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Theory and Design in Counseling and Psychotherapy
Susan X Day , Iowa State University and University of Houston
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CHAPTER 3: Ethics in Psychotherapy, Counseling,
and Research
Chapter Review
ACA (American Counseling Association) and APA (American Psychological Association) set ethical standards for member counselors and psychologists. Both codes apply principles used to make professional decisions for the practice of counseling, teaching, consultation, and research. ACA emphasizes human development, client welfare and rights, confidentiality, family involvement, career and employment needs, respect for diversity and differences, dual relationships (including the prohibition of sexual intimacy), group work, fees and bartering, termination, and use of computer programs. APA sets principles regarding competency, integrity, professional and scientific responsibility, respect for people's rights and dignity, concern for other's welfare, and social responsibility.
Counselors set the client's needs as primary, assuring that services do no harm and that clients are respected. Counselors carefully assess the therapy process to make sure the client's needs are being met and that the counselor's issues do not drive the choice of questions, topics and interpretations. Counseling is terminated when client needs are met or when the therapist recognizes that therapy is not working for the client.
Clients are informed as to what they can expect in counseling, and the limits of confidentiality are explained. Confidentiality cannot be upheld if the client threatens harm to another, when child abuse is reported, when suicidality is imminent, or when clients sign a release for records or consultation. Sometimes, counselors are employed to evaluate a client's mental condition for an agency or the courts, so clients are told that the counselor represents the agency, not the client. Children and some adults are not legally competent to give informed consent, and permissions are gained from parents or guardians. When it is not reasonable to gain informed consent, the counselor acts in the best interest of the client.
Counselors avoid dual relationships, those situations where the counselor would serve more than one role in a client's life. Friends or family members cannot be clients because the counselor could not be objective in a counseling relationship. Clients and their counselors are discouraged from becoming friends during or after counseling because the power differential between therapist and clients would carry over to the friendship. Also, the client retains an image of the counselor that would be tainted if informal contacts occurred after counseling sessions ended. Sexual intimacy with clients is, of course, the ultimate violation of the dual role prohibition. However, the arousal of sensual feelings is not uncommon in therapy, and counselors must then seek consultation to analyze the source of such feelings and decide what to do.
Using standardized tests in education and counseling is sometimes criticized as categorizing people with scores rather than seeing them as human beings. However, tests can be a useful tool in counseling. The information indicated by an instrument can help clients gain insights. However, tests are only useful if they are assigned for a legitimate reason, and the instrument chosen serves the intended purpose. Also, to learn the appropriate administration and interpretation of specific tests and/or coursework supervision is needed. The best practice in interpreting tests involves clients in an interactive process where the client points to scores, discusses the meaning, and describes examples from her life. Tests must be determined to be reliable and valid, and, if widely used, will provide a manual. To use instruments, publishers require proof of educational background, and counselors are obligated by ethical standards to provide security for the test's content. Test results are kept secure so nonexperts cannot gain access to them. Psychologists write reports summarizing results when others need the information, recognizing that raw results are open to misinterpretation.
Belmont Principles To Guide Research protect human subjects in empirical studies. These ethical guidelines describe how participants should be treated. Subjects are given the respect accorded to autonomous individuals who have the right to choose to participate or not and to be told about the experiment's activities. To the extent that participants act without full awareness of the study's methods, it is the duty of the researcher to protect them. Investigators must decide whether some risks are justifiable given the need to gain knowledge that would be of benefit to humankind. Harm to participants is limited, minimizing the impact and the time a negative impact could be expected to last. With limited impact, some negative consequences might be tolerated for the greater good of learning how to help others in the future.
Two safeguards are expected when professionals make ethical choices. The first is to document the decision-making process in clinical notes, keeping an ongoing account as the situation develops. It is important to record the ethical principles involved and the thinking behind the course of action taken. The second is to discuss the situation with other professionals to check your own thinking and then document the consultation.
Cultural sensitivity requires counselors to make adaptations to their practices when clients demonstrate differing values and orientations. Socioeconomic and religious rules may dictate that adult clients accede to the authority of parents, for example. Discrimination due to sexual orientation and minority group status may affect a client's psychological symptoms, and counselors need to factor in such external pressures when diagnosing and choosing interventions. Training in cultural differences may offer some insight regarding many client characteristics, but practitioners must guard against stereotyping all individuals within a group when cross-cultural attributes are assumed. Expressing an interest in a client's ethnic background is most often perceived positively and can encourage the client to explain what factors are relevant to him. The following topics are ones that may be relevant in the client/counselor dialogue: primary spoken language; family roles; sex roles and differences; independence; spirituality; definitions of success; methods for dealing with conflict; cultural history; money issues and economic class; and acculturation.
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