Introduction
Counseling is a sensitive profession that requires the counseling team to behave in a manner that upholds ethical standards toward the clients. Ethics and legal requirements dictate how the counseling sessions operate and function because they lay a good practicing foundation for the therapists. Counselors must act under professional standards and ensure appropriate behavior in their practice. Each country has a unique code of ethics that safeguards and promotes ethical standards. For California, this would be the California Board of Psychology. The code of ethics helps to alleviate ethical dilemmas and stress in practice.
Integrating ethical standards in counseling aims to prevent client harm and define professional obligations, values, and limitations. For instance, the board in California makes laws that protect clients who seek counseling by investigating and accepting complaints. Ethical dilemmas that arise in counseling should be addressed regarding the code of ethics for sound decision-making. Counselors must integrate the code of ethics to address ethical dilemmas and efficiently deliver quality services to clients. By integrating the ethical and legal requirements knowledge into the decision-making process, professional response to ethical dilemmas is enhanced and clients’ well-being (Reitz., 2020).
The Concept of Ethical dilemma
The need to choose between two or more morally acceptable options and one choice prevents the selection of the other, is called an ethical dilemma. Culture and religion, confidentiality, abortion, dual relationships, and gifts are key ethical dilemmas in counseling. I will describe an ethical dilemma where the professional codes of ethics to be upheld conflict with my values. A university student comes to seek help from the counseling department at the university. The student reports to been abusing marijuana for the past three years. His close friend has been pushing him to seek help because when not under the influence of marijuana, he acts aggressively and weirdly toward those around him. The friend has observed the behavior for the past month, hence the concern’s need.
After a thorough history taking, the student is assessed to be having a psychotic disorder. On the family’s mental history, the student reports a history of major depressive disorder in one of the uncles. The assessment findings are discussed with the student, together with other psychological and medical care. However, the student doesn’t believe the fact that he has a psychotic episode and is not willing to commence therapeutic care. Again, the student refuses to bring up the idea of parents’ involvement in the issue. The student still comes for counseling sessions but is becoming more violent and aggressive toward those around him.
From the above scenario, the dilemma is whether the parents or university management should be informed about the symptoms and refusal to start care or maintain confidentiality and try to manage the student only during counseling sessions. Confidentiality, in this case, should be handled with a lot of sensitivity because the student will feel betrayed. In the case of a psychotic attack, he will end up harming others or himself badly. Another bit is the student still uses marijuana which is worsening the current mental status (Bayne & Doyle., 2019). Following the guidelines and the code of ethics, the counselor is not supposed to break confidentiality when consent is not given by the client, who is also an adult (Tulyakul & Meepring., 2020). Despite knowing that there are important cases where confidentiality can be broken, the counselor is still not satisfied with the option to take because the student has a say too.
Alternative perspectives
The main ethical dilemma in the scenario above about the student is confidentiality. The first perspective is whether to uphold confidentiality as the student wants and address the problem during counseling sessions only. The idea is good, as confidentiality is key in ethics. Still, the student will not be helped since, despite counseling therapy, medical and mental care is needed to cure the psychotic episodes at least. Another alternative is to break confidentiality and discuss the issue with the parents or the university management concerning the student’s situation and constant refusal to seek hospital care. The second alternative looks good, but the student will feel betrayed, lose trust, and may even stop coming for the counseling sessions. In an instance of a psychotic attack, the student may bring more harm to himself or those around him.
Confidentiality ACA Code of Ethics
Counseling professionals strive to earn clients’ trust because it is the cornerstone of counseling sessions. Trust can be created by ensuring ongoing partnership, maintaining confidentiality, and establishing appropriate boundaries. American counseling association (ACA) is a professional and scientific organization that offers services that promote wellness, mental health, and education to its clients (Firmin & Shell., 2019). The ACA code of ethics addresses important areas, including confidentiality and privacy. According to the ACA code of ethics, there are key areas that are addressed regarding confidentiality. Respecting clients’ rights helps the counselors and clients agree on when, with whom, and how the information is shared. The exception is another key factor where keeping the information confidential does not apply, and only disclosure is needed to keep the client and those at risk of being harmed safe. Incidences like contagious, life-threatening diseases, court-ordered disclosure to protect a child, end-of-life decisions, and serious, foreseeable acts require confidentiality to be broken but with additional sensitivity when tackling end-of-life cases. Also, information shared with others, including the interdisciplinary team, if need be, third-party payers after authorization from clients, and when discussing in a confidential setting is a key point that should be upheld. Clients lacking the capacity to give informed consent, in the case of groups and families, and case consultation are key areas where confidentiality is needed.
The national board for certified counselors (NBCC) is a board that certifies counselors as having met the specialty and general practices to practice as professional counselors. The NBCC code of ethics provides a minimal ethical standard that guides behavior in the counseling profession. AMCHA initiative is a group in the pro-Israel American campus that seeks to boycott, divestment, and sanction (BDS) activities in institutions. AMCHA is a Hebrew word meaning “your nation” or “your people .”The code of ethics for AMCHA includes a commitment to students, clients, other professionals, employee relationships, supervisees, and also the commitment to the profession. On the other hand, ACA refers to a group of counseling professionals directed by a code of ethics to ensure quality services. The codes of ethics for ACA include privacy and confidentiality, counseling relationship, professional responsibility, interprofessional relationship, and resolving ethical dilemmas.
Ethical Guidelines relating to confidentiality
The American Counseling Association (ACA) gives clear guidelines on the counselor’s responsibilities and roles in solving dilemmas in counseling. The primary guideline is to respect and promote clients’ dignity (Woo et al., 2020). Clients deserve a meaningful relationships and need to be treated as people with desires, emotions, needs, and preferences. Counselors must know that their attitudes, values, behaviors, and beliefs should not be imposed on the counseling goals. The diversity of clients should be respected. Again, counselors are required to practice only within the area of their specialty based on their education level, maintain boundaries of their competence, and have appropriate counseling experience. Adherence to the ethical guidelines enhances ethical and therapeutic engagements in practice and provides safety against abuse of power in the counseling relationship.
Decision-making model
This is a three-legged approach in counseling. The three stages are the problem definition, the work phase, and the action phase. The alternative definition that the client can choose from is considered in the problem definition phase. In this phase, the client’s problems are aired out, alternative options are given out, and the client is asked to stick to one of them. In the scenario, the student is presented with the option of maintaining confidentiality and only benefiting from counseling sessions but knowing that he will still experience psychotic episodes. Or to allow a break in confidentiality which will, in turn, ensure medical and mental care that may resolve the psychotic episodes. In the work phase, the counselor assists the client in viewing the issues from a different point of view and choosing a therapeutic solution. In this case, the student is helped to realize that counseling will not fully resolve the problem. Because psychotic episodes will still present, and more advanced care is needed. Hence, involving the parents and the medical team is important due to the refusal to seek medical attention. Lastly, the client chooses an option and tests it in the action phase. The student is allowed to choose the option that best suits him. Either continue with counseling and its effectiveness, or the parents be told following his refusal to seek medical care.
In confidentiality, the counselor is expected to explain and clarify the limits of confidentiality to the clients. Cases that can break confidentiality include involvement of legal requirement force, cases of self-harm or harm to others, i.e., homicide and suicide, and child protection. Besides the cases, it is important to ensure clients’ confidentiality. I agree with the above cases where confidentiality can be broken. This is because the main priority in the situation will be working to save lives and seek justice. These are vital needs in everyday life.
Legal and ethical issues
The significant legal and ethical issues and processes facing a counselor in the confidentiality dilemma include beneficence, non-maleficence, and autonomy. In autonomy, the counselor is expected to allow the client to have independent thinking and decision-making and to prevent any form of dependency. Beneficence, the counselor is to support and promote what is good for the patient regardless. Non-maleficence is where the counselor avoids any activities that may bring in a conflict of interest. Finally, veracity requires that the counselor will be committed to the truth.
Role of a counselor
Confidentiality is a critical subject in counseling and the counselor should ensure involvement and the role well played. The roles include agreeing with the client what will be shared, listening keenly, and confirming that the client’s situation is understood, empathizing with the clients, helping clients see clearly from a positive point of view, and challenging the clients when need be.
In the case of the confidential dilemma, the counsellor should be heavily involved in helping the client understand that taking a different view will bring more than the perceived harm of the parents knowing his condition. The counselor can also explain to the student that the parents will be made to understand the situation and work together to help him get out of drug abuse.
Risk management strategies and self-evaluation practices
Confidential dilemma being a sensitive issue, self-evaluation practices and risk management strategies need to be incorporated to solve the dilemma. First, building a strong counselling foundation by coming up with the exact resources to address the dilemma after understanding and knowing the needs of the client. A good foundation entails a means to report confidentiality violations and training on ethical standards. Secondly, having a culture of integrity with the client from the start till termination of the counselling therapy. Integrity is the desire to do the right thing always. Again, ensuring a value focus in all moments. Keeping a focus in counselling practice will lead to achieve the targeted goal despite having a dilemma on the way. Lastly, constantly revise and re-evaluate as a counselor. Bearing in mind situations and needs change, it is important to note newly emerged dilemmas, any progress made so far, and where work is yet to be done. The counselor is also supposed to be disciplined and regularly revisit code of ethics and compliance at work. The strategies will help resolve the dilemma.
The resolution of the conflict
Ethical dilemmas faced at the workplace can be resolved consistently and adequately by putting in place guidelines and a framework for analysis which will ensure sound decision-making. Excellent ethical decision making is a vital concept in counselling and counselors should be well trained for the same. The client in the counseling session should be able to trust that the shared information will not be known to other people. Besides being mandated to protect the confidentiality of clients as in the American Psychological Association (APA), there are situations where confidentiality needs to be broken for the good of the client. In the above scenario the student demonstrates behaviors that might bring harm. If he is given the advanced care other than counselling which he constantly denies fatal harm may be caused following the worsening of the psychotic episodes. This is an ethical dilemma that conflicts with codes of ethics and guidelines according to American counseling association that upholds client-centeredness approach and independence in choosing their best option. The counsellor on the other hand feels that the client’s rights, dignity, and choice in decision making are not appropriate since the client will not benefit. According to the American Counseling Association code of ethics, counselors are allowed to break confidentiality in cases that are identified as bringing harm to the patient or others, in child protection, or following legal law orders. The counselor is left with the choice of breaking confidentiality and reporting the matter to the parents who in turn come in to collaborate and work for the good of the student.
Conclusion
Knowledge of professional code of ethics is important to the practice of counselling. When faced with ethical dilemmas sound decision-making will be made easily in accordance to the legal and ethical standards (Ewuoso & Dierickx., 2021).
References
Bayne, H. B., & Doyle, K. (2019). Licensure portability through an ethical lens: Considering multiple stakeholders. Journal of Mental Health Counseling, 41(2), 97-111.
Ewuoso, C., Hall, S., & Dierickx, K. (2021). How do healthcare professionals respond to ethical challenges regarding information management? A review of empirical studies. Global bioethics = Problemi di bioetica, 32(1), 67–84. https://doi.org/10.1080/11287462.2021.1909820
Firmin, M. W., DeWitt, K., Zurlinden, T. E., Smith, L. A., & Shell, A. L. (2019). Differences in competency and qualification requirements between APA and ACA code of ethics. Journal of Integrated Social Sciences, 9(1), 39-56.
Reitz, S. M., Scaffa, M. E., Commission on Practice, & Dorsey, J. (2020). Occupational Therapy in the Promotion of Health and Well-Being. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 74(3), 7403420010p1–7403420010p14. https://doi.org/10.5014/ajot.2020.743003
Tulyakul, P., & Meepring, S. (2020). Ethical issues of informed consent: Students as participants in faculty research. Global Journal of Health Science, 12(3), 86-90.
Woo, H., Dondanville, A., Jang, H., Na, G., & Jang, Y. (2020). A Content Analysis of the Counseling Literature on Technology Integration: American Counseling Association (ACA) Counseling Journals between 2000 and 2018. International journal for the advancement of counseling, 42(3), 319–333. https://doi.org/10.1007/s10447-020-09406-w
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