Ethical Issues in Agency Counseling

Sabrina Dougherty
Amy Haney
 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
What motivates your ethical practice?
Class discussion

 Fearful motivation; fear of consequences?

Ethical Principles of the Therapeutic Professions (Five Golden
Principles)

 Autonomy- honoring the client’s 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
Confidentiality

 Confidentiality is a therapist’s ethical

obligation to keep the identify of their clients
private.
 Being clear with clients about the limits of
confidentiality is important
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.
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.
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.
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.
 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.
Sexual Contact with Clients

Don’t Do It!
TRUE or FALSE

1. Male therapists are most often

the offenders and female clients
most often the victims.
2. The sexual contact is not limited
to adults and includes children.
3. The problem is increasing
reported worldwide, not just in
North America.
(Welfel, 1998)
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.”
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
What do I do?

 Establish therapeutic relationship

 Start where the client is
 Foot-in-the-door OR Door-in-the-face
 Punishment/Reinforcement
 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)
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.
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)
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).
Working with Clients with HIV or AIDS
What 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).
 Justification in Breaking
Confidentiality

 According to Gray and Harding (1988), therapists

are justified in breaking confidentiality when:
1. “a therapeutic relationship exists between the
counselor and client”

2. “the client is known to have a medically verified

diagnosis of HIV infection or AIDS and refuses to
make contacts aware of the situation”

3. “the risk of other identifiable victims is (or seems)

imminent.”
 Erickson’s Idea

1. Initial session: tell the client about limits of

confidentiality
2. Get permission from client to contact
relevant medical personnel
3. 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 client’s
life, the counselor will report to the contacts
or state health department (if contacts are
unknown) (Erickson, 1990)
 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)

 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.”
 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.
Principles by Sabin (1996)

1. Provide services without “overtreatment”

2. Least costly treatment plan

3. Advocate

4. Informed consent
 Diagnosis and Third-Party Payors
Issues

 “Quick” diagnoses to justify payments for

services

 Issues with “over diagnosing” to receive

payment
 What do I do?

Welfel (1998) suggests the following:

1. Does the financial agreement with the payor
allow for the counselor to make
independent professional judgment based
on the client’s goals and needs?

2. Do the people conducting the utilization

review have the appropriate clinical
background to make informed decisions?
 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.

 References Con’t

 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.