Ethical Decision Making Paper
If you’re up for some reading, this is my Ethical Decision Making Paper about a counselor who decided to sell vitamins and homeopathic remedies in her practice. Enjoy.
Ethical Decision Making Paper: Scenario 3
Liberty University; COUC501
This paper is about making ethical decisions in practical counseling situations. A situation with Amy is utilized as she seeks to make extra income by selling items on her professional web page and in her office. This paper looks at the problems created because of Amy’s decision and what the ACA Code of Ethics has to say about this situation. It also looks at Georgia’s Rules and Regulations. Each of the six moral principles is reviewed to determine how they may impact Amy’s scenario. There is also referenced a few sources to see what others would have to say and lists some people and associations that would be good to contact with this type of question. Six potential courses of action are given and narrowed down to two, one for Amy and one for the author of the paper. The determined action is then broken down into steps so that it can be implemented.
In this scenario Amy most certainly needs extra income. She must meet her expenses and pay for her education. Apparently, her private counseling practice is not covering these expenses and she resorts to an outside source of income. This is still not an issue. The problem arises when Amy brings her outside business into her practice. She now has two differing relationships with her clients. She is a counselor to them and also a salesperson. This could be viewed as a dual relationship and is certainly a boundary crossing. In this capacity, there is the opportunity to use or abuse her influence to increase sales. There is the chance that a client could get upset with her product resulting in issues during the counseling session.
This situation would develop into two likely problems and could result in a third if taken to far. The first is professional. There is the professional issue of selling these items to clients in the office. They could easily be mistaken as fixes to their clinical problems. A client may assume that vitamins and homeopathic remedies are useful resolutions to whatever brought them into the office for counsel. A chiropractor may have a massage device for sale in the office to help with pain. This is directly tied to his practice and may be helpful for certain clients. It could be recommended to those who need it. However, do these vitamins or homeopathic remedies offer any solution for Amy’s clients or is it simply another source or unrelated income? This could cause a professional problem when a client assumes it to be an answer to their problem.
This brings us to the ethical issue. The client making those assumptions, which have already been mentioned, is now depending on them to keep from having further issues. Amy, perhaps unintentionally, is creating a dual relationship that is likely to do more harm to her clients than good. There are times when crossing a boundary can be helpful, but is this one of those times? (Legal and Ethical Issues for Mental Health Professionals, 2008) It seems that Amy’s pursuit of extra income may very well inhibit her practice.
That last two, clinical and legal, are possibilities as well. There may be clinical repercussions if the client stops coming for counseling because he or she now has a homeopathic remedy. The client may also, as mentioned early, refuse to be open in sessions if a certain vitamin was not deemed effective. The legal issues could result if Amy does not make it clear that these items are not a substitute for proper counseling and are not proven to solve the issues dealt with in her counseling practice. Simply having them in the office may cause a client to take them for depression, anger, anxiety, etc. and sue Amy if they did not meet those expectations.
This issue is related to Amy and what she is and is not doing. She is advertising a product on her counseling website and in her office that seems to have nothing to do with counseling nor resolving any problems associated with counseling. As far as we know from the scenario given, she is not making that distinction and is crossing a boundary. Crossing a boundary is not always a negative activity, but, in this case; it appears to hold no positive help and could lead to harm of her clients. (2008)
Apply the ACA Code of Ethics
This area is one which is a little gray. The counselor is the one who really needs to make the decision as to whether they should enter in this relationship at all. The ACA Code of Ethics states the following in A.6.b.
“Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony…purchasing a service or product provided by a client…In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure the judgment is not impaired and no harm occurs.” (2014)
As can be seen here, there is not an exact parallel to Amy’s situation, however, there is mention of “purchasing items from a client” and taking “appropriate professional precautions”. (2014) These seem to flash a huge caution light on what Amy is attempting.
Another section in the ACA Code of Ethics, C.3.f, states this:
“Counselors do not use counseling, teaching, training or supervisory relationships to promote their products or training events in a manner that is deceptive or would exert undue influence on individuals who may be vulnerable.” (2014)
Here we see that it is not unethical to promote a product, but it is unethical to do so in a deceptive way or one that overextends the counselors influence on the client. (2014)
I would also like to take this opportunity to relate Amy’s scenario to the “Rules and Regulations of the State of Georgia”. There are two statements under the heading “Responsibility to Clients”. The first states that “Unprofessional conduct includes, but is not limited to, exploiting relationships with clients for personal or financial advantages”. (2019) Amy may, intentionally or not, be using her status as a counselor to impose her products on her clients in an unethical fashion. Simply having these products in her office and her attempting to coax clients into buying them could be construed as exploiting those clients.
The second statement in the “Rules and Regulations of the State of Georgia is this, “Unprofessional conduct includes, but is not limited to participating in dual relationships with clients that create a conflict of interest which could impair the licensee’s professional judgment, harm the client, or compromise the therapy.” (2019) This dual relationship of business person or sales person to client and counselor to client could cause emotions on either side that may result in Amy giving poor counsel or the client closing off in therapy or leaving altogether. It is a delicate balance that must be maneuvered carefully.
Determine the Nature/Dimensions of the Dilemma
There are several of the moral principles that could apply in this situation. Let me go through each of them. The first is autonomy. This moral principal says that the client has freedom of choice and action. (Forester-Miller, H., & Davis, T. E., 2016) One could say that the client has the free choice to participate in Amy’s new side business or may freely choose to not participate. That is true, however, the counselor-client relationship could cause the client an extra burden to participate.
The second moral principle is that of justice. This principle would mean that Amy must treat each client with the same respect and give the same skill level to each whether or not they choose to buy her products. This could be difficult if Amy feels slighted by a client who decided not to be a consumer of her vitamins and remedies.
The third moral principle is beneficence. This is the idea of doing good and not causing harm. (Forester-Miller, H., & Davis, T. E., 2016) Amy may be capable of not causing harm here and doing good. It is possible that some of these vitamins and homeopathic remedies could be helpful to her clients, but giving these types of items out could put her on the verge of something a medical doctor would need to do. Amy may be walking a thin line by suggesting these remedies, especially the vitamins, as helpful to her client’s problems.
The fourth moral principle is nonmaleficence. “‘This principle reflects both the idea of not inflicting intentional harm, and not engaging in actions that risk harming others.’ (2016) Weighing potential harm against potential benefits is important in a counselor’s efforts toward ensuring ‘no harm.’” (2016) This seems to be a key moral principle. Amy is rolling the dice with this side business being integrated into her counseling practice. She is taking the chance that everything will work out when, in reality, there is a better chance of her clients experiencing harm as a result and almost no chance that this will be helpful to their counseling sessions.
The final moral principle is that of fidelity. This is encapsulated in the word ‘faithfulness’. (2016) A client’s involvement with Amy’s business could improve their trust in her, but if a product or experience did not seem to go well to the client then it would affect the counselor-client relationship in a negative manner.
Sanders talks about these types of relationships. He uses the term “nonsexual multiple relationships”. (2013, p 139) Here he talks about how these types of relationships are not forbidden, but that “the intent of the code is to leave the judgment about rightness or wrongness of an NSMR in the hands of the therapist first, who it is assumed will rely on any or all of the resources at his disposal”. (2013, p 141) Sanders is looking at the APA code rather than the ACA code, but it seems the principles in each are quite similar.
Another source was that of Lynn Gabriel. She states, “I define therapy relationship then, as a contracted relationship between a person in the role of client and a person in the role of therapist for the express purpose of entering into narrative relations aimed at resolving the client’s ‘problem’ or helping them develop their goals”. ( Gabriel, 2005, p 52) This definition gives a distinct purpose to the counselor-client relationship. Amy will need to look at her business and determine if it will help “resolve a client’s ‘problem’ or help them develop their goals”. (2005)
Marriage and family counselor Sharon Erickson says this about multiple or dual relationships, “The problem with multiple relationships is that they can at any time become unpredictable and confuse the current relationship. Even when the second relationship is thought to not be harmful or even to be beneficial, precautions must be taken to prevent potential harm.” (2001, p 302) She goes on to say, “if the relationship is avoidable, avoid it”. (2001, 303)
In Amy’s situation, she is in graduate school. She could consult with her professor. If she has a supervisor in her state she could consult with him or her. In my situation, I would consult with the head of the counseling department at the church I attend. She is a state-approved counseling supervisor so she would certainly have some ideas. I also have a few friends who are licensed counselors. They do live in Michigan so their advice would be more along ethical and moral guidelines than any state legalities that may be involved, but, in this case, that is the main concern.
The simple answer here is the ACA. That would likely be the first association to come to my mind in seeking advice. Georgia has a state division of the ACA and I would seek them out first. Another similar association in Georgia is the Licensed Professional Counselor’s Association of Georgia. Their website has an area dedicated to consultation, giving up to three, 20 minute calls for nonmembers and longer consultations or in office consultation for members. These appear to be good associations to consider and certainly there would be those who have had similar encounters in their private practices.
Potential Courses of Action
There are a few courses of action that Amy can take. She can continue to do as she has been doing, while making it clear to her clients that there is no obligation to buy and that none of these remedies will resolve their counseling problems.
Secondly, Amy could separate her business from her practice. She could create a new website just for selling her products online. She could refrain from using her office to sell her products and purpose to not go to clients homes to initiate sales. She may also want to use a pseudonym on her business’ website so that clients who find her vitamin and homeopathic remedy store online do not associate her counseling practice with that business.
Dropping the vitamin and homeopathic remedy business completely, Amy could change over to selling products directly associated with the problems she talks about in her counseling sessions. She could sell books, videos and audio that deal with the types of problems she encounters. She may find counseling therapy products that would be beneficial to her clients and suggest them to those to whom they would be helpful.
Amy may want to consider having another professional counselor join her in her practice or she could join them to help reduce costs. This could save her the money that she is attempting to earn.
A similar option is to drop the private practice altogether and find an organization with which to practice counseling. It would eliminate most of the costs of her private practice and she would have the money she then needs without taking on a second business.
Lastly, I would suggest that Amy look at classes she is taking in graduate school. Could she reduce the number of classes and take on more clients? Is she attempting to pay for graduate school all out of pocket? Taking out a loan could relieve the pressure for a short time until graduate school is completed and then she could take on more clients to pay off her student loan.
Consider Consequences / Determine Course of Action
The first option to continue as she is doing while telling clients that there is no obligation to buy and that these items will not help resolve their problems sounds too difficult and confusing for clients. It will not solve anything but will likely end up creating more problems.
The second option of separating the two businesses is possible, but it is going to be quite a bit more work and take much more time. Amy has graduate school and a private practice. She does not have time for a completely separate business. It also has a huge potential to create problems because a client somewhere down the line is going to discover that Amy runs the vitamin and homeopathic remedy business. This will lead back to the previous issues.
The third option of selling counseling related items is definitely a possibility. There is still the difference in relationship of a business and a counselor, but the products are now of benefit to the client and the counselor has a much better explanation to any ethical board that may question her motives. Amy would have to maintain that purchasing products does not affect the counselor-client relationship nor the quality of the counseling sessions.
The fourth and fifth option are similar in that both require finding another person or organization. These options only work if there is an opportunity for employment somewhere else or if there is another counselor willing to join with Amy. The fifth possibility, especially, would eliminate Amy from having a private practice. If she is determined to maintain a private practice then this is not a path she would want walk down. She would also need to decide what would happen with her current clients. Do they go to another counselor or would they be able to still be counseled by Amy at her next position?
The last option may depend much on whether Amy is comfortable with taking out a loan or has the ability to do so. Taking less classes would need to be determined by whether she would be able to complete her program in the time allotted while taking fewer classes.
It seems to me to boil down to options three through six. Much of this depends on what Amy desires to do. I’m going to assume that she wants to be in a private practice. As a result, I would eliminate option 5, finding a counseling position at another organization. Going by Amy’s current model, I think that she would go with option three. She has already shown that she is capable of selling items. I think that Amy would be able to sell counseling related items while maintaining her private practice. I did look online and there are websites with such items and even seminars that one can attend to help a counselor sell these items at their practice.
Having said all of that, for myself, if I wanted to maintain a private practice, I would likely go with the last option. I have attempted to sell products in the past and I do not really like that position. I doubt I would be successful with it and would most likely become more frustrated at all of the extra work that it would take to make money from it. I would likely take out a loan in order to free up some finances or reduce the number of classes I was taking or both. I can say this because that is what I have done to take these classes. I can then take money I have to put toward schooling as I am able and, after I am finished, dedicate more money toward school loans. Also, due to no longer having classes after I have completed the program, I can take on more clients to help cover the costs of those loans. If I wanted to begin selling counseling related items after I am finished school then that would be an option as well, but I would want to consult with other counselors who have done that previously to learn how to avoid any pitfalls and still continue to benefit my clients.
Implement the Course of Action
The first course of action would be to stop selling vitamins and homeopathic remedies. The advertisements for that on Amy’s website would need to come down and the products removed from the office. She may want to bulk sell all of the items to someone who would like to get into that business. For any clients who wanted to continue buying those items, she could refer them to another seller letting the client know that she no longer sells those products.
For her resolution, she would want to meet with counselors who sell counseling related items as part of their practice. She needs to find out what products are most beneficial to the client and price ranges. She would need to find out how they advertise without being pushy, especially onto their own clients. She should ask about how selling these items affects the counselor-client relationship and how to properly maintain that relationship. Amy may also benefit from a seminar about selling items in her practice, while being careful that she isn’t being manipulated by a product-placement salesperson. It would be best to check with national and state associations to verify any seminar she would consider attending.
After gathering all possible information, Amy could set up her items online and in the office. She would still need to be certain that she isn’t suggesting any items that would not be beneficial to clients and that she does not hold any animosity toward those who do not buy items.
If it was me, then I would need to follow the same first step as Amy, but then check with the school about classes and look into loan options. I would also do well to determine my personal budget and how this would work into a scenario with a school loan.
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https://www.counseling.org/resources/aca-code-of-ethics.pdf
Erickson, Sharon H. (2001, July 1). Multiple Relationships in Rural Counseling. The Family Journal, Vol 9, Issue 3, pp302-304. Retrieved from https://journals-sagepub-com.ezproxy.liberty.edu/doi/pdf/10.1177/1066480701093010
Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev. ed.). Retrieved from http://www.counseling.org/docs/default-source/ethics/practioner’s-guide-toethical-decision-making.pdf “
Legal and Ethical Issues for Mental Health Professionals, Vol. 2: Dual Relationship Boundaries, Standards of Care and Termination” [Video file]. (2008). Retrieved from https://search-alexanderstreet-com.ezproxy.liberty.edu/view/work/bibliographic_entity%7Cvideo_work%7C1779008?utm_source=aspresolver&utm_medium=MARC&utm_campaign=AlexanderStreet
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“Rules and Regulations of the State of Georgia: Chapter 135-7 Code of
Ethics”. (2019). Retrieved from http://rules.sos.ga.gov/gac/135-7
Sanders, Randolph K. (2013). Christian Counseling Ethics: A Handbook for Psychologists,
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