Transcript Retelling the Story: Couple and Family Counseling in the

The Ethical Family Counselor
(Chapter 10)
Objectives for this chapter
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Appreciate the complexity of ethical decision making and
behavior when working with couples and families
Understand the functions of context, values, ethics codes,
and law in guiding decision making
Recognize and improve your ways of making ethical choices
Identify common ethical issues in work with couples and
families
Apply values in creating an ethical stance for your own
practice
Ethical decision-making
processes
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In a context where laws and professional ethics codes may
conflict, professionals need to focus on process
Values and principles are essential in making sense of ethics
Ethics codes highlight issues but do not always resolve
decisions
Principles and values
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Principles (broader) that are generally accepted:
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Autonomy
Beneficence
Nonmaleficence
Fidelity
Values (narrower) differ
Values are socially constructed, manifested in discourses
Two or more sets of values can compete
Even when values are clear, different actions may result from
the same value
Identifying ethical issues
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Many times the clear ethical option is not apparent. This is
known as a dilemma
The case of Kevin and the Ellingtons illustrates the potential for
acting without carefully examining ethical issues
Ethics codes highlight many of the most frequently encountered
issues
Proactively ethical practitioners go beyond codes, looking at
their motivations and attempting to recognize multiple
perspectives
Consultations, codes, and laws
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Consulting a supervisor, trusted colleague, or legal advisor is a
basic strategy
Ethics codes provide a basis for such a consultation
Multiple codes may define issues in different ways—but in this
case they agree on the risk for the clients if Kevin becomes
involved in their family
Ethics themes in couple and
family counseling
Family counseling
presents special ethical
dilemmas
Competence
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Professionals are expected to only practice in areas where they
have appropriate training and supervision to justify a claim of
competence
At the same time, the complexities of family life exceed any
single professional’s ability to provide expert assistance
Ethical professionals must
– Network with a variety of helping fields
– Confer and consult when in doubt
– Help clients make informed decisions about referrals
Systemic versus individual ethics
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Two competing values have shaped contemporary family
counseling practice:
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A systemic view that privileges relational needs and concerns,
resisting competitive and individualistic pressures
A Western cultural emphasis on the individual, with rights and
needs, revitalized with feminist concerns that not all individuals are
equally valued
Gender and sexuality
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Both gender and sexuality have been concerns in many
cultures (and many families) over the generations, e.g.
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Can women be warriors?
Can children receive the love and support they need from a male
caregiver?
Do men who love each other have to marry women anyway?
These issues become ethical to the extent that competing
claims for correct behavior cannot easily be resolved
When people’s lives are negatively affected by social
structures, counselors see a social justice concern
Race and class
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Race and class are intertwined with oppression:
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Negative characterizations of “the other”
Limiting access and opportunity
Avoidance of dialogue
We all have racial and class identities, and these identities can
create barriers when we seek to help
Ethical practice calls for acknowledging these social forces and
working to challenge them
Power and deception
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The history of family counseling includes many practices that
were based on overt and covert use of power and deception
These practices were justified on the basis that the clients were
asking to be manipulated
These practices led to negative perceptions of our field
Ethical practice calls for open and honest engagement with
clients and the community
Diagnosis
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The family perspective finds itself in tension with
reimbursement systems and other institutions that only grant
validity to problems residing in the individual
Diagnosing an individual as a way of getting funding may be
ethical, when the diagnosis is valid, but people can also be
harmed by being labeled. We need to be careful with our
applications of diagnoses
A movement is underway to get acknowledgement for relational
problems as valid and deserving of intervention
Consent
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Family work is inherently complex in the varied levels of
motivation and voluntary participation of family members-especially when we consider children and others whose
understanding may be limited
Participants may not understand their rights
Ethical practice requires recognizing the power imbalances in
couples and families so that family members are not victimized
by our helping efforts
Confidentiality
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Confidentiality is a constant concern in family counseling
Clients expect confidentiality
They do not know what to expect regarding their individual
disclosures to a counselor who is working with the family
When counselors learn family secrets, we are caught in
triangles--if we don’t learn them, we are operating without
important knowledge
We need to be clear with clients about what they can expect
Multiple relationships
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Multiple relationships are unavoidable in couple and family
practice--this is one of the reasons many people avoid this kind
of work
When multiple relationships are present, abuses of power can
occur if all participants are not clearly aware. Ethical practice
requires discussing potential conflicts
Even with awareness, some multiple relationship situations are
dangerous and should be avoided
Psychotropic medications
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In many cases, relational problems create psychiatric
symptoms that can be treated with medications. Clients often
want immediate help, and a referral for medication can produce
rapid change.
However, relieving a symptom may do the client(s) a disservice
if the source of distress is left unresolved
There is no simple solution to this ethical dilemma
Records and reimbursement
Systems of payment
and record-keeping
typically don’t
understand a family
approach
Identifying an individual with
appropriate needs
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When a couple or family come to an institutional setting where
individuals are the unit of treatment, there are two likely
outcomes:
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The intake screeing will identify a member of the relational system
who fits eligibility criteria
The couple or family will be told that their problems are not
individual-level, and therefore they cannot be served (or they will
pay a full fee, when individual treatment would have been covered)
Assessing the appropriateness of
couple or family treatment
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Once clients are accepted for treatment, the decision to provide
services in a couple or family format has to justified based on
theories about the source of the problem and possible ways of
eliminating the problem
These theories should clearly appear in the clinical
documentation so that evaluators understand what will be
happening
Conducting focused, theorydriven treatment
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Starting with a clearly identified set of issues, the familyoriented practitioner should provide a treatment plan that
describes
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What procedures will be used, and
How their success can be evaluated
Maintaining family-oriented
progress notes
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Clinical documentation will generally focus on the primary client
but will differ from individual notes by:
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Acknowledging the participation of others
Discussing interactions
Assessing change
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Even though eligibility is based on the needs of the primary
“patient”, a family treatment plan will identify ways in which
others need to change as well
Reduction in symptoms is essential information about progress,
but it is not enough to justify the family approach. Relational
changes must also be documented