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THEORY AND PRACTICE OF COUNSELING AND
PSYCHOTHERAPY
CHAPTER 1: INTRODUCTION AND OVERVIEW
INTAKE INTERVIEW AND STAN’S AUTOBIOGRAPHY
Stan comes to counseling because of his drinking.
He was convicted of driving under the influence, and
the judge determined that he needed professional
help.
Stan recognizes that he does have problems, but he
is not convinced that he is addicted to alcohol.
When it comes to my personal life, I’ve always had
difficulty in getting along with people.
I like people in my life, but I don’t seem to know how
to stay close to people.
Probably the reason I sometimes drink a bit too
much is because I’m so scared when it comes to
socializing.
I’m afraid that people don’t find me very interesting.
I’m a part-time college student majoring in
psychology.
I can’t afford to really commit myself to pursuing
college full time because I need to work to support
myself.
Someday, I’m hoping to get a master’s degree in
counseling or in social work and eventually work as a
counselor with kids who are in trouble.
I have few friends and feel scared around most
people.
One of my problems is that I frequently get drunk.
This happens when I feel alone and when I’m scared
of the intensity of my feelings.
I have abused drugs in the past also.
I feel overwhelmed and intimidated when I’m
around attractive women
I think about committing suicide, and I wonder who
would care.
I get down on myself and wallow in guilt and feel
very depressed.
I know that nobody is going to change my life for me.
It’s up to me to get what I want.
A major turning point for me was the confidence my
supervisor had in me at the youth camp where I
worked the past few summers.
He helped me get my job, and he also encouraged
me to go to college.
He said he saw a lot of potential in me for being able
to work well with young people.
That was hard for me to believe, but his faith
inspired me to begin to believe in myself.
Another turning point was my marriage and divorce.
Joyce was a strong and dominant woman who kept
repeating how worthless I was and how she did not
want to be around me.
My mother (Angie) constantly criticized my father
(Frank Sr).
My parents compared me unfavourably with my
older sister (Judy) and older brother (Frank Jr.).
They were “perfect” children, successful honour
students.
My younger brother (Karl) and I fought a lot.
They spoiled him.
In high school I started using drugs.
I was thrown into a youth rehabilitation facility for
stealing.
Later I was expelled from regular school for fighting,
and I landed in a continuation high school, where I
went to school in the mornings and had afternoons
for on-the-job training.
I got into auto mechanics, was fairly successful, and
even managed to keep myself employed for 3 years
as a mechanic.
I can still remember my father asking me: “Why can’t
you be like your sister and brother? Why can’t you
do anything right?” And my mother treated me
much the way she treated my father.
Most of all, I would like to start feeling better about
myself.
I would like to be able to stop drinking altogether
and still feel good.
I want to like myself much more than I do now.
I hope I can learn to love at least a few other people,
most of all, a woman.
I want to lose my fear of women.
I would like to feel equal with others and not always
have to feel apologetic for my existence.
I want to let go of my anxiety and guilt.
I want to become a good counselor for kids.
I do know that I want to be free of my self-
destructive tendencies and learn how to trust people
more.
Perhaps when I begin to like myself more, I’ll be able
to trust that others will find something about me to
like.
OVERVIEW OF SOME KEY THEMES IN STAN’S LIFE
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Although I’d like to have people in my life, I just
don’t seem to know how to go about making friends
or getting close to people.
I’d like to turn my life around, but I have no sense of
direction.
I want to make a difference.
I am afraid of failure.
I know when I feel alone, scared, and overwhelmed, I
drink heavily to feel better.
I am afraid of women.
Sometimes at night I feel a terrible anxiety and feel
as if I’m dying.
I often feel guilty that I’ve wasted my life, that I’ve
failed, and that I’ve let people down. At times like
this, I get depressed.
I like it that I have determination and that I really
want to change.
I’ve never really felt loved or wanted by my parents.
I’d like to get rid of my self-destructive tendencies
and learn to trust people more.
I put myself down a lot, but I’d like to feel better
about myself.
CHAPTER 2: THE COUNSELOR: PERSON AND
PROFESSIONAL
THE COUNSELOR AS A THERAPEUTIC PERSON
Counseling is an intimate form of learning, and it
demands a practitioner who is willing to be an
authentic person in the therapeutic relationship
It’s within the context of such a person-to-person
connection that the client experiences growth
Our own genuineness can have a significant effect on
our relationship with our clients
The centrality of the person of the therapist as a
primary factor in successful therapy
The person of the psychotherapist is inextricably
intertwined with the outcome of psychotherapy
Clients place more value on the personality of the
therapist than on the specific techniques used
Evidence-based psychotherapy relationships are
critical to the psychotherapy endeavour
Techniques have limited importance in the
therapeutic process
The contextual factors are the primary determinants
of therapeutic outcome
Alliance
Relationship
Personal and Interpersonal Skills of the
Therapist
Client Agency
Extra-Therapeutic Factors
The therapy relationship and the therapy methods
used influence the outcomes of treatment, but it
essential that the methods used support the
therapeutic relationship being formed with the client
PERSONAL CHARACTERISTICS OF EFFECTIVE
COUNSELORS
Identity. They know who they are, what they are
capable of becoming, what they want out of life, and
what is essential.
Respect and appreciate themselves. They can give
and receive help and love out of their own sense of
self-worth and strength. They feel adequate with
others and allow others to feel powerful with them
Open to change. They exhibit a willingness and
courage to leave the security of the known if they
are not satisfied with the way they are. They make
decisions about how they would like to change, and
they work toward becoming the person they want to
become
Make choices that are life oriented. They are aware
of early decisions they made about themselves,
others, and the world. They are not victims of these
early decisions, and they are willing to revise them if
necessary. They are committed to living fully rather
than settling for mere existence.
Authentic, sincere and honest. They don’t hide
behind rigid roles or facades. Who they are in their
personal life and in their professional work is
congruent
Sense of Humour. They are able to put the events of
life in perspective. They have not forgotten how to
laugh, especially at their own foibles and
contradictions.
Make mistakes and are willing to admit them. They
don’t dismiss their errors lightly, yet they don’t
choose to dwell on misery.
Generally live in the present. They’re not riveted to
the past, nor are they fixated on the future. They are
able to experience and be present with others in the
“now”
Appreciate the influence of culture. They’re aware
of the ways in which their own culture affects them,
and they respect the diversity f values espoused by
other cultures. They are sensitive to the unique
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differences arising out of social class, race, sexual
orientation, and gender.
Sincere interest in the welfare of others. This
concern is based on respect, care, trust, and a real
valuing of others
Possess effective interpersonal skills. They’re
capable of entering the world of others without
getting lost in this world, and they strive to create
collaborative relationships with others. They readily
entertain another person’s perspective and can work
together toward consensual goals.
Become deeply involved in their work and derive
meaning from it. They can accept the rewards
flowing from their work, yet they’re not slaves to
their work
Passionate. They have the courage to pursue their
dreams and passions, and they radiate a sense of
energy
Able to maintain healthy boundaries. Although they
strive to be fully present for their clients, they don’t
carry the problems of their clients around with them
during leisure hours. They know how to say no,
which enables them to maintain balance in their
lives.
PERSONAL THERAPY FOR THE COUNSELOR
Counselors can benefit greatly from the experience
of being clients at some time
The vast majority of mental health professionals
have experienced personal therapy
A review of research studies on the outcomes and
impacts of the psychotherapist’s own psychotherapy
revealed that more than 90% of mental health
professionals report satisfaction and positive
outcomes from their own counseling experiences
Orlinsky and colleagues suggest that personal
therapy contributes to the therapist’s professional
work in following 3 ways:
As part of the therapist training, personal
therapy offers a model of therapeutic practice
in which the trainee experiences the work of a
more experienced therapist and learns
experientially what’s helpful or not helpful
A beneficial experience in personal therapy can
further enhance a therapist’s interpersonal
skills that are essential to skilfully practicing
therapy
Successful personal therapy can contribute to a
therapist’s ability to deal with the ongoing
stresses associated with clinical work.
Norcross states that lasting lessons practitioners
learn from their personal therapy experiences
pertain to interpersonal relationships and the
dynamics of psychotherapy
Counselors can prevent their potential future
countertransference from harming clients by
participating in personal therapy
Through our work as therapists, we can expect to
confront our own unexplored personal blocks
This doesn’t mean that we need to be free of
conflicts before we can counsel others, but we
should be aware of what these conflicts are and
how they’re likely to affect us as persons and as
counsellors.
Personal therapy can be instrumental in healing the
healer.
By becoming clients ourselves, we gain an
experiential frame of reference with which to view
ourselves.
Our own therapy can help us develop patience with
our patients
As we increase our self-awareness through our own
therapy, we gain increased appreciation for the
courage our clients display in their therapeutic
journey
Gold and Hilsenroth studied graduate clinicians and
found that those who had personal therapy felt
more confident and were more in agreement with
their clients on the goals and tasks of treatment than
were those who didn’t experience personal therapy.
Participating in a process of self-exploration can
reduce the chances of assuming an attitude of
arrogance or of being convinced that we are totally
healed
Our own therapy helps use avoid assuming a stance
of superiority over others and makes it less likely
that we would treat people as objects to be pitied or
disrespected.
THE COUNSELOR’S VALUES AND THE THERAPEUTIC
PROCESS
ROLE OF VALUES IN COUNSELING
Our values are core beliefs that influence how we
act, both on our personal and our professional lives.
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We need to guard against the tendency to use our
power to influence clients to accept our values;
persuading clients to accept or adopt our value
system is not a legitimate outcome of counseling.
The counseling task is to assist individuals in finding
answers that are most congruent with their own
values
You may not agree with certain of your clients’
values, but you need to respect their right to hold
divergent values from yours.
Your role is to provide a safe and inviting
environment in which clients can explore the
congruence between their values and their
behaviour
If clients acknowledge that what they’re doing is not
getting them what they want, it’s appropriate to
assist them in developing new ways of thinking and
behaving to help them move closer to their goals.
Bracketing, managing your personal values so that
they don’t contaminate the counseling process
Counselors must have the ability to work with a
range of clients with diverse worldviews and values.
Value imposition, refers to counsellors directly
attempting to define a client’s values, attitudes,
beliefs, and behaviours.
Value exploration is at heart of why many counselor
education programs encourage or require personal
therapy for counsellors in training.
Clients are in a vulnerable position and require
understanding and support from a counselor rather
than judgment
Counseling is about working with clients within the
framework of their value system
If you experience difficulties over conflicting
personal values with clients, the ethical course of
action is to seek supervision and learn ways to
effectively manage these differences.
THE ROLE OF VALUES IN DEVELOPING THERAPEUTIC
GOALS
The general goals of counsellors must be congruent
with the personal goals of the client.
The client and the counselor need to explore what
they hope to obtain from the counseling
relationship, whether they can work with each other,
and whether their goals are compatible.
Therapy ought to begin with an exploration of the
client’s expectations and goals.
The initial interview can be used most productively
to focus on the client’s goals or lack of them.
When a person seeks a counseling relationship with
you, it’s important to cooperatively discover what
this person is expecting from the relationship
It’s the client’s place to decide on the goals of
therapy
BECOMING AN EFFECTIVE MULTICULTURAL
COUNSELOR
Learning how to recognize diversity issues and
shaping one’s counseling practice to fit the client’s
worldview
It’s an ethical obligation for counselors to develop
sensitivity to cultural differences if they hope to
make interventions that are consistent with the
values of their clients
Counselors need to become aware of how clients
from diverse cultures may perceive them as
therapist, as well as how clients may perceive the
value of formal helping.
Effective counseling must take into account the
impact of culture on the client’s functioning,
including the client’s degree of acculturation
Culture, the values and behaviours shared by a
group of individuals
ACQUIRING COMPETENCIES IN MULTICULTURAL
COUNSELIING
Effective counselors understand their own cultural
conditioning, the cultural values of their clients, and
the sociopolutical system of which they’re a part.
Counselors from all cultural groups must examine
their expectations, attitudes, biases, and
assumptions about the counseling process and about
persons from diverse groups
Everyone has biases, but being unaware of the
biased attitudes we hold is an obstacle to client care
Becoming a diversity-competent counselor involves
challenging the idea that the values we hold are
automatically true for others.
BELIEFS AND ATTITUDES
They believe cultural self-awareness and sensitivity
to one’s own cultural heritage are essential for any
form of helping
Counselors are aware of their positive and negative
emotional reactions toward people from other racial
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and ethnic groups that may prove detrimental to
establishing collaborative helping relationships
They seek to examine and understand the world
from the vantage point of their clients
They respect clients’ religious and spiritual beliefs
and values
They’re comfortable with the differences between
themselves and others
They’re able to accept and value cultural diversity
They realize that traditional theories and techniques
may not be appropriate for all clients or for all
problems
Skilled counselors monitor their functioning through
consultation, supervision, and further
training/education
KNOWLEDGE
They know specifically about their own racial and
cultural heritage and how it affects them personally
and professionally
They’re in a position to detect their own racist
attitudes, beliefs, and feelings
They understand the worldview of their clients, and
they learn about their clients’ cultural background
They don’t impose their values and expectations on
their clients from differing cultural backgrounds and
avoid stereotyping clients
Culturally skilled counselors understand that
external socio-political forces influence all groups,
and they know how these forces operate with
respect to the treatment of minorities
They possess knowledge about the historical
background, traditions, and values of the client
populations with whom they work
They know about minority family structures,
hierarchies, values and beliefs
They know how to help clients makes use of
indigenous support systems
They seek resources to assist them in areas where
they are lacking in knowledge
The greater their depth and breadth of knowledge of
culturally diverse groups, the more likely they’re to
be effective practitioners
SKILLS AND INTERVENTION STRATEGIES
Counselors take responsibility for educating their
clients about the therapeutic process
Multicultural counseling is enhanced when
practitioners use methods and strategies and define
goals consistent with the life experiences and
cultural values of their clients
Such practitioners modify and adapt their
interventions to accommodate cultural differences
They don’t force their clients to fit within one
counseling approach, and they recognize that
counseling techniques may be culture-bound
They’re able to send and receive both verbal and
non verbal messages accurately and appropriately
They become actively involved with minority
individuals outside the office
They’re willing to seek out educational, consultative,
and training experiences to enhance their ability to
work with culturally diverse client populations
They consult regularly with other multiculturally
sensitive professionals regarding issues of culture to
determine whether referral may be necessary
INCORPORATING CULTURE IN COUNSELING PRACTICE
It’s a good idea for counselors to ask clients to
provide them with the information they will need to
work effectively
It’s critical that therapists take into account the
worldview and background of every client
Counseling is by its very nature diverse in a
multicultural society, so it’s easy to see that there
are no ideal therapeutic approaches
Different theories have distinct features that have
appeal for different cultural groups
Effective multicultural practice demands an open
stance on the part of the practitioner, flexibility, and
a willingness to modify strategies to fit the needs
and the situation of the individual client
Practitioner who truly respect their clients will be
aware of clients’ hesitations and will not be too quick
to misinterpret this behaviour
Instead, they will patiently attempt to enter the
world of their clients as much as they can
The empathy shown by counselors for the feelings
and struggles of their clients is essential to good
therapeutic outcomes
PRACTICAL GUIDELINES IN ADDRESSING CULTURE
Learn more about how you own cultural background
has influences your thinking and behaving
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Identify your basic assumptions, especially as they
apply to diversity in culture, ethnicity, race, gender,
class, spiritually, religion and sexual orientation.
Think about how your assumptions are likely to
affect your professional practice
Examine where you obtained your knowledge about
culture
Remain open to ongoing learning of how the various
dimensions of culture may affect therapeutic work.
Be willing to identify and examine your own personal
worldview and any prejudices you may hold about
other racial/ethnic groups
Learn to pay attention to the common ground that
exists among people of diverse backgrounds
Be flexible in applying the methods you use with
clients
Remember that practicing from a multicultural
perspective can make your job easier and can be
rewarding for both you and your clients
Multicultural competence requires a combination of
cultural awareness and sensitivity, to a body of
knowledge, and to a specific set of skills.
ISSUES FACED BY BEGINNING THERAPISTS
DEALING WITH ANXIETY
A willingness to recognize and deal with these
anxieties is a positive sign
Self-doubts are normal; it’s how we deal with them
that matters
Discuss self-doubt with a supervisor and peers
The possibilities are rich for meaningful exchanges
and for gaining support from fellow interns who
probably have many of the same concerns and
anxieties
BEING YOURSELF AND SELF-DISCLOSURE
If we’re able to be ourselves in our therapeutic work,
and appropriately disclose our reactions in
counseling sessions, we increase the chances of
being authentic
It’s this level of genuineness and presence that
enables us to connect with our clients and to
establish an effective therapeutic relationship with
them.
2 extremes for counselors:
Counselors who lose themselves in their fixed
role and hide behind a professional façade
Engaging too much self-disclosure
In determining the appropriateness of self-
disclosure, consider what, when, and how
much to reveal
Remain observant during any self-disclosure to
get a sense of how the client is being affected
by it.
The most productive form of self-disclosure is
related to what’s going on between the counselor
and the client within the counseling session
Sharing persistent reactions can facilitate
therapeutic progress and improve the quality of our
relationship with the client
Even when we are talking about reactions based on
the therapeutic relationship, caution is necessary,
and discretion and sensitivity are required in
deciding what reactions we might share.
AVOIDING PERFECTIONISM
If our energies are tied up presenting an image of
perfection, this will affect our ability to be present
for our clients.
Students willing to risk making mistakes in
supervised learning situations and willing to reveal
their self-doubts will find a direction that leads to
growth
BEING HONEST ABOUT YOUR LIMITATIONS
It’s important to learn when and how to make a
referral for clients when your limitations prevent you
from helping them
Before deciding that you don’t have the life
experiences or the personal qualities to work with a
given population, try working in a setting with a
population you don’t intend to specialize in
UNDERSTANDING SILENCE
The client may be waiting for the therapist to take
the lead and decide what to say next, or the
therapist may be waiting for the client to do this.
The silence may be refreshing, or may be
overwhelming
Perhaps the interaction has been on a surface level,
and both persons have some fear or hesitancy about
getting to a deeper level
When silence occurs, acknowledge and explore with
your client the meaning of the silence
DEALING WITH DEMANDS FROM CLIENTS
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One way of heading off these demands is to make
your expectations and boundaries clear during the
initial counseling sessions or in the disclosure
statement.
DEALING WITH CLIENTS WHO LACK COMMITMENT
Counselors who omit preparation and don’t address
clients’ thoughts and feelings about coming to
counseling are likely to encounter resistance
It’s critical that therapists not promise what they
cannot or will not deliver
It’s good practice to make clear the limits of
confidentiality as well as any other factors that may
affect the course of therapy
It’s especially important to prepare them for the
process; doing so can go a long way toward
increasing their cooperation and involvement
TOLERATING AMBIGUITY
Realize that oftentimes clients may seemingly “get
worse” before they show therapeutic gains
Realize that the fruitful effects of the joint efforts of
the therapist and the client may manifest themselves
after the conclusion of therapy
BECOMING AWARE OF YOUR COUNTERTRANSFERENCE
If you’re unaware of your personal dynamics, you’re
in danger of being overwhelmed by a client’s
emotional experiences
The most therapeutic thing is to be a fully present as
we are able to be during the therapy hour, but to let
clients assume the responsibility of their living and
choosing outside of the session
Countertransference, any of our projections that
influence the way we perceive and react to a client.
Recognizing the manifestations of our
countertransference reactions is an essential step in
becoming competent counselors
It’s all the more important that we be willing to work
on ourselves in our own sessions with another
therapist, supervisor, or colleague
The emotionally intense relationships we develop
with clients can be expected to tap into our own
unresolved problem areas
We have to realize that it’s their pain and not carry it
for them lest we become overwhelmed by their life
stories and thus render ourselves ineffective in
working with them
Our personal therapy can be instrumental in
enabling us to recognize and manage our
countertransference reactions
DEVELOPING A SENSE OF HUMOR
It’s important to recognize that laughter/humour
doesn’t mean that clients aren’t respected or work is
not being accomplished
There are times when laughter is used to cover up
anxiety or to escape from the experience of facing
threatening material
SHARING RESPONSIBILITY WITH THE CLIENT
One mistake is to assume full responsibility for the
direction and outcomes of therapy
Another mistake is for you to refuse to accept the
responsibility for making accurate assessments and
designing appropriate treatment plans for your
clients
It’s important to be alert to your clients’ efforts to
get you to assume responsibility for directing their
lives
It’s not your role to assume responsibility for
directing your clients’ lives
DECLINING TO GIVE ADVICE
Therapist help clients discover their own solutions
and recognize their own freedom to act
Our task is to help clients make independent choices
and accept the consequences of their choices
DEFINING YOUR ROLE AS A COUNSELOR
The central function of counseling is to help clients
recognize their own strengths, discover what’s
preventing them from using their resources, and
clarify what kind of life they want to live
Counseling is a process by which clients are invited
to look honestly at their behaviour and make certain
decisions about how they want to modify the quality
of their life
Counselors provide support and warmth, yet care
enough to challenge clients so that they will be able
to take the actions necessary to bring about
significant change
You will need to consider that the professional roles
you assume are likely to be dependent on factors
such as:
The clients populations
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Specific therapeutic services
Particular stage of counseling
Setting
You will have to reassess the nature of your
professional commitments and redefine your role at
various times
LEARNING TO USE TECHNIQUES APPROPRIATELY
Therapeutic techniques should evolve from the
therapeutic relationship and the material presented,
and they should enhance the client’s awareness or
suggest possibilities for experimenting with new
behaviour
It’s imperative that you know the theoretical
rationale for each technique you use, and you need
to be aware that the techniques are appropriate for
the goals of therapy
It’s important to avoid using techniques in a hit-or-
miss fashion, to fill time, to meet your own needs, or
to get things moving
Your methods need to be thoughtfully chosen as a
way to help clients make therapeutic progress
DEVELOPING YOUR OWN COUNSELING STYLE
You will inhibit your potential effectiveness in
reaching other if you attempt to imitate another
therapist’s style or if you fit most of your behaviour
during the session into the Procrustean bed of some
expert’s theory
Your counseling style will be influenced by others,
but don’t blur your potential uniqueness by trying to
imitate them
MAINTAINING YOUR VITALITY AS A PERSON AND AS A
PROFESSIONAL
It’s of paramount importance that we take care of
ourselves, for how can we take care of others if we
are not taking care of ourselves
We need to work at dealing with those factors that
threaten to drain life from use and render us
helpless
Consider how you can apply the theories you will be
studying to enhance your life from both a personal
and a professional standpoint.
Learn to look within yourself to determine choices
you’re making (and not making) to keep yourself
vital
Professional Burnout
You cannot always control stressful events, but you
don’t have a great deal of control over how you
interpret and react to these events
It’s important to realize that you cannot continue to
give and give while getting little in return
There is a price to pay for always being available and
for assuming responsibility over the lives and
destinies of others.
Self-monitoring is a crucial 1
st
step in self-care
You can determine whether you’re living the way
you want to live
Decide what you’re willing to actually do to make
changes occur
By being in tune with yourself, by having the
experience of centeredness and solidness, and by
feeling a sense of personal power, you have the
foundation for integrating your life experiences with
your professional experiences
Such an awareness can provide the basis for
retaining your physical and psychological vitality and
for being an effective professional
Self-care is an ethical mandate
It’s not possible to provide nourishment to our
clients if we are not nourishing ourselves
We must take care of ourselves physically,
psychologically, intellectually, socially, and spiritually
Our self-care should mirror the care we provide for
others
If we hope to have the vitality and stamina required
to stay focused on our professional goals, we need
to incorporate a wellness perspective into our daily
living
Wellness, the result of our conscious commitment to
a way of life that leads to zest, peace, vitality, and
happiness
CHAPTER 3: ETHICAL ISUES IN COUNSELING PRACTICES
INTRODUCTION
Mandatory ethics involves a level of ethical
functioning at the minimum level of professional
practice
Aspirational ethics focuses on doing what is in the
best interest of clients
Higher standards of thinking and conduct
It entails understanding the spirit of the code
and the principles on which the code is based
Fear-based ethics does not constitute sound ethical
practice
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Strive to work toward concern-based ethics, and
think about how you can become the best
practitioner possible
Positive Ethics is an approach taken by practitioners
who want to do their best for clients rather than
simply meet minimum standards to stay out of
trouble
PUTTING CLIENTS’ NEEDS BEFORE YOUR OWN
Ethically, it is essential that we become aware of our
own needs, areas of unfinished business, potential
personal problems, and especially our sources of
countertransference and
Our professional relationships with our clients exist
for their benefit.
It is not unethical for us to meet our personal needs
through our professional work, but it is essential that
these needs be kept in perspective.
An ethical problem exists when we meet our needs
at the expense of our clients’ needs
As helping professional, we must actively work
toward expanding our self-awareness and learn to
recognize our areas of prejudice and vulnerability
If we are aware of our personal problems and are
willing to work through them, there is less chance
that we will project them onto clients
We must also examine other, less obviously harmful
personal needs that can get in the way of creating
growth-producing relationships
It is crucial that we do not meet our needs at the
expense of our clients
ETHICAL DECISION MAKING
You will have to apply the ethics codes of your
profession to the many practical problems you face
Professionals are expected to exercise prudent
judgment when it comes to interpreting and
applying ethical principles to specific situations
Learn about the resources available to you
You should also be aware of the consequences of
practicing in ways that are not sanctioned by
organizations of which you’re member or the state in
which you’re licensed to practice.
THE ROLE OF ETHICS CODES AS A CATALYST FOR
IMPROVING PRACTICE
They educate counseling practitioners and the
general public about the responsibilities of the
profession.
They provide a basis for accountability, and protect
clients from unethical practices.
They provide a basis for reflecting on and improving
your professional practice.
Self-monitoring is a better route for professionals to
take than being policed by an outside agency
An unfortunate recent trend is for ethics codes to
increasingly take on legalistic dimensions, rule-based
dimensions
It makes sense to be aware of the legal aspects of
practice and to know and practice risk management,
but we should not lose sight of what’s best for our
clients
Prevent being sued for malpractice is to demonstrate
respect for clients, keep client welfare as a central
concern, and practicing within the framework of
professional codes.
No code of ethics can delineate what would be the
appropriate or best course of action in each
problematic situation a professional will face
Ethics codes are best used as guidelines to formulate
sound reasoning and serve practitioners in making
the best judgments possible.
SOME STEPS IN MAKING ETHICAL DECISIONS
1. Identify the problem or dilemma. Gather
information that will shed light on the nature of the
problem. This will help you decide whether the
problem is mainly ethical, legal, professional, clinical,
or moral.
2. Identify the potential issues. Evaluate the rights,
responsibilities, and welfare of all those who’re
involved in the situation
3. Look at the relevant ethics codes for general
guidance on the matter. Consider whether your own
values and ethics are consistent with or in conflict
with the relevant guidelines
4. Consider the applicable laws and regulations, and
determine how they may have a bearing on an
ethical dilemma
5. Seek consultation from more than one source to
obtain various perspectives on the dilemma, and
document in the client’s record the suggestions you
received from this consultation
6. Brainstorm various possible courses of action.
Continue discussing options with other
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professionals. Include the client in this process of
considering options for action. Again, document the
nature of this discussion with your client
7. Enumerate the consequences of various decisions,
and reflect on the implications of each course of
action for your client.
8. Decide on what appears to be the best possible
course of action. Once the course of action has been
implemented, follow up to evaluate the outcomes
and to determine if further action is necessary.
Document the reasons for the actions you took as
well as your evaluation measures
The more subtle the ethical dilemma, the more
complex and demanding the decision-making
process.
Demonstrate a willingness to explore various aspects
of a problem, raise questions, discuss ethical
concerns with others, and continually clarify your
values and examine your motivations.
THE RIGHT OF INFORMED CONSENT
It’s an ethical and legal requirement that is an
integral part of the therapeutic process.
It establishes a basic foundation for creating a
working alliance and a collaborative partnership
between the client and the therapist
It involves the right of clients to be informed about
their therapy and to make autonomous decisions
pertaining to it.
Promote the active cooperation of clients in their
counseling plan.
It is a positive approach that helps clients become
active partners and true collaborators in their
therapy
Aspects of Informed Consent
General Goals of Counseling
Responsibilities
Of the counselor toward the client
Of the client
Limitations and expectations to confidentiality
Legal and Ethical parameters that could define
the relationship
Qualifications and background of the
practitioner
Fees involved
Services the client can expect
Approximate length of the therapeutic process
Benefits of counseling
Risks involved
Possibility that the client’s case will be
discussed with the therapist’s
colleagues/supervisors
It’s wise to discuss the potential privacy problems of
using a wide range of technology and to take
preventive measures to protect both you and your
clients
Educating the client begins with the initial counseling
session and this process will continue for the
duration of counseling.
The challenge of fulfilling the spirit of informed
consent is to strike a balance between giving clients
too much information and giving them too little.
It can be provided in written form, orally or some
combination of both
It is a good idea to have basic information about the
therapy process in writing, as well as discussing with
clients topics that will enable them to get the
maximum benefit from their counseling experience.
DIMENSIONS OF CONFIDENTIALITY
Confidentiality is an ethical concept, and in most
states the legal duty of therapists to not disclose
information about a client.
Privileged communication is a legal concept that
protects clients from having their confidential
communications revealed in court without their
permission
All states have enacted into law some form of
psychotherapist-client privilege, but the specifics of
this privilege vary from state to state
Confidentiality is central to developing a trusting and
productive client therapist relationship
Counselors have an ethical and legal responsibility to
discuss the nature and purpose of confidentiality
with their clients early in the counseling process.
Clients have a right to know that their therapist may
be discussing certain details of the relationship with
a supervisor or a colleague
ETHICAL CONCERNS WITH THE USE OF TECHNOLOGY
Section H of the ACA Code of Ethics contains a new
set of standards with regard to the use of
technology, relationships established through
computer-mediated communication, and social
media as a delivery platform
EXCEPTIONS TO CONFIDENTIALTIY AND PRIVILIEGED
COMMUNICATION
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Therapist must consider the requirements of the
law, the institution in which they work, and the
clientele they serve
There is a legal requirement to break confidentiality
Here are some other circumstances in which
information must legally be reported by counselors:
When the therapist believes a client under the
age of 16 is the victim of incest, rape, child
abuse, or some other crime
When the therapist determines that the client
needs hospitalization
When information is made an issue in a court
action
When clients request that their records be
released to them or to a third party
The counselor’s primary obligation is to protect
client disclosures as a vital part of the therapeutic
relationship.
Informing clients about the limits of confidentiality
does not necessarily inhibit successful counseling.
ETHICAL USSUES IN A MULTICULTURAL PERSPECTIVE
Ethical practice requires that we take the client’s
cultural context into account in counseling practice.
ARE CURRENT THEORIES ADEQUATE IN WORKING
WITH CULTURALLY DIVERSE POPULATIONS?
Current theories need to be, and can be, expanded
to include a multicultural perspective.
For traditional theories to be relevant in a
multicultural society, they must incorporate an
interactive person-in-the-environment focus.
It’s essential for therapists to create therapeutic
strategies that are congruent with the range of
values and behaviors that are characteristic of a
pluralistic society.
IS COUNSELING CULTURE-BOUND?
Western models of counseling have some limitations
when applied to special populations and cultural
groups
Multicultural writers have asserted that theories of
counseling and psychotherapy represent different
worldviews, each with its own values, biases, and
assumptions about human behavior.
Contemporary therapy approaches are grounded on
a core set of values, which are neither value-neutral
nor applicable to all cultures
Competent therapists understand themselves as
social and cultural beings and possess at least
minimum level of knowledge and skills that they can
bring to bear on any counseling situation.
Counselors need to understand and accept clients
who have a different set of assumptions about life,
and they need to be alert to the possibility of
imposing their own worldview
FOCUSING ON BOTH INDIVIDUAL AND
ENVIRONMENTAL FACTORS
They view individuals in the context of the family and
the culture, and their aim is to facilitate social action
that will lead to change within the client’s
community rather than merely increasing the
individual’s insight.
An adequate theory of counseling does deal with the
social and cultural factors of an individual’s
problems.
It is essential to focus on both individual and social
factors if change is to occur.
ETHICAL ISSUES IN THE ASSESSMENT PROCESS
THE ROLE OF ASSESSMENT AND DIAGNOSIS IN
COUNSELING
Assessment, an ongoing part of the therapeutic
process that leads to a formal diagnosis
Assessment consists of evaluating the relevant
factors in a client’s life to identify themes for further
exploration in the counseling process
Diagnosis, which is sometimes part of the
assessment process, consists of identifying a specific
mental disorder based on a pattern of symptoms
The purpose of diagnosis in counseling and
psychotherapy is to identify disruptions in a client’s
present behavior and lifestyle.
A diagnosis provides a working hypothesis that
guides the practitioner in understanding the client.
Diagnosis begins with the intake interview and
continues throughout the duration of therapy.
Diagnostic and Statistical Manual of Mental
Disorders as the guide to practitioners in making
diagnostic assessments
This manual advises practitioners that it represents
only an initial step in a comprehensive evaluation
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and that it is necessary to gain information about the
person being evaluated beyond that required for a
DSM diagnosis.
Some clinicians view diagnosis as central to the
counseling process, others view it as unnecessary, as
a detriment, or as discriminatory against ethnic