The Ethical Family Counselor (Chapter 10)

Objectives for this chapter

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

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

Principles (broader) that are generally accepted:– 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

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

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

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

Two competing values have shaped contemporary family counseling practice:

– 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

Both gender and sexuality have been concerns in many cultures (and many families) over the generations, e.g.

– 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

Race and class are intertwined with oppression:– 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

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

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

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

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

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

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

When a couple or family come to an institutional setting where individuals are the unit of treatment, there are two likely outcomes:

– 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

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, theory-driven treatment

Starting with a clearly identified set of issues, the family-oriented practitioner should provide a treatment plan that describes

– What procedures will be used, and – How their success can be evaluated

Maintaining family-oriented progress notes

Clinical documentation will generally focus on the primary client but will differ from individual notes by:

– Acknowledging the participation of others– Discussing interactions

Assessing change

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