Ethical Dilemmas in Counselling and Treatment Methods

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Introduction: What is an Ethical Dilemma?

An ethical dilemma is an intricate situation that involves an apparent mental conflict. One is unable to choose a result that professionally is right but would transgress another. In counselling, it emanates from conflicting professional approaches that affect ones moral imperativeness therefore leading to a moral paradox. Professionally, either a diagnosis pits a previous diagnosis by a counsellor of psychiatrist in an incompetence situation or legal implications arise after confidential data from a diagnosis are released against a patients will, but with the sole purpose of helping the patient recover. In such an event, to ‘disclose these contexts to aggrieved parties or not disclosing’ becomes a moral paradox. Ethical dilemmas are commonplace in counselling and psychiatry. Professionals in these careers often face these dilemmas especially when referrals are made to them.

An Ethical Dilemma

June and Ward’s son Brett is having a physiological problem. A diagnosis by the school counsellor points out a condition known as ADD, ‘attention deficit hyperactivity disorder (Foreman, 2006).

The case of Brett has become an ethical issue based on the following; questions are revolving around what information can be released to the parents (refraining from diagnosis) and parents request to review the diagnosis since no procedure existed in the school (informed consent in assessment).

The Ideal Decision Making Model in This Case

Counsellors face ethical dilemmas throughout their profession. How to address these dilemmas require one to follow an outlined guideline referred to as an ethical decision making model. Ethical decision-making model helps counsellors resolve and treat diagnosed conditions (Ethical Decision-making Models across the Professions, 2003).

Identifying the problem

Brett’s parents sought a second opinion from a family counsellor. He filed their report. He requested the school counsellor to furbish him with the records of his diagnosis on Brett. This information arms the counsellor with adequate information about the boy, his background, pre-existing conditions and any other relevant information that can be helpful (Kitchener, 1984).

Each detail acquired about the case is put down on paper. This helps the counsellor to outline facts and separate hypothesis, assumptions, suspicions and innuendos. This helps clarify the problem, classify it as fitting, professional, legal, ethical, or clinical approach. This approach helps in establishing a comprehensive resolve for the problem (Miller & Davis, 2006).

Ethical Decision making model

In this case, the perspectives of Van Hoose & Paradise (1979), Kitchener (1984), Stadler (1986), Haas & Malouf (1989), Foster-Miller & Rubenstein (1992), and Sileo & Kopala (1993) form the ideal structure of making a proper ethical decision making model. Their perspectives form a practical 7 steps ethical decision-making model that is ideal for this ethical dilemma. This ethical decision making model is as follows, and it addresses comprehensively this dilemma.

Applying the ACA code of ethics

According to the ACA code of ethics, once you identify the problem, the ACA code of ethics helps you to resolve dilemmas (ACA, 2005). It addresses various issues and if the dilemma you face is addressed here, it is ideal to use the approach underline on the ACA code of ethics. If the ethical dilemma takes the dimension of what you deem as the redress offered by the ACA code of ethics, then you should resolve it promptly, only if you understand the context as per the caps and the implications of taking that route to resolve the issue (Standler, 1986).

Determine the ethical dimension of the dilemma and its nature.
Come up with a list of resolve fitting this problem, through analysing all available medical, therapeutic, and even rehabilitative measures.
Put down all the implications that would emanate from resolves of this problem. This protects the counsellor from making the wrong decision that would jeopardize his career, compromise his patient, infringe his patients rights and confidentiality and his guardians rights.
Carefully weigh the course of action. Many counsellors fail to identify the correct measures since the ethical dilemma and the appropriate medication to treat the condition interfere with the code of ethics and could result to legal implications.
Based on your findings, resolve this problem comprehensively, this may include treating the condition through medication and therapeutic approaches.

Bias and influence

Professionally, personal opinion and objectives to address this issue and a reciprocal from both parents is biased. However, what would compel one professional approach is based on ethical considerations. The child’s well being could compel a biased approach since as a counsellor; the patient’s confidentiality is case is paramount. Protecting the kid is important than the interests of the parents. The approach the counsellor takes is influenced by the previous diagnosis, professional ethics and personal opinion (Haas & Malouf, 1989). The parents might feel denied the chance to participate and contribute to their child’s well being by the counsellor’s methods. This is due tot the fact that the counsellor is biased to the child (Exploratory study of common and challenging ethical dilemmas experienced by professional school counsellors, 2009).

I feel it’s my obligation to treat the child without divulging as much information as the parents want. The counsellor in his capacity has to deliver based on acting in an ethically responsible way concerning the patient (Van Hoose, 1980). The counsellor in his capacity maintains honesty and the best interests or the client without prejudice or objective to gain. He should understand comprehensively the implications, that the solution will work, and that the approach was based on professionalism (Van Hoose & Paradise, 1997). In the event of breaching these codes of ethics principles, the counsellor exposes himself to legal prejudices arising from his failure to understand these guidelines properly (Kitchener, 1984).

Pennsylvania State laws on ethical dilemmas involving schoolchildren

If the guardians or a client questions the treatment, physiological, clinical or rehabilitative, legal implications may follow. This will force the counsellor to appear in court and defend his actions. Unfortunately, professional ethics might force a counsellor to use an-unpopular method.

The law clearly states that, counsellors are required to abide by the ethical standards of their particular professional organizations.
The law emphasizes that the professional counsellor should strictly abide to the confidentiality perspective (Van Hoose, 1980).
Disclose to the clients/parents methods of treatment, the risks and benefits of the method and make sure the patient’s welfare and health is maintained.
Inform the parents about the limitations, goals risks and benefits when counselling is initiated.
Determine if the client is receiving services from another practitioner, if so; refrain from providing services until the other professional consents alongside the client.
Recognize conflicts of interest and inform all parties of the nature and directions of loyalties and responsibilities involved.

These laws are stated in the Pennsylvania counselling laws and directly affect this case. Breaking them could have eventual legal implications (Sileo & Kopala 19).

How State laws affect this approach

Balancing Brett’s confidentiality and parental rights is overburdening. Brett is a minor (under 18 years of age), hence he cannot legally provide informed consent for his counselling and treatment, and as such, his parent’s rights supersede the context of confidentiality. Ethically, confidentiality is needed between the counsellor and Brett within to establish a relationship (Kitchener, 1984); however, his parents want more information than the counsellor believes should be divulged to them in this case.

The sensitive nature of the counsellor relationship with the child cannot be prejudiced in favour of the parents. The counsellor is bound by the law to strictly follow a code of ethics. He will have to deliver without prejudice, favour, or objective to gain in any way from his actions.

The previous diagnosis and subsequent recommendations by the school counsellor forces the counsellor to recognize conflicts of interest. This compels him to inform all parties of the nature and directions of loyalties and responsibilities involved.

The counsellor should determine if the client is receiving services from another practitioner, in this case the school counsellor. If so; refrain from providing services until the other professional consents alongside the client. During treatment, a child may reject treatment or to undergo psychiatric examination. This calls for a closer look at the code of ethics and ones professional priorities. If the ACA code of ethics fails to address this, and then a referral is the obvious next step.

Resolution to Ethical Dilemma

Ethical and legal perspectives surrounding ethical dilemmas should be understood, well (Kitchener, 1984).The ethical practices in the treatment of this condition are consistent with the four principles of beneficence, non-maleficence, justice, and respect to confidentiality or autonomy. There are minimal legal implications that would arise from the diagnosis or treatment of ADHD. However, legal implications would arise in the event where the counsellor treating the patient involves other agencies to supply or disseminate crucial material or information that would contribute to the treatment of this disorder (Foreman, 2006).

Resolving the ethical dilemma using the ACA Code of ethics provisions

The questions revolving around what information can be released to the parents. This type of ethical dilemma is renowned refraining from diagnosis while the ethical dilemma emanating from parents request to review the diagnosis since no procedure existed in the school is known as informed consent in assessment (Rosenbaum, 1982)..

Dialogue

The initial steps of resolving this dilemma is to open communication with all parties involved. Dialogue will help the counsellor inform the parents about his findings, recommendations and other core issues necessary to treat the child.

In this case, it is advisable to widely consult with other professionals. Seek their opinion and recommendations, especially the school counsellor.

Use knowledge

Counsellors need to review the counsellor’s ACA code of ethics thoroughly. This will provide him with an insight on treatment and legal implications. Failure to understand the code of ethics is not defence against unethical conduct.

Assess conflicts between ethics and laws

The counsellor’s ethical responsibilities may conflict with the law. The counsellor should make known his commitment to the ACA code of ethics as the way forward to resolve the problem. In the event the dilemma cannot be resolved through the Code of ethics, then the legal way should be used promptly.

Report ethical violations

The report by the school counsellor indicates that he violated the code of ethics. He failed to abide by the ethical standards. Unless reported, the parents will still pursue the same and sue the current counsellor for failing to do so.

Consultation

If uncertain about his actions, the counsellor should consult with other professionals who are knowledgeable about ethics and the ACA code of ethics. Consultations provide resolves to the dilemma easily (Sileo & Kopala, 1993).

Resolving the ethical dilemma legally

The law clearly states that, counsellors are required to abide by the ethical standards of their particular professional organizations. It is then advisable to stick to the laws governing the practice and avoid indulging in processes that would result to breaking these laws. Breaking the laws will have legal implications.

The law advises that the counsellor disclose to the clients/parents methods of treatment, the risks and benefits of the method and make sure the patient’s welfare and health is maintained (ACA Code of ethics, 2005). The client will have no legal edge since he/she was informed promptly.

The counsellor should inform the parents about the limitations, goals risks and benefits when counselling is initiated (Miller & Rubenstein, 1992). The parents will be aware of each these benchmarks hence cannot accuse the counsellor of withholding such information.

The counsellor should recognize conflicts of interest and inform all parties of the nature and directions of loyalties and responsibilities involved. This will help him to confidently carry out his duties in the sessions.

Regardless of the nature of his findings, the counsellor should not withhold results (Van Hoose, 1980). It is his obligation to report all his findings promptly. The law requires of the counsellor to report the results of any research of professional importance. The results here are unfavourable on Brett’s school counsellor (ACA Code of ethics, 2005).

Bias influence, personal values, and emotion in ethical dilemmas

Bias influence

The patient (Brett) is a victim of professional ethics. Apparently, it is important to make him priority. Recommending a treatment is more important than the interests of the parents are. My perception is, once the kid begins recovering, the parents will be happy and thankful. However, resolving the dilemma is not priority while taking the schools counsellor to task will be important (Van Hoose & Paradise, 1997). It is an important step to show the credibility of my diagnosis and adherence to the code of ethics (Exploratory study of common and challenging ethical dilemmas experienced by professional school counsellors, 2009).

Personal values

Imposing personal values are commonplace in counselling. Treating Brett’s condition through a pharmacology approach is apparently more effective than the behavioural therapy approach. The parents are insistent that a therapeutic approach is better. Two, ignoring the school counsellor’s failure to diagnose the condition earlier is not priority to the parents; however, my recommendation is that, this should be reported.

Emotions

The plight of the June and Ward family is moving. As a counsellor, I have developed emotions, especially toward the child Brett who is suffering. The child is oblivious of his problem. He is struggling innocently with a debilitating condition. Am feeling that it is my obligation to correct this condition and help the family go through this difficult phase in their lives. I have developed a special bond with the child and become protective.

My Recommendations to these problems

While bias, emotions and personal values might contribute positively, it is important to uphold professional ethics and rise against these personal influences, biases and emotions (Rosenbaum, 1982). Resolving the ethical dilemma should be prioritized, seconded by the treatment of Brett (Ethical Decision-making Models Across the Professions, 2003).

Adhering to the code of ethics and following the provisions of the law should remain the principals of my profession (ACA Code of ethics, 2005). This way I will be able to diligently and professional come over these personal influences, (Haas & Malouf, 1989). Consulting about the same with a close professional will also provide me with insight to manage this.

References

American Counselling Association (2005). Code of Ethics. Web.

Ethical Decision-making Models Across the Professions (2003). Web.

Exploratory study of common and challenging ethical dilemmas experienced by professional school counsellors (2009). Web.

Foreman (2006).Attention deficit hyperactivity disorder: legal and ethical aspects. Web.

Haas, L.J. & Malouf, J.L. (1989). Keeping up the good work: A practitioner’s guide to mental health ethics. Sarasota, FL: Professional Resource Exchange, Inc.

Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The Foundation for ethical decisions in counselling psychology. Counselling Psychologist, 12(3), 43-55.

Miller & Davis (2006) A Practitioner’s Guide to Ethical Decision Making. Web.

Sileo, F. & Kopala, M. (1993). An A-B-C-D-E worksheet for promoting beneficence when considering ethical issues. Counselling and Values, 37, 89-95.

Stadler, H. A. (1986). Making hard choices: Clarifying controversial ethical issues. Counselling & Human Development, 19, 1-10.

Van Hoose, W.H. (1980). Ethics and counselling. Counselling & Human Development, 13(1), 1-12.

Van Hoose, W.H. & Paradise, L.V. (1979). Ethics in counselling and psychotherapy: Perspectives in issues and decision-making. Cranston, RI: Carroll Press.

Forester-Miller, H. & Rubenstein, R.L. (1992). Group Counselling: Ethics and Professional Issues. In D. Capuzzi & D. R. Gross (Eds.) Introduction to Group Counselling (307-323). Denver, CO: Love Publishing Co.

Rosenbaum, M. (1982). Ethical problems of Group Psychotherapy. In M. Rosenbaum (Ed.), Ethics and values in psychotherapy: A guidebook (237-257). New York: Free Press.

Counsellor’s positions about ethical dilemmas

An interview with a family psychiatrist

What professional ethical code do you adhere to as a professional?

I adhere to the ACA code of ethics. It has ready resolves for dilemmas in this profession.

Please discuss an example of the most difficult ethical dilemma that you have faced as a counsellor.

I had this case; it was about an alcoholic teen since her mother was having and affair while still married. I had to keep the information regarding infidelity to the father. However, I had to find a way to treat this kid without tearing the family apart. Her knowledge was to remain confidential while her well being was entirely dependent on the union of the father and the mother.

What is the most common ethical concern or dilemma that you see or experience professionally?

Issues of confidentially have become prevalent. Parental rights are becoming a pressing issue. And most of these cases involve teenagers who know their rights.

As a counsellor, how were you trained to deal with ethical dilemmas and do you feeling your training was adequate?

As a counsellor, resolving ethical dilemmas through seeking the most rational, legal and professional approach from the ACA code of ethics is the most reliable method of addressing ethical dilemmas. My training was good. I feel it suffices in managing the psychological well being of other humans.

If you needed assistance in dealing with an ethical question or concern, what would be your likely course of action? Why?

In the event that I feel am not sufficiently equipped to proffer a solution, I call my fellow practitioners for advice or referral.
I always make sure is study the ethical codes before embarking on treatment.
The code of ethics is a clear guide to resolving ethical dilemmas.

Interview with a counsellor

As a counsellor, how does confidentiality cause ethical dilemmas?

When a patient shared very sensitive info and says it’s confidential whereas if the info is divulged to parents can save or help treat him.

What is the most commonplace ethical dilemma faced by counsellors today?

Confidentiality issues and parental rights

Can you briefly expound on that?

Many patients do not want to share. However, parents are insistent that this information be divulged to them since they have the rights over the children (Van Hoose, 1980). However, the ethical consideration is to seek a balance between breaking the law to correct the problem and finding appropriate measures so as not to abuse the code of ethics in the profession; Seeking parental and patient consent in resolving a problem (Miller & Davis, 2006.

Counsellors find ethical dilemmas as intricate to resolve especially when decision-making models help find the problem what do you do in this case.

Infringing the patients rights would result to legal implications. There are no provisions that allow infringing of these rights (ACA, 2005).

As a counsellor, resolving ethical dilemmas through legal and professional approaches from the ACA code of ethics addresses ethic al dilemmas.

How is that?

Using models of solving ethical dilemmas helps the counsellor address, diagnose, and treat patients. The same also provides a guideline to resolving ethical dilemmas professionally.

Findings about commonplace ethical dilemmas faced by counsellors

Ethical dilemmas and their causes: most counsellors face ethical dilemmas throughout their professional background. My survey on what are the commonplace ethical dilemmas faced by counsellors often shows that, almost all counsellors face similar ethical dilemmas. The issue of questions revolving around what information can be released to the parents is commonplace ethical dilemma. Another commonplace ethical dilemma is parental rights. This leads to the context of confidentiality.

This makes confidentiality to be cited as the most commonplace cause of ethical dilemma. This is often related to teenage related cases. Young adults recommend that the counsellor keeps the information they divulge as confidential.

Different approaches in refraining from diagnosis dilemmas: Due to the sensitivity of some information divulged, counsellors confess divulging bits of information to the parents where teenagers are involved. This information has however been beneficial in the long run. The counsellor pointed out that, this information ended strengthening the family and correcting the problem.

However, most Counselors admit that they would rather stick to the code of ethics and the legal guidelines than risk this approach. They fear going to that extent is unprofessional and risks ones career.

Decision making models used: Almost every counsellor finds the practical 7 steps ethical decision-making model. They confirm that it is ideal for resolving ethical dilemmas.

My take about these Counselors views: I believe going to the extreme of positively contributing to the well being of a family is important and bold. About parents, they want to know what a counsellor discusses with their children. This alright, however, most parents want all information regardless of confidentiality. School Counselors cannot play the role of a professional psychologist due to such parental influence. Actually, it is frustrating not being able to assist a child who you relate with daily when you also know the child’s parents and see the problem both parent and child are facing.

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