Question

Joe, a thirty-five-year-old, male mental health counselor, received a client referral, thirty-five-year-old Jill, from a community counseling clinic. He began providing counseling services to her. Jill's complaint was that she was unsatisfied with her current job as a bank teller and was experiencing mild anxiety and depression. Joe had been providing services to Jill for three weeks when she disclosed that she was confused about her sexuality because she experienced sexual attraction toward some women. Joe immediately responded to Jill with wide eyes and a shocked look. He told Jill that he was a traditional Catholic, who felt that this type of feeling was immoral and wrong. He informed her that she should avoid thinking about this and pray for forgiveness. He also told her that he felt uncomfortable talking about the issue any further. Jill continued to talk to Joe about dealing with her family issues. Joe had recently read about a new technique and immediately became excited about trying it. He explained to her that he had read an article in a magazine about a new technique called rebirthing. The new technique was being used in Europe to help people change their views about their relationships with their family. Joe said, "It is supposed to be really effective in almost wiping out your memory of your family; it is like hypnosis." "I would really like to try it on you today, what do you think?" Jill declined his offer and continued to talk about her family. Joe thought to himself that even though Jill said no, he was still going to try to hypnotize her as they talked because he thought she could benefit from the technique. Jill disclosed that she was raised in a traditional Asian American home with many cultural influences and culture-specific rules and behavior. Jill was struggling with balancing her individualism and her cultural heritage. Joe explained to her that because he was living and working in a rural community, mostly consisting of people of East European descent, he could not relate to Jill’s culture and the issues with which she was struggling. He apologized and explained that he was not required to study these cultural issues because of his geographical location. Jill moved on to talk about her depression. She began talking about feeling lonely and how it contributed to her depression. During a counseling session several months later, she revealed that she was attracted to Joe and would like a closer, intimate relationship with him. Joe, aware that he was also attracted to Jill, talked about his feelings toward her but explained that engaging in a relationship outside the established counseling relationship was unethical. He informed her that because of the mutual feelings of attraction, the counseling relationship would be ineffective and that he would refer her to another counselor for continued services. Jill agreed, and they terminated the counseling relationship. Later, she contacted him to continue counseling and to discuss the referral. Joe agreed to meet her that evening at a restaurant and bring her the referral information. That night they began an intimate sexual relationship. Joe never got around to providing the referral for Jill even though he was aware of her ongoing state of depression and anxiety. Joe stopped seeing Jill after a month of intimate sexual encounters. Joe enjoyed the relationship but felt guilty due to the unethical nature of the relationship. Because of his continued concern about Jill's depression, Joe considered going to his current clinical supervisor to discuss the case but decided against it. This was because he and his supervisor were good friends and he suspected his supervisor would be hurt by knowing the real reason he had been cancelling get-togethers. Joe decided to call Jill's boss at the bank to check on her and see how she was doing. He called her boss and explained that he had been counseling her for anxiety and depression and wanted to check if she was feeling fine. Her boss informed Joe that Jill had quit her job and was in the county hospital undergoing treatment for severe depression. Joe quickly hung up and decided not to call or visit the bank again. After thinking it over, Joe decided that general counseling might not be for him. He decided to begin marriage and family therapy. He ordered some business cards and advertised in the yellow pages. He thought, “After all, I am a mental health counselor, and it can’t be hard to counsel a couple. You don't need anything special. I already have one degree, and that's enough!”

Describe the ethical issues related to cultural competence.

Answer 1

There are different ethical considerations in this case such as developing an intimate relationship, persuading one to change one’s basic belief system, not open minded, incompetency etc. From a cultural standpoint, there are two ethical considerations, firstly, the counsellor’s inability to accept the client’s changing sexual orientation and secondly he was not trying to accept the fact that she is not a catholic Christian. Both these reasons blindfolded him and he was not able to focus on the reason for which Jill approached him for counselling, mild depression and anxiety. He even tries to persuade her to pray and seek for forgiveness which was very incompetent for a professional counsellor to do, besides it is very unethical.