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Ethics and Confidentiality in Substance Abuse and Mental
Health
Linda K. Harrison, MS, LPCS, CCS, MAC AshevilleClinicalCounseling.com
[email protected] 828-380-2948
Write Down An Ethical or Legal Concern
• Write down an ethical or legal concern. Be specific to what concerns you most. You can also add if you were able to report it and what was done. Behavioral health ethical concerns in any setting.
• Make a decision about how to get support around your ethical or legal concern. Do you have an immediate clinical or administrative supervisor that can help you?
Ethics Defined in Relation to Culture:
• In mental health care, ethics and culture are intimately intertwined. To practice ethically requires awareness, sensitivity, and empathy for the patient as an individual, including his or her cultural values and beliefs.
• Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions.
Jinger G. Hoop , Tony DiPasquale , Juan M. Hernandez & Laura Weiss Roberts (2008) Ethics and Culture in Mental Health Care, ETHICS & BEHAVIOR, 18:4, 353-372, DOI: 10.1080/10508420701713048
To link to this article: https://doi.org/10.1080/10508420701713048
Recognize and Work Within The Power Differential
• Client to counselor • Counselor to supervisor • Supervisor to governing board and
professional board • Governing board to professional
board and legal system
Approaches to Ethics
• Normative: What is normally acceptable. • Common Morality: What does society hold
to in accepted standards of morality. • Codes of Professional Ethics: APA, NASW,
NBCC, NCSAPPB • Governmental Guidelines/Public Policy/
Agency Policy
Powell, 2004.
Kitchener’s Model of Ethical Formation: Reflective Judgment Model
• Ethical Theory leads to…… • Ethical Principles leads to….. • Ethical Rules and Guidelines leads to……… • The Intuitive Level which is immediate
action and judgement based on….
The facts of the situation and ordinary common sense.
Four Principles of Ethical Decision-Making
• Autonomy • Beneficence • Non-Malfeasance • Justice • Fidelity
A Practitioner's Guide to Ethical Decision Making. 1996 ACA. Holly Forester-Miller, Ph.D. Thomas Davis, Ph.D.
Four Questions That Assist with Ethical Decision-making
1. Is the counselor giving the client the freedom to make choices about his or her direction in treatment? (Autonomy)
2. Is the counselor providing hope, encouragement, and support for the client’s decisions that are individualized , in line with the client’s values, and in the client’s best interest regarding change toward successful recovery?
(Beneficence)
Four Questions That Assist with Ethical Decision-making
3. Is the counselor working with the client in a way that will “do no harm”? (Non-malfeasance)
4. Are ethical codes, laws, and universal values being followed by the counselor and is the counselor providing fairness to all that are involved with this client’s treatment? (Justice)
5. Is the counselor displaying faithfulness, and honoring commitments to support the therapeutic relationship? (Fidelity)
A Practitioner's Guide to Ethical Decision Making. 1996 ACA. Holly Forester-Miller, Ph.D. Thomas Davis, Ph.D.
Case Study
• You are having your house painted. You arrive home from work early and see that one of the people that is painting your house is a former client. What do you do?
Would it make a difference if he were currently your client?
• You go out with your friends to Papa’s and Beer after work. You’re having a beer and nachos when you look up and see a current SA client tossing down a few cold ones in the next booth. What do you do?
Case Study
• Your co-worker that helps with SAIOP from time to time is reporting about their years of sobriety to the group and how he got sober. A week later, you see him out at a bar drinking what appears to be beer. What to do?
• A co-worker, peer support specialist confides in you that she has started seeing a client that is actively on her caseload….what to do. You don’t want to see her lose her job she’s great with clients and so helpful.
Case Study
• A woman and man are dating. Both are counselors. One specializes in a therapy that she can supervise other counselors to achieve their certification. Her boyfriend is seeking that certification and she tells him that she can supervise him. It is a mostly platonic relationship but they still date. Is this an ethical decision? What are possible consequences?
Case Study• A wilderness program for teens is using
timeout to address noncompliant behaviors by placing the student (ages 13-17) in a 4x4 ft square on the forest floor away from other students. They only come out of the square to use the bathroom and sleep. They must eat their meals while in the square. This can last up to 3 days. You’re a new counselor and this seems harsh to you. You are assured by staff that this is both effective in changing the child’s behavior and ethical. What steps do you take to explore whether or not this is ethical and or legal?
Case Study• An agency has bought an old two story
house with a large front porch that sits downtown right on the sidewalk in a major thoroughfare. It’s a beautiful day and the counselor says, “Let’s go outside on the porch for group therapy today”. Everyone in the group jumps up, ready to go except 2-3 members. Is this ethical and how might it be resolved? Side note: Going out on the porch allows the counselor and clients to smoke.
Ethical and Legal Perspectives
• Ethical: Exercise control to the highest ethical standards of the profession
• Legal: Exercise minimal control, just above the level of acceptable practice in the profession
Acid Test for Ethical Dilemmas
• Is it legal? • Is it fair? • How do I feel about it myself? • Have I checked it out with someone I trust
and who has strong ethical and moral values?
Ethical Decision Making
• Whose interests are involved? • Who can be harmed and do they have a
voice? • What universal values apply? • Are there values in conflict? • What ethical or legal standards apply?
The Spirit of Ethical Decision-making and Behavior
Do no harm. Do support the benefit of the client. Do set down an example that rises above. Do seek to grow in your own right as a
professional. Do give back with pro bono service. Do sit in the stillness, feeling and knowing the
Spirit of all goodness and healing has brought you to this place. So, ask for help!
Codes of Ethics: The Categories
• Purpose and Scope • Counseling Relationship • Confidentiality, Privileged Communication, Privacy • Counselor Supervision, Training and Teaching • Professional Responsibility • Relationships With Other Professionals • Evaluation, Assessment and Interpretation • Research and Publication • Resolving Issues
ACA Code of Ethics 2014. Link to this site: https://www.counseling.org/knowledge-center/ethics
Ethics: Purpose and Scope
• Ethics involve the recognition of diversity, embracing a cross-cultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts.
ACA Code of Ethics. Link to this site: https://www.counseling.org/knowledge-center/ethics
Ethics: Purpose and Scope
• Professional values are an important way of living out an ethical commitment. Values inform principles. Inherently held values that guide our behaviors or exceed prescribed behaviors are deeply ingrained in the counselor and developed out of personal dedication, rather than the mandatory requirement of an external organization.
ACA Code of Ethics, 2014
The Counseling Relationship:
• Primary responsibility is to respect the dignity and to promote the welfare of the client.
ACA Code of Ethics, 2014
Defining the Counseling Relationship
• Records • Treatment planning • Utilize client support
network • Informed consent • Avoid harm • No romantic or sexual
relationships (5 years) • Advocacy for client • Confidentiality
• Screening and protecting clients (group work)
• End of life care • Refer out if there is a bias
or conflict of interest • Establishing fees and
dealing with nonpayment and bartering
• Technology applications • Termination and Referral
Confidentiality, Privileged Communication and Privacy
Trust is the cornerstone of the counselor relationship. Counselors aspire to earn the trust of the client by creating an ongoing partnership, establishing and upholding appropriate boundaries and maintaining confidentiality.
ACA Code of Ethics, 2014
Confidentiality
• Respecting client rights • Exceptions such as
abuse, neglect, or a judge’s order for records.
• Information shared with others on your team. “Need to know basis.”
• Confidentiality in groups. Is it guaranteed?
• Clients lacking capacity for informed consent: mental illness or inebriated.
• Records • Research and Training • Consultation
Professional Responsibility
• Counselors actively participate in the world, taking on responsibilities from self to all levels of society that impact the counselor and the counseling profession.
ACA Code of Ethics, 2014
Professional Responsibility
• Boundaries of competence: Practice within your “scope of practice”
• Advertising and soliciting clients. Know your boards ethics.
• Professional qualifications and certifications • Nondiscrimination towards all. • Public responsibility. • Advocacy for clients.
Relationships with Other Professionals
• Counselors are respectful of approaches to counseling different than their own.
• Counselors work to develop and strengthen interdisciplinary relations with colleagues
• Counselors participate in interdisciplinary teams • Counselors alert their employers of
inappropriate practices • Counselors consult within their expertise.
Evaluation, Assessment, and Interpretation
Counselors use assessment instruments as one component of the counseling process, taking into account the client personal and cultural context. Counselors promote the well-being of individual clients or groups of clients by developing and using appropriate educational, psychological, and career assessment instruments.
Evaluation, Assessment, and Interpretation
• Explore, discuss and list how evaluation, assessment and interpretation are carried out in the counseling experience.
ACA Code of Ethics, 2014
Supervision, Training, and Teaching
Counselors aspire to foster meaningful and respectful professional relationships and to maintain appropriate boundaries with supervisees and students. Counselors have theoretical and pedagogical foundations for their work and aim to be fair, accurate, and honest in their assessments of counselors-in-training.
American Counseling Association, Code of Ethics 2014
Supervision, Training, and Teaching
• Counselor supervision and client welfare • Counselor supervision competence • Supervisory relationships • Supervisor responsibilities • Counselor educator responsibilities
Research and Publication
Counselors who conduct research are encouraged to contribute to the knowledge base of the profession and promote a clearer understanding of the conditions that lead to a healthy and more just society. Counselors support efforts of researchers by participating fully and willingly whenever possible. Counselors minimize bias and respect diversity in designing and implementing research programs.
ACA Code of Ethics, 2014
Research and Publication
• Explore, discuss and list how research and publication are carried out in the counseling world.
Resolving Ethical Issues
Counselors act in a legal, ethical, and moral manner in the conduct of their professional work. They are aware that client protection and trust in the profession depend on a high level of professional conduct. They hold other counselors to the same standards and are willing to take appropriate action to ensure that these standards are upheld.
Resolving Ethical Issues
• Talk with the person that may have violated their professional ethics first if is it is safe to do so.
• Standards and the law • Suspected violations • Cooperation with ethics committees
ACA Code of Ethics, 2014
Resources
ACA Code of Ethics 2014. https://www.counseling.org/knowledge-center/ethics A Practitioner's Guide to Ethical Decision Making (Kitchener’s Model) https://www.counseling.org/docs/ethics/practitioners_guide.pdf Powell, David. Clinical Supervision in Alcohol and Drug Abuse Counseling. 2004
