Healthcare providers include nurses, doctors, social workers and a number of other professions that seem to exist on the periphery of the helping field. One of those on the outside, that many do not consider when looking at the healthcare profession, are professional counselors. Since the term "counselor" has been diluted by everyone from friends to lawyers, it is unclear what one is talking about when employing such a generic term for an occupation, but professional counselors are vital members of the healthcare field. These individuals work in hospitals, nonprofits and private offices, working with couples, individuals and groups.
Among the many different specialties extant within the professional counselor fold is that of mental health counselor. Since the population of individuals who have a diagnosed mental illness has risen in recent years, the need for mental health counselors has risen with them. Alongside other healthcare professionals, counselors work with people who have a mental illness to help the afflicted individual try to live a successful life in the larger society. This interview is with a mental health and substance abuse counselor who currently has 14 years experience working for hospitals and nonprofits and is currently employed in a hospital alternative short-term residential facility for individuals with acute mental illness.
What is your basic employment history as a counselor?
I first started as an intern at two facilities while completing my Masters. I worked with teenage boys who had some form of acquired brain injury, and in a residential facility for individuals who had some form of acute mental illness. During college I also worked with young men who were involved with the department of corrections because of drug convictions. The program was a rehabilitation alternative to jail or prison. After college, prior to my present job, I have worked as a counselor in a hospital setting for patients who were in a locked facility, as a case manager for high functioning individuals who needed some degree of advocacy, and as assistant director in a residential program for children and teens whose parents were, for various reasons, involved with the Department of Child and Family Services. Currently I direct a program that houses individuals on a very short-term (usually about a two-week stay) basis. The consumers have some previous, acute mental health diagnosis that has been active just prior to their admittance to the program (Arnold, 2011).
What would you consider your basic ethical stance?
Primarily I believe that respect is the most important ethic that anyone can have. The people I work with have generally been on the fringes of society. Because of their persistent diagnosis, they have not been able to function successfully in society, for the most part, and many times they have little chance of doing so. They receive many different reactions from the people they encounter on a daily basis, but not many are accorded even rudimentary respect for who they are as a person. Most of the time all anyone sees is the diagnosis, and in most cases it is readily apparent that something is very different about my average client. However, every single one of these individuals has the same need to be accepted, and respected as a member of society. That is what I hope to give them (Arnold, 2011).
What ethical challenges do you face?
Every day there is something happening in the facility that poses an ethical challenge. Working with people who are constantly on the edge of volatility means that decisions are often made as to whether a person should be discharged to protect other clients. I have to always be checking the dynamics of the house to make sure that treatment is optimal for every client we have at a particular time. Usually, the communal living situation we have is a positive for treatment, but, occasionally, one person will be a disruptive force that endangers the progress of others. I have found that following an ethical code is often not easy because it sometimes means that we have to discharge someone who is in desperate need of further treatment. We try to discharge them to a higher or equal level of care, but that is not always possible. In this case though, the good of the many outweighs the individual good (Arnold, 2011).
Do you have any specific examples of ethical issues you have faced?
Far too many to mention. As a director, I also have to look at the good of the company I represent. Unfortunately, even a nonprofit is constrained by money, and there are certain requirements to maintain the government assistance we require. Also, the reputation of the company must be maintained. These two factors mean that I need to keep the facility safe and operating efficiently. In one such case, we had a client who had been at the facility multiple times, and he was asking for re-admittance due to an increase of psychotic symptoms. The company policy is that an individual may not return to the same facility within a year of their last admittance date. Since there are five other programs of the same type operating, this is usually not a problem, but, at this particular time, none of the other facilities had a bed available. We were forced to turn him away. We asked that the requirements be relaxed this one time, but the beds in our facilities are at such a premium that it could not be done (Arnold, 2011).
How do you use the input of colleagues to solve ethical dilemmas?
I work with around 40 other counselors in my facility, as well as a team of three or four nurses, and three psychiatrists who visit on certain days. Whenever a situation arises that has an ethical component, I always seek the advice of one, or several, of these professionals. I have long believed that it is wise to seek counsel, and unwise to try and make a decision on my own. Although I realize that I, many times, have the ultimate responsibility for a decision, I want to consider every possible option (Arnold, 2011).
Can you think of any specific instances where you would have done something differently if, at the time, you had the benefit of the experience you have accumulated?
Trying to make me feel old? Actually, there are many times that I should have advocated for a client that I did not because I did not wish to "rock the boat" so to speak. During my college years, I was hesitant to counter what a nurse, doctor or licensed counselor said with regard to a client, even if I knew better based on having spent more time with the individual. Now, I try to always think about the client and that person's needs first. I have no problem questioning what another team member is saying with regard to treatment, and I always seek the advice of junior staff, even interns, who have more face-to-face dealings with specific clients (Arnold, 2011).
The counseling code of ethics is similar to most of the other codes that helping professions claim (ACA, 2005). Drawn from the original Hippocratic Oath, the first, and most important, tenet seems to be to do no harm (MedTerms, 2011). The first section in the ACA code of ethics has to do with "The Counseling Relationship" (ACA, 2005), and everything else in the code seems to stem from that. In looking at how counselor's view ethics, Ponton and Duba (2009) talked about how counselors seem to be more engaged in the business of counseling than the care of clients in recent times, and this seems to be the gist of the interview I conducted with Mr. Arnold.
From the research there has been a trend toward business…