Counselors make hundreds of decisions as they work with clients. They use professional skills and knowledge to gather information in order to assess, clarify, categorize, and respond to client concerns. Most often, counselors, after some consideration and reflection, know how, or if, to respond to situations. Yet, on occasion, counselors may find themselves facing uncertainty, confusion, or doubt in relation to their or their clients’ concerns, behaviors, or needs. Supervision and peer consultation are two recognized and typically effective methods that counselors use in order to clarify concerns related to clinical or treatment questions. Occasionally, counselors will encounter questions or circumstances that seem to originate from ethical and/or legal concerns. These questions, by their very nature, can create a heightened sense of concern or urgency for counselors.
Ethics or ethical codes are standards of behaviors and practices agreed upon by the members of professional organizations such as the American Counseling Association (ACA) or the American Psychological Association (APA). Ethical codes include a general rather than a specific description of mandatory and aspirational behaviors and beliefs. Counselors are expected to be familiar with and to adhere to these codes as a privilege of membership in the organization. Compliance with the ethical codes ensures client welfare, standardizes the practices of the professional, and is a means of professional self-regulation. Counselors use these codes to guide their practice and determine the appropriateness and degree of obligations they may have in relation to their clients. Yet, being familiar with and adhering to ethical codes will not prevent the counselor from encountering circumstances that are confounding and/or confusing. The ethical codes are necessary but not sufficient to prevent counselors from encountering these circumstances or ethical dilemmas.
Ethical Dilemmas in Context
A dilemma is generally defined as a circumstance or situation that is perplexing because a decision is required between equally unacceptable or unfavorable choices. An ethical dilemma incorporates the concepts in the preceding definition and is a situation in which there is an apparent conflict of moral standards or imperatives. In essence, to uphold one standard would mean violating another. For example, many of the ethical codes in counseling and psychology are based on what some define as universal moral principles. The most commonly identified moral principles are autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity. Counselors who uphold these principles will support clients’ freedom to be self-determining in word and deed (autonomy), will do no harm to clients (nonmaleficence), will do good or promote clients’ health and wellness (beneficence), will be fair and equitable in their treatment of all clients (justice), will be trustworthy and uphold their word and promises (fidelity), and will be truthful in their interactions with clients. These moral principles are typically presented to counselors as a holistic set of discrete and equally occurring ideals, yet in reality these principles are in relative contextual tension to each other. Upholding one principle will have some impact, positive or negative, on the others. Counselors may encounter an ethical dilemma when they consider the circumstances of involuntary hospitalization of an imminently suicidal client. The client’s freedoms (autonomy) will be restricted or impeded in order to promote good for the client (beneficence) to keep harm (nonmaleficence) from happening to him or her.
Identifying Ethical Dilemmas
For most counselors, an ethical dilemma is apparent when they encounter a confounding situation in which they feel hindered in their decision making because (a) there appears to be conflict between or inconsistency among the ethical standards, (b) the situation is so complex that the ethical codes offer little guidance, (c) there appears to be a conflict between ethical and legal standards, and (d) there appears to be a conflict between the moral principles that underlie most ethical codes. Counselors can be involved in ethical dilemmas directly, as in the case of client care or supervisory responsibilities, or they can be involved as a colleague, as in the case of witnessing a peer, supervisor, or supervisee struggle with a predicament. Ethical dilemmas differ from ethical violations in that the counselors have not yet engaged in any action that would violate the rights of the client or the ethical or legal standards.
Ethics have their conceptual roots in philosophy and as such are open to interpretation and influence from many sources (e.g., theoretical stance, cultural and personal factors, morals). Because of these influences, ethical dilemmas vary in their degrees of clarity and distinction. Some issues or questions may be readily apparent to some individuals but not to others, and some dilemmas emerge only upon reflection or after consultation or supervision. Identifying, addressing, and resolving ethical dilemmas is a dynamic process that requires counseling professionals to do more than simplistically apply the codes with respect for the uniqueness of each situation or circumstance.
Ethics and ethical codes are bounded by the cultural contexts in which they were produced. An act that might appear to be an ethical violation to a White male counselor may not be considered unethical when viewed by first generation Hispanic American female. For example, consider this scenario: Both counselors are providing counseling to male teenagers from Korea. In the course of the counseling sessions, each counselor asks his or her client to have his family attend the next session in order to begin family counseling. At the next week’s session, both clients bring their family members to the session. Each family is composed of some combination at least one biological parent, one biological grandparent, a couple of siblings, two cousins, and another person who is generally described as a neighbor or friend. One counselor allows all the family members into the session while the other counselor does not, because the cousins and neighbor or friend are not really family members. Clearly, these two counselors have very different ideas as to what constitutes “family” and who should have access to client information. Both could be practicing ethically according to their interpretation of the ethical codes, and depending on one’s point of view, both may be engendering an ethical dilemma as the result of their actions. The questions are these: Which actions by the counselors promote clients’ welfare, and what actions may the counselors need to take to ensure all parties are fully informed of the consequences of their decisions? Dilemmas are difficult and complex events to resolve, because there are no easy, clear, and definitive answers.
Making Ethical Decisions and Resolving Dilemmas
Being a professional means engaging in behaviors that demonstrate concern for client welfare, accountability, reflective practice, use of best practices, and recognition of ethical practice. Counselors must be familiar with their respective codes of ethics, use a systematic approach to ethical decision making, employ sound judgment and reasoning, and act in a respectful and deliberate manner.
Researchers have identified no fewer than nine ethical decision-making models in the field of counseling and psychology. These models provide practitioners a framework from which they can systematically evaluate a set of circumstances or a situation that may evolve into an ethical dilemma. Although the various schools of thought (e.g., rationalism, moral reasoning, feminism, social constructivism, and social justice) differentiate the models of ethical decision making, they all possess similar steps to use when analyzing a potential dilemma.
Most models comprise at least five steps. Counselors are encouraged to go through these five steps with a peer or supervisor in order to provide an additional perspective. First, counselors are to identify the potential problem from as many perspectives as possible. Next, recognize all the potential issues or concerns involved for all relevant parties. This is similar to brainstorming, which requires counselors to think and reflect broadly. In the third step, counselors are to review the relevant ethical and legal codes and identify points of support, contradiction, or contention. Fourth, counselors are to generate a list of probable courses of action related to each concern. From this list counselors will select one upon which to act. If counselors have not utilized a supervisor or a peer, it is at this point in the process that seeking consultation is strongly recommended. The final step of ethical decision making involves executing the course of action and evaluating and documenting the results.
By engaging in an ethical decision-making process, counselors should be able to take an action to resolve the dilemma that is in the best interest of their clients. The counselors’ actions may not represent the ideal response, as ideal responses to dilemmas are rare. Rather, counselors’ responses to ethical dilemmas that are a result of an appropriate use of the ethical decision-making model demonstrate professionalism, deliberation, and sound judgment.
References:
- Corey, G., Corey, M. S., & Callanan, P. (2007). Issues and ethics in the helping professions (7th ed.). Pacific Grove, CA: Brooks/Cole/Thomson Learning.
- Duska, R. F., & Whelan, M. (1975). Moral development: A guide to Piaget and Kohlberg. New York: Paulist.
- Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press.
- Kohlberg, L. (1981). Philosophy of moral development. San Francisco: Harper & Row.
- Neukrug, E., Milliken, T., & Walden, S. (2001). Ethical complaints made against credentialed counselors: An updated survey of state licensing boards. Counselor Education and Supervision, 41, 57-71.