Running Head: Advanced Ethical and Professional Issues

Advanced Ethical and Professional Issues

COU5140
Karen Decelis
University of Malta
Running Head: Advanced Ethical and Professional Issues

Advanced Ethical and Professional Issues

COU5140

Case Study

Martina is a 12 year old girl in Year 6 in the school where you are working as a Trainee

Counsellor. Her teacher refers her to you because she is unfocused in class and is coming to

school without her HW. You start sessions with the child and build a strong therapeutic

relationship with her.

After 3 sessions, she tells you that her mother is sometimes not washing her clothes, not

cooking for her and recently left her alone from 9pm till 1am. Her father is not in the picture

and the child doesn’t mention other family members. You are concerned about the well-being

of the child but when you ask if you can meet her mother, the child always tells you that she

would rather you don’t. She tells you that she is ok and knows how to take care of herself. She

says that she loves her mother and she knows her mother loves her back. She says that it is just

her mother’s character to be forgetful and a bit immature. Martina says that she is just happy

to have someone to talk to.

After around 8 sessions with Martina, her mother comes for Parent’s Day. She tells the

Headmistress that her daughter told her she is speaking to a counsellor, and the Headmistress

shows her to your office. She comes in your office and you are surprised to see that she is a

friend who you used to go to school with. She is very happy to see you and starts reminiscing

about old times. You end up not talking about the child as the mother starts telling you about

her recent boyfriends and what she is getting up to. You go home and you find a friend request

from her. When you don’t reply, she sends you a Facebook Message asking you to meet her

for drinks. What do you do?

Running Head: Advanced Ethical and Professional Issues

Assignment

Counselling may be described as

‘Professional activities involving Association Members, hereafter called practitioners, and

their clients. The practitioner offers an impartial helping relationship which respects the client's

personal values and autonomy.’ (IAC Code of Ethics, 2003, p.1)

In order to help our clients in the best way possible, professional counselling associations from

around the world have set up Code of Ethics, made to answer difficulties related to ethical

issues. Apart from that, through supervision, counsellors are given the opportunity to discuss

problems encountered at work with someone impartial and detached from the case. It is

important to note that

‘Counsellors are vulnerable to all the frailties of the human condition and these may affect their

competence’ (Bond, 2000 p.136)

Counsellors are normal humans with feelings and dilemmas and it is of utmost importance that

counsellors feel supported in their profession. Sometimes, it is easy to be blinded by personal

thoughts and opinions, which is why we are given practical rules and guidelines on how we are

to lead our counselling career. Tim Bond in his book ‘Standards and Ethics for Counselling in

Action’ discusses ethical standards. Professional ethics provide guidelines for good practice, in

order to help clients in such a time of personal anguish, and at a point which they are most

vulnerable. Counselling is not ‘doing something to the client…rather it is freeing him for

personal growth and development and from obstacles so that he can move forward.’ (Bond,

2000p.41)
Running Head: Advanced Ethical and Professional Issues

Having an ethical framework creates an environment where the counsellor feels safe and

supported. This can lead to the counsellor having a sense of direction when ‘feeling

overwhelmed with ethical uncertainty’ (Bond, 2000, p.57) It is not just counselling which has

ethical guidelines. Most of the careers related to people, like Law and Medicine, have their

own Code of Ethics, in order to help the professional make good decisions. When it comes to

Counselling, we follow mainly the Code of ethics of the British Association for the Counselling

Profession, the New Zealand Counselling Association, the Canadian Counselling and

Psychotherapy Profession and the Malta Association for the Counselling Profession.

All the major Professional Associations emphasise the importance of certain values, mainly

client safety, fitness to practise, respect for all clients, contracting and confidentiality. When it

comes to my client, Martina, there are various ethical issues which worried me as a counsellor.

Martina clearly trusts me and has confided in me because I told her that whatever she tells me,

remains confidential, as long as she doesn’t tell me anything that is going to cause harm to self

or others. Hearing that Martina is not finding food and clean clothes at home concerns me, but

the fact that she is a responsible and mature girl, who assures me that she is doing well, puts

me in a difficult position. Should I focus on the fact that the mother may be neglecting the

child, or shall I work on continuing to help the child in her needs? There is also the ethical

dilemma of boundaries. The fact that you were friends with her mother at school brings a sort

of dual role for me as a counsellor. Am I the child’s counsellor or the mother’s friend?

The BACP places being trustworthy as one of the most important qualities one can have in

order to understand and resolve ethical issues. Martina seems to be very happy to be my client

and seems to feel comfortable with me, particularly because she is the only one in her family

to know me. This seems to make her feel special. She is trusting me with her thoughts and

feelings. If I am her mother’s friend, I would feel that I am betraying that trust. What if the

mother starts asking me what Martina tells me in the session? What if she tells me something
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which is the opposite of what Martina had told me in a session? Who do I believe? How would

that affect my congruence in the sessions with Martina? I am expected, as a counsellor, to

honour the agreements done with the client.

The BACP Code of Ethics also points out personal moral qualities which are important in order

to be ethical. A quality which I feel goes hand in hand with this case is that of integrity. Integrity

is the ‘commitment to being moral in dealings with others, personal straightforwardness,

honesty and coherence.’ (BACP Code of Ethics, 2001, p.4) I feel like, in this case, with Martina

and her mother not having a very strong relationship, I would feel like I am betraying Martina

by going out with her mother and being her friend.

Dual relationships is a situation between client and counsellor where multiple roles exist. This

usually has a ‘beneficial or detrimental impact’ (BACP Code of Ethics, 2001, p. 5) on the client.

Because of this, counsellors are usually asked to reconsider entering into dual relationships.

The BACP Code of Ethics also points out another issue which is of concern to me. Martina is

still a child so technically, her mother is responsible for her needs. However, in this case,

Martina seems to be coping well with the fact that she needs to do take care of herself. The

BACP Code of Ethics (2001) claims that

‘Working with young people requires specific ethical awareness and competence. The

practitioner is required to consider and assess the balance between young people’s dependence

on adults and carers and their progressive development towards acting independently.’ (p. 6)

When it comes to Martina, there would already be an ethical dilemma if the mother wasn’t a

friend of mine, as I, as a counsellor would debate whether I should meet with the mother, even

though the child doesn’t want this, seeing that it could be seen as neglect. However, the added

layer that the mother is a friend, complicates the matter further. I should tell the mother of a 12

year old that it is not right that the child sometimes doesn’t find food and clean clothes,
Running Head: Advanced Ethical and Professional Issues

however, the child doesn’t want me to break confidentiality. I am allowed to break

confidentiality if there is a life at risk, but the child is telling me that she is ok and there is no

need to change the situation. This is already an ethical dilemma in itself. Adding the fact that

the mother is a friend of mine and wants to hang out is making the matter even worst.

There is a difference between having a Code of Ethics and an Ethical Framework. An ethical

framework gives you guidelines while a code of Ethics tells you what you should and shouldn’t

do. The Canadian Counselling and Psychotherapy Association’s Code of Ethics, brings the

counsellor some questions to help him reflect. In a chapter called ‘Virtue based Ethical decision

making’ on p. 4, the code of ethics explain that the virtue ethics approach is based on the belief

that counsellors want to be virtuous and caring because they believe it is the right thing to do.

They also gave some questions to help the counsellor reflect. I will be answering the questions

in regards to Martina’s case study.

The first question is ‘What emotions and intuition am I aware of as I consider this ethical

dilemma and what are they telling me to do?’ My intuition is telling me that Martina is my

client and seeing that she is a mature, responsible girl, I shouldn’t speak to her mum about her

not taking care of her sufficiently as yet. However, I should work towards the child feeling

comfortable about me talking to her mother. Regarding the situation of being friends with her

mother, I feel that I would be betraying the child if I accept the friend request and go for drinks

with the mother. This is a situation where the child is trusting me and is happy that I am her

counsellor, therefore I wouldn’t be comfortable referring her.

The second question is ‘How can my values best show caring for the client in this situation?’ I

believe that I need to be genuine with Martina and tell her what happened. There is nothing

which can hurt the child as I genuinely didn’t know her mother was my friend before Parent’s

Day. Therefore, I would tell the child everything. I would also need to tell the mother that
Running Head: Advanced Ethical and Professional Issues

although we are old friends, I am now her daughter’s counsellor and that is the only role I will

be having with this family. I would make it clear that it is my role as a counsellor to keep all

sessions confidential. I would also explain to the child that I am impartial and unbiased, and

whatever the child needs, I am there as her counsellor. Should the child suddenly come and say

that her mother is abusing her in any way, or the neglect is getting worse, my loyalties stand

with the child, and I will proceed as needed.

The third questions is ‘How will my decision affect other relevant individuals in this ethical

dilemma?’ It is clear that I am not close friends with the mother. Had I been her close friend, I

would have recognized the child the second she walked into my room. I would need to be very

careful that the mother doesn’t take it against the daughter. It could be that she got excited to

see me and was looking forward to going out with me. It could be that if I don’t explain the

situation to her gently, she might take it on the child and think that the child is preventing her

to be friends with me. I would explain that this would have happened with any other child and

mother, and the child has nothing to do with my decision.

The fourth question is ‘What decision would I feel best about publicizing?’ I would feel

comfortable, if I were publishing a paper, to say that I would ignore the friend request and

explain gently to the mother that I cannot be friends with her since I am her daughter’s

counsellor. I would also feel comfortable saying that for now, since the child is quite calm and

stable, I won’t speak to the mother about the child not finding food and clean clothes. I would

make it clear, however, that should the mother start leaving her daughter alone at home for

long hours, I would have to report. I would also feel safer if I spoke to my supervisor about this

situation.

The last question asked by the Canadian Counselling and Psychotherapy Association Code of

Ethics is ‘What decision would best define who I am as a person?’ Although I am concerned
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about Martina, I know that she is not being abused and I also know that her mother loves her.

I am not reporting it as a case of neglect as the child seems to be able to handle the situation,

although I don’t agree that children should have to be in that position in the first place. I would

feel comfortable as a person to choose a client over a person who could be my friend,

particularly because I have built a strong therapeutic relationship with the girl. As the MACP

Code of Ethics (2001) states in p. 3,

‘Trust is the cornerstone of the therapeutic relationship between the client and the counsellor.

It is the counsellor’s duty to maintain this trust under all circumstances, as long as this doesn’t

fall under the confidentiality parameters explained further down. In every decision taken,

counsellors should act genuinely according to the trust built throughout the therapeutic

relationship.’

It is also important to reflect on what makes me, as a counsellor, have my specific ethical

opinions. Tim Bond names six sources where people get their ethical opinions from: their

personal ethics, ethics implicit in therapeutic models, agency policy, professional codes, moral

philosophy and law. In my case, I would say that as a person, my personal values go quite well

with the values a counsellor is supposed to have. I believe that it is my values which made me

want to help people. I feel that Martina deserves to have a good therapeutic relationship with a

counsellor who is genuine and congruent with her. It is extremely useful and important that I

can go through the professional codes of the different Counselling Associations.

Working in the Education Department, it obviously makes a difference, the fact that we work

with assent and not consent. Had I needed consent from the parent in the first place, perhaps I

would have made a meeting with the mother and would have immediately noticed who she is.

Maybe I would have spoken to my supervisor who would have suggested that the Principle

Counsellor at my college could refer the case to someone else, seeing that I wouldn’t have met
Running Head: Advanced Ethical and Professional Issues

the child yet. Then I could have accepted the friend request, and we could have gone out for

drinks, as I would not have been involved in the child’s life. However, seeing that at the

Education Department, we start by calling the child, I obeyed that policy and worked according

to it. I believe that Martina has the right that I respect her individual autonomy. Raanon gillon

(1985) has provided a more meaningful definition which identifies autonomy as ‘the capacity

to think, decide and act on the basis of such thought and decisions, freely and independently

and without, as it says in the passport, let or hindrance.’ (p.1806) Martina is a mature,

responsible girl who I feel is already independent. I almost see her as being the grown up in

her family, although I don’t think that is the right thing. However, I would be crossing my

boundaries if I spoke to her mum about this just because I don’t feel a child should be making

food and cleaning her clothes.

Another ethical dilemma which I am faced with is that of Martina’s mother adding me on

Facebook. While I post a lot of things on Facebook, I make sure to keep my profile private. In

that way, only the people who are my friends online can see what I have posted. Since Martina’s

mother is a friend from school, had I not been in this situation, I would have accepted her friend

request and even gone for drinks with her. However, in this situation, do I accept the friend

request? Am I comfortable with a client’s mother seeing me post videos about traffic or pictures

of me goofing around with my friends?

Bond (2003) p. 185 states that ‘the use of digital technology and on-line communications has

transformed the living and social environment over the last thirty years for everyone who has

access to it.’ I agree with this. With social media like Facebook, Instagram and snapchat, we

are in contact with everyone we want to be in contact with, all the time. I think this creates an

issue with boundaries. If my clients and their families can see me all the time, I would feel

awkward and uncomfortable in the sessions. What makes a client different from a friend is

boundaries. And boundaries have to be kept even online. This also leads me to a constant battle
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I have every day before I post something. How I present myself on Facebook and Instagram

influences people. I need to show myself; my real self, and I have to be a person of integrity

and trustworthiness. I cannot post photos of me partying or say something insensitive about

other people. This is something which is not just about being careful what to post, but being

careful what to think, and becoming a better person in general. Counselling is about being and

not doing. Which is why it is a process which I am still learning from.

Bond (2003) says that there are 2 ways of being safe online as a counsellor. The first is to make

everything private. The second is ‘establishing clear expectations around whether or not a

counsellor will accept invitations to be a friend on site like Facebook, and what will happen

should counsellor and client accidentally encounter each other on-line outside the counselling

relationship.’ (p.189) It is my duty to tell Martina’s mother, perhaps by calling her from the

school or my office, that I will not be able to accept her friend request and that it is something

I do with all mothers of clients and not just her. I would explain that Martina had nothing to do

with it, just in case she might feel that it is her daughter’s fault.

A source of wisdom and knowledge which I feel is even more useful than reading Code of

Ethics is supervision. In supervision, you have the luxury of having an experienced counsellor

listen to your case. Bond (2000) claims that

‘The Distinctive strategy, which characterizes most of the reputable counselling movement, is

an emphasis on receiving regular and ongoing counselling-supervision. (p.123)

I would definitely discuss this case with my supervisor as well as my Principle counsellor.

Since I am still a trainee, I feel that I wouldn’t take a decision like this on my own. I would

definitely consult both these people and get their expert opinion on the matter.

A former chairperson of the American Association for Counselling and Development (Stadler

1986a, 1986b) proposed three tests for deciding what to do when you have an ethical dilemma.
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You need to check on your decision and see it in relation to universality, publicity and justice.

I can comfortably say that in any other case, I would behave in the same way I am behaving

with Martina’s case. I can also say that I would make the decision publicly and I would be

willing to have my actions exposed to scrutiny in a public forum. Thirdly, I would do the same

thing is my client was an influential or well-known person.

Being a counsellor is not about having a job. It is about having a constant responsibility of

putting your client at the heart of what you do. You have to make sure that all you say and do

in the session and outside, is for the benefit of the client. In this case, Martina and her safety

and happiness are my first priority. Therefore, answering the case study question, I would call

the mother from my office phone and tell her that I would like to tell her that I cannot accept

her friend request as I am Martina’s counsellor and it would be crossing boundaries. I would

also tell Martina about this and assure her that I will not be telling her mother anything of what

she told me in the sessions. Regarding the mother’s neglect, I would explain to Martina that I

am seeing that perhaps the fact that her mother doesn’t clean and cook for her, may be creating

some stress on her, and perhaps we can talk to mummy to see if anything can change. If the

child says no, I will continue supporting her. If things change, then I would talk to my

supervisor and see what the next step will be.

Running Head: Advanced Ethical and Professional Issues

References

Beauchamp, T and Childress, J (2013) Principles of Biomedical ethics. Oxford: Oxford

University Press

Bond, T. (2000). Standards and ethics for counselling in action. London: Sage Publications.

Casemore, R. and Gabriel, L. (Eds) (2009) Relational Ethics in Practice: Narratives from
Counselling and Psychotherapy.

Corey, G., Corey, M.S., & Callanan, P. (1998) Issues and ethics in the helping professions,
(5th ed.). London: Brooks/Cole.

Daniels, D. (2010) Therapy with Children (Ethics in Practice Series) Sage.

Gillon, R (1985) Autonomy and the principle of respect for autonomy, British Medical
Journal (Clinical research ed.) 290(6484):1806-8 · July 1985

Irish Association for Counselling and Psychotherapy (2000) Code of Ethics

The British Association for the Counselling Profession (2001) Ethical Framework

The Canadian Counselling and Psychotherapy Association (2007) Code of Ethics

The Malta Association for the Counselling Profession (2011) Code of Ethics

The New Zealand Association of Counsellors (2002) Code of Ethics