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Part 3
Study Guide
Chapter 1—Introduction to Professional Ethics
Learning Objectives
■ Identify common themes and limitations of ethics codes
■ Understand the difference between law and ethics
■ Learn about professional monitoring of practices
■ Differentiate between aspirational ethics, mandatory ethics, principle ethics, and virtue ethics
■ Learn about the role of ethics codes in making ethical decisions
■ Understand how the six moral principles can be applied to ethical dilemmas
■ Learn about the steps to take in working through an ethical dilemma
■ Appreciate involving the client in the ethical decision making process
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
g. professional credentialing, including certification, licensure, and accreditation practices and standards, and the effects of public policy on these issues
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
Professional Codes of Ethics
1. If codes of ethics do not provide specific answers to the ethical dilemmas you will encounter, of what value are they?
2. What are common themes of codes of ethics?
3. What are some of the main limitations of ethics codes?
4. What are the main objectives that codes of ethics fulfill?
5. What is the relationship between law and ethics? What might you do if you were faced with a conflict between a legal standard and an ethical principle?
6. How is the practice of counseling regulated?
Ethical Decision Making
1. Be familiar with the meaning of the following terms and the differences among these terms: ethics, values, morality, community standards, reasonableness, and professionalism.
7. Differentiate between mandatory ethics and aspirational ethics.
8. What are the differences between principle ethics and virtue ethics?
9. One model of ethical decision making is based on these six basic moral principles: autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity. Be able to define each concept and provide an example for each principle.
10. Select an ethical dilemma and apply systematic steps to the resolution of the dilemma. Show the steps you might use in making an ethical decision. How might you include a client in making such a decision?
11. What are some of the advantages of including the client in the process of working through ethical decisions? Discuss the feminist model of ethical decision-making, showing how some of the ideas of this model can lead to client empowerment. If a professional disagrees with a particular ethical standard, and decides to practice in a way that is not sanctioned by an association, what are the consequences for that practitioner?
12. The text states that you need to develop an ethical sense that will enable you to better serve the welfare of your clients. What are some ways that you can think of to best develop this ethical sense?
Dealing with Suspected Unethical Behavior of Colleagues
1. What would you do if you suspected a mental health professional or a colleague was engaging in ethically questionable behavior?
Self-Assessment: An Inventory of Your Own Attitudes and Beliefs About Ethical and Professional Issues
1. After taking this inventory, what are a few of the items that you found yourself most struggling to answer?
13. How does taking this inventory provide you with some awareness of what is involved in ethical dilemmas?
Chapter 2—The Counselor as a Person and as a Professional
Learning Objectives
■ Appreciate the role of counselor self-awareness in ethical practice
■ Provide a rationale for the importance of personal therapy for counselors
■ Clarify how countertransference can be an ethical concern
■ Explore client dependence as a potential ethical problem
■ Examine how stress can lead to therapist impairment
■ Develop a personal strategy for maintaining vitality
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
d. self-care strategies appropriate to the counselor role
3. HUMAN GROWTH AND DEVELOPMENT—studies that provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, including all of the following:
f. human behavior, including an understanding of developmental crises, disability, psychopathology, and situational and environmental factors that affect both normal and abnormal behavior
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
a. an orientation to wellness and prevention as desired counseling goals
b. counselor characteristics and behaviors that influence helping processes
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
14. What are a few of the items in this inventory that you most strongly agreed with?
15. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. In what way do you see your personal life being related to your professional work?
16. How do you think that your work as a counselor might have an impact on your personal life?
Self-Awareness and Influence of Therapist’s Personality and Needs
1. How do unresolved personal conflicts affect the counselor’s ability to work with clients?
17. What are some of your major motivations for you becoming a counselor? How might these motivations and needs be met through your work?
18. Assume you were asked the question, “What do you personally get from doing counseling?” How would you answer this in a job interview?
Personal Therapy for Counselors
1. What is the rationale for the premise that therapy is essential for therapists and for trainees?
19. What role do you think experiential learning toward self-understanding should play in a counselor training program?
20. Do you think that personal therapy should be required of all trainees in a counseling program? If so, why? And what form of therapy do you think should be required?
21. To what extent should therapists make use of therapy for themselves? For those practitioners who are reluctant to seek professional assistance for themselves when they are highly stressed, what do you think might account for this reluctance?
22. Do you think that therapy should be required for an impaired therapist?
Transference and Countertransference
1. How can transference and countertransference be ethical issues?
23. In what way is transference an “unreal” relationship in therapy?
24. When is countertransference a problem? If you were to become aware of countertransference reactions toward a particular client, what course of action would you likely follow?
25. Identify some of the major ways that countertransference is likely to be manifested. What are some of the signs that a therapist is experiencing countertransference?
Client Dependence
1. In what sense is promoting client dependence an ethical issue? What are some examples of fostering client dependence?
26. How can delaying termination of therapy be a form of client dependency?
27. What are some ways that you can develop collaborative relationships with your clients?
Stress in the Counseling Profession
1. What are the major sources of stress for therapists? What are some sources of stress that you are most concerned about pertaining to your work as a counselor?
28. In what sense can a career in counseling be a “hazardous profession?”
29. How does the stress of professional practice impact the counselor’s personal life? What are the ethical issues here?
30. What are some of your concerns about your ability to cope with the stresses associated with being a professional?
31. To what degree might you be susceptible to stress caused by being overly responsible?
Counselor Burnout and Impairment
1. What is your concept of the impaired therapist? What suggestions would you have if an impaired colleague sought you out for help?
32. How can you prevent burnout as a counseling professional?
Maintaining Vitality Through Self-Care
1. How is self-care an ethical issue?
33. What are the components of wellness? How can wellness be a model for preventing burnout?
34. What is your personal strategy for maintaining your vitality?
Chapter 3—Values and the Helping Relationship
Learning Objectives
■ Explore the ethical issues involved in imposition of therapist values
■ Differentiate between exposing and imposing of therapist values
■ Critically examine a variety of case examples on value situations
■ Explore the role of spiritual/religious values in counseling
■ Examine end-of-life decisions from an ethical perspective
■ Learn how to effectively address value conflicts in therapy
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
2. SOCIAL AND CULTURAL DIVERSITY—studies that provide an understanding of the cultural context of relationships, issues, and trends in a multicultural society, including all of the following:
d. individual, couple, family, group, and community strategies for working with and advocating for diverse populations, including multicultural competencies
e. counselors’ roles in developing cultural self-awareness, promoting cultural social justice, advocacy and conflict resolution, and other culturally supported behaviors that promote optimal wellness and growth of the human spirit, mind, or body
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
a. an orientation to wellness and prevention as desired counseling goals
b. counselor characteristics and behaviors that influence helping processes
c. essential interviewing and counseling skills
7. ASSESSMENT—studies that provide an understanding of individual and group approaches to assessment and evaluation in a multicultural society, including all of the following:
f. social and cultural factors related to the assessment and evaluation of individuals, groups, and specific populations
g. ethical strategies for selecting, administering, and interpreting assessment and evaluation instruments and techniques in counseling
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
35. What are a few of the items in this inventory that you most strongly agreed with?
36. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. Is it possible for counselors to keep their values out of their counseling sessions? What are the various views on this issue?
37. How do counselors’ values influence every phase of the therapeutic process?
Clarifying Your Values and Their Role in Your Work
1. How can therapists discuss value issues with clients in an open and noncoercive way?
38. What do the ethics codes state about the therapist’s personal values and working with values in the therapeutic process?
The Ethics of Imposing Your Values on Clients
1. Do you think that there are times or circumstances where it is ethical for you to direct clients in a particular direction? What about instilling in clients certain basic values such as responsibility, avoiding harm to others, being honest with others, self-determination, developing the ability to give and receive affection, finding a sense of purpose, and living authentically?
39. You will inevitably incorporate certain value orientations into your therapeutic practice. What is the ethical obligation you have in informing clients about your value orientation? How might you do this in your practice?
40. Is it possible for you, as a therapist, to interact honestly with your clients without making value judgments? Do you see it as desirable to avoid making judgments in all circumstances?
41. Can you remain true to yourself and at the same time allow your clients the freedom to select their own values, even if they differ sharply from yours?
42. At what point are counselors ethically obligated to refer a client because of a conflict of values? When would you feel it necessary to refer?
43. Do counselors need to share the same life experiences and worldviews of their clients to effectively work with them? If you have a background that is quite different from your client, how will you be able to make a connection with him or her?
Value Conflicts Regarding Sexual Attitudes and Behavior
1. What are your values pertaining to sexuality? In what ways might these values either help or hinder you in making effective contact with clients? Can you think of any areas where you would have a tendency to push clients to make a certain decision with respect to sexual behavior?
44. If you were working with a couple, and if one person had been involved in an extramarital affair for some time, how might this affect your work with them?
45. Can you counsel people who are experiencing conflict over their sexual choices if their values differ dramatically from your own?
Value Conflicts Pertaining to Abortion
1. In what way might clients who are exploring abortion as an option present a challenge to clinicians, both legally and ethically?
46. What are your own moral and ethical views on abortion, and how do you think your values might influence your work with clients who are considering having an abortion?
47. Before a counselor were to make a referral for a client considering abortion, what are some of the key ethical issues involved?
48. In counseling minors who are considering an abortion, what are some legal and ethical issues that need to be addressed?
Case Studies of Other Possible Value Conflicts
1. Identify one specific value that you are likely to push, or an area where you expect to struggle because of a value conflict with a given client. How might this value either enhance or inhibit the effectiveness of counseling. How could you proceed to lessen the chances of imposing your values?
49. Review the cases in this section of the textbook. Which case would you find most challenging because of a possible value conflict? What would you do in this situation?
The Role of Spiritual and Religious Values in Counseling
1. Discuss the trend in the counseling profession that seems to be taking a stronger stand on incorporating spirituality and religion as a factor in assessment and treatment.
50. To what extent do you understand your own spiritual and religious beliefs? How might this influence your ability to understand and work with the spiritual and religious beliefs of your clients?
51. The premise of the authors is that spiritual and religious values can play a major role in a client’s life. What is your reaction to this premise?
52. Religion and spirituality are oftentimes part of the client’s problem, and they can also be part of the client’s solution. What are your thoughts about that statement?
53. How would you expect your spiritual and religious values to affect the manner in which you counsel? Would you be inclined to introduce the topic of spirituality or religion if your client did not make specific mention of such factors, if you believed that doing so would be helpful?
54. What are some ways that religion and spirituality in counseling might conflict? In what ways can the two work in concert? What is the interface between the values espoused by religion and spirituality within the framework of counseling practice?
55. What ways could you include a client’s background in spirituality as part of the assessment process?
56. What are some reasons to include spiritual and religious values in treatment? What potential problems can you see with doing so?
57. What is the responsibility of training programs in preparing future counselors to deal with the religious and spiritual concerns of their clients?
58. What kind of competencies in spirituality do you think counselors should have by the end of their training?
End-of-Life Decisions
1. What are the ethical considerations in the right to die and in rational suicide?
59. If a person is able to make a free and rational choice about ending his or her life, do you think that the state should interfere in this choice?
60. What are some of the arguments for and against physician-assisted suicide? What is the possible role that a counselor might assume in such cases?
61. What is the essence of the NASW’s policy on end-of-life decisions? To what extent do you support the client’s self-determination in end-of-life decisions?
62. What are your values regarding clients exercising self-determination in the area of making end-of-life decisions? How might your values influence your interventions in such cases?
63. How do the concepts of rational suicide, aid-in-dying, and hastened death differ from each other?
Chapter 4—Multicultural Perspectives and Diversity Issues
Learning Objectives
■ Learn essential terminology related to multiculturalism and diversity
■ Identify how cultural encapsulation is an ethical issue
■ Examine ethics codes from a diversity perspective
■ Examine cultural values and assumption in therapy
■ Clarify when matching of client and counselor is important
■ Explore ethical issues pertaining to sexual orientation
■ Critically examine what is involved in developing multicultural competence
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
i. advocacy processes needed to address institutional and social barriers that impede access, equity, and success for clients
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
2. SOCIAL AND CULTURAL DIVERSITY—studies that provide an understanding of the cultural context of relationships, issues, and trends in a multicultural society, including all of the following:
a. multicultural and pluralistic trends, including characteristics and concerns within and among diverse groups nationally and internationally
b. attitudes, beliefs, understandings, and acculturative experiences, including specific experiential learning activities designed to foster students’ understanding of self and culturally diverse clients
c. theories of multicultural counseling, identity development, and social justice
e. individual, couple, family, group, and community strategies for working with and advocating for diverse populations, including multicultural competencies
e. counselors’ roles in developing cultural self-awareness, promoting cultural social justice, advocacy and conflict resolution, and other culturally supported behaviors that promote optimal wellness and growth of the human spirit, mind, or body
f. counselors’ roles in eliminating biases, prejudices, and processes of intentional and unintentional oppression and discrimination
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
64. What are a few of the items in this inventory that you most strongly agreed with?
65. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. What do you think is the major challenge you might encounter in understanding the role of cultural diversity in your work?
66. How does addressing cultural diversity present ethical concerns?
67. Define each of the following terms: ethnicity, culture, ethnic minority group, multiculturalism, multicultural counseling, cultural diversity, diversity, cultural diversity competence, cultural empathy, culture-centered counseling, racism, cultural racism, unintentional racism, and stereotypes.
The Problem of Cultural Tunnel Vision
1. How is cultural tunnel vision sometimes a problem with mental health practitioners?
68. What are the characteristics of the culturally encapsulated counselor?
69. What are some steps you can take to deal effectively with cultural diversity and pluralism?
70. What are some reasons you can offer for the need for a multicultural emphasis in the practice of counseling?
The Challenges of Reaching Diverse Client Populations
1. What are some of the main challenges you expect to face in reaching diverse client populations?
71. How do you think that your own culture, life experiences, attitudes, values, and biases influence your view of counseling practice?
Ethics Codes From a Diversity Perspective
1. What are the limitations of existing codes for multicultural counseling?
72. To what degree, if at all, are the ACA Code of Ethics and the APA Ethical Principles culturally biased and culturally encapsulated? What evidence is there in these codes that they are culturally sensitive?
73. What evidence is there that the NASW’s Code of Ethics deals with diversity perspectives and multicultural concerns?
Cultural Values and Assumptions in Therapy
1. What are some of the main differences between Western and Eastern values? What are the implications of these differences for practice?
74. In what respects are contemporary theories of therapy and therapeutic practices grounded in Western assumptions?
75. What are some specific values associated with a Western orientation?
76. What are some specific values associated with an Eastern orientation?
77. What is one example of a stereotypic belief that you hold toward a particular group? How might you challenge this belief?
78. How are a counselor’s assumptions about self-disclosure pertinent in counseling certain ethnic groups? How about the counselor’s assumptions about assertiveness? About self-actualization? About nonverbal behavior? About directness? About trusting?
Addressing Sexual Orientation
1. What do the ethics codes of the various professional organizations generally state pertaining to sexual orientation?
2. How does working with lesbian, gay, and bisexual individuals present a challenge to counselors who hold conservative values?
3. What is your reaction to the following statement? “Any therapist who may work with lesbian, gay, or bisexual people has a responsibility to understand the special concerns of these individuals and is ethically obligated to develop the knowledge and skills to competently deliver services to them.”
4. Review the court case (Bruff v. North Mississippi Health Services, Inc.) that involves a therapist’s refusal to counsel a lesbian couple. What are your thoughts about the implications of this case? Do you think it is ever ethically appropriate for a counselor to refer potential clients on the basis of sexual orientation?
5. For those counselors who believe that homosexuality is immoral, do you think that they have an ethical right to counsel gay, lesbian, or bisexual clients?
6. How might the values you hold either help or hinder your ability to establish effective relationships with lesbians or gay men?
7. What are the main ethical issues that you think need to be addressed pertaining to counseling gay and lesbian clients?
8. What are some guidelines you could use in working with gay, lesbian, and bisexual clients?
9. Do you think that therapists should be ethically required to obtain specialized training in counseling gay and lesbian clients? If yes, what kind of training would you propose? If no, what are your reasons for not requiring this specialized training?
Matching Client and Counselor
1. Does a counselor have to share the racial and cultural backgrounds of the client to be effective?
79. What are your thoughts on the issue of matching client and counselor? In what areas do you think it is important to be matched with your client? How can you bridge any differences?
80. What is the basic difference between an intentional racist and an unintentional racist? In what way might you be an unintentional racist? What are some of the best ways of changing any unintentional racist attitudes or behaviors?
81. What are your thoughts about this statement? “Clinicians can make a mistake by assuming there is a standard way to work with clients of a certain cultural background.”
Multicultural Training for Mental Health Workers
1. Becoming a culturally aware therapist is not an either/or condition, but it is best considered on a continuum from being unaware of cultural issues to a heightened awareness of the role that cultural factors play in counseling. Where do you see yourself on this continuum? How aware are you of the cultural dynamics that enter into a therapeutic relationship? How comfortable do you feel in working with cultural differences that may emerge in helping relationships?
2. What are the main characteristics of the culturally skilled counselor?
3. What do you consider to be the essential components of multicultural counseling? Include a discussion of beliefs and attitudes, knowledge, and skills of culturally skilled counselors.
4. What are your thoughts on an ideal training program for multicultural counseling?
5. Read the multicultural counseling competencies. Describe your relative strengths and weaknesses with regard to the competencies. In what areas do you feel competent? In what areas do you need to concentrate your efforts to increase your competence?
Chapter 5—Client Rights and Counselor Responsibilities
Learning Objectives
■ Learn what is involved in informed consent
■ Develop an informed consent document
■ Examine a counselor’s responsibility in record keeping
■ Explore ethical issues related to online counseling
■ Become familiar with ethical issues in working with minors
■ Learn about involuntary commitment and human rights
■ Examine the basis for malpractice liability in therapy profession
■ Learn practical strategies for risk management
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
f. professional organizations, including membership benefits, activities, services to members, and current issues
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
b. counselor characteristics and behaviors that influence helping processes
c. essential interviewing and counseling skills
f. a general framework for understanding and practicing consultation
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. How would you alert your clients to their rights and responsibilities?
2. What do you see as some of your major responsibilities as a counseling professional?
The Client’s Right to Give Informed Consent
1. How is informed consent a basic right of clients?
2. What do the ethics codes generally state regarding the rights of clients and informed consent? What are some common themes found in the various ethics codes pertaining to informed consent?
3. From an ethical perspective, why is informed consent of paramount importance?
4. From a legal perspective, what are the three elements involved in adequate informed consent? Define these terms: capacity, comprehension of information, and voluntariness.
5. What are some of your ideas on how you would go about educating clients about informed consent?
The Content of Informed Consent
1. If you were to create an informed consent document that you would give your clients, what are the main elements that would be contained in this document?
2. How much information would you include in your informed consent document about your approach to therapy and your professional background?
3. Termination should be addressed from the outset of therapy. What information about termination would you include in the informed consent process?
6. Do you think that your clients should have access to their files? Why or why not?
7. Do you think clients have a right to know their diagnostic classification? Why or why not?
The Professional’s Responsibilities in Record Keeping
1. What are the main points of the ethics codes pertaining to keeping records?
2. From a clinical perspective, what are the main purposes of maintaining client records?
3. From a legal perspective, why is it essential to keep accurate records on clients?
4. What should be the general content of clinical records?
5. What are the differences between process notes and progress notes?
6. How does record keeping apply to managed care programs?
7. Considering the high student-to-counselor ratio in school settings, how can school counselors do a good job of maintaining records?
8. What is your stance on record keeping? What kind of records do you think would be most helpful?
9. As a counselor, what are your responsibilities pertaining to storing, transferring, sharing, and disposing of client records?
Ethical Issues in Online Counseling
1. What are some advantages of counseling via the Internet?
2. What are some disadvantages of counseling via the Internet?
3. What are your thoughts about counseling via the Internet? What specific ethical issues do you think need to be raised? How comfortable would you be in using this form of technology in your counseling practice?
4. How might you acquire a level of competence in delivering services over the Internet?
Working with Children and Adolescents
1. What are some laws that you would need to be aware of if you were to work with minors?
2. How might you obtain informed consent of minors? Would you see children or adolescents without parental consent?
3. How might you balance the ethical right of minor clients to privacy and confidentiality with the legal right of parents to information pertaining to counseling sessions with their children?
4. How might you explain resistance that you may get as you counsel reluctant children and adolescents? What are some possible meanings of this resistance, and how would you work with it?
5. Why is specialized training needed for those who counsel children and adolescents? What kind of training do you think is essential?
Involuntary Commitment and Human Rights
1. Before involuntarily committing a client, what would be some of the steps that you would take? What other courses of action would you take before you resorted to involuntary commitment procedures?
2. What are some of the major ethical and legal issues involved in the process of involuntary commitment?
Malpractice Liability in the Helping Professions
1. How would you define malpractice?
2. What constitutes professional negligence?
3. What is the meaning of the concept of standard of care?
4. What four conditions must be present in malpractice litigation? Define these four elements of malpractice: duty, breach of duty, injury, and causation.
5. What are the main grounds for malpractice suits? What kinds of violations have received the greatest attention in the literature?
6. Be able to describe each of the following as a cause of malpractice suits:
■ Failure to obtain informed consent
■ Client abandonment and premature termination
■ Departing from established therapeutic practices
■ Practicing beyond the scope of competency
■ Misdiagnosis
■ Repressed or false memories
■ Unhealthy transference relationships
■ Sexual misconduct with a client
■ Failure to control a dangerous client
82. What has been the impact of malpractice litigation on practitioners?
83. What are some precautions that you would like take in dealing with high-risk clients?
84. What do you understand by the concept of risk management? What are some ways to protect yourself from malpractice suits? Identify specific safeguards and risk management strategies to lessen the chance of being successfully sued.
85. What course of action might you follow in a malpractice suit?
86. How do legal liability and ethical practice overlap at times?
Chapter 6—Confidentiality: Ethical and Legal Issues
Learning Objectives
■ Differentiate between confidentiality, privacy, and privileged communication
■ Understand the purpose and limitations of confidentiality
■ Identify privacy issues with telecommunications devices
■ Understand the implications of HIPAA for mental health providers
■ Differentiate between duty to warn and duty to protect
■ Become familiar with landmark court cases and implications for practice
■ Evaluate ethical and legal duties pertaining to suicide
■ Become aware of one’s duty to protect children, dependent adults, and the elderly from harm
■ Identify some confidentiality issues in area of HIV/AIDS counseling
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
a. history and philosophy of the counseling profession
b. professional roles, functions, and relationships with other human service providers, including strategies for interagency/interorganization collaboration and communications
c. counselors’ roles and responsibilities as members of an interdisciplinary emergency management response team during a local, regional, or national crisis, disaster or other trauma-causing event
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
3. HUMAN GROWTH AND DEVELOPMENT—studies that provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, including all of the following:
c. effects of crises, disasters, and other trauma-causing events on persons of all ages
f. human behavior, including an understanding of developmental crises, disability, psychopathology, and situational and environmental factors that affect both normal and abnormal behavior
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
c. essential interviewing and counseling skills
g. crisis intervention and suicide prevention models, including the use of psychological first aid strategies
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. Why is it not possible for you to make a blanket promise to your clients that everything they talk about will always remain confidential?
2. Why is legal knowledge alone not enough to help you make sound professional decisions in matters pertaining to privacy and confidentiality?
Confidentiality, Privileged Communication, and Privacy
1. Define these terms: confidentiality, privileged communication, and privacy. How are these related concepts? How is each term distinct?
2. How does privileged communication differ from confidentiality?
3. What do the ethics codes generally state with regard to confidentiality in clinical practice?
4. What ethical and legal ramifications of confidentiality would you want to present to your clients? What are the limits of confidentiality?
5. What limitations do you see on the confidentiality of the therapeutic relationship? When would you deem it necessary to breach confidentiality?
6. How might you educate your clients about the purposes and limits of confidentiality?
7. What are some ways that you might invade a client’s privacy unintentionally?
8. What are some issues pertaining to confidentiality and privacy in a school setting?
Privacy Issues With telecommunication Devices
1. What are some privacy issues you are concerned about with telephones, answering machines, voice mail, faxes, cellular phones, and e-mail?
Implications of HIPAA for Mental Health Providers
1. What is HIPAA and how does it pertain to protection of confidentiality?
2. How does HIPPA potentially impact the practice of counseling?
3. What are the four standards of HIPAA?
The Duty to Warn and to Protect
1. What is involved in the therapist’s duty to protect potential victims from dangerous acts of violent crimes?
2. What are the major implications of the Tarasoff case?
3. What was the ruling in the Bradley case?
4. What are the implications of the legal ruling in the Jablonski case?
5. What are the implications of the decision in the Hedlund case?
6. In what ways did the Jaffee case extend the confidentiality privilege?
7. What might be the consequences of the Jaffee case for licensed therapists and their clients?
8. How might your therapeutic practices be modified in light of your understanding of the above court cases?
9. What guidelines might you employ for dealing with dangerous clients? How might you go about making the determination of whether or not a person is potentially dangerous to self or others?
10. What are the ethical and legal duties to protect suicidal clients?
11. What are a few guidelines for assessing suicidal behavior?
12. What are the arguments in the case for suicide prevention?
13. What are the arguments in the case against suicide prevention?
14. What is your stance on the issue of suicide prevention?
15. What are the implications of duty to warn and to protect for school counselors?
Protecting Children, the Elderly, and Dependent Adults From Harm
1. Once you suspect abuse or neglect of a child, an elderly person, or a dependent adult, what are you expected to do from both an ethical and a legal standpoint? Can you think of situations where what is ethical and what is legal might be in conflict? What would you do if you experienced such a conflict?
2. What are your thoughts about the mandatory reporting laws of suspected cases of child or elder abuse?
3. What are the different types of elder abuse?
4. Some believe that professionals should decide whether or not to report child abuse if their client is an offender, on the grounds that reporting could result in the end of therapy with this client. What do you think?
5. A review of some literature reveals that clinicians are hesitant to report suspected child abuse unless they are fairly certain that abuse is currently occurring. Do you think that ethical practice demands that practitioners report abuse, regardless of how long ago it occurred?
6. How do you distinguish abuse from harsh punishment? What cultural factors might enter into this assessment?
Confidentiality and HIV/AIDS-Related Issues
1. What are your ethical responsibilities with respect to educating yourself about the problems involved in working with HIV- positive clients and with persons with AIDS?
2. As a professional, what responsibilities, if any, do you think you have in educating the public about the disease?
3. What are the ethical issues involved in either maintaining or breaching confidentiality with clients who are HIV-positive and who are sexually active? Do you think you have a duty to warn and to protect identified third parties? What are the legal considerations in these situations?
4. How might HIV-positive clients who refuse to inform their partners of their HIV status be a matter related to duty to warn and protect?
5. Do Tarasoff principles apply in AIDS-related psychotherapy?
6. What rights do your clients have who are HIV-positive? What are the rights of their partners? How do you balance the rights of both parties?
7. What key issues do you think are involved in considering the handling of confidentiality in HIV and AIDS-related therapy cases? What are some of the main ethical and legal considerations in these cases?
8. From an ethical perspective, what kind of special training on HIV-related issues should counselors receive?
Chapter 7—Managing Boundaries and Multiple Relationships
Learning Objectives
■ Examine various perspectives on multiple relationships
■ Formulate ways to minimize risk and promote client welfare
■ Differentiate between boundary crossings and boundary violations
■ Explore the pros and cons of bartering and receiving gifts
■ Identify what ethics codes say about specific dual relationships
■ Examine legal and ethical aspects in managing boundaries
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
b. counselor characteristics and behaviors that influence helping processes
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. What are dual and multiple relationships, and why do they pose an ethical challenge to counselors?
2. What are the general themes in the codes of ethics pertaining to dual and multiple relationships?
3. What is the definition of dual relationships? Of multiple relationships? What are some of the more common forms of dual/multiple relationships?
The Ethics of Multiple Relationships
1. Some writers focus on the problems inherent in dual/multiple relationships. What are some of these problems?
2. Are all dual/multiple relationships necessarily unethical? Why or why not?
3. Some claim that dual or multiple relationships are inherent in the work of all helping professions, that they are not necessarily harmful, and that there may be some beneficial aspects to some dual relationships. What do you think of this perspective?
4. Some hold that dual/multiple relationships are inevitable and unavoidable, and that it is the responsibility of the professional to find ways to monitor the risks and safeguard clients. What are your reactions to this view?
5. What are the reasons that ethics codes caution practitioners against engaging in dual/multiple relationships?
6. What are some issues to consider in determining the degree to which dual/multiple relationships pose problems or raise the potential for harm to clients?
7. The case is often made that dual or multiple relationships often lead to a misuse of power and the exploitation of a client. Do you think these actions are necessarily linked to the existence of dual or multiple relationships? Why or why not?
8. What ways can you monitor yourself pertaining to decisions to engage in any form of dual or multiple relating with clients? What kinds of safeguards can you think of to protect clients if you are involved in an unavoidable dual or multiple relationship?
9. What are some differences between boundary crossings and boundary violations?
10. What is your understanding of the term “role blending?” Can you think of ways that you might blend roles in your professional practice?
11. What relationship do you see between boundaries in your personal life and your ability to establish appropriate professional boundaries? In what areas, if any, might you expect to have difficulties in managing boundaries in the work setting?
Controversies on Boundary Issues
1. Dr. Arnold Lazarus takes the position that certain boundaries and ethics actually diminish therapeutic effectiveness. He believes that some well-intentioned guidelines can backfire and that rather than being driven by rules, it is best for therapists to engage in a process of negotiation in many multiple relationships. What do you think about his views?
2. Before entering into a multiple relationship, what general issues would you want to explore and clarify?
3. What are some examples of boundary crossings that might promote healing?
Managing Multiple Relationships in Small Communities
1. What are some of the challenges to ethical practice faced by counselors who work in small communities?
2. What are some differences between urban and rural communities pertaining to dealing with multiple relationships?
Bartering for Professional Services
1. What do the ethics codes state about bartering?
2. When is bartering problematic? Why do some contend that bartering of services and goods for therapy services raises ethical concerns? What cultural factors need to be taken into account in determining whether to barter?
3. What are some arguments both for and against the practice of bartering for therapeutic services?
4. If a client were unable to pay for your services, would you be inclined to consider bartering if the client initiated this as a solution? If yes, what guidelines would you want to establish between you and your client? If you would not be willing to engage in bartering, what alternatives, if any, might you suggest?
Giving or Receiving Gifts
1. If a client offered you a gift, what would you say or do? What factors would you take into consideration in making a decision about accepting or not accepting the gift?
2. Can you ever think of an instance where you might give a gift to a client? Explain.
3. What guidance can you find in the ethics codes pertaining to receiving gifts from clients?
Social Relationships with Clients
1. What are the potential problems in situations where there is a blending of both personal and professional relationships? Do social relationships of any form necessarily interfere with therapeutic relationships? Explain.
2. When do you think that social relationships with current clients are unethical? What about the ethics of forming personal or social relationships with former clients?
3. Some counselors take the position that counseling and friendship should not be mixed. The argument is that blending social relationships with professional ones simultaneously can negatively affect the therapy process, the friendship, or both. What are your ideas about this viewpoint?
4. Some peer counselors might claim that friendships before or during counseling are actually positive factors in establishing trust and a productive therapeutic relationship. What do you think?
Sexual Attractions in the Client/Therapist Relationship
1. What are your thoughts on the matter of sexual attractions in the client/therapist relationship? To what extent have you thought about or discussed this topic?
2. If a client was attracted to you and expressed this, what do you think you would do? What if you were attracted to a client? What might you do or say?
3. What kind of education and training do you think graduate programs should include for trainees on the matter of learning how to deal effectively with sexual attractions?
4. If you were designing a training program to help counselor trainees learn how to recognize and effectively deal with sexual attractions in therapy, what would your program look like?
Sexual Relationships in Therapy: Ethical and Legal Issues
1. In your education and training, what kind of information have you been given pertaining to sexual activity in a professional relationship? What kind of educational activities do you think would be useful in addressing this topic?
2. Under what practices does touching tend to lead to intercourse in the therapy relationship?
3. What do the studies show concerning the frequency of sexual contact with clients?
4. What do the ethical standards say about sexual relationships with current client?
5. What are the reasons that sexual intimacy between therapist and client is considered unethical and unprofessional?
6. What are some common misconceptions that tend to influence the therapist’s decision to engage in sexual intimacies with a client?
7. What are the harmful effects of sexual intimacy on clients?
8. What are some legal sanctions against sexual violators? What are some ethical sanctions?
Sexual Relationships with Former Clients
1. What are the ethical and legal aspects of therapists forming either social or romantic relationships with former clients? What specific factors need to be addressed by therapists before they get involved in any personal way with former clients? Do you think it is ever justified, regardless of the amount of time elapsed since termination, for a therapist to form a sexual relationship with a former client? Explain your position.
2. What do the ethics codes state with regard to sexual relationships with former clients?
A Special Case: Nonerotic Touching with Clients
1. What are the arguments for and against the use of touching in therapy? What are your thoughts pertaining to touch in the therapeutic relationship?
2. What guidelines can you think of to help you make decisions pertaining to the practice of touching in therapy?
Chapter 8—Professional Competence and Training Issues
Learning Objectives
■ Clarify how therapist competence is an ethical issue
■ Look at when and how to make referrals
■ Examine ethical issues in training therapists
■ Understand the basis of screening candidates in training programs
■ Learn about the purpose of licensing and credentialing
■ Discuss ways that continuing education is a way to maintain competence
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
a. history and philosophy of the counseling profession
f. professional organizations, including membership benefits, activities, services to members, and current issues
g. professional credentialing, including certification, licensure, and accreditation practices and standards, and the effects of public policy on these issues
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
3. HUMAN GROWTH AND DEVELOPMENT—studies that provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, including all of the following:
f. human behavior, including an understanding of developmental crises, disability, psychopathology, and situational and environmental factors that affect both normal and abnormal behavior
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
b. counselor characteristics and behaviors that influence helping processes
c. essential interviewing and counseling skills
7. ASSESSMENT—studies that provide an understanding of individual and group approaches to assessment and evaluation in a multicultural society, including all of the following:
b. basic concepts of standardized and non-standardized testing and other assessment techniques, including norm-referenced and criterion-referenced assessment, environmental assessment, performance assessment, individual and group test and inventory methods, psychological testing, and behavioral observations
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. Competence is a process rather than something that is achieved once and for all. What are your thoughts about this statement?
2. How is competence an ethical issue?
Therapist Competence: Ethical and Legal Aspects
1. How can you assess your level of competence in deciding which services to deliver or not to deliver?
2. What are the major ethical and legal issues related to therapist competence?
3. What is the distinction between formative assessment and summative assessment?
4. How might you know when to refer a client because of limited competence? In such a case, how would you go about making this referral? What would you do if a client refused to accept your referral?
5. In general, what are the themes of the codes of ethics pertaining to competence?
Ethical Issues in Training Therapists
1. If you were a part of a screening committee to determine which candidates would be admitted to a counselor-training program, how would you best go about assessing a candidate’s personal characteristics? What other factors would you want to use in screening applicants for a counselor-preparation program?
2. What are your thoughts about the assumption that training programs need to be designed so that students can learn a good deal more about themselves as well as acquire theoretical knowledge?
3. How do you think practitioners can best be trained? How can academic and personal learning be combined? What are your thoughts on the training of therapists?
Evaluating Knowledge, Skills, and Personal Functioning
1. What are your thoughts on how training programs can best carry out their dual responsibility to honor their commitment to the students they admit and to protect future consumers who will be served by those who graduate?
2. What responsibility do you see professional organizations as having in determining minimum standards of competence and for defining what it means for a candidate to be unsuitable as a counselor?
3. What are your thoughts regarding evaluating a trainee’s interpersonal behaviors, personal characteristics, and psychological fitness?
4. How would you describe the difference between professional impairment and incompetence? In what ways do these concepts overlap?
Gatekeeper Role of Faculty in Promoting Competence
1. What is the gatekeeper role of faculty in promoting and evaluating competence on the part of the students?
2. Why do you think faculty in a training program may be hesitant in carrying out their gatekeeping role?
Dismissing Students for Non-Academic Reasons
1. What responsibility do you think a training program has to dismiss from the program a student who is psychologically or academically not able to perform satisfactorily in an internship? What kind of process would you recommend for providing feedback to such a student?
2. When a student is doing well academically, but demonstrates problematic interpersonal functioning or has poor clinical skills, what kind of action do you think should be taken?
3. What are the legal deterrents to dismissing students for non-academic reasons?
4. What systematic procedures should be in place to evaluate student performance in a counselor training program?
Professional Licensing and Credentialing
1. Define the following terms: registration, licensure, and certification.
2. Does professional licensing indicate professional competence? Give reasons for your answer.
3. What are the purposes of legislative regulation of professional practice?
4. What are the arguments for and against professional licensing and credentialing?
5. The process of licensure, certification, credentialing, and registration can promote a sense of professional identity. It can also lead to professional jealousy over turf battles and interprofessional bickering. What are your views on the process of regulation of professional practice?
Continuing Education and Demonstration of Competence
1. What are your views on continuing education as a way to maintain competence? Are you in favor of requiring continuing education as a condition for relicensure?
2. What do the codes of ethics say about continuing education as a pathway toward maintaining competence?
Review, Consultation, and Supervision by Peers
1. How can peer review be a means of ensuring quality?
3. What value do peer-consultation groups have for counselors-in-training? For experienced practitioners?
Chapter 9—Issues in Supervision and Consultation
Learning Objectives
■ Identify ethical and legal issues in clinical supervision
■ Become aware of roles and responsibilities of supervisors
■ Examine ethical and effective practices in supervision
■ Identify the role of informed consent in supervisory relationships
■ Examine multicultural issues in supervision
■ Clarify appropriate boundaries in the supervisory process
■ Examine ethical issues pertaining to consultation
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
b. professional roles, functions, and relationships with other human service providers, including strategies for interagency/interorganization collaboration and communications
e. counseling supervision models, practices, and processes
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
2. SOCIAL AND CULTURAL DIVERSITY—studies that provide an understanding of the cultural context of relationships, issues, and trends in a multicultural society, including all of the following:
b. attitudes, beliefs, understandings, and acculturative experiences, including specific experiential learning activities designed to foster students’ understanding of self and culturally diverse clients
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
f. a general framework for understanding and practicing consultation
7. ASSESSMENT—studies that provide an understanding of individual and group approaches to assessment and evaluation in a multicultural society, including all of the following:
b. basic concepts of standardized and non-standardized testing and other assessment techniques, including norm-referenced and criterion-referenced assessment, environmental assessment, performance assessment, individual and group test and inventory methods, psychological testing, and behavioral observations
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. What do you understand as the role of supervision in the training of competent practitioners?
2. What are the major goals of supervision?
Ethical Issues in Clinical Supervision
1. In what ways are supervisors responsible ethically for the actions of their trainees?
2. What is the role of informed consent in the supervision process? As a supervisee, what kind of information have your supervisors provided you with regarding what they expected of you? What, if anything, would you have wanted to know from your supervisor about the supervisory process or supervisory relationship?
3. What are your thoughts about the list of supervisee’s bill of rights that are described in this chapter?
The Supervisor’s Roles and Responsibilities
1. What are the main roles and responsibilities that counseling supervisors have toward supervisees? What about the supervisor’s responsibilities to the clients of those being supervised?
2. What are some specific ways that supervisors can promote counselor development?
3. A variety of methods are used in supervision. What methods would you be most comfortable using if you were a clinical supervisor?
4. The text states: “A supervisor’s task is to strive for an optimal level of challenge and support.” As a supervisor, how would you achieve this?
Ethical and Effective Practices of Clinical Supervisors
1. The quality of the supervisory relationship is believed to be one of the key components in determining outcomes. As a supervisee, how would you describe the ideal supervisory relationship?
Competence of Supervisors
1. What do you think constitutes a competent supervisor? What kinds of experiences do supervisors need to be competent? How do you think a supervisor’s competence can best be assessed or determined?
2. From both an ethical and a legal perspective, why is competence a main element in supervision? Does possession of an advanced degree imply that a counselor can also supervise effectively? Does competence as a therapist necessarily imply competence as a supervisor? Explain.
Legal Aspects of Supervision
1. What are three legal considerations in the supervisory relationship?
2. What are a few risk management practices supervisors can take to prevent malpractice actions?
Special Issues in Supervision for School Counselors
1. What are some advantages of clinical supervision for school counselors?
87. What are a few ethical and legal issues that arise in school counselor supervision?
Multicultural Issues in Supervision
1. What is the price to be paid for ignoring racial and ethnic factors in supervision?
2. What are your thoughts regarding ways of making supervision more multiculturally sensitive and effective?
88. What kind of training and supervision are required to achieve multicultural competence on the part of supervisees?
89. In what way can spirituality be considered a key dimension of multicultural supervision?
90. What importance do you place on gender issues in supervision?
Multiple Roles and Relationships in the Supervisory Process
1. When might multiple relationships in the supervision process become an ethical issue? What are some examples of such relationships that you think are most problematic?
91. Most training programs in the helping professions involve educators playing more than one role. Educators and supervisors often engage in role blending to carry out their functions. What are your thoughts about ways to ethically manage training that frequently uses both didactic and experiential approaches?
92. What are the major problems associated with sexual intimacies between supervisors and supervisees?
93. What are your thoughts about supervisors who combine supervision with personal counseling, especially in cases where a supervisee’s personal problems are interfering with providing effective counseling?
94. What are the ethics involved of educators who counsel their current students? What about educators or supervisors who eventually accept a former student or supervisee as a client in therapy?
95. If you were a supervisor, what kind of boundaries would you want to establish with your supervisees? How would you establish and maintain these boundaries?
96. Have you encountered any problems pertaining to multiple roles and relationships with your professors or supervisors? How comfortable are you in learning to manage certain multiple roles and relationships from the perspective of a student?
97. If you were a supervisor, what would you want to tell your supervisees about multiple roles and relationships that are ethically problematic? What would you tell them about multiple roles and relationships that may be beneficial or inevitable?
Ethical Issues in Consultation
1. How is consultation defined? What are the aims of the consultation process?
2. What are some of the common characteristics of consultation?
98. Why is a code of ethics needed for consultants? What are some of the important ethical principles for consultants?
99. As a consultant, how would you handle value conflicts?
100. What kind of training do you think consultants need to function competently?
101. From an ethical standpoint, what do you think consultants should know about an organization before they agree to enter into a contract with a particular group?
102. What do consultants need to know before providing their services in a crisis or disaster situation?
103. How might hidden agendas be a particular problem in the practice of consulting?
Chapter 10—Issues in Theory and Practice
Learning Objectives
■ Identify how one’s theory pertains to ethical practice
■ Learn about ethical issues involved in using techniques
■ Understand ethical, clinical, and cultural issues in assessment and diagnosis
■ Clarify arguments for and against diagnosis
■ Learn about the use of tests in counseling
■ Explore ethical issues involved in managed care
■ Become familiar with evidenced-based therapy practice
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
3. HUMAN GROWTH AND DEVELOPMENT—studies that provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, including all of the following:
f. human behavior, including an understanding of developmental crises, disability, psychopathology, and situational and environmental factors that affect both normal and abnormal behavior
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
b. counselor characteristics and behaviors that influence helping processes
c. essential interviewing and counseling skills
d. counseling theories that provide the student with models to conceptualize client presentation and that help the student select appropriate counseling interventions. Students will be exposed to models of counseling that are consistent with current professional research and practice in the field so they begin to develop a personal model of counseling
e. a systems perspective that provides an understanding of family and other systems theories and major models of family and related interventions
7. ASSESSMENT—studies that provide an understanding of individual and group approaches to assessment and evaluation in a multicultural society, including all of the following:
b. basic concepts of standardized and non-standardized testing and other assessment techniques, including norm-referenced and criterion-referenced assessment, environmental assessment, performance assessment, individual and group test and inventory methods, psychological testing, and behavioral observations
f. social and cultural factors related to the assessment and evaluation of individuals, groups, and specific populations
g. ethical strategies for selecting, administering, and interpreting assessment and evaluation instruments and techniques in counseling
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. How does your theoretical orientation influence your counseling practice?
2. If a client asked you about your theoretical orientation, would you be able to explain what you most hoped to accomplish and how you would go about it?
Developing a Counseling Style
1. How would you describe your counseling stance? What are your assumptions about the nature of counseling and the nature of people?
2. How does your theoretical orientation affect your view of practice? In what way might your theoretical views become an ethical issue?
The Division of Responsibility in Therapy
1. In what way is therapy a joint venture of both the client and the therapist?
2. What are your thoughts on the division of responsibility in the therapeutic relationship?
3. Under what circumstances might this division of responsibility become an ethical concern?
Deciding on the Goals of Counseling
1. What do you consider to be a few of the most important goals of counseling?
2. Who is in the best position to determine therapeutic goals? Explain.
3. In what way might the process of deciding on goals for therapy become an ethical issue?
The Use of Techniques in Counseling
1. What are the main ethical issues regarding the appropriate and ethical use of techniques?
2. In what situations is it likely that techniques could be abused?
3. What are the ethical issues involved in adapting techniques to the needs of the client?
4. What are your guidelines for using techniques in an ethical way?
Assessment and Diagnosis as Professional Issues
1. What is the main purpose of diagnosis? What are some potential ethical issues associated with the process of diagnosis?
2. What does differential diagnosis mean?
3. How do you differentiate between assessment and diagnosis and how are the two processes integrally related to therapeutic practice?
4. How is a practitioner’s theoretical orientation related to assessment and diagnosis? Describe each of the major theories’ perspective on assessment and diagnosis.
5. What are the main arguments for and against psychodiagnosis? What is your position on this topic?
6. If you worked in an agency that required you to formulate a diagnosis and treatment plan based upon your impressions at the initial session, how would this influence your practice?
7. What is the role of a client’s ethnic and cultural background as it pertains to the process of diagnosis?
8. What do the ethics codes say about considering cultural factors in making a proper diagnosis?
9. What would be considered unethical diagnostic practices?
10. What are some possible legal issues surrounding diagnostic practices?
Using Tests in Counseling
1. What guidelines would help you decide when you might want to use tests for counseling purposes?
2. What are some main ethical considerations in using tests?
3. In interpreting test results to a client, how would you take into account his or her ethnicity and cultural background?
4. What are some multicultural considerations in using tests?
Counseling in a Managed Care Environment
1. How did managed care come about?
2. What are some of the key differences between the fee-for-service system of private practice and the newer system of managed care?
3. Identify some of the main advantages and disadvantages of the managed care system, for both the client and the therapist? How can clients best be served, given the limited mental-health resources?
4. What are some of the main ethical issues associated with managed care?
5. If you were working in a managed care setting, how would you handle informed consent with your clients? What would you most want them to know?
6. If you were working in a managed care setting, how would you handle the topic of confidentiality with your clients?
7. If you were working in a managed care setting, how might you deal with a client who was no longer entitled to services, yet you clearly believed that this person required further treatment? Do you have any thoughts about how you might deal with potential issues surrounding abandonment of a client?
Evidence-Based Therapy Practice
1. What is evidence-based practice? Why is it so appealing to managed care systems?
2. What are the potential ethical issues associated with evidence-based practice?
3. In the text, the point is made that research, in addition to theory, can inform ethical practice. What are some major research findings about psychotherapy process and outcomes that could inform your practice as a clinician?
Chapter 11—Ethical Issues in Couples and Family Therapy
Learning Objectives
■ Learn about key ethical issues in working with couples and families
■ Clarify how therapist values can be an ethical issue in couples/family work
■ Explore role of confidentiality and informed consent in family therapy
■ Identify responsibilities of couples and family therapists
■ Appreciate the role of gender issues in working with couples and families
■ Understand training and education requirements for family therapists
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
2. SOCIAL AND CULTURAL DIVERSITY—studies that provide an understanding of the cultural context of relationships, issues, and trends in a multicultural society, including all of the following:
b. attitudes, beliefs, understandings, and acculturative experiences, including specific experiential learning activities designed to foster students’ understanding of self and culturally diverse clients
c. theories of multicultural counseling, identity development, and social justice
f. individual, couple, family, group, and community strategies for working with and advocating for diverse populations, including multicultural competencies
e. counselors’ roles in developing cultural self-awareness, promoting cultural social justice, advocacy and conflict resolution, and other culturally supported behaviors that promote optimal wellness and growth of the human spirit, mind, or body
f. counselors’ roles in eliminating biases, prejudices, and processes of intentional and unintentional oppression and discrimination
3. HUMAN GROWTH AND DEVELOPMENT—studies that provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, including all of the following:
a. theories of individual and family development and transitions across the life span
d. theories and models of individual, cultural, couple, family, and community resilience
5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:
b. counselor characteristics and behaviors that influence helping processes
e. a systems perspective that provides an understanding of family and other systems theories and major models of family and related interventions
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. How does couples and family counseling basically differ from individual counseling models?
2. What is the essence of the systems perspective?
Ethical Standards in Couples and Family Therapy
1. What are some ethical standards that are specific to the practice of couples and family therapy?
2. What do you consider to be the major ethical issue couples and family therapists need to address?
Special Ethical Considerations in Working with Couples and Families
1. Because most therapists who work with couples and families focus on the system rather than an individual, what are some potential ethical dilemmas that need to be clarified from the outset?
2. If you were going to practice with couples and families, what are a few of the ethical issues that you might face?
Contemporary Professional Issues
1. What are the major personal characteristics needed for an effective family therapist?
2. What are the educational requirements of marital and family therapists?
3. What are the main standards of training and clinical experience?
4. What kind of supervised practice and clinical experience is needed to produce competent couples and family counselors?
5. What is the rationale for expecting family therapists to experience their own personal therapy and to work with their family of origin?
Values in Couples and Family Therapy
1. In what ways do the therapist’s values take on special significance in counseling couples and families?
2. What are some areas where you might have difficulty in counseling families because of your values?
Gender-Sensitive Couples and Family Therapy
1. How are gender-role stereotypes especially concerning for therapists who work with couples and families? How might your own values pertaining to traditional and nontraditional family arrangements influence your practice with couples and families?
2. How are gender stereotypes problematic in counseling both men and women? When do the gender stereotypes of counselors become an ethical issue?
3. What are some ways of becoming a nonsexist family therapist? How can you use the therapeutic process to challenge the oppressive consequences of stereotyped roles and expectations in the family?
4. What are your thoughts on what constitutes gender-aware therapy?
5. What are some of the key concepts of the feminist approach to family therapy?
Responsibilities of Couples and Family Therapists
1. What are some special responsibilities of couples and family therapists?
2. When is it necessary to consult in this area of therapy?
Confidentiality in Couples and Family Therapy
1. What are the exceptions to confidentiality as it applies to counseling with couples and families?
2. If you were working with a couple, what would you tell them from the outset about confidentiality?
3. If you were working with a family, what would you tell each member of that family from the outset about confidentiality?
4. How is confidentiality a special issue in couples and family therapy? What are some issues pertaining to confidentiality that a family therapist needs to clarify from the outset with each family member? What problems might you have in this area if you were to work with a family?
Informed Consent in Couples and Family Therapy
1. How is informed consent a special consideration in couples and family therapy?
2. If you were going to work with a couple, what would you most want them to know about how you conduct couples counseling?
3. If you were going to work with a family, what are some things you would most want each of the family members to know about how you view family therapy? What might you expect of them? What could they expect of you?
4. What are some issues involved in cases where therapists require attendance by all the members of a family as a condition for family therapy?
5. What are your thoughts about conducting a family therapy session without all the members of the family being present?
Chapter 12—Ethical Issues in Group Work
Learning Objectives
■ Explore the topic of training and supervision of group leaders
■ Clarify special ethical issues in working with groups
■ Identify important considerations in using the Co-leadership Model
■ Identify ethical issues in screening, selection, and orientation of members
■ Understand the role and limitations of confidentiality in groups
■ Understand how values affect the group process
■ Learn about the ethical use of techniques in group work
■ Examine diversity issues in group work
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
6. GROUP WORK—studies that provide both theoretical and experiential understandings of group purpose, development, dynamics, theories, methods, skills, and other group approaches in a multicultural society, including all of the following:
a. principles of group dynamics, including group process components, developmental stage theories, group members’ roles and behaviors, and therapeutic factors of group work
b. group leadership or facilitation styles and approaches, including characteristics of various types of group leaders and leadership styles
c. theories of group counseling, including commonalities, distinguishing characteristics, and pertinent research and literature
d. group counseling methods, including group counselor orientations and behaviors, appropriate selection criteria and methods, and methods of evaluation of effectiveness
e. direct experiences in which students participate as group members in a small group activity, approved by the program, for a minimum of 10 clock hours over the course of one academic term
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. Some practitioners view group therapy as a second-choice form of treatment. What do you think about this?
2. What are a few ethical issues that you think you might face if you were to facilitate groups?
Ethical Issues in Training and Supervision of Group Leaders
1. What knowledge and skills are essential for effective group counselors? What about supervised experience in group work?
2. What are some of the main provisions of the Professional Standards for the Training of Group Workers? What do you think about different standards of training for the various group work specialties?
3. What are your reactions to the authors’ views on training group workers?
4. In what kind of group counseling training program would you like to participate? What can you do to get the training in group work you are likely to need?
Ethical Issues in the Diversity Training of Group Workers
1. What specific characteristics do you need to become a diversity competent group counselor?
2. What awareness, knowledge, and skills do you already possess that you can build on to help you develop the ability to work well with multicultural groups?
3. What are the ethical guidelines that the authors suggest counselors adhere to when facilitating groups?
Ethical Considerations in Co-Leadership
1. Ethically, when would you feel ready to lead or co-lead a group in a community agency?
2. What ethical issues can you identify as they relate to co-leadership practices? Identify some advantages and disadvantages of the co-leadership model.
3. What qualities would you look for in selecting a co-leader?
Ethical Issues in Forming and Managing Groups
1. In recruiting members for a group, what would you want to tell prospective members before they made the decision to join?
2. What are some ethical issues involved in screening and selecting group members? How do you decide whom to include and exclude? Are there any ethical alternatives when screening is not practical or possible?
3. What kind of preparation and orientation would you want to provide for members in a group you lead?
4. Should group membership always be voluntary? Are there any situations in which it is ethical to require participation in a group?
5. Once members make a commitment to be a part of a group, do they have the right to leave at any time they choose?
6. What are a few of the major psychological risks in group participation? What could you do to minimize these risks?
Confidentiality in Groups
1. What are the main ethical, legal, and professional issues pertaining to confidentiality in group situations?
2. As a group leader, how would you teach your members about confidentiality? How would you encourage confidentiality?
3. When, and under what circumstances, would you breach confidentiality in a group?
4. If you were leading a group with minors, what would you want to say to the members of your group about confidentiality? Would you require parental consent for children or adolescents to be in your group? Do parents have a right to information that is disclosed by their children in a group? Explain.
5. What kind of ethical issues surround group therapy over the Internet? What are the implications for confidentiality in Internet group therapy?
Values in Group Counseling
1. How can a group leader’s values influence the group process? What is the ethical way a leader can use his or her values without imposing them on members?
2. What ethical issues are involved in members pressuring other members to adopt a particular value stance or to make a decision of how to live?
Ethics in the Use of Group Techniques
1. In what ways can group leaders employ techniques unethically?
2. What are some guidelines group leaders can follow to prevent them from abusing techniques in a group?
3. How is therapist competence an ethical issue as it pertains to using group techniques?
Ethics in the Consultation Process
1. What are some ethical guidelines pertaining to the consultation and referral process as it pertains to group work? In what cases would you seek consultation in your work as a group leader?
2. When might you make a referral of a member to another professional?
Ethical Issues Concerning Termination
1. What ethical and practical issues would you be concerned with as a group moves toward termination?
2. How might you approach termination if you were leading a closed group? How would this differ if you were leading an open group?
3. What kind of follow-up might you design for a group you have led?
Chapter 13—Ethical Issues in Community Work
Learning Objectives
■ Become familiar with the community mental health orientation
■ Understand the main responsibilities of helping professionals in a community setting
■ Understand the goals of the social justice perspective and become familiar with the advocacy competencies
■ Learn about alternative roles in a community perspective
■ Identify ways to involve oneself in the community and promote change
■ Look at ways of working within a system
■ Critically evaluate case examples from a community perspective
CACREP Standards (2009)
1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:
b. professional roles, functions, and relationships with other human service providers, including strategies for interagency/interorganization collaboration and communications
i. advocacy processes needed to address institutional and social barriers that impede access, equity, and success for clients
j. ethical standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling
2. SOCIAL AND CULTURAL DIVERSITY—studies that provide an understanding of the cultural context of relationships, issues, and trends in a multicultural society, including all of the following:
c. theories of multicultural counseling, identity development, and social justice
g. individual, couple, family, group, and community strategies for working with and advocating for diverse populations, including multicultural competencies
e. counselors’ roles in developing cultural self-awareness, promoting cultural social justice, advocacy and conflict resolution, and other culturally supported behaviors that promote optimal wellness and growth of the human spirit, mind, or body
f. counselors’ roles in eliminating biases, prejudices, and processes of intentional and unintentional oppression and discrimination
Pre-Chapter Self-Inventory
1. Before you read this chapter, take the pre-chapter self-inventory as a way to assess your beliefs and attitudes pertaining to the topics addressed in this chapter.
2. What are a few of the items in this inventory that you most strongly agreed with?
3. What are a few of the items in this inventory that you most strongly disagreed with?
Introduction
1. What are the advantages of looking at the community as a whole to identify assets and opportunities as well as to identify problems?
2. What is your reaction to the following statement? “If practitioners are limited in their ability to adapt their roles to the needs of the community, they are not likely to be effective in reaching those who most need assistance.”
Ethical Practice in Community Work
1. Look over the codes of ethics pertaining to responsibilities to the community and society. What implications do you see for practitioners?
2. In what way do community workers encounter ethical dilemmas that are different from those encountered in clinical practice?
The Community Mental Health Orientation
1. What is a definition of community counseling?
2. What are some of the main ethical responsibilities you have to the community and to society?
3. What are the four main activities that make up a comprehensive community-counseling program?
4. How does the community mental health approach differ from the traditional approach to therapy?
Social Justice Perspective
1. What are the goals of social justice and advocacy?
2. Why is the social justice perspective so important to embrace?
Advocacy Competencies
1. What is advocacy competence? What are the three major levels of advocacy intervention?
2. If you are a counselor who works primarily at the individual client/student level, how could expand your skill set so that you could intervene at the other levels?
Roles of Helpers Working in the Community
1. Within the community perspective, what is the professional’s role in educating the community?
2. What are the main goals of the outreach approach? What are some strategies of this approach?
3. What is cultural mediation and why is it so important for school counselors to be cultural mediators?
4. Describe the differences between a developmental and a service approach.
5. Describe each of the following alternative roles counselors might play in working in the community: change agent, consultant, adviser, advocate, facilitator of indigenous support system, and facilitator of indigenous healing system.
6. If you were to work in the community, what ideas do you have about ways you could become involved in that community?
7. How can those who work in a community best promote change? What are some alternative ways to make a difference in the community?
Promoting Change in the Community
1. What are the important questions that community workers need to reflect on as they attempt to promote change within a community?
2. As a community worker, how would you involve yourself in the community?
Working within a System
1. How do you think you could retain a sense of vitality and integrity, while working within the boundaries of a system? How does this become an ethical issue?
2. What do you see as your relationship as a counselor to the agency where you work?
3. What are some ways that you can deal with the tendency to avoid responsibility by blaming the institution or system where you work?
4. What strategies can you think of for not getting lost in the system, yet for attaining your own professional goals? How might you assume power within the system?
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