Chapter 1 "Introduction to Professional Ethics"

Professional mental health workers are designated by variety of terms:

Mental health professional, practitioner, therapist, counselor, social worker, school counselor, rehabilitation counselor, addictions counselor, community worker, couples and family therapist, helper and clinician.

Important to foster an attitude of "Concern-Based Ethics"

Early in your training program, striving for the highest level of ethical care for your clients.

6 Basic Moral Principles that form the foundation of functioning a the highest level as a professional (Kitcherner 1954, Meara and colleagues 1996)

- Autonomy - Nonmalefience - Beneficence - Justice - Fidelity - Veracity Applying these ethical principles and the related ethical standards is not as simple as it may seem, especially when dealing with culturally diverse populations.

Koocher & Keith-Spiegel (2008) similar themes amounts various professional orginizations

- Being interested in the welfare of clients - Practicing within the scopes of ones competence - Avoiding harm and exploitation - Protecting clients confidentiality and privacy - Acting ethically and responsibly - Avoiding discrimination in providing services to clients - Upholding the integrity of the profession by striving for aspirational practice.

Specialty guidelines of the National Association of Social Workers (NASW) two in which are helpful in the area of en-of-life care

- Client self-determination in end-of-life decisions (NASW, 2003) - NASW Stands for social work practice in palliative and end-of-life care (NASW, 2004)

Koocher and Keith-Spiegel (2008) question their effectiveness and identify some specific criticisms of ethics committees:

- Conflict of interest or bias among committee members - Lack of training and experiences of ethics committee members to adequately carry out their functions - Excessive time taken to adjudicate cases, resulting in harm of consumers - Failure to follow due process - Timid procedures due to fear of lawsuit - Reactive rather than proactive stance

The Committee on Professional Practice and Standards (2003) of the American Psychological Association differentiates between ethics and law

- Ethics pertains to the standards that govern the conduct of its professional members. - Law is the body of rules that govern the affairs of people within a community, state or county. Laws define the minimum standards society will tolerate, which are enforced by the law. EX. Of minimum standard is the legal obligation mental health professionals have to report suspected child abuse. The law can also encourage us to work toward changing attitudes for example, to prevent child abuse rather than merely report it.

Specialty guidelines of the American Psychological Association (APA)

- Guidelines for psychological practice with older adults (APA, 2004) - Evidence-based practice in psychology (APA Presidential Task Force, 2006) - Record keeping guidelines (APA,2007)

Four Core Virtues (Meara & Collegues 1996) "Principle of Ethics and Virtue Ethics"

- Prudence - Integrity - Respectfulness - Benevolence are appropriate for professional to adhere to in making ethical decisions.

Problems you might encounter as you strive to be ethically responsible

- Some issues cannot be handled solely by relying on ethics codes. - Some codes lack clarity and precision, which makes assessment of an ethical dilemma unclear. - Simply learning the ethics codes and practice guidelines will NOT necessarily make for ethical practice. - Conflicts sometimes emerge within ethics codes as well as among various organizations codes - Practitioners who belong to multiple professional associations are licensed by their state and hold national certifications may be responsible to practice withing the framework of numerous codes of ethics, yet these codes may not be uniform. - Ethics codes tend to be reactive rather than proactive. - A practitioners personal values may conflict with a specific standard within an ethics code. - Codes may conflict with institutional policies and practices. - Ethics codes need to be understood within a cultural framework; therefore they must be adapted to specific cultures. - Codes may not align with state laws or regulations regarding reporting requirements. - Because of the diverse viewpoints within any professional organization, not all members will agree with all the elements of the organizations ethics codes.

Steps that may help you think through ethical problems

1. Identify the problem or dilemma 2. Identify the potential issues involved 3. Review the relevant ethics 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. Choose what appears best course of action

Major duties of regulation boards

1. determine standards for admission into the profession 2. screen applicants applying for certification or licensure 3. regulate the practice of psychotherapy for the publics good 4. to conduct disciplinary proceeding involving violations of standards of professional conduction as defined by the law.

Code of Ethics for the National Association of Social Workers (2008) the limits of the code are succinctly described:

A code of ethics cannot guarantee ethical behavior. Moreover, a code of ethics cannot resolve all ethical issues or disputes or capture the richness and complicity involved in striving to make responsible choices within a moral community. Rather a code of ethics sets forth values, ethical principles, and ethical standards to which professionals aspire and by which their actions can be judged.

Mandatory Ethics

A level of ethical functional wherein counselors act in compliance with minimal standards, acknowledging the basic "musts" and "must nots". The focus is on behavioral rules, such as providing for informed consent in professional relationships.

"Ethics Codes and the Law" LO4

All of the codes of ethics state that practitioners are obligated to act in accordance with relevant federal and state statutes and government regulations. In court cases, the law generally OVERRULES ETHICS. As ethical mental health practitioners, however, we can advocate for social justice both WITH and ON BEHALF of our clients and the communities we serve. It is essential that practitioners be able to identify legal problems as they arise in their work because many of the situations they encounter that involve ethical and professional judgment will also have legal implications.

Code of ethics or the Canadian Counselling and Psychotherapy Association (2007) makes it clear that professionals are challenged to make sound decisions based on their own values

Although a code of ethics is essential to the maintenance of ethical integrity and accountability, it cannot be substitute for the active process of ethical decision-making.

Canadian Counselling and Psychotherapy Association (CCPA, 2007) on Virtue Ethics

Approach is based on the beliefs that counselors are motivated to be virtuous and caring because they believe it is right thing to do. Virtue Ethics emphasizes the counselors responsibility in making complex ethical decisions.

Conflicts between ethics codes and the law may arise

Areas such ad advertising, confidentiality and clients rights of access to their own files.

Nonmaleficense

Avoiding doing harm, which includes refraining from actions that risk hurting the client. Professionals have a responsibility to minimize risks for exploration and practices that causes harm or have potential to result in harm

Morality

Concerned with perspective of right and proper conduct and involved an evaluation of actions on the bias of some broader cultural context or religious standard.

Example of potential conflict between legal and ethical standards involving counseling minors

Counselors may be committed to following ethical standards in maintaining the confidentiality of the sessions with a minor, yet at times parents/legal guardians may have a legal right to information that is disclosed in these sessions.

"Evolution of Ethics Codes"

EX. ACA (2014) Code of ethics adopted in March 2014 and it addresses evolving ethical issues pertaining to technology, online counseling, and social media, all of which were in response to recent developments in the field. A new section of this code covers informed consent, privacy, and security of electronic communications; distance counseling; web and records maintenance; and social media.

APA's (2010) "Limitations of Codes of Ethics"

Ethics code is quite clear that it nether provides all the answers nor specifically addresses every dilemma that may confront a practitioner. The ethical principles in the APA Code are not enforceable rules, but they should be considered by psychologist in arriving at an ethical course of action.

Barnett, Behnke, Rosenthal, & Koocher (2007) "Using ethics codes as guides"

Ethics codes cannot be applied in a rote manner because each clients situation is unique and may call for a different solution. When practitioners weigh multiple and often competing demands and goals they must rely on their professional judgement.

Positive Ethics (Knapp & VanderCreek 2012)

Focuses not only on how professionals can harm clients but on how therapists can do better at helping clients. Instead of focusing on remedial approach to dealing with an ethical issues, positive ethics addresses an aspirational level of practice. Goal: shifts the emphasis of mental health providers away from a focus on wrongdoing and disciplinary actions and towards an articulated vision of the highest level of practice.

Virtue Ethics

Focuses on the character traits of the counselor and nonobligatory ideals to which professionals aspire rather than on solving specific dilemmas. "Am i doing what is best for my client?"

Pope & Vasquez (2011) "Using ethics codes as guides"

Formal ethical principles can never be substituted for an active, deliberative and creative approach to meeting ethical responsibilities.

Self-Care

Involved taking adequate care of ourselves so that we are able to implement the moral principles and virtues that are fundamental ethical concepts. If mental health professionals fail to practice self-care their ability to effectively implement to other principles will be impaired.

Fear-Based Ethics "Ethics Codes and the Law"

Laws and ethics codes tend to emerge from what has occurred rather than from anticipating what may occur. Limiting your scope of practice to obeying statues and following ethical standards is inadequate.

Remly and Herlihy (2014) "Ethics Codes and the Law"

Note that counselors sometimes have difficulty determining when their is a legal problem, or what to do with a legal issue once it has been identified. To clarify whether a legal issue is involved, it is important to asses the situation to determine if any of the following apply (a) legal proceedings have initiated (b) laws are involved (c) the practitioner is in danger of having compliant filed against him/her for misconduct.

Trans-cultural Interrogation Model

Of ethics decisions making that address the need fr including cultural factors in the process of resolving ethical dilemmas. They present their model step-by-step format that counselors can use in dealing with ethical dilemmas in a variety of settings with different client populations,

Values

Pertains to beliefs and attitudes that provide direction to everyday living.

Ethics

Pertains to the belief we hold about what constitutes right conduct.

Fidelity

Professionals make realistic commitments to keep these promises. This entails fulfilling ones responsibilities of trust in a relationship. Involves creating trust and therapeutic relationship which people can search for a solution

Johnson, Garasso, & Malowki (2010) "Ethics Codes and the Law"

Providers in military settings are occasionally forced to choose between client-centered therapeutic interests and organization-centered administrative interest. Information that is viewed as confidential in the civilian sector may not be protected from disclosure in the military setting EX. A commanding officers needs to know about the dependability of a service member "Genuine conflict between ethical and legal course of action- when abiding by the law will automatically violate the code of ethics or vice versa - are infrequent occurrences"

Handelsman, Gottlieb, and Knapp (2005) "Using ethics codes as guides"

Recommended that ethics course provide opportunities for students to explore their acculturation and begin to develop an ethical identity. "Ethics is the study of right and wrong bu is often taught as the study of the wrong. Many ethics courses are devoted to laws, disciplinary codes, and risk management and strategies and do not focus on best practices" (p.59)

Beneficence

Refers to doing good for others and to promoting the well being of clients. Includes doing good for society, ideally counseling contributes to the growth and development of clients withing their cultural context.

Autonomy

Refers to the promotion of self-determination, or the freedom of clients to be self-governing within their social and cultural frame work.

Pope & Vasquez (2011) "Limitations of Codes of Ethics"

Remind us that ethics codes, standards, and laws are the beginning not the end of ethical considerations. They inform us but do not replace our effort in critically thinking through ethical issues. In, short, ethics codes are necessary but not sufficient, for exercising ethical responsibility.

Ethics

Represents aspirational goals, or the maximum or ideal standards set b the profession, they are enforced by professional associations, national certification boards, and government boards that regulate professions.

Principal Ethics

Set of obligations and a method of focuses on moral issues with the goal of a. solving a particular dilemma or set of dilemmas b. establishing a framework to guide future ethical thinking and behavior. Principles typically focus on acts and choices and they are used to facilitate the selection of social and historically acceptable answers to the question "what shall i do?" "Is this situation unethical?"

Professionalism

Some relationship to ethical behavior, yet it is possible to act unprofessionally and still not act unethically. Ex. not returning a clients phone call promptly might be viewed as unprofessional but it would probably not be considered unethical unless the clients were in crisis.

Herlihy and Corey (2015a) "Using ethics codes as guides"

Suggest that codes of ethics fulfill three objectives: - Educate professionals about sound ethical conduct. Reading and reflecting on the standards can help practitioners expand their awareness and clarify their values in dealing with the challenges. - Ethical standards provide a mechanism for professional accountability. Practitioners are obliged not only to monitor their own behavior but also to encourage ethical conduct in their colleagues. One of the best ways for practitioners to guard the welfare of their clients or students and to protect themselves from malpractices suits to practice within the spirit of the ethical codes. - Codes of ethics serve as catalysts for improving practice. When practitioners interpret and apply the codes in their own practices, the questions raised help clarify their positions on dilemmas that do not have simple or absolute answers.

Justice

To be fair by giving equally to others and to treat others justly. Practitioners have the responsibility to provide appropriate services to all clients.

Veracity

Truthfulness, which involves the practitioners obligation to deal honestly with clients. Unless practitioner are truthful with their clients the trust requires to form a good working relationship will not develop.

Reasonableness

Usually defined as the care that is ordinary exercised by others practicing within that specialty in the professional community.

Community standards (or mores)

Vary on interdisciplinary, theoretical and geographical bases. The standard counselors social contact with clients may be different in a larger urban area than in a rural area, or between practitioners employing a humanistic vs. behavioral approach. - often become the ultimate legal criteria for determining whether practitioners are liable for damages - define what is considered reasonable behavior when a case involving malpractice is litigated

Knapp, Gottlieb, Berman & Handelsman (2007) "Ethics Codes and the Law"

When laws and ethics collide practitioners need first to verify what the law requires and determine the nature of their ethical obligation. Practitioners may not understand their legal requirements and may assume conflict exists between the law and ethics when there is no such conflict. If there is a real conflict between the law and ethics, and if the conflict cannot be avoided, "psychologists should either obey the law in a manner that minimizes harm to their ethical values or adhere to their ethical values in a manner that minimizes the violation of the law" p.55

Barnette & Johnson (2010) "Ethics Codes and the Law"

You may encounter conflicts between the law and ethical principles or competing ethical standards may appear to require incompatible courses of action. In these cases the value of the counselor comes into play.

Welfel (2013) "Limitations of Codes of Ethics"

Your own ethical awareness and problem solving skills will determine how you translate the various ethics code into professional behavior. Codes represent the best judgment of ones peer about common ethical problems.

Aspirational Ethics

describes the highest standards of thinking and conduct professional counselors seek, and it requires that counselors do more than simply meet the letter of the ethics code. EX. providing services for no fees (pro bono) for those in the community who cannot afford needed services.

Unethical

not conforming to approved standards of behavior, a socially accepted code, or professionally endorsed principles and practices

Social Constructionist Model

of ethical decision making shares some aspects with the feminist model but focuses primarily on the social aspects of decision making in counseling. This model redefines the ethical decision-making process as an interactive rather than an individual or intrapsychiatric process and places the decisions in the social context itself not in the mid of the person making the decisions. This model involved negotiation, consensualizing, and when necessary arbitrating