Ethics in Counseling Essay

This paper analyses social, ethical and lawful issues within a complaint initiated by the NSW health Care Complaints Commission (HCCC) against a psychologist, Steven Kreft (HCCC v Kreft, 2011). The HCCC investigated a complaint by a customer of Kreft of personal and sexual disclosures, as considerably as amateurish sermon in the solicitation of a photograph of the guest in which the client was habilimented in underwear. Krefts actions are assessed in light of headmaster and ethical standards as well as potential breaches of the law. Steven Kreft, was an experient psychologist narrowly specialising in the treatment of men with anxiety conditions using cognitive-behavioural therapy (HCCC v Kreft, 2011). The client, a 19-year-old get married woman, was referred to Kreft because of anxiety and possibly panic attacks, but during the initial stages of counselling, she raised blood problems, her appearance and sexual needs and answers with him and these became the focus of their sessions.Kreft conveyed to the client that he was non experienced or skilled in the treatment of kinship problems or sexual disorders, however, the client enjoind that she wished to continue working with him and he did non insist on referring her elsewhere. The client ultimately accused Kreft of failing to watch over proper professional boundaries and engaging in inappropriate discussions of a personal nature in which he Complimented her on her appearance referring to her petite size, short height and thin build, and likened her to his girlfriend Commented on her wearing Bonds underwear like his girlfriend wore Asked the client to commentary on his physiologic appearanceDisclosed details of his personal life including the number of sexual partners he had had, that his girlfriend would share a bed with other girlfriends when they slept over, that he had been in love numerous times, and that he had thought somewhat homosexuality during his youth (HCCC v Kreft, 2011). In addit ion, Kreft was accused of failing to follow or observe appropriate therapeutic practice and/or failing to observe proper professional boundaries when he asked the client for photographs for a study in which other sight would rate the clients appearance. One of these photographs pictured the client dressed in underwear. Kreft copied these photographs onto his own computer for later presentation to unnamed others.This exercise was not recorded in the clients clinical notes (HCCC v Kreft, 2011). The HCCC investigated the clients complaints and took disciplinary action against him. There are numerous social, ethical and legal issues in this case. Although Kreft was in fact a psychologist, for the purpose of this paper, his conduct will be assessed against the Australian Counselling Associations Code of Ethics and pattern (2012). This paper will explore the power imbalance between Kreft and his client, the effect of his behaviour on the therapeutic relationship and whether Krefts behav iour might cast off breached sexual harassment laws. Ethical and legal guidelines exist to offer protection to people who may experience harm as a result of the actions of another(prenominal) person. According to Welfel (2013, p.3), professional ethics in counselling encompasses five dimensions of behaviour including having sufficient knowledge, skill and judgement respecting the clients human dignity and granting immunity using a counsellors inherent power responsibly and, acting to promote public confidence in the counselling profession.This provides a helpful framework for assessing Krefts conduct in this case. Beginning with Krefts expertise, Kreft usu wholey used a strict cognitive-behavioural protocol for the management of anxiety and panic disorders. Kreft is depict by his own treating psychiatrist as a skilled practitioner in a narrow field, having been trained to think rationally and logically. Krefts practice involved administering protocols, carrying out logic-based i nterventions and requires his patients to occupy a mindset where they share a common objective and commitment to the treatment and its proposed outcome (HCCC v Kreft, 2011 at 227).Although referred to Kreft because of his germane(predicate) expertise, the treatment interaction became sexualised when the client began talking about her sexual experiences and practices. There was further exploration of her concerns about her personal appearance, low self-esteem, need for validation by men via her sexual activities and descriptions of her specific sexual behaviour. Here, Kreft was out of his professional depth. Specifically on this matter, the Australian Counselling Associations (ACA) Code of Ethics and rehearse states that counsellors must endeavour to make suitable referral where competent service so-and-sonot be provided (p.3) and undertake regular command and debriefing to develop skills, monitor performance and adjudge professional accountability (p.3).Although Kreft prize th atthe clients relationship and sexual issues were beyond his expertise and conveyed as much to the client, he could bring forth insisted on referral, contempt the clients preference for continued sessions with him. The ACA further states that competence includes being able to recognise when it is appropriate to refer a client elsewhere (p.12). The rationale for this professional expectation is that counsellors are required to take all fairish steps to ensure that the client does not suffer physical, emotional or psychological harm during counselling sessions (p.4). Sexualisation of the therapeutic relationship can be harmful to clients, and in this case, it is difficult to see how it served the client. According to the ACA Code of Ethics and Practice, the helping relationship constitutes the effective and appropriate use of helpers skills that are for the bene fit(p) and safety of the client in his or her circumstances (2012, p.3), and counsellors must take all reasonable steps t o ensure that the client does not suffer physical, emotional or psychological harm during counselling sessions (2012, p.4).In relation to the disclosures, for whose benefit where they? It is unreadable what led Kreft to make sexualised self-disclosures and what purpose he thought they served. Perhaps it was a response to the clients exploration of her relationships and sexual activities. such client self-disclosure can sexualise the therapeutic relationship (Gurtheil & Brodsky, 2011, p. 183). Counsellor disclosures are inevitable and sometimes useful, but self-disclosure can become burdensome to the client and therefore detrimental. Gurtheil and Brodsky (2011) state that in cases of sexual misconduct, a key turning point often occurs when the relationship shifts from a therapeutic exchange to one of sharing personal confidences and feelings (p.114). They further state that even therapists whose practice deliberately includes open self-disclosure, it is rarely useful and usually bur densome for clients to hear details of the therapists emotional, sexual, personal or family life. Such disclosures, especially when they involve sexual feelings, are nearly always considered boundary violations (p.115).It seems that Kreft may have been meeting some personal need by qualification the disclosures. Without having observed the interaction, it is difficult to judge, however, perhaps in an attempt to normalise the clients experience or keep her engaged, Kreft seems to also be almost brag of his own sexual prowess. This amounts to an exploitation of the client forhis own needs. The APA states that, counsellors must not exploit their clients financially, sexually, emotionally or in any other way (pp.4-5). If sick handled, the power imbalance inherent in the therapeutic relationship can lead to exploitation of clients (Barnett, Lazarus, Vasquez, Moorehead-Slaughter & Johnson, 2007, p.402). A tender female client, is less likely to repugn the appropriateness of such com ments. In addition to the sexualised disclosures, Kreft devised an exercise based on his narrow focus on CBT, which he believed would help the client. He requested and obtained a photo of his client wearing a bra and underpants for the purpose of an exercise aimed at challenging the clients maladaptive or negative beliefs about her appearance.The photo was to be shown to a number of unnamed people in order for them to rate her appearance. Kreft claimed in his testimony that he created the exercise based on his expertise and training. He did not state that he researched current effective practice or discussed the clients needs in supervision. It would seem wise to educate oneself about an unfamiliar field of practice or client. In fact, the ACAs ethical expectations include counsellors committing to ongoing personal and professional development, as well as undertake regular supervision and debriefing (p.3). A cursory investigation of accepted treatments for body image problems Butt ers and Cash (1987) research into effective cognitive-behavioural treatment of women with body-image dissatisfaction found that a combination of methods produced improved affective body image, reduced maladaptive body-image cognitions and enhanced social self-esteem about fitness and sexuality. The methods included providing clients with information about body-image dissatisfaction, having clients construct a personalised hierarchy of body areas, desensitisation to automatic thoughts and developing counterarguments for irrational thoughts.Butters and Cash (1987) did use observer ratings of client physical attractiveness as part of the series of exercises, but there is no suggestion that clients were to be barely dressed in the photographs used. Kreft seemed to exercise poor discernment in his selection of a photograph in which the client was so scantily clothed. Kreft seemed unaware of his power in the relationship. Power within the therapeutic relationship can take numerous forms. Proctor (2002, p.8) states that one basic form is societal power which is expressed in the imbalances between the genders and between the old and young. In thiscase, Kreft was an older male with a teenage female client. According to testimony in his case, Kreft was accustomed to working with male clients, so he may have been unaccustomed to working with a young female. He may have been unaware of the subconscious power he held in the relationship simply by virtue of his stronger position in society. Pope and Vasquez (2007, pp41-42) describe other forms of power that therapists have in relation to clients. These include the power of expectationclients expects that the therapists interventions will be able to induce beneficial change.Related to this is the power to choose the approach to therapy. Kreft chose to make personal disclosures and chose the therapeutic exercise involving the clients photograph. She complied with the activity, although she stated in her complaint that she wa s very uncomfortable about it. Kreft failed to recognise this in her delayed provision of the photo, but also failed to recognise that any young woman might be uncomfortable with such an exercise, yet reluctant to refuse. He did not make this psychologically safe for her. Under the prim adapted Opportunity Act 2010, both the disclosures and the request for photographs could be deemed sexual harassment and therefore unlawful. A person sexually harasses another person if he or she engages in unwelcome conduct of a sexual nature in relation to another person in circumstances in which a reasonable person, having regard to all the circumstances, would have anticipated that the other person would be offended, humiliated or intimidated. Conduct of a sexual nature includes making orally, any remark or statement with sexual connotations to a person or about a person in his or her presence, and, making any comment of a sexual nature in a persons presence (Victorian Equal Opportunity and Hum an Rights Commission, 2013a, p.79).There are therefore three characteristics of behaviour that would have it constitute sexual harassment being unwelcome being conduct of a sexual nature and being conduct that a reasonable person would consider likely to offend, humiliate or intimidate in the circumstances. There seems little doubt that Krefts disclosures about his sexual activities fit this definition of conduct of a sexual nature. In relation to whether the comments were unwelcome to the client, it certainly appears so, as she has complained of as much. For conduct to be unwelcome, it must be unrequested or uninvited by the client, and regarded as undesirable or offensive by the client. Kreft does not suggest that theclient invited the comments. Even if a client does not speak up or complain at the time, the conduct might still be considered unwelcome (Victorian Equal Opportunity and Human Rights Commission, 2013b, p.6).The clients age is a factor recognised as causing someone to tolerate behaviour even if unwelcome. Numerous sexual harassment cases have recognised how a power imbalance between the parties can contribute to a person remaining silent about how unwelcome the behaviour is (VEOHRC, 2013a, p.85). The final part in sexual harassment is whether the conduct occurred in circumstances in which it could reasonably have been expected that the conduct would offend, humiliate or intimidate the person. Again, presumptuousness the clients age in relation to Kreft, and the highly sexual nature of the disclosures, within a relationship that should be focusing on the clients concerns, it seems that this third criterion of sexual harassment would be met. In conclusion, it seems that Steven Krefts behaviour in this case fell far short of recognised ethical, legal and social expectations. He took on a client with issues outside his narrow expertise and attempted to work with her in relation to the highly sexualised disclosures she make about her relationship s with men. Krefts own highly sexualised personal disclosures were unethical according to professional guidelines and potentially unlawful, under sexual harassment laws.Krefts attempts to help the client change her negative beliefs about her body were devised without reference to existing knowledge in the treatment of such problems and again became sexualised when Kreft chose a photo of the client dressed only in underwear. Ultimately, Kreft was required to update his training, engage in regular supervision, and undergo a suspension of practice for six months. Krefts case provides a number of warnings for other practitioners about the dangers of a narrow knowledge and experience base, as well as the importance of understanding the various dimensions of therapeutic relationships. Counsellors would do well to have a sound understanding of ethical boundaries and how they might appropriately respond to a clients disclosures of sexual behaviour. Having regular supervision is crucial for assisting counsellors in all of these areas.ReferencesAustralian Counselling Association. (2012). Code of ethics and practice. QLD Author.Barnett, J., Lazarus, A., Vasquez, M., Moorehead-Slaughter, O., & Johnson, W. (2007). Boundary issues and multiple relationships Fantasy and reality. Professional Psychology Research and Practice, 38(4), 401410. Butters, J. W. & Cash, T. F. (1987) Cognitive-behavioral treatment of womens body-image dissatisfaction. Journal of Consulting and Clinical Psychology, 55, 6. Gurtheil, T. G. & Brodsky, A. (2011). 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