Transcript Ethics in Rehabilitation Counseling Michael Maxwell PhD. Candidate Sam Houston State University Rehabilitation Counseling • Definition – from text (as taken from Szymanski & Danek, 1985) •

Ethics in Rehabilitation
Counseling
Michael Maxwell
PhD. Candidate
Sam Houston State University
Rehabilitation Counseling
• Definition – from text (as taken from
Szymanski & Danek, 1985)
• “A profession that assists persons with
disabilities in adapting to the environment,
assists in accommodating the needs of the
individual and works toward full
participation of persons with disabilities in
all aspects of society, especially work”
(Szymanski & Danek, 1985, p.83)
Rehabilitation Counseling
• Definition – George Washington University
Rehabilitation Counselor Education
Programs
• “ …. Concerned with assisting individuals
who have disabilities with maximizing their
potential and their independence.”
(http://www.gwu.edu/~chaos/rehab/Rc_def.h
tm)
What specific disabilities do
Rehabilitation Counselor work with?
• Physical disabilities (ie. cerebral
palsy)
• Sensory disabilities (ie. blindness)
• Developmental disabilities (ex.
mental retardation)
• Cognitive disabilities (ie. head
injured)
• Emotional disabilities (ie. substance
abuse)
Ethics
• Definition – Van Hoose & Kottler, 1985
• “Ethics is concerned with questions that
have no ultimate answers, yet are
important to planning one’s life, justifying
one’s activities, and deciding what one
ought to do” (p.3).
Ethical Dilemma
As defined by Toriello & Benshoff (2003)
1. A choice must be made between 2 courses of
action
2. There are significant consequences for taking
either course of action
3. Each course of action can be supported by
ethical principal
4. The ethical principal supporting the unchosen
course of action will be compromised.
Brief History of Rehabilitation
Counseling
• Began in the early 20th century in
the area of vocational
counseling.
• Evolved out of events such as
the Industrial Revolution, vast
immigration, the Great
Depression, and World Wars I
and II.
Brief History of Rehabilitation
Counseling
• Later, rehabilitation
counselors adapted their
vocational approaches to
match the needs of clients
with disabilities.
• During the 1970s, the
independent living movement
stimulated another surge in
the service delivery of
rehabilitation counseling.
Why rehabilitation counselors?
• Attitudinal, social, and economic barriers
exist when it comes to individuals with
disabilities obtaining fair market
employment
• Rehabilitation Counselors work more as
social advocates within, as well as outside
of session
Striking statistic
• As of 2004, there were an estimated
43 million Americans who had
disabilities that restricted some
major life activity, and prevented
them from attaining a job
Striking statistic
• As of 2001, there
were 99 accredited
rehabilitation
counseling master’sdegree programs
Rehabilitation Counselor Skills
• Rehabilitation counselors
primarily work as generalists,
vocation specialists, and
personal adjustment assistants
• Following are the specific areas
of expertise a rehabilitation
counselor may be expected
have:
Rehabilitation Counselor Skills
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Assessment
Diagnosis
Careers
Individual and groups counseling
Case management
Program evaluation
Advocacy
Consultation
Job placement
technology
New trend: Teamwork
• Rehabilitation practice is
typically conducted
within a collaborative
team context.
• Training in this area will
be imperative
• Case management and
medical knowledge
should be areas of
strength
Rehabilitation Counselor
Qualification Standards
For certification, a
rehabilitation counselor
must have:
• Master’s degree in
rehabilitation counseling
or related program
• Achieved national
certification
• Attained state licensure
Rehabilitation Counseling
Pre - Test
Ethical Issues in
Rehabilitation Counseling
• Confidentiality & Privilege
Communication
• Informed Consent
• Client to counselor relationship
• Responsibility
• Counselor Competence
Confidentiality & Privilege
Communication
Areas of possible ethical dilemmas:
• Maintaining confidentiality in institutional
settings
• Disclosure to client employer of danger or
discipline
• Sharing client info. with family members
• 3rd party payment agencies and disclosure
• Client illness unsafe to self and others
Confidentiality & Privilege
Communication
Additional areas of
ethical dilemmas:
• Group counseling
setting
• Treatment team
debriefings
Confidentiality & Privilege
Communication
• In all cases, maintain a conceptualization
of client advocacy
• A clear and concise explanation of your
limitations and obligations as a counselor
is imperative, via personal statement and
informed consent.
• Share only what is pertinent and
necessary.
Informed Consent
• Three areas pertaining
to rehabilitation
counselors :
• Capacity
• Comprehension
• Voluntariness
Informed Consent
• It is the counselor’s duty to be certain that
the client either has the capacity to give
consent, or a legal authority ( parent or
bureaucratic appointed ) provides consent.
• Again, as an expression of advocacy, any
attempt to equalize the power differential
between counselor and client is
recommended.
Client – Counselor Relationship
• Sexual relations with a client is illegal in all
50 states.
• Sexual relations with a client is potentially
harmful, at the least
• New code allows for client-counselor
relations a minimum of 5 years after
termination
• Take to the notion: Do No Harm.
Responsibility
• Code clearly specifies that the primary
responsibility of the rehabilitation
counselor is the client ( advocacy )
• Cannot deny secondary responsibility to
other parties ( employer, 3rd party
payment, law, etc. )
• Issues of paternalism / co-dependence
need to be processed.
Counselor Competence
• Rehabilitation counselors should practice
only within the realm of their scope of
practice.
• New to the field is diagnosing according to
a medical model.
• Continuing education is a must
• Refer out whenever necessary.
Rehabilitation Counseling
Case Scenarios
A few hand picked areas of concern, for
rehabilitation counselors and ethics.
• Working with 3rd party payment
agencies
• Traits clients find most and least
important from rehabilitation
counselors
• HIV positive patients
• 12 step programs
Ethics in Managed Care
Organization (MCO )
• Understand the MCO is a business and
looks for profit.
• Look for best balance between advocacy
and fulfilling needs of MCO
• Explain MCO service limits to client
• Do no harm
( Kontosh, 2000 )
Traits clients find most and least
important from Rehabilitation
Counselors
• Top 3 traits:
1. Consumer first attitude and advocacy
(28.5%)
2. Nurturing and promotion of counselor
relationship ( 20% )
3. Knowledge about disability and
rehabilitation ( 14% )
Traits clients find most and least
important from Rehabilitation
Counselors
•
Bottom 3 traits:
7. Disability experience in personal life (4%)
8. Educational background ( 2.5% )
9. Maturity and professional experience
(1.5%)
( McCarthy & Leierer, 2001 )
HIV positive client and duty to
break confidentiality / privacy
• This is a hot dilemma that most practicing
counselors face.
• The stance of the law is unclear
• The danger is advising sex partners of the
client & advising the employer or third
party payment agency.
• No clear answer to provide
• Client advocacy is the key.
12-step Programs
• Have proven to be very effective for the
rehabilitation of substance abusers
• They have a regimented format, with little room
for adaptation
• All require an admittal to a problem (not
consistent with some theoretical constructs)
• All require an admittal that a higher power is the
only means to help (N/A for a counselor who
does not share same beliefs)
References
Cotton, R.R., & Tarvydas, V.M. (2003). Ethical and professional issues
in counseling 2nd ed. Upper Saddle, NJ: Pearson Education.
Kontosh, L.G. (2000) Ethical rehabilitation counseling in a managedcare environmen. The Journal of Rehabilitation. 66, 9-24.
McCarthy, H. & Leierer, S.J. (2001) Consumer concepts of ideal
characteristics and minimum qualification for rehabilitation
counselors. Rehabilitation Counseling Bulletin,45, 12-23.
Szymanski, E M.; Danek, M. M.; (1985). School-to-work transitions for
students with disabilities: Historical, current, and conceptual issues.
Rehabilitation Counseling Bulletin,29, 81-89.
Torielly, P.J., Benshoff, J.J. (2003) Substance abuse counselors and
ethical delimmas: The influence of recovery and education level.
Journal of Addictions and Offender Counseling, 23, 83-98.
Van Hoose, W.H., & Kottler, J.A. (1985) Ethical an legal issues in
counseling and psychotherapy 2nd ed. SanFrancisco: Jossey
Bass,,p .258.