Ethical Considerations in Counselling PDF

ETHICAL CONSIDERATIONS 1. CONFIDENTIALITY ▪ Confidentiality is one of the most important aspects of the counselling relationship. It is also a subject which generates a great deal of interest and discussion when it is raised in training groups. This is because it is a topic ab...

ETHICAL CONSIDERATIONS 1. CONFIDENTIALITY ▪ Confidentiality is one of the most important aspects of the counselling relationship. It is also a subject which generates a great deal of interest and discussion when it is raised in training groups. This is because it is a topic about which most people have very firm views. ▪ It is often seen as an absolute right for clients who, after all, trust counsellors with some of their most intimate thoughts, feelings and desires. The information clients disclose in counselling may never have been spoken to anyone before, and indeed it often takes clients a very long time to summon up the courage to approach helpers in the first place. ▪ For this reason, clients need to have confidence in the professional integrity of helpers and in their ability to keep private anything they discuss. Clients may take some time to arrive at a state of complete trust in counselling. One indication of this initial reticence and caution is the way in which clients often focus quite extensively on secondary issues before they feel secure enough to reveal themselves fully. This could be seen as a way of testing the counsellor in order to ascertain just how unshockable, non-judgmental and discreet she is likely to be. ▪ Clients who do not get these assurances may retreat from counselling, but once trust has been established, they should feel sufficiently confident to disclose more about themselves. Some general guidelines relating to confidentiality: 1. Confidentiality is a subject which needs to be addressed as early as possible in counselling, although in crisis situations this may not be immediately feasible. 2. Even in crisis situations the issue of confidentiality should be addressed at some stage. 3. An atmosphere of trust is just as important as an explicit statement of confidentiality. ▪ There are certain situations where clients reveal information which, because of the guidelines laid down by a particular counselling agency or organisation cannot remain confidential. These usually include some of the following: 1. a client threatens to injure another person 2. a client discloses information about abuse of children 3. a client expresses suicidal tendencies 4. a client develops severe mental illness. 2. THE COUNSELLING RELATIONSHIP o People are usually affected by some degree of emotional stress when they first seek counselling. This fact alone makes it imperative that they receive the best possible help, with the lowest possible risk of exacerbating any of the problems they already have. The difficulties clients experience may have been with them for a very long time. These include problems of depression, faulty relationships, marital problems, anxiety, phobias, diffi culties at school or university – to name just a few. One of the factors which prompts people to seek help through counselling is the realisation that it might be impossible to continue to cope alone. When people feel helpless like this, they frequently look for someone who is ‘expert’ in a particular field. Though trained counsellors do not regard themselves as experts in this way, they nevertheless need to be aware that vulnerable people may have such a perception of them. o The majority of clients have a basic trust in a counsellor’s ability to help them deal with the problems they experience. In fact, it is probably true that many clients over-estimate any helper’s prowess, and may actually ascribe to a counsellor exaggerated or magical powers which are, of course, unrealistic. It is important that clients do in fact trust the counsellors who help them, but excessive expectations can work against clients unless counsellors are aware that they do exist. When there is this awareness on the counsellor’s part, then it becomes possible to help clients become more autonomous and self-directed over a period of time. Such a position of autonomy cannot, of course, be achieved until clients are given the opportunity to explore their problems and to consider what it is they need to do in order to effect change. 1|Page 3. TRANSFERENCE AND COUNSELLING RELATIONSHIP Transference refers to the client’s emotional response to the counsellor (or to any other helper) and we know that it is based on much earlier relationships, especially those formed in childhood with parents and other important people in the client’s life. Transference, therefore, is by definition unrealistic since it stems from outdated information which people carry with them and apply to others who help them (as parents might have done) in times of emotional upheaval or distress. When people are distressed they are, of course, vulnerable and it is this vulnerability which makes them open to abuse, however unintended. 3.1. Unconscious feelings. Unconscious transference feelings may be either positive or negative, idealising, loving, erotic, envious or antagonistic. Though these (and many other possible responses) may not be obvious at the beginning of counselling, they tend to emerge once the client/counsellor relationship is established. In other words, clients may respond to helpers in totally realistic ways to start with, but later on they may respond in ways which are inappropriate or out of date. 3.2. The counsellor’s response. The word counter transference describes the counsellor’s emotional response to the client’s transference. A counsellor who is, for example, cast in the role of critical parent, may well be drawn into responding in the way that a critical parent would respond. This kind of unconscious role play situation might continue unproductively and indefinitely, unless and until it is identified and changed either through spontaneous insight or with the aid of supervision. 3.3. Lack of objectivity. Any distorted view of the client/counsellor relationship will inevitably get in the way of objectivity when working with clients and their problems. When counsellors experience countertransference feelings towards clients, they need to be able to ‘contain’ these, rather than acting on them in a way that clients act on their transference feelings. In addition, counsellor awareness of both transference and countertransference feelings can prove to be an invaluable asset to therapy, especially when it provides information about the client’s emotional problems. However, it is important to remember that not all responses to clients come under the heading of countertransference. Counsellors frequently perceive their clients as they really are, and often the responses elicited by clients in counselling are similar to those elicited in any other situation or relationship. On the other hand, it is often difficult to differentiate between what is real in our responses to clients, and what is countertransferential. Some indications of countertransference reactions which may be experienced by counsellors: 1. strong sexual or loving feelings towards the client 2. inexplicable feelings of anxiety or depression 3. feelings of over-protectiveness towards the client 4. feelings of guilt in relation to the client 5. extreme tiredness or drowsiness 6. feelings of anger towards the client 7. loss of interest in the client 8. inability to make proper interventions when necessary 9. dreaming about clients, or thinking about them outside sessions One way in which counsellors can monitor their own countertransference feelings is to ask the following questions in relation to work with clients: 1. Do I experience any strong feelings at this moment which seem inappropriate or out of place? 2. Are my interventions geared to the client’s needs? 3.4. The possibility of exploitation Any discussion about exploitation in counselling tends to focus on the more obvious forms, including those relating to the sexual and financial abuse of clients. It is true (and unfortunate) that these forms do indeed occur, but there are other, less obvious forms which counsellors can, either knowingly or unknowingly, inflict on clients. It is fairly easy to see how sexual involvement with clients can arise, especially when we consider the heightened emotions which clients often experience in relation to counsellors, as well as the imbalance of power which exists within the relationship. Such responses can be seductive and irresistible to those helpers who currently experience some problems in their own lives, especially if these are relationship problems or problems of loneliness. Once again 2|Page  this emphasises the point that counsellors need to know how to take care of their own needs without involving vulnerable clients. Counsellors who work in private practice, or those who charge direct fees for their work, need to be especially careful about the quality and standard of their service. However, all counsellors, regardless of their work setting, should ensure that their clients are aware of certain important aspects of counselling. These include clear details about the following: 1. financial terms, if these apply 2. how payments should be made 3. confidentiality 4. arrangements concerning missed appointments 5. any special concessions for people on low incomes or those unemployed 6. length of sessions and the number likely to be needed 7. counsellor qualifications and training 8. counsellor’s theoretical orientation and details about any specific 9. procedures to be used 10. counsellor supervision 11. any records or notes the counsellor may keep. Some of the other possible areas of abuse within counselling and therapy include the following: 1. failure on the counsellor’s part to undertake adequate supervision 2. arriving late for sessions or leaving too early 3. encouraging clients to become dependent 4. being unclear or inconsistent about financial arrangements 5. premature termination of counselling, and lack of consultation with clients 6. failure to maintain confidentiality or failure to inform clients if there is a conflict of interest in relation to confidentiality. 3.5. Contracts. One way of providing explicit and clear guidelines for clients is to establish contracts with them. Establishment of a contract ensures that both client and counsellor understand the nature of the commitment between them, and that they work together in harmony. Culley (2004) highlights the importance of letting clients know the exact nature of the counselling relationship. When contracts are made in this way confusion is less likely to arise, especially when objectives and desired outcomes are also clarified and priorities discussed. Many of the factors already mentioned in this chapter, including those listed under the heading ‘what clients should know’, would form part of the client/counsellor contract. Among these are issues relating to number, frequency and length of sessions. 4. ENDING COUNSELLING We have noted several times throughout this book that the main objective in counselling is to help clients become more independent, self-reliant and capable of dealing with any present or future problems. This means, in effect, that the counselling relationship, unlike many other relationships, is meant to end. Termination of therapy is, therefore, always implicitly present. Endings can be difficult for all of us however, and clients in counselling are no exception in this respect. Many people experience a variety of conflicts about endings in general, and this is especially true of those people who have been traumatised by separations in the past. The ending of any relationship is obviously much more difficult for someone who has lost a parent in early life, for example, or indeed for anyone who has been bereaved in later life too. Each new ending in an individual’s life tends to reactivate memories of previous separations, endings or loss. Clients need to be able to talk about these experiences and what they mean to them, and counsellors can help by encouraging expression of all these feelings. 5. REFERRAL One of the difficulties which helpers themselves can have as a result of these trends, is to determine the limits of their own capabilities in providing the right support for clients. An important aspect of training, therefore, is identification of specific problem areas which might require other forms of help or support. Obviously helpers differ in terms of professional training and background and it is these very differences which necessitate discussion of the subject so that proper guidelines for referring clients can be defined. 3|Page  Some helpers may not, for example, have the specific skills needed to deal with clients in crisis, or those with severe depression or other forms of psychological illness. We all need to know what our own limitations are, and the first step is to look for these and then acknowledge them. The next step is to know ‘how’ to refer clients so that they receive the appropriate help when they need it. Referral may be difficult for clients for a number of reasons: 1. some may have experienced rejection in the past, while others may come to believe that they (or their problems) are just too formidable for anyone to cope with. 2. if referral is left too late, clients will not receive the kind of support or specialised help they need. This last point emphasises the importance of good communication with clients from the outset, so that the possibility of referral is identified early on. Clients should be given the opportunity to discuss their feelings about the prospect of referral too. If they are not given this chance to express feelings, they may experience resentment or anger in relation to the whole process. Reasons for referral. At every stage of the counselling process, however, helpers need to ask themselves what is the best course of action for specific clients. The reasons for referral are obviously very varied. A counsellor or client may, for example, be in the process of moving away from the area, in which case referral might be necessary if the client is to receive ongoing help. Certain clients may require psychiatric support or other specialised health services. There are clients whose problems are specific to certain areas, for example adoption, recovery after surgery, disability or language difficulties, who might well benefit from contact with a helper specially trained in one of those areas. The following is a list of factors which may imp inge on your ability to help certain clients: 1. your level of expertise or lack of it 2. time: you do not have sufficient time to offer the client 3. your theoretical orientation and training: this may not be right for the client 4. information: you lack the kind of information the client needs 5. confidentiality: you may not be able to offer this to certain clients 6. relationship: your relationship with the client is difficult or compromised 7. distance: the client may receive appropriate help nearer home. 6. CLIENTS IN CRISIS These include those circumstances in which clients threaten suicide or violence towards other people. We have already considered the issue of confidentiality in relation to such expressed intentions, and the point has been made that many agencies have very specific guidelines about them. Apart from the practical steps which counsellors can initiate, however, the emotional impact on them needs to be considered too. Suicide and violence are not subjects which people readily talk about, but we need to address them in order to identify our own feelings in relation to them. We could start by looking at the following points: 1. some people take the view that as far as suicide is concerned there is no ultimate preventative 2. other people take the view that clients who say they feel suicidal are, in fact, asking for positive intervention from helpers. Helping clients in crisis These two points are likely to generate a great deal of discussion in any training group, and you need to be clear about your own responses in relation to them. The view taken here is that clients should be offered whatever support and help we can possibly give. It seems to me that clients who reveal themselves in this way are, in fact, seeking the reassurance that someone else cares sufficiently to intervene. It should be added that intervention does not necessarily mean dramatic action; what is usually needed is identification of all the client’s feelings and plans so that a realistic assessment of risk can be made. When this is done, clients are frequently relieved to be taken seriously. Afterwards, practical steps can be implemented to lessen the suicide risk. These steps may include consultation with the client’s doctor so that medication can be prescribed or adjusted, though none of this can be done without the client’s permission. Helpers are sometimes reluctant to address the subject of suicide openly, on the grounds that to do so would encourage the client’s action. This is an entirely mistaken belief, and one with immense potential for causing harm to clients. More often than not people are very relieved to articulate their worst fears and impulses in the presence (or hearing, as in telephone counselling) of someone who is supportive and calm. In order to determine the extent to which a person is serious about suicide it is useful to establish the following: 1. Has the person made a plan? 4|Page  2. Is the plan specific? 3. Does the person have the means to follow through a plan? 4. Is there a past history of deliberate self-harm? Without looking closely at these factors, it is impossible to establish the level of risk to those clients who may refer to suicide in oblique terms only. Counsellors and helpers should also be aware of some other factors which may accentuate the risk of suicide: 1. history of depression 2. history of being in trouble with the law alcohol or substance abuse 3. family history of alcohol or substance abuse 4. mental illness (e.g. Schizophrenia) or family history of mental illness 5. family history of suicide 6. family violence or sexual abuse 7. experience of conflict, either socially or within the family, because of 8. sexual orientation 9. experience of being bullied 10. loneliness, isolation or loss of an intimate relationship 11. exposure to the suicidal behaviour of others, including friends or media figures. When helping clients in crisis counsellors need to be prepared to look at the underlying causes. Suicidal feelings are usually precipitated by a number of accumulating factors, and it is these factors which need to be identified and discussed with clients. Once this is done clients tend to experience relief of pressure, and with ongoing support and therapy they may be able to deal with their problems. Counselling can be continued with those clients who are referred for medical help, and often it is this combined approach which proves most beneficial for them. Threats of violence Sometimes clients express violent feelings or impulses towards other people. In these circumstances helpers need to assess the degree of actual danger involved and act accordingly. This is much easier said than done, since all of us have probably experienced antagonistic and negative emotions occasionally, as a result of conflict with others. Most people hide these feelings, for fear they will cause unnecessary alarm or upset. However, clients in counselling may express their negative feelings more readily, especially when they know they will not be judged for doing so. On rare occasions, though, clients may be serious in the threats they make, and in these instances, helpers need to adhere to the guidelines set down by the agencies in which they work. Clients who threaten violence to others, like those who threaten violence to self, may in fact wish to be stopped. It is unlikely that they would verbalise their impulses if they did not expect some intervention. However, counsellors, in common with other responsible citizens, have a duty to safeguard vulnerable people who might be at risk of violence. Support through supervision is probably the most effective way for helpers to deal with problematic issues of this kind. Other crisis situations Suicide and threats of violence are not the only forms of crisis which counsellors and other helpers may hear about from clients. Others include: 1. sudden death 2. rape and assault 3. accident and injury 4. discovery of child abuse 5. acute illness 6. diagnosis of terminal illness 7. unexpected break-up of a relationship 8. burglary or loss of belongings 9. sudden financial problems 10. loss of a job. 7. SUPERVISION The word supervision refers to the practice of giving support, guidance and feedback to counsellors who work with clients. It is, in fact, mandatory for anyone who works with clients in a therapy or counselling context, including trainees. Supervision is of benefit to counsellors for a number of reasons. These are: 1. it provides a more objective view of the counsellor’s work 2. loss of confidence and ‘burnout’ are less likely when supervision is regular 3. it gives the counsellor a clearer picture of transference/countertransference issues 4. it allows the counsellor to appraise the skills and approaches used with 5|Page  5. individual clients 6. it provides support, guidance, encouragement and differing perspectives 7. it affords time for reflection and thought 8. aspects of the relationship between client and counsellor are often 9. mirrored in the supervisory relationship; this can provide important 10. information about the counsellor’s work 11. it is rewarding for counsellors, both intellectually and emotionally 12. it can help counsellors to clarify and modify any negative emotions 13. they may experience in relation to certain clients 14. personal problems which counsellors have may be identified through 15. supervision, although these are not directly dealt with by supervisors 16. it serves to identify the counsellor’s own need for personal therapy 17. it enables counsellors to increase and develop their range of therapeutic techniques. What supervision is not. The supervisor’s principal task is to improve the counsellor’s relationship with her clients. This means that a supervisor is never directly involved in helping a counsellor to deal with personal problems, although evidence of these sometimes appears in the course of supervisory sessions. It may even be difficult to distinguish between the counsellor’s personal problems and those of the client. One of the supervisor’s duties is to help the counsellor differentiate between the two and to recommend therapeutic support for the counsellor when necessary. Although supervisors do not give counselling, therefore, they nonetheless encourage counsellors to consider personal issues and to look at the way these impinge on their relationships with clients. Forms of supervision: 1. Individual supervision where there is one supervisee and one supervisor. This approach allows more time for the counsellor to present and discuss their work in a safe environment. 2. Group supervision where a number of counsellors meet with one designated supervisor. This approach is more cost effective than individual supervision, but a possible drawback is that less time is available for feedback to individual members of the group. 3. Peer group supervision where a number of counsellors provide super vision for each other. This form of supervision is often used by trained and experienced counsellors, and is not recommended for trainee counsellors. 4. Co-supervision or peer supervision where two counsellors provide supervision for each other, taking turns to do so and alternating the roles of supervisor/supervisee. This form of supervision is not suitable on its own for inexperienced or trainee counsellors who may not feel confident enough to benefit from it. 8. EDUCATION AND TRAINING/RESEARCH The British Association for Counselling and Psychotherapy and other professional organisations are committed to continuing research and development in relation to both training and standards within the profession. This means that key elements in counsellor training programmes are quite likely to be deemed essential or even mandatory in the near future. These key elements, including supervision (which is already a requirement) and personal therapy, have been highlighted throughout this text. In addition, there is now greater emphasis on continuing professional devel opment for trained and accredited counsellors. Continuing professional development (CPD) There is widespread recognition that counsellors must offer the best quality service to clients, and to do this they need to improve and update their knowledge and skills at regular intervals. Counsellors benefit personally from a commitment to training and development because such a commitment keeps them in touch with the rapidly expanding discipline of psychotherapy, and with other practitioners whose support and knowledge are invaluable. The following are examples of activities which support or enhance continuing professional development: seminars and conferences 1. courses on professional or related issues 2. academic study and research 3. counselling-related committee work 4. facilitating courses and workshops for others 5. personal therapy 6. research and publication Reference: Hough, M. (2014). Counselling Skills and Theory (4th ed.). London : Hodder Education. 6|Page