Ethics in counselling are very important. I will be using the BACP’s Ethical Framework as contextual guidance to explore these hypothetical Ethical dilemmas.
A client has been in counselling for a year and has made great progress. She brings in an expensive gift for you. She knows that this is something that you would like, and she knows that you know that she would know this.
If it were something that could be used in a communal area of my agency, such as a plant, or something that could be shared out between many of us such as a box of chocolates, then I would be more inclined to accept. But as it is expensive and tailored specifically for me, I could not accept. All I ask is payment for my services and my client’s ongoing quest for wellbeing.
On the other hand, a year is a long time to be in counselling – we must really have a strong relationship. She is clearly very grateful of our therapeutic relationship, but ultimately I could not accept the gift.
You have been counselling someone for six months who has a serious medical condition. You have a similar medical problem yourself. At the start of counselling you decided not to mention your similar health problem to the client. However, now you are finding it extremely difficult to carry on with your counselling, because what the client is talking about reminds you of your own pain, and you keep wanting to cry during sessions.
I think that honesty would be the best course of action here. I would explain how I felt at the start of the therapeutic relationship, and give my reasons why I never disclosed my illness, and then go on to tell the client how our sessions are making me feel now. This would ensure maintaining the integrity of the practitioner-client relationship. I think the client may feel diminished, or that they are hurting me somehow, but overall I do think that we would develop a deeper understanding about our commonalities, and sharing this information with them would strengthen our relationship. The hardest part would be taking that first step in mentioning it to them.
You are a counsellor in a school. The rule is that any children under 16 need to have parental permission to see you. You have just finished a group workshop for a class of 15-year-old children, on relationship skills. At the end one of them comes up to you and launches into the story of her problems. When asked, she says that her parents would never give her permission to see you officially.
Checking in with the member of staff that is most responsible for the student in the school setting would definitely be beneficial, and my first move would be to speak to them to see if they knew of any existing issues or if this is previously undisclosed. I think it would be important for me to do this because of the age of the student – as well as from a responsibility point of view.
Even though it was not an official counselling session, the student still came to me with a problem, and if I never told anyone about it, and it escalated, and something untoward happened then I could be held accountable. It would be irresponsible for me to not say anything. I think ultimately, the approach would depend on the severity of the problems, and if the student was in imminent danger. I would also have to contact my supervisor and ask them about the legal obligations of a 15 year old having confidential counselling without their parents’ consent, because I am not sure. Keeping the child safe is the most important thing here.
You work in a counselling agency where you have a first assessment session with a client and then decide whether to offer them counselling or refer elsewhere. During the first assessment meeting with the client, you realise that: (a) his problem is within the remit of the service, (b) he is motivated to use counselling and (c) you find him physically threatening and intimidating.
I think that my approach to this one is tricky, given that I’m six foot tall and heavy set – I don’t tend to find anyone physically intimidating so much. However, if I were a female, or didn’t feel I could look after myself, or worried about my physical safety in this situation, then it would be a different question altogether. In this case, I would probably bring it up with my line manager, and see if I could refer them to someone else within the agency. As their problem is within the remit of the service, and they are clearly motivated towards positive change via counselling, it would be a shame to turn them away. I don’t think in this case this person would turn violent, but you can never be too careful. That I find him physically threatening could be my unconscious telling me that I am potentially in danger. It would be unwise not to listen.
You have been counselling a couple for some time. You decide that it would be useful to have a couple of individual sessions, where you see the husband and wife separately. In the first individual session with the wife she tells you that she has been having an affair but that she does not want you to tell her husband.
I think, ultimately, if they have come to counselling to save their relationship, then the wife needs to tell her husband herself. In systemic counselling, the counsellor’s role is to be the neutral anchor point, not be the bearer of bad news. In that respect, I would not tell her husband, but I would ask her to think about the ramifications of not telling him herself. Also, it would be better for her to tell him in the safe environment of the counselling room.
This would cause a bit of a see-saw effect with regards to the Ethics section of the BACP Ethical Framework. One point is to enhance people’s wellbeing, but the revelation of the wife’s affair would hurt the husband. Another point is to alleviate symptoms of personal distress and suffering – the wife’s personal distress at hiding her affair may be relieved, but it would cause personal distress and suffering for the husband. In the long run though, I think the honesty and openness would make things turn out for the best.
Sure, it would be heart-breaking to learn your wife has had an affair. But likewise, it would be heart-breaking to go to counselling, work out the troubles in the relationship, or at least on the part of the husband, “believe” you’ve worked out the troubles in the relationship, then years later, discover that your wife had had an affair, had told your counsellor, and the counsellor didn’t tell you. I think it is up to the husband whether he forgives her, and it is up to the both of them if they want to work together to move past it. The affair is an event that happened, and there is no point in ignoring it or pretending it didn’t happen. Both parties need to acknowledge it, accept it, and see where they can go from there. The behaviours of both parties that led up to the wife having the affair could also be examined, as they are what caused the event in the first place.
You have been counselling a couple for some time, and it is clear that they have serious relationship difficulties. At the time of the appointment only the wife turns up. The phone rings. It is the husband. He tells you that he has moved his belongings out of the house, and the marriage is over. He asks you to convey this information to his wife.
This is a bit different than the last dilemma, because this event is happening in the here and now, but I think my behaviour would remain similar. I would ask the husband to tell her himself. Again, it is not the counsellor’s place to be the bearer of bad news, and I would ask the husband to attend the session if he could, and tell her himself. Or, if he doesn’t want to come in, I would ask him to phone her and tell her himself. If he does none of this, I would remind him that under no circumstances would I tell her.
This one is tricky as it requires an instantaneous decision on my part. I do not have time to call the BACP Ethics Hotline. I do not have time to mention it in my next supervision session. It demands a response there and then, and the counsellor needs to be decisive, and then resolute in their decision. I think not doing anything drastic in the heat of the moment is important, but rather, the counsellor keeping a cool head and attempting to deescalate the situation would be more beneficial.
For some time you have been struggling to find a publisher for a book you want to write. It emerges that a client is a senior executive in a major publishing house. Her professional advice would be invaluable to you. In passing, at the end of a session she mentions, “If you ever need any help getting a book published…”
I don’t think it would be ethical for me to ask my client to help get my book published. Doing so would not ensure the integrity of the practitioner-client relationship, a key point in the Ethics section of the BACP’s Ethical Framework. It could also change the dynamic of our relationship, as I may feel I owe her something, and treat her differently as a result.
This point is moot anyway, as it is possible to publish your own books online nowadays. I think it would be more realistic if the problem were getting publicity for your already self-published book. But even then, I would not ask her for help in getting more publicity for my book. All I ask is payment for my services and my client’s ongoing quest for wellbeing.
After a long day seeing several clients, you use your partner as a “sounding board” to talk through aspects of the work, but without disclosing details of the identity of any of your clients.
I think it is dangerous, unethical and unprofessional to do this, as well as dishonouring any clients discussed as it is not based on the relationship between counsellor and client, in the moment, in the room. One of the key aspects of counselling is being present in the room and building that relationship, making that connection – and this is not happening here. Involving a third party, one that is not a trained counsellor, is dangerous and irresponsible. Although confidentiality is not necessarily broken, it does set a precedent that could lead to a breach in privacy in the future. Also, your partner could gossip about what you told them – this is definitely a breach of privacy.
This sounds more like an inexperienced counsellor trying to get advice on what to tell their clients to do, and is wrong on so many levels. I get that it’s nice to talk to your partner about your day, and if you have had a particularly long or emotionally hard day then it can help you unwind by talking about it, but it is just not appropriate. Also, portraying your clients to your significant other in this way presents them as you see them, through your lens, not as they really are, and this is doing them a disservice.
Ultimately, this is what supervision is for.
With a client, you consistently feel a pull of sexual attraction.
I would terminate the contract. Sexual attraction is difficult; because once those hormones are pumping throughout the human body, they can over-ride all your sensibilities and good intentions. If it were reciprocated by the client, then it could lead to many, many more ethical dilemmas. The BACP Ethical Framework is very clear in that we as counsellors should not exploit our clients in any way, sexually or otherwise.
I have read a few case studies of clients that become attracted to their therapist, I think it’s quite understandable, but it’s important to be aware of what is actually happening: A client that is feeling unimportant or ignored or lonely comes to counselling, and the counsellor pays attention to them, listens to them, and seems to truly understand them. I can see how it would happen. Or some kind of transference could manifest, in that the client could feel things for the counsellor that they are not allowed to feel for someone else, and they end up using the counsellor as a proxy for their denied emotions. There are endless ways in which it could happen.
To conclude, I would definitely take a lot of these ethical dilemmas to my supervisor. If I were a counsellor right now and these things were actually occurring in my practise, I don’t feel like I have enough experience of ethical dilemmas to properly deal with some of these given my current level of training. My comments here are my initial gut reactions to the problems, but I would be more than happy to take someone else’s professional opinion into account. Even talking about it in a group supervision session would be beneficial, given the breadth of opinions and experience from my fellow counsellors.
I struggle with ethical dilemmas such as these, not because I am an immoral person, but because I often sit on the fence – my persona is very balanced and fair and in arguments between two people for example, I can see things from both points of view. It’s not because I cannot see right from wrong, but because I can see how both parties perceive their viewpoints as right or wrong. No-one ever likes to think they are the baddie, or they are in the wrong, so they devise mental schema to convince themselves the thing they have done was the morally right thing to do. It’s all about perspective, and quite often, the reasons that people acted the way they did were 100% ethically correct to them at the time.
I like to have definite answers to problems. I like simple heuristics such as: “if someone does X, the response is Y”. But with ethical dilemmas this is not always possible because of the layers of moral complications – things could be morally right but legally wrong, or to help one person you’d be hurting another – it all needs to be taken into consideration before a course of action is decided upon. Above all, it is more important to be able to recognise ethical dilemmas and be able to consider them from multiple angles honestly and subjectively, taking into account all the professional knowledge available to you, rather than coming up with the perfect solution. Because when it comes to things like this, there is often no ultimate “correct” answer.
For example, one dilemma that really made me reconsider my perennial position on the fence was the one about the man that stole bread to feed his family because he didn’t have enough money to buy it. I have gone from one end of the spectrum to the other while thinking about it, sometimes thinking he’s right to feed his family, other times thinking it’s wrong to steal, but it’s only recently that I’ve started thinking about what he could or should do to make his situation more legal. It was easy for me to look at it from one side or the other; I think I could convince myself either way was “right” – but what is really needed is simply taking a step backwards and looking at the bigger picture which would enable me to see all of the factors at work.
