Introduction
In this unit our focus in the ethics for the counseling profession. We shall start by first trying to understand the meaning of counseling ethics and the principles upon which they have been developed. Importance of ethics in counseling will also be discussed as well as ethical issues in counseling. Types, uses and storage of records in counseling are other issues that will be discussed.
By the end of this chapter you will be able to explain what counseling ethics is. You will also be able to list and discuss the principles of counseling ethics and the importance of ethics in counseling. You will be in apposition to discuss in detail the ethical issues in counseling with relevant examples. You should also be able to enumerate the types of records kept in the profession, how they are stored and their uses.
Meaning of counseling ethics
Ethics is a set of law or rules that govern that govern an institution or certain profession and professionals regarding their behavior. Professions such as the legal, teaching, accounting, medical and so on all have set rules and standards that govern their behavior and operations.
Counseling ethics is the laid down rules and regulations that govern the professional conduct in counseling. They are the set of moral standards that govern the operation of counselors.
Principles of counseling ethics
- Respect for autonomy
Autonomy is the freedom of the individual to make their own choices and to decide their own actions or destiny.
Individuals have a right to self determination. As a counselor you need to appreciated that counselees have their own resources, capacity and potential. They are able to come with heir own decisions on what to do when faced by certain situations
Each person is unique and reacts and behaves differently. The counselor needs to allow each counselee to be different and independent. The counselees have a right to think the way they want and to feel the way they are feeling even if others disagree.
One of the ways in which a counselor respects the counselee’s autonomy is by respecting their values and beliefs. As a counselor you must not impose your values on the counselee.
The counselee has a right to withdraw from the sessions as and when he/she wishes.
The counselee needs to make an informed choice when entering into the counseling contract. As a counselor define your role and the counselee role as clearly as possible. Explain confidentiality and its limits and all other relevant aspects such as fees, frequency and length of sessions and so on.
Respect for autonomy assures that individuals are capable of understanding the implications and consequences of he decisions or choices they make.
Can a child’s autonomy be respected?
Yes when they reach an age that they understand their decisions.
- Beneficence (Beneficial)
This is the working to promote the greatest good to our counselees. Counselors have the obligation to benefit their counselees through their interventions. Counselors must do what they can to help their counselees.
This means that if for one reason or another you as the counselor are not able to be of postponing the session or even referring the counselee to another counselor.
- Non malficience (no harm)
This regards the counselor ensuring that he does no psychological harm to the counselee. One of the ways to do this is to make accurate assessment of the counselee. Chose any strategy and intervention wisely and use skills correctly. The impact on the counselee also needs to be monitored closely.
Another way that the counselor ensures no harm is done on the counselee is by practicing within the limits of his/her competence. If your level of training is for that of general psychology and a counselee comes who has drug addiction problems, it is wise to refer them to a counselor specifically trained in drug and substance abuse addictions.
Counselors also ensure no harm is done to the counselee by ensuring that they get regular supervision of their work. The ode of ethics requires that a counselor goes for supervisor after every eight counselee hours. This supervision must e conducted by an accredited supervisor.
Counselees should not be exposed to research or experiments which have high risks and little hope for benefit.
- Justice (fairness)
These are standards for fairness and equal distribution of costs and benefits. We need to treat all counselees equally despite their race, gender, religion, status and so on. As counselors we should display respective and unbiased attitude when counseling counselees.
- Fidelity
This is promise keeping and the value of trust, which is paramount in maintaining a good working relationship. It is about enhancing disclosure and being loyal to the counselee and to the profession.
Fidelity is about not abandoning our counselees in the middle of the counseling contract. Any situations that may arise making the counselor unable to attend a session or continue with the contract need to be communicated to the counselee in good time. Examples include going outside the country, being sick or being held up by emergency situations. Proper arrangements for referral need to be made if necessary.
Fidelity principal relates to the existence of loyalty, reliability, dependability and acting in good faith.
IMPORTANCE OF ETHICS INCOUNSELING
- Ethics in counseling provide a framework for counselors to consult when faced with ethical dilemma or uncertainty.
- Ethics promote standards of practice and quality of service available to counselees.
- They establish a framework within which malpractice can be identified and disciplinary procedures applied.
- Ethics enhance the image of counseling-Counseling code of ethics focus discussion on ethical issues for future improved codes and standards of practice.
- Ethics provide a mechanism for self regulation and self governing of the organization produced the code.
Ethical issues in counseling
Generally, any involvement by a professional with a counselee, that may impair his judgment or result in exploitation or harm to the counselee is considered unethical. Specifically, the following are ethical issues that arise in counseling.
- Informed consent
The counselor is responsible for informing the client of the limitations of the confidentiality. Disclose the limit of confidentiality to the counselee during structuring by telling him/her that the only time when you will disclose his/her information to other parties is if there is danger to. life e.g. any plan to harm his/her life or anybody else’s life. Specifically, breaking confidentiality is mandatory when:
- Counselees pose a danger to others or themselves such as suicidal case, child/elderly abuse, acts of terrorism and so on.
- A counselee under the age of 16 has been the victim of incest, rape, child abuse or some other crime.
- When information is asked for in a court of law.
- The counselee has a right to either consent or refuse to consent to counseling after understanding the limits of confidentiality.
- Confidentiality
Counselors treat with confidence personal information about counselees. Whether obtained directly or indirectly or by inference. Such information includes name, address, biological details and other descriptions of the counselee’s life and circumstances, which might result in identification of the counselee. Treating with confidence means not revealing any of the information noted above to any other person or through any public media expect to those whom counselors owe accountability for counseling work (incase of those working within the agency of organizational setting) or on whom counselees rely for support and supervision on issues of responsibility.
A counselor must not break confidentiality without the consent of the counselee. Safe guarding information about an individual that has been obtained by the counselor in the course of his practice is a primary obligation. Such information must not be communicated to others unless certain important conditions are followed.
Clinical and other materials should be used in teaching only when the identity of the persons involved is adequately disguised.
The confidentiality of professional communications about individuals must be maintained. Only when the originator and other persons involved five their express permission should a confidential professional communication be shown to the individual concern.
The counselor should make provisions for the maintenance of confidentiality in the preservation and ultimate disposal of confidential records.
- Intimate and Sexual Relationship
A counselor must not be involved in intimate sexual relationship with the counselee during or even after termination of the therapeutic relationship. Engaging in sexual relationship with a counselee whilst also engaging in therapeutic relationship is unethical.
Ethical behavior should make provisions for the maintenance of confidentiality in the preservation and ultimate disposal of confidential records.
- Dual Relationships
A counselor must no engage in dual relationships with the counselees. This is when counselors blend their professional relationship/role with another kind of relationship or role at the same time or sequentially with a counselee. When there is dual relationship, there is potential for crossing boundaries and not acting in the best interest of the client. Counselors are responsible for setting and monitoring the boundaries between a working relationship and friendship or for making the boundaries as explicit as possible tot h counselee.
Examples of dual relationships include assuming more than one professional role such as instructor and therapist, blending a professional and non professional relationship such as counselor and friend or counselor and business partner, bartering therapy for goods and services, socializing with clients, accepting gifts form clients, becoming emotionally or sexually involved with a client or former client and so on.
- Counselor competence
Counselors commit themselves to basic training course in counseling and undertake further training at intervals.
Counselors seek ways of increasing their professional development and self awareness. Counselors monitor the limits of their competence. It is unethical when a counselor handles cases beyond his/her competence. This sis for example when a general practitioner handles a complicated case say in marriage and family or drugs and substance abuse, or any other specialized area that he/she is not trained in.
Counselors with their employers or agencies, have a responsibility opt themselves and their counselees to maintain their own effectiveness, resilience and ability to help the counselee and to know when their personal resources are so depleted as to make necessary for the seek to seek help and / or withdraw from counseling whether temporarily permanently.
- Counselor Values, Attitudes and Beliefs
Another unethical issue is when the counselor imposes his/her own values, attitudes and beliefs onto the counselee. The counselee must e respected. Counselors respect counselees as human beings working towards autonomy, able to make their decisions and changes in the light of their own beliefs and values.
Some of the areas that may cause a clash with the counselee are values and beliefs about divorce, abortion, sexual orientation, religious orientation and so on.
Aw need to note here that for the counselor to be able to respect the counselee’s values, attitudes and beliefs, he ought to be clear about his own values, attitudes and beliefs and how influences his work and the direction taken by his clients.
- Fees
Overcharging of fees by the counselor is unethical. There should be a standard fee per counselee per session. Let the counselee know the standard fee even if the session is being offered voluntarily.
- Creating Dependence
Creating unethical of fees by the counselor is unethical. The counselor should challenge the counselee to explore their own resources in order to use them. Help the counselee to be able to find their own solutions and be able to move on. Dependence is created when the counselor offers advice, solutions and becomes too directive in the counselee’s issues.
- Improper Advertisement
Another unethical behavior relates to the counselor giving improper advertisement without the consent of the counselee. This includes publishing counselee material in books and periodicals without the counselee’s permission. Only after explicit permission has been granted shall an identity of research subject be published. When data has been published without permission to reveal identities having been given, the counselor assumes responsibility for not adequately disguising the source.
- Privacy where to meet
Ideally a counselee should be able to come to a service without necessary revealing to others that he or she is there for counseling. Privacy during the session is of paramount importance to some degree. Ideally, counseling should take place in a room with no one but the counselor and the counselee present. It is important that others should not interrupt sessions and it is best to ensure that telephone calls are not put through.
ROLE OF RECORDS IN COUNSELING
TYPE OF RECORDS
Counselors are encouraged to keep as part of their records certain information. These are discussed here below.
- A counselor must keep for each counselee written and signed consent to all treatments.
An example of an therapy consent form would be as follows:-
- COUNSELEE CONSENT FORM
1/we ……………………………………………………………….agree to be counseled by …………………………………… counselor and to abide by the following terms of contract:
- To pay Kshs. ……………..per session payable before session.
- To be committed t therapy sessions and maintain punctuality.
Counselee sign ………………………………..
Counselor sign…………………………….….
Date……………………………………………
- A counselee intake form is also maintained. This usually summarizes some minimum details about the counselee, the fees and some administrative information. An example is as follows:-
COUNSELEE INTAKE FORM
Code number of counselee…………………………..
P.O. Box …………………………………………………………..
Phone ………………………………………….
Next of kin…………………….. Phone…………………………..
Counselee Information
Age …………………… sex ………………………… Nationality …………………
Religion …………………………………Occupation……………….
Status ( ) Single ( ) Married ( ) Divorced ( ) separated ( ) other …………
Problem and background
Presenting problem ………………..
Referral source …………………
Administrative Information
Time counselee is available ………………………………………………
Language counselee is comfortable in ………………..
No. of sessions contracted……………………….
Mode; Weekly ( ) Fortnight ( ) Monthly ( ) other ( )
Date of first session……………………
Counselee code ……………………….
- The counselor is also supposed to keep a record of the confidential information shared by the counselee.
This is supposed to conceal any information that may expose the identity of the counselee. Counselee code is used in place of his/her name. This record is kept I place different from where the counselee consent form.
- The counselor is also supposed to keep a counselee’s record of appointments including those not attended by the counselee.
The reason for non attendance or cancellation of the sessions should also be indicated.
- The counselor should also record any consultation he makes with anyone about the counselee e.g. supervision.
- The counselor should keep copies of any correspondence from the counselee relating working with him.
- The counselor must record and keep any instructions give to the counselee whether he/she acted on it or not.
This may be in form of homework or any or any questions given to the counselee to carry home for further reflection.
- Finally the counselor should record and keep his/her own thoughts and feelings about the sessions.
Storage of records
The counselor’s code of ethics requires clients to be informed about the degree of security under which records are kept.
Good practice suggests that records are kept with sufficient security to prevent them landing with unauthorized people. This is ensured by locking records in a desk or cabinet. This prevents interception by anyone with access to the room but it is inadequate against breakages. In such cases use of safes is an appropriate alternative.
Another method of storing records is the use of codes exclusive for counselee’s information. The counselor may adopt a simple coding system that is easily understood by him/her. An example of such as code would indicate the initials of the counselor, number allocated to the counselee and the year when the session is held. If for example the counselor is Elija Mkokoteni Ngari, and he is seeing the 50th counselee, and the session was in 2007, the code may be something like EMN/50/2007.
Finally the counselor may use a split system of record keeping. Here two cards re maintained, one with personal identifiable details including the code given to the counselee. The other card has the details of the sessions and the code of the client. The two cards are kept in separate places.
Records and technology
Technological advancement has been on the increase with the increased use of computers in daily operations of most offices. This means that client information may also be recorded in the comp0uter. This is done minimizing access of the computer to only authorized personnel. The client records are also safeguarded by use of passwords that deny access to them.
Destruction of counselee records
When the counselor is working for an institution or organization, he should follow the laid down procedure in destruction of counselee records. These will detail the period of retention of such documents and the method of destruction.
In the absence of such institutional or organizational procedure, one year retention period might be appropriate. However it is important to note that where there are unresolved issues a much longer period might be required. In the absence of better guidelines three years are maximum time which the records can be kept hoping that if there are any legal proceedings they will have been finalized.
While destroying the records, complete destruction must be ensured. This implies shredding of the documents or burning them completely. At no time should the documents be thrown in the paper basket whole or in a manner that predisposes them to being priced and read by third parties.
Uses of records
Keeping of records by counselors is important as it summarizes what they have done with the counselees. It is part of the professional way of doing things.
Records need to be kept safely. The counselee needs to be made aware that his/her records will be kept.
Counselees should be availed the records as and when they request for them. The records could also be released to the people allowed by the counselee. The counselor should assure the counselee of the safety of the records.
There have been differing views on record keeping. Some of the views are in favor of keeping client records while other views are against.
Role of records in counselling
- to stimulate discussion and interaction
- to remind the counsellor of the information to be communicated
- to communicate information in a simple relevant way to the woman and her family
- to act as a reminder to the woman and family of previous communication
- to illustrate examples and consequences of action/inaction
- to strengthen links and communication between the different levels of the health system
Test your understanding
- My position on the ethics involved in the role of values in therapy is that:-
- Counselors never impose their values on counselees
- Counselors should teach counselees proper values
- Counselors should openly share their values when appropriate
- Values should be kept out of the relationship
- If counselee evidenced strong feelings of attraction or dislike for me, I would
Help the counselee work through these feelings and understand them
Enjoy these feelings if they were positive
Refer my counselee to another counselor
Direct the session to less emotional areas
- What might you do if your counselee had values sharply contrasting with your own, to the point where you found that it interfered with your therapeutic relationship?
………………………………………………………………………………………………
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- The ethical codes of most professional organizations require the counselees be presented with enough data to make informed choices about entering the counselor/counselee relationship. What are some matters you should explore with your counselee at first and second counseling sessions?
- Assume that during an initial session with a counselee you determine this individual would best be helped by a referral. If there are no referral sources available what would you do?
- What information would you give your counselee about the nature and purpose of confidentiality?
7.What would you say if a counselee asked you under what circumstances you would break confidentiality?
- How would you explain the limits of confidentiality to your counselee during the initial session?
- Do you think dual relationships are an inevitable part of practicing in any setting? Explain
- If you were involved in a dual relationship with a counselee, what procedure would you follow to minimize the risk of harm?
- In the course of counsel ling session, a youth tells you that he is planning to do serious physical harm to his fellow student. What would you tell your counselee? How would you proceed?
- Your counselee is a 15-year old girl sent to you by the parents. One day the parents request sessions to discuss their daughter’s progress and to what they can do to help. What information can you share with the parents, and what can you disclose? What might you discuss with the girl before you see the parents? What will you do if she makes it clear that she does not want you to see her parents or tell them anything?
