Tag Archives: Ethics & Legal Issues

2014 ACA Code of Ethics approved by governing council

March 26, 2014

The 2014 ACA Code of Ethics was approved by the ACA Governing Council this week at its meeting at the ACA conference in Honolulu, Hawaii.

The 2014 ACA Code of Ethics replaces the 2005 edition.  The new edition is the first code that speaks to the ethics of using social media with clients.  It also presents new or expanded Branding-Box-Ethicsguidelines for preventing the imposition of counselor personal values, distance counseling, confidentiality, dual relationships, multiculturalism and diversity, the use of technology, record keeping, diagnosis, end-of life care and the selection of interventions.

The 2014 ACA Code of Ethics is posted on the ethics section of the ACA website at counseling.org/ethics

ACA conference attendees can be the first to hear about the new code by attending the six-hour Learning Institute, “Hot Off the Press – The New 2014 ACA Code of Ethics: An In-Depth Review of Critical Changes” on Thursday, March 27, or the 90 minute education session, “A Town Hall Meeting on the New 2014 Code of Ethics: What You Need to Know” on Saturday, March 29.

A podcast focusing on the updates in the 2014 ethics code with Perry Francis, chairman of ACA’s Ethics Revision Task Force, is available at counseling.org/knowledge-center/podcasts

More resources focusing on the 2014 ACA Code of Ethics will be soon be posted on the ACA website, including a six-part webinar series, a ten-part interview series with the Ethics Revision Task Force, updated ACA books such as the bestselling ethics casebook and branch presentations.

 

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See the June issue of Counseling Today for an in-depth cover story on counseling ethics.

In July, Counseling Today will begin a column series highlighting significant changes in the new Code of Ethics.

 

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For more information on the 2014 Code of Ethics, see counseling.org/knowledge-center/ethics

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Resolution of EMU case confirms ACA Code of Ethics, counseling profession’s stance against client discrimination

Heather Rudow January 9, 2013

(Photo:Flickr/krossbow)

(Photo:Flickr/krossbow)

In December, after years of litigation, the court case Julea Ward v. Board of Regents of Eastern Michigan University was resolved. The resolution upheld the university counseling program’s policies and confirmed the ACA Code of Ethics as the guide for defining ethical behavior for professional counselors. The case also reiterated that equal rights and social justice remain key pillars of the counseling profession.

“The resolution of the lawsuit leaves the university’s policies, programs and curricular requirements intact,” said Walter Kraft, vice president for communications at Eastern Michigan University (EMU), in a press release. “The faculty retains its right to establish, in its learned judgment, the curriculum and program requirements for the counseling program at Eastern Michigan University. EMU has made the decision that it is in the best interest of its students and the taxpayers of the state of Michigan to resolve the litigation rather than continue to spend money on a costly trial. The matter has been resolved in the amount of $75,000. The university’s insurance company, M.U.S.I.C. (Michigan Universities Self-Insurance Corporation), will pay the cost of the settlement.”

The case began in 2009, when then-student Ward began her practicum at EMU. Upon reading the file of a client to which she was assigned and finding he had previously been counseled about his same-sex relationship, Ward, a conservative Christian, notified her supervisor that, in accordance with her religious beliefs, she would not be able to counsel the client and needed to refer him to someone else.

Ward’s supervisor canceled the counseling session and scheduled an informal review, during which EMU faculty members explained to Ward that she needed to abide by the university counseling program’s policies and curricular requirements, which adhere to the ACA Code of Ethics. The ACA Code of Ethics states that “counselors may not discriminate against clients on the basis of age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital status/partnership, language preference, socioeconomic status or any basis proscribed by law.” This meant Ward was required to set aside her personal beliefs and values when working with clients during practicum.

Given the choice of completing a remediation program, leaving the EMU counseling program or requesting a formal hearing, Ward chose the hearing. As a result of the formal hearing, she was dismissed from the program for violating the ACA Code of Ethics.

Ward sued EMU for her dismissal with the backing of the Alliance Defending Freedom (ADF) — formerly the Alliance Defense Fund — an organization of Christian lawyers that also assisted in another counseling student’s case at Augusta State University that revolved around counseling clients who are lesbian, gay, bisexual or transgender (LGBT).

According to the EMU press release, “The ADF lawsuit sought to stop [EMU] from enforcing its policies prohibiting discrimination and requiring the students in its counseling program to counsel students in conformance with the code of ethics of the American Counseling Association.”

ACA provided expert testimony for the case, which the judge quoted when granting the summary judgment in the decision.

On July 27, 2010, the U.S. District Court for the Eastern District of Michigan granted summary judgment in favor of EMU, which Ward appealed. She made her oral arguments on Oct. 4, 2011, and on Jan. 27, 2012, the 6th Circuit Court of Appeals sent the case back to district court for a jury trial. ACA Chief Professional Officer David Kaplan spent a morning being deposed for the scheduled trial.

In December, Ward officially left the program.

“Personally and as a department, we are pleased that the lawsuit is settled,” says Perry Francis, counseling professor and counseling clinic coordinator at EMU. “It has taken a great deal of time and energy to defend ourselves, and now we can continue to focus on educating our students to become excellent clinicians in the mental health profession.”

Francis believes implications from the court case are clear, showing that counseling is “best accomplished by entering into the world of the client, valuing that client as a worthwhile individual who deserves [our] nonjudgmental care and concern. That has been what we teach to our students; it drives our policies and is a reflection of the professional values and ethics of the counseling profession. To accomplish this, we teach our students how first to become aware of their own values and issues, how to bracket off those values and issues that would interfere with client care and then to enter into the client’s world to help him or her develop into the best person he or she can be.”

Kaplan echoed those sentiments. “ACA is pleased that the settlement leaves intact the district court ruling that fully supported Eastern Michigan University’s gatekeeping function in dismissing a student who refused to counsel an [LGBT] client, the right for CACREP to require adherence to the ACA Code of Ethics and the nondiscrimination statement within the ACA Code of Ethics,” Kaplan says.

Pete Finnerty, president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA, says the case was especially relevant for LGBT individuals, who are often marginalized and discriminated against.

“Eastern Michigan stood strong for nondiscrimination and should be applauded for doing so,” Finnerty says. “When Julea Ward refused to counsel a gay man, she was discriminating against an individual for religious reasons. This not only shows a refusal to move past her own values but also creates an environment where it is impossible for all persons to have equitable treatment under policies long in effect at university and community levels.”

Because of the lawsuit, EMU has also come under fire from Michigan legislators, Finnerty adds.

“Two bills within the last few years, including the recently shelved SB 975 …  sought to make it illegal for Eastern Michigan and all other educational institutions in the state to enforce its nondiscrimination policies by allowing medical and mental health professionals to refuse service based upon ‘conscience,’” he says. “This bill nearly made it to the governor’s desk but was not voted on in the House before the end of the legislative session. There was specific language in this bill that targeted educational institutions [that] utilize a nondiscrimination policy. The language noted penalties and fines for enforcing nondiscrimination clauses.”

Finnerty notes the likelihood exists that similar legislation could still come about, however, because other freedom of conscience bills were passed into law in states such as Arizona.

In 2011, Arizona passed HB 2565, which prohibits schools from disciplining a student in a counseling, social work or psychology program if the student refuses to counsel a client about goals that conflict with the student’s “sincerely held religious belief.” In 2012, the state passed SB 1365, prohibiting the denial, suspension or revocation of a person’s counseling license or certification for “declining to provide any service that violates the person’s sincerely held religious beliefs, expressing sincerely held religious beliefs in any context, as long as services provided otherwise meet the current standard of care or practice for the profession, providing faith-based services that otherwise meet the current standard of care or practice for the profession, making business-related decisions in accordance with sincerely held religious beliefs, including employment decisions, client selection decisions and financial decisions.”

In Michigan, SR 66, a resolution to enact legislation protecting the rights of conscience of students seeking counseling degrees and licensed professional counselors, calls out ACA directly: “Whereas, the American Counseling Association, a private organization that promulgates a code of ethics widely used by university counseling programs and state licensure boards in training for and regulating the counseling profession, has publicly supported universities that have punished or dismissed students for adhering to their sincere religious convictions.”

However, says Finnerty, “The conclusion to [Julea Ward v. Board of Regents of Eastern Michigan University] is a win for the LGBTQQIA community, as those who serve this population were activated to defeat the legislation and not allow anti-gay groups to press their agenda upon the counseling profession that holds equitable and fair treatment as paramount to counseling. LGBTQQIA clients can be sure that counselors will continue to be trained through a multicultural lens where nondiscrimination and personal growth, not a counselor’s personal values, is pertinent to the counseling relationship. For counselors and educators, this shows that believing in a world that values nondiscrimination and diversity is still very much a plausible reality and must be continually strived for.”

Says Francis, “We as a profession must continue to teach these professional values to our students so they can have a positive impact not only on our clients’ lives but on the society as a whole.”

To learn more about the case, visit emich.edu/aca_case

  Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Bio/neuroethics and counseling: A novel partnership

Kevin Wreghitt May 1, 2012

Bioethics is the multidisciplinary field that applies knowledge of health care policy, law, philosophy, sociology and dispute mediation/resolution to solve moral dilemmas in clinical practice and research in medicine and allied professions. Human cloning and stem cell research, which are hotly debated in society, are examples of bioethical issues. Beginning roughly in 2002, neuroethics emerged as a subdiscipline of bioethics that seeks to solve moral dilemmas arising from neuroscientific research and clinical cases of brain trauma and mental illness.

Daniel Buchman of the National Core for Neuroethics at the University of British Columbia said this about his field: “Neuroethics has deep roots in ancient philosophical discussions of mind and brain and has joined this history with contemporary thinking in biomedical ethics and neuroscience devoted to elucidating ethical challenges prior to and during the transfer of new research capabilities to the bedside.” The use of psychiatric drugs and other treatments for patients who are mentally ill, issues related to neuroscience and national security (such as brainwashing) and the use of “designer drugs” to change one’s personality or enhance cognitive function are examples of neuroethical issues.

In clinical or consultative ethics cases, which revolve around an identified patient/client and his or her cognitive status, counselors can play an important role by uncovering the psychological issues belonging to that person and the people around him or her and explaining how those characteristics might influence bioethics or neuroethics decisions. Therapists could assist bio/neuroethicists, the courts and others in keeping those psychological variables “in check” and preventing irrational behavior from being destructive to the ethical decision-making process.

What often receives less consideration, however, are the psychological factors of the participants trying to reach bio/neuroethical decisions. For instance, what types of psychosocial interactions occur between the individuals involved in clinical bio/neuroethical discussions? It is reasonable to suspect that issues such as personal values and cultural issues are presented, but is that enough? Are there situations that go beyond the capabilities of bio/neuroethicists and require more of a mental health approach?

Case of persistent vegetative state

According to a 1991 Multi-Society Task Force on PVS (persistent vegetative state) as cited in The New England Journal of Medicine, individuals are considered to be in PVS when they have been unconscious for longer than 12 months due to brain trauma and also have a poor prognosis. Higher cognitive processes are nonfunctional, with awareness of self and the environment being absent. These patients cannot communicate or follow commands in any way. Sensory experiences may occur but have no conscious meaning.

One of the most famous cases concerning PVS centered around Terri Schindler Schiavo, who died on March 31, 2005, almost two weeks after her feeding tube was removed and her hydration cut off under court order. Terri’s death was preceded by a lengthy court battle between her family and her husband, Michael. The psychosocial questions and issues surrounding the Schiavo case are numerous. What was the state of the marriage between Michael and Terri before she suffered massive brain damage and was put on life support in 1990? What did life and death mean to each participant in the conflict?

Perhaps psychometric testing (for example, the Minnesota Multiphasic Personality Inventory, or MMPI-2) could have assisted in identifying who was best mentally fit to make decisions on Terri’s behalf. Was Michael Schiavo violent toward Terri as some claimed? More questions could be added as possible psychological influences. None of these issues came out in the bioethics proceedings.

Clearly, PVS cases are complex, and the mental health of each participant and the family as a whole has to be taken into account. Mental health and ethics professionals need to ensure that a careful psychological examination takes place, and the courts should require such assessments. The people involved in PVS cases are dealing with heart-wrenching experiences, and psychological assistance is needed.

Health care system implications

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, and a few days later, he signed the Health Care and Education Reconciliation Act. Among other major reforms, these two laws allow for 32 million Americans to obtain health insurance who do not currently have coverage. The future of health care delivery is in question, not only because of new governmental regulations and bureaucracy, but because our wavering economy might influence any outcome as well.

New moral and legal questions will challenge the fields of bio/neuroethics in the United States because of health care reform. For example, will new regulations interfere with best practices in medical and mental health services? Will vulnerable populations have difficulties accessing needed specialized treatments and services? Perhaps treatments that are offered now will be excluded or reduced because of cost or rationing. If some of these negative consequences take place, there might be emotional fallout. Everybody hopes the new policies will benefit our health care system, but counselors should remain cognizant of the potential pitfalls of this new system — especially because no one really knows yet how or if it will work.

The field of neuroplasticity has offered discoveries on how patients can rebuild neural networks, even after brain damage, through certain therapeutic experiences and targeted exercises. There are neuroethical concerns, however, that some systematic difficulties might impede clinical practice. In the fall 2009 Focus newsletter of the Center for Health Care Policy and Ethics at Creighton University in Nebraska, Caroline Gaudet and Trisha Cochran said, “Given the limited length of stay and reimbursement for in- and outpatient rehabilitation services, clinicians have a sense of urgency to get their patients as functional and independent as possible as quickly as possible, often having to teach compensatory behaviors instead of fostering neural recovery.”

Counselors need to be sensitive to ethical and societal questions that might affect their clients who have various types of illnesses. Sociological changes such as health care reform can usher in much hope and, simultaneously, significant concern. Such opposing outcomes probably depend on what people expect medical or mental health care to do for them. As another example, professionals who work with psychiatric clients know that any change in their environment might cause these individuals anxiety and perhaps trigger a total relapse of their conditions. Changes in the U.S. health care system might become a direct or indirect trigger for such challenges.

Other bioethical issues

Beyond the neurological areas, there are other bioethical issues that may require mental health attention. For example, should medical providers assist in ending the life of terminally ill patients? With biotechnological advances and societal changes, the bioethical, psychological and medical issues of death and dying have become more complicated than they once were for persons with terminal illness and their families. Recommending that patients have feeding tubes implanted or making decisions concerning who should receive an organ transplant presents both bioethical and mental health implications.

These represent only a couple of examples of the bioethical issues that health care clinicians face daily. We should ask ourselves whether counseling and therapy might help to improve the prevalence of healthy and ethical outcomes in these scenarios. Counselors must bear in mind that there are often competing values between the patient, the health care team, the family and society in many such situations.

Counseling initiatives and strategies

Organizations such as the American Counseling Association have the opportunity to promote clinical practice, research, legislative advocacy and education in this specialized area. People vying for guardianship in court (for example, in the Schiavo case) should be psychologically screened so the party that is most mentally fit for the task can be identified.

It might be beneficial for ACA to partner with other organizations such as the American Society for Bioethics and Humanities; the American Society of Law, Medicine & Ethics; the Neuroethics Society; and the National Bioethics Advisory Commission to create initiatives that would foster integration between our respective fields. We could partner with these organizations to devise new protocols for cooperation between bio/neuroethicists and counselors. More training opportunities on bioethical issues for the counseling profession would also be beneficial. Perhaps some counselors might want to earn another degree in bio/neuroethics and develop a subspecialty in clinical or research areas.

Health care workers who come into contact with these types of cases supposedly receive ongoing bio/neuroethics training. This does not mean, however, that such staff could not use additional emotional support as well. This could involve values clarification classes as well as individual or group psychotherapy. A mental health clinician, independent of the case being considered, could be included in bio/neuroethical discussions to identify and assist with the psychological issues that may arise.

Offering a grief model might be helpful. Part of the difficulty might be that each person is at a different place along the grief journey. The father may have accepted the reality, while the mother might be in denial and a nurse could be bargaining. Counselors have to help identify and reconcile the psychosocial variables in any health care dilemma.

The patients who can participate in the decision-making process should be in counseling/therapy to help them cope with what is happening to them. The counselor might have to assist these patients in reshaping their expectations to bring about a resolution. Bear in mind, “incompetence,” if imposed, is a legal term — not a medical or psychiatric diagnosis. Even though the legal profession pronounces some people to be incompetent, it doesn’t necessarily mean the person cannot think for himself or herself. However, he or she may need added support in making decisions. The person should not be dehumanized by the label of incompetence or by the bio/neuroethical process, and counselors can play a role in ensuring that does not occur.

It will be important in the coming years for counselors to monitor changes in the U.S health care system, not only as these changes pertain to the counseling profession but to medical professions as well. Starting in 2014, when health care reform goes into full effect, some clients might experience confusion and distress. Counselors will be needed to help individuals navigate both expected and unforeseen challenges. If systematic difficulties become acute or long term — necessitating rationing of services, for example — this could lead not only to a medical crisis but to a mental health crisis as well. If so, strategies and changes to the counseling profession might need to be developed.

In the beginning of the bio/neuroethics process, the individuals involved should be made aware that they have biases that will come out. People should be encouraged to pinpoint their own motives and the meaning of the actions they take. For those who want to hide behind the objective professional cloak, they should be reminded of their humanity and that their motives will ultimately escape from the mental iron curtain. Finally, the legal profession might need to be educated about the influence of psychological factors in these dilemmas. The Schiavo case illustrates what can happen when such psychic forces are overlooked.

Conclusion

I’m writing this article not as a bio/neuroethical expert but rather as a casual observer of the process and a newcomer to the counseling profession. I am also a quadriplegic due to cerebral palsy from birth, so I can empathize with people with disabilities who might feel that others are in control of the quality of their lives. It is frustrating to know others are in charge of making choices on one’s behalf, even though some patients/clients might not be as aware of this due to their inability to comprehend. Counselors can play a significant role in assisting patients/clients, families and professionals to cope with bio/neuroethical issues. I think it would be worth the effort.

Kevin Wreghitt is a mental health clinician and a Massachusetts mental health counselor licensure candidate at Coastal Connections Inc., an adult developmental disability day program. He has an interest in counseling clients with neurological injuries. Contact him at kevinwreghitt@verizon.net.

Letters to the editor: ct@counseling.org

Engaging counseling students in their ethical development

Julie Koch and Adrienne Erby January 1, 2012

As counselors, we recognize the importance of ethics, so much so that it is a required component of our training. Particularly in our current social climate, with issues such as personal values versus counselor competencies being debated in U.S. court systems, it is crucial for students to prepare to be ethical practitioners.

Unfortunately, students do not usually look forward to ethics classes. They often perceive ethics as boring or, as Karin Jordan and Patricia Stevens noted in a 2001 article for The Family Journal, “legal mumbo-jumbo.” In our experience as instructors, students often enter ethics classes thinking that the ACA Code of Ethics will “have the answer” or that they will be able to refer to a law to tell them what to do. They typically don’t understand the ambiguous nature and complexities of ethical dilemmas.

The use of case studies can help students conceptualize ethical dilemmas, but we believe a need exists for more hands-on, applied training to prepare students for their future practice. Moving beyond lectures and case studies to truly engage students in their learning assists them with problem-solving and increases their confidence in tackling future ethical dilemmas. Here, we share a few activities we have used through the years to engage students in their ethical development.

The use of base groups

On the first day of ethics class, we split the class into base groups of three to five students each. The membership of these base groups will remain consistent throughout the semester. We tell students they should check in with their group at the beginning of every class.

Base groups begin classroom activities and help engage students in small group discussion, which is usually related to assigned readings. Base groups also serve to create an intimate, safe learning environment in which students get to know some of their classmates very well. We encourage students in base groups to exchange contact information with one another. That way, if a student is ever absent or late, one of his or her group mates can provide that student with notes, discuss what happened in class or bring a paper to class for the student.

Base group discussions prime students to participate in more in-depth conversations on specific topics with the entire class later in the class period. Topics of discussion might include “What concerns do you think clients have about confidentiality? Make a list of five” or “Would you be willing to lend a client $5? Attend the same gym? Attend the same weekly yoga class? Why or why not?” As the students hear other perspectives and collaborate with one another, they generate a myriad of options on the basis of their classmates’ experiences, values and understanding of ethical obligations. This structure also teaches students the practice of consulting with colleagues when complex situations arise. Occasionally, we offer questions meant simply to allow the students to get to know one another better, such as “How did you spend fall break?” We then generalize these base group conversations to the overall class discussion, creating space for an even more developed class dialogue.

One final note: Base groups are a nice, practical way of transitioning, allowing the instructor a few minutes to get organized at the beginning of class while students are engaged in discussion. (Resource: David W. Johnson and Frank P. Johnson provide a nice description of base groups and other cooperative learning activities in the 10th edition of their book Joining Together: Group Theory and Group Skills.)

Values Auction

The Values Auction is an activity that helps students identify the values they hold in their private and vocational lives. Students are placed in small groups of three to five individuals. We supply a handout containing several general life values (family, love, culture, etc.) and work values (high income, security, helping others, etc.). As the auction begins in each group, each student can bid on any value he or she considers most important — family, religion, nature, freedom and so on — but the student has only $500 to spend in total. Bidding begins at $100 for each value, and bids can be increased only in increments of $10 up to the total limit of $500. This activity can prove to be quite lively, with students often becoming emotionally invested in the process. We hear, “Oh! I lost family!” or “Yes! I got religion for $400!”

After completing the activity in small groups, the whole class can process the experience of choosing values. Students can discuss some of the reasons for selecting their chosen values in the auction and reasons for sacrificing the other values. This prompts further discussion of the importance of values in the counseling process and how values affect the practitioner’s ethical decision-making process. It can also be useful to have students write a reflection paper on the process of selecting their values and how this relates to ethical practice in counseling. (Resource: Values Auction activities can be found online through an Internet search, or refer to Mark Pope and Carole W. Minor’s book Experiential Activities for Teaching Career Counseling Classes and for Facilitating Career Groups.)

Jigsaw activities

A jigsaw activity allows students both to teach and to learn from their peers. It is particularly useful in helping students comprehend large amounts of material. With the jigsaw, students can focus on one area in depth and then teach that area to their peers in small groups.

In the first phase of the activity, the class is divided into groups. If six topics need to be covered, we form six groups; if four topics, four groups, and so on. Each group is assigned a portion of reading or a topic in the area of ethics to research. The students meet in their groups to share, discuss and debate what they believe to be their topic’s most important points. They then reach agreement concerning what they want to “teach” to others in the class. The first phase looks like this, with each letter representing one student: (A, A, A, A) (B, B, B, B) (C, C, C, C) (D, D, D, D).

In the second phase, the members of each group are placed into another group with students who have reviewed different topics. Each individual is required to summarize the information about his or her topic thoroughly, yet make the topic as easy to understand as possible. As each student explains his or her topic, the other students ask questions and discuss how the concepts relate to their practical work in the field. The second phase might look like this: (A, B, C, D) (A, B, C, D) (A, B, C, D) (A, B, C, D).

In this activity, students are given the opportunity to dialogue about the complicated issues of ethical practice, legal guidelines and ethics codes. In our class, we use the jigsaw technique to review a seminal article by Naomi Meara, Lyle Schmidt and Jeanne Day that appeared in The Counseling Psychologist. The article, including references, exceeds 70 pages. Each student group is assigned different portions of the article, and each portion covers different principles and virtues with which the students must familiarize themselves and share in jigsaw groups. This type of activity can be used with a variety of articles, book chapters and ethical and legal guidelines. (Resource: For more information regarding jigsaw activities, refer to The Jigsaw Classroom by Elliot Aronson.)

Role-plays and skits

Role-plays can be useful in transferring textbook knowledge into practice by having students act out what they would say or do in a given situation. Through role-plays, students can practice the counselor role in assessing suicide risk, discussing limits of confidentiality or going over a release of information form with a client.

In this activity, students are assigned to groups of three to four individuals, depending on class size. One student plays the counselor, another plays the client, and the remaining group members function as observers providing feedback. During the activity, the roles shift, giving each student the opportunity to play every role. By acting in these roles, students prepare for real-world ethical dilemmas that arise in counseling practice. This activity allows students to gain practical experience, while also helping them consider different ways of handling difficult situations as they observe other students. As students “try on” these roles, they become more familiar with the roles and gain useful feedback in a supportive setting. Later on, as these situations arise in actual practice, students will possess some experience to fall back on.

The main difference between role-plays and skits is that role-plays are performed in small groups, while skits are acted out in front of the entire class. Class skits provide a way for students to use their creativity to construct a story that centers on ethical concerns in counseling situations. Students might use props, costumes and the room layout to set up a case scenario, and then invite the class to process the ethical issues involved and generate possible solutions.

We typically bring a suitcase full of hats, scarves, dishes, cups and random items such as sunglasses, baby bottles and stuffed animals to class. The class can be broken into small groups of three to five students, depending on class size, allowing for several different skits to take place in one class period. In this activity, the instructor assigns a specific issue related to counseling ethics. The small groups can then create any storyline or scenario in which an ethical dilemma must be solved. In our class, small groups are asked to create a situation in which a multiple relationship is exposed (such as running into a client at a party) and act out how the counselor handled the situation, both in the moment and in a therapy session. After each skit, the class is invited to discuss the story, the decision-making process and how the situation could have been avoided or handled differently.

Constructive controversy

Constructive controversy is an activity that places students in situations in which some kind of conflict exists between two opposing ideas, opinions or theories. The students present their opinions and then work together to reach an agreement.

In this activity, students may be paired (one student engages with another student), work in small groups (a pair of students engages with another pair of students), or the class can be split in two (a group of five to 10 students engages with another group of five to 10 students). The students are presented with two sides of an argument, but instead of deciding which side they wish to argue for or against, they are assigned to a side arbitrarily. This forces students, many of whom have preconceived notions or opinions about certain topics, to think critically and consider both sides of an issue. A number of controversial topics within the area of counseling ethics could be presented for consideration using this activity.

In our course, we use the following topic:

Situation: An agency has a policy in which clients are given a diagnosis in the first intake session, after which clients can be seen under a brief counseling model for a total of five counseling sessions. Side A will argue that early diagnosis is crucial in this situation. Side B will argue that rushing into diagnosis is harmful.

Each side is given time to prepare its position, including a rationale and conclusion. Each side then takes turns presenting its position without interruption or rebuttal from the other side. Students are encouraged to take notes and prepare for rebuttal while listening to the other side’s presentation. Both sides then engage in a rational discussion of the issues, with each side defending its own position and pointing out flaws in the reasoning of the other side’s argument. The next step, which is crucial, involves each group reversing positions. Each side must now summarize the other’s arguments to ensure understanding. Finally, both sides discuss the situation and reach a consensus. (Resources: For more information regarding constructive controversy, see Johnson and Johnson’s Joining Together: Group Theory and Group Skills or David W. Johnson, Roger T. Johnson and Karl A. Smith’s article “Constructive controversy: The power of intellectual conflict,” which appeared in Change: The Magazine of Higher Learning in 2000.)

Illustrations of decision-making models

This is a fun activity that facilitates visual learning and creativity. In this activity, students work collaboratively to create a graphic presentation of an ethical decision-making model. We first introduce the class to several well-known ethical decision-making models through readings and discussion. Students are divided into small groups, and each group is given a large poster-size paper (we use the paper that is like an enormous sticky note, available at office supply stores, so these can be hung up around the room). Each group selects a different model, and group members collectively come up with a design to illustrate its particular model.

Students really embrace their creativity in this exercise. We have seen a “Mario Brothers” video game illustration, a flower, a cartoon strip, a house, a road map and several trees. Each group then presents its poster and explains how the picture relates to or simplifies the ethical decision-making model. The visual serves as a reminder of the steps for that particular model. This activity provides students with presentation experience, encourages group work and collaboration, and inspires creativity in understanding and retaining some of the most common ethical decision-making models in the field. (Resources: R. Rocco Cottone and Ronald E. Claus provide a nice overview of several different decision-making models in their 2000 article “Ethical Decision-Making Models: A Review of the Literature,” which appeared in the Journal of Counseling & Development. In our course, we also use models by Marcia Hill, Kristin Glaser and Judy Harden, and Karen Kitchener.)

Informed consent analysis

The informed consent analysis is an activity in which pairs of students review sample informed consent forms from several agencies. These forms can be downloaded online or gathered from local internship sites, hospitals and practices. We typically allow time for four different informed consent documents.

Students are provided a handout of a table with agency names across the top and different components of informed consent down the side. We ask students to look for a number of these components, including (but not limited to) credentials, responsibility for payment, supervisory relationship, confidentiality and privilege. Using this table as a guideline, students examine each consent form and check which aspects are covered sufficiently.

In the small group, students discuss the content, format, brevity and level of reader friendliness of each form. In this process, students identify commonalities and differences within the various forms, what information must be presented, what information should be presented and explain their reasoning. (Resource: In our course, we utilize a table adapted from Appendix C of Cottone and Vilia M. Tarvydas’ book Counseling Ethics and Decision-Making.)

Our takeaway message

Ethics can be fun! Fun to teach, fun to think about and fun to learn. This is not to take away from the seriousness of our duty to be ethical practitioners. Rather, we think it is important to instill in students the idea that ethics is neither scary nor boring. We want to communicate to them that proper consideration of ethics is more than a duty or an obligation — it is something that should be aspirational and inspirational. We believe that by providing students with these experiences and practice, we are preparing them to be more confident later when faced with real-life dilemmas.

In our experience, the use of active learning strategies increases students’ level of engagement, encourages them to engage in critical thinking, raises their level of preparedness for future practice and increases awareness of how ambiguous ethical dilemmas can be.

“Knowledge Share” articles are adapted from sessions presented at past ACA Annual Conferences.

Julie Koch is an assistant professor in the College of Education’s School of Applied Health and Educational Psychology at Oklahoma State University. Contact her at julie.koch@okstate.edu.

Adrienne Erby is a doctoral student in the College of Education’s Department of Counseling at the University of North Carolina at Charlotte. Contact her at aerby@uncc.edu.

Letters to the editor: ct@counseling.org

Look out – and beyond: The Singularity is coming

Jeffrey T. Guterman October 1, 2011

Robotic counselors. Virtual solutions. Personality uploading.

These are not science fiction fantasies but real possibilities that lie just beyond the horizon for the field of counseling. According to some futurists, a trend of great historical magnitude is unfolding: the exponential growth of technological development leading to an event referred to as the Singularity.

Ray Kurzweil, author of the 2005 best-seller The Singularity Is Near: When Humans Transcend Biology, predicts that the pace of technological development is becoming so rapid that the rate of progress will become vertical by the middle of this century. Then, in a short period of time — perhaps in one single moment — the world may be transformed beyond recognition. It is this special point in time that is referred to as the Singularity.

The Singularity could change everything as we know it, and the implications for counseling are significant. The Singularity may challenge us to reconsider the multicultural dimension that is a defining feature of our profession. The Singularity may take disciplines such as neuroscience to a new frontier. The Singularity may also challenge the fundamental question, “What does it mean to be human?”

What is the Singularity?

The cause of the Singularity would be the creation of greater-than-human artificial intelligence (AI). As a result of advances in the development of AI and complex networked supercomputers, a positive feedback loop would result whereby smarter computers are capable of designing even smarter computers. This feedback loop would be so sudden and rapid that AI would eventually develop. In effect, machines would have consciousness and act like real people and, conversely, humans would transcend their own biology by augmenting themselves with AI.

Some futurists question if the Singularity will happen at all. In particular, some question whether a computer will ever be able to attain human intelligence. But not Ray Kurzweil! He developed the theory of accelerating returns, which holds that the rate of technological progress is exponential rather than linear. Most humans, according to Kurzweil, are linear thinkers. We understand progress as occurring in single, incremental steps (for example, 1 + 1 = 2, then 2 + 1 = 3, then 3 + 1 = 4, and so on). In contrast, exponential progress occurs when the growth rate is in proportion to current and subsequent values (1 + 1 = 2, then 2 + 2 = 4, then 4 + 4 = 8, and so on). Consider that it took about 30,000 years for humans to develop agriculture, but it took only a quarter century for the first computers, which took up the size of a large room, to be condensed into a hand-held gadget. And in only five years since its development, social media has become ubiquitous.

It is astonishing to trace exponential technological progress throughout human history and to consider where it might lead. Increasingly, people have used technologies as extensions of the self  — for example, eyeglasses, the Sony Walkman, pacemakers and prostheses. As a result of technological advances, it is foreseeable that some humans might be almost entirely nonbiological within the next 50 years. Progress in the field of biotechnology may even make it possible for humans to someday achieve immortality.

The changing nature of humanity

The Singularity may change human nature itself and raise questions about who we are and what we will become. Since the beginnings of counseling, the field has developed numerous theories of human nature. In particular, counseling has been influenced by a tradition that conceptualizes and values the self. For example, psychoanalysis theorizes that there are conscious and unconscious parts of the self. Person-centered therapy holds that there is a social self and a real self. Although these and other counseling theories disagree about how to conceptualize and intervene in relation to the self, most agree that the self is a central locus of problems and change.

Coinciding with the postmodern movement, a marked shift occurred in the field, with the self being situated in conversational, cultural and relational domains. From a postmodern perspective, the self is understood as a narrative phenomenon that is socially constructed. As technology develops exponentially in the 21st century and humans become increasingly augmented by technology, the nature of humanity itself may change and two new types of human beings could emerge: transhuman and posthuman.

Transhuman refers to a person who has become so significantly augmented by technology that, in effect, he or she has transcended the original definition, based on biology, of what it means to be human. Some people already consider themselves to be transhuman. Transhuman also refers to a human in transition who seeks to learn about new technology and might be preparing to become posthuman.

Posthuman refers to a completely synthetic entity with AI. Such beings likely could appear in the middle of this century. A posthuman is a superintelligent robot, but not the type we have become accustomed to in science fiction. Posthumans would be able to share their experiences with one another, change their bodies into data forms and choose to reside in computer networks. They might be able to think, feel and behave very much like real people. It is also conceivable that humans and transhumans will be able to transform themselves into posthumans. When considered in this way, the relationship between humans and posthumans is not about “us” and “them,” but rather about how humans may gradually transform into increasingly posthuman beings.

Implications for counseling

Many questions arise, especially for the field of counseling, if we imagine a world in which humans, transhumans and posthumans coexist. The question of what it means to be human may be thrown into critical relief as machines perform more complex human functions and as we ascribe human qualities to these machines. Even today, we refer to some of our machines as if they have personalities. For example, one might refer to his or her car as “my baby.” If computers possess AI and become superintelligent, there would be a real convergence between biology and machine. Biology would no longer necessarily define humanity. Instead, a set of characteristics and capabilities might determine what it means to be human. Among the questions that may arise for the counseling profession:

  • How might counseling be changed in a world coinhabited by humans, transhumans and posthumans?
  • What unique opportunities and problems might humans, transhumans and posthumans face in this new world?
  • How might counselors, who themselves may become transhuman or posthuman, prepare to meet these new challenges?

One possible scenario is that a human counselor encounters a transhuman or posthuman client. Or a posthuman counselor might provide counseling to a human or transhuman client. As a result of future technology, people might even possess the capability of recreating the self in ways that are unimaginable today. Software uploading to the brain, which is already being done for individuals with Parkinson’s disease, could allow one to experience and manifest alternative personalities. Personality uploading may permit an individual to be anyone or anything he or she wishes to be, presenting new challenges and opportunities for clients and counselors alike. This would challenge the traditional assumption that an essential self exists that is “just there” and instead support the postmodern understanding that the self is an evolving, fluid phenomenon.

Reconsidering our mission, ethics code and multicultural competencies

The Singularity may also challenge the American Counseling Association to one day reconsider its mission and the ACA Code of Ethics. ACA’s current mission statement is as follows:

 

The mission of the American Counseling Association is to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.

 

If we accept that transhumans and posthumans may someday inhabit the world, then ACA’s mission might need to be revised to account for these new beings. Moreover, a review of the ACA Code of Ethics and the Association for Multicultural Counseling and Development’s Multicultural Counseling Competencies may be needed to address the coexistence of these multiple, diverse forms of humanity. In particular, these guidelines would need to address diversity and multiculturalism from a broader perspective. The scope of diversity and multiculturalism has already been expanded beyond race, ethnicity and gender to include other domains such as age, family structure, sexual orientation and disability. As people become increasingly augmented by technology, new opportunities will arise for counselors to promote respect for the dignity and diversity of transhumans and posthumans as well as humans.

In the future, our mission, our ethical imperatives and our multicultural competencies may in some respects be no different than they are today. The Singularity may, however, require what philosopher Peter Singer refers to as expanding our circle of empathy. According to Singer, human progress has involved an expanding moral circle.

Through time, the circle of whom we count as members of our group has expanded to include other races, other sexes, other religions and other species. It is not a stretch to imagine humans accepting and embracing transhumans and posthumans. But work still needs to be done in the area of social justice strategies aimed at promoting respect for the dignity and diversity of human beings. It follows that the inclusion of transhumans and posthumans in the world would present society with challenges that counselors need to be prepared to address.

What now?

Kurzweil suggests the pace of technological change will become so fast in the next 40 years that you will not be able to keep up unless you enhance your own intelligence with AI. Already today, it is essential for many of us to access the Internet on a regular basis. Some people feel they would be lost without their smartphones. The good news is that more and more people are able to access the new technologies, and the playing field will continue to level. But are people prepared for the exponential technological change that may be coming?

Counselors are all too aware of the importance of preparing for change. Change is the business of counseling. But there has never been a change in human history like the change occurring now — a change that may culminate in the Singularity. If you observe closely, you will find many people are being affected by the sudden, rapid increase in technological change. Sociologist and futurist Alvin Toffler came up with a name for this condition, which served as the title of his 1970 book, Future Shock. In this seminal book, Toffler predicted that people would become disconnected, overwhelmed and “future shocked” as a result of accelerating technological and social change. The cause of this condition, according to Toffler, is “too much change in too short a period of time.” Basically, technological evolution is outpacing our biological capability to manage it.

We need to find ways to help others with these new challenges. Already, many counselors are dealing with technology-related issues such as online counseling and Internet addiction. But this is only the beginning. New possibilities, some of which are unimaginable today, are closer than you may think. Counselors, educators and especially students, the future of our profession, need to be willing and prepared to look out — and beyond. The Singularity is coming!

Suggested websites

Nick Bostrom- nickbostrom.com

Ray Kurzweil- kurzweilai.net

Singularity Hub- singularityhub.com

Transhumanist FAQ- extropy.org/faq.htm

Suggested readings

Human Enhancement edited by Julian Savulescu and Nick Bostrom

Radical Evolution: The Promise and Peril of Enhancing Our Minds, Our Bodies — and What it Means to Be Human by Joel Garreau

The Age of Spiritual Machines: When Computers Exceed Human Intelligence by Ray Kurzweil

The Singularity Is Near: When Humans Transcend Biology by Ray Kurzweil

Jeffrey T. Guterman is associate professor of counseling in the Counseling Department of the Adrian Dominican School of Education at Barry University in Miami Shores, Fla. Contact him at jguterman@mail.barry.edu.

Letters to the editor:
ct@counseling.org