1 Ethical dilemmas Level 4 Counselling

2 Suicidal intent Clare has recently received some medical test results. Her diagnosis is bad news. She has a disease that will eventually destroy her quality of life and kill her. How should her counsellor respond, particularly when she talks about ending her life? What are the most important issues to consider?

3 Antagonistic personal valuesMark is a committed pacifist for religious and personal reasons. He has counselled soldiers recovering from post-traumatic stress disorder who are returning to civilian life. Does respect for a client’s values, beliefs and capacity for self-determination mean that he should also be willing to counsel soldiers wishing to return to active military service?

4 Self-administered euthanasiaSally has terminal cancer and has been told by doctors that her illness is well advanced, with an increasing number of secondaries. She has announced to her family and her doctor that she does not wish to battle futilely against her imminent death. She would prefer to die at home at a time of her choosing. Her family and doctor attempt to dissuade her or suggest alternative ways of providing good quality terminal care, but Sally remains committed to her planned suicide and has discussed her plans with her counsellor over several months.

5 RACIST/SEXIST CLIENT Rachel is conscientious in attempting to establish relationships with her clients that have the qualities of integrity, impartiality and respect. Tom, the client, is deeply committed to views that are intolerant and often exploitative of people with different ethnic origins from his own, and these are the basis of his chosen courses of action. How should Rachel respond?

6 Exploitation of clients ideologicalClive is in the midst of a painful separation from his partner that has led him to doubt his previously strong religious convictions. As he had contacted his counsellor through a religious network, he appears to assume that the counsellor is committed to the beliefs that he is now questioning. This assumption seemed of marginal significance when working on the break-up of the relationship, but the counsellor senses that Clive’s assumption about his counsellor’s beliefs might be and their impact on what he might want in future relationships.

7 Exploitation of clients financialStephanie seeks counselling and agrees to monthly payments of £30. After the first two months they agree to meet more frequently and change from fortnightly sessions to weekly. The discussion about the new arrangements was hurried and at the end of a session. Some time later, Stephanie is perplexed and shocked to receive a bill for £160 at the end of the next month. She had wondered what the cost would be, but had calculated that the maximum charge would be for four weekly meetings at £30 pounds, a total of £120. When she raised the issue, her counsellor explained that his charges had gone up to £40 per session at a point during the first two months of seeing her and, as this was a new arrangement, he felt obliged to charge at the higher rate.

8 Intimacy Lesley seeks counselling to help her to manage a conflict between her and a colleague at work better. A combination of problem-solving and assertiveness techniques is successful. After two counselling sessions she has resolved her problem and the counselling stops. Six months later she bumps into her counsellor socially at a party and after a pleasant evening together they decide to meet socially. Neither person is in a relationship with someone else. Some weeks later they start a sexual relationship

9 intimacy David uses counselling to explore his difficulty in having close relationships that last longer than a few months. During the counselling, which was weekly over five months, attention is paid to his feelings towards his counsellor, Sarah, who points out when she feels David is trying to distance himself from her. As a result, David becomes aware of how he pushes people away and how this re-enacts a painful period during his childhood. Six months after the end of the counselling David meets Sarah at a charity event and suggests they meet again for a meal. Both of them realize that there is a mutual sexual attraction. What should Sarah do?

10 Limits of confidentialityLiam has benefited greatly from counselling. However, in a passing remark, he reveals something that causes his counsellor to be concerned about the safety of other students and the college buildings. How should the counsellor respond ethically? Where do the limits of confidentiality end and other ethical priorities take over?

11 Child protection Frank is a young adult who is talking about the impact of having been abused by his step-father. He does not want his step-father to be prosecuted and asks for his confidences to be protected. However he reveals that his step-father is now living with a younger half-brother, Alfie. He thinks that Alfie is not at risk of abuse by his step-father – but is not sure. Frank feels strongly that he wants his confidences protected. What should his counsellor do – keep his confidences or report abuse for each of these situations to an agency that could investigate and, if necessary, intervene?

12 Risks of undertaking counsellingJohn is a student who is shortly to sit important examinations. He is actively anxious about taking the exams and this anxiety is compounded by a sense that the current stress has re-stimulated early childhood traumas

13 suicide Brian is over-burdened by financial problems and social isolation following the ending of a longstanding relationship. He is becoming increasingly depressed and is talking about suicide as a way out of his problems and to escape the emotional pain he is experiencing.

14 Suicidal ideation David is a student teacher who has chosen to see a counsellor privately rather than see the university counsellor or the one attached to his doctor’s practice. He has made this decision because he wants to protect the confidentiality of the counselling. However, his counsellor insists that he inform his GP or she will do so when he discloses that he is feeling suicidal. David refuses to do so because he does not want his emotional state to be recorded on his medical notes. He is concerned that this might lead to him failing a compulsory medical which he needs to pass in order to practise as a teacher.

15 Refusing life saving treatmentJane is eight months pregnant and has been told that she has pre-eclampsia by her GP and should be admitted to hospital urgently for a Caesarean birth and treatment in order to protect her and the foetus from serious disability or death. Jane believes that serious illness and death are natural events that should not be interfered with. She refuses an emergency admission and instead asks to see the practice counsellor for personal support and insists on minimum medical intervention during the birth should she reach that point

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18 bibliography Bond, Tim Standards and Ethics https://bookshelf.vitalsource.com/#/books/ /cfi/6/36!/4/2/ Counselling in action