Becoming an Ethical Helping Professional

Cultural and Philosophical Foundations

Rita Sommers-Flanagan, John Sommers-Flanagan

• Publisher: Wiley
• Year: 2015
• Print ISBN: 9781119084969
• eBook ISBN: 9781119087922
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

An engaging way to cover ethical choices in counseling settings

This guide will take readers on a wide-ranging tour of ethics—covering both the theoretical and practical aspects of providing sound, ethical care. In addition to invaluable information, this book provides access to chapter objectives, candid case studies, stories from both students and counselors, questions for reflection, and student discussion activities.

Coverage goes beyond a laundry-list approach to rules of conduct, and plumbs the philosophical roots embedded in today's professional codes. Engaging case studies explore how ethical rules and principles apply in various real-world settings and specialties.

After covering ethical philosophies, codes, and standards, Becoming an Ethical Helping Professional further discusses:

• The helping relationship from beginning to end
• Confidentiality and trust
• Boundaries, roles, and limits
• Assessment: peering through the right lens
• Research, efficacy, and competence

John & Rita Sommers-Flanagan have written an exceptional resource that considers both the process and the content of making ethical choices as a counselor or psychotherapist.

SECTION TWO

THE DAY TO DAY CHALLENGES COMMON TO ALL

Chapter Five
THE HELPING RELATIONSHIP: FROM BEGINNING TO END

You must learn to be still in the midst of activity, and to be vibrantly alive in repose.

—Indira Gandi

CHAPTER ORIENTATION

This chapter represents a turning point in the text. Until now, we have considered three important strands in the fabric of ethical practice:

• moral philosophy
• professional ethics and identity
• personal attributes and values you bring to the helping endeavor

Now (at last?) we turn to the work itself—the particular issues in the development of the professional helping relationship. This chapter provides an overview of elements especially relevant to the beginning and end of an ethical helping relationship, including informed consent, issues in basic competency and referral, and termination or ending well. We examine tensions between autonomy and fiduciary responsibilities that may, at times, seem paternalistic. Children, the elderly, and those deemed unable to act in their own best interests present specific challenges and opportunities for mental health professionals.

Later chapters delve into four dimensions essential to maintaining helping relationships:

• confidentiality and trust
• boundaries
• assessment
• competent professional practice

In this chapter we also begin considering technology in mental health service provision, but this topic spans the chapters and specialties, so the thread is picked up throughout relevant chapters. Specifically, this chapter will provide you with food for thought on:

• considerations before the professional relationship begins, such as your office and your professional persona;
• informed consent and refusal and all related concerns;
• anxieties and skills related to the first session;
• technological concerns; and
• issues to consider in ending the professional relationship well.

BEFORE THE BEGINNING

When does a professional counseling or helping relationship begin? This may seem self- evident, but it is actually more complicated than one might think. In schools or large agencies, you may be introduced as the “counselor” or “social worker” to hundreds or even thousands of people who are potentially your professional responsibility in some way. When a large group introduction occurs, have you started a thousand helping relationships simultaneously? These impersonal first impressions play a role in people's beliefs about and responses to counseling, and affect their willingness to seek help. It may be a stretch to claim that your professional relationship begins at the moment of a large group introduction, but you are on display as the professional and are therefore communicating about yourself and how you might behave in a more personal one- on- one contact.

Similar exposures occur in mental health, community, rehabilitation, and other types of professional positions. Mental health professionals are often asked to comment publicly on events of interest, or to offer psychoeducational programs or classes to the community. Your professional persona is on display and potential clients are sizing you up and taking in information about both you and the profession. The same is true about your professional listing in the local telephone book. Your ethical (and clinical) obligations begin long before you are sitting comfortably in your office, getting acquainted with someone seeking your assistance (J. Sommers- Flanagan & Sommers- Flanagan, 2003). In this section, we cover factors to consider in optimizing those important first impressions.

Portraying Yourself and Your Services

From paperwork, such as intake materials or graduate program descriptions (Bidell, Turner, & Casas, 2002) to assumptions about handshakes and personality (Chaplin, Phillips, Brown, Clanton, & Stein, 2000), first impressions are powerful (Gladwell, 2005).

Pause for Reflection

Do you recall how counselors and counseling services were initially introduced to you in your life? How did you come to know about your school counselor's existence? What assumptions have you made and do you make about people introduced to you as counselors? Have you ever tried to decide on a mental health counselor for yourself or family members? What factors influenced you? As you read this section allow your reflections to these questions to guide your thoughts on what is important to consider when presenting yourself as a counselor.

There is no single correct ethical way to make yourself and your services known to potential students and clients. However, here are a few points to consider:

• If you include a picture of yourself in the school literature, your literature, on your card, or in the advertising pages of the phone book, what do you hope to communicate? How would you assess if you have achieved your goal?
• If you use letterhead, what credentials do you include? Do you list a long set of abbreviated educational and professional memberships, degrees, or licensures after your name, which are designed to impress, but will likely confuse the general public?
• Do you allow your home address and phone number to be readily available to the public?
• If you agree to be introduced in a large group setting, do you provide the speaker with the correct description of your job and training credentials?
• What does your wardrobe communicate?
• What does your level of preparedness to speak publicly communicate?
• What does your choice in jokes or personal self- disclosures communicate?
• How do you let other professionals know about your professional orientation and preferences?
• How do you let students or clients know enough about you to make an informed choice about working with you?

Officing Yourself

The location, size, and décor of your surroundings contribute to your clients' first impressions. We are aware of school counselors who are forced to work out of converted storage closets due to space shortages. We have known social workers, rehabilitation, and school counselors who had large windows in their office doors, so that those going by in the hall could see who was visiting the counselor. We even knew one agency mental health counselor who believed it was best to keep the door open a crack when she was talking with clients so they would not think counseling was a “closed” process. Obviously, there are some serious status and confidentiality problems with these examples. You need to give careful thought to the location and physical attributes of the space in which you work, and exercise as much control as possible over the comfort, privacy, and accessibility factors.

Physical and psychological accessibility

The Americans with Disabilities Act of 1990 has been invaluable to professionals who needed legal support in their quest to make sure all clients, regardless of their ability to climb stairs, read signs, or hear directions, could make it safely into their offices. In most situations, it is both unethical and illegal to offer services that are inaccessible. If you find yourself considering office space that is inaccessible, you are well- advised to make sure you can conform to both local and federal laws regarding serving the general public.

Besides being physically accessible and welcoming, mental health professionals need to consider the ramifications of psychological barriers as well. What do we mean by psychological barriers? These are office or décor attributes that might make potential clients uncomfortable before they've even met you. Examples might include:

• office reading materials that indicate a certain political or moral stance
• an office located in a high- crime area
• an office located in a very upscale area
• dim lighting in the halls or waiting room
• loud background noise that intrudes into the office space
• an office located so that a lot of people can watch someone approaching your door
• an office with a shared waiting area, or no waiting area at all
• a mental health office located in a building devoted primarily to other uses, such as businesses, probation offices, or medical offices
• a telephone system that allows clients to hear the phone ring, to hear the answering machine start operating, or to see when a call is coming in
• office staff who interact in dismissive, controlling, intrusive, or unpleasant ways with clients

Of course, all potential psychological barriers cannot be eliminated—they vary from person to person, and are often out of your control. However, ethical professionals take these barriers into account, talk about them if appropriate, and try to accommodate client needs as resources and other factors allow.

The Health Insurance Portability and Accountability Act of 1996, fondly known as HIPAA (see Applications 5.2), is a comprehensive set of federal regulations that includes regulations pertaining to office arrangements. Additionally, many preferred provider panels or managed care organizations require that participating providers have private offices that meet specific standards. Consequently, in addition to legal and ethical concerns about physical and psychological office accessibility, there are also practical or employability issues requiring minimal office standards.

Comfort and aesthetics

Beyond the ethical, legal, and practical standards associated with the helping professions, to the extent possible, when we finally get an office, most of us want to personalize it. Furniture, art work, even desk size and location all contribute to overall first impressions. There are no absolute rules. Obviously, tastes and incomes vary greatly—and this is a good thing. Humans tend to be blessed with more or less awareness of the space around them and what it communicates. There are excellent professionals who furnish their offices with the most expensive furniture and elegant art available. There are also excellent helpers who furnish their offices by shopping at Goodwill, Salvation Army, and rummage sales. We even know a psychiatric nurse who keeps little gnome statues sprinkled around her office and manages to have a sound professional reputation. Colleagues or friends can provide an external perspective regarding what your office communicates.

If your work will focus mainly on young people or people with disabilities, your office furniture and set- up should take this into consideration. For children, soft, comfortable furniture that allows fidgeting or curling up can facilitate a sense of connection and trust (Thompson & Rudolph, 2000).

INFORMED CONSENT AND INFORMED REFUSAL

All professional counseling- related codes require some type of informed consent from clientele. Many professional groups include an entire section on informed consent within their codes, or r...

Table of contents

• Cover
• Title Page
• Copyright
• Table of Contents
• Dedication
• Acknowledgments
• About the Authors
• About the Contributors
• Preface
• SECTION ONE: THE FOUNDATION
• SECTION TWO: THE DAY TO DAY CHALLENGES COMMON TO ALL
• SECTION THREE: SPECIFIC SPECIALTIES AND PROFESSIONAL IDENTITIES
• Epilogue
• References
• Appendix A: Universal Declaration of Human Rights
• Author Index
• Subject Index
• About the Video Resource Center
• Video Resource Center
• End User License Agreement