Research Paper on "Knowledge Concerning Ethical Issues Involved in Counseling"

Research Paper 11 pages (4963 words) Sources: 10

[EXCERPT] . . . .

knowledge concerning ethical issues involved in counseling teenagers with alcoholism, including informed consent contents in psychotherapeutic settings, dual relationships and psychological testing considerations in personnel selection in organizational settings. In addition, the paper examines the rules governing sexual intimacy with clients and former clients as well as the value of personal psychotherapy as a requirement of a graduate training program. A discussion concerning deception in research is followed by an analysis of special concerns and particular benefits of an outpatient setting. Finally, a description of the relevant minimum HIPAA requirements is followed by a discussion concerning how psychologists become involved with fraudulent practices and an evaluation of professional responsibilities. A summary of the research and important findings are provided in the conclusion.

Ethical Issues in Counseling Teens with Alcoholism

Introduction

Counselors charged with treating young people who abuse substances in general and alcohol in particular are faced with some challenging issues as they seek to formulate timely and effective clinical interventions using evidence-based protocols. These young people are frequently abusing other substances as well, and their involvement with the law enforcement community and premarital sex further exacerbates their condition. Indeed, treating anyone suffering from alcoholism is a daunting enterprise, but these problems are especially pronounced with teenage alcoholics given their propensity for experimentation and proclivity for impulsive behaviors. To gain some fresh insights in these areas, this paper reviews the relevant literature to identify ethical issues involved in counseling teenagers with alcoholism, including informed consent contents in psychotherapeutic settings, a discussion concerning dual relationships and psychological testing in personnel selection. A discussion concerning the rules governing sexual intimacy with clients and former clients is followed by a discussion of personal psychotherapy as a requirement of a graduate training program, including an examination of deception in research. Next, an assessment of special concerns and particular benefits of an outpatient setting is followed by a description of the relevant minimum HIPAA requirements. Finally, a discussion concerning how psychologists become involved with fraudulent practices is followed by an evaluation of professional responsibilities. A summary of the research and important findings are presented in the conclusion.

Review and Discussion

Minimum contents of an informed consent for psychotherapy

Adolescents suffering from substance abuse issues have a right to understand and approve of any treatment in a process known as informed consent. Informed consent is required for all medical and research procedures based on the guiding principle that people who undergo these procedures have a fundamental right to be informed concerning the implications of the treatment and to provide their consent to that treatment with a complete understanding of those implications (Barnes & Murdin, 2001). According to Barnes and Murdin, "Informed consent means that an individual grants to someone the permission to do something they would not have the right to do without such permission. Need for consent arises from the recognition of the individual's right to autonomy and self-determination" (p. 117). The complete understanding of the treatment that is involved in a psychotherapeutic setting is regarded as an essential element for informed consent, but this level of understanding is not always attainable depending on the cognitive and emotional capabilities of the clients involved (Barnes & Murdin, 2001). In these cases, therapists should consider alternative methods of obtained informed consent (Barnes & Murdin, 2001).

Given the universal applicability of informed consent for medical treatment, it is not surprising that a growing number of authorities maintain that informed consent is also recommended for psychotherapy. In this regard, Croarkin and Berg (2003) report that many authorities have concluded that informed consent should include information relevant to the client's decision. According to Croarkin and Berg:

This includes treatment contracting, information about the effectiveness and safety of therapy, as well as alternatives and consequences of no therapy. However, applying this doctrine to psychotherapy is challenging due to the diversity of psychotherapists, the myriad of variables inherent in the process of psychotherapy, and to the potential risk of contaminating the process of psychotherapy with this information. (p. 384)

Advocates of informed consent for psychotherapeutic settings maintain that this procedure is necessary in order to "protect patients' rights to their best interests, empowers them to exercise control in their treatment, and provides a means for legal recourse should their rights be violated" (Croarkin & Berg, 2003, p. 384). In addition, informed consent for psychotherapy can provide some significant psychotherapeutic benefits. In this regard, Croarkin and Berg report that:

This interactive educational process may hone patients' self-esteem, encourage autonomy, defend against pernicious regression, and establish their active role in the therapeutic process, setting the groundwork for the therapeutic alliance and for effective psychotherapy. This process may also broaden treatment options for patients and distribute liability more judiciously. Specifically, liability is transferred from the psychotherapist to the therapeutic dyad of patient and therapist. (2003, p. 384)

Notwithstanding the foregoing considerations, the minimum contents of an informed consent for psychotherapeutic purposes consist of two elements: (a) disclosure of information the client needs to make an informed decision concerning participation in therapy and (b) free consent to therapy without experiencing undue influence from others (Charman, 2004). In this regard, Charman advises that, "Consent is grounded in the view that adult clients are fully autonomous human beings who deserve the freedom to make decisions about therapy that they exercise in other aspects of their lives" (2004, p. 350). Not only do all clients, including teenagers, have a right to informed consent, they also have a right to undergo therapy without becoming emotionally or romantically involved with their therapists and these issues are discussed further below.

Dual relationships

Dual relationships involving boundary issues have been the source of countless ethical dilemmas for psychotherapists. In this regard, Reamer (2003) reports that, "Ethical issues related to professional boundaries are among the most problematic and challenging. Boundary issues involve circumstances in which therapists encounter actual or potential conflicts between their professional duties and their social, sexual, religious, or business relationships" (p. 121). Interestingly, the boundary issues that are involved extent to others besides just clientele, and practitioners can become involved in dual relationships with colleagues as well (Reamer, 2003). In this regard, Moleski and Kiselica (2005) note that, "Some of the most challenging ethical situations result from dual relationships between counselors and others. A dual relationship is created whenever the role of counselor is combined with another relationship, which could be professional (e.g., professor, supervisor, employer) or personal (e.g., friend, close relative, sexual partner)" (p. 4).

Whatever their nature, dual relationships are considered unethical and potential threatening to the treatment process. For instance, according to Zur and Lazarus (2002), "Dual relationships between psychotherapists and clients have been frowned upon and denounced by the majority of therapists, ethicists, courts, licensing boards, ethics committees and educators" (p. 3). This disapproval of dual relationships is based on the need to protect clients as well as the validity of the treatment process itself, an issue that is especially important when adolescent patient are involved. In this regard, Zur and Lazarus add that, "The main reasons given for this proscription are that clients must be protected from exploitative and harmful therapists and that dual relationships, according to some, are not only harmful to clients but also compromise the integrity of the therapeutic process" (2002, p. 3). The research to date, though, shows that there is a divergence of opinion concerning the ethical nature of post-termination non-sexual dual relationships. In this regard, Pritchett and Fall (2001) report that:

Despite evidence that these relationships are harmful to the client, both counselor perception and ethical codes are vague about the ethics surrounding this issue. Although sexual dual relationships have clearly defined characteristics and ethical guidelines that most professionals understand, non-sexual dual relationships do not enjoy the same level of ethical clarity. (p. 73)

As a result, non-sexual relationships between clients and therapists that exist beyond the duration of treatment remain a source of ethical concern (Pritchett & Fall, 2001). In this regard, Kagle and Giebelhausen (1999) emphasize that, "Few would argue that sexual relationships between practitioners and clients are ethical. Such relationships clearly violate the norms of social work and other helping professions" (p. 213). With younger patients, sexual conduct in a dual relationship has been equated to child abuse and sexual conduct between practitioners and clients is regarded as a felony in seven states (Kagle & Giebelhausen, 1999).

A final important point is that every therapeutic relationship is unique and the boundaries that are established by the therapist will therefore be individualized to the setting. For example, Harper and Steadman (2003) emphasize that, "Many authors agree that maintaining boundaries with clients is basic to the development of an emotionally and physically safe therapeutic environment in which a trusting relationship can be developed. However, because boundaries emerge from the interaction, they are unique to each relationship" (p. 64).

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