Ethical Dilemma in Counseling - Essay Example

Ethical Dilemma in Counseling A hypothetical problem, as presented, suggests that as a volunteer at a local church, a counselor has been given the task to counsel a member of the church leadership who is having a personal crisis and difficulty that is affecting his life, both at home and in the church. Leader X has been viewing pornography through the internet and fears that this activity has been negatively impacting his relationships with his wife, his children, and the other members of the church. Meanwhile, leader Y has noticed that there is a difficulty with leader X and is insisting that the information be revealed for the benefit of the safety of the church. The ethical considerations of counseling someone who has come in need of help are put to task when a member of a group believes that the person in need of help is a danger to the overall community. In order to best address the problems presented by this scenario, they must be divided for their individual needs and the responses for which they require. The first problem facing the counselor in this situation is how to help leader X deal with his difficulty with internet pornography. In dealing with this issue, the methods through which the counseling takes place must be directed at the bets possible outcome for the client. The second problem that is being faced is concerned with the expectation that leader Y has that personal information concerning leader X is relevant to the performance of leader X’s leadership and capability within the church. This concern suggests that revealing the personal information about leader X is the course of action that leader Y has come to expect. However, ethical concerns must be addressed and considered when trying to decide whether or not to reveal information about leader X. In addressing the issues that leader X has come to the counselor to address, the first issue that must be examined is the extent to which the internet pornography has infiltrated leader X’s relationships. Internet pornography can be the source of a form of sexual addiction which is defined by a pathological connection to sexual activity. Within a religious context, the pathology of a sexual behavior may be defined differently than within the greater secular community. The key to determining if the behavior is pathology of a behavior is through the amount of control over the behavior the client can exhibit (Franklin and Fong 41). In this hypothetical, it must be assumed that the client has lost his ability to control his behavior because he is allowing it to affect his relationships. Another aspect of a pathological behavior towards sex is that it might indicate a need to separate from intimacy with a spouse. According to Franklin and Fong “Sexual acting out is a factor of the addict’s loneliness and anger” (41). The perception of a lack of control is often a symptom of being at war within the mind, the need to rebel and continue the behavior in conflict with the need to stop the behavior and confront whatever issue has led to this pathology. One of the first methods of counseling someone who has developed a sexual pathology is through finding out the core problems that have led to this separation from intimacy. It is possible that this separation occurred long before marriage or the pathology began. Therefore, psychotherapy can be very beneficial in getting to the core of the reasons behind the behavior (Roukema 176). One of the most important forms of psychotherapy that can be suggested to leader X is that he become a part of group therapy. According to Cairnes and Adams, group therapy has shown a great deal of success in dealing with issue of sexual addiction. While there is no definitive research as to why it works, it is assumed that a series of human experiences, including but not limited to the instillation of hope, universality, imparting of information, altruism, and the recapitulation of the family group, can lead to effective relief from the need to indulge in the addictive behavior (184). Whether through group therapy or within private therapy sessions, the first thing that must be achieved is the instillation of hope within the client who most likely feels at the mercy of his addiction (Cairnes and Adams 185). Sexual addiction can be alleviated, the behaviors brought under control and intimacy established between a husband and wife. It might be beneficial to bring the wife into the dialogue, her life being affected by leader X’s addiction, thus his relief coming through reestablishing or establishing for the first time, a true intimacy within the marriage. Masters and Johnson developed a method of approaching sexual addiction that are defined by a “thorough assessment of the partners and the relationship, education about sexual functioning, and behavioral exercises” (Hales, Yodofsky, and Gabbard 1319). One of the core issues in much of the sexual addiction cases, especially those concerning internet porn by otherwise moral individuals, is that a lack of true education in sexual functioning is appreciated within the clients. Therefore, this three prong approach is the first way in which to begin the healing with leader X, one of the first steps being to promote a higher level of sex education for the client so that he can begin to more fully understand his own possibility of a healthy sexual nature. The behavioral exercises that were developed by Masters and Johnson are referred to as Sensate-Focus exercises. The exercises are intended to establish a healthy understanding between a husband and wife about their intimacy. The exercises include abstaining from sex and establishing touching of non-sexual parts of the body, then graduating up to more intimate contact (Hales, Yadofsky and Gabbard 1319). There is some support for using a 12-step program approach to the curbing of sexual addiction behaviors (Hales, Yodofsky, and Gabbard 1319). The way in which to define sexual compulsive behavior as an addiction in through recognizing that “the existence of a physiological componant to sex and/or love addiction is used as a primary way to alter mood and as a coping mechanism” (Parker and Guest 52). There is some controversy as to whether pathological sexual behavior can be considered an addiction, but since the behaviors have the same affect as other physiological addictions, it is more than likely within the same framework as any other addiction, thus will respond to the same kind of therapeutic work. According to Parker and Guest, “the primary philosophy of these programs (referring to 12-step programs) includes the need to define abstinence or sexual sobriety, a belief in the value of psychotherapy, and a stronger need for anonymity based on the degree of shame associated with this addiction “(52). The course of therapy for leader X will be determined by discussing his needs with him and how he and the counselor will best come to an end to his destructive behaviors. This might include nothing but private counseling sessions, sessions that include his wife, or his introduction to group therapy through a program that is best suited to address his issues. Staying within his comfort zone and graduating to a place where he can deal best with his issues is primary to helping him feel comfortable in safe in whatever therapy environment is used in order to address his issues. Encouraging him to accept that his behavior is defined by something that is within himself, rather than blaming an outside source, will go a long way in helping him to get his behavior under control. One of the first issues that come to the forefront when dealing within a counseling situation with a religious context is that the individual will wish to blame an outside source, such as Satan, for his behavior. While prayer and the help of God will have a great power within finding a way in which to control these behaviors, blaming an outside resource will not deal with the problems that are the foundation for sexual addiction behaviors such as are being experienced by leader X. Choosing to believe that an evil influence has affected leader X may be valid, but it is the core issue within leader X that must be addressed, whether or not an evil outside influence has had an affect on the situation. If this attitude has been adopted, if leader X has decided that an outside influence is to blame, he is not taking responsibility for his behavior and will then never be able to achieve a healthy sex-life through the therapy that is offered. Leader X may choose to keep his therapy private, the issue between himself, the counselor, and God. If this is the case, his wishes should be honored and the sessions that are undertaken should be kept in confidence. Healing can only come through trust. Sanders states that “Confidentiality is crucial to an effective and trusting counseling relationship” (44). Privacy should be defined as “an individual’s right to be left alone and to decide the time, place, manner, and extent of sharing one’s self (one’s thoughts, behavior, or body) with others” (Sanders 44). There are a few exceptions to confidentiality that must be shared with a client in order for them to understand under what conditions there confidentiality might by breached. These conditions are: when the client consents in writing, when a law is being broken and it is required that the counselor report the incident of its violation, when there is a duty to warn or protect, when a client has waived confidentiality by litigation against the counselor, and under the circumstance of an emergency in which dire circumstances require disclosure (Sanders 45). The core legal precedent that defines when a counselor should violate confidentiality is Tarasoff v Board of Regents of the University of California, where it was determined that “when a therapist determines that patient presents a serious, violent threat to another person, that therapist has an obligation to protect and warn the intended victim and to notify others, including the police, against such danger” (Sanders 46). In the case of leader X, there has been no apparent indication of a danger to his family or to the church. While for therapeutic purposes he should be encouraged to discuss his problem with his wife and to include her in his recovery, there is little to no threat apparent against the church or the members. Having this issue is relevant to the life of leader X, under his own right to privacy, and within his own power to reveal and share if he deems it necessary. Not only should the counselor not reveal the nature of his problem to leader Y, the counselor is under legal, moral, and ethical constraints from revealing the nature of the issues that leader X is experiencing. The first priority for the counselor is to protect the client and to work towards his recovery. The needs of the church in regard to the concerns expressed by leader Y are not relevant to the recovery of leader X. In fact, the concerns that leader Y has brought to the counselor should be discussed with leader X so that he can make a decision about how he wishes to handle the issue with leader Y. As leader X is the client, and not leader Y, leader X must make the decisions about the revelations of his issues. Leader Y should be reminded that as a counselor, should leader X pose any sort of danger to anyone, that would have to be revealed, but as the counselor is refusing to reveal the nature of the problem, it is clear that leader X poses no threat to the community. In a problem where leader X finds himself out of control, taking away his right to privacy, the right to control his own destiny, would be a blow to his recovery. If he were to express his addiction as a point from which he wishes to launch into other behaviors that put people at risk, such as rape fantasies, pedophilia, or violence against sexual partners, then revelation of his problem most likely would be necessary. However, his problem appears to be limited to voyeurism on the internet, therefore, treating him should be limited to confidential rules of conduct and control of his privacy left to leader X. Works Cited Cairnes, Patrick and Kenneth M. Adams. Clinical Management of Sex Addiction. New York: Routledge, 2002. Print Franklin, Cynthia, and Rowena Fong. The Church Leader's Counseling Resource Book: A Guide to Mental Health and Social Problems. New York: Oxford University Press, 2011. Print. Hales, Robert E, Stuart C. Yudofsky, and Glen O. Gabbard. The American Psychiatric Publishing Textbook of Psychiatry. Washington, DC: American Psychiatric Pub, 2008. Print. Parker, Jan, and Diana L. Guest. The Clinician's Guide to 12-Step Programs: How, When, and Why to Refer a Client. Westport, Conn: Auburn House, 1999. Internet resource. Roukema, Richard W. Counseling for the Soul in Distress: What every Religious Counselor Should Know about Emotional and Mental Illness. Bingingham, NY: The Haworth Pastoral Press, 2003. Print. Sanders, Randolph K. Christian Counseling Ethics: A Handbook for Therapists, Pastors & Counselors. Downers Grove, Ill: InterVarsity Press, 1997. Print. Read More