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> Now I'd like to talk about ethical issues in counseling practice. This is a real challenge to be able to integrate all of this in one very short 15 or 20-minute segment because I teach a whole course for 16 weeks on ethics. But I'm just going to take a few topics. First one is putting your client's needs before your own. I think our main job as counselors is to be attentive to the welfare of our clients, and I think we always want to ask the question, "What is best for each client?" That ought to be our guideline, and unfortunately sometimes ethics and the law get intertwined and mixed, and I think they are very different entities, although there's some relationship between ethics and the law, but ethics is far more than just following a code of ethics and state laws that have some relationship to counseling. I mentioned ethical codes. It's important to know the codes of your profession. For example, American Psychological Association has a code. The social workers have a code. Licensed counselors have a code. American Counseling Association has a code of ethics. And all of these codes undergo revision approximately every 5 to 7 years. So don't think of a code of ethics as something that's in concrete, that never changes. As times change and new issues come up, the codes are revised and re-looked at. I'd like to differentiate between what we sometimes call mandatory ethics versus aspirational ethics. Mandatory ethics means that we're simply following the basics. We're following the codes basically, but we may not be functioning at the highest level. Aspirational ethics, on the other hand, means that we're really concerned about the spirit of the ethical codes and we go out of our way to do more than what's minimally required. An example of that would be doing pro bono work, giving away some of our services for no charge or greatly reduced fee. So I hope that as long as you're in this profession you think of ethics, not as something that you want to do to keep yourself out of trouble or keep yourself from getting involved in a malpractice suit or losing your license, although all those are important topics, but more in terms of how it can enhance your practice. If you're an ethical practitioner, you're going to probably be a very effective practitioner. That's the spirit I'm hoping you'll be thinking about. There are steps in resolving an ethical decision, and so when you meet an ethical dilemma, and we're going to all meet them as long as we're in practice, I hope you would be open to thinking that you don't have to all of this thinking and deciding on your own. You have colleagues, you have supervisors, and we can always go to others and say, "I'd like input. I'd like some feedback. I've got a dilemma here, and it would be helpful if I could bounce this topic off of you and this issue and just get another perspective." So don't think that you have to solve an ethical dilemma by yourself, no matter how long you've been in the, in this kind of work. Also realize that your client is a very important part of working through an ethical dilemma. As much as possible, I think we want to include the client in the process of making ethical decisions. There are 8 steps that we frequently talk about, different models of working through ethical dilemmas like, first of all looking at what is the nature of the problem. Is it an ethical dilemma, a legal matter, a clinical issue, and then the last step is probably reviewing what we did making a decision and then rethinking about this. Another area that I want to cover relative to ethics is informed consent. Nowadays informed consent is central to effective counseling, and we really need to be attentive to this with our clients from the very beginning, and there are two errors we could make. On one hand we can overload our client with too much information, too soon about the counseling process. On the other hand, if we don't cover certain topics from the very beginning, we may be in problems. So there's a balance between giving too much information and too little in the initial stages of counseling, and I think what we want to do is include the client in this process and ask the client, "Is there anything you need to know or would like to know about how you and I will be working in this process," and realize it may take two, three, several sessions to address many of the topics that are part and parcel of informed consent. Just a few areas that we want to think about with informed consent are, you know, how does therapy work, confidentiality-that's a very big area. You don't want to say to your client, "Whatever we say in here I'll never talk about," because there are limitations. So you certainly want to talk about the limitations of confidentiality, like when you might have to breach confidentiality because of legal or ethical reasons. So that's something you'd want to attend to up front. But other areas, like what techniques you might use, what's your theoretical orientation, the matter of fees, the matter of homework, the matter of how clients can get the most from their therapy, the benefits and the risks of being in therapy. There are just a whole array of topics that clients need to have information about and have dialogue with you as a counselor, but it all doesn't have to be accomplished after the first session. Don't overwhelm your client with too much, and be primarily concerned about listening to the client's reason for being there, the client's story, the client's perception of his or her problems. That's the first thing we want to do. One area of confidential... of ethics is confidentiality. Now we can't cover all aspects of this, but at least I want to educate clients about what it is-means that I won't be talking about what we discuss in here except in limited sorts of ways. We talked about that. And also if I'm in supervision as a trainee, I'll need to talk about our conversations, but I may not need to identify you by name. The other aspect is that I would hope you as a client are free to ask questions at any juncture of our therapy about confidentiality. So if you ever worry about that, you can say, "You know, this is a concern." Technology and confidentiality is another area. Nowadays there's online counseling, there's email, there are all sorts of technologies that compromise confidentiality, and I think our clients need to know that what they talk about, if it's done not just in person one to one, but it's done, let's say, online, that we can't guarantee confidentiality, that there are limitations. So that is an area that we need to examine. I mentioned earlier something about becoming a multiculturally effective counselor. I'd like to talk about culture as an ethical issue in counseling. We cannot afford as counselors to ignore the client's culture or how culture is going to be emerging in the counseling sessions. If we do ignore culture, our counseling won't be very effective. So from an ethical standpoint, I think we need to be attentive to the client's culture and how it's being played out in our counseling sessions--extremely important. As I mentioned earlier, we can't know everything about a client's culture, and we don't have to be perfect. We will, at times, maybe be insensitive or make a mistake, but if we're respectful of our clients and we're really open to feedback from the client and encourage our clients to let us know if something we're doing or not doing is effecting their ability to get the most from our relationship, particularly because of their cultural values or certain cultural beliefs, I think we're going to be far more ahead of the practice. I want to mention something about evidence-based practice from an ethical perspective. Again, currently there's a lot more emphasis on using scientific and empirically proven techniques for given problems, and there are pluses and minuses on that. I'd like to just very briefly say that evidence-based practice probably is here to stay, but I don't think it has to rule us, and I think we can think of evidence-based practice from a broader perspective. It's not just going to a pool of techniques and pulling out techniques that have been empirically validated. I think there are three big pillars of evidence-based practice. One is the clinician's expertise. That's the first part. The clinician, you as a clinician, have expertise, and you're an artist in some ways, and what you bring to the counseling session needs to be factored in. Secondly, your client is a very important variable in evidence-based practice. Your client's needs, preferences, culture, and client characteristics are a very important part of this counseling process. So you really want to be very attentive to that. Thirdly are techniques that have a research base and research support, but you see, evidence-based practice, then, has techniques that have some validation. Also the client is important and the counselor, and hopefully, again, we won't get lost in finding research to support every single intervention we make. Realize that research is important, but that it's only one piece of the mix, and that even though we may work in an agency that requires us to be thinking about evidence-based practice, we don't have to allow ourselves to be slaves to that. I'd like to make a quick comment about-this is a topic that's dear to my heart, and I'd like to spend a lot more time but we don't have it-is about managing boundaries and multiple relationships as an ethical issue and concern. You know, there was, in the past, a lot of concern about dual relationships. The favorite term now is multiple relationships because sometimes we occupy more than just one role with a client-or even two roles. And I think our main role with our client is professional, but it's very difficult sometimes to say we have only one role. In small communities, sometimes we'll see our client in a grocery store, in a bank, or on the street or in a church, and I think we cannot always avoid, you know, dual relationships and multiple relationships, but we can manage them, and we can realize that boundaries are there to protect the client, but we don't have to think that all multiple relationships are unethical or exploitative or harmful. I think the key is to realize that we don't want to exploit a client ever, and certainly we don't want to harm a client. Boundaries are somewhat flexible, and there's a difference certainly between boundary crossing and boundary violation. So some areas like boundary violation, we want to stay away from for sure where they would harm a client, but many crossings are therapeutic, and you'll read about that, so we can leave that there. Sometimes multiple relationships aren't avoidable, particularly in small communities because you'll go to church and maybe your client will be there or you'll see your client in a bank, in a grocery store, at social gatherings, community events, and I think what's important is to learn how to talk to your client ahead of time about what will we do if we meet each other. So I don't have to go up to you and say, "Oh," even introduce myself. In fact maybe I'll wait for you to somehow acknowledge that you know me. So boundaries and multiple relationships can be managed. I just want you to realize that all multiple relationships are not unethical, and they don't have to all be avoided. Only those multiple relationships that harm a client, exploit a client, or in some way are against our code of ethics or the law need to be avoided, but sometimes crossing boundaries can be very therapeutic and what clients need. A brief example... What if a client offers you a gift? In some cultures to say, "Oh, I can't accept that gift," is offensive, and it might rupture the relationship. So gift receiving from certain clients, depending when that is done, is an example of a boundary that we need to think about. Bartering, another topic that we don't have time to go into a great deal, in some cultures, bartering is a norm, and we really need to think about that before we do that. I'm not encouraging you to barter necessarily, but we need to think that sometimes what the client needs, you know, will have to... is flexible, and is not covered by a list of rules and regulations. So hopefully you'll realize that this is an area where we can bring to our supervisors our issues that we're wrestling with pertaining to boundaries and multiple relationships.