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Ethical Considerations in Counselling
Zuzana Connelly
Yorkville University
PSYC 6203: Ethical Standards for Mental Health Service Providers
Dr. Maliba Ibrahim
September 20, 2023
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Ethical Considerations in Counselling
This paper discusses three ethical concerns in the counselling setting. The writer depicts
the scenario from their own perspective and integrates relevant regulations, best practices, and
current literature.
Dealing with a Value Conflict
I believe I could be vulnerable to promoting autonomy in contexts where interdependence
is highly valued. Ironically, this emphasis stems from my family of origin where community and
intergenerational relationships are of higher regard in comparison to Western culture. I had lost
many of these connections and, to ease the grief, I embraced the perks of autonomy while
building my new community and relationships in Canada. When dealing with a client who
reports being exhausted by the demands of her extended family, my instinct would be to work on
setting healthy boundaries. However, I must consider the meaning of healthy boundaries in her
cultural context (Allen et al., 2020; Tseng & Hsu, 2018). Shabnam (2021) urges therapists to be
thoughtful about discussing boundary-setting in a collectivist culture. I realize that my intention
would be to uphold one of the main ethical principles of psychotherapy, i.e., autonomy (CCPA,
2020). I must remember that I must consider the person in front of me as a unique individual and
respond to them with cultural awareness and sensitivity (CCPA, 2020, Section A12, B9, C10).
Failing to recognize the importance of the values they hold would be undermining their
autonomy and compromising my commitment to providing inclusive and culturally intelligent
services (CCPA, 2020, Section A12, B9, C10). Furthermore, I must respond to them with
awareness of my own feelings and attitudes (CCPA, 2020, Section A12, B9, C10). I now realize
that I lost part of myself after leaving my home country. The loss took a long time to process,
and I wonder how much my own wound inhibits my ability to potentially navigate such a
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counselling situation with integrity. As I am writing this, I realize I must continue to process this
personal issue (CCPA, Section A1, D9), so I can enter the above-described counseling situation
without bias and distraction from my own internal value conflict and grief. Consistently with
current literature (Nelson et al., 2018; Posluns & Gall, 2020), the CCPA (2020) recognizes the
weight of insight and self-care on one’s ability to offer effective and ethical counseling services
(Section A1, E11, G8).
Throughout my short time in this program, I must acknowledge the emphasis on selfdevelopment, self-awareness, personal growth, and self-care integrated into the course
assignments; it demonstrates the commitment of the educational institution to uphold its ethical
obligations related to training aspiring counselors (CCPA, 2020, Section G8, G9, G10)
Informed Consent
After researching the process and the legal, ethical, and clinical implications of informed
consent over the past week, I am proud and fortunate to conclude that the team I am working
with is fulfilling the requirements CCPA (2020) outlines. I have been learning from the skilled
clinicians I am fortunate to work alongside over the past year.
Upon first meeting the family who has accepted admission to our Family Intensive
Outreach Program, we first describe the program (length of treatment, location, the composition
of family and caregiver sessions each week, and the stages of treatment) (CCPA, 2020, Section
B4). We then outline the risks and benefits of treatment (CCPA, Section B4). The family is
cautioned that this is an intensive program and that the content might be triggering and
overwhelming. They are reminded that this program is voluntary and that they can decide not to
participate now or at any point during treatment (CCPA, 2020, Section D3; CCPA, 2021, Section
B4). During this segment, we discuss our obligation to maintain confidentiality and inform the
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client about its limitations (CCPA, Section B2, B3, B4, B18). It is important to note that this
process is a conversation with frequent check-ins about shared understanding and making space
for clarifying questions the clients might have rather than a monologue (CCPA, 2021, Section
B4). We are lucky to work in a team of two and we usually assign the person who is not
currently talking (especially when obtaining informed consent from minors) to be mindful of
jargon. If the speaking mental health practitioner accidentally uses a complicated word, the other
one interrupts them, looking for clarification to best meet the developmental levels of our clients
and therefore enhance their opportunity to make an intelligent decision (CCPA, 2021, Section
B4, B5). Consent forms to permit the release of information to other providers or important
individuals in the family’s ecosystem are introduced and discussed (CCPA, 2020, Section A10,
B4, C8).
The process of informed consent begins with the first session and should continue
throughout treatment (CCPA, 2021, B4; Trachsel & Grosse Holtforth 2019). Clients are
informed about the stage and rationale of each step we take, even when it is a board game with
light-hearted questions used to build rapport and assess the familial dynamics (CCPA, 2020,
Section C2). Our service is dedicated to working with intention. It is equally important to be
transparent about the intentions of each session (including the assessment process and its results)
with clients (CCPA, 2020, Section C2, C7; CCPA, 2021, B4). Trachsel and Grosse Holtforth
(2019) emphasize the importance of detailed and customized information offered to clients
throughout psychotherapy treatment, including the endorsement that active client engagement is
crucial. Understanding the rationale behind treatment decisions, and the weight of clients’ active
participation positively influences trustworthiness, therapeutic alliance, and therefore treatment
outcomes (CCPA, 2021, Section B4; Trachsel & Grosse Holtforth, 2019).
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During this past week, I have suggested developing a minor-focused consent form as well
as supportive visual aids to better fulfill the obligations as set in sections B4 and B5 (CCPA,
2020). I commit to practice as a mental health provider who has a better understanding of the
informed consent process and intends to continually strive for improvement (CCPA, 2021,
Section B4)
Confidentiality
The client is a thirty-seven-year-old female whom I have been seeing for two months.
During our last session, Lena disclosed that her seven-year-old son was sexually assaulted by his
uncle on the paternal side. The incident was reported to the police a few days ago and the
suspected relative is currently under investigation. The Department of Community Services is
already involved. The family has been assigned a case worker and all four children are staying
with maternal grandparents as Lena indicated she needs time to process the family trauma before
she can take care of her children again. Lena shared that she had been experiencing waves of
overwhelming and uncontrollable rage. Lena disclosed that she had been blacking out and
finding herself in front of the suspect’s house. I was curious about her intentions. Lena had
shared that she wanted to kill him. She did not remember getting into the car and driving towards
his house. Reportedly, it felt as though she was not in control of her actions. When she came
back to her senses, she concluded that the need to support her son was stronger than her desire
for revenge. I was curious about her current feelings and attitudes. She disclosed that, when
regulated, she feels the same way and knows if she had acted on her rage, she would worsen the
situation for her son. However, Lena shared worries about her ability to control her emotions and
actions (aggravated by her mental health diagnosis) and could not guarantee she would not be
overwhelmed by rage again. I shared with Lena that I worry about the well-being and future of
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her family and reminded her that I have a legal and ethical responsibility to report any
foreseeable imminent danger to others (CCPA, 2020, Section B3). Although I have a
responsibility to uphold the confidentiality of my client (CCPA, 2020, Section B2), that
“protective privilege ends where the public peril begins” as Justice Trobiner concluded in a
breakthrough case of Tarasoff v. Regents of the University of California (Gorshkalova &
Munakomi, 2022). This case shaped the landscape of the United States legislation and informed
Canadian law, regulations, and best practices in psychotherapy (CCPA, 2021) and across the
medical field (Robinson, 1996, as cited in Sheppard, 2015).
Upon seeking consultation from my supervisor as endorsed in sections A4, and seeking
legal counsel as advised in section B3 of the CCPA (2021), I believe they would support me in
reporting the disclosure to the person at risk and the authorities if no other steps to prevent harm
were taken (CCPA, 2020, Section B3). Alternatively, I might be consulting my client’s
psychiatrist. Ideally, this decision would be reached in collaboration with my client (CCPA,
2020, section B1; CCPA, 2021, B3), and I must be vigilant in documenting the process (CCPA,
2020, Section A10). Based on my assessment, Lena is invested in remaining in control of her
actions and she may need additional help to do so. Should Lena embrace collaboration with
psychiatry (perhaps leading to admission based on a psychiatric assessment) and/or a thorough
safety plan in collaboration with a family member, my supervisor and I might decide not to share
this disclosure as it is my responsibility to choose the less intrusive option that leads to protecting
the third party (CCPA, 2021, Section B3). Lastly, if unwilling to collaborate, based on a further
clinical assessment of blackouts and associated risk, the level of trauma, and Lena’s mental
health history, I might advise involuntary hospitalization (CCPA, 2021, Section B3).
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References
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