Abstract
Counselors often
walk a delicate line between helping their clients, and the ethical and legal
issues that come with working with individuals who are in distress. While there
are set guidelines in place for counselors regarding such issues, it is often not
a clear pathway to navigate smoothly. If a counselor does not make the right
choice during practice, they risk repercussions, not just professionally, but
on a personal level as well. Being entrusted with the lives of others, knowing
that steps and decisions made during treatment can ultimately change the life
of another human being, is a massive responsibility, and one that should not be
taken lightly. Cultural competence plays a role in therapeutic pathways, and
approaches should be tailored to suit the unique needs of clients, while still
abiding by the legal and ethical implications that may arise. Working with a
variety of professionals can also complicate the journey, making effective
communication with clients and other treatment team member an essential key to
mental health.
Legal
guides for counselors
Counselors often
wear many hats in the course of their position: confidant, guide, assistant,
life coach, advocate, mentor, and occasionally work as a mediator between the
legal system and their client. Working in such a diverse role, counselors are
tasked with a great deal of responsibility, which also brings consequences for
both the client and the counselor depending on the efficacy of treatment and
the adherence to the ethical and legal standards in place. There are several
guiding organizations, each contributing a different piece of the legal puzzle
counselors are asked to navigate.
Consulting
the established guidelines is essential for counselors, their clients, and the
entire mental health treatment community. Each branch of counseling has their
own guide to standard of care, but most use the American Counseling
Association’s Code of Ethics (2005) as a template from which they design their
own guiding principles of care. There are currently 19 divisions of the
American Counseling Association (Remley & Herlihy, 2010), allowing for a
multitude of specialties, ranging from testing and gerontology, to art and
sexual minority counseling. However, with the variety of areas available for
counselors to practice, it is ultimately the responsibility of the counselor to
seek out, learn, and abide by the regulations in place on the local, state, and
governmental levels.
Decision-making
models in counseling
Due to the complexities involved in
making ethical decisions for others, as well as remaining on the correct side
of the legal system, counselors are often aided by the use of decision-making
models. There are several to choose from, so finding one that best suits the
situation, client, and specialty is possible with an examination of those
available. Some specialties also have their own versions of decision-making
models, including school, career, and addiction areas of focus. Some models are
influenced by theoretical or philosophical sources, whereas others are founded
in evidence-based practices (Cottone & Claus, 2000), further stressing the
importance of finding the right one to fit the current need and dilemma.
While the approaches may vary, one
key aspect to any decision model remains constant: the legal standard of care
counselor’s use when working with clients. The standard of care practiced by
counselors, regardless of setting, must be consistent with what a reasonable,
similarly trained and educated counselor would practice under the same set of
circumstances (Remley & Herlihy, 2010). When consulting a decision-making
model, it is imperative that counselors are able to separate their personal
values from their professional role, as clients may possess a different value
system, not shared by the counselor. Additionally, counselors need to realize
that one decision-making model may not apply to all of their clients, thus
making the need to be familiar with a multitude of approaches a necessity for
an effective therapeutic outcome.
One decision-making model for
counselors working with a possible ethical dilemma, developed by Sileo and
Kopala (1993), is a five-step model divided into an A-B-C-D-E method of
approach that fits a variety of possible situations. The steps include
assessment (A), benefit (B), consequences and consultation (C), duty (D), and
education (E). Sielo and Kopala have even devised a worksheet to simplify the
steps to what can be a complex process in finding a resolution to an ethical
problem. While such a simplistic sounding approach may seem straight forward,
it is essential for counselors to remember that despite the model used, that it
cannot substitute for the combination of character, virtue, and counselor
decision-making skills that come from experience and education (Jordan &
Meara, 1990).
Even
after employing the steps in a decision-making model, counselors may feel
unsure about their actions and conclusion. In such instances, there are four
self-tests one can take to evaluate the approach used and the outcome achieved
(Remley & Herlihy, 2010). By analyzing the justice, universality,
publicity, and moral traces that remain after a decision, a counselor can
either feel more confident in their actions, or use their findings as an
opportunity to learn and grow.
The
A-B-C-D-E decision-making model in use
In the case of Simone, an
18-year-old new mother who has a limited formal education, is receiving
government assistance, and has no real motivation or future goals, it is
essential for a counselor to approach the therapeutic relationship in a method
that is helpful and does not come across as judgmental. Simone reports that she
does not have a large support system in place, and lacks healthy and effective
coping mechanisms, which are essential for individuals in similar positions.
Teen pregnancy and motherhood is often associated with a negative impact in the
realms of biological, social, and financial arenas of one’s life (Kramer &
Lancaster, 2010).
Further
complicating Simone’s situation is her familial history of mental health issues
and her own possible learning disability, which some teachers had alluded to in
the past. Possibly due to her stunted education and unhealthy family
environment as a child, Simone is using marijuana to help her cope with the
stress of being a new mother. All of these observations are associated with the
first step in the decision-making model, assessment. Gathering information from
clients allows the counselor to assess the strengths, weaknesses, depression,
and resources, which can influence future steps. It is essential during the
initial stage, and throughout the entire counseling relationship, that
counselors put aside their own possible value conflicts and recognize that if
such thing is not possible, they are ethically bound to make referral
recommendations as per the 2005 ACA Code of Ethics (A.11.b.).
Upon
assessing Simone’s presenting information, there are several areas that could
benefit from further investigation. However, the physical and mental health of
Simone and her child are the most pressing issues, and the ones that could
benefit the most during the limited counseling sessions set forth by the grant
that is providing payment for the services. Determining the key areas are
essential in limited-duration counseling sessions, such as those arranged by
Simone’s social worker.
After
identifying the areas that would benefit most from assistance and change, it is
time to move to the evaluation of the consequences and consultation stage of
decision-making. It would be important to be honest with Simone about what
could happen if she were to continue on her current path, including the
possible legal implications that may occur due to her using and selling of
marijuana. Simone’s lack of interest in pursuing any career goals could also
negatively influence the quality of her life and that of her child as well. It
is important for the counselor to remember that the approach used during
counseling sessions has a possibility of pushing the client away, resulting in
a negative consequence for themselves, as well as for their client.
Consultation with outside professionals, namely addictions counselors, supervisors,
and colleagues, may be of benefit to gain additional insight into the situation
and steps that could be of benefit to the client.
Upon
presenting the possible consequences and paths available to Simone, it is time
for the counselor to assess who they have a duty to in the situation.
Complicating the case is the fact that Simone has a child who solely depends on
her for physical and emotional support. There could be possible child abuse or
neglect at risk, which would make the question of “To whom do I have a duty?” a
challenging one for the counselor to answer. According to the ACA Code of
Ethics, counselor’s primary responsibility is to promote the welfare of the
client (A.1.a.), however, with the addition of a child into the equation, it
would be recommended for a counselor to consult their colleagues to determine
if further notification is warranted. Under B.2.a. of the ACA Code of Ethics,
confidentiality can be breached in the case of possible harm or legal
requirements. However, such actions should be evaluated prior to undertaking,
as the therapeutic relationship may be damaged, so it is imperative for the
counselor to evaluate the possible ramifications that could occur because of
breaching the confidentiality of the client and notifying law enforcement.
The
final step in the current decision-making model is education, which applies to
both the counselor and Simone. Education should be a career-long goal, as
techniques, intervention methods, and laws evolve over time. In addition to
addressing the ethical and legal issues that are associated with Simone’s case,
it would also be important for the counselor to be culturally competent, as
there are unique needs associated with the needs of the client. Not much is
known about Simone’s cultural background, so it may be useful to delve into
that area of her life to learn a little more about how her counselor and social
worker can effectively address her needs. There are specific challenges that
arise when counseling women, including the societal pressures to be a caregiver
and provider for her child, discrimination based on gender, and employment
barriers, especially among single mothers (Sue & Sue, 2013).
Education
about the local marijuana laws would be applicable in Simone’s case, as there
are avenues she could take that would allow her to legally obtain medicinal
marijuana to help her cope with the anxiety of becoming a new mother. Under
Oregon’s Medicinal Marijuana Program (OMMP), Simone would qualify for a reduced
application fee since she receives public assistance (http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Pages/top20.aspx)
if she wanted to pursue that option. However, it may be a challenge finding a
doctor that would recommend her to the OMMP to obtain medicinal marijuana due
to her present condition of being the sole caretaker for her child. While
medicinal marijuana is legal in the state of Oregon, it is still considered a
felony according to the federal government. Due to the possible legal
implications, as Simone’s counselor, it would be important to educate her on
other healthier options for stress management.
Personal
values of counselors
Keeping one’s professional and
personal boundaries separate is essential in the field of counseling and mental
health; however, it is not always possible to keep aspects of one out of the
other. Counselors are people, with beliefs and values of their own, which may
influence their view on certain subjects that may arise during sessions with
clients. In the case of Simone, her drug use while caring for her child may violate
the belief system of her counselor. Society and the medical community has
deemed marijuana as a therapeutic drug that can help to soothe a variety of
ailments. However, under federal law it is illegal, thus presenting a possible
issue in both the legal and ethical realms for the counselor. Seeking
amplifying information, in conjunction with consultation with colleagues and
supervisors, can contribute to finding an amicable outcome for both the
counselor and client.
Personal and professional goals are
an important aspect to the lives of many individuals, and without such, many
counselors would not have achieved their goals of licensure. Encountering
someone such as Simone, who does not identify as having any aspirations or
goals to work towards may be another area where the values and beliefs of the
counselor would be challenged. While Simone’s possible learning disabilities
may hinder her potential, with effective assistance, she may be able to become
motivated to achieve more out of life than sitting at home caring for her
child, passively watching television and listening to music. However, it would
be important to remember that not all individuals are motivated by goals, so
projecting the desires of the counselor onto Simone could end in disaster due
to the incongruent outlooks.
Just as Simone’s history and
background have influenced who she is today, counselors often bring their
beliefs and experiences with them into practice. It is essential that they do
not allow their values to taint their practice, which is often easier said than
done. During the educational process, the professional horizons are broadened
and effective counselors are able to live in a state of essential cognitive
dissonance, holding that two possible conflicting beliefs can occur at the same
time. Becoming comfortable with the fact that the values of clients will often
differ from those held by the counselor is a key trait for successful
therapeutic practice.
Conclusion
Personal and professional value
systems for counselors, while ideally exist in two different realms, may
intertwine with one another, thus posing a risk of tainting the client and
providing less than optimal therapeutic services. One key tool that counselors
can when evaluating a possible ethical dilemma is known as decision-making
models, one of which has been identified in the current paper. While the models
do not guarantee an ethical and legal outcome of the situation, it does provide
key questions to help the counselor to navigate and evaluate the challenges
posed by their clients. Providing fair, factual, and helpful feedback to the
clients regarding the possible ramifications associated with the choices they
make can return a sense of personal power to the clients, knowing that
ultimately the choice is theirs.
**References Available Upon Request**
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