A prominent aspect of counsellor training involves the analysis of ethical situations. Counsellors need to be malleable to the variety of situations in which the client’s personality traits and environmental circumstances are prominent barriers to the relationship’s progress.
Codes of practice, ethical guidelines and counselling micro-skills play a role in supporting the counsellor’s decision-making process towards the relationship; however, client and situation uniqueness are not the exception in the therapeutic process – they reign supreme. Effective counselling invokes the ongoing need for adaptability and critical analysis.
In this context, three situations which frequently give rise to ethical dilemmas are dual relationships, mandatory reporting and informed consent. Are you aware of the particular conditions which delineate each of these situations, and how to act upon them? This article provides a snapshot of the topic, along with some strategies for practising and student counsellors who are likely to face similar situations throughout their careers.
Dual relationships can be defined as social interactions between counsellor and client, in addition to their professional (or therapeutic) relationship. Because the relationship was initiated in a therapeutic environment – which invokes behavioural restrictions and requires particular decorum from both entities – clients and counsellors are likely to face natural obstacles when developing relationships outside of the counselling room.
As Corsini (2000, p. 447) states: “It is often awkward for both the therapist and the client when interactions occur outside the psychotherapeutic relationship. Some relationships, such as those that include sexual or financial involvement, clearly violate the ethical codes of almost all professional organizations. Others, such as allowing a client to buy the therapist a cup of coffee after a chance meeting in a restaurant, appear to be quite harmless. Most decisions are not this straightforward, however, and deciding whether to accept a Christmas gift or flowers for the waiting room can become a vexing dilemma”.
The main question to be asked is how much influence particular social interactions can wield in the professional relationship – that is, the counsellor’s perspective towards the client, and vice-versa. Simple interactions, such as a chat on the street or even the cup of coffee cited by Corsini are likely to have little influence over both entities’ mindsets, thus it is generally not perceived as a challenging situation. But certain situations which induce emotional attachment can be damaging to counselling goals and/or outcomes.
Mental health professionals diverge in opinions when it comes to dual relationships. However, the vast majority of therapists agree that dual relationships should be avoided, arguing that transference and counter transference are powerful responses that will inevitably influence the therapeutic relationship. Along with most ethical dilemmas, it is largely a matter of each case: context, individual personality traits and nature of the counselling relationship.
According to Karen Kitchener (1988), the types of dual relationships which were most likely to be detrimental to a therapeutic relationship included the following aspects: “incompatibility of expectations between roles; diverging obligations associated with different roles, which increases potential for loss of objectivity and; increased power and prestige between professionals and consumers, which increases the potential for exploitation”.
To surpass difficulties with dual relationships, counsellors ought to ascertain clear and realistic boundaries around the professional relationship with their clients. Such boundaries need to consider the needs and characteristics of each client, and how that will reflect in the overall relationship. Codes of practice and guidelines are important to set these boundaries; however, professionals must be sensitive to particular needs in each relationship and apply such knowledge to improve decision-making in the counselling process.
Mandatory reporting, or duty to warn, is one of the most sensitive topics in therapy and mental health. The bare existence of this concept already conflicts with ethical principles of confidentiality, thus deciding to report a client is a paradoxical pattern of thinking for any such professional. Nevertheless, it is an extremely important issue.
It can be defined as the necessity to break client confidentiality in order to protect the client or the community as a whole, when the client imposes a threat to his/her own safety, the community’s safety or the framework of law to which the community abides by. When laws and values conflict, which side should you take? Most cases of information disclosure in therapy are for the benefit of the client, such as sharing information with colleagues or supervisors in order to obtain an alternative opinion or perspective. However, when it comes to mandatory reporting, best interest of the community or society are preceded over the client’s interests. Thus, the default answer to the previous question is in fact, the law.
Needless to say, counsellors should be flexible when making decisions regarding mandatory reporting. There are several law frameworks which govern countries, states and regions, and each of them has its own agenda in respect to mandatory reporting requirements. Additionally, a wide variety of codes of conduct are also likely to influence the decision-making process for therapists and mental health professionals.
A common basis for reporting a client is the imminence of danger for the individual (self harm) or others (e.g. an ex-partner). “Exceptional circumstances may arise which give the counsellor good grounds for believing that serious harm may occur to the client or to other people. In such circumstances the client’s consent to change in the agreement about confidentiality should be sought whenever possible unless there are also good grounds for believing the client is no longer willing or able to take responsibility for his/her actions. Normally, the decision to break confidentiality should be discussed with the client and should be made only after consultation with the counselling supervisor or if he/she is not available, an experienced counsellor.” (Australian Counselling Association – Code of Conduct)
Informed consent involves the communication of any information which matters to the client and which is pertinent to the therapeutic relationship. A building aspect of the client-counsellor relationships is the development of trust and rapport. A premise for creating trust and rapport is good communication. Good communication, conversely, is based on honesty. Thus, informed consent is not only an ethical requirement for the counsellor, but also a condition to achieve the collective goals of the relationship.
“Clients are entitled to know about all matters that affect them. They deserve to know the likelihood of harm (physical or mental) that could result from treatment, the possibility of side effects, the probability of success for treatment, the limits of confidentiality, whether student counselors will be involved, and the likely duration and cost of treatment.” (Corsini, 2000)
An effective way to ensure clients are adequately informed is to produce a standard information disclosure statement: a contract which comprises the counsellor’s and clients’ responsibilities and rights. A well-defined statement will provide the client with valuable information about areas such as: confidentiality, record-keeping, counselling management, relationship boundaries, and more. It is also a measurement which improves the quality of the service provided as it creates a clear framework of conduct for clients which are not acquainted with the process of therapy.
“Counsellors are responsible for reaching agreement with their clients about the terms on which counselling is being offered, including availability, the degree of confidentiality offered, arrangements for the payment of any fees, cancelled appointments and other significant matters. The communication of essential terms and any negotiations should be concluded by having reached a clear agreement before the client incurs any commitment or liability of any kind.” (Australian Counselling Association – Code of Conduct)
Australian Counselling Association (2002). ACA Code of Conduct. (4th version). Brisbane: Author. Corsini, R., & Wedding, D. (2000). Current Psychotherapies. (6th Edition). Belmont: Brooks/Cole. pp. 445-453. Kitchener, K. S. (1988). Dual role relationships: What makes them so problematic? Journal of Counseling & Development, 67(4), pp. 217–221.
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