Ethics can be defined as a philosophical treatment of a moral order (Bonhoeffer, 2009). There are various codes of ethics established to govern different practices for example nursing, teaching, and counselling codes of ethics. Counselling is an act of helping a person in need where a counsellor meets a client usually in a private and confidential area to look into a problem faced by the client after the client request for the service. The problem may be in a form of anguish suffered by the client, frustrations in life matters or even disappointments where the clients may lose taste in life as nothing seems fulfilling (Anonymous, 2009).
The counsellor listens to the clients and uses his or her psychology skills to get the problem from the client’s point of view and thereafter suggests points of change of the client’s attitude towards the specific situation thereby reducing confusion and introducing a sense of direction. There are various ethics in line with counselling, for instance; confidentiality in handling of clients’ information, safety of the client and those surrounding him/ her, lack of discrimination under all circumstances, and not being involved in sexual or other social affiliation with the clients. In this paper, I will look into confidentiality and dual or multiple relations as the main ethical issues of concern in my counselling work (Waichler, 2010).
The American Counsel Association
The American counsel association is the body that governs the operation of counsellors. It intends at promoting the society’s quality of life through nurturing young counsellors and upholding integrity (Anonymous, 2005). The American counsel association stipulates the American counsel association (ACA) codes of ethics that should be followed by the counsellors in their day to day practices.
The purposes of the ACA codes of ethics include; enabling the association to make it clear to present and future members and also the people served by the members the ethical responsibilities of all its members, supporting the mission of the association stated above, establishing principles that outline ethical behaviour and best practices to be followed by members of the association, acting as a basis for dealing with ethical complaints and other issues raised against members of the association and acting as an ethical guide that aid members in establishing a professional course of action that best serves the people in need of counselling services and also enhances the values of counselling as a profession (Kocet, 2005).
The ACA codes of ethics are subdivided into eight main parts where each deal with an aspect(s) in regard to ethical issues governing the counselling profession. The first section deals with the counselling relationship, the second one covers aspects of confidentiality, privacy and privileged communication, the third one deals with professional responsibility, the fourth deals with a counsellor’s relationship with other professionals, the fifth with evaluation, assessment and interpretation, the sixth with supervision, teaching and training, the seventh one with research and publication and the last one covering ways of resolving ethical issues.
General Standards of Counselling Associations
Many associations have been set in regard to the practice of counselling process. There are usually set standards by which the members of the associations should abide to throughout their term of service as counsellors. For example, the counselor should offer professional services to clients with respect to individuality of each client, establish helpful relationship with the client so as to uphold dignity and integrity and at the same time empower the client without using advise, ensure confidentiality and inform the client the extent of the duty of care, inform the clients of the process of counseling, its boundaries and purpose, make suitable referral services where the needs of the clients cannot be met sufficiently, carry out some supervision so as to develop counseling skills, keep track of performance and maintain professional accountability, and have no personal or sexual relationships with clients (Collins, 1991).
A good counselor should also cooperate with other counselors and enhance his or her skills by being at per with what is happening in the field of counseling. Ethical standards aim at ensuring competent professional behaviour where the counselors instil trust on the public and keep track of their behaviour and that of peer counselors. It also avoids the controversies brought about by development of the ethical codes. The ethical principles advocates for independence and self determination, avoidance of harm, promotion of welfare, fairness, and fidelity (Reynolds and Welfel, 2009).
According to Lambie, Hagedorn, & Ieva (2010), a counselor is a very important person in the society due to the services he or she provides. Counseling being an intimate kind of exercise needs a person to do away with personal attributes and be authentic in carrying out the counseling process. A Counselor should do anything necessary to help the client by being friendly and showing the will to assist.
A good counselor should posses most if not all of this characteristics; he or she should have an identity where he or she understands his/her strengths and weaknesses and how to deal with them, should be honest sincere and authentic, should be able to put life aspects into perspective, maintain healthy boundaries, be passionate, and have the courage to pursue his or her work passionately so as to deliver effectively, should be deeply involved in his or her work so as to gain meaning from it and be of help to people, have effective interpersonal skills so that he or she can easily intermingle with different clients, fit into their conditions and try help them overcome their problems, be sensitive on matters concerning people’s welfare by exercising aspects like care, trust, respect and value for others, be responsive on matters regarding culture by having the understanding that there is diversity in culture and different clients will portray different cultures and hence have respect to all and consider differences in social classes, race etc and treat them equally, he or she should always be at per with what is happening in the world so as to solve client’s problems adequately and sufficiently, should embrace change by making adjustment to his or her lifestyle to have job satisfaction by doing what is right and resourceful and make good choices that can yield good results when implemented (Norcross, 2002).
Making Ethical Decisions
Anonymous (2010) asserts that it is usually a hard task for counselors to make ethical and informed decisions. Forester- Miller and Davis (1996) states that one should first identify the problem and gather adequate and relevant information about it to know its nature, assess the issues associated with the problem including all the parties involved, consider relevant ethic codes that may guide in making the decision to avoid the violation of the codes of ethics, look into the responsible laws and regulations and determine their influence on the problem, seek views from various sources to come up with the best way to deal with the problem, making record of the received suggestions, integrate the client in searching for possible solutions to the problem, consider consequences of each decision made and evaluate the impact they would make in solving the problem and finally deciding on the best course of actions after considering the many options, implementing the course of action and undertaking a follow up to gauge the performance and making necessary adjustments is then done. The whole process of decision making should be documented for future reference (Corey, Corey, & Callan, 2003).
The counseling code of ethics ensures that counselors do not in any way harm the clients. It also assists counselors to enhance their counseling practices and therefore improve the image of the counseling profession. It as well gives information on what should be done to the counselors in case of any form of violation of the ethics hence offering guidelines to be followed and protecting client’s right. In general, the counseling codes of ethics aims at producing excellent performance by giving standards of practice to be followed in the counseling exercise (Cathrein, 1909).
According to Sanders (1997), there are various aspects that a counselor should adhere to, for example, its is unethical to use strict persuasion as a means of probing information from a client or making the clients adopt your measures in regard to the problem, a counselor should not use his relationship with the client to promote any form of interest for example personal, religious or even business interests. There should be no extra fee charged on a client apart from the agreed charge, a counselor should not go beyond the boundaries stated by the client unless the client introduces new aspects within the counseling process and should always protect citizens against unethical practices by challenging the practices.
The counseling should be undertaken professionally and the counselors should uphold integrity and respect when dealing with others especially the clients so as to protect their welfare. There should be no discrimination in offering counseling services regardless of gender, political and religious grounds, race or any other factor and in case a counsel cannot be able to maintain this due to some connections with the client, he or she is expected to pass the case to someone else (Foster and Black, 2007).
A counselor should be careful while giving his or her point of view to avoid direct influence on the behaviour of the client but rather to provide options from which the client should choose and make a decision. Confidentiality is also another aspect that is highly regarded in the counseling field and should be maintained to the highest level. Supervision of the counselled clients should be done to ensure they improve positively (Bostock, 2000).
Corey (2004) states that a counselor should keep the trust the client have on him or her by maintaining privacy and confidentiality in handling the client’s details given during the counseling sessions. The information should not be leaked without written permission given by the client. Confidentiality is essential in promoting a productive and trusting relationship between the client and the counselor. The counselor should define the degree of confidentiality to be maintained so as to set the client at ease to enhance disclosure of any necessary information that aid in solving the problem.
The counselor should discuss with the client the nature and purpose of the aspect of confidentiality at the initial stages of the counseling process (Barclar, 1996). However, a counselor should take rational action if the client is likely to harm him or herself or/and inform people who may fall victims of harm from the clients and accountable authorities whenever there is a possibility of danger as stipulated by the National Board for Certified Counselors (NBCC).
Information that can jeopardize the counselor if withheld may also be revealed, when the client needs hospitalization, or in case the court orders that the information be revealed for example in case of child abuse like in cases of rape, incest etc. In determining whether to reveal the clients information or not, a counselor should consider the legal requirements, the requirements of the institution in which they work and the most important aspect, the client in question (Pope and Vasquez, 2010).
Confidentiality and HIV/AIDS Related Issues
In my work as a counselor I consider confidentiality a very essential aspect especially in dealing with HIV/AIDS related issues since it’s a personal problem and sensitivity is crucial. HIV/AIDS is treated as a deadly disease and many people prefer their HIV/AIDS status especially when positive to be known to them only. It is usually a traumatizing disease most especially because of the negative perceptions that people associate it with and the means through which it is contracted.
It is mainly associated with immorality and lack of carefulness on sexual matters and it’s hard to convince someone that you never got the disease through immorality even if you got it through other means like blood transfusion or contact with an infected person through open areas or cuts. It is just recently that people have come to accept the disease like any other and learnt to deal with its effects positively. During the voluntary counseling and testing process, I would first make it known to my client that the discussion concerning the sexual practices, the number of partners and also the results of the test will be treated with high confidentiality level and that the information will not be revealed to anyone else whatsoever.
I will also not need the specific personal information of the client like name and identification number so as to instil trust, create a relaxed mode and an atmosphere that will allow the client to discuss the issue comfortably and at ease. HIV/AIDS is a personal aspect and should be treated with privacy and confidentiality. There should be an agreement between me, as a counselor, and the client on the condition that may lead to breach of confidentiality, for example, when the patient is advised for referral services like collection of Antiretroviral medication which is for her or his own good. I would undertake the counseling process prior to the testing with care showing the client the possibility of the test being either negative or positive and the various ways of responding to it.
I would clearly inform the client of the whole process of HIV/AIDS counseling and testing, how the test is conducted, the interpretation of the result and where one should access follow-up and other support facilities, the benefits of being tested and the importance of disclosure of the information to people concerned for example sexual partners or family members. Post test counseling is essential as it helps the client to accept the results, either positive or negative, and deal with the condition appropriately. Risk minimization information and emotional support should be offered to all and referral services advocated to those found infected.
In my practice I would always adhere to the three principles of HIV/AIDS testing and counseling which are consent, counseling, and confidentiality. The HIV and AIDS prevention and control Act (2006) asserts that people should not be tested without their consent unless the test is required to be done under a written law or when the clients is unconscious and the test is needed for immediate diagnosis. They should give accurate and sufficient information voluntarily without use of force and the counselor should also give adequate information that aid the client in making decision in regard to the test (Corey, 2009).
As a counselor, I may be faced with the challenge of warning and protecting the third party from the risk involved especially when I try my best to convince the client to share the HIV/AIDS status information with those at risk without success. I would therefore use the chance to disclose the information to the sex partners or other people exposed to the risk as a means of avoiding instances of more infection to many people. This is however done as the last resort after the client completely fails to disclose the information even after persistent request by the counselor. Failure to disclose the information is a denial of the right to the health and well being of the persons in risk (National AIDS and STI Control Programme, 2008).
Dual or Multiple Relationships (Non professional interactions)
There are usually high chances of occurrence of dual or multiple relationships which may be either sexual or nonsexual (Bruhn and Levine, 1993). Dual or multiple relationships occur especially when the counselor takes up more roles with a client or combination of professional and unprofessional roles leading to loss of direction and breach of the code of ethics of the counselors. The relationships take various forms for instance; having sexual relationships with the client or ex-client, borrowing money from a client, giving and acceptance of gifts, touching or physical comforting of the client, or going into business deals with the client (Gutherl and Gabbard, 1998).
Since the counselor is vulnerable to situations that may result in dual or multiple relationships due to possibility of combination of roles, it is advisable to be careful when dealing with clients and think of the complexities involved in the unethical practices. One should reflect on the code of ethics to enhance ethical judgment and decision making in any particular situation and always carry out multiple roles and responsibilities in an ethical manner. Dual or multiple relationships are considered difficult to identify, unavoidable, harmful but not always since they are sometimes beneficial and generally controversial.
They usually tamper with the objectivity of the counseling process; enhance misuse of power and exploitation of clients. Boundaries are rules that govern our physical and emotional limits of our relationship with others. There should be a distinct boundary between me and my clients to protect privacy and reflect individualism. This ensures objectivity and professionalism in the counseling process (Cook-Greuter and Soulen, 2007). In my work as a counselor, I would consider contact time a very crucial aspect. In this, the time spent together should be considerable to avoid going past the agenda set and should also ensure that the meeting juncture is official to facilitate objectivity and does not draw the minds out of the problem to be discussed. The topics of discussion should also be limited and the extent of discussion defined to avoid going into matters that were not planned for and which could form a basis of social relationships between the counselor and the clients.
I would also check into the physical closeness when together with my clients, for example, touching each other should not be allowed and the non verbal communication mechanism should be controlled. I would also ensure that there is an emotional space between me and my clients such that there is a limit of expressing my feelings towards my clients especially in regard to sensitive topics (Skovholt and Ronnestad, 1992).
A clear boundary defines the counselor roles giving clarity regarding the range and limits of the roles, acts as a basis from which a counselor makes decisions on how and when to cross physical and psychological boundaries, acts as a reference point that reminds a counselors of the legal consequences of violating boundaries and also acts as a source of security as it helps counselors to abide by the stipulated boundary rules. To the client, a clear boundary gives him or her a strong sense of individuality due to the control accorded to him or her, acts as a basis to determine when or whether the counselor is crossing certain boundaries and if it is acceptable, creates a safe and conducive environment for the client such that he or she can give information comfortably and with ease and finally it establishes a good relationship between the counselor and the client where the client feels appreciated, empowered, and respected (Walsh, 2000).
There has been a change in perspective of dual relationships due to the complexity of the issues concerned with it. Different ethical scholars and professionals have made it clear that not all dual or multiple relationships should be avoided or perceived to be harmful. It is argued that sometimes when a dual or multiple relationships occurs in the counseling context, it is very fruitful and promotes growth and development (Kocet, 2005).
Social network sites have become very popular in modern days and everybody feels obligated to be in one or more social network groups for socialization and fun purposes. A counselor could find him or herself in the dilemma of whether he or she should be involved in socialization through the social networks with his or her client. A good example is when a counselor receives a friend request from a client on face book social network. Here, the counselor has the option of accepting, rejecting or ignoring the friend request based on his judgment of the ethical issues associated with the act of either accepting or ignoring the request.
As a counselor, I would first weight the consequences of any act bearing in mind the codes of ethics governing the counseling profession. First, accepting the friend’s request would bring our social relationship closer which is not recommended. This is because I will be giving my client the power to know much information about me through the wall post and comments and personal information in my profile in the social network and I will also know much about the client through the same. It would interfere with the boundary set and may lead to lack of respect and objectivity in the subsequent counseling sessions.
Ignoring the friend request can also create hostility between the counselor and the client and this will affect the counseling process negatively as the client may consider this as an undermining attitude or lack of importance of the counselor towards the client. This argument shows the complexity that may be posed by dual relationships. As a counselor, I would either ignore the friend request and if the client insist of the acceptance, give logical reasons like am no longer an active member on face book or may be am planning to quit or even tell her or him that my face book account is experiencing some problems and that accepting a friends request is not possible. The other option is that of accepting the friend’s request, this is tough though.
Before accepting the request I would make sure that my wall page is clear and very minimal information about me can be accessed through use of security measures and in all ways try to limit my interaction with the client through face book bearing in mind that our relationship should not be social in nature and should have boundaries. Another form of reacting to this problem is by accepting the request and still maintaining a formal relationship where I can use the social network site as a means of serious communication for example passing information on the next dates of counseling, and constantly monitoring the performance of the client hence mutual benefits (Corey, Corey, & Callan, 2007).
Reducing Risks of Dual or Multiple Relationships
Multiple relationships affect counselors and mental practitioners irrespective of the setting and clients they are associated with. This has been acknowledged in various professional codes of ethics and they warn against the effects involved in dual relationships since they affect counselors in making rational decisions in their practices. Since the dual or multiple relationships seem inevitable and there are no stipulated ways of dealing with them, it is good to check onto the ways in which the incidences of dual or multiple relationships can be minimized (Curtis and Hodge, 1994).
One should also weigh between the positive effects and the negative effects that are associated with dual or mutual relationships. Some of the ways include; defining and maintaining a healthy boundary between the counselor and the client at the beginning of the counseling session, discussing with the client the potential risks and benefits associated with dual relationships and interrelatedness of roles, be open to talk about the possibilities of arising problems and conflicts to help solve them early enough to avoid major unethical consequences.
A counselor should also seek help from other peer counselors whenever the tendency of harm due to dual relationships becomes high or when the multiple relationships go out of control since a problem shared is usually a problem half solved. Details concerning the multiple relationships should also be documented for reference in case a case arises about them, and where it is completely impossible to undertake the counseling process objectively due to the relationship with a client, it is logical to refer the client to another counselor for support and also perform a self monitoring process so as to gauge whether the motivation of the counseling process is in line with the objectives of counseling and referring to the codes of ethics where necessary (Herlihy and Corey, 2006).
Counseling involves a private interaction between the counselor and the client creating an understanding of the problem in question in a conducive environment that enhances interaction and is a very essential feature in our day to day life as human are vulnerable to things that may cause disturbance in their functioning thereby needing counseling. It is however a very sensitive aspect as the client is usually on trying moments and shares a lot of information with a stranger (Spinoza, 2010).The counselor should therefore take caution when handling the clients by exercising their skills gained through training and adhering to the counseling code of ethics, which gives a standard way of performance in counseling, to ensure that they satisfy their client’s quench and avoid worsening their condition.
Any form of counseling should always make sense at any given time and help the client overcome the problem easily without use of force. Confidentiality should be maintained at the highest level possible and multiple relationships avoided or handled carefully whenever they occur since some are considered to be helpful but only to a certain degree when integrity and rational measures are considered. It is always important for a counselor to establish a way of dealing with ethical dilemmas since they are inevitable and complex. A good idea is consulting with colleagues as this helps in combination of different ideas to come up with the best way to solve a problem that could otherwise be very difficult to solve when handled by one person.
Anonymous (2005). ACA code of Ethics. American Counseling Association. 3-20.
Anonymous (2009). What is Counseling? Web.
Anonymous (2010). Counseling Ethics. Web.
Backlar, P. (1996). The three Rs: Roles’ Relationships and Rules. Community Mental Health Journal, 32, 505- 509.
Bonhoeffer, D. (2009). Ethics. London: Fortress Press.
Bostock, D. (2000). Aristotle’s Ethics. Oxford: Oxford University Press.
Bruhn, J.G, Levine, H.G, & Levine, P.L (1993). Managing Boundaries in the Helping Professions. Springfield, IL: Charles C Thomas.
Cathrein, V. (1909). Ethics. Web.
Collins, G.R (1991). Excellence and Ethics in Counseling. London: Word Publishers.
Cook- Greuter, S.R and Soulen, J. (2007). The Development Perspective in Integral Counseling. Counseling and values, 51, 180 -192.
Corey, G; Corey, M.S., & Callan, P. (2003). Issues and Ethics in the Helping Professions. 6th ed. Pacific Grove, CA: Brooks.
Corey, G, Corey, M.S and Callan, P (2007). Issues and Ethics in the Helping Professions. 7th ed. USA: Cengage Learning.
Corey, G. (2004). Case Approach to Counseling and Psychotherapy. 6th ed. USA: Cengage Learning.
Corey, G., (2009). Theory and Practice of Counseling and Psychotherapy. 8th ed. USA: Cengage Learning.
Curtis, L.C., & Hodges, M. (1994). Old Standards, New dilemmas: Ethics and Boundaries in Community Support Services. In l. Spanial (Ed), Introduction to Psychiatric Rehabilitation (pp 340-354). Columbia, MD: International Association of Psychosocial Rehabilitation Services.
Forester- Miller, H., & Davis, J. (1996). A Practitioner’s Guide to Ethical Decisions Making. Alexandria, VA: American Counseling Association.
Foster, D and Black, G.T (2007). Counseling and Values. Falls Church Vol. 51, Iss. 3; p. 221.
Gutherl, T.G, and Gabbard, G.O (1998). Misuse and Misunderstandings of Boundary Theory in Clinical and Regular Settings. American Journal of Psychiatry, 155, 409 – 415.
Herlihy, B and Corey, G (2006). Boundary Issues in Counseling: Multiple Roles and Responsibilities.2nd ed. American Counseling Association.
Kocet, M.M. (2005). Highlights of the ACA Code of Ethics. American Counseling Association.
Lambie, W.G, Hagedorn, B.W and Ieva, P.K. (2010). Counselor Education and Supervision. Washington Vol. 49, Iss. 4; p. 228.
National AIDS and STI Control Programme, Ministry of Public Health and Sanitation Kenya (2008). Guidelines for HIV Testing and Counseling in Kenya. Nairobi: NASCOP.
Norcross, J.C. (2002). Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients. USA: Oxford University Press.
Pope, S.K., & Vasquez, J.M. (2010). Ethics in Psychotherapy and Counseling: A Practical Guide. 4th ed. United Kingdom: John Wiley and Sons.
Reynolds, E., & Welfel, E. (2009). Ethics in Counseling and Psychotherapy: Standards, Research, and Emerging Issues. 4th ed. Northwestern University: Brooks/Cole Cengage Learning.
Sanders, K.R. (1997).Christian counseling Ethics: A Handbook for Therapists, Pastors & Counselors. UK: Intervarsity Press.
Skovholt, J.M., & Ronnestand, M.H. (1992). Themes in Therapist and Counselor Development. Journal of Counseling and Development, 70, 505 – 515.
Spinoza, B. (2010). Ethics, Part 4, Part 1. England: ICON Group International.
Waichler, I. (2010). The Counseling Code of Ethics. Web.
Walsh, J. (2002). Recognizing and Managing Boundary Issues in Case Management. Case Management Journals, vol. 2. No. 2. Springer Publishing Company.