Law VS ethics

  • Law and ethics are not the same thing but obviously related
  • If you practice ethically you wont break the law e.g. a psychologist can break confidentiality and lose their registration but isn’t criminally convicted.

 

Ethics in counselling practices

  • Ethics are there to enhance our practice not to be punitive
  • Have the dual role of protecting us as practitioners
  • Ethical practice requires that we take the client’s cultural context into account in counselling practice

 

Code of ethics

 General principle Aàà Respect for the rights and dignity of people and peoples

  • Combines the principles of respect for the dignity and respect for the rights of people and peoples, including the right to autonomy and justice

 General Principle Bàà Propriety

  • Incorporates the principles of beneficence, non-maleficence and responsibility to clients, the profession and society

 General principle Càà Integrity

  • Reflects the need for psychologists to have good character and acknowledges the high level of trust intrinsic to their professional relationships and impact of their conduct on the reputation of the profession.

 

Client’s needs before the counsellors

  • Constantly mirror whose needs are being met?
  • Transference: client’s strong emotional feelings towards the therapistàà transferal of some unresolved issue from the clients life projected onto the therapist
  • Transference can lead to ethical problems
  • Countertransference: therapist strong feels from unresolved issues projected onto the client
  • It is not unethical to meet your personal needs through professional work but it must not harm the client
  • We have to avoid at all times harming or exploiting the client

 

Ethical decision-making

  • Codes of ethics serve a number of purposes:
    • Codes of conduct educate the public and the professionals
    • They make us accountable and when enforced, the public is protected from unethical practices.
    • Provide a basis for reflecting and improving your professional practice
  • When working through any ethical dilemma, there is rarely just one course of action to follow
  • Steps of ethical decision making
    • Identify the problem/dilemma 2. Who will be affected by the decision?
      • Who is the client?
      • Consult with colleagues and codes of ethics
      • Consider the local and applicable laws and regulations
      • Brainstorm various possible actions
      • Decide what to do and take action
      • Document the process and assess the results
      • Assume responsibilities for the consequences

 

Informed consent

  • It is an ethical and legal requirement for all health practitioners
  • It means the client is informed about what therapy they are having and they have given their permission for it
  • This can be verbal, written or both
  • The challenge is to strike a balance between too much and too little information

 

Confidentiality

  • Not disclosing information about a client
  • Limits of confidentiality should always be outlined at the start of the first session
  • Privileged communication: legal concept that generally bars the disclosure of confidential communications in a legal proceeding. In general it doesn’t apply to group counselling, couples counselling, family therapy or child and adolescent counselling
  • There is a legal requirement to break confidentiality in cases involving child abuse, abuse of the elderly, abuse of dependent adults and danger to self or others.
  • Some other situations which information must be legally reported by counsellors include:
    • When the therapist believes a client under the age of 16 is the victim of incest, rape, child abuse, or some other crime
    • When the therapist determines that the client needs hospitalization  o When information is made an issue in a court action  o When clients request that their records be released to them or to a third party.

Multiple relationships

  • Can be sexual or non-sexual, and occur when a counsellor assumes two or more roles simultaneously or sequentially with a client.
  • Not all multiple roles are prohibited, but should try to be avoided. If unavoidable they need to be managed well.
  • Sexual relationship with a current client (even two years after seeing this client) is unethical, unprofessional, exploitative, immoral and illegal.
  • Boundary issues can be dealt with by effectively dealing with the power differential- this is the key element.
  • They are unavoidable at times; they are potentially harmful but not always harmful.
  • Ways of minimizing the risk:
    • Does the benefit outweigh the potential harm?
    • Set clear and healthy boundaries at first session, and always have clear informed consent and clear expectations.
    • Consult with fellow peers, work under supervision where possible to maintain objectivity
    • Keep up the self-monitoring àà whose needs are being met?
    • Discuss with the client what you expect of them and what they can expect of you
  • One important aspect of maintaining appropriate professional boundaries is to recognize boundary crossings and prevent them from becoming boundary violations.
  • Boundary crossing: departure from a commonly accepted practice that could potentially benefit a client. E.g. attending the wedding of a client may be extending a boundary- but it could be beneficial
  • Boundary violation: serious breach that harms the client and is therefore unethical. This takes the practitioner out of the professional role and generally involves

 

Advertising and social media guidelines

  • A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that is:
    • Is false, misleading or deceptive or is likely to be misleading or deceptive; or
    • Offers a gift, discount or other inducement to attract a person to use the service or the business, unless the advertisement also states the terms and conditions of the offer; or
    • Uses testimonials or purported testimonials about the service or business; or
    • Creates an unreasonable expectation of beneficial treatment; or
    • Directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services.
  • The key message of the new social media policy is clear: Health practitioners must be aware that their professional obligations apply to their online activities in exactly the same way as a face-to-face consultation with a patient.
  • When using social media (Facebook, Twitter and LinkedIn) health professionals must ensure that patient confidentiality is not breached.
  • A practitioner must take reasonable steps to have any testimonials associated with their health service or business removed when they become aware of them
  • ‘The guidelines make it clear that health practitioners are responsible for all of the content on social networking pages that they control or administer.

 

Ethical issues in the assessment process

  • Assessment and diagnosis are essential in planning treatment
  • Assessment: identifying themes for further exploration
  • Diagnosis: identifying a specific mental disorder based on a pattern of symptoms – Both provide a working hypothesis
  • Not all practitioners view diagnosis as necessary
  • Danger with the DSM is that sometimes ethnic and cultural patterns are not consideredàà unless cultural variables are considered; some clients may be subjected to erroneous diagnoses.
  • Both feminist perspective and the postmodern approaches assert that these diagnoses ignore societal contexts.
  • Your theoretical perspective will influence your thinking on diagnosis.
  • Ethical dilemmas may be created when diagnosis is done strictly for insurance purposes
  • It is a clinical, legal and ethical obligation of therapists to screen clients for life-threatening problems.

 

Evidence-based practice

  • Specific interventions for specific problems based on empirical evidence.
  • Three principles of EBP should be:
    • Best available research o Relying on clinical expertise
    • Taking into consideration the clients’ characteristics, culture and preferences
  • Challenges against EBP:
    • Human need and change is complex and difficult to predict and measure o Not all clients have define, categorized disorders
  • The central aim of EBP is to require psychotherapists to base their practice on techniques that have empirical evidence to support their efficacy.
  • Practice-based evidence involves using data generated during treatment to inform the process and outcome of treatment