Ethics in Clinical Practice Compiled by Victoria A. Fitton, PhD with assistance from: Corey, G., Corey, M.S., & Callanan, P. (2006) Issues and ethics in the helping professions (7 th ed.). Belmont, CA: Brooks/Cole. Reamer, F. G. (). Social work values and ethics (3 rd ed.). New York, NY: Columbia University Press.

Ethical Considerations Ethics – beliefs we hold about what constitutes right conduct; moral principles adopted by individuals or groups to provide rules for right conduct. Ethics – beliefs we hold about what constitutes right conduct; moral principles adopted by individuals or groups to provide rules for right conduct. Professional responsibility to examine and clarify personal values and professional practice.Professional responsibility to examine and clarify personal values and professional practice. Personal values exert considerable influence on a professional ’ s views of clients, their intervention frameworks and strategies, and definitions of successful or unsuccessful outcomes.Personal values exert considerable influence on a professional ’ s views of clients, their intervention frameworks and strategies, and definitions of successful or unsuccessful outcomes.

Personal and Professional Values Social workers occasionally face tension between their personal values and those held by clients, employers, or the social work profession itself.Social workers occasionally face tension between their personal values and those held by clients, employers, or the social work profession itself. Social workers sometimes encounter clients whose values and behaviors seem immoral and abhorrent (child abuse, violence).Social workers sometimes encounter clients whose values and behaviors seem immoral and abhorrent (child abuse, violence). Some dilemmas relate to the congruity or incongruity between the professional ’ s value orientation and those of the client.Some dilemmas relate to the congruity or incongruity between the professional ’ s value orientation and those of the client. Reamer, 2006

Personal and Professional Values Client difficulties often contain a moral dimension.Client difficulties often contain a moral dimension. Clients often wrestle with moral aspects of problems (divorce/infidelity; IPV/child care).Clients often wrestle with moral aspects of problems (divorce/infidelity; IPV/child care). These emerge vividly and emotionally in expressive therapeutic work.These emerge vividly and emotionally in expressive therapeutic work. Learn to view problems through an ethical lens with clear understanding of personal values.Learn to view problems through an ethical lens with clear understanding of personal values. Actively explore clients ’ perspectives about what they believe is ethically right and wrong.Actively explore clients ’ perspectives about what they believe is ethically right and wrong. Reamer, 2006

Cultural and Religious Values Important to recognize the influence of our own and clients ’ religious and cultural values and beliefs (abortion/marriage/women…).Important to recognize the influence of our own and clients ’ religious and cultural values and beliefs (abortion/marriage/women…). Be mindful of potential conflicts between our personal values and clients ’ cultural and ethnic norms (medical).Be mindful of potential conflicts between our personal values and clients ’ cultural and ethnic norms (medical). This will also be manifest in expressive therapies. (What can be avoided in talk therapy is direct in expressive therapies.)This will also be manifest in expressive therapies. (What can be avoided in talk therapy is direct in expressive therapies.) Professional (NASW) and religious views on sexual orientation are often in conflict.Professional (NASW) and religious views on sexual orientation are often in conflict. Reamer, 2006

Free Will and Determinism Values or beliefs related to the determinants of clients ’ problems.Values or beliefs related to the determinants of clients ’ problems. Social workers make assumptions regarding the causes of client problems which significantly impacts treatment planning.Social workers make assumptions regarding the causes of client problems which significantly impacts treatment planning. Biology (Medical/Disease model)Biology (Medical/Disease model) Environment (Social Learning Theory)Environment (Social Learning Theory) Institutional/Political (Racism, Left-Right)Institutional/Political (Racism, Left-Right) Economic (Oppression/Globalization)Economic (Oppression/Globalization) Personal DeficitPersonal Deficit Reamer, 2006

Defining Your Personal Ethics Personal beliefs and valuesPersonal beliefs and values Spiritual and religious valuesSpiritual and religious values End of life decisionsEnd of life decisions

Thinking Through Ethical Problems & Dilemmas 1. Identify the problem or dilemma 2. Identify the potential issues involved 3. Review relevant ethical codes 4. Know the applicable laws and regulations 5. Obtain consultation 6. Consider possible and probable courses of action; 7. Enumerate the consequences of various decisions 8. Decide on what appears to be the best course of action Corey, Corey & Callanan, 2006

Documentation - Ethical Dilemma Remember to document: Client nameClient name Date of serviceDate of service Aspects of the issue or dilemma (delineate)Aspects of the issue or dilemma (delineate) Intervention and response to treatment goalsIntervention and response to treatment goals Action/s takenAction/s taken ClinicianClinician SignatureSignature CredentialsCredentials DateDate

Legal Aspects of Informed Consent Four elements are basic to the legal aspects of informed consent: 1. Full Disclosure or Full Information – giving clients information on all aspects of therapeutic process, expectation, and intervention upon which informed consent can be based 2. Capacity – client has ability to make rational decisions (parent or guardian) Corey, Corey & Callanan, 2006

Legal Aspects of Informed Consent 3. Comprehension of information - must give clients information in clear ways and check for understanding. Clients must have adequate information about both procedure and possible consequences (risk/benefit) 4. Voluntariness - acts freely in decision-making process and is legally and psychologically able (competent) to give consent Corey, Corey, & Callanan, 2006

Ethical and Legal Issues - Confidentiality & Privilege Confidentiality – the right to expect that communications will be kept within the bounds of the professional relationship. Confidentiality – the right to expect that communications will be kept within the bounds of the professional relationship. Privileged Communication – a legal concept that protects against forced disclosure in legal proceedings that break a promise of privacy. Privileged Communication – a legal concept that protects against forced disclosure in legal proceedings that break a promise of privacy. Does not apply to group counseling, marital and family therapy, or child and adolescent therapy.Does not apply to group counseling, marital and family therapy, or child and adolescent therapy. Corey, Corey, & Callanan, 2006

Ethical and Legal Issues – Privacy Privacy – refers to the constitutional right of an individual to decide the time, place, manner, and extent of sharing oneself with others. Privacy – refers to the constitutional right of an individual to decide the time, place, manner, and extent of sharing oneself with others. Exercise caution with regard to the privacy of clients. Do not invade a client ’ s privacy.Exercise caution with regard to the privacy of clients. Do not invade a client ’ s privacy. Think about the use of telephones, answering machines, voice mail, pagers, faxes, cell phones, and .Think about the use of telephones, answering machines, voice mail, pagers, faxes, cell phones, and . Corey, Corey, & Callanan, 2006

Ethical and Legal Issues – Duty to Warn Duty to Warn – mental health professionals have a double responsibility to protect other people from potentially dangerous clients and to protect clients from themselves. Duty to Warn – mental health professionals have a double responsibility to protect other people from potentially dangerous clients and to protect clients from themselves. Identifying clients who pose a threat to othersIdentifying clients who pose a threat to others Protecting others from potentially dangerous clientsProtecting others from potentially dangerous clients Treating those clients who are dangerousTreating those clients who are dangerous Corey, Corey, & Callanan, 2006

Full Disclosure – Checklist for Treatment 1.Voluntary Participation 2.Client Involvement 3.Counselor Involvement and contact 4.No Guarantees 5.Risks and Benefits Associated with Counseling. Emphasize role of client ’ s responsibility in treatment. 6.Confidentiality and Privilege 7.Counseling Approach or Theory

Full Disclosure – Checklist for Treatment 8.Exceptions of Confidentiality and Privilege 9.Counseling and Financial Records 10.Ethical Guidelines 11.Licensing Regulations 12.Credentials 13.Fees and Charges 14.Insurance Reimbursement 15.Responsibility for Payment 16.Disputes and Complaints

Full Disclosure – Checklist for Treatment 16.Cancellation Policy/Interruptions in Therapy 18.Affiliation Relationship 19.Supervisory Relationship 20.Colleague Consultation 21.Alternatives to Traditional Therapy 22.Tape-Recording or Videotaping Sessions 23.Client Access to Files and Diagnostic Classification Corey, Corey, & Callanan, 2006

Personal Issues and Ethics - Protective Factors Balancing Life Tasks – creating and maintaining a commitment to promoting ones own wellness from a holistic perspective: Balancing Life Tasks – creating and maintaining a commitment to promoting ones own wellness from a holistic perspective: SpiritualitySpirituality Self-directionSelf-direction Work and leisureWork and leisure FriendshipFriendship LoveLove

Personal Issues and Ethics - Risk Factors Counselor Impairment Counselor Impairment Fragile self-esteemFragile self-esteem Difficulty establishing intimacy in personal lifeDifficulty establishing intimacy in personal life Professional isolationProfessional isolation A need to rescue clientsA need to rescue clients A need for reassuranceA need for reassurance Substance abuse of any kindSubstance abuse of any kind Lack of empathyLack of empathy Poor social skillsPoor social skills Preoccupation with personal needsPreoccupation with personal needs Discounting possible harm to clients or othersDiscounting possible harm to clients or others

Ethics in Child Practice Full disclosure Full disclosure Ages of children trained to treatAges of children trained to treat Childhood issues trained to treatChildhood issues trained to treat Theoretical orientationTheoretical orientation Treatment philosophyTreatment philosophy What a family can expect - risks/benefitsWhat a family can expect - risks/benefits Continuing education and trainingContinuing education and training Supervision and peer consultationSupervision and peer consultation Range of treatment options/interventionsRange of treatment options/interventions

Treatment Options Information on child treatmentInformation on child treatment Information on child developmentInformation on child development Brief overview of play and expressive therapyBrief overview of play and expressive therapy Directive, non-directive and prescriptive techniquesDirective, non-directive and prescriptive techniques Expectable outcomesExpectable outcomes Pamphlet and/or video about play therapyPamphlet and/or video about play therapy Tour of playroomTour of playroom Answer questionsAnswer questions

Ethical Considerations Who is the identified client?Who is the identified client? Meeting child first, parent/s first, or familyMeeting child first, parent/s first, or family Divorced and custodial parentsDivorced and custodial parents Family/social environment for childFamily/social environment for child If a long-term problem, is there long term commitment?If a long-term problem, is there long term commitment? Is everyone working for the good of child?Is everyone working for the good of child? Financial, time, social resources of familyFinancial, time, social resources of family

Ethical Considerations Competence to treat the childCompetence to treat the child Fully equipped for treating specific childFully equipped for treating specific child Treat the child or treat the familyTreat the child or treat the family Full disclosureFull disclosure ConfidentialityConfidentiality Consultation with parent/sConsultation with parent/s What is revealed in consultation?What is revealed in consultation? Is the child included in parent consultation?Is the child included in parent consultation?

Ethical Considerations Speaking for or about a childSpeaking for or about a child Documentation - harm and benefitDocumentation - harm and benefit In cases of separation and/or divorce documentation can be a nightmareIn cases of separation and/or divorce documentation can be a nightmare Information handling in separation and divorceInformation handling in separation and divorce The “ Problem ” is the CHILDThe “ Problem ” is the CHILD What are the costs to the child for intervention?What are the costs to the child for intervention?

Ethical Considerations Complete a thorough assessment:Complete a thorough assessment: developmental milestones from pre-birth to current age of childdevelopmental milestones from pre-birth to current age of child all domains of child ’ s functioningall domains of child ’ s functioning all systems in child ’s worldall systems in child ’s world maintain contact with collateralsmaintain contact with collaterals Include “ family ” in goal setting and treatment planningInclude “ family ” in goal setting and treatment planning Contract for “ completion ” of treatmentContract for “ completion ” of treatment

Ethical Considerations Treatment ethicsTreatment ethics Child ’ s needs first and foremostChild ’ s needs first and foremost Safety firstSafety first Mediate/facilitate family connectionMediate/facilitate family connection Communication/consultation with familyCommunication/consultation with family Family treatment including filial therapy, psychoeducation, and supportive therapyFamily treatment including filial therapy, psychoeducation, and supportive therapy Holistic approachHolistic approach Responsive to child and familyResponsive to child and family

Ethical Considerations TerminationTermination Reinforce progress and forward movementReinforce progress and forward movement Celebrate with child and familyCelebrate with child and family Give follow-up recommendationsGive follow-up recommendations Leave the door openLeave the door open Offer extended referralsOffer extended referrals Follow-upFollow-up EvaluateEvaluate