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SA 127 Chapter 3

by: Andolina Ziolkowski

SA 127 Chapter 3 SA 127-IC1

Andolina Ziolkowski
Erie Community College
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Major key components in chapter 3 include end-of-life care and how counselor values and spirituality affect the counseling relationship.
Topics in Addiction
Tracey Taylor
Class Notes
values, Ethical issues, Ethical Issues and Life Choices, end-of-life, Counseling




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This 12 page Class Notes was uploaded by Andolina Ziolkowski on Sunday October 2, 2016. The Class Notes belongs to SA 127-IC1 at Erie Community College taught by Tracey Taylor in Fall 2016. Since its upload, it has received 3 views. For similar materials see Topics in Addiction in Substance Abuse Counseling at Erie Community College.

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Date Created: 10/02/16
Chapter 3: Values & the Helping Relationship ­Counselors need to understand how their own values can permeate their work with  clients for good or ill, perhaps unconsciously. CLARIFYING YOUR VALUES & THEIR ROLE IN YOUR WORK Bracketing – the ability of counselors to manage their personal values so that they do  not contaminate the counseling process  Clients should not be exposed to further discrimination by counselors who refuse  to render services to them because of differing values. Value exploration is at the heart of why many counselor education programs encourage  or require personal therapy for counselors in therapy  Provides an opportunity for you to examine your beliefs & values & to explore your  motivations for wanting to share or impose your belief system Counseling is a dialogue between therapist & client that is meant to further the client's  goals. Because your values can significantly affect your work with clients, you must clarify your assumptions, core beliefs, & values & the ways in which they may influence the  therapeutic process. *If counselors rarely reflect on their own values, it is unlikely that they can provide a  climate in which clients can examine their values. THE ETHICS OF IMPOSING YOUR VALUES ON CLIENTS Value Imposition – counselors directly attempting to inflience a client to adopt their  values, attitudes, beliefs, & behaviors In group work values imposition may come from both the leader & members in the  group.  Value clashes often occur between members & leaders have a responsibility to  intervene so that no member can impose his/her values on others in the group. Value Conflicts: To Refer or Not to Refer Before considering a referral, explore your part of the difficulty through consultation or  supervision.  Merely disagreeing with a client or not particularly liking what a client is proposing to do is not ethical grounds for a referral. When you recognize instances of such value conflicts, ask yourself this question:  Why is it necessary that there be congruence between my value system & that of my client? The ethical course of action is to seek supervision & learn ways to effectively manage  these differences. Value conflicts may become apparent only after a client has been working with you for  some time. Discriminatory Referrals Students often wrestle with the question of when to refer a client.  Insufficient training is sometimes a cover for the real reason – the counselor's  difficulty with the client's values. Students who want to make a referral based on a value conflict should ask themselves:  What skills am I lacking in counseling a client struggling with a critical life  decision? 2  How can I determine what would ethically justify a referral? THE LEGAL FRAMEWORK REGARDING VALUES DISCRIMINATION In some states students & practitioners in the helping professions are being given the  legal right to refuse to offer counseling services to a client who does not share their  religious beliefs.  Conscientious objection acts violate the letter & spirit of the ethics codes of the  helping professions. Counselors cannot ethically discriminate against clients because of a difference in  values or refuse to work with a general category of clients. Seeking Supervision Regarding Your Values Through supervision, counselors in training can learn that they do not need to renounce  their own values, but they must avoid using their values to steer their clients in a given  direction or make decisions for clients. VALUE CONFLICTS PERTAINING TO ABORTION From a legal perspective, professionals are expected to exercise "reasonable care," & if they fail to do so, clients can take legal action against them for negligence. Laws, regulations, & policies vary widely; consult w/ an attorney when necessary. *Ask clients to talk about the value systems they hold & in what ways these values  support or conflict with the choices they are considering. 3 Striving for Openness in Discussing Values When you experience discomfort due to a client's very different system of values,  challenge yourself to develop ways of working with this client. Your task is to discover what is bothering the client & to explore this with them.  The emphasis should be on the client's problem & not on your problem with your  client. THE ROLE OF SPIRITUAL & RELIGIOUS VALUES IN COUNSELING Addressing spiritual & religious values in the practice of counseling encompasses  particularly sensitive, controversial, & complex concerns. If the therapists are to utilize spirituality in therapy, it is critical that they are comfortable  with spirituality as a topic of discussion in therapy. st  1  step: for the therapist to be sincerely interested in the client's spiritual beliefs & experiences & how s/he finds meaning in life when the client is interested in  talking about these matters. Spiritual assessment provides insight into how a client relates to spirituality & religion &  how this may be affecting the client.  If spirituality is not important to a clinician's worldview, s/he may be less likely to  attend to a client's spiritual concerns. 4 Religion & spirituality may be part of the client's problem & can also be part of the  solution. There are many ways of utilizing spirituality as a resource, a few of which include:  Meditation  Prayer  Being in nature  Mindfulness  Connecting with others  Enjoying the arts  Yoga  Etc. *Pay attention to the unique ways your clients make sense of their lives & derive  meaning. Spiritual & Religious Values in Assessment & Treatment Recommended to understand & respect a client's religious beliefs & to include such  beliefs in their assessment & tx practice. Reasons for conducting assessments in the area of spirituality:  Understanding clients' worldview & the contexts in which they live  Assisting clients in grappling with questions regarding the purpose of living &  what they most value  Exploring religion & spirituality as client resources  Uncovering religious & spiritual problems  Determining appropriate interventions o Gives counselors an opportunity to identify possible negative influences  that spirituality or religion may have on a client's presenting problem 5 Ethically, the counselor can then assist the client in exploring spiritual or religious  concerns. *When a client indicates concerns about their religious beliefs or spiritual concerns or  practices, the therapist needs to be capable of working at this level. It is not appropriate to urge clients to explore religion & spirituality if they do not see  these as relevant factors in their lives. Religious Teachings & Counseling At their best, both counseling & religion are able to foster healing through:  An exploration of self by learning to accept oneself  By giving to others  By forgiving others & oneself  By admitting one's shortcomings  By accepting personal responsibility  By letting go of hurts & resentments  By dealing with guild  By learning to let go of self­destructive patterns of thinking, feeling, & acting *Keep in mind that it is the client's place to determine what specific values to retain,  replace, or modify. PERSONAL BELIEFS & VALUES OF COUNSELORS Counselors must understand their own spiritual & religious beliefs, or lack thereof, if  they hope to gain an in­depth appreciation of the beliefs of their clients. TRAINING IN DEALING WITH SPIRITUAL & RELIGIOUS CONCERNS 6 Ethical practice sometimes demands that mental health professionals be willing & able  to refer a client to a member of the clergy or to an indigenous healer.  The Association for Spiritual, Ethical, & Religious Values in Counseling  (ASERVIC) developed a set of competencies in spirituality & proposed including  these competencies in the Standards of the Council for Accreditation of  Counseling & Related Educational Programs (CACREP)  These competencies outline the knowledge & skills counselors need to master to effectively engage clients in the exploration of their spiritual & religious lives. Counselor education programs need to inform students of the ASERVIC competencies  so students have a framework for evaluating their readiness to apply these  competencies in their work with client. Value Conflicts Regarding End­of­Life Decisions End of life decisions pertain to wide range of options that individuals may want  professional assistance in exploring. ­ie:  How to talk to one's health care providers about one's pending death  Whether & how to complete a living will  Whether to have a DNR order Withholding & withdrawing tx is legal in all 50 states, so all of us have some choices  regarding our own death. If you will be working with clients concerned with end­of­life care, it is essential to know  the laws in your jurisdiction & state & to be familiar with the ethical guidelines of your  7 professional organization concerning an individual's freedom to make end­of­life  decisions. Rational suicide – a person has decided – after going through a decision­making  process & without coercion from others – to end his/her life because of extreme  suffering involved with a terminal illness Aid­in­dying – providing the person with the means to die; the person self­administers  the death­causing agent, which is a lethal dose of legal medication Hastened death – ending one's life earlier than would have happened without  intervention Mental health professionals who are involved in end­of­life care decisions need to be  knowledgeable about the implications of advance directives & their involvement with the client. Advance directives – decisions people make about end­of­life care that are designed to  protect their self­determination when they reach a point in their lives when they are no  longer able to make decisions of their own about their care The 2 main forms of advance directives are a Living Will & Durable Power of Attorney  for Healthcare. Living will – document in which the person specifies the conditions under which s/he  wishes to receive certain tx or to refuse or discontinue life­sustaining tx Durable Power of Attorney for Healthcare – enables a person to identify one or more  individuals who are empowered to speak for the ill person if this individual becomes  unable or unwilling to speak for themselves 8 Mental health counselors must understand their own values & attitudes about end­of­life options. A host of ethical challenges & dilemmas that counselors may need to consider:  Respecting client autonomy  Assessing an individual's capacity for decision making  Honoring advance directives  Respecting an individual's cultural values  Maintaining confidentiality  Dealing with medical futility  Establishing & maintaining appropriate boundaries  Include families in the scope of the care **Professional must develop death competence. Death competence – specialized skill in tolerating & managing client's problems related  to dying, death, & bereavement CODES OF ETHICS REGARDING END­OF­LIFE DECISIONS End­of­life decisions – choices individuals make about terminal conditions regarding  their continuing care or tx options including:  Aggressive tx of the medical condition  Life­sustaining tx  Medical intervention intended to alleviate suffering  Withholding or withdrawing life­sustaining tx  Voluntary active euthanasia  Physician­assisted suicide Terminal conditions – one in which there is no reasonable chance of recovery & in  which the application of life­sustaining procedures would serve only to postpone the end of life 9 The policy statement of NASW, the standards on end­of­life care of NASW & the end­ of­life care standards of the ACA provide social workers & counselors with some  general guidelines by which they can examine the ethical & legal issues pertaining to  end­of­life decisions. DIFFERING PERSPECTIVES ON END­OF­LIFE ISSUES Therapists can explore alternatives to suicide & at the same time, be attentive to the  client's autonomy & freedom of choice. *Most arguments favoring rational suicide center on the premise that individuals should  have the right to make appropriate decisions about their lives when they are terminally  ill. Most typical circumstances under which they would consider a decision to die by suicide as being rational as follows:  Terminal illness  Severe physical pain  A nonimpulsive consideration of the alternatives  An unacceptable quality of life IMPORTANCE OF ASSESSMENT Conducting a thorough assessment is critical in situations pertaining to end­of­life  decisions should consider matters such as:  Diagnosable mental disorders  Psychological factors that may be causing distress  Quality of relationships 10  Spiritual concerns Depression, hopelessness & social isolation can contribute to an individual's suicidality  & these same conditions may be present when terminally ill people are making end­of­ life decisions. ROLE OF PROFESSIONALS IN HELPING CLIENTS WITH END­ OF­LIFE DECISIONS Some end­of­life decisions are made more broadly than is the case with physician­ assisted suicide. ­One path is refusing all tx as a choice of ending one's life. Even though it is not against the law to refuse tx, the client may have made this decision based on misinformation or misunderstanding. ­A counselor could help a client assess the nature of the info upon which this  decision was based. *It is also essential to assess for depression when clients decide to forgo tx. Mental health practitioners need to acquire knowledge about the psychological, ethical,  & legal considerations in end­of­life care. *As a counselor, you are obligated to assist clients in an informed decision­making  process, regardless of your personal thoughts & beliefs about the outcome. Palliative care – specialized approach to medical care for people with serious illnesses Transitions & Palliative Care Therapy Model ­includes 7 core components of communication & decision­making:  Getting ready  Assessing the situation 11  Managing conflict  Providing info  Identifying roles  Processing essentials  Follow through ­enhances interactions among providers, departments & health care settings If counselors are unable to help in making end­of­life decisions, they should provide a  referral so clients are not abandoned. 12


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