SAINT MARY’S UNIVERSITY

Weekly Journal on Legal and Ethical Issues

MAED-GC 206
JOMAR BUMIDANG Week 1

Part I Becoming a Virtuous Therapist

1 Building Character: Virtues of Excellent Practitioners

A. Questions for Review and Reflection

1. What is virtue ethics, and why is it so demanding?

Virtue Ethics is the practice of becoming virtuous, it is also identified as the one that emphasizes
the virtues or moral character of a person. It is very demanding because in a profession or not,
it is here where good moral character and values starts.
2. What is the motive that a virtuous person has for telling the truth? How do you
think this might relate to being a virtuous therapist?
The motive that a virtuous person has for telling the truth is to give information. Being truthful
may relates to being a virtuous therapist because by becoming truthful, you will not be able to
deceive or mislead others particularly your client. Instead, you will be able to inform and make
them understand what they should know.
3. How does a virtuous person decide right from wrong? Is there a formula for
doing so?
A virtuous person may decide right from wrong by seeing what is good for others. This is being
done by carefully evaluating and assessing the situation- what possible repercussion to occur
and who will benefit from the course of action to be done.
4. What did Aristotle mean when he maintained that virtues are means between
extremes of excess and deficiency?
5. What is benevolence and non-malevolence, how are they related, and why are
they important virtues in counseling?
Benevolence is becoming committed to advancing the welfare of clients, it is to eliminate their
pain and suffering and to feel joy at their progress and sadness or regret at setbacks. On the
other hand, non-malevolence is a condition of benevolence which is to safeguard and prevent
future harm to clients as well as third parties.
6. What is empathy, and why is it important in counseling?
Empathy is the feeling and ability to resonate with the plights of others, to sense the subjective
meanings of their personal and interpersonal challenges, and to be there for them in helping
facilitate constructive change. Empathy is very important because it is something like putting
yourself in the situation of your client in a balanced way, through this, you will sense what the
client is going through and you will be able to reflect back and conveys insight and
understanding, which, in turn, encourages further client disclosure.

7. What is authenticity, and why is it an important counselor virtue?

Authenticity is something that involves genuineness meaning that what is going on inside the
person’s thoughts, desires, and emotions also reflects or matches what is going on outside.
Authenticity is an important virtue that a counselor must uphold for it makes clients more likely
to confide in them and disclose deeply personal matters. Authenticity is also important for we
can be able to inspire clients to exercise the courage to make constructive changes in their lives
rather than make excuses about why they cannot.
8. What is courage, and how does it relate to counseling?
Courage is taking risks for the sake of a “noble end” which means that doing what you think is
morally right even when you believe that doing so means risking suffering some substantial
harm. Courage relates to counseling for it is through courage a counselor can stand with his/her
ethical judgement.
9. Is honesty the same as truthfulness? Explain.
Honesty is not the same as truthfulness, but a broader concept instead. This is because a person
can tend to be truthful but nevertheless deceitful and therefore dishonest. Thus, honesty should
involves being both truthful and non-deceitful.

10. What’s the difference between a lie and a half-truth?

The difference between a lie and a half truth is that lie is a statement which intent is to deceive
others from the fact while half-truth provides part of the truth while intentionally leaving out
other information that is needed to form an informed perspective.
11. What is candor? What sort of information would a candid therapist disclose to a
client?
Candor is the provision of therapy which involves disclosing those facts about therapy that a
client would reasonably want to know. The sort of information that a candid therapist would
disclose to a client are all the risk that may potentially affecting the decision of the clients.
12. What is respectfulness and how does it relate to what psychologist Carl Rogers
calls “unconditional positive regard”?
Respect is an unconditional state of acceptance. The relationship of respectfulness to what
Carl’s called “unconditional positive regard” is that it should be given no matter what his
condition, his behavior, or feelings.”
13. What did the philosopher, Immanuel Kant, mean when he said that we should
treat others as well as oneself as “ends in themselves” and not as “mere means”?
The Philosopher Immanuel Kant means that we should treat a person as a person and not a
mere objects or things.
14. What does it mean to say that respectfulness is “universal”? Why is this aspect
of respectfulness significant in counseling?
Respectfulness was said to be universal because it is not only given to selected people or merely
respect for some people, instead it is respect that should be given and applied to all.
15. What does it mean to respect oneself?
To respect oneself means not to permitting others to treat us as an object to be manipulated. It is
also to avoid berating ourselves, instead it is to value our own rational autonomy. Furthermore,
respecting oneself is not to self-destructively degrading ourselves for our own mistakes or
professional misjudgments but to recognize such mistakes and rectify and/or learn from them.
16. What does it mean to be an empowering therapist?
To be an empowering therapy means to facilitate clients’ autonomy or self-determination in
making constructive change. It is not to manipulate, threaten, trick, intimidate, or cajole clients
into making changes; for this would not be consistent with respecting the client as a person; nor
would it promote future constructive change.
 17. What does it mean to be a discreet therapist? Would a discreet therapist ever
disclose something a client disclosed to him or her in confidence? Explain.
We can be called discreet therapist by exercising discretion which involves taking care not to
offend or violate others’ privacy through the disclosure of their private or personal information.
It is a process of giving respect to this given trust by not disclosing the confided information to
anyone else. However, a discreet therapist may still disclose something a client disclosed to him
or her when harm is present, this to save the life of the person who disclosed the information or
the lives of third parties. In such cases, the discreet person exercises rational judgment about
what information to disclose, where, when, and to whom.
18. Why does being loyal to a client require independence of judgment? Why does
loyalty also require temperance or self-control?
Being loyal to a client requires independence of judgement to avoid the occurrence of conflict of
interest which makes it harder to exercise independent, professional judgment on behalf of the
client. At the same time, loyalty also requires temperance or self-control to avoid moral and
physical temptation which may put the live of the client and of the third party into risk.
19. What does it mean to be diligent? List at least five things that we would expect a
diligent therapist to do.
To be diligent means to meet the client responsibilities in a reliable and efficient manner. It is a
matter of doing self-welfare but not by means of abandoning and sacrificing the welfare of client
for personal interest. It is also to maintain and store counseling records, as appropriate, in a
safe and secure manner and to conduct themselves in all other manners that provide for the
efficient operation of their practices conducive to client welfare. We may expect a diligent
therapist to do the following:

1. Diligent therapists must keep appointments, do not ordinarily cut short sessions, have
an answering service, check messages regularly, return calls in a timely way and leave a
competent therapist on call while away.
2. A diligent therapist is flexible and has the ability to adjust his schedules when
necessary to meet unexpected situations.
3. Diligent therapists avoid the extremes of irresponsibility and rigidity on the other.
4. A diligent therapist may cancel or shorten a client’s session to accommodate another
client’s crisis situation, when this is the only reasonable way to address the crisis.
5. A diligent therapist reschedules the missed appointment in a timely manner.

20. How does a therapist acquire competence in counseling? Why would

multicultural knowledge part of being competent?
A therapist may acquire competence in counseling through practical experience and ethics
consultation from colleagues. Multicultural knowledge is part of being competent as it will guide
us in making inferences as we take appropriate steps in educating ourselves about the cultural
backgrounds of the client populations we serve. From this, we will be able to determine what
actions are likely to best help such particular clients.

21. Would a competent therapist ever seek consultation from other therapists in
addressing client issues? Explain.
A competent therapist may seek consultation from other therapist when there is sufficient time
and when he/she has questions about how to respond to such ethical challenges. However, in the
end, the competent therapist rationally considers the insights gleaned from the consultation and
exercises his/her own prudent judgment in making a decision.

22. What is fairness, and how do you distinguish between fair and unfair treatment
of clients?
Fairness is equity which involves treating clients relevantly despite of differences. We can
distinguish between fair and unfair treatment of clients based on the therapeutic outcome and
goals.
23. What is a fiduciary relationship, and why is counseling such a relationship?
Fiduciary relationship is a relationship that based on trust where in a client relies on the
expertise of the therapist to help him/her with his/her personal problems and therefore to trust
the therapist to make progress. Counseling is said to be a relationship because just like other
relationship, trust is a very important factor that should be present on this where a client shares
the most intimate, private details of his/her life with you whom he/she really do not know.

24. Why is attaining client trust paramount in counseling?

Attaining client’s trust is a paramount in counseling because once trust is gained, client will be
more likely to tell you things he/she otherwise would not have told you, offer less resistance, be
more attentive, and display greater openness to the therapeutic process.

25. Does one virtue ever support another? That is, do you ever need to have one
virtue to have another? Explain.
It is absolutely true that one virtue support another and you must need one to have another since
each virtue is interconnected and they serve as the foundation of one another.

B. B. Cases for Analysis

1. Francine Fuentes is a 48-year-old city councilwoman who has been diagnosed with major
depressive disorder with recurrent suicidal ideation. She is in counseling with Dr. Henrietta
Ettinger, a clinical psychologist. As election season is drawing near, Fuentes discusses her
fears about handling the rigors of her office while struggling with her depression. Ettinger
has some doubts about whether Fuentes will be able to perform competently on the job and
addresses these concerns with Fuentes. Fuentes is undeterred in finally deciding to run for
reelection. Ettinger is concerned about the welfare of her client and how the pressures of
her job may affect her. She is also worried about the future of the city in which both she
and Fuentes reside. As a virtuous therapist, how should Ettinger proceed? What are her
ethical and legal responsibilities? What therapist virtues are relevant to the decisions that
Ettinger makes?
Ettinger has a good intention to help her client. However, she is faced with issues as to how she
would convey her doubts about her client’s desire to run for public office, which may aggravate
her disorder. Ettinger is showing the virtue of being benevolent, though, it is now a quandary for
her as to how she would advance the welfare of her client without inflicting harm to her when
she contradicts the decision of the client to re-run for public office. In short, how could Ettinger
tell to her client that she might worsen her condition along the way when he continue her desire
to serve as politician without hurting her emotions which may also intensify her disorder due to
unachieved goal. So being benevolent and at the same time being no malevolent. If Ettinger
chose to tell her qualms about her client’s decision to run she might upset her that would
heighten the disorder of her client. Although, it would depend on how she would convey her
thoughts and opinions on her decision to run for public office. On the other hand, if she would
not be able to tell her thoughts and would just allow her client to follow her decision to run for
public office, the latter may likely to worsen her condition especially both whether she would
win or not. If she would win the pressure and expectation would be higher and may likely to
suffer her constituents. If she would not win, then her psychological health condition would
likely to exacerbate.

Facing this kind of dilemma, Ettinger may also seek opinions from another therapist, if
she thinks she could not decide for herself. Asking for help would not make her less a
therapist. However, at the end of the day she should be the one to decide on what she thinks
would be the best choice for her dilemma. She may also look on the legalities of her decision
as to whether she is violating existing laws and regulations in assisting her clients.

Nevertheless, If I were Ettinger, I would try to talk to my client and relay my concern
about her decision to run. In a RESPECTFUL manner, I would provide the pros and cons of
her desire to run for public office and let her decide on her own reassuring that whatever
happens along the wat or after the election, she would have me as her therapist and would
support her whatever will be her decision.

2. Catalina Smythe is a clinical social worker with a large private practice. When she first
began practicing, Smythe carefully got both oral as well as written informed consent from
all her clients. As time goes on, and her practice grows, Smythe decides that it is more
expedient to have her receptionist give all new clients the informed consent form before
therapy commences. In that way, Smythe can save time and see at least one more client
each day. This is important to her because she is saving up for a more spacious home. So
far there have been no known negative consequences from only getting written consent.
Discuss whether what Smythe is doing comports with virtuous practice. Which virtues
might militate against what she is doing? Which virtues, if any, might be demonstrated by
her decision to only get written consent?

The intention of Smythe to save time and effort so she could assist more clients is
valid and understandable. Though so far, no problems have been encountered yet with her
 decision to transfer the responsibility of getting informed consent from clients to her
receptionist, it may raise an issue on her virtues in terms of no malevolence and diligence.

Letting a receptionist to get the written consent should not be passed on to the
receptionist. It should be her sole responsibility to get both oral and written informed
consent from the clients as she should personally explain the contents of the informed
consent form as to the purpose, participation, benefits and risks and confidentiality in
becoming a client. This is done in order to prevent future harm to clients as well as third
parties. In accord with the premier medical ethic, “First, do no harm” (Latin: Primum non
nocere), getting an informed consent personally by Smythe shows her competence as a
clinical social worker because she knows what she is doing and she puts first the welfare of
her client and looking to it that she could not inflict harm in one way or the other.

Putting the responsibility to her receptionist also questions her being diligent. Smythe
should be careful in delegating work, while her intention is good, she should remember that
a diligent therapist disposes against overbooking or taking on more clients than they can
accommodate.

Thus, If I were Smythe, rather than looking quantity of clients, I would ensure instead
the quality of service that I would give to my clients in order to avoid future problems.

3. Xavier Merrill is a 19-year-old male, who lives with a roommate and who graduated from
high school last year. He has begun counseling with Elvira Moreau, a licensed mental
health counselor, because he is confused about the direction of his life. Although Merrill is
no longer a minor child, he is still on his parents’ insurance policy. During the course of his
counseling, he reveals that he is undergoing treatment for Hepatitis C and is experiencing
significant side effects from the medication. He stresses that he does not want his parents to
know about his illness. Moreau is concerned about the health and safety of her client;
however, she is wary of compromising his autonomy. How should a virtuous therapist
handle this situation? Discuss which virtues are most important to consider.

In this case, the virtue of trustworthiness is at stake. If Moreau would disclose the
information shared by her client, there would be an issue of breach of trust and
confidentiality while if she would conform to her client’s request not to divulge her
conditions to her parents, there would be an issue of benevolence and no malevolence
.
If I were Moreau, I would rather uphold the virtue of benevolence and non-malevolence
because the positive welfare of the client is the first and foremost consideration that we
need to look at and then ensuring that potential harm in the future would be lessen if not
totally eliminated. While it is true that Merrill is at legal age, still he is on his parents’
insurance policy, thus, his parents ought to know about his illness, considering that there is
a potential harm about himself. As one of the ethical guidelines of counselor, if there is a
 potential harm to one self or to others or to properties or objects, confidential information
may be disclosed to appropriate person, in this case, the parents. When worse comes into
scenario, the physical health as well as mental health of the client would be aggravated,
thus, he would be suffering a lot and no one would take care of him, considering that he is
only living with his roommate.

Trust and confidentiality may seem to be violated, however, with proper communication
with client, like convincing him to disclose such information for his own good would help in
still sustaining the trust built in the context of client-counselor relationship. Showing care,
empathy and honesty to the client would also help in maintaining the trust built, it is
because the client may likely to realize the he still needs the guidance and assistance of his
parents, especially so that is ill. Thus, it is only his parents that could genuinely oversee his
health until his full recovery.

2 Being Trustworthy: Case Studies: Two Resistant Clients

A. Questions for Review and Reflection

1. Hilda makes occasional visits to Dawn’s home after sunset, even though she
sometimes fears for her own safety. What are some pros and cons of doing this in the
context of counselor nonmaleficence?

The pros for this scenario is that Dawn might build more her trust to Hilda by seeing
the sincere and sacrificial doing of Hilda in helping her, however in case that Hilda
encountered some danger on her way, Dawn as her primary purpose for such visiting
will be liable and be suspected on what happened to her which will put Dawn now
into danger.

2. When Dawn moves without informing Hilda, Hilda makes great effort to locate her.
As it turns out, Dawn appears to be testing the trustworthiness of the therapist. What
safety and therapeutic risks could Hilda be making in trying to find Dawn? What
might have been some other reasons for Dawn leaving without a trace?

The possible risk that Hilda may encounter is that she will be suspected of doing
threat by Dawn which will give more a distance between her and the client. Some
possible reason also why Dawn left with out a trace is the feeling of fear and
uneasiness towards Hilda because of her frequent visitation. It can also be due to her
fear on the judgement of those people around her if they found out her story from
Hilda.

3. Hilda provides equitable services for Dawn even when she is not being paid for her
services. What are some therapeutic pros and cons of her doing this in the context of
Dawn’s personal circumstances?
 With this, Dawn might appreciate Hilda for her kindness and economical
consideration, however this might lead an issue to their relationship boundary as
client and therapist.

4. Hilda allows Dawn to miss several counseling sessions without notifying her. What,
if any, potential pitfalls could arise from this practice?

In case a potential pitfall arises from this practice, Hilda would not still be liable
since Dawn was the one who tried and intentionally missed the session and given that
Hilda was able to rescheduled the missed session.

5. Dawn has a boyfriend who appears to have a chronic, untreated illness. What, if any,
ethical responsibilities do Hilda have to him? Explain.

Hilda does not have any ethical responsibility towards Dawn’s boyfriend because her
main focus is Dawn who was the one affected by the situation. Maybe the thing she
could only offer is to help Dawn manage the situation of her boyfriend through
counseling but not to focused on the case of the sick one because it will conflict with
her objective towards Dawn.

6. Hilda attempts to conduct herself in ways intended to promote client autonomy and
self-determination. Is there a risk that some of the strategies that she uses could
backfire and actually promote client dependence? Explain.

Yes, there is a risk since it was very visible that Hilda is somewhat obsessed in trying
to promote beneficence in this case.

7. Why does Harold appear to feel more comfortable discussing historical feelings
rather than the feelings that he is currently experiencing?

Harold appears to be more comfortable in discussing historical feelings rather than

the feelings that he is currently experiencing because he is still never got over with
the betrayal in the past which serves as the main root of his current situation
.
8. Selmon suggests making a referral to Harold for family therapy to avoid any
uncomfortable feelings on the part of the family members and also to avoid the
appearance of a conflict of interests. What virtue(s) is Selmon practicing in so doing?
Explain. How does this relate to the therapist’s trustworthiness?

The virtue that Selmon is practicing is benevolence/non-malevolence and loyalty

because he was still able to considered the benefit of Harold and his sons, the
comfort of each family member including the conflict of interest and bias that might
occur if he ever allows himself to be the family therapist. With this, Selmon did not
also think of losing client and revenue. This may relate to the therapist’s
trustworthiness because Harold was able to agree on the decision of Selmon which is
 to refer them to another therapist, by this means, Harold was able to put his trust on
Selmon’s decision, expertise and knowledge regarding what is beneficial to them.

9. In the case of Harold, how does the counselor’s virtue of diligence affect the quality
and success of the termination process?

The counselor’s virtue of diligence affected the quality and success of the termination
process because Selmon was became considerate to the feeling of Harold by making
adjustment on his session’s schedule.

10. How might Selmon’s candor, specifically with respect to the potential disclosure of
certain confidential client disclosures affect the trust and rapport that he develops
with Harold? Is it ethically necessary for Selmon to reiterate over time, state laws and
codes of ethics dealing with such disclosures of confidential material?
Selmon’s candor really played an important factor because it gave Harold the
assurance of security that whatever he discloses to Selmon will be kept confidential.
Yes, it is ethically necessary for Selmon to reiterate overtime, state laws and codes of
ethics dealing with such disclosures of confidential material to gained more the trust
of the client and to inform them as well that such law, code and ethics exist to protect
their privacy.

11. In discussing his sons with Selmon, Harold talks about “falling to pieces” if he is
rejected by them. How does Selmon work with Harold’s apparent irrational
supposition without imposing his values on his client?

Selmon work with Harold’s apparent irrational supposition without imposing his
values on his client by using cognitive restructuring and rehearsal exercise wherein
various scenarios were practiced to dispel the irrational belief that Harold would fall
to pieces if his efforts with his sons were unrequited

B. B. Cases for Analysis

1. Martin is a middle-aged male with a history of committing minor crimes and lying to friends
and associates when truth telling is often the easier route. The offspring of alcoholic parents,
Martin states that he was never able to trust his parents and is having difficulty trusting his
psychologist of 3 months’ duration, Dr. Silvan Barton. Martin has served time for his
criminal behaviors and has stated that he is not afraid that revealing these crimes now could
put him in any legal jeopardy; however, he has said that he fears that Barton will use his past
against him and judge him unfairly. He has vacillated between beginning to speak of his past
and saying that he will never reveal it to Barton. Barton’s suspects that resolution of issues
related to this past are critical to the success of treatment. How can Barton responsibly
proceed with treatment?

Based on my understanding, the client – Martin is doubtful about sharing his

criminal experiences to his psychologist because the latter might disclose such information
and might be used against him. The case is all about establishing trust with a suspicious,
 apprehensive client. The situation is seemingly difficult to resolve, for there is no specific or
generic formula on how to win a trust for these kinds of clients. Although, one of the
counselor’s first objectives when meeting with a client is to build some form of trust, in this
case, it obviously not met.

As such, handling this kind of client is such a challenge for a psychologist like Dr.
Barton. I believe that trust is not something that can be built overnight. Establishing trust in
a professional counseling relationship requires work, planning and dedication. It is where
the virtue of diligence comes in. I believe that through careful and persistent work and effort,
I would be able to win the trust of Martin, in due time. In doing so, I would demonstrate a
desire to understand his perspective and persevering with empathy and active listening skills.
Also, as his psychologist, I would help him to see that his resistance is not to his advantage.
Thus, pinpointing the advantage and disadvantage of not fully opening up about himself
would not help in achieving our goal.

I will also show that I am really caring about his situation and that assisting him to
achieve his full recovery is what I desire. When he feels that I truly care about his positive
welfare and that his past and criminal records would be kept confidential and will not be
used against him, perhaps he would be able to completely open up to me.

Being connected with him in a professional level may likely to lessen his suspicion
and apprehension about me. This means that I should be reliable - he must feel that he can
count on me. Having the courage to be honest and transparent to him in terms of what to be
achieve in the therapy sessions could also be helpful to win his trust. Likewise, being
authentic to him so he would not fear that everything he discloses would be used against
him.

2. Cynthia is a Hispanic female who has been in therapy with Dr. Brianna Karlton for 3 weeks.
She had requested a Latina therapist but was not able to be accommodated because the
satellite office of the agency where she receives services does not have one on staff and
Cynthia is unable to travel 15 miles to the main office. Cynthia has repeatedly expressed
doubts that Karlton, a white woman, will be able to fully understand her experiences and
concerns. Karlton is versed in the dynamics and challenges that sometimes occur with
multicultural counseling but is sensing that she is at a standstill with Cynthia. How can she
ethically and responsibly address Cynthia’s concerns?

The case of Cynthia and Karlton trust issue rooted from having been culturally
different. The feeling of Cynthia is valid as she struggles with cultural issues and Karlton is
faced with the challenge of multicultural counseling.

In order to address this challenge, I would forego with the counseling sessions
bearing in mind that the counseling approach would be on the context of the Cynthia’s
 situation. Thus, my own cultural values or bias must not take precedence that of her. In
order to work progressively with Cynthia, I must recognize and understand where she is
coming from and her background. I will connect to her properly by letting her understand
that I am aware of her culture. Respect and empathy as virtues must prevail in order to
convince her that I am trustworthy. I believe that by using empathy, sensitivity, and
understanding, I could help her feel heard and respected.

However, if despite of everything that I have done and still she requests to have
another therapist whom she believes would better treat her, then, I respect her right for
autonomy to choose her therapist. Proper termination of the client-therapist relationship will
be done and proper referral procedures would be followed.

3. Alvin is a 7-year-old male child who is in therapy because he has been the victim of long-
term school bullying. His counselor of 4 weeks, Bernard Jarold, has been able to engage
Alvin in limited play therapy but finds that he appears reluctant to speak about his school
experiences. Alvin seems to fear expressing what happened to him, stating that he was
referred to counseling for some “misunderstandings with other kids.” How can Jarold begin
to establish trust with this client?

It is stated in the case that Alvin has been engaged to limited play therapy. I think
that play therapy is an effective method to establish trust with clients. So Jarold may
continue this method to Alvin as they go through with their therapy session. It is a nature of
a child like Alvin to verbalize his feelings especially so that he suffered from a traumatic
event, which is bullying. I believe that play is effective with Alvin because it creates a safe
way for him to communicate difficult feelings without forcing him to speak. Through play,
studies have shown that children may automatically ‘play out’ their worries, fears and
anxieties, because in play there is no expectation to talk and verbalize one’s feelings.

With this method, Jarold can take advantage to establish trust with Alvin. Jarold
should allow Alvin to freely express himself through play. Jarold could start by gradually
getting to know Alvin by asking what he likes to play or do, among others. With this, I
believe that Alvin would begin to sense that Jarold really cares about him and this increases
the trust that Alvin has for him. This is another means to help Alvin open up about the
difficulties he is having, and when Alvin is ready to speak his mind and feelings then the
therapy session would become smoother and easier leading to the complete recovery of
Alvin.