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Ethics in Rehabilitation Counseling


Ethics in Rehabilitation Counseling Michael Maxwell PhD. Candidate Sam Houston State University Rehabilitation Counseling Definition from text (as taken from ... – PowerPoint PPT presentation

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Title: Ethics in Rehabilitation Counseling

Ethics in Rehabilitation Counseling
  • Michael Maxwell
  • PhD. Candidate
  • Sam Houston State University

Rehabilitation Counseling
  • Definition from text (as taken from Szymanski
    Danek, 1985)
  • A profession that assists persons with
    disabilities in adapting to the environment,
    assists in accommodating the needs of the
    individual and works toward full participation of
    persons with disabilities in all aspects of
    society, especially work (Szymanski Danek,
    1985, p.83)

Rehabilitation Counseling
  • Definition George Washington University
    Rehabilitation Counselor Education Programs
  • . Concerned with assisting individuals who
    have disabilities with maximizing their potential
    and their independence.
  • (http//

What specific disabilities do Rehabilitation
Counselor work with?
  • Physical disabilities (ie. cerebral palsy)
  • Sensory disabilities (ie. blindness)
  • Developmental disabilities (ex. mental
  • Cognitive disabilities (ie. head injured)
  • Emotional disabilities (ie. substance abuse)

  • Definition Van Hoose Kottler, 1985
  • Ethics is concerned with questions that have no
    ultimate answers, yet are important to planning
    ones life, justifying ones activities, and
    deciding what one ought to do (p.3).

Ethical Dilemma
  • As defined by Toriello Benshoff (2003)
  • A choice must be made between 2 courses of action
  • There are significant consequences for taking
    either course of action
  • Each course of action can be supported by ethical
  • The ethical principal supporting the unchosen
    course of action will be compromised.

Brief History of Rehabilitation Counseling
  • Began in the early 20th century in the area of
    vocational counseling.
  • Evolved out of events such as the Industrial
    Revolution, vast immigration, the Great
    Depression, and World Wars I and II.

Brief History of Rehabilitation Counseling
  • Later, rehabilitation counselors adapted their
    vocational approaches to match the needs of
    clients with disabilities.
  • During the 1970s, the independent living movement
    stimulated another surge in the service delivery
    of rehabilitation counseling.

Why rehabilitation counselors?
  • Attitudinal, social, and economic barriers exist
    when it comes to individuals with disabilities
    obtaining fair market employment
  • Rehabilitation Counselors work more as social
    advocates within, as well as outside of session

Striking statistic
  • As of 2004, there were an estimated 43 million
    Americans who had disabilities that restricted
    some major life activity, and prevented them from
    attaining a job

Striking statistic
  • As of 2001, there were 99 accredited
    rehabilitation counseling masters-degree programs

Rehabilitation Counselor Skills
  • Rehabilitation counselors primarily work as
    generalists, vocation specialists, and personal
    adjustment assistants
  • Following are the specific areas of expertise a
    rehabilitation counselor may be expected have

Rehabilitation Counselor Skills
  • Assessment
  • Diagnosis
  • Careers
  • Individual and groups counseling
  • Case management
  • Program evaluation
  • Advocacy
  • Consultation
  • Job placement
  • technology

New trend Teamwork
  • Rehabilitation practice is typically conducted
    within a collaborative team context.
  • Training in this area will be imperative
  • Case management and medical knowledge should be
    areas of strength

Rehabilitation Counselor Qualification Standards
  • For certification, a rehabilitation counselor
    must have
  • Masters degree in rehabilitation counseling or
    related program
  • Achieved national certification
  • Attained state licensure

  • Rehabilitation Counseling
  • Pre - Test

Ethical Issues in Rehabilitation Counseling
  • Confidentiality Privilege Communication
  • Informed Consent
  • Client to counselor relationship
  • Responsibility
  • Counselor Competence

Confidentiality Privilege Communication
  • Areas of possible ethical dilemmas
  • Maintaining confidentiality in institutional
  • Disclosure to client employer of danger or
  • Sharing client info. with family members
  • 3rd party payment agencies and disclosure
  • Client illness unsafe to self and others

Confidentiality Privilege Communication
  • Additional areas of ethical dilemmas
  • Group counseling setting
  • Treatment team debriefings

Confidentiality Privilege Communication
  • In all cases, maintain a conceptualization of
    client advocacy
  • A clear and concise explanation of your
    limitations and obligations as a counselor is
    imperative, via personal statement and informed
  • Share only what is pertinent and necessary.

Informed Consent
  • Three areas pertaining to rehabilitation
  • Capacity
  • Comprehension
  • Voluntariness

Informed Consent
  • It is the counselors duty to be certain that the
    client either has the capacity to give consent,
    or a legal authority ( parent or bureaucratic
    appointed ) provides consent.
  • Again, as an expression of advocacy, any attempt
    to equalize the power differential between
    counselor and client is recommended.

Client Counselor Relationship
  • Sexual relations with a client is illegal in all
    50 states.
  • Sexual relations with a client is potentially
    harmful, at the least
  • New code allows for client-counselor relations a
    minimum of 5 years after termination
  • Take to the notion Do No Harm.

  • Code clearly specifies that the primary
    responsibility of the rehabilitation counselor is
    the client ( advocacy )
  • Cannot deny secondary responsibility to other
    parties ( employer, 3rd party payment, law, etc.
  • Issues of paternalism / co-dependence need to be

Counselor Competence
  • Rehabilitation counselors should practice only
    within the realm of their scope of practice.
  • New to the field is diagnosing according to a
    medical model.
  • Continuing education is a must
  • Refer out whenever necessary.

  • Rehabilitation Counseling
  • Case Scenarios

A few hand picked areas of concern, for
rehabilitation counselors and ethics.
  • Working with 3rd party payment agencies
  • Traits clients find most and least important from
    rehabilitation counselors
  • HIV positive patients
  • 12 step programs

Ethics in Managed Care Organization (MCO )
  • Understand the MCO is a business and looks for
  • Look for best balance between advocacy and
    fulfilling needs of MCO
  • Explain MCO service limits to client
  • Do no harm
  • ( Kontosh, 2000 )

Traits clients find most and least important from
Rehabilitation Counselors
  • Top 3 traits
  • 1. Consumer first attitude and advocacy (28.5)
  • 2. Nurturing and promotion of counselor
    relationship ( 20 )
  • 3. Knowledge about disability and rehabilitation
    ( 14 )

Traits clients find most and least important from
Rehabilitation Counselors
  • Bottom 3 traits
  • Disability experience in personal life (4)
  • Educational background ( 2.5 )
  • Maturity and professional experience (1.5)
  • ( McCarthy Leierer, 2001 )

HIV positive client and duty to break
confidentiality / privacy
  • This is a hot dilemma that most practicing
    counselors face.
  • The stance of the law is unclear
  • The danger is advising sex partners of the client
    advising the employer or third party payment
  • No clear answer to provide
  • Client advocacy is the key.

12-step Programs
  • Have proven to be very effective for the
    rehabilitation of substance abusers
  • They have a regimented format, with little room
    for adaptation
  • All require an admittal to a problem (not
    consistent with some theoretical constructs)
  • All require an admittal that a higher power is
    the only means to help (N/A for a counselor who
    does not share same beliefs)

  • Cotton, R.R., Tarvydas, V.M. (2003). Ethical
    and professional issues in counseling 2nd ed.
    Upper Saddle, NJ Pearson Education.
  • Kontosh, L.G. (2000) Ethical rehabilitation
    counseling in a managed-care environmen. The
    Journal of Rehabilitation. 66, 9-24.
  • McCarthy, H. Leierer, S.J. (2001) Consumer
    concepts of ideal characteristics and minimum
    qualification for rehabilitation counselors.
    Rehabilitation Counseling Bulletin,45, 12-23.
  • Szymanski, E M. Danek, M. M. (1985).
    School-to-work transitions for students with
    disabilities Historical, current, and conceptual
    issues. Rehabilitation Counseling Bulletin,29,
  • Torielly, P.J., Benshoff, J.J. (2003) Substance
    abuse counselors and ethical delimmas The
    influence of recovery and education level.
    Journal of Addictions and Offender Counseling,
    23, 83-98.
  • Van Hoose, W.H., Kottler, J.A. (1985) Ethical
    an legal issues in counseling and psychotherapy
    2nd ed. SanFrancisco Jossey Bass,,p .258.