The Ethical Family Counselor (Chapter 10). Objectives for this chapter Appreciate the complexity of...
Transcript of The Ethical Family Counselor (Chapter 10). Objectives for this chapter Appreciate the complexity of...
The Ethical Family Counselor (Chapter 10)
Objectives for this chapter
Appreciate the complexity of ethical decision making and behavior when working with couples and families
Understand the functions of context, values, ethics codes, and law in guiding decision making
Recognize and improve your ways of making ethical choices Identify common ethical issues in work with couples and
families Apply values in creating an ethical stance for your own
practice
Ethical decision-making processes
In a context where laws and professional ethics codes may conflict, professionals need to focus on process
Values and principles are essential in making sense of ethics Ethics codes highlight issues but do not always resolve
decisions
Principles and values
Principles (broader) that are generally accepted:– Autonomy– Beneficence– Nonmaleficence– Fidelity
Values (narrower) differ Values are socially constructed, manifested in discourses Two or more sets of values can compete Even when values are clear, different actions may result from
the same value
Identifying ethical issues
Many times the clear ethical option is not apparent. This is known as a dilemma
The case of Kevin and the Ellingtons illustrates the potential for acting without carefully examining ethical issues
Ethics codes highlight many of the most frequently encountered issues
Proactively ethical practitioners go beyond codes, looking at their motivations and attempting to recognize multiple perspectives
Consultations, codes, and laws
Consulting a supervisor, trusted colleague, or legal advisor is a basic strategy
Ethics codes provide a basis for such a consultation Multiple codes may define issues in different ways—but in this
case they agree on the risk for the clients if Kevin becomes involved in their family
Ethics themes in couple and family counseling
Family counseling presents special ethical dilemmas
Competence
Professionals are expected to only practice in areas where they have appropriate training and supervision to justify a claim of competence
At the same time, the complexities of family life exceed any single professional’s ability to provide expert assistance
Ethical professionals must– Network with a variety of helping fields– Confer and consult when in doubt– Help clients make informed decisions about referrals
Systemic versus individual ethics
Two competing values have shaped contemporary family counseling practice:
– A systemic view that privileges relational needs and concerns, resisting competitive and individualistic pressures
– A Western cultural emphasis on the individual, with rights and needs, revitalized with feminist concerns that not all individuals are equally valued
Gender and sexuality
Both gender and sexuality have been concerns in many cultures (and many families) over the generations, e.g.
– Can women be warriors?– Can children receive the love and support they need from a male
caregiver?– Do men who love each other have to marry women anyway?
These issues become ethical to the extent that competing claims for correct behavior cannot easily be resolved
When people’s lives are negatively affected by social structures, counselors see a social justice concern
Race and class
Race and class are intertwined with oppression:– Negative characterizations of “the other”– Limiting access and opportunity– Avoidance of dialogue
We all have racial and class identities, and these identities can create barriers when we seek to help
Ethical practice calls for acknowledging these social forces and working to challenge them
Power and deception
The history of family counseling includes many practices that were based on overt and covert use of power and deception
These practices were justified on the basis that the clients were asking to be manipulated
These practices led to negative perceptions of our field Ethical practice calls for open and honest engagement with
clients and the community
Diagnosis
The family perspective finds itself in tension with reimbursement systems and other institutions that only grant validity to problems residing in the individual
Diagnosing an individual as a way of getting funding may be ethical, when the diagnosis is valid, but people can also be harmed by being labeled. We need to be careful with our applications of diagnoses
A movement is underway to get acknowledgement for relational problems as valid and deserving of intervention
Consent
Family work is inherently complex in the varied levels of motivation and voluntary participation of family members--especially when we consider children and others whose understanding may be limited
Participants may not understand their rights Ethical practice requires recognizing the power imbalances in
couples and families so that family members are not victimized by our helping efforts
Confidentiality
Confidentiality is a constant concern in family counseling Clients expect confidentiality They do not know what to expect regarding their individual
disclosures to a counselor who is working with the family When counselors learn family secrets, we are caught in
triangles--if we don’t learn them, we are operating without important knowledge
We need to be clear with clients about what they can expect
Multiple relationships
Multiple relationships are unavoidable in couple and family practice--this is one of the reasons many people avoid this kind of work
When multiple relationships are present, abuses of power can occur if all participants are not clearly aware. Ethical practice requires discussing potential conflicts
Even with awareness, some multiple relationship situations are dangerous and should be avoided
Psychotropic medications
In many cases, relational problems create psychiatric symptoms that can be treated with medications. Clients often want immediate help, and a referral for medication can produce rapid change.
However, relieving a symptom may do the client(s) a disservice if the source of distress is left unresolved
There is no simple solution to this ethical dilemma
Records and reimbursement
Systems of payment and record-keeping typically don’t understand a family approach
Identifying an individual with appropriate needs
When a couple or family come to an institutional setting where individuals are the unit of treatment, there are two likely outcomes:
– The intake screeing will identify a member of the relational system who fits eligibility criteria
– The couple or family will be told that their problems are not individual-level, and therefore they cannot be served (or they will pay a full fee, when individual treatment would have been covered)
Assessing the appropriateness of couple or family treatment
Once clients are accepted for treatment, the decision to provide services in a couple or family format has to justified based on theories about the source of the problem and possible ways of eliminating the problem
These theories should clearly appear in the clinical documentation so that evaluators understand what will be happening
Conducting focused, theory-driven treatment
Starting with a clearly identified set of issues, the family-oriented practitioner should provide a treatment plan that describes
– What procedures will be used, and – How their success can be evaluated
Maintaining family-oriented progress notes
Clinical documentation will generally focus on the primary client but will differ from individual notes by:
– Acknowledging the participation of others– Discussing interactions
Assessing change
Even though eligibility is based on the needs of the primary “patient”, a family treatment plan will identify ways in which others need to change as well
Reduction in symptoms is essential information about progress, but it is not enough to justify the family approach. Relational changes must also be documented