The main ethical issue that might arise from the session between the counselor and the delusional patient is the potential for the practitioner to place her need over those of the client. It is a common challenge for counselors to understand the limits of their competencies and prevent their ego from interfering with their work. In the context, the insistence of the patient to continue the therapeutic relationship with the counselor might make her violate Section A.12 of the ACA Code of Ethics since she has told her of her inability to handle her case. According to the ACA (2014), counselors do not abandon or neglect their patient after termination or referral but make appropriate arrangements for continuation of treatment. I believe it would be beneficial if the counselor could explain to the client that referral is in the client’s best interest. I learned from this week video clip that we have to be very careful when we want to suggest a referral to the client.
2. Meanwhile, the guidelines of the ACA Code of Ethics would influence the approaches that I would use to handle a situation that involves the refusal of my client to reject referral when her therapeutic needs are outside my competency area. First, I would discontinue the counseling relationship despite the unwillingness of the client to consult a competent practitioner for her condition since my acceptance of her desires or wishes would amount to a violation of Section A.11.a of the ACA Code of Ethics. Secondly, I will engage in pre-termination counseling by highlighting the referral options available to the client before recommending the most appropriate service provider to the patient, which is an action that is consistent with Section A.11.c of the same regulation. Finally, I will ensure that all the clinical and administrative processes are completed for both client and practitioner to ensure the continuation of treatment services.
3. In conclusion, my effort to improve my competence in dealing with a delusional patient would entail the acquisition of appropriate education and training in this specialty. Once the appropriate level of knowledge is acquired, it is essential to attend to the under the supervision of an experienced practitioner until the level of competence for this new specialty meets the minimum standard for the profession.
The main ethical issue in this role play is the concern of the counselor practicing outside of her boundaries of competence. The two standards that are most relevant include C.2.a. and A.11.a. C.2.a., Boundaries of Competence, may be violated if the counselor continues to see this client without obtaining the proper training to work with delusions. A.11.a, Competence with Termination and Referral, applies because the counselor needs to understand when it is appropriate to make a referral. In this case, I believe the client’s presenting problem needs to take priority, and it is more than a mere concern of the client’s values.
2. In a similar situation, the first thing I would do is speak to my supervisor. Especially in the early stages of one’s training, I believe it is always acceptable to seek consultation from a supervisor when there is uncertainty. If my client completely refused the idea of a referral, I would highly suggest the option of having a co-counselor as the video role play suggested. If the client only wanted to speak with me during a session, I would suggest the client see a professional who works with delusions, in addition to continuing counseling. As much as I would want to help this client in the manner they select, in order to balance the principles of nonmaleficence and beneficence, I believe it is in the best interest of the client to see an additional professional with greater competence.
3. To improve my own competence, I would begin by seeking consultation with a professional who is experienced in this area. I would also work on continuing education to improve my counseling skills by reading literature on delusions and attending workshops.