Ethical Principles in Clinical Mental Health Counseling
Ethical Principles in Clinical Mental Health Counseling
Any professional working within a helping profession such as mental health or other similar therapeutic professions is bound to encounter several ethical issues within his or her work. Mental health counselors are no exemption. They face ethical issues and dilemmas in many circumstances compounded by the fact that clients might not be in good mental position to make rational judgments. Therefore, understanding what ethical issues exist within the mental health counseling and their subsequent implications will better equip the counselors to excel while providing services professionally as well as radically improve the effect on patients. Mental health counselors are therefore guided by a set of principles which if followed will enable them to provide the best service to the client.
1. In health care, autonomy is a principle that recognizes an individual’s right to self-determination or self-governance (Barker, 2011). The principle of autonomy is pegged on society’s respect for an individual’s capabilities to make informed choices and decisions about health. Autonomy has become an important aspect in the society, since medical quality is shifting to considering the desirable outcomes of treatment from the patient’s point of view as opposed to the expected outcomes of medical professionals. Autonomy forms the basis for medical concepts such as informed consent. The ability for someone to be autonomous is an indicator for mental well being. (For example, a mental health counselor converses with a patient suffering from depression in order to find out their expectations. He then proceeds to perform the therapy in line with the desires of that particular patient. The outcome of the therapy therefore becomes tailor-made for the patient just as they wanted.)
2. Non-malfeasance is an ethical principle that ensures that health professionals above all do no harm to the patients under their care (Gladding, Newsome, & Gladding, 2010). Some believe that it is important to ensure that no harm befalls a patient rather than do what is considered good and cause harm. Many practitioners rush to propose procedures in the hope of helping the patient before evaluating the level of harm that may be inflicted on the patient. It is not enough to know that one is not supposed to do any harm, but also knowing that treatment may be harmful to a patient is also very important. (A mental health counselor who is carrying out treatment on an HIV positive patient who is suffering from stigma, for example, is supposed to carry out treatment by giving them sound advice and therapy. He should not, for example, give potentially dangerous advice such as asking them to take alcohol or any drug that may cause harm to the patient.)
3. Beneficence is a term that refers to any action that is meant to help others. In essence, beneficent circumstances or actions are meant to help prevent or eliminate harm or in some cases to simply improve other peoples situations (Barker, 2011). The role of beneficence in clinical mental health counseling is to ensure that the individual receives treatment that is most beneficial to them. Clinical counselors have an obligation to prevent harm to a patient and apply correction treatment to situations that threaten the patient’s wellbeing. They also have the obligation to assess and balance the probable benefits against the probable risks regarding an action. (A mental health counselor who attends to a patient suffering from stress in the spirit of beneficence will advise them to try quitting their drinking and smoking.)
4. Justice can be considered a complex principle. It pertains to equality, fairness and impartiality (Gerig, 2007). The concept of justice in clinical mental health counseling and healthcare in general, involves two categories of justice. The first is distributive justice, and in this capacity, all should be treated equally regardless of the race, gender, and nationality among other social divides. The second is social justice. Social justice ensures that the resources available to one person should be available to everyone else when it comes to healthcare. (For example, a counselor may possess different attitudes towards Jews and Hispanics. However, when it comes to therapy, the Jewish patient should be treated equally with the same respect and with due diligence as the Hispanic.)
5. The concept of fidelity lies in the ability to remain loyal to a patient. In this regard, the issue of confidentiality plays a major role in this (Gladding, Newsome, & Gladding, 2010). In confidentiality, one is expected to keep secrets and remain loyal to the patient’s requests about remaining mum about medical issues. (If a person is suffering from stress and or depression, the counselor should not divulge any information to family members without the express consent of the patient he or she is treating.) The obligation of a counselor in keeping information a secret lies in the fact that revelation of such information is unlawful and may cause harm to the patient.
6. Veracity, in health issues, refers to the ability of an individual to ensure that they are truthful at all times (Palmo, Weikel, & Borsos, 2011). To begin with, veracity is about being truthful to the persons who deserve to understand what is happening to them with regard to their health issues. (For example, patients results come back showing that someone is HIV positive, it is up to the patient or counselor to be truthful and tell the patient about the state of things (Gladding, Newsome, & Gladding, 2010). ) The professional must be able to tell the truth regardless of whether it may have a negative or positive impact on the person. The obligation of a professional is to tell the truth at all times.
7. Aspirational ethics in mental health counseling refers to the desire of an individual to perform their duties according to high standards. It is a principle that encourages counselors to aspire for the highest performance levels. It therefore represents the very best of effort and practice that an individual can give. For example, a counselor attending to a patient who is suffering from post-traumatic stress in exhibiting aspirational ethics, will ensure that confidentiality is upheld and will do all they can to help the patient.
8. Mandatory ethics is the primary level of ethical functioning it indicates an individual’s effort to adhere to the law and to follow the ethical codes of practice. For example, a counselor attending to the same patient suffering from post-traumatic stress considers himself or herself unbound by any other issues outside the profession that may affect the healing of the patient. The counselor considers himself only bound by the mandatory laws and will not give any further assistance beyond that stipulated by law even if the patient needs it.
Inclusion in medical terms refers to putting into practice all the principles of clinical mental health counseling. A mental health counselor can combine all the principles of mental health counseling during therapy. It entails incorporating the virtues of trust, loyalty, equality, truthfulness and all the other principles in treatment. Inclusion shows that the counselor is empowered with the right formula for therapy; he/she possesses all the ingredients necessary for successful treatment of the patient. The impact of these principles into a counselors practice is very significant, since a counselor is more capable of taking care of his or her patients when the principles are taken into serious consideration (Gerig, 2007). A combination of these principles will serve to achieve the greater good and elicit the best results in all the patient-counselor interactions.
Referral refers to a counselor’s ability to refer a mental health patient to a different counselor. This must be done bearing in mind the six principles. When a doctor feels a patient is incapable of making sound decisions, they are referred to a clinical counselor to ascertain the patient’s wellness in terms of their ability to make informed decisions. The counselor also has the option or referring treatment that is less invasive to the patient in the spirit of non-malfeasance and achieving the greatest good. For example, if a counselor is unable to provide the necessary treatment, then it is possible for them to refer the patient only if it will be of great benefit to the patient. It should also be geared toward reducing the chances of harming others. In referring a patient to a different counselor, it is essential that the patient receive treatment similar to what everyone else gets (Gerig, 2007). The referral of a patient to a different counselor must be advised to the patient, and the patient has to accept before the referral is complete. It is also important to ensure that the reasons for the referral are truthful.
Best practice refers to a counselor adopting practices that are beneficial to the patient yet acceptable by professional standards. Best practice would dictate that a patient be made aware of their condition and the course of the treatment. This is done in the spirit of informing the patient of their true situation and the treatment likely to yield the best results. Best practice will also dictate that a counselor assesses the capability of a patient to make an informed decision (Koocher, & Keith-Spiege, 2008). Best practice will dictate that the health practitioner does the least harm for the benefit of the patient. Non-malfeasance requires that the patient be given treatment that is not harmful. However, this may not always be true, and the counselor must adhere to the concept of beneficence to ensure that the patient receives the best medical care. This is what best practice entails. Best practice entails that whatever information is divulged to family members and others be information that is acceptable to the patient
Limitations as Counselor
The principles present certain limitations as a practicing counselor. While the counselor may be hoping to ensure that treatment is not harmful, this kind of treatment may be the only option that is available. In this sense, the principle of non-malfeasance will deter a counselor to offer the best treatment available. Again, a counselor may face certain limitations with regard to justice. The limitations to justice in mental health counseling are that social disparities reveal that it is impossible to offer equality in terms of counseling (Lakhan, Hamlat, McNamee, & Laird, 2009). This is also true for fidelity and confidentiality. A patient may refuse to allow information to be given to family members. The limitations to such rules on the counselors side is that a patient may refuse treatment yet the only person able to convince the patient otherwise is not an acceptable recipient of the message.
Mental health counselors must ensure that, in the course of practice, they act with in compliance with the wishes of their colleagues and their respective institutions. Counselors are indebted to clients, supervisors, supervisees and other professional groups that complement their work. The relationship between supervisor and supervisee must adhere to a professional code of conduct. Any form of discrimination, harassment or sexual behavior with the supervisee is not allowed in the counseling profession. Supervisors must also ensure that the clients’ information shared with the supervisee is kept confidential. The role of the supervisor is to ensure the client receives the best from the counselor. They monitor the supervisee’s work along with their clinical records and when possible organize regular meetings with them to ensure that their work adheres to ethical principles. Supervision that is in line with the ethical principles will ensure that the client’s welfare is always the main consideration during therapy. Practice as Counselor
The counselors practice always has to adhere to the principles of mental health counseling. They always have to remain neutral in all situations. Failure to do so may have serious implications on the future practice of the counselor. Counselors may at times rush to help patients without considering the impacts that may arise because of such treatment (Koocher, & Keith-Spiege, 2008). The impact of this in practice has not been fully observed as patients are subjected to harmful procedures in the guise that the procedure offers the best chance of recovery. However, such treatment may be necessary, and a counselor may have to administer treatment that harms the patient but serves the greater good. Social justice remains a challenge to all healthcare providers. In practice, hospitals give priority to those who have insurance, and the wealthy. In this sense, justice remains a difficult principle to adhere to in health related issues. Regardless of the challenges these principles offer, it is important that the counselors try to ensure that they adhere to them.
Adhering to the above ethical principles comes with several other implications as follows; mental health counselors are able to maintain some level of competence. They also recognize that efficiency in their line of work depends on the way they handle ethical issues across the cultural divide. They also become aware of the responsibility of ensuring that their professional conduct is highest at all times. Counselors are also able to disengage themselves from discrimination that may otherwise affect the way they perform their duties.
Cultures vary and with this difference, treatment may at times be difficult. Yet counselors are expected to accept the differences in people to ensure that they receive the best treatment at all times. Multicultural issues related to mental health may affect how certain ethical principles may be viewed. It seems that what is right or wrong differs with different cultures (Lakhan, Hamlat, McNamee, & Laird, 2009). For example, the principle of autonomy can be affected in cultures where women are viewed as lesser beings and are therefore subject to male domination. In such cases, a counselor’s view might be the woman cannot make sound decisions and requires assistance such an attitude will influence the outcome of therapy in a negative way.
Multicultural issues relating to non-malfeasance may vary in circumstances and personal beliefs. There are counselors who may feel that counseling homosexuals in relationship issues may be going against their religious beliefs. In this regard, a counselor may opt to refer the patients to a different counselor. In this case, a counselor has observed that his beliefs may hinder his ability to help these individuals (Koocher, & Keith-Spiege, 2008). In the principle of non-malfeasance, the counselor opts not to cause harm to the patient. In this case, the decision is meant to help the individuals to get help in an environment that will not judge them for who they are which may cause even more distress in the patients. The multicultural issues that may affect beneficence are dependent on what is considered to be of benefit to the individual and to the society. While others may believe that a clinically depressed individual is better being institutionalized, others believe that treatment should take place in an environment where they a can interact with loved ones. Some consider mentally ill individuals a danger to themselves and in some cases to the society. The best act of beneficence is one that serves in the best interest of the society and the ill individual care (Gladding, Newsome, & Gladding, 2010).
The concept of justice varies across different cultures. However, what remains evident is the fact that social disparities still inform how patients are treated. For example, in all cultures, the wealthy are treated differently from the poor. Therefore, is possible to find that the poor often end up in asylums while the rich are accorded the best mental health care to ensure they are well. In the past, African Americans could not access similar health care benefits as their whit counterparts. This was a form of injustice because the resources meant for health were not equitably distributed because of race conflicts and issues.
Fidelity may also vary across diverse cultures; a counselor, for example, may not see the need to maintain some level of loyalty with someone from another race or creed. This may be brought about by historical and cultural differences that brought about some level of animosity and mistrust between particular people or ethnic groups. Such sour relationships across ethnic groups or races may cause a breach of loyalty between patient and counselor.
Veracity can also be affected by culture; there exists a particular level of mistrust between races have shared a warring past, for example. When such mistrust exists, and it happens to come in between patient-clinician interactions then veracity cannot be accomplished. A patient may decide to be truthful only to a particular extent; beyond that, imaginary fears take over and suspicion arises.
Cultural diversity may also affect the aspirational and mandatory ethics. Counselors who consider some practices as taboo and unacceptable will only give the minimum effort in such cases. Such counselors do not want to be associated with taboo cases, and aspirational ethics in this case is greatly affected. In such cases, only mandatory ethics applies since the counselor will never attempt to give their best.
Ethical principles are the framework that guides a mental health counselor’s practice. There are very widespread implications if ethical issues are ignored in mental health. To avoid such implications, counselors need to understand the principles and their application in counseling. Counselors should also be aware of the multicultural issues that affect therapy and avoid them if possible. During practice, counselors should be aware of any limitation that could lead to one or a few of the ethical issues discussed above. In cases where it would be hard to avoid such ethical issues between a counselor and clients, the counselor should be ready to refer the client to another counselor to ensure ethical issues are kept at check. The ethical principles above represent what is best for both client and counselor and must be exercised by all mental health clients regardless of the cultural factors surrounding therapy.
Barker, P. J. (2011). Mental health ethics: The human context. Abingdon, Oxon: Routledge.
Gerig, M. S. (2007). Foundations for mental health and community counseling: An introduction to the profession. Upper Saddle River, N.J: Pearson, Merrill Prentice Hall.
Gladding, S. T., Newsome, D. W., & Gladding, S. T. (2010). Clinical mental health counseling in community and agency settings. Upper Saddle River, N.J: Pearson Education.
Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions: Standards and cases. Oxford: Oxford University Press.
Lakhan, S. E., Hamlat, E., McNamee, T., & Laird, C. (January 01, 2009). Time for a unified approach to medical ethics. Philosophy, Ethics, and Humanities in Medicine: Pehm, 4.
Palmo, A. J., Weikel, W. J., & Borsos, D. P. (2011). Foundations of mental health counseling. Springfield, Ill: Charles C. Thomas.