Ethics in Counseling: Confidentiality and Bias - Essay Example

?Running Head: Psychology Ethics in Counseling: Confidentiality and Bias A Reflective Paper Introduction Ethical norms are flexible and changeable, and this paper argues that counseling is presently at a very critical phase in the growth of ethical standards, particularly in relation to confidentiality and bias. The main objective of ethics in counseling is to promote the notion that a counselor will do his/her best to advance the interests of and protect the patient. The patient has the right to embark on a counseling activity with definite expectations about the values and qualification of the counselor. The field of counseling is moving toward some critical judgments about the future status of the discipline. This paper discusses two of the most common ethical issues in counseling and other professions, confidentiality and bias. Confidentiality in Counseling The issue of confidentiality poses numerous concerns and dilemmas, and should be studied thoroughly in any training sessions. Problems are probable to emerge all over the occupational life of an individual. I have personally realized that confidentiality is essential to the building of good rapport in counseling. Protecting confidentiality produces trust and confidence. Devoid of trust the bond will be weak. Hence, supposing that I am a counselor, if the patient does not trust me s/he will not be able to express those aspects about him/herself that may be problematic. S/he will not make him/herself open in any way if s/he thinks that I will disclose to someone else. If details have to be disclosed to anyone else, like the patient’s physician, or as a legal prerequisite for court trials or insurance, the approval of the patient should be obtained first (Barnes & Murdin, 2001). Unambiguous agreement should be gained of the information to be divulged, and under what conditions. It is will be my duty to divulge to the patient what part of their work will be disclosed and with whom. This has to be explained to the patient with the guarantee that caution is taken to protect his/her identity (Barnes & Murdin, 2001). According to Jones and colleagues (2000), as the purpose of supervision is to observe the professional and his/her performance, the supervisor is also aware of the confidentiality matter. There are occupational contexts where a professional may be a member of a group, where there are obligations of patients’ information being disclosed to help the group in their task. If the professional does not divulge particular information, this could be viewed as hindering, or producing dilemmas. For instance, in comparison to therapy, there are major distinctions between what is supposed to be disclosed in legal or medical conditions (Jones et al., 2000). How can a physician or lawyer act for the patient if they do not have the necessary information? How can they assume the obligations that are mandatory of them? On the contrary, the professional values patients’ right to refuse disclosure of information about them. A justification of that courtesy is confidentiality. In these contexts it is the obligation of the counselor to evaluate the circumstances in open dialogues, to explain what the probabilities and expectations are (Gross, 2002). In order to determine what information is needed to help legal or medical prerequisites, I think I have to clarify the boundaries of confidentiality as mandatory for counseling, and to talk about the possible solutions to problems. I should inform and discuss with his/her patients what s/he is obliged to divulge. The patient can afterwards be ready for what will be divulged, and has decisions as to what s/he can openly communicate. Having an agreement of the boundaries is less probable to disrupt the trust in the therapeutic bond. Where I think that there is a significant possibility of the patient inflicting harm to him/herself or other people, I should seek advice from my supervisor and attempt to obtain my patient’s agreement and approval to discontinue. Where this is unsuccessful then confidentiality can be disregarded (Gross, 2002). The situations that allow a violation of confidentiality are enumerated in the Code of Ethics and Practice that a professional conforms to. Suicidal patients create a problem that counselors have to confront throughout their profession. Any indications of suicide have to be critically dealt with. Patients may bring up suicide and this has to be warily and delicately discussed with the patient first. If the patient refutes that s/he is suicidal, and the counselor is doubtful, then s/he has to seek advice from his/her supervisor (Corey et al., 2010). Communicating about and evaluating the possibility of suicide, or in case there is any medical issues or ethical uncertainty, the counselor consults the supervisor. Confidentiality is questioned or violated in instances of perceived risk to self or other people. Theoretically, counselors do not disclose any information to their non-administrative coworkers, partners or acquaintances, but there is obviously no way to monitor or regulate this (Jones et al., 2000). Is inflexible confidentiality constantly in the patient’s favor? Take for instance this example adapted from Corney and Jenkins (1993). A lady calls a counselor and informs him that her physician recommends she enrolls to anxiety counseling. She mentions particular warning signs. The counselor tells her that he should check on these signs first before organizing a counseling course, but he is somewhat uncertain where to go to. This case is not an urgent matter demanding telephone calls to the supervisor, who, nevertheless, has quite modest clinical expertise. The counselor then tells this case to his wife, whose line of work is clinical in nature. Inadvertently, she has currently watched a documentary about a neurological problem, the signs of which characterize those mentioned by the patient. The counselor conducted some investigations and conveys the findings to the patient, who later goes back to her physician, requests for more examinations, and has verified that her condition is a neurological problem. However, for the procedural violation of confidentiality of the counselor, the patient would have proceeded with an uncertain number of meetings of absolutely futile anxiety counseling. An accidental diagnosis aided the patient when inflexible confidentiality would have not brought about any positive outcomes. For a number of patients, inflexible confidentiality could be more vital than even the lightening of their grief. Confidentiality builds or proves a sense of exceptionality. The patient is exceptional, his/her conditions and issues are distinctive and individually interesting, and s/he would be simply recognized if discussed. At present, all therapists, and definitely anyone who has taken part in group therapy, should be aware that most issues are ominously widespread, that numerous human problems are common. One of the most widespread and possibly negative visions constructed by patients is that they are distinctively hopeless, victimized, dreadful, evil, and insane. Large numbers of active counselors will confess confusing one patient with another at times in their own memories, exactly due to the fact that stories of anguish are frequently somewhat alike (Barnes & Murdin, 2001). Possibly in facilitating patients’ certainties in their exceptionality I would unintentionally bring about unfavorable sentiments: by its core essence, confidentiality may form a vague fantasy realm. Certainly, several sociologically knowledgeable scholars of counseling identify its socially sinister inclination to underplay what is common (Barnes & Murdin, 2001). I have heard a number of patients say “My life is an open book. There is nothing confidential about it.” This can be seen as an absence of self-respect or a deceitful attempt. Nevertheless, it can be considered as a plain reality. It can imply that there is nothing to conceal. Ironically, the requirement of confidentiality in counseling could at times strengthen the feeling of seclusion that brings about a great deal of illness in the first place. If individuals could begin rebuilding a trusting environment, they might self-assuredly express their weaknesses to each other, rather than only to selected specialists. In reality, when individuals admit their faults, imperfections or bad habits in spiritual, teamwork or awareness-raising organizations, they are performing simply this (Corey et al., 2010). Fascinatingly, a lot who prefer to express their issues and secrets openly frequently seem to get positive results by doing so. I am not arguing for the removal or mitigation of confidentiality but proposing a continuous questioning of one’s own cherished principles in order to save myself from becoming simple false beliefs or myths. Bias in Counseling Counselors are commonly viewed as caring, sympathetic practitioners. Nevertheless, the words or expressions that counselors use to characterize their patients at times contribute slightly to the reliable evaluation and medication of psychological difficulties and are impolite to patients (Dorre & Kinnier, 2006). The long-established image of the counselor as a truthful, compassionate, accommodating individual might result in hopes of courteous behaviors, words, and sentiments toward patients. However, the counseling literature proves the contrary. Counselors, whether confidentially or openly, reasonably or unreasonably, display irritation with patients and take part in this kind of linguistic attitude as labeling, mockery, and the use of unfair expressions (Dorre & Kinnier, 2006). The issue of bias is an important issue in my counseling work because even though several words or expressions are obviously derogatory, others are profoundly embedded in the traditions and language of counseling. Since the American Mental Health Counselors Association’s (AMHCA) ethics code promotes respect and courtesy for patients and that virtue ethics encourages counselors to aim for the greatest principles (Gladding & Merrill Education, 2008), it becomes important to resolve a number of relevant issues, such as to what degree do counselors believe that the expressions and terms they use to characterize patients are considerate and helpful? Which terms do counselors regard inconsiderate and unethical? Why are these terms applied, and what impact does the use of these terms have on the patients and the counselors? All individuals have prejudices, and counselors are not an exemption. Linguistic prejudice has been infamously obvious in nearly all societal groups all over humanity’s history (Dorre & Kinnier, 2006). Counseling and psychotherapy have the possibility of being biased too. One of the difficulties with contemporary language, according to Gladding and Merrill Education (2008), is that there is an absence of present-day agreement to identify which terms are prejudiced. As argued by Maggio (1997), prejudiced expression is incorrect and involves, but is not restricted to, “unwarranted assumptions,” “names and labels [that individuals and groups] did not choose for themselves… or that are derogatory,” and “stereotypes” (Maggio, 1997, 2). Rosenthal and Kosciulek (1996) denote medical bias as “initial impressions that are resistant to change, even when contradictory evidence emerges” (Rosenthal & Kosciulek, 1996, 31). Counseling bias, according to Schlossberg and Pietrofesa (1973), is “an opinion, either unfavorable or favorable, which is formed without adequate reasons and is based upon what the bias holder assumes to be appropriate for the group in question” (Schlossberg & Pietrofesa, 1973, 44). Rogers (1951) identified the inclination of counselors to express prejudices and to assess their patients. For that reason, he stressed the significance of empathy, unreserved favorable consideration, and sincerity in the therapeutic relationship. With respect to sincerity, Rogers (1989) argued that the counselor should be genuinely him/herself, with no pretense. He defined unreserved favorable consideration as valuing, caring, and truthful acceptance of the individual, which disallows a behavior of assessment. Even though Rogers (1989) was sensible to believe that unreserved favorable consideration was “a matter of degree” (Dorre & Kinnier, 2006, 67), he claimed that “the effective therapist experiences unconditional positive regard for the client during many moments” (Roger, 1989, 225). The idea of Rogers (1980) of a model counselor was founded on the beliefs of psychotherapists of the professionals they aimed to become. Others have talked about the sought-after characteristics of counselors. Rogers (1951) successfully described the nature of the vital responsibility of a counselor (Dorre & Kinnier, 2006, 67): The primary point of importance here is the attitude held by the counselor toward the worth and significance of the individual. How do we look upon others? Do we see each person as having worth and dignity in his own right? If we do hold this point of view at the verbal level, to what extent is it operationally evident at the behavioral level? Do we tend to treat individuals as persons of worth, or do we subtly devaluate them by our attitudes and behavior? Is our philosophy one in which respect for the individual is uppermost? The manner in which counselors view and treat their patients is vital to the practice of counseling. Certainly, the institution of counseling has been characterized as a moral or ethical venture (Dorre & Kinnier, 2006). Therapeutic capability is insufficient; patients should be capable of trusting the moral quality of counselors, which involves characteristics like empathy, reliability, and truthfulness. The model counselor of Rogers (1980) is applicable to the counselors’ use of terms or expressions. In an effort to promote obedience to a moral counseling principle, AMHCA developed a code of ethics for counselors. As stated in the First Principle, Welfare of the Consumer, “the primary responsibility of the mental health counselor is to respect the dignity and integrity of the client” (Gladding, 2008, 67). Likewise, the Second Principle, Clients’ Rights, states that “the client has the right… to be treated with dignity, consideration and respect at all times” (Gladding, 2008, 67). Even though the code of ethics of AMHCA functions as a helpful instruction for counselors in their ethical relationships with patients, it is, at least, a core behavioral norm. To elaborate, the code of ethics of AMHCA is an illustration of principle ethics instead of virtue ethics. The former may be defined as a responsibility, while the latter may be characterized as a model to which practitioners aim for (Dorre & Kinnier, 2006). Principle ethics promotes decisions and actions founded on norms and regulations and needed but not adequate for professional practice (Barnes & Murdin, 2001). On the contrary, according to Barnes and Murdin (2001) virtue ethics includes decisions and actions associated with individuals with personal characteristics. Discussions There are several roots of counselors’ breach of confidentiality and bias. The fundamental cause of confidentiality breach and bias could be traced in the ideals of different value systems, beliefs, theories, and philosophies. With regard to the procedure of counseling, Holiman and Lauver (1987) claimed that the counselors’ theoretical knowledge is what determines the expression used for patients. The most evident case in point is the inclination of the medical framework to perceive issues as living within patients without keeping in mind situational aspects (Holiman & Lauver, 1987). On the contrary, according to Jones and colleagues (2000), a stress-associated, social-learning paradigm ascribes a patient’s problems to the bigger societal sources like poor living conditions, while a family systems paradigm does not hold accountable any of the members of the family. Rosenthal and Kosciulek (1996) ascribed medical bias to cognitive adjustments that shift complicated problem solving to controllable answers or solutions. For instance, counselors making use of the accessible logical basis might believe that, since most of their patients have issues with alcohol misuse, most patients take part in alcohol misuse. A number of scholars have ascribed bias and breach of confidentiality to counter-transference. In general, counter-transference denotes all unconscious and conscious responses and emotions toward patients’ transferences, even though counter-transference has been perceived, currently, in connection to the actual connection rather than patients’ transferences (Dorre & Kinnier, 2006). Likewise, counselor breach of confidentiality and bias has been ascribed to attitudes toward patients that surface in therapy meetings. Investigations by Fremont and Anderson (1988) explained a number of circumstances where in counselors might become disappointed or annoyed with a patient, forcing some counselors to divulge information that are supposed to be confidential. Counselor biases can become evident as well when exhaustion arises. Maslach and colleagues (1997) took into account the variables of depersonalization and emotional burnout in their description of exhaustion. Emotional burnout implies a reduction of emotional resources that leads to people sensing that they have given everything. Depersonalization is distinguished by the pessimism and distrust that counselors show toward patients (Maslach et al., 1997). Maggio (1997) states, “Power belongs to those who do the naming, which is why naming is one of the most critical issues for fairness and accuracy in language” (Maggio, 1997, 15). Imbalanced power relationships between patients and counselors were initially raised by medical sociology. The theory of professional dominance states that professional power emanates from a social institution governed by clinical practitioners, which permits the medical professional to manipulate, regulate, and monitor information (Maggio, 1997). Similarly, according to Corney and Jenkins (1993), the tradition of counseling protects and builds its own professional organization, which involves its own culture and language. Gaining knowledge of the causes of counselors’ breach of confidentiality and biased expression do not justify the immediate and indirect impacts that these unethical actions can have on patients. The history of counseling is stuffed with cases of the difficulties that individuals have endured due to belittling terminologies and violation of confidentiality. Studies have demonstrated that biased terminologies and breach of confidentiality can lead to permanent problems. Even the sheer process of diagnosing a client can be detrimental. Understanding why counselors commit violation of confidentiality or turn to biased expressions is merely the first approach toward discovering means to “respect the dignity and integrity” (Gladding, 2008, 33) of patients and their related rights. Conclusions and Recommendations As a counselor, it is mandatory that I take sensitive consideration of the confidentiality of some of the information I have about the patient and the terminologies I use. Simultaneously, it is improbable to presume that I can satisfy all the characteristics of a model counselor or achieve the greatest ethical ideals without fail. Still, I can aim to treat patients with empathy, compassion, and care and can persevere for the application of an expression of caring instead of an expression of conflict. If counseling practices can lead to unfavorable thoughts, bias, breach of confidentiality, and even absolute damage to patients, then the ethical repercussions of counseling as a moral venture are apparent. Nevertheless, what can I do to guarantee that my actions or attitudes towards patients are respectful and helpful? Identifying and employing ethical counseling practices starts with awareness and understanding. Holiman and Lauver (1987) argued that counselors usually perceive patients through stereotypes, which influence their attitudes toward patients. They proposed that if awareness is to be attained, counselors should scrutinize their stereotypes in an attempt to understand patients further. As discussed in the preliminary sections, counseling is a means where the standards of social interactions are postponed, and where it is secure to relapse occasionally into forms of behavior that would be fairly improper in another context. This feeling of security necessitates a firm recognition that what takes place in counseling sessions is sternly between clients and counselors. Due to the social bias against individuals enduring psychological anguish, there can be a feeling of disgrace connected with consulting a therapist. This clearly explains why not merely the features of a therapeutic bond but also the reality of such a bond should be considered as an issue of confidentiality. In this case, there are valid explanations for assuming that the rule of valuing confidentiality in counseling should be quite firm. Devoid of such a belief, most counseling would not be possible. Nevertheless, it does not imply that there should be a complete prohibition on counselors disclosing to other people what they have been informed of in private by their clients. In truth, the courts have stated that the obligation of confidence to clients is rigidly restricted by an obligation to the larger society. Indeed, in all conditions where in confidentiality is breached, I should only divulge the precise information needed to satisfy the intention of the breach. The discussed restrictions or exemptions to confidentiality are valid to group, family, couple, and individual therapy. To prevent any uncertainty, misunderstanding, or eventual view of deception, all patients, irrespective of the kind of treatment, should plainly recognize the boundaries of confidentiality before carrying out any possibly major or important disclosures. Confidentiality is regarded a vital right of the patient that the duty of the counselor to protect confidentiality does not stop when the patient completes therapy, nor when the patient passes away. To make sure the counselor is accomplishing his/her legal and ethical obligations, the Code of Ethics for every certification the counselor has and pertinent state decree should be evaluated. In the case of disparity in the criteria of different administrative units, the counselor should conform to the most rigorous. Being a counselor, I have an ethical duty to question the prejudice that is present in my own terminology anywhere and anytime I use them. Even though some may claim that the scrutinizing of counselor language stems from the campaign for political correctness, it is more an issue of respect for the interests and rights of the patient and treating them with courtesy, empathy, and self-respect. In choosing the appropriate terminologies, I should ask myself whether such terms respect or are sensitive to the patient. I should also ask myself what effect a label may have on individuals. Furthermore, I should ask patients how particular labels or terminologies might influence them personally, especially when words or expressions are related with unfavorable aspects. It may be helpful for counselors to challenge themselves with the similar issues as well. References Barnes, P. & Murdin, L. (2001). Values and Ethics in the Practice of Psychotherapy and Counseling. Philadelphia: Open University Press. Corney, R. & Jenkins, R. (1993). Counseling in General Practice. London: Routledge. Corey, G., Corey, M.S., & Callanan, P. (2010). Issues and Ethics in the Helping Professions. Belmont, CA: Brooks Cole Publishing Co. Dorre, A. & Kinnier, R. (2006). “The Ethics of Bias in Counselor Terminology” Counseling and Values, 51(1), 66+ Fremont, S.K. & Anderson, W. (1988). “Investigation of factors involved in therapists’ annoyance with clients” Professional Psychology: Research and Practice, 19, 330-335. Gladding, S.T. & Merrill Education (2008). A guide to ethical conduct for the helping professions. The University of Michigan: Pearson. Gross, B. (2002). “The Constraints on Confidentiality” Annals of the American Psychotherapy Association, 5(2), 31. Holiman, M. & Lauver, P. (1987). “Related perspective: The counselor culture and client-centered practice” Counselor Education and Supervision, 26, 184-191. Jones, C. et al. (2000). Questions of Ethics in Counseling and Therapy. Philadelphia: Open University Press. Maggio, R. (1997). Talking about people: A guide to fair and accurate language. Phoenix, AZ: Oryx Press. Masclach, C., Jackson, S.E., & Leiter, M.P. (1997). “Maslach Burnout Inventory: Third Edition”. In C.P. Zalaquett & R.J. Wood (eds.), Evaluating stress: A book of resources (pp. 191-218). Lanham, MD: Scarecrow Press. Rogers, C.R. (1951). Client-centered therapy. Boston: Houghton Mifflin. Rogers, C.R. (1980). A way of being. Boston: Houghton Mifflin. Rogers, C.R. (1989). “The necessary and sufficient conditions of therapeutic personality change.” In H. Kirschenbaum & V.L. Henderson (eds.), The Carl Rogers reader (pp. 219-235). Boston: Houghton Mifflin. Rosenthal, D.A. & Kosciulek, J.F. (1996). “Clinical judgments and bias due to client race or ethnicity: An overview with implications for rehabilitation counselors” Journal of Applied Rehabilitation Counseling, 27(3), 30-36. Schlossberg, N.K. & Pietrofesa, J.J. (1973). “Perspectives on counseling bias: Implications for counselor education” The Counseling Psychologist, 4, 44-54. Read More