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.
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.
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
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
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
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
Defining Your Personal Ethics
• Personal beliefs and values
• Spiritual and religious values
• End of life decisions
Thinking Through Ethical Problems & Dilemmas
1. Identify the problem or dilemma
2. Identify the potential issues involved
3. Review relevant ethical codes
4. Know the applicable laws and regulations
5. Obtain consultation
6. Consider possible and probable courses of action;
7. Enumerate the consequences of various decisions
8. Decide on what appears to be the best course of action
Corey, Corey & Callanan, 2006
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
Legal Aspects of Informed Consent
Four elements are basic to the legal aspects of informed consent:
1. Full Disclosure or Full Information – giving clients information on all aspects of therapeutic process, expectation, and intervention upon which informed consent can be based
2. Capacity – client has ability to make rational decisions (parent or guardian)
Corey, Corey & Callanan, 2006
Legal Aspects of Informed Consent
3. 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)
4. Voluntariness - acts freely in decision-making process and is legally and psychologically able (competent) to give consent
Corey, Corey, & Callanan, 2006
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
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
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
Full Disclosure – Checklist for Treatment
1. Voluntary Participation
2. Client Involvement
3. Counselor Involvement and contact
4. No Guarantees
5. Risks and Benefits Associated with Counseling. Emphasize role of client’s responsibility in treatment.
6. Confidentiality and Privilege
7. Counseling Approach or Theory
Full Disclosure – Checklist for Treatment
8. Exceptions of Confidentiality and Privilege
9. Counseling and Financial Records
10. Ethical Guidelines
11. Licensing Regulations
12. Credentials
13. Fees and Charges
14. Insurance Reimbursement
15. Responsibility for Payment
16. Disputes and Complaints
Full Disclosure –Checklist for Treatment
16. Cancellation Policy/Interruptions in Therapy
18. Affiliation Relationship
19. Supervisory Relationship
20. Colleague Consultation
21. Alternatives to Traditional Therapy
22. Tape-Recording or Videotaping Sessions
23. Client Access to Files and Diagnostic ClassificationCorey, Corey, & Callanan, 2006
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
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
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
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
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
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?
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?
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
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
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