Matakuliah
Tahun
: L0332 – Psikologi Konseling
: 2009
Ethical Issues
in Counselling Practice
Pertemuan 13
PERTEMUAN 13
Ethical Issues
in Counselling Practice
Gerald Corey. (2005). Theory and practice of counselling and psychotherapy
(pp. 36-52). Belmont, CA: Brooks/Cole
Introduction
•
It is clear that therapists are challenged to deal with questions that do
not always have obvious answer
•
To help you make these decisions:
* Consult with colleagues
* Keep yourself informed about laws affecting your practice
* Keep up-to-date in your specialty field
* Stay abreast of developments in ethical practice
* Reflect on the impact your values have on your practice
* Be willing to engage in honest self-examination
•
Ethical decision making is an evolutionary process that requires you
to be continually open and self-critical
Putting Clients’ Needs before your own
•
•
•
•
Ethically, it is essential that we become aware of our own needs, areas
of unfinished business, potential personal conflicts, and defences. We
need to realize how such factors could interfere with helping our
clients.
Our professional relationships with our clients exist for their benefits.
A useful question to frequently ask yourself is:
 “Whose needs are being met in this relationship, my client’s or my
own?”
It is ethical for us to meet our personal needs through our
professional work, YET it is essential that these needs be kept in
perspective. The ethical issue exists when we meet our needs, in
either obvious or subtle ways, at the expense of our clients.
We all have certain blind spots and distortion of reality. However, we
also have responsibilities to work actively toward expanding our own
self-awareness and to learn to recognize areas of prejudice and
vulnerability
Ethical Decision Making
•
Part of the process of making ethical decisions involves learning
about the resources from which you can draw when you are struggling
with an ethical question.
•
Be aware of the consequences of practicing in ways that are not
sanctioned by organizations of which you are a member or the state in
which you are licensed to practice.
•
The role of ethics code as a catalyst for improving practice:
* Educate about the responsibilities of the profession
* Provide a basis for accountability, through their enforcement, client
are
protected from unethical practices
* Provide a basis for reflecting on and improving one’s professional
practice
Ethical Decision Making
Steps in Making Ethical Decisions:
1. Identify the problem / dilemma. Gather information that will shed light
on the nature of the problem. This will help you decide whether the
problem is mainly ethical, legal, professional, clinical, or moral
2. Identify the potential issues. Evaluate the rights, responsibilities, and
welfare of all those who are involved in the situation.
3. Look at the relevant ethics codes for general guidance on the matter.
Consider whether your own values and ethics are consistent with or in
conflict with the relevant guidelines
4. Consider the applicable laws and regulations, and determine how they
may have a bearing on an ethical dilemma
Ethical Decision Making
Steps in Making Ethical Decisions:
5. Seek consultation from more than one source to obtain various
perspectives on the dilemma
6. Brainstorm various possible courses of action. Continue discussing
options with other professionals. Include the client in this process of
considering options for action
7. Enumerate the consequences of various decisions, and reflect on the
implications of each course of action for your client
8. Decide on what appears to be the best possible course of action. Once
the course of action has been implemented, follow up to evaluate the
outcomes and to determine if further action is necessary
Ethical Decision Making
•
Professional maturity implies that you are open to questioning and
that you are willing to discuss your quandaries with colleagues.
•
Ethics code DO NOT make decisions for you, so demonstrate a
willingness:
* to struggle,
* to raise questions,
* to discuss ethical concerns with others, and
* to continually clarify your values and examine your motivations
•
To the degree that it is possible, include the client at all phase of the
ethical decision-making process.
The right of Informed Consent
•
Regardless of the theoretical framework from which you operate, informed
consent is an ethical and legal requirement and is an integral part of the
therapeutic process
•
By educating your clients about their rights and responsibilities, you are both
empowering them and building a trusting relationship with them
•
Some aspects of the informed consent process include:
* The general goals of counselling
* The responsibilities of clients
* Limitations of and exceptions to confidentiality
* Legal and ethical parameters that could define the relationship
* The qualifications and background of the practitioner
* Fees involved
* The services the clients can expect
* The approximate length of the therapeutic process
* The benefits of counselling
* The risk involved
* The possibility that the client’s case will be discussed
with the therapists’ colleagues or supervisors
Dimensions of Confidentiality
•
Confidentiality, which is central to developing a trusting and
productive client-therapist relationship, is both a legal and an ethical
issue
•
Professionals have the responsibility to define the degree of
confidentiality that can be promised
•
Although most counsellors agree on the essential value of
confidentiality, they realize that it cannot be considered an absolute
•
In general, confidentiality must be broken when it becomes clear that
clients might do serious harm to either themselves of others.
•
There is a legal requirement to break confidentiality in cases involving
child abuse, abuse of the elderly, and of dependent adults
Dimensions of Confidentiality
There are other circumstances that dictate when information must legally
be
reported by counsellors:
1. When the therapist believes a client under the age of 16 is the victim of
incest, rape, child abuse, or some other crime
2. When the therapist determines that the client needs hospitalization
3. When information is made an issue in a court action
4. When clients request that their records be released to themselves or
to a third party
Dimensions of Confidentiality
•
In general, however, it is a counsellor’s primary obligation to
PROTECT client disclosures as a vital part of the therapeutic
relationship
•
Counsellors should tell the clients of any limitation on confidentiality
•
This practice does not necessarily inhibit successful counselling
Ethical Issues in a Multicultural Perspective
•
It is essential for therapists to create therapeutic strategies that are congruent
with the range of values and behaviours that are characteristic of a pluralistic
society
•
Regardless of the therapist’s orientation, it is crucial to listen to clients and
determine why they are seeking help and how best to deliver the help that is
appropriate for them
•
The greater problem does not rest with inadequate theories and techniques but
with unskilled clinicians and with the poor delivery of certain techniques
•
Counsellors may well be at a loss in trying to bring about social change when
the are sitting with a client who is in pain because of social injustice. By using
techniques from many of the traditional therapies, counsellors can help clients
increase their awareness of their option in dealing with barriers and struggles.
•
It is essential to focus on both individual and social factors if change is to
occur, as the feminist, postmodern, and family systems approaches to therapy
teach us
Ethical Issues in the Assessment Process
•
Both clinical and ethical issues are associated with the use of
assessment and diagnostic procedures.
The Role of Diagnosis in Counselling
• Psychodiagnosis is the analysis and explanation of a client`s problem.
It may include:
* an explanation of the causes of the client`s difficulties, and account
of how
these problems developed over time,
* a classification of any disorder,
* a specification of preferred treatment procedure, and
* an estimate of the chances for a successful resolution
•
The purpose of diagnosis in counselling and psychotherapy is to
identify disruptions in a client`s present behaviour and lifestyle.
Ethical Issues in the Assessment Process
•
The guidance in making diagnostic assessments is the fourth edition of the
American Psychiatric Association`s DSM-IV-TR (Diagnostic and Statistical
Manual of Mental Disorder, Text Revision)
•
This manual advises practitioners that it represents only an initial step in a
comprehensive evaluation.
•
A danger of the diagnostic approach is the possible failure of counsellors to
consider ethnic and cultural factors in certain patterns of behaviour.
•
Unless cultural variables are considered, some clients may be subjected to
erroneous diagnoses.
•
It is essential to assess the whole person, which includes assessing
dimensions of mind, body, and spirit. The biological perspective can contribute
to effective assessment.
•
Therapists need to take into account the biological processes as possible
underlying factors of psychological symptoms and need to work closely with a
physician.
Dual and Multiple Relationships
in Counselling Practice
•
A multiple relationship occur when a psychologist is in a professional role
with a person and (1) at the same time is in another role with the same person
(2) at the same time is in a relationship with a person closely associated with or
related to the person with whom the psychologist has the professional
relationship, or
(3) promises to enter into another relationship in the future with the person or a
person closely associated with or related to the person.
•
A psychologist refrains from entering into a multiple relationship if the multiple
relationship could reasonably be expected to impair the psychologist`s
objectivity, competence, or effectiveness in performing his or her functions as
a psychologist, or otherwise risks exploitation or harm to the person with
whom the professional relationship exists.
•
Multiple relationship that would not reasonably expected to cause impairment
or risk exploitation or harm are not unethical.
Ways of Minimizing Risk
•
Set healthy boundaries early in the therapeutic relationship. Informed
consent is essential from the beginning and throughout the therapy
process. Involve the client in ongoing discussions and in the decisionmaking process, and document your discussions.
•
Consult with fellow professionals as a way to maintain objectivity and
identity unanticipated difficulties. Realize that you do not need to
make a decision alone
•
When dual relationships are potentially problematic, or when the risk
for harm is high, it is always wise to work under supervision.
Document the nature of this supervision and any actions you take in
your records
•
Throughout the process, self-monitoring is critical. Ask yourself
whose needs are being met and examine your motivations for
considering becoming involved in a dual or multiple relationship.