As a clinical practitioner, not only is it important to receive training on theoretical approaches and counseling techniques, but one must also have an understanding of the ethical codes established within their profession. The following paper documents the knowledge acquired by this student while taking an ethics class that addressed legal and ethical situations that have the potential to surface during their career as an art therapist, or a counselor.
For the purpose of demonstrating this knowledge, this student has created a fictional case-study that examines issues relating to counseling a minor and understanding the concepts associated with reparative therapy. Review of Literature This paper addresses several ethical issues. The first issue involves counseling a child and understanding the role the child’s parents play in the counseling process. The second issue addresses the parents requesting a therapeutic approach that the therapist has not been trained to perform. Also, the therapist believes that the requested therapeutic approach could potentially harm the child.
The third issue is maintaining the child’s moral right to confidentiality while still keeping the parents informed about the child’s progress in therapy. Relating to the first issue and the third issue, it is important to establish a collaborative environment that includes the participation of the parents, while trying to maintain the child’s moral right to confidentiality. Regarding the second issue, it is unethical for the therapist to provide services for a treatment for which she has not been trained in and one that has not been supported by empirical evidence.
Although the therapist disagrees with the principals included in a specific therapeutic treatment they must provide an unbiased view while educating the parents and child about this specific treatment. When selecting sources regarding reparative therapy, this student looked for references that addressed the limitations, outcomes, and whether there was research that supported this therapeutic modality. This student examined the ACA code of ethics in order to maintain sensitivity for the views of all parties involved.
This student located many sources, but found several that this student felt were relevant to these specific ethical issues. Of the studies that the student looked at there were three areas of relevance to the issues: modes of ethical thinking, a decision making model and reparative therapy. Modes of Ethical Thinking Ethical thinking is more than adherence to specific rules; each situation is unique and should be approached in terms of achieving a desirable outcome for all parties. However, it does not apply that the end justifies the means.
In other words, according to Moon (2015), ethical practice “requires a deep commitment to aspire to practice according to high moral principals” (Moon, 2015, p. 19). Moon (2015) describes ways in which a clinical practitioner, specifically art therapists, can ethically engage in counseling. Also, Moon (2015) discusses that there are different approaches that a clinical practitioner can take, such as a legalistic path, an impulse-driven path, and a third path that incorporates both an understanding of ethical codes and reaching for an answer with the best probable outcome.
One wants to be aligned to the code, but you don’t want to dogmatically follow a code to the last letter. Although the Ethical Principals for Art Therapists, which was created by the American Art Therapy Association (AATA), are referenced through out Moon’s (2014) book, this student finds that the principals used by art therapists closely align with the code of ethics created by the American Counseling Association (ACA). A Decision Making Model
Part of the work of counseling is to take events or situations that have significant ambiguity and move them to a state of clarity as to how to deal with that ambiguity. The way to do this is through a structured process. While Moon (2015) describes ways of thinking about ethical issues, Remley’s and Herilhy’s (2014) decision making model brings one’s moral thinking to life through actionable steps. Also, Remely and Herilhy (2014) examine the ways in which the ACA Code of Ethics are applied to specific case studies in order to provide examples of the application of the decision making model.
Reparative Therapy Before 1973, homosexuality was categorized in the Diagnostic Statistical Manual (DSM) as a mental illness. Although reparative therapy was once an acceptable form of treatment for homosexuality, there is no body of evidence that supports its validity. Therefore, it is no longer approved by organizations such as the American Psychological Association. However, it does continue to live on through the beliefs of religious organizations who insist that homosexuality is a choice.
According to Anderson and Holland (2015), homosexuality was considered to be a medical condition that attracted serious social stigma and legal complications, but is now considered to be a normal variation of human sexuality (Anderson & Holland, 2015). However, Anderson and Holland (2015) further describe how the medicalization of homosexuality still affects how sexual orientation is viewed today (Anderson & Holland, 2015). The notion that homosexuality can be treated like a diagnosable illness is the backbone of reparative therapy and is the reason why it is still in existence.
Drescher (1998) connects the origins of reparative therapy to the field of psychoanalysis. Furthermore, he documents how reparative therapy was once considered a viable treatment in the psychiatric community but is now reduced to an unscientific “cure” promoted by the National Association for Research and Therapy of Homosexuality (NARTH). In another research article, Drescher (2015) addresses the topic: can sexual orientation be changed. Here he exposes the fallacies associated with research studies that are supportive to reparative therapy. Thus, he concludes that there are no valid scientific studies that support reparative therapy.
Moss (2014) creates a fictional account of a minor subjected to reparative therapy to promote legislation to ban the practice of this therapeutic modality. This account demonstrates the potential for serious harm to minors who are forced to undergo this treatment. He also uses case law that has resulted in bans in California and New Jersey to support his arguments. Conclusion This review of literature has provided the scientific framework that allows this student to confidently addressee the ethical issues and ways to address them in the following vignette: The Case of Mathew.
The Case of Matthew Matthew is a 13-year old boy, who lives in a small, rural town where there is very little cultural diversity. His father is a minister for a Protestant congregation and his mother is a house wife. Matthew and his parents are rooted in traditional values, including the sanctity of marriage between a man and a woman and that homosexuality is considered a violation of the teachings of the Bible. Lately, Matthew’s academic performance in school has declined and his behavior has become increasingly violent towards fellow students.
After receiving a three-day suspension from his school for fighting and at the insistence of a teacher, Matthew’s parents agreed to seek therapy for Matthew. Mary is the only board certified counselor within a 50-mile radius and has offered to see Matthew and his parents for a consultation. During the initial session, Matthew’s parents repeatedly inform Mary that there is no history of mental illness in their family and disclose that Matthew has refused to attend Church services for the last month.
Matthew’s father confesses that he believes that Matthew’s behavior stems from his refusal to participate in Protestant rituals, including praying in order to seek forgiveness for his sins and partaking in the memorial meal during Church services. Both of Matthew’s parents admit that they question the validity of therapy and finally resorted to seeking therapeutic services as an action of last resort. At the end of the consultation, Mary agrees to meet with Matthew on a weekly basis.
Although it takes several sessions, Mary develops a strong rapport with Matthew. At one point, Matthew discloses to Mary that he thinks he is a homosexual and admits to engaging in sexual acts with a boy in his grade level. Matthew discusses his fear of going to hell and the homophobic content of his father’s sermons during Church services. Also, Matthew feels that he would receive severe repercussions from his parents and his community if he were to openly identify as homosexual.
A week later, Matthew’s father catches Matthew and another boy involved in a sexual act and immediately contacts Mary. During this phone call, Matthew’s father demands that Mary perform conversion therapy on Matthew. Also, Matthew’s father demands a copy of case notes taken during therapy sessions between Mary and Matthew. However, Matthew has explicitly forbidden Mary from disclosing his sexual orientation to his parents. Desired Approach to Ethical Thinking The situation described above addresses several ethical mandates included in the ACA Code of Ethics.
Before looking at these mandates, there are several modes of ethical thinking that Mary can choose from that will help direct her in making the right decision. Moon describes three possible modes, which include deontological legalism, antinomian, and teleological contextualism approaches (Moon, 2015). A deontological legalistic approach “hold(s) that the worth of an action is determined by its conformity to some binding rule rather than by its consequences” (Moon, 2015).
On the opposite side of the spectrum, an antinomian approach is “unprincipled, anarchic, and lawless” (Moon, 2015). Lastly, a teleological contextualistic approach acknowledges established ethical codes, yet clinicians “must ultimately resolve ethical dilemmas for themselves” (Moon, 2015). One way to conceptualize these approaches is to compare them to Freud’s theory of personality development, which revolves around the interactions of three structures; the id, the super ego, and the ego. Like the id, antinomianism is impulsive and lacks control.
On the other hand, deontological legalism is similar to the super ego because it strictly adheres to ethical and moral codes and leaves little room for interpretation. Teleological contextualism is similar to the ego structure because it utilizes rationalism in the situation, thus balancing out the other two modes of ethical thinking. In the case of Matthew, it is advisable that Mary adhere to teleological contextualism, which would allow consideration of the ethical codes involved and the well-being of her client, Matthew. Ethical Issues
