The landscape of psychotherapy is changing significantly this year in Ontario, with the introduction of the College of Registered Psychotherapists of Ontario (CRPO). Ethical practice in psychotherapy is of utmost importance. As psychotherapy is soon becoming a controlled act in Ontario, there is a new set of ethical guidelines that Registered Psychotherapists must abide by. The following is the CRPO's code of ethics:
Another code of ethics that I subscribe to is the Feminist Therapy Code of Ethics. This code was introduced to me during the Assaulted Women and Children's Counsellor/Advocate program that I took at George Brown College in 2009-2010.
The Canadian Counselling and Psychotherapy Association
Until the College of Registered Psychologists of Ontario is in place, many psychotherapists in Ontario will continue to register as members of the Canadian Counselling and Psychotherapy Association (CCPA). The CCPA is not a regulatory body (hence the need for the CRPO), it is a professional association for people practicing psychotherapy. The CCPA lists the expectations for ethical conduct based on six principles:
a) Beneficence - being proactive in promoting the client’s best interests
b) Fidelity - honouring commitments to clients and maintaining integrity in counselling relationship
c) Nonmaleficence - not wilfully harming clients and refraining from actions that risk harm
d) Autonomy - respecting the rights of clients to self- determination
e) Justice - respecting the dignity and just treatment of all persons
f) Societal Interest - respecting the need to be responsible to society
The CCPA also has an ethical decision-making model to help guide counsellors in this process:
Principle-Based Ethical Decision-Making
Step One --What are the key ethical issues in this situation?
Step Two -- What ethical articles from the CCPA Code of Ethics are relevant to this situation?
Step Three — Which of the six ethical principles are of major importance in this situation? (This step also involves securing additional information, consulting with knowledgeable colleagues or the CCPA Ethics Committee, and examining the probable outcomes of various courses of action.)
Step Four -- 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 Five --What do my feelings and intuitions tell me to do in this situation? (Counsellors may consider "2. Virtue-Based Ethical Decision-Making" at this point).
Step Six --What plan of action will be most helpful in this situation? (CCPA, 2007)
Until the College of Registered Psychologists of Ontario is in place, many psychotherapists in Ontario will continue to register as members of the Canadian Counselling and Psychotherapy Association (CCPA). The CCPA is not a regulatory body (hence the need for the CRPO), it is a professional association for people practicing psychotherapy. The CCPA lists the expectations for ethical conduct based on six principles:
a) Beneficence - being proactive in promoting the client’s best interests
b) Fidelity - honouring commitments to clients and maintaining integrity in counselling relationship
c) Nonmaleficence - not wilfully harming clients and refraining from actions that risk harm
d) Autonomy - respecting the rights of clients to self- determination
e) Justice - respecting the dignity and just treatment of all persons
f) Societal Interest - respecting the need to be responsible to society
The CCPA also has an ethical decision-making model to help guide counsellors in this process:
Principle-Based Ethical Decision-Making
Step One --What are the key ethical issues in this situation?
Step Two -- What ethical articles from the CCPA Code of Ethics are relevant to this situation?
Step Three — Which of the six ethical principles are of major importance in this situation? (This step also involves securing additional information, consulting with knowledgeable colleagues or the CCPA Ethics Committee, and examining the probable outcomes of various courses of action.)
Step Four -- 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 Five --What do my feelings and intuitions tell me to do in this situation? (Counsellors may consider "2. Virtue-Based Ethical Decision-Making" at this point).
Step Six --What plan of action will be most helpful in this situation? (CCPA, 2007)
During our Ethics course in the Master of Counselling program, we also examined the Canadian Psychological Association's ethical decision-making model:
1. Identification of individuals and groups likely to be affected by the decision
2. Identification of relevant ethical principles, standards and guidelines
3. Consideration of personal bias, stress or self-interest
4. Development of alternative courses of action
5. Analysis of likely short-term, ongoing and long-term risks and benefits of alternatives
6. Choice of course of action
7. Action
8. Evaluation of the results of the course of action
9. Assumption of responsibility for consequences of actions taken
10. Appropriate action to prevent further occurrences of the dilemma. (CPA, 2000)
A Case Example: Record Keeping
During my practicum, I encountered an ethical issue. I did an intake interview with a client who had been in a car accident, and was involved in a legal proceeding. As we must keep detailed process notes of each session with our clients, I knew this could be problematic, in terms of my notes possibly being subpoenaed. I was not sure how to proceed with my client, so I consulted with my supervisor, and we used the problem solving model to come to a decision. Here is a brief run down of what we did:
1. We identified my client, and her family member also involved in the accident as the main people affected by the decision.
2. For space sake, I will identify the major ethic standard here which is record-keeping. Client notes have a dual function: one, to allow the counsellor to keep track of the client’s progress, and have a case history to refer to if needed, and two, to have written proof that the counsellor has taken steps to ensure ethical practice. Counsellors should only record relevant material from counselling conversations, and not include opinion or speculation. Counsellors should keep in mind while writing notes that the client or a third party may see them at any time. Therefore, it is of utmost importance to always be respectful and to the point when note-taking (Truscott & Crook, 2011).
3. I did not feel I had any personal biases around this issues, rather than feeling nervous about my note-taking abilities and how they may affect my client's case if they were to be subpoenaed.
4. An alternative courses of action is not taking on this client at our clinic, because record-keeping is a strict policy at our centre. Therefore, the only way to ensure there are no notes to be subpoenaed is to not take on the client. We would refer the client to another counsellor in the community who specializes in taking notes that are not harmful to potential court cases (i.e. she has a good knowledge of the law around motor-vehicle accidents, and court proceedings in these types of suites).
5. In considering risks and benefits, the short term risk would be somewhat high as the client was hoping to begin counselling as soon as possible. However, we would support her in connecting with the new therapist. The long-term benefit outweighs this risk however, because the new counsellor could be instrumental in helping her both with emotional issues, and with her court case. The long-term risks would be seriously compromising her case.
6. Based on this criteria, we decided not to take her on as a client, and connect her with the other, outside counsellor.
7. We contacted the counsellor, and found that she was willing to take on a new client. We were also encouraged the client to speak to her lawyers about coverage for therapy from a victim's benefit fund, which she was able to access.
8. Although it was frustrating for the client in the moment, we feel that this was the best, most ethical course of action.
9. We also asked the client to let us know if it was not a good fit with the new counsellor, and we would be willing to give her more referrals. We also provided her with community crisis resources, such as a 24 hour crisis phone line for secondary students while she was waiting for her first appointment, should she encounter a crisis.
10. To ensure this type of incident does not happen again, our centre made it a policy to not see clients who are involved in a court case. We ask clients on the sign-up form (the form they fill out before coming for the intake interview) if they are involved in a legal proceeding. If they indicate that they are, we have a resource list of other counsellors that could see them.
It is important to have policies in a counselling setting to ensure ethical practice. Here are some excerpts from a paper I wrote during my ethics course where I created a ethical policies for a fictional mood disorder clinic:
"Respect for the dignity of the client:
The concept of respect for the dignity of clients includes valuing the worth, insight and knowledge of each client. At our centre, we practice anti-oppression in all our interactions with our clients, and with each other as staff. This is reflected in our mission statement, our literature about the clinic, and in our everyday practice. We want our clients to know that we will honour their insight and knowledge. There are many ways to practice anti-oppression at the centre, and one example is our intake form. Where it asks the client to identify their gender, the client can check off male, female or transgender. As we are constantly learning and evolving as a team, we will revisit this question any time we feel we are leaving out a group, or oppressing a group. Another concept involving respect for the dignity of our clients is appreciation for the client’s autonomy. Autonomy is the person’s capacity for self-determination, and we respect our clients’ right and ability to make competent choices for themselves (Sinclair & Pettifor, 2001). Respecting our clients’ autonomy includes avoidance of value imposition (Corey et al., 2011). As counsellors, we must be aware of our own values and biases, and ensure they do not interfere with the counselling process. Our clients are unique individuals with their own ideas of what is best for them, and we strive to support them in the way that best works for them. Our clients are our best educators on how to treat them respectfully."
"Confidentiality.
Confidentiality is taken very seriously at the centre. In order for our clients to have a positive working relationship with us, they must be able to trust us.
Every client has the right to privacy when seeing a counsellor. The client must trust the counsellor to keep his/her information private, because without it, counselling would be worthless (Truscott & Crook, 2011). Confidentiality has numerous elements to it, including the client’s right to privacy, and informing the client of occasions where we must break confidentiality. A difficult situation that may arise in any counselling relationship is the time when confidentiality must be broken. Since some of our clients experience severe depression, we may encounter suicidal clients. In such a situation, we are obligated to “stop or offset the consequences of actions by others when these actions are likely to cause harm or death” (Sinclair & Pettifor, 2001, p.69).
This also includes situations where we suspect the client will do harm to another individual. In this case, we will contact authorities, or possible victims to ensure the safety of everyone involved. Safety of our clients and anyone they may harm takes precedent over maintaining their privacy in this situation."
"Informed consent.
Relating to respect for the client’s dignity, informed consent includes the client’s right to consent to treatment. As counsellors, we “seek as full and active participation as possible from others in decisions that affect them, respecting and integrating as much as possible their opinions and wishes” (Sinclair & Pettifor, 2001, p.49). This includes our consent forms, which each of our clients signs prior to beginning counselling at our clinic. The form discusses the type of therapy our clinic provides, the fees for our services, possible risks of therapy and limits to confidentiality (Truscott & Crook, 2011). The counsellors and clients may revisit these forms at any time, not just at the beginning of counselling. It is important that client consent is something that is continually obtained and respected throughout the counselling relationship (Sinclair & Pettifor, 2001)."
References:
Canadian Counselling and Psychotherapy Association. (2007). Code of ethics. [PDF File]. Retrieved online from: http://www.ccpa-accp.ca/_documents/CodeofEthics_en_new.pdf
Canadian Psychological Association. (2000). Canadian code of ethics for psychologists(3rd ed.). Ottawa: Author. Included in the text: Sinclair, C., & Pettifor, J. (2001). Companion manual to the Canadian code of ethics for psychologists (3rd ed.). Ottawa: Canadian Psychological Association.
Corey, G., Corey, M.S. & Callanan, P. (2011). Issues and ethics in the helping professions (8th ed.). Belmont, CA:Brooks/Cole.
Feminist Therapy Institute (1999). Feminist therapy code of ethics [Revised 1999]. [PDF File]. Retrieved online: http://old.psy.auth.gr/isotita/files/article/14/Feminist%20Therapy%20Code%20of%20Ethics%20%20(Revised,%201999).pdf
Sinclair C., & Pettifor, J. (2001). Companion manual to the Canadian code of ethics for psychologists (3rd ed.). Ottawa: Canadian Psychological Association.
Truscott, D. & Crook, K. H. (2010). Ethics for the practice of psychology in Canada. Calgary, AB: The University of Alberta Press.
Canadian Counselling and Psychotherapy Association. (2007). Code of ethics. [PDF File]. Retrieved online from: http://www.ccpa-accp.ca/_documents/CodeofEthics_en_new.pdf
Canadian Psychological Association. (2000). Canadian code of ethics for psychologists(3rd ed.). Ottawa: Author. Included in the text: Sinclair, C., & Pettifor, J. (2001). Companion manual to the Canadian code of ethics for psychologists (3rd ed.). Ottawa: Canadian Psychological Association.
Corey, G., Corey, M.S. & Callanan, P. (2011). Issues and ethics in the helping professions (8th ed.). Belmont, CA:Brooks/Cole.
Feminist Therapy Institute (1999). Feminist therapy code of ethics [Revised 1999]. [PDF File]. Retrieved online: http://old.psy.auth.gr/isotita/files/article/14/Feminist%20Therapy%20Code%20of%20Ethics%20%20(Revised,%201999).pdf
Sinclair C., & Pettifor, J. (2001). Companion manual to the Canadian code of ethics for psychologists (3rd ed.). Ottawa: Canadian Psychological Association.
Truscott, D. & Crook, K. H. (2010). Ethics for the practice of psychology in Canada. Calgary, AB: The University of Alberta Press.