Abstract
The issue of ethics is paramount in counseling practice whereby practitioners are required to carry out their different therapeutic roles within specified Codes of Ethics. Ethics within practice has become important especially in guiding the practitioners on the appropriate ways of making sound decisions in their daily therapeutic roles. In principle the Code of Ethics, usually function to prevent the practitioners from indulging in malpractices that may harm the client or the entire profession as whole.
Ethics and ethical dilemma are two concepts that have for a long time influenced the professional conduct of counseling therapists. Sometimes conflict has occurred between the two concepts especially when dealing with particular sensitive cases. For instances ethics may require the practitioner to act in one way but as a result of particular experience applying such ethical requirements become problematic thereby necessitating the need for ethical sensitivity.
In general, counseling therapists in going about their daily professional work are challenged to deal with questions that do not always have obvious answers and they become forced to assume responsibility of deciding how to act in ways that will put the interests of the clients above anything else. There exist a number of different models that guide counseling therapists into making sound ethical decisions when faced with ethical dilemmas.
The issue of ethical dilemmas in counseling therapy is and will continue to be live as practitioners face new and dynamic challenges everyday, a situation that is further compounded by creation of new laws that practitioners have to work within and respect. Therefore, it is always necessary for practitioners to identify the best and most appropriate sources of which they can utilize solve or manage the issue of ethical dilemma.
Ethical dilemma of psychologist
‘What do I do?’ This is the introductory sentence in Kenneth S. Pope and Melba J. Vasquez’s book titled ‘Ethics in Psychotherapy and Counseling: A Practical Guide’. According to the authors, counseling therapists and the larger body of psychologists are confronted with pertinent questions or dilemmas that sometimes leave them ‘deficiency’ of solutions or way out.
The authors’ observation is that, in everyday of psychologists’ lives, there exist situations that will results into dilemma. The authors identify aspects such as telling truth or lie when such instances may compromise the therapist’s benefit, revealing client’s confidential report even when such decision may harm clients and other people.
This is in addition to reporting fellow colleagues due to their misconduct even when such colleagues hold higher positions or are critical in the professional progress of the therapists’ or going against the administration requirement to do what one believes will compromise the ethics of the profession (Pope and Vasquez, 2010). All these constitute situations that psychologist have to face in their daily activities and practice.
Pope and Vasquez (2010) assert that carrying out psychotherapy confronts the professionals with constant dilemmas, and whether each dilemma is small or large, delicate or blaring, brings a tangle of questions (Pope and Vasquez, 2010). The basic question that majority of psychotherapists will ask is whether there is something right that can be done and if such thing exist how can it be executed (Pope and Vasquez, 2010).
In general therapists will ask, “is there a right thing to do, if so, how do I find out what it is, what makes it right, who says so, if I do it, what will happen to the patient, to me, to innocent and not-so-innocent bystanders?” (Pope and Vasquez, 2010, p.1). Psychotherapists have to deal with hard questions that are personal and hard to make an admission to themselves or others.
When this happens, the therapist will ask questions such as “What am I tempted to do, what could I get away with, would doing the right thing cost too much, get people mad at me, get me sued, get me fired, would doing the wrong thing be all that bad, especially if no one found out about it?
What if I’m not strong enough, not good enough to do the right thing, and can I duck this one and palm it off on someone else?” (Pope and Vasquez, 2010, p.1). According to the authors, these pertinent questions generally lead therapists back to the basic question of ‘what do I do now?
One avenue that majority of therapists have utilized in addressing the above questions has been adherence to ethics. For instance, Pope and Vasquez (2010) note that ethics provides help to therapists in answering the pertinent questions they face. Through ethical awareness, psychotherapists are able to perceive in clear ways how their various choices are able to implicate and impact the lives of their clients, their fellow professional colleagues, and the public at large.
According to the authors, ethical awareness, “frees professionals from the confining webs of habit, fatigue, fallacy, dogma, carelessness, hurry and daily pressures while at the same time enable psychologists to see new possibilities, respond in new ways, and act with greater understanding” (Pope and Vasquez, 2010, p.2). Therefore, ethical awareness should be perceived as continuous, active process that involves constant questioning and personal responsibility.
Confidentiality is an ethical aspect that for sometime has characterized the psychology profession by guiding the psychotherapists in many situations. In its sense, confidentiality refers to the legal duty therapists have where as part of therapy psychologist are not supposed to disclose information about their clients (Corey, 2009).
The country has enacted laws that form part of psychotherapist-client privilege where the laws requires that disclosure clients make during the therapy process should be protected from exposure and that such disclosure need to be perceived and regarded as confidential (Corey, 2009).
The importance of confidentiality in psychology is critical and paramount, an aspect every psychologist needs to observe. It constitutes an aspect that is central and vital to development of trusting and productive client-therapist relationship since the general conviction among the professionals is that no genuine therapy can take place or be conducted unless the clients have that assurance that the information and revelations they make to the therapist will be accorded uttermost privacy and kept confidential.
Although this aspect has become a considerate to many therapists, the general understanding is that though confidentiality should be valued, it cannot be considered an absolute (Corey, 2009).
Specific situations will force or will require the therapist to divulge the confidential information of a client and in such circumstances; the therapists will be guided by appropriate law that is there (Corey, 2009). Nevertheless, in determining when to breach confidentiality, recommendations have been that the therapists should be guided by the requirements of the law, institutions in which their services are being utilized, and the kind of clients they are provided services for (Corey, 2009).
Certain situations are permitted by the law for therapist to make disclosure of client information hence breaching the aspect of confidentiality. Such instances include when the therapist has evidence and he is convinced that his or her client is aged less than 16 years and is a victim of incest, rape, child abuse or any other related crime.
In addition, when the therapist is convinced that the particular situation the client is in, requires hospitalization, when the client information is key requirement in court for appropriate action, and lastly, when the clients request that their records be released to them or to a third party (Corey, 2009). However, in all these, the paramount obligation of the psychotherapy is to ensure there is adequate protection of client disclosure to ensure a healthy and productive therapeutic relationship exists.
Ethical dilemma in working with high school adolescents
Ethical dilemma: Revealing underage/adolescents confidential information to their parents or relevant authorities while therapeutic process is underway constitutes an ethical dilemma to modern therapists. Most underage/adolescent students engage in risky behaviors that intervention from parents and guardians is needed.
The under-age students may seek the help of a therapist when still under heavy influence of and addiction to the risk behaviors. The question that arises is whether the therapist should disclose the confidential information given by the underage client to parents or school administration for intervention.
In actual circumstances, psychotherapists are normally confronted with wide range of ethical challenges where no clear solution is apparent especially when working with high school adolescents engaged in risky behaviors (Goforth and Hayter, 2010). As a starting point, it should be noted that almost all ethical challenging situations are vague and making an appropriate and satisfying decision may not be easy.
Adolescence is a period that has been described to be ‘stressful’ to young people, as majority of them becomes victims of ruined lives as a result of wrong decisions or choices. Adolescents take part in multiple risk health behaviors, which cause their lives to have negative impact.
For example, adolescents have in most instances entered into conflicts with their parents, teachers, guardians, and society in their attempt to create and develop their own identity, opinions, and values (Miller, 1989 cited in Rolison and Scheman, 2002). When freedom is presented to them to utilize or make decisions, adolescents have greatly become ‘victims’ of negative and costly wrong decisions.
Trends that have been studied by majority of researchers show that adolescents’ risky behaviors are increasingly becoming a problem, which at the same time may have negative future consequences to the young people (DiClemente, Hansen and Ponton, 1996). For instance, studied show that the high percentage of adolescents start using alcohol, tobacco and other drugs at an early age (DiClemente, Hansen and Ponton, 1996).
At the same time, high percentage of adolescents from disadvantaged socio-economic homes are likely to engage in risky health behaviors at an early age (DiClemente, Hansen and Ponton, 1996). On overall, majority of adolescents are venerable to experiment and initiate risk behaviors that in essence have deleterious consequences during the adolescence stage (DiClemente, Hansen and Ponton, 1996).
At the same time, these risky behaviors have resulted into deadly consequences for the adolescents. For example, drinking excessively and driving has resulted into accidents, smoking has led to development of cancer, and unprotected sex has led to unwanted pregnancies and contract of deadly diseases such as HIV/AIDS, and STIs (Worren and Danner, 1989 cited in Rolison and Scheman, 2002).
Providing psychotherapy to adolescents engaged in risk behavior has been one of the roles psychologists have been playing especially in schools. Many schools seek services of psychologists to respond to psychopath behaviors that majority of students may be engaged in.
It is at this stage of providing therapy that ethical dilemma engulfs the therapists. For Instance, carrying out students’ assessment, the student in this case a client of the therapist may disclose to the therapist that he or she has been frequently using drugs and tobacco while at the same time, engaging in unprotected sex activities (Goforth and Hayter, 2010).
The situation becomes unusual to the therapist as to whether such revelation or disclosure should be made known to the parents of the student or the school administration of the student. Further, the law and ethical guidelines postulate clearly that the parents or guardians of under-age adolescents engaging in sex should be informed (Goforth and Hayter, 2010).
The ethical dilemma for the therapist in this case is whether to obey the law and ethical requirements which in turn may ruin the counseling or therapeutic process with the client, or continue with therapeutic counseling for the client and provide necessary help that might lead to change of these behavior. Observation in such a case is that divulging the confidential information of the client to parents or school administration in the process of therapy might affect the therapy process negatively.
Therefore, it is from this concern that majority of psychologists finding themselves in such situations are advised to keep the client’s information confidential as this would help to maintain a good relationship with the client that may lead to change of behavior (Goforth and Hayter, 2010). Nevertheless, the therapists are advised to constantly monitor the behavior of the adolescents to ensure there is progress in the change of behavior.
Ethical decision-making process
The above outlined case, which present ethical dilemma to therapists, can be handled appropriately through an effective ethical decision-making process that leads to sound or ‘wise’ decisions on the part of the therapist. One interesting aspect with ethical decision-making process is that, sometimes the process may occur very first leading to an easy resolution of any particular ethical issue (Canadian Psychological Association, 2000).
This happens when the particular being resolved has clear-cut guidelines or standards and no conflict of principles exists (Canadian Psychological Association, 2000). On the other hand, other ethical issues particularly those that exhibit conflict between ethical principles may have no quick resolution, in some instances might be emotionally distressful, and might require time-consuming deliberation (Canadian Psychological Association, 2000).
Ethical decision-making process should take place within the broad spectrum of ethical principles that guide the counseling and therapy process. In sense, therapy or counseling process operates within four main principles: respect for the dignity of persons, where this is the paramount principle and it should be given highest weight except in circumstances in which there is a clear and inevitable danger to the physical safety of any person (Canadian Psychological Association, 2000).
The second principle has to do with responsible caring which constitute a principle that requires competence while carrying out therapy and the process should be conducted in ways that give respect and dignity to the person (Canadian Psychological Association, 2000). Third principle has to do with integrity in relationships where the principle requires therapists to have utmost integrity while conducting therapy.
Lastly, there is the principle of responsibility to society, where the general view is that this principle should be given lowest weight when a conflict exist though societal responsibility needs to be considered in every ethical decision (Canadian Psychological Association, 2000). In general, there are ten steps in which ethical decision-making takes place.
Identifying individuals and groups affected by the decision
In the context of the above case, individuals involved in therapeutic process constitute high school teenagers at risk by engaging in risky health behaviors such as unprotected sex, drug abuse, and excessive drinking. Further, other affected groups include teenagers’ parents, guardians, and school community.
Identifying relevant ethical issues and practices
In adolescents’ therapeutic process, ethical issue involved is the confidentiality of the information and revelation adolescents make to the therapists. It is necessary for the therapist to establish productive and meaningful relationship with the client and therefore it would be of great help if the therapist kept the teenagers revelation confidential while at the same time continue with therapy while monitoring the teenagers progress.
Breach of this step can only be realized in circumstances the adolescents’ risky behavior gravitates and accelerate at a rate that the therapist perceives intervention of parents, guardians and other stakeholders will be of benefit (Canadian Psychological Association, 2000).
Consideration of personal biases, stresses and self-interest
It is important for the therapist to consider his or her personal factors that might lead into bias while the therapy process is going on. In some stressful events and circumstances, the therapist may be biased, stressed and self-interest may be overpowering when certain revelations are made by the client.
In such instances, the therapist is supposed to be guided by the Code of Ethics and other relevant codes that might elaborate on the relationship that needs to be established with the client. In situations that are beyond the therapist intervention, he or she is advised to seek professional help and guidance from fellow colleagues and other relevant authorities.
Developing alternative course of action
In general, therapist especially those providing help to teenagers involved in risk behaviors should have numerous interventional strategies to employ in order to see that meaningful help of therapy is provided to the affected clients.
The process might be tedious and stressing especially teenagers revealing their secrets and what they might consider personal to them. In such circumstances, the therapist is supposed to explore the possibilities of adopting and utilizing different available alternatives in order to ensure appropriate therapy is administered to the client.
Analysis of short-term, ongoing and long-term risks and benefits
While taking part in the therapeutic process the therapist need to assess possible risks and benefits any particular course of action will incur to the client, to the client’s family, school, or society at all. As explained in the principles of therapeutic process, the client’s needs should outweigh all other needs though not dominate. Therefore, both short-term and long-term effects of each adopted course of action should be evaluated and the likely impact to the client, the therapist and family, and the school.
Choice of course of action after application of principles
After the therapists are convinced that principles of the profession and therapeutic process have adequately been applied, they are supposed to turn attention to devising the course of action to take in order to realize benefits to the client and all those concerned. Adolescents’ engaged in risky behaviors in general will require interventional programs to help them recover or stop the particular actions they are engaged in. Therefore, the therapist should come up with appropriate and meaningful course of action to implement.
Assuming responsibility for consequences of the implemented actions
Generally, the course of actions a therapist undertake to pursue and implement with aim of realizing meaningful therapeutic procedure and results always aim at bringing about positive results for the clients. The aim is not to aggravate the problem any further but to provide adequate and sustainable help to the client by adopting particular course of actions perceived to be correct. Any particular course of actions undertaken, the therapist should be ready to take full responsibility.
Evaluation of the results of the course of action
The therapist should be in a position to carry out assessment and evaluation of the course of actions undertaken and pursued and where possible intervene where necessary. Evaluation will help the therapy to assess and monitor the success or failure of any particular intervention or course of actions pursued.
Re-engaging in the decision-making process for unresolved issues
As part of assuming responsibility for consequences of action, the therapy should be ready to correct the negative consequences that may result from particular course of actions. Such correction initiatives require the therapy to re-engage in the decision-making process in order to resolve the issue.
Appropriate actions to prevent occurrence of the ethical dilemma
The therapist needs to undertake necessary and appropriate actions to prevent future occurrences of the specific dilemma. Such appropriate actions can include adopting necessary communication mechanisms and problem solving techniques with colleagues. All the therapist can front for changes in procedures and practices that he or she perceive to be inappropriate or hindrance to the therapeutic process.
Conclusion
The issue of ethical dilemma for therapists is real in psychology profession. There have been attempts to address this aspect through numerous and different ethical codes which have and continue to play important roles in resolving the dilemma.
Nevertheless, what is required for therapist especially those working with adolescents is to operate within the precepts of the code of ethics while at the same time seeking professional guidance where necessary. In addition, the therapists should embrace continuous training and workshops as this will lead to their professional growth while impacting necessary skills to deal with in challenging circumstances that result in ethical dilemmas.
References
Canadian Psychological Association. (2000). Canadian Code of Ethics for Psychologists. Ontario: CPA Publishing. Web.
Corey, G. (2009). Theory and practice of counseling and psychotherapy. OH; Cengage Learning. Web.
DiClemente, R. J., Hansen, W. B. and Ponton, L. E. (1996). Handbook of adolescent health risk behavior. NY: Springer. Web.
Goforth, A. N. and Hayter, C. A. (2010). Ethical Dilemmas during training: Students’ Perspective. National Association School Psychologists, Vol. 38, No. 7. Web.
Pope, K. S. and Vasquez, M. J. (2010). Ethics in Psychotherapy and Counseling: A Practical Guide. MA: John Wiley and Sons. Web.
Rolison, M. R. and Scheman, A. (2002). Factors influencing adolescents’ decisions to engage in risk-taking behavior. Health Publications. Web.