3005PSY Module 2 Ethics PDF

So you've now learned that for psychologists, we have a code of ethics, the APS code of ethics, which we all that we all need to adhere to and practice in accordance with. For counsellors we have a couple to choose from. But the primary adopted one is PACFA's of ethics. And so you've now read a litt...

So you've now learned that for psychologists, we have a code of ethics, the APS code of ethics, which we all that we all need to adhere to and practice in accordance with. For counsellors we have a couple to choose from. But the primary adopted one is PACFA's of ethics. And so you've now read a little bit about those. And we're just going to have a look at these in a little bit more detail. So first one first thing, when we look at the APS code of ethics, the Code of Ethics has three general ethical principles A, B and C. So firstly, respect for the rights and dignity of people and places. Propriety - this is promoting good and removing harm, not doing any harm to people in your contact with them and in your treatment and responsibility to clients, the profession and society. And so when we think particularly about that responsibility, firstly, we have a responsibility that we give the clients the best treatment that we can, that we do not put them in the way of harm and that we promote good. And when we think about case conceptualisation, given that we know that case conceptualisation and incorporation of theory leads to better client outcomes, this comes under this standard that we have a responsibility to clients to give them the best that we can, and that includes effective case conceptualisation. We also have a responsibility to our profession and to society, to our profession, that we don't bring our profession into disrepute or that we act in a way that is in the best standards of the profession. So, again, that is effective treatment and effective case management and to society more broadly, that we are good members of society and we act in responsible ways And then finally, integrity, and this relates to the need for good character, it acknowledges the high level of trust, intrinsic and professional relationships, that there is an inherent power imbalance when people come to see us and they place a lot of trust in us in terms of their stories, their life history and their difficulties, their inner thoughts and feelings at a high level of trust. And we have to be very mindful of that and respect that, you know, treat it with the integrity and respect that it deserves. It also acknowledges the impact of conduct on the reputation of the profession, which I was mentioning before, under propriety as well, that we have a responsibility to our profession to act in ways that bring that profession, highlight the good points of the profession, and do not bring it into disrepute or do not, you know, don't be that person on the front page of the Courier Mail, that psychologist or counsellor who has engaged in bad practices. When we look at PACFA, there are 14 ethical standards for clinical practice, and I haven't listed these all here, but I've listed some of the key ones. And what I'm hoping that you'll see is that there is a high level of overlap or concordance between the two. So with PACFA, put clients first, work to high professional standards, build a relationship of trust. So again, we're acknowledging the importance of that relationship between a client and the treating professional respect, diversity, respect confidentiality, respect professional boundaries like ethically with colleagues, and take responsibility for care for self care, which is a lovely one on the end that we don't actually have in the APS Code of Ethics. What I'm hoping you're seeing is some overlap here, really about putting the clients first, not doing harm and promoting wellness, but also the responsibilities that we have not only to the client, but to our profession and our colleagues and to society more broadly. So I'm hoping that you see that overlap between the two parts practice. So there's way too much in both of these codes to go into them into in any great detail, but what we are going to do in this module is look at some of the key principles that come out most commonly in counseling or therapy practice. So these are, these are principles or standards that are common to both professions and which are really particularly important and come out as frequent ethical issues when we work with clients. So firstly, informed consent. So you might think back to perhaps some of the first courses that you did where you had to engage in some research tasks, and they probably had a big, long piece of paper regarding informed consent. Now we need to obtain informed consent from clients when we work with them as well, but it's a little bit more involved than just getting consent at the start, although that is an important component. So informed consent in therapy relates to explaining the nature and purpose of procedures. So this isn't just at the start of therapy, this is before we undertake any new activity with the client. So, for example, if we're going to engage in exposure or get them to talk through their traumatic memories from childhood, we need to explain upfront what we're going to be doing, what involved in it, and what the purpose is of it, that there is a purpose, that we're working towards, a goal with it. We need to clarify reasonably foreseeable risks again at the start of therapy. But again, before we do any new activity, we need to explain how information is collected, recorded. So, for example, if we record our sessions, so, for example, if your provisional psychologist in our clinic here at the university or your sessions are recorded so that your supervisor can check up on them and give you feedback. So you need to explain that to the client in terms of how it's recorded, where it's stored, for how long and the purpose of that. And this also relates then to the notes that you take in session. Anything that goes in their client file. We need to clarify the frequency, expected duration and financial details of services all up front so there's no surprises and we need to make clear the circumstances under which services may be terminated. So, for example, if you know that you have a big block of leave coming up, you need to outline that to a client at the start. So that gives them the opportunity to seek another therapist if they want to, if they prefer to have a period of uninterrupted therapy. So you need to make all these things clear to clients at the start and then that continual process of consent as you progress through therapy and counseling, as I mentioned, you need to obtain consent prior to using interventions, and that is an ongoing process. And if capacity is impaired, you obtain consent from people with legal authority to act on the client's behalf. So this could be if you're working with a client with intellectual impairment, for example, or a brain injury, noting also that when you work with children, you need to have consent from their caregivers or their legal guardians. And that relates to consent at the start of therapy, but also before you engage in any procedures with children as well. Confidentiality is another important standard that goes across both codes, and this relates to how we disclose confidential information with the consent of the client. So it could be to another professional involved in treatment. So one of the common ones we do is speak to a patient's GP. So we have a client or patient who's come into therapy and you're working with them on their depression. But you also want to touch base with the GP and speak to them about the possibility of them also having some medications or common one is with anxiety. You're thinking of doing some exposure for panic attacks which involve some physical exertion, as we commonly do. And you want to check with the GP that they don't have any medical conditions. That would be a contraindication for that particular type of exposure. Or you speak to a nutritionist if they've got an eating disorder, or whoever it happens to be, a social worker. So there are many professionals that often become involved in the care of a client. And to be able to disclose effectively and have those discussions with another help with another professional, you need to have that consent for disclosure. You can disclose details and supervision or professional training, providing the identifying information is concealed. So throughout your professional career, if you go on to be a counselor or psychologist, you'll have ongoing supervision each year as part of you’re requirements from registration. And part of that supervision is you'll often discussed client cases and get guidance on where to go next with cases. Now, that's completely fine as long as you don't identify the client. Now, that doesn't just mean that you don't use the client's name. Identifying information is much broader than that, particularly if you're working in a small area or the client you're working with is part of a small enough group that they could be identified. So, for example, if you are working in a small area and you're saying, well, I've got this new client, she's an 83 year old widow person who's recently lost her husband, that might be enough information, even without saying the client's name for your supervisor to know who that is and you've broken then confidentiality. Or if you were even living in Brisbane, say, oh, look, I'm working with this new client. There are professional athlete, but they've just had this big media scandal and they're going through significant anxiety and issues with shame around that. Again, you've not said any names. You're in a big area, but you've said enough specific details about the client that they could be identifiable so that identifying information is not just their name or their age is anything that could potentially be used to identify them. Those limits to confidentiality, so if there is a legal obligation like you're subpoenaed or if you have knowledge of a criminal activity that the client is engaging in, then you need to disclose that and and break that confidentiality if there's imminent risk of harm to self. So, for example, there is a high risk of suicide even without a client's permission. You have a right to then to break confidentiality to ensure that they are safe. Or similarly, if there is a risk of harm to others, then you have a duty to protect, which is primarily for psychologists. And what that means is that if the person has in therapy disclosed that they are going to harm another person and there is enough detail there to indicate that that is a realistic risk, then you need to tell the police about that or take steps to protect. It may not necessarily be telling the police, but you need to take steps, for example, getting the person admitted to an inpatient ward until that risk has been reduced. So you need to a duty not necessarily to disclose, but a duty to protect, which in some cases may mean a disclosure. So coming back to informed consent, you need to explain the limits of confidentiality at the outset of the professional relationship, you need to explain what confidentiality is, what it relates to, what's covered under confidentiality, and then the instances in which confidentiality may be broken. So, for example, with the clients consent or where there is those other instances in which you would be obliged to do so. Professional conduct is another common area of ethical concern, and this really relates to issues around competence to deliver services. So, for instance, I wouldn't go and deliver psychodynamic treatment myself without considerable supervision and training because it's not my area of competence. So we need to practice within the limits of our expertise and not go beyond this unless we have enough supports around us to be able to do so in a competent manner. We need to undertake continued professional development and maintain our competence to practice psychologists. This is mandated, depending on your type of registration, whether you have specialized endorsement or you're a general psychologist will differ, will change the number of hours of professional development you need to do each year. But it is mandated. We need to seek professional supervision as required. And again, for psychologists, this is mandated and you need to ensure emotional, mental and physical state does not impair your competent practice. So this means that if you are going through some issues yourself and you're really not mentally or emotionally available for your clients, then you shouldn't be giving therapy. And you must continually monitor problems that may impair your competence and take steps to address these problems, and one of the key supports that you have for you, for yourself in doing this is supervision. When you are experiencing any difficulties, often your first step is to bring it to a supervisor, which may or may not be within your workplace. You may have an external supervisor who you see separately, but to bring it to supervision and get advice and support from there. And finally, the last common area of ethical concern that we're going to look at is conflicts of interest and professional boundaries. So again, this cuts across both the PACFA and the APS Code of Ethics. We won't go through all of the areas within this conflict of interest and professional boundaries. But some of the common ethical issues that come up for both psychologists and counselors are around your relationships. I can speak to my own practice that this comes up more commonly than you would expect where a client comes in and you may not think that you have a dual relationship, but then all of a sudden you realize some early sessions that actually, you know, their partner is a friend of yours or used to work with you in a previous previous workplace or is somehow connected to a member of your family. Because it's a small world and we live in a small city. So we need to refrain from multiple or dual relationships that impair confidence, effectiveness and objectivity or ability to provide a service. So the reason for this is that dual relationships are often harmful and exploitative of clients. So a client is coming to you with issues that they want to know are going to be treated confidentially and are going to be, you're going to deal with in an unbiased manner. If you're somehow connected to them in another way that might impair your ability to be unbiased and objective or may raise concerns for them about your capacity to keep everything confidential, given that you're in the same network of people. If a multiple relationship is unavoidable and this is often the case in rural settings, that you just simply can't wipe out the pre-existing relationships that you have with people in the area that you live and work, then you would need you need to adhere to the principles of informed consent that you actually have that discussion with the person at the outset around the fact that a dual relationship seems to be unavoidable and how you, the two of you, will manage it from there, what it means. And that includes, for example, if I if I see you in the shopping center, the local shopping center, would you like me to acknowledge you or would you like me to engage in some sort of planned ignoring if you're with your family? What sort of things can be said in a social context and what sort of things should I not say? And you cannot give services to your friends or family or obtain favors from a client. So, for example, you can't give sessions to a person and then find out that they're a mechanic and swap them a session for them. Doing a service on your car simply doesn't work that way. So you have to avoid conflicts of interest and your relationships. So you also can't exploit people with whom you have a professional relationships, so this includes research assistants. So some of you may get some part time work as a research assistant. And one thing to keep in mind is that your supervisor, if they're psychologists, you as a research assistant are considered the client and the Code of Ethics applies to them in terms of they need to treat you as a client with all of the same respects that we would a client and similarly with employees, colleagues, supervises and students. So students are also considered our clients when we work in a school or teach in a psychological capacity. You cannot engage in a sexual relationship with a client or anyone closely related to a client. So, for example, you can't start dating the single parent of your child client. This is just a big no no. And there are a number of reasons around this which relate to the power differentials and also what that can mean for your client if a relationship goes south. So if you're a psychologist, you can't have sexual relationships within two years of terminating professional relationships. In PACFA it's five years. I can't tell you the reason for the difference in years. I wish I knew, but either way, I would just encourage you. Please don't do it. Every year there are reports that come out of psychologists and counselors who unfortunately do not follow this rule and it never looks good for them or the profession. And you can imagine it can be incredibly harmful for a client, particularly when they've come into therapy in a vulnerable state, and then they may be taken advantage of whilst they're in that vulnerable state. And you cannot accept anyone as a client if you've had a previous sexual relationship with them. So all of this said ethical breaches are common. Unfortunately, they are. So this is some recent data, that should say 2017- 2018. But in that particular year, there were 437 notifications or complaints or concerns. These are complaints or concerns that are lodged to offer the governing body. Of those 60 were mandatory notifications. These are notifications that come from other health professionals regarding inappropriate conduct. This could be practicing whilst intoxicated. It could be knowing that it was a sexual relationship going on with a client or a counselor, a psychologist. Sorry, a psychologist, because this is the board practicing without beyond their area of competence. So, for example, doing a neuropsychological assessment when they're not trained in that particular assessment. Of those 437 cases, not all of them were finalized at the time of this report. But of those that were, most have no further notifications. So if it's not a mandatory notification, it's a voluntary one. And these are the complaints that come from family or friends or the clients themselves. And sometimes it may be a simple misunderstanding between the client or the family and the therapist. So the vast majority, there's no further action. However, there is a substantial proportion of those where they receive a caution or an undertaking or conditions are imposed on their registration. So this may mean that they can now no longer see clients with eating disorders, or they can now only practice one particular theoretical perspective, or they can no longer work with child clients or they can keep practicing. But they have to have an exorbitant amount of amount of supervision each week of people checking up on that practice and monitoring their practice and then a small proportion who then have their registration suspended or cancelled, which means they can no longer practice. So ethical breaches, unfortunately, are more common than what we would like. And all I can say is, don't be one of those people. So managing ethical issues, some key things to pathways to consider, like I mentioned before, one of the first things you should do is discuss with a colleague or supervisor. Get a second opinion and get some support. Acknowledge and take responsibility for your mistakes. We all make mistakes as therapists or counselors. You will make mistakes in therapy. And the best thing you can do is acknowledge that and acknowledge it early on onset. You've got a chance to correct it. Be familiar with your ethical codes. The key point here is that not knowing that something was going against the code or not knowing that you were violating the code isn't a defense. So it's your responsibility to know the code and to practice accordingly be able to communicate ethical guidelines clearly with clients. A communication is often key in ethical situations where ethical issues have arisen and have awareness of your own competencies, limits and limitations, and stay within your competencies and primarily always put your clients well first beyond your own interests. So always putting their interests at the top. So there are a number of ethical issues that are common within therapy and counseling practice. And hopefully you've seen the ways in which the guidelines, whether it's PACFA or APS address some of these common ethical issues. But for your second assignment, you're going to need to pick out an ethical issue and discuss it. Now, there's some more tips further along this page. But hopefully from having gone through some of the common ones, it's given you a starting point to think about what might be some of the common things that come up in therapy. And when you look at your specific case, trying to think specifically with this client, what could be an ethical issue that I would need to be mindful of, of the outset and start to set up those processes early on to try and avoid or manage that potential ethical issue.