This assignment considers some of the ethical and legal considerations involved in the provision of counseling services to clients with whom a practitioner may occupy more than one professional or personal role within the counselling relationship.
Considerations When Dealing with Multiple Roles
When entering into a counseling relationship with new clients, psychologists must take reasonable and appropriate steps to ensure that those relationships are not blurred by conflicting or overlapping professional, social or interpersonal roles. Section 3.05 of the American Psychological Association (APA) code of ethics makes it clear that, where such roles may exist, they hold the potential to create confusion and impair the professional judgment
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of clinicians. (APA, 2010). It is important to note that multiple relationships only cross the line which defines unethical behavior if the existence of such a relationship holds a reasonable potential to cause harm to clients. Where carefully considered and weighed against their benefits, multiple relationships frequently exist and can often be necessary and beneficial to the client (Fisher, 2013). Some common considerations include: Confidentiality Where clinical and non-clinical relationships become intermingled, the distinction between what information is revealed, and thus open to, therapeutic intervention may become difficult to recognize (Wheeler and Bertram, 2013). Particularly in isolated or rural setting, separation of material which a client wishes to remain outside of the counseling relationship may not be possible. Clients frequently come to counseling with perspectives and interpretations of their day to day life which a clinician may know or believe to be false or incorrect based on their own non-clinical interactions. Keeping these outside interpretations outside of the counseling relationship and providing an unconditional positive regard for their client may present an extremely difficult scenario interfering with objectivity and overall effectiveness. Consent When entering into a counseling relationship, clients generally have the right to consent to any therapeutic intervention or to withdraw from therapy free of consequences (APA, 2010) (CPA, 2000) (ACA, 2005).
Where multiple roles exist, it may become difficult to distinguish where the limits of consent are applied. Remley and Herlihy (2010) point out that with the intertwining of such roles, the line between the clinical and non-clinical setting, and thus the need to seek informed consent, becomes impossible to separate as the nature of those roles moves further away from a strictly clinical setting. The inability to withdraw from the non-clinical component of such relationship may also leave clients feeling trapped in a therapeutic role from which they feel as though they have no choice but to participate lest they incur negative consequences that extend beyond their wish to withdraw from clinical services, thus scuttling their de facto right to consent to treatment (Wheeler and Bertram, …show more content…
2013). Conflict of Interest The traditional professional boundaries between the clinician and their client serve as an important component of creating a safe therapeutic space that is different in form and function than day to day living (Fisher, 2010). Within this space, seeking consent and willing participation builds upon the foundation of trust that is necessary for an effective working alliance. Removing that distinction holds the potential to create conflicting goals and feelings as non-clinical considerations intrude upon the safety of disclosure within the context of the insulated clinical roles of both therapist and client (Erford, 2010). Application to Vignette One The practical impact of these considerations can be applied to this week’s vignettes. In this first vignette, a couple is referred by a colleague for pre-marital couples counseling. Boundary Issues Present In this scenario we see that the client being referred is a personal relative of a colleague. While referral is a responsible choice for the referring colleague, they are creating a multiple relationship for both themselves and for the treating clinician in the process. The dual relationship that will result from this referral holds the potential to cause problems as the therapeutic relationship unfolds. The clinician must consider a number of possible outcomes and carefully weigh any involvement within the broader context of Section 3.05 of the APA code of ethics.
A conflict of interest may unfold during therapy as the clinician attempts to balance either negative consequences should therapy not conclude to the satisfaction of the client, or positive consequences should the clinician anticipate the realization of some form of secondary gain at the hands of a contented colleague.
Issues that may be contentious or uncomfortable may not be treated in the manner in which they should out of concern for the clinicians’ professional relationship thus compromising the depth and effectiveness of work with the client couple as objectivity may be compromised.
Due to relationship between colleague and clinician, confidentiality may be difficult to ensure. Physical proximity creates a more informal air and increases the chances that either discussion or exposure to written records may occur as curiosity or personal relationships encroach on the professional relationship.
Moving
Forward In contemplating a course forward, a number of considerations should be taken into account: The vignette mentions that the clinician is not the only provider available to the couple. Unless there is some compelling reason why the clinician is the only appropriate option, it would be wise to decline the referral and suggest that an alternate clinician should be considered. Section 3.05(a)(2) of the APA code of ethics is reasonably clear that based on the existing personal relationship between the colleague and the client, and the co-existing professional relationship between the colleague and the clinician, a referral to another clinician should be the chosen course of action. (APA, 2010). In the absence of such a clear statement, deferring to the larger ethical principle of fidelity and responsibility should have the clinician questioning the role of the looming conflict of interest inherent in such an interaction. Where questions regarding the appropriateness of such an arrangement exist, consultation with a supervisor or another colleague should be considered. While overt boundary violations and crossings are easily detected, subtle and personal influences may impact objectivity and should be balanced against input from other professional sources (Erford, 2010). While ostensibly more mindful, clinicians are still human and still view the world within their own perceptions. Where situations arise that contain an element of grey, as this one does, perspicacity can be achieved by inviting an objective professional voice into the decision making process (Wheeler and Bertram, 2013). Application to Vignette Two In the second vignette, we see a psychologist who is teaching at a university and recognizes a client with who he has had a recent professional encounter seated in the front row of his class. The vignette indicates that information obtained from this earlier professional encounter is undoubtedly finding its way into his perception of the client within this new environment as the line between the two professional roles becomes blurred. Objectivity in such matters is always a cause for concern. In this particular instance, the psychologist is using information that he gleaned from his assessment of the student to form conclusions about her behavior as she sits in his classroom. Without considering his previous encounter, one wonders if the behavior of the young lady would be perceived as anything other than friendly or even pleasant. Accessing information that should be confidential in one role is clearly causing him concern within this role and represents a potential conflict of interest as his need to remove himself from a client he is apparently uneasy with conflicts with his obligation to treat his student fairly and objectively while fulfilling his role as an educator. Having referred the student to a female colleague in the face of concerns regarding her covertly sexual behavior would have been a wise decision if the clinician is not competent to deal with matters of sexual transference and countertransference within a therapeutic context; however, carrying that concern into this secondary role, particularly considering the brevity, nature and referral of her clinically, does not support the APA principles of justice or respect for people’s rights or dignity and may be construed as harm to the client if objectivity cannot be achieved or if the client suffers harm in the face of the clinicians differential treatment of her based on his earlier clinical role (Wheeler and Bertram, 2013). When making a decision as to how to proceed in such a matter, a number of factors should be considered. Does the psychologist’s knowledge from his professional encounter hold the potential to be applied in a harmful or unfair manner to his student within their current roles? If not, are there other options for either the student or himself to transfer to another course or class? Is it possible to achieve such a resolution without disclosing information which is both confidential and potentially damaging to his client? Is such a disruption necessary? The first consideration in this matter should be obtaining professional consultation in an effort to clarify objectivity. Whether the concerns of the clinician regarding the students’ covert sexuality have a basis in reality or whether they are more a matter of perception or personal discomfort should be explored with an objective third party as well as any concerns that may be present with respect to harm. Mention is made of the student being Asian-American. As a matter of further exploration, some consideration should be made as to the role that culture may play in this scenario. Does the observed behavior constitute normative custom within the culture of this client? Is the clinician within his boundaries of competence to make such a determination? Are the observations of the clinician healthy and valid? (Sue and Sue, 2008). The code of ethics of the Canadian Psychological Association contains extensive verbiage regarding the need to also consider a clinicians own biases, perceptions and competencies within the context of their interactions with their clients as well as consider the role of culture in both behavior and observation (CPA, 2000), a habit which should be engrained in any consideration of matters such as this. Concluding Comments The circumstances and complexities of multiple relationships are a career long challenge for most professionals. Multiple relationship complaints constitute the bulk of ethical and legal complaints to the profession and are an ever-present concern. Wheeler and Bertram (2013) assert that most ethical and legal body actions could have been avoided if more care had been taken to avoid entering those relationships in the first place. Where clinicians do enter such relationships, consultation, supervision and detailed records as to the nature and rationale behind them should be considered and employed wherever possible (Remley and Herlihy, 2010). It is important to remember that, while not without risk, multiple relationships when undertaken with care and under sound support can offer great potential to benefit our clients. In the end, we ask our clients to trust us and at some point we need to do the same.
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
Sim, J (1997). Ethical Decision Making in Therapy Practice. Oxford: Reed Educational and Professional Publishing Ltd. p.16.
This case study is an interpretation of a problem or situation that has occurred within a LPC’s (License Professional Counselor) care. As information is gathered, the depiction to this specific problem in this case study may also include additional information that may deem so to be necessary, in order to place possible solutions or actions that could have or will arise from the situation. This document will consist of a step by step analysis of the factors which impact the case, mostly in the order of what appears to be the most ethically sound decision. This document involves Stephanie’s (therapist) treatment of Martha Rose (client). The therapist, Stephanie, has been given a case through referral from an unknown source; Stephanie is working with this new case in SC (South Carolina).
Especially, in small communities where it is more common for psychologists to interact with clients and/or patients on a regular basis, such as social events, personal engagements, restaurants, grocery stores, shopping centers, and/or church outside of the workplace (Knapp, Handelsman, Gottlieb, & VandeCreek,, 2013; Pipes, Holstein, & Aguirre, 2005; & Schank, Helbok, Haldeman, & Gallardo, 2010), where the line between professional conduct, personal values, biases, and beliefs blur. It is at these times the aspirational principles of the APA, such as beneficence and nonmaleficence, fidelity and responsibility, integrity, justice, and respect for people 's rights and dignity can provide guidance and remind psychologists of the necessity of upholding professional codes of conduct regardless of situation (APA, 2010; Fisher, 2013). Discriminatory remarks and prejudicial views on an individual 's gender, sexual orientation, language barrier, or political views can harm current clients and patients as well as prevent potential clients and patients for seeking services and/or treatment from psychologists in the future harming the profession. Additionally, as psychologists the need to understand an individual 's multicultural identities as an essential part in providing services and treatment and failure to recognize and understand these similarities and
Disclosure is an essential aspect of a medical professional and his or her patients’ relationships. In the 1950s, the medical client and professional relationship was one of paternalism as opposed to the now fiduciary relationship. Then a paternalistic professional took all of the responsibilities, disclosed what he then thought was necessary, and essentially told the patien...
Mandatory ethics is the level of functioning where the counselor is abiding by the basic “do’s and don’ts” of professional counseling. These are definitive codes that will protect a counselor from legal action and professional censure. All mental health professionals will be held accountable by the minimum standards set by state licensure boards and courts of law. Issues addressed by the Code of Conduct of the American Psychological Association (APA) include, but are not limited to, competence, human relations, confidentiality and fees. (American Psychological Association, 2002)
...f dual relationship there was also a possibility of the client becoming dependant on the therapist which could be seen as unethical by the BACP (2010).
Ruddy, N. B., Borresen, D. A., & Gunn Jr., W. B. (2008). Colocating with medical professionals: A new model of integrated care. In The collaborative psychotherapist: Creating reciprocal relationships with medical professionals (pp.115–133). Washington, DC: American Psychological Association.
Understanding the counseling session from the client’s perspective is a very important aspect in the development of a therapeutic relationship. A clinician must be an excellent listener, while being to pay attention to the client’s body language, affect and tone. The dynamics in the counseling session that is beneficial to the client include the recognition of the pain that the client is feeling. The detrimental part of this includes a misunderstanding of the real issues, a lack of consideration of the cultural aspects of the client, and a lack of clinical experience or listening skills. In this presentation, we will discuss the positive and negative aspects of the counseling session from the client’s perspective which includes the client’s attitudes, feelings, and emotions of the counseling session. We will next examine the propensity of the client to reveal or not reveal information to the counselor, and how transference, and counter-transference can have an effect on the counselor-client relationship.
According to Allison L. Kramer (2016) in her “Why we can’t be friends” article, researches have observed numerous relationships between psychotherapists and their present and/ or previous clients. Boundary issues have been studied in the world of ethics and dual-role relationships with current clients are ordinary for some practitioners in their daily practice. Meaning it isn’t rare to run into dual relationships in counseling. These relationships aren’t always negative nor avoidable states Kramer. The example she used for dual-role relationships being advantageous and unavoidable was a school guidance counselor having multiple roles in the school. The counselor could also be “a coach of a sports team, thus filling both a counselor and
The Code of Conduct for Psychologists seem to be more strict or demanding. When in the position as psychologist or counselor you are responsible for the life of another. Not dealing with a client with standards could destroy the client’s life and the lives surrounding the client. People entrust of with their lives, thoughts, and care.
Workers in the helping professions endure a massive amount of ethical and professional issues. These issues affect the practice of counseling and the relationship with the client. The book Issues and Ethics in the Helping Professions by Corey, Corey, and Hallanan gives many themes that one will encounter throughout their career. The book also gives possible solutions to problems and stimulates different ways to think about issues. The authors of this book provide good knowledge and information for anyone in the helping professions.
This paper will explore the concept of dual relationships between counselors and clients and the ethical implications of such relationships. In addition to presenting several examples of dual relationships, this paper will also explore how ethical decisions must be made to avoid potentially harmful or exploitive relationships in therapy as well understanding how different interactions between counselor and clients can be understood from an ethical standpoint, as well as how reviewing these ethical dilemmas may shape my future career as a counselor.
Ethical issues in a counseling practice lay the foundation of a therapist in practice. Ethics are at the center of how the counseling process functions and operates in a successful manner for the clients who seek help in such a setting. In order for the counseling profession to be ethical and hold professional recognition, there are many facets that need to be examined and outlined to make sure all counselors and practitioners are functioning at the highest level and withholding their duties required by the counseling profession. The first introduction so to speak of the area of ethics also happens to be one of the first steps in counseling, which is the informed consent. The informed consent provides the basis of what happens or will be happening in a counseling setting and serves to inform the client to their rights, responsibilities, and what to expect. Most importantly, the informed consent is in place for the client’s benefit. It also is important to understand that culture and environment play a role in the treatment of a client and how theories can positively or negatively impact this treatment. Therapists need to understand how to work within the context of a theory while being able to understand the individual in their own environment. Although theories are put into place to serve as a framework, there are also alternative ways to approach counseling, one example being evidence-based practice. Such an approach is very specific, which presents a series of solutions for counseling as a whole, but also brings forth many problems. Every approach or theory introduces ethical concerns that need to be taken into consideration by the entire counseling community and how each can positively and negatively affect clients and the pr...
In this case, the psychologist is presented with several ethical issues which could cause harm to the client. The first ethical issue that arose in this case is the potential for a role conflict. The psychologist and Mr. Hartwig had contact prior to the development of a therapeutic relationship when the psychologist bought a car from Mr. Hartwig. It may not be enough that the brief, informal relationship ended. The psychologist must assess the dimensions of the previous relationship from the viewpoint of the client as well as his/her own personal feelings (Koocher & Keith-Spiegel, 2008). For example, the client could feel that he gave the psychologist a good deal and that the psychologist was indebted to him. This could leave the psychologist vulnerable to being manipulated by the client. Or, what if the car broke down? This could leave the psychologist feeling cheated and resulted in hostile feelings toward the client. The psychologist has an ethical responsibility to examine both relationships for role incompatibility prior to forming a therapeutic relationship. The psychologist seemed to be aware that there was the potential role conflict resulting from their initial meeting, and he acted ethically by attempting to refer Mr. Hartwig to a Psychology Registry.