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ETHICS

ETHICS. Chuck Holt, Ph.D., MFT, LCADC Jennifer Dustin, M.A., NCC, MFT Intern, CADC Intern.

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ETHICS

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  1. ETHICS Chuck Holt, Ph.D., MFT, LCADC Jennifer Dustin, M.A., NCC, MFT Intern, CADC Intern

  2. “[Ethics] grades from a consciousness of a duty nearly as strong as positive law, to a feeling that the matter is all but a question of personal choice. . . . [It] is the domain of obedience to the unenforceable. That obedience is the obedience of a man to that which he cannot be forced to obey. He is the enforcer of the law upon himself.” -John Fletcher Moulton, 1924

  3. ETHICAL CODES • NAADAC: http://www.naadac.org/resources/185-pr11 • AAMFT: http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx • NASW: http://www.socialworkers.org/pubs/code/code.asp

  4. STANDARDS OF PRACTICE • NAC 641C (for CADC/ LADC/LCADC): http://www.leg.state.nv.us/nac/nac-641c.html#NAC641CSec400 • NAC 641A (for MFT/ CPC): http://www.leg.state.nv.us/NAC/NAC-641a.html#NAC641ASec243 • NAC 641B (for MSW): http://www.leg.state.nv.us/nac/NAC-641B.html#NAC641BSec200

  5. What if the ethical codes and statutes differ?? -- Does law trump ethics? --The safest bet is to go with whichever is more stringent.

  6. THE IMPACT OF PERSONAL VALUES • Bruff v. North Mississippi Health Services, Inc. (2001) • Bruff made clear to her employer (an EAP) that she was unwilling to provide counseling to clients in any area which conflicted with her religious beliefs. • Bruff was ultimately terminated after having been provided due process by the EAP; she filed a federal suit on the grounds of discrimination. • The court determined that an employer is not mandated to adapt to such rigidity, and took a stance on the potential harm to clients. • Ward v. Eastern Michigan University (2010) • Grad student dismissed from program due to refusing to treat a same-sex couple, citing a religious conflict. • The court sided with EMU due to the clarity of university policy against discrimination, and the programs stated incorporation of ACA / CACREP standards. • Keeton v. Augusta State University (2010) • Grad student made anti-gay statements in class. • Refused remediation plan, which intended to increase her clinical ability to treat clients without imposing personal values (NOT to change her mind…)

  7. The Common Factors… • Ethical code violations occur in each case, and the judgments have been in favor of the institutions’ obligation to those codes. • ACA (2005) asserts that counselors must do no harm (A.4.a.) and take steps to avoid imposing their own values on clients (A.4.b.). • Additionally, “Counselors do not condone or engage in discrimination based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital status/partnership, language preference, socioeconomic status, or any basis proscribedby law” (C.5., p.10). • These cases all referred to ACA, however other codes reflect similar philosophies. • NAADAC principles: 1 (nondiscrimination), 8 (preventing harm), and 9 (duties of care) • AAMFT principles: 1.1 (nondiscrimination), 1.8 (respect clients’ rights to make life decisions) • NASW sections: 1.01 (commitment to clients),1.05 (cultural competence and social diversity)

  8. PROFESSIONAL BOUNDARIES • Traditional ideas of a boundary • A line to be crossed… one side is acceptable, and the other is…?? • Crossing vs. Violating • What’s the difference? • Motives, behaviors, therapeutic considerations

  9. RE-THINKING BOUNDARIES* THE HIGHWAY METAPHOR – Rules of the road THE BRIDGE METAPHOR – Two sides finding a way to connect THE TERRITORY METAPHOR – A mutually agreed upon meeting space * Austin, W., Bergum, V., Nuttgens, S., & Peternelj-Taylor, C. (2006). A re-visioning of boundaries in helping relationships: Exploring other metaphors. Ethics & Behavior, 16(2), 77-94.

  10. DUAL RELATIONSHIPS • Typically refers to any relationship occurring outside of the therapeutic context • Examples… • What do the codes say? • AAMFT – Avoid dual relationships when possible; take precautions if you must. • NAADAC – Attend to the power differential; avoid dual relationships which pose any threat of harm to clients and others; do not accept “substantial” gifts. • NASW – Avoid dual relationships when possible; take precautions if you must. • They all agree: NO SEX!! Romantic relationships are prohibited… Time lines? Ex-clients?

  11. What would you do? Personnel in a Pickle…

  12. Considerations for Online Counseling • Things to consider: • Security (e.g. encryption software, virus protection, HIPAA) • Legal ramifications of practicing across state lines • Contact licensing board in your state, client’s state, and get legal counsel. • Confirm coverage with your malpractice insurance • Informed consent • Must address security issues, risks, benefits, etc. • Face-to-face first session for assessment and review of consent docs • Back-up plan for emergency contact, and if technology is not working • Resources for practitioners • Online Therapy Institute (http://www.onlinetherapyinstitute.com/) offers resources and information for online practitioners. • American Distance Counseling Association: http://www.adca-online.org/ • Distance credential & ethics: http://www.cce-global.org/DCC/Ethics Reeves, A. (2011, Sept/Oct). Therapy and Skype. Family Therapy Magazine, 10(5), 48-49. Shallcross, L. (2011, Oct). Finding technology’s role in the counseling relationship. Counseling Today, 54(4), 26-35.

  13. FACEBOOK SAFETY TIPS* • Carefully consider the risks and benefits of being “friends” with current or former clients, and family/friends of clients. • Apply privacy settings – even allowing “friends of friends” to view your page puts you at risk. • Avoid accepting friend requests from unknown sources. • Do not include personal information on your page such as birth date, physical address, phone number, etc. • Address boundaries about Facebook communication as part of the informed consent process. • Carefully screen which photos you post. • Be judicious about which clubs or fan pages you join – others on these pages can access your info. • Do not engage in work-related discussion in an online forum. * Parrish, K. & Friedman, J. C. (2011). Counselors, clients, and Facebook: To friend or not to friend? Counselor, 12(1), 10-13.

  14. ASSESSING VIOLENCE RISK IN TARASOFF SITUATIONS* ACTION A – attitudes the support or facilitate violence; antisocial tendencies C – capacity to act (mental, physical) T–thresholds crossed (pathway to violence) I – intent (specific plan, means, commitment) O – others’ reactions (is the client justified? Discouraged?) N – noncompliance with risk reduction Borum, R. & Reddy, M. (2001). Assessing risk in Tarasoff situations: ACTION. Behavioral Science Law, 19, 375-385.

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