Common Ethical Issues
One of the signs of a maturing profession is the development of a set of ethical guidelines. These guidelines serve to guide the practice of individual’s practice within a given profession. They also, however, reflect the values and, to some extent, the society in which the profession is positioned. The helping professions of counseling and human services are no different. While the practice of counseling and psychotherapy has been governed by ethical guidelines, the closely related activity of clinical supervision has only recently come under a set of ethical guidelines. The purpose of this module is to provide a brief overview of the theories that inform the development of ethics, ethical principles, codes of ethics in counseling and human services, and ethical issues that a student might encounter in clinical supervision.
In This Module
Theories of Ethics
Ethics is a branch of philosophy that, at its core, seeks to understand and to determine how human actions can be judged as right or wrong. We may make ethical judgments, for example, based upon our own experience or based upon the nature of or principles of reason. Those who study ethics believe that ethical decision making is based upon theory and that these theories can be classified. What follows is a very brief description of four classes of ethical theories (See Garrett, Baillie, & Garrett, 2001).
Consequentialism: Ethical theories that fall under the classification of consequentialism posit that the rightness or wrongness of any action must be viewed in terms of the consequences that the action produces. In other words, the consequences are generally viewed according to the extent that they serve some intrinsic good. The most common form of consequentialism is utilitarianism (social consequentialism) which proposes that one should act in such a way to produce the greatest good for the greatest number.
Kantian Deontologism: Deontologism is a position based, predominately, on the work of Immanuel Kant. Most simply, deontologism suggests that an act must be performed because the act in some way is characterized by universality (i.e. appropriate for everyone) or that it conforms with moral law (formal rules used for judging the rightness or wrongness of an act). According to this theoretical position, the rightness or wrongness of some acts are independent of the consequences that it produces and the act may be good or evil in and of itself.
Natural Law: This theoretical position suggests that one may, through rational reflection on nature (especially human nature), discover principles of good and bad that can guide our actions in such a way that we will move toward human fulfillment or flourishing. This position suggests that human beings have the capacity within themselves for actualizing their potential.
Virtue Ethics: Virtue ethics consists of two differing approaches to ethics and can, therefore, be confusing to understand.
Very briefly, the first approach to ethics in this theoretical orientation proposes that there are certain dispositional character traits (virtues) that are appropriate and praiseworthy in general and or in a particular role. More formally, virtue ethics represents a “systematic formulation of the traits of character that make human behavior praiseworthy or blameworthy” (Shelp, 1985, p.330).
The second approach to virtue ethics not only identifies the virtues, but focuses on their integration into what can be described as “practical wisdom” or “right reason.” Practical wisdom is the phrase used to describe ones ability to choose patterns of actions that are desirable. These patterns of actions are informed by reasoning that is, in part, influenced by habits of emotional experience or virtues (Baillie, 1988), but also by the depth and breath of experience available to the human being as he or she is placed in society.
Ethical Principles
Ethical principles provide a generalized framework within which particular ethical dilemmas may be analyzed. As we will see later in this module, these principles can provide guidance in resolving ethical issues that codes of ethics may not necessarily provide. What follows are definitions of five ethical principles that have been applied within a number of professions (Beauchamp & Childress, 1979).
Respecting autonomy: the individual has the right to act as a free agent. That is, human beings are free to decide how they live their lives as long as their decisions do not negatively impact the lives of others. Human beings also have the right to exercise freedom of thought or choice.
Doing no harm (Nonmaleficence): Our interactions with people (within the helping professions or otherwise) should not harm others. We should not engage in any activities that run the risk of harming others.
Benefiting others (Beneficence): Our actions should actively promote the health and well-being of others.
Being just (Justice): In the broadest sense of the word, this means being fair. This is especially the case when the rights of one individual or group are balanced against another. Being just, however, assumes three standards. They are impartiality, equality, and reciprocity (based on the golden rule: treat others as you wish to be treated).
Being faithful (Fidelity): Being faithful involves loyalty, truthfulness, promise keeping, and respect. This principle is related to the treatment of autonomous people. Failure to remain faithful in dealing with others denies individuals the full opportunity to exercise free choice in a relationship, therefore limiting their autonomy.
Ethical principles provide generalized frameworks that may be employed in the resolution of ethical dilemmas in our daily lives. These principles may be applied to our interpersonal relationships as well as to our professional lives. However, as members of a profession, we will encounter more specific codes of ethics that are designed to govern our professional behavior and to offer some guidance for the resolution of commonly faced ethical issues that occur in the practice of our chosen professions.
Codes of Ethics in Counseling and Human Services
According to Neukrug (2000), codes of ethics are a fairly recent development in the mental health professions. He states that the APA formulated its first set of ethical standards in 1953; the ACA in 1961; and the NASW in 1960. Within this relatively short period of time, these ethical codes have undergone a number of revisions. This is due to the fact that they reflect ever changing societal and professional values. Those charged with the formulation of such codes struggle with how these issues should be dealt with. These guidelines, however, do serve a number of purposes that have remained constant. Neukrug (2000, pp. 48-49) delineated the general purposes of codes of ethics as highlighted in a number of works (see Ansell, 1984; Corey et al., 1998; Lowewenberg & Dolgoff, 1996; Mabe & Rollin, 1986; VanZandt, 1990). He goes on to point out that “ethical guidelines are moral, not legal, documents, and our professional associations expect us to be bound by them (p. 49).
Purposes of Codes of Ethics
They protect consumers and further the professional stance of the organizations.
They denote the fact that a particular profession has a body of knowledge and skills that it can proclaim and that a set of standards can be established that reflect this knowledge.
They are a vehicle for professional identity and provide an indication of the maturity of a profession.
They profess a belief that the professional should exhibit certain types of behaviors that reflect the underlying values considered desirable in the professional.
They offer the professional a framework in the sometimes difficult ethical and professional decision-making process.
They represent, in case of litigation, some measure of defense for professionals who conscientiously practice in accordance with accepted professional codes (pp. 48-49).
Although codes of ethics provide an effective means of guiding professional practice and decision-making, they do pose certain limitations. Neukrug (2000, p.49) summarized these limitations, drawing especially on the work of Mabe and Rollin (1986).
Limitations of Codes of Ethics
Some issues cannot be handled in the context of a code.
There are some difficulties with enforcing the code, or at least the public may believe that enforcement committees are not tough enough on their peers.
There is often no way to bring the interests of the client, patient, or research participant systematically into the code-construction process.
There are parallel forums in which the issues in the code may be addressed, with the results sometimes at odds with the findings of the code (for example, in the courts).
There are possible conflicts associated with codes: between two codes, between the practitioner’s values and code requirements, between the code and ordinary morality, between the code and institutional practice, and between requirements within a single code.
There is a limited range of topics covered in the code. Because a code approach is usually reactive to issues already developed elsewhere, the consensus requirement prevents the code from addressing new issues and problems on the cutting edge.
An Ethical Decision Making Model
Given the fact that ethical dilemmas may not always be readily resolved through the use of codes of ethics, it might be useful to have a framework in which to analyze and make ethical decisions. The following ethical decison-making model comes from the work of Corey et al. (1998).
Identify the problem.
Identify the potential issues involved.
Review relevant ethical guidelines.
Know relevant laws and regulations.
Obtain Consultation.
Consider possible and probable courses of action.
List the consequences of the probable courses of action.
Decide on what appears to be the best course of action.
It is extremely important that you keep your immediate supervisor and all involved parties informed during this process. After you have made your decision, take some time to reflect on the process and to review what you have learned with a trusted supervisor or colleague.
How do you think this model is helpful in the resolution of ethical dilemmas? How might the model be improved? Try applying this model to an ethical dilemma that you have experienced or try one of the cases included in this module.
Now that we have looked codes of ethics and how they apply to counseling and humans services, we will now look more specifically at how ethics apply to clinical supervision in counseling and human services. This is not meant to be an exhaustive treatment of the subject. For a more thorough treatment, see Chapter 9 in Bernard and Goodyear (1999).
Ethical Issues in Clinical Supervision
If ethical guidelines for the helping professions are perceived as fairly recent developments (Neukrug, 2000), the development of guidelines for the professional practice of clinical supervision could be said to be in its infancy. According to Bernard and Goodyear (1999) the first code of ethics that specifically addressed clinical supervision was passed in 1993 (Supervision Interest Network, 1993). Because of its close relationship to the practice of counseling and psychotherapy, it may not come as a surprise that many of the same ethical issues that arise in these settings also arise in the practice of clinical supervision. What follows is a discussion of some of these common issues as well as some of the unique issues common to clinical supervision. This section is drawn heavily from the work of Bernard & Goodyear (in press; 1999).
Informed Consent
Informed consent covers not only the relationship between a therapist and his or her client, but also the relationship between a supervisors and trainee. Trainees should be made aware of the fact that supervision is an evaluative process and upon what criteria they will be judged. Furthermore, the roles and responsibilities of both the supervisor and the trainee should be clearly delineated. More specifics should be presented in a clinical supervision disclosure statement. Elements of this disclosure statement would include, but not necessarily be limited to the following:
Rationale for providing the disclosure statement.
Name and contact information of the clinical supervisor
Unique qualifications for the provision of clinical supervision (licenses, coursework, certifications, etc.)
Supervisor’s theoretical orientation
Types of interventions and supervision strategies that might be used (e.g. roleplay, reviewing tapes, homework, journaling, etc.)
The supervisor’s position on referral for counseling should the trainee prove to need it.
Evaluation strategies
Time and place where supervision will be conducted
Responsibilities of supervisor
Responsibilities of trainee
Contact information for licensure or credentialing agencies or an appropriate individual should the trainee experience a problem or dissatisfaction with supervision.
It should also be noted that trainees who are receiving clinical supervision should inform their clients of this fact. This provides clients with the opportunity to choose a more “experienced” therapist should they feel that they need one. A number of agencies will often have a form that you may present to your clients.
Confidentiality
In the helping professions confidentiality is one of the key ethical principles. Helpers are relied upon to provide a safe environment for clients are free to disclose their problems. This principle becomes more complicated to enforce in the supervision process. Trainees must learn that all client information must be kept confidential except that used for supervision purposes. Cases should be presented with first names only. Tapes and videotapes must also be treated carefully. Once again, clients must be made aware of the fact that they are being seen by a counselor in training and furthermore, that content from his or her sessions will be shared with supervisors (class instructors, etc.) in an educational context. Trainees must also apply the principle of confidentiality to their own supervision.
Supervisors must also treat their interactions with their trainees as confidential to the extent possible due to the complexity of the relationship. Trainees should be made aware of the fact that information might be shared with persons who have some stake in their evaluation. Furthermore, trainees should be made aware of the limits of confidentiality at the beginning of the supervisory relationship so that he or she can make an informed decision about what might be appropriate to share in supervision.
Falvey (2002) listed some situations when a therapist or supervisor may break confidentiality:
when a client gives informed consent to disclosure
when a therapist is acting in a court-appointed capacity
when there is a suicidal risk or some other life-threatening emergency
when a client initiates litigation against the therapist
when a client’s mental health is introduced as part of a civil action
when a child under the age of 16 is the victim of a crime
when a client requires psychiatric hospitalization
when a client expresses intent to commit a crime that will endanger society or another person (duty to warn)
when a client is deemed to be dangerous to him- or herself
when required for third-party billing authorized by the client
when required for properly utilized fee collection services (p. 93)
Dual Relationships
Dual relationships in supervision are often tricky because of the fact that the clinical supervisor often has more than one professional relationship with the supervisee. For example, your clinical supervisor might be your teaching assistant or instructor in another class. In an agency, your agency supervisor might provide clinical and professional supervision. Hall (1988) described a dual relationship as unethical when the relationship impairs the supervisor’s judgment and the trainee faces the possibility of exploitation as a result of the relationship. Supervisors should be diligent in helping trainees understand the ramifications of dual relationships with their clients.
Evaluation
As mentioned previously in this module, supervision is an evaluative process. It is imperative that the trainee be made aware of the criteria by which he or she will be evaluated. Trainees should know what constitutes the successful mastering of the criteria. They should also be aware of the possible consequences and their rights should the criteria not be met. Evaluation should be an on-going process and the results of any formal evaluation should not come as a “surprise” to the supervisee.
Due Process
While you are receiving clinical supervision, you have the right to due process. Due process is a legal concept. It describes a process that ensures that notice and hearing must be given before an important right can be removed (Disney & Stephens, 1994). There are two types of due process—substantive and procedural. In terms of clinical supervision, substantive due process addresses the fair and consistent application of the criteria that govern a training program. Procedural due process concerns itself with the rights that you have as a participant in a training program. They are delineated as follows:
The supervisee or student should be apprised of the academic requirements and program regulations.
The supervisee or student should receive notice of any deficiencies.
The supervisee or student should be evaluated regularly.
The supervisee or student should have an opportunity to be heard.
Reporting Ethical Breaches
As mentioned previously in this module, your supervisor should provide a clinical supervision disclosure statement that contains contact information for the appropriate person, licensing and or credentialing organizations, should you feel that a breach of ethics has occurred during your clinical supervision experience. There are usually procedures put in place by your academic department, agency, and/or professional organization to follow should you need to file a grievance. Try following your organization’s grievance procedures first.
You might want to read some codes of ethics that professional organizations use to guide professional practice in a number of counseling and human services practices. This will allow you to see how they address breaches of ethics and other ethical issues. Take note of the similarities and differences in the various codes. See, for example:
References
Ansell, C. (1984). Ethical practices workbook. In Preparatory course for national and state licensing examinations in psychology (Vol. IV): Los Angeles: Association for Advanced Training in the Behavioral Sciences.
Beauchamp, T.L., & Childress, J.F. (1979). Principles of biomedical ethics. Oxford, England: Oxford University Press.
Bernard, J.M., & Goodyear, R.K. (In press). Fundamentals of clinical supervision (3rd ed). Needham Heights, MA: Allyn & Bacon.
Bernard, J.M., & Goodyear, R.K. (1999). Fundamentals of clinical supervision (2nd ed). Needham Heights, MA: Allyn & Bacon.
Corey, G., Corey, M., & Callanan, P. (1998). Issues and ethics in the helping professions (5th ed.). Pacific Grove, CA: Brooks/Cole.
Disney, M.J., & Stephens, A.M. (1994). Legal issues in clinical supervision. Alexandria, VA: ACA Press.
Falvey, J. E. (2002). Managing clinical supervision: Ethical practice and legal risk management.Pacific Grove, CA: Brooks/Cole.
Garrett, T.M., Baillie, H.W., & Garrett, R.M. (2001). Health care ethics: Principles and problems(4th ed). Upper Saddle River, NJ: Prentice Hall.
Hall, J.E. (1988). Dual relationships in supervision. Register Report, 15(1), 5-6.
Loewenberg, F., & Dolgoff, R. (1996). Ethical decisions for social work practice (5th ed.). Itasca, IL: Peacock.
Mabe, A.R., & Rollin, S.A. (1986). The role of a code of ethical standards in counseling. Journal of Counseling and Development, 64(5), 294-297.
Neukrug, E. (2000). Theory, practice, and trends in human services: An introduction to an emerging profession (2nd ed.). Belmont, CA: Wadsworth/Thomson Learning.
Shelp, E.E. (1985). Virtue and medicine: Explorations in the character of medicine. Boston, MA: D. Reidel Publishing.
Supervision Interest Network, Association for Counselor Education and Supervision (Summer, 1993). ACES ethical guidelines for counseling supervisors. ACES Spectrum, 53(4), 5-8.
Van Zandt, C.E. (1990). Professionalism: A matter of personal initiative. Journal of Counseling and Development, 68(3), 243-245.
Case Studies
What follows are three case studies taken from Bernard and Goodyear (1999). Try analyzing the cases from the perspective of a trainee and a supervisor. How does the ethical decision-making model presented in this module apply to the case? You might also want to talk with your supervisor, classmates, professors, or other practitioners about these cases. After the three cases are presented there are some questions that might guide your discussion.
Case #1
Vanessa has been a marriage and family therapist at an agency for six months. Gary, one of the other three therapists in the agency and the only other single therapist, is her clinical supervisor. It will take Vanessa 2 years under supervision to accrue the experience she needs to be eligible to sit for the state licensing examination for her LMFT. One evening Gary calls Vanessa to inquire whether she would like to go to a day-long workshop with him. The speaker for the workshop specializes in a kind of therapy in which Vanessa has expressed interest. Vanessa accepts and the workshop turns out to be an excellent professional experience. On the way home, Vanessa and Gary stop for dinner. Vanessa picks up the tab to thank Gary for including her. The following day Vanessa is sharing some of the experiences of the workshop with Camille, another therapist at the agency. When Camille asks, “Isn’t Gary your supervisor?” Vanessa feels defensive and misunderstood. Later that day, Vanessa decides to go to her agency director and ask his opinion of the situation. He tells her not to be concerned about it and that Camille “worries about everything.” During her next supervision session, Vanessa chooses not to mention either conversation to Gary (pp. 191-192).
Case #2
Margaret is a school counselor who has been assigned a trainee from the local university for the academic year. As she observes Noah work with elementary school children, she is increasingly impressed with his skills. She asks him to work with Peter, a nine-year-old, who has not adjusted well to his parents’ recent divorce. Again, she is impressed with Noah’s skill, his warmth and understanding, and ultimately, with the success he has in working with Peter. Margaret is a single parent who is concerned about her nine-year-old son. She decides to ask Noah to see him. Noah is complimented by her confidence in him. Margaret’s son attends a different school, but she arranges to have Noah see him after school hours (p. 192).
Case #3
Ruth has been assigned to a local mental health hospital for her internship to work with patients who are preparing to be discharged. It is her first day at the site and she is meeting with her site supervisor. He gives her a form to fill out, which asks for information regarding her student malpractice insurance. When Ruth tells her supervisor that she does not carry such insurance, he advises her that it is their policy not to accept any student who does not have insurance. The supervisor also expresses some surprise because this has always been the hospital’s policy and Ruth is not the first student to be assigned to them from her training program (p. 186).
Questions for Case Studies
What are the main issues in the case?
What ethical issues are of concern in the case?
Are there particular breaches of ethical principles? What are they?
What can the supervisor do, if anything, to resolve the ethical problem(s) presented in the case?
What can the trainee do, if anything, to resolve the ethical problem(s) presented in the case?
Is there other information that might have been helpful in the resolution of this case?
What could have been done to prevent the ethical problem from occurring in the first place?
Test Your Knowledge
What follows are 15 multiple choice items designed to test the knowledge that you have gained as a result of completing this module. Answers are provided at the end. Good Luck!
The branch of philosophy that seeks to understand and to determine how human actions can be judged as right or wrong:
epistemology
eschatology
pragmatism
ethics
teleology
Which of the following is not a classification of ethical theories?
Kantian Deontologism
Consequentialism
Pragmatism
Virtue ethics
Natural Law
Are all of the following ethical theories and their brief definitions correct?
Natural Law: Reflection on nature can lead one to discover principles of good and bad.
Kantian Deontologism: An act must be performed because the act is approrpiate for everyone or conforms with moral law.
Virtue Ethics: Certain character traits are appropriate and praiseworthy. They can be integrated into “practical wisdom” or “right reason.”
Consequentialism: The rightness or wrongness of an action must be judged according to the effects that it produces.Yes
No
What ethical principle assumes the three standards of impartiality, equality, and reciprocity?
Respecting autonomy
Doing no harm (Nonmaleficience)
Benefiting others (Beneficence)
Being just (Justice)
Being faithful (Fidelity)
Your clinical supervisor shares his or her disclosure statement with you, giving you the opportunity to see the types of interventions that will be used in clinical supervision. You are given the opportunity to decide which, if any, of the interventions are uncomfortable to you. This process best complies with which ethical principle?
Respecting autonomy
Doing no harm (Nonmaleficience)
Benefiting others (Beneficence)
Being just (Justice)
Being faithful (Fidelity)
Your clinical supervisor shares information with others about your disclosures during supervision. The information shared was “personal” and had little if any bearing on your work with clients. What is the primary ethical principle violated by your supervisor?
Respecting autonomy
Doing no harm (Nonmaleficience)
Benefiting others (Beneficence)
Being just (Justice)
Being faithful (Fidelity)
Which of the following is not a purpose served by professional codes of ethics?
They provide protection to consumers and further the professional stance of organizations.
They provide a vehicle for professional identity.
They provide a framework to resolve all ethical issues that might face a profession.
They provide some means of defence for those who conscientiously practice within the ethical guidelines laid down by a particular profession.
They provide evidence that a particular profession has a body of knowledge and skills that it can proclaim.
Because ethical code development is a process driven by concensus and the fact that problematic issues developed outside of this process may have to be addressed within a code of ethics, we may view codes of ethics as “reactive” documents.
True
False
An ethical decision-making model provides you with a set of guidelines for making ethical decisions. If you were facing a difficult ethical dilemma, after identifying the problem and the potential issues involved, what would be, using Corey’s model, one of the first places that you would look for assistance in the resolution of the dilemma
Ethical guidelines
Ethics scholarship
supervisor and respected colleagues
practicum class
internship class
Substantive due process
Covers the relationship between supervisor and trainee. Trainees are made aware of their responsibilities and those of the supervisor during the clinical supervision process.
The extent to which interactions between supervisor and trainee can be disclosed to others.
Your clinical supervisor is also the instructor for one of your classes.
Addresses the extent to which fair and consistent application of the criteria that governs your training program has been followed.
Addresses the rights that you have as a participant in a training program.
Dual relationship
Covers the relationship between supervisor and trainee. Trainees are made aware of their responsibilities and those of the supervisor during the clinical supervision process.
The extent to which interactions between supervisor and trainee can be disclosed to others.
Your clinical supervisor is also the instructor for one of your classes.
Addresses the extent to which fair and consistent application of the criteria that governs your training program has been followed.
Addresses the rights that you have as a participant in a training program.
Informed consent
Covers the relationship between supervisor and trainee. Trainees are made aware of their responsibilities and those of the supervisor during the clinical supervision process.
The extent to which interactions between supervisor and trainee can be disclosed to others.
Your clinical supervisor is also the instructor for one of your classes.
Addresses the extent to which fair and consistent application of the criteria that governs your training program has been followed.
Addresses the rights that you have as a participant in a training program.
Procedural due process
Covers the relationship between supervisor and trainee. Trainees are made aware of their responsibilities and those of the supervisor during the clinical supervision process.
The extent to which interactions between supervisor and trainee can be disclosed to others.
Your clinical supervisor is also the instructor for one of your classes.
Addresses the extent to which fair and consistent application of the criteria that governs your training program has been followed.
Addresses the rights that you have as a participant in a training program.
Confidentiality
Covers the relationship between supervisor and trainee. Trainees are made aware of their responsibilities and those of the supervisor during the clinical supervision process.
The extent to which interactions between supervisor and trainee can be disclosed to others.
Your clinical supervisor is also the instructor for one of your classes.
Addresses the extent to which fair and consistent application of the criteria that governs your training program has been followed.
Addresses the rights that you have as a participant in a training program.
Should a breach of ethics occur during your clinical supervision, one of the first steps that should be taken is to:
file police charges.
call your professional organization.
talk to the appropriate person in either your academic department or in the agency in which you are working to determine the proper procedure for filing a grievance.
report your supervisor to the state licensing board.
do nothing. It was probably a mistake.
Answers
1: d; 2: c; 3: a; 4: d; 5: a; 6: e; 7: c; 8: a; 9: a; 10: d; 11: c; 12: a; 13: e; 14: b; 15: c