The case study at hand involves a number of issues. The first and foremost is that of the treatment and counseling of an addict that refuses to admit that he has a problem that needs to be dealt with in order for him to not only lead a normal healthy life but also might have implications for his family life. Additionally, the patient involved refuses to keep up with AIDS clinic appointments, to which he had been declared HIV seropositive by the doctors at the hospital where he was initially admitted for alcohol-related trauma. In such a situation, counselors are faced with certain number of ethical dilemmas which present themselves during the psychological treatment of such patients. Although there are standards of practice and codes ethics defined by professional bodies such as the American Counseling Association (ACA) (ACA, 2005). Such professional bodies set forth a set of principles that outline the ethical behavior that is required by the profession from all those serving in it. However, being a professional medical counselor for addicts requires the additional hardship of using one's professional judgment (as the answer for all possible situations that can arise while dealing with patients cannot be documented in a rule book), ethical decision-making, clearly defined personal code of ethics, and regular introspection. With addiction often being a potentially fatal disease, full compliance with all ethical considerations on the part of the therapist or counselor then becomes a matter of life and death.
To be effective, a counselor needs to posses certain personal and professional attributes that are necessary in the profession. The most important being a conscious understanding of their own personalities, i.e., knowing their unique gifts, as well as their limitations in certain aspects, along with their opinion of what is important to them and how they operate as human beings. Another aspect of being a sound professional counselor for addicts is to be emotionally objective. A counselor should not get tied up in the emotions of the patient and impair his/her objectivity as a result. In order to asses and evaluate the situation of the patient thoroughly, the counselor needs to be able to be in control of his/her emotions and not let his/her personal opinions and feelings get in the way of the treatment of the patient. If the counselor feels that his/her professional performance is impaired in any manner then he/she should be willing to seek treatment for one or enter a peer support program if he/she suspects impairment in the objectivity, integrity and professional performance of a colleague. Nor should the counselor in any way impose his/her own values on the patient. The counselor should at all times be self-aware of his/her integrity and how his/her actions and words will reflect on it. Also every counselor needs to adopt an investigative approach towards the therapy of their patients. They should be intrigued by their stories, however, but should take it all in with a hint of professional skepticism. It is the counselors' job to understand the root and nature of the addiction that the patient suffers from, and develop a treatment plan in accordance with the personality traits and lifestyle of the patient (Amodeo, Ellis, & Samet, 2006), that the patient would be able to accept readily and adopt without much difficulty.
An important part of the ethical decision making that the counselor practices is the treatment of all patients fairly and without any discrimination. As members of professional addiction counseling bodies, professional addiction counselors are required to maintain an attitude of patience and tolerance towards their patients, and not exercise any sort of discrimination in relation to race, religion, gender, sexual orientation, age, disability, natural ancestry or economic condition etc. The code of ethics presented by the National Association of Alcoholism and Drug Abuse Counselors stipulated multi-cultural ethical standards in order to minimize the risk of the patients being treated by counselors representing the views of the dominant society (which is far from accepting and forgiving, especially in the case of addiction patients) (Doyle, 1997). Confidentiality of information is also important. Drug or substance abuse patients already have this dilemma in their lives. Come to think of how adamant they are to subject themselves to counseling. Well, with this, the counselor should be professional enough to understand that the patient will never like it if any information about him will be disclosed to others. Here is where the role of the code of ethics on confidentiality of information comes in. Thus, the relationship between an addiction counselor and patient should be that of mutual trust and respect (Watts, 1999). Both are enhanced by the counselor's consistent attention to such ethical considerations.
An ethical breach stands to irrevocably destroy the trust between the patient and the counselor. It is the responsibility of the addiction counselor to acquire knowledge and skills that helps him to combat addiction disease and alcoholism. The counselor should avoid unethical conduct or of unprofessional modes of practice, and should report such inappropriate behavior to appropriate authorities. he/she should maintain respect for institutional policies and management functions of the agencies and institutions within which the services are being performed, but will take initiative toward improving such policies when it will better serve the interest of the patient. The counselor should uphold the legal and accepted moral codes which pertain to professional conduct. The counselor shall ensure that products or services associated with or provided by the counselor by means of teaching, demonstration, publications or other types of media meet the ethical standards of the prescribed ethical code. The main purpose and fulfillment for the counselor should be patient welfare.
The case of Mr. B can be understood as an ethical dilemma for the mental health counselor. To continue with the therapy of Mr. B, it is important for the health counselor to first identify the key problem that has put Mr. B in his current situation. His background and details about his life would also be required to effectively become a part of his therapy. As per my observance, the case of Mr. B has quite a few ethical problems involved and would require me to be ethically strict upon the matter at hand. The first dilemma of this case that I understand is that Mr. B recently arrived to his clinic appointments and revealed that he was involved in the abuse of alcohol and cocaine even after the hospitalization. On his previous visit he had refused to acknowledge that he had been consuming any alcohol or cocaine after the hospitalization phase. Here the possible problem that can be seen is that either Mr. B lacks trust upon the counselor or that his mental health has deteriorated to such an extent that he is now indulging in the act of lying. As his counselor, I would have to remain alert whenever he discusses about something and do not believe him instantly, as his mental health might be making him go for deceiving the counselor to achieve a better report so he might be allowed to go meet his children and continue with his job. This would require me to handle this case with professional skepticism, as blaming Mr. B with lying can also be incorrect and he actually might be willing to recover from his problems. If there is any problem with handling his case, then I would consider obtaining consultation, while also use the current ethical laws and regulation in place to ensure that this ethical problem is handled appropriately.
I can notice is that Mr. B has been a regular drug abuser for most of his life, which has caused him his two marriages and the rights to his three children. Upon his latest visit, he promised to continue regular visits so that he might be allowed to support his children and visit them. He also has revealed that he is a bus driver and is highly motivated to continue with his current job. Although his expressions to be able to continue with his job as a bus driver and to have the right to visit his children seem to be the motivational factors for him for his therapy, he might be only temporarily ready to recover as his history shows that he promises to continue with treatments but eventually skips them. As his counselor, employing the social constructivism model of ethical decision making (Corey, Corey, & Callanan, 2011), I would have to ensure that a proper interactive mode of treatment is designed so that he might stay focused upon the task at hand and continue his visits to the clinics regular as he has promised.
Emotionally, Mr. B can use his story to influence upon the counseling process to go in his favor. He can even use the idea of transference to make the counselor more supportive towards his cause. The ethical problem here would be to deal the transference issue appropriately. As a counselor, it would be important to stay aware of…