The modern equivalent of this description of the duties of a healer is the set of ethical principles adopted by a recognized authority that guides the provision of mental health services. Ahalya Raguram, Ph.D., is Professor in the Department of Clinical Psychology and former head of the department, NIMHANS, Bengaluru, with over 25 years of experience.
Philosophical Positions in the Field of Ethics
Ethical competence – knowledge and understanding of ethical codes, the ability to recognize, analyze and solve ethical situations and understanding oneself as responsible for one's own actions (Sporrong et al. 2007) is the foundation of professional development in the helping profession. . One of the earliest studies (Haas et al. 1986) among psychologists in the United States identified the most prominent ethical dilemmas related to confidentiality, concerns about one's own or a colleague's professional competence, and responding appropriately to a colleague's unethical behavior.
Ethics in Context
Some ethical guidelines, such as the American Counseling Association (ACA2005), discuss the importance of cultural context regarding ethical guidelines. Open discussions and nuanced debates about the cultural universality or the validity of ethical guidelines arising from international frameworks are needed.
Ethical Guidelines: A Clear Road Map?
Similarly, unique and complex ethical issues may arise in couple and family therapy and require clarification in professional ethical codes (Margolin 1982). The Code evolved from reviewing more than 1,000 incidents involving ethical decision-making by members of the APA (Fisher 2012).
Intersections Between Ethics and the Law
Avashi and Grover (2009) highlighted the lack of clarity on privileged communications and the limits of disclosure in Indian law. Mental health trainees and professionals should be aware of the legal frameworks that may affect their practice in the states or countries where they work.
Ethics Training: How and When to Teach (and Learn) Ethical Practice?
There are a variety of ethical decision-making models that may be philosophically based, practice-based, or relevant to particular specialties (Cottone and Claus 2000). Ethical approaches to decision-making and therapist self-awareness can be key tools to help clinicians understand, evaluate and choose between options (Evans et al. 2012).
Conclusion
A comparison between ethics of justice and ethics of care.Journal of Advanced Nursing. The concept of boundaries in clinical practice: theoretical and risk management dimensions. American Journal of Psychiatry.
Introduction
The private practice environment is described as an environment with greater freedom to act, accompanied by greater ethical responsibility. The business end of therapy and the impact on practitioner, client and therapist agendas are explored.
Working as a Private Practitioner
The private practitioner should also engage in regular self-care practices, be aware of issues such as compassion fatigue and burnout (Figley 2002) and seek appropriate and timely help for these. Maintaining a therapeutic relationship(a) competency (b) continuing professional development (c) the business side of therapy (d) documentation (e) complex issues (f) ethical decision making.
Starting a Therapeutic Relationship .1 Setting up a Practice
Sustaining the Therapeutic Relationship
A cancellation fee helps the client take therapy seriously and also protects the practitioner's income. C may be aware of the dual relationship all along and assume that I am cooperating with them.
Ending the Therapeutic Relationship
Premature Termination Sometimes clients may want to discontinue therapy before the clinician feels they are ready to do so. If a doctor becomes physically incapacitated or dies, a "professional will" is needed.
Conclusion
Abstract Children represent one of the most vulnerable population groups, and it is the mental health professional's responsibility to identify ethical issues and incorporate ethical principles into the practice of psychotherapy. When a child is admitted to therapy, it is the therapist's obligation to create and protect the integrity of the psychotherapeutic space.
Basic Principles
Respect for Boundaries
Children and adolescents are less able to understand that the therapist plays a role; be governed by certain rules (Gaines 1995). They experience the relationship as real, and the therapist's expressions or lack of expressions as his or her true feelings.
Respect for Autonomy
Tactful and carefully planned self-disclosure by the therapist can be a natural part of the therapeutic interaction and help foster engagement with the child. The therapeutic alliance between the child and the therapist is strengthened when the child feels that his opinion has been taken into account instead of experiencing the treatment/therapy as imposed by others.
Maintaining Confidentiality
Examples of scenarios requiring disclosure are cases of harm to the child/adolescent—abuse/neglect, suicidal thoughts, plan or attempt. They may feel responsible for the child's problem and feel that they have a 'right' to know and expect the clinician to discuss confidential details discussed in therapy.
Therapist-Related Ethical Considerations .1 Competence
Counter Transference: What Does One Do When One Experiences Strong Feelings Towards a Client?
They are easier to identify if they are inconsistent with the therapist's personality and expectation of his or her role (Hughes and Kerr2000). The therapist's awareness of her own feelings and uncharacteristic behavior, and the supervising discussion helped her to understand her countertransference and interpretation of it, helped her to understand the patient and his therapy needs.
Understanding Multiple Relationships
She felt hopeless about her ability and began to postpone sessions with the child. The mother had then died suddenly and social services had forced the father to take custody of the child.
More Than One Therapist
Online Practices
Therapists must exercise caution when posting case studies online and strive to significantly change identifying information and protect their clients' right to privacy.
Documentation
Considering the fact that the mother is the sole guardian of the child now and that the child should receive justice, if the mother's relationship with the abuser will be documented in the file. Should legal action be taken against the sole carer the child has, leaving her in the care of child protective services.
Communication with Third Parties
Child Therapy, Ethics and Law
Child Abuse and Reporting
In the course of therapy, the child revealed that the father had sexually abused her (contact of a non-penetrative nature) three years ago. The therapist must refrain from giving false reassurances and answer the child's questions to the best of their ability.
Child Custody Disputes
On the downside, mandatory laws may in rare cases prohibit a professional from using their own discretion to act in the "best interests of the child", particularly in cases where reporting may cause more harm than good to the child and family.
Termination
Showing Feelings in Therapy: Crying?
Public Encounters
Gifts
Fees
Conclusion
Current ethical issues in child and adolescent psychotherapy. Child and Adolescent Psychiatric Clinics of North America. Cognitive analytic therapy for borderline personality disorder in the context of a community mental health team: individual and organizational psychodynamic implications.
Introduction
General psychiatrists have the relative luxury of focusing only on the adult patient, while a child psychiatrist must consider the needs, abilities, and availability of the child's parents, family, and school. As a rule, children have many more expectations and tasks of society, have a more limited set of adaptive skills and have fewer behavioral options than adults.
General Ethical Considerations in Psychological Intervention with Children
- Con fi dentiality
- Informed Consent
- Respecting Boundaries
- Data Recording and Protection
- Communication with Parents and Guardians
- Written and Verbal Communication with Parties Outside of Family
- Ethical and Clinical Considerations with Email and Telephone Communication
- Unique Issues in the Consultation-Liaison Setting
Often it may be necessary to involve more than one family member in the therapeutic alliance. It is a unique challenge in our framework to draw the line to decide who all should be involved in the care of the child.
Case Scenarios
The ethical issue here was - what to do with the information provided by the child. If the child has not given permission to discuss this, can I still talk to the parents?
Training Issues
Finally, I decided to talk to the child and emphasize the need to protect him from bullies and how, in the long run, it is necessary to learn the skills to deal with such children. The child was included in all the discussions and this helped him to understand the importance of narration.
Ethics in Child Psychotherapy: The Way Forward
The counselor establishes a good relationship with the child and keeps both parents informed of progress in the talks. The counselor and the student are aware of the school's zero tolerance policy towards underage drinking.
School Counselling: Context Matters
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). Huey (1986) notes that the only characteristic that distinguishes school counselors from other mental health professionals is their work environment.
De fi ning Roles
The role of the school counselor originally involved providing guidance and career information to students. The school counselor can also connect with and support teachers who may share a counseling relationship with some of their students.
Ethical Challenges
- Privacy
- Informed Consent
- Client Identity
- Confidentiality
- Teachers as Counsellors
The counseling worker is not obliged to explain to the teacher the reason for which the student turned to counselling. Does the counselor believe in the student's ability to effectively stop drinking on her own?
Resolving Dilemmas
While some of these relate specifically to counselors working in American schools, they provide a point of reference for school counselors in India. Mandating licensing requirements to practice as counselors in Indian schools, creating opportunities for research and continuing education and establishing a code of ethics is the dire need of the hour.
Ethical Practice: Considerations
- Responsibilities to Students
- Responsibilities to School
- Responsibilities to Parents
- Responsibilities to Self
When working with minors, counselors must remember that the parents' legal rights supersede the counselor's ethical concerns. Ethical dilemmas faced by members of the national association of school psychologists. Psychology in schools.
Competence of Therapist
In such a scenario, the contractor must consider the client's context; their rights, professional obligations and integrity. Some relevant areas of ethics to consider when working with families and couples as reflected in codes of ethics in other countries and India are listed below.
Responsibilities of the Therapist
Therapeutic Contract
Ethics of Responsibility Towards the ‘ Client ’ : A Balancing Act
It was important to understand the concerns of the first wife given the entry of the second wife. Through the sessions, the first wife was helped to empathize with the second wife's position.
Con fi dentiality in the Marital Subsystem
In this case, the simultaneous sessions helped the woman to understand the husband's anxiety and concern about her EMI. The woman could not openly express her emotions in family sessions in the presence of her father-in-law.
Therapist ’ s Values: Intersections with Ethical Frameworks in Therapy
The couple's therapist in Case6.8 was a devout Christian with strong views on sexuality and sexual orientations. Therapeutic involvement with same-sex couples means that the therapist must be willing to explore different aspects of the relationship.
Managing Boundaries in Couple and Family Therapy
Multicultural Competence in Couple and Family Therapy
In the initial days of work, she had to work with a family from one of the northeastern states. Her husband was married seven times and one of the wives was the client's own younger sister.
Ethics of Therapy and Legal Directives
The support system in India that deals with the family or child after mandatory reporting has inadequate provisions to address the effects this may have on the child and family. An ethical choice is required when it comes to the self-determination of the individual versus the collective decision of the family or the attitude of divorce or separation.
Conclusion
Practicing family therapy in India: how many people are there in a marital subsystem? Journal of Family Therapy. Connectedness versus apartheid: Applicability of family therapy to Japanese families. Family Process Evidence-Based Internships: Field Manual.
Intimate Partners in the Life of Women in Sex Work
Women often report silence on the issue of sex work and violence with excuses other than those listed above. Here, the sex work that takes place may continue to be hidden, or the client may take control of the sex worker's earnings (Karandikar 2008).
Relationships of Women in Sex Work with Their Clients Versus Intimate Partners
Other times the men know but do not question it directly, as they are economically dependent on the women. It is necessary for counselors to understand the underlying needs of the women who keep them despite the violence in these relationships.
The Need for Love
The Need for a Social Identity
The Need for Security
Resistance to Report Intimate Partner Violence
- Threat of Loss: Psychological
- Threat of Loss: Emotional
- Threat of Loss: Social
- Threat of Loss: Economic
By examining what women in sex work seek from intimate partner relationships, we can better understand this resistance and the fear of loss that underlies it. This loss extends across psychological, emotional, economic and social domains. As mentioned earlier, despite having sex with many men, women in the sex work sector draw boundaries and try not to become emotionally involved with their clients (Maher et al.2013).
The Complexity of IPV Faced by Women in Sex Work
In addition, the reporting may lead to the disclosure of identity which may also make the practice of sex work difficult (for example reduction in partners, as hidden clients do not like to visit 'open' sex workers; or social sanctions; or a closure by the law). But in sexual and psychological violence, women in sex work are left with very few options for support.
Ethical Challenges in Counselling Women in Sex Work Facing IPV
At the workplace (the sex worker collective) her injuries were noticed and she was investigated about them, but she was not ready to talk about the violence. As the violence increased, the senior leaders of the collective, after discussing with her, met with her partner and issued him a warning that they would file a First Information Report (FIR) at the police station if the violence repeated.
The Helping Process in Intimate Partner Violence
- Step 1: Unobtrusive First Contact
- Step 2: Creating Safe Spaces for Communication and Interaction
- Step 3: History Taking
- Step 4: Overcoming Ambivalence and Taking Decisions
- Step 5: Drawing up Safety Plans
- Step 6: Action Against Violence: Accompaniment and Support
- Step 7: Long-Term Psychological Support
The counselor will have to deal with the client's fear and anxiety for personal safety and the safety of the children. Box 7.7: Key challenge for the counselor: helping clients overcome resistance by analyzing risks and making concrete safety plans.
The Multisectoral Model
Key Principles of Counseling Respect, non-judgmental attitude, self-determination Throughout the process, professional supervision and support for the counselor is critical. The client's autonomy must also balance her safety and this is a huge responsibility and burden for the counselor.
Summary and Conclusion
The trial of the case began more than a year after the incident and she was further traumatized by the court process. She was afraid to go to court as the relatives of the accused would be there and could intimidate her.
Ambivalence About Homosexuality Among Mental Health Sciences
The LGBT movement/s in India has been vibrant and assertive, especially in the last decade and a half in most cities and some rural parts of the country. The decriminalization of homosexuality through the Delhi High Court's judgment on Section 377 (section criminalizing homosexuality) of the Indian Penal Code has been one of the biggest boosts for the LGBT movement/s in India.
Need for Gay Af fi rmative Counselling Practice
Some of these issues, which are at the heart of ethical and affirmative practice with gay and lesbian clients, will be addressed in this chapter. Sexual minority stress, or gay-related stress, is another concept that will be discussed in more detail in this chapter, as it forms the basis of affirmative mental health practice with gay and lesbian clients.
Sexual Minority Stress and Gay-Related Stressors
In this chapter, while we will not discuss specific principles of GACP, we will discuss the gay affirmative stance/position regarding several ethical issues that arise while working with gay and lesbian clients in counseling and clinical settings.1.
Ethical Concerns While Working with Gay and Lesbian Clients
Working with Clients Who Want to Change Their Sexual Orientation
A GACP practitioner must be aware of these in order to help clients work on barriers to self-acceptance as well as understand the client's resistance to the same. Exploring the emotional impact of these early corrective responses and their role in hindering self-acceptance is essential.
Educating Oneself as MHPs on LG Issues
This context of social marginalization provides the framework for understanding some of the common mental health issues or unique life stressors that LG populations face. Life's unique stressors are the underlying basis for some of the mental health manifestations or issues that clients bring to sessions.
Self-awareness Among MHPs
The purpose of self-disclosure is never the counselor's own needs, but instead about the client's needs and the appropriateness of the same for the therapeutic relationship. Homosexuality in India: The light at the end of the tunnel. Journal of Gay &.
Employee Assistance Programmes
EAPs typically make these payments at the end of the month after the Associate member submits session notes/summaries to the EAP. EAPs typically appoint an Associate Advisor Manager who helps coordinate all Associate Advisor activities.
EAP Services: Ethical Dilemmas and Decision-Making
Ethical challenges are not limited to counseling sessions with employees, but begin at the beginning of the business relationship between the EAP provider and the company. This would enable the exploration of more effective avenues for discovery, with minimal risk to the client.
Ethical Questions for EAP Service Providers
It is not enough for the counselor to understand the individual's concerns and their impact. An EAP consultant must have a clear understanding of where to protect individual confidentiality and when to defer to the company in the event of potential liability.
Ethical Issues in Documentation and Reporting
Competent WHP services will typically require all counselors to submit session summaries, with dates of sessions. It is possible that the WHP provider may be tempted to exaggerate usage data, especially if there is a significant drop in persons registering for WHP services.
Codes of Ethics for EAP Providers
Usage reports are the reports that the EAP therapists must provide to the company annually, semi-annually or quarterly depending on their protocols. The commitment to ethical guidelines should be seen as critical and non-negotiable by all stakeholders; The EAP provider, the company and the employee.
Conclusion
The chapter discusses the possible ethical issues that may arise in connection with client-therapist interaction in the digital world. It also highlights the ethical concerns regarding client-therapist encounters in the online space.
Terminologies in the Digital Space
Therapists may have questions about how to translate the ethical issues commonly encountered in face-to-face therapy into the areas of online therapy and the client interface. Emergent ethical issues can be more nuanced in nature, requiring interpretations according to cultural context and thinking beyond what is set forth in the guidelines.
My Introduction to Telepsychology: A Personal Account
I prefer to see them face to face at least once to assess whether they are good candidates for therapy via video conference or not. I have met each of these clients face-to-face for the first session and have continued to work with them via video conference ever since.
Online Client – Therapist Interface: Recognizing and Responding to Ethical Dilemmas
- Is e-Therapy an Appropriate Choice for Everyone?
- How Do We Ensure Confidentiality and Electronic Security?
- Do Professional Boundaries Work the Same Way in e-Therapy as in Face-to-Face Therapy?
- Personal and Institutional Social Media Policies
What might be the potential impact on the client if the therapist refuses the request. The therapist may struggle with how to use the information and the merits and demerits of disclosure to the client.
Professional Guidelines and Digital Ethics
With the proliferation of e-therapy and its associated convenience, online therapy is practiced across states within a country, across countries and continents. In some states in the United States, licensed mental health professionals cannot practice online counseling in another state (Corey et al. 2014).
Conclusion
Sounding off on social media: the ethics of patient storytelling in the modern era.Academic Medicine. Ego distortion in terms of true and false self. The maturation process and the facilitating environment (pp. 140–152).
