Ethics in Clinical
Practice
Compiled by Victoria A. Fitton, PhD
with assistance from:
Corey, G., Corey, M.S., & Callanan, P. (2006) Issues and ethics in the helping
professions (7th ed.). Belmont, CA: Brooks/Cole.
Reamer, F. G. (). Social work values and ethics (3rd ed.). New York, NY:
Columbia University Press.
Ethical
Considerations
• Ethics – beliefs we hold about what constitutes
right conduct; moral principles adopted by
individuals or groups to provide rules for right
conduct.
• Professional responsibility to examine and clarify
personal values and professional practice.
• Personal values exert considerable influence on a
professional’s views of clients, their intervention
frameworks and strategies, and definitions of
successful or unsuccessful outcomes.
Personal and
Professional Values
• Social workers occasionally face tension between
their personal values and those held by clients,
employers, or the social work profession itself.
• Social workers sometimes encounter clients whose
values and behaviors seem immoral and abhorrent
(child abuse, violence).
• Some dilemmas relate to the congruity or
incongruity between the professional’s value
orientation and those of the client.
Reamer, 2006
Personal and
Professional Values
• Client difficulties often contain a moral dimension.
• Clients often wrestle with moral aspects of
problems (divorce/infidelity; IPV/child care).
• These emerge vividly and emotionally in expressive
therapeutic work.
• Learn to view problems through an ethical lens
with clear understanding of personal values.
• Actively explore clients’ perspectives about what
they believe is ethically right and wrong.
Reamer, 2006
Cultural and
Religious Values
• Important to recognize the influence of our own and
clients’ religious and cultural values and beliefs
(abortion/marriage/women…).
• Be mindful of potential conflicts between our personal
values and clients’ cultural and ethnic norms (medical).
• This will also be manifest in expressive therapies. (What
can be avoided in talk therapy is direct in expressive
therapies.)
• Professional (NASW) and religious views on sexual
orientation are often in conflict.
Reamer, 2006
Free Will and
Determinism
• Values or beliefs related to the determinants of
clients’ problems.
• Social workers make assumptions regarding the
causes of client problems which significantly
impacts treatment planning.
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Biology (Medical/Disease model)
Environment (Social Learning Theory)
Institutional/Political (Racism, Left-Right)
Economic (Oppression/Globalization)
Personal Deficit
Reamer, 2006
Defining Your
Personal Ethics
• Personal beliefs and values
• Spiritual and religious values
• End of life decisions
Thinking Through Ethical
Problems & Dilemmas
1. Identify the problem or dilemma
2. Identify the potential issues involved
3. Review relevant ethical codes
4. Know the applicable laws and regulations
5. Obtain consultation
6. Consider possible and probable courses of action;
7. Enumerate the consequences of various decisions
8. Decide on what appears to be the best course of
action
Corey, Corey & Callanan, 2006
Documentation Ethical Dilemma
Remember to document:
• Client name
• Date of service
• Aspects of the issue or dilemma (delineate)
• Intervention and response to treatment goals
• Action/s taken
• Clinician
• Signature
• Credentials
• Date
Legal Aspects of
Informed Consent
Four elements are basic to the legal aspects of
informed consent:
1. Full Disclosure or Full Information – giving
clients information on all aspects of therapeutic
process, expectation, and intervention upon
which informed consent can be based
2. Capacity – client has ability to make rational
decisions (parent or guardian)
Corey, Corey & Callanan, 2006
Legal Aspects of
Informed Consent
3. Comprehension of information - must give
clients information in clear ways and check for
understanding. Clients must have adequate
information about both procedure and possible
consequences (risk/benefit)
4. Voluntariness - acts freely in decision-making
process and is legally and psychologically able
(competent) to give consent
Corey, Corey, & Callanan, 2006
Ethical and Legal Issues Confidentiality & Privilege
• Confidentiality – the right to expect that
communications will be kept within the bounds of
the professional relationship.
• Privileged Communication – a legal concept that
protects against forced disclosure in legal
proceedings that break a promise of privacy.
• Does not apply to group counseling, marital and
family therapy, or child and adolescent therapy.
Corey, Corey, & Callanan, 2006
Ethical and Legal Issues –
Privacy
• Privacy – refers to the constitutional right of an
individual to decide the time, place, manner, and
extent of sharing oneself with others.
• Exercise caution with regard to the privacy of
clients. Do not invade a client’s privacy.
• Think about the use of telephones, answering
machines, voice mail, pagers, faxes, cell phones,
and e-mail.
Corey, Corey, & Callanan, 2006
Ethical and Legal Issues –
Duty to Warn
• Duty to Warn – mental health professionals have a
double responsibility to protect other people from
potentially dangerous clients and to protect clients
from themselves.
• Identifying clients who pose a threat to others
• Protecting others from potentially dangerous
clients
• Treating those clients who are dangerous
Corey, Corey, & Callanan, 2006
Full Disclosure –
Checklist for Treatment
1.
Voluntary Participation
2.
Client Involvement
3.
Counselor Involvement and contact
4.
No Guarantees
5.
Risks and Benefits Associated with Counseling.
Emphasize role of client’s responsibility in treatment.
6.
Confidentiality and Privilege
7.
Counseling Approach or Theory
Full Disclosure –
Checklist for Treatment
8.
Exceptions of Confidentiality and Privilege
9.
Counseling and Financial Records
10. Ethical Guidelines
11. Licensing Regulations
12. Credentials
13. Fees and Charges
14. Insurance Reimbursement
15. Responsibility for Payment
16. Disputes and Complaints
Full Disclosure –
Checklist for Treatment
16. Cancellation Policy/Interruptions in Therapy
18. Affiliation Relationship
19. Supervisory Relationship
20. Colleague Consultation
21. Alternatives to Traditional Therapy
22. Tape-Recording or Videotaping Sessions
23. Client Access to Files and Diagnostic Classification
Corey, Corey, & Callanan, 2006
Personal Issues and Ethics Protective Factors
• Balancing Life Tasks – creating and maintaining
a commitment to promoting ones own wellness
from a holistic perspective:
• Spirituality
• Self-direction
• Work and leisure
• Friendship
• Love
Personal Issues and Ethics Risk Factors
• Counselor Impairment
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Fragile self-esteem
Difficulty establishing intimacy in personal life
Professional isolation
A need to rescue clients
A need for reassurance
Substance abuse of any kind
Lack of empathy
Poor social skills
Preoccupation with personal needs
Discounting possible harm to clients or others
Ethics in Child
Practice
• Full disclosure
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Ages of children trained to treat
Childhood issues trained to treat
Theoretical orientation
Treatment philosophy
What a family can expect - risks/benefits
Continuing education and training
Supervision and peer consultation
Range of treatment options/interventions
Treatment Options
• Information on child treatment
• Information on child development
• Brief overview of play and expressive therapy
• Directive, non-directive and prescriptive techniques
• Expectable outcomes
• Pamphlet and/or video about play therapy
• Tour of playroom
• Answer questions
Ethical
Considerations
• Who is the identified client?
• Meeting child first, parent/s first, or family
• Divorced and custodial parents
• Family/social environment for child
• If a long-term problem, is there long term
commitment?
• Is everyone working for the good of child?
• Financial, time, social resources of family
Ethical
Considerations
• Competence to treat the child
• Fully equipped for treating specific child
• Treat the child or treat the family
• Full disclosure
• Confidentiality
• Consultation with parent/s
• What is revealed in consultation?
• Is the child included in parent consultation?
Ethical
Considerations
• Speaking for or about a child
• Documentation - harm and benefit
• In cases of separation and/or divorce
documentation can be a nightmare
• Information handling in separation and divorce
• The “Problem” is the CHILD
• What are the costs to the child for intervention?
Ethical
Considerations
• Complete a thorough assessment:
• developmental milestones from pre-birth to current age
of child
• all domains of child’s functioning
• all systems in child’s world
• maintain contact with collaterals
• Include “family” in goal setting and treatment
planning
• Contract for “completion” of treatment
Ethical
Considerations
• Treatment ethics
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Child’s needs first and foremost
Safety first
Mediate/facilitate family connection
Communication/consultation with family
Family treatment including filial therapy,
psychoeducation, and supportive therapy
• Holistic approach
• Responsive to child and family
Ethical
Considerations
• Termination
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Reinforce progress and forward movement
Celebrate with child and family
Give follow-up recommendations
Leave the door open
Offer extended referrals
Follow-up
Evaluate