Reflections on Ethics in Counselling

One day I received a call from the executive director of one of the Christian counseling centers to which I had sent my resume. This agency was an established center, well known and well respected by many in the lay community.

After some preliminary discussion of my qualifications, I asked the director for more details about the programs at his center. “Just a minute,” he replied. I could hear him rustling through some papers. “Take down these names and numbers,” he said rather brusquely once he returned to the phone. I complied, but after taking down several listings, I felt myself becoming vaguely uncomfortable. “Dr. Doe (not his real name), exactly who are these people?” I asked.

“They’re my clients,” he replied. “I want you to call them and hear from their perspective what we do here and how they like what we do. If you like what you hear, you can call me back.”

After pausing for a moment, certainly not wanting to question an older, seemingly wiser colleague, I ventured rather carefully, “Uh Dr. Doe, have these clients given you permission to release their names and numbers?”

“Sure,” he replied flippantly. With a hint of sarcasm he asked, “Why is that so important to you?”

“Well,” I began hesitantly, “I was trained to follow the APA (American Psychological Association) Code of Ethics, which says-”

He cut me off abruptly. “APA Code of Ethics? Well, Dr. Sanders, that tells me something about you. We hold to a higher standard of ethics here – Christian ethics, not APA ethics! You know, Dr. Sanders,” he continued, “I don’t think we need your services at our center after all. Goodby!” And with that he abruptly hung up the phone. (Sanders, 1997, pp.11-12)

As a Christian who has actively chosen to be educated in a Christian college in order to practice as a Christian counsellor in future, Dr. Sander’s ethical dilemma greatly challenged me and highlighted several issues that have impacted me in unit SO 251. Here, I have chosen to enumerate the more impacting issues; personal values and beliefs and how are they affecting my view of counseling; importance of ethics; my views about secular ethics and Christian ethics, strengths and limitations of the different codes; my understanding of ethical principles and how they challenge my personal principles and values; importance of informed consent process; multiple relationship issues; interaction with colleagues; cultural issues; on the continuum of absolutism and relativism; interaction with various ethical decision-making models.

This paper will present the above-mentioned questions sequentially. Where relevant I will present implications of Christian perspective and how the issues discussed have been integrated into my personal ethical and professional approach to counselling. The final section of the paper will present four ways I will develop my awareness and skills to cultivate a sound ethical and professional approach to my counselling practice.

Studying ethics made me realise that the first element in making ethical decisions is to continually examine my personal feelings, motives and values. In order to be ethical, I need to examine perhaps first and foremost, my motives behind being a counsellor. Darrell Reeck identified “exploitation of clients supported by egoism” as the opposite to the goal of “enablement” in client relationships (1982, p. 12). I am relieved to declare that my motivation to practice as a counsellor comes from a desire to see the client develop into a fully functioning person (Roger, 1961). I believe that only Jesus can save anyone and my role as a counsellor is to provide a safe and empathetic environment for the client to hear the guiding voice of God within.

Ethics is important to me because, like the Law in the Bible, it serves to inform and govern my behaviour as a professional. Ethics is also the authority and institutional empowerment to act as a counsellor. Reeck describes professional ethics as “ the ensemble of moral skills, institutional mandates, and psychological identities that inevitably influence a professional’s reflection on the ethical dimensions of problems encountered in one’s practice” (1982, p.15).

As Christians, we want to practice not only doing right but also being moral people. Morality is a state of being as much as it is doing. Ideally, if we are to follow a higher ethic, we must be growing in virtue as well as in principle. Character traits such as trustworthiness, wisdom, humility and integrity must have been developed and be developing alongside a knowledge of the rules of conduct; otherwise we become legalistic, applying rules arbitrarily to situations where the spirit of the law- the internal law- might tell us to intervene more carefully. (Sanders, 1997, p. 20)

The introduction to this paper presented an ethical dilemma in which “Dr. Doe” argued that his organisation is called to “higher standards of ethics – Christian ethics” and therefore not subjected to the APA code of ethics. Although Dr. Doe’s logic was incongruent with his behaviour, the incident highlights important issues of which codes do I subscribe to as a Christian.

The ethics codes that have been created by various secular professional guilds are fundamental rules of practice hammered out through years of common experience. For the most part these codes are straightforward and place most of their emphasis on the patient’s welfare. Recognising that professional intervention can have negative as well as positive outcomes, the codes encourage practitioners to take all reasonable steps to “do no harm” to their patients (Fernhoff, 1993). As documents devised in a pluralistic culture, the codes usually avoid issues that would undoubtedly offend a particular cultural or religious group. In a certain respect they represent the minimum that a therapist should do to behave ethically, and there is relatively little in them that would clearly contradict a Christian ethic. (Sanders, 1997, p. 19)

Dr. Sanders (1997) is of the opinion that secular and Christian ethics are non-conflicting as demonstrated in the above quote. Personally, I agree with Dr. Sanders’ sentiment and I have not been able to identify any conflict thus far.

Beyond specific ethical dilemmas, Christians must also consider whether or not they are called to more than a mere practice of the “rules ethics” established by professional guilds. Surely those who live under grace are called to a higher ethic. (Sanders, 1997, p. 20)

In Australia, depending on location and area of specialisation, a counsellor has many codes of ethics from many organisations as reference. In Queensland, a counsellor may refer to these organisations; Australian Counselling Association (ACA), Psychotherapy & Counselling Federation of Australia (PACFA), Queensland Counsellors Association (QCA), Christian Counsellors Association of Australia(CCAA), Australian Association of Social Workers (AASW) and Australian Community Workers Association (AACW) etc. Choosing to work with certain codes may arise from a membership obligation, as I choose to be affiliated with a certain organisation, or from an active decision to be guided by experienced practitioners from a certain organisation.

PACFA, for example, acknowledges in their code of ethics that there are diverse approaches to ethics and warns against “relying too heavily on any single ethical approach” (PACFA, 2011, p. 8). An examination of three codes of ethics demonstrates the different approaches to professional practice. The PACFA code of ethics, which provides an ethical framework targeted towards “best practice for counselling and psychotherapy”, does not offer an ethical decision-making model for members but provides detailed descriptions of principles and values (2011, p. 1). In contrast, AASW aims “to ethically engage and interact with Aboriginal and Torres Straits Islander Australians to promote, achieve and maintain their overall well being” (2010, p. 2). AASW’s code of ethics is more descriptive and presents practice responsibilities in greater detail. The CCAA code of ethics (2007), written for members who are presumably Christian counsellors, takes a more instructional tone. It does not explore the ethical decision-making process and presumes knowledge of counselling values. As a counsellor in training, I will gain from understanding and applying all three codes as each has its own special strength and focus.

Principles are founded on values and are the outward action of values applied (Sanders, 1997, p. 9). PACFA listed six principles; Fidelity, Autonomy, Beneficence, Non-maleficence, Justice and Self-respect. Diane Perrin listed eight others apart from the above six; Confidentiality, Gratitude, Ordering, Publicity, Reparation, Respect for persons, Universality, Utility and Veracity (Perrin, D, Week 1 lecture notes, 2013, pp. 2-5). Personally, I used to rank Beneficence as the highest priority followed by Non-maleficence, Justice, Self-respect and Respect for persons, Veracity, Fidelity, followed by the other principles. I now see the fallacy of placing Beneficence as the highest priority regardless of situation. In addition, I realised that Autonomy is one of the key principles of an ethical therapeutic relationship. Autonomy is extremely important to empower clients to become fully functioning people. These principles need to be executed simultaneously to achieve an ethical professional practice. Empowerment is so crucial in an ethical therapeutic relationship that it should govern the process on the outset.

Informed consent process is one of the essential ways to empower the client at the onset of the therapeutic relationship, learning about the process and its importance has further impacted my understanding of counselling practice. Many ethical dilemmas can perhaps be avoided from with a comprehensive and well-implemented informed consent process. “Taking the time needed to complete the informed consent process effectively will greatly reduce the possibility of a misunderstanding, and an ethical complaint against the therapist, later” (Ford, 2001, p. 104). According to Corey, Corey and Callaghan (2011, p. 161 – p. 168) the consent should include; therapeutic process, background of therapist, costs, length of therapy and termination, consultation with colleagues, interruption in therapy (emergency practice), benefits and risks of treatment, alternatives to traditional therapy, recording, clients’ right of access to their files, rights pertaining to diagnostic classifying, nature and purpose of confidentiality. In the process of writing assessment two, I realised the importance of informed consent and how it can guide the therapeutic relationship. I would like to dedicate time to the informed consent process and begin synthesising a process for myself as a part of my journey towards an ethical practice.

Another topic that impacted me is the discussion and codes on multiple relationships. This topic challenged me to consider when, where and why I might be tempted or placed in situations where I have multiple relationships with clients. Pope & Vasquez suggested that three aspects of multiple relationships increases the probability of ethical dilemmas; roles expectation conflicts; different roles might cause disunited obligations and reduction in objectivity; disproportionate power and greater risk of exploitation. In my practice, I will endeavour to avoid multiple relationships except in situations where I have had adequate consultation with my supervisors and client and we are sufficiently assured that it is serves the most good and no harm to the client. Mention of consultation with supervisors brings me to another topic that has impacted me.

That topic is, how do I perceive interaction with colleagues. Closely tied in with this topic is the realisation of the limitation of training and need to seek other colleagues who possess specialised knowledge and are more experienced. I have so far greatly benefitted from having lecturers from diverse backgrounds and listening to their experience and strategies to apply theoretical knowledge. I hope to continue to keep in touch with these lecturers as my colleagues and part of my support network for more effective practice. Reflection on the importance of support network brings me to other issues involved in interacting with colleagues. Apart from benefiting from colleagues’ support and being accountable to each other, colleagues may be a good source of peer review and professional evaluation (Reeck, 1982, pp.123-124). PACFA advises maintenance of professional relationships with colleagues by not being “prejudiced by own personal views about a colleague’s lifestyle, gender, age, disability, race, sexual orientation, beliefs or culture” (2011, p. 20).

Not only do I need to respect diversity in my colleagues, but to be an ethical counsellor, I need to show cultural sensitivity to my clients. Multicultural issues are complex and not limited to general and observable differences such as; gender, race, age, nationality, social class. Diversity can stem from differences in beliefs and values. For example, not all Australian, middle class, heterosexual males of English descent share the same beliefs and values. SO 251 has opened my eyes to greater sensitivity to cultural diversity and established the need to sensitively check with the clients on any cultural issues.

Along the continuum of absolutism and relativism, I leaned heavily towards relativism. I realised this tendency during the lecture by Dr. Lake where he discussed four approaches to confidentiality in child safety practice. Upon reflection I realised that I had unknowingly leaned heavily towards provisional or conditional confidentiality, and even perhaps, unqualified or total confidentiality (Lake, S, lecture note, 2013, p. 15) in my most recent encounter with children on the issue of deception. The results of the encounter together with awareness of the need to involve the parents in dealing with issues caused me to reanalyse my position. In my future practice, I hope to increase and consider engagement of parents in the process as much as it is ethically viable. I am further reminded of the God given mandate to parents by biblical verses such as Proverbs 29, Proverbs 13, Proverbs 23, and Proverbs 22. I believe now that engaging and empowering parents also serves to facilitate and empower children to obey and honour their parents as instructed by verses; Ephesians 6 and Exodus 20. I have chosen the revelation to demonstrate that I need to continue to examine where I stand on the continuum of absolutism and relativism with regards to approaches other major ethical dilemmas so I will not be caught off guard and commit similar ethical mistake in future.

Apart from examining my stand on the continuum of absolutism and relativism, there are numerous ethical decision making models that can assist me to make effective ethical decisions. I see the benefit of using the feminist model where a practitioner examines both rationale-evaluative and feeling-intuitive aspects of the dilemma and engages the client as much as possible in the process. Most of all, I appreciate Sanders’ model where God’s nature is an integral part of the decision making process, set in relevant code of ethics.

Generally, unit SO 251 has helped me to realise that there is much I need to do to develop a sound ethical and professional approach to my counselling practice. This paper illustrates four ways that I can continue to develop the awareness and skills required for this development. Firstly, I will have a proactive reflection of values. I have created a personal creed and displayed it on my bedroom wall for this purpose. I hope to continue to examine and refine this creed throughout my practice. Secondly, I plan to create awareness through frequent review of my practice. Video, audio recordings and written records, along with processing with my supervisor should facilitate my professional development. Thirdly, I plan to continue to attend professional events and read relevant latest legislation, in addition to holding conversations with colleagues about legislative and service changes. The conversations would hopefully inform me and assist me in gathering strategies to make informed decision about my own practice. Fourthly, I plan to read about available case studies in order to contemplate and familiarise with availability of different strategies and tactics to manage a variety of ethical decisions.

“For a Christian the process of being ethical and becoming ethical takes place in the context of relationship – with God, the Holy Spirit and our fellow Christians.” (Sanders, 1997, p. 22) Dr. Sanders presented one of my sentiments that the complexity and intricacies of ethical practice calls for integrated assistance from God and fellow colleagues. I realised during unit SO 251 that knowledge is the responsibility of the beholder. CCAA implies this revelation in 1.1.2 and 1.1.3 of their code of ethics; “Accept and maintain the highest ethical standards in their own personal life, and; Not judge others by such standards” (2007, p. 1). While I possess knowledge and skills of counselling and ethics, it is my responsibility to perform them and execute them to the highest standards in my personal life. However, it is not my place to judge others with these standards that I have chosen to receive. In cases, where colleagues have fallen short of the ethical standards, I am called to walk alongside those colleagues, encourage them and refer them to relevant help.

In conclusion, unit SO 251 has greatly impacted me in many areas and facilitated awareness, examination and development of an ethical and professional approach to my counselling practice. Whilst I was unsure about my values in different areas paramount to counselling practice, I now have clear ideas and direction for improvement. The unit has also challenged my understanding of what it means to be a Christian counsellor, where I now understand that ethics is my mandate to offer best practice with the help of God and colleagues.

References :

Australian Association of Social Workers. (2010). Code of ethics. Australia : Australian Association of Social Workers. Retrieved 18 July 2013, from http://www.aasw. asn.au /document/item/740

Christian Counsellors Association of Australia. (2012). Code of ethics. Retrieved 18 July 2013, http://www.ccaa.net.au/aust/documents/ CCAA%20Code%20of%20Ethics.pdf

Corey, G. Corey, M. S. & Callaghan, P. (2011). Issues and ethics in the helping professions. (8^th ed.) USA : Brooks /Cole, Cengage Learning.

Ford, G. G. (2001). Ethical reasoning in the mental health professions. USA : CRC Press.

Lake, S. (2013). SO 251 Lecture Notes, Brisbane: Christian Heritage College.

Perrin, D. (2013). SO 251 Lecture Notes, Brisbane: Christian Heritage College.

Pope, K. & Vasquez, M. (2011). Ethics in Psychotherapy and Counseling : A Practical guide. (2^nd ed.) New Jersey : John Wiley & Sons, Inc.

Psychotherapy & Counseling Federation of Australia. (2011). Code of ethics: The ethical framework for best practice in counselling and psychotherapy. Lutterworth, Leicestershire : British Association for Counselling and Psychotherapy, BACP House. Retrieved 18 July 2013, http://www.pacfa.org.au /sitebuilder/aboutus/knowledge/asset/files/4/2012pacfacodeofethics.pdf

Reeck, D. (1982). Ethics for professions: A Christian perspective. USA : Augsburg.

Rogers, C. R. (1961). On  becoming a person : A therapist’s view of psychotherapy. New York : Houghton Mifflin.

Sanders, R. K. (1997). Christian counseling ethics: A handbook for therapists, pastors & counselors. (Ed.) Downers Grove, Illinois : Inter