ASU Ethical Dilemmas in Therapy Paper

1.Fees. Regarding the matter of establishing fees, I would tend to

have a standard fee that is the same for all my clients.

use a sliding scale to accommodate those with financial hardships.

increase my fees with existing clients as the cost of living increases.

retain the fee agreement initially made with clients.

2.Therapy for therapists. For those who wish to become therapists, I believe personal psychotherapy

should be required for licensure.

is not an important factor in the ability to work with others.

should be encouraged but not required.

is needed only when the therapist has some form of psychological impairment.

3.Therapist effectiveness. To be an effective helper, I believe a therapist

must like the client.

• must be free of any personal conflicts in the area in which the client is working.

needs to be licensed by the state.

needs to have experienced feelings or situations similar to those being experienced by the client, but not necessarily the same problem.

4.Ethical decision making. If I were faced with an ethical dilemma, the first step I would take would be to

1. review the relevant ethics codes.
2. consult with an attorney.
3. identify the problem or dilemma.
4. decide on what appears to be the best course of action.

5.Being ethical. For me, being an ethical practitioner mainly entails

acting in compliance with mandatory ethical standards.

reflecting on the effects my interventions are likely to have on the welfare of my clients.

avoiding obvious violations of my profession’s ethics codes.

thinking about the legal implications of everything I do.

• 6.Unethical supervisor. If I was an intern and was convinced that my supervisor was encouraging trainees to participate in unethical behavior in an agency setting, I would

first discuss the matter with the supervisor.

report the supervisor to the director of the agency.

ignore the situation for fear of negative consequences.

1. report the situation to the ethics committee of the state professional association.
2. 7.Multicultural knowledge and skills. Practitioners who work with culturally diverse groups without having multicultural knowledge and skills
3. may be insensitive to their clients.
4. may be guilty of unethical behavior.

should realize the need for specialized training.

may be acting illegally.

8.Feelings toward clients. If I had strong feelings, positive or negative, toward a client, I would most likely

discuss the feelings with my client.

keep my feelings to myself.

• discuss my feelings with a supervisor or colleague.

accept my feelings unless they began to interfere with the counseling relationship.

9.Being ready. I won’t be ready to counsel others until

my own life is free of major problems.

1. I have experienced counseling as a client.
2. I feel confident and know that I will be effective.
3. I have developed the ability to examine my own life and relationships.
4. 10.Client’s feelings. If a client expressed strong feelings of attraction or dislike for me, I would
5. help the client work through these feelings and understand them.

enjoy these feelings if they were positive.

refer my client if these feelings were negative.

direct the sessions into less emotional areas.

11.Dealing with diversity. Practitioners who counsel clients whose sex, race, age, social class, or sexual orientation is different from their own

will most likely not understand these clients fully.

• need to be sensitive to the differences between their clients and themselves.

should refer the client to someone who is more culturally competent.

will probably not be effective with such clients because of these differences.

12.Ethics versus law. If I were faced with a counseling situation in which it appeared that there was a conflict between an ethical and legal course to follow, I would

1. immediately consult with an attorney.
2. always choose the legal path first and foremost.
3. strive to do what I believed to be ethical, even if it meant challenging a law.
4. refer my client to another therapist.

13.Values. In terms of appreciating and understanding the value systems of clients who are culturally different from me, I would

not impose my cultural values on them.

refer them to another therapist.

attempt to modify my counseling procedures to fit their cultural values.

familiarize myself with the specific cultural values of my clients.

• 14.Objectivity. If a client came to me with a problem and I could see that I would not be objective because of my values, I would

respect my client’s values, even though I have different values.

tell the client at the outset about my fears concerning our conflicting values.

refer the client to someone else.

attempt to understand my need to impose my values.

1. 15.End-of-life decisions. With respect to a client’s right to make his or her own end-of-life decisions, I would
2. use the principle of a client’s self-determination as the key in any dilemma of this sort.
3. tell my client what I would do if I were in this situation.
4. suggest that my client see a clergy person.

encourage my client to find meaning in life, regardless of his or her psychological and physical condition.

16.When to refer. I would tend to refer a client to another therapist

if I had a strong dislike for the client.

if I did not have much experience working with the kind of problem the client presented.

if I saw my own needs and problems getting in the way of helping the client.

• if I had strong value differences with my client.

17.Role of values. My ethical position regarding the role of values in therapy is that, as a therapist, I should

never impose my values on a client.

expose my values, without imposing them on the client.

1. challenge my clients to find other ways of viewing their situation.
2. keep my values out of the counseling relationship.
3. 18.Sexual orientation. If I were to counsel lesbian, gay, bisexual, and transgender clients, a major concern of mine would be
4. accepting them as clients because of my personal values or internalized homophobia.

not knowing and understanding enough about their sexual orientation or overidentifying because of my own identity.

establishing a positive therapeutic relationship and deciding whether to disclose my own sexuality identity.

making mistakes that could damage the therapy process.

19.Unethical behavior. Of the following, I consider the most unethical form of therapist behavior to be

promoting dependence in the client.

• becoming sexually involved with a client.

breaking confidentiality without a good reason to do so.

accepting a client who has a problem that goes beyond my competence.

20.Counseling friends. Regarding the issue of counseling friends, I think

1. it is seldom wise to accept a friend as a client.
2. it should be done rarely, and only if it is clear that the friendship will not interfere with the therapeutic relationship.
3. friendship and therapy should not be mixed.
4. it should be done only when it is acceptable to both the client and the counselor.

21.Confidentiality. Regarding confidentiality, I believe it is ethical to break confidence

when there is reason to believe a client may do serious harm to him- or herself.

when there is reason to believe that a client will do harm to someone else.

when the parents of a client ask for certain information.

and inform the authorities when a client is breaking the law.

• 22.Termination. A therapist should terminate therapy with a client when

the client decides to do so.

the therapist judges that it is time to terminate.

it is clear that the client is not benefiting from the therapy.

1. the client reaches an impasse.
2. 23.Sex in therapy. A sexual relationship between a former client and a therapist is
3. always ethically problematic because of the power imbalance.
4. ethical only 5 years after termination of therapy.

ethical only when client and therapist discuss the issue and agree to the relationship.

never ethical, regardless of the time that has elapsed.

24.Touching. Concerning the issue of physically touching a client, I think touching

is unwise because it could be misinterpreted by the client.

should be done only when the therapist genuinely thinks it would be appropriate.

• is an important part of the therapeutic process.

is ethical when the client requests it.

25.Sex in supervision. A clinical supervisor has initiated sexual relationships with former trainees (students). He maintains that because he no longer has any professional responsibility to them this practice is acceptable. In my view, this behavior is

clearly unethical because he is using his position to initiate contacts with former students.

1. not unethical because the professional relationship has ended.
2. not unethical but is unwise and inappropriate.
3. somewhat unethical because the supervisory relationship is similar to the therapeutic relationship.
4. 26.Spirituality and religion. Regarding the role of spiritual and religious values, as a counselor I would be inclined to

ignore such values out of concern that I would impose my own beliefs on my clients.

actively strive to get my clients to think about how spirituality or religion could enhance their lives.

avoid bringing up the topic unless my client initiated such a discussion.

conduct an assessment of my client’s spiritual and religious beliefs during the intake session.

27.Family therapy. In the practice of family therapy, I think the

• therapist’s primary responsibility is to the welfare of the family as a unit.

therapist should focus primarily on the needs of individual members of the family.

therapist should attend to the family’s needs and, at the same time, be sensitive to the needs of the individual members.

therapist has an ethical obligation to state his or her bias and approach at the outset.

1. 28.Managed care. The practice of limiting the number of therapy sessions a client is entitled to under a managed care plan is
2. unethical as it can work against a client’s best interests.
3. a reality that I expect I will have to accept.
4. an example of exploitation of a client’s rights.

wrong because it takes away the professional’s judgment in many cases.

29.Gift-giving. If a client were to offer me a gift, I would

accept it cheerfully.

never accept it under any circumstances.

discuss the matter with my client.

• attempt to figure out the motivations for the gift.

30.Bartering. Regarding bartering with a client in exchange for therapy services, my position is that

it all depends on the circumstances of the individual case.

I would consider this practice if the client had no way to pay for my services.

1. the practice is unethical.
2. before agreeing to bartering I would always seek consultation.
3. 31.Diagnosis. Concerning the role of diagnosis in counseling, I believe
4. diagnosis is essential for planning a treatment program.

diagnosis is counterproductive for therapy because it is based on an external view of the client.

diagnosis can be harmful in that it tends to label people, who then are limited by the label.

the usefulness of diagnosis depends on the theoretical orientation and the kind of counseling a therapist does.

32.Testing. Concerning the place of testing in counseling, I think tests

generally interfere with the counseling process.

• can be valuable tools if they are used as adjuncts to counseling.

are essential for people who are seriously disturbed.

can be either used or abused in counseling.

33.Risks of group therapy. Regarding the issue of psychological risks associated with participation in group therapy, my position is that

1. clients should be informed at the outset of possible risks.
2. these risks should be minimized by careful screening.
3. this issue is exaggerated because there are very few real risks.
4. careful supervision will offset some of these risks.

34.Internet or technology-enhanced counseling. Regarding the practice of counseling via the Internet, I believe

the practice is fraught with ethical and legal problems.

technology offers real promise for many clients who would not, or could not, seek out face-to-face counseling.

it is limited to dealing with simple problems because of the inability to make an adequate assessment.

I would never provide distance counseling without having some personal contact with the client.

• 35.Inadequate supervision. As an intern, if I thought my supervision was inadequate, I would

talk to my supervisor about it.

continue to work without complaining.

seek supervision elsewhere.

1. question the commitment of the agency toward me.
2. 36.Supervision. My view of supervision is that it is
3. a place to find answers to difficult situations.
4. an opportunity to increase my clinical skills.

valuable to have when I reach an impasse with a client.

a way for me to learn about myself and to get insights into how I work with clients.

37.Social justice counseling. Counseling from a social justice perspective involves addressing the realities of oppression, privilege, and social inequities. This means that I

need to be aware of sociopolitical forces that have influenced my clients.

need to teach my clients how to become advocates for themselves.

• will assist people in gaining full participation in society.

need to be an advocate beyond the office if I am to make a difference.

38.Advocacy competence. To become a competent client advocate, a counselor must

gain awareness of his or her own beliefs, attitudes, and biases as they relate to the impact social and political factors have on marginalized and underserved populations.

1. have the courage to speak out against injustices.
2. engage in considerable reflection before taking action.
3. assess whether to engage in social advocacy action, and if so, what kinds of actions are practical and appropriate.
4. 39.Community responsibility. Concerning responsibility of mental health professionals to the community, I believe

practitioners should educate the community concerning the nature of psychological services.

professionals should attempt to change patterns that need changing.

community involvement falls outside the proper scope of counseling.

practitioners should empower clients in the use of the resources available in the community.

40.Role in community. If I were working as a practitioner in the community, the major role I would expect to play would be that of

• a change agent.

an adviser.

an educator or a consultant.

an advocate

1. Take the Self Assessment. Upon completing the assessment circle three items you had the strongest reaction to or that you had the hardest time answering. Discuss why you believe you had a reaction to those three items. What personal and professional approaches can you take to ensure those items do not affect your work with clients?
2. The Assignment:
3. In a 1- to 2-page paper:  
4. Discuss why you believe you had a reaction to those three items.

Identify personal and professional approaches you can implement to ensure the three items you had the strongest reaction to do not affect your work with clients?