The Ethics of Counseling — How Would YOU Handle This Problem?

Another discussion revealed to me that many people have no idea of the ethical quandaries that people engaged in psychological counseling have to deal with, and that their "cut through the bull" solutions would likely have unforeseen consequences threatening to cause more harm than good.

Consider an example which is very common: You are a clinical psychologist or social worker. Pat (unisex name chosen intentionally) has come to you with this problem: he/she has cheated on his/her marital partner and feels very guilty and regretful. His/her question is simple: whether to confess to the marital partner. Let's also assume that he/she has been tested and is free of STD's.

Harmless dissembling like setting up a surprise party aside, we normally assume that total honesty between marital partners is key to a healthy relationship, don't we?

But what about this situation? How would you advise the client: Confess or don't, and why/why not?

Tags: counseling

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Do whatever makes your boat float.

I'm not sure why you bothered to write that comment. How about this: Does the person's mate have a right to know that their partner has gone outside the marriage for sex? And if the counselor advises the client to tell their mate because they have a right to know, whom is the counselor really working for, then?

In the ethics of counseling (and I'm rather new to this so bear with me), the person who came to you is your client (not the others involved with the client).  Your job is not to tell them what to do or convince them to right their wrongs.  You must do your best to set your personal feelings and assumptions on the topic aside.  Your job is rather to help your client figure out his or her goals, help the client seek out information and consider choices, and eventually collaborate with the client and help them to commit to a course of action that will help them meet their goals.

You're generally right, but there are different schools of counseling, and the one you described doesn't really provide counsel (advice).

Presumably, the counselor has some expertise and in the case of one's who've been around for a while, some expertise in terms of the consequences (some obvious, some not so much) of different courses of action.

In the end, while it isn't fair of the counselor to force his or her values on the client, it might be derelict not to help the client understand which path might suit the client's needs and values best.

In the case we're thinking of here, the client might feel a need to "come clean." The therapist might then point out, "Okay, you'll unburden yourself, but is it at the expense of placing a burden on your partner and perhaps ruining your marriage?"

Has the counselor no obligation to the marriage partner? Does the marriage partner deserve to know how trustworthy their mate has been? Can this be ignored in the interest of saving the marriage?

See, these problems are very knotty.

I think you misunderstood.  Talking about options, consequences, and collaborating on a course of action that fits the clients goals, values, and needs are all part of it.  I believe that it is important for the counselor to maintain neutrality.  If the husband is seeking counsel, the husband is the client not the wife.  Imagine if you were the husband in this scenario, would you seek the help that you need if you feared that the counselor might call your wife?  Were the wife to come to the same counselor for help - I might suggest couples therapy or refer the wife to a different counselor due to the conflict of interest.  It is not up to the counselor to answer questions about what the wife deserves or doesn't deserve to know, nor is it up to the counselor to decide if the marriage is worth saving.  The counselor in the interest of resolving some of the marital problems might suggest coming in with the wife, but only after confirming that the husband has an interest in resolving problems within the marriage.  The counselor is merely a guide.  I've learned from experience that counselors who assert their opinions about what will or won't work often lose the clients before helping them to resolve anything at all.  Learning when and when not to challenge a client is one of the hardest things I've ever had to learn to do in my life.

I believe that it is important for the counselor to maintain neutrality.  If the husband is seeking counsel, the husband is the client not the wife.

On their face, those two sentences might embody a contradiction. To help one but not the other can be viewed as a partisanship. Many counselors see themselves as advocates for their clients, helping and defending them to the exclusion of all others (exceptions being the client who intends violence, rape, incest, etc.). This is the function of another kind of counselor, for example: the attorney.

There is more than one school of counseling, so prescriptions can vary widely. Also, the presumption is (on the part of the client) that the counselor possesses wisdom to some degree, otherwise why seek their counsel? What to do about the client who despite one's best efforts just doesn't get it, or has highly and possibly dangerously dysfuctional values or attitudes.

If the counselor is wise, why should they not help the client arrive at a wise conclusion? Not through mental coercion but through gentle argumentation and examples. A hard press will likely just, as you noted, engender resistance and drive the client away.

I think you are confusing a counselor with a social worker, but as many social workers act as counselors in some settings this is an understandable error.  It's not about defending the client, but rather about helping them to overcome emotional barriers and/or thoughts that prevent them from meeting goals.  This to me is not the equivalent of taking sides, for you have placed no value on who is right or wrong.  It would not, however, be wise for the counselor to make assumptions about the wife and what the wife needs after only hearing the perspective of the husband.  While a counselor does have expertise in human behavior and emotion, they do not have all of the answers to every situation (even if they specialize in a particular field).  Often times, with guidance around and over barriers, the client comes up with the best solution for their own situation.  The counselor provides choices, discusses the potential outcomes, and challenges the client to commit to a course of action.  As for a client that has dysfunctional values, there must be some standard by which we deem something as dysfunctional - this is why I would hope any counselor is vigilant of DSM criteria and appropriate courses of treatment.  If this occurs, the counselor brings up the concern and provides information.  If there are risks to others, the counselor immediately reports to the appropriate agency (e.g. CPS, mental health, etc.).

"Counselor" is a general term whereas there are many different sorts of workers subsumed under that category. A few would be clinical social worker, psychologist, psychiatrist. But that's just one dimension, across those categories are different schools of counseling and therapy.

You are describing how one sort of counselor works, but it's now how they all work. Some take the "counsel" part of "counselor" seriously, meaning that they DO give advice. There is nothing unethical about this, since advice may be what the client is there for, and in fact it usually is. Whether this is best for the client or not is arguable, but your view of counseling seems to reflect your view rather than the full spectrum.

"Therapist" is a related word, and it implicitly implies that the client/patient needs work to overcome a problem or deficit. Their client isn't so much the client who is stuck in a conundrum or on the horns of a dilemma, but rather is sick or broken in some way. Thus, the need for therapy rather than counseling. Psychiatrists do therapy as do some psychologists.

A dear friend told me this story a few years ago: "When I was much younger I got into a sticky relationship with a married woman in which we were both drawn to each other, and I could see she was unhappy in her relationship and I wanted her to break it off so that we could be together.

"More than a year went by in a stalemate sending me into a clinical depression for another year. In order to try to stop the pain and resolve the situation, I found myself becoming controlling. This damaged my self-respect. I needed a way back to normality.

"I finally started meeting a clinical social worker through Lutheran Family Service and in about 3 or 4 sessions with her just asking hard questions and revealing observations she come by in her years of work in couples/marriage counseling,

"Because of her insights and the ones she helped me see about myself, I finally saw my way out of both the relationship and the depression.

"In the end, I had the strength to tell the other I needed her to go away, that I could see no good outcome of continuing it.

"BTW, despite the religious affiliation, she respected my own religious beliefs and gave me what I would call 100% secular counseling."

Unseen, it seems that there has been a break down in communication here.  Re-reading your responses and now reading the anecdotal experience of your friend (thank you for sharing), I do not think that our opinions on the matter are all that different.  It seems, to me, that we are talking about similar ideas in different ways.  Advice to me is something my best friend gives me when I go to her with a problem.  My best friend might share her experience and tell me what she thinks I should do.  I believe that an effective and ethical counselor, on the other hand, does more than just give advice.  I believe that he/she will ask those "hard questions" to help reveal motivation, she/he will share observations and ask you to think about it, and through this the counselor will guide you through and out of the pain or conflict that you are experiencing.

I agree we're not that far apart. I do like to maintain the distinction in the language (even if people in the profession don't honor it) of counsel being advice and therapy being work toward a solution.

One one hand, I have no qualifications to answer this question.  On the other hand, I'm bored, and having no qualifications seems to be the primary qualification for answering questions online.

From a personal point of view, I don't think it boils down to a 'confess or don't confess' senario for my role as a counselor. In the same vein as Colleen's response, I think that the primary task is to get the client to understand, consider and weigh the potential consequences of potential courses of action.  I think it's less important to make the 'right' choice than it is to make a choice the client can live with.  

But there are a lot of reasons that won't work.  If the client is unable to entertain certain perspectives, or is irrationally favouring certain views, I do think it is my job to apply a bit of force and turn their head in a certain direction.  For instance,  If I know this client has a history of infidelity, and this is just a part of a repeating pattern, then simply letting them continue to hide in secrets and silence may be fruitless.  Or let's say the client's spouse is physically or emotionally abusive, then I may have cause to recommend a specific course of action.

But if I was giving advice to myself, I would push for confession.  It is difficult to know if that path would cause more or less harm to myself or my spouse, but it is the easier stance to justify on principle.  The past is done; it cannot be changed.  Confessing the past allows for both parties in the relationship to assess the truth and make an informed decision.  Possibly an angry, emotional decision, but an informed angry, emotional decision nonetheless.  If the client was unable to make a decision and there were no significant complicating factors, my suggestion would be confession.

On one hand, I have no qualifications to answer this question.  On the other hand, I'm bored, and having no qualifications seems to be the primary qualification for answering questions online.

LOL

From a personal point of view, I don't think it boils down to a 'confess or don't confess' senario for my role as a counselor. In the same vein as Colleen's response, I think that the primary task is to get the client to understand, consider and weigh the potential consequences of potential courses of action.  I think it's less important to make the 'right' choice than it is to make a choice the client can live with.  

Well, then it seems to me you may be operating with a diminished concept of what "right" means, because in its fullest form, philosophically speaking, everyone has a duty to bring about what's right in the interest of achieving The Good. Also, if you don't give advice, you're not living up to the meaning of "counselor," a counselor is an advice giver. A counselor gives counsel. Of course, the client doesn't have to take the advice. You can give counsel on a take it or leave it basis and not literally force the client to accept your advice.

But there are a lot of reasons that won't work.  If the client is unable to entertain certain perspectives, or is irrationally favouring certain views, I do think it is my job to apply a bit of force and turn their head in a certain direction.  For instance,  If I know this client has a history of infidelity, and this is just a part of a repeating pattern, then simply letting them continue to hide in secrets and silence may be fruitless.  Or let's say the client's spouse is physically or emotionally abusive, then I may have cause to recommend a specific course of action.

So, now you see that being a counselor is a lot more difficult than always guiding the client toward confession come what may or toward moving forward being faithful and keeping the damaging secret to him/herself and sparing the partner the pain of the revelation.

(Note: a counselor friend of mine with whom I discussed this topic said, "But you know what? The truth almost always comes out sooner or later. Someone saw you and your adultery partner making out in a park and tells your marriage partner, a love note you forgot to dispose of turns up, a motel receipt that fell behind the dresser turns up. And the marital partner usually suspects something is going on anyway, poisoning the trust in the relationship. There is no foolproof answer.")

But if I was giving advice to myself, I would push for confession.  It is difficult to know if that path would cause more or less harm to myself or my spouse, but it is the easier stance to justify on principle.  The past is done; it cannot be changed.  Confessing the past allows for both parties in the relationship to assess the truth and make an informed decision.  Possibly an angry, emotional decision, but an informed angry, emotional decision nonetheless.  If the client was unable to make a decision and there were no significant complicating factors, my suggestion would be confession.

FYI, that is probably the least-given advice (or guidance, if you prefer that terminology). If you read the literature on the subject, especially by couple/marriage counselors, they'll tell you that the main goal of such counseling is typically to preserve the marriage, especially if children are involved. But even that doesn't trump every situation. When the marriage partner is abusive, one might want to help the client consider ending the marriage.

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