Psychotherapy And Counseling
Psychotherapy and Counseling involves an interactive relationship between a counselor and a counselee in which the counselor guides, encourages and assist the counselee in resolving his/her problems which are of psychological nature. This process acts as a catalyst or a medium for the counselee for the process of self evaluation (Reaves, 1965). Confidentiality and Fidelity form baseline of this relationship. Many other ethics and norms are expected to be
followed by the counselor during the whole process of counseling. But a number of crises arise in this therapeutic process and handling these ethical issues efficiently and justly is the hallmark of an efficient counselor (Goldstein, 1939). There are possibilities of further complications in the counseling process if the counselor gets into any kind of personal attachment or contact with the client (can also be sexual). This is considered as the breach of code of ethics by the British Association for Counseling and Psychotherapy (BACP, 2010). One of the most important precautions to be followed by the counselor is that the counselor should not get carried away by the idea that the client is in the’ victim’ state and the counselor is his/her ‘savior’. The client also should not be incorporated with any such ideas. The counselor is a medium through which the client attains his decision making potential and is certain of their life decisions (Raskin, 1989).
The most neglected area of research in the past and the most researched area in the present is Cultural influence on human behavior. (Welfel, 1998). Right from the first stage of development, Culture has a great influence on the attachment patterns of an individual and it starts at the very early stage of development itself (Bowlby & Ainsworth, 1988). Thus, it is no wonder that cultural back ground of the client should be given utter importance during the process of counseling (Blocher, 1966). At the same time, the counselor should be free of any judgments or stereotype they make based on the client’s nativity. It can be very clearly seen that Counseling is rather a very complicated process and it demands a lot of expertise and knowledge to be successful. The following report analyses the case and explains the possible ethical dilemmas that may arise in the process of Counseling or to the client or to the counselor and it also includes a therapeutic recommendation for the client.
Ethical Dilemmas for the Client:
One of most evident dilemmas faced by the client is her immigration from Nigeria to the United Kingdom where the chances of racial discrimination is high. During the time of her immigration, the rates of discrimination might be pretty high. In general, any immigrant from any part of the world will face discrimination by the country’s native. But as Nigerians did not have any roots in the UK, the client must have faced discrimination in her daily needs like getting a job or availing any basic amenity for her. (Patricia, 1989).
Statistics has shown convergence in affair rates between men and women (Mccarthy, 2014). This is because Women of the modern era have equal exposure to the world and the society as equally as the men. The opportunities for an affair out of marriage are also equal and balanced. But the causation of infidelity differs from a man to a woman. In an extra marital affair, a man enjoys being with a younger mate than his wife whereas a woman demands emotional
security and warmth from the affair (Glass,1992). Thus, the affair has a remarkable influence over the mental health of the client. This also leads to the crisis of the client to reveal her husband about her affair when she confesses about the presence of HIV positive. There is a moral value clash for the client as she is cheating upon her husband. The key factor for the cause of anxiety is guilt (Marano, 2014).
The client is also very unclear whether she can reveal the presence of HIV to her husband and her lover. Researches on presence of HIV and Mental health suggest that AIDS poses a remarkable threat to the psychological well being of an individual (WHO, 2008). Any ailment for that case causes stress in the mental health of the individual. But the chronic onset of symptoms and the stigma AIDS carries with it may worsen the mental state of the client. The client also has an uncertainty and insecurity about her future; this in turn can lead to a state of helplessness and depression by the client (Cruse, 1976).
Ethical Dilemmas for the Counselor
The Counselor faces a number of dilemmas in dealing with the counseling sessions of the patients. Various factors such as the existing law, the cultural context, the expected consequences and personal feelings influence the judgment of the Counselor (Ethics Council, British Psychological Society, 2009). In this case, the cultural factor has a major role to play as the client is Nigerian in native but is settled in the United Kingdom. The influence of discrimination faced by the client should be taken into account before drawing into any conclusions. There is a also a need to train the counselors to comprehend the maladjustment problems faced by the client as a result of mismatch between the individual and the society that they live in (Ramirez, 1999).This is the foremost consideration a counselor should account for in case of an immigrant client.
An ideal counseling session is balanced, collaborative and there is attention to the context and the society in which the client lives in (Tarvydas, 1998). The problems faced by the client as a result of her affair should be analyzed in a non-judgmental manner. There should be no influence of personal values in counseling. For example: the counselor
can hold personal values against the idea of an extra marital relationship but this should not come in the path of counseling the client. The client , at any cost, should not be judged for her behavior or actions based on the personal values the counselor may adhere to (Jordan, 1995). This may lead to filtered listening of the client’s information. The counselor may neglect the information related to the affair or deny the influence of the affair on the client. Clearly, the client is much disturbed by the affair. So because of the personal values that the counselor holds, important details should not be left unconsidered (Hall,1977).
Another major source of conflict for the counselor arises from the contextual influences that he/she is imposed with. i.e: People other than the client and the counselor may be incriminated in the process of therapy (Rest, 1984). In this case, if the client confesses of her HIV infection and her affair, the spouse may doubt her of the infection due to promiscuity when in reality it may be due to her drug usage. This confession of the client may lead to the loss of her familial relationships or even break of her marriage. In this situation, the counselor has to weigh the options available and identify the nest possible action for the welfare of the client. The identified action should also be a morally upright one (Schwartz, 1994). The behavior and attitude of a counselor are always directed towards winning the trust of the client. This is a prime quality of a counselor in accordance to the British Association for Counseling and Psychotherapy (BACP, 2000). This also places emphasis on the attentiveness to the client’s communication, respecting the client’s privacy and value systems and courteous way of communicating with the client. However in this case, the therapist may face a new dilemma as the client is infected with HIV. The counselor cannot breach the trust of her client and inform the client’s spouse about the infection but she should direct/ encourage the client to confess the infection (Axelson, 1984). This is related to the ethics in British Psychological Society which suggests that the counselor owns the responsibility for the goodness of the client. One more aspect of dilemma in this case is the counselor guessing the man with whom the client has an affair is known to the counselor. Such thoughts should not be entertained or further researched upon because this again is a breach of the client’s trust and the doubts certainly do not have any objective proof for the same. This ethical decision can be made in accordance to the rational model of ethical decision making thereby avoiding/ researching upon unnecessary and insufficient data (Kitchener, 1984).
Ethical Issues in the process of Counseling
Counseling is an umbrella term referring to the professional help from a counselor to a client to deal with his/her interpsychic, internal and personal issues and conflicts (Tyler, 1986). This continuous process poses numerous problems due to the subjectivity of the clients and other influences of the problems faced by them. The model of Moral Justification and Ethical reasoning suggests two levels of reasoning and a list of ethical principles (Beauchamp & Childress, 1989). The extent to which each of the ethical principle is practiced varies from case to case. In this particular client with respect to the extent of Autonomy, the client is encouraged to make her own choice of disclosing about the affair, her drug usage and her HIV infection to her husband as it can be harmful for others. This therapeutic stance is increasing the intrinsic reliability of the client and providing the freedom she desires. But the use of autonomy must be backed by practicality of the situation (Beauchamp & Childress, 1989). The encouragement of the client towards confession also implies the principle of Beneficence i.e: to give the benefit of doubt to the possible positive outcome and Non- Maleficence .i.e: the concept of intent to do no harm or do the least harm (BPS, 2006).
Probably the most essential consideration in the process of counseling is Confidentiality and Law. In the UK, it is compulsory to report the usage of drugs but not in the case of private practice (Bond, 2000). The client should also be informed that under legal circumstances, the counselor might have to reveal the case details to a third party. This should be taken into considered in this case of client.
The most important ethical issue in counseling this client is working with a HIV positive individual. This has drawn the attention of many researchers in the recent past. Numerous models of ethical decision making for individuals with AIDS are prevalent as the conflict faced by the counselor is great in dealing with such individuals (Erikson, 1990). The counselor is committed to protect sensitive and personal information about the client and if required by the Government/ Legal Procedures, the counselor should clarify the details. In this case the counselor should take ethical and legal advice on disclosing any sensitive information about the client ( Rest, 1994). This model is paired up with the cognitive theory of Kohlberg and is the most reliable way of analyzing moral behavior. The confidentiality of such cases becomes questionable if the individuals are sexually active. In this case of our client, the sexual activeness is subtly notified but the client is very much bothered about her husband or lover contracting the infection.
Three important sub factors in a counseling has a great control over the decision making process in counseling. They are power, duration and termination status. This model of decision making was proposed as an extension of Kitchener’s model in 1988 (Gottlieb,1993).This model lays its base along the discord between the present and the contemplated relationships. Another fact of consideration is that in the process of decision making, the rational thought process and the intuitive thought process should be given equal importance and are dependent on each other (Koocher, 1985).It can be concluded that any decision making model can be used as guidelines in counseling and cannot be followed word by word due to high subjectivity in Psychotherapy.
Several factors have to be taken into account when carrying out the process of counseling. The issues have to be prioritized and should be addressed systematically (Cottone, 2001). The resolution of the dilemmas is processed by the professional rules not legal rules. The problems regarding the drug abuse should be solved in the first place. The husband of the client should be made aware of her HIV infection. This should not be disclosed by the counselor but the client herself (Wolfe, 2010). The first phase of therapy usually begins with the active role of the therapist. The counselor starts to engage the offending mate in helping the partner surpass the “victim” role. The husband should be able to believe that the wife is truthfully regretful for the mistake. Then the counselor can aid them both in exploring the dynamics in their marriage that led to the onset of the affair. Importance of mutual trust and confession of feelings is huge as mistrust and inability to express feeling often leads to infidelity (Feltham, 2012). The last stage of counseling is when the couples decide if the marriage is worth pursuing or to end up in separating. This can also be helped by the counselor in case of divorce the counselor can negotiate for a healthy divorce. However, the counseling sessions should enhance the empathy and communication skills between the couples.
In counseling infidelity between partners there are many issues to be solved upon. Once the infidelity has happened, both the partners’ tend to look at the whole relationship/marriage as a flaw and a mistake in order to maintain their respective cognitive dissonance (Fechner, 1990). It should also be considered that not all clients are powerless but they are disillusioned by ignorance and uncertainty when compared to the counselor. In accordance to the ethical code of Fidelity and Justice, the counselor should not exploit the psychological vulnerability of the client. In this case, the possibility of psychological vulnerability is high as the client faces with physical and psychological stress (Welfel, 1998). The client provides the counselor with his/her personal knowledge, this should be used to empower the client and not exploit him/her. The counselor should be aware of the influential position they hold, with respect to the client. They should not take advantage of the client. A successful therapy procedure is organized in a step by step manner, the problems should be addressed one at a time. The prioritization of the problems can be listed by the therapist but the ultimate decision/ resolution should be left in the hands of the client (Miller, Munde & Theler, 1986) At a larger scale, the wisdom and experience of the society should be used to support the client in need of help (Douglas, 2010).
The last and the most important step in this whole process is decision analysis during the procedure of counseling. This should be a step by step method breaking down the decision into smaller components and tracing the orderly sequence of events leading us to the best possible decision (Koochner, 1985). This can be done in accordance to any of the ethnic decision making models.