ethics in clinical practice compiled by victoria a. fitton, phd with assistance from: corey, g.,...

Ethics in Clinical Practice

Compiled by Victoria A. Fitton, PhD

with assistance from:

Corey, G., Corey, M.S., & Callanan, P. (2006) Issues and ethics in the helping professions (7th ed.). Belmont, CA: Brooks/Cole.

Reamer, F. G. (). Social work values and ethics (3rd ed.). New York, NY: Columbia University Press.

Ethical Considerations

• Ethics – beliefs we hold about what constitutes right conduct; moral principles adopted by individuals or groups to provide rules for right conduct.

• Professional responsibility to examine and clarify personal values and professional practice.

• Personal values exert considerable influence on a professional’s views of clients, their intervention frameworks and strategies, and definitions of successful or unsuccessful outcomes.

Personal and Professional Values

• Social workers occasionally face tension between their personal values and those held by clients, employers, or the social work profession itself.

• Social workers sometimes encounter clients whose values and behaviors seem immoral and abhorrent (child abuse, violence).

• Some dilemmas relate to the congruity or incongruity between the professional’s value orientation and those of the client.

Reamer, 2006

Personal and Professional Values

• Client difficulties often contain a moral dimension.

• Clients often wrestle with moral aspects of problems (divorce/infidelity; IPV/child care).

• These emerge vividly and emotionally in expressive therapeutic work.

• Learn to view problems through an ethical lens with clear understanding of personal values.

• Actively explore clients’ perspectives about what they believe is ethically right and wrong.

Reamer, 2006

Cultural and Religious Values

• Important to recognize the influence of our own and clients’ religious and cultural values and beliefs (abortion/marriage/women…).

• Be mindful of potential conflicts between our personal values and clients’ cultural and ethnic norms (medical).

• This will also be manifest in expressive therapies. (What can be avoided in talk therapy is direct in expressive therapies.)

• Professional (NASW) and religious views on sexual orientation are often in conflict.

Reamer, 2006

Free Will and Determinism

• Values or beliefs related to the determinants of clients’ problems.

• Social workers make assumptions regarding the causes of client problems which significantly impacts treatment planning.• Biology (Medical/Disease model)• Environment (Social Learning Theory)• Institutional/Political (Racism, Left-Right)• Economic (Oppression/Globalization)• Personal Deficit

Reamer, 2006

Defining Your Personal Ethics

• Personal beliefs and values

• Spiritual and religious values

• End of life decisions

Thinking Through Ethical Problems & Dilemmas

1. Identify the problem or dilemma

2. Identify the potential issues involved

3. Review relevant ethical codes

4. Know the applicable laws and regulations

5. Obtain consultation

6. Consider possible and probable courses of action;

7. Enumerate the consequences of various decisions

8. Decide on what appears to be the best course of action

Corey, Corey & Callanan, 2006

Documentation - Ethical Dilemma

Remember to document:• Client name

• Date of service

• Aspects of the issue or dilemma (delineate)

• Intervention and response to treatment goals

• Action/s taken

• Clinician• Signature • Credentials• Date

Legal Aspects of Informed Consent

Four elements are basic to the legal aspects of informed consent:

1. Full Disclosure or Full Information – giving clients information on all aspects of therapeutic process, expectation, and intervention upon which informed consent can be based

2. Capacity – client has ability to make rational decisions (parent or guardian)

Corey, Corey & Callanan, 2006

Legal Aspects of Informed Consent

3. Comprehension of information - must give clients information in clear ways and check for understanding. Clients must have adequate information about both procedure and possible consequences (risk/benefit)

4. Voluntariness - acts freely in decision-making process and is legally and psychologically able (competent) to give consent

Corey, Corey, & Callanan, 2006

Ethical and Legal Issues - Confidentiality & Privilege

• Confidentiality – the right to expect that communications will be kept within the bounds of the professional relationship.

• Privileged Communication – a legal concept that protects against forced disclosure in legal proceedings that break a promise of privacy. • Does not apply to group counseling, marital

and family therapy, or child and adolescent therapy.


Ethical and Legal Issues – Privacy

• Privacy – refers to the constitutional right of an individual to decide the time, place, manner, and extent of sharing oneself with others.• Exercise caution with regard to the

privacy of clients. Do not invade a client’s privacy.

• Think about the use of telephones, answering machines, voice mail, pagers, faxes, cell phones, and e-mail.


Ethical and Legal Issues –Duty to Warn

• Duty to Warn – mental health professionals have a double responsibility to protect other people from potentially dangerous clients and to protect clients from themselves.• Identifying clients who pose a threat to

others• Protecting others from potentially

dangerous clients• Treating those clients who are dangerous


Full Disclosure – Checklist for Treatment

1. Voluntary Participation

2. Client Involvement

3. Counselor Involvement and contact

4. No Guarantees

5. Risks and Benefits Associated with Counseling. Emphasize role of client’s responsibility in treatment.

6. Confidentiality and Privilege

7. Counseling Approach or Theory

Full Disclosure – Checklist for Treatment

8. Exceptions of Confidentiality and Privilege

9. Counseling and Financial Records

10. Ethical Guidelines

11. Licensing Regulations

12. Credentials

13. Fees and Charges

14. Insurance Reimbursement

15. Responsibility for Payment

16. Disputes and Complaints

Full Disclosure –Checklist for Treatment

16. Cancellation Policy/Interruptions in Therapy

18. Affiliation Relationship

19. Supervisory Relationship

20. Colleague Consultation

21. Alternatives to Traditional Therapy

22. Tape-Recording or Videotaping Sessions

23. Client Access to Files and Diagnostic ClassificationCorey, Corey, & Callanan, 2006

Personal Issues and Ethics - Protective Factors

• Balancing Life Tasks – creating and maintaining a commitment to promoting ones own wellness from a holistic perspective:• Spirituality• Self-direction• Work and leisure• Friendship• Love

Personal Issues and Ethics - Risk Factors

• Counselor Impairment• Fragile self-esteem• Difficulty establishing intimacy in personal life• Professional isolation• A need to rescue clients• A need for reassurance• Substance abuse of any kind• Lack of empathy• Poor social skills• Preoccupation with personal needs• Discounting possible harm to clients or others

Ethics in Child Practice

•Full disclosure• Ages of children trained to treat• Childhood issues trained to treat• Theoretical orientation• Treatment philosophy• What a family can expect - risks/benefits• Continuing education and training• Supervision and peer consultation• Range of treatment options/interventions

Treatment Options

• Information on child treatment

• Information on child development

• Brief overview of play and expressive therapy

• Directive, non-directive and prescriptive techniques

• Expectable outcomes

• Pamphlet and/or video about play therapy

• Tour of playroom

• Answer questions


• Who is the identified client?

• Meeting child first, parent/s first, or family

• Divorced and custodial parents

• Family/social environment for child

• If a long-term problem, is there long term commitment?

• Is everyone working for the good of child?

• Financial, time, social resources of family


• Competence to treat the child

• Fully equipped for treating specific child

• Treat the child or treat the family

• Full disclosure

• Confidentiality

• Consultation with parent/s

• What is revealed in consultation?

• Is the child included in parent consultation?


• Speaking for or about a child

• Documentation - harm and benefit

• In cases of separation and/or divorce documentation can be a nightmare

• Information handling in separation and divorce

• The “Problem” is the CHILD

• What are the costs to the child for intervention?


• Complete a thorough assessment:• developmental milestones from pre-birth to

current age of child• all domains of child’s functioning• all systems in child’s world• maintain contact with collaterals

• Include “family” in goal setting and treatment planning

• Contract for “completion” of treatment


•Treatment ethics• Child’s needs first and foremost• Safety first• Mediate/facilitate family connection• Communication/consultation with family• Family treatment including filial therapy,

psychoeducation, and supportive therapy• Holistic approach • Responsive to child and family


•Termination• Reinforce progress and forward

movement• Celebrate with child and family• Give follow-up recommendations• Leave the door open• Offer extended referrals• Follow-up• Evaluate

ethics in clinical practice compiled by victoria a. fitton, phd with assistance from: corey, g.,...

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