Multiple Relationships in Psychotherapy and Counseling

ou are also required to integrate additional evidence-based research, taken from professional journals, to support and enhance the textbook information. A minimum of 4, current, research articles are required

You must identify and cite the Code of Ethics that are relevant to each of the vignettes. The Ethics Codes are located in under Resources. If the links do not work, please copy and paste them into your browser.

You must illustrate multicultural competence. All discussions must take into account issues of culture and human diversity that may pertain to the situations presented below. Information on Culture and Diversity are covered in the course text, but you are encouraged to utilize other cultural resources to enhance your analysis for this assignment. For example, if the client in the vignette is a Native American who asks to participate in a healing ritual, you would research Native American ceremonies and the ethical issues relating to this.

Please keep your responses focused on what is presented in the vignette. Creativity is encouraged but do not add information or change the vignette.

Your response to each vignette should be approx 2 ½-pages per vignette.

Your entire assignment will be approx 10 pages total plus a title and reference page. ?

For each of the four vignettes presented below:
What are the ethical issues in the case? Identify the issue in the ethics code.

Did the professional act in a manner consistent with current standards and principles? If not, what other courses of action would be more ethical? Support your decision by identifying the standards and principles relevant to this case.

Are there any indications of bias, stereotyping or marginalization present?

If relevant did the professional advocate for the client?

How can colleagues and supervisors help the professional to act ethically in this situation? Please be specific.

Vignette 5
Toula is a college counselor who is well known on campus for her skill and compassion in helping students cope with relationship problems. Currently, Andrew is one of her clients. He came to counseling because he is distraught that his girlfriend, Collette, ended their relationship. Andrew is making slow progress, but still hopes that the will be able to rekindle the relationship with Collette at some point. Louisa is another of Toula’s clients. One day Louisa enters counseling feeling happier than she has in months. She reports that she has met a new lover, Collette, with whom she is very happy. After hearing Louisa describe Collette, she is fairly certain that it is the same woman with whom Andrew was involved. Toula decides to continue counseling both Andrew and Louisa, determined to maintain the confidentiality of each person’s disclosures.

Vignette 6
Dorian, licensed psychologist, has a 79-year-old African American client named Roberta who has come to counseling at the insistence of her children. Roberta wants to maintain her own home, but her children and neighbors are convinced that she can no longer care for it properly. Roberta begins the interview by stating that if anyone forces her to move she will commit suicide because she has nothing else to live for. In the course of the session Roberta admits some problems with independent living, and seems to be distractible and unfocused in her comments. However, she does not seem disoriented or unable to meet her own needs. After several sessions, Dorian concludes that Roberta would probably be better off not having responsibility for a large home on her own. Dorian also concludes that while Roberta’s mental capacities are not as strong as they once were, this woman is competent and in touch with reality. Whatever suicide risk that existed before has diminished. When the family calls Dorian to ask about Roberta’s progress in counseling he decides to reveal this information to them, even though he has not received prior permission from Roberta to do so.

Vignette 7
Joshua and Elaine are co-leaders of a marriage encounter group. They are both skilled family therapists and participants’ evaluations of their groups are generally very positive. Their leadership style is dominating and confrontive. When Chad and Jan, Hopi Indians, enroll in their group they feel uncomfortable with the leadership style of Joshua and Elaine. It is not consistent with their personalities or the style of interpersonal communication patterns most common in their tribe and family. When Chad and Jan express discomfort to the leaders, they remark that they seem to be using their culture and personality as a defense against exploring their issues. Soon thereafter Chad and Jan drop out of the group and refuse further contact.

Vignette 8
Earl is a counselor in a community mental health agency that serves an urban population. Earl conducts an intake session with a client named Brenda, a 19-year-old Korean American woman he had seen in family therapy 2 years ago. Brenda is currently an art student and sculptor. As a student, she lives on grants and student loans and wants to pay for counseling services with the art that she produces. She tells Earl that she trusts him, and wants to see him individually, as he helped her family through some painful times in the past. Brenda suggests that she could get the art appraised so that its value would be independently determined. When Earl offers a sliding-scale fee arrangement as a better option Brenda says that she comes from a proud family that has never accepted charity and she would not feel comfortable with that arrangement. Her actual cash income is so low that Brenda would qualify for free services. Earl is considering this arrangement as long as the art is independently appraised.

ANSWER

Multiple Relationships in Psychotherapy and Counseling

Vignette 5: Toula’s Case

A dual relationship exists every time mental health professionals have associations with a client more than the therapist-client connection. Considerably, for mental health professional’s multiple associations with the clients can influence objectivity and interrupt the therapeutic progress. Therefore, this may end up influencing the emotional connection of the client to the clinician.

In reality, the code of ethics requires that the mental health professionals to put into consideration the conflict of interest that may arise and need to take part in proper measures of resolving them. For instance, the ACA code of ethics addresses the situations where the counselor comes across a conflict of interest while offering services to many clients that have associations.

Ethics codes offer professional standards for counselors to protect the well-being and dignity of others. The main reasons for the code of ethics entail informing professional counselors about the ethical guidelines, responsibilities, and professional obligations to their clients. The health professionals and counselors will decide on an appropriate approach of actions for the clients and offer ethical standards through which inquiries and complaints can be made. Therefore, the ACA Code of ethics dictates such situations where the counselor or the health professional is required to clarify, withdraw, and adjust from assuming the potentially conflicting roles (Kaplan et al., 2014).

When examining the boundary extension risk, the therapist must honor the promises made to the individual and be thoughtful about their control over the individual. Additionally, being mindful of the client’s sensitive exposure during engagement and handling. Confidentiality is one of the most essential concepts that therapists need to consider. The ACA Code of Ethics offers guidance to counselors to gain the trust of clients through upholding confidentiality and maintaining appropriate boundaries (Kaplan et al., 2014).

Considerably, Toula’s case has various essential factors that need to be considered since they have entered into unintentional multiple connections. These multiple associations have the capacity of resulting harm to at least two individuals Louisa and Andrew. Some of the major risk factors that Toula might have experienced are accidental information disclosure, confidential issues, and the inability to be neutral and avoid the unintentional provision of information that reveals something about their client to the other client. This is considered ineffective since it would lead to inappropriate disclosure, violation of the ACA Code of Ethics, and breach of confidentiality.

Relatively, Toula is at a higher risk of being exposed and discovered that she is treating both clients which can lead to loss of trust and confidentiality. Toula has several alternatives such as terminating one of the clients or even referring the clients to another therapist. This is because she has to be careful about the confidential information and give any valid reasons why she wants to disclose certain information to either party.

Considerably, failure to continue with the needed services without an effective referral is usually considered a violation of the codes of ethics. For instance, a possible valid reason would be referring Louisa to a colleague that has professional competence with the same sex-couples. Toula should check with her associates as seen in the ACA Code of Ethics, that states that therapists have to take responsible procedures to turn to other counselors, the professional standards department, and ACA ethics or other specialists in case of doubts about professional practice and ethical obligations.

Vignette 6: Dorian’s Case

The work of psychology promotes the health and well-being of individuals. While pursuing this goal, the psychologists demonstrate an active concern about the welfare of those they work with as well as acknowledge the institutional and social power. The American Psychological Association (APA Code of ethics) encourages psychologists to have respect for the dignity of people that require each person and all individuals to be valued positively (American Psychological Association, 2017).

Respect requires sensitivity to social diversity and cultural recognition. Psychologists are required to honor the worth as well as dignity of all individuals and the rights of people to confidentiality, privacy, and autonomy. The significance of privacy derives from the ethical principle of fidelity and autonomy as well as the principles of nonmaleficence and beneficence. Additionally, the APA Code of Ethics states that authorization is needed for the revelation of confidential data. Therefore, the legal and ethical duties of mental health practitioners are to uphold private information.

Mental health professionals are required to disclose essential information regarding their services. They are also required to freely consent to them. Free consent entails the decision to engage or participate in an activity without undue pressure or coercion. The APA also encourages the relevance of informed consent in the code of ethics. It recommends that the psychologists act in the best of their interest and seek the assent of anyone that does not have the capacity of offering independent consent American Psychological Association, 2017). Considerably, an upright and competent client should not have their rights of self-determination interrupted by the mental health professions.

The mental capacities of the client are not as strong as they were but she is competent and keeps in touch with reality. This means that there is no indication of harm since the rate of suicide risk that existed before had lowered. Therefore, it means that Dorian has no responsibility to protect the client from harm, break confidentiality, or inform the family about any dangers. However, Dorian offered personal information to the family with the client’s consent which means Dorian has carried an improper paternalistic manner towards his client. The main issue was dignity and independence.

Dorian has placed himself in a legal and ethical situation that has questioned their moral reasoning and sensitivity since he failed to respect the dignity and independence. The challenge while dealing with clients is that they require meaningful connections and engaging activities that are essential in their day to day life. They have to be treated as people who have desires, emotions, needs, and preferences since they still want to live lives in the fullest possible and with security, dignity, and comfort.

Vignette 7: Elaine and Joshua’s Case

The vital ethical standards and values that control individual psychotherapy and counseling are also at the fundamental of couple, group, and family involvements. Given this facet of therapy, family and group therapist have a duty to assist clients in developing an interdependence that encourages rather than weakens them. The ACA Code of Ethics demands counselors to monitor potential members of group therapy for compatibility and to protect groups from harm. Additionally, the ASGW (Association for specialists in Group work), a division of the ACA provides resources for group leaders, multicultural and social justice competence, and the professional standards for training groups (Singh, Merchant, Skudrzyk and Ingene, 2012). These resources offer a wide range of information and guidance to group counselors that are required to exercise them on daily basis.

The growing body of theory and research offers the practitioner a thoughtful analysis of some most complex challenges in group work. Altogether, these resources have compensated for the omissions in the guide and codes that the practitioner is solid to understand in his or her ethical duties while dealing with a group.

Group counselors have a vital factor to consider while counseling individuals from varying cultural settings and the heterogeneity of any group (Singh, Merchant, Skudrzyk and Ingene, 2012). For instance, an individual whose cultural settings discourage indirect confrontation or emotional expression must be offered the flexibility in reacting to the responsibilities of the group and ought not to be considered or ridiculed as dysfunctional due to the cultural settings. As indicated in the social justice as well as multicultural capability principles for group employees, when working with racially varying individuals “leaders tolerate the load of taking into justification the duty of ethnic range in the reaction of the individual to both the policy on dropping out and group process.

In the case of Elaine and Joshua, they failed to take any step to discuss Jan and Chad’s benefits, goals, techniques, risks, and multicultural dimensions of the association, Elaine and Joshua required to confess the level of emotional expression, intensity, and confrontation anticipated in the group sessions. They failed to act professionally and to adhere to the ethical principles and standards practiced during group counseling.

Considerably, there a difference in personalities, cultural norms, and the approach of counseling that might have led to psychological harm to the clients. However, having not approached this situation with moral sensitivity, Elaine and Joshua drove Jan and Chad away and this denied the clients the opportunity for essential personal learning and lowers group effectiveness and cohesiveness for other members. Through following the material found in the Multicultural and social justice competence principles for Group Workers, they could have greatly benefited. In a group setting the counselors need to take reasonable precautions that will protect the clients from emotional, physical, and psychological trauma.

Vignette 8: Earl’s Case

Bartering is considered as the exchange of services and goods in place of payment. Bartering is not unethical nor prohibited in counseling relationships but there are circumstances that it may not run as smoothly as anticipated. Therapists are allowed to barter under certain situations in the current professional ethical codes. Therapists may barter if the connection is not harmful, exploitative or puts the counselor in prejudiced benefit in case the client needs it and in case such provisions are an acknowledged conduct among community therapists (Welfel, 2016).

Counselors examine the cultural implications of bartering and discuss significant issues with the client and various documents such as a written contract. For instance, in case the APA and ACA code of ethics explain the situations under which the expert can agree to barter as compared to offering monetary services. The APA code of ethics also indicates the risk of abuse as a situation along with the clinical reflections.

Generally, bartering practice is not recommended or highly favored by the code of ethics but that does not mean that it’s prohibited in all situations. However, the mental health counselors have to be conscious about the conflicting state licensing board regulations that either regulate or forbid the practice of bartering for those that accept this form of payment while offering psychological services. The mental health professional service providers need to be educated to boost their understanding and awareness on when bartering is considered beneficial and advisable for the client. This is because some people find free services as affronting their dignity and are willing to provide barter arrangements.

For Earl’s case, he needs to take into serious consideration the various factors such as economic status, culture, welfare, and the kind of treatment before agreeing to this form of payment. The NAADAC Code of ethics offers a well-written guide to certified counselors which is effective during ethical situations in the bartering arrangement. For instance, the code of ethics states that the counselor can engage in bartering professional services if the client’s requests are not exploitative or harmful, the professional relationship is not distorted and that the federal rules and laws allow for bartering with an established contract (Welfel, 2016).

Relatively, it is important to check with the legal profession about any form of licensing conflicts that may hinder the bartering practice. This is because the client may fail to fulfill the agreed up obligations or disengage from the bartering agreement which will interfere with therapy. Therefore, if Earl decides to proceed with bartering, he must disclose all the potential policies and risks in writing to his client. He also needs to consult from professionals that are conversant and knowledgeable with the area. Relatively, Earl can consider requesting the client to sell the art elsewhere and rely on the sale to get services. The bartering arrangement needs to be regularly and openly scrutinized by the therapist’s professional colleagues.

Conclusion

Each professional counselor offering the counseling services has several responsibilities that they need to uphold to ensure public trust. They must seek guidance and ethical practices in the application of counseling practices. The ethical standards that have been developed by professional associations are effective in guiding the counselors to carry out their duties legally and ethically.

References

American Psychological Association. (2017). Ethical principles and code of conduct for psychologists.

Kaplan, D. M., Francis, P. C., Hermann, M. A., Baca, J. V., Goodnough, G. E., Hodges, S., … & Wade, M. E. (2017). New concepts in the 2014 ACA Code of Ethics. Journal of Counseling & Development, 95(1), 110-120.

research, and emerging issues (6th ed.). Boston, MA: Cengage.

Singh, A. A., Merchant*, N., Skudrzyk*, B., & Ingene*, D. (2012). Association for specialists in group work: Multicultural and social justice competence principles for group workers. The journal for specialists in group work, 37(4), 312-325.

Welfel, E. R. (2016). Ethics in counseling and psychotherapy: Standards,