ETH8283 - Leadership, Authority and Ethical Decision Making for More Advanced Clinicians presents:


by Charles D. Safford, LCSW

Charles D. Safford, LCSW is President of, Inc., with guidance and input from other senior, Inc. course developers and from NASW GA. Mr. Safford has over 20 years of post-master’s experience as a clinician, and has over fifteen years of experience as a training developer and trainer in business and clinical settings. A live version of this course was presented at the 2001 annual conference of NASW GA.

This course is the copyrighted property of and may not be copied in part or in entirety without the express written permission of For information on how to secure permission to use this course or any part of this course, contact us at:




The objective of this course is to help the counselor understand the process of making ethical decisions, and the importance of leadership issues that are involved in ethical decision making. This training will use a number of scenarios to highlight some of the common ethical dilemmas that counselors are likely to face. When the trainee completes this course, he or she will know:

1) The stages of ethical decision making;
2) The competing elements and principles in ethical situations;
3) Key principles of leadership;
4) Key principles related to professional authority, and the use of professional authority.

This course is designed for mental health clinicians in the intermediate stage of their career.

Course length: 310 minutes or 5 contact hours

Easy Navigation Instructions

You may move through this course by simply scrolling down, using the scroll bar on the right side of the page. You may also move quickly to any specific page in the course by clicking on the Pages tab on the left side of the course. This will open thumbnail pages. Using the scroll bar on the left, simply scroll down to the thumbnail of the page you wish to move to, and click on that thumbnail. The page you have chosen will immediately open.

On the first page of each section, you will also find a navigation button that will allow you to move easily to the next section. To move to the next section in the course, click on this Next Section button.

Prior to beginning this course, you must read the following agreement related to each mental health clinician's ethical obligations towards fulfilling continuing education requirements.


- to complete this course in its entirety
- to complete all exercises contained in this course
- to complete the course post-test
- to complete the evaluation form after taking this course

Your decision to continue at this time constitutes acceptance of this agreement.


Section I: Introduction
Section II: Scenarios
Section III: Leadership, Authority and the Ethical Decision Making Process: Setting the Stage
Section IV: Understanding Leadership
Section V: The Stages of Ethical Decision Making: A Brief Review
Section VI: The Competing Principles and Interests of the Ethical Decision Making Process: A Review
Section VII: Advanced Leadership Issues in Ethics
Section VIII: Analysis of the Scenarios
References and Test



Section I: Introduction

The position of a mental health clinician is one that requires its practitioners to take a leadership position and operate from a position of authority. The mental health clinician who does not will inevitably run into ethical problems. There are two connected reasons why this is so.

1) The position of mental health clinician is one in which expertise is expected. From this expertise, certain kinds of authority are generated, in ways that we will look at later in this training; 2) The nature of the work is such that only experts should do it, and can do it ethically. This fact is actually written into the code of ethics for each mental health clinician in sections that are concerned with the idea of operating within one's area of competence.

As an expert, you will find yourself in a position that tests your understanding of ethical decision making almost every day. Because of the complexity of the work, a factor that is created by the very nature of the work itself, you will be presented with situations whose ethical implications are not easily covered by the codes of ethics that each of the several mental health professions puts forth as guidelines.

The codes of ethics we see and read are fixed and general. The situations mental health clinicians deal with are specific and organic in nature – they change, they mutate, they respond to interventions and become different before one's eyes.

Codes of ethics state as much. The social work code of ethics, for instance, states, “The code offers a set of values, principles, and standards to guide decision making and conduct when ethical issues arise. It does not provide a set of rules that prescribe how social workers should act in all situations.”

It goes on in a later section, "Reasonable differences of opinion can and do exist among social workers with respect to the ways in which values, ethical principles, and ethical standards should be rank ordered when they conflict. Ethical decision making in a given situation must apply the informed judgment of the individual social worker. . . "

As we shall see, when really difficult ethical situations arise, one discovers the limitations of a professional code. One must rely on a deeper understanding of the nature of ethical decision making, as well as a willingness to draw from the wisdom of your colleagues.

In plain English, this means that the mental health clinician is expected to have a degree of individual responsibility for making complex ethical decisions. This is the difficult responsibility of a leader. People expect experts to have the capacity to make good decisions, even when the ground is difficult and complex.

It is for this reason that we will take the approach that we are undertaking here. We will leave the nuts and bolts of ethical decision making to other people in other training programs. The real concern resides in understanding things fully and deeply, not in looking for a strict blueprint to give detailed instructions on how to proceed in any given ethical situation.

This task will consist of integrating three connected areas: 1) The ethical decision making process; 2) The nature of leadership; and 3) The nature and uses of authority. This three part combination allows the mental health clinician to approach complicated ethical dilemmas with much greater clarity and certainty.

We will further integrate our learning by applying what has been learned in an analysis of a number of ethical situations. The analysis of these scenarios will be based upon feedback received from a panel of experts: experienced clinicians who will have been given the same scenarios to study.

Analysis will be further aided by answers given in a prior presentation of these same scenarios to a training audience of almost a hundred experienced clinicians. This analysis was undertaken in a live training program given in October of 2002.

In order for the trainee to ascertain what he/she has learned from this training program, we will present the scenarios first. You will be asked to write down your responses to the scenarios so you can compare them with the answers from our panel.

Later in the training, as part of the test section, you will be presented with new scenarios that will re-test your knowledge and understanding of the principles learned in the course of this training. Let us proceed.