Posted: February 27th, 2023

HW 5

Steps in Ethical Decision Making

Pope et al., (2016) Chapter 8

[Name of Scenario]

Type the full scenario as written in text

Step 1: State the Question, Dilemma, or Concern as Clearly as Possible

Step 2: Anticipate who will be affected by the Decision

Step 3: Figure out who, if anyone is the client

Step 4: Assess whether out areas of competence-and missing knowledge skills, experience, or expertise – fit the situation

Step 5: Review relevant formal ethics codes and standards

Step 6: Review relevant legal standards

Step 7: Review the relevant research & theory

-Which chapters of the text and/or readings are relevant?

-Handler (1990) as cited in……

Step 8: Consider whether personal feelings, biases or self-interest might shade our ethical judgment

Step 9: Consider whether social, cultural, religious, or similar factors affect the situation and the search for the best response.

Step 10: Consider Consultation

Step 11: Develop alternative courses of action (after naming the first that come to mind)

Step 12: Think through the alternative courses of action

Step 13: Try to adopt the perspective of each person who will be affected

Step 14: Decide what to do, review or reconsider it, and take action

Step 15: Document the process and assess the results

Step 16: Assume personal responsibility for the consequences

Step 17: Consider implications for preparation, planning, and prevention



Readiness to help is an essential characteristic of an excellent human service provider. The service provider must be empathetic to develop a genuine personal relationship with the client. Appropriate self-disclosure with clinical rationale is a necessary trait of the service provider. A service provider must be self-aware enough to avoid being biased due to their personal experiences. Being a professional helper is emotionally demanding, and listening to a client’s problems may cause harm to the helper’s mental state hence professional burnout. When a practitioner realizes that the help the client needs is outside their field of expertise, they must refer the client to a suitable professional. A professional must not impose spiritual, social, or religious beliefs on clients. During sessions, a helper should only push clients to share information they are ready to disclose. Putting too much pressure on a client to share experiences may result in an overdiagnosis or misdiagnosis. Supervising intern practitioners is fundamental in ensuring that clients receive optimum care, preventing professional burnout in the intern, and access to advice when the intern is challenged.


The article,
Sitting down with Nedra, by Alice Munoz discusses paradoxical subjects, including healthy ultimatums, toxic forgiveness, and premature resilience. The article reminds me of my narcissistic partner. The manipulation led me to a dark and isolated place until I set my boundaries clearly and decided never to forgive unless I wanted to. Toxic forgiveness is unhealthy and impedes the client’s judgment as they become pretentious to avoid being labeled as bitter. When dealing with a selfish person, it is best not to engage because such people are fueled by the attention they receive. A gentle ending was the most appropriate in my case. Self-actualization and knowing what triggers me was an essential step in my mental growth, and
Chapter six, Competence, Humility and the Human therapist, urges one to live as their most authentic self. I could not confront my partner because they would gaslight me, and the devastating cycle of self-doubt would continue. Although psychology encourages communication, I chose a controversial path to slowly distance myself without any explanation, and I can attest that it positively impacted my emotional stability. Social media is very educative, provided that one follows the right influencers. It is a platform where Tawwab shares stories about her mental health, and this helps destigmatize mental disorders. Moreover,
the AMHCA Code of Ethics (Revised 2020) discusses further the benefits of technology-assisted counseling.


The mechanic scenario is relatable in
Chapter 2 of Ethics in Psychotherapy and Counseling. Ms. Huang never confronted Dr. Jackson about incompetence and never gave negative feedback regarding the sessions. On the contrary, she quit therapy without paying and sued the doctor for incompetence. I was in a similar situation where a client made derogatory claims about my brand to her friends. I get that clients are under no obligation to protect my privacy. This case was, however, different because it was defamatory to my brand. To top it off, the client never complained to me. She used to be excited and very eager to attend our sessions. I was surprised when I was informed of the allegations on her social media platform. After receiving the information, I told her during our following session that I would not be able to work with her following her claims and referred her to another mental health practitioner. After the experience, I resolved to be curious and obtain genuine client feedback, set boundaries with clients and seek professional help from my colleagues when I doubt myself. In this scenario, the dilemma is why a client would give positive practitioner feedback and slander the practitioner. The principle of termination and referral is relevant in this case because, despite client disagreements, a practitioner should not neglect the client. They should refer the client to an appropriate service provider.


ACA (2014) ACA code of Ethics – American Counseling Association. Available at:

 AMHCA (2020) AMHCA code of Ethics, AMHCA Code of Ethics – American Mental Health Counselors Association. Available at:



Ethical clinical services illustrate respect for every client’s autonomy, dignity, and freedom. Informed consent reflects that respect since ethical codes highlight consent as a critical value (Pope & Vasquez, 2016). Making sound ethical decisions requires full attention to every relevant fact in full and proper context hence the need to follow suggested steps. Counselors should treat all clients with dignity and respect, regardless of their origin, state of mind, or characteristic which distinguishes them from others. Treating people with respect for their dignity is the basis of the profession.

Ethical behavior guides counselor-client relationships. CMHCs maintain healthy relationships with their clients and avoid any action which seeks to meet their personal needs at the client’s expense (AMHCA, 2020). Individuals with disabilities need to have accessible counseling environments too. Informed consent is essential as clients should know what to expect, including having the freedom to choose their counselors. CMHC should always act in the client’s best interests when a client cannot provide informed consent. Generally, for the counseling process, CMHCs ensure that client’s rights are respected, clients should not get abandoned, and terminally ill clients should receive high-quality end-of-life care.

According to the ACA code of ethics, informed consent is necessary for counseling as counselors must review verbally and in writing with their clients the responsibilities and rights of both counselors and clients (ACA, 2014). Counselors must provide all information necessary to allow clients to make informed decisions. Cultural competence is vital during practice as counselors should use appropriate language or a qualified translator or interpreter when necessary. Counselors respect every ethical code associated with working with minors and mandated clients. Counselors avoid imposing their values on their clients.


ACA and AMHCA sections share similarities in the sense that they center on ethical behavior by counselors and how they should relate with their clients. The sections remind me of my internship at a mental health clinic where I worked with specific clients. I had to give them all the details relevant to the care and inform them of my level of study. This led me to some of the clients assigned to me requesting a different counselor, according to them, “a more experienced” person. However, I also gained some clients who were even more comfortable with being with me because they felt they could trust me more and that I was open about my education.

Chapter 16 on
Informed Consent and Informed Refusal reminded me of that internship period because I informed my clients of my study level and allowed them to choose whether to work with me or choose a different professional. I learned a lot from this experience. Chapter 4,
Dignity and Respect, states it is necessary to respect the dignity and worth of everyone. With the clients whom I worked with, I ensured that I upheld my clients’ rights to self-determination, privacy, and confidentiality.


The mechanic scenario is relatable in
Chapter 2 of Ethics Real Life. The scenario indicates that there was no informed consent. While Dr. Jackson met Ms. Huang for three months, the doctor needed to acknowledge that they had no experience working with clients of Chinese descent. The client, Ms. Huang, needed to be fully informed of her treatment, as evidenced by the lack of written informed consent. Question 14 is on practitioners working with culturally diverse groups but needing more cross-cultural knowledge and skills and reflects the doctor’s failure to acknowledge having no experience working with culturally diverse groups. As an intern, my supervisor was very respectful and supportive. Reflecting on question 13, if my supervisor had encouraged trainees to engage in unethical behavior, I would have reported him to the agency’s director. According to chapter 8,
Steps in Ethical Decision-Making, the doctor should have informed Ms. Huang of their lack of experience with clients of Chinese descent as this would have enabled the client to make an informed decision on whether to gain counseling services from the counselor or not.


ACA (2014) ACA Code of Ethics – American Counseling Association. Available at:

 AMHCA (2020) AMHCA code of Ethics, AMHCA Code of Ethics – American Mental Health Counselors Association. Available at:

Pope, K. S., & Vasquez, M. J. (2016). 
Ethics in psychotherapy and counseling: A practical guide. John Wiley & Sons. (Chpts 4 Dignity & Respect, 16 Informed Consent & Informed Refusal, and 8 Steps in Ethical Decision Making).



Informed consent is a crucial aspect of clinical practice. It intends that healthcare workers operate ethically and ensure that clients voluntarily participate with complete information regarding the service. Informed consent had three mandatory principles: disclosure of all relevant facts and figures about the service, voluntariness of the client to accept the service, and competence of the therapist to deliver the service optimally. The therapist must give alternative options or referrals if the client does not wish to accept counseling terms. The involvement of third parties, such as supervisors, should be discussed with the client (Kuhne et al., 2020). Experimental therapy must be contained in the consent form, and the client must willingly agree before service provision.

Moreover, no guarantees or promises about what will happen should be included in the form. The form discusses payment and the policies governing payment. It should contain the therapist’s contacts and the agency’s details. The client should only sign when they understand and agree with all terms and conditions in the consent form.

The video on limitations and extent of confidentiality describes that confidentiality is not absolute. It discusses the situations under which confidentiality can be breached: when the client proves to be a danger to themselves or others. A therapist is a mandated reporter obligated by law to report suspicion of neglect or abuse of a minor, elderly, or disabled individual. The third video is a mock therapy session, and the therapist gives the client options to either stay or have them referred to a different therapist. Discussing the limits of confidentiality is paramount in therapy.


The focus of the second film is new therapists working under supervision. A valid informed consent form uses clear language easily understandable by the client. It must inform the client of their right to refuse services and the risks associated with refusal of service. It makes me think of my time as a trainee. I was required as a trainee to get permission before recording the session for the supervisor’s evaluation. The client must be informed and provide their consent to have their sessions recorded in cases when confidentiality is violated. Furthermore, it is important to be aware that patient identification must not be revealed while discussing client matters with coworkers. This was a great learning experience for me because I had the opportunity to use my knowledge and put it into practice. After challenging instances, supervision is a fantastic arena for debriefing. I always made sure to get informed consent from the clients before working with them. It also made it possible for me to consult my superiors while maintaining the usual confidentiality agreements. Generally, I learned that working under supervision can have immense benefits because it felt like someone always got my back.


The mechanic scenario in Chapter 2 of Ethics in Psychotherapy and Counseling was previously discussed. Concerning the steps from Pope & Vasquez (2016) Chapter 8, I followed the steps in ethical decision-making. The concern in that scenario was a client making defamatory claims about my services. The concern is justified because such claims about my services could have jeopardized my career and the agency’s marketing influence. The incident had implications for both the client and me. The client was self-enrolled into the therapy program, and no third party pushed her to begin therapy. I was emotionally fit to continue providing services to the client. The emotional distress from the negative comments made me incompetent to continue psychotherapy for that particular client. A trusted colleague, my previous supervisor, advised that I attend therapy sessions to deal with the issue before continuing practice. To avoid personal feelings and self-bias from getting in the way of my practice, I consulted with my seniors on what action to take. The alternative approach was to refer the client to a different therapist. After careful consideration, I made a list of alternative therapists for the client. In the future, I will have a good therapeutic relationship with clients and have them be as honest as possible.


Kühne, F., Heinze, P. E., & Weck, F. (2020). Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial. Trials, 21(1), 1-7.

Pope, K. S., & Vasquez, M. J. (2016). 
Ethics in psychotherapy and counseling: A practical guide. John Wiley & Sons. (Chpts 4 Dignity & Respect, 16 Informed Consent & Informed Refusal, and 8 Steps in Ethical Decision Making).

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