions to the
local context along with a set of guidelines adopted
to international standards in mental health and
psychosocial interventions. In most of the western
developed countries, under the metal health policy
of the state, bioethical framework for psychological
interventions have been introduced with guidelines,
standards and even with legal implications in case
when the expected standards are not met by the
practitioners. In addition, global bodies and
organizations, such as World Health Organization
(WHO), American Psychological Association, etc,
have introduced guidelines, tools and standards in
psychological interventions in which social and
cultural considerations in interventions are included
and compiled as an “Ethical Framework” for the
practitioners. These global tools are having been
developed leaving adequate flexibility for
adaptation in to local context in accordance with the
social, cultural religious and other diversities. Also
most of the guidelines and the standards presented
in these global tools are possible to be used cross-
culturally. But unfortunately, in most of the
developing countries the policy level governmental
and organizational involvement for psychological
interventions is at infantile stage. Hence proper
policies, locally adopted guidelines, and standards
are not yet available in the countries like Sri-Lanka.
Though there is a great need of standardized and
systematic operational mechanism for the
psychological interventions today to ensure a
quality and sustainable service delivery.
Thought there are no proper policies and ethical
frameworks formulated by recognized bodies, the
human problems that have to be addressed in a
professional and ethical manner. Hence the
counselors who are practicing in the areas where
there are no properly documented , stated or
approved ethical framework or a code of conduct,
alternative implications have to be applied in lieu of
bio-ethical framework, ensuring a quality,
sustainable and a professional service.
It is highly necessary to consider what is really
included in an ethical framework and what is the
expected change in professionals and the service
through such a code of conduct of professionals.
Ethical framework can be defined as a
comprehensive document that clearly states the
limitations expected conduct of professionals who
profess a certain profession and the standard level
of quality of the service along with the required
minimum level of human as well as physical
resources for meeting the accepted standard. It`s
guidance, dimensions and limitations are inspired
by social, religious and moral values blend with
professionalism, competencies, genuineness,
accountability, and specificity. Hence when there is
not properly stated, documented and approved code
of ethics or conduct for the psychological
interventions, the counselors, psychologists or
psychotherapists should align their interventions in
accordance with above mentioned values in the
local context. This would be very understandable
when we consider each set of values separately and
analyze how they can be implied in lieu of a bio-
ethical framework.
Respecting social norms, mores and customs, or
in resumption respecting social values, the process
of counseling should be done in absence of ethical
framework. Social values can be considered as
accepted dimensions or standards of behavior such
as good manners, good and bad, traditions, etc.
These values have to be respected by the counseling
professionals during the therapeutic interactions
with the clients.
Along with the social values or sometimes within
the social values, oral and religious values are
highly considered in a society. The demarcation
between “right” and “wrong” ,“good” and “bad”
and other “do s” and “don’t s” are inspirations of
religions. Respect to the socially accepted morale
values in the process of counseling, or any form of
psychological intervention is a must irrespective of
availability of an ethical framework.
Apart from cultural, social religious and moral
values, in him psychological professionals should
respect the values and beliefs of the client, even
though those are not values that are not respected in
counselor`s private life. Hence a cross-cultural
counseling approach based on respect of social,
religious and cultural values makes the counseling
process less problematic and more professional and
recognized when there is not documented or stated
cultural, social and religious limitations in
interventions.
The professionalism matters the most in
developing a professional relationship. Being the
facilitator for one`s healthy growth and solving
problems, psychological counselor should be
capable of adopting the professional standards
(international or country wide) in to the local
context as well as respecting the individual
differences ensuring an optimum level of quality
and client centric service while maintaining a high
level of professionalism. Hence the counselor
should be sensitive to the culture, traditions and
other diversities of counselee`s context and should
be competent enough to adopt the approach in
accordance with her context.
The values, professionalism and the
competencies, all these above detailed factors are
supportive and complementary to establish a
healthy therapeutic alliance. The relationship
between the client and the therapist, and its nature
influence a lot to the success or the failure of the
intervention. When “Ethics” are concerned, not only
the relationship between the therapist and the client,
but also the therapists or counselors relationship
with profession, with referral systems aas well as
the relationship to himself are also significant. The
counselor knowing his professional limitations,
based on his competencies, and experiences, should
refer the cases beyond his competencies to a
professional referral system. Hence he should be
well networked with the allied professions such as
psychologists , psychiatrists, substance abuse
interventionists etc in order to evite the duplications
and ad hock treatments. When the relationship with
the counselee is concerned, the nun-judgmental
approach based on the fundamental principles of
counseling should be established. Also, necessarily
the reliability should be the key of the counselor-
counselee relationship. Further, confidentiality, its
limits in the therapy, the relationship and
communication n with the loved ones and peers of
the client should be done very sensitively in order to
avoid further harm and with only intention of
facilitating healthy growth and solving problems of
counselee ensuring the final goal “healing” .
Hence, in conclusion, the implications, in
absence of a clearly stated, documented and
approved bio-ethical framework or code of conduct
for psychosocial interventions, are the above
detailed values and dimensions.