Potential Conflicts between Cultural Values and the Role of Confidentiality when Counseling South As

1
Potential Conflicts between Cultural Values and
the Role of Confidentiality when Counseling South
Asian ClientsImplications for Ethical Practice

• Savita Abrahams, M.A., LPC-I
• Carmen Salazar, Ph.D., NCC
• Texas AM University-Commerce

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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.

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We Will Explore (cont.)

• 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.

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Eurocentric Worldview

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

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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 individuals actions do not
  interfere with the rights of others (Meer
  Vandecreek, 2002)

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Autonomy (cont.)

• Respect for the clients right to
  self-determination requires respect for the
  individuals choices about uses and disclosure of
  his or her own information (Remlihy Herlihy,
  2001)
• Autonomy and Individuality form the foundation
  for Confidentiality

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Confidentiality

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

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Confidentiality (cont.)

• Counselor expectations
• How it works
• Benefits for the client
• Role of clients family members

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Traditional South Asian Worldview

• Emphasis on collectivism and family
  interdependence
• Individuality is considered a flagrant social
  norm violation

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Traditional South Asian Worldview (cont.)

• Counselors are encouraged to assess the clients
  worldview
• Do not assume ALL South Asians value these
  concepts equally
• Clients level of acculturation affects where he
  or she lies on the continuum of interdependence
  and independence (Chandras, 1997)

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Collectivism Family Interdependence

• Definition of family
• How is the individual defined, in terms of
• Family
• Identity
• Adult or child
• Gender
• Marital status

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South Asian View of Counseling

• Not widely accepted
• Why?
• It is the familys business
• Issues of shame and dishonor
• Family disapproval

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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

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ImplicationsClients Decision-Making Process

• Decisions are not made by thinking of the
  clients individual needs exclusively
• What is best for the client is what is best for
  the family (Chandras, 1997 Das Kemp, 1997)

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ImplicationsConfidentiality

• Clients 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)

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Risks to client

• Stop counseling, thereby, losing the only source
  of support
• Continue counseling and have family members be
  privy to clients personal information

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Risks to client (cont.)

• When family members attend counseling sessions,
  authority figure may dominate, giving client no
  opportunity to speak
• Emphasis may only be on negative aspects of
  clients behavior and effects on the family

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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)

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Conflicts between South Asian Cultural Values
Ethical Codes (cont.)

• 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)

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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

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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

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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

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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)

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Ethical Decision Making Model (cont.)

• 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

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Ethical Decision Making Model (cont.)

• 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

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Our EmphasisCreative 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.

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Our EmphasisCreative Problem Solving (cont.)

• 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.

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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.

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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.

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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.