Becoming an Ethical Helping Professional, with Video Resource Center

RITA SOMMERS-FLANAGAN, PhD, is Professor of Counseling and Director of Women's Studies at the University of Montana. JOHN SOMMERS-FLANAGAN, PhD, is Assistant Professor of Counseling at the University of Montana and a mental health consultant with Trapper Creek Job Corps. He also maintains a private practice. Rita and John are the authors of two previous texts: Clinical Interviewing, now in its fifth edition, and Counseling and Psychotherapy Theories in Context and Practice: Skills, Strategies, and Techniques, now in its second edition (both from Wiley).

Acknowledgments xvii

About the Authors xix

About the Contributors xxi

Preface xxiii

Section One: The Foundation

One Counseling Ethics and the Big Picture 3

Chapter Orientation 3

Defining the Terms 4

Ethics and Morals 4

Morality, Ethics, and Essence 5

The Role of Ethics in the Professions 5

The Role of Morality in Human Culture 6

Are There Universal Morals? 9

Tension between Relativism and Absolutism 9

The Dialectic of the Moral Life 9

Global Human Rights 11

Moral Values, Rules, and Principles 12

Professional Identity: Power and Peril 13

Attributes of Professional Helping: Common Ground 14

Professional Organizations and Associations 15

And Who Is the Client? 16

Chapter Wrap-Up 19

Two Philosophical and Culture: Roots and Prisms 20

Chapter Orientation 20

Exploring Moral Philosophies 21

Character or Virtue Ethics 24

Defining Virtue 25

Character Development 26

The Golden Mean 26

Rationality, Emotions, and Habits 27

Doing the Right Thing 27

Current Expressions of Character Ethics 28

Deontological Ethics 28

Kant and Moral Duties 29

John Rawls and Social Justice 31

Utilitarian or Consequentialist Ethics 32

The Contributions of Jeremy Bentham and John Stuart Mill 33

Current Adherents and Approaches 33

Situation Ethics 34

The Principles Approach 35

Bioethics and Mid-Level Principles 36

Alternative Cultural Views on Morality and Ethics 37

Religion’s Interactive Relationship with Ethics 37

Traditional Asian Ethics 38

African Ethics 44

American Indian Ethics 45

Feminist Ethics and the Ethics of Care 48

Chapter Wrap-Up 51

Three Ethics Codes, Codes of Conduct, Employer Policies, and the Law 53

Chapter Orientation 53

Why Codes? 54

Recognizing the Moral Dimensions of Professional Knowledge 54

Legal Concerns and Fears as a Driving Force 55

Functions of the Codes 56

Distinctions between Codes and Laws 58

Policies and Practices 59

Policies within Schools and Agencies 59

Standard of Care or Acceptable Practices 61

Guidelines, Codes of Behavior, and Mission Statements 61

Mission Statements 62

Ethical Decision-Making Guides 68

Decisions about Decisions 68

Ethical Considerations in Crisis Counseling 71

Using Ethical Principles to Guide Crisis Work 74

Beneficence 75

Nonmaleficence 76

Justice 77

Autonomy 77

Fidelity 78

Chapter Wrap-Up 80

Four Professional Identity Development: Values and Definitions 81

Chapter Orientation 81

The Intricacies of Helping 82

Why People Become Professional Helpers 83

Motives for Helping and the Golden Mean 83

The Intersection of Motivations and Values 85

When Values Contrast in Interesting Ways 90

When Values Clash 90

When Shared Values Present Challenges 90

Moral Sensitivity and Clinical Concerns 91

Choices about Displaying Values 92

Care for the Caring 93

Anxieties That Are (or Should Be) Common to Graduate Students 94

The Imposter Syndrome 96

The Invisible Knapsack 97

Burnout Awareness and Prevention 98

Factors and Symptoms of Stress and Burnout 99

Resilience and Hardiness 102

Weaving the Strands Together 103

Chapter Wrap-Up 104

Section Two: The Day to Day Challenges Common to All

Five The Helping Relationship: From Beginning to End 109

Chapter Orientation 109

Before the Beginning 110

Portraying Yourself and Your Services 110

Officing Yourself 111

Informed Consent and Informed Refusal 113

Autonomy for All? 114

Informed Refusal 116

The Nuts and Bolts 119

Legal Concerns 122

Considerations for Particular Populations 122

The First Session: Competency and Referral 126

When Your Skills and Client Needs Do Not Match 128

Technology Rears Its Ugly (Beautiful?) Head 130

Ending Well 131

Chapter Wrap-Up 134

Six Confidentiality and Trust 135

Chapter Orientation 135

Confidentiality and the Therapeutic Relationship 136

Professional Dimensions of Confidentiality 136

Why Confidentiality? 138

The Limits of Confidentiality and Their Evolution 140

Categories of Exceptions to Confidentiality 141

Protection of Self and Others 141

Communication with Office Staff and Other Professionals 147

Communication with Funding Sources or Third Party Payers 148

Depositions, Subpoenas, and Court Orders 149

Summarizing the Limits and Exceptions 152

Technology and the Internet 152

Particular Populations and Confidentiality Concerns 154

Children and Adolescents 154

Confidentiality Concerns in Families, Couples, and Groups 155

Mandatory or Involuntary Clients 157

Professional Record Keeping 157

Chapter Wrap-Up 159

Seven Boundaries, Roles, and Limits 160

Chapter Orientation 160

Introduction to Roles, Boundaries, and Relationship Rules 161

Why All the Fuss about Boundaries and Relationships? 162

Distinctive Aspects of Professional Helping Relationships 163

Transference 164

Countertransference 166

Client Indignation or Relief 168

Ethics Codes and Terms 168

Boundaries, Roles, Timing, and Informed Consent 171

Boundary Overlaps That Predate the Professional Relationship 172

Boundary Overlaps During the Professional Relationship 174

Postprofessional Relationship Boundary Considerations 175

Practices and Techniques with Boundary Implications 176

Gift Giving and Receiving 176

Self-Disclosure 178

Considerations about Touch 179

Assessing Potential Benefit and Harm 179

Little Communities, Big Boundaries? 182

Romance, Sex, Love, and Lust 183

Sex Before or After? 186

Chapter Wrap-Up 187

Eight Assessment, Evaluation, Testing: Peering Through the Right Lenses 188

Chapter Orientation 188

The Roots and Nature of Assessment 189

The ABCs of Ethical Assessment 190

Assessment Requires Judgment 190

The Assessment Continuum 191

Practitioner as Instrument 192

Informed Consent and Confidentiality 192

Multi-Method, Multi-Source Assessment 195

Informal Assessment 195

Observational Strategies 196

Using Art and Drawings in Assessment 196

Clinical Interviewing 197

Assessment and Science 198

Testing 199

Formal Evaluations 201

Psychological Evaluations 201

Social, Learning, Career, and Need-Based Evaluations 202

Diagnosis and the DSM System 202

The Purpose of Diagnosis 204

The XYZs of Ethical Assessment 206

Be Mindful of Issues in Technology and Setting 206

Use the Least Severe Diagnostic Label 206

Recognize That All Assessment Procedures Are Flawed 207

Honoring Client Perspectives 207

Be Attentive to Diversity Issues and Potential Misuse 207

Chapter Wrap-Up 210

Nine Competence, Accountability, and Research: How We Know What We Should Know 211

Chapter Orientation 211

Competence: You’ll Know It When You See It? 212

Defining the Minimal Boundaries of Competence 212

Education and Training 213

Supervised Experience 213

State and National Professional Credentials 213

Appropriate Professional Experience 214

Specialties, Specialization, and Competence 214

Ongoing Competence and Self-Assessment 215

Competence, Accountability, and Research Evidence 217

Counseling and Psychotherapy Outcomes Research 218

Searching for Compromise: Evidence-Based Practice Principles 221

Evidence-Based Mental Health Practice 222

Evidence-Based School Counseling Practice 223

Outcomes Research on Divergent Minority Groups 225

Ethical Concerns in Research and Publication 226

Research with Multicultural and Vulnerable Populations 227

Research and Informed Consent 228

Ethics in Qualitative, Quantitative, and Mixed Designs 229

Ethical Concerns with Funding and Findings 229

Research Topics: Choosing Wisely 231

Chapter Wrap-Up 232

Section Three: Specific Specialties and Professional Identities

Ten Counseling in the Schools 235

(By John Sommers-Flanagan, Nancy Bodenhorn, and Rita Sommers-Flanagan)

Chapter Orientation 235

Professional School Counseling 236

The History 236

The Transformations 237

Why Are School Counseling Ethics So Challenging? 239

A School Is a School Is a School . . . 240

The Role and Function of the Professional School Counselor 245

General Guidelines for School Counselors 246

Confidentiality: A Common Conundrum 247

Sexual Abuse 248

Sexual Harassment 249

FERPA, Records, and Sole Possession Records 249

Informed Consent(s): An Increasingly Important Practice 250

With and For Students 251

For Parents 251

Legal Concerns 252

Subpoenas and Testifying 252

Negligence 253

Multiple Relationships: Many Hats, One School 253

With Students 253

With Colleagues 254

Managing Consultation Relationships 254

Assessment and Accountability 254

Hot Counseling Topics and Concerns 255

Counseling in the Event of an Unwanted Pregnancy 255

Dangerous Behaviors: Sex, Drugs, Eating Disorders, and More 256

Suicidal Threats or Behaviors 258

Career Counseling and College Guidance 259

Diversity Issues 259

Working Ethically with Groups in Schools 260

An Ethical Decision-Making Model for School Counselors 262

Chapter Wrap-Up 262

Eleven Psychotherapy, Mental Health Counseling, and Career Counseling 263

Chapter Orientation 263

Mental Health Counseling: Roots and Directions 264

Distinguishing and Common Features Among Mental Health Professions 264

Nature of Human Health and Distress 265

Educational Backgrounds 265

Terminology Distinctions 269

Professional Organizations 270

Issues in Agency and Independent Practice 271

Health Insurance, Managed Care, and Fees 271

Self-Pay Issues and Problems 275

Confidentiality with Other Professionals 278

Competence and Supervision 279

Professional Representation 281

Ethical Concerns in Career Counseling 283

Speciality Competencies and Credentials 284

Specific Ethical Concerns and Challenges 284

Chapter Wrap-Up 286

Twelve More Specialties: Families, Couples, Rehabilitation, Addictions, Pastoral 287

Chapter Orientation 287

Introduction: Why These Specialties? 288

Couple and Family Therapy 289

Definition and Origins 289

Professional Identity 290

Specific Ethical Concerns and Challenges 291

Rehabilitation Counseling 295

Definition and Origins 295

Professional Identity 295

Specific Ethical Concerns and Challenges 296

Addictions Counseling 298

Definition and Origins 299

Professional Identity 300

Specific Ethical Concerns and Challenges 300

Pastoral Counseling 303

Definition and Origins 303

Professional Identity 304

Specific Ethical Concerns and Challenges 305

Beyond Specialty 307

Personal Coaching 308

Spiritual Direction 309

Chapter Wrap-Up 310

Thirteen Teaching, Mentoring, Supervision 312

Chapter Orientation 312

Alpha, Omega: Beginning and End 312

Moral Philosophy and Professional Elderhood 314

Deontological Dimensions 314

Utilitarian Usefulness 314

Character Concerns 315

Teaching: The Transforming Force of Knowledge 316

Client Welfare 316

Teaching Competence 317

Teaching Relationship 318

Teaching and Technology 321

Supervision: Undergirding and Oversight 322

Client Welfare 323

Supervision Dimensions and Competencies 324

Multicultural Competence 327

Supervisory Relationships 329

Technology and Supervision 331

Chapter Wrap-Up 331

Epilogue 333

A Life-Long Balancing Act 333

No One Is Perfect 333

Unreported, Unaccused, but Unethical 334

If You Are Accused 334

If You Know of Unethical Behavior 335

Best Practices and Likely Concerns 336

A Fond Farewell 337

References 339

Appendix A: Universal Declaration of Human Rights 367

Author Index 373

Subject Index 385

About the Video Resource Center 393