Informed Consent and Ethical Responsibilities During the Counseling Process
Counseling of any sort requires that an assessment is taken in order for the counselor to gain insight to the dynamics, which brings a client into counseling. As a result, it is pertinent that issues of confidentiality and circumstances that would legally bind the counselor to report and/or provide confidential information to a third party are discussed during the initial interview. The American Counseling Association Code of Ethics (2005) (ACA) states that the counselors foremost priority is to ensure the clients welfare. In order to do so, the informed consent process is crucial in order to ensure the client is aware of the ethical and legal responsibilities that encompass confidentiality. The informed consent process must be documented and gone over verbally with the client (ACA, 2005). Furthermore, it must be noted that this should be a continuous process throughout the counseling relationship (ACA, 2005).
The informed consent process covers that a client is fully aware of the procedures that will be implemented (ACA, 2005). The ACA (2005) specifically states that informed consent includes: “the purposes, goals techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, and relevant experience; continuation of services upon the incapacitation or death of a counselor; and other pertinent information” (p.4). Furthermore, clients need to have a clear understanding of any tests, results, diagnoses, and financial responsibilities on part of the client (ACA, 2005). Most importantly, a client must understand the limitations of confidentiality and when a counselor is legally required to notify an outside source. This applies in cases when someone is being abused, or if they intend to commit a criminal act, which would cause serious harm to another person.
The initial assessment and ongoing assessment process is crucial to the counseling process. This enables the counselor to gain information to adequately implement strategies and techniques to help the client with the issues that are presented during counseling. Nonetheless, it is also important to be aware of circumstances where the counselor may be faced with false results and reporting by the client. This may be more evident when helping professionals are conducting assessments with minors, which consists of anyone under the age of eighteen years-old. A minor may be hesitant to report pertinent information if they fear the consequences when certain information is released to a third party. The counselor should ensure that environmental factors are managed properly in order to provide security and support for the child. (Adcock, 2009). The helping professional needs to balance the rights of the client and the rights of the guardians when a third party is directly involved (ACA, 2005).
Furthermore, it is important to note that a parent may refuse consent for a child to proceed with an assessment. If this occurs, an assessment can still occur “if the child has been assessed to be competent to provide their own consent” (Adcock, 2009, p. 359). It is noteworthy, that if a parent is involved during the consent process that the counselor adequately advises the parents about the dynamics, which encompass the release of information. Although, much attention has been given to children giving false responses this could happen with adults as well. Court referred clients may be apt to falsify information in fear of already being in the legal system. Furthermore, during couples’s therapy one partner may be hesitant to fully participate in the assessment process, or fear what being completely truthful will do to the relationship. It is essential, that the assessment process is ongoing and continuous throughout counseling and the counselor is attentive to verbal and non-verbal responses.
The ACA (2005) specifies that prior to an assessment being conducted the nature and purpose of the assessment should be clearly explained. The client should be aware how the assessment will be used and what it entails. Nonetheless, a helping professional may gather information about a client to gain insight into what avenues need to be further examined. For example, a clinician may implement a screening measurement such as an informal checklist, rating scales, or additional screening tests to assess and narrow down problem areas within the client (Whiston, 2009). Although, the clinician is taking this information and measuring possible problem areas the client may not be fully aware on what information is being gathered. Instead, they are selecting answers that apply to them. As a result, the counselor is equipped to further implement additional testing instruments in order to validate a hypothesis received from one of these instruments.
It is not that a client is not aware of what is being conducted, because the informed consent process entails the helping professional going over with the client what counseling entails. Informal assessment techniques such as observation and interviewing are pertinent to the counseling process (Whiston, 2009). Therefore, it is the ethical responsibility to keep the client informed on what is occurring during counseling and it is equally essential to acknowledge that counseling is a collaborative process and the counselor should continually be assessing the client. Although, these are important components Whiston (2009) points out that “research has continually indicated that statistical or actuarial methods are much better predictors than clinician judgment” (p.326). Therefore, informal techniques should only be used as a piece of the complexity of treatment planning. As a result, the integrity of the client is still being protected.
Next, it is important to note that not only is there an ethical responsibility to explain the assessment process, but the client also has the right to have the results efficiently explained (Whiston, 2009). Nonetheless, the client’s welfare is of the upmost importance. Therefore, the manner in which the results are interpreted and explained may vary depending if there is potential to cause adverse affects on the client (Whiston, 2009). It is important that results are explained in a way that the client can comprehend (Whiston, 2009). The helping professional should be prepared to have alternative ways to explain the results to help the clients better understand the assessment results (Whiston, 2009). In addition, there are cases where a diagnosis may have been made on the client. If it is determined that this diagnoses will cause negative harm to the client the clinician is not ethically bound to release this information (ACA, 2005). Furthermore, Whiston (2009) states that if diagnoses are made a client should be diagnosed with the less stigmatizing label.
It is not only important, but it is the ethical responsibility for helping professional to provide accurate and adequate services to a client being assessed for various issues. Nonetheless, a client’s welfare is essential when one begins to explain assessment tools and potential diagnoses. A clinician does have the ethical responsibility to the client not to cause further harm. Nonetheless, a client must be an active member of the assessment process and be fully aware of the procedures that encompass treatment. When working with clients who may be referred by the court, children, and so forth it may be difficult to always ensure accurate results. It is up to the clinician to be mindful of any potential dynamics that may compromise a treatment program. This could entail not receiving accurate information, due to various reasons or having to protect the welfare of the client by being selective, but being accurate in the assessment results being reported. If a clinician is unsure where this line is drawn they should refer to one of the recognized ethical codes and/or consult another helping professional for guidance (ACA, 2005).
Adcock, C. (2009). Obtaining Consent for child protection medical assessments. Child Abuse
Review, 18, 354-362.
American Counseling Association (2005). ACA Code of Ethics. Alexandria, VA: Author.
Whiston, S.C. (2009). Principles and applications of assessment in counseling (3rd ed.).