Dealing with ethical dilemmas can be challenging, particularly when collaborating with clients who possess varying values and perspectives. Resolving ethical concerns is rarely a simple task, and counselors frequently rely on the expertise of seasoned practitioners, although this does not ensure an ideal result. The field of counseling adheres to a set of regulations tailored specifically for this occupation to establish benchmarks for professional behavior.
Both moral principles and virtue serve as the fundamental bases for ethics codes, which aim to protect both counselors and their clients. Legal matters in counseling often arise from unethical actions or perceived misbehavior, putting counselors at risk of being sued for malpractice or unethical conduct. There may be instances where conflicts arise between ethics codes, federal and/or state laws, and even employer’s policies. Consequently, counselors may be called upon to testify as witnesses in legal proceedings.
This paper will explore the ethical and legal concerns that impact counselors and their clients in various areas of counseling. The initial standard in the ACA’s (1995) Code of Ethics emphasizes that counselors have a fundamental duty to uphold the dignity and wellbeing of their clients [italics added] (p. 2). The same principle is reiterated in the updated version of the ACA code of ethics (2005).
The AACC code of ethics highlights the significance of preventing harm as stated in the initial standard ES1-100 (p. 6). This standard lays the groundwork for all other ethical standards by giving priority to valuing and respecting clients. When faced with ethical dilemmas, counselors must use a thorough decision-making process to maintain the utmost professional standards for both clients and the counseling profession.
When encountering ethical dilemmas, counselors should seek advice from other professionals who specialize in this area. This is because counselors have limitations in their expertise and knowledge. However, it is essential for counselors to take personal responsibility for their actions regarding their ethical, moral, legal, and professional obligations towards clients. Hence, gathering multiple opinions and considering various outcomes can be advantageous in such situations.
Christian counselors may encounter ethical dilemmas when they enforce their personal beliefs on clients or have difficulty accepting specific behaviors. These challenges can arise from various issues, including homosexuality, promiscuity, abortion, extra-marital affairs, spirituality, and theological or denominational discrepancies. Studies indicate that religion and spirituality are significant for about 75% of Americans (University of Pennsylvania, 2003), with 95% professing belief in God or a Higher Power (Gallup & Lindsay, 1999).
Many clients often want their counseling sessions to center around their spiritual worries and expect that their counselor will acknowledge and prioritize these concerns (Sperry, 2003). Spirituality refers to the personal development and growth experienced by individuals (Artress, 1995, p.15). Nevertheless, some counselors choose not to address spirituality because of ethical considerations and potential risks.
According to Stifoss-Hanssen (1999), counselors and psychotherapists may exceed their professional competence if they try to address spirituality since matters of God belong to religion and should be left to clergy and theologians, not therapists. Another aspect discussed by Richards and Bergin (1997) is the potential ethical concerns, such as religious and professional dual relationships, shifting religious authority, imposing religious values on clients, violating professional boundaries, practicing outside the limits of professional competence, getting involved in superstition, and trivializing sacred matters. Additionally, Tan (1994) warned about the ethical risks linked to neglecting to inform clients adequately about therapy, excessively focusing on religious goals rather than therapeutic goals, inappropriately seeking third-party reimbursement, engaging in disputes over doctrinal issues instead of clarifying them, and relying solely on spiritual interventions for issues that may require medical or psychological treatments.
The ethics of spirituality in counseling involve the counselor being open to discussing values and beliefs that are different from their own. Counselors who have rigid ideas about spirituality may hinder the progress of counseling. Counselors are expected to empathize with clients, try to understand their perspective, accept differences in beliefs and values, and help facilitate the development of their spirituality, regardless of the counselor’s own views. The client’s spiritual and religious beliefs and values should be given the same respectful and ethical attention as any other personal belief or value if they are relevant to the client’s issues. Prayer in counseling is the act of turning our mind and heart to the sacred. It is a deliberate act where we focus our concentration and open ourselves up to our inner depths.
The relationship between religion, spirituality, and health is being researched and is of growing interest to counselors. They are considering how and when to incorporate religious and spiritual resources, such as prayer, into counseling (Richards & Bergin, 1997). Weld and Ericksen (2007) found through reviewing research and polls that both mental health counselors and the general population value spirituality and prayer highly. They also view them as important components of multicultural sensitivity. They suggest that a thorough assessment should be done to understand the client’s view on these issues and their knowledge on effectively incorporating them in counseling. As prayer can be used as a therapy intervention, Weld and Ericksen stress the need for exploring the ethical implications and for counselors to examine their own values to avoid imposing them on clients. It is also important to help clients understand both the positive and negative aspects of spirituality in their personal lives.
Within mainstream psychotherapy, the incorporation of prayer into counseling and psychotherapy has often been met with skepticism and caution rather than being welcomed as a helpful tool for change and support (Gubi, 2002). The use of prayer in counseling can create ethical dilemmas and confusion, which counselors must be mindful of. These challenges primarily revolve around considering the potential impact that prayer may have on both the counseling process itself and the interactions taking place within it.
Recent research suggests that religion, particularly prayer, plays a valuable role in promoting mental health and healing (Rossiter-Thornton, 2002). There are various methods to integrate prayer into counseling sessions, but it is crucial to respect boundaries and follow guidelines. The initial and essential step is to recognize prayer as a significant component in the healing process and to tailor its implementation according to what seems suitable (LaTorre, 2004).
A wise healer recognizes the significance of effective methods (Dossey, 1993) and acknowledges the power of prayer when working with minors. Various ethical and legal concerns arise when children are treated as clients, in addition to counselor competence. These concerns encompass their ability to provide informed consent for treatment, establish contractual relationships within legal capacity, maintain confidentiality, and report incidents of child abuse (DeKraai & Sales, 1991; Myers, 1982).
One of the challenges in recognizing fundamental rights for children is finding a balance between the interests of three key societal entities. These entities include the state, which is responsible for maintaining social order and protecting the well-being and rights of its residents, including children; the parent or family unit, whose goal is to maintain autonomy within the family and have the freedom to raise their children without interference from the state; and finally, the minor child themselves, who seeks to protect themselves from potential harm, preserve their privacy, and uphold their personal dignity (Croxton, Churchill, & Fellin, 1988).
It should be recognized that counselors who are successful in working with adults may not have the same success in working with children, and vice versa. In order to effectively work with children, counselors must obtain and enhance their specialized knowledge and skills in certain areas such as attention deficit disorder (ADD), attention deficit/hyperactivity disorder (ADHD), reactive attachment disorder (RAD), and separation anxiety disorders (SAD).
For those interested in working with children, it is crucial to receive education in child psychopathology and child counseling. The age of a child greatly affects the most appropriate approach for working with them. Therefore, counselors should have a thorough understanding of theories in child and adolescent development (Darden, Gazda, & Ginter, 1996).
Some examples of these theories include: * Erikson’s ego identity development * Freud’s psychosexual development * Kohlberg’s moral development, and * Piaget’s cognitive development. Having a strong comprehension of these developmental theories is crucial for being successful when working with children. When deciding on a course of action, a counselor must base their interventions on the child’s level of comprehension and stage of development.
The ACA Code (1995) Preamble emphasizes the importance of promoting human development at every stage of life. It warns that child counselors who have not studied child and adolescent development risk facing legal consequences for acting unethically. The ACA (1995) Code explicitly emphasizes that counselors must work within the limits of their competence as determined by their education, training, experience, and professional credentials.
Counselors are expected to show dedication in acquiring knowledge, self-awareness, sensitivity, and skills relevant to working with diverse clients (C. 2. a). The challenge of confidentiality arises for counselors working with minors, particularly when deciding what information can be disclosed to parents or legal guardians. This is due to the fact that parents possess a legal entitlement to access all records related to the examination, assessment, and therapy of a minor.
There are four positions identified regarding confidentiality with minors. These positions include: 1) complete confidentiality, where the counselor does not disclose anything about the treatment to the parents; 2) limited confidentiality, where the minor waives the right to know in advance what will be revealed to the parent or guardian; 3) informed forced consent, where the child is informed before disclosure is made to the parents, but has no control over what is disclosed; and 4) no guarantee of confidentiality is given to the child (Hendrix, 1991).
Confidentiality challenges arise when working with minors, posing a dilemma for counselors. On one side, maintaining full confidentiality in cases where parental consent is necessary may lead to legal repercussions from the parents. Conversely, any alternative approach could discourage the minor from seeking essential treatment or cause them to discontinue it upon discovering their parents’ entitlement to certain information.
When there is a conflict between ethical guidelines and the law, counselors are confronted with a dilemma. They must decide between doing what is ethically correct and what is legally mandated. For example, if a counselor follows the law by informing the parent, they may neglect their professional obligation to the client. Conversely, withholding information from the parent to fulfill their ethical duty could result in legal violations.
A suggested method is to involve parents in the initial meeting and collectively come to an agreement on the information that will be shared. This should be documented in a contract signed by all parties involved. This approach helps establish boundaries, builds trust, and allows for the sharing of information without causing worry for the child. Furthermore, it serves as an effective means for counselors to ensure their own protection.
Duty to Warn is a significant ethical and legal obligation, similar to confidentiality. In many states, counselors can be held accountable if they fail to warn or protect a third party when there is a specific and intentional threat made by a specific person, including minors. This limitation should be addressed in the initial meeting and included in the contract signed by all parties, including the minor.
Minors need to understand that making threats of harm towards themselves or others may breach confidentiality. Informed consent is a legal agreement required to initiate treatment, and it must be given willingly. For minors, the parents can provide this consent even if the minor does not agree, as long as the parents give their approval. Juvenile courts also have the authority to enforce treatment for involuntary minors.
Having sufficient knowledge about the treatment, including its consequences, expected outcomes, and any implications related to the suggested choices, is important for everyone involved in a counseling session. The issue of minors and consent is specifically addressed by the ACA (1995) Code. According to this code, parents or guardians may be involved in the counseling process if appropriate when counseling clients who are minors or individuals unable to provide voluntary, informed consent. Counselors must prioritize their clients’ best interests and ensure confidentiality. Failing to obtain parental informed consent before treating a minor can put counselors at risk of being sued (Myers, 1982). However, there may be situations such as court-ordered treatment where parental consent may not be necessary.
The American Bar Association (ABA, 1980) recommends informing parents promptly about court-ordered treatment, except in cases of emancipation or life-threatening emergencies. Emancipated minors are individuals under 18 years old who live independently and manage their own finances (ABA, 1980, p. 66). Some states have additional exceptions for minors, such as treatment for drug use, sexually transmitted diseases, pregnancy counseling, birth control counseling, and examinations after alleged sexual assault for minors aged 12 or older.
When working with a minor whose parents are divorced, it is crucial to obtain the consent of the custodial parent. Obtaining consent from the noncustodial parent instead has resulted in malpractice suits for some counselors (Stein, 1990). Therefore, it is important for counselors to understand divorced parents’ rights related to informed consent and information disclosure. In certain states, noncustodial parents may not have access to their children’s counseling session details. Disclosing this information not only violates confidentiality but also exposes the counselor to potential legal issues.
Child Abuse Reporting In 1968, every state enacted laws that required doctors and healthcare professionals to report child abuse and neglect, in response to the findings of Kempe and his colleagues in 1962, which revealed more than 700 cases of abused children. The primary motives behind reporting such incidents are to ensure the well-being of the child and to offer assistance to the family. It is mandatory for anyone who suspects or has valid grounds to believe that a child is being neglected or abused to report it (ten Bensel, 1984).
Child abuse and neglect continues to be a prevalent and critical issue. In 2008, the U.S. Department of Health and Human Services’ Administration on Children reported 772,000 cases of abused children, but it is believed that the actual number is much higher, with a 5:1 underreporting ratio. It is now a legal requirement for anyone with responsibility for children to immediately report any suspected abuse. Failure to do so is a breach of both the law and ethical standards. When dealing with cases of child abuse, counselors should consult with colleagues and seek expert legal advice as necessary. The field of counseling has a Standard of Care that outlines the conditions and qualities expected of professionals in the field. However, the specific standards may vary slightly between states. Legally, the Standard of Care is defined as the level of care that a reasonably prudent person would demonstrate in similar circumstances (Black, 1990, p. 1405).
The standard focuses on the decision-making process rather than the outcome, and clients should not be promised their desired result. The standard of care is not about being perfect, and making a judgment error or careless mistake does not mean failing to meet the standard. Therapists are not expected to be flawless, but repeatedly making careless mistakes that reasonable therapists would not make can be considered gross negligence, which is a significant factor in malpractice suits and licensing and board hearings.
When ethics and law collide, the ACA Code of Ethics (2005) H. 1. b. states that if ethical responsibilities conflict with law, regulations, or other governing legal authority, counselors must disclose their commitment to the ACA Code of Ethics and work towards resolving the conflict. If resolution cannot be reached, counselors may choose to follow the requirements of the law. It is crucial for counselors to carefully consider their actions and avoid impulsive reactions when faced with legal questions.
When counselors realize they may be dealing with a serious legal matter, they should consult their peers and, if necessary, involve an attorney. If lawyers are involved and the case is taken to court, it can imply a grave legal issue where the counselor might be accused of unethical conduct or misconduct. Counselors must persist in honing their ability to address ethical dilemmas before they escalate into legal problems or harm the client.
As professional counselors, it is our responsibility to regularly make ethical decisions that impact both our clients and ourselves, as well as every aspect of the therapy process. When confronted with complex issues, it is crucial to abide by the principle of “do no harm.” Ethical decision making requires traits such as honesty, integrity, and courage, which are essential components of one’s character. As professionals, we have an obligation to exemplify the highest standard of moral behavior. It is important for counselors to be unified in their adherence to the professional code of ethics and decision making. As Nelson Mandela once said, “Education is the most powerful weapon which you can use to change the world.”
