Ethical dilemmas in counselling (+5 coping Tips)

In this brief article, we will discuss the various ethical dilemmas encountered by counsellors and therapists in their practice and ways to avoid such situations. There are 8 Ethical dilemmas that we will discuss in this article, namely: 

• Autonomy and agency 

• Do-no-harm

• Benevolence 

• Dual relationships 

• Allegiance 

• Informed consent 

• Justice 

• Duty to report and confidentiality 

We will discuss these dilemmas further in the article. 

The life of a professional psychologist can be rewarding but also difficult.

In many situations, psychologists need to balance competing concerns and conflicting obligations, or negotiate among overarching ethical principles that appear to collide. They may be found in all types of counselling, from short-term counselling to long-term treatment, eating disorder counselling to career counselling. 

In the field of psychological counselling, it can be seen that the concepts of ethics, values, morals, law and professionalism are used interchangeably.

What is an ethical dilemma?

Ethical dilemma is defined as “a situation which is caused by the chaos between two values in a decision-re- quiring circumstance” or “in circumstances when two or more options are encountered and there is a difficulty in deciding about which one is better; as a result of which the existing necessities cannot be met by present alternatives”.

In recent research, a contradiction between appropriate ethical norms has been identified as a source of ethical difficulty throughout the psychological counselling process. Furthermore, it is stated that psychological counsellors face ethical dilemmas as a result of factors such as the difficulty in applying idiosyncratic but tacit ethical standards, certain circumstances that prevent clear application of standards, or situations that include a failure to distinguish between right and wrong and involve an ethical problem. 

It is stated that the most common ethical dilemmas encountered in psychological counselling are privacy, blurring of boundaries, fuzzy, multiple or conflicting relationships, academic environment, teaching dilemmas and education problems, and colleague behaviour. 

Codes of practice and ethical standards related to counselling can be useful in guiding a counselor’s decisions; however, with effective counselling it is the individuality and uniqueness of the client and counselling situation that ultimately determine decision-making. With effective counseling, continual flexibility and critical analysis are important so as not to become rigid in one’s thinking.

Ethical dilemmas that counsellors face in practice.  

Autonomy and agency 

Autonomy means choosing the direction your life will take without outside influence. The essence of this principle is offering a patient a choice, and encouraging self-direction when possible. This ultimately requires us to learn the patient’s values by supporting them in their choices and actions so long as it does not cause any harm or distress for others or themselves. 

It’s important that we understand that clients choose certain things that therapists can provide them with what they want. Counsellors may want to let them know that they are focused on their best interests by supporting any decisions they make directly related to healthcare decisions and physically what concerns might do more harm than good.

First, assisting clients in comprehending how their judgments and ideals may be interpreted in the context of the society in which they live, as well as how they may affect others’ rights. The client’s capacity to make reasonable and sensible judgments is the second factor to evaluate. People who are unable to make competent judgments, such as children and some people with mental disorders, should not be permitted to make decisions that might hurt them or others.

Do-no-harm

Nonmaleficence is the concept of minimizing harm to others. This principle can be defined as “doing no harm” or “above all means well” (Kitchener, 1984; Rosenbaum, 1982; Stadler, 1986). 

The idea of not inflicting intentional harm and not engaging in actions that can cause others to get harmed was considered by some to be the most critical principle, even though the hierarchy advocates for equality among them (Forester-Miller & Rubenstein, 1992). Counselors should consider both potential harms and benefits when working toward ensuring nonmaleficence in counseling practices.

Benevolence 

Beneficence is about “doing good” and trying to prevent harm from happening – not only to you but also to others. To illustrate, we can think of a nurse who has an interest in helping people maintain their health and wellness (e.g., through healthy eating and exercise routines). 

A family practice physician might prescribe medication and make sure follow-up appointments take place for their patients as they work to help them manage their illnesses. Similarly, counselors are interested this sense of doing good or preventing harm; however they do so primarily through verbal interactions (e.g., through interpretation and feedback).

Dual Relationships

In addition to their professional (or therapeutic) relationship, dual relationships can be described as social interactions between counsellor and client. Clients and counsellors are likely to confront natural hurdles when forming connections outside of the therapy session because the relationship began in a therapeutic context, which imposes behaviour constraints and needs special decorum from both parties.

Counsellors must establish clear and realistic boundaries around their professional connection with their clients in order to overcome challenges with dual relationships. Such limits must take into account each client’s demands and qualities, as well as how they will impact the entire relationship. 

Codes of practise and standards are helpful for establishing these limits; nevertheless, professionals must be attentive to the unique demands of each relationship and use this information to assist decision-making throughout the counselling process.

Allegiance 

Fidelity means being loyal to your clients when you are in a counseling relationship. The client needs to be able to trust the counselor and have faith in the therapeutic relationship if growth is to occur, so the counselor must take care not to threaten the therapeutic relationship or leave their clients in a lurch by failing to honor a commitment.

Informed consent 

Informed consent is a term that refers to a procedure taken in therapy. Informed consent means that the counsellor needs to provide information to his or her patient, who then proceeds with treatment after being fully informed of all the necessary details. Informed consent is an important part of therapy because it helps build trust, respect, and rapport between the client and therapist. 

A lot of people think that informed consent isn’t important for service providers such as lawyers or nurse practitioners, but actually it’s really important for all therapeutic relationships – even more so than other professions considering trust is so crucial when dealing with mental health issues. 

It’s very important on many levels for therapists to be honest with their patients about everything so they know exactly what to expect while getting treated, especially if their patients are minors.

Justice 

If a person is to be treated differently, the counsellor must be able to provide a justification that explains why treating the individual differently is necessary and acceptable. Instead of sending a person who is blind a conventional written form to fill out, a counsellor might provide him or her a form in braille or go through the form with that individual verbally as an example of fairness. In all other ways, the counsellor would treat him or her the same as any other client.

Confidentiality and duty to report 

Doctors and therapists deal with a very delicate and sensitive issue: duty-to-warn, also called mandatory reporting. This concept goes against the ethics of confidentiality and is a paradoxical form of thinking for any professional to grapple with; thus deciding whether or not to report a client can be such an agonizing choice. 

Nonetheless it is imperative to ensure there are no threats to others in any client you come across.

It may be characterised as the need to breach client confidentiality in order to safeguard the client or the community as a whole, when the client poses a threat to his/her personal safety, the safety of the community, or the legal framework that the community adheres to.

Basics of avoiding ethical dilemmas in counselling 

An ethical quandary is a disagreement between two ethically right actions. There is a clash of ideals or principles. The conundrum is that you will be doing something both right and wrong at the same moment, and adopting one right option will negate the other right course.

• Understand what constitutes a multiple relationship.

• Protect confidentiality.

• Respect people’s autonomy.

• Know your supervisory responsibilities.

• Identify your client and role.

• Document, document, document.

• Practice only where you have expertise.

• Build a culture of integrity — from the top down.

• Talk about the importance of ethics.

• Keep employees adequately informed about issues that impact them.

• Uphold promises and commitments to employees and stakeholders.

• Acknowledge and reward ethical conduct.

• Hold accountable those who violate standards, especially leaders.

Ethical decision making is a process fundamental to a professional practice of counseling. Ethical codes of conduct generated by professional organizations rest on the general moral principles that guide counselors’ behavior within professional relationships. 

Counselors have generally agreed that the moral principles of autonomy, diligence, nonmaleficence, justice, veracity, and fidelity provide the conceptual underpinnings for ethical decision making.

When counselors learn about these ethical codes, they must consider them as a unified whole. The codes can be used to examine potential conflicts and evaluate their own behavior in the face of an ethical dilemma.

Counselors and all professionals adhere to and appreciate ethical standards and aspire to “do no harm,” honoring their integrity in all matters both personal and professional

Conclusion 

Counselors are professionals, and they are expected to have a certain set of abilities as a result of their training, experience, and education. Counselors must grasp and display an awareness of the significance, importance, and relevance of their activities in order to make appropriate ethical judgments.

It’s important to remain ethical when making critical decisions so that people you are serving feel confident in the services provided. So give yourself enough time to carefully consider your options and present choices with as much clear visualization as possible so as to avoid accidentally imposing any unnecessary confusions or complications on those who require your expertise. 

Ensure anyone can unravel the process of decision-making so as to provide the greatest sense of comfort and security, and give yourself enough time to go through these considerations thoroughly: Keep an open mind and weigh every side of the situation.

Citations 

Practitioner’s Guide to Ethical Decision Making by Holly Forester-Miller, Ph.D. and Thomas E. Davis, Ph.D. https://www.counseling.org/docs/default-source/ethics/practioner-39-s-guide-to-ethical-decision-making.pdf

Counseling Ethics by http://psychology.iresearchnet.com/counseling-psychology/counseling-ethics/

Ethical Situations in Counselling