Old+Q1

Mark Hopkins works with a private Christian counseling center. Mark’s particular religious philosophy and belief is that homosexuality should not be encouraged. A new client, Peter Hall, has come to his first counseling session with the stated intention of improving his relationship with his partner, Rick Johnson.
 * Case #3: Mark Hopkins, LCPC**

__Define the Problem/Dilemma__: What are the core problems (legal, ethical, clinical, professional, moral or a combination)?

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Following is a draft of Q1 for the ppt. The star-breaks ( * * *) suggest break points between slides. I've tried to incorporate and organize what everyone posted, add some information, and make some decisions pertaining to content. Some of the formatting went askew in the transfer from Word into wiki (e.g. some things are centered, some left-justified; some things italicized, some not). Feel free to amend. Thanks. Sarah

The core problem is the clinician's values are in conflict with the client's values, and this problem has legal, ethical, clinical, professional, and moral dimensions. * * *  Legal Dimensions * * * Article by Herman and Herlihy (2006) “Legal and Ethical Issues in Counseling Homosexual Clients”

Case: //Bruff v. North Mississippi Health Services, Inc.//

“From a legal perspective, the court case clarifies that refusing to counsel homosexual clients on relationship matters can result in the loss of a therapist’s job” (Corey //et al//, 2007, p. 139).

* * * Maryland law stipulates: “A counselor may not:

(a) Place or participate in placing clients in positions that may result in damaging the interests and the welfare of clients… (b) Condone or engage in discrimination based on …sexual orientation…”. (COMAR, 10.58.03.05.05) * * * Ethical Dimensions // According to Remley, 1996, "Ethics //represents aspirational goals, or the maximum or ideal standards set by the profession, and they are enforced by professional associations, national certification boards, and governemtn boards that regulate professions" (Corey et al, p. 14) * * * // There are two points in the ACA Code of Ethics that come into play: avoiding harm and personal values. // // * * * // Avoiding Harm

“Counselors act to avoid harming their clients … and to minimize or to remedy unavoidable or unanticipated harm.” (ACA Code, A.4.a)

* * *

Personal Values

“Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients….” (ACA Code, A.4.b.)

* * * Clinical Dimensions * * * It is unknown the extent to which Mark is aware of his values and if or how these values affect his clinical work. There is risk that Mark would impose his values, either actively or passively, and so do harm to his client. It is possible, however, as Hermann and Herlihy (2006) advise, that Mark could engage in clinical practice with “nonjudgmental and accepting attitudes, regardless of [his] own value system” (Corey //et al//, p. 139).

* * * Professional Dimensions * * * Setting: A Private Christian Counseling Center Hermann and Herlihy (2006) suggest that counselors “might choose to work in setting that are compatible with their values” (Corey //et al//, p. 140). It is not known if Mark’s religious philosophy and belief is “compatible with” the values of this counseling center.

* * * Disclosure Hermann and Herlihy (2006) identify two points at which disclosure should occur: (1) advertising and (2) informed consent.

* * * (1) Advertising Counselors should “advertise [their] values to potential consumers of counseling services” (Corey //et al//, p. 140).

* * * (2) Informed Consent Further, Hermann and Herlihy (2006) state that counselors “have an ethical duty to avoid harm to clients by ensuring that counselors’ informed consent procedures provide potential clients with adequate information about counselors’ values” (Corey //et al//, p. 140).

* * * Moral Dimensions "Morality is concerned with perspectives of right and proper conduct and involves an evaluation of actions on the basis of some broader ... religious standard" (Corey et al, p. 14). * * * Mark’s particular religious philosophy and belief is that homosexuality should not be encouraged.

Mark Hopkins' values pose an ethical dilemma for counseling his client, Peter Hall, about his homosexual relationship with his partner. If Mark imposes his own values on his client, either actively or passively, he will also not be able to meet professional standards of behavior (ACA standard). Mark needs to be fully aware of the depth of his discomfort with homosexuality. If he is unable to be open and set aside his own beliefs, he may not be able to provide adequate counseling services to Peter Hall and should refer him to someone with the expertise in counseling gay/lesbian clients or someone more open than Mark. Personally, I think someone in counseling who has such strong beliefs about homosexuality perhaps might not be fully aware of the issues behind these strongly held beliefs and may not be a good judge of whether he can provide adequate counseling services. If I were the client, I would not want to work with a counselor who felt homosexuality was wrong. So another dilemma for Mark is whether he should discuss this with the client before working with the client or referring him. That discussion feels like a moral obligation to me. (Susan)

The presenting issue is the clinician's personal values are in conflict with the client's values. This may cause biases and may harm the therapeutic relationship and the client.Since this is a private Christian facility, I wonder what the policies on this issue for this organization. This moral obligation can not impede on the client because it then violates ethical morals. (Gerdine)

On reading ahead in Chapter 4 (p. 139) there is a discussion of the Bruff case, which is similar to our case study. Bruff was a therapist at a hospital who refused to counsel a gay client. The hospital tried to make accommodations for her, but eventually fired her. One of the legal points in the case was that Bruff's unwillingness to work with anyone who has conflicting beliefs is not protected by the law. And, a counselor who refuses to work with homosexual clients can cause harm to them. **The refusal to work on a homosexual client's relationship issues constitutes illegal discrimination.** You can't use religious beliefs to justify discrimination. So while I think Mark would see this initially as a moral dilemma, it quickly becomes a professional, ethical, and especially, a legal dilemma. (Susan).

I think the answer (above) covers the core problems. My statement of the core problem is close to what Gerdine has said. I would say, "The core problem is the clinician's values are in conflict with the client's values." I would then organize a discussion of the answer by legal, ethical, clinical, professional, and moral aspects of the problem. (Sarah)

Here's Michael's post: First of all, I think it's extremely important to point out that the organization in question is a __private__ Christian counseling center (whose official position is most-likely not supportive of homosexuality). As such, I don't believe that Mark Hopkins' reluctance to provide counseling would be illegal in this case. Having said that, the counseling center should either advertise it's views regarding homosexuality or have Hopkins clearly inform Peter Hall at the outset of his personal values. Testing...testing....

From a clinical standpoint, Hopkins' negative views toward Hall's lifestyle if he were to take Hall's case would be certain to hinder the therapeutic process. Absent an overnight change of heart, it would unwise clinically, not to mention unprofessional and unethical for Hopkins to take up Hall's case.

In terms of ethics, allow me to share the following...According to "Hermann and Herlihy" from Corey (2007), "counselors who discriminate based on sexual orientation are violating ethical standards." Nevertheless, even they would say that Hopkins made a responsible decision about where to work given his views (p.139).

In short, the main issue here may just be moral; perhaps one could argue that Hopkins would be a more fully developed person if he were to develop a more accepting attitude towards the issue of homosexuality. (Michael) This is actually pretty interesting, given that nothing has “happened” yet—we only know about the personal values of the counselor, and we have to make some assumptions about the organization he works for. “Christian” does not necessarily imply an anti-homosexuality stance, although it is probably a reasonable assumption that Mark Hopkins’ views are in line with the place he chooses to practice. The crux of this issue lies with the question: “What does he do next?” There are potential ethical, legal and moral issues involved in this scenario. (And, arguably, professional issues as well.)

If he chooses to “work his own agenda” with this client he would potentially be in violation of two aspects of the ACA ethics code, the mandate to avoid harming clients (A.4.a) and the mandate to avoid imposing his values on the client (A.4.b.).
 * Potential Ethics Issues **

// A.4.a. Avoiding Harm // “Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.”

// A.4.b: Personal Values // “Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.” --ACA Code of Ethics

There are several laws which govern what Mark Hopkins should do. Maryland law (COMAR, 10.58.03.05. 05) makes the following stipulations which would preclude Mark from agreeing to see the client if he were to allow his own values to govern his work with Peter: “A counselor may not: (a) Place or participate in placing clients in positions that may result in damaging the interests and the welfare of clients, employees, employers, or the public; (b) Condone or engage in discrimination based on age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status;” Moral issues would be created for Mark if he chooses to counsel the client in ways that conflict with his strongly held personal beliefs.
 * Potential Legal Issues **
 * Potential Moral Issues **

Final Analysis: Mark should not work with this client, but rather make an appropriate referral. (DANA)