Graduate Student Ethics Awards for Doctoral Degree Students
By Anitra Y. Powell, Sylvester R. Smith and Ulisha L. Fraser Reese
Department of Counseling, North Carolina A&T State University, Greensboro, North Carolina
Faculty Advisor: Shea Dunham
Prompt: James is a third year, full-time, doctoral student in a counselor education and supervision program. James identifies as a cisgender, white, male. He is providing weekly telehealth supervision to a master’s level internship student, Selena, who is enrolled in his Practicum course. Selena identifies as a Hispanic, female.
Selena has been receiving weekly supervision with James for the past 2 months and has planned to show a recording of a new client during their weekly scheduled supervision session. James asks Selena for verification that all informed consent documents and client’s permission were obtained to record the session. Selena verifies that she has used the informed consent intern forms from her practicum site and has obtained permission from the client. These forms disclosed that Selena was a student under supervision, but it did not specifically state what university Selena is enrolled in, or who her faculty supervisor was.
Selena shows the recording of the counseling session to James for review. In the recording, Selena’s client, Henry, is discussing a recent affair that he had and how he plans on leaving his spouse in the near future. James is visibly upset as he watches the recording with Selena. James begins to give Selena advice on how she needs to strongly encourage the client to tell their spouse about the affair. Selena does not feel comfortable with this guidance from the supervisor but follows through with the recommendation due to feeling pressure from her supervisor.
Fifteen minutes prior to their next scheduled supervision session, James informs Selena that his Doxy.me account has not been working properly and states that he will FaceTime her instead for supervision just this once, because he does not want to miss their weekly supervision. During this supervision session, James then focuses only on this case and continues to give advice on how Selena should be protecting the client’s spouse in this situation. Selena is uncomfortable with this direction and the attention that James is giving to this case. She decides to consult with her site supervisor who encourages her to focus on the client’s perspective. In the next session with the client, he stated that he is apprehensive about how his spouse and in-laws will treat him if he discloses the affair. In this meeting Selena finds out that James is the father-in-law of her client. Selena is now unsure how to approach this situation.
Abstract: Defining ethics of clinical supervision as an area of specialization involving supervisor, supervisee, and the client is key in ethical decision making. The essay discusses areas of responsibility, informed consent, values, and decision making, ethics and technology, ethics and diversity/multiculturalism, responsibility to colleagues, confidentiality, privacy, due process, and competence. The authors further explain the ethical violations and the legal issues that arise while providing strategies for their prevention. Lastly, the essay applies the Tarvydas Integrative Decision-Making Model for formulating decision making to avoid ethical violations down to enforcement; while seeking to give insight, adding to a collaborative relationship, and serve as competent stakeholders and gatekeepers for best practice (Cottone & Tarvydas, 2006).
Doctoral Prompt and Tarvydas Integrative Decision-Making Model
The prompt describes James (cisgender, white male) a third year, full-time doctoral student in the role of educator and supervisor to Selena (master’s level Hispanic female student enrolled in her practicum) for over 2 months. All preliminary documents such as informed consent appears to be verified via her practicum site to show telecommunication recordings of her sessions for supervision; however, documents did not specify her university or faculty supervisor invalidating the documentation. Consents should discuss the nature of the procedure, risk and benefits of the procedure, reasonable alternatives, risk and benefits of alternatives, and assessment of the consumers understanding of the elements of the consent form, confidentiality, and contacts.
James and Selena either out of incognizance or oversite proceed their course of action and inevitably confronts a dilemma. James witnesses his son-in-law’s infidelity in the video where he confronts his personal values with his ethical obligations. Selena is clearly uncomfortable as noted by her confronting her site supervisor. James advances a line of decisions that continues to blur his objectivity as a supervisor essentially harming the client, supervisee, distorting his role, and compromising the code of ethics.
The authors will use the Tarvydas Integrative Decision-Making Model to explore our prompt and reach a resolution of the present prompt. The model is chosen because it blends and reflects on personal and moral sensitivity of persons impacted, respects the philosophy of the American Counseling Association (ACA) profession, gauges objectivity and perspectives stakeholders (Cottone & Tarvydas, 2006). It incorporates multiple contexts such as social, cultural, political, legal, and economic factors while also analyzing the efficiency and competence of ethical considerations (Cottone & Tarvydas, 2006).
Awareness and Fact-Finding
The purpose of the American Counseling Association Code of Ethics (ACA, 2014) is to have a written understanding to help counselors with the process of analyzing limits and competing interest. This agreed upon “handbook” facilitates for the counseling professional ways to help promote the welfare of the consumer, make sure we are “doing no harm,” practicing with competence, respecting confidentiality and privacy, acting in an ethical and responsible way, and avoiding exploitation of consumers (ACA, 2014).
As we engage in the fact-finding process, we consider reasonable sequences of actions on all involved in the dilemma to help with analyzing thoughts, feelings, expectations, motivations, concerns, the reaction on others, as well as ourselves as counselors. We reflect our ethics and professional etiquette while taking into consideration basic consumer principles: do no harm, beneficence, nonmaleficence, veracity, fidelity, justice, and autonomy (ACA, 2014). These principles are pillars in counseling and provide a fair and balance weighing to situations. It is necessary that as supervisor and supervisee work to enhance the lifespan of the client while considering multicultural lens, diversity approaches, social justice advocacy; together, safeguard counseling, counseling relationship, and demonstrating competence in an ethical manner (ACA, 2014).
Diversity and Multiculturalism
Understanding cultural differences and diversity amongst professionals is essential in respecting individuals’ cultural mores and gaining greater insight on an individual’s professional identity. Belief systems can assist with identifying how individuals are shaped and influenced in which create ideologies that help interpret our daily reality (Smith, 1966). Social norms within the Hispanic culture emphasize the importance of both verbal and nonverbal communication (Smith, 1966). This could have assisted with the interpersonal relationship between the supervisor and supervisee.
In reviewing the 2014 ACA Code of Ethics many ethical concerns were observed. However, the most prevalent are listed below with justifications:
- A.1.a. Client Welfare – Although James is aware, he knows Selena’s client upon reviewing the video recording, he pushes Selena to provide guidance to the client based off his own personal feelings and agenda. Therefore, neglecting the best interest of the client and possibly causing an unhealthy relationship between Selena and the client and Selena and himself.
- A.2.a. Informed Consent – James only verbally verified Selena’s informed consent form, leaving gaps in the documentation process. Counselors have an obligation to review this form in writing and verbally with the client. This hindered the client’s freedom of choice whether to enter into or remain in the counseling relationship. If provided with the adequate information such as Selena’s faculty supervisor, the client would have been aware that he was related to Selena’s supervisor.
- A.4.a. Avoiding Harm – Once James was aware that the client was his relative, he should have removed himself from the counseling process to prevent bias and imposing his personal beliefs onto Selena. James also created discomfort in the supervisor/supervisee relationship and caused Selena to seek additional support from her site supervisor.
- A.4.b. Personal Values – When James met with Selena for supervision, he only focused on the current ethical dilemma. James imposed his personal opinion and provided unsolicited advice on how Selena should assist the client which was opposite of Selena’s views.
- A.5.d. Friends or Family Members – James was aware when watching the recorded session that the client was his daughter’s husband and his supervision direction to Selena and body language towards the session convey how he is unable to remain objective.
- B.1.b. Respect for Privacy – James knew before finishing the recorded session that the client was his son-in-law, however watched it to the end. At this time James violated the client’s privacy and watching the entire recording was only for his personal benefit.
- B.1.c. Respect for confidentiality – Selena shared the recorded session of her client to her supervisor without appropriate consent.
- B.3.e. Transmitting Confidential Information – James should not have conducted supervision through an unsecured method such as FaceTime when his Doxy.me account was not working properly. James should have additional consents in place to use alternative secure method and a reschedule policy.
- B.6.d. Permission to Observe – Although Selena received permission to record the session, no permission was received for any other person to observe the counseling session.
- C.2.e. Consultation on Ethical Obligations – While Selena sought out assistance from her site supervisor after her weekly supervision meeting, Selena should have considered the fact she was unconformable when receiving guidance from her supervisor prior to and would have known to consult with other counselors as per the ACA Code of ethics.
- F.11.d. Multicultural Competence — In Hispanic traditional patriarchal structure women are expected to be submissive to older male adults, therefore James should have been more cognizant of this. Although Selena was uncomfortable with James’ advice, she still followed through with telling the client. If Selena understood the body language queues, she would have noticed her supervisor was visibly upset after watching the recorded session. Selena should have used a cultural developmental model such as A.S.Ruiz (1990) to be more aware of Western society and cultural barriers. This could have assisted in her understanding of cultural identity, forced assimilation and freedom to advocate for her client (Sue & Sue, 2008).
Distance Counseling and Technology
The Licensed Clinical Mental Health Counselors (LCMHC) Act NC GS Article 24 (2019) surrounding counseling via technology are centered around protecting the client. These laws do not specify system qualifications in distance counseling except services must be provided via an encryption platform (NCBLCMHC, 2019, Article 24). James recognized an issue with his secure platform Doxy.com before his meeting with his supervisee. However, James proceeded to use FaceTime as a platform to meet with Selena for supervision. James did not consider ethical and legal ramifications for this change in their confidential platform Doxy.com. North Carolina General Statutes does not identify specific platforms in which counselors can provide distance counseling (NCBLCMHC, 2019, Article 24). When technology is utilized as a part of counseling services it has to be maintained and regular maintenance checks are required (H.5.c.). One focus of the law is encryption of technology platforms (NCBLCMHC, 2019, Article 24). Encryption serves as a safeguard against breaches in the confidentiality (H.2.b.). FaceTime does not meet the qualifications as an encrypted platform and should not have been used for this meeting. It is the responsibility of James and Selena to protect their client’s information (H.5.a.).
In addition to encryption of technology platforms the General Statutes stresses the importance of educating the client in the ramifications and procedures of participating in counseling via the internet (NCBLCMHC, 2019, Article 24). Safeguarding information surrounding the encrypted platform address how the client’s records will be maintained over time (H.2.b). During the initial meeting with the client to obtain informed consent the counselor should educate the client and include in their handbook how session records will be preserved and disclosed (H.5.c.). It would have been best ethical practice for James and Selena to provide the client with the details on how recorded sessions are shared and preserved through Doxy.com. Client education on the use of technology details how long records are saved and consist of permission from the client on exactly who this information can be disclosed to (H.2.a.).
James and Selena are obligated to follow the laws of practicing counseling at the state level when utilizing technology for counseling services (NCBLCMHC, 2019, Article 24). The implications of the use of a session recording and platforms should have been addressed through their supervision and with the client (H.1.b.). James did not maintain professional boundaries once he viewed the recording and saw his son-in-law in session with Selena (H.4.a.). It was an inappropriate use of technology when did not disclose his dual relationship with Henry but viewed the recording as means to direct Selena on how to get the affair shared with his daughter (I.1.c.).
Due to a dual relationship, (A.5.d.) James interrupted his ability to be an objective supervisor (A.4.a., A.6.d.). James’ personal values and loyalties ran counter to the welfare of the client and his ability to be impartial as a supervisor (A.4.a). James should have consulted with his colleagues (B.7.a. B.7.b.) in efforts to eliminate nonmaleficence. James’ blind spot and personal bias for his daughter created competing loyalties.
James unwittingly engages in cultural marginalization and negates his role as a supervisor. The dual relationship forced him to become an arbitrator playing favorites rather than delivering best ethical practice in a culturally sensitive and objective manner with respect to the supervisee and client (A.6., A.6.a.). Cultural competence amongst professionals is essential in respecting individuals’ cultural differences within their social and cultural contexts (A.4.b.).
In the prompt, James never accounts for the systematic influence that his role as a white male supervisor plays in the supervisory role at the university level or within society (A.7.). He never takes account of his personal or professional position in the hierarchy and how it contrasts with her cultural foundations. He never acknowledges the implications of Selena’s family structures, sex-role expectations, acculturation conflicts, educational characteristics, linguistic context, intrapsychic issues of society such as suspiciousness of outside authorities (Sue & Sue, 2008). James in the prompt never allow Selena to state her own words to the problem as she sees them. Also, he does not evaluate whether Selena has a grasp of her responsibilities as a supervisee. It seems James is oblivious to the power differential that exist between them on multiple levels (C.2.d.).
Planning and Executing the Selected Course of Action
It would benefit James to discuss with his university ways to manage confidentiality, privacy, video (G.5.) consent at various stages to prevent further intrusion into matters that may challenge his own personal biases and cause harm to the client. It would help if James utilized case consultation to discuss and review documentation to respect privacy, protect the client’s identity and to avoid undue invasion of privacy. James then can monitor the effectiveness of the case and provide reasonable steps to evaluate before viewing the videos (G.5.). Video consent and review of documents could have been reexamined to make sure all pertinent information was in place to protect the identity of the client.
In becoming culturally competent it is feasible for James to start exploring his own historical roots, beliefs, and values. It would benefit him to learn about diverse cultures, interact with diverse groups, attend diverse focus conferences, and talk with his university about his blind spots and biases. Cross-cultural competency training is a preferred course of action to help him gain knowledge of supervision models to learn sensitive interventions and strategies to heighten awareness of culturally different populations.
Suspending James of his role as a supervisor until he can receive evidence base training in a conceptual model of supervision is recommended. James showed critical issues in supervision around areas of competence, theoretical identity, respect for individual and cultural differences, direction and purpose of goals, personal meaning and motivation for the supervisee, and professional values (Bernard & Goodyear, 2018). James never demonstrated he understood Selena’s developmental level within the supervisory process. Selena supervision would have been enhanced by integrating counseling theory, academic coursework, overlapping steps of counseling principles in the parameters of supervisee and supervisor related issues such as professional disclosure, tracking development, and evaluation statements for feedback and parallel process (Bernard & Goodyear, 2018).
The counseling profession can often be complex and intricate. Therefore, having a set of rules and expectations that can be followed for not only ethical obligations, but also ethical decision making is of the upmost importance. While the mission of the 2014 ACA Code of Ethics emphasizes the importance of professional counselors’ development and advancement of the counseling professional, it also highlights how professionals should uphold professional values that primarily safeguard the client’s interest.
In maintaining the standards of the profession supervision is needed. Supervision is an intervention with its own models and techniques. Training is structured in a progressive way so supervisee can development from a novice to a professional with skills acquired along the path (Bernard & Goodyear, 2018). It is wholly the supervisor and supervisee task to support the developmental stages by scaffolding prior knowledge and skills (Bernard & Goodyear, 2018). As a competent supervisor or aspiring supervisor, it is important to understand the clinical supervision domains of client’s and supervisee’s supervision to help with the overall orientation of the counseling process (Bernard & Goodyear, 2018). Committing to competency-based supervision recognizes the importance goals being served by clients, supervisees, supervisors, accredited programs, the professions, and society at large.
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