Chapter 1 Ethical Foundations

The first chapter orients the student to the concepts necessary in discussing ethics and sets the structure for those discussions. It is important for the instructor to set the stage clearly and openly. Modeling honest, open discussion makes this subject more accessible to learners. We suggest that ethics be clearly defined, and that students have a chance to explore their own value systems and then begin professional practical application. The Six-Step Resolution Model has proven to be a valuable tool for professionals over time and is best taught as a “Caper.” The core psychological concepts establish an important base for client relations and ongoing discussions throughout the book.

These lesson plan builders are divided into three sections: Goals (Roman numerals), Objectives (Capital letters), and Classroom Activities (numbers); Capers (this is where you will find detailed instructions for in-depth activities); and Handouts.

First identify the goals and objectives that align with your overall curriculum. Next, choose how to best address each objective according to your time allotment, class personality, and structure. Please note that each learning objective has more than one activity. You can also facilitate additional classroom discussions using the scenarios found in the chapter and exploring the Points to Ponder.

Review the Key Terms and the Table of Contents topics per chapter. Determine which subjects you will cover in your course/module. Make a handout of those topics and distribute to each learner. Have the learners place a dot next to each topic that they don’t feel like they would get correct if tested on. When the class/module is finished, have students check off all of the topics they feel confident about and highlight the ones they still need to work on.

Goals, Objectives, and Classroom Activities

Learners will:

IDevelop safe and ethical professional therapeutic relationships.

  1. Define the elements of the therapeutic relationship.
  2. Learners simulate the various aspects of the therapeutic relationship: client-centeredness, safety, privacy, a clear structure, and a power differential.
  3. Discuss as a class what it really means to be client-centered. If time allows, determine as a group 5-6 practical ways for practitioners to express being client-centered.
  4. Learners list as many client-centered activities as they can in three minutes. The person with the most answers gets a prize. Use an Attribute Web.
  5. Identify the factors that contribute to the development of safety and trust in the therapeutic relationship.
  6. Each learner describes on a piece of paper the factors that have made a positive difference to them as a client/patient regarding the trust level with their healthcare providers. Then have the class share voluntarily.
  7. In dyads, learners complete the First Impressions Caper.
  8. Invite a panel of professionals to the class to discuss their experience in the therapeutic relationship.
  9. Identify the primary duties of a healthcare professional.
  10. Dyads discuss the duties of a healthcare professional and bring back to the group the top four duties.
  11. Triads describe three practical examples of the primary duties of the healthcare professional in everyday practice.
  12. Identify clients’ rights.
  13. Taking turns as practitioner and as client, learners role-play the therapeutic relationship when the practitioner is confident in a particular course of action and when the client is against it.
  14. Learners discuss why the client’s right to refusal is a positive action to be supported and encouraged.
  15. Learners discuss how to tell when the line is crossed and education turns into harassment.
  16. Debate: Client preference versus Practitioner knowledge.
  17. Learners journal their opinion on duties and rights. Use figure 1.2 on page 6 as a reference.
  18. Triads explore the basic rights a client has in this profession.
  19. Apply the concept of power differential.
  20. Learners reflect on positive and negative experiences they have had in relationships where there is a power differential, then share behaviors that work well and those that do not.
  21. Role-play power differentials. Assemble learners in dyads. Each learner role-plays the following power differentials then reverses roles before discussing what they have learned in each role: Student and Teacher negotiating a late paper; School Director and Teacher discussing what to do with a difficult student; Practitioner and Client discussing payment for a missed appointment.
  22. Invite a panel to speak on the power differential in practice.
  23. Learners write policies regarding the power differential for their practices.

IIDefine the factors that contribute to the ethical complications of power differentials.

  1. Identify the conditions that might contribute to a greater or lesser power differential.
  2. Learners complete the “Evaluating Power Differentials” activity on page 8 [Workbook page 6]. Brainstorm answers to each on the front board and discuss.
  3. Learners brainstorm strategies for practitioners to achieve balance in their personal applications of the power differential. Some practitioners will tend to exaggerate one or the other.
  4. Instructors divide the group into at least two groups to role-play greater and lesser power differentials.
  5. In dyads, learners make a list of five behaviors that lessen the power differential.
  6. Learners simulate the ideal balanced relationship, staying mindful of power differentials and the therapeutic relationship in general.
  7. Learners create a table: One column for the negative characteristics of power differentials and the other for the benefits of power differentials to the therapeutic relationship. Or use a Venn Diagram.
  8. Do the First Impressions Caper.

IIIApply the concepts of transference and countertransference.

  1. Define the concepts of transference and countertransference.
  2. Learners complete the Transference and Countertransference Caper.
  3. Learners complete “The Impact of Transference and Countertransference” activity on page 11 [Workbook page 6]. Share examples in small groups.
  4. Instructors assign points from the “Signs of Transference” and “Signs of Countertransference” from pages 9 & 10 to each learner. The learners write a dialog illustrating their point(s). Either the instructor or learners share them with the class.
  5. Divide the class into dyads. Each group role-plays a transference scenario and a countertransference scenario (both partners get to experience each role for a total of four role-plays). A variation is to have the “practitioner” handle it professionally and unprofessionally. Afterward hold a discussion about insights gained.
  6. Identify the impact of countertransference and transference in the practitioner/client relationship.
  7. Divide the class into two groups, giving one group the assignment to come up with a worst-case scenario and the other the assignment of the best-case scenario. Each group presents their scenarios to the whole class starting with transference then countertransference. Then class discusses the impact of transference and countertransference on the client/practitioner relationship.
  8. As a homework assignment, learners journal their response to the classroom discussions on transference and countertransference and speculate how they might choose to respond in the future.
  9. Recognize countertransference reactions in themselves.
  10. Learners journal at least two examples of countertransference reactions in themselves.
  11. Learners brainstorm countertransference issues that might occur if a practitioner just reacts, rather than staying present. Then discuss as a class the benefits of choosing to listen and respond rather than react.

IVIdentify the universal principles that apply to all ethical behavior.

  1. Define the universal principles of justice, honesty, reverence for life, and adherence to law.
  2. Learners brainstorm examples of each of the four universal principles in the context of the therapeutic relationship. Discuss how each relates to the other.
  3. Learners journal the positive and negative effects of adherence to these universal principles in their own lives.

VDiscern the various sources of ethical guidance.

  1. Define and differentiate ethics, values, morals, principles, laws, and professionalism.
  2. Triads review the professional codes of ethics in the Appendix. Note the differences in complexity, breadth, and clarity. Are there any contradictions within a specific profession’s code? Can you identify any weaknesses or omissions? How do the various codes relate to one another? [Workbook page 10.]
  3. Learners complete the “Ethical Behavior Evaluation” activity on page 15 [Workbook page 7].
  4. Learners research how ethics and morals vary in different countries [Workbook page 10]. Each project group of 2-6 reports back to the class their lists of specific examples.
  5. Learners create a pictorial dictionary of the following concepts: Ethics, values, morals, principles, laws, and professionalism.
  6. Small groups create a presentation on one of the following concepts: Ethics, values, morals, principles, laws, and professionalism.
  7. Ethical Behavior Continuum Exercise: Ask a series of questions related to topics in this chapter. Poll the class asking: How many of you think this is Never Okay? Sometimes Okay? Most of the Time Okay? (This shows how ethics really is a continuum not just within oneself but also within the community. Examples: Is it never, sometimes, or most of the time okay to work on the following: Your relatives; Co-workers; Your friend’s children? Is it okay to ask clients personal or professional questions outside of the need to know within the therapeutic relationship?)
  8. Learners debate taking opposing views on various ethical issues.
  9. Apply the concept of self-accountability.
  10. Quad pods share reasons for going into this profession. “What inspired you to seek this type of work?” “How do you see yourself helping others?” “What are the personal gains you anticipate?”
  11. Learners keep a self-accountability journal for at least one week. Entries will reflect the learner’s observances of their behavioral choices.
  12. Clarify your personal and professional values.
  13. Learners complete the “Core Values Assessment” activity on page 15 [Workbook pages 7 and 8]. For variety, stage an open forum for those who wish to share or postulate with the group.
  14. Learners journal on how their personal values conflict with their profession’s code of ethics [Workbook page 9].
  15. As a class, discuss how to you stay professional when there’s a conflict in your values vs. laws or codes of ethics.
  16. Simulate in dyads how you would handle working with a client when there’s a values conflict. For example, what would you do when you value structure and your client values flexibility and the client expects to be able to arrive for the appointment 15 minutes after the scheduled time? Each dyad creates two scenarios.
  17. Learners trace their ethical values from their family history [Workbook page 9].
  18. Learners create a visual family tree of values using multimedia.
  19. Learners categorize their professional code of ethics according to their personal ethical standards in a way that is meaningful to them.
  20. Instructors ask learners to make a list of their personal and/or professional values, then combine the lists of values and rank them as a group.
  21. Do the Core Values Caper.
  22. Do the Universal Values Caper.
  23. Describe the ethical obligations of a practitioner.
  24. Invite a guest speaker to discuss third party welfare and confidentiality issues. When do the practitioner’s concerns over a third party’s welfare take precedence over upholding client confidentiality?
  25. Small groups of 4-6 brainstorm on the top 10 ethical obligations of a practitioner, then the instructor facilitates the larger group discussion on blending the small groups’ list into a single list.
  26. Learners describe ethical attributes of professionals they respect. For more depth, have learners choose no less than three goals they have for their professional growth. Use an Attribute Web.

VIMake appropriate decisions regarding ethical dilemmas.

  1. Identify the key elements that constitute an ethical dilemma.
  2. Discuss as a class how the desire for money influences our ethical decision-making both personally and in the society at large.
  3. Learners list at least three major problems they expect to encounter in their practice.
  4. Learners discuss the difference between ethical dilemmas and boundary crossings.
  5. As a class, brainstorm a list of warning signs that an ethical dilemma has come up. Review the Ethical Congruence Checklist on pages 17 and 18. Learners spend time thinking about a specific ethical dilemma they have already experienced or one that they may be concerned about and journal responses to the Ethical Congruence Checklist questions.
  6. Apply the six steps to resolving ethical dilemmas.
  7. Learners explore a current ethical dilemma using the 6-step process [Workbook page 10].
  8. Learners complete the Ethical Dilemma Caper.
  9. As a group create a unique ethical dilemma and work through the Six-Step Resolution Model on page 20.
  10. Quad pods choose a standard from an appropriate ethics code and follow through the Six-Step Resolution Model on page 20 creating a realistic ethical dilemma.
  11. Discern how and when to utilize consultation when faced with an ethical dilemma in their practice.
  12. In dyads, ask learners to discuss when they would choose to, or not to, consult with others and with whom they might choose to consult.
  13. As a class, discuss the difference between consulting with a peer, mentor, and professional advisor/consultant.
  14. Discuss: Professionals who do not report the misconduct of others are behaving unethically, True or False?

Capers

First Impressions Caper

Objective: Show the importance of first impressions and illustrate how body language contradicts or reinforces verbal messages. In this context, it can be taken a step further in regards to the therapeutic relationship. The learners can ponder how to best present themselves as a trustworthy practitioner.

Procedure: Form groups of five people. Have them “meet and greet” each other in each of the following ways: 1) They really don’t want to meet the other person; 2) They fear the other may reject their greeting; 3) They already know they are friends; and 4) They already know the person but just a little. After announcing each of these role-plays allow a few minutes for each meeting and greeting. Direct the groups to switch people as the different role-plays are acted out.

Discussion: How did you feel when you weren’t exactly thrilled to be meeting the other person? What most influences you when making a first contact with someone? How does your body language support or negate what you are saying? Why did the first few activities feel uncomfortable? Are you aware of your non-verbal signals?

Materials Required: None.

Approximate Time Required: 20-40 Minutes

Transference and Countertransference Caper

Objective: Understanding Core Psychological Concepts.

Procedure: Tell the learners “During this exercise you will be working in pairs. Find someone you would like to work with and sit facing each other.” When they are settled say, “One of you is the client and the other the practitioner. Decide who wants which role.”

Pass out the envelopes. The ones labeled C go to those playing the clients and those labeled T go to the practitioners. Tell the participants not to open these envelopes until instructed to do so.

Then say, “You are taking a history of a new client. Begin now and stop wherever you are when I signal you.” Let the learners do the history for two to three minutes only and then say, “Stop (or freeze) where you are.”

Ask those playing the role of the clients to open their envelopes and read the paper inside. Also say, “If anyone does not understand something please come up to me privately and I will help clarify anything that you do not understand.” Tell the learners, “When you are done reading put the paper back in the envelope and wait for my signal to begin so we are all working together. Do not tell your partner what you have read.” Wait until all are finished reading and then have them begin.

They resume wherever they were in taking the history, acting on the new information they have received (but not telling their partner what they have read). Let them continue for two to three minutes. Ask them to stop again and both write down what they noticed was different in the interaction or how they felt.

Ask the practitioners to read the paper in their envelopes and then continue again with the history taking for two or three minutes. Ask them to stop again and take down notes on what they noticed was different. When they seem done have them discuss in their pairs what they experienced.

Discussion: Ask the group to move into a circle and share with each other what they learned, what surprised them and to explore what they think was happening.

Wrap Up: After the exercise is over say, “We just experienced Transference and Countertransference in action.” Now teach didactically what transference and countertransference are using the slides provided.

Instructor’s Note: It is good to follow up with the instruction and exercise on the concept of the Power Differential, as it is a vital part of understanding the power of transference and countertransference.