Assessment 2 Case Studies (total 4417 words)
Case Vignette: Odette
Odette is undertaking a placement at a private practice as part of her Master's
course in counseling. The practice is owned by Raqib, who provides
supervision for Odette, and his wife, Nila, who works as the practice manager.
Raqib is so far very impressed with Odette's progress and ability to connect
with the clients she has seen at the practice. Unfortunately, referrals have
slowed down in the past couple of months, and Odette is finding it difficult to
gain enough client contact hours; she is worried she may not be able to finish
her placement on time. Odette discusses this issue with Raqib during a
supervision session. Raqib suggests Odette provides counseling for his 15year-old daughter Aria, who is having some significant friendship difficulties at
school, as this will provide Odette with the experience and client contact hours
she needs while giving Aria support at a difficult time. What should Odette do
as an ethical counselor?
Steinman, Richardson, and McEnroe (1998) proposed an ethical decisionmaking model that will be used to address the scenario of the counselor in
training as Odette, and she needs to develop the best course of action in this
case. These steps are:
Identify the ethical issues:
This case shows the ethical issue of Boundaries and Multiple Relationships.
The APA(2010) ethics code defines multiple relationships as one in which a
practitioner is in a professional role with a person in addition to another position
with that same individual or with another person who is close to that individual.
(Gerald, C., Marianne, S.C., Cindy, C.,(2018)Issues and Ethics in the Helping
Professions(10th Ed). In this Odette's case, she is undertaking her placement
of her Master's counseling course at Raqib's clinic and who is also her
supervision provider, if she takes the advice from Raqib of providing counseling
service to Raqib's 15 years old daughter, for reach her finishing placement of
enough client contact hours on time purpose, she involves multiple
relationships, which means she plays counselor role with Aria and supervisee
role with Aria's father, Raqib.
There are many ethic code standards on dual relationships that state that
counselors
better
avoid
multiple
connections.
These
codes
caution
professionals against any involvement with clients that might impair their
judgment and objectivity affect their ability to render effective services, or result
in harm or exploitation of clients. Like American Association for Marriage and
Family Therapy (2015) states: "Therapists make every effort to avoid conditions
and multiple relationships with clients that could impair professional judgment
or increase the risk of exploitation." (1.3) In this case, Raqib as a maturity
professional, he put himself in multiple roles and relationships in his supervisory
process with Odette, which this is should be avoided, in AMHCA (2015) ethical
standard state: "avoid all dual relationships that may interfere with the
supervisor's professional judgment or exploit the supervisee" (III.B.2.i.) by
supervisors.
"Multiple roles and relationships are common in clinical supervision; some may
be unavoidable, and most can be beneficial" (Gerald, C., Marianne, S.C., Cindy,
C.,(2018)Issues and Ethics in the Helping Professions(10th Ed). How to
effectively and ethically manage those multiple relationships will be a challenge
for any counselor, whoever in any setting. They need to be aware of their
professional roles blending, address boundary issues, and prevent boundary
crossings from turning into boundary violations. When the multiple relationships
indeed exploit clients, or the supervisor could not maintain objectivity or have
significant potential to harm clients, that's unethical.
Back to this case, Odette needs to identify six intertwined potential issues:
Raqib's dual roles and relationships in their supervisory process, which means
he needs to decide for avoidance; the client-counselor relationship, which
means client identification in this case; client welfare and rights, which means
Aria's confidentiality right as a minor when her father seeking information from
counseling session; the nature of the client's issues of friendship difficulties;
parental rights, which means Raqib's right as Aria's father; boundaries setting
of professional roles blending, which means Raqib is Odette's colleague and
Aria's father at the same time. The overarching concern throughout all of these
issues is managing dual relationships and setting a clear boundary to protect
Aria's welfare and rights.
Ethical trap possibilities:
Objectivity:
If Odette takes Raqib's suggestion because he is her supervisor and she
relies on him, he can help her finish her placement requirements of client
contact hours. And neglect the relationship between Raqib and Aria, and
here, she might lose her objective competence.
Values:
As human beings, we believe parents always love their children, always try to
help them, and always make the right decision for them, though sometimes in
an inappropriate way. In this case, If Odette firmly believes that Raqib, as a
professional counselor, is a father, he has the responsibility to help his
daughter Aria to solve the friendship difficulty issue, or Odette has a suspicion
about manipulation of Raqib to Aria, she will be staying in a values trap for
sure.
Circumstantiality:
Every counselor in training wants to reach his/her placement requirements of
client contact hours on time. In this case, Raqib as Odette's supervisor and the
placement owner offered a piece of very tempting advice to Odette. If Odette
puts her needs on priority, she will be in the circumstantiality trap.
Initial response:
After identifying the ethical issues, if I were Odette, I would have a discussion
with Raqib about the multiple relationship scenario between Aria Raqib and me
before I decide to counsel his adolescent daughter Aria or not. I might talk about
my deep concern about his dual roles in our supervisory relationship if I am
counseling Aria, which seems like an emphasized prohibition in many ethical
code standards. Like ACA (2014) states, "Supervisors are prohibited from
engaging in supervisory relationships with individuals with whom they have an
inability to remain objective." (F.3.d. ). I would worry about it may occur the
potential violation in the future rather than finish my placement requirement of
enough client contact hours on time.
And then, I might talk about other concerns about Client identification; The
client-counselor relationship; Client welfare and rights; The nature of the client's
issues. Raqib is a father right in this case. I might follow ACA (2005) standard
state: "strive to resolve ethical dilemmas with direct and open communication
among all parties involved" (H. Introduction). Offer Raqib to invites Aria to come
to communicate the details of informed consent.
Possible consequences:
The ethically preliminary response will bring both positive or negative
consequences, whether right or wrong. Raqib as Odette's supervisor and the
placement owner might feel offended when Odette points, he ignores the
multiple relationship issues and might decline Odette. But Raqib also is a
maturely trained counselor, and he might notice that intensive dual supervisory
relationship and make a decision to avoid it. This means he could let Odette
counseling his daughter Aria for reaching Odette's placement client contact
hours requirement but would not provide the supervision service by himself.
If Odette determines to provide counseling service to Aria, which means she
considers the factors of the multiple relationships and ready to set ethical
boundaries between her and Raqib.
Ethical resolution:
To conclude regarding this case, if Odette and Raqib could regulate their
supervisory relationship, and Raqib could make a decision of his dual
relationship issue, which means he needs to "clarify his roles and to distinguish
between flexible and rigid boundaries" (Gerald, C., Marianne, S.C., Cindy,
C.,(2018)Issues and Ethics in the Helping Professions(10th Ed).
After that, Odette, the counselor, needs to determine her primary client is Aria,
who is going through her adolescence. Like her father, Raqib, who has
experiences with the profession of counseling, he may want to contribute his
professions on solving her issues of friendship difficulties at school. Regarding
the issue of Aria as a minor consenting to counseling, counselors should
become familiar with the laws in their country pertaining to minors.
Odette can follow by the guidance as A minor who is "fifteen years of age or
above, whether with or without the consent of a parent or legal guardian, may
consent to receive mental health services" (C.R.S., 27-65-103). This confirms
that Aria is legally able to receive counseling services without her parents'
consent. As determine Aria is the client, her welfare and rights are paramount
throughout the decision-making process. The most important right of Aria,
which should be considered by Odette as a counselor, is about her privacy and
confidentiality. The reasons are "respect client rights to privacy" (B.1.b.), and
"do not share confidential information without client consent or without sound
legal or ethical justification" (B.1.c.) by The ACA code (2005) states, and this is
the fundamental of trust between counselor and client in a therapeutic
relationship. On the other side, neither privacy nor confidentiality is an absolute
right afforded to minors. Raqib as Aria's father, also has his parental rights,
which Odette needs to respect, whatever Raqib is her supervisor or not. The
ACA(2005) code would advise Odette to inform Raqib about the nature of
counseling, the importance of confidentiality and divulging only what is
necessary, and doing what is in the best interest of Aria while working to
establish a "collaborative" relationship amongst all parties (B.5.b.; B.2.d.).
Odette may discuss with Raqib about circumscribed information regarding the
counseling process, but she may not discuss confidential details about the
content of any of the sessions without Aria's explicit consent.
Odette maybe needs to consider Aria is in Erikson's stage of identity versus
role confusion, in which adolescents construct their identity through defining
who they are, what they value, and what directions they choose to go in life
(Berk, 2004). Identity versus role confusion is the major psychological conflict
for adolescents because they are searching for what is true about themselves
in regard to many aspects of life, including sexual orientation, interpersonal
relationships, career path, and cultural, moral, political, and religious ideals.
Self-reflection:
Multiple relationships with clients are strongly discouraged and cautioned by
ethical standards in the mental health field. However, the issue of multiple
relationships between supervisors and supervisees is a complex and dynamic
topic that involves role conflicts, power differentials, and various ethical
considerations. Although these relationships, on the other hand, are not always
contentious and can be useful if a counseling supervisor is conscious of the
power imbalance in the supervisee's connection. This makes it difficult for
supervisors to continue discussing the complex aspect of counseling
supervision; these relationships are not about the development of the
relationship but about the behavior.
Many supervisors appear to have multiple relationships with their supervisees,
and it is thought that the situation may be unavoidable. Most researchers point
that the ideal standard in counseling supervision is to avoid dual relationships,
but this ideal is unattainable. First, supervisors have more power than their
supervisees in the supervisory relationship, which could lead to supervisees
being exploited. Second, when supervisors have dual relationships with their
supervisees, they risk losing their objectivity.
As a counselor in training, Odette may believe that some dual relationships are
unavoidable. Nonetheless, she should be thoroughly investigated both at the
start and throughout the course of the investigation. She and Raqib should
discuss the dynamics of their multiple relationships and might create a contract
that acknowledges their dual relationships and outlines steps to prioritize the
therapeutic process between Odette and Aria.
Case Vignette: Conrad
Tia is a trained counselor. After becoming estranged from her family following
a financial dispute, Tia has moved from overseas and begins to work at a
community agency providing family and couples therapy. She lives alone and
has found it difficult to make friends outside of the workplace, as she did not
know anybody in the area before she moved six months ago. Conrad also
works at the agency as a counselor, and he has become Tia's closest friend at
work, often sharing lunch with her. Tia has mentioned that she is finding it rather
difficult living alone in a different country away from her friends. Over the last
month, Conrad has noticed more often than not that Tia's breath smells of
alcohol in the morning. Conrad also sees some posts on Tia's Facebook
profile that indicate she might be meeting with clients outside of sessions
socially. Last night, Tia posted a seemingly intimate photo with a man who is
very familiar to Conrad. The next morning, Conrad realizes the individual in
the photo was one of Tia's clients at the agency, but when he looks up Tia's
profile to double-check, the photo is no longer there.
Identify the ethical issues:
In this case, there are some ethical dilemmas that need to be cautious as a
trained counselor. When a counselor is in a small community, he/she would
easily be involved in multiple relationships, whether he/she willing to do it or not.
He/she needs to learn how to manage multiple relationships as they have to
balance the roles of being a counselor, a friend, a colleague, etc. Counselors
must take steps to establish and maintain proper professional boundaries with
clients and colleagues. In this case, Conrad is seeing one of his close friends
becoming his work friend's client, which means he is in dual relationships with
his friend and his colleague Tia. Regarding the description of this case, Conrad
"has become Tia's closest friend at work, often sharing lunch with her," which
means he is most likely to have a supervisory relationship with Tia in any
therapeutic process in the future. In these multiple relationships between
Conrad and Tia, both need to recognize how to protect client confidentiality,
potential concerns about boundary issues, and how best to safeguard client
privacy should be discussed at the very first time.
In this community agency which Conrad and Tia work, multiple relationships
may be hard to avoid, but facing closest work friends suspect unprofessional
behavior will be another challenge for Conrad. He found Tia posted her photo
with her client on Facebook indicated they were meeting socially, and he also
"has noticed more often than not that Tia's breath smells of alcohol in the
morning." Maybe Conrad might wonder whether it is his place to judge the
practices of another trained counselor like Tia, but "Ignoring evidence of peer
misconduct is an ethical violation in itself."(Gerald, C., Marianne, S.C., Cindy,
C.,(2018). Issues and Ethics in the Helping Professions(10th Ed) Counselors
have an obligation to deal with colleagues when they suspect unethical conduct.
In National Organization for Human Services (2015) states the relevant
principle as Human service professionals respond appropriately to unethical
and problematic behavior of colleagues. Usually, this means initially talking
directly with the colleague and, if no resolution is forthcoming, reporting the
colleague's behavior to supervisory or administrative staff. (Standard 21) This
standard might lead Conrad to have an opening conversation with Tia about
her alcohol issues and the frequent social events with her clients. He might
invite Tia to have a discussion about ACA (2014) guidance principle as
Counselors are expected to advocate to promote changes at the individual,
group, institutional, and societal levels that improve the quality of life for
individuals and groups and remove potential barriers to the provision or access
of appropriate services being offered. (C. Instruction)
As for Conrad, he needs to 1) Deal with the Dual relationships issues in a small
community with his closest work friend Tia, 2) Address issues regarding
suspected unethical behavior to his colleague.
Ethical trap possibilities:
It will make counselors stay in the ethical traps without identifying the ethical
dilemmas and will arise the potential harmful causes to the clients. Those traps
could be:
Objectivity:
Conrad has noticed that Tia's breath often has smells of alcohol in the morning,
which means Tia could have come to work with a hangover. It's normal for
adults to drink, but when they get drunk regularly or drink too much, the
underlying causes deserve attention. If Conrad neglects the reason for Tia's
recent behaviors and directly reports to the supervisor or administrator of the
agency about her issues without any communication with Tia beforehand, then
he would be most likely to lose the chance to understand Tia's situation. This
also includes the ongoing financial disputes that Tia faces.
Values:
If Conrad holds his family-oriented beliefs towards Tia, which is to let Tia forgive
her family and stay with them together, or Conrad is a non-alcoholic believer,
he is adamant that Tia's drinking behavior is completely unacceptable. However,
these can be a values trap.
Circumstantiality:
If Conrad has hypothetical guessing that Tia has a sexual relationship with her
client because of the post on her Facebook profile the photo she with a client
out of session socially, and he has no valid evidence to prove that hypothesis
is correct and start to worry about Tia might lose her professional competence
in her therapeutic process with the client, Conrad will be in a circumstantiality
trap.
Preliminary response:
For Conrad, the preliminary response to Tia will regard what ethical issues he
identified here. For the multiple relationships issue, Conrad might let Tia know
the extent of the friendship between him and his friend. And discuss with Tia
how to manage the boundary, the difficulty of maintaining confidentiality with
the client.
He might directly talk about Tia's unethical behavior as a trained counselor what
he noticed already, like alcohol issues, personal social relationships with the
client.
Possible consequences:
As a trained counselor like Tia, she must have experience about how to
manage the dual relationship with Conrad and most likely keen to have a
conversation with him about this issue. She might evade talking about her
family issues and give plausible reasons to explain why she socialized with
clients or drink too much. Or she might take other professional's help, willing to
go deeper to explore her own life issues with her family. It is not ruled out that
there is another possibility that she is still drinking excessively and socializing
with clients, but she will no longer disclose it on Facebook or let Conrad know.
Ethical resolution:
Many circumstances can engender multiple relationships in the therapeutic
process when counselors in a rural community. Even when every effort has
been made to avoid such situations, the extended relationship tends to be
inevitable in such an environment. As a result, multiple relationships must be
conducted with the client's best interest in counselors' minds when they are
established.
Conrad needs to identify the multiple roles that are at play and what problems
they may present. In this case, Conrad's dual relationships with his familiar
friend and Tia, how to set clear boundaries, and how to protect the
confidentiality right of the client(friend) will be one of the important
considerations by Conrad. He couldn't play both roles as a friend with Tia's
client and supervisor of Tia at the same time. Some researches define kinds of
dual/multiple relationships as below, to help counselors measure the dual
relationship and make a decision:
It can be avoidable, unavoidable, or mandated.
It can be consecutive or sequential.
It can be expected or unexpected-accidental.
It can be initiated by therapists, clients, both, or a third party.
It can be of low, medium, or high intensity
(Ofer Z., 2019 Therapeutic Boundaries and Dual Relationships in
Psychotherapy and Counseling.)
At here, this is an unavoidable, consecutive, and high-intensity dual relationship
for Conrad. If I were Conrad as a counselor in a rural setting, I would consider
the ethical conduct basis on Tia's informed consent with her client to decide
which role I want to play. The informed consent needs to include some
considerations are: the welfare of the client, confidentiality and privacy rights,
effectiveness of treatment, avoidance of harm/exploitation, conflict of interest,
and clinical impairment, etc.
Compare the dual relationship dilemma for Conrad and the other ethical issues
will be more challenging for him. That is Tia be suspected of unethical behaviors,
such as hangover often which means she drinks too much; posted her
socialized photo on Facebook with her client out of session, what's more, the
client who only socialized the night before would show up in the agency the
next day. There are no very specific codes of ethical standards that legally or
ethically prohibit counselors from entering social relationships with clients.
Some counselors will think during or before counseling, maintain appropriate
social contacts with the client would be a positive factor in trust establishment
between counselors and clients. "Other peer counselors take the position that
professional and social relationships need to separate." (William B., 2010,
Ethical Considerations of Social Networking for Counsellors) They think
counselors should not enmesh their own needs with clients to cause their
objectivity lost, and power differential in the therapeutic relationship will arise
the exploitation if counselors blend their professional and social relationships
with clients. But almost all kinds of codes of ethics emphasize that have a
sexual relationship with a client is absolutely forbidden. So, measure the social
intimacy level with the client will the factor that needs to be considered by
counselors. These are including the nature of the client's cultural background,
the nature of the client's population, the nature of the client's problem, the
nature of the social function, the setting of the counselor's work, etc.
Counselors need to maintain clear boundaries of professional and social
relationships blending by their self-awareness and honesty, prevent negative
effect simultaneously occur on the therapeutic process with clients, the
friendship, or both. (Ofer Z., 2019 Therapeutic Boundaries and Dual
Relationships In Psychotherapy and Counseling. )
In this case, Tia works at a community agency, which means she is in a small
set lack of client population, and she told Conrad that she was suffering from
making friends difficulty outside from agency. She has made friends needs for
her personal life and clients pool for her career. But mixing personal and
professional relationships can destroy the therapeutic relationship and could
lead to a malpractice suit for her. She needs to know that she has a more
important responsibility to become aware of how her actions impact others as
a professional counselor. She needs to recognize her own needs and strive to
keep those needs from impeding the therapeutic growth of their clients. In a
rural setting or a small community will arise exploration for Tia, but there is a
big difference between meet clients at a coffee shop or grocery store randomly
and socialize with certain or potential clients in a restaurant or bar. The late will
cause a self-disclosure issue, Tia. Self-disclosure is defined as the revelation
of personal, rather than professional, information by a counselor to a client. (Zur
et al., 2009). Unless the counselor believes there may be some benefit to the
clients; otherwise, it is considered ethical to suspend action. Tia needs to
maintain a level of control over personal disclosures made by way of direct
interpersonal interactions. While working within the counseling process, Tia
likely to embrace and use the common attitudes of effective helpers, such as
empathy and open-mindedness. However, outside the session, it is
conceivable that she will demonstrate attitudes or behaviors that are nontherapeutic. She may, in her personal life, engage in political criticism or even
demonstrate prejudicial attitudes. （William B., 2010）If she acts on socially
unacceptable attitudes or engages in irresponsible or problematic behavior in
her private life, this may become known by her clients.
Consequently, her professional reputation will become tarnished. It, therefore,
follows that if she engages in similar behavior within the context of a socialized
relationship with her clients, the potential for negative consequences is
magnified by her clients. The ACA Code of Ethics (2014) gives guidance about
ethical issues that counselors must examine before engaging in self-disclosure,
whether in person or online. So, there are reasons to believe that a lack of
professionalism in Tia's socialized relationship with her clients can have
significant deleterious effects on her career.
Her making friends needs is not a proper enough explanation for her alcohol
issue. Regarding Tia came to this community agency from overseas and
estranged from her family following a financial dispute, Conrad, as her closest
working friend, needs to consider this factor as her problems and conflicts.
Because they both providing family and couples therapy for clients, Tia's
frustration might let her over the lack of attention to the basic needs of her
clients. As a result, Tia should seek personal therapy to promote her vitality
through self-care by other professionals cause her distressing situations will
lead to burnout and harm to clients potentially. ACA (2014) ethical codes state:
Counselors assist colleagues or supervisors in recognizing their professional
impairment and provide consultation and assistance when warranted with
colleagues or supervisors showing signs of impairment and intervene as
appropriate to prevent imminent harm to clients. (C.2.g) An ongoing self-care
strategy will be an essential part of a counselor's professional competence and
personal wellness program. It will help counselors like Tia increase awareness
of her current wellness state cause "this is a fundamental component in
maintaining personal wellness and promoting wellness in others." (Gerald,
C.,Marianne, S.C., Cindy, C.,(2018)Issues and Ethics in the Helping
Professions(10th Ed)
Self-reflection:
The topic about "self-disclosure of the counselor" today could happen in a
therapeutic process with clients and relate to online networking of counselors.
"For professional helpers, the Internet has significantly changed the nature of
self-disclosure and transparency" (Zur, 2008; Zur et al., 2009). As a counselor,
we could not only think about avoiding self-disclosure in front of clients in the
counseling room simply, but we also need to be aware that the online expose
influences our social networking. Setting clear self-disclosure and personal and
professional boundaries on our online social networking should be one of the
priority considerations in our daily life as a counselor.
By including only therapeutic practice-related information in our professional
profiles, we may avoid unintentional online disclosures and keep our contact
with clients on a strictly professional level. By examining the advantages and
disadvantages of using online social networks, we might maintain an ethical
balance between professional lives, personal lives, and online personae.
References
American Counseling Association. (2005) (2014). ACA code of ethics.
American Psychotherapist Association (2010). APA code of ethics.
American Mental Health Counselor Association (2015) AMHCA code of ethics
American Association for Marriage and Family Therapy (2015)AAMFT code of
ethics
Colorado Revised Statutes, Titles 9, 12, 18, 27
William B., 2010, Ethical Considerations of Social Networking for Counsellors
Zur, O., Williams, M. H., Lehavot, K., & Knapp, S. (2009). Psychotherapist selfdisclosure and transparency in the Internet age. Professional Psychology:
Research and Practice, 40(1), 22–30.