Week 3: Couselling Ethics and Self-Care

Question 1

Definition of Ethics

Answer 1

“moral principles that govern a person’s behavior or the conducting of an activity” (Google Dictionary, 2017)

Question 2

College of Registered Psychotherapists of Ontario (CRPO) (2)

Answer 2

Psychotherapy Act 2007 was proclaimed April 1st 2015 which brought CRPO into full operation as health regulatory college and act proclaimed on Dec 31st 2017 (2 year grace period)

Purpose is to “Regulate the members in the public’s interest ” (CRPO, 2015)

Question 3

The controlled act of psychotherapy is:

Answer 3

“treating by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgment, insight, behaviour, communication or social functioning.”

Question 4

Ethical Guidelines
Sommers-Flanagan & Sommers-Flanagan, 2004 (3)

Answer 4

Have three key features:
a) provide a knowledge base
b) describe activity sanctioned within the profession
c) offer a clear picture of boundaries of the professional activity

Question 5

Code of Ethics: Goal
(CCPA) Canadian Counselling & Psychotherapy Association (2007) (4)

Answer 5

A code of ethics also:

• Expresses ethical principles and values
• Serves as a guide to the professional conduct of all its members
• Informs the public of the standards of ethical conduct for which members are to be responsible and accountable
• Reflects values such as integrity, competence, responsibility, understanding and respect for cultural diversity

Question 6

Is the Code of Ethics static? Why?
(1+2)
Canadian Counselling & Psychotherapy Association (2007)

Answer 6

The code is not static.

• It is revised over time to account for the fact that ethical knowledge continues to develop and that there is emerging consensus on challenging ethical issues.*
• There continues to be ongoing discussions regarding best standards of practice and codes of ethics.*

Question 7

Six Ethical Principles
Canadian Counselling & Psychotherapy Association (2007)

Answer 7

Beneficience

Fidelity

Nonmaleficence

Autonomy

Justice

Societal interest

Question 8

Beneficience (Six Ethical Principles)

Answer 8

~ being proactive in promoting the client’s best interest

Question 9

Fidelity (Six Ethical Principles)

Answer 9

~ honouring commitments to clients and maintaining integrity in counselling relationships

Question 10

Nonmaleficence (Six Ethical Principles)

Answer 10

~ not willfully harming clients and refraining from actions that risk harm

Question 11

Autonomy (Six Ethical Principles)

Answer 11

~ respecting the rights of clients to self-determination

Question 12

Justice (Six Ethical Principles)

Answer 12

~ respecting the dignity and just treatment of all persons

Question 13

Societal interest (Six Ethical Principles)

Answer 13

~ respecting the need to be responsible to society

Question 14

Ethical Principles (CRPO) (6)

Answer 14

Autonomy and Dignity of All Persons –

Excellence in Professional Practice –

Integrity –

Responsible Citizenship –

Responsible Research –

Support of Colleagues –

Question 15

Ethical Principles (CPRO): Autonomy and Dignity of All Persons –

Answer 15

Respect diversity and dignity and rights of all; to reject all forms of harassment and abuse; maintain appropriate therapeutic boundaries at all times

Question 16

Ethical Principles (CPRO): Excellence in Professional Practice –

Answer 16

Work in the best interests of clients; to work within abilities and competencies; and to pursue personal and professional growth throughout career

Question 17

Ethical Principles (CPRO): Integrity –

Answer 17

To openly inform clients about options, potential risks and benefits of professional services; to recognize and strive to challenge my own professional and personal biases; and to consult on ethical dilemmas

Question 18

Ethical Principles (CPRO): Responsible Citizenship –

Answer 18

To participate in community as responsible citizen, always mindful of role as a trusted professional; and to consult on potential conflicts-of-interest and other personal-professional challenges

Question 19

Ethical Principles (CPRO): Responsible Research –

Answer 19

To conduct only such research as potentially benefits society, and to do so safely, ethically and with the informed consent of all participants

Question 20

Ethical Principles (CPRO): Support of Colleagues –

Answer 20

To respect colleagues, co-workers, students, and members of other disciplines; to supervise responsibly; to work collaboratively; to inspire others to excellence

Question 21

A. Principle-based Ethical Decision-Making (6)
Ethical Decision-Making Processes
(Canadian Counselling & Psychotherapy Association (2007))

Answer 21

Step 1 What are the key ethical issues in this situation?

Step 2 What ethical articles from the CCPA Code of Ethics are relevant to this situation?

Step 3 Which of the six ethical principles are of major importance in this situation?

Step 4 How can the relevant ethical articles be applied in this circumstance and any conflict between principles be resolved and what are the potential risks and benefits of this application and resolution?

Step 5 What do my feelings and intuitions tell me to do in this situation?

Step 6 What plan of action will be most helpful in this situation?

Question 22

B. Virtue-Based Decision-Making
Ethical Decision-Making Processes
(Canadian Counselling & Psychotherapy Association (2007))
(3+5)

Answer 22

Based on the belief that counsellors are motivated to be virtuous and caring because it is the right thing to do.

Virtue ethics focuses on the counsellor as an ethical agent with the capacity to make complex ethical decisions.

No step-by-step methodology, the following questions may be helpful guides:

1. What emotions and intuition am I aware of as I consider this ethical dilemma and what are they telling me to do?
2. How can my values best show caring for the client in this situation?
3. How will my decision affect other relevant individuals in this ethical dilemma?
4. What decision would I feel best about publicizing?
5. What decision would best define who I am as a person?

Question 23

C. Quick Check (3)
Ethical Decision-Making Process Canadian Counselling & Psychotherapy Association (2007)

Answer 23

Publicity ~ Would I want this ethical decision announced on the front page of a major newspaper?

Universality ~ Would I make the same decision for everyone? If every counsellor made this decision would it be a good thing?

Justice ~ Is everyone being treated fairly by my decision?

Question 24

What is Self Care? (4)

Answer 24

Self-Care =“Although no consensus exists about a ‘true’ definition of self-care (Lee & Miller, 2013), it is often seen as proactive and intentional” (Thompson et al., 2011 as cited in Koenig & Arnold, 2017).

• Self care is the combination of activities, behaviours, or practices that people participate in to ensure that their needs are met in healthy ways
• It involves an awareness of caring for various aspects of the self – physically, mentally, spiritually, emotionally, psychologically

While many can engage in self care practices, it is essential for those in helping professions to maintain regularly

Question 25

Personal Care Examples (3)

Answer 25

Creative expression - Writing (journal, fiction, non-fiction, poetry), drama, photography, cooking, drawing, painting, dancing Skill Development - Learn something new - E.g., musical instrument, construction, sport, etc. Spiritual practices and Meditation - Shown to improve breathing, increase relaxation, increase feelings of hope and well-being (Trippany et al., 2004)

Question 26

Professional Care (2)

Answer 26

Balance - Have an attitude of altruistic egotism! Continual behavioural monitoring of one’s other-care-self-care balance Boundaries/limitations - “Know your limit, play within it”

Question 27

General warning signs

Answer 27

If noticing these things, time to meet own therapist/ more self-care Feeling Hopeless or Helpless Sense one can never do enough Hypervigilance Diminished Creativity Inability to embrace complexity Minimizing Chronic exhaustion/physical ailments Inability to listen/deliberate avoidance Dissociative moments Guilt Fear Anger and cynicism Inability to empathize/numbing Addictions Grandiosity

Question 28

Burnout (1+3+1+3)

Answer 28

“a progression of unsuccessful attempts by an individual to cope with a variety of conditions that are perceived to be threatening" Operationalized as - Emotional exhaustion - Depersonalization - Lack of personal accomplishment (Maslach & Johnson, 1981) Workplace related Brought on by long-term emotionally demanding situations - Feeling of physical, emotional, mental exhaustion - Emotional distress - Potential exploitation of client

Question 29

Example Statements of Burnout

Answer 29

- Emotional Exhaustion “I am just so emotionally fried” “I really don’t want to get up this morning to deal with another day on the job” “It feels like I’m a hamster in a running wheel” - Depersonalization “I don’t really care what happens to Bob” “So this depressed kid came to me and said...” - Lack of Personal Accomplishment “I don’t make a difference at my job” “I get all tense when people come to me with emotional problems”

Question 30

Burnout Consequences

Answer 30

Anger Cynicism Impatience Hopelessness Helplessness Denial of feelings Hard headedness (rigid in perspective) Physical ailments

Question 31

Compassion Fatigue (Secondary Traumatic Stress) (6)

Answer 31

Develops due to the emotionally shocking material - Related to interactions with clients and the traumas they have experienced More acute consequence of work - Reduced capacity or interest to bear witness to those suffering Like PTSD but do not personally experience the trauma “the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced by a significant other” (Figley, 1995, p. 5)

Question 32

Symptoms of Compassion Fatigue (3)

Answer 32

Arousal = heightened/persistent arousal – difficulty sleeping, becoming irritable, being hypervigilant Re-experiencing = dreams, recollections, flashbacks Avoidance = numbing reminders of the trauma through detachment from others, physiologic amnesia, diminished affect Other CF Consequences – headaches, high rates of illness, somatization, distancing from loved ones, absenteeism, guilt, desensitization, difficulty separating personal from professional life, resentment, lose creativity, disproportionate reaction

Question 33

Compassion Fatigue is a concern because… (5)

Answer 33

- Helpers may be more likely to engage in boundary violations, dual roles or role reversal - May be more difficult to maintain a therapeutic stance (not objective) - May delay returning phone calls, being pleased about cancelled appointments - Helpers may be more likely to question the efficacy of therapy - May feel reluctant to start the day, daydream

Question 34

Other Compassion Fatigue Consequences

Answer 34

Sadness Depression Sleeplessness Generalized anxiety Can affect helper’s family, friends, colleagues (Contagion)

Question 35

Vicarious Trauma (4)

Answer 35

Results from cumulative exposure to client trauma Changes in cognitive schemas - Identity, worldview, belief system/spirituality Intense empathic engagement with clients Gradual onset

Question 36

VT Consequences (6)

Answer 36

Depression Despair Cynicism Alienation from colleagues, family and/or friends Premature job changes Other psychological and physical symptoms

Question 37

What increases Burnout, CF, VT

Answer 37

Heightened emotions of client’s families Inability to maintain self-care Lack of social support Uncontrolled work stressors Lack of defined boundaries Lack of experience Own experiences of trauma Stressors in personal life Typical coping style Lack of training Increased workload/demands/pressures Feelings of isolation Organizational rules

Question 38

Professional Considerations: Integrity in the relationship (Everall & Paulson, 2004) (7)

Answer 38

therapist needs to be able to have meaningful relationship, meet needs in life avoid over-involvement with client's problem being obsessed with client, the problem withdrawal from other clients, family deviating from professional behaviour, wishing the case would terminate those who are overly idealistic or dedicated may be more likely to become enmeshed with client ('needing to fix, solve problem') important for therapist to model appropriate boundaries

Question 39

Professional Considerations: Responsible Caring (Everall & Paulson, 2004) (4)

Answer 39

refer to ethical guidelines in the CCPA or other regulatory body or organization need to have control over clientele – i.e., not too many trauma cases most difficult situation are those in which the therapists' own issues get triggered need sound clinical supervision, therapy

Question 40

Professional Considerations: Implications for Practice (Everall & Paulson, 2004) (3)

Answer 40

Self-monitoring – ‘know thyself’; an ethical responsibility Obtaining supervision – ways of maintaining psychological and physical health Intervention and support of colleagues – ongoing support and connection with colleagues is important; be aware of, and open to, discussing stressors

Question 41

The ABCs of Self-Care (Gamble (2002)) (3)

Answer 41

Awareness - ‘waking up’ to one’s experience rather than distracting oneself. A need to slow down, do less, be mindful* Balance - how clients are scheduled, being open to restoration and growth, not just trauma, setting limits, appropriate boundaries with clients; personal priorities Connection - supportive relationships with colleagues, family, friends; nonjudgmental places to talk