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4, Privacy Information, Limits of Confidentiality
16. Does the site have a waiver that clients must electronically sign or mail in before beginning counseling that specifically states the limits of ensuring confidentiality over the Internet?
Confidentiality: a.4., Limits of Confidentiality; Confidentiality: c., Client Waiver
Source: Shaw & Shaw, 2006, p. 42
Other changes that will undoubtedly influence the types of codes of ethical conduct mandated for counselor in the future will be the enormous demographic shifts taking place in the United States. Indeed, Pack-Brown et al. conclude that nowhere is the change more evident than in the need for cross-cultural awareness on the part of counselors today. According to these authorities, "The recent changes in the professional ethics of American Counseling Association, American Psychological Association, and National Association of Social Workers reflect a growing sensitivity and moral-ethical respectability for the diverse cultural constructions of terms such as mental health and appropriate helping interventions and the meaning of ethical practices" (Pack-Brown et al., p. 297).
Therefore, in an increasingly multicultural society, ethical counseling requires a recognition and appreciation of the cultural values held by others which may very well conflict or not be completely understood by counselors. As Watson, Herlihy and Pierce (2006) point out, "In recent years, multicultural competence increasingly has been recognized as an essential component of ethical counseling practice" (p. 99). Likewise, Wiggins-Frame and Williams (2005) emphasize that, "The ethical practice of counseling and psychotherapy requires that practitioners have knowledge about and sensitivity to clients' cultural background and social context" (p. 165). Unfortunately, many counselors fail to receive enough or any ethical training during their counselor education (Downs, 2003). Nevertheless, ethical counseling requires first and foremost an awareness of how the worldviews held by individual counselors may differ from those who seek out their assistance. In this regard, Watson and her associates emphasize that, "The assertion has appeared repeatedly in the literature that it is unethical for counselors to provide clinical services to clients who are culturally different from themselves if the counselors are not competent to work effectively with these clients" (p. 99). Therefore, counselors who fail to recognize important cross-cultural differences between themselves and their clients, though, will inevitably be doing a disservice to themselves as well as those who seek their help. According to Strous (2003), "Ethnocentric strategies which ignore worldview, may conflict and militate against trust and an effective therapeutic alliance. Therapy training frequently presents white middle-class, urban, English-speaking, traditionally structured values as a normative measure" (p. 27). Therefore, expanding the counselor's awareness of other cultures and how these traditional values measure up is an important step in developing a therapeutic alliance and providing effective counseling services. Moreover, an increased understanding of fundamental cross-cultural differences can have a number of other benefits as well, including the following:
1. It assists counselors in understanding both their client and themselves.
2. It makes explicit both the counselor's and the client's values, beliefs, suppositions, and attributions.
3. It facilitates the choice of mutually agreed-upon goals and processes appropriate for the client.
4. It provides a subjective reality that is important in gaining knowledge and developing meaningful skills.
5. It enhances ethical counseling by making counselors aware of imposing culturally dominant beliefs, paternalism, condescension, and mislabeling clients as 'sick' (Strous, 2003, p. 27).
In fact, improving awareness of cross-cultural differences between practitioners and the patients they serve is a fundamental aspect of the American Counseling Association's code of ethics, the preamble of which states that, "Members are dedicated to the enhancement of human development throughout the life span. Association members recognize diversity and embrace a cross-cultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts" (2005, para. 1). Despite the availability and importance of following the guidelines set forth in professional codes of ethics, Wiggins-Frame and Williams (2005) maintain that counselors may find themselves in an ethical dilemma when confronted with cross-cultural issues that require actions that may violate their profession's code of ethics. For example, these authors note that, "In order to uphold these standards in a multicultural world, counselors may well be caught in difficult double binds. For example, on one hand, the ACA (1995) Code of Ethics discourages dual relationships such as engaging in social activities with clients, but on the other hand, the same activities may be precisely the vehicles for promoting client welfare" (Wiggins-Frame & Williams, 2005, p. 166). In such cases, the counselor may be unable to achieve their treatment goals and develop the therapeutic relationship that is needed for positive clinical outcomes without some way of satisfying their code of ethics while balancing the needs of their clientele. In this regard, Wiggins-Frame and Williams note that this cross-cultural conundrum may be encountered by counselors of all types: "Such a paradox creates a significant ethical dilemma for mental health practitioners of all disciplines" (p. 166).
To help address this potential ethical dilemma, Wiggins-Frame and Williams suggest that counselors follow the steps outlined in Table 2 below as a multicultural ethical decision-making model.
Multicultural Ethical Decision-Making Model
Ethical Components of the Process
Decision-Making Step Questions
Identify and define the ethical dilemma
What is the crux of the dilemma? Who is involved? What are the stakes? What are my values? What are those of my client, my supervisor, and others involved? What are the cultural and historical factors that are at play? How do the principles of altruism, responsibility, justice, and caring apply? How could these principles affect different behaviors based on cultural diversity? What insights does my client have regarding the dilemma? How is my client affected by the various aspects of the problem? How do I feel about the problem? What does my intuition tell me to do?
Explore the context
Where am I located in the power structures of power in my culture and community? Where is my client located? How could the use of power affect my decision? How could a power differential between me and my client affect the welfare of my client? How can we share lenses to come to an ethical and just decision?
Where is my client in the process of racial acculturation? Where am I? How do these identity levels of acculturation affect my ethical development thinking and acting? How far do I need to go to meet my client's needs? What about my needs?
Who do I know that is a culturally competent counselor? What are the values, beliefs, meanings, cultural traditions of my consultant? How do these shape my consultant's perspective? What is my consultant's position in the context of power?
Generate alternative solutions
How does each of the options available to me fare when examined on the basis of the model's criteria above? What does my intuition tell me to do? What are my fears or misgivings about each option?
Select a course of action
What role has my client played in the decision-making process? What contributions has my client made? What are my motives in selecting this course of action? What is my rationale? What is the critique of my decision? Have I documented my plan of action?
Evaluate the decision
How does this choice fit with the ethical code? How were my client's cultural values and experiences taken into consideration? How were my own values affirmed or challenged? How was power used in the action? How would others appraise the action? What did I learn from the struggle to resolve this ethical dilemma?
Source: Wiggins-Frame & Williams, 2005, p. 166
Perhaps one of the most important aspects of the guidance to be gleaned from the above-described decision-making model is the emphasis on "what does the counselor's intuition say to do?" Equally important as well is the need to consult others with the requisite expertise when confronted with an ethical dilemma that confounds the counselor to the extent that there are problems in formulating an effective treatment plan. Notwithstanding the strictures of the various codes of ethics involved to the contrary, Wiggins-Frame and Williams suggest that by following the above-described ethical decision-making model, it may be possible to be "both multicultural and ethical at the same time" (2005, p. 166).
Finally, counselors who work in group settings will inevitably encounter some ethical dilemmas that may be unique to such settings. According to Corey, Williams and Moline (1995), Some of the ethical issues typically confronted by group counselors include (a) the screening and orientation of group members; (b) the rights of group members, including informed consent and confidentiality; (c) the psychological risks of groups; (d) personal relationships with clients; (e) the impact of the group leader's values; (f) working sensitively and ethically with diverse client populations; and (g) the uses and misuses of group techniques. Here again, though, the emphasis is on the need for counselors be develop an awareness of differences among diverse populations and to seek to expand their own awareness so that an ethnocentric approach is…[continue]
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