Tag Archives: Ethics & Legal Issues

Behind the book: The Counselor and the Law

By Bethany Bray February 1, 2016

When Anne Marie “Nancy” Wheeler and Burt Bertram took over the authorship of The Counselor and the Law: A Guide to Ethical and Legal Practice in 2007, four editions of the title had already been published.

Like the profession itself, counseling’s legal and ethical standards are a moving target, an ever-Branding-Box-Lawevolving and growing entity. It only makes sense that The Counselor and the Law, first published by the American Counseling Association in 1975, needs updating every few years.

Remaining current as a counselor “requires mindful awareness of the evolution of legal and ethical practices,” write Wheeler and Bertram in the preface of the book’s newly-released seventh edition. “We are honored to assist our readers in meeting this worthy professional standard.”

Wheeler, an attorney, and Bertram, a professional counselor, have collaborated and co-presented workshops and seminars on legal and ethical issues for counselors at professional events since the 1990s. They have coauthored three editions of The Counselor and the Law: The fifth edition in 2008, sixth in 2012 and seventh in 2015.

 

 

Q+A: The Counselor and the Law: A Guide to Legal and Ethical Practice

Responses co-written by Anne Marie “Nancy” Wheeler and Burt Bertram

 

What is one main take away you would want a newly-graduated counselor to know about legal issues?

The most important message for a newly-graduated counselor is “you should never be alone when faced with complex legal or ethical issues.” Consulting trusted resources when challenged by the complexities of real world clinical practice is not only the responsible thing to do; it is a demonstration of acting in the best interests of the client. Our book is practical and grounded in the real world of clinical practice and therefore is a wonderful companion for students during practicum/internship as well as pre-licensed counselors, when combined with clinical supervision and colleague consultation.

A newly-graduated counselor should develop a cadre of “go to” consultants as well as carefully selecting an experienced clinical supervisor. These consultants might include seasoned counselors, a local health care attorney, the ACA-sponsored Ethics and Risk Management Services, an accountant and a computer technician. The Counselor and the Law offers suggestions for finding such consultants.

 

What is one main take away you would want counselors of all types — from those who work in addictions to school settings — to know?

The challenges of clinical practice continue to grow and change. Responsible counselors know that remaining current about legal and ethical issues is just as important as remaining current about new treatment modalities. Therefore, with careful thought and planning, counselors in all settings can minimize the risks inherent in their practices. Additionally, if a complaint is brought against the counselor, that careful thought and planning can often mean the difference between a bad outcome and a successful outcome.

 

When do you suggest a counselor seek outside help — an attorney or otherwise — in a challenging or troubling situation? Are there particular “red flags” or indicators that mean a counselor shouldn’t go it alone?

Just as we mentioned above in regards to newly-graduated counselors, even seasoned counselors must consult other professionals. It’s tempting to try to solve everything on one’s own, but consultation is now the cornerstone of good, ethical counseling practice. “Red flags” calling for supervision or consultation (clinical, legal and/or risk management) include: subpoenas or requests for records, especially when the counselor is aware of potential litigation; divorce and custody disputes; privacy breaches; entering into contracts with prospective employers or practice groups; boundary extensions; threats of harm to self or others; and reporting duties.

 

Nancy, as an attorney who often advises and works with counselors and mental health practitioners, what is the most common question or dilemma you hear about? In general, what types of questions are commonly asked by counselors?

The most common question I get is “What do I do with this subpoena that was just served on me?” I’m getting more and more questions related to counselors’ involvement in divorce and custody cases. The counselor is often squeezed in the middle between parents who can’t agree on important issues regarding the child.

 

The last update of this title was in 2012. How have you seen the landscape of counseling, and its legal implications, change in the years since?

Technology is changing at such a quick pace that it’s hard for the laws and counseling regulations to keep up. One of the most important changes that we see involves the issues of confidentiality and privacy. These changes are being driven by 1) the loosening of the boundaries of privacy brought by the advent of social media; 2) complexities and risks associated with the intersection of gun safety and mental health; and 3) tensions surrounding extremist views, mental health and terrorism.

 

What would you want readers to know about the updated information in the new (seventh) edition? What’s new and different?

The world of the professional counselor continues to evolve, whether the setting is private practice, school counseling, agency counseling or myriad other counseling venues. However, the imperative to serve the clients’ best interests never changes even though the complexities of modern life continue to create new legal and ethical dilemmas. The widespread use of technology by practicing counselors continues to create new opportunities and new challenges. In this seventh edition of The Counselor and the Law, we have updated every chapter to reflect changes brought by the 2014 ACA Code of Ethics, recent court cases, and new legislation. At the same time, we remained committed to identifying and thoughtfully addressing the timeless legal and ethical challenges associated with the practice of counseling, as well as peeking behind the curtain to anticipate future legal and ethical implications of such changes. Some of the most critical changes in this edition include updated information and resources on HIPAA/HITECH privacy breach notification, communication technology and its effect on counseling, and sub-issues such as cyber-bullying.

 

You took over this book from another author (Attorney Barbara S. Anderson) in 2007. What made you decide to take on this project? Why is it important to you?

In 2007, after decades of collaborating on seminars involving counseling risk management, we agreed to take over the authorship of this book and give it the voice of a practicing counselor (Burt) as well as that of a practicing health care attorney (Nancy). Because of rapid changes in the privacy landscape, technology, compliance issues regarding reimbursement, and legal developments regarding counselor education between 2012 and 2015, we believed it was time to update the book. It has been our great pleasure to create a book that has been so widely embraced by counselor educators, on behalf of students, as well as providing an important resource for practicing professional counselors in all settings.

 

 

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The Counselor and the Law: A Guide to Legal and Ethical Practice is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222.

 

 

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About the authors

 

Anne Marie “Nancy” Wheeler is an attorney based in Maryland who has extensive experience working with counselors and in the field of mental health. She has managed the American Counseling Association-sponsored insurance program’s risk management helpline for more than two decades; she is also an affiliate faculty member in the Graduate Pastoral Counseling Program of Loyola University Maryland.

 

Burt Bertram is a licensed mental health counselor (LMHC) and licensed marriage and family therapist (LMFT) based in Orlando, Florida who specializes in the resolution of relationship issues. He also provides professional development and counseling to physicians associated with the Florida Hospital System in Orlando and is an adjunct faculty member in the Graduate Studies in Counseling Program at Rollins College in Winter Park, Florida.

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

Meet John Duggan: ACA’s new ‘answer man’

By Bethany Bray October 28, 2015

John Duggan spends the majority of his workdays talking counselors through the challenges that inevitably confront them in their jobs. From insurance paperwork to licensure issues, questions run the gamut, says Duggan, the American Counseling Association’s manager of professional development.

Duggan, a licensed professional counselor (LPC) and licensed clinical professional counselor (LCPC), is just the person to have on the other end of the phone answering questions from ACA members. In addition to having more than a decade of professional experience from which to draw,

Duggan leads a session titled “The Business Side of Counseling” at ACA's Institute of Leadership Training in July 2015.

Duggan leads a session titled “The Business Side of Counseling” at ACA’s Institute of Leadership Training in July 2015.

he also possesses a natural love of helping others, communicating, mentoring and teaching, he says.

Duggan joined ACA this past summer, taking over for Rebecca Daniel-Burke, who retired June 30 after nearly eight years as ACA’s director of professional development.

In addition to answering member questions and giving guidance via phone consults, Duggan also produces ACA’s podcasts and webinars.

Duggan says his focus at ACA will always be on helping members with the everyday issues that pop up – the “nuts and bolts” of the counseling profession, as he calls them. These include questions ranging from when a counselor should refer a client out to another helping professional, to the regulations associated with establishing a private practice.

“There’s a lot you just never get taught in [graduate] school. I want to help people be ready,” he says. “Being in private practice is hard work.”

Duggan ran a private practice for more than 10 years in Silver Spring, Maryland. His particular areas of interest include the bipolar spectrum, post-traumatic stress disorder (PTSD), dissociation, spirituality, diversity, and multicultural and LGBTQ issues. He also has experience in providing pastoral care, managing clinical services in an agency setting and providing crisis services in a hospital setting.

He has been in the trenches, so to speak, and knows how the job of being a counselor can be isolating, he says.

Duggan experienced something of an unconventional journey to the counseling profession, but he says the skills he honed along the way are helping him in his new role at ACA.

Duggan started out as a writer and producer in television and radio, including documentary film work. From there, he moved into marketing and promotion for radio and TV stations.

In his mid-20s, he had an existential crisis, he says, which led him to leave the media industry and study to become a Catholic priest. Part of his training involved doing chaplaincy work on college campuses and advocacy work with immigrants and refugees through the Catholic Church.

It was this advocacy and social justice work that sparked Duggan’s interest in counseling, he says. After earning a master’s degree in theology, he again shifted course and enrolled in the master’s in counseling program at Marymount University in Arlington, Virginia.

Duggan_1

(Photos by Paul Sakuma)

Soon thereafter, he established a private practice and settled into counseling work, eventually becoming an approved counselor supervisor, an LPC and a national certified counselor.

Duggan says he’s always been interested in “helping people tell their own life story.” Whether it’s been through documentary films or his work as a chaplain and professional counselor, his goal has always been to “help people talk about things that are meaningful in their lives,” he says.

At ACA, Duggan’s past experience in television and radio lends itself to the production of webinars and podcasts, while his experience in private practice helps him answer member queries and phone calls.

He decided to apply for the ACA job last year, after calling to speak with Daniel-Burke about a question concerning private practice. He worked alongside Daniel-Burke for a few weeks before she retired, recording a couple of podcasts and working in the career center at ACA’s Annual Conference & Expo.

“Had you told me two years ago that I’d be sitting here [working at ACA], I would have said ‘Are you crazy?’” says Duggan, chuckling. However, when the opportunity presented itself, he came to realize that it was “the next right step” in his career, he says.

Duggan has scaled his own private practice down but continues to see a handful of clients during evening hours. He lives in Maryland with his husband and four cats.

 

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Have a professional query? Contact John Duggan at JDuggan@counseling.org or 800-347-6647, ext. 230

 

Learn more about Duggan in the ACA podcast “Counselors in Transition,” which he recorded with Rebecca Daniel-Burke this summer.

 

Duggan’s next webinar, a seven-part series on trauma, begins this month. See counseling.org/continuing-education/webinars for more information.

 

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Lynn Linde also joins ACA staff

Lynn Linde joined ACA headquarters this summer as senior director of the ACA Center for Counseling Practice, Policy and Research.

LindeLinde is well known at ACA, serving as the association’s president in 2009 – 2010. She has also served on the ACA Ethics Committee, chaired ACA’s School Counseling Task Force and represented ACA at numerous professional events, including a recent Capitol Hill briefing on the importance of school counselors.

Previously, she was director of clinical experiences at the school counseling program at Loyola University Maryland. Her past experience also includes serving as coordinator and director of school counseling programs for the state of Maryland.

 

Contact Linde in her new role at ACA at LLinde@counseling.org

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

A living document of ethical guidance

By Laurie Meyers May 22, 2014

Branding-Box-EthicsAfter three years of work that included 40 conference calls, numerous face-to-face meetings, two meetings at American Counseling Association annual conferences, two town hall meetings and the evaluation of feedback received from more than 100 ACA members, the 2014 ACA Code of Ethics was approved and released at the end of March, replacing the prior ethics code that had been in place since 2005.

“The revised code makes it clear that we have completely made the transition as a profession from focusing on the needs of the counselor to the needs of the client — that our clients are more important than we are,” says David Kaplan, ACA’s chief professional officer and staff liaison to the ACA Ethics Revision Task Force. “The code now states the values of the counseling profession and the basic ethical principles that all counselors — not just ACA members — are expected to use to inform their practice, teaching, supervision and research.”

The 11 members of the ACA Ethics Revision Task Force, chosen for their backgrounds and expertise in ethics, started the process knowing that every area of the code would need scrutiny. Two areas in particular stood out, however — the sticky question of counselor personal values and the ethical use of technology and social media with counseling clients. These areas wound up influencing the ethics code in its entirety because task force members decided it was important to infuse the issues throughout the finalized ethics language.

“A code of ethics is a living document that is meant to change as the profession grows and develops over time,” says Ethics Revision Task Force Chair Perry Francis, a counseling professor in the Department of Leadership and Counseling at Eastern Michigan University (EMU).

The counseling profession has experienced a substantial amount of growth, development and change in the nine years since the release of the 2005 code, and the Ethics Revision Task Force thought it was important for the 2014 ACA Code of Ethics to address the current professional and societal climate. Therefore, task force members carefully considered feedback from practitioners in the field to ensure the revised ethics code would provide guidance for current practices and challenges in the profession, says Francis, who also coordinates EMU’s counseling training facility and sees clients on a limited basis.

“The major sections were, as expected, social media, technology and distance counseling; clarifying the concepts of boundaries in our connected world; [and] addressing the confusion on the difference between values and competence when working with or referring clients,” he says.

Professional values

The committee’s changes started with the ethics code’s preamble. For the first time, specific professional values are delineated at the very beginning of the document.

“We wanted to state the values of the profession,” says task force member Richard Watts, a professor and director of the Center for Research and Doctoral Studies in Counselor Education in the College of Education at Sam Houston State University in Huntsville, Texas. “We didn’t think previous versions had emphasized — to this degree — the values of the profession.”

Specifically, the preamble names these core professional values:

1) Enhancing human development throughout the life span

2) Honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential and uniqueness of people within their social and cultural contexts

3) Promoting social justice

4) Safeguarding the integrity of the counselor-client relationship

5) Practicing in a competent and ethical manner

“While the professional values of counseling have always been in our code of ethics, we clarified and highlighted them to ensure that there was no confusion on the expectation of professional counselors as they interacted with clients,” Francis says.

Task force members pointed to two legal cases that made it clear that not all counselors or counselors-in-training understood the overarching values and expectations of the profession. Ward v. Wilbanks involved an EMU student in the school counseling program, Julea Ward, who, during her practicum at the in-house clinic, refused to counsel a client who stated on the intake form that he wanted help with issues relating to a same-sex relationship. Ward wanted to refer the case to another counselor-in-training because her religious beliefs held that same-sex relationships were immoral. After being informed that referring a client based solely on personal beliefs was unethical, she was offered a remediation program to help her counsel such clients. Ward requested a formal hearing instead and was dismissed from EMU’s program for violating the ACA Code of Ethics. She later filed a lawsuit alleging infringement of her religious freedom.

The other case, Keeton v. Anderson-Wiley, was similar. Jennifer Keaton, a counseling student at Augusta State University in Georgia, declared her opposition to counseling members of the lesbian, gay, bisexual and transgender community and stated that she was a proponent of reparative therapy. After declining to enter remediation, she was removed from the university’s counseling program. She subsequently filed a lawsuit against the school.

“We kind of had this little ‘out’ in the old code,” says Ethics Revision Task Force member Linda Shaw, professor and head of the Department of Disability and Psychoeducational Studies at the University of Arizona. “The standard that allows you to refer when you feel you’re not going to be effective was stated very generally.”

In other words, a counselor who wanted to refer a client based solely on personal beliefs might sidestep the issue of discrimination by claiming he or she would not be effective counseling the client, Shaw explains. “We just didn’t have the clarity [in the 2005 ethics code] saying that there is a difference between a lack of knowledge and referring because of personal values,” she says.

Adds Watts, “There was a lot of discussion about making sure that we treat all clients inclusively — that clients are not discriminated against because of subjective values or class identity.”

“I think we made it more clear that client welfare is the paramount issue in every mental health code,” he continues. “Refusing to see clients because of sexual orientation or any other subjective reason is clearly discriminatory, and we were concerned that competence was functioning as a smoke screen.”

Online without being out of line

The other big change in the 2014 ACA Code of Ethics is the addition of an entire section on the ethical use of technology and social media with clients.

“I think the most glaring omission in the 2005 code was technology,” says Ethics Revision Task Force member Gary Goodnough, a professor and chair of the Counselor Education and School Psychology Department at Plymouth State University in New Hampshire. “We were not as detailed as we should have been. It really needed its own section.”

“I think as a group we were certainly conscious of the need of bringing the code into this decade in terms of addressing new technologies and questions counselors have about social media,” agrees Shaw.

The new section devoted to social media and technology addresses a growing need in the profession, Francis says. Given the transient and ever-evolving nature of technology, the task force tried to write the guidelines as broadly as possible so that the standards will remain relevant to future applications of technology — even those not dreamed of yet.

“A major goal was to make sure that technology was focused on not just in a new section but infused throughout, like multiculturalism was infused in the 2005 code,” says Michelle Wade, who was a private practitioner and a student representative to the task force until stepping down in July 2013 to join the ACA Ethics and Professional Standards Department as an ethics specialist.

“The profession is in growth,” Wade notes. “Some counselors are still very traditional and only conduct face-to-face sessions, but others are doing distance counseling, both by phone and online.”

This shift brings with it some significant concerns. “Sometimes, I think a lot of our profession thinks that Skype is all you need [to provide] distance counseling,” Wade says.

In reality, Skype is not compliant with the Health Insurance Portability and Accountability Act (HIPAA). But the ethical concerns don’t end there. Distance counselors need to understand that they may be subject to the rules and regulations of both their state and the state in which the client is located, emphasizes task force member Mary Hermann, an associate professor and department chair of counselor education at Virginia Commonwealth University in Richmond.

Counselors must be aware of these differences for every state in which they have a distance client. “Counselors have to make sure that they have a secure means of connecting and that their encryption standards are current,” Hermann says. “Different states may have different standards.”

“Informed consent and disclosure are important in this area,” adds Goodnough, who is also Plymouth State’s graduate program coordinator for school counseling. “What are the risks and benefits? What do we do if the technology fails or there is a client emergency?”

“Distance counseling definitely starts first and foremost with informed consent,” agrees Wade.

As it states in the new code: “In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology and/or social media, are addressed in the informed consent process:

  • distance counseling credentials, physical location of practice and contact information;
  • risks and benefits of engaging in the use of distance counseling, technology and/or social media;
  • possibility of technology failure and alternate methods of service delivery;
  • anticipated response time;
  • emergency procedures to follow when the counselor is not available;
  • time zone differences;
  • cultural and/or language differences that may affect delivery of services;
  • possible denial of insurance benefits; and
  • social media policy.”

But after counselors obtain informed consent and find a secure, HIPAA-compliant method of communication, Wade doesn’t think that distance counseling should differ significantly from face-to-face counseling. For example, she says, counselors should already have a crisis plan in place for their regular clients. Distance counseling just requires that counselors become aware of the resources available in the distance client’s location, she says.

Distance counseling is not for every client or counselor, but in some ways, it can be empowering, Wade says. Because the counselor is less available, the client is encouraged to learn what other resources are available and how to use them.

“For instance,” she says, “say I have a client I treat face to face during the summer who has to return to college in the fall. We can do distance counseling, but I would make her aware that the crisis center at her college is there as a backup resource.”

Social media scrutiny

Some counseling professionals have demonstrated resistance to new technology, but others have jumped right in, especially when it comes to social media, Wade says.

In fact, she notes, counselors have not always looked carefully before leaping into the social media pool, getting caught up in a technological and cultural movement that was not even in its infancy when the 2005 ACA Code of Ethics was released. “People were just doing things — participating in social media — and not thinking about it from an ethical perspective,” she says.

Social media guidance for today’s counselors is critical, says Goodnough, who notes that if counselors are going to be online, they need to present a professional image.

There are other issues that the revised code of ethics addresses as well. For instance: “We don’t follow our clients online. We don’t look at their Facebook,” Goodnough says emphatically. “These guidelines are helpful.”

Specifically, the code states that counselors respect the privacy of their clients’ presence on social media unless given consent to view such information.

Wade adds that although Googling a client online is tempting, especially if a counselor feels like the client is holding back, it is still regarded as an invasion of privacy.

When both the counselor and client are online, distinguishing boundaries can be tricky, Wade says. “I wanted to take a firm stand on ‘friending’ clients,” she says. “Counselors really need to distinguish between their personal online presence and their professional one.”

“You have a professional relationship with the client,” she continues, “and seeing you as a person, not just as a professional, could really change the balance of the relationship.”

As the new code makes clear, counselors who are on Facebook both personally and professionally need to set up distinct, separate profiles for each, Wade emphasizes. “Your personal profile should not have the same email or name as your professional profile,” she says.

“If you have a company name, use it for your professional page. Make the security settings on your personal Facebook page as high as possible so that you cannot be found accidentally,” Wade suggests.

For counselors who are new to social media or concerned about privacy on Facebook, Twitter may be a better option, says Wade. “It’s more anonymous than other social media,” she explains.

Twitter is a social media platform in which users “tweet” their thoughts — which may or may not include a link to an article, photo or video — in 140 characters or less. Signing up requires only a name, a username (such as @ACA_CTOnline) and an email address. Counselors can also sign up with their real names or the names of their practice if they wish to tweet about their areas of counseling expertise. For more personal tweeting, anyone who wishes to remain anonymous can sign up using a nom de plume, an anonymous email address and a Twitter name that doesn’t hint at his or her profession, location or true identity (think @Cyrano not @AdlerDC).

At the same time, counselors must remember client boundaries. For example, a counselor should not follow a client’s tweets without permission. Even if permission is granted, think ethically, advises Wade.

“Think carefully about how to handle the information your client may release,” she says. “What if a client posts something suicidal? You will have to deal with it.” Unless a counselor checks his or her social media networks every five to 10 minutes, many of the posts or tweets will not be read in real time, which makes timely crisis intervention unlikely, Wade points out.

If a client asks a counselor to follow him or her on social media, the counselor should sit down and discuss why the client wants to be followed, Wade says. In addition, the counselor should make sure the client understands that social media activity cannot serve as a mode of direct counselor-client communication, she says. If a counselor does decide to follow a client, it is probably best that the counselor and client review the client’s activity in a session so they can discuss the content and address any potential problems.

To respect their clients’ privacy, counselors should not routinely ask them about their social media activity, Wade says. If a client mentions specific activity or incidents on social media multiple times, the counselor might want to ask if there is something the client would like to discuss about his or her online activity.

Ethics Revision Task Force member Lynn Linde, a clinical assistant professor in the school counseling program at Loyola University Maryland, is well aware of the dark side of social media — particularly Instagram, a platform that allows users to upload photos and use a number of filters to change a photo’s appearance. The pictures are public, and people can “like” and post comments to them.

“Cyberbullying is an epidemic on Instagram,” says Linde, who is also a past president of ACA. “Kids don’t understand that once they take a picture and [post it or] send it to someone, it’s there forever. … Cyberbullying can happen anywhere, with anyone.”

For this reason alone, ethically, school counselors must have a basic understanding of social media so they are aware of the issues students may be facing, Linde emphasizes.

Counselors also need to know where the boundaries are. “I’ve gotten a lot of questions from school counselors about whether they can look at a client’s Facebook page,” she says. Linde’s response is that the school itself may have the legal right to access the student’s Facebook page, but, ethically, counselors should always respect their clients’ virtual privacy.

With all the new technologies available, Linde also thinks that counselors need to reconsider one technology that has become old hat — email. Because it is a method of communication that has become ubiquitous, counselors can get lazy about putting the proper safeguards in place. Particularly at schools, she says, everyone emails everyone else — counselors to teachers, counselors to parents, counselors to counselors and so on. “People forget that anything that is put in an email can go anywhere to anyone,” Linde says.

Other changes

The definition of relationship has expanded in the 2014 ACA Code of Ethics. Language has been added that prohibits counselors from having personal virtual relationships with clients, Goodnough notes. In addition, the prohibition on counselors having a relationship with a former client has been brought back after an inadvertent omission in the 2005 code, Hermann says.

Certain types of nonsexual, yet still problematic, counseling relationships are prohibited as well, such as counseling a family member or friend if the counselor will be unable to remain objective, Goodnough says.

Again, however, task force members assert that lack of objectivity should not be confused with the imposition of personal values.

The revised ethics code has also removed the end-of-life exception to the referral rule. Counselors may no longer refer a client because he or she is terminally ill and considering either physician-assisted or self-inflicted suicide. If the client wants to discuss the decision, counselors should check the laws in their state. If a counselor’s state has legalized physician-assisted suicide, then any discussion is legally covered. If the state does not allow physician-assisted suicide, counselors should consult an attorney to see if that ban includes discussing the issue, Kaplan says.

The 2014 code has also clarified “duty to inform.” If a client has revealed a diagnosis of a life-threatening disease and the counselor is concerned that a third party may be at risk, the counselor does not have to confirm his or her client’s diagnosis but should check state laws to see if it is legal to inform the third party, Kaplan explains.

Another area that has been clarified in the revised code is providing pro bono services. “The pro bono issue was one we kept coming back to, deciding what we meant by ‘pro bono,’” Shaw says. “Did pro bono mean reduced rate, or in some way addressing unmet needs?”

The task force also discussed whether it was fair to ask counselors who might be struggling financially to offer free or reduced rate counseling, Shaw says.

“We wanted to broaden the notion of what pro bono means,” Goodnough says. The revised code says that counselors should make a reasonable effort to engage in pro bono activity, but this can include public speaking, putting free professional information on their websites or volunteering counseling services in the wake of a disaster, Kaplan explains.

“The pro bono requirement is in many ways related to social justice,” Shaw says. “It is an attempt to do what you can as a counselor to improve access to services or information. It means sharing your knowledge and expertise in ways that benefit others, without posing an unreasonable burden on you.”

The revised ethics code also attempts to clarify counselors’ responsibilities with mandated clients. As Goodnough points out, these clients may be mandated, but they don’t really give up their autonomy. “Let them know what the reporting requirements are, the type of [information] we might be sharing, who we might be sharing it with and what the consequences are for not participating,” he says. “But they can still refuse counseling services.”

Another ethics issue the task force addressed was where client confidentiality starts and where it ends. Under the revised code, the responsibility to protect confidentiality begins even before a counselor takes on a client and continues after the client’s death.

“A good example comes from college counseling centers,” says Francis. “It is not uncommon on a college campus for a dean of students or a member of the faculty to refer a student for counseling services. In some cases, the referring agent may follow up to see if the student has sought services.”

“The ethics code now point out that a prospective client — someone who has an appointment but has not yet come in for services — is afforded the same privacy and confidentiality as a regular client,” he explains. “We do not release information without permission or sound ethical or legal justification.”

The 2014 ACA Code of Ethics also includes updated requirements for counselor educators. “The code now makes it their ethical obligation to teach classes within their areas of competency, provide current information and provide students with direct assistance with
field placements and career assistance,” Kaplan says.

Educators and researchers will find some significant changes in the area of ethical research as well. “The emphasis on anonymity of persons and case studies was strengthened,” Watts points out. “If you are going to use a case study, you should get permission. … The use of clients, students or research participants is appropriate only if the person has seen and agreed to it or details are obscured enough that they cannot be identified.”

Thinking and acting ethically

The 2014 ACA Code of Ethics requires counselors to use a problem-solving model when confronted with an ethical dilemma, Kaplan says.

“There are a number of models out there,” Shaw adds. “Which one [to use] is not as important as that we ensure that counselors are familiar with one, have working knowledge of it and use it to sort out some of the thornier issues.”

But the Ethics Revision Task Force members also hope the entirety of the code, including its tone throughout, will guide counselors when they are in doubt.

“I felt that we needed to work at making the code more than just specific guidance for specific situations,” Shaw says. “We needed to create a context for counselors’ ethical conduct by having a mindful, thoughtful approach to practicing ethically.”

“The whole code of ethics needs to be looked at in its entirety. It’s all connected,” adds Linde. “I hope the message comes across that we want people to be thoughtful.”

Concludes Shaw, “If you asked me what the most important change was — technology is going to keep changing, but I think the values issues questions … are really fundamental to who we are as counselors. To me, it is the most profound change in the code.”

 

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The five most common ethical concerns

American Counseling Association members receive free confidential ethics consultations as a benefit of their membership. Michelle Wade, an ethics specialist in the ACA Ethics and Professional Standards Department, handles many of these calls and emails. She provided Counseling Today with a list of the five ethical concerns that ACA members seek guidance on most frequently.

Although she here suggests applicable areas of the revised ACA Code of Ethics for each of the five concerns, she cautions that none of this should be taken as official ethical advice. To receive assistance with a specific ethical dilemma or question, contact the ACA Ethics Department at 800.347.6647 ext. 314 or ethics@counseling.org.

Subpoena questions/release of information

There are several ethical standards within the 2014 ACA Code of Ethics that need to be considered regarding the release of client information: A.1.a., A.2.a., A.4.a., B.1.c., B.1.d., B.2.d. and B.2.e.

Breaking confidentiality/mandated reporting

Note that the ACA Code of Ethics does not address mandated reporting directly because every state has its own regulations. Therefore, it is important to understand what your state’s regulations are regarding reporting. With regard to ethics, Wade refers counselors to standards B.2.a. and B.2.e. as well as A.2.a., B.1.b., B.1.c. and B.1.d.

Extending professional boundaries

Navigating the relationship between counselor and client can be difficult at times. The ethical standards that address this situation within the 2014 ACA Code of Ethics are found in A.6.

Distance counseling/social media/technology

There is a brand-new section within the 2014 ACA Code of Ethics that addresses distance counseling, technology and social media. That section (Section H) provides some guidance and considerations when working with technology and distance counseling as well as social media.

Personal values

“ACA celebrates that our members are all different and would never ask anyone to change who they are,” Wade says. “However, ACA would ask counselors to put themselves second to their clients. In the 2014 ACA Code of Ethics, A.4.b. was expanded to include the necessity of obtaining training and multicultural competency as a counselor. A.11.a. and A.11.b. were also added to suggest that referrals need to be based on competency, not values, and the reasoning for that was, again, the client comes first.”

 

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Getting familiar with the revised ACA Code of Ethics

In addition to the hard copy of the 2014 ACA Code of Ethics that was packaged with the June issue of Counseling Today, ACA members can access the code online at counseling.org/ethics.

A Spanish language version of the code is available here: counseling.org/docs/default-source/ethics/2014_code_of_ethics_ph_spanish.pdf?sfvrsn=2

To familiarize themselves with the differences between the 2005 and 2014 ethics codes, counselors may also wish to listen to a podcast, “The NEW 2014 Code of Ethics: An Overview,” also available at counseling.org/ethics.

Additional resources, including a six-part webinar series (worth a total of six CEs), can be found at counseling.org/continuing-education/webinars.

Also, beginning next month with the July issue, Counseling Today will feature a new column series that highlights the most significant changes in the revised ethics code.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

 

Letters to the editor: ct@counseling.org

 

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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