Ethical Dilemmas in Counseling - Essay Example

Ethical Dilemmas in Counseling Working with children in an has created a several ethical dilemmas for me. As an art therapist and teacher in Korea I am faced with a variety of issues because I work with children and I love my work. The most important ethical dilemma for this paper is when I want to give gifts to my clients. It is a Korean custom to give gifts and this is a part of my heritage. When I see that someone has done a good job I want to reward them by giving a gift. As a therapist I understand that this is not a good thing to do for many reasons. In some situations a counselor would argue that this can create a problem of dual relationship because the client can begin to feel like a friend instead of a client. This can create several problems for the therapist and may harm the client. When dealing with this ethical situation I have found it interesting to take it through the nine stages that Welfel suggests. STAGE 1: DEVELOP ETHICAL SENSITIVITY According to Hervey (2007) this first stage states that you must first understand that there is an ethical dilemma (Hervey, 2007, p. 101). She suggests that we feel these situations in our bodies first which is the result of a change it the body. According to this stage when I first thought about giving gifts to my clients I feel like it was wrong. I felt agitation, some tightness in my chest and I began to sweat. My hands were very sweaty as I thought about what I was doing. Although giving gifts is a natural thing for me to do when it came to my client I was hesitant because of what I have been taught in my art therapy education. I was unsure of myself because I did not know whether my client would accept the gift or whether it was right to give it to her. I was not sure whether it was the right thing to do. STAGE 2: DEFINING THE DILEMMA AND CONSIDERING OPTIONS I considered that there were basically two options: I could either give my client a gift or I could not give her a gift. I explored these two options. In giving the gift I would satisfy my need to give the client a gift for a job well done. I would feel good about doing this and I would know that I did something I considered to be a good thing. I also thought about the fact that the client might misinterpret my gift. As an example, I had one client who I had given a gift at the end of her therapy want to come and visit me without an appointment. This was fine with me and I allowed this for a period of time until a student told me "you should adopt her." I began to wonder whether I had overstepped my boundaries with this client and I was not sure what I should do next. Hervey suggests tat we must weigh our options in this phase and that we should do something outside of what we normally would do in thinking about decisions (Hervey, p. 103). This was a time for me to draw out the situation to examine it from a different perspective than my own. STEP 3: RELYING ON STANDARDS, RULES AND REGULATIONS According to Hervey "when we dont know what to do, rules provide a safe structure behind which we can deliberate, bobbing and weaving until we are clear about what to do (Hervey, p. 103)." We are supposed to fall back on the ethical guidelines that are built into our counseling training when we have an ethical dilemma. When I checked the American Counseling Association ethical guidelines there was no mention of giving gifts: Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and having gratitude. When determining whether or not to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, a client’s motivation for giving the gift, and the counselor’s motivation for wanting or declining the gift. (American Counseling Association, "Code of Ethics". Section A.10.e). According to these guidelines a therapist must weight several issues when they are deciding to take a gift from a client and in some respects this could be applied to the giving of gifts. I asked myself, "What is your motivation for giving this gift?" "How will this affect the counseling relationship with this client?" "How will the client react to this?" According to the Arts Therapy Board of Credentialing (2005) an art therapist: Art therapists shall not engage in exploitative relationships with clients. Exploitative relationships include, but are not limited to, borrowing money from or loaning money to a client, hiring a client, engaging in a business venture with a client, engaging in a romantic relationship with a client, or engaging in sexual intimacy with a client. (Section 4.1.3.2). The challenge is that this does not describe giving gifts. However, it does imply that an art therapist must think about whether the relationship is turning into an exploitive relationship or a non-therapeutic relationship. Giving gifts could fall under this category because it changes the therapeutic relationship from counselor/student to friends. At least this could be what the student may interpret and a counselor should stay away from this type of situation. The bottom line for clients is that the art therapist is supposed to provide a safe environment for the individual to work within. Because I give gifts after therapy it would seem that it would be an appropriate thing to do. However, some ethical codes suggest that you should not have a relationship of any kind with a client for up to five years after they are your client (American Counseling Association, "Code of Ethics" Section A.5.b. Former Clients). STEP 4: APPLYING FUNDAMENTAL ETHICAL PRINCIPLES TO THE SITUATION This step seemed a little more complicated to use because there are several components that are important. I felt that giving gifts was an extension of "non-maleficience" because it was a way for me to continue to do no harm. The "respect for autonomy" was created within the counseling relationship and when it was finished I gave the gift as a way of closure for both the client and myself. I felt that it was a "beneficience" actuion because the gift is always something that a student can use when they leave therapy. They are not personal gifts in the sense that it would create an attachment to me specifically. Under "justice" I cannot say that I felt anything about this one because I did not see myself seeking justice or the client needing justice when I gave a gift. I have to admit that when I studied "fidelity" and what it meant to me it meant loyalty. I wanted my clients to feel that I had been loyal to them in the helping profession and that I was available to them if they needed me in the future. Gift giving at the end for me was a way to allow them the process of closure and at the same time to tell them the door was open if they needed it. If I look at my own ethical principles outside my art therapy profession I would say that I enjoy working with children and that I know that they need extra support sometimes. I am clearly aware of my boundaries and I would not do anything to harm a child. It is in my nature and my culture to nurture others and many children need this in the therapeutic relationship. I see that this is important for their well being and giving a gift is part of that nurturance. One of the challenges with Herveys work is that she only applied it to her own study of body work. In order to understand the five areas that she mentions here, I turned to Forester-Miller and Davis (2005) who give another explanation of this counseling model presented by Hervey. In their definition autonomy is about helping the client make good decisions. This happens in the art therapy relationship in my counseling sessions so I feel that students are ready to take on their own autonomy when they leave therapy. The gift is for them to maintain that autonomy as they go back to their lives. Beneficience is defined as making sure that the client is helped in some way. My work with clients seems to help them and giving a gift seems to be important for closure. Justice in their model is about how one treats the client and how they are related to within the counseling situation. I do not give a gift to everyone of my clients at the end of their counseling experience because some clients are still too vulnerable. It does not seem to me that a gift will encourage independence in these situations but more of dependence. Under fidelity they state that: Clients must be able to trust the counselor and have faith in the therapeutic relationship if growth is to occur. Therefore, the counselor must take care not to threaten the therapeutic relationship nor to leave obligations unfulfilled. (Forester- Miller and Davis p. 2). I feel that once the session is done the gift is something that helps cement the relationship for future counseling if it is necessary. STEP 5: CONSULT WITH TRUSTED AND RESPECTED COLLEAGUES OR SUPERVISOR It is very important to check with a supervisor when you are having an ethical dilemma. The supervisor would be someone who is in practice regularly who you as a therapist can trust and confide in when they face an ethical dilemma. Mulhauser (2002-2008) suggests that a counselor should have a supervisor for two reasons: "1) to protect the client and 2) to improve the ability of counsellors to provide value to their clients."(Mulhauser, par. 5). He suggests that the supervisor is there to provide an objective ear to the client. Colleagues are people who are have been in the field longer than the therapist but who may not be a supervisor. These people will be active in the field and be able to direct an individual therapist to understand from all sides what is available to them in any ethical situation. In my estimation my supervisor is always willing to work with me. I did not initially talk to her about the giving of gifts because it is such a natural part of my culture. I went to her afterwards and discussed the situation with her. She helped to point out that I could have created a duo relationship with the client that would have been detrimental to her. She helped me to see that if I allowed clients to come back and see me without an appointment it may imply that there is more to our relationship than client therapist. She also helped me to see that giving gifts could create more problems for the client and the therapist later. STEP 6: DELIBERATE AND DECIDE ON A PLAN OF ACTION In this stage it is important to make a plan of action about how you will confront an ethical situation in the future. It means that you will need to journal or mediate on the way that you will handle the ethical dilemma. I have found that it is difficult for me not to give a gift because I do not see anything wrong with it. I have though about the idea of countertransference and examined my reasoning for giving the gift. I just think it is part of my culture to do so and it is important for me to care about people in this way. As Hervey says, "there is no easy and correct answer that can be accessed quickly by following the process like a recipe … each unique situation needs to be mindfully embodied through the process until a decision can be made, behind which one can stand with integrity, if not comfort" (p. 106). I feel that I can stand behind the process of giving gifts and that it stays within my integrity to do so. I do not feel that I am doing any harm to a client because I do not give gifts until their very last session. Conclusion Hervey did not give all nine of the steps because it seemed that she did not think it was important. I have presented the stages that she gave and explained. I also did more research to find Welfels work but was unable to find anything in my research. Working with this model seemed difficult at first but as I thought about the situation I was in the information unfolded. I would have liked to see more information about Wefels work included so that I could have created all 9 stages. References American Counseling Association. (2005). Code of Ethics. Retrieved December 23, 2008 from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/ CT2.aspx?new_sess=1. Art Therapy Credentials Board, Inc. (2005). Art Therapy Credentials Board Code Of Professional Practice. Retrieved December 22, 2004 from http://www.atcb.org/export/sites/atcb/_resources/author_files/code-2005.pdf. Forester-Miller, H. and Davis, T. (2005). Practitioners Guide to Ethical Decision Making. American Counseling Association. Retrieved December 22, 2008 from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx. Hervey, L.W. (2007). Embodied Ethical Decision Making. American Journal of Dance Therapy. 29(2). 91-106. Mulhauser, G. (2002-2008). Counselling Supervision. Retrieved December 22, 2008 from http://counsellingresource.com/aboutcouns/supervision.html. Read More