Ethics and Law in Psychotherapeutic Practice - Essay Example

? A Case Study in Ethics and Law in Psychotherapeutic Practice A Case Study in Ethics and Law in Psychotherapeutic Practice Introduction This essay aims at analyzing the nature of therapeutic relationships in psychotherapy and counseling as well as examining the various interventions that are used and relating any such interventions to the prescribed ethical and legal framework governing the profession of counseling and psychotherapy. The paper will begin by looking at the nature of therapeutic relationships in Britain with relation to counseling children and adolescents. This will be followed with a detailed analysis of the interventions used in counseling and psychotherapy to help patients. The essay will then examine and analyze the various ethical and legal guidelines set out by the British Association of Counseling and Psychotherapy (BACP). A case study of a 14-year-old girl who has been attending counseling sessions for about four weeks will be used for this essay. An analysis of the interventions used in the treatment of the girl will be assessed in relation to the set out ethical and legal framework by the BACP. The British Association of Counseling and Psychotherapy (BACP) is a body that brings together various counseling and psychotherapy individuals and organizations to help address emerging issues in counseling and to help improve the profession. The organization has two main objectives of educating the various professionals in counseling and psychotherapy to help them improve their professional skills and also educating the public on the importance and role of therapy and counseling in helping them overcome their problems in life. The main ethical principles outlined by the BACP include autonomy, which refers to respecting the right of the client to be self governing; fidelity, refers to honoring the mutual respect that exists between the client and the therapist; beneficence refers to the need to promote the well being of the client throughout the therapy session; non-malfeasance refers to the commitment to avoid any harm or threat to that effect to the client; justice refers to the ability of the therapist to give a faire and impartial treatment to all clients; self-respect on the other hand refers to the practitioners willingness to learn and advance their skills and treat their clients in the ethical framework identified as well as observing all standards of the practice (McGuire-Snieckus, et al, 2007). The counseling and therapy practice is also governed by laws and regulations requiring practitioners to work within a recognized legal framework (McLeod, 2003). There are both civil and criminal legal systems governing the counseling profession. These legal systems are meant to protect both the therapists and their clients from illegal activities that may threaten the profession. Criminal legal systems in therapy and the wider medical profession emanate from various statutes enacted by parliament or from the contracts signed between practitioners and their clients. Criminal law therefore ensures that contracts signed between the clients and the practitioners are adhered to. The law also ensured the therapy treatment is conducted in line with other statutes governing the profession such as financial disclosure among others (McGuire-Snieckus, et al, 2007). Civil law on the other hand deals with dispute resolution between practitioners and their clients. The disputes may arise from failure to observer contractual observations or any other disputes that may develop in the course of the treatment. The Case Study This essay is based on a case study of a 14-year-old client who has been working with a psychotherapist practitioner for the past four weeks in a bid help her overcome the various challenges she has been facing lately. Being 14 years old, she is still a minor and a teenager for that matter. She is faced with different problems and challenges common among most adolescents her age. The young girl recently confided to me that she had been cutting herself with a razor blade and even showed me her wounds to that effect. She had wound o her arms and legs. She often hides the wounds from the people around d her by wearing long sleeved shirts and trousers so that she is not questioned about the source of the wounds. This self-injurious behavior has led to her damaging her skin tissues and if it persists, it is likely to cause her further health complications. The Dilemma The girl’s case presents a very big dilemma any practitioner can face. First, she is a minor who is causing injury to herself without the knowledge of her parents and guardians. By her confiding this to the therapist, it shows the amount of trust that she has gained in the practitioner during the four weeks that they have been seeing each other and developing their therapeutic relationship (Howe, 2005). The main dilemma here is whether the therapist should let the parents and guardians of the young girl know about her self- injurious tendencies or just keep it between themselves. If the therapist reveals the information to her parents and guardians, they are likely to be more involved in her life trying to control her, which will only increase her stress and depression. The client will also lose her trust in the therapist and she may not have any other person she feels free to tell her problems. Telling her parents and guardians would also mean that the therapist goes against her ethical vow of fidelity, thus creating civil disputes with her client subject to civil legal proceedings in court. On the other hand, if the therapist does not let the parents and guardians of the young girl know about their child’s behavior, it is likely going to be hard for me to monitor the girl’s situation outside our therapy sessions. This may cause difficulties in determining whether she is following my instructions and working towards the goals we have set. It may also create a rift between the therapist and the girl’s parents if they found out on their own initiative that their daughter was injuring herself and she had informed me but the therapist did not discuss with them. The Ethical Framework The British Association of Counseling and Psychotherapy (BACP) has set ethical guidelines within which practitioners in this profession ought to adhere to. Some of them are very relevant to my current dilemma with my client. The ethical principle of fidelity for instance requires me and my client to have a trustworthy relationship in the course of the treatment. Confidentiality is an obligation that each practitioner ought to adhere to given the fact that the client trusts them to the extent of telling them personal problems. My client has for instance trusted me to the extent of telling me her self- injurious behavior. Following the principle of fidelity requires me to keep our conversation to ourselves and never let it out to third parties, including her friends and relatives. The ethical principle of autonomy requires the practitioner to recognize that his or her client has a right to govern herself and thus cannot therefore impose things and ideas on her. This required the practitioner to give the client full disclosure of their role and services in order to enable her make an informed judgment on whether to take up services provided or not. These principles ensure that the client and the practitioner get in to a voluntary contract with each party having understood their roles (McLeod, 2003). The principle of beneficence requires the practitioner to act in the best interest of my client in order to promote her well-being (Schneider et al., 2001). This requires practitioners to use their professional skills and experience to help the client become a better person by all professional standards. In this case, the therapist ought to ensure that her client ends her self-injurious tendencies and become a better person at the end of our therapy program. The principle of non-maleficence on the other hand requires practitioners to work in a manner that avoids creating harm to the client. They should strive to avoid any emotional, financial, sexual or any other form of exploitation on the client (Prochaska, & Norcross, 2010). In this case, discussing the girl’s situation with her parents is likely to cause her more emotional stress. The therapist should therefore avoid engaging in any activity that will cause her client’s situation to deteriorate. The ethical principle of justice requires therapists to respect their client’s rights and dignity as they engage in treatment, while the principle of self respect requires one to apply their knowledge and skills as well as working within the advised ethical framework in order to help patients become a better people (Slattery, & Park, 2011). The Relevant Legal Framework There are also various legal provisions that are related to this ethical dilemma. The law of contracts for instance governs contract with clients and requires practitioners to observe the details of the contract to the later. Failure to observe contractual obligations is likely to lead to civil proceedings in court. The law also guards practitioners against exploiting their clients financially or otherwise. This safeguards a practitioner’s relationship with the client, knowing that she has the backing of the law in case she is exploited financially, sexually or otherwise. There are several policies devised by the government to protect children against exploitation and all forms of abuse during treatment. Therapy is a very personal form of treatment and children can get so personal with their therapists to the extent of risking their innocence and trust and becoming victims of abuse and exploitation by practitioners. The current legal framework ensures children are protected by the law and that the practitioners who engage in any form of abuse are apprehended and punished in accordance with the law. The child protection and treatment Act for instance protects children against all forms of abuse during treatment. Other policies protecting children include mandatory vetting of all individuals who deal with children in treatment to ensure that they meet established ethical and professional standards. One of the most important government policies is the requirement that all children attending medical treatment be logged in to a database. Through this database the government will be able to monitor how the treatment proceeds and thereby identifying and dealing with any form of abuse when it occurs. Pros and Cons of decision making in the dilemma Making a decision in this kind of a dilemma has many implications to both the practitioner and the client and has both pros and cons. An advantage of making a decision in the dilemma is that it helps to solve the problem at hand and find a way forward. Even though not everybody will be pleased with the decision made, they will be happy that the stalemate has been broken (Hubble, Duncan, Miller, 2006). The other advantage is that it also presents the practitioner as a decisive individual. This is likely to work better for the practitioner if the decision yields better results and results in helping the client to become a better person. One of the disadvantages of making a decision in this kind of a dilemma is that not everybody can be pleased with the outcomes of the decision. If for instance the practitioner decides to maintain confidentiality and never inform third parties about the client’s situation, her parents are likely to be upset is they found out later on. On the other hand if the therapist tells the girl’s parents, she is likely to be more depressed, and lose trust in me. The other demerit of making a decision in the dilemma presented it puts one’s career at risk. Since not all people involved will be happy with the decision made, they are likely to jeopardize the practitioner’s careers by advising their friends and other not to come for their counseling services. This can greatly affect one’s practice. Appropriate Cause of Action Given the scenario, the most appropriate cause of action will be to work within the legal and ethical framework governing one’s profession. This implies that the therapist observes her contractual obligations and that she maintains fidelity, and working in the best interest of her client by avoiding causing her any harm. This means that the best decision is not to inform the parents and guardians of the girl about the situation. With this in mind the therapist will take several measures to ensure that the young girl becomes a better person at the end of the therapy program. The first step would be to inform her about the practitioner’s duty of care. This means that as an adult the therapist has the responsibility to watch over her with caution, attention and prudence that any other reasonable person ought to (Howe, 2005). The practitioner will therefore let her understand that she will work in her client’s best interest in order to ensure that the client overcomes her problems and become a better person. The therapist will then explain to the girl about her rights, the ethical framework and legal framework within which our relationship will be based. This will help them to develop a strong bond based on trust upon which they shall work efficiently and collaboratively throughout the therapy process (Stiles, 2004). They shall then together determine the goals and objectives of the therapy as well as the things to do in order to help us get to the identified goals within the stipulated timelines. One of the interventions the therapist has to take is to set SMART objectives for the therapy program. This implies that the objectives have to be Specific, measureable, Achievable, Realistic and Time-bound (Howe, 2005). The practitioner will then set timelines for specific course of action including weekly therapy sessions where they will be meeting with the client to determine if they are working towards the goals and have a session where the girl can let out her emotions and problems as the therapist advises her on appropriate courses of action. Evaluation of the Outcome At the end of the therapy session, the client will have overcome her emotional problems and stopped her self-injurious behavior. One of the biggest outcomes from this situation is that they shall also have developed a strong bond through our therapeutic relationship. This will be very beneficial going in to the future as the cline will feel very free to go to the therapist whenever she is faced with an issue that needs help from a counseling professional (Orlinsky, Ronnestad, Willutski, 2004). Conclusion Ethics and law are necessary elements in the counseling and psychotherapy profession. They both create a conducive environment where both the client and the practitioner can have the freedom to express themselves and for meaningful therapeutic relationships that lead to improvements in the lives of the clients (Dryden, 1992). In my professional work, the ethical guidelines established by the British Association for Counseling and Psychotherapy (BACP) have been very resourceful in guiding practitioner’s relationships with clients. The legal framework in place has also worked in the best interest of practitioners and both have been very instrumental in success of many professionals in this field. One is likely to face dilemmas from time to time while working as a counselor. The ethical and legal framework in place acts as a reliable basis for decision making in such dilemmas (Hubble, Duncan, Miller, 2006). Bibliography Dryden, W. 1992. Integrative and Eclectic Therapy: A Handbook Open University Press. Howe, D. 2005. Child Abuse and Neglect Attachment, Development and Intervention. Hampshire. Palgrave Macmillan. Hubble, M.A., Duncan, B.L., Miller, S.D. 2006. The Heart & Soul of Change. What Works in Therapy. London. American Psychological Association. McGuire-Snieckus, R., McCabe, R, Catty, J., Hansson, L., and Priebe, S. 2007. A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine, 37, 85-95. McLeod, J. 2003. An Introduction to Counselling. Buckingham. Open University Press. Orlinsky, D. E., Ronnestad, M. H., Willutski, U. 2004. Fifty years of psychotherapy process- outcome research: Continuity and change. In M. J. Lambert (Ed.) Handbook of psychotherapy and behaviour change (5th Ed.). New York: John Wiley & Sons. Prochaska, J.O. & Norcross, J.C. 2010. Systems of Psychotherapy: A Transtheoretical Analysis 7th Ed.. Belmont. Brooks Cole/Cengage Learning. 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