Ethics in counselling Essay

Issue One Br all(prenominal)ing Confidentiality in Counseling Minors originally we break d bear into the topic, we want to explore the issue of confidentiality in counseling. This is applicable to not just nippers only as healthy all age congregations, religions, lasts and genders. Remley (1985) stated that confidentiality is an estimable standard that is a rule of practice set forth by a profession. The Ameri abide Counseling Associations (ACA) inscribe of Ethics and Standards of expend require that advocators like their customers right to privacy and avoid illegal and unwarranted disclosures of confidential in public figureation. The ACA code lists the exceptions to confidentiality as when disclosure is required to prevent clear and impendent danger to the client or others or when legal require workforcets demand that confidential info be revealed. When counseling clients who atomic number 18 minors or idiosyncratics who are uneffective to give voluntary, in orga nize consent, upraises or guardians whitethorn be included in the counseling do by as appropriate. Counselors act in the best interest of clients and induce measures to safeguard confidentiality.Confidentiality should exist for the benefit of the client be it whether the client is a minor or not. Should bring ups or guardians be gather upd in the counseling process, the pleader must act with exceedingly professional expertise when disclosing confidential teaching. on that point is an h cardinalst responsibility to obtain the minors permission before relinquish information. For counseling to be effective and to provide an environment in which the client feels free to luck concerns, the direction must be able to assure minor clients that personal information leave be kept confidential to build trust between them. in that respect are vacillating priorities between the rights of the electric s progress tor, civilize policy, guardians rights, and dictates of laws and ethic al codes (Glosoff & Pate, 2002 Lawrence & Kirpius, 2000). There is a tenuous balancing act among the parents who desire autonomy in raising their children, the governmental agencies safeguarding public welfare, and the minor who deserves both privacy and protection. The ACA Code of Ethics (1995) highlights the postulates for the counselor-at-law to clarify client kins infamilies to directly address any possible conflicts, and to promote flexibility in the decision to involve a guardian in the counseling process as long as confidentiality and the clients best interests are safeguarded. Recognition of the demand for a thorough understanding of ethical and legal requirements alike applies to the issue of duty to warn. A counselor with a flexible orientation toward confidentiality will usually watch an independent decision based on merits of each separate case that promotes the moral principle of fidelity in which the childs trust is defend by keeping the promises inherent in con fidentiality issues (Glosoff & Pate, 2002). An evaluation of what is in the childs best interest will predominate, which underscores the moral principles of beneficence. This is seen as an ambiguous process that is influenced by the counselors heathen background and personal value and biases.Conversely, no guarantee of confidentiality erodes the foundation of trust in therapy, leading to increased client resistance and premature termination. In this situation, from the go forthset an adolescent will be reluctant to enter a counseling race with a professional who ostensibly views the referring agency, court, school, or guardian as the real client rather than the teen. An attitude of flexibility toward confidentiality offers the ability to be adaptable to various situations, but throws the counselor into the turbid area of trying to negotiate the balance of ethical and legal dictates. A more moderate stance embraces the advice of the ACA Code of Ethics regarding clarification of counseling relationships and can draw the adolescent into the decision-making process, which strengthens therapeutic rapport. Similarly, a counselor asking the childs permission before disclosure gives the minor a sense of chink and helpers diminish damage to trust when share information is necessary.In the course of work when on the job(p) with minors, I sometimes can be unclear intimately my ethical certificate of indebtednesss concerning confidentiality, especially with adolescents. When they mention activities such as shoplifting, alcoholism, drug experimentation and the most tricky case of sexual habits, it becomes a difficult issue. The question of confidentiality in ethics come into question and the counselor, or myself in this case, will struggle withbuilding trust with the client and involving the parents in the counseling process. Lets deliberate a case study.Josephs parents divorced when he was 5 and he has been living with his mother since. His mother used to at race therapy with him when she noticed he was actually withdrawn and didnt communicate very much since the incident. The therapy went on for a year. Now at age 16, he has been sent to his counselor after his form teacher has noticed his constant late coming to school and also looking listless and distracted during lessons. His grades have also taken a sharp dip. His close friend, Kenneth, tells the teacher that Joseph has been attending all-night transgressies and has started to experiment with drugs and alcohol. Joseph doesnt say much during the counselling sessions except mentioning that he has got a girlfriend now, who is 7 years his senior, and wants to move in with her. They met at a party and got sexually involved with each other and he now feels responsible for taking care of her. He insists the relationship is built out of love and that his parents should not hear or have a say in any of this.His counsellor has shared her concerns with Joseph and is struggling with wheth er she has an obligation to disclose anything to his parents. It would be helpful to consider this case from three perspectives that of law, clinical practice and ethics. The law generally states that minors cannot consent to treatment and a parent or guardian will consent on the minors behalf. The parent who consents on the minors behalf generally has the right to know the meat of the childs treatment until the minor reaches the legal age of (usually) 18. From a clinical perspective, the situation is more complex. An consequential aspect of treatment is to foster an individuals autonomy, and a great pleasure of treating adolescents is to watch as they come to enjoy their growing independence. One aspect of independence is privacy. As a child grows into adolescence and adulthood, the surrounding zone of privacy should increase, thus making room for a more defined sense of self and a greater sense of autonomy.A paradox thus arises Good clinical treatment may require what the law ge nerally refuses, that is, a zone of privacy. I feel that early in the relationship the counselor should fixate clear what relationship she will have to each of the parties (the minor and the parents/guardians). It should be accompanied by an explanation of how information-sharing will work, whatinformation will be shared, with whom and when, in a manner appropriate to the minors age and understanding. As the child intermits and grows up, the structure of the therapy may change for clinical reasons and this will have ethical implications. The minors greater sense of self and enhanced capacity for autonomy may require greater respect for the childs need for privacy. The counselor will thus need to revisit earlier discussions and explain that, for clinical reasons, the structure of the therapy should change. Such boundary renegotiation is clinically and ethically indicated. However, a counselor cannot promise a minor that information will be kept from a parent who has legal custody. A parent with the legal right to treatment information may choose, however counterproductive in the counselors eyes, to exercise that right. Clinical judgement will also be able to indicate to what extent maintaining an adolescents privacy is central to the treatment. A counselor may conclude that an adolescents wish not to have information shared reflects an appropriate separation and so should be honored or he may also conclude that sharing certain information would be helpful.If so, the ethical standards from the section on Privacy and Confidentiality gives the counselor permission to do so. Nonetheless, regardless of whether an adolescent assents to have information tell to a parent, it makes both clinical and ethical sense to tell the adolescent beforehand, what information will be shared, and when. Ideally, the adolescent would be part of such conversations. There may also be times when a counselor will be mandated to disclose information. Serious threats of harm, neglect and abuse falls under authorization reporting laws and must be disclosed in legion(predicate) states. Adolescents should be told that serious threats of harm to self or others will also not be kept confidential. A counselor may feel strongly that revealing information to a parent could harm the minor or be damaging to the treatment. Refusal to disclose in such a case, even in the face of a parents request, may be legally take forable. A counselor in this position should look for both legal counsel and consultation from colleagues. Josephs therapist revisited the issue of confidentiality when Joseph draw outed a wish that she not articulate with his mother.A compromise was reached whereby the therapist would speak to Josephs mother only with Joseph present. The issue of confidentiality became more complicated when the therapist felt that certain information should be shared and Josephrefused. The therapist should gently explore with Joseph the reasons behind this refusal. During some sessions, the therapist should be direct with Joseph about her discomfort with his behavior, especially the illegal activities, and point out the kinds of risks he was taking. Hopefully, over time, they would agree that Joseph himself would begin to speak to his mother about these issues, and that the therapist could fol scummy up with a phone call. It is serious to discuss each and every contact between the therapist and mother thoroughly with Michael, as well as to support his independent use of psychotherapy. Issue Two transcultural Issues in CounselingAs a counselor, we will be working with clients from various coatings. In order to work effectively with culturally diverse individuals and groups, it is important to know what gardening means in peoples lives and to recognise differences that might be culturally-based. The idea of culture is interesting and important, but can be very hard to define and understand. Culture is a set of meanings that provides a sort of bluepr int for how we should think, feel, and behave in order to be a part of a group. It includes patterns of traditions, beliefs, values, expectations, and symbols in fact, every aspect of who we are that isnt biological in origin. Often people are part of more than one culture for modelling, we may belong to a professional group, a religious group, and social groups each of which has its take way of speaking, dressing, and behaving. Often we dont recognise aspects of our culture until we encounter cultural ideas or practices that are variant from ours. Knowing our own culture is an important aspect of self-awareness, however, because we need to be able to recognise culturally-based differences. well-nigh cultural differences that affect counselling relationships include communication styles, for example the way words and phrases are used, the degree of importance given to non-verbal communication, and the appropriate degree of self-assertiveness in communicating. Different attitudes toward conflict, for example whether conflict is positive or should be avoided, whether conflict should be resolved in face-to-face meetings. Different approaches to completing tasks, for example whether or not it is important to build a relationship with another person in order to work with him or her on completing a task. Different styles of decision-making, forexample majority rule or consensus. Different attitudes about unmortgaged emotion and personal matters. Different approaches to knowing, for example through symbolic imaginativeness and rhythm, library research, visiting people who have had similar challenges. As a counsellor, we will be working with children and families from various cultural backgrounds.One of the most important things to remember is not to assume that another person has the same values, beliefs, and practices that you do. We have to use our observation, listening, and questioning skills to learn what is important to the other person and how they see th e world. We need to be open to learning about other ways of seeing and living in the world.Counselors need to be aware of their own ethnicity and how it influences their interactions with other cultural groups. Problems need to be undersas welld within the context of the persons ethnicity. We learn from our culture, appropriate ways of responding to illness. For example, one group of people may tend to complain about their physical problems, opus another may deny having any pain and see it as a form of punishment. Attitudes towards seeking help also vary from one ethnic group to another. It is important to clearly spell out the tasks of the first session to all family members and explain in enlarge the client-counselor relationship. The expectations the family may have about the encounter might be based on its experience with the medical profession. The family may expect the counselor to take guide and provide advice. By being direct, active and using a structured approach, the c ounselor establishes rapport with the family. The ethnic group may perceive the family as the primal source of support for its members. If this is the case, the family may be experiencing shame and guilt for not being able to solve its own problems. For example, an individual may turn to the family for support and seek our outsiders for support as a last resort. In some cultures, it is not acceptable to express personal concerns with a stranger therefore, the clients adopt the counselor into their family. There may be fears and embarrassment about not being able to speak the language of the dominant culture well enough to express difficulties. As a result the counselor may view the client as passive and resistant.Culture influences the familys orientation toward being internally or externally controlled. An internally oriented family has the belief that their happen uponments, or lack of achievements, are determined by their own actions, thus shaping their destiny. On the other hand, an externally oriented family has the belief that achievements and non achievements occur independently of their actions and that the future is predicated on chance. An externally oriented family may be interpreted by an internally focused counselor as procrastinators. Another important dimension when working with the people who are from cultures different than our own is the locus of responsibility. Locus of responsibility assesses the amount of responsibility or blame given to the client or the clients system. Determining if the individual or the system is the cause of the behavior is important when making an assessment and determining interventions. In Canadian culture practically the individual is seen as being responsible for his/her actions. Racial and ethnic minorities whose behaviors deviate from the middle class are labeled as deviant.Be aware of ethno cultural roles and hierarchy. If the father is considered the authority figure, make sure you address him, first sho wing respect for his cultural positions. In attempting to seek information from the children, it is important to acquire permission before proceeding with the interview. Inquire about issues that may be specific to a particular ethnic group. Family members are a good deal delighted to teach counselors about the key insults of their cultural group. If you experience resistance, check to see if you have violated a culture norm. We need to take punctuate when the counselor becomes overly concerned about the familys ethnicity to the point where one loses perspective as to their reason for seeking help.A major assumption for culturally sensitive counseling is that counselors can acknowledge their own tendencies and the limit of their cultures on other people. Thus, it is essential for counselors to understand their cultures and their worldviews before helping and assisting other people. According to Padilla, Boxley, and Wagner (1973), there is increasing evidence that the trained couns elor is not prepared to deal with individuals who are culturally different from them. Cultural sensitivity remains as one of theimportant characteristics of effective counseling. Padilla et als writing also shows that one of the characteristics of an effective counselor is the ability to recognize alteration and cultural differences. It is undeniable that the need to attend multicultural diversity of clients is more obvious when counselors and clients have different cultural backgrounds.Culture is the core of internal ways in which human beings develop their sense of self, including values, beliefs, thought patterns, perceptions, and worldviews. All these qualities help determine and shape ones external culture the ways in which one establishes and maintains a relationship with the environment and others through implicit norms, language, traditions, rituals, and loyalties that influence attitudes, behaviors, and customs (Gushue, 1993). While it is true that Singapore is a mix of d ifferent ethnic groups, each group has bear much of its individual unique cultural character. This is because Singapores policy has always been geared towards multiculturalism, where every ethnic group is allowed to preserve its own culture opus peacefully interacting with others. In the light of this, counselling and intervention is always presented within the cultural context and constraints inherent in our cosmopolitan society. The understanding of a clients unique culture is necessary in order for a counsellor to effectively help the former behave and feel other than in a trusting relationship so as to achieve their goals. Psychological judgments are never free from the influence of therapists own cultural values. In intervention, counsellors need to be knowledgeable of the culture of their clients because each culture holds different ideas about what constitutes problems in living.As we have grown up in a cosmopolitan environment, we are immersed in various orientations of di fferent ethnic groups. Our awareness of our own culture only increases when we go to baffles where our culture is not the norm. Similarly in a counselling room, when we are with our client from a different culture, our awareness of our own culture tends to increase too. We are aware too of the diversity existing within the same culture as people may communicate and interact in a whole range of ways. Our worldviews as ethnic majority are highly correlated with cultural upbringing and life experiences. There is a tendency to take for granted that the ethnic nonage has full knowledge of our culture since it is pervasive inthe society. On the other hand, some of us harbor tinted views of the ethnic nonage that cause us to unwittingly impose upon them stereotypes and preconceived notions. In my opinion, sensitivity includes respect and acceptance of who they are, the way they are and their beliefs.People of the minority race should be treated fairly and equally. There isnt a need to tr eat them with sympathy otherwise, it would only re judgement them that they are being differentiated. I learned from my Indian and Malay friends at school about their feelings as minority races in Singapore and that they prefer to be seen as equals. To be more effective counsellors, we have to first examine ourselves or be aware of our personal values, beliefs, prejudices and motives for helping people. For instance, my own cultural beliefs that men should be stronger and be able to take on the world and solve their problems rationally and efficiently make me more sympathetic toward my female clients. The curiosity to explore the deeper meaning of our own cultural behavior will sure as shooting enlighten and make us more sensitive to the differences or similarities existing in different cultural groups. A wise counsellor would always try to transcend such barriers and enter into the frame of reference of his client and operate from there.The clients we see include students from as young as 6 years old, elderly patients at nursing Homes/hospital. We also have couples with marital, family and financial issues. Their age group ranges from early 20s to the 70s. They are a mix of Singaporean Chinese, Malay, Indian and some immigrants. Our clients are mainly from low to average income group with basic education. English and Mandarin are the main languages used. Dialects are used when counselling the elderly folks.Each member in the group shared both common and unique cultural issues they face in counselling. The sexism issue Annie regularly encounters involves female victims of domestic violence in Indian family whose men predominate in positions of power. Most oppressed Indian women inevitably choose not to react for fear of being ostracized by their own family and community. According to Yeo (1989), Asian derives their identity from membership in a family and a community and focusing on the individual might well alienate the person from the family.Peter and Juli et shared about the common gender issue where parents think they must stay with sons only, while conflicts with daughters-in-law are common issues too. Some parents choose to stay on their own to avoid humiliating their sons. Medical and emotional problems may result from loneliness, poor self care and diet.Jennifer related her early experienceIve encountered difficulties on many occasions with clients of a different race, particularly Malay clients, in dealing with issues on pregnancy crisis. My early impression was that they were either not willing to share nor receptive to explore other options and alternatives pertaining to their decision to terminate their pregnancy. The session became more fruitful only after I acquired greater understanding of the Malay culture.For Magdalene, while she is fit in conversational skills with some dialects, attempting to apply counselling techniques or skills present a real challenge. Majority of the counselling approaches are western in origin. The concepts and explanation are all in English. It is easy to miss the deeper nuances when she attempts to apply or translate them into dialect or language which she is not fully competent in.Both Magdalene and Ruth observed that it is culturally the norm of the older generation to attribute crisis to some external causes and to seek help from temple mediums. The words of the mediums will then be accepted as truth. It can be a real challenge to counsellors from a different faith.Ruth, the youngest member in our group, perceives age as a stumbling block to effective counselling when her clients are much older. In the Asian context, age is a sign of maturity and wisdom. With elderly clients, we are judge to show respect and humility, not as someone to solve their problems.Annie faced the social-economic issue when she encountered Singaporean men who resorted to increase their socio-economic status by taking wives from the poorer ASEAN countries. The wives service more as domestic helpers orcare providers to the elderly/invalid parents or young nephews and nieces within the extended family. The relationship is further strained by language barrier and other cultural issues.Western Counselling Models in Singaporean ContextThe group is pragmatic in our counselling approach, integrating different therapy models to meet the clients unique needs. With cross-cultural interaction comes the possibility that the clients intentions and actions may be misperceived, misinterpreted, and misjudged notably, when we employ the western counselling models on culturally different clients. We are aware that some of these models may not even fit people from western cultures due to within-culture diversity and other diversity factors beyond culture. (Egan, 2005)The second radix that emerged was the need to understand the worldview of culturally different clients in order to know how best to integrate the western counselling models in our counselling work.Magdalene commented that t he concept of individuation in Bowen Theory is culturally not in tandem with many elderly Chinese clients, who come from an environment where the family, community, or clan takes precedent over self hence differentiation of self can be alien to them.A persons identity is formed and continually influenced by his or her context. Working effectively with clients requires an understanding of how the individual is embedded in the family, which in turn requires an understanding of how the family is affected by its place in a pluralistic culture. (Sue, Ivey & Pedersen, 1996).Bowen Theory encourages the therapist to look into the Family of Origin to examine the interlocking relationships. This can present itself negatively as in-laws or family members may not be forthcoming when it comes to talking about sensitive and conflicting issues inflicting the family. Juliet presumed Bowen Theory will be better understood and accepted by theEnglish-educated clients, but she found out to her dismay t hat some concepts contradict their cultural beliefs.Peter found Rational-Emotive Behavioral Therapy (REBT) to be too confrontational in style. Telling a client that he is horriblising and catastrophising his life issues when he is seeking understanding from a counsellor in his moments of anxiety is not going to be welcomed. Asians generally seek familial help when they have problems. The concept of going to a counsellor who is a stranger is already a major deviation from their social norms. lining a challenging counsellor may pose as a humiliating experience for some.Annies observationSolution-focused Brief Therapy (SFBT) focuses on what clients want to achieve through therapy rather than on the problem(s) that made them seek help. The approach does not focus on the past, but on the present and future instead. This goes down well with the clients she sees who are pragmatic and time-conscious.However, Magdalene observed that asking the miracle question to a pragmatic elderly client may pose a challenge. Some of them have mindsets that have been deeply entrenched in their being they do not see the need to change. Similarly, to challenge the Irrational Beliefs (Cognitive Behavioral Therapy) of the elderly whose sense of self has been teach to adopt a resigned disposition can be an uphill task.The use of hot-seat fantasy technique to help clients express their feelings where there is unfinished business may not be favored by the more conservative and traditional clients as unleashing negative emotions towards the deceased is considered a taboo.Magdalene related her encounterUsing Gestalt approach, I encouraged him to imagine that the mother was present at the moment, and for him to tell her what was on his mind. He responded, she is already dead, what is there to say? I realized laterthat while he might be bad mouthing and blaming her for his current plight, it was culturally not appropriate for him to confront her.Ruth felt incompetent when she encountered elde rly people who often interrupted her during conversation to correct her. Her age and lack of knowledge in dialects made it difficult for her to express herself aptly. But she found Carl Rogers Person-Centered therapy useful when working with clients who question her abilities.Multi-cultural CompetenciesThe challenges we face as counsellors in a multicultural environment require that we know and understand the clients culture so as to be congruent with the frame of the world that the client is in during counselling, i.e., individuals are best understood by taking into consideration salient cultural and environmental variables. Regardless of the therapists orientation, it is crucial to listen to the clients and determine why they are seeking help and how best to deliver the help that is appropriate for them. (Corey, 1996) In this pluralistic and post-modern age, no one helping approach has all the answers for the clients we see due to the complexity of human beings, as expressed by Su e, Ivey and Pedersen (1996).The third theme that emerged was the need for therapists to create therapeutic strategies that are congruent with the range of values and behaviours that are characteristic of a pluralistic society.Jennifer had this to sayWithout a deeper understanding of the Malay culture and religion, my counselling sessions with the Malays would certainly be unfruitful. There are family and social pressure to learn within the context of religion and culture. The Malay clients who are enceinte out of wedlock find themselves opting for abortion as the only way to avoid violating family tradition. I have to work on interventions that are congruent with the values of the clients.It is a sign of respect that counsellor refrains from deciding what behaviour should be changed. Through skilful questioning on the counsellors part, ethnic minority clients can be helped.The process of internalizing a new culture is an on-going undertaking. Generally the group is willing to be ex posed to all kinds of clients so as to open up our own world views of the different cultures in our society. This includes interacting with people of different races at social events and festive celebrations. We recognized that with the culturally-constraint client we have to go softened during the first counselling session. The clients can be invited to teach the therapists about the significant parts of their cultural identity.We all acknowledged the importance of supervision and guidance when we are unsure and need clarification. We also will be seen as more professional if we master the basic terminologies of counselling approaches in other languages/dialects.Having an enquiring and inquisitive mind about the different cultures will help broaden our perspectives. Formal education on the multicultural aspects of counselling will help to hone our skills. We can also gain insights by reading articles and books related to multicultural counselling. There are hefty handbooks offerin g the theoretical background, practical knowledge, and training strategies needed to achieve multicultural competence. (Pope-Davis, Coleman, Liu, & Toporek, 2004). In addition, there are highly detailed research studies offering further insights in multicultural competence. (Darcy, Lee, & Tracey, 2004). The greater our depth and breadth of knowledge of culturally diverse groups, the more we can be effective practitioners (Corey, 2001).ConclusionIn summary, the qualitative inquiry has promoted self-awareness of our own personal culture as we develop a sense of the world. Courage, openness and humility are some important elements we identified to secure trust andacceptance by our clients of different cultures. Our group will certainly strive to integrate appropriate counselling approaches to create therapeutic strategies that are congruent with the clients range of values and behaviours, without abdicating our own deepest beliefs and values.