Week 3: Couselling Ethics and Self-Care Flashcards
Definition of Ethics
“moral principles that govern a person’s behavior or the conducting of an activity” (Google Dictionary, 2017)
College of Registered Psychotherapists of Ontario (CRPO) (2)
Psychotherapy Act 2007 was proclaimed April 1st 2015 which brought CRPO into full operation as health regulatory college and act proclaimed on Dec 31st 2017 (2 year grace period)
Purpose is to “Regulate the members in the public’s interest ” (CRPO, 2015)
The controlled act of psychotherapy is:
“treating by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgment, insight, behaviour, communication or social functioning.”
Ethical Guidelines
Sommers-Flanagan & Sommers-Flanagan, 2004 (3)
Have three key features:
a) provide a knowledge base
b) describe activity sanctioned within the profession
c) offer a clear picture of boundaries of the professional activity
Code of Ethics: Goal
(CCPA) Canadian Counselling & Psychotherapy Association (2007) (4)
A code of ethics also:
- Expresses ethical principles and values
- Serves as a guide to the professional conduct of all its members
- Informs the public of the standards of ethical conduct for which members are to be responsible and accountable
- Reflects values such as integrity, competence, responsibility, understanding and respect for cultural diversity
Is the Code of Ethics static? Why?
(1+2)
Canadian Counselling & Psychotherapy Association (2007)
The code is not static.
- It is revised over time to account for the fact that ethical knowledge continues to develop and that there is emerging consensus on challenging ethical issues.*
- There continues to be ongoing discussions regarding best standards of practice and codes of ethics.*
Six Ethical Principles
Canadian Counselling & Psychotherapy Association (2007)
Beneficience
Fidelity
Nonmaleficence
Autonomy
Justice
Societal interest
Beneficience (Six Ethical Principles)
~ being proactive in promoting the client’s best interest
Fidelity (Six Ethical Principles)
~ honouring commitments to clients and maintaining integrity in counselling relationships
Nonmaleficence (Six Ethical Principles)
~ not willfully harming clients and refraining from actions that risk harm
Autonomy (Six Ethical Principles)
~ respecting the rights of clients to self-determination
Justice (Six Ethical Principles)
~ respecting the dignity and just treatment of all persons
Societal interest (Six Ethical Principles)
~ respecting the need to be responsible to society
Ethical Principles (CRPO) (6)
Autonomy and Dignity of All Persons –
Excellence in Professional Practice –
Integrity –
Responsible Citizenship –
Responsible Research –
Support of Colleagues –
Ethical Principles (CPRO): Autonomy and Dignity of All Persons –
Respect diversity and dignity and rights of all; to reject all forms of harassment and abuse; maintain appropriate therapeutic boundaries at all times
Ethical Principles (CPRO): Excellence in Professional Practice –
Work in the best interests of clients; to work within abilities and competencies; and to pursue personal and professional growth throughout career
Ethical Principles (CPRO): Integrity –
To openly inform clients about options, potential risks and benefits of professional services; to recognize and strive to challenge my own professional and personal biases; and to consult on ethical dilemmas
Ethical Principles (CPRO): Responsible Citizenship –
To participate in community as responsible citizen, always mindful of role as a trusted professional; and to consult on potential conflicts-of-interest and other personal-professional challenges
Ethical Principles (CPRO): Responsible Research –
To conduct only such research as potentially benefits society, and to do so safely, ethically and with the informed consent of all participants
Ethical Principles (CPRO): Support of Colleagues –
To respect colleagues, co-workers, students, and members of other disciplines; to supervise responsibly; to work collaboratively; to inspire others to excellence
A. Principle-based Ethical Decision-Making (6)
Ethical Decision-Making Processes
(Canadian Counselling & Psychotherapy Association (2007))
Step 1 What are the key ethical issues in this situation?
Step 2 What ethical articles from the CCPA Code of Ethics are relevant to this situation?
Step 3 Which of the six ethical principles are of major importance in this situation?
Step 4 How can the relevant ethical articles be applied in this circumstance and any conflict between principles be resolved and what are the potential risks and benefits of this application and resolution?
Step 5 What do my feelings and intuitions tell me to do in this situation?
Step 6 What plan of action will be most helpful in this situation?
B. Virtue-Based Decision-Making
Ethical Decision-Making Processes
(Canadian Counselling & Psychotherapy Association (2007))
(3+5)
Based on the belief that counsellors are motivated to be virtuous and caring because it is the right thing to do.
Virtue ethics focuses on the counsellor as an ethical agent with the capacity to make complex ethical decisions.
No step-by-step methodology, the following questions may be helpful guides:
- What emotions and intuition am I aware of as I consider this ethical dilemma and what are they telling me to do?
- How can my values best show caring for the client in this situation?
- How will my decision affect other relevant individuals in this ethical dilemma?
- What decision would I feel best about publicizing?
- What decision would best define who I am as a person?
C. Quick Check (3)
Ethical Decision-Making Process Canadian Counselling & Psychotherapy Association (2007)
Publicity ~ Would I want this ethical decision announced on the front page of a major newspaper?
Universality ~ Would I make the same decision for everyone? If every counsellor made this decision would it be a good thing?
Justice ~ Is everyone being treated fairly by my decision?
What is Self Care? (4)
Self-Care =“Although no consensus exists about a ‘true’ definition of self-care (Lee & Miller, 2013), it is often seen as proactive and intentional” (Thompson et al., 2011 as cited in Koenig & Arnold, 2017).
- Self care is the combination of activities, behaviours, or practices that people participate in to ensure that their needs are met in healthy ways
- It involves an awareness of caring for various aspects of the self – physically, mentally, spiritually, emotionally, psychologically
While many can engage in self care practices, it is essential for those in helping professions to maintain regularly
Personal Care Examples (3)
Creative expression
- Writing (journal, fiction, non-fiction, poetry), drama, photography, cooking, drawing, painting, dancing
Skill Development
- Learn something new
- E.g., musical instrument, construction, sport, etc.
Spiritual practices and Meditation
- Shown to improve breathing, increase relaxation, increase feelings of hope and well-being (Trippany et al., 2004)
Professional Care (2)
Balance
- Have an attitude of altruistic egotism!
Continual behavioural monitoring of one’s other-care-self-care balance
Boundaries/limitations
- “Know your limit, play within it”
General warning signs
If noticing these things, time to meet own therapist/ more self-care
Feeling Hopeless or Helpless
Sense one can never do enough
Hypervigilance
Diminished Creativity
Inability to embrace complexity
Minimizing
Chronic exhaustion/physical ailments
Inability to listen/deliberate avoidance
Dissociative moments
Guilt
Fear
Anger and cynicism
Inability to empathize/numbing
Addictions
Grandiosity
Burnout (1+3+1+3)
“a progression of unsuccessful attempts by an individual to cope with a variety of conditions that are perceived to be threatening”
Operationalized as
- Emotional exhaustion
- Depersonalization
- Lack of personal accomplishment
(Maslach & Johnson, 1981)
Workplace related
Brought on by long-term emotionally demanding situations
- Feeling of physical, emotional, mental exhaustion
- Emotional distress
- Potential exploitation of client
Example Statements of Burnout
- Emotional Exhaustion
“I am just so emotionally fried”
“I really don’t want to get up this morning to deal with another day on the job”
“It feels like I’m a hamster in a running wheel” - Depersonalization
“I don’t really care what happens to Bob”
“So this depressed kid came to me and said…” - Lack of Personal Accomplishment
“I don’t make a difference at my job”
“I get all tense when people come to me with emotional problems”
Burnout Consequences
Anger
Cynicism
Impatience
Hopelessness
Helplessness
Denial of feelings
Hard headedness (rigid in perspective)
Physical ailments
Compassion Fatigue (Secondary Traumatic Stress) (6)
Develops due to the emotionally shocking material
- Related to interactions with clients and the traumas they have experienced
More acute consequence of work
- Reduced capacity or interest to bear witness to those suffering
Like PTSD but do not personally experience the trauma
“the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced by a significant other” (Figley, 1995, p. 5)
Symptoms of Compassion Fatigue (3)
Arousal
= heightened/persistent arousal – difficulty sleeping, becoming irritable, being hypervigilant
Re-experiencing
= dreams, recollections, flashbacks
Avoidance
= numbing reminders of the trauma through detachment from others, physiologic amnesia, diminished affect
Other CF Consequences
– headaches, high rates of illness, somatization, distancing from loved ones, absenteeism, guilt, desensitization, difficulty separating personal from professional life, resentment, lose creativity, disproportionate reaction
Compassion Fatigue is a concern because… (5)
- Helpers may be more likely to engage in boundary violations, dual roles or role reversal
- May be more difficult to maintain a therapeutic stance (not objective)
- May delay returning phone calls, being pleased about cancelled appointments
- Helpers may be more likely to question the efficacy of therapy
- May feel reluctant to start the day, daydream
Other Compassion Fatigue Consequences
Sadness
Depression
Sleeplessness
Generalized anxiety
Can affect helper’s family, friends, colleagues (Contagion)
Vicarious Trauma (4)
Results from cumulative exposure to client trauma
Changes in cognitive schemas
- Identity, worldview, belief system/spirituality
Intense empathic engagement with clients
Gradual onset
VT Consequences (6)
Depression
Despair
Cynicism
Alienation from colleagues, family and/or friends
Premature job changes
Other psychological and physical symptoms
What increases Burnout, CF, VT
Heightened emotions of client’s families
Inability to maintain self-care
Lack of social support
Uncontrolled work stressors
Lack of defined boundaries
Lack of experience
Own experiences of trauma
Stressors in personal life
Typical coping style
Lack of training
Increased workload/demands/pressures
Feelings of isolation
Organizational rules
Professional Considerations: Integrity in the relationship (Everall & Paulson, 2004) (7)
therapist needs to be able to have meaningful relationship, meet needs in life
avoid over-involvement with client’s problem
being obsessed with client, the problem
withdrawal from other clients, family
deviating from professional behaviour, wishing the case would terminate
those who are overly idealistic or dedicated may be more likely to become enmeshed with client (‘needing to fix, solve problem’)
important for therapist to model appropriate boundaries
Professional Considerations: Responsible Caring (Everall & Paulson, 2004) (4)
refer to ethical guidelines in the CCPA or other regulatory body or organization
need to have control over clientele – i.e., not too many trauma cases
most difficult situation are those in which the therapists’ own issues get triggered
need sound clinical supervision, therapy
Professional Considerations: Implications for Practice (Everall & Paulson, 2004) (3)
Self-monitoring – ‘know thyself’; an ethical responsibility
Obtaining supervision – ways of maintaining psychological and physical health
Intervention and support of colleagues – ongoing support and connection with colleagues is important; be aware of, and open to, discussing stressors
The ABCs of Self-Care (Gamble (2002)) (3)
Awareness
- ‘waking up’ to one’s experience rather than distracting oneself. A need to slow down, do less, be mindful*
Balance
- how clients are scheduled, being open to restoration and growth, not just trauma, setting limits, appropriate boundaries with clients; personal priorities
Connection
- supportive relationships with colleagues, family, friends; nonjudgmental places to talk
