Tuesday, May 29, 2012

Ethical Biography

Ethical Autobiography

Bertrand Russell once said "without civic morality communities perish and without personal morality, their survival has no value" (Russell, Egner, & Denonn, 1961, p. 146).  Likewise, the counseling profession must bind itself to ethics and the law, or it will not thrive as a viable, trustworthy profession. Counselors, too, must bind themselves to the same parameters, or the value of the profession becomes null. Embracing the tremendous responsibility the profession has to humankind necessitates an overt, yet personal pact between the profession and each counselor, that they engage in growth and development that will contribute to their ability to follow legal guidelines as well as make moral judgments and ethical choices.

Moral and Ethical Influences in Early Development

I had the good fortune of being raised in an environment in which my parents' profession dictated their compliance with the Hippocratic oath. The greater fortune was that they did not simply follow this oath as one follows the rules of a game, but with a passion and fervor that filled my childhood home with thoughtful conversation and an evolving awareness of conscience and choice. We were taught the value of making appropriate choices, not simply choosing the prescribed right or wrong of ordinary decision making. Even as children, we became aware that decisions can bring benefit as well as harm, and embracing the multiple aspects of circumstances provided a foundation for the best outcome.

Mine was a democratic household in which conversations about war, poverty, and personal choice were dinner table discussions. My brother and sisters and I were not afraid of making mistakes, but dreaded the thought of making unconscious choices that merely accommodated personal ease or agendas. Worse was the thought of decision making without taking others into account or understanding in my heart of hearts (as my father used to say) that what I was about to do was the best course of action. My father told me that nations can be judged on how they treat their animals. At a young age, this stood out to me as the ultimate meaning of ethical behavior. The significance of caring for a dumb animal who could never tell on me was the precise essence of ethical behavior. It meant doing what is right, or, at least the most right, because that was what had to be done.

Counseling Issues and Related Legal and Ethical Guidelines

Although mental health counselors must contend with the issues of humans, rather than animals, they are, nevertheless, called upon to make choices that are right, or perhaps appropriate, given the unique circumstances of the situation. Several legal and ethical issues are common to the counseling profession: confidentiality and the duty to warn or protect, boundaries, transference and countertransference, and dual relationships. Although each is a common theme in the therapeutic process, the situations in which these issues manifest are as different as the clients themselves, and each one requires an ethical decision or a legal action specific to the circumstance.

Confidentiality and the Duty to Warn

Confidentiality and the duty to warn are critical issues in counseling (Remley & Herlihy, 2001). The American Counseling Association (ACA) (2005) Code of Ethics Standard B.1.c. and Standard I.A.2.a. in the American Mental Health Counseling Association (AMHCA) (2010) obligates counselors to keep client information confidential. Counselors must make exceptions for protecting clients from foreseeable harm (ACA, Standard B.2.a.), and when clients admit to having a communicable and life threatening illness (ACA, Standard B.2.b.). As advocates and protectors, mental health counselors must preserve privacy and simultaneously implement duty to warn or protect when there is foreseeable danger. Understanding the ethical and legal ramifications of duty to warn and protect in conjunction with preserving confidentiality is critical for the safety of the client, for the protection of the counselor's livelihood and the profession. As evident in the Tarasoff case (Simone & Fulero, 2005), the duty to warn is a critical decision that must be made by counselors.

In the state of Hawaii, Rule 503(d)(2) Tarasoff exception (Hawaii State Legislature, 2011) allows psychotherapists to break confidentiality in cases where duty to warn is necessary. Although a counselor has a legal obligation to warn in such cases, it is an ethical obligation to gather as much information as possible, notify the client of your ethical and legal obligations, and notify authorities in any case when the counselor is reasonably sure of impending harm by the client to self or others. The issue of the ethical obligation to gather information is personally significant to me.

A close friend of mine has been in therapy for chronic depression for over 20 years. Once, when she re-entered therapy, she had to use an alternative therapist. During the session, the counselor asked her if she ever considered suicide. She said she had, but she would never carry it out. It was simply thoughts, nothing more. After the session, she returned home to find the police waiting to take her to a facility for a 48-hour involuntary committal. This was extremely embarrassing for her, her family, and the therapist. The therapist later apologized and admitted she did not have enough information to support her decision to notify authorities. My friend maintains she will forever moderate what she says to a therapist.

This experience taught me that the ethical obligation to gather pertinent and accurate information for decision making may not be as critical as upholding the duty to warn, but it is crucial to have reasonable and reliable information. Without articulate orientation to the issue, I can neither act in clients' best interest, nor can I adequately respect and promote their dignity, privacy, and welfare (ACA, 2005, Standard A.1.a.). Standard B.1.c. states "counselors do not share confidential information without client consent or without sound legal or ethical justification" (ACA, 2005, p. 7) and further states in Standard B.1.d. counselors must use informed consent to notify clients of confidentiality's limitations and exceptions. The ACA (2005) Standard B.2.a. addresses the need for counselors to consult with other professionals when in doubt about exceptions to confidentiality. When counselors face ambiguous circumstances regarding the duty to warn or protect, implementing an appropriate decision-making model and consultation with peers and supervisors contributes to best case outcomes (Cottone & Claus, 2000).


The prescribed boundaries of a therapeutic relationship are not always well defined. Some boundaries are easier to cross than others, and some must be crossed because of a lack of alternate options (Remley & Herlihy, 2010). When boundary crossings are unavoidable, care should be taken because in a therapeutic relationship they can be detrimental to the client (Remley & Herlihy, 2010). Sonne (1994) explains when a counselor enters into a secondary relationship with a client, the therapist's needs in that relationship may affect the power differential of the therapeutic relationship as well as the conscious and unconscious thoughts and actions of both individuals. Secondary or dual relationships and boundary crossings with former clients are as potentially harmful as with existing clients. Any boundary crossing may result in ethical and legal infractions that have the potential to end in ethical hearings or criminal court (Remley & Herlihy, 2010).

Pope and Keith-Speigel (2008) suggest when counselors find themselves crossing non-sexual boundaries, taking various circumstantial factors into account prior to making an assessment, can help determine the crossing's usefulness. Additionally, the author's believe fostering one's ethical awareness, as well as a maintaining a cognizance of ethical codes and legal standards is crucial to ethical decision making. Aside from the prescribed parameters of making such decisions, it is wise for the counselor to consider internally conflicting feelings about boundary issues as well as intuitive experiences (Pope & Keith-Speigel, 2008).

The ACA (2005) Standard A.5.c. recommends avoidance of non-professional relationships with clients and others associated with clients, except as in Standard A.5.d. when such relationships may be potentially beneficial to the client. In this case, counselors must document the justification for entering into the relationship prior to its initiation (ACA, 2005). As mentioned in Comparing Codes of Ethics (Stone, 2012), I worked in end-of-life care in a hospice environment. In this capacity, I provided services for a woman and her family until her passing. Within a week after her death, the woman's husband called to ask me out to dinner. Although the man's motives were most likely driven by loneliness and a desire to return to familiar camaraderie, I recognized the gravity of his vulnerability and declined his offer. I did, however, recommend a counselor for him. In this case, developing a personal relationship with him would have been a violation of ACA (2005) Standard A.5.c. and AMHCA (2010) Standard A.3.a. Although my friendship could have been a potentially beneficial relationship to the man, his greater need was for a consistent and structured therapeutic relationship.

Transference and Countertransference

The client/counselor relationship plays a significant role in counseling, and contributes to the overall effectiveness of counseling, so understanding transference and countertransference is critical for the therapist (Burwell-Pender & Halinski, 2008). Transference occurs when clients redirect feelings from a significant person in their lives to the therapist. On the contrary, countertransference takes place when the counselor becomes emotionally intertwined with the client or when the counselor inappropriately redirects unresolved emotional issues onto the client. In therapeutic relationships, the client's transference is an expected part of therapy that when appropriately addressed, can benefit the relationship and provide insight into the client (Burwell-Pender & Halinski, 2008). With self-reflection and self-awareness, Burwell-Pender and Halinski (2008) suggest countertransference can provide counselors with insight into their personal unresolved emotional issues.

Most mental health counselors have unresolved personal issues, and if left unattended, can result in ethical infractions and other adverse counselor behaviors. It is important for counselors to understand that countertransference is a natural part of counseling. Pope & Tabachnik (1993) discovered over 87% of therapists had sexual feelings for one or more clients. Some countertransference is a natural part of developing a relationship, and it is not always detrimental to the counseling relationship. For best outcomes with clients, however, Gelso and Hayes (2001) state counselors must be aware of reactions to clients, especially when the reactions result from the counselor's unresolved issues. Although counselors cannot eliminate conscious and unconscious reactions to their clients, they must be aware of them.

Gelso and Hayes (2001) suggest countertransference can be managed with self-insight, self-integration, anxiety management, empathy, and conceptualizing ability. Counselors must develop an interrelated understanding of these factors as well as learning how to implement them into their personal and professional lives (Gelso & Hayes, 2001). Managing these aspects is part of counselors' self care that may include participating in counselor support groups, inspiring spiritual awareness in themselves and their peers, and encouraging appropriate rest and respite for themselves and other mental health counselors (Trippany, White Cress, and Wilcoxon, 2004).

One distinct personal experience of transference was when the company I worked for hired a new manager with whom I had to collaborate. His personality distinctly reminded me of my ex-husband, and it became difficult to separate my feelings about my ex-husband from those of the new coworker. I found myself thoroughly aggravated by the way he would respond to me or when he took too long to return a phone call. At one point, I thought it was likely my coworker, like my ex-husband, disliked animals. Eventually I realized the genesis of my feelings toward my coworker, which led me to reflect on my anger toward my ex-husband.

Dual Relationships

The codes of the AMHCA (2010) Standard I.3.a and the ACA (2005) Standard A.5.a and A.5.b. recognize the unethical nature of developing sexual or romantic relationships with clients, former clients, or with anyone associated with clients or former clients. The ACA (2005) prohibits counselors from entering into an intimate relationship for five years after their termination as a client, or according to state regulations. Standard A.5.c. recommends avoiding nonprofessional interactions or relationships with clients or former clients. Both codes do, however, recognize that some nonsexual dual relationships are unavoidable and have a potentially positive effect on the client/counselor relationship. Standard A.5.d. states if the counselor determines entering into such a relationship will not be harmful to the client, the counselor must document the rationale for the relationship, its potential benefit, and any foreseeable consequences. The client's consent should be obtained prior to entering into the relationship when feasible. The ACA (2005) Standard A.5.d. further obligates counselors to prove an attempt to reconcile any unintentional harm to the client from a nonprofessional interaction.

Section I.A.3.a. of the American Mental Health Counselors Association (AMHCA) (2010) directs counselors to "make every effort to avoid dual/multiple relationships with clients that could impair professional judgment or increase the risk of harm" (p. 3). Standard I.A.3.b. directs counselors to seek consultation and use a reasonable decision-making model prior to acting on a decision to enter into a dual relationship. Section I.A.3.c. suggests when dual relationships cannot be avoided, counselors should "take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation has occurred" (AMHCA, 2010, p. 3).

Personal Meaning in this Assignment

This assignment has been more meaningful than I anticipated. Observing my journey through the gray areas of ethics has helped me perceive it more objectively. From childhood experiences through early and later adulthood, I was compelled to make decisions that made sense within the scope of the circumstance, even when there was no right or wrong. My choices were made, not solely from the purity of my intention, but sometimes out of fear of future repercussions for myself or others. Sometimes I made the decision believing someone was watching, even only if in spirit, encouraging my proper choice, like the proverbial image of conscience - the angel on one shoulder, the devil on the other!

Ultimately this assignment has helped me realize being ethical takes determination and a deliberate effort that must be developed over time. In any helping profession, individuals must make an ongoing attempt to implement moral judgment and ethical decision-making. I have reflected on information gained from an undergraduate class in ethics that claimed the American Psychological Association contends with thousands of ethical and moral infractions every year (Plante, 2011). Most of the offending individuals understood ethical behavior by its rules, not by its essence. Without personal ethics, an individual has only rule-following to guide them in professional and ethical conduct. Ethics must be understood deeply, like a secondary enculturation, similar to childhood experiences that remain foundational in one's worldview.

Adherence to Ethical and Legal Practice as an Influence of Social Change

Whether associating with one individual or many, people act according to intrinsic values and beliefs, and behavior changes with evolving ethical understanding. It seems far more beneficial to assist others in strengthening their ability to grasp wisdom and integrity rather than passing judgment on their ignorance. Wisdom and ethical character in humanly diverse situations create interactions based on integrity, honesty, benevolence, and justice. Personal ethical and moral interactions encourage similar interactions in others. In support of the pay-it-forward theory, as one individual navigates ethically and morally throughout life, others learn by imitation and by consciously choosing to act similarly. By doing for someone else what someone has done for them, people have the ability to teach grand lessons. In the human social context, kindness, tolerance, and consciousness seem to be as infectious as chaos, hatred, and ignorance. Inspiring the former encourages positive social change.

Adhering to a legal counseling practice protects counselors, clients, and society, and promotes a sense of trust in a relatively new profession that has founded itself upon ethics and the law. Legal statutes create a standard for the profession as well as a foundation for a safe experience for those who rely upon the psychological professions (Remley & Herlihy, 2010). Furthermore, such a practice contributes to a profession that will continue to offer a viable service and the profound ability to care for the well-being of the human spirit. This, I think, is the true meaning of social change.

Revisiting Personal, Ethical, and Social-Political Values

This class has been both thought- and anxiety-provoking, although an extremely valuable learning experience. Incorrect assumptions and unreasonable resolutions I made at various times disturbed my sense of self-efficacy. I am confident, however, in my introduction to the ACA (2005) and AMHCA (2010) ethical codes as a foundation with which I will navigate future ethical dilemmas. I have long been a proponent of collaboration - to help others as well as to gain knowledge. I will not hesitate to consult on any issues that defy my ability to find resolution and clarification. In most ethical decision-making models, consultation is a key component (Cottone & Claus, 2000). Additionally, I have a new and keen awareness that I cannot neglect the growth of my character and that growth must be an ongoing and deliberate undertaking. Certainly this class has shown me that quick fixes are neither realistic nor are they a plausible solution in ethical decision making.

My closest friends would say I tend to see the grayer areas of life rather than the simplistic perspective of black and white, especially when determining right and wrong. I think of myself as a spiritual diplomat, of sorts, always taking into account the various aspects in any situation. Ethical decision making is difficult because the situations are neither linear nor superficial. They are multidimensional and broad, so much so that it can become difficult to embrace the whole and perceive its entirety without subjective interference. In my estimation, although many ethical decisions will be made easily according to the prescribed ethical guidelines, some will be far more difficult and perplexing.

Overall, I take pride in what I have learned from this class. I have a renewed perspective of how I affect others, and how I might modify and refine those influences to the benefit of my future clients and colleagues. In addition to applying reason to circumstance, or perhaps ethics to circumstance, I have a retooled goal to develop a keen intrinsic ability to understand ethics, not only by the profession's guidelines, but by its essence. Considering the abundance of gray area in the full range of ethical decision making, understanding the essence of ethics as well as the ethical codes of the profession should enable my resolve of challenging decisions and ethically ambiguous situations.

Pennsylvania State University (2010) supplies a personal code of ethics for its students: be honest, courteous, and responsible. Have integrity, give credit where credit is due, be respectful, trustful, and live harmoniously. Additionally, do not change the wonder of who you are to please others. Be happy (Pennsylvania State University, 2010). In retrospect, this class has compelled me to re-evaluate each of these standards in a more meaningful way, not simply as a conclusive way of life, but as a starting point on a grander curve of learning that will foster a profound understanding of ethical values. As a counselor, these standards take on professional meaning as well, and an understanding that ethical decisions have a tremendous effect on people's lives.


As mental health counselors, the depth and quality of ethical decision making and the development of fundamental values and beliefs upon which these decisions rely, must reflect the foundational aspects of counseling ethics and the law. Developing a sense of justice, beneficence, non-maleficence, fidelity, autonomy, respectfulness, and self-reflection and awareness must be a deliberate and lifelong process. In the first week of this class I wrote, "It is not simply according to law and ethical codes that counselors practice ethical behavior; such behavior emanates from personal and professional values". Mental health counselors have a tremendous responsibility to humankind, offering resolve, reconciliation, reorganization, and the renewed ability to pursue happiness. Laws and ethical codes are references that ensure counselor's decisions and actions are based on sound legal, professional, and moral judgment rather than prejudice, bias, rationalization and self-interest. Without these foundations, the profession could neither inspire nor contribute to the crucial need for positive social change.


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