BCP+2202+Ethical+and+Legal+Issues+in+counseling_1_ (4)-1

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1 MT KENYA UNIVERSITY SCHOOL OF SOCIAL SCIENCES DEPARTMENT OF PSYCHOLOGY COURSE CODE: BCP 2202 COURSE TITLE: ETHICAL AND LEGAL ISSUES IN COUNSELLING Instructional Module for B. COUNS. Distance Learning P.O BOX 342-01000 THIKA www.mku.ac.ke EMAIL:info@mku.ac.ke

2 COURSE DESCRIPTION In the course “ Ethical, Legal and Professional issues in counseling ”. We shall first explore the definitions of various terms differentiating counseling from other professions and evolution of professions, and evolution of professional. Then we shall discuss ethical principal in counseling. Then we discuss ethical issues in supervision and consultation and how we can appreciate these ethical issues in supervision and consultation. Then we shall explore the term malpractice, discuss various forms of malpractice in counseling the value of client’s rights and counselors responsibilities. Finally we shall discuss the various emerging issues in counseling versus ethical and legal dilemmas.

3 COURSE OUTLINE: TOPIC ONE: BACKGROUND • Definition of the term counseling • The origins of professional ethics. • Definition of key terms • Levels of ethical practice • Principle ethics and virtue ethics • Differentiating counselling as a profession from other professions. TOPIC TWO: IDENTIFYING ETHICAL PRINCIPLES IN COUNSELING AND THE ROLE OF ETHICAL ISSUES IN COUNSELLING PROFESSION ETHICAL PRINCIPLES checkbld Beneficence and non-maleficence checkbld Fidelity and responsibility checkbld Integrity checkbld Justice checkbld Respect for people’s rights and dignity/autonomy ETHICAL ISSUES • Putting clients needs before your own • Ethical decision making. • The right of informed consent. • Dimensions of confidentiality and its limitations. • Ethical issues in a multicultural perspective • Ethical issues in assessment process • Dual relationship in counseling practice • Professional boundaries. • Professional competence and training. • The counselor as a person and as a professional • Personal values.

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4 • Ethical problem solving process during counseling TOPIC THREE: ETHICAL ISSUES IN SUPERVISION AND CONSULTATION: • Ethical issues in clinical supervision • Multi-cultural issues in supervision • Ethical and professional issues in consultation • Ethical issues in private practice • Ethical issues in psychological research • Rationale for legal guidelines. • Legal concerns for counselors • Record keeping in counseling TOPIC FOUR: MAL PRACTICE: • Definition of mal practice. • Examples of malpractice. • Dual and multiple relationships. TOPIC FIVE: EMERGING ISSUES IN COUSELLING VERSUS ETHICAL AND LEGAL DILEMAS. Emerging issues in counseling versus ethical and legal dilemmas. H.I.V/AIDs disability. Sexual orientation. Technology assisted distant counseling (T.A.D .C) Legal and ethical dilemmas case study. Way forward. MODE OF ASSESSMENT NATURE MARKS EXAMINATION 70% CONTINOUS ASSESSMENT & ASSIGNMENT 30% TOTAL 100% PASSMARK 40%

5 TOPIC ONE INTRODUCTION TO ETHICAL, LEGAL AND PROFESSIONAL ISSUES ☺ OBJECTIVES The learner should be able to (i) Define the term counseling (ii) Define the term ethics (iii) Define the term legal ethics (iv) Define the term morality ,values etc (v) Highlight the evolution of counseling ethics (vi) Differentiate counseling from other professions (vii) Appreciate the role of ethical ,legal and professional issues in counseling Definition of the term counseling - The attempt to define counselling has aroused much argument and contrasting definitions. Let us look at just a few: - counselling can be defined as a "...scientific process of assistance extended by an expert in an individual situation to a needy person". This depicts counselling as entirely the work of professionals called counsellors. counsellors must receive rigorous and extensive training. Limits are set of what does and what does not constitute counseling will become apparent.

6 Counselling enables a person to look at his inner self and relate his capabilities, achievements, interests and mode of adjustment to what change he has made or has to make counselling is concerned with finding creative and efficient solutions to developmental crises. This finding of solutions is the work of the client, who has to be desiring and willing to change, not the counsellor. To facilitate the client's voluntary change, counselling does not include such actions as admonishing, warning, threatening, coercing, as they amount to disciplining. There is neither persuasion nor brainwashing; no guiding, advising, suggesting or even recommending any action to be taken by the client. - Some other definitions are more liberal. While on one hand recognising that counselling is a professional activity, it as "...guidance on practical personal problems such as vocational choices, problems in studying etc". Remember that we delinked 'Guidance' from counselling in our earlier definitions. counselling can also be seen as the "...discussion of a person's problems and the provision of advice by a comparative stranger whether professionally trained or not." We ruled out advice earlier and emphasized that a counsellor must be a trained professional. May be, to stop this 'war', the first set of definitions is dealing with what we calls 'therapeutic counselling'. Its practice differs from other forms of counselling vis-a-vis 'career counselling', 'colour counselling', 'financial counselling', 'tourist counselling' and 'horoscope counselling'. - Though differing in their methodology the two sets of definitions agree that counselling aims at helping an individual to have a more resourceful and satisfying life. This will be evidenced when he is able to take responsibility and make decisions for himself. The second set of definitions of counselling, which has been disowned by professional counsellors, depicts the directive counselling. ORIGINS OF COUNSELLING ETHICS It has been acknowledged that various mental health practitioners have developed codes of ethics to govern them in their helping practice. Professional counselors are expected to know the ethics codes of their areas of specialization and be aware of what happens when one breaches the organizational

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7 sanctions. As a counselor one should be ready to work with other practitioners through consultation and also read widely to be updated with current information. Of important is the counselor’s behavior as a person. Codes of ethics provide general standards but a counselor should be ready to make sound judgment about situations in the best interest of their clients. A counselor therefore has a challenge of finding possible solutions to ethical dilemmas. Professional codes of ethics Professional codes of ethics provide broad guidelines for mental health practitioners. The ethics do not provide specific answers to problems rather they offer general guidelines. As much as codes of ethics are necessary they are not sufficient, they only highlight a judgment blue print on which specific can be implied. Objectives of the code of ethics The objectives are three fold: xrhombus To educate professionals about sound ethical conduct xrhombus To provide a mechanism for professional accountability xrhombus Codes of ethics serve as catalyst for improving practice Ethic code and the law Both laws and professional codes regulate ethical issues in the mental health profession. Law defines minimum standards the society will tolerate. The government enacts and enforces law. Law and ethic codes have been formulated from what has occurred rather than what may occur. Counselor should not look for answers to legal problems or mythical answers; rather they need to make the best choices as far as the welfare of the client is concerned. Evolution of ethic codes New concerns do arise and therefore ethic codes have to be reversed. A group of profession organizations establish codes in order to:

8 xrhombus Protect consumers xrhombus Provide guidelines for customers xrhombus Clarify professional stand of organization Of important for a counselor to note is that codes do not convey ultimate truth nor do they give ready made answers to dilemmas. For this reason, the counselor is expected to make informed judgment instead of following the law or code to the letter. A counselor should not ignore a client’s culture. Professional monitoring of practice Ethics committees are elected in a professional organization to oversee the conduct of members of the organization and to educate the association’s membership about ethics codes and protect the public from unethical practices. The committee members meet regularly to process formal complaints against individual members of the professional organization. In cases where ethical standards have been violated, sanctions such as reprimacy, probation, suspension or resignation may be imposed. Members have a right to appeal committee’s decision and appeal process must be completed and passed. Practitioners expelled from the organization may lose their licenses and certificates to practice. Cases of expulsion involve law enforcement and criminal charges and are normally published in the local press. HOW DOES COUNSELLING DIFFER FROM OTHER HELPING ACTIVITIES head2right Some helping r / ship involves giving advice and counseling doesn’t head2right Other helping relationship may not have the same kind of boundaries. head2right There may be a conflict of interest in other relationship/ terminates. head2right There are some helping relationship in which the helper might be judgmental. head2right Other helpers may offer sympathy other than empathy. head2right Other helper may not be objective. head2right There is an absence of mutual expectation to counseling which may not be true in r / ships. head2right Counselors do not impose expectations upon clients while other helpers may expect their clients behave in certain ways.

9 Key terms Values and ethics cannot be used interchangeable Values: beliefs and attitude that provide direction everyday living. Ethics: beliefs we hold about what constitutes right conduct Ethical: are moral principles development by an individual or group to provide rules to right conduct. Morality: is concerned with perspective of right and proper conduct and involve an evaluation of actions on basis of broader cultural context or religious standard. Moral : (community standards) moral vary from one culture to another. What is considered as malpractice or misbehavior in one place may not be considered as malpractice or misbehavior in another place. More so about counselor’s social conduct with clients. Community standards therefore become the ultimate legal criteria for assessing counseling behavior. Professionalism: has to do with adhere to what is expected in ethic codes. It is possible to act unprofessionally and also unethically. However these are some issues that are unprofessional and also unethical. E.g. sexual intimacy between counselors and clients. Level of ethical practice Professional ethic consist of lower level and higher level functioning. Mandatory ethics are lower levels of professional ethics whereby a counselor adheres to the basic minimal standards of professionalism. Aspiration ethics on the other hand describe the highest standards of conduct to which professional counselors can aspire. Aspiration ethics requires that a counselor does more than simply meet the letter of the ethic code. Has to do with the spirit behind the code and the principles in which the code rest. Differentiate Principle ethics from virtue ethics Principle ethic: is a set of the obligation and a method that focuses on moral issues with the goals of: Solving a particular dilemma or set of dilemmas

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10 Establishing a framework to guide future ethical thinking and behavior Principle ethics answer the questions What shall I do in the situation unethical? Virtue ethics: focuses on the character that of the counselor and his or her non-alligator ideas and aspirations While a counselor guided by principle will avoid malpractice, a guided by virtue ethics will think of what is the best for their clients e.g. Making referrals than simply adhering to principles. A virtuous counselor will emphasize on what is preferred rather than what is permitted. There are four core virtues- prudence, integrity, respectfulness and benevolence. ACTIVITY In the above topic, we have indentified one definition of counseling. Identify other ways counseling differ from other profession. SELF-ASSESSMENT QUESTIONS - Define the term counseling, ethics, profession and the term legal. - Access how counseling differ from other helping activities. - Discuss the four core values; prudence, integrity, respectfulness and benevolence.

11 FURTHER READING - Mara et all (1996) - Cores, G (2005) theory and practice of counseling and psychotherapy (7 th edition brooks/Cole Belmont INTERNET

12 TOPIC TWO ETHICAL PRINCIPLES IN COUNSELING ☺ OBJECTIVES The learner should be able to (i) Identify various ethical principles in counseling profession (ii) Explain the various ethical principles in counseling profession (iii) Discuss the role of ethical issues in counseling profession (iv) Appreciate the role of ethical issues in counseling profession ETHICAL PRINCIPLES This chapter introduces you to some of ethical principles and issues that will be a basic part of professional practices. Ethical Principles, as opposed to Ethical Standards, are aspirational in nature. Their intent is to guide and inspire psychologists toward the very highest ethical ideals of profession. General Principles, in contrast to Ethical Standards, do not represent obligations and should not form the basis for imposing sanctions. Relying upon Ethical Principles for either of these reasons distorts both their meaning and purpose. PRINCIPLE A: BENEFICENCE AND NONMALEFICENCE Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologist seek to safeguard the welfare and rights of those with whom the interact professionally and other affected persons, and the welfare of animal subjects of research.

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13 When conflicts occur among psychologists obligations or persons, and the welfare of animal subjects When conflicts occur among psychologists obligations or concerns, they attempt to resolve these conflicts in a responsible fashion that avoids or minimizes harm. Because psychologists scientific and professional judgments and actions may effect the lives of others, they are alert to and guard against personal, financial, social, organizational, or political factors that might lead to misuse of their influence. Psychologist strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work. PRINCIPLE B: FIDELITY AND RESPONSIBILITY Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarity their professional roles and obligations, accept appropriate responsibility for their behavior and seek to manage conflicts of interest that could lead exploitation or harm. Psychologist consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work. They are concerned about their ethical compliance of their colleagues scientific and professional conduct. Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage. PRINCIPLE C: INTEGRITY Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology. In these activities psychologists do not steal, cheat, or engage in fraud, subterfuge, or intentional misrepresentation of fact. Psychologists strive to keep their promises and to avoid unwise or unclear commitments. In situations in which deception may be ethically justiable to maximize benefits and minimize harm, psychologists have a serious obligation to consider the need for, the possible consequences of and their responsibility to correct any resulting mistrust or other harmful effects that arise from the use of such techniques. PRINCIPLE D: JUSTICE

14 Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributors of psychology and equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices. PRINCIPLE E: RESPECT FOR PEOPLE’S RIGHTS AND DIGNITY Psychologists respects the dignity and worth of all people, and rights of individuals to privacy, confidentially, and sell determination. Psychologists area aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making. Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices. ETHICAL ISSUES IN COUNSELLING INTRODUCTION Its purpose is to stimulate you to think further about these issues so that you can form a sound basis for making ethical decisions. Issues addressed include balancing clients' needs against your own needs, ways of making sound ethical decisions, educating clients about their rights, parameters of confidentiality, ethical concerns in counseling diverse client populations, ethical issues involving diagnosis and testing, and dealing with dual relationships. As you become involved in counseling, you will find that interpreting the ethical guidelines of your professional organization and applying them to particular situations demand the utmost ethical sensitivity. Even responsible practitioners differ over how to apply established ethical principles to specific situations. It is clear that therapists are challenged to deal with questions that

15 do not always have obvious answers. You will have to struggle with yourself to decide how to act in ways that will further the best interests of your clients. To help you make these decisions, consult with colleagues, keep yourself informed about laws affecting your practice, keep up to date in your specialty field, stay abreast of developments in ethical practice, reflect on the impact your values have on your practice, and be willing to engage in honest self-examination. You will need to reexamine the ethical issues raised in this chapter periodically throughout your professional life. You can benefit from both formal and informal opportunities to discuss ethical dilemmas during your training program. Even if you resolve some ethical issues while completing a graduate program, there is no guarantee that they have been settled once and for all. These issues are bound to take on new dimensions as you gain more experience. I have found that students often burden themselves unnecessarily with the expectation that they should resolve all problem issues before they are ready to practice. Ethical decision making is an evolutionary process that requires you to be continually open and self-critical. In recent years there has been an increased awareness of the ethical responsibility of counselors to alleviate human suffering on a broader scale. It is clear that practitioners cannot afford to confine themselves to their offices if they hope to reach a wide group of people who are in need of services. Many mental health professionals now emphasize social action by exerting their influence against such wrongs as discrimination against women and minority groups, the continuation of racism in society, the neglect of the aged, and inhumane practices against children. Seminars and workshops are conducted to awaken professionals to pressing needs in the community. In fact, many states now require continuing education in ethics as a condition for relicensure as a counselor or a psychologist. In sum, counselors are discovering that to bring about significant individual change they cannot ignore the major social ills that often create and exacerbate problems for individuals. Counselors must become active agents of constructive social change. I) PUTTING CLIENTS' N££DS B£FOR£ YOUR OWN I do not think that as counselors we can keep our personal needs completely separate from our relationships with clients. Ethically, it is essential that we become aware of our own needs, areas of

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16 unfinished business, potential personal conflicts, and defenses. We need to realize how such factors could interfere with helping our clients. Our professional relationships with our clients exist for their benefit. A useful question to frequently ask yourself is, "Whose needs are being met in this relationship, my client's or my own?" It takes considerable professional maturity to make an honest appraisal of your behavior and its impact on clients. I do not think it is unethical for us to meet our personal needs through our professional work, yet it is essential that these needs be kept in perspective. Ethical issue exists when we meet our needs, in either obvious or subtle ways, at the expense of our clients. The crux of the matter is to avoid exploiting clients. What kind of awareness is crucial? We all have certain blind spots and distortions of reality. As helping professionals, we have responsibilities to work actively toward expanding our own self- awareness and to learn to recognize areas of prejudice and vulnerability. If we are aware of our personal problems and are willing to work them through, there is less chance that we will project them onto clients. If certain areas of struggle surface and old conflicts become reactivated, we have an ethical obligation to seek our own therapy so that we will be able to assist clients in confronting these same struggles. We must also examine other, less obviously harmful, personal needs that can get in the way of creating growth-producing relationships. These other aspects of our personality include the need for control and power; the need to be nurturing and helpful; the need to change others in the direction of our own values; the need to persuade; the need for feeling adequate, particularly when it becomes overly important that the client confirm our competence; and the need to be respected and appreciated. One cannot be asserting that these needs are neurotic; on the contrary, it is essential that our needs be met if we are to be involved with helping others find satisfaction in their lives. There is anything amiss in out' deriving deep personal satisfaction from our work. And surely many of our needs for feeling worthwhile, important, respected, and adequate may enhance the quality of our work with others.

17 handhalt SUMMARY I believe many are motivated to enter the counseling profession because of their needs for power, for feeling useful and significant, and for reinforcing their feelings of adequacy. If helpers depend inordinately on others for their psychological gratification, they are likely to keep others in a dependent position. Because of their own emotional hunger they are unable to focus genuine attention on the client's deprivations. At the extreme, the helper is in greater need of the "helpee" than the other way around. For these reasons, ethical practice demands that counselors recognize the central importance of continuously evaluating in which direction their personality might influence clients toward progress or stagnation. II) ETHICAL DECISIONMAKING As a practitioner you will ultimately have to apply the ethical codes of your profession to the many practical problems you face. You will not be able to rely on ready-made answers or prescriptions given by professional organizations, which typically provide only broad guidelines for responsible practice. Part of the process of making ethical decisions involves learning about the resources from which you can draw when you are struggling with an ethical question. Although you are ultimately responsible for making ethical decisions, you do not have to do so in a vacuum. You should also be aware of the consequences of practicing in ways that are not sanctioned by organizations of which you are a member or the state in which you are licensed to practice. The Role of Ethical Codes as a Catalyst for Improving Practice Professional codes of ethics serve a number of purposes. They educate counseling practitioners and the general public about the responsibilities of the profession. They provide a basis for accountability, and through their enforcement, clients are protected from unethical practices. Perhaps most important, codes can provide a basis for reflecting on and improving one's

18 professional practice. Self-monitoring is a better route for professionals to take than being policed by an outside agency. It should be emphasized that codes of ethics typically address a broad range of issues and behaviors. Thus, they describe minimal standards of behavior and identify and prohibit those behaviors that are unethical. There is a real difference between merely following the ethical codes and making a commitment to practicing with the highest ideals. Mandatory ethics entails a level of ethical functioning at which counselors simply act in compliance with minimal standards. Inspirational ethics pertains to striving for the optimum standards of conduct. Rather than merely focusing on ways to avoid a malpractice suit, therapists who are committed to inspirational ethics are primarily concerned with doing what is in the best interests of their clients. From my perspective, one of the unfortunate trends is for ethics codes to increasingly take on legalistic dimensions. Many practitioners are so anxious about becoming embroiled in a lawsuit that they gear their practices mainly toward fulfilling legal minimums rather than thinking of what is right for their clients. In this era of litigation it makes sense to be aware of the legal aspects of practice and to do what is possible to reduce the chances of malpractice action, but it is a mistake to confuse legal behavior with being ethical. Although following the law is part of ethical behavior, being an ethical practitioner involves far more. One of the best ways to prevent being sued for malpractice rests in demonstrating respect for clients, having their welfare as a central concern, and practicing within the framework of professional codes. Over time, most of the ethical codes of various mental health professions have evolved into lengthy documents, setting forth what is desired behavior and proscribing behavior that may not serve the client's welfare. Even though codes are becoming more specific, they do not convey ultimate truth, nor do they provide ready-made answers for the ethical dilemmas that practitioners will encounter. Ultimately, professionals are expected to exercise prudent judgment when it comes to interpreting and applying ethical principles to specific situations. In my view, ethical codes are best used as guidelines to formulate sound reasoning and serve practitioners in making the best judgments possible. Because ethics codes are creations of human beings, and because they are evolving documents that are modified

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19 over time, some degree of flexibility is essential in applying them. No code of ethics can delineate what would be the appropriate or best course of action in each problematic situation a professional will face. Some Steps in Making Ethical Decisions There are a number of different models for ethical decision making; most tend to focus on the application of principles to ethical dilemmas. After reviewing a few of these models, my colleagues and I have identified a series of procedural steps to help you think through ethical problems. ■ Identify the problem or dilemma. Gather information that will shed light on the nature of the problem. This will help you decide whether the problem is mainly ethical, legal, professional, clinical, or moral. ■ Identify the potential issues. Evaluate the rights, responsibilities, and welfare of all those who are involved in the situation. ■ Look at the relevant ethics codes for general guidance on the matter. Consider whether your own values and ethics are consistent with or in conflict with the relevant guidelines. ■ Know the applicable laws and regulations. It is essential to determine whether any laws or regulations have a bearing on the ethical dilemma. ■ Seek consultation from more than one source to obtain various perspectives on the dilemma. Obtain consultation with professionals who are knowledgeable about the issues involved in the situation under question. ■ Brainstorm various possible courses of action. Continue discussing options with other professionals. Include the client in this process of considering options for action. ■ Enumerate the consequences of various decisions, and reflect on the implications of each course of action for your client. Again, include the client in this process. ■ Decide on what appears to be the best possible course of action. Once the course of action has been implemented, follow up to evaluate the outcomes and to determine if further action is necessary.

20 handhalt SUMMARY In reasoning through any ethical issue, there is rarely one ideal course of action to follow; different practitioners will make a variety of decisions. The more subtle the ethical dilemma, the more difficult the decision-making process will be. Professional maturity implies that you are open to questioning and that you are willing to discuss your quandaries with colleagues. Because ethical codes do not make decisions for you, demonstrate a willingness to struggle, to raise questions, to discuss ethical concerns with others, and to continually clarify your values and examine your motivations. To the degree that it is possible, include the client at all phases of the ethical decision making process. III) THE RIGHT OF' INFORMED CONSENT By educating your clients about their rights and responsibilities, you are both empowering them and building a trusting relationship with them. Assisting clients to make informed choices consists of providing them with the information they need to become active participants in the therapeutic re- lationship. Some aspects of the informed consent process include the general goals of counseling, the_ responsibilities of the counselor toward the client, the Responsibilities of clients, limitations of and exceptions to confidentiality, legal and ethical parameters that could define the relationship, the qualifications and background of the practitioner, the fees involved, the services the client can expect, and the approximate length of the therapeutic process. Further areas might include the benefits of counseling, the risks involved, and the possibility that the client's case will be discussed with the therapist's colleagues or supervisors. This process of educating the client begins with_the initial counseling session and continues for the duration of counseling.

21 The challenge of fulfilling the spirit of informed consent is to strike a balance between giving clients too much information and giving them too little. For example, it is too late to tell minors that you intend to consult with their parents after they have disclosed that they are considering an abortion. In such a case both the girlfriend and the boyfriend have a right to know about the limitations of confidentiality before they make such highly personal disclosures. Clients can be overwhelmed, however, if counselors go into too much detail initially about the interventions they are likely to make. It takes both intuition and skill for practitioners to strike a balance. Providing for informed consent tends to promote the active cooperation of clients in their counseling plan. Clients often do not realize that they have any rights and do not think about their own responsibilities in solving their problems. Those who feel desperate for help may unquestioningly accept whatever their counselor says or does. They seek the expertise of a professional without realizing that the success of this relationship depends largely on their own investment in the process. It is a good idea to have basic information about the therapy process in writing, as well as discussing with clients topics that will enable them to get the maximum benefit from their counseling experience. Clients can take this written information home and then bring up questions at the following session. IV) DIMENSIONS OF CONFIDENTIALITY Confidentiality, which is central to developing a trusting and productive client/therapist relationship, is both a legal and an ethical issue. State laws now address confidentiality in therapy, as do the ethical codes of all the mental health professions. Because no genuine therapy can occur unless clients trust in the privacy of their revelations to their therapists, professionals have the responsibility to define the degree of confidentiality that can be promised. Counselors have an ethical responsibility to discuss the nature and purpose of confidentiality with their clients early in the counseling process. In addition, clients have a right to know that their therapist may be discussing certain details of the relationship with a supervisor or a colleague.

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22 Although most counselors agree on the essential value of confidentiality, they realize that it cannot be considered an absolute. There are times when confidential information must be divulged, and there are many instances in which whether to keep or to break confidentiality becomes a cloudy issue. In determining when to breach confidentiality, therapists must consider the requirements of the institution in which they work and the clientele they serve. Because these circumstances are frequently not clearly defined by accepted ethical codes, counselors must exercise professional judgment. In general, confidentiality must be broken when it becomes clear that clients might do serious harm to either themselves or others. There is a legal requirement to break confidentiality in cases involving child abuse, abuse of the elderly, and danger to others. All mental health practitioners and interns need to be aware of their duty to report such abuse. General Guidelines on Confidentiality Here are some of the circumstances that dictate when information must legally be reported by counselors: - When clients pose a danger to others or themselves. - When the therapist believes a client under the age of 16 is the victim of incest, rape, child abuse, or some other crime - When the therapist determines that the client needs hospitalization - When information is made an issue in a court action - When clients request that their records be released to themselves or to a third party In general, however, it is a counselor's primary obligation to protect client disclosures as a vital part of the therapeutic relationship. When assuring clients that what they reveal in sessions will generally be kept confidential, counselors should also tell them of any limitations on confidentiality. This practice does not necessarily inhibit successful counseling. Therapists should discuss with their clients how certain information about them might be shared with others. It is generally accepted that therapists will have no professional contact with the family or

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23 friends of a client without first securing the client's permission. It is accepted, in addition, that information obtained in therapeutic relationships should be discussed with others for professional purposes only and limited to persons who are clearly related to the case. The issue of confidentiality takes on added dimensions for students who are involved in a fieldwork placement or internship as part of their program. In most cases these counselor interns are required to keep notes on the proceedings with their individual clients or the members of their group. Also, group-supervision sessions at a clinic or university typically entail open discussions about the clients with whom these counselor interns are working. These discussions should always be conducted in a professional manner. If a particular individual client is being discussed, it is important that this person's identity be protected if at all possible. In many situations interns can actually show their clients what they are writing and discuss these notes with them. When clients receive this type of openness from their counselors, I have found they respond with greater frankness because they feel that information will be used for them, not against them. Counselors must become familiar with local and state laws that govern their specialization. Yet this knowledge alone will not settle difficult situations. There are various and sometimes conflicting ways to interpret a law and professional judgment plays a critical role in resolving most cases. Legislators and judges seem inclined to bind all mental health practitioners to confidentiality while at the same time limiting its scope. They appear to believe confidentiality is necessary for a counseling relationship to be effective, but that it need not be absolute. For instance, practitioners have an obligation not only to warn and to protect others from the acts of dangerous people but also to protect suicidal clients. There are definite limitations to confidentiality when the counselor determines that a client is a suicide risk. The assessment and management of suicidal clients are typically stressful for counselors. The possibility of a client's suicide raises a number of difficult issues that practitioners must face, such as their degree of influence, competence, level of involvement with a client, responsibility, and legal obligations. Counselors need to demonstrate the ability to make appropriate interventions in critical situations. V) ETHICAL ISSU£S IN A MULTICULTURAL P£RSP£CTIV£

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24 Ethical practice requires that we take the client's cultural context into account in counseling practice. In this section we look at how it is possible for practitioners to practice unethically if they do not address cultural differences in counseling practice. Have Current Theories Outlived Their Usefulness? Some writers allege that current theories of counseling and psychotherapy— including some of the theories in Part Two of this textbook—are inadequate to describe, explain, predict, and deal with the richness and complexity of a culturally diverse population. It has also been asserted that contemporary theories cannot be easily adapted to a wide range of cultures and that the helping professions need to develop a theory of multicultural counseling and therapy. I agree only to a point with this assertion. I believe current theories can be expanded to include a multicultural perspective. With respect to many of the traditional theories, assumptions made about mental health, optimum human development, the nature of psychopathology, and the nature of effective treatment often have little relevance for some clients. For traditional theories to be relevant in a multicultural society, they must incorporate an interactive person-in-the-environment focus. That is, individuals are best understood by taking into consideration salient cultural and environmental variables. It is essential for therapists to create therapeutic strategies that are congruent with the range of values and behaviors that are characteristic of a pluralistic society. Are Counseling and Therapy Culture-Bound? Multicultural specialists have asserted that theories of counseling and psychotherapy represent different worldviews, each with its own values, biases, and assumptions about human behavior. Some counselors have criticized traditional therapeutic practices as irrelevant for people of color and other special populations such as the elderly. Most techniques are derived from counseling approaches developed by and for White, male, middle-class, Western clients and therefore may not be applicable to clients from different racial, ethnic, and cultural backgrounds. Western models of counseling have major limitations when they are applied to certain special populations and minority groups such as Asian and Pacific Islanders, Latinos, Native Americans, and African Americans. Moreover, value assumptions

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25 made by culturally different counselors and clients have resulted in culturally biased counseling and have led to under use of mental health services. Some of the values implicit in contemporary counseling theories include an emphasis on individualism, the separate existence of the self, individuation as the foundation for maturity, and decision making and responsibility as resting with the individual rather than the group. In contrast, an Asian perspective would play down individuality and focus on interdependence and losing oneself in the totality of the cosmos. It cannot be denied that the psychoanalytic, behavioral, cognitive behavioral and existential approaches originated in the Euro-American culture and are grounded on a core set of values. I think it is a myth that these approaches are value-neutral and are applicable to all human beings. There is a danger of imposing these values as being the only right ones and as having universal applicability. The relationship-oriented therapies (person-centered theory, existential therapy, and Gestalt therapy) emphasize freedom of choice and self-actualization. Practitioners with such an orientation tend to focus on individual responsibility for making internal changes as a way to cope with problems, and they view individuation as the foundation for healthy functioning. In some cultures, however, the key values are collectivist. Rather than emphasizing the development of the individual, they focus on what is good for the group. Certainly, therapists who operate on the assumption that all clients should embrace individualism are in error. Regardless of the therapist's orientation, it is crucial to listen to clients and determine why they are seeking help and how best to deliver the help that is appropriate for them. Focusing on both Individual and Environmental Factors A theoretical orientation provides practitioners with a map to guide them in a productive direction with their clients. It is hoped that the theory orients them but does not control what they attend to in the therapeutic venture. Counselors who operate from a multicultural framework also have certain assumptions and a focus that guides their practice. They view individuals in the context of the family and the culture, and their aim is to facilitate social action that will lead to change within the client's community rather than merely increasing the individual's insight. Both multicultural practitioners and feminist therapists maintain that therapeutic practice will be effective only to the extent that

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26 interventions are tailored toward social action aimed at changing those factors that are creating the client's problem rather than blaming the client for his or her condition. An adequate theory of counseling does deal with the social and cultural factors of an individual's problems. However, there is something to be said for helping clients deal with their response to environmental realities. Counselors may well be at a loss in trying to bring about social change when they are sitting with a client who is in pain because of social injustice. By using techniques from many of the traditional therapies, counselors can help clients increase their awareness or their options in dealing with barriers and struggles. It is not a matter of focusing strictly on an individual's intrapsychic dynamics and forgetting about bringing about change in the environment; rather, it is a matter of aiding clients in clarifying how they are personally affected by external conditions and challenging them to make decisions about what they can do to change themselves if they cannot directly change the outside world. It is essential to focus on both individual and social factors if change is to occur, as both feminist therapy and family systems therapy teach us. Indeed, the person-in-the-environment perspec- tive acknowledges this interactive reality. VI) ETHICAL ISSUES IN THE ASSESSMENT PROCESS Both clinical and ethical issues are associated with the use of diagnostic and testing procedures. As you will see when you study the various theories of counseling, some approaches place heavy emphasis on the role of assessment as a prelude to the treatment process. Other theories mainly the relationship- oriented and experiential therapies tend to view diagnosis and testing as an external frame of reference that can remove the therapist from understanding the deeply personal and subjective world of the client. These theories also have ethical implications for practitioners who focus too much on the client's history while failing to pay sufficient attention to present attitudes and behavior. The Role of Diagnosis in Counseling Psycho diagnosis is the analysis and explanation of a client's problems. It may include an explanation of the causes of the client's difficulties, an account of how these problems developed over time, a classification of any disorders, a specification of preferred treatment procedure, and an estimate of the

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27 chances for a successful resolution. The purpose of diagnosis in counseling and psychotherapy is to identify disruptions in a client's present behavior and lifestyle. Once problem areas are clearly identified, the counselor and client are able to establish the goals of the therapy process, and then a treatment plan can be tailored to the unique needs of the client. A diagnosis is not a final category; rather, it provides a working hypothesis that guides the practitioner in understanding the client. The therapy sessions provide useful clues about the nature of the client's problems. Thus, diagnosis begins with the intake interview and continues throughout the duration of therapy. The "bible" for guiding practitioners in making diagnostic assessments is the fourth edition of the American Psychiatric Association's. Clinicians who work in community mental health agencies, private practice, and other human service settings are generally expected to assess client problems within the framework of the DSM-IV. This manual advises practitioners that it represents only an initial step in a comprehensive evaluation. There is also a caution about the necessity of gaining additional information about the person being evaluated beyond that which is required to make a DSM-IV diagnosis. Although some clinicians view diagnosis as central to the counseling process, others view it as unnecessary, as a detriment, or as discriminatory against ethnic minorities and women. As you will see in Chapter 12, feminist therapists contend that traditional diagnostic practices are often oppressive and that such practices are based on a White, male-centered, Western notion of mental health and mental illness. The feminist perspective also charges that these diagnoses ignore societal contexts. Feminists also chal- lenge many DSM diagnoses. However, they do make assessments and draw conclusions about client problems and strengths. Considering ethnic and cultural factors in assessment and diagnosis A danger of the diagnostic approach is the possible failure of counselors to consider ethnic and cultural factors in certain patterns of behavior. Unless cultural variables are considered, some clients may be subjected to an erroneous diagnosis. Certain behaviors and personality styles may be labeled neurotic or deviant simply because they are not characteristics of the dominant culture. Thus, counselors who work with African Americans, Asian Americans, Latinos, and Native Americans may erroneously conclude that a client is repressed, inhibited, passive, and unmotivated, all of which are seen as undesirable by Western standards.

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28 In the Code of Ethics and Standards of Practice, American Counselling Association recognizes that there are cultural implications of making proper diagnoses and of using tests. Furthermore, in assessments of clients with different backgrounds, the DSM-IV emphasizes the importance of being aware of unintentional bias and keeping an open mind to the presence of distinctive ethnic and cultural patterns that could influence the diagnostic process. A commentary on diagnosis is there a way to bridge the gap between the extreme view that diagnosis is the essential core of therapy and the extreme view that it is a detrimental factor? Most practitioners and many writers in the field consider assessment and diagnosis to be a continuing process that focuses on understanding the client. The collaborative perspective that involves the client as an active participant in the therapy process implies that both the therapist and the client are engaged in a search-and- discovery process from the first session to the last. Even though some practitioners may avoid formal diagnostic procedures and terminology, it seems that they do raise certain questions, such as: ■ What is going on in the client's life now, and what does the client want from therapy? ■ What are the client's strengths and limitations? ■ What is the client like in the counseling setting, and what does this behavior reveal about the client's actions outside of therapy? ■ How far should therapy go? ■ What is the client learning from therapy, and to what degree is he or she applying this learning to daily living? In dealing with these questions, the therapist is formulating some conception about what clients want and how they might best attain their goals. Thus, diagnosis becomes a form of making tentative hypotheses, and these hunches can be formed with clients and shared with them throughout the process. This perspective on assessment and diagnosis is consistent with the principles of feminist therapy, an approach that is critical of traditional diagnostic procedures. The process of assessment and diagnosis cannot be separated from treatment, and ideally, this process helps the practitioner conceptualize a case. Ethical dilemmas are created when diagnosis is done strictly for insurance purposes, which often entails arbitrarily assigning a client to a diagnostic

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29 classification. However, it is a clinical, legal, and ethical obligation of therapists to screen clients for life- threatening problems such as organic disorders, schizophrenia, bipolar disorder, and suicidal types of depression. Students need to learn the clinical skills necessary to do this type of screening, which is a form of diagnostic thinking. To function in most mental health agencies, practitioners need to become skilled in understanding and utilizing assessment and diagnostic procedures. Guidelines for the Use of Tests in Counseling The place of testing in counseling and therapy is another controversial issue. Models that emphasize the objective view of counseling are inclined to use testing procedures to get information about clients or to provide them with information so that they can make more realistic decisions. The person centered and existential orientations view testing much as they do diagnosis as an external form of understanding that has little to do with effective counselling. A wide variety of tests can be used for counseling purposes, including measures of interest, aptitude, achievement, attitudes and values, and personal characteristics. In my view tests can be used as an adjunct to counseling; valuable information, which can add to a client's capacity to make decision, can be gleaned from them. But some cautions and guidelines regarding I he uses of tests are worth noting: ■ Client should be involved in the test-selection process. They should decide which categories of tests, if any, they wish to take. ■ Clients' reasons for wanting tests, as well as their past experience with text, should be explored. ■ A client needs to be aware that tests are only tools, and imperfect ones at that. As means to an end, tests do not provide "the answer." At best they provide additional information that can be explored in counseling and used in coming to certain decisions. ■ The counselor should clarify the purposes of the tests and point out their limitations. This role implies that the counselor has a good grasp of what the test is about and that he or she has taken it. ■ The test results, not simply scores, should be given to the client, and their meanings should be explored. In interpreting the results, the counselor should be tentative and neutral,

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30 refraining from judgments as much as possible and allowing clients to formulate their own meanings and conclusions. ■ It is especially important to consider the ways in which socioeconomic, ethnic, gender, and cultural factors can affect test scores. VII) DUAL RELATIONSHIPS IN COUNSELING PRACTICE Dual (or multiple) relationships, either sexual or nonsexual, occur when counselors assume two (or more) roles simultaneously or sequentially with a client. Some examples of dual relationships are combining the roles of teacher and therapist or of supervisor and therapist; bartering for goods or therapeutic services; borrowing money from a client; providing therapy to a friend, an employee, or a relative; engaging in a social relationship with a client; accepting an expensive gift from a client; becoming emotionally or sexually involved with a former client; and going into a business venture with a client. Because dual relationships are necessarily complex and multidimensional, there are few simple and absolute answers to neatly resolve them. It is not always possible to play a single role in your work as a counselor, nor is it always desirable. You will probably have to wrestle with balancing more than one role, regardless of the setting in which you work or the client population you serve. Thus, it is critical that you give careful thought to the complexities of multiple relationships before embroiling yourself in ethically questionable situations. Dual relationships are rarely a clear-cut matter, for ethical reasoning and judgment come into play when ethical codes are applied to specific situations. Although dual relationships do carry inherent risks, they are not always harmful, unethical, and unprofessional. Some dual relationships are clearly exploitative and do serious harm both to the client and to the professional, but others may have more potential benefits to clients than potential risks. Ethics Codes and Dual Relationships What guidance do codes of ethics offer on handling dual relationships? Almost all of the codes of the professional organizations now advise against forming such relationships. These codes typically caution professionals against entering into those relationships "that could impair objectivity." The

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31 problem is that the codes are usually written in general terms, which demands that practitioners use their best judgment in each situation to determine if there is a potential for harm. The current focus of ethics codes is on keeping alert to the possibilities of damaging exploitation rather than a universal prohibition of all dual and multiple relationships. Perspectives on Dual and Multiple Relationships Some of the problematic aspects of engaging in dual relationships are that they are pervasive, they can be difficult to recognize, they are unavoidable at times, they are potentially harmful, and they are the subject of conflicting advice from various experts. A review of the literature reveals that dual and multiple relationships are hotly debated. Except for sexual intimacy with current clients, which is unequivocally considered unethical, there is not much consensus regarding the appropriate way to manage dual relationships. A consensus of many writers is that dual and multiple relationships are inevitable in some situations and that a global prohibition does not seem to be a realistic answer. Because interpersonal boundaries are not static but undergo redefinition over time, the challenge for practitioners is to learn how to manage boundary fluctuations and to deal effectively with overlapping roles. One key to learning how to manage dual relationships is to think of ways to minimize the risks involved. Ways of minimizing risk in determining whether to proceed with a dual relationship, it is critical to consider whether the potential benefit of such a relationship outweighs the potential harm. It is your responsibility to develop safeguards aimed at reducing the potential for negative consequences. The following guidelines are identified. ■ Set healthy boundaries early in the therapeutic relationship. Informed consent is essential from the beginning and during the therapy process. Involve the client in ongoing discussions and in the decision making process, and document your discussions. ■ Consult with fellow professionals as a way to maintain objectivity and identify unanticipated difficulties. Realize that you don't need to make a decision alone. ■ When dual relationships are potentially problematic, or when the rills for harm is high, it is always wise to work under supervision. It may be necessary to refer a client to another

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32 professional if problem develop or if harm seems likely. Document the nature of this supervision and any actions you take in your records. ■ Throughout the process, self-monitoring is critical. It is a good idea to unit yourself whose needs are being met and to examine your motivation for becoming involved in a dual or multiple relationship. A decision-making model in working through a dual relationship concern, it is best to begin by ascertaining whether such a relationship can be avoided. Sometimes dual relationships are avoidable, and to get involved in them may be putting the client needlessly at risk. In other cases dual rela- tionships are unavoidable. For instance, a counselor in a rural community may have as clients the local banker, merchant, and minister. In this setting, mental health practitioners may have to blend several professional roles, mid functions. They may also attend the same church or belong to the same community organization as their clients. These professionals are likely to find it more difficult to maintain clear boundaries than practitioners who work in a large city. The decision-making model proposed by Healthy and Corey (1997a) differentiates between unavoidable and avoidable relationships. In cases where a dual relationship is unavoidable, the guidelines for minimizing risks discussed in the previous section apply. If the dual relationship is avoidable, the counselor has a choice of what course of action to take. If the potential benefits outweigh the risks, it is still sound practice to follow all of the procedures listed earlier. If the risks outweigh the benefits, ethical practice demands that the counselor decline to enter into a conflicting relationship. You are likely to encounter many forms of nonsexual dual relationships. One way of dealing with any potential problems is to do whatever is possible to completely avoid such relationships. Another alternative is to deal with each dilemma as it surfaces, making full use of informed consent and at the same time seeking consultation and supervision in dealing with the situation. This second alternative provides a professional challenge for self-monitoring. It is one of the hallmarks of professionalism to be willing to grapple with these ethical complexities of day-to-day practice.

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33 THE COUNSELOR AS A PERSON AND AS A PROFESSIONAL Self awareness and the influence of the therapist’s Personality and needs For counselors to avoid obstructing the process of their clients, they need to have a high level of self awareness. This is because counselors may unconsciously shift their focus from meeting the client’s needs to meeting own needs. Counselors need to be aware of their needs, personal conflicts, defenses, vulnerabilities and their ‘unfinished business’. A potential counselor therefore needs to examine two specific areas: Motivation to become a counselor Unresolved personal conflicts Motivation for becoming a counselor As one becomes a counselor, one should define one’s motivation. What drives me to become a counselor? Are there any rewards? The experiences should act as a mirror in which counselor are able to see their own lives being reflected. Therapy should therefore stimulate change in both the counselor and the client. However a therapist should guard against gaining popularity in his counseling as opposed to meeting the needs of the client. The therapist should aim at helping the client regain control over his or her life. In other words the determination to help the client get solutions should be the driving force not rewards the therapist gets by counseling others. Unresolved personal conflicts Counseling should be aware of biased, areas of denial and the issues they find difficult to deal with in their lives as they influence their ability to render services. Personal therapy for counselors

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34 This includes formal, individual therapy, group counseling, and consolation with police in a formal manner, continuing education especially of experimental nature. Lesser forms of personal therapy includes: Reflecting and evaluating the meaning of one’s life Remaining open to the reaction of significant people in one’s life Enjoying music and art, traveling, experiencing different cultures and mediating Engaging in spiritual activity prayers Spending time with friends and families Transference and counter transference When clients project their past feeling and attitudes they had towards significant people in their lives to therapist, this is called transference. Counter transference occurs when the therapist his feelings to the client. If a therapist helps the client to change old dysfunctional themes, transference, is said to be constructive. When a therapist’s own needs or unresolved personal conflict becomes entangled in the therapeutic process thereby obstructing or destroying a sense of objectivity, it is said to be destructive. When a therapist meets its own needs at the expenses of the client’s needs it is unethical. Client dependence The counselor has a duty to facilitate change, autonomy, independence and also interdependence rather than dependence. The client is not to be pushed or manipulated by the counselor. They should be allowed to make their own decision and allow for collaboration. Maintaining vitality Wellness is defined as a way of life oriented towards optimal health and wellbeing in which body, mind and spirit are integrated by the individual to live more fully within the human and the natural community. It does not make much sense when a counselor promotes the well being of others and fails to promote the wellbeing of self.

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35 VALUES AND THE HELPING RELATIONSHIP (process) Counselors need to be aware of values and life experiences and find out how these influence their counseling. As much as the therapist values may differ from those of his client, teaching clients some moral rules and values is a violation to a client’s choice and diversity. Values used by the therapist should be geared toward enhancing the therapeutic process. The values should not be used to abuse the therapist’s power nor to exploit the therapist’s vulnerability. Values must be not inculcated into clients. A therapist needs to be aware of two extremes when counseling values. o Some therapists have a definite absolute value system which must be taught to clients. o Other therapists keep themselves and their values hidden as through contaminating the client process. Bruce’s ten ethical rules for ethical guidelines for counselors assisting clients in developing their own counseling goals (values) Examine goals (are my goals in the interest of the client?) Ensure the goals are mutually consistence Justify the pursuit of end goals and the means to attain these goals Inform clients of their values (therapist’s values) especially if some values are likely to influence the client’s social goals. Avoid the error of clinical judgment Assess the risk that the client goals might affect others Consider how the client goals might affect others Avoid deceiving clients Honor any promises made to the clients The therapist needs to clarify his own values and how they enter the therapeutic process.

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36 Values for clients to be mentally healthy Counselors should be aware of how personal values influence their professional work. The values that facilitate good mental health to the client are: xrhombus Self determination xrhombus Developing effective strategies for coping with stress xrhombus Developing ability to give and receive affection xrhombus Incasing one’s ability to the sensitive to the feelings of others xrhombus Being able to practice self control xrhombus Having a sense of purpose for living xrhombus Being open, honest and genuine xrhombus Finding satisfaction in one’s work xrhombus Having a sense of identity and self worth xrhombus Being skilled in interpersonal relationships xrhombus Having a deepened self awareness and motivation for growth xrhombus Practicing good habits of physical health The above twelve values were found to be universal and that therapists based their therapy on them The therapeutic endeavor is a value ladder process and that all therapists to some degrees communicate their values to clients. Value conflict in relationship to referral Value conflict between therapist and clients are inevitable. Being a professional, does not necessary mean being able to assist anyone. It is the duty of the therapist to recognize when their values clan with those of their clients to an extent that they cannot function. A therapist should not hurry into a referral. He should receive supervision and through consultation find out the barriers that might prevent him from working with the client.

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37 Referrals should be made at the last resort. When the therapist is convinced that he and the client are not able to function effectively. When referrals are made it should be made clear to the client that the problem is with the therapist and not the client, lest he feels rejected and suffer harm. Shared experiences and values The counselor should employ the strategy of empathy to tune the client’s feeling and relate to their own. They need to feel with an experience each of the struggles of their clients in order to work with them. A counselor should be able to communicate to any person through appropriate empathy and not sympathy. When the counselor and the client connect at a certain level, Cultural and age different can be transcended. THE ROLE OF SPRITUAL AND RELIGIOUS VALUES IN COUNSELING Major professional organizations have recognized the importance of spiritual issues in counseling practice. A client’s spiritual values should be viewed as potential resources in the therapy because spiritual and religious value plays a major part in human life. Spiritual and Religious values therefore need not to be ignored because they are critical sources of strength for many clients. They are instrumental in promoting healing and well being. For one to understand clients one needs to appreciate their spiritual beliefs and practices. There is growing empirical evidence that our spiritual values and behavior can promote Physical and psychological well being. There is group interest in incorporating spiritual & religious values in counseling cure. Three reasons in supplying the growing interest. a) Client spiritual values should be renewed as a potential in therapy b) Both are source of strength for many clients. c) Are instrumental in promoting healing & well being. Counselors should prescribe in any particular way to a client to fulfill spiritual needs. It’s up to the clients to determine what specific values to retain or modify.

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38 Counselors must therefore be prepared to deal with spiritual that are at the very ‘core’ of human being. Referring clients to spiritual leaders in an ethical practice. A counselor should help the client in reforming his self assessment and then by help him to be true in his or own belief system. For therapists to be able to do pioneer assessment of a client and prescribe treatment, they should understand and respect a client’s religious beliefs sine his or beliefs may have been the factors in the development of his or her problem. Such beliefs any have include the assessment and treatment practice. Spirituality is a significant force for many clients and is especially important for practitioners to pursue spiritual concerns if clients initiate them. MULTI CULTURAL PERSPECTIVE AND DIVERSITY ISSUES Multicultural perspective is about zeroing of cultural values, sexual orientations beliefs and assumptions of the counselor in therapy processes. The focus is on multicultural perspective or lack the helping profession. Multiculturalism refers to any relationship between and within two or more diverse groups. As much as counselors are expected to be cultural sensitive they should be careful not to use their culture as a standard measure. Some ethic dimensions of multi cultural practice Cultural influences every aspect of our lives for it influence our view of social and psychological reality. Multi cultural counseling is based on the following premises: square4 All cultural represent meaningful ways of coping with the problem particular group faces. square4 All cultural can be regarded as multi cultural if culture is defined not only to include race, ethnicity and nationality has also gender, age, social class, sexual orientation and disability. ETHICAL PROCESS IN COUNSELLING DECISION MAKING Why is making contract important? Confidentially should be based on informed consent client should fully understand the limits of confidentiality before entering a therapeutic relationship.

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39 It is expected that where practical, recourse to relevant supervision and opinion from a professional body such as British American counseling psychologist. Is sought before any action. Organization who offer counseling have differing policies on confidentiality for example some drug treatment centres ask counsellers to break confidentiality if the client disclosed limit drug usage. N.B: Always be clear of both the organizations and the ethical body code of ethics before offering confidentiality. ETHICAL PROBLEM SOLVING PROCESS There are six steps in ethical problem solving process during counselling STEP 1 – produce a brief description of the problem or dilemma. Write down what the dilemma is consider all aspects such as; - Impact to the client - Impact to general public - Impact to self STEP 2 - - Whose dilemma is it anyway? Your choices - Client - Counseling - Client and counselor STEP 3 - Consider all available ethical principles and guidelines - What codes of standard are available to you. - What if anything does the law dictate - What actionare prohibited

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40 - What actions are required? - What are the people involved entitle by law? STEP 4 - Identify all courses of actions - Consider all form of action no matter ridiculous they may sound - Write them down STEP 5- Select the best course of action. - Test your selected course of action against o University o Justice o Publicity STEP 6 - Evaluate the outcome - Was the outcome what you hoped? - Had you considered all the relevant factors - Would you do the same again People seek counseling because of problems that emerge out of social cultural conditions. All cultures have developed formal or informal ways of dealing with cultural problems. A counselor should be able to describe the following cultural terminologies. Culture, ethnicity, minority group. Multi-culturism, multi-cultural counseling. Culture centered counseling, stereotypes, racism and tribalism.

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41 ACTIVITY Reflect on ethical principles in counseling. In your own opinion how do these principles affect counseling. Discuss the various ethical issues in counseling and how do they affect the counselor as a person and as a professional SELF ASSESSMENT Highlight various ethical issues in counseling. Discuss the counselor as a person and as a professional FURTHER READING Ethical and professional standards for clinical practice CACES, 1993, 1995) An introduction to counseling 3 rd edition- John Mcleod INTERNET

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42 TOPIC THREE ETHICAL AND PROFESSIONAL ISSUES IN CONSULTATION ☺ OBJECTIVES The learner should be able to (I) Identify ethical issues in supervision and consultation (II) Explain various ethical issues pertaining supervision and consultation (III) Appreciate the role of ethical issues in supervision and consultation Psychological consultation involves a broad helping approach in which qualifies consultants help consults: - Resolve work related issues pertaining to individuals , clients or programs that they are responsible for - Become active agent in achieving solutions to problems - Strengthen consults work related competencies to address similar issues in the future. Professionals who functions in the role of consultants are involved in collaborative form of consultation the aim at improving the mental health individuals and the functioning or organizations. The needs for ethical standards for consultation include: - value issues - multicultural issues - competence training in consultation - relationship issues in consulting

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43 - rights of consults - issues involving consulting groups ISSUES INSUPERVISION AND CONSULTATION Supervision is a process that involves a supervisor overseeing the professional works of a trainee. Supervision has three major goals: • To enhance the skills and knowledge of supervisee • To ensure the welfare of the supervisee’ salient • To serve a ‘gate keeping function’ or the profession It is important that counselors be trained in construction and supervision Ethical and legal issues in clinic supervision Ethic guideline or counseling has supervisors addressing issues like client’s welfare and rights, supervisory role, program administration role, purpose and intent of supervision, qualifications of supervisors, and conduct of supervision, legal issues and ethic issues. Specific rights of supervisees include: • The right to a supervisory session free from interruptions and distractions. • The right to be fully informed of supervisor approaches to supervision. • The right to confidentiality with regard to the supervisee’s disclosure as well as that of client except as mandated by law. • The right to offer feedback to supervisors concerning the helpfulness of supervision. • The right to receive timely feedback, assessment and evaluation from the supervisor. • The right to seek consultation from other professional as necessary. Roles and responsibilities of supervisors

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44 • Supervisors must be well trained, knowledgeable and skilled in the practice of clinical supervision. • Supervisors are ultimately responsible both ethically and legally for the actions of their trainees. They are therefore cautioned not to supervise more trainees than they can responsibly manage at one time. • Supervisors must check on their trainees ‘case loads’ They must keep recording pertaining to their work with trainees. • Counseling or clinical supervisors have a position of influence with their supervisees. They operate in multiple roles as teachers, evaluators, counselors, models, mentors and advisors. Supervisors therefore need to monitor their own behavior so as not to misuse the inherent power in the supervisor/ supervisee relationship. • Supervisors are face with the responsibility of protecting the welfare of the client, the supervisees, the public and the profession. • In supervision there is a risk of harm to both client and supervisee from a supervisor’s ‘blurred objective’ impaired judgment or exploitation. • Supervisors are responsible for ensuring compliance into relevant legal , ethical and professional standards for clinical practice. The main purpose of ethical standards for clinical supervision is to provide behavioral guidelines to supervisors in order to protect supervisees from undue pressure or neglect and to ensure quality client care . • Supervisors can demonstrate these ethical guidelines through the behavior they model in the supervisory relationships. Responsibilities of supervisors to their clients Some ways in which a supervisor can promote counselor supervision are:- • State the specific objectives of supervision • Formulate a sound supervisory contract that clarifies the expectation and parameters of the supervision agreement. • Negotiate mutual decisions rather than make unilateral decision about the needs to the trainee. • Perform the role of the teacher , counselor or consultant as appropriate

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45 • Clarify the supervisory role • Integrate knowledge of supervision with one’s personal talents or areas of expertise. • Meet with supervisees on a regular basis to give ongoing evaluation and feedback. • Evaluate the supervisee’s role and conceptual understanding of the therapeutic process. • Promote the supervisee’s ethical and legal knowledge and behavior • Interact with counselor trainees in a manner that facilitate their self exploration problem solving ability and confidence • Provide supervisees with guidance in the assessment and treatments of their clients. • Be aware of clients being treated by supervisees. • Teach and model ethical and professional behavior • Be aware of the techniques being employed by the trainees • Be sensitive to possible cried that may indicate that a clients is at risk • Maintain confidentiality of client • Maintain confidentiality of the supervisees and explain the parameters of supervisees and explain the parameters of confidentiality in the supervisory relationship. • Maintain documentation of supervision. Methods of supervision It is essential that supervisors have a clearly developed model of supervision and the methods they employ. Some commonly used methods of supervision are: • Self report • Audio tapes • Video tapes • Live supervision – No client Styles of supervision Supervisees may require different style of supervision where a directive style and a persuasive one are balanced .The supervisor has the task to strike for an optional level of challenge and support .He is

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46 supposed to promote autonomy without overwhelming the supervisee . The Socratic supervisors help trainees realize that the answer lies within themselves , he trainees and between the supervisors and the client .Instead of teaching and giving supervisors education and information, they should rather strive to help them identify institutions and insight e.g using their own words instead of those of supervision . Some qualities to help supervisees develop their style are: • What are you waiting to say to your clients? • What is going on with you as you listen to your clients? • How are you reacting to your clients? • How is your behavior affecting them? • Which clients bring out your own resistances? • How might out relationship in these supervisory session, mirror your relationship with your clients? Are you feeling free enough to bring into these supervisory session any difficulties you are having with your clients? The supervisory process can be therapeutic and growth producing. One of the most important goals of clinical supervisors is to promote the supervisee’s self awareness and the ability to recognize personal characteristics that would have a negative impact on the therapeutic relationships. • When the supervisor over emphasized legal responsibilities and threats of being involved in a malpractice suit .This is a dilemma that may give internal struggle to supervise. • Being concerned about liability issues should not prevent supervisors from giving their best efforts in helping supervisees. Ethical practices of clinical supervisor Research has revealed that ethical issues may be common in the following activities: square4 Performance evaluation and monitoring supervisor’s activities square4 Ability to work with alternative perspectives: supervisors not being receptive to theoretical approaches other than their own.

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47 square4 Session boundaries and respectful treatment: Supervisors are expected to demonstrate respectful to the supervisee’s. square4 Expertise competency issues: the supervisor has the responsibility for making appropriate disclosures to the supervisees when the supervisor or supervisee does not possess the competence to deal with a particular case or situation. square4 Disclosure to clients: It is the responsibility of the supervisors to ensure adequate disclosure of the supervisor training status to the super supervisee’s clients. square4 Modeling ethical behavior and responding to ethical concerns: supervisors have often failed to provide model and respond to ethical concerns. square4 Crisis coverage and intervention: In the event of crisis, the supervisor is to provide adequate communication with the supervisee and appropriate supervisory report and guidance. Dual roles: it is the responsibility of the supervisor to handle role related conflicts in an appropriate and ethical manner Termination and follow up issues: supervisors have the responsibility of ensuring continuity of a clients care and of preventing a abandonment of a client. Differentiating supervision from psychotherapy: it’s expected that the supervisee’s personal issues will be dealt with appropriately and that referrals will be made to the therapist when a supervisee experiences a personal problem, that interfered with providing adequate are to client. Sexual issues: Some supervisors were reported to regard sexual or romantic issues in the supervising relationship inappropriately. Legal aspects of supervision The three legal consideration with supervisors are: • Informed consent • Confidentiality and its limits • Liability

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48 Supervisors must see that trainees provide the information clients need to make informed choices. The following must be made clear to the client: • That the counselor they are seeing is a trainee and that they’ll be meeting in a regular basis for supervision sessions. • That the client’s case may be discussed in group supervision meeting with other trainees. • That session may be taped or observed. Points recommended in addressing areas in a written informed consent document. • Purpose of supervision • Professional disclosure statement • Practical issues • Supervision process • Administrative issues • Ethical and legal issues • Statement of agreement The supervisors must understand the legal ramification of their supervisory work, be familiar with each case of every supervisee to avoid possible legal and ethical malpractice. COMPETENCE OF SUPERVISORS For both ethical and legal standpoints, it’s essential that supervisors have educational training and adequately carry out their word • A course working theories of supervision is needed • Knowledge of working with difficult supervisees • Working with culturally adverse supervisees

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49 • One has to be acquainted with method of supervision for instance mutually in the supervision relationship • Need to have an in-depth knowledge of the specialty area in which they will have an in-depth knowledge of the specialist and in which they will provide supervision. • It is unethical for supervisors to offer supervision in areas that are beyond the scope of their practice. • Supervisors need to have an academic background in the area of marriage and family, child counseling and so on. Research has revealed that a good supervisor is one the : Supervisees prefers most, responds to positively, finds satisfactory and are able to trust. The supervisor said to be a good should have the following personal attributes: respect, genuineness, empathy, ability to confront immediacy, concern for supervisee growth and well being , availability for self reflection , flexibility , courage , tolerance, openness to various styles of learning and humor. The general future of the good supervisor reveals an individual who : - Is a technically competent professional - Has good human relation skills - Have effective organizational and managerial skills Multi-cultural issues in supervision Ethical supervision must include the ways in which individual difference can influence can influence the process .The ACA’s standards dealing with supervision and training call for counsel or educators and supervisor to demonstrate knowledge of individual differences with respect to gender , race , ethnicity , culture , sexual orientation, disability and age to understand the importance of these characteristics in supervisors , relationships and training. Multi-cultural supervision encompasses a broad definition of culture that include race ethnicity, social-economic status sexual orientation, religion, gender and age. Issues to address in multi-cultural supervision include:

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50 head2right Racial issues in supervision head2right Multicultural effective supervision head2right Gender issues and feminist supervision Multiple roles and relationship in the supervisory process Counseling supervisors are expected to assess the personal and professional maturity to play multiple roles. Although multiple roles and relationships are common in the context of training and supervision, it is essential for supervisors to thoroughly discuss and process issue relevant to these multiple roles with their supervisees. Ethically, supervisors need to clarify their roles and to be aware of potential problems that can develop when boundaries become blurred .The crux of the issue of multiple role relationships in the training and supervisor process the potential for abuse of power. Therapy clients , students and supervisees are in a vulnerable position and can be harmed by an educator or supervisor who exploits them, misuse power or crosses appropriate boundaries . Multiple roles and relationship in the supervisory process include: • Sexual intimacies during professional training • Ethical issues in combining supervision and counseling • Educators who counsel students. ETHICAL AND PROFESSIONAL ISSUES IN CONSULTATION Psychological consultation involves a broad helping approach in which qualifies consultants help consults: - Resolve work related issues pertaining to individuals , clients or programs that they are responsible for - Become active agent in achieving solutions to problems

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51 - Strengthen consults work related competencies to address similar issues in the future. Professionals who functions in the role of consultants are involved in collaborative form of consultation the aim at improving the mental health individuals and the functioning or organizations. The needs for ethical standards for consultation include: - Value issues - Multicultural issues - Competence training in consultation - Relationship issues in consulting - Rights of consults - Issues involving consulting groups THE COUNSELER’S RESPONSIBILITIES IN RECORD KEEPING From an ethical, legal and cultural perspective an important responsibility of counseling practioners is to keep adequate records on their clients. Moure, Williams and Autism (1998) have listed a number of arguments for keeping records including these points. - Record keeping has become a standard of care practice set by most professional organization. - Adequate counseling records often sense as a counselor’s defense with an ethical violation - A counseling record can serve clients by reflecting their condition at a particular time. - Records document counseling given - Records can be useful for clients in the event of transferring to a new counselor. - Records can help counselors improve their skills and promote more effective counseling for clients - Federal and or state law may require the practice of record keeping. RECORD KEEPING IN COUNSELLING Report writing should be done immediately after the counseling session while or the relevant information is fresh in the counselor’s mind and before other intrude have had time to intrude - You should start by identifying client’s so as not to confuse between different clients.

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52 - You might decide to include clients surname and other name, date of birth, address, contact phone number, mental status, name of partner or spouse name and age of children and referral source. CONTENT OF THE RECORD THE RECORD NEED TO INCLUDE, • Date of session • Factual information given by the client • Details of the clients problem, issues or dilemma, • Notes on the process that occurred during the session. • Notes on the outcome of the counseling session • Notes on the interventions given by the counselor. • Notes on the goal identified • Notes on any contract between the client and counselor • Notes on matters to be considered at subsequent sessions • Notes on counselor’s own feelings relating to the client and the counseling session • Counselor’s initials or signature • Records needs to be detailed, accurate and legible if they are to be maximumly useful. • When writing records be aware of the confidentiality and the possibility that the legal system may demand that such records be made available to a court. • Client may wish to read them. ACTIVITY Discuss various issues in supervision and consultation. In which ways do these issues affect the counselor as a person and counselor as a professional.

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53 SELF EVALUATION QUESTION - Highlight various issues in clinical supervision, multi- cultural issues, and ethical and professional issues. - In which ways do you think these issues affect counseling as a profession FURTHER READING - An introduction to counseling 3 rd edition- John Mcleod - Corey, C, Cory, M.S and Callen, P (1998), issues and ethical in the helping professionals Brook/ Cole, Boston. INTERNET TOPIC FOUR

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54 MALPRACTICE ☺ OBJECTIVES The learner should be able to (i) Define the term malpractice (ii) Explain various forms of malpractice (iii) Appreciate the value of clients right and counselors responsibility in curbing malpractice. MALPRACTICE LIABILITY IN THE HELPING PROFESSIONS Definition of malpractice Malpractice is the failure to render professional services or to exercise the degree of task that is ordinary expected of other professional in similar situations. Malpractice is legal concept involving negligence that results in injury loss to the client. Professional negligence can result from unjustified departure from usual practice or from failing to exercise the care in fulfilling ones responsibilities. Sexual misconduct has received the greatest attention in the literature as regards for malpractice suits. Failure to prevent suicide and incorrect treatment are the major psychologists face a dilemma is the area of confidentiality and its limits and application to various settings. Forms of malpractice The general problem areas that pose the highest risks of malpractice law suits include: • Violation of client’s personal rights (typically related to sex privacy or wrongful commitment)

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55 • Failure to protect others from clients (alleged in failure to worn. Failure to commit and wrongful lease cases) • Incompetent treatment of clients (often alleged in suicide cases) The types of professional negligence that put therapist at risks include: • Failure to document informed consent • Client abandonment • Marked departures from therapeutically practices. • Practicing beyond the scope of competency • misgivings • Crisis intervention • Repressed or false memory • Unhealthy transference relationships • Sexual abuse of a client • Failure to control a dangerous client • Risk management Providing quality professional services to client is best preventive step one can take. 1. DUAL RELATIONSHIPS IN COUNSELLING By a dual relationship is meant the blending of a professional relationship with another kind of relationship, for example being both a counsellor and teacher to the same person, or counselling a relative or friend or even neighbour. Initially the idea of counselling a friend or neighbour or even pupil might seem both attractive and helpful. However experience shows that such dual relationships can create lots of difficulties. The most obvious problem is the question of boundaries and therefore of confidentiality. If I have heard something in confidence (in what can be called the internal forum) then I must keep it confidential and not transfer it to the external forum. Some examples can help to highlight these problems. - A teacher who learns through counselling that her pupil is stressed and depressed because of

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56 the separation of her parents and who therefore gives her extra marks in an exam. - A religious superior who learns through counselling that a seminarian has had a sexual affair and who then dismisses him at the end of the year, it is for this reason that church law is very clear in forbidding a superior from being a counsellor or spiritual director of a subordinate... so in reality this example should never occur. - A counsellor who agrees to counsel a neighbour's 17-year-old son on the estate and who then finds he is sometimes smoking marijuana. Does he inform the parents or the other youngsters on the estate or his own children? Smoking marijuana is not in itself life threatening, so the counsellor respects confidentiality and tries to help the client by continuing the counselling. But he need not have had to worry about this private information if he had only referred the young man to a counsellor who didn't live on the estate and who had no chance of meeting him. 2. TRANSFERENCE AND COUNTER-TRANSFERENCE - Transference is where the client transfers to the counsellor feelings or Attitudes, whether positive or negative, that she had towards a significant person or persons in her life. Quite often these feelings are associated with childhood experiences. The counsellor may therefore be idealized, as the perfect person or as an all-knowing and powerful person or as a 'nurse' who nurtures, or as a loving mother or father. Sometimes the counsellor may be looked upon negatively as an authority figure or as a manipulative father or mother. The client unwittingly experiences these feelings as though the counsellor were a significant figure from his or her past. - The counsellor should be aware of the transference so that it does not get In the way of the counselling process. When this occurs it could usefully brought, in confidence, to the attention of an experienced counsellor or counselling supervisor. - In the area of HIV/AIDS counselling the client may easily look on the counsellor as a saviour, a loving father or mother or indeed as a hostile Authority figure.

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57 - Counter transference refers to the emotional reaction of the counsellor to the client where the unconscious needs or wishes of the counsellor are provoked by the client. In this case the counsellor might feel like a protective father, a caring, nurturing mother, or on the contrary as a judge. Once again self-awareness is all important in not allowing these unconscious needs to cloud the genuineness, respect and empathy of a proper counselling relationship. - Counter transference can show itself in many ways. The following are most common: 1. Being overprotective with a client 2. Treating clients in superficial ways. 3. Reject a client 4. Needing constant reinforcement and approval. 5. Seeing yourself in you clients 6. Developing sexual or romantic feelings toward a client 7. Giving advice compulsively. 8. Desiring a social relationship with a client. 9. Delaying termination 3. SEXUAL EXPLOITATION OF THE CLIENTS A number of surveys of psychologists and psychotherapists have discovered that sexual contact between therapists and their clients is not uncommon, despite being explicitly prohibited by all the professional associations in that country. In a survey of 1,000 psychologists, found that 8.1 per cent of the male and 1.0 percent of the female therapists had engaged in sex with clients. Some 4 per cent of their sample believed that erotic contact with clients might in some circumstances be of therapeutic benefit to the client. A similar survey carried out a similar anonymous questionnaire survey of 1,000 psychotherapists, and found that 7 per cent reported having had sex with a client. Finally, in another large –scale survey of American practitioners, revealed admission of erotic contact with clients in 9.4

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58 percent of male and 2.5 of female therapists. The meaning of these figures is open to interpretation. The estimates made by the surveys cited must be regarded as representing a minimum estimate of the prevalence of client sexual abuse by therapists, because of the many factors that would lead respondents to conceal or under-report their involvement. Bates and Brodsky have given a detailed account of one case of sexual exploitation of a client. This case, and other cases that have been studied in depth, support the following general conclusions regarding such events. 1. Effective therapy can include phases when the client is highly dependent on the counselor, and open to such suggestion or manipulation. 2. Within the confidential, secretive environment of the counselling relationship it is possible for counselors to engage in unethical behavior with little likelihood of being found out. 3. The focus of counselling on the personality and inner life of the client may readily result in the client blaming himself or herself and his or her own inadequacies for what has happened. 4. Clients who have sexually abused by professionals encounter great difficulty in achieving redress. These principles make it possible to understand how sexual abuse of clients can occur, and why it is under-reported. The damage that this type of abuse does to clients has been documented in a number of studies. Many instances of suicide attempts, severe depressions (some lasting months), mental hospitalizations, shock treatment, and separations or divorces from husbands… women reported being fired from or having to leave their jobs because of pressure and ineffectual working habits caused by their depression, crying spells, anger and anxiety. One way of making sense of the prevalence of sexual acting out between clients and therapists is to regard it as an inevitable, if unfortunate, consequence of the high levels of intimacy and self-disclosure

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59 that occur in therapy. An example of this approach can be found in the work of Edelwich and Brodsky (1991), who regard sex with clients as a professional issue for which therapists should be trained to cope. They take a position of encouraging to view strong feelings for clients as normal: anyone who minist to the needs of other is bound to have unsettling experiences with emotional currents that run outside the bounds of professional propriety. These cross current arise from normal, universal human feelings. Difficulties arise not because counselors have these feelings, but because they act on them inappropriately. Edelwich and Brodsky identify a number of guidelines for recognizing seductiveness in themselves and in their clients, and suggest strategies for dealing ethically with feeling of attraction. - Acknowledge your own feelings - Separate your personal feeling from your dealing with the client; - Avoid over-identifying- the client’s problems are not your own; - Don’t give your problems to the client - Talk to someone else about what is happening (e.g. colleagues or supervisor) - Set limits while giving the client a safe space for self expression - Don’t be rejecting - Express non-sexual caring - Avoid giving double messages. They also point out that most sexual misconduct begins with other boundary violations, such as touching the client, seeing him or her socially or in appropriate counselor self- disclosure to the client, and recommend that these apparently less significant boundaries be treated with great respect. CLIENT RIGHTS AND COUNSELLORS RESPONSIBILITIES The ethic codes of most professional organizations requires that clients be given adequate information to make informed choices

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60 • Counselors should develop procedures that aid their clients in making informed choices. • The client needs to understand the scope of professional responsibility. The therapist has responsibility to clients to agencies (e.g. KCA) or own agency, to profession, to the community and to the client’s family. Ethics codes should be based on sound judgment which means what feels right as guarded by core qualities of a counselor. The core qualities of a counselor are:- checkbld Genuineness checkbld Empathy checkbld Unconditional positive regard • When therapists ignore legal and ethical standards, professional responsibilities become professional liabilities. If the counselor’s conduct is below the expected standards of can or if they fail to keep adequate records of their procedures, the responsibilities will also become professional liabilities. Doing the wrong things such as stealing from a client, leaking of confidential information, imposing of cultural values, having sexual relationship with a client are considered as malpractices. CONFIDENTIALITY • It is the right of the client to have disclosure in therapy session protected. • The client needs to be informed of limitations of confidentiality since not everything they talk about in the session will be confidential • It is the therapist’s duty to protect clients who are likely to hurt themselves or adversely affect others. CONFIDENTIALITY, PRIVILEGED COMMUNICATION AND PRIVACY Confidentiality, privacy communication and privacy are related concepts but these are important distinctions among them. While confidentiality is an ethical concept and privileged communication is a legal concept.

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61 CONFIDENTIALITY Mental health professionals have ethical responsibility, legal and professional duty to safeguard clients from unauthorized disclosure of information given in the therapeutic relationship, except when authorized by law or by the client to do so. PRIVILEGED COMMUNICATION Privileged communication is a legal proceedings that would break a promise of privacy. It is the clients right to prevent the counselor from revealing confidential information in the court of law ( in a legal proceeding). This means therapist can refuse to answer questions or refuse to produce a client’s record in a court of law. Confidentiality and privilege belong to the client and not the practitioner and his client who can wave his or her privacy. PRIVACY Privacy as a matter of law refers to the constitutional right of an individual to decide the time, place, manner and extent of sharing oneself with others. The use of telephone answering machines, voice mail pagers, faxes, cellular phones and email can pose a number of potential ethical problems regarding the protection of privacy of clients. CONFIDENTIALITY AND PRIVACY IN SCHOOL SETTING School counselors are warned of their responsibility to safeguard students’ right when teachers or principals ask counselors to divulge confidence of students. When minors are unable to give informed consent, and they may need to be included in the counseling process. Parents and guardians have some legal right to request information about counseling sessions but minors have an ethical right to expect confidentiality in the relationship. School counselors have an ethical responsibility to ask for client permission to release information. School counselors should clearly inform their counselees of their limitations of confidentiality and how and when confidential information may be shared. Parents, guardians and teachers should be made to understand the school counselor’s role with emphasis on the confidential nature of the counseling relationship between the counselor and the counselee.

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62 EXCEPTIONAL CIRCUMSTANCES THAT MAY LEAD TO BREACH OF CONFIDENTIALITY • When the client consents disclosure • When legal rules require disclosure • When clerical assistance (administrative assistants) handle confidential information as in ‘ managed care’ e.g. social workers • When the counselor consents with experts or peers • When the counselor is working under supervision • When other mental health professionals are involved in treatment team and coordinate care of a client CONDITIONS THAT MAY WARRANT DISCLOSURE ARE: i. Disclosure ordered by court ii. When clients file complaints against their counselors iii. When clients claim of psychological damage in law suit iv. When civil commitment proceedings are initiated PROTECTING CHILDREN FROM HARM The national child abuse prevention and treatment Act (1974), defines child abuse and neglect as “ physical or mental injury, sexual abuse or exploitation, neglecting treatment or maltreatment of a child under the age of eighteen or the age specified by the child protection law of state in question, by a person who is responsible for the child’s welfare, under circumstances which indicate that the child’s health or welfare is harmed or threatened thereby. Privileged communication does not apply in most cases of child abuse and neglect. If children report that they are being abused or neglected, the professional is required to report the situation to necessary authorities. If adults reveal in a therapy session that they are abusing or have abused their children, the matter must generally be reported.

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63 COUNSELOR’S RESPONSIBILITIES IN RECORD KEEPING From an ethical, legal and cultural perspective, an important responsibility of mental health practitioners is to keep adequate records on their clients. • Record keeping has become a ‘standard of care, practice set by most professional organization • Adequate clinics records often serve as a counselor’s defense against malpractice claim or in the event of being charged with an ethical violation. • A clinical record can serve clients by reflecting their condition at a particular time. • Records document that treatment occurred • Records can be useful for clients in the event of transferring to a new counsel or school • Records can help counselors improve their skills and promote more effective treatment for clients • Federal and or state law may require the practice of record keeping. COUNSELING CHILDREN AND ADOLESCENT The general rule is that a parent is entitled to general information from the counselor about the child’s progress in counseling. In most cases a minor to enter into a counseling relationship, it is necessary to have informal parental or guardian concern or for counseling to be order. However there are expectorations to this general rule. Informed consent of parents or guardians may not be legally required when a minor is seeking counseling for dangerous drugs or narcotics, for sexually transmitted diseases, for pregnancy and birth control or for an examination following alleged sexual assault of a minor over 12 years of age. From an ethical perspective, therapists who work with children and adolescents have the responsibility to provide information that will help minor clients become active participants in their treatment. These are both ethical and therapeutic reasons for involving minor in their treatment.

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64 ACTIVITY List various forms of malpractice in counseling profession. In which ways does counter transference show itself in a counseling setting. Is it unethical to meet our personal needs through our professional work? Don’t we benefit by being nurturing? Feeling adepture, displaying competence, being respected and appreciated? SELF EVALUATION QUESTIONS Highlight various forms of malpractice in counseling profession. So as to avoid counter transference as a form of malpractice are you able to identify your own needs. Do you have areas of unfinished business?. Are these potential personal conflict that would interfere with helping the client?. Do you recognize your own areas of prejudice and vulnerabilities? NB: Counselors impairment often leads to counter transference. FURTHER READING American counseling Association (1995), Ethical principle of psychologists and Cole of conduct, Ather Washington DC

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65 INTERNET

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66 TOPIC FIVE EMERGING ISSUES IN COUNSELLING VERSUS ETHICAL AND LEGAL DILEMMAS ☺ OBJECTIVES The learner should be able to (i) Identify the various emerging issues in counseling versus ethical and legal dilemmas (ii) Discuss the emerging issues in counseling versus ethical and legal dilemmas (iii) Appreciate the role of technology assisted distant counseling (TADC) MULT CULTURAL PERSPECTIVE AND DIVERSITY ISSUES Multicultural perspective is about zeroing of cultural values, sexual orientations beliefs and assumptions of the counselor in therapy processes. The focus is on multicultural perspective or lack the helping profession. Multiculturalism refers to any relationship between and within two or more diverse groups. As much as counselors are expected to be cultural sensitive they should be careful not to use their culture as a standard measure. Some ethic dimensions of multi cultural practice Cultural influences every aspect of our lives for it influences our view of social and psychological reality. Multi cultural counseling is based on the following premises: square4 All cultural represent meaningful ways of coping with the problem particular group faces. square4 All cultural can be regarded as multi cultural if culture is defined not only to include race, ethnicity and nationality has also gender, age, social class, sexual orientation and disability. People seek counseling because of problems that emerge out of social cultural conditions.

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67 All cultures have developed formal or informal ways of dealing with cultural problems. A counselor should be able to describe the following cultural terminologies. Culture, ethnicity, minority group. Multi-culturalism, multi-cultural counseling. Culture centered counseling, stereotypes, racism and tribalism. THE PROBLEM OF CULTURAL TUNNEL VISION A counselor’s beliefs and attitudes about people will influence therapy in helping profession. A counselor is to understand his own assumptions in order to understand others. He will then be able to see areas of uniqueness and areas of commonality. A counselor therefore cannot ignore his culture and the culture of his clients through encapsulation. A cultural encapsulated counselor exhibits mono- cultural tunnel vision. Cultural tunnel vision includes:- - Limited cultural experience - Imposing personal values in the assumption that everyone shares in these values - Attitudes about minority groups because of perceived resistance to change - Racism and tribalism A mono-cultural tunnel visioned individual is one who: - Defines reality according to one set of cultural assumptions. - Is not sensitive to cultural variations among individuals. - Accepts unreasoned assumptions without proof in order to hold his or her assumptions. - Does not accommodate behavior of others and fails to evaluate the view point of others. The challenge of reaching diverse clients population The practitioners are reminded to be aware of how their own culture, life experiences, attitudes, values and biases influences them. They have also been challenged to respect the role of family members and the community structures hierarchies, values.

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68 And beliefs that are an integral part of the client’s culture. Mental health practitioners have moral and professional responsibility to:- • Beware of stereotypes biases and assumptions that under guard the practice. • Be aware of the culturally different client values and world view. • Develop appropriate intervention strategies that take in account the social cultural, historical and environmental influences of cultural different clients. It is the duty of counselors guard against strategies that would make different clients. It is the duty of counselor to guard against strategies that would make clients lose their values in the process. CULTURAL PLURALISM Multiculturalism is an attitude to be embraced not to be tolerated. Operating multicultural and monolingual as if all clients are the same is not in accord with reality. This can result in unethical and ineffective practice. The complexity of culture helps us to avoid seeking easy answer to hard questions. People in the counseling profession should be ready to seek consultation, see continuing education and make referrals to a professional who is competent to work with particular client population. ETHIC CODES IN MULTICULTURAL COUNSELING Most ethics codes mention is practitioner’s responsibility to recognize the special needs of diverse client’s population. The counselor has the responsibility to recognize the diversity in theory, practice, training and research, respect cultural differences and understand diversity as part of the competence. The code of ethics of both ACA and APA are culturally biased and culturally encapsulated. They tend to have a bias towards an individualistic perspective which is not appropriate for collectivistic culture, e.g. African culture. The convectional counseling therefore does not fit the multicultural expectations. It guards against dual relationship, yet in collective counseling counselors may need to relate through many different roles and relationships. The convectional standards encourage independence rather than dependence on counselor by client yet dependency may apply in some cases e.g. assisting clients with some needs or allowing a client not to pay.

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69 CULTURAL VALUES AND ASSUMPTION IN THERAPY • Research advocates that many therapeutic practices are biased against racial and ethnic minorities, whereby counseling reflects racism, sexism, and other forms of prejudice. • Ethnocentric bias has been destructive to the natural help giving networks of minority communicates. Helpers are therefore being advised to expand their perception of metal health practices to include support systems such as family, friends, community, self help programs and occupational networks. Counselors need to reach out ,shop ,visit ,make home visits and join community improvement efforts in order to be effective. • The diversity counseling movement focuses attention on the problems of discrimination, oppression and racism. Counselors may misunderstand clients of a different sex, race, age, social class, sexual orientation. If practitioners fail to integrate those diversity factors into their practice, they are infringing on the clients cultural autonomy and basic human rights which will affect the counseling relationship negatively. ADDRESSING SEXUAL ORIENTATION The concept of human diversity encompasses much more than racial and ethnic factors. It encompasses all forms of oppression, discrimination and prejudice including those directed toward age, gender and sexual orientation. The American Psychiatric Association, and the American Psychological Association, stopped labeling homosexuality as a form of mental illness because of human rights. The mental health system has finally begun to treat the problem of gay and lesbian people rather than treating them as the problem. The ethic codes of ACA, the APA and the NASW state clearly discrimination on the basis of minority status, be it race, ethnicity, gender, sexual orientation is unethical and unacceptable. Working with lesbian, gay and homosexual individuals can be very challenging to a counselor’s value system. Counselors who have negative reactions to homosexuality are likely to impose their own values and attitudes.

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70 There is need for counseling to comfort their personal prejudices, myths, fears and stereotypes regarding sexual orientation in order understand the special concerns of homosexuals. MATCHING A CLIENT AND A COUNSELOR Diversity includes culture, religion, race, ability, gender, sexual orientation, education and social economic level. The complex diversity of a pluralistic society, suggests the bridges of shared concern that unite culturally different individuals. Counselors and clients are both unique and similar. Well trained counselors even though they differ from their clients are capable of providing effective counseling. Counselors can be trained to hear the inner voices of their culturally different clients. It is important for the counselor to learn how to pay attention to clients’ salient cultural identity as it changes within the context of a single interview. Competence is measured by one’s ability to know what his client is thinking and not saying. The most important aspects of culture centered counseling can be learned but not necessarily taught. We can become our own best teachers if we pay attention to the voices within us and within our clients. There is need for counselors to have counseling in multi-cultural perspective, both academic and exponential. They can then learn to work with clients who differ from them in gender, race, culture, social-economic background, physical ability, age, or sexual orientation. The counselor and the client need to agree to develop a working relationship. Counselors are advised to be in applying theories and techniques to specific situations and be open to being challenged and tested. MULTICULTURAL TRAINING FOR COUNSELORS Referrals should not be seen as a solution of inadequately trained counselors. It is important that all counseling students receive multicultural counseling and therapy (MCT). The trainees expected to study about ethnic groups, changing ideas of women, sexism in urban and rural societies, culture mores, spiritual issues, and differing life patterns. Dimensions of multi-culturally competent, mental health practitioners

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71 • The first dimension deals with the practitioner’s attitudes and beliefs about race, culture, ethnicity, gender and sexual orientation. Concerning this: • The second dimension is knowledge. • The third dimension deals with skills, intervention techniques and strategies necessary in serving diverse client groups. ETHICAL AND LEGAL DILEMMAS IN REFERENCE TO HIV/AIDS DISABILITY. INTRODUCTION Ethical issues are those pertaining or dealing with morals or the principle of morality, pertaining to right and wrong in conduct. These are issues that guide people in conforming to m,oral standards (www.thefreedictionary ) Legal issues refer to conforming to the law. Actions done according to the rules and regulations of a state. Dilemma refers to one being in a fix and not being able to go through a challenge. Ethical and legal issues related to HIV/AIDS are based on testing, treatment and how one is viewed in the society. The HIV/AIDS issues put counselors in a dilemma because of its complicated nature in the way it is handled, it becomes difficult for counselors to undertake sessions with HIV/AIDS clients duew to these dilemmas. Key ethical dilemmas analyzed include: 1. Confidentiality 2. Informed consent 3. Conflicts of interest 4. Justice (Both legal and ethical) 5. Respect for persons

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72 6. Beneficience and non-malificience Key legal dilemmas analyzed include: 1. Stigmatization 2. Protecting those at risk 3. Counseling sex commercial workers 4. Counseling a discordant couple Although both the ethical and legal issues are useful guidelines that help to focus on, they may exceptionally be left out in some cases or situations. Furthermore conflicts may arise especially in serious case where the client poses a danger to himself/herself or to the society at large. Therefore these issues should be interpreted in the context of specific case, because of the dilemmas attributed to them in the counseling profession. ETHICAL DILEMMAS CONFIDETIALITY This is the assurance that information shared during the counseling will not be revealed to anyone. Confidentiality is both an ethical issue in counseling as well as a legal issue required in the sake of a HIV/AIDS client. Because of the sensitivity of HIV related information laws have been adopted to provide protection to HIV clients. For example, according to the HIV information may be disclosed on a general release of medical information on specific authorization for the release of HIV related information must be obtained. Exceptions to the legal and ethical obligation to maintain confidentiality of HIV related information exist. However, because of HIV testing carries the risks of discrimination and stigmatization if confidentiality is breached, this becomes a dilemma to the counselor handling the case. Counselors may only be

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73 permitted to disclose a patient’s HIV infection to persons at risk of infection without legal penalty in such situations which are justifiable by both the law and counseling ethics: i. Breaching confidentiality will help prevent serious harm to an identifiable person for example a spouse of the client. ii. There is no other effective means in achieving the goal which is helping relationship between the client and the counselor. iii. When the HIV client needs hospitalization for example in this case, the client may require antiretroviral therapies. Therefore counselors handling cases of HIV clients have to struggle with the confidentiality dilemma since it may hinder the counseling session to be effective or may block the session. ETHICAL ISSUES IN ONLINE COUNSELING Use of technology for counseling services involves both potential benefits and risks. Just like any new practice area, practitioners have a primary duty to consider the best interests of the client, to strive to do no harm and to advice to legal requirements. Mental health professionals must make decisions about how they wish to incorporate delivery of services via the internet into their practices and that professional associations should develop standards for these services. The disadvantages of using internet technology to provide physiological services need to be carefully considered. Simply having technology available does not mean that it is appropriate to employ it. The potential benefits need to be greater than the potential risks for clients to ethic justify any form of technology that is used for counseling purposes. The problems presented by the growing of the online advice industry is that consume have few ways to check the credentials of these offering online counseling and there is little to distinguish component therapists firm untrained individuals. Online counseling should be used as an exclusive or primary means of delivering services but initially have value if it’s used as a supplement to face to face counseling.

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74 INFORMED CONSENT Consent is an approval given without any force or threat and with full knowledge and understanding of the matter to which assent relates. A HIV client has also the right for informed consent i.e. he/she has the right to get complete information in order for the client to make an informed choice. It is also against the law to force a client to do what he/she may not be comfortable with. This becomes a dilemma to a counselor when he/she has realized that his/her clients show some signs and symptoms of HIV and maybe the client feels that it is not the one. By educating the client and proving important information about the consequences of HIV/AIDS on the client’s life. This will help them make an informed decision on whether to choose and go for an HIV test then undertake the antiretroviral for the sake of her and others who may be at risk. CONFLICTS OF INTEREST This can bring a dilemma in a counseling session whereby the counselor might gain fame but resulting into conflicts with the client for example a client who comes in the session, and manifests signs and symptoms of HIV. As a counselor you recommend that he/she goes for HIV test. This creates a conflict between the client and counselor since the client may not be comfortable with the issues as she may feel you are imposing things that she may not be ready for. Counselors need to uphold professional conducts, clarify their professional roles and obligations and accept responsibility of their behavior and seek to manage conflict of interest that may lead to confrontations. They need to consult with other professionals and institutions to the extent they need to carry the services to the best interest of their clients. JUSTICE This is the fairness entitled to all people in Kenya. It requires that people with HIV/AIDS be treated fairly and equally. It is often understood to require that benefits and burdens be distributed fairly within the society.

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75 Although the ethical principle are useful guidelines that help to focus discussion, they cannot be mechanically or rigidly be applied nor are they absolute; exceptions to the principle may be appropriate in particular cases. Furthermore they often conflict. Accordingly these ethical principles must be interpreted in the context of specific cases. In the case of a HIV client, the counselor may fail to carry out the session due to biasness on the ground that client seems to be very sick and requires medical attention rather than counseling. Here the clients may not be treated as required by the due to discrimination and stigmatization. RESPECTS FOR PERSONS Respect refers to considering other people’s values and beliefs regardless of their status and age. According to the law of Kenya, respect is one of the rights that all people are entitled to. It is the obligations of the counselor to therefore respect. The client regardless of their status for HIV/AIDS. The counselor needs to be aware of the client’s sickness and protect the individual from stigmatization by going further and psycho-educating his/her members of the family to avoid this. This can be a challenge to the counselor because he/she may not be able to get in touch with the family members. In some cases the client may not want his/her family members to be aware of his/her status. BENEFICENCE AND NON-MALNIFICIENCE Beneficence is working for the benefit of the client while non-magnificence is not doing harm to the client. This is one of the ethical principles of counseling. Counselors in their professional actions should seek to safeguard the welfare and rights as they serve. In the case of a HIV/AIDS clients counselors need to use the attending skills and the UPR. Unconditional positive regard, where they serve their clients regardless of their status. This becomes a dilemma when the counselor is judgmental in his/her work especially when the client poses a risk of infecting others. LEGAL DILEMMAS because he/she has discriminated the client. He/she may also be tempted to discriminate especially if the client is seriously sick with manifested signs.

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76 PROTECTING THOSE AT RISKS As much as the information regarding a HIV/AIDS client should be regarded to be confidential, the law especially in the health fraternity accepts one to disclose the patient’s status without any legal penalty. The counselor may find it difficult to keep this information confidential especially if the client poses a risk to infect others, the counselor may find himself/herself in dilemma not being sure of what to do, whether to keep the information confidential and not bother about those ones at risk or whether to disclose and lose his/her client. COUNSELLING COMMERCIAL SEX WORKERS As per required by the law in relation to health matters, each and every person is required to have an HIV test. In relation to this therefore a counselor, may find him/herself in dilemma in giving out the service to this group. The group may accept to be counseled but refuse to go for a test. The counselor may also not able to counsel sex workers because of how they are regarded by the society. COUNSELING A DISCORDNT COUPLE Discordant couple is a couple which are partner is positive and the one is negative in HIV status. For example if both partners come in a counseling session and one of them is negative, the counselor may find it difficult to help them as a couple. As per how the session is carried out, if does not understand the partners status, then the counselor may not be able to go through the session well because the issue might create conflicts later if the negative partner is not briefed about it may even cause separation or divorce. CONCLUSION As much as we may view counseling as a relationship between the client and the counselor whereby the counselor helps the client in coping up with his/her problems, the relationship may fail due to the dilemmas discussed above. The counselor may be forced to push, direct, persuade or even suggest a solution for the client’s issues which is against the counseling profession. Therefore the counselor may also be required to use techniques that may raise questions regarding the ethnical principles and legal issues of counseling.

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77 ACTIVITY Outline the various emerging issues in counseling - Identify the various legal dilemmas in couselling - In your own view what is the role of technology assisted distant counseling (TADC) and the way forward SELF EVALUATION ASSESSMENT In which ways does the various emerging issues in counseling affect counseling profession, H.I.V /AIDs disability. - Sexual orientation - Multicultural client - Technology assisted distant counseling (T.A.D.C). FURTHER READING Theodore pliant Remley, Barbara Herlihy (2009) Ethical, legal and professional issues in counseling, Practice Hall. INTERNET

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78 GLOSSARY Assent - Express concurrence, when a client has agreed to a counselling service or counselling plan. Child- Person under the age of eighteen (18) years, or as defined in the Children's Act Child abuse- Any physical, mental or sexual harm committed against a child Client - An individual who seeks counselling services, or referred to the professional services of a counsellor for assistance with a situation problem. Confidential- Information that is intended to be kept concealed and should not be disclosed Confidentiality - This is the assurance that information shared during counselling will not be revealed to anyone (conditional) Consent- Approval given without any force, fraud or threat and with full knowledge and understanding of the matter to which the assent relates Contract- A formal agreement between a counsellor and a client in which the counsellor obtains consent to offer assistance to the client. Counselling - A helping relationship, in which a counsellor assists a person through a process to resolve their issues / concerns / situational difficulty, or cope with situation/s Counselling Practicum - A course of practical counselling work undertaken to supplement counselling academic work Counselling Records - Content of counselling session/s Counselling Session - Time spent with a client in a counselling setting Counsellor - A professional who assists people to resolve their issues, concerns or situational difficulty. Counsellors fulfill several roles and responsibilities such as counsellor educators, researchers, supervisors, practitioners, and consultants.

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79 Counsellor Educator - A professional counsellor who is engaged in developing, implementing and supervising through counsellors training. Counsellor Supervisor - A more experienced professional and certified counsellor, psychologist or psychotherapist who provides counsellor support and ensures counselling standards and ethics are upheld in high esteem. The counsellor supervisor engages in a formal relationship with a practicing counsellor or counsellor in-training. This is for the purpose of overseeing the individual development in counselling or clinical skills development. Disclosure- The act of revealing sensitive information especially of about the self to another person Document- Any written, digital, audio, visual, or artistic recording of counselling work in the relationship between counsellor and client. Guardian- A person who has charge, or is appointed to take over parental responsibility of a child, or is in control of the child. Parent- Refers to mother or father, or any other person who has been given the responsibility to maintain a child, or has been granted custody of a child Policy- A statement of intent of an organization’s position on a particular issue Referral- This happens when a person Is recommended to another person or agency for appropriate care and services Sexual harassment - Unwelcome acts of a sexual nature that cause discomfort to the targeted person. These include words, persistent request for sexual favours, gestures, touch, suggestions, coerced sexual intercourse or rape Supervisor - A counsellor who are trained to oversee the professional training and development of a counsellor in training including clinical work. Student- Individual engaged in formal educational preparation as a counsellor.

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80 Teaching- All activities that are elements of formal educational programme for Preparation in counselling. Therapy- A healing process, treatment without medication. Training- Instruction and practice of counselling skills. Autonomy. Respect for the individual client without imposing counsellors values. This is to allow the client to be their unique self Beneficence. Working for the good of the client. Working for the benefit of the client. Non-Maleficience. Do no harm to the client. Whatever the counsellor will do will be for the good of the client. Justice. Being fair to all irrespective of their race, faith, colour, economic status, gender, and ethnicity. Fidelity. Trustworthiness with the client. Veracity. The trustfulness of the therapist/counsellor when dealing with the client. Competence. Therapist/counsellor should be adequately trained, exposed, experienced and under supervision when handling clients. Ability to assess clients for purposes of ascertaining case management and / or placement. Empathy. The ability to get into the world of the client and to communicate this to the client. This is a core quality. Integrity . Personal genuineness and honesty. What you see is what you get. Respect. Showing consideration and esteem for others as individual human beings and* not because of their role or position. Humility . To look at oneself truthfully and assess one's own strengths and weaknesses. It is therefore self-awareness of one's own truth. Wisdom . To practice sound judgment and common sense. To realize that exceptions and ambiguities and contradictions quite often exist in real life situations. The law can sometimes be an ass.

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81 Courage . The capacity to act not without fear but despite fear. To risk going outside one's own comfort zone. Ethics: beliefs we hold about what constitutes right conduct Ethical are moral principles development by an individual or group to provide rules to right conduct. Morality: is concerned with perspective of right and proper conduct and involve an evaluation of actions on basis of broader cultural context or religious standard. Moral (community standards) moral vary from one culture to another. What is considered as malpractice or misbehavior in one place may not be considered as malpractice or misbehavior in another place. More so about counselor’s social conduct with clients. Community standards therefore become the ultimate legal criteria for assessing counseling behavior. Professionalism: has to do with adhere to what is expected in ethic codes. It is possible to act unprofessionally and also unethically. However these are some issues that are unprofessional and also unethical. E.g. sexual intimacy between counselors and clients.

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82 REFERENCES (i) Tarvydas 2 nd Edition Cottone (2006); Outlines &Highlights For Ethical And Professional issues in counseling ;Isbn: 0130268526; Academic Inernet Publishers. (ii) Pliant Remley ,Barbara Brooks/ Herlihy (2009); Ethical ,Legal And Professiona l Issues in (iii) counseling ;Prentice Hall. (iv) American Counselling Association (19.95);Code of Ethics and Standards of Practice;Author ,Alexandria, V A. (v) Corey, C., Corey, M. S & Callan, P. (1998); Issues and Ethics in the Helping Professionals Brooks/Cole, Boston. (vi) American Counseling Association (1995); Ethical Principles of Psychologists and Code of conduct; Author, Washington,DC.

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83 SAMPLE PAST PAPER MT. KENYA UNIVERSITY SCHOOL OF SOCIAL SCIENCES DEPARTMENT OF PSYCHOLOGY OF SEMESTER UNIVERSITY EXAMINATION DISTANCE LEARNING PROGRAMME UNIT CODE: BCP 2202 TITLE: ETHICAL, LEGAL AND PROFESSIONAL ISSUES IN COUNSELLING Time: 2 hrs. Instructions: Answer Question ONE and any other TWO from section B

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84 SECTION A Question One a) Define the following terms i) Professionalism- (1mk) ii) Code of ethics. (1mk) iii) Counter- transference. (1mk) i) Counselling- (1mk) ii) Liability (1mk) b) Identify and explain five steps in making ethical decisions in counselling (10mks) c) Discuss five difficult issues that a suicidal client may raise to the counsellor (practioners) (5mks) d) Discuss the issue of transference and counter-transference in counselling profession (10mks) SECTION B Question Two a) Discuss the various ethical issues in counselling and explain in details their implication counselling practices (20mks) Question Three a) Define the term Dual relationship (2mks) b) Identify five problematic aspects of engaging in dual relationship (10mks)

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85 c) Identify ethical guideline which should be developed to safeguard or reduce potential negative consequences in counselling (8mks) Question Four a) Discuss various forms of malpractice in counselling gives various examples (10mks) (Every answer should be well explained) 5x2 points=10mks b) Identify and explain five responsibilities of a counsellor to a client counselling (5mks) c) Define the term liability and identify two types of liability (5mks) Question Five a ) Discuss five emerging issues in counselling versus ethical and legal dilemmas (10mks) b) Identify guidelines/strategies for dealing ethically with feelings of attraction so as to avoid sexual exploitation of clients (10mks)

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86 SAMPLE CAT PAPER MT. KENYA UNIVERSITY SCHOOL OF SOCIAL SCIENCES DEPARTMENT OF PSYCHOLOGY OF SEMESTER UNIVERSITY EXAMINATION DISTANCE LEARNING PROGRAMME UNIT CODE: CCU 212 TITLE: ETHICAL, LEGAL AND PROFESSIONAL ISSUES IN COUNSELLING Time: 2 hrs. Instructions: Answer Question ONE and any other TWO from section B 1a) Define the following terms (5mks) i) Malpractice ii) Dual relations iii) Code of ethics iv) Ethical

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87 v) Legal b) Identify and explain five rights of a client in a counseling profession (5mks) c) Explain the implication of the following ethical issues in supervision and consultation in counselling profession i) Ethical issues in private practice (2mks) ii) Ethical issues in legal guidance (3mks) TAKE AWAY ASSIGNMENT Discuss the underlined five emerging issues in counseling versus ethical and legal dilemmas. - HIV/AIDS disability - Sexual orientation - Technology assisted distant counselling

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