Applied Ethics and Decision Making in Mental Health

Michael S. (Shufelt) Moyer, Charles R. Crews

• Publisher: SAGE Publications, Inc
• Year: 2016
• ISBN:
  9781506346533
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

"Moyer and Crews move beyond simply presenting and explaining the ethical code. In this book, they challenge counselors-in-training to grapple with their own values and understand how ethical decision-making is influenced by the lens through which they see the world as much as it is influenced by the actual code." –Kristi Gibbs, University of Tennessee at Chattanooga Applied Ethics and Decision Making in Mental Health covers professional issues and ethical decision making related to the codes of ethics of the American Counseling Association, the American Psychological Association, and the American Association for Marriage and Family Therapy in an easy-to-read format, connecting ethical standards to real-life scenarios. This book not only focuses on the various aspects of legal issues and codes of ethics, but also includes ethical decision making models and exploration into the philosophy behind ethical decision making. By challenging readers to understand their own morals, values, and beliefs, this in-depth guide encourages critical thinking, real world application, and classroom discussion using case illustrations, exercises, and examples of real dialogue in every chapter.

1 Introduction to Ethics

In order to properly understand the big picture, everyone should fear becoming mentally clouded and obsessed with one small section of truth.

—Xunzi

Chapter 1 introduces ethics and the various codes of ethics pertinent to professional counselors. The authors will discuss the reasons and need for ethical codes and how they impact both practitioners and the general public. The authors will also discuss ethics as philosophy, in addition the concepts of relativism and absolutism, and introduce methods of knowing along with how individuals are motivated to act. The main purpose of this chapter is to introduce ethics and get students to begin reflecting on and evaluating the ways in which they make decisions in their lives. Specifically, after reading Chapter 1, students will be able to do the following:

1. Define what it means to be an ethical professional counselor.
2. Explain the purpose of professional organizations’ codes of ethics.
3. Discuss the principles on which the ACA Code of Ethics is based.
4. Explain the difference between relativism and absolutism.
5. Describe how counselors’ motivations may affect their interpretation of ethical standards.
6. Explain the Socratic method and ways to apply it when facing ethical dilemmas.

Codes of ethics are living, changing documents and continue to change over time. Thus, it is more important to understand how to interpret a code of ethics and make ethical decisions than it is to memorize specific ethical standards. Throughout this text you will find many case illustrations and ethical dilemmas along with guided discussion questions to help you identify your own values and personal ethics. The combination of providing (1) an in-depth review of ethical codes, (2) ethical dilemmas, and (3) review questions geared toward challenging students to understand how morals, values, and beliefs affect one’s interpretation of codes of ethics will engender vibrant discussions throughout any ethics course. Although you are most likely reading this text as a part of your graduate course and not actually faced with the dilemmas presented, the authors encourage you to think about them and respond to the dilemmas as if you were in a real-life scenario. In responding, think about how you might act, what you might say, and the impact your words or actions might have on your client and others.

Defining Ethics

Before delving into ethical codes, the authors believe it to be important to first understand what we are talking about when we use the term “ethics.” Merriam-Webster’s (2013) online dictionary defines ethics as “the principles of conduct governing an individual or a group.” Others (Cottone & Tarvydas, 2007; Ford, 2006; Remley & Herlihy, 2014) describe ethics as a practice that protects clients, practitioners, and the general public; guidelines for acceptable behavior within a profession; and a field of study seeking to understand right and wrong. Ethics, in general, refers to the study of acceptable behaviors and standards governing the conduct of those within a profession. For our profession, ethics encompasses everything you do as a professional counselor. When you begin your training, ethics is included in your education and the acquisition of your licensure. As a practicing counselor, ethics is involved in everything from the way you conduct your practice and interact with clients and other professionals to the way you keep records and bill for services. Ethics encompasses every action and interaction.

Codes of Ethics

Codes of ethics are the building blocks for professional organizations, their morals, their values, and what they find to be important. In our own personal ethics, it is our own morals, values, and what we find to be important in interacting with others. Personal ethics include what we find to be important in ourselves and how we put value to those we interact with and the actions we take. When we talk about professional ethics, we’re talking about the values and the important aspects of a profession—in this case counseling and counselor education. One of the most difficult aspects of being a professional counselor is keeping personal ethics separate from professional ethics. It is critical for professional counselors to understand their own personal ethics and avoid imposing personal values onto the values of the profession. Consider Case Illustration 1-1 as Becky struggles with keeping her personal ethics separate from professional ethics.

Case Illustration 1-1

Becky is a clinical mental health counseling student currently enrolled in her program’s practicum class. As part of the class, she spends three days a week at her university’s free counseling clinic. The clinic offers free counseling services to the surrounding community and is primarily comprised of practicum students. One of Becky’s first clients is a 35-year-old female experiencing symptoms related to anxiety. The client is recently divorced and has sole custody of her two children (ages 10 and 14).

During the first few sessions Becky’s client reports confusion related to her current relationships. Becky’s client claims that she entered into a relationship with a new partner shortly after her divorce was finalized. However, the client reports having intimate encounters with both her new partner and her ex-husband, and she describes feeling invigorated by being able to string along both people.

In hearing her client describe her new relationships, Becky feels the urge to talk to her client about how moving back and forth between two relationships may be negatively impacting her children. Becky knows the client’s children stay with aunts, uncles, and cousins while their mom goes out to party with her husband and partner and are never exposed to their mother’s escapades. Still, Becky believes her client has a duty to be at home with her children and raise them properly rather than pawn them off on family members.

• What can you surmise about Becky’s values from this case illustration?
• How should Becky handle her strong feelings about her client’s parenting choices?

Case Illustration 1-1 is an example of how a counselor’s values can get in the way of his/her work with clients. Becky has strong beliefs about her client’s behaviors and how her client raises her children. In response to the first question posed in Case Illustration 1-1, the reader is able to determine that Becky has strong beliefs in favor of parents staying at home with their children rather than sending them to other family members’ houses. One might also deduct from the illustration that Becky believes in monogamous relationships and may not approve of her client’s lifestyle.

In response to the second question, there are many ways Becky might respond. Whichever she chooses it is critical that she separates her own values from the values of the counseling profession. There are no ethical standards guiding counselors to instruct parents on assumed proper parenting styles.

Various professional organizations, licensure boards, and agencies have developed codes of ethics to help guide their members’ decisions. For example, the ACA developed the ACA Code of Ethics (2014), the American Psychological Association (APA) developed ethical principles of psychologists (2010), and the AAMFT developed the AAMFT Code of Ethics (2015). Each of the previously mentioned associations developed ethical standards to act as a guide of best practices for their respective professions. In the preamble, the ACA identifies five main purposes of the code of ethics: (1) to clarify the nature of the ethical responsibilities held by the members of the organization; (2) to help support the mission of the organization; (3) to establish principles, best practices, and ethical behaviors for members; (4) to serve as an ethical guide to members in making decisions about practice; and (5) to serve as a basis for processing ethical complaints (ACA, 2014). Even with these five main purposes, the ACA and other codes of ethics do not provide a cure-all or dictate specific guidelines for practice. Ethical standards cannot be applied in a prescription-type manner (Freeman, 2000). Rather, codes of ethics provide a broad, general guide to what is generally considered “best practice.” See Case Illustration 1-2 as an example of how the ACA Code of Ethics guides a counselor without providing strict, prescription-type instruction.

Case Illustration 1-2

Faisal is a newly licensed professional counselor who works at a community mental health clinic. He has been meeting with Mr. and Mrs. Vasquez for almost two months due to some minor marital conflict. In the past few sessions, the Vasquezes have made tremendous progress and are considering terminating the counseling relationship because they have accomplished the goals set at the onset of services. At one of their last counseling sessions, Mr. and Mrs. Vasquez express their extreme gratitude to Faisal for his help in strengthening the couple’s relationship. Mrs. Vasquez invites Faisal to a dinner at the couple’s house. Mr. and Mrs. Vasquez both describe the dinner as a “celebration of their rejuvenated love for each other.” There will be many friends and family members attending, and they would be honored to have Faisal attend as he played such a large role in their marital success.

• How should Faisal respond to the couple’s request?
• How does the ACA Code of Ethics direct Faisal’s response?

As stated previously, codes of ethics do not offer prescription-type guidelines; therefore, in Case Illustration 1-2 Faisal has many options. The only action he “should” take is to engage in an ethical decision-making model. In response to the second question in Case Illustration 1-2, the ACA Code of Ethics offers Faisal guidance in ethical Standard A.6.b. (Extending Counseling Boundaries). Standard A.6.b. requires Faisal to consider risks and benefits of extending boundaries with the Vasquez family and directs Faisal to discuss possible concerns with his clients. Ethical Standard A.6.b. does not direct Faisal to either attend or not attend the dinner. Rather, it guides him on “best practices” for making a thoughtful choice of how to respond to the Vasquez’s invitation.

Professional ethical codes provide assistance and protection to both practitioners and the general publi...