Ethics in Counseling and Psychological Services

Role of a Registered Counsellor (RC)

• Provide preventative and developmental counselling and interventions
• Screen and identify mental health challenges
• Competent in psychometric assessments within their scope of practice
• Support to assist in restoring functioning
• Psycho-education and mental health promotion
• Promotion of primary psychosocial well-being
• Work with interdisciplinary teams
• Refer to appropriate professionals or resources

Primary Interventions

• Basic mental health care
• Identifying and addressing problems or containing them from getting worse (secondary intervention)
• Psycho-education, workshops and training
• Reduce stress and develop coping abilities
• Screening for mental health status

Scope of Practice for a RC

• Manage complete intervention programmes with associate interventions
• Design elements of programmes and processes
• Execute less advanced, more structured interventions
• Design and implement psychoeducation presentations and workshops
• The following Acts fall within the scope of practice of RCs:
  • First line of community-based psychological support
  • Provide preventative and developmental counselling
  • Performing supporting psychological interventions to enhance functioning
  • Basic psychological screening to refer accordingly
  • Develop preventative interventions
  • Provide psychoeducation and mental health promotion

Ecosystems

• Dynamic interaction between individuals, couples, families, groups, communities, and societies

Fundamental Understanding of Psychopathology

• Understanding of psychopathology for the purpose of screening, identification of challenges, and accurate referral

Primary Prevention

• Psychoeducation and mental health promotion addressing relevant community issues
• Proactive transfer of information to promote well-being or prevent harm

Glossary - Counselling

• Reflective, disciplined relationship between the RC and client, based on trust, empathy, equality, and positive regard

Glossary - Crisis

• State of psychological turmoil where the person feels unable to cope

Glossary - Crisis Intervention Counselling

• Counselling focusing on acute or critical situations

Multi-dimensional RC Assessment Process

• Multiple measures (norm and criterion-based tests, informal assessments, interviewing, and observations)
• Multiple domains of functioning (attention, cognitive, and scholastic development)
• Multiple sources (family, teachers, or professionals)
• Multiple settings (school, work, one-on-one, or with peers or parents)
• Multiple occasions to obtain relevant, valid information

Intelligence Tests

• Cattell Culture Fair Intelligence Tests
• Raven's Progressive Matrices
• School-readiness Evaluation by Trained Testers (SETT)

Aptitude Tests

• General and Graduate Tests
• General Scholastic Aptitude Test (GSAT)
• Aptitude for School Beginners (ASB)

Study Habits Test

• Survey of Study Habits and Attitudes (SSHA)

Scholastic Tests

• ESSI Reader and Spelling Tests

Ability Tests

• Critical Reasoning Test Battery (CRTBI or CRTB2)
• Figure Classification Test
• General Reasoning Test Battery (GRT2)
• Graduate Reasoning Test Battery (GRT10)
• Paper and Pencil Games (PPG)
• APIL

Learning Potential Tests

• Learning Potential Computerised Adaptive Test
• TRAM-1
• TRAM-2

Personality Tests

• Personal, Home, Social, & Formal Relations Questionnaire
• Jung Personality Questionnaire
• Career Development Questionnaire (CDQ)
• Nineteen Field Interest Inventory (19FII)
• Occupational Interest Profile (OIP)
• South African Vocational Interest Inventory (SAVII)
• Strong Interest Inventory (SII)

Developmental Measures

• Goodenough-Harris Drawing Test
• Bender

Respect for Persons

• Respect individuals' worth, dignity, and sense of value
• Acknowledge clients' rights to self-determination

Non-maleficence

• Avoid harming or acting against clients' best interests

Human Rights

• Recognize human rights of all individuals

Beneficence

• Act in the best interest of the client

Integrity

• Incorporate core ethical values and standards as a foundation

Autonomy

• Honour clients' right to self-determination

Truthfulness

• Regard truthfulness as the basis for trust

Confidentiality

• Treat personal information confidentially unless overriding reasons exist

Compassion

• Be sensitive to and empathise with the individual and social needs of clients and provide support

Tolerance

• Respect the rights of clients to hold differing ethical beliefs

Justice

• Treat all individuals and groups fairly, impartially, and justly

Professional Competence and Self improvement

• Continuously strive to attain the highest level of knowledge and skill

Community

• Strive to contribute to society's betterment

Formulate the Problem

• Determine if the issue is ethical and find a better understanding

Gathering Information

• Collect all relevant clinical, personal, and social data, consult resources and colleagues.

Consider Options

• Consider alternative solutions in line with principles and values

Conclusion

• Discuss the proposed solution with those affected, act on the decision, and evaluate the decision for future actions

Kinds of Duties

• Natural duties (e.g., fairness)
• Moral obligations (e.g., professional duty)
• Institutional duties
• Legal duties (statutory and common law)

Duties to Clients - Best Interest or Wellbeing

• Always prioritize client best interest
• Honour client trust
• Be mindful of power dynamics
• Ensure personal beliefs do not prejudice client care

Duties to Clients - Best Interest or Wellbeing Continued

• Explain beliefs that may affect treatment
• Don't refuse or deny treatment based on beliefs
• Apply a discerning approach to counselling
• Respond to criticism and complaints promptly; and constructively
• Ensure professional training and education
• Have experience based on program requirements

Respect for Clients

• Respect privacy, dignity, and confidentiality
• Treat clients politely
• Listen to client opinions
• Avoid improper relationships with clients or others supporting them
• Guard against human rights violations

Informed Consent

• Provide clients with information about their condition, treatment, and prognosis
• Give information in an understandable way (language, manner, values, beliefs)
• Avoid withholding information from clients
• Respect client autonomy in decision-making
• Apply informed consent principles consistently
• Allow patients access to their records

Impartiality and Justice

• Be mindful of fair treatment and discrimination free approaches
• Follow laws and protocols concerning any unfair discrimination

Access to Care

• Promote access to healthcare
• Refer clients to other HCPs or facilities when needing services outside their scope,
• Avoid over-servicing or unnecessary treatment

Potential Conflicts of Interest

• Prioritize client treatment purely based on clinical need
• Declare any financial or other interests to clients.
• Avoid coercing clients about referrals or other benefits
• Avoid giving gifts or undue benefits

Referral to Colleagues and Conflict of Interest

• Act in clients' best interest when making referrals and arranging care
• Avoid undue inducements or incentives in referral processes.
• Should not serve as a client in numerous capacities;
• Respect other HCPs and work in clients' best interest,
• Do not discriminate, speak ill, or challenge their qualification or abilities.

Respect for Clients Continued

• Respect privacy, dignity, and confidentiality of clients.
• Treat clients politely with consideration
• Listen to the client's opinions.
• Avoid improper relationships with clients or anyone accompanying them.
• Protect against human rights violations.

Confidentiality

• Recognize the client's right to have confidential information protected.
• Unless there is a court order, or it is in the client's best interest.

Duties to Patients of Other HCPS

• Act quickly to protect clients from risk
• Report violations and seek compensation
• Report impaired colleagues to protect clients

Duty to Self - Maintaining a Professional Practice

• Maintain proper equipment and environment
• Maintain accurate, up-to-date client records

Duty to Society - Access to Scarce Resource

• Deal responsibly with scarce health resources and refrain from providing unnecessary services
• Refrain from participating in financial arrangements

Duty to Society - Health Care Policy Development

• Include ethical considerations and human rights in health care policies

Duty to Health Care Profession - Reporting Misconduct

• Report violation or seek compensation if a client's rights are violated.

Duties to Society - Access to Appropriate Health Care

• Promote access to health care.
• Refer clients to appropriate providers if unavailable.

Delegation and Supervision of Psychological Services

• Not delegate to anyone not qualified to perform the service
• Supervisee must have appropriate education and training and appropriate qualifications
• Supervisor is responsible for determining the competency of the supervisee and for ensuring not to delegate tasks beyond scope of competence and training.
• Supervisors must provide supervisees with specific instructions.
• A supervisee should inform the client of the supervisee's status and their right to consult with the supervisor
• Client may consult supervisors about every aspect of the service being performed

Multidimensional RC Assessment

• Include norm and criterion-based tests, informal assessment, interviews and observation
• Multiple domains such as attention, cognitive, and scholastic development
• Multiple sources such as families, teachers, and professionals
• Multiple settings such as school, work, one-on-one or group
• Multiple occasions to gather data over a period of time

Informed Consent in Assessments

• Obtain written consent from client.
• Outline details of assessment including personal details, specific psychological services and any limits associated with services
• Written consent is not necessary where testing is required by law, legal requirements, or routine practice
• Disclose any procedures which may create risk factors;
• Explain any procedure or test that is used, providing adequate explanations

Informed Consent in Assessments Continued

• Explain the limits to any procedure/test result
• A counsellor should ensure to explain the use of an interpreter.

Cultural Diversity

• Be familiar with reliability, validation, and related standardisation or outcome studies.
• Recognize limitations in the certainty of diagnosis and prognosis. - Recognize the impacts of multiple considerations such as linguistic, cultural, and socio-economic factors when making interpretations.

Interpreting Assessment Results

• Consider test factors and characteristics of clients
• Indicate significant reservations about interpretations when there are uncertainties or specific limitations

Test Scoring and Interpretation Scores

• Select scoring methods based on reliability, validity, and all appropriate considerations.
• Be responsible for assessment activities - including administration, scoring, interpretation, and use
• Assess tools whether used by the counsellor themselves or automated processes
• Ensure there are no ethical conflicts associated with the use of assessment tools or methods

Ethical and Professional Rules Annex 12 - Chapter 9 - Teaching, Training and Supervision

• Educational training programs adhere to current competency standards and requirements
• Descriptions of education/training programs provide the required current and accurate content detail, training goals and objectives, and requirements.
• Descriptions of education and training programs use reasonable degree of objectivity in teaching and training

Ethical and Professional Rules Annex 12 - Chapter 9 - Teaching, Training and Supervision - continued

• Accurate and objective information teaching/training
• Counsellors should ensure the constitutional rights of learners are upheld
• Counsellor should recognize power imbalances when interacting with supervisees and learners

Legally Dependent Clients

• Client's best interests are paramount.
• Counselors should address the needs of 14 under-age clients cautiously.
• Client needs to be informed of the specific legal framework about confidentiality.

Release of Confidential Information

• Follow court orders, requests from clients or client's legal guardians.
• Disclose information when required by law

Reporting Abuse of Children and Vulnerable Adults

• Be aware of professional responsibilities when child abuse or abuse of vulnerable adults is suspected.
• Report abuse according to relevant laws

Disclosing Confidential Information for Education

• Ensure that confidential client information is de-identified and protected from disclosure;

Professional Consultations

• Share confidential information about clients when in a team setting with appropriate consent with
• Obtain consent from client, unless it is an emergency, or if disclosure is legally required
• Respect client confidentiality in consultations.
• Disclose confidential information under specific circumstance such as those stated by the law, court, or when it's in the best interest of client or others to prevent harm,
• Counselors should not disclose information without client informed consent where disclosure isn’t required.

Maintain Competency and Limits

• Maintain up-to-date competence in practice areas
• Use CPD, consultations and other necessary procedures to maintain competency

Confidentiality, Privacy and Records

• Safeguard confidential information in practice, teaching, and research
• Disclose information only with
• Written consent from client
• Exceptions to confidentiality such as court orders or threats to self or others

Limits on Invasion of Privacy

• May disclose when necessary to a third party
• Disclose information relevant to the current purpose or goal

Duty to self

• Be aware of the potential risks or harms, and take measures to resolve or address problems, should any arise
• Take appropriate steps to maintain a healthy and balanced professional life,
• Maintain a healthy lifestyle and balanced personal life to prevent any harm to clients or conflict
• Make appropriate decisions or referrals if there are any potential conflicts of interest.

Accuracy in Professional Representation

• Avoid misrepresenting qualifications, education and competencies
• Be honest and transparent in relation to the education, training and experience
• Avoid making false, deceptive, fraudulent statements relating to areas of competence

Conflicts of Interest

• Avoid dual relationships
• Make sure client's rights are protected in prior relationships
• Respect personal/professional boundaries

Importable Complaints

• Refrain from filing frivolous or harmful ethics complaints as a conflict of interest or concern
• Do not discriminate in relation to receiving and/or filing an ethics complaint.

Confidentiality as a Client Rights

• HCP should safeguard client's confidentiality during any professional interactions such as consultations, treatment, or research;

Responsibility of HPC to HIV Positive Clients

• HIV status should not determine whether treatment is given
• HPC must be ethically and legally correct and obtain consent before testing
• Continue counselling with consent and refer if required
• Support the client in implementing strategies to prevent HIV
• Provide counseling regarding HIV status issues

HIV-Ethical Dilemma

• Recognize ethical dilemma in situations where HIV-positive clients do not disclose to their partners
• Ensure clients have appropriate access to and understanding of their rights
• Counselling is needed to ensure that clients understand, and comply with their associated obligations,

Confidentiality and Sharing Data

• Ensure data safety when shared.
• Share data responsibly with competent professionals to ensure claims are accurate.

Uncertainty about Ethical Issues

• Seek guidance or consultation from experienced professionals or committees for uncertainty
• Act appropriately.
• Act in the best interests of the client and society
• Resolve conflicts.
• Resolve conflicts.

Reporting Ethical Violations

• Investigate and resolve violations of ethical conduct;
• Adhere to relevant laws and regulations
• Take appropriate steps to resolve ethical violations appropriately,

Informational Disclosure

• Be aware the circumstances that warrant confidential communication disclosure,
• Ensure professional judgement, objectivity, and maintain ethical standards in all interactions /communications.

Resolution of Ethical Violations - Informal

• Approach colleagues who are suspected to be struggling and or in violation of ethical standards, in a non-confrontational way;
• Collaborate to solve issues and make a positive impact
• Respect confidentiality during ethical issues' resolution

Co-operating with Ethics Committees

• Actively cooperate with ethics committees throughout all procedures and investigation.
• Complete all relevant documentation and maintain accountability and transparency throughout the process.

Acceptable Business Models

• Solo practice, Partnerships, Associations, and Incorporated practice

Undesirable Business Models

• Corporate ownership of professional practice (inappropriately sharing profits)
• Corporate involvement where there's a transfer or acquisition of profit or other forms of influence in a private practice without proper ethical consideration,
• If any form of business relationship causes conflicts of interest, the counsellor should be cautious to resolve the conflict fairly and appropriately to ensure the interests of all stakeholders

Employment of Practitioners

• Employment decisions should consider various factors including personal motives and or intentions for employment, the specific nature of the service or job, and the potential for conflict of interest.
• The employment of registered practitioners should conform with policies governing practice.

Franchises/Undesirable Business Practice

• Be wary of franchises, or similar business models that have a potential to violate ethical standards by inappropriate business relationships (taking financial incentives or profits).

Sexual intimacy with clients

• Not engage in any sexual activity with current clients
• Maintain professional boundaries

Interruption of Services

• Ensure continuity of services should there be an emergency/difficulty and/or should service be interrupted by events like practitioner or client illness, or relocation.

Respect for Human Rights and Others

• Respect the dignity and human worth of a client.
• Recognize a client's right to hold their own beliefs and values.
• Recognize the client's inherent right to bodily and psychological integrity.

Testing and Measures

• Avoid using tests that are not applicable to clients.
• Ensure the test is reliable, valid, and appropriate to the situation.
• Tests should be based on acceptable standards/norms and follow the laws of the relevant state.

Culture Variable

• Avoid using tests based on foreign norms
• Test should be appropriate to cultures, languages

Ethical and Fair Practice Testing in SA

• Understanding cultural contexts and sensitivity for testing
• Validity and appropriateness of tests being used.
• Cultural norms are considered

Sharing Data

• Data should be shared with competent professionals who will use the data for accurate reanalysis
• Data should be appropriately shared.