The black, the white and the grey.

Specialist Wellness Counselling has become an integral aspect of the management of mental health promotion in the South African environment making mental health more accessible to the wider South African community; thus, it is critical to grasp the many ethical problems relevant to the field of Specialist Wellness Counselling in the South African context.

Ethics typically refers to a set of certain, aspirational moral values and principles that are intended to guide ethical conduct (Walsh, 2015).

The primary goals of ethical guidelines are to create the minimum ethical requirements for counsellors to undertake professional wellness therapy. These recommendations give a broad framework that can be used to a variety of ways utilized in practice by specialized wellness counsellors as these recommendations address frequent ethical difficulties that arise from the common components of expert wellness counselling.

Barnette (2007) states that the three most important issues for the best ethical practice include positive ethics, risk management, and defensive practice.

Positive ethics focuses on the constant efforts made by counsellors for achieving the best possible ethical standards. This is mainly guided by aspirational virtues of the therapist to do no harm and provide maximum benefit to the client (beneficence), avoid exploitation and harm to the clients and those associated with the client (non-maleficence), faithful to the explicit and implicit obligations that a therapist is expected to be with their client (fidelity), promoting independence, rather than dependence of the client on the therapist through own actions (autonomy), providing fair and equal treatment, and access to treatment, to all individuals (justice) and taking care of own physical and psychological wellbeing so that they are able to implement the required virtues effectively (self-care) (Barnette, 2008).

Risk management focuses primarily on lowering the risks for counsellors in the form of complaints to ethics agencies or malpractice lawsuits. Risk management is primarily concerned with informed consent, effective recordkeeping, and consultation (Barnette, 2008).

Defensive practice is concerned with the direct protection of the psychotherapist and entails decision-making based on minimizing the risk of negative results for the counsellor (Fisher, 2003). For example, because of the heightened risk, restricting the type of clients accepted for therapy and refusing to accept a certain type of client, such as those with active suicidal ideation and suicidal behavior or those with significant personality problems. In the South African context it is also necessary to notice that defensive practice can be concerned with approaches to diversity in counselling and that the therapist has the moral obligation to practice only in the fields that they are comfortable with due to sufficient knowledge of the clients personal believes, lifestyle and orientations.

According to Blow et al., (2007), the counsellor should be aware that they are an important element of the counselling process because the human contact with clients is the channel through which the work of therapy is done. There is a strong argument to be made that the counsellor, rather than the counselling model, has a greater influence on the result of the counselling process. Thus, regardless of their own cultural and religious beliefs, values, and internal convictions, the therapist must constantly be cognizant of the ethical norms relating to the therapy context and the self.  This fosters more intimate understanding into what clients are experiencing, as well as more intuition into the dynamics of the client’s experience. This will help the counsellor to look beyond the “self” and consider the importance of personal values, culture, and spiritual beliefs, as well as the social influences in the counsellor’s life, such as gender, lifestyle, race, ethnicity, and social location.

In mastering this, it is of importance to always adhere to the ethical standards as laid out by the ASCHP:

  • Retain a high level of competence in the interest of the profession and the public in general.
  • Be aware of the influence of personal morals, ethics, values, and norms on the quality of service.
  • Ensure that public statements are directed at the provision of information in an attempt to assist individuals to make informed decisions in general. Such statements shall be accurate, qualified, and objective.
  • Guarantee the confidentiality of personal information acquired during counseling or instruction and regard all disclosures as privileged.
  • Respect colleagues and individuals in the professional and counselling sphere. Conflicts in direction, evaluation, training procedures and loyalty shall be clearly defined to encourage freedom of participation.
  • Acknowledge the requirements, competence and responsibilities of colleagues and other professional organizations.
  • Undertake research while protecting and recognizing the welfare, dignity and respect of the participants.
  • Terminate counselling as soon as it becomes apparent that no professional contribution can be made as a consequence of a lack of special knowledge or personal limitations.
  • Refer a client to a designated specialist in circumstances which reasonably require such referral.
  • Decline further counselling where a client refuses to recognize a reasonable referral for specialist attention.

The revised Rules and Regulations of the ASCHP also entails counsellors to focus on their humane duty to be friendly, respectful, and helpful to their clients, while upholding the professional duties to be well qualified to enter contractual relationships with clients. Furthermore, it is expected that all legal duties as imposed by common law and by statute law that govern the health professions will be adhered to in the best interest of the client or the client’s wellbeing.

Specialist wellness counsellors should always respect their clients’ human rights, value, and human dignity. This includes their right to privacy, confidentiality, self-determination, and independence.  Specialist wellness counsellors should be aware of the differences between people insofar as age, gender, ethnicity, nationality, religion, sexual orientation, disability, language, culture, marital status and socio-economic status are concerned and strive to eliminate the effect of prejudice based on these differences in their work situation, and they refrain from any such discriminatory practices themselves by being impartial and not judgmental.

Specialist wellness counselling is a special situation, especially in a country like South Africa where the counsellors will work with various and diverse individuals. In this regard it is advised that the counsellor explicitly states what the limitations (including limitations linked to being not comfortable working with certain aspects like differences in cultural believes, religion, and sexual orientation) to the counselling relationship will be. Specialist wellness counsellors should always be honest, respectful, and fair towards everyone.  They should strive to promote integrity in the science, education, and practice of the profession. Specialist wellness counsellors should always be aware of their own convictions, values, needs and limitations and the effect thereof on their work situation.  If necessary, they should clarify those roles with the parties involved and act accordingly.

Author: Kornel Korb