Excelsia College

School of Counselling
Ethical Issues and Practice
Week 13A
Ethics When Working with Diverse
Client Groups

1
 Devotion

Speak up for those who cannot speak for themselves, for

the rights of all who are destitute. Speak up and judge
fairly; defend the rights of the poor and needy.

Proverbs 31:8-9
 Objectives & Structure

• Explore ethical issues when working with diverse

groups of people including:
• Children & Young People
• Aged Population
• Intellectual Disabilities
• Sexual and Gender Diversity
• Cross Cultural Diversity
Children & Young People
 Ethics And The Law When Working With
Young People

• Child clients differ from adults

• Therapy has to be safe for all participants
• Parents need to know information about their
children so they can take care of them
• Child clients have the right to confidentiality
• Parents have the right to regular progress
updates
 Child Clients

• Counsellors working with children:

• Should undertake relevant training
• Comply with government “Working with Children”
regulations
• Provide proof of a Working With Children Check
 Working With Children Check...

• A prerequisite for anyone in child-related work

• A national criminal history check and review of findings
of workplace misconduct
• The result of a WWCC is:
• a clearance to work with children for five years, subject to
ongoing monitoring, where relevant new records may lead
to the clearance being revoked
• or a bar against working with children
• The Check is fully portable which means it can be used
for any paid or unpaid child-related work in NSW for as
long as the worker remains cleared
 Definitions: “Child” & “Young Person”

• Most laws define a “child” as a person under 18 years

of age; however, The Children and Young Persons
(Care and Protection) Act is a bit different
• Child - under 16 years of age
• Young Person - 16 or 17 years of age
• Child 10 or older may be presumed capable of giving
proper instructions to a legal representative (Section 99)
[Link]/acts/[Link]
 What Is The Age Of Consent?

• It is an offence to have sexual intercourse with a person

without their consent
• The age of consent is an age at which a young person is
deemed capable of consenting to sex
• In NSW, that is 16 for both homosexual and heterosexual
intercourse
• There is NO CONSENSUAL SEX with any child under the
age of 16
• The law prohibits two children under 16-years-old from
having sex
• BUT if one is over 18 yrs of age, they are guilty of a sexual
offence; the person under 18 is the victim of sexual crime
 Consent For Counselling

• 0-8: Parents or legal guardians are the client and

gives consent
• 8-14: Parents are still the client, however
• Issues of confidentiality discussed with client and
parent/s
• Minors 12 - 14+ : grey area, can make an
informed consent, can be considered the client if
they have the capacity and maturity to make an
informed choice
 Child Clients- Confidentiality

• Limits to Confidentiality

• Counsellors may breach confidentiality when there is

risk of serious harm (i.e. drug use, sexual behaviour,
self harm, suicide)

• Disclose only what is necessary to protect the child

 Counsellors Are Mandatory Reporters Of
Risk Of Harm

• A person who, in the course of his or her

professional work or other paid employment delivers
health care, welfare, education, children's services,
residential services or law enforcement, wholly or
partly, to children; and
• A person who holds a management position in an
organisation, the duties of which include direct
responsibility for, or direct supervision of, the
provision of health care, welfare, education,
children's services, residential services or law
enforcement, wholly or partly, to children
 Moral Obligation

• Anybody who has reasonable grounds to suspect

that a child or young person is (or that a class of
children or young persons are) at risk of significant
harm may make a report
 Making a Report

• To make a report, a phone call is sufficient, and it may be

made anonymously
• Reports can be made 24 hours a day, 7 days a week
• Must be made ASAP - for health professionals within 48 hrs
• May be professional misconduct consequences if abuse not
reported or adequate steps not taken to make an ethical
judgement.
• Phone number :
• For mandatory reporters is: 133 627
• For the general public: 132 111
• Mandatory Reporter Guide
[Link]
 What Constitutes Abuse?

• Physical Abuse
• Child
• Neglect -
• Lack of age appropriate • Medical Care - non–
supervision medical professionals
• Physical Shelter/ • Mental Health Care
Environment • Education - Not Enrolled
• Food
• Education - Habitual
• Hygiene/Clothing Absence
• Medical Care - medical
professionals
 What Constitutes Abuse?

• Sexual Abuse: • Psychological Harm:

• Child • Child/Young Person is a
danger to self and/or
• Young Person
others
• Child/young person • Carer Concern
problematic sexual
behaviour towards other • Substance Abuse
children • Mental Health
• Relinquishing Care • Domestic Violence
More information at: • Unborn Child
[Link]
lies/Protecting-kids/reporting-
child-at-risk
 Significant Risk Of Harm

Policy definition
• What is meant by ‘significant’ in the phrase ‘to a
significant extent’ ?
• That which is sufficiently serious to warrant a response by
a statutory authority irrespective of a family’s consent…
• Is not minor or trivial and may reasonably be expected to
produce a substantial and demonstrably adverse
impact on the child or young person’s safety, welfare or
well being
• In the case of an unborn child, …after the child’s birth
• Significance can result from a single act or omission or
an accumulation of these
Aged Population
 Working With Aged Populations

• No mandatory reporting requirements, except

when there is abuse, such as:
• Unlawful sexual contact with a resident of an aged
care home, and
• Unreasonable use of force on a resident of an aged
care home
Australian Government in the Aged Care Act 2007 (see S.63-1AA)

• What other types of abuse may older people be

subject to?
 Working With Aged Populations

Things to consider:
• Inability to give consent
• Use of appropriate tools and techniques
• Consider sensory issues such as poor hearing
• Suspicions and assumptions
re: mental health &
counsellors
• Clarification of role and values
in later life
• Focus on client as a unique
collection of strengths and challenges
not as “old”
 End Stages of Life Decisions

• Autonomy and self determination

• Helping clients make choices

• Wills, power of attorney, guardianship

• Advance directives - regarding end of life wishes

for treatment or not
 Working With Aged Populations

• What are issues that older people face?

• What are the ethical considerations when

counselling older people?
Intellectual Disabilities
 Ethical Guidelines For Clients With an
Intellectual Disability

• Respect for the rights and dignity of people

• Disability is a multi-dimensional construct

encompassing

• Intellectual abilities

• Adaptive behaviour

• Health status (including physical and mental health)

 Ethical Guidelines For Clients With an
Intellectual Disability

• Disability is a multi-dimensional construct

encompassing

• The ability and opportunity to participate in the

community

• The context in which they live

• The supports they have available relative to their

needs
 Ethical Guidelines For Clients With An
Intellectual Disability

Fairness
• Assist clients and those who support them, to
challenge and address unfair discrimination and
prejudice, which might include supporting the client
to access a suitable independent advocate
• They may be subject to neglect, exploitation or
other harms
• Consider the welfare of the client as paramount
and take appropriate action, which might include
notifying relevant agencies
 Ethical Guidelines For Clients With an
Intellectual Disability

Informed consent
• Use plain language
• If client can’t give consent, consult with legal guardians
• In the absence of a person prescribed by law, consult
among appointed decision-makers or significant others
• Where a third party provides valid consent, still seek the
agreement of the client
• Be aware that this can change over time, with further
experience of the assessment and therapeutic
intervention
 Ethical Guidelines For Clients With an
Intellectual Disability

Competence
• Seek education and training and/or supervision as
necessary, or refer the client to a more experienced
practitioner
• Be familiar with and work within state, territory and
commonwealth legislation which includes legislation
pertaining to discrimination and guardianship
• Understand the National Disability Insurance Scheme
(NDIS)
 Working With Interpreters

• Competency
• Confidentiality
• Dual relationships
• Verbatim translation - not a filter of information
• Informed consent
• Clarification of task
• Debriefing of interpreter
Sexual & Gender Diversity
 Sexual and Gender Diversity

• Awareness of the use of terminology;

• Male, female, transgender, intersex, transsexual,

lesbian, gay, bisexual

• Work within competency

• Be research savvy

• Confront personal bias and judgements

 Sexual and Gender Diversity

• Lesbian, gay, bisexual thoughts or experiences, are

not indicative of a psychological disorder (APS &
DSM-5 ); however…

• Constant negative social responses make them more

vulnerable to psychiatric issues and disorders

• Like any other client - focus on their well-being`

 PACFA Position Statement (2017)

“Lesbian, gay, bisexual, transgender, intersex and

queer (LGBTIQ+) people and their families are
subject to significant pressures and
discrimination based on prejudice towards their
sexual and/or gender identity.” (p. 1)
[Link]/wp-content/uploads/2018/10/Position-
[Link]
 PACFA Position Statement (2017)

• “A national study… found …direct negative mental

health impacts from discrimination… almost 40% of
respondents seeking therapy in the previous 12 months
for anxiety, depression, family and relationship
concerns (Leonard et al, 2012)
• Address underlying causes of discrimination
• PACFA stands with other professional associations that
oppose conversion or reparative therapies therapies
– what do you think of this?
• Conversion therapy, including gender identity, is being
banned throughout Australia, BUT lawsuits may start to
overturn the more troubling aspects of these bans
(HRLA, 2022)
Cross Cultural Diversity
 Working Cross-Cultural
Therapist Self-Awareness

• We often assume the universality of ‘normality’

• Everyone values individualism and independence

• We often expect:
• Trust and openness as given

• Psychological mindedness

• A client's willingness to self disclose

 Cultural Factors In Counselling

• Consider your cultural background (perhaps think

about your parent’s or grandparent’s answers to
these questions):
• How is mental health viewed?
• Who do people go to for psychological help?
• What is their attitude towards authority figures such
as doctors, clergy, psychiatrists?
• Tips for counsellors treating people from your
cultural background?
 Therapist Self-Awareness

Awareness of ones own worldview, biases and values is

important in the assessment phase when working cross-
culturally.

Behaviour that we may think is abnormal in fact may be

situationally and/or culturally appropriate.

Examples?
 Differences: Eastern & Western

Western Eastern
Family Structure Nuclear family Extended family
Equality of roles Patriarchal Roles

Individual Autonomy Filial piety

Independence Group-centred
identity
World View Internal control External
responsibility
Personality Emotionally Self-control
expressive Restraint
Discipline
 Cross-Cultural Differences

• What stereotypes do you know exist about your own

culture?

• What about

• Communication styles?

• Ways of coping?

• What else may be different in your culture?

 Beliefs/Values In Some Cultures

Where does your culture lie with regards to:

• Modesty/ politeness?
• Maintaining harmony with others:
• Collective needs precede individual
• Family is the essential social unit
in life
• Others?
• Endurance is a virtue
• Belief in fate (hardship is inevitable)
• Acceptance of fate as a positive virtue
• Others?
 Beliefs/Values In Some Cultures

How does your culture view Mental Health?:

• Maintained through avoidance of bad thoughts and
exercise of willpower?
• To express feelings is emotionally weak/ not
acceptable?
• Distress attributed to personal
weakness?
• Does mental illness represent a failure
of family?
• What/who is acceptable to go to for help?
 Beliefs/Values In Some Cultures

• How are problems dealt with within the family?

• Belief that close-knit families protect other family
members and maintains harmony?
• Shameful/ loss of face/ loss of family face?
• Kids keep things to themselves?
• Burden to others?
 Behaviour In Some Cultures

• What is your culture’s communication style?

• Reserved/exhibit fewer emotions?
• Silence = respect?
• Little physical touch (especially in public)?
• Little eye contact?
• How about their pattern of coping?
• Emotional control?
• Perseverance?
• Psychosomatisation?
• External locus of control?
 Be Aware of Cultural Diversity

• Subcultures/ Individuals within a cultural group

may differ
• Culture is far from homogenous
• Culture changes over time
• How are you or your group of
friends different from your
culture regarding attitudes
towards mental health and
counselling?
 Australian Indigenous Clients

• Historically, a lack of cultural sensitivity,

understanding and consideration:
• Be aware of any relevant and current research
pertaining to the provision of counselling to
indigenous populations
• Be aware of, show respect for value systems &
authority structures
• Where possible consult Aboriginal Liaison Officers
etc…
 Australian Indigenous Clients

• Historically, a lack of cultural sensitivity,

understanding and consideration:
• Use appropriate language
• Be aware of socio-political issues
• Be aware of own beliefs, stereotypes and
communication rules
• Clearly inform of client rights
• React appropriately against prejudice or discrimination
 Cross-Cultural Counselling

When we try to hold our beliefs and another’s beliefs in

mind at the same time, a tension is created. It is this
tension that generates a psychological space for
discovery, understanding and wisdom.
(Dupuy & Merchant, 1996)
 References

Child Trends (2005). Race and Ethnicity Trends. [Link]

Cohen, E.D. & Cohen, G.S. (2019). Counseling ethics for the 21st century: a case-based guide to virtuous practice.
Sage Publications.
Communities & Justice (2022). Reporting a child at risk (NSW Government).
[Link] at-risk
Hays, P. (1996). Addressing the complexities of culture and gender. Journal of Counselling & Development 74(4).
Hays, P. A. (2008). Addressing cultural complexities in practice: A framework for clinicians and counselors. American
Psychological Association.
Human Rights Law Alliance (HRLA) (2022). New case to call ‘gender affirmation’ into question.
[Link]
Pietrantoni, Z. & Glance, D. (2019). Multicultural competency training of school counselor trainees: development of
the social class and classism training questionnaire. Journal of Multicultural Counseling & Development, 47(1), 2-
18.
Ponterotto, J. & Vazquez-Nutall, E. (1998). Multicultural Counseling Competencies: Individual and Organizational
Development (Multicultural Aspects of Counseling and Psychotherapy). Sage Publications.
Rosenberg, M., & Rahimi, S. (2012, July 9). Afghan woman executed by Taliban on “trumped up” adultery charge.
Sydney Morning Herald. [Link]
[Link]
Toelken, B. “Cultural Worldview.” (1996). Dynamics of Folklore (revised and expanded edition). Utah State University
Press.