Ethics in Clinical Practice

1. Ethics in Clinical Practice Compiled by Victoria A. Fitton, PhD with assistance from: Corey, G., Corey, M.S., & Callanan, P. (2006) Issues and ethics in the helping professions (7th ed.). Belmont, CA: Brooks/Cole. Reamer, F. G. (). Social work values and ethics (3rd ed.). New York, NY: Columbia University Press.

2. Ethical Considerations • Ethics – beliefs we hold about what constitutes right conduct; moral principles adopted by individuals or groups to provide rules for right conduct. • Professional responsibility to examine and clarify personal values and professional practice. • Personal values exert considerable influence on a professional’s views of clients, their intervention frameworks and strategies, and definitions of successful or unsuccessful outcomes.

3. Personal and Professional Values • Social workers occasionally face tension between their personal values and those held by clients, employers, or the social work profession itself. • Social workers sometimes encounter clients whose values and behaviors seem immoral and abhorrent (child abuse, violence). • Some dilemmas relate to the congruity or incongruity between the professional’s value orientation and those of the client. Reamer, 2006

4. Personal and Professional Values • Client difficulties often contain a moral dimension. • Clients often wrestle with moral aspects of problems (divorce/infidelity; IPV/child care). • These emerge vividly and emotionally in expressive therapeutic work. • Learn to view problems through an ethical lens with clear understanding of personal values. • Actively explore clients’perspectives about what they believe is ethically right and wrong. Reamer, 2006

5. Cultural and Religious Values • Important to recognize the influence of our own and clients’religious and cultural values and beliefs (abortion/marriage/women…). • Be mindful of potential conflicts between our personal values and clients’cultural and ethnic norms (medical). • This will also be manifest in expressive therapies. (What can be avoided in talk therapy is direct in expressive therapies.) • Professional (NASW) and religious views on sexual orientation are often in conflict. Reamer, 2006

6. Free Will and Determinism • Values or beliefs related to the determinants of clients’problems. • Social workers make assumptions regarding the causes of client problems which significantly impacts treatment planning. • Biology (Medical/Disease model) • Environment (Social Learning Theory) • Institutional/Political (Racism, Left-Right) • Economic (Oppression/Globalization) • Personal Deficit Reamer, 2006

7. Defining Your Personal Ethics • Personal beliefs and values • Spiritual and religious values • End of life decisions

8. Thinking Through Ethical Problems & Dilemmas • Identify the problem or dilemma • Identify the potential issues involved • Review relevant ethical codes • Know the applicable laws and regulations • Obtain consultation • Consider possible and probable courses of action; • Enumeratethe consequences of various decisions • Decide on what appears to be the best course of action Corey, Corey & Callanan, 2006

9. Documentation - Ethical Dilemma Remember to document: • Client name • Date of service • Aspects of the issue or dilemma (delineate) • Intervention and response to treatment goals • Action/s taken • Clinician • Signature • Credentials • Date

10. Legal Aspects of Informed Consent Four elements are basic to the legal aspects of informed consent: • Full Disclosure or Full Information– giving clients information on all aspects of therapeutic process, expectation, and intervention upon which informed consent can be based • Capacity–client has ability to make rational decisions (parent or guardian) Corey, Corey & Callanan, 2006

11. Legal Aspects of Informed Consent • Comprehension of information - must give clients information in clear ways and check for understanding. Clients must have adequate information about both procedure and possible consequences (risk/benefit) • Voluntariness - acts freely in decision-making process and is legally and psychologically able (competent) to give consent Corey, Corey, & Callanan, 2006

12. Ethical and Legal Issues - Confidentiality & Privilege • Confidentiality – the right to expect that communications will be kept within the bounds of the professional relationship. • Privileged Communication – a legal concept that protects against forced disclosure in legal proceedings that break a promise of privacy. • Does not apply to group counseling, marital and family therapy, or child and adolescent therapy. Corey, Corey, & Callanan, 2006

13. Ethical and Legal Issues – Privacy • Privacy – refers to the constitutional right of an individual to decide the time, place, manner, and extent of sharing oneself with others. • Exercise caution with regard to the privacy of clients. Do not invade a client’s privacy. • Think about the use of telephones, answering machines, voice mail, pagers, faxes, cell phones, and e-mail. Corey, Corey, & Callanan, 2006

14. Ethical and Legal Issues –Duty to Warn • Duty to Warn – mental health professionals have a double responsibility to protect other people from potentially dangerous clients and to protect clients from themselves. • Identifying clients who pose a threat to others • Protecting others from potentially dangerous clients • Treating those clients who are dangerous Corey, Corey, & Callanan, 2006

15. Full Disclosure – Checklist for Treatment • Voluntary Participation • Client Involvement • Counselor Involvement and contact • No Guarantees • Risks and Benefits Associated with Counseling. Emphasize role of client’s responsibility in treatment. • Confidentiality and Privilege • Counseling Approach or Theory

16. Full Disclosure – Checklist for Treatment • Exceptions of Confidentiality and Privilege • Counseling and Financial Records • Ethical Guidelines • Licensing Regulations • Credentials • Fees and Charges • Insurance Reimbursement • Responsibility for Payment • Disputes and Complaints

17. Full Disclosure –Checklist for Treatment • Cancellation Policy/Interruptions in Therapy • Affiliation Relationship • Supervisory Relationship • Colleague Consultation • Alternatives to Traditional Therapy • Tape-Recording or Videotaping Sessions • Client Access to Files and Diagnostic Classification Corey, Corey, & Callanan, 2006

18. Personal Issues and Ethics - Protective Factors • Balancing Life Tasks – creating and maintaining a commitment to promoting ones own wellness from a holistic perspective: • Spirituality • Self-direction • Work and leisure • Friendship • Love

19. Personal Issues and Ethics - Risk Factors • Counselor Impairment • Fragile self-esteem • Difficulty establishing intimacy in personal life • Professional isolation • A need to rescue clients • A need for reassurance • Substance abuse of any kind • Lack of empathy • Poor social skills • Preoccupation with personal needs • Discounting possible harm to clients or others

20. Ethics in Child Practice • Full disclosure • Ages of children trained to treat • Childhood issues trained to treat • Theoretical orientation • Treatment philosophy • What a family can expect - risks/benefits • Continuing education and training • Supervision and peer consultation • Range of treatment options/interventions

21. Treatment Options • Information on child treatment • Information on child development • Brief overview of play and expressive therapy • Directive, non-directive and prescriptive techniques • Expectable outcomes • Pamphlet and/or video about play therapy • Tour of playroom • Answer questions

22. Ethical Considerations • Who is the identified client? • Meeting child first, parent/s first, or family • Divorced and custodial parents • Family/social environment for child • If a long-term problem, is there long term commitment? • Is everyone working for the good of child? • Financial, time, social resources of family

23. Ethical Considerations • Competence to treat the child • Fully equipped for treating specific child • Treat the child or treat the family • Full disclosure • Confidentiality • Consultation with parent/s • What is revealed in consultation? • Is the child included in parent consultation?

24. Ethical Considerations • Speaking for or about a child • Documentation - harm and benefit • In cases of separation and/or divorce documentation can be a nightmare • Information handling in separation and divorce • The “Problem” is the CHILD • What are the costs to the child for intervention?

25. Ethical Considerations • Complete a thorough assessment: • developmental milestones from pre-birth to current age of child • all domains of child’s functioning • all systems in child’s world • maintain contact with collaterals • Include “family”in goal setting and treatment planning • Contract for “completion”of treatment

26. Ethical Considerations • Treatment ethics • Child’s needs first and foremost • Safety first • Mediate/facilitate family connection • Communication/consultation with family • Family treatment including filial therapy, psychoeducation, and supportive therapy • Holistic approach • Responsive to child and family

27. Ethical Considerations • Termination • Reinforce progress and forward movement • Celebrate with child and family • Give follow-up recommendations • Leave the door open • Offer extended referrals • Follow-up • Evaluate