Counseling South Asian Clients - Implica

Potential Conflicts between Cultural Values and the Role of Confidentiality when Counseling South Asian Clients:Implications for Ethical Practice : 

Potential Conflicts between Cultural Values and the Role of Confidentiality when Counseling South Asian Clients:Implications for Ethical Practice Savita Abrahams, M.A., LPC-I Carmen Salazar, Ph.D., NCC Texas A&M University-Commerce

We Will Explore: : 

We Will Explore: Confidentiality as perceived by South Asian population. Meaning of autonomy to clients for whom individuality is considered a flagrant violation of social norms.

We Will Explore: (con’t.) : 

We Will Explore: (con’t.) Ethics of fostering individuality in such a client even if he or she desires it. How a counselor might proceed when the code of ethics mandates confidentiality, but to do so may adversely impact the client.

Eurocentric Worldview : 

Eurocentric Worldview High value on autonomy, individuality, and confidentiality Reinforced through the ethical codes Autonomy and Individuality are closely intertwined

Autonomy : 

Autonomy Individual self-determination; “rights of clients to choose their own directions, act in accordance with their beliefs, and control their own lives” (Remlihy & Herlihy, 2001) Encompasses freedom of thought and action, provided the individual’s actions do not interfere with the rights of others (Meer & Vandecreek, 2002)

Autonomy (con’t.) : 

Autonomy (con’t.) Respect for the client’s right to self-determination requires respect for the individual’s choices about uses and disclosure of his or her own information (Remlihy & Herlihy, 2001) Autonomy and Individuality form the foundation for Confidentiality

Confidentiality : 

Confidentiality Ethical responsibility Legal and ethical limits Foundation of trust in helping relationship

Confidentiality (con’t.) : 

Confidentiality (con’t.) Counselor expectations: How it works Benefits for the client Role of client’s family members

Traditional South Asian Worldview : 

Traditional South Asian Worldview Emphasis on collectivism and family interdependence Individuality is considered a flagrant social norm violation

Traditional South Asian Worldview (con’t.) : 

Traditional South Asian Worldview (con’t.) Counselors are encouraged to assess the client’s worldview Do not assume ALL South Asians value these concepts equally Client’s level of acculturation affects where he or she lies on the continuum of interdependence and independence (Chandras, 1997)

Collectivism & Family Interdependence : 

Collectivism & Family Interdependence Definition of family How is the individual defined, in terms of: Family Identity Adult or child Gender Marital status

South Asian View of Counseling : 

South Asian View of Counseling Not widely accepted Why? It is the family’s business Issues of shame and dishonor Family disapproval

Preferred ProblemSolving Method : 

Preferred ProblemSolving Method Deference to the authority figure in the family Family decision maker unilaterally decides; this person has unlimited authority to do so Display of obedience through acceptance of decision

Implications:Client’s Decision-Making Process : 

Implications:Client’s Decision-Making Process Decisions are not made by thinking of the client’s individual needs exclusively What is best for the client is what is best for the family (Chandras, 1997; Das & Kemp, 1997)

Implications:Confidentiality : 

Implications:Confidentiality Client’s fear or reluctance in disclosing he or she is receiving counseling Potential effect and action by authority figure, if he were to learn the client is receiving counseling services Insistence by family members to be part of counseling sessions (Chandras, 1997; Das & Kemp, 1997)

Risks to client : 

Risks to client Stop counseling, thereby, losing the only source of support Continue counseling and have family members be privy to client’s personal information

Risks to client (con’t.) : 

Risks to client (con’t.) When family members attend counseling sessions, authority figure may dominate, giving client no opportunity to speak Emphasis may only be on negative aspects of client’s behavior and effects on the family

Conflicts between South Asian Cultural Values & Ethical Codes : 

Conflicts between South Asian Cultural Values & Ethical Codes ACA and APA ethical codes have been criticized for the high value on autonomy and individuality (Atkinson, 2004)

Conflicts between South Asian Cultural Values & Ethical Codes (con’t.) : 

Conflicts between South Asian Cultural Values & Ethical Codes (con’t.) Conflicting messages in ethical codes: There is an ethical mandate to understand the cultural background of diverse clients Yet the emphasis on autonomy and individuality reflect the culture, norms, and values of Western society (Atkinson, 2004; Meer & Vandecreek, 2002)

Potential Problems : 

Potential Problems Counselor fails to critique the applicability of Eurocentric values with clients whose worldview embraces collectivism and interdependence Counselor aspires to a cultural understanding while simultaneously upholding the value of individual autonomy

Alternative Viewof Autonomy : 

Alternative Viewof Autonomy Relational Autonomy Emerged from feminist critiques of traditional conceptions of autonomy and individual rights Person is socially embedded Identity is formed within context of social relationships, and shaped by intersection of forces such as race, ethnicity, and social class

Relational Autonomy : 

Relational Autonomy If we view autonomy as self-government and the self as constituted by relations with others, then autonomy is relational (Mackenzie & Stoljar, 2002) More relevant and realistic concept than individual autonomy for clients whose worldview embraces: Selfhood as defined through relationships with others Self-determination as collective rather than individual

Ethical Decision Making ModelRidley, Liddle, Hill, & Li (2001) : 

Ethical Decision Making ModelRidley, Liddle, Hill, & Li (2001) Framework for working toward ethical resolution of cultural conflicts Multicultural responsibility: “a fusion of personal and professional commitments to consider culture during all ethical encounters” (Ridley et al., 2001)

Ethical Decision Making Model (con’t.) : 

Ethical Decision Making Model (con’t.) Counselors may achieve multicultural responsibility by: Examining and making explicit their philosophical assumptions about culture and ethics Examining alternative philosophical assumptions Understanding how culture is always relevant in counseling Developing complex thinking skills and creativity Emotionally investing themselves in multicultural responsibility

Ethical Decision Making Model (con’t.) : 

Ethical Decision Making Model (con’t.) Two partially overlapping processes: ethical consideration of cultural data & ethical resolution of cultural conflicts Each process has two partially overlapping stages: critical reflection & creative problem solving Partial overlap suggests two processes; two stages “are separate but sometimes occur simultaneously in an integrative fashion”

Our Emphasis:Creative Problem Solving : 

Our Emphasis:Creative Problem Solving 1. Be vigilant to view ethical conflicts from multiple perspectives resulting in more possibilities. 2. Be open to sharing the ethical conflict with others, possibly through supervision or consultation.

Our Emphasis:Creative Problem Solving (con’t.) : 

Our Emphasis:Creative Problem Solving (con’t.) 3. Include all involved parties in exploring how the conflict occurred and in brainstorming solutions. 4. Match each possible solution to the ethical conflict, analyzing goodness of fit.

Case Study : 

Case Study Discuss the ethics of fostering individuality in a client whose worldview embraces collectivism and interdependence even if he or she desires it. Describe and discuss how a counselor might proceed when the code of ethics mandates maintaining confidentiality, but to do so may adversely impact the client.

References : 

References Atkinson, D. R. (2004). Counseling American minorities (6th ed.). Boston: McGraw Hill. Chandras, K. V. (1997). Training multiculturally competent counselors to work with Asian Indian Americans. Counselor Education & Supervision, 37, 50-59. Chandras, K. V., Eddy, J. P., & Spaulding, D. J. (1999). Counseling Asian Americans: Implications for training. Education, 120, 239-246. Das, A. K., & Kemp, S. F. (1997). Between worlds: Counseling South Asian Americans. Journal of Multicultural Counseling & Development, 25, 23-33. Mackenzie, C., & Stoljar, N. (Eds.). (2000). Relational autonomy: Feminist perspectives on autonomy, agency, and the social self. New York: Oxford University Press. Meer, D., & Vandecreek, L. (2002). Cultural considerations in release of information. Ethics & Behavior, 12, 143-156. Ramisetty-Mikler, S. (1993). Asian Indian immigrants in America and sociocultural issues in counseling. Journal of Multicultural Counseling & Development, 21, 36-49. Remley, T. P., Jr., & Herlihy, B. (2001). Ethical, legal, and professional issues in counseling. Upper Saddle River, NJ: Prentice-Hall.

References : 

References Ridley, C. R., Liddle, M. C., Hill, C. L., & Li, L. C. (2001). Ethical decision making in multicultural counseling. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds). Handbook of multicultural counseling (2nd ed., pp. 165-188). Thousand Oaks, CA: Sage. Sandhu, D. S. (1997). Psychocultural profiles of Asian and Pacific Islander Americans: Implications for counseling and psychotherapy. Journal of Multicultural Counseling & Development, 25, 7-22.