CHAPTER 11 ETHICAL, LEGAL AND PROFESSIONAL ISSUES IN COUNSELING.

Under what act does counseling case notes are kept in the sole possession and parents do not have access to it only by a court order?

Family Educational Rights and Privacy Act (FERPA; 1974),

Counselor that work with clients making end-of-life decisions should take several steps to ensure that clients receive quality care such as:

First, counselors should determine whether they have the competency and training to work with such clients. Second, they should conduct a thorough assessment of the client, or refer the client to a competent provider. Third, it is wise to consult with other professionals. Fourth, counselors should document carefully the assessment, consultations, and treatment options that were considered and chosen.

What reasons counselors may also want to obtain the minor's signature on the form, depending on the minor's level of development and ability to understand the meaning of the document?

For therapeutic rather than legal purposes

When would counselor determine that parents or guardians must be given information that a child has disclosed in counseling sessions?

If counselors determine that a child is at risk of harm (to self or others), they must inform the child's parents.

11-6 The Case of Karen Karen is a counselor who works in a hospital, and her job is to counsel patients and families while they are hospitalized. Weldon is a 73-year-old widower with a grown daughter. Although Weldon has been diagnosed with terminal cancer, his doctors tell him that he might expect to live more than another year with further surgery and chemotherapy. Weldon wants to request physician-assisted suicide, stating that he doesn't want to die a lingering death or to consider hospice care. He adds that he doesn't want to be a burden to his daughter, who is a single mother and works long hours to support her two children. He insists that he would find it humiliating to be cared for by strangers in a hospice. He doesn't want to involve his daughter in his decision-making process because she would never accept the idea of a hastened death for him and because he wants her memories of him to be happy ones. How should Karen proceed in her counseling relationship with Weldon? Do you believe that other states should follow the example of Oregon, Vermont, and Washington and pass laws that permit physician-assisted suicide? Why or why not?

Karen's first action should be to determine whether her state allows physician-assisted suicides. If they are allowed in her state, Karen should learn as much as possible about the requirements for a person to choose that option. If she feels competent to counsel Weldon regarding physician-assisted suicide, she can use her counseling skills to help him review his options and make his final decisions. Karen might assist Weldon by helping him to examine his motives for wanting physician-assisted suicide and to explore other alternatives. She also could work to facilitate an open dialog between him and his daughter. Arguments for physician-assisted suicide laws include the following: Persons should have a right to choose to die with dignity. It is inhumane to keep people alive when their quality of life has diminished beyond reason. Physicians have been assisting people with dying throughout history. It is time now to make it legal. Arguments against such laws include the following: It is impossible to know whether a person who wants to commit suicide is able to make such a choice. Vulnerable individuals would be at the mercy of others who might want them to die. Only God should decide when a person will die.

Which state allows physician-assisted suicide as the result of a court ruling?

Montana

What two states the Court heard appeals to two circuit court decisions that had struck down criminal prohibitions against assisted suicide?

New York and Washington.

Will the counselor be protected when they report suspect child abuse when the suspected perpetrator is not the caretaker?

No counselor will not be protected.

Is it required to get parents consent before counseling a student?

No, it is not required principles requires due to request of the parents to be aware their child is been counseled.

What counselors must take care to avoid when counseling with an older person, or a client with a pervasive developmental disability or severe mental illness?

The paternalistic assumption that others (including the counselor) know what's best for the client.

What strategies can a counselor employ when counseling a gay youth?

The use of inclusive, nonsexist language; challenging antigay and antifemale comments made by students and school personnel, educating students and staff about sexual harassment and homophobia, and having a repertoire of appropriate referral resources for students and families who need them.

What should a counselor do if they are asked opinion questions, especially regarding the fitness of a parent?

They should decline to give an opinion, maintaining that they do not have enough information to form a judgment on that matter, which is true. Counselors know only what is told to them. They do not have in-depth knowledge regarding the parents of their child clients.

What should a counselor do whenever they are frustrated because they do not believe the state agency handles investigations properly or they believe children are put at risk after reports are made?

They should report additional incidents and should request a meeting with governmental agency representatives to discuss the perceived problems.

Why should clients be careful to distinguish between clients who have been declare legally incompetent by the court and those who are depends adults?

Those who are declare legally incompetent, the court will assign a legal guardian who has the same legal powers over the individual that a biological parent or a legal guardian would have over a child, while dependent adults maintain their legal rights until a court, upon a petition filed by some party, declares them incompetent and appoints a guardian.

Why it is wise to establish a thorough understanding with all parties regarding the issue of confidentiality before the counseling relationship is initiated?

To avoid situations in which parents demand information and minor clients refuse to authorize counselors to provide it.

What does Standard B.5.a. requires counselors to do?

To protect the confidentiality of clients who lack the capacity to give voluntary, informed consent.

What does Standard A.2.d. reminds counselors?

To seek the assent of clients to counseling services and to include them in the decision-making process as appropriate.

What does standard A.2.d. advises counselors, when working with minors?

To seek the assent of minor clients to services and include them in the decision-making process as appropriate.

What forms can be a representation of psychological abuse?

Verbal berating, threats to institutionalize the elder individual, and threats of abandonment, intimidation, or humiliation.

When can counselors make a child abuse report ?

When the perpetrator is the child's caretaker

Factors a counselor should considered in exercising their judgment

a) the credibility of the alleged victim b) prevailing standards for discipline in the community, and c) information that is known about the alleged victim and alleged perpetrator.

Important language in the statutes includes are:

a) who must make the report to the governmental agency (the person with the suspicion or the supervisor) b) when the report must be made (immediately, within 24 hours, 48 hours, or some other time frame) c) whether the oral report must be followed by a written report. d) what specific information is required when the report is made (such as age of the child, name and address of the child, specifics of cause of suspicion, name and address of parents) e) whether past abuse must be reported. f) whether specific categories of suspected perpetrators must be reported (parents or guardians only, caretakers, siblings, other), whereas other categories of suspected perpetrators do not have to be reported.

why do counselors should refuse to support one parent over the other in a child custody controversy?

(a) The counselor must be able to maintain working relationships with both parents to be an effective counselor for the child (b) Counselors of children know very little about what goes on in a home or in a marriage, so it would be inappropriate for counselors to support one parent over the other. (c) Child custody evaluators, not the children's counselors, should be giving advice to judges related to custody matters.

What steps are to be follow if you are ever presented with such a challenge and decide that the child's desire for the parent or guardian to not be told is reasonable?

1-Discuss the inquiry with the minor and see if the minor is willing to disclose the content of the counseling session to the adult. Sometimes counselors are more concerned about privacy than a child is. If that doesn't work, go to step 2. 2-Try to persuade the adult that the child's best interests are not served by revealing the information. Attempt to educate the inquiring adult about the nature of the counseling relationship, and assure the adult that information will be given if the child is in danger. If that doesn't work, go to step 3. 3-Schedule a joint session with the adult and the minor. Assume the role of a mediator at this session. Hope that the adult's mind will be changed about wanting the information or that the minor will be willing to disclose enough information to satisfy the adult. If that doesn't work, choose step 4 or step 5. 4-Inform the child ahead of time and then disclose the content of the session to the inquiring adult. If the adult is not a parent or guardian, inform the parent or guardian before disclosing the information. Remember that the adult may have a legal right to the information. 5-Refuse to disclose the information to the inquiring adult. Secure approval from your direct administrator before doing this. Remember that the adult may have a legal right to the information.

What are the guidelines for counselors faced with situations of elder maltreatment?

1-Remember to consider the possibility of elder maltreatment when working with older clients who are dependent on family or others for their care. 2-Interview family members separately to increase the likelihood of honest disclosures about the situation. Often, older adults feel intimidated by the presence of family members or embarrassed over the nature of the information. 3-Provide an empathic and supportive environment in which clients will feel safe to reveal information that they may find shameful, humiliating, or acutely distressing. Ask nonjudgmental questions, like "Do you feel safe in your home?" or "Do you feel in control of your finances?" 4-Focus on helping the older clients and their families or caregivers to improve the quality of care. Educate clients and families about the services available in their communities to assist them, such as advocacy groups and respite care facilities. 5-Know the risk factors related to elder abuse. These include, for an older person, poor physical health, cognitive impairment, sufficient frailty to make independent living impossible, and a tendency to act disruptively. Risk factors for caregivers include a history of mental disorders, substance abuse problems, and a history of using violence to resolve conflict. Family characteristics that increase risk include social isolation and inadequate financial resources to assist with caregiving.

Provide five facts about children and privacy:

1-Younger children often do not have an understanding of confidentiality or a need for privacy, which is a socially learned concept. Young children may not be nearly as concerned about confidentiality as the counselor is (Huey, 1996) and may not need reassurances of confidentiality (Corr & Balk, 2010). 2-Preadolescents and adolescents may have a heightened desire for privacy that is appropriate to their developmental stage of growth. 3-Some children may not be concerned about their privacy. It is inappropriate to assume that children do not want their parents or guardians to know information they have told counselors. 4-Children sometimes tell an adult about their concerns hoping that the adult will act as an intermediary in telling their parents. 5-The reasoning capacity of children is limited, and because of their age they may not be able to make decisions that are in their own best interest.

Who determine whether a child abuse or neglect report reflects actual abuse or neglect and the degree to which a child may be in danger?

Agency personnel or police officers.

Counseling vulnerable adults and clients who have been legally declared incompetent was also addressed in this chapter. Key points include the following:

Counselors have an ethical and legal obligation to protect adult clients who are vulnerable to abuse or neglect due to a diminished capacity to protect themselves. Elder abuse and neglect are underreported and are common problems in today's society. As the U.S. population ages, counselors will be confronted more often with requests to assist clients in their end-of-life decision making. All of the legal issues that apply to minor clients apply to individuals who have been declared by courts to be legally incompetent. Counselors need to be careful to distinguish between legally incompetent clients and clients who are dependent on others but who retain their legal rights.

What does §B.5.b. advises?

Counselors to "respect the inherent rights and responsibilities of parents/guardians regarding the welfare of their children/charges according to law."

What other functions are counselors ask to perform in the school system?

Court witness; liaison with social services; and counselor to the victim, perpetrator, or family.

What effects can be develop due to maltreatment?

Depression; posttraumatic stress symptomology; learned helplessness; and feelings of isolation, alienation, and mistrust.

11-4 The Case of Tonya Tonya, a Licensed Professional Counselor (LPC) in a community counseling agency, has begun counseling the Hernandez family. The parents, Guillermo and Anabella, emigrated from Guatemala 6 years ago. They are experiencing some family conflict in their relationships with their three children: two teenage girls and a 7-year-old boy. Today, as Tonya is walking down the hallway to the reception area to greet the Hernandezes, she sees Guillermo grab the young boy roughly by the arm and slap him across the face. She is alarmed to see this abusive behavior and thinks she may have to report it to Child Protective Services. Do you believe that child-rearing practices that are acceptable in a subculture should be tolerated by the U.S. legal system? What do you think Tonya should do in this situation?

Discussion: Within the concept of familismo, family is a source of pride in Latino cultures, and it is very important for children to be well-behaved and represent the family well in public. When children misbehave publicly, Latino parents may respond immediately with physical punishment, which places them at greater risk for reports to child protection agencies. Knowing this information may make a difference in whether Tonya believes that what she saw was child abuse. If Tonya believes, after considering cultural values, that what she saw Guillermo do (roughly grab his son by the arm and slap him in the face) constitutes child abuse, she is legally obligated to make a report. She should explain to him that, by law, she has to make a report. If Guillermo cannot understand or speak English very well, Tonya should obtain an interpreter. She should explain to him that although his behavior might be common and acceptable in his native country of Guatemala, it may not be acceptable by law in the United States. She could explain to him how American parents might discipline their children in public in a way that is culturally acceptable here and help him understand how his behavior might be viewed by the majority culture. If she makes a report, she should explain to him what might happen after she does so, and she should make a sincere attempt to continue her counseling relationship with him and his family. Tonya may decide that what she saw did not constitute child abuse. If she makes that determination, she will not make a report.

Which one is the largest group of adults who are vulnerable to abuse or neglect?

Elders

11-2 The Case of Leslie As a result of a play counseling session, Leslie, an elementary school counselor, has come to suspect that Arielle, a second-grader, is being physically abused by her father. Leslie realizes that the law in her state requires her to report the suspected abuse within 24 hours. Leslie is hesitant to do so, however, because her experience with the local child protective services agency is that it is ineffective in responding to such reports. Leslie fears that the agency social worker will visit Arielle's home but take no further immediate action. Her concern is that the father will escalate the abuse, placing Arielle in even greater danger. What should Leslie do when she believes following the dictates of the reporting abuse statute might endanger her child client? What problems could occur if Leslie decides not to make a report?

Even though Leslie believes filing a report might endanger Arielle, she should consider the importance of compliance with the law that requires her to report. Leslie should think about actions she might take to help ensure the child's safety. These might include enlisting the assistance of the child's mother or other relatives or teaching the child self-protection strategies. She might also emphasize her concerns for the child's safety to the child protective services personnel and request that they take steps to protect the child. Leslie should document her contact with the agency and should inform her principal (or other immediate supervisor) of the situation. She should talk with Arielle further after the report has been made to determine what happened thereafter. She should make additional reports if she believes the abuse has continued. If Leslie decides not to make a report and if Arielle is harmed by further abuse and it is learned that Leslie knew about but did not report the abuse, Leslie could face legal repercussions. Leslie could also face disciplinary action by her school administrator. Leslie would have to deal with her feelings, which could include regret and guilt, if Arielle were harmed when a different decision on Leslie's part might have prevented the harm.

What is neglect?

Failure to provide essential physical or mental care for an older person, is the most common form. It can be intentional or unintentional, or even self-inflicted.

11-3 The Case of Jeffrey Jeffrey is a high school counselor who is well liked and respected by his student clients. He has a reputation among his students for being willing to go out of his way to help them. One morning at 2:00 a.m., 16-year-old Edmund, who is a member of one of the counseling groups that Jeffrey conducts at school, shows up at Jeffrey's home. Edmund claims that he has been kicked out of the house by his parents and that he has nowhere else to go. It is raining, and Edmund is soaking wet. He begs Jeffrey to let him stay there for just one night and promises that he will call his parents in the morning. What would happen if Jeffrey were to allow Edmund to spend the night and later Edmund accused Jeffrey of making sexual advances toward him during the night he stayed at Jeffrey's home? What would be the wisest things for Jeffrey to say and do in this situation?

If Jeffrey allowed Edmund to spend the night and later Edmund accused Jeffrey of making sexual advances toward him during the night, Jeffrey might face the following problems: Jeffrey would appear to have been unprofessional in allowing a student to spend the night with him. No matter what Jeffrey said or did in response to Edmund's claims, people would still wonder whether Edmund was telling the truth. Jeffrey might get fired from his job for allowing Edmund to spend the night with him. The school district probably would deny any responsibility for what happened that night because Jeffrey was at home and not on duty. Jeffrey should consider the following steps: Jeffrey could take Edmund in and give him a towel to dry off with and require Edmund to stay in the public parts of his home, such as the kitchen or front porch. He could call Edmund's parents and ask them to pick Edmund up. Other relatives, such as grandparents or aunts or uncles, might also be called to intervene. If Jeffrey determines that he should not call the parents, he could call the police and ask them to come and pick Edmund up.

What issues may counselor encounter with policies that require counselors to report students' destructive impulses or contemplation of illegal acts?

If students, particularly adolescents, know that counselors will routinely be reporting any disclosures of their thoughts about hurting someone, they may decide not to reveal that information to their counselors.

Provide examples of situations that school counselors would breach confidentiality

Impending suicide or suicide pact, violent retaliation for victimization, use of crack cocaine, sexual intercourse with multiple partners when HIV positive, armed robbery, and signs of serious depression.

What should counselors considered when making a report?

In addition to adhering to statutory requirements in making mandatory suspected child abuse or neglect reports, counselors also must follow any procedures in effect in their employment setting.

11-5 The Case of Marjorie Jerome is 89 years old and lives with his 58-year-old son, Tyler. Tyler is an accountant whose wife divorced him after many years of attempting to get him to kick his cocaine habit. Jerome suffers from mild dementia and is partially paralyzed as a result of a stroke. He needs assistance with bathing and dressing, but he is able to get around the house using a walker. Tyler often leaves for work before Jerome awakens in the morning, which results in Jerome being forced to spend the day unbathed and in his pajamas. It is not uncommon for Tyler to fail to come home after work because he is out looking to buy cocaine. On several such occasions, Jerome has burned himself while trying to cook his dinner. Tyler cashes Jerome's Social Security checks for him, but more often than not he spends the money to buy drugs. When Jerome tries to discuss these problems with his son, Tyler yells at him and threatens to put him into a nursing home. Jerome is so terrified by this possibility that he withdraws into silence. Marjorie is a home visit counselor from the local mental health center. The first time she visits Jerome in his home, she is disturbed by his grooming and physical condition. Very reluctantly, Jerome tells Marjorie about some of Tyler's behaviors. Marjorie becomes even more concerned about Jerome's welfare. What should Marjorie say to Jerome? What do you think Marjorie should do?

Marjorie should inform Jerome that he does not have to endure the conditions in which he is living. She should assure him there are alternatives that he might find acceptable and explain to him what those alternatives are. Marjorie should consider taking the following actions: If her state law requires counselors to report cases of suspected elder abuse, Marjorie should make the report. If there is no statutory requirement, then Marjorie should decide whether it is in Jerome's best interest to report the suspected abuse to authorities even though there is no legal requirement to do so. Marjorie should try to arrange an appointment with Tyler to determine whether she can be of assistance in helping him care for his father and perhaps persuade him to seek treatment for his drug addiction.

Key points made in chapter 11 about counseling children include the following:

Minor clients have an ethical right to privacy and confidentiality in the counseling relationship, but the privacy rights of minors legally belong to their parents or guardians. Counselors should not automatically assume that all minor clients do not want their parents to know information they have shared with their counselors. The stance that minor clients take toward privacy will vary according to their age, developmental stage, and motivation for sharing information with the counselor. The Code of Ethics (ACA, 2014) allows counselors latitude to use their professional judgment in determining whether and when to involve parents or guardians in the counseling process. Generally, clients under the age of 18 are not considered legally competent to give informed consent to counseling, although there are exceptions to this rule. Parents or guardians probably have the legal right to know the contents of counseling sessions with their children. Noncustodial parents have certain rights and might be included in the counseling process if it is in a child's best interest. Counselors can follow a sequence of steps in resolving a situation in which a parent or guardian demands information and the minor client feels strongly that the information should not be divulged to the parent or guardian. Counseling is a contractual relationship into which minors cannot legally enter on their own. Nonetheless, school counselors do not have a legal obligation to obtain parent permission before counseling student clients. On the other hand, parents who object to their child's participation in counseling probably have the legal right to demand that services be discontinued. For legal purposes, informed consent to counsel a minor should be obtained from the parents. As an ethical matter, the child client should be actively involved in giving consent and determining treatment goals and strategies. Counselors are required by law to report suspected child abuse or neglect. Counselors need to be very familiar with reporting requirements in the state where they practice, because statutes vary considerably from state to state. The reporting of suspected child abuse requires counselors to exercise their professional judgment before and after making a report. A host of factors must be taken into consideration throughout the process. School violence has become an increasing concern that raises questions for counselors regarding reporting threats and how to prevent bullying and harassment of children. School counselors often play multiple roles. Conflicts can occur between the role of counselor and other roles such as bathroom or lunchroom monitor, coach or club sponsor, and friend to teachers and parents of student clients. Difficult challenges are posed by the need to maintain appropriate boundaries around dual professional roles or simultaneous personal and professional roles.

What two states concluded that there is still much to be learned about palliative care, societal beliefs about dying, and laws that eventually might be passed related to this topic?

Oregon and the Netherlands

What states have legalized physician-assisted suicide through legislation?

Oregon, Vermont, and Washington.

What should reporters do when they made a report?

Reporters should always make a note to themselves indicating the date and time they made the oral report and the name of the person who took the report, along with a written summary of what was said when the report was made.

What forms can be a representation of physical abuse?

Slapping, pinching, withholding medication or overmedicating, misuse of physical restraints, and force feeding.

What is the difference between teachers and counselor in school setting?

Teachers are accustomed to the sharing that occurs among colleagues, and they value open communication with other school personnel regarding students with whom they all work. Counselors, on the other hand, come from a position of honoring the confidentiality of their child clients.

What does the wording of §A.2.d. acknowledges?

The need to balance the rights of minor clients with the rights of their parents or guardians and to include minor clients in decision making, as appropriate.

When can self-neglect occur in elders?

When elderly people forget to take their medications or take them incorrectly, skip meals, use alcohol to self-medicate against depression or loneliness, or fail to maintain personal hygiene.

In what situations does the law allow minors themselves to give informed consent to counseling?

When they are in emergency situation, or when they need treatment for use of dangerous drugs, sexually transmitted diseases, pregnancy, or birth control.

Goal that a counselor should keep in mind after a report has been made:

a) Maintaining, to the extent possible, any counseling relationship they have with the parties involved. b) Being concerned about the welfare of the alleged victim before and after the report (Remley & Fry, 1993) c) Helping the parties deal with the process that follows reports. d) Fulfilling their statutory legal obligations.

What does standard B.5.b., encourages?

counselors to work to establish collaborative relationships with parents and guardians, allows counselors some latitude to use their professional judgment in determining whether and when to involve parents or guardians in the counseling process.

According to the Center, abusers in many instances are :

financially dependent on the elder's resources, often have alcohol or drug problems, have mental or emotional illnesses, and feel burdened by their caregiving responsibilities.

11-1 The Case of Benjamin Mary, age 14, reveals to Benjamin, her school counselor, that she once smoked marijuana with her friends on a weekend. She states that she has never tried any other drugs and insists that she knows better than to "get hooked on marijuana or even try the hard stuff." Mary also insists that the counselor must not tell her parents and that to do so would be a betrayal of her trust. What are the arguments for and against Benjamin informing Mary's parents of her one-time marijuana use? What factors should Benjamin consider in making his decision?

if his school system has a policy that parents must be informed in situations like this, Benjamin would be unwise to ignore the policy. If no such policy exists, however, Benjamin must weigh the risks to Mary and to himself. How serious is the danger involved in the one-time use of marijuana? Is it better to honor the client's wishes and not tell the parents in the hope of maintaining a trusting counseling relationship in which the problem can be further explored? Or is informing the parents a wiser choice? Benjamin should consider several factors in making his decision. First, he should check out any values issues of his own that might be involved: Is his decision-making process being influenced by his own liberal attitudes toward marijuana use, for instance? What are the prevailing standards and attitudes in the community? He should also consider factors such as the age and maturity of the student involved, his judgment about whether the parents' response would harm the student if the parents were told, the student's willingness to consider informing her parents in the near future, any applicable school policies, and any relevant ethical standards and laws. If Benjamin decides that the parents must be informed, he should let Mary know that he cannot keep this particular secret and try to negotiate a procedure for informing the parents that will be acceptable to her. This case is an example of a situation that requires a counselor to make a judgment call about informing parents. There are no easy answers to these questions. Benjamin would be well advised to consult with other school counselors who are likely to have dealt with situations like this one.

Counselors who provide services to terminally ill individuals who are considering hastening their own deaths have the option to :

maintain confidentiality, depending on applicable laws and the specific circumstances of the situation and after seeking consultation or supervision from appropriate professional and legal parties.

What states have enacted statutes that require certain categories of professionals to report suspected child abuse or neglect ?

the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands

Minors

usually need parental consent before they can receive counseling services.

When do counselors experience conflicts between what they consider to be their ethical or moral obligations and what the law dictates that they must do ?

when counseling minor clients or vulnerable adults.

Emancipated minors

who are under the age of 18 but live separately from their parents, manage their own finances, and have been adjudicated legally emancipated by a judge—can enter into a contract for counseling.