Importance of Initial Consultation and Ethical Issues Facing the Therapist

Category: Confidentiality, Ethical Issues, Psychotherapy

Last Updated: 24 Jun 2020

Pages: 9 Views: 658

Introduction

This paper discusses why the initial consultation is so important and what factors an ethical therapist will cover in this aspect of the therapy process. It also tackles the ethical issues besetting a therapist in the conduct of his profession dealing with psychotherapeutic counseling and hypnotherapy and counseling skills. The role of a therapist in the behaviour alteration of his or her client is so vital that it is necessary to observe some ethical considerations in the practice of his profession.

Importance of initial consultation

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An initial consultation is the first of the stages of psychotherapy and generally includes a discussion of the reasons as to why the client is seeking psychotherapy help and what he is hoping to obtain from the experience. Why it is important is because it provides an opportunity to find out whether the needs, interests, and goals of the client fit with the skills of the therapist. This stage also provides the initial clarification about the limits of confidentiality, therapeutic approach, and other terms of professional services. Moreover, the initial consultation helps both the client and the therapist to gauge whether each is likely to be able to work with the other successfully (Plante, 2011). The importance of initial consultation is also found in making a formal determination of the client’s fit for a psychotherapeutic relationship and potential for meaningful change (Klonoff, 2010). Whilst informed consent is shown as important in the therapy process, with a clear description of the limits of confidentiality, full informed consent to treatment has been mandated by ethical guidelines. If for example, a client approaches a therapist for initial consultation, informed consent to treatment may involve information on behavioural therapies demonstrating effectiveness and rapid changes in the treatment of the behavioral problem that the client is complaining about (e.g. panic) (Weiner and Hess, 2006).

Further, initial consultation is important because it is where a range of decisions are in terms of whether to schedule a second session. For example, the client may evaluate whether it is adequate to have his or her needs be met by working with the therapist, as well as whether the practical terms of the therapy are acceptable to the client. In addition, considering the information thus provided during the consultation session, the therapist may ascertain whether he or she possesses the needed expertise to work effectively and successfully with the client (Klonoff, 2010).

Another importance of initial consultation is that it allows initiating a collaborative relationship between the client and the therapist and evaluating initial consultation efforts. If the therapist happens to assess a need for consultation services, then the entry stage would then initiate a consulting relationship. The value of initial consultation is seen in the establishment of a voluntary and collaborative consulting relationship between the counselor and the client. Different role expectations can lead to resistance on the part of the client, which thus necessitates a vital importance of agreement relating to role expectations to reduce such potential resistance. An initial step in evaluating a client’s condition is establishing an accurate diagnosis, which is done during the initial consultation (Boylan et al., 2011).

Much as the above are important for conducting an initial consultation, it is also because such consultation may potentially lead the client not to continue further services. The client may come to a decision that the therapist, for some reason, cannot adequately meet his or her needs. For example, he or she may find the therapist as being too direct, aloof, expensive, inexperienced, young, old, etc., and thus may conclude that the therapist’s qualities are not fit to his or her needs. The client may also feel better after the initial consultation and may no longer feel compelled to continue further sessions. Similarly, the therapist may decline from providing continued services for a variety of reasons, such as the client’s revelation of an alcohol problem, about which the therapist might decide to refer him or her instead to a specialist in the treatment of problems relating to substance abuse (Plante, 2011).

Alternatively, there are times that patients are referred by their physician right after discharge from an inpatient rehabilitation setting. Of note, the one seeking therapy for the patient is in fact not the patient himself but the patient’s family. Perceptive health care professionals are the ones who usually recognise a need for psychotherapy by the patient, with an emphasis on coping, psychoeducation, and deficit adjustment. Therefore, it must not always be assumed that it is the client who is motivated to seek psychotherapy (Klonoff, 2010). In cases of patients being considered for psychotherapy, a physician’s referral is needed, in which relevant medical records must be acquired to determine whether the patient is appropriate for therapy as well as whether he or she anticipates potential psychotherapeutic needs and challenges. It is during the initial consultation in which records are presented after being obtained and reviewed in advance in order for the therapist to thoroughly understand what the client has gone through or is going through (Klonoff, 2010).

Therefore, without the initial consultation, psychotherapeutic intervention might not be sufficient and effective enough.

Ethical issues faced by therapists

The psychotherapist is guided by ethical standards and codes that provide professional standards aimed at guiding their ethical conduct (Kohlenberg and Tsai, 2007). One ethical issue faced by a therapist in terms of initial consultation is whether to provide the consultation free of charge to the client, as some clients who have taken up this offer tended to decide to continue in counseling because of being obliged to do so. This would prompt a concern whether the therapist has violated any portion of the code of ethics (Welfel, 2013). There are some who do not charge for initial consultations, and it is important that the client is informed whether the therapist does or does not charge for the first session (Wheeler, 2014). A potential problem may ensue with the use of a free initial consultation. This is because clients may feel committed after the initial consultation and may have difficulty declining further treatment because the initial consultation was free of charge. Some might even regard this practice as taking advantage of clients and may perhaps be seen as undue influence mentioned in the code of ethics (Welfel, 2013).

Another ethical issue that may ensue during initial consultation is sexual attraction between the client and the therapist, which is identified as a boundary ethical issue (Houser et al., 2006). The client may have emotional or sex-related problems that he/she initially presents to the therapist, which the therapist must approach objectively. Albeit discussion of these feelings can foster therapeutic progress, it is still unethical and counter-therapeutic to act on them. Even when it may seem sound to become sexual with a client with sexual problems as an intervention, engaging in such unethical activity is definitely against established ethical standards and codes. Rather, the best intervention that the therapist may adopt for his/her client with sexual problems is sex therapy with the client and a significant other.The several malpractice suits filed against therapists relating to sexual relationships with their client only confirm the unethical and counter-therapeutic stance of sexual relationship between the therapist and client (Kohlenberg and Tsai, 2007). Even at the onset of the initial consultation, sexual attraction may already spark, which the therapist, being the more responsible person, must put a wall against.

Emotional tyranny is also a common ethical issue that may occur even during an initial consultation. It is a term describing abuse of power by psychotherapists to the disadvantage of their clients, caused by the power imbalance between them. For example, during the initial consultation, the therapist’s power is seen in how he establishes the therapy session, how long the session should last, how often he and the client should meet, how much the session costs, and what the permissible and impermissible behaviour must be within the session (Kohlenberg and Tsai, 2007). The realm of ethical decision-making involves the aspects of ethical dilemma, the client and the therapist’s values, race, gender, personal history, etc.; local and national laws; professional knowledge; and codes of ethics (Houser et al., 2006).

The therapist may also face violations relating to dual relationships. Such relationships are nonsexual that may involve counseling a friend, relative, or neighbour, as well as receiving referrals from people who know the client and the counseling process. An ethical dilemma of dual relationships may potentially occur when the therapist has several roles with a client; in that apart from being a client, the person is also a friend, a neighbor, a relative, etc. to the therapist. It has been suggested that accepting referrals from existing clients may constitute a boundary violation (Houser et al., 2006). Indeed, even at the initial consultation, the therapist is already face-to-face with the issue of whether to continue with the professional relationship, or terminate it right away upon seeing his or her friend across the table as a client seeking therapy.

Self-disclosure is another ethical issue besetting the therapist. Even during the initial consultation, the issue of self-disclosure may occur. Relating to this issue, it is important to determine the extent of information a therapist should share with the client and the types of self-disclosure to be made as well. Another example of ethical issue involving boundary is socialising with a client outside the counseling session and negotiating for fees (Houser et al., 2006).

One possible ethical dilemma facing the therapist during is confidentiality, which deals with maintaining privacy and non-disclosure of information to others outside the counseling relationship, unless the client expresses consent to do so (Jenkins, 2007; Houser et al., 2006). Whenever the client enters the counseling room for the first time, he or she already expects that anything being discussed with the therapist would be kept confidential. It has been found that violations of confidentiality were a common complaint made against therapists and counselors. The client, even in the initial consultation, already begins disclosing some personal matters to the therapist, which the therapist is expected to keep confidential as his legal duty. Of important note however is the fact that confidentiality is not absolute and that there are times in which the therapist may divulge certain information a necessary (Corey, 2013; Houser et al., 2006). Examples of these are those surrounding harm that may involve the client who is contemplating about suicide or is expressing thoughts about inflicting harm to others; court-involved clients; child abuse reports; and clients with medical conditions who express engaging in precarious acts relating to their condition (e.g. HIV) (Houser et al., 2006).

Further, it was found that successful outcomes ensue when clients change their personal values and take a close resemblance of that of the therapist/counselor. A relevant ethical dilemma with regard to this is in order for the counseling to be successful, how similar the client’s values must be to the counselor. Moreover, another dilemma is whether fostering such similarity is ethical and helpful enough to the client. A question for the profession is whether therapists utilise moral and ethical frameworks reflecting society’s norms as the only basis of their ethical decision-making, or whether therapists come to an ethical decision whilst taking into account the values, morality, and ethical stances of their diverse client population (O’Donohue and Fisher, 2009; Houser et al., 2006). These issues are being dealt with even upon an initial consultation.

Conclusion

This paper dealt with the importance of initial consultation and the ethical issues facing the therapist in the performance of his profession. An initial consultation is important because it forms the basis of the client’s diagnosis. It generally covers finding out the reasons as to why the client seeks help and what he or she aims to obtain as a result of the psychotherapy experience.

The ethical issues faced by the therapist in the conduct of his profession during the initial consultation are those involving a decision to charge the client for a specific fee or not for the initial consultation; potential sexual attraction between them; the issue of confidentiality and client consent; emotional tyranny; violations relating to dual relationships; and self-disclosure. Having laid down these ethical factors besetting a therapist, the conclusion being arrived at is that the therapist is bound by set standards and ethical codes through which the expected functions of his performance must be based, and that he/she should conduct the initial consultation and further sessions objectively.

References

Boylan, J. C., Malley, P. B/, and Reilly, E. P. (2011) Practicum Internship: Textbook and Resource Guide for Counseling and Psychotherapy. Third Edition. NY: Brunner-Routledge.

Corey, G. (2013) Theory and Practice of Counseling and Psychotherapy. Ninth Edition. Mason, OH: Cengage Learning.

Houser, R., Wilczenski, F. L., and Ham, M. (2006) Culturally Relevant Ethical Decision-Making in Counseling. London: Sage Publications, Inc.

Jenkins, P. (2007) Counseling, Psychotherapy and the Law. London: Sage Publications, Inc.

Klonoff, P. S. (2010) Psychotherapy After Brain Injury: Principles and Techniques. NY: The Guilford Press.

Kohlenberg, R. J. and Tsai, M. (2007) Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. NY: Springer.

O’Donohue, W. T. and Fisher, J. E. (2009) General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy. NJ: John Wiley & Sons.

Plante, T. G. (2011) Contemporary Clinical Psychology. NJ: John Wiley & Sons.

Weiner, I. B. and Hess, A. K. (2006) The Handbook of Forensic Psychology. NJ: John Wiley & Sons.

Welfel, E. (2013) Ethics in Counseling and Psychotherapy. Mason, OH: Cengage Learning.

Wheeler, K. (2014) Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-to Guide for Evidence-Based Practice. NY: Springer Publishing Company, LLC.

Bibliography

Boylan, J. C., Malley, P. B/, and Reilly, E. P. (2011) Practicum Internship: Textbook and Resource Guide for Counseling and Psychotherapy. Third Edition. NY: Brunner-Routledge.

Clarkson, P. (2005) Transactional Analysis Psychotherapy: An Integrated Approach. NY: Routledge.

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Corey, G. (2013) Theory and Practice of Counseling and Psychotherapy. Ninth Edition. Mason, OH: Cengage Learning.

Forrest, G. G. (2010) Self-disclosure in Psychotherapy and Recovery. Plymouth: Jason Aronson.