STUDY UNIT 6

LEARNING OUTCOMES:

− explain the role of personal values in the helping process (Egan, Ch 2; HPCSA; READER)
− discuss the ethical regulations/codes for psychotherapy under the following headings (HPCSA; The
reader)
✓ general ethical principles
✓ confidentiality
✓ boundaries of competence
✓ informed consent/information regarding the process of therapy
✓ double relationships and set of boundaries in psychotherapy
✓ ethical behaviour and multicultural issues
− the ethical decision-making process; explain human rights with reference to mental health services
(Internet: www.Constitutionalcourt.org.za – Bill of rights).

STUDY MATERIAL:

− Egan, G. (2020). The skilled helper: A client-centred approach. (3rd ed.). Hampshire, UK:
Brooks/Cole, Cengage Learning, Chapter 2
− Internet: www. Constitutionalcourt.org.za – Bill of rights
− Internet: HPCSA / ETHICAL CODE OF PROFESSIONAL CONDUCT: PSYCHOLOGISTS (In South Africa)
− The reader

SELF AWARENESS AND AWARENESS OF OTHERS:

AWARENESS OF SELF

− Counseling is a special job that requires that the counselor knows his or her own strengths,
limitations and characteristics, and is aware of how these traits have an impact on others
− for instance, someone who has a short temper may seem unapproachable to others, or someone
with a naturally loud voice may have a negative impact on the client in counseling
− there are also many reasons why we want to talk to other people about their problems
− however, it is very important that we try to listen to how we talk to ourselves about our own
problems, before we venture to do counseling
− the reason why it is important to understand ourselves is because the way we talk to ourselves, is
often not different from the way we talk to others

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AWARENESS OF OTHERS:

− Counselling is mainly about the interaction between a councilor and a person seeking counseling
− it is therefore, also important that the councilor has an awareness of diversity and is open to
exploring differences and similarities amongst people of different cultures, beliefs and backgrounds
− this will help the councilor to understand the person better and to convoy an atmosphere of
acceptance
− in a multicultural country like South Africa, awareness and respect of the various cultures, languages
and beliefs of others is important in preventing prejudges, bias and discrimination, all of which are
destructive in the counseling relationship

VALUES:

explain the role of personal values in the helping process

− values can be seen as ‘mental maps’ which define how to act in situations.
− However, even though people have values (behavioural maps), they do not always use them.
− So clients (like the rest of us) have both ‘espoused’ values, which are like ideals, and ‘values-in-use’,
that is, behavioural maps they use more or less consistently to make decisions and guide behaviour.
− Often enough there is a split between espoused values and action on the part of either helper or
client that adds a note of uncertainty to the helping process.
− Moreover, some values-in-use lead to life-limiting rather than life-enhancing outcomes.
− Values are norms set out by the society at a given time and moment
PERSONAL VALUES IN THE HELPING PROCESS

− Respect as a foundation value

− Empathy as a primary orientation value
− Proactive appreciation for diversity
− Self-responsibility as an empowerment focused value
− A bias for action as an outcome-focused value

ETHICS:

DEFINITION OF ETHICS

− Principles and standards that ensure that professionals provide quality services and are respectful of
the rights of the other people.
− Acting in an ethical manner –following the laws and rules governing one's profession.
− Ethical codes that are intended to protect both the practitioners and the clients.
− Ethical principles provide guidelines to helpers for behaving in a responsible manner and resolving
ethical dilemmas.
− Professional ethics can be seen as being confident that one has the correct combination of attributes
to enable one to maintain, promote and enhance our patients abilities, health, while being an
optimal functioning in a responsible way

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4 DIMENSIONS OF ETHICS

− Sufficient knowledge, skill and judgement in effective interventions

− Respect dignity and freedom of client
− Using power in a responsible manner
− Acting in ways that promote public confidence

GENERAL ETHICAL PRINCIPLES:

1. AUTONOMY

− Refer to the right of both the client and the therapist to make choices, take action provided that the
choice does not affect someone else.
− This principle grants individuals the opportunity to determine their actions on the basis of their
belief systems.
− A helper may be working with a client about career decisions, independent of the client's parents”
hopes for her to pursue law school.
− Suddenly, the client announces that she is ending counseling and giving up her scholarship to pursue
a career as a country music singer.
− The helper might suggest that the client reevaluate this decision and consider the pros and cons of
life as a country music singer.
− However, the principle of autonomy allows the client the right to make her own decisions, provided
these decisions are not harmful to others.
− In this example, the helper supported the client’s decision to attend college and simultaneously
pursue her dream of becoming a musician.
2. BENEFICENCE

− refers to the intent “to do good” by helping and promoting growth in others.
− This principle clearly states that helpers should be committed to the growth and development of
their clients.
− Helpers who strive to provide the most comprehensive, empirically supported services to their
clients are embodying the principle of beneficence
− Whereas helpers who see clients solely to make money violate this important principle.
3. NONMALIFENCE

− Do no harm
− Professionals are asked to ensure that their interventions and actions do not inadvertently harm
their clients.
− Thus, neglect on the part of the helper (even if unintentional) would be problematic.
− For example, a student in a helping class might be out drinking margaritas with friends and telling
them about the practice helping session he had in class that day.
− Later, he might notice that his practice client is in the booth next to him and had probably overheard
him telling his friends about her issues.

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− Although the helper may not have used the client's name or intended to harm her, he would be
responsible for the unintentional harm that results from having disclosed confidential information
about his practice client.
4. JUSTICE

− Fairness
− Ensuring equality of opportunities and resources for all people.
− Helpers have an ethical responsibility to rectify the unequal distribution of helping services by
making their services more accessible to those who are unable to pay.
− For example, helpers can contribute to building a just society by volunteering at not-for-profit
agencies (e.g., shelters for battered women, clinics for people with AIDS).
− An additional method of promoting justice involves attempts to influence public policy or legislation
to ensure that mental health services are available to those in need, regardless of their ability to pay,
location, language preference, or disability status.
5. FIDELITY

− keeping promises and being trustworthy in relationships with others.

− Fidelity is a critical component of the relationship between helpers and clients.
− Without confidence in the helpers ability to be faithful to the agreements articulated in the helping
− session, minimal progress can be made.
− For example, the agreement between helpers and clients typically involves both parties meeting at a
certain time for a specified number of sessions.
− If helpers are consistently 20 minutes late for each session, they are breaking the promise to be
available to clients at an arranged time.
− Violations like these can have a detrimental impact on the development of the helping relationship.
6. VERACITY

− refers to telling the truth, is a powerful and necessary principle in helping settings.
− Clients often rely on their helpers to provide honest feedback about their interactions in the helping
sessions.
− Takiesha had not made much progress in the last few sessions and asked the counselor for some
direct feedback about her work in the helping sessions.
− The helper provided several positive remarks and also indicated that at times, Takiesha appeared to
place responsibility for her problems on others instead of empowering herself.
− Although Takiesha was upset about hearing this feedback, she was grateful to the helper for being
honest and was able to understand how her reluctance to take responsibility prevented her from
making necessary changes in her life.

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ETHICAL ISSUES FOR BEGINNING HELPERS:

CONFIDENTIALITY

− It is important that helpers respect a client's confidentiality by not divulging information shared in
the helping session, except in limited circumstances
− There are a few limits to confidentiality
− First, you need to be able to talk about your clients with supervisors so that you can learn from your
errors and grow as a helper.
− Second, if the client reveals to you harm (or intent to harm) to self or other, you (and/or the
responsible instructor or supervisor) may be legally obligated to report this threat to the appropriate
authorities.
− Third, if the client reveals abuse to children, elderly persons, or disabled persons, you {and/or again
the responsible instructor or supervisor) may be legally obligated to report such abuse to the
appropriate authorities.
− It is important to inform clients about the general principle of confidentiality at the beginning of the
first session and then have the client sign an informed-consent form
− helpers have to deal with issues related to confidentiality as they arise in sessions, by first reminding
clients about the limits of confidentiality as they begin to disclose issues related to harm or abuse
and second by consulting immediately with supervisors and legal authorities and then carrying out
the recommended procedures.

RIGHTS TO CONFIDENTIALITY

− A psychologist shall safeguard the confidential information obtained in the course of practice,
teaching, research or other professional duties, subject only to the exceptions set forth as limits to
confidentiality.
− A psychologist shall only disclose confidential information to others with the written informed
consent of a client
RECOGNIZING LIMITS

− helpers should recognize and practice only within the areas for which they have been trained and
are competent
− A friend who discovers that you are learning helping skills may ask you to speak with her cousin who
has been acting in a strange manner and hearing voices that tell him to destroy the psychology
building at the university.
− Appropriate ethical behavior in this case would involve telling your friend that meeting with her
cousin is outside of your area of competence.
− In a related vein, as a helper, you need to be honest about your qualifications—that you are a
beginning trainee.
− Helpers who describe themselves as counselors or advertise that they provide psychological
interventions they have not been trained to use are not acting ethically.
− To act only in the areas in which they are trained and competent

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 BOUNDARIES OF COMPETENCE

− A psychologist shall develop, maintain and encourage high standards of professional competence to
ensure that the public is protected from professional practices that fall short of international and
national best practice standards.
− A psychologist shall accept that he or she is accountable for professional actions in all domains of his
or her professional life.
EDUCATE CLIENTS ABOUT THE HELPING PROCESS

− Clients has the right to understand the nature of a helping relationship

− Many clients have never experienced a formal helping relationship and are uncertain about what to
expect.
− Helpers can explain their theoretical orientation in simple and clear terms, so that a decision can be
made regarding participation
− For example, helpers should provide information about fees, length of the helping relationship,
techniques used, whether anyone will be observing or supervising, and whether the sessions will be
audio- or videotaped.
− Beginning helpers must also inform clients about the limits of confidentiality and their status as
helpers (e.g., that they are not professionals).
− It is a good idea for helpers to ask clients to sign an informed consent that explains the process
− Clients has the right to understand the outcomes that can be experienced
− Don't promise something you can't provide
− When providing services to families or couples, helpers must clarify their roles and the relationships
that occur during the time of service.
− For example, a helper was seeing an adolescent client whose parents were divorcing. The mother
was struggling during this time and asked if she could talk privately with the helper to discuss some
of her issues related to the divorce. The helper gently reminded her of the importance of having a
special relationship with the client (the daughter) and indicated that this relationship might be
jeopardized by even one helping session with the mother. The mother was given referrals to other
qualified helpers.

INFORMED CONSENT/ INFORMATION REGARDING THE PROCESS OF THERAPY

− When a psychologist conducts research or provides assessment, psychotherapy, counselling, or

consulting services in person or via electronic transmission or other forms of communication, he or
she shall obtain the written informed consent of a client, using a language that is reasonably
understandable to such client.
FOCUSING ON THE NEEDS OF THE CLIENT

− At times, the best interests of clients may conflict with the needs of helpers.
− For example, Jim may be preoccupied during a session because he needs to study for an exam.
− Jim may have a difficult time focusing on the client {e.g., listening, giving eye contact), and he may
hope to end the session early to go home and study.

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− However, it is critical that the helper focus on listening carefully to the concerns of the client and be
as present as possible in the helping session
AVOID HARMFUL DUAL RELATIONSHIPS

− When someone with power (helper, professor) adds another role to his or her interactions with a
less powerful individual (client, student) because the dual relationship may lead to harm of the less
powerful person.
− May lead to exploration and damage
− Helpers need to be aware of the power differential when working with others and ensure that clients
are not harmed by their interactions.
− For example, if a beginning helper is assigned a client for whom she or he is also a teaching assistant,
harm might occur if the client-student felt that disclosures could be used against him or her when
the helper was grading exams.
− Hence, helpers should not take on clients with whom they have other relationships if that would
interfere with the helping process.
− Helpers also should not provide helping sessions to friends or family members.
− Although helping skills can be used to communicate more effectively in personal relationships, taking
on the role of helper with friends or family members can be detrimental for several reasons.
✓ It is difficult to be objective when listening to the problems of friends or family members. A lack
of objectivity could have a negative impact on a helping session because the helper’s own needs
could interfere with assisting the client to act in her or his best interests.
✓ The role of helper is powerful and could disturb the power dynamics in the relationship.
− the most blatant example of harmful dual relationships involves a helper having a sexual relationship
with a client.
− Sexual involvement with clients (and former clients) has been shown to have negative outcomes
− Many professions have developed explicit rules prohibiting sexual intimacies between helpers and
clients.
− In addition, providing counseling to someone with whom one has been sexually involved in the past
can be destructive to the client.
− Helpers typically cannot be objective and provide quality services to clients with whom they have
been intimately involved.
DEVELOPING APPROPRIATE BOUNDARIES

− Helpers needs to think about boundaries, rules and limits with the helping relationship
− Boundaries can be about the structure of helping (e.g., length, fees, policies about touching and
violence, confidentiality) or about the interpersonal nature of the interaction (no sexual intimacies,
friendships, or business relationships with clients outside of helping).
− Helpers need to clarify the rules about confidentiality, the length of helping, and any fees involved.
− Helpers typically choose to avoid involvement in social activities with clients outside of sessions
because such activities may make it difficult for helpers to be objective and for clients to feel
comfortable disclosing in the therapy setting
− Beginning helpers can provide the phone number at a work setting so clients can reach them for
emergencies, but I suggest they not give them a home phone number.

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− The reason not to give out home phone numbers is that some clients take advantage of beginning
helpers, who have difficulty setting limits about not talking on the phone at any hour for any reason.
− Developing appropriate boundaries is often quite difficult.
− It is probably better for beginning helpers to start out being overly cautious and then relax their
boundaries as they gain experience.
− Consultation with supervisors can be helpful when in doubt about which boundaries are appropriate
and how to set them.
− Furthermore, exploring one’s own countertransference issues (i.e., personal reactions to clients) is
important when thinking about establishing boundaries in general.
− It is even more important for helpers to examine their own issues when they want to violate or
adjust boundaries with a particular client, as these urges to violate boundaries often reflect
countertransference issues.

DOUBLE RELATIONSHIP + SET OF BOUNDARIES

− A multiple relationship occurs when a psychologist is in a professional role with a person or

organization and at the same time
(a) is or was in another role with the same person or organization;
(b) is in a relationship with a person or organization closely associated with or related to the person
or organization with whom they have the professional relationship; or
(c) promises to enter into another relationship in the future with the person or organization or a
person or organization closely associated with or related to the person or organization.
BE AWARE OF YOUR OWN VALUES

− Helpers' values influence clients.

− Helpers need to be aware of the influences and values of their interaction with clients
− Beginning helpers, like advanced clinicians, should work to understand their biases.
− The influence of values in helping can be subtle.
− Helpers can influence the direction of sessions and clients’ selection of actions through nonverbal
behavior of which they are unaware, such as smiling or nodding their heads at particular moments.
− Beginning helpers sometimes struggle with inadvertently encouraging clients to talk about situations
that are comfortable for or interesting to the helper.
− For example, a helper might use nonverbal behaviors to indicate great interest when the client is
talking about her romantic relationship but seem somewhat less interested when the discussion
moves to roommate concerns
ETHIVAL BEHAVIOUR RELATED TO CULTURE

− Ethical behavior mandates that helpers be mindful of differences among Individuals and use basic
helping skills that reflect an understanding of the people with whom they are working
− Beginning helpers should not assume that helping skills transfer across cultures and individuals.
− One example is the assumption that maintaining eye contact is a sign of openness, interest, and
willingness to participate in the session.
− In some cultures however, a lack of eye contact signifies respect for an authority figure

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− Helpers who are working with clients from a different culture either neglect or attach too much
significance to the culture of their clients when providing interventions.
− It is important for helpers to realize that helping in the traditional manner may (or may not) be
sufficient for these clients.
− a helper who is working with a client from a different culture should not assume that the client's
goals are to assimilate (or not assimilate) into the majority culture
− Demonstrating interest in clients’ cultures is important, but helpers should not expect clients to
educate them about culture.
− Helpers can educate themselves about culture through talking with people from different cultures,
trying foods from different places, and watching movies.
− Above all, though, perhaps the best idea is to read relevant materials.
− All of us need to engage in serious self-examination to discover our cultural values and beliefs as well
as our prejudices and biases.
− Being aware of our cultural beliefs {e.g., valuing independence, autonomy, religion, and family) is
important so that we can recognize what we value; but it is also important so that we do not
automatically assume these values are right for everyone else.
− Understanding our prejudices and biases is important so that we do not harm clients who are
culturally different from us.
− All of us have been raised with prejudices and biases that can surface when we are least aware of
them.
− Sometimes we are so used to these feelings that we do not even question their validity
− It is also important to think about what biases clients might have toward you as a helper.
− Ethical behavior goes beyond having an awareness of individual and cultural differences to
embracing a commitment to eliminate bias and discrimination in one’s work.
− This commitment may involve actively examining our biases, confronting colleagues who act in a
discriminatory manner, advocating for those with less power, and working for social change.

ETHICAL BEHAVIOUR + MULTICULTURAL ISSUES

− A psychologist shall not engage in behaviour that is harassing or demeaning to persons with whom
they interact in their work based on factors such as those person’s age, belief, birth, colour,
conscience, culture, disability, disease, ethnic and social origin, gender, language, marital status,
pregnancy, race, religion, sexual orientation or socio-economic status.
BEING CULTURALLY COMPETENT HELPER

− Becoming a culturally skilled helper is an active, ongoing process that never reaches an end point
− It is something helpers aspire to, and work toward, rather than accepting complacency.
− Characteristics of a culturally sensitive helper:
✓ Strive to understand their culture and how it affects their work with clients
✓ Striving to understand how their beliefs and values regarding help is influenced by their culture
✓ Honestly confront their prejudices and discrimination and work through it
✓ Recognize client's cultures so that appropriate helping skills can be used.
✓ Has a wide variety of helping skills and adapts to their clothes and their own culture

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 ✓ Understand the extent of discrimination and oppression and its impact on lives and problems
✓ Recognize and address cultural differences between themselves and their class, and to continue
to communicate willingly
✓ Seek supervision and referrals where necessary
ACT IN A VIRTUOUS MANNER

− Professionals concerned with ethical behaviors have begun to move from a focus on behaving in an
ethical manner (i.e., following the guidelines delineated in an ethical code) to behaving in a virtuous
manner.
− Virtues are not as concerned with laws and rules as much as with striving to be a person of positive
moral character
− Part of this change results from the reality that ethical codes, in and of themselves, cannot provide
exact specifications for behaviors.
− Helpers need to internalize the six basic ethical principles practice a comprehensive ethical decision-
making model, and monitor themselves and their behaviors to ensure respectful interactions with
clients.
− It is important to recognize that it is not possible to provide helpers with answers to every ethical
situation they might encounter; instead, helpers need to behave with clients in a caring and
respectful manner that is consistent with acting in a virtuous manner (which is most likely also
ethical).
TAKE CARE OF YOURSELF TO ENSURE THAT YOU CAN CARE FOR OTHERS

− One final often-ignored dimension of ethical behavior involves helpers taking care of themselves.
− Helping can be an exhausting enterprise that requires helpers to give much of themselves to others.
− The fastest road to burnout involves taking care of others without paying attention to relaxation and
caring for one’s own needs.
− It behooves helpers to monitor their health and energy to ensure that they can provide quality
services to others.
− Helpers might evaluate regularly the presence of added stressors, poor health, and exhaustion.
− Helpers can try to achieve balance by integrating rewarding work, supportive relationships, regular
exercise, and healthy eating habits into their lives. Helpers can also seek counseling when they need
support or assistance with pressing concerns.

WORKING THROUGH AN ETHICAL DILEMMA:

− Ethical dilemmas occur when there are competing ethical guidelines

− At times, the actions that helpers could take to uphold one ethical principle would violate another
ethical principle.
− Kitchener described inherent contradictions that exist in ethical codes (e.g., individual autonomy vs.
making decisions for clients; confidentiality vs. protecting others).
− For example, ethical codes often ensure a client's right to privacy and confidentiality
− They also endorse the importance of working to minimize harm to others.
− These important standards can, at times, conflict with one another.

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− Helpers can follow the A-B-C-D-E strategy for ethical decision making when they are confronted with
an ethical dilemma.
− Let’s consider a situation in which a client discloses to a helper that she was raped by an
acquaintance the previous night. The helper in this case is a beginning helper who feels outraged by
the crime and wants to call the police immediately. The client, however, is concerned about her
relationship with her boyfriend and definitely does not want the rape to be reported. The helper
realizes that this is not a situation in which he is legally required to break confidentiality and report
the rape, but instead is an ethical dilemma between reporting a crime against the client's wishes and
maintaining confidentiality.
− The helper uses the A-B-C-D-E strategy for ethical decision making to work toward resolving how to
proceed in this challenging situation.
A: ASSESSMENT

− The helper identifies the situation; the client's status and resources; and the helper’s values, feelings,
and reactions to the situation.
− In this case, the helper notes that the client is a well-adjusted, bright, and competent young woman
who is finishing her 4th year in college, majoring in business administration. She reports having a
good relationship with her boyfriend. Two close friends have promised to support her through her
recovery from the rape, and she has indicated an interest in attending a rape survivors’ group.
− The helper, however, feels strongly that the rapist should be punished for what he did to the client.
− When he reflects more on the issue, however, the helper acknowledges that the strength of his
emotions may result from his feeling helpless when he discovered that his younger sister had been
raped.
B: BENEFIT

− The helper evaluates what is most likely to benefit the client, the helping relationship, and the
client's significant others.
− In this case, the helper believes that disclosure of the rape to the police and subsequent prosecution
of the rapist could benefit the client, her boyfriend, and possible future victims. However, he also
acknowledges that the client believes that she would be helped most by discussing the rape with her
helper, her best friends, and a rape survivors’ support group.
− As with many ethical dilemmas, different benefits are present for several possible solutions.
C: CONSEQUENCES + CONSULTATION

− Moving on to the ethical, legal, emotional, and therapeutic consequences that could result from
possible actions, the helper consults with a supervisor who provides assistance in identifying and
working through salient issues.
− In this case, the supervisor helps the helper identify that his disclosure of the rape to the police
would undermine the trust he had worked to develop with the client.
− Moreover, the helper would be violating the client’s confidentiality and right to privacy.
− His reporting of the rape might reinforce feelings of powerlessness that the client felt after being
raped.
D: DUTY

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− The helper next considers to whom a duty exists.
− In this case, the helpers primary duty or responsibility is to the client rather than to her boyfriend or
other women that the rapist might harm.
− His job as a helper is to do no harm to his client and to provide services that enhance her growth and
potential.
− The helper is beginning to realize how important it is to abide by the client's wish for nondisclosure,
despite his own desire to prosecute the rapist.
− Sometimes, the helper may have a duty to protect someone other than the client (i.e., an
identifiable person whom the client is threatening to harm).
− In situations in which a child is being abused, helpers are mandated by law to report the abuse or to
assist the client in reporting the abuse.
− Furthermore, in cases in which the client threatens to harm self or others, the helper must ensure
the safety of the individuals identified to be at risk for harm.
− For example, if this client told her helper that she planned to murder the rapist and had enlisted the
assistance of an assassin to carry out the plan, the helper would have a responsibility to prevent
harm to the rapist.
E: EDUCATION

− The helper reviews his education to determine what he has learned about appropriate actions to
take in dealing with similar ethical dilemmas.
− The helper refers to his notes from his courses, consults current Web sites, and determines that in
this situation, the best strategy is to maintain the client's confidence and assist in her recovery from
the rape.
− The helper also decides to go for therapy to address his residual feelings about his sister's rape.

HUMAN RIGHTS RELATED TO MENTAL ISSUES:

THE BILL OF RIGHTS

− This Bill of Rights is a cornerstone of democracy in South Africa. It enshrines the rights of all people
in our country and affirms the democratic values of human dignity, equality and freedom.
− The state must respect, protect, promote and fulfill the rights in the Bill of Rights.
− The rights in the Bill of Rights are subject to the limitations contained or referred to in section 36, or
elsewhere in the Bill.

RIGHTS

− Everyone has the right to have access to-

a. health care services, including reproductive health care;
b. sufficient food and water; and
c. social security, including, if they are unable to support themselves and their dependents,
appropriate social assistance.

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− The state must take reasonable legislative and other measures, within its available resources, to
achieve the progressive realization of each of these rights.
− No one may be refused emergency medical treatment.

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