Week 10 Ethical Considerations

Question 1

what do we mean by ethics?

Answer 1

‘a moral philosophy, or science of morality,
which seeks to establish guidelines by which
human character and action may be judged as
good or bad, right or wrong.’ (Shillito-Clarke,
1996, p. 555)

‘the science of morals or rules of behaviour.’
(BPS, 2009, p. 6)

Question 2

Codes of Ethics

Answer 2

Codes of ethics of professional bodies
– A minimum set of standards for ethical
practice
– Acceptable to the majority of members
– All members of that Society must be
accountable in their practice

Serve to protect client and therapist

Where practice falls below standard
– Addressed by Society

Question 3

Organisations

Answer 3

bacp (British Association for Counselling and Psychotherapy)

BPS

hcpc (health & care professions council)

Code of ethics and conduct (2009)

Question 4

BPS (2009)

Answer 4

Main domains of responsibility within which
ethical issues are considered
Respect
Responsibility
Competence
Integrity
Statement of values and standards to be met

Question 5

Respect

Answer 5

‘Psychologists value the dignity and worth of all persons, with sensitivity to the dynamics of perceived authority or influence over clients, and with particular regard to people’s rights including those of privacy and self
determination’ (BPS, 2009, p. 10)

– Standard of general respect
– Standard of privacy and confidentiality
– Standard of informed consent– Standards of self-determination

Question 6

Competence

Answer 6

Psychologists value the continuing development and maintenance of high standards of competence in their professional work, and the importance of preserving their ability to function optimally within the recognised limits of their knowledge, skill, training, education, and experience

– Standard of awareness of professional ethics
– Standard of ethical decision making
– Standard of recognising limits of competence
– Standard of recognising impairment

Question 7

Responsibility

Answer 7

Psychologists value their responsibilities to clients, to the general public, and to the profession and science of Psychology, including the avoidance of harm and the prevention of misuse or abuse of their contributions to society
– Standards of general responsibility
– Standards of termination and continuity of care
– Standard of protection of research participants
– Standard of debriefing of research participant

Question 8

Integrity

Answer 8

Psychologists value honesty, accuracy, clarity, and fairness in their interactions with all persons, and seek to promote integrity in all facets of their scientific and professional endeavours

– Standard of honesty and accuracy
– Standard of avoiding exploitation and conflicts of interest
– Standard of Maintaining Personal Boundaries
– Standard of Addressing Ethical Misconduct

Question 9

HPC (2009) - HCPC (2012)

Answer 9

Standards of Proficiency for Practitioner
Psychologists
– Safe and effective practice
– Minimum standards for proficiency
* Expectations of a health professional
* Skills required for the application of practice
* Knowledge, understanding and skills

Clinical, counselling, educational, forensic, health, occupational, and sport and exercise psychologists

Question 10

BACP Ethical Framework (BACP, 2016)

Answer 10

Values, Principles and Personal Moral Qualities

Values
– Values are a useful way of expressing general ethical
commitments that underpin the purpose and goals of our actions
– Values inform principles. They become more precisely defined
and action-orientated when expressed as a principle

Principles
– The ethical principles focus on important
ethical responsibilities
* Being trustworthy, autonomy, beneficence, non-maleficence, justice, self-respect

Question 11

Principles in BACP

Answer 11

Autonomy
Being Trustworthy
Justice
Beneficence
Non-maleficence
Self-respect

Question 12

Personal Moral Qualities BACP

Answer 12

Integrity, resilience, respect, sincerity, wisdom, care, diligence, courage, empathy, identity, humility

Question 13

Ethical Issues

Answer 13

Within the individual therapist
Arising through the work of the therapist

Question 14

1 Arising within the individual therapist

Answer 14

Competence/Diligence
–Recognising limits of knowledge and experience

‘maintain and develop their professional competence, to recognise and work within its
limits and to identify and ameliorate factors which restrict it’ (BPS, 1993, p.1) ‘the conscientious deployment of the skills and knowledge needed for a beneficial
outcome’ (BACP, 2016, p. 7)

Question 15

2 Arising within the individual therapist

Answer 15

Fitness to practise
–Psychological, emotional and physical state of the practitioner

‘Monitor their own personal and professional lifestyle in order to remain alert to signs of impairment…’ and ‘seek professional consultation or assistance when they become aware of health-related or other personal problems that may impair their own professional competence’ (BPS, 2009, p. 17)
‘take responsibility for our own wellbeing as essential to sustaining good practice’ (BACP,
2016, p.21)

Question 16

3 Arising within the individual therapist

Answer 16

Personal safety
– Safeguarding physical state
* Boundaries
* Personal availability
* Acceptable behaviour
* Training in assessment

Question 17

Arising through the work of the therapist

Answer 17

Perceived power balance
Client is in a vulnerable position

Respect for autonomy
Respect ability to be self-directing

Contracting and informed consent
‘adequately understood the nature of
the…intervention and it anticipated
consequences’ (BPS, 1993, p. 2)

Quality of relationship
Clarity of the contract
Management of the practice
Maintenance relationship boundaries

Confidentiality
Complex, trust, legal
requirements - total confidentiality - unethical?

Dual relationships
Client/therapist hold more than one role in respect to their relationship with the other person -> power, confidentiality, no therapy to a friend

Question 18

Ethical Dilemmas

Answer 18

How should I proceed when working
with someone who expresses serious
suicidal thoughts and feelings?

Question 19

Working with someone who expresses serious suicidal thoughts and feelings

Answer 19

Establish level of intent
Important not to:
– Play down the importance of the threat
– Or misread the situation and offer medical help too early

Complex interaction
– Ethical, legal responsibilities, context, cultural,
religious considerations

Question 20

Working with someone who expresses serious suicidal thoughts and feelings cont.

Answer 20

Strong personal feelings, beliefs and values of
therapist and those of the client

Does a person have the right to take their own
life?

Fidelity of the relationship set against the need to act in the client’s best interests

Question 21

Confidentiality

Answer 21

Should the therapist inform police or
medical services?

Negligence?

Not protecting client against harm?

Obtain client’s permission wherever possible

Sharing responsibility of client’s intended actions

Therapist accountability

Decision must be relevant, appropriate and only disclosed if therapist believes it is likely to alleviate the problem

Question 22

Client Autonomy

Answer 22

How to balance respect for the client’s
right to decide whether to live or die
against the therapist’s ‘duty of care’ to avoid
harm?

‘responsible for working in ways which
respect and promote the clients ability to
make decisions in the light of their beliefs,
values and context’ (BACP 1997:B.2.2)

Not ethically acceptable for a therapist to
coerce the client into a change of mind?

Must be able to demonstrate have taken care and reasonable precautions that would be expected of a competent practitioner

Question 23

Legal Considerations

Answer 23

Committing suicide is not an offence
however aiding and abetting is (Suicide
Act, 1961, Section 2(1))
‘there is no general duty to rescue in
British law’ (Menlowe & McCall Smith,
1993 – cited by Bond, 1999, p.9)

In some settings there may be an obligation to break confidentiality
‘to ignore that obligation may be challenged as professional negligence not protecting someone against themselves’ (Jenkins, 1997; Bond, 1999)

Question 24

Ethical Issues and Gifts

Answer 24

Good opportunity for therapist to remind client of the basis of their relationship

What are the motives for the gift?
– Testing therapist’s integrity
– Wanting to be remembered
– To address an imbalance in
the relationship
– The generous client

Nature of gift
– Invite to a social event?
* Social vs contractual relationship
– Use of supervision

Question 25

Client autonomy gifts

Answer 25

Bringing gifts to sessions:
– Conflict between client autonomy and trustworthiness and responsibility of
therapist

Gift to final session
– Acceptance of ending

What will do most good and least harm?
Ultimately the giving or receiving of gifts or favours by either party should be avoided

Question 26

Persistent Unwanted Contact

Answer 26

What is the nature of the contact?

Record any intrusion of privacy

Meet with supervisor to discuss situation whilst
maintaining confidentially

Examine work around
endings
* Examine work around ending
– Were client’s needs appropriately met?
– Whose decision was it? Referral on? Door open?
* If so, needs to be taken seriously and seen as a form of harassment

Question 27

Persistent unwanted contact cont.

Answer 27

Therapist’s responsibility remains re: harm to
former client

Ethical duty to protect themselves from physical harm

Investigate all aspects of former
relationship
Earlier history of therapy and
difficulties with endings?
N sessions, content of sessions
Further work necessary?

Advised to see help from professional body

Question 28

Ethical decision making

Answer 28

Core themes of ethical decision making:
–What are the parameters of the situation?
–Is there research evidence that might be relevant?
–What legal guidance exists?
–What do peers advise?
–Is there guidance available from the Health Professions Council or other relevant bodies?

BPS Code of Ethics
‘provides the parameters within which professional judgements should be made. However, it cannot, and does not aim to, provide the answer to every ethical dilemma a psychologist may face.’ (BPS, 2009, p. 25)

Question 29

Ethical Decision Making BACP

Answer 29

‘ethical decisions that are strongly
supported by one or more of these
principles without any contradiction with
the others may be regarded as well
founded’ (BACP, 2016, p. 5)

quite often is contradiction