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British Journal of Guidance &

Counselling
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Ethical Issues in Counselling

and Psychotherapy: The
Background
a
Grahame F. Cooper
a
Training and Consultancy Services , Moseley,
Birmingham
Published online: 16 Oct 2007.

To cite this article: Grahame F. Cooper (1992) Ethical Issues in Counselling and
Psychotherapy: The Background, British Journal of Guidance & Counselling, 20:1, 1-9,
DOI: 10.1080/03069889208253605

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 SYMPOSIUM: ETHICS IN COUNSELLING
PRACTICE
Edited bv Grahame F. Cooper
Ethical Issues in Counselling and Psychotherapy: the Background
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G r a h a m e F. Cooper

Training and Consultancy Services, Moseley , Birmingham

Ethical issues have their roots in the belief systems of individuals and society.
Codes of ethics are seen as attempts to ensure that behaviour accords with
these belief systems. An outline model is presented which highlights some
aspects of beliefs, feelings and conscious and unconscious processes, and their
effects upon the conscious behaviours of the individual. Aspects of social
change and context are briefly considered, together with the subsequent effects
upon beliefs and ethics, and issues of responsibility.

The considerable increase during recent years in the emphasis placed upon
the importance of ethics in counselling and psychotherapy makes this an
appropriate time to present a symposium on ethical issues. The increased
interest is shown both by the adoption of new codes by the British Associ-
ation for Counselling (1988; 1989; 1990) and by the emphasis being placed
upon ethical issues within the United Kingdom Standing Conference for
Psychotherapy. The selection of topics covered in the symposium that
follows has been made with the intention of looking at the application of the
ethics of counselling and psychotherapy within some main areas of daily
living: work (Sugarman, 1992), education (Bond, 1992), health (Higgs and
Dammers, 1992), relationships (Hill, 1992), and religion (Foskett, 1992).
An exploration of the legal underpinning of ethical practice (Cohen, 1992)
precedes these papers.

Beliefs, feelings and unconscious drives

Before exploring the detailed application of ethics in counselling and
psychotherapy, it is important to consider the part played in human psycho-
logical functioning by belief systems, feelings and unconscious drives.
It could be said that a function of codes of ethics and practice is to control
the behaviours of practitioners by attempting to ensure that behaviours
accord with the beliefs underlying the establishment of the codes. The
intention is to prevent behaviours from being driven by feelings (conscious

British Journal of Guidance and Counselling 1

 or pre-conscious) or ‘idpulses’ (i.e. the instinctual drives of the
unconscious).
I have briefly presented elsewhere (Cooper, 1988) a pyramid model
outlining the interaction of beliefs, feelings and unconscious drives as
determinants of behaviour. I now wish to consider the application of that
model in the context of ethical practice. These interactions are illustrated in
figure 1, which shows the three levels of this pyramid of personal
functioning.
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Figure 1: Pyramid of personal functioning, showing the interactions between

unconscious and pre-consciouslevels affecting conscious behaviours (derived from
Cooper and Harvey, 1985; Cooper, 1988).

UtIAT I WNI

VWTIpeEL YWTIBEUWE

+-
(Pre-conscious)

Deepest drivea: To WAIN: LOVB AND BELONGING

To AVOID: LOSS AND ABAMxlNMwT
(Unconscious)

Level I presents, in symbolic form, conscious functioning, i.e. that which

is in awareness and is apparent to self. This is the level of our conscious
intellect and is composed of verbal communication, of activities and be-
haviours and of thoughts and conscious fantasies. It is also the level of
conscious factual information and knowledge.
Level I1 is designated as ‘pre-conscious’, and feelings and beliefs are
represented here. Level IIa symbolises the experience of emotions.
Emotions are ‘felt’ at locations within the body, particularly if the emotions
are very intense. This fact helps to distinguish the feeling processes from the
‘thinking’ processes of Level I, which are more akin to computer functions.
It is worth noting that the English verb ‘to feel’ is commonly used in
2 Volume 20 No. I , Januury 1992
 describing both physical sensations (‘I feel hot’; ‘It feels heavy’) and
emotional experiences (‘I feel anxious’; ‘I feel angry’). Emotions may be
present and felt in conscious awareness, or they may be present but below
the level of conscious awareness (‘pre-conscious’). If the latter, then they
may be raised to a conscious-awareness level if they become more intense or
if attention is focused upon them. This occurs when a counsellor uses non-
verbal cues to pick up emotions of which the client is unaware and, by
reflection, brings them to the client’s conscious awareness. Emotions which
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remain below the level of conscious awareness will still influence the
activities of Level I.
Level IIb symbolises individual beliefs and values. In addition to the
major belief systems which underpin the life style of the individual, it
includes morals and codes for personal conduct. This level is also pre-
conscious, i.e. the beliefs may be at the level of conscious awareness or may
be below it. Even if the beliefs are below the level of conscious awareness,
they will still influence behaviours. Johnson and Vestermark (1970) have
expressed this clearly: ‘Whether we recognise it or not, all facets of our
behaviour, the way we treat other people, our choices and decisions, our
reactions, our values, our responsibleness or lack of it, are embedded in a
philosophical base. Whether or not we are philosophically aware, we
function one way or another depending upon what we believe.’ The beliefs
can be usefully considered in three categories:

(1) Zntrojected beliefs. These are primarily based upon childhood beliefs
acquired from family and culture (including family and cultural myths
and taboos). These beliefs will have been taken in at a time when the
intellectual capacity to challenge or question them was not developed;
they sometimes persist thoughout adult life.
(2) AfJirmed beliefs. If an introjected belief is examined after the individual
has developed adult thinking capacity, and if - after comparison with
alternative beliefs - it is accepted as currently appropriate for that
individual, then it becomes an affirmed belief.
( 3 ) New beliefs. These replace introjected beliefs which, after due consider-
ation with adult thinking capacity, have been rejected by the individual.

Level 111represents the realm of the unconscious. It is the symbolic broad

base of the pyramid upon which all other levels stand: it includes the deepest
drives and unconscious fantasies. It represents the residuary of the experi-
ences of infancy and early childhood relationships, particularly with the
primary carer. These unconscious drives and fantasies act through the
upper levels of the pyramid, ultimately leading to behaviours which can be
viewed as likely to minimise isolation (to avoid loss and abandonment) and
to fulfil the basic need for intimacy (to retain love and belonging or attach-
ment). Unless the individual has become aware of these drives during

British Journal of Guidance and Counselling 3

 psychotherapy or certain trainings. these processes will normally remain
unconscious, but their effects will be observable by others.
The boundaries between the levels of the pyramid are not impermeable,
and interactions, including conflicts, will occur across them, as indicated by
the arrows in figure 1 . This simple model provides a way of looking at the
interactions, particularly of beliefs and feelings, and the resultant be-
haviours. It is highly relevant to a consideration of the belief systems which
underpin ethical behaviours in the practice of counselling and psycho-
therapy. It is a valuable aid in helping some clients to understand their own
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functioning and the structure of their conflicts.

Looking at this model, it can be seen that beliefs, particularly the
introjected beliefs. are derived from early cultural experiences, and that, in
turn, the belief system will sustain the cultural norms of the individual in
adult life. The belief systems of the practitioner and the client may be
derived from different cultural backgrounds which result from differences in
race. gender, class, religion and even geographical region. The ethical
implications of such cultural differences must always be considered in
maintaining awareness of the dynamics of power and control in the therapy
situation. For example, as migration, voluntary or enforced, continues to
increase the multi-cultural and multi-ethnic nature of nations and societies,
it now should be considered unethical for any counsellor or psychotherapist
to practise without giving attention to the dangers of falling into inappropri-
ate ethnocentric practice. Both theoretical and practical aspects of trans-
cultural counselling are discussed by d’Ardenne and Mahtani (1989), who
emphasise that responsibility for these issues lies with the counsellor from
the dominant cutture.

Responsibility and accountability

A Consideration of the practical legal aspects of counselling and psycho-
therapy provides not only a clear foundation for soundly based practice, but
also a stimulus to thinking about the relationship between ethics and the law.
Gray (1Y83) and Proctor (1987; 1988). in developing ideas about super-
vision, made a helpful contribution by clarifying that, in addition to the
contract between counsellor and client, there are other ‘lines of contract’ -
some explicit, some implicit - which must always be taken into account in
decision-making. These include the lines of contract to the supervisor, to the
employing organisation. to the counsellor’s validating organisation (which
provides codes of ethics and practice). and to society.
The extent to which the individual practitioner’s behaviours are con-
trolled by these multiple lines of contract may depend upon the extent to
which the lines of contract are ethically based or legally based. The British
Association for Counselling recognises such multiple lines in the introduc-
tion to it5 Code of Ethics and Practice f o r Trainers: ’... responsibilities to
trainees. colleagues and clients, this Association, their agencies and society’

1 Voliime 20 No. I, January 1992

 (BAC, 1985). Blackham (1974) acknowledged them in a slightly different
way when referring to the ‘multiple loyalties’ which a counsellor may have.
Loyalties, perhaps, implies an ethical or moral contract, rather than a legal
contract.
Multiple loyalties or multiple lines of contract can have a positive effect in
maintaining awareness of responsibility to all interested parties, but may
have a negative effect in producing conflicting loyalties. For example, the
difficulties arising for some nurses who counsel patients are described by
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Goldie (1991). He writes of the conflicting loyalties of nurses who find

themselves in the position of go-between in their relationships with patients,
doctors and relatives. The BAC Code of Ethics and Practice for Counsellors
(1990) recognises the difficulties of conflicting loyalties and gives clear
guidance on dealing with them. By contrast, Black (1984) advocates that
ethical problems in medical settings should be approached in the light of
each situation rather than by relying on dogmatic guidelines.
Ethical difficulties of conflicting interests and loyalties may arise when the
treatment of an individual client alters the dynamics of her or his family
relationships: for example, when partners or spouses become upset and send
anonymous threats to the therapist. Strean (1988) gives a clear personal
account of such experiences with a patient in psychoanalysis. His chapter
‘When Family Members Appear’ conveys the intensity of his ethical di-
lemma, his thinking processes and his emotional reactions in working to
resolve the difficulty.
The study of ethics clarifies the moral responsibility of the worker.
Although there may be some overlap, moral responsibility can be differen-
tiated from legal responsibilities; in turn, legal aspects can be divided into
criminal or civil liabilities (see Cohen, 1992). Codes of ethics and practice
represent an attempt to ensure that counselling and psychotherapy work is
carried out within a framework of moral responsibility: ‘responsibility
means a liability to be called to account, and to have behaved responsibly is
to be able to justify oneself when called to account’ (Blackham, 1974). Each
of us has to consider to whom we are ultimately answerable: the client? the
employer? the organisation? the law? our own ‘conscience’(whatever that is
conceived to be)? A medical colleague tells his students: ‘When embarking
upon surgery, before you do anything, always ask yourself: what will I say to
the coroner?’ This is a timely reminder that we all should behave and
practise as if we are likely to be called to give account of ourselves and our
actions.
For those whose practice is psychodynamicallybased, the moral responsi-
bility is extended to take account of the unconscious components of the
client/worker relationship and to ensure that the boundaries of behaviour
take account of this transference component in the duty to care. This is
particularly emphasised in a case described by Cohen (1992) in his paper on
legal aspects, which highlights the possible legal consequences of failing to

British Journal of Guidance and Counselling 5

 maintain appropriate boundaries. It is noteworthy that there are recently
formed organisations in the UK and in the USA offering support and help to
those clients who have experienced abuse in professional relationships.
However, as Foskett (1992) shows in relation to pastoral work and Higgs
and Dammers (1992) show in relation to medical practice, there is another
level of ethics which is beyond the scope of codes of ethics and practice.This
level encompasses the fundamental value systems upon which the worker’s
life and beliefs are based, including her or his understanding of the nature
and meaning of human life and existence. The question then is whether or
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not that level of value system can be differentiated from practical ethical
issues of responsibility to clients, which must be based to some extent upon
personal beliefs about the very nature of human beings, human relationships
and existence. These fundamental ‘meta-beliefs’ in a sense underpin all the
other belief systems which are represented in Level IIb of the pyramid of
personal functioning outlined earlier.

Social context
As the Government of the United Kingdom has moved during the past
decade in an explicit and deliberate way towards creating a society which
functions on the basis of ‘market forces’, many previously accepted values
and beliefs have come under challenge, if not duress, and practices are now
presented as desirable which would in the past have been considered
unethical. The concept of market forces is related to a system of accounting,
and in any accounting system the unit of currency must be considered. Is
money the only valid currency, or are there other values which have to be
balanced and entered into the account? Ethical norms of practice and the
values upon which they are based are, like legal issues, not established in the
hard-and-fast way which would be most comfortable and easy to work with,
but are always subject to different interpretations according to viewpoint,
context and time.
It follows from this that the material in this symposium cannot provide
those hard-and-fast guidelines which we might have hoped for in terms of
childhood thinking. Rather, it confronts us with the challenges, the di-
lemmas and the realities of the adult world, with its constant shifts and
changes. The distress which can be caused as belief systems shift is illustrated
by the statement of Mrs A, made during a marital therapy session:

‘When we first met I was still strongly influenced by the seventies and
independence, and I insisted that we had an “open” relationship. Now I
can’t tolerate him going with anyone else.’

Facing the current realities of the world in which we live should stimulate
all practitioners to think about the ethical aspects of their own practice in a
way which will enable them to be clear about their own current inner and

6 Volume 20 No. 1, January 1992

 outer guidelines for working and living. The ethical implications of the
boundary between daily living and the organisational aspects of the ethics of
counselling practice are further considered by Bond (1992) for counselling in
education and by Hill (1992) for relationship counselling.
If we look honestly at ourselves and our practices, there is a moral
challenge: can we be sure that we are always acting in the best interests of the
client, or do we sometimes take shortcuts because of our own needs? We
then have to consider the philosophical basis of our lives and the meaning of
our work as counsellors, psychotherapists, medical practitioners, tutors,
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psychologists, lawyers or whatever.

The work of Power and Pilgrim (1990) clearly, and perhaps painfully,
illustrated how psychotherapists’ functioning and belief systems might be
influenced by circumstances. They interviewed psychotherapy practitioners
on the issue of fees. Their results ‘indicated that those who felt most strongly
that fee-paying was essential for ,effective psychotherapy, and that the
payment of a fee was symbolically important to their clients, were also those
who were most heavily dependent upon fee-paying for their livelihood and
who tended to be less likely to express ambivalence about receiving money’.
This issue is briefly but usefully discussed in the context of possible financial
exploitation in therapy by Holmes and Lindley (1989).
In virtually all cases, it is the practitioners themselves who define what is
ethical practice and what is not. This raises questions about ethics and beliefs
within the systems and the organisations which draw up codes of ethics and
practice, ostensibly for the benefit of the clients, but utilising a process which
does not normally give the clients a voice in the process of establishing those
codes. Sugarman (1992) considers related issues in the context of counsel-
ling at work, including the possibility of the employees of the organisation
being involved, through union representation, in the process of establishing
the ethical practice of a work-based counselling service. The present move-
ment towards professional ethical or disciplinary committees being con-
stituted with a majority of lay members represents a welcome widening of
opinion upon such issues and a move away from a totally inward-looking
professional self-regulation. Such moves are being actively encouraged and
promoted within the European Community.
At the time of writing, neither counselling nor psychotherapy are formally
recognised as regulated professions within the UK. They are, therefore,
self-regulatory on the issues of ethics and practice, and there are no real
sanctions against those who transgress, unless a legal action is started by a
dissatisfied client. Although most counsellors and psychotherapists belong
to professional organisations which have codes of ethics and practice for the
protection of the public, being deprived of membership as a sanction for
transgressing the codes does not prevent the individual from continuing to
practise in the UK. This also applies to members of other professions (e.g.
clergy, social workers, nurses, doctors, etc.) who use counselling skills and

British Journal of Guidance and Counselling 7

 belong to the British Association for Counselling, subscribing to its Code of
Ethics and Practice for Counselling Skills (BAC, 1989).
Daines (1988), in addressing the underlying values and assumptions of sex
therapy, has provided a challenge which it behoves counsellors and thera-
pists in other areas of work to consider carefully. Can the practice be
considered to be ethical if it is based upon beliefs (and/or assumptions)
which have not been consciously examined and/or challenged? This is
comparable to the developmental process of challenging introjected beliefs
in adult thinking capacity and either affirming o r rejecting the beliefs. Segal
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(1985) provides a useful contribution to this process by bringing to attention

the unconscious and unknown underpinnings of our daily and professional
lives. She uses a psychoanalytical approach to understanding ourselves and
the influence of unconscious fantasies in relation to, inter alia, blame,
intention and responsibility, and work - all issues which are closely related
to the practical ethics of counselling and psychotherapy.
It is worth noting that in the branches of psychotherapy which are derived
from the theory and/or practice of psychoanalysis, it is considered essential
for the practitioner to have undergone a training therapy or analysis which
will have provided insight into herhis unconscious motivations and beliefs.
Indeed, there are those who consider it unethical to practise any form of
psychotherapy without such a training experience. Jones (1991) has chal-
lengingly drawn attention to some ethical dilemmas arising during training
for psychotherapy, and in supervision, including confidentiality for clients
and for traineees who are required to be in therapy. Whilst remaining aware
that there is no commonly accepted definition of the difference between
psychotherapy and counselling, it is interesting to note that Jones makes no
reference to the British Association for Counselling’s Code of Ethics and
Practice for Trainers (BAC, 1985).

Moving forward
Lest some of the points discussed in this paper should induce a sense of
despair about ever getting it right, let us finally turn to Ross (1989), who
considers the position of counselling in a society which is dominated by the
market economy and hence by the demand for proving cost-effectiveness.
After discussing the considerable difficulties involved, she concludes that
these ‘should not preclude us from having faith to go on doing what we know
to be right for as long as we can and for as many as we can, even if we do not
have the methodology to prove it beyond a significant doubt factor’. Maybe
faith is not about being perfect, but rather about trying to improve.

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Correspondence should be addressed to: Dr Grahame F. Cooper, Training

and Consultancy Services, 6 Clarence Road, Moseley, Birmingham B13 9SX.

British Journal of Guidance and Counselling 9