1 A Counsellors Ethical Responsibilities in Reporting Clients This essay is a critique of a practice session based upon an ethical issue raised

by a client. The essay will look at my ability to respond to the ethical issue appropriately and summarise skills used with verbatim examples. In addition, my reflections on the session and improvements to skills or application of other skills that could have been used and whether the session was effective along with further reflection on future implications as a professional counsellor. Clients Presenting Problem The client came to me with a presenting problem about her sister who is five months pregnant and is a recreational user of drugs and alcohol. The client who is unable to have children has suggested to her sister that if she does not want the child she would be willing to adopt the baby; her sister has indicated that she would never let that happen. Although the client is concerned about the welfare of the unborn child, the ethical issue is whether the baby is in danger or not. There is evidence to suggest that pregnant mothers who are recreational drug and alcohol users do refrain from these activities whilst pregnant, according to West Australian Drug & Alcohol Office (2008). One of the biggest hurdles facing counsellors is knowledge or lack of it in this instance, although I was only aware of the dangers to children from continued drug and alcohol use during pregnancy and yet unaware if there is a system in place to force an expectant mother to stop. Research since this session has revealed that although it is mandatory for health professionals to report incidents of child abuse it is not however mandatory to report on unborn babies at risk. I believe this is due to the Law in New South Wales that does not presently recognise the rights of unborn infants; which are not classified as living human beings until they draw breath at birth. Therefore, it is up to the discretion of

2 the health professional to decide if the unborn child is at risk and needs to be reported, however, there is no legal justification for intervention other than to educate expectant mothers of the risks of drug and alcohol use. That said NSW Health recommends that health professionals consider the following benefits to reporting; firstly, reporting enables agencies and community services to set in motion beneficial services to assist both the mother and the unborn child. Secondly, allows them to set in motion interventions through enabling statutory/protection to take affect after the child is born (Childrens Research Center, 2009). According to statistics provided by Australian Institute of Health and Welfare (AIHW, 2010), of the 162,259 abuse cases investigated, 34% were substantiated, although this figure is unacceptably high, it does also indicate that 66% were fortunately false reports. The ethical issue in this case is whether or not to report based upon this clients word and knowing her desire to have this baby, who suspects her younger sister is acting in a manner that will deliberately endanger the life of the unborn baby. Armed with the knowledge from my own research and having given the client similar research homework I could then call her to confer and let her know of my findings. If she is still of the belief that her sister is acting recklessly and endangering the unborn childs life then contacting Community Services to investigate would be an option worth pursuing. Because this session related to a third party and not a real problem of the clients, not that she did not have a genuine problem it was more a matter of a vested interest in the unborn baby. The session progressed with the client seeking advice on a problem of conscience, her conundrum, being should she report and risk losing the chance to adopt by alienating her sister or let nature take its course. Therefore, she sought advice on what to do and as a result, I did advise her for the most part of the session because I was focussed upon the ethical issue rather than her as a client. Although I maintained rapport with the client and at times mirrored her posture, I did at times lose eye contact with her. The reason for this lapse is because

3 during the entire session the recording equipment echoed back both our voices and as a result I found it difficult to concentrate on what she said and equally so hearing my own voice rebounding off the glass behind me. Although the client and I formed a mutual bond in that our values were very similar in respect to the risks facing the unborn baby, as a counsellor I needed to maintain perspective, the client has an agenda and just because her sister may be showing signs of rebellion does not mean she would deliberately harm the unborn baby. Therefore, another ethical issue arose in that I must not act on emotions and be aware that my emotions do not interfere with any action I decide to take. I would also need to be certain that the sister is putting the child at risk and my verbalised thoughts of an intervention could help or harm the situation, depending upon the mental state of the sister. According to Brill & Levine (2002), health care workers need to be aware that, People can and do change values as they perceive the dichotomy between what they profess and what they do in terms of implementing values (p. 31). Additionally a counsellor should according to Stanard & Hazler (1995 ) seek consultation prior to reporting any information and ensuring all reasonable alternatives have been utilised and information received is verifiable as well as relevant. By raising the idea of researching both autonomously and collaboratively, I attempted to move the client forward toward learning more about the issues of drugs and alcohol abuse in pregnancy and to seek other avenues of approaching her sister and to reflect upon other choices such as approaching friends or organisations like Bernardos Homes. Bond (2010) suggests a client should be steered toward self-talk and to engage in a reflective process to consider other options and to empower them. Because there was an uneven power distribution favouring the counsellor, which I felt reluctant and uncomfortable to act upon, the research homework given to the client helped to redistribute power through the offer to contact the client later that week to confer on our discoveries. This imbalance is what Solace (1996, p.

4 148) described as a conflict between competing interests the clients in possessing the baby and my own in protecting the baby. According to Erik Ericksons theory of human development, my client is exhibiting stages six, seven, & eight, the first of these, intimacy and isolation, the clients sense of loss with her relationship with her sister and being unable to connect. The second, generativity versus stagnation, where the clients need to nurture through giving back, by caring for her sisters unborn child and finally, the clients need for her life to have a purpose and meaning as fulfilling a self interest in the need to have a child. Reflecting on the session, what I did miss was an opportunity to address the aforementioned issues and those she had of feeling guilty for not doing anything to protect the rights of her sisters unborn baby. The only option I considered was to report her concerns to Community Services, however, armed with knowledge I did not have at the time, I could have said, Unfortunately youre not alone, there is little you or I can do in the circumstances as the Law only allows us to intervene after the baby is born. Although this may have helped toward suppressing her guilt and normalising her situation, it would however, also have raised another issue of helplessness, which she expressed later in the session. When the client said, She just laughs in my face and says, You will never get your hands on my baby!, I empathised with her situation saying in a concerned tone, Sounds like she really knows how to pull your heart strings. My sharing her concern by disclosing my own need to have another child did not upon reviewing the session normalise her feelings because she unlike myself never had any children and therefore was a good example of why it is not always practical to self disclose. Bond (2010) would call this crossing a boundary and irrelevant considering the clients feelings are entirely different to those of the therapist. Although rapport had been established prior to the session, there was a time when I found it appropriate to advise the client that I am legally and ethically bound to report any

5 instances of child abuse. That if she still wished to speak about her relationship with her sister and the unborn baby further, and then I may have to report any potential harm she discloses. Advising the client or warning the client in advance that confidentiality has its limits helps in the therapeutic alliance between counsellor and client (Kaslow, 1998). However, in hindsight I realise that reporting the clients sister would help relieve her of any guilt but also aid her in gaining custody of the baby, a catch 22 situation. At one stage during the session I began to say, Shes not going to give you the child anyway, the sentence went unfinished because the client interrupted by saying, Well she says that but, um she may change her mind, what I did not get to finish saying was, What will you do if that happens? The intention as suggested by Kay & Tasman, (2006) was to get her to think about alternatives, other avenues she may have considered or express her feelings if she could not adopt the baby. I also asked the client, What would you like to be able to do with your sister? she replied, I would like her to look after her to child... allow me to help look after it. I empathised with the client at this stage regarding her feelings for her sister and frustration she was feeling, she interrupted to say her sister is unwell and may not really mean to act out the way she does. It was after asking whether she has confronted her sister that she stated, She lies low I said, So she avoids you? to which she repeated my words, which made me feel that we were in contact with each other. My initial thoughts of an intervention arose but changed as I believed that further investigation was needed and set the client a task of researching organisations and services as well as mutual friends of her sister. Closing off the session with an assurance that I would keep in touch, and follow up with her then and review the options available with her.

6 Conclusion What this session has taught me is that where ethical issues arise, those issues must be acted on with careful consideration and based upon fact rather than hearsay. The word of a client cannot be discarded even though there may be a conflict of interest and the client may be attempting to use common moral values empowering a therapist to act on their behalf against someone else. Although I am not under any obligation to report this instance, I think that the clients needs must be attended too in a way that her perceptions of her sisters reaction are normal for cases of sibling rivalry. Additionally, whether she was always like this and the clients sister sees her as an interfering and judgmental person trying to control her life. In addition, ascertain whether her sister is just deliberately bating her for a reaction, which may be the case. Because I was focussed upon the subjective element of the ethical issue rather than the whole picture, the clients feelings of guilt and loss and based upon Ericksons stages of developmental theory, I could have challenged her more on those areas. Other skills I need to work on are paraphrasing and self-disclosing appropriately. I did feel that my posture was neutral and I that I maintained an air of congruence throughout.

References AIHW (2010). Child welfare series number 47, Child protection Australia 200809. Retrieved July 25, 2010 from http://www.aihw.gov.au/publications/cws/35/10859.pdf Brill, N. & Levine, J. (2002) Working with people, the helping process (7th ed.). Boston: Allyn & Bacon, pp 19-37. Bond, T. (2010). Standards and ethics for counselling in action. London: SAGE Publications Ltd. Childrens Research Center (2009). New South Wales mandatory reporter guide. Retrieved July 25, 2010 from http://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_gui de.pdf. Kaslow, F. (1998) Ethical problems in mental health practice. Journal of Family Psychotherapy, 9:2, 41-54. Kay, J., & Tasman, A. (2006). Essentials of Psychiatry. West Sussex: John Wiley & Sons Ltd. Solas, J. (1996) The limits of empowerment in human service work. Australian Journal of Social Issues, 31:2, 147-156. Stanard, R. & Hazler, R. (1995) Legal and ethical implications of HIV and duty to warn for counselors: Does Tarasoff Apply? Journal of Counseling and Development, 73:4, 397-400. West Australian Drug & Alcohol Office (2008). Policy framework for reducing the impact of parental drug and alcohol use on pregnancy, newborns and infants. Retrieved July 21, 2010 from http://www.dao.health.wa.gov.au/Publications/tabid/99/DMXModule/427/Default.asp x?EntryId=1052&Command=Core.Download.