There are three parts to ethical decision making that will be covered in the next three sections of the training. They work together in complicated ways and ideally would be presented simultaneously, not sequentially.

The first section will look at different steps, or stages, of making ethical decision, describing all that is involved in a step by step approach.

The second section looks at the competing interests and principles involved in ethical decision making. It will look at some general understandings of how to rank order the different principles and interests as they occur in counseling situations.

The third section will cover defining the nature and boundaries of the therapeutic relationship. Specifically, we will be looking at two important questions:

Who is the client?

When is the client a client?

Learning the process of making ethical decisions is more than simply learning the code, or codes, that are applicable to each clinician's licensure in the state in which he or she practices. The code of ethics for clinicians is derived from the ethical decision making process, but is not sufficient in and of itself to cover every ethical situation.

The language of the code is constructed to speak of discrete and concrete issues, such as "harm to the client", or "the best interests of the client", with modifying terms such as "reasonable efforts" and "reasonably clear". There are many shadings and degrees of "harm" and "best interests" that can occur in real life ethical situations. And one person's "reasonable efforts" are another person's "undue burdens".

Clearly, there is much room for confusion even in a very strict reading of the ethical code. The clinician is often left to consider the shadings and meanings of the code according to how he or she can best understand or decipher it.

There is also the problem of confronting more than one element in an ethical decision. The code is sometimes written as if an ethical dilemma will only contain a single element to consider. The truth is there are at times multiple elements that compete and conflict with one another.

Moreover, there are differences between various codes of ethics. A clinician may be in compliance with the code from his or her state licensing board, and in violation of the code of the national body for his or her professional group. A clinician may have two different licensures with different codes of ethics.

This is because different groups and different individuals can come to different conclusions about specific ethical situations, even when using a similar ethical decision making process.

The process of making ethical decisions is, ultimately, the responsibility of the individual clinician. The balancing of the different elements in making an ethical decision, and the balancing of the different interpretations that show up in the codes, are not going to happen in theory. They are going to be presented to the clinician in real time with real situations with real people.

For this reason, the orientation of this program will be towards an in-depth understanding of the elements that are involved in ethical decision making. It is still important for the clinician to know the code or codes of ethics under which he or she operates. But the code of ethics is a summation of what is known at given points in time about certain ethical understandings.

Ultimately, it is far more helpful for the clinician to understand both the code and the ethical decision making process in order to navigate the complex and confusing situations that can occur in real therapeutic relationships. 

Throughout this program, reference will also be made to the overall process of ethical decision making which is fundamentally integrative in nature. Towards this end, has developed form to provide structure and focus to the essential elements of ethical decision making. This form is called the Ethical Decision Process Worksheet, and it may serve as both a tool for organizing a robust ethical decision making process and a tool for recording the process in a manner that may be used within the client record to demonstrate the steps taken to ensure that the right ethical approach has been undertaken. Built into this form are the steps and stages of the ethical decision making process, with each of the stages noted in sequence. These steps and stages will be addressed more thorough in a later section. 

Below is copy of this form, with each of the elements noted:


                  Ethical Decision Process Worksheet

Client Name:                                                    Date/Time:

Nature of ethical dilemma:

Knowledge Stage:

What knowledge must be known to address this ethical dilemma? (laws and statutes, regulations, code of ethics sections, moral considerations, etc.)

Identification Stage:

What ethical principles and considerations are in conflict?
What model(s) of ethical decision making will be used to address this ethical dilemma?

What other parties will be involved in examining and resolving this ethical dilemma?

What are the best potential solutions to resolve this ethical dilemma?

Evaluation Stage:

What are the strengths and weakness of each potential solution (Apply the Consequentialist test, Fairness test, Enduring Values test, Light of Day test)?

Selection Stage:

What solution has been selected to address the ethical dilemma?


Assessment Stage:

What occurred as the result of the implementation of this selection?

Adaptation Stage:

What changes to the ethical decision were implemented based upon assessment of the outcomes of the initial ethical decison?


Post-test Preparation: Review questions

At this point in the training, the trainee should be able to answer the following questions:

True or False: The code of ethics for any of the mental health professions is not sufficient in and of itself to solve all ethical dilemmas.