The idea of psychotherapy itself is a luxury in India that is not affordable for most families. Discussing ethics in psychotherapy seems a great leap that we are not ready for yet. There are a few guidelines but trainees in clinical psychology are not exposed to these guidelines during their training and hence, this is not inculcated into their thinking and action while working with children and their families. It is now left to individual therapists to formulate their own brand of ethics in their practice.
In the medical context, failure on the part of the mental health professional to emphasize confidentiality and need for sensitivity in handling ethical issues to their medical counterparts is one of the reasons for this not being adhered to in routine clinical practice. Having said that, the medical undergraduate training in India is coming of age and, in medical colleges that follow the Medical Council of India guidelines, ethics in medical practice is part of the training programme. There is, therefore, definite hope that future medical undergraduates will at least have exposure to thinking of ethics in their medical practice.
Boundary issues are more of an issue in child psychotherapy as therapists and children too feel some physical contact is acceptable—like patting on the back, ruffling the hair or, with very young children, seating them on the lap as a gesture of affection. However, in the era of boundary violations and legal implications thereof,
70 V. Raman
therapists will do well to monitor their behaviour. The yardstick that most experts agree on, and is a fair one to use, is the level of comfort or discomfort the child displays when the therapist does touch her/him.
The other relevant issue is to answer the question—who is ultimately our client?
The parents who have sought treatment and who pay the fees and control the visits, or the child herself/himself? Many a time, the answer to this question is unclear as the goals of the therapy are formed between the parents and the therapist for the child. Obviously, in many cases, the parents need to serve as co-therapists for the therapy to work and, hence, the dilemma.
Many a time, in routine clinical practice, child mental health professionals are called upon to make ethical as well as moral judgements. This will, without doubt, be influenced by the therapist’s own biases and prejudices. It is imperative, therefore, that therapists take an objective view as much as possible and always do what is in the best interests of the child, who is and always should be, the primary client (Goldsmith and Joshi2012).
The way forward is to design guidelines that are relevant to South Asian culture and the way psychotherapy is practised in India. Self-regulation and constant monitoring of one’s work and, at the same time, discussing with colleagues and seniors about any dilemmas will be crucial. Awareness of the legal and ethical frameworks within which psychotherapy should be practised is a strong recom- mendation. Training programmes would also do well to include modules on ethics in psychotherapy practice with special reference to the South Asian context.
References
American Academy of Child and Adolescent Psychiatry. (2009):Code of Ethics. Retrieved March 4, 2016 from https://www.aacap.org/App_Themes/AACAP/docs/about_us/transparency_
portal/aacap_code_of_ethics_2012.pdf
American Psychological Association. (1990).Guidelines for providers of psychological services to ethnic, linguistic and culturally diverse populations. Washington, DC: American Psychological Association.
Ascherman, L. I., & Rubin, S. (2008). Current ethical issues in child and adolescent psychotherapy.Child and Adolescent Psychiatric Clinics of North America., 17, 21–35.
Belitz, J., & Bailey, R. A. (2009). Clinical ethics for the treatment of children and adolescents: A guide for general psychiatrists.Psychiatric Clinics of North America, 32(2), 243–257.
Goldsmith, M., & Joshi, S. V. (2012). Ethical considerations in child and adolescent psychiatry.
FOCUS, 10(3), 315–322.
Kassaw, K., & Gabbard, G. O. (2002). The ethics of email communication in psychiatry.
Psychiatric Clinics of North America, 25, 665–674.
Krener, P. (1995). Ethical issues in pediatric consultation-liaison. Child and Adolescent Psychiatric Clinics of North America, 4(4), 723–745.
Schetky, D. H. (1995a). Boundaries in child and adolescent psychiatry.Child and Adolescent Psychiatric Clinics of North America, 4(4), 769–778.
Schetky, D. H. (1995). Preface. Child and Adolescent Psychiatric Clinics of North America, 4(4), XIII–XXIV.
Wright, W. T., & Roberts, L. W. (2009). A basic decision making approach to common ethical issues in consultation liaison psychiatry.Psychiatric Clinics of North America, 32(2), 315–325.
4 Ethical Issues in Working with Children in the Consultation… 71
Chapter 5
Classrooms and Counsellor Ethics:
A Daily Balancing Act
Neena David
Abstract Schools are being acknowledged as important sites for the delivery of mental health interventions. The dynamic and complex layers that constitute school systems create a unique setting for counsellors working in schools. Counsellors should possess a working knowledge of these nested frameworks when they begin to explore ethical issues specific to school counselling. While counsellors in school settings consider the child as the primary client, they are also required to work with multiple stakeholders who often have differing interests. A counsellor would need to recognize that in navigating through ethical dilemmas, the best interests of the child have to be balanced by appreciating the interconnectedness of collaborative relationships with parents and teachers. The chapter addresses the school counsellor in the Indian context and acknowledges the challenges they are confronted with ranging from the lack of adequate professional training, and meaningful national child mental health policies to a lack of clarity in defining their roles. It examines frequently encountered ethical issues in a school context from a practitioner’s perspective. Drawing from established international codes of ethical practice, it encourages counsellors to use ethical decision-making models and processes. The chapter concludes with a core set of ethical considerations that provide a basic framework that would support ethical and reflective practice.
Keywords School counsellors
Ethical dilemmas Counsellor role IndiaCase 1
R, a 10th grade student walks into the counselling room looking visibly upset.
This is her first visit and she looks around the room anxiously asking if anyone standing outside the room can hear what she has to say. On being reassured, she proceeds to tell the counsellor that she has been getting into
N. David (&)
Clinical Psychologist, Counselling Services, Mallya Aditi International School, Near NIPCCD, Yelahanka New Town, Bengaluru 560106, India
e-mail: [email protected]
©Springer Science+Business Media Singapore 2016 P. Bhola and A. Raguram (eds.),Ethical Issues in Counselling and Psychotherapy Practice, DOI 10.1007/978-981-10-1808-4_5
73
trouble over the past few weeks with Mrs. T: a teacher known for her abrasive approach with students. Mrs. T sternly conveyed her concern to R about the poor quality of classroom participation and tests. R describes the teacher as being overly harsh and frequently unfairly picking on her, an observation that even her friends apparently agree with. R feels that nothing she does in class will ever meet with Mrs. T’s approval. She also reveals that she does not want to share her concerns with her parents as her father had been recently been laid off from his work and arguments aboutfinances between her parents have increased. R recognizes that she will be appearing for a public board examination and that her teacher could give her a low internal grade if she chooses to complain. R reported feeling increasingly upset and anxious. The counsellor is also privy to information that while issues specific to Mrs. T’s classroom interactions had been raised in the past, the management appeared to focus on the excellent grades her students received in their public exams.
Case 2
Mrs. B, a parent of a 3rd grade child, requests that her child D be seen by the counsellor as the father had recently announced that he was walking out of the marriage. The abruptness of the announcement had left the family members shocked with Mrs. B insisting that she would not give her husband a divorce and Mr. B claiming that he was going to initiate divorce proceedings.
Both parents agreed that D would benefit from seeing the counsellor who would address his emotional concerns. The counsellor establishes a good rapport with the child and keeps both parents informed of progress in the sessions. Mrs. B asks if the counsellor can recommend to her husband that he spend more time with the family and participate in marital counselling for the sake of their child. Mrs. B feels that if this suggestion is to come from the school counsellor, the husband would be more receptive. She follows this up with getting her personal counsellor to speak to the school counsellor about the importance of convincing the husband of the need to engage in marital therapy and to not consider divorce for the sake of their son.
Case 3
During a coffee break, Mrs. P, an elementary school teacher greets the counsellor, and enquires about a particular child who is not in her class:“I saw L coming into your counselling room yesterday; is everything all right with her? I taught her a few years back and she was such a model student. Does her mother know that her child is coming to see you? From my interactions with her mother, I know that she’s very ambitious for her children and may not be all right with the fact her daughter was seen by the counsellor. I’m sure L is strong enough to sort out whatever is troubling her—what do you think?” Case 4
A 16-year-old student working through issues of past sexual abuse and occasional lying behaviours that had got her into trouble with her friends, reveals to the counsellor that she has over the past few weeks begun to help
74 N. David
herself to her friend’s parent’s liquor cabinet. Both her fairly conservative parents work late hours and the student admits that shefinds it fairly simple to access the liquor from her friend’s house storage and be able to deal with the evidence before they returned from work. The student expresses concern over this trend but specifically asks the counsellor not to involve her parents and that she would sort it out on her own eventually. The counsellor and the student are aware of the school’s zero tolerance policy towards underage drinking.
The potential of school-based delivery systems to dramatically improve access to and positive impact of mental health prevention and intervention services cannot be underestimated (Hoagwood and Erwin1997).