Ethical and Legal Issues in the Counseling Profession - Research Paper Example

?Running head: Reflective autobiography Ethical and Legal Issues in the Counseling Profession Ethical and Legal Issues in the Counseling Profession Introduction In the course of my counseling, I was able to encounter various facets of the mental health practice which helped me understand the deeper explanations and conceptualizations of the human mind. I encountered different patients with similar needs, but who needed different types of care or counseling techniques. I also encountered various issues in the practice which prompted me to question the ethical applications of my decisions and choices in relation to patient care. All in all, these dilemmas and decisions have made me more prudent and more discerning in my approaches to patient care. This essay will now serve as my reflective ethical autobiography with various sources and theories used to help support and evaluate the choices I have made during my immersion. Discussion One of the main teachings which were drilled to us by our professors was the fact that there were various ethical principles which we had to follow and consider with each patient that we cared for. These main ethical principles include: beneficence, patient autonomy or self-determination, non-maleficence, and justice. These principles helped me develop my sense of right or wrong. Whenever I doubted my actions or did not know whether my actions were right or wrong, I always considered these four ethical principles as a guide or as a foundation for my decisions. Beauchamp and Childress identified these ethical principles which should govern the ethical practice of our profession. They discuss that the principle of autonomy is basically about the personal rule of oneself which is apart or free from the influences of others and from the limitations which negate meaningful choice (Beauchamp and Childress, 1994). This autonomous decision making process allows the individual to act in accordance with his plans and his choices. Without such autonomy, an individual is dictated by others and is incapable of acting on his desires or plans (Beauchamp and Childress, 1994). In other words, patient autonomy is about allowing the patient to make his own decisions about his care – without forcing him or influencing him to decide in a particular way. In my practice, I often had to explain to patients the different types of care or interventions which can be implemented in their favor. There were times when I was tempted to influence their choices and to sway them towards making decisions which, I felt, were more favorable to the patients and to me. But noting that I might be unjustly and unfairly influencing them to make decisions on their care, I ended up being more restrained and being more balanced in explaining possible choices in their care. By allowing them to make their own choices, I was able to afford more respect to my patients as individuals. Patient autonomy is also about respecting the patient’s decision even if such decision is not the best decision for him. One time, I encountered a patient who refused further care and counseling. I knew that he needed to be in therapy and he needed to undergo intensive rehabilitation. However he wanted to undergo a less structured rehabilitation process and he wanted to do it outside the mental health institution. Even if I knew that his choices may not be effective in rehabilitating him, ethics dictated that I had to respect his choice. And so we released him and allowed him to make his own choices of care. The principle of beneficence is based on doing acts of kindness for others (Beauchamp and Childress, 1994). In essence, this principle “asserts an obligation to help others further their important and legitimate interests” (Beauchamp and Childress, 1994, p. 260). In applying this principle to my counseling practice, I often encountered situations where I knew that my patients needed more intensive counseling. One time, I encountered a high school student whom I assessed to be depressed. She had significant self-image issues and was verging on anorexic. She was apparently also being bullied in school. I recognized signs in her which were cause for concern. I then recommended her for further assessment by a mental health professional. She ended up undergoing counseling for her depression twice a week for a month. She did not recognize that she was depressed, but by observing her, I picked up signs which told me that she needed help. The principle of non-maleficence is also another basic and important principle in the ethical practice. This principle is based on the statement ‘first, do no harm’ as seen in the doctor’s Hippocratic Oath (Beauchamp and Childress, 1994). This principle also encompasses the rest of the medical health practice. As counselors, it is important for our actions to not do the patient any harm. I always tried my best to ensure that the counsel I gave my patients were for their benefit and did not cause them harm. I encouraged them when it was necessary and I pushed them in just the right amount in order to draw them out of their self-pitying state. This principle helped me to make decisions on whether or not I needed to recommend patients for possible psychopharmacological drugs. Finally, the principle of justice also guided my actions and my decisions. This principle is based on the concept of giving a person his due (Beauchamp and Childress, 1994). In other words, it is about giving every patient the type of care that he deserves, regardless of race, gender, age, ethnicity, or any other subjective considerations. In my practice, I have encountered a wide range of patients, from teenagers to the elderly; from traditionalists to liberalists; from Christians, Muslims, to atheists, and from different ethnic and cultural orientations. I have tried my best to give them the same type of care, regardless of their individual qualities. I consider myself successful and unbiased in this regard because I have granted my patients equal and quality care, regardless of their individual and subjective qualities. My moral and ethical development was influenced by various factors and people. From the very start, my early ethical development was largely influenced by my parents and my family. My parents taught me from a very early age what was wrong and what was right and why these were wrong or right. They also taught me about treating other people with respect, about being polite, and about being nice to other people. They taught me that it was wrong to physically and emotionally hurt other people because I would not want other people to do the same thing to me. We were also regular churchgoers. Our religious leaders taught us about Christ and his teachings and about the different commandments and Biblical teachings that should guide us in our activities. My school also helped me in my ethical and moral development. The school system taught me about the rules I should follow and the values I needed to live a decent and honorable life. In evaluating the different experiences which contributed to my personal and professional beliefs, I have gone through various problems and disagreements with my parents and siblings while growing up. These arguments often revolved around my parents not understanding me and my needs. This made me angry at them and this anger often affected my activities in school and my social life. In the process of growing up, I began to see the point of my parents’ teachings and restrictions. My parents also eventually learned to compromise with me as I got older and as they understood why I wanted the things I did. These experiences taught me that teenagers tend to be more adventurous and have a burning desire to rebel against their strict parents. I also noted that parents are reluctant to let their children grow up and make their own decisions. Much of their “strictness” also comes from fearing for the safety of children. Using these beliefs and understanding of human behavior, I learned how to deal with teenage clients. I learned how to empathize with them and to see things from their perspective. I viewed their behavior as a desire to be more independent and to fit into the popular social scenes. There is congruence in my personal and professional life because I went through a rebellious teenage phase and the lessons I learned about myself during that phase taught me how to understand teenage behavior. The years of maturity also gave me the tools I needed to understand and to counsel parents about their children. In the process of counseling my clients, I have come to understand that there is no absolute right or wrong. For the most part, there are shades of gray in between and these shades often are the best and most beneficial place to be. When I first face a client, I am given the barest facts about their behavior and actions. I am often not given details about their behavior. In the process of counseling and spending time with these clients, their life story often eventually unfolds. All of a sudden, I am faced with facts and circumstances about their lives which made me understand why their behavior, beliefs, attitudes, and actions were the way they were. But without knowing the reasons behind their actions I sometimes made judgments on these actions as right or wrong. However, as a counselor, I eventually ended up taking the middle road once I learned about the circumstances of my client’s lives. As a result, I have learned to hold judgment until such time when I could objectively carry out my duties as a counselor. The shades of gray in people’s lives often guided me in the counseling process. Although I sometimes understood why they acted the way they did, I also did not allow my clients to make their past experiences or trauma as excuses for their wrong behavior. I know that giving my clients too much sympathy and allowing them to use their trauma to excuse their wrong behavior would be akin to allowing their actions to be unaccounted for. In effect, my idea of right and wrong was dictated by my religious and ethical beliefs. I do not exclusively prescribe to the extreme ideas of right or wrong because I believe that most of people’s decisions come from good intentions. But, this would not stop me from holding people accountable for their wrong actions, regardless of their intentions. It may prompt me to be more lenient, but it would not allow me to relieve them of responsibility for their actions. My job as a counselor would be to help my clients make better choices despite the bad or traumatic experiences they have gone through. The basic values that have guided my work and my life are the values of honesty, patience, diligence, and compassion. The value of honesty has made me more trustworthy to other people and to my clients. They know that I would not hesitate to express and reveal to them my opinions and what they should know about themselves. I have also been guided by the value of patience. I have prided myself in the fact that I can sit through hours of work or of an activity without losing patience. This value has proven to be very useful in my counseling sessions with. This is especially useful among clients who are reluctant or just unwilling to cooperate or participate in the counseling process. I am also a very diligent person. I have acquired this value from my parents who are hard-working people. My diligence has taught me to give 100% to each client who comes to my care. I research their case and brainstorm with other mental health professionals in order to conceptualize an appropriate plan of care for each patient. For patients who need more time and effort, I diligently plan my work hours to accommodate their needs. Finally, I am a very good listener. For some reason, when I was growing up, I have found myself being the ‘shoulder-to-cry-on’ for most of my friends. Even if I did not have good advice to give them, I listened to them while they unloaded their problems. This value has translated to my professional life. Throughout my client’s accounts of their experiences, I have often found myself being drawn into their lives. As a good listener, I have allowed my clients to open up and to trust me with the heartbreaking details of their lives. And knowing these intimate details has helped me become a better counselor. I believe that my patience and my being a good listener are qualities which are most compatible with the counseling field. My patience has been very useful and compatible in my counseling practice. From the very start, most of the clients we deal with are not willing to open up about their lives. Some of them are in denial about their mental health issues and would just refuse to cooperate and participate in the counseling sessions. My best efforts at getting through to them are often rebuffed and rejected. But my patience in trying every possible way to talk and to get through to my clients has been a valuable resource. As a result, I have gotten through most of their defenses and in the process have managed to be highly effective as a counselor. I have also used my skill as a very good listener in my work as a counselor. As a good listener, clients have found a person with whom they could share their problems and issues with. In their personal lives, most of them expressed how other people did not listen to them. This often frustrates them and makes them act out in negative ways. As a good listener, they have found a voice and an understanding person in me. Although I have qualities which are highly compatible with the counseling field, I have found that my obsessive and brutal honesty can sometimes not be compatible with the counseling field. My obsessive quality relates to my extreme diligence about the clients I handle. I can work for hours on end on one case and devote so much time on the difficult cases that I often end up ignoring other aspects of my life, and in some instances, other clients. There are times when I can also be brutally honest with my clients. This brutal honesty can sometimes close down patients and cause them to be guarded because they fear that they would be reprimanded. I know I need to work on these qualities in order to ensure that I would still connect well with clients using the good qualities which I already possess. There was a time in my personal life, when I was a teenager when I felt like my confidentiality was violated. When I was a teenager, I was sent to the principal’s office for disorderly behavior in the classroom. The principal labeled me a problem child and without giving me a chance to explain and without consulting with my parents, I was sent to the guidance counselor. I felt rebellious in front of the guidance counselor and the counselor immediately looked into my school file and also labeled me a difficult child. I was recommended for regular counseling sessions every Wednesdays for one hour until the end of the term – all of this without consulting me or my parents. Throughout these sessions, I was probed and was prompted to open up about my life and about my issues. I was included in a self-help group along with other ‘problem children.’ During the counseling sessions, the counselor liberally shared details of our lives with the other members of the group. I did not want these details of my life to be shared, but they were shared with other people who also spread these details to other children in the school. I felt very much violated during these sessions because I considered these details of my life to be private and if I wanted to share them then my consent should have been sought first. As it were, the counselor justified that since I was a student in the school, they had the right to implement policies based on what they saw was applicable to my case. In the course of my counseling practice, there were times when I sensed that my client was transferring feelings of rage against his parents towards me. This phenomenon is known as transference. Transference is seen when a person “takes perceptions and expectations of one person and projects them onto another person. They then interact with the other person as if the other person is that transferred pattern” (Changing Minds, 2002). It was difficult to resolve that incident because the patient was uncooperative. In the end, it was in my and the patient’s best interests to transfer him to another counselor. The patient suggested at one point that he thought it best to completely terminate the counseling sessions. In some instances, this is a valid and commendable choice for the patient (Conner, 2002). However, recommending him to another counselor is the more appropriate choice. At one point during the counseling process, I also noted that different patients had different boundaries and by getting through those boundaries, I was able to effectively carry out my work as a counselor. Most people have an invisible boundary around them where they let other people get through. In general, boundaries include the personal space, physical boundaries, communication boundaries, and social boundaries (Philips, n.d). Boundaries are there to determine how close other people can get close to a person and still allow such person to feel comfortable. Most of my clients were not comfortable with me on an emotional and a personal level, so they allowed me space into their lives on a communication and social level. At such levels, I was only able to gain superficial access into their minds and emotions. Eventually however, with patience, I was able to slowly get beyond the communication boundaries of my clients. I made sure that I still remained professional, but I also tried to get past the emotional barriers and the space that the client created between him and the rest of the world. I knew that by getting through those barriers while still keeping the professional boundaries in place, I would be an effective counselor (Philips, n.d). This assignment has been meaningful to me because it allowed me to evaluate the ethical foundations and applications of my counseling practice during my period of immersion. It allowed me to reflect on my values and the experiences in my life which have impacted on my attitudes and behavior as a counselor. This period of self-reflection also made me realize the different experiences in my life which have impacted on my current role as a counselor. To some degree, I have discovered that some of these experiences have often influenced how I counseled my clients. These experiences helped me be a better counselor and helped me relate to the experiences of my clients. When they spoke of pain and hurt, these were something I could relate to and understand. And being able to relate to my client’s pain helped me conceptualize an effective counseling and care plan for each client. This assignment helped me realize that without the experiences I have had in the past, I would not have been as effective a counselor. This assignment helped me accept and embrace my own past and to accept the experiences I have had as a necessary part of my growth and maturation as a strong person and as an effective counselor. Adherence to ethical and legal practice can influence social change because it can ensure that the rights of patients are respected and that they can feel secure in the counseling process. It would also help clients in undergoing a less intrusive counseling process because they know that the counselor and everyone involved in their recovery would protect and respect their ethical and legal rights. There would also be fewer stigmas involved in relation to mental illnesses. Our society is often ruled by stigmas and preconceived notions about mental illnesses. This makes people reluctant in seeking mental help while they endure and live with these mental illnesses. In the process, some of them manifest behavior which is deemed criminal, disorderly, and dangerous to society. Some of them end up being incarcerated without getting the appropriate help they really need. With the appropriate legal and ethical processes in place, individuals seeking and needing mental help would be able to seek treatment and assistance for their mental issues. Consequently, they would also be able to function effectively in society as productive citizens. I have changed significantly because of the work I have done in this class. On a personal note, this class has given me more confidence in counseling and conversing with clients. It has changed me personally because it has made me feel stronger as a person for having gone through difficult experiences in my youth without having these experiences significantly affect my daily activities. I have encountered various clients who went through difficult teenage years and these experiences still impacted them beyond their teenage years. I feel like this class has empowered me as a person and as a counselor by giving me more confidence in relating to troubled teenagers. On an ethical standpoint, this class has also changed my approach to counseling because it has made me more conscious of my patient’s rights. This class has emphasized that it is important for me to know the detailed applications of the ethical rights of my clients. I found out that by respecting these ethical rights, I was also able to gain a more cooperative and more trusting client. This class taught me to see and address each case, not just in the eyes of a counselor, but also in the eyes of a client and a patient. In terms of socio-political values, this class has opened my eyes to the difficulties that mental health patients face on a daily basis. This class has taught me that even in the current age of modern medicine, many people still do not fully understand mental illnesses. Some people still view people with mental illnesses as “crazy” people who need to be committed to mental health institutions for the rest of their lives. They also view these people as unable to function in the workplace as productive citizens. As a result, these mentally ill individuals are often shunned and made to feel inadequate. This class has taught me to be more objective in viewing people with mental illnesses. It has also taught me to be more active in enlightening other people about mental illnesses and about how normal mentally troubled individuals can eventually live their lives after receiving appropriate mental health care. This class has also taught me that there are gaps in the legal mandates in relation to mental health care. These gaps have to be brought to the attention of legislative officials for proper action. This class has taught me that specific legislation on voluntary and involuntary commitment to mental health institutions have to be set forth in order to protect both the patients and the general public. Works Cited Beauchamp, T. & Childress, J. (1994). Principles of Biomedical Ethics. 4th edn. New York: Oxford University Press. Conner, M. (2002) Transference: Are you a biological time machine? Crisis Counseling. Retrieved 10 February 2011 from http://www.crisiscounseling.com/articles/transference.htm Transference (2002) Changing Minds. Retrieved 10 February 2011 from http://changingminds.org/disciplines/psychoanalysis/concepts/transference.htm Philips, B. (n.d) The Importance of Personal Boundaries. Betty Philips Psychology. Retrieved 10 February 2011 from http://www.bettyphillipspsychology.com/id111.html Read More