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Assignment Questions

Nature and Purpose of Ethical Frameworks

Essay Title :
What is the nature and purpose of Ethical Frameworks and how does ethical practice involve working positively with diversity and difference?

when writing this essay please consider the fact that i am an African living in Britan. i am disable. the following is an email i received from my tutor which includes reading list. i want all the bibliography, works cited, etc to come from the following books and handouts which is mentioned in the email from my tutor:

EMAIL FROM TUTOR:
I think you are the ones who might be doing the ethics essay. Some have asked for reading. You don?t have to go into all individual differences in the essay but reading about them can help put you into the shoes of others.

The docs which start eth opp above are handouts and exercises. Don?t be overwhelmed- just see what is helpful for you.

Tim Bond for the general stuff, yes,
The Therapeutic Relationship (Petruska Clarkson)
BACP Ethical Framework (bacp.co.uk)
The Mirror Crack?d–really good (ANNE KEARNS)
?good fences make good neighbours??
Being White in the Helping Professions (JUDY RYDE)
Black Issues in the therapeutic process (ISHA MCKENZiE-MAVINGA)
the chapter on gay affirmative
Guidelines for LGBT- an A4 sized thing, bright pink- good brief read, might just get you thinking about working with any stigmatised minorities

Don?t forget that differences are all kinds- think culture in the broadest sense=- and what happens when we think someone is the same as us?

Handouts1

mkSame-Sex Relationships, an Historical Overview

My intention in this presentation is to look at some of the main religious influences on our attitudes to homosexual relationships in Britain. The law banning consenting sex between two adult men was repealed in Britain in 1967. The origins of this common law can be traced back to the decision by King Henry VIII to incorporate the Church’s condemnation of homosexuality into secular governance in 1533. Even then, the attempt to outlaw and punish those who preferred sex with their own gender was nothing new.
One of the earliest recorded laws so far found on the matter is usually regarded as the Holiness Code of Leviticus, which is generally considered well over 3,000 years old. Verse 20:13 reads: “If a man also lie with mankind as he lies with a woman, both of them have committed an abomination: they shall surely be put to death.” This passage has been used throughout the intervening centuries by innumerable religious sects and governments to justify the imprisonment, torture, and execution of people imagined, rightly or wrongly, to be gay.
Not all Jews and Christians have accepted it without question. Many, such as John Selby Spong, have pointed out that surrounding passages also call for the execution of teenagers who are rude to their parents, and describe the wearing of polycotton shirts as an abomination in the eyes of Adonai. That has a certain surreal humour value, unless you happen to know of someone who was murdered or driven to suicide by the unrelenting hatred of the supposedly godly.
Many scholars also look to Persian religion as a source of sanction against homosexuality. Whilst Zoroastrianism has not had a prominent influence on British attitudes, it has arguable! had an indirect influence via its impact on Judaism, Christianity and Islam. In its earliest form, the religion of Persia was polytheistic and had no laws against gay sex ~ a fairly common circumstance back then, given that polytheism tends to embrace diversity. For most of those ancient religions, an individuals sexual preferences were essentially a matter of personal taste, rather than a matter of morality or spirituality.
When the prophet Zarathushtra converted the Persians to monotheism, he appears to have made no comment on the matter either. It was not until the writing of the Vendidad many centuries later, between 200 and 400CE, that we find the first Persian sanction. Fargad 8, Verse 32 states ~ “The man that lies with mankind as man lies with womankind, or as woman lies with mankind, is the man that is a Daeva; this one is the man that is a worshipper of the Daevas, that is a male paramour of the Daevas.”
The word Daeva is usually translated as meaning a devil, though originally it signified one of the Shining Ones, or gods. Ahura Mazda was asked, in Verse 27, how a Zoroastrian may cleanse themselves of the sin of homosexuality. He responded ~ “For that deed there is nothing that can pay, nothing that can atone, nothing that can cleanse from it; it is a trespass for which there is no atonement, for ever and ever.”
It is curious that the word used to criticise homosexuals can mean either a devil or a shining god. The Phoenician or Canaanite religion had priests known as qedeshim. For a time they were part of early Hebrew religion too, though the Old Testament recommended their expulsion. This Canaanite word originally meant holy man, though the King James and various other translations render it as sodomite. The feminine term, qedeshoth, is conventionally translated as prostitute. These religious castes were primarily devoted to the goddess Asherah, also called Astarte. Historians hotly debate wether this caste offered sexual services in addition to the more conventional priestly ones. Certainly in the minds of a great many Bible translators they did. Modem-day devotees of Asherah take the concept of sacred sexuality very seriously.
Victorian schoolteachers would often fmd their Classics classes a little difficult when the euphemistic ‘unspeakable sin of the Greeks’ reared its head in poetic and philosophical texts. Way back in 630BCE, the Greek poet Alcman composed poetry for a lesbian wedding. Same-sex marriages are nothing new. The word lesbian itself, of course, derives from the Greek. The isle of Lesbos was once the home of poet, playwright, and headmistress Sappho, most of whose poetry to the beautiful girls in her Finishing School was repressed and burnt by the Vatican. Enough survived that people two thousand years later should speak of lesbians and sapphics. As well as being a literary genius, the bisexual Sappho was also a priestess to the goddess Aphrodite. Not only did the ancient world invent the idea of same-sex weddings, but it had no particular problem with gay priests or priestesses either. It should be noted that Romano-Greek definitions of sexual identity were not structured by the issue of gender, such as our views are today. For the Mediterranean cultures the social status of the two partners was far more crucial than the gender, and defined what erotic acts were considered socially acceptable. They had no concepts of gay, straight or bisexual. Only ideas of high caste and low caste. Such sexual laws as those cultures had then, mostly dealt with issues of class rather than gender.
The Greeks also gave us such now-outmoded words for gay men as uranians and catamites, both terms derived from the names of old gods. Greek myth attributed the invention of homosexual love not to some fiendish devil, but to the most beautiful of all the Olympians ~ Apollo himself. His was the first male-male partnership, when he fell in love with the beautiful prince Hyacinthus. The mighty warriors of Sparta so admired Hyacinthus and his love for the radiant sun god, that every summer they held a three-day festival in his honour, which still occurs in some places today.
The Egyptians referred to homosexual activity in a variety of mythical and cultural contexts. They have even left us what may well be the earliest tomb of two male lovers. Khnum-hotep and Ni-ankh-khnum were courtiers, unrelated by blood, who took the unusual step of being buried together in the same tomb. One of the wall paintings shows them with arms round each other, an act of intimacy almost unknown in Egyptian art ~ even for heterosexual married couples.
The Greeks, Romans and Egyptians were apt to engage in apotheosis – the process by which the recently deceased are elevated beyond the realms of minor ancestral spirits and into the ranks of demigods. One of the last pagans to be apotheosised was Antinous. This classically handsome young man was the lover of the Emperor Hadrian (he of the Scottish wall), who took the throne in the year 117CE, dying in 138. Greek-bom Antinous was loved for a few short but passionate years, before he drowned in the Nile at the age of about 20. A spontaneous reverence for the lost youth soon sprang up, along with tales of his rising from the grave to become an immortal god. When Hadrian heard of this, he responded by instituting a state cult. At least seven large temples were built across the Empire to this sanctified figure, and a whole city was built in his honour on the banks of the Nile.
Festivals were instituted in honour of Antinous, most notably his death on October 28th and birth on November 27th. Whilst Britain was part of the Roman Empire, these festivals were marked here too, indeed they are still marked by some modem pagans. In the numerous small shrines built to him, he was (and still is) honoured as a patron of the arts, of male beauty, and seen as a general protector and guide to the dead. Whilst the impact of Antinous on British attitudes has not been large, it is worth noting that whilst for some faiths homosexuals are devils, for others they are gods!
Whilst the attitudes of Mediterranean polytheist religions is well documented, the views of the faiths from Northern Europe are less well known. Some commentary has, however, survived. The Hellenic writer Diodorus, back in 400BCE, described, with some degree of surprise, how the Celts had no concepts of social dominance within the sexual arena, but “…they weave around other males in a strange frenzy. They are accustomed to sleeping on the ground upon hides of wild beasts and indulge together ?with male partners on both sides for sex.” At much the same time Aristotle spoke of “…those nations which openly approve of sexual relations between men, such as the Celts and certain others.”
The Christian commentator Bardaisan wrote in the early 3rd century that “In the countries of the north, in the lands of the Germans and those of their neighbours, handsome young men assume the role of wives towards other men, and they celebrate marriage feasts.” Fellow Christian historian Eusebius ofCaesarea, wrote in the 4th century that “Among the Gauls, the young men marry each other with complete freedom. In doing this, they do not incur any reproach or blame, since this is done according to custom amongst them.” Commentary on lesbian relationships is harder to find, largely because the mostly male historians of that period had little interest in what women got up to.
Whilst we cannot say that every single tribe followed the same pattern, the suggestion is that same-sex love was not considered odd or strange, or something to be stamped out. The Fenechus law codes of Ireland, which changed little under Christian rule, make no specific mention of homosexuality. The Tain bo Cualigne myth, itself committed to writing by monks during a period when Ireland maintained both Christian and Druid traditions, contains some beautiful love poetry sung by the warrior Cuchulainn over the corpse of his dead companion Ferdiad. The poem describes them as “men ~who shared a bed”, and does so in entirely sympathetic terms.
During the 19th century it was common for European writers to refer to homosexuality as either the German .or the English vice, different predilections being associated with different countries. Whether this was in any way a hang-over of those early tribal attitudes, or simply a matter of nationalist stereotyping, is hard to say.
We have already mentioned Leviticus as a source for justifying later laws against gay unions. Another Biblical tale frequently quoted is that of Sodom and Gomorrah. Two angels visit Lot in the city, and the men of the city gather in a mob outside demanding to “know” the visitors ~ which a good many have taken to mean rape, though this is not actually stated. Many theologians have considered angels as essentially sexless, neither male nor female. The attempted rape (if such a thing took place at all) of a genderless entity could hardly be constituted as a homosexual act, or a heterosexual one either. Quite how it should be labelled is anyone’s guess. Many commentators have focussed on the sin of Sodom as being inhospitality towards strangers, not a particular sexual predilection. By the end of the first century CE, an increasing number of Jewish and Christian thinkers, such as the historian Josephus, promoted the idea that the sin of Sodom was homosexuality. It is ironic that this tale should have been made into one of sexual morality, given that Lot’s apparently religiously acceptable response to the mob was to offer his own two daughters up to be raped instead. Scarcely an icon of sexual probity.
Despite the proscriptions, there have been vicars, priests, rabbis and so forth over the centuries who have broken with tradition to bless same-sex unions. Often ending up in a good deal of trouble for doing so. In recent years those religions that stigmatise homosexuality have seen growing lobbies from within to either change their views entirely, or to distinguish between the sinner and the sin ~ that is, to tolerate gays so long as they are celibate. Much of the latter argument has been largely in response to assorted unproven psychological theories claiming genetic origins for homosexual desire. Those who subscribe to such ideas have inclined to the view that me urge is taken out of the realm of choice (and therefore can scarcely be condemned), it being only the decision to act on the urge that carries a moral value.
Pressure to change laws in Britain has been growing since the Victorian age, and has come primarily from secular and humanist sources. Whilst some religious voices have been in favour of liberalisation, the loudest have usually been conservative ones. Britain has yet to see the more extreme examples from America of evangelists picketing the funerals of gay people, and screaming abuse at the mourners. However, we still have many examples of people who feel it their moral right to spit at, or beat up suspected gays. Or to kick them to death, or bomb gay pubs. The views of such people are not bom in a moral vacuum, but out of generations of people being indoctrinated with the socially-sanctioned notion that homosexuality warrants violence or death.
In concentrating primarily on those religions that have had a strong influence on our British legal and moral system, I have not touched upon the wealth of sources from the Far East. Acceptance of same-sex marriages was common in China, as was nanshoku in Japan. Nor have I mentioned the diverse array of practices amongst the native tribes of North and Central America, some of which had third and fourth genders. Nor have we looked at practices in India, nor at the love poetry of Muslims such as Abu Nuwas and later medieval writers. Suffice to say that world is a vast and diverse place. Gay marriage is not some bit of contemporary political correctness. It is a long tradition, with its roots in the polytheist faiths of the ancient world, that has continued to grow and develop throughout the prominence of monotheism and secular humanism.
The earlier quote from the Vendidad relates specifically to how Zoroastrians are expected to behave. It makes no proscription as to the behaviour of non-believers. Clearly it is the right of each religion to demark what is and is not acceptable for their own followers. In exploring the attitudes of varying faiths, it is not my intention to suggest that religion A adopt the views of religion B, simply to comment on the source of those views. However, I would like to emphasise my personal view that the world would probably be a happier place if religions focussed on instructing their own devotees, and did not attempt to impose their laws on the world at large.
A review by Robin Heme
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Handout 2

What are the potential abuses of these kinds of power in the relationship between counsellor and client?

This exercise should be done bearing in mind everything you know about ethics, moral values, cultural identity and working with difference. Think about the differing constraints between the context of the counselling; eg private practice, doing outsourced work for EAPs (Employee Assisted Programmes) or other agencies, employment by the NHS or other agencies.

Ability to offer or withhold rewards, privileges or specialist services
Power to compel or punish the other into compliance
Having specialist knowledge or training
Possession of knowledge and the ability to communicate effectively
Power invested by law or status
Status of the two parties in relation to each other
Ability to meet the other?s emotional needs
Sexual power
Cultural power- belonging to the dominant culture (gender, race, sexuality, etc)
Social, class based power
Coping power- being more able to cope or function, emotionally or practically, than the other
Economic power
Being in possession of the territory
Any other kinds?

Janet Dowding 02.2010 saved as power
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Handout3

Attitudes Toward Difference Survey: The Riddle Scale
Put a check next to each statement with which you agree. Bracket the 2-3 consecutive statements that reflect your current range of thinking about lesbian, gay, bisexual, and transgender (LGBT) people.
___ 1. Homosexuality is unnatural and immoral. LGBT people are emotionally or psychologically ill.
___ 2. LGBT people should participate in reparative therapy or any other treatment available to help them change their sexual orientation.
___ 3. We should have compassion for LGBT people. They can?t be blamed for how they were born.
___ 4. LGBT people didn?t choose to be the way they are. If they could somehow become heterosexual, they would surely do so.
___ 5. Homosexuality is a phase that many people go through and most grow out of.
___ 6. LGBT people need our support and guidance as they wrestle with the many difficult issues associated with their lifestyle.
___ 7. I have no problem with LGBT people, but see no need for them to flaunt their sexual orientation publicly.
___ 8. What LGBT people do in the privacy of their own bedroom is their business.
___ 9. LGBT people deserve the same rights and privileges as everybody else.
___10. Homophobia is wrong. Society needs to take a stand against anti-LGBT bias.
___11. It takes strength and courage for LGBT people to be themselves in today?s world.
___12. It is important for me to examine my own attitudes so that I can actively support the struggle for equality that LGBT people have undertaken.
___13. There is great value in our human diversity. LGBT people are an important part of that diversity.
___14. It is important for me to stand up to those who demonstrate homophobic attitudes.
___15. LGBT people are an indispensable part of our society. They have contributed much to our world and there is much to be learned from their experiences.
___16. I would be proud to be part of an LGBT organization, and to openly advocate for the full and equal inclusion of LGBT people at all levels of our society.

Attitudes Toward Difference Survey Scoring Guide
Find the numbers below that correspond to the bracketed range on your survey. Read the attitude and characteristics that encompass this range. According to the Attitudes Toward Difference Scale developed by psychologist Dorothy Riddle, this is where you stand with regard to lesbian, gay, bisexual and transgender (LGBT) people.
1-2 Repulsion: LGBT people are strange, sick, crazy and aversive.
3-4 Pity: LGBT people are somehow born that way and it is pitiful.
5-6 Tolerance: Life for LGBT people is hard; anti-gay attitudes just make things worse.
7-8 Acceptance: Homosexuality is a fact of life that should neither be punished nor celebrated.
9-10 Support: The rights of LGBT people should be protected and safeguarded.
11-12 Admiration: Being LGBT in our society takes strength.
13-14 Appreciation: There is value in diversity. Homophobic attitudes should be confronted.
15-16 Nurturance: LGBT people are an indispensable part of society.
Adapted from: Riddle, D. (1985). “Homophobia Scale.” In Opening Doors to Understanding and Acceptance. ed. K. Obear and A. Reynolds. Boston: Unpublished essay.
Your Rating:
1-4 Your personal feelings may be preventing you from accepting and respecting LGBT people.
5-8 You are somewhat accepting, but may not be willing to actively work against anti-LGBT bias.
9-12 You are willing to provide support and work toward equal rights for LGBT people.
13-16 You are able to fully embrace LGBT people as equal and valuable members of the community.
Food for Thought:
Are your attitudes toward LGBT people based upon experience or preconceptions?
Are you as accepting of LGBT people as you are of people from different racial, ethnic or religious backgrounds? Why or why not? Have you ever had an LGBT friend? How might your attitudes help or hinder you from being an ally for LGBT people? What can you do educate yourself about LGBT issues and improve your attitude with regard to LGBT people?
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Handout 4

Acceptance
One of Rogers? core conditions for counselling was ?unconditional positive regard?. Acceptance is a major aspect of this.

Much has been written about what unconditional positive regard might mean and what the difficulties are. One of the other core conditions is that of congruence, or genuineness. What are the conflicts between congruence and acceptance?

Classifying, stereotyping, prejudice
As human beings we are naturally prone to organising our world by classifying things:
?these things are furniture- this is a table, but that is a chair?
?that is a wren and that is a blackbird?

– and we do it with our fellow human beings:
?You are male, you are female?,
?you are black, she is white?

This leads to: ?you are like me, you are not like me?

? and stereotypes are born:
?men can?t express their feelings?,
?women can?t read maps?,
?black people can run faster?

And the judgements and assumptions based on the stereotypes creep in:
Scots are mean with money,
gay relationships never last,
black boys drive too fast,
These are clearly a barrier to seeing people as individuals.

It happens. We are all prejudiced, and we have all grown up absorbing the values and norms of society. However we can be aware of which ones are still active which dormant, and which have truly been changed by life experience.

Why is acceptance a prized attitude in counsellors?
An attitude of acceptance enables the client to feel free to explore their difficulties
? Without judgement
? Knowing that the therapist will not become involved in their lives
? Without having the opinions or values of the counsellor imposed on them
? Whilst maintaining their autonomy (ie no advice!)
? With the minimum of shame, which interrupts the process

As a counsellor the aim is to accept the client?s
? worth
? experience
? thoughts, feelings, desires and fantasies-
? identity and culture
? the validity of their values, even if they are different

?The subject matter of psychotherapy includes fantasies, fears, and feelings which patients find very hard to acknowledge, even to themselves? psychotherapy is a medium where the normal rules of social encounters are suspended and where it is safe to regress at times into kinds of behaviour which would be quite inappropriate in another setting.?
Holmes and Lindley quoted by Bond in Ethics of Counselling , 2000, p151

Acceptance of the client?s experience involves listening for the emotional rather than literal truth? clients often use metaphor, or use highly emotional language in order to convey the complexities of their inner world. Even when you suspect that another person might experience the same thing quite differently, it is the client?s experience which leads to the necessary understanding.

Acceptance of the person rather than their behaviour

Person centred theorists suggest that respecting the person and accepting their worth might be distinguished from the counsellor? feelings about behaviour.

Clients may exhibit judgemental, hostile, prejudiced or narrow views- they may admit to disloyalty, cruelty, to lying or cheating, to hurting someone else; they may appear to be incapable of love or empathy for others or for themselves? they may offend you your values or your principles? the behaviour may be out there in the world or in the room with you.

(NB Whether s/he admits it initially or not, the client may have come because s/he doesn?t like the behaviour either.)

The behaviour may be due to
? outmoded childhood survival strategies
? an avoidance of negative feeling- sadness, fear
? defence against shame
? entrenched patterns of relating
? a lack of self-worth
? unresolved trauma
? a history of being bullied or neglected
-and so on.

The following examples might illustrate this point:
? a teacher who tells you that she enjoys humiliating her pupils
? a man who makes it clear that a woman?s place is in the kitchen
? a client who swears aggressively throughout the session
? a client who considers beatings from her partner to be justified or normal
? a manager who brags to you about sexually harassing his staff

Acceptance of the client?s identity and culture

Person centred theorists haven?t generally paid a great deal of attention to cultural difference.

A cautionary note:

It?s vital for counsellors to be self-aware about their morals beliefs and values, to examine how thoroughly they have questioned those that they were brought up with to arrive at their own.

Where your values beliefs and morals are so different from the client?s and when the behaviour in question is related to the culture or identity of the client, beware the pull to ?love the sinner, hate the sin?. Taking homosexuality as an example: It is oppressive to cloak feelings of disapproval, repulsion or negative views of homosexuality in a warm but less than genuine regard for the client.

?Gay clients have no desire to be confronted by therapists who warmly offer to help them with a poor situation. In fact, such an attitude is one of the subtler forms of homophobia. Therapists who are unable to accept homosexuality as a positive and potentially creative way of being should recognize this fact and not take on gay clients: their fear, anxiety and ambivalence will inevitably be conveyed to their clients?.

(Woodman and Lenna, 1980) quoted in Pink Therapy Vol 2: Ed. Davies and Neal Therapeutic perspectives on working with lesbian, gay and bisexual clients. 2000, p100.

To summarise:
Acceptance in the Rogerian sense is an acceptance of the client?s experience and inner world.

Acceptance of this need not require you to like their behaviour (or allow it, if it violates your boundaries). However acceptance that it is as it is may help you to stay open enough to find out what lies behind it.

?Acceptance? can be experienced by some stigmatised minorities as patronising or pathologising; they might ask:

?What is there to accept? Who are you to say that I am alright by you? Are you judging that my way of being in the world is less valid than yours??

What are the challenges to us as counsellors in aiming to be congruent and accepting?

Where might your limits lie?

Which clients do you feel that you really could or should not work with?

Janet Dowding March 2010 Saved as Acceptance

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Handout 5

How does your internalised oppression operate?

In what ways does the way that you identify hold you back?

Do you stand in your own way because you have embedded beliefs about how your identity makes you unacceptable to others?

Think about which of your cultural identifiers make you a member of a stigmatised minority- even if it is mainly only in certain situations.

Have you internalised injunctions about how women, or (substitute your sexual orientation, religious background, ethnicity, etc) should be or behave?

If you are not in the dominant culture in your workplace, do you imagine that there is only so far that you can progress and still be liked by other people?

Do you sometimes feel / fear that people see you as a stereotype and not as an individual?

Do you find yourself acting out stereotypes?

Do you start to believe the stereotypes?

Are you hyper-critical of yourself, of others like you, of others different to you?

Do you blame your identity for a lack of self-esteem?

Do you blame your identity for a lack of academic or career progress?

Do you skimp on self-care or settle for less than what you really need?

Do your feelings of difference stop you from getting close to people?

Do you tone down your culturally determined behaviour to blend in or make yourself more acceptable, when with people not like you? (e.g. as a man in a group of women, be less macho / as an American, tone down your accent , as a Christian, choose not to mention your religious beliefs.)

If the stereotype about your identity is that you are prone to anger, do you spend a lot of time trying to be nice?

Do you wear a mask in certain situations either to hide an aspect of your identity or to make you acceptable in spite of your difference?

If the stereotype about your identity is that you are vulnerable, do you minimise your needs?
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Handout 6

AN ETHICAL DECISION MAKING MODEL

1. Identify the situation or problem and write a clear description

2. Whose problem is it?
? Practitioner?s dilemma?
? Shared dilemma?
? Organisational dilemma?
Consider all relational aspects

3. Check out relevant ethical frameworks and the law
? What is required by law?
? What is prohibited by law?

4. Consider the principles and values underlying the counselling work
? Beneficence ? what decisions and actions will achieve the greatest good?
? Non-maleficence ? what decisions and actions will cause the least harm?
? Justice ? what decisions and actions will be fairest for all parties concerned?
? Autonomy ? what decisions and actions respect and maximise opportunities for individuals to implement their own choices?
? Fidelity ? what decisions and actions honour the trust placed in the practitioner?
? Self-respect ? how should the practitioner?s own need for the above principles and values be taken into account?

5. Identify all available support

6. Identify all possible courses of action

7. Review each possibility by identifying which principles/values are brought into conflict by each one, and consider the impact and likely consequences of each.

8. Select the appropriate course of action. Take into account three tests:
? Universality ? could your chosen course of action be recommended to others? Would you condone it, if it was done by someone else?
? Publicity ? could I explain my chosen course of action to other practitioners? Would I be willing to have my actions and rationale exposed to scrutiny in a public forum?
? Justice ? would I do the same for other clients/counsellors in a similar position? Would I do the same if the client/counsellor was well known or influential (or was not)?

9. Document the above process carefully

10. Evaluate the outcome
? Was the outcome as you hoped?
? Had you considered all relevant factors?
? Would you do the same again in similar circumstances?

11. Review any personal impact the situation has caused
? How has this situation affected me?
? Can I identify any skills or knowledge areas that need to be developed?
? Has any need for personal therapy emerged?

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Handout 7

Boundary problems and dual relationships

Dual relationships are seldom neutral. It is necessary to consider their impact on counselling process and entering into them calls for careful consideration, not least because of the boundary issues involved.

? Direct dual relationships e.g. client and trainee; trainee and supervisee; line management and supervision; supervisee and friend
? Indirect dual relationships e.g. counselling someone when you know their partner; acting as a consultant for a training course when one of the students is a current client of yours; counselling a client who is the supervisee of your supervisor; counselling a client who is the supervisee of a colleague

In these situations it is necessary to consider confidentiality and the potential for compromising the efficacy of specific roles. Ethical principles that come into play include justice, fidelity and self-respect.

? Crossing boundaries – usually involves consideration, negotiation and has the client?s needs in the foreground eg client arrives with a flat tyre and without their mobile phone, so you offer the use of your phone or negotiating seeing a client twice weekly when your usual practice is once weekly.
? Breaking boundaries ? usually involves the intentional or unintentional use or abuse of a client, financially, emotionally or sexually

?A board-certified psychiatrist saw a woman in individual therapy for ten years. During the course of the therapeutic relationship, he negotiated with her to sell her two of his boats, sight unseen. Additional transactions involved sales of her personal property to him: Waterford crystal, china, and a silver service, the last of which as appraised at $1,600 but was purchased by the psychiatrist for $200. In the same year he accepted a refrigerator and a dining table with six chairs as gifts. During the course of these commercial trasactions, the patient had run up a significant bill with the psychiatrist. She sold her father?s coin collection to the psychiatrist for $1,000 as a means of getting one of the boats into the water. Within a year, the back repossessed the boat and the patient declared bankruptcy.?

(Norris, Gutheil and Strasburger 2003)

This seems improbable but illustrates the potential power of a practitioner. Less obvious forms of exploitation or enmeshment might include taking on a client with issues beyond your competance because of the need for work; over running sessions because of enjoying the client?s company; continuing to see a client within an organisational setting when they are no longer entitled to counselling, because of feeling no one else can help.

Breaking sexual boundaries

A US studies (Pope 1988) showed that on average 8.3% of male mental health professionals and 1.7% of female mental health professionals had sexually engaged with clients. Given that the respondents willingly gave this information it is reasonably to expect that others had sexually engaged with clients but did not want to disclose this.

Practitioners who sexually engage with clients often thought of as ?a scheming, malicious therapist overpowering ? perhaps by physical force ? a reluctant client? (Pope 1988 p.222). This is a misconception.

Common scenarios (from Pope 1988 p.223)

Role Trading therapist becomes the ?patient? and the wants and needs of the therapist become the focus of the treatment
Sex Therapy therapist fraudulently presents therapist-client sexual intimacy as a valid treatment for sexual or other kinds of difficulties
As if? therapist treats positive transference as if it were not the result of the therapeutic situation
Svengali therapist creates and exploits an exaggerated dependence on the part of the client
Drugs therapist uses drugs or alcohol as part of the seduction
Rape therapist uses physical force, threats, and/or intimidation
?True Love? therapist uses rationalizations that attempt to discount the professional nature of the relationship with its attendant responsibilities and dynamics
It just got out of hand therapist fails to treat the emotional closeness that develops in therapy with sufficient attention, care and respect
Time out therapist fails to acknowledge and take into account that the therapeutic relationship does not cease to exist between scheduled sessions or outside the therapist?s office
Hold me therapist exploits client?s desire for non-erotic physical contact and client?s possible difficulties distinguishing between erotic and non-erotic contact

Therapist risk factors (Norris, Gutheil and Strasburger 2003)

? Life crises
? Transitions
? Therapist illness
? Loneliness and the impulse to confide
? Idealisation and the ?special patient? ? ?I don?t usually do this with my clients, but??.?
? Pride and shame (this couldn?t happen to me: I know what I?m doing)
? Problem with setting limits
? Denial

These are a variety of circumstances that may create vulnerability for the therapist and so increase the likelihood of using a client or clients to resolve the sense of uncertainty, loneliness, stress etc, as well as evoking feelings that skew judgement and inhibit finding support and help.

Factors increasing client vulnerability

? a pattern of seeking enmeshment
? the difficulty of challenging therapist behaviour
? previous experience of boundary violations, especially early in life
? shame and self-blame
It is important to remember that whatever is happening for the client, it is always the practitioners responsibility to maintain appropriate boundaries. Boundary violations are never the fault of clients.

Damage done by therapist-client sexual contact (Pope 1988)

? Ambivalence ? feelings of alternately or simultaneously wanting to get away from the therapist and cling to or protect the therapist
? Feelings of guilt ? affected clients feel to blame, although the responsibility always rests with the therapist
? Sense of emptiness and isolation ? a sense of being cut off and worthless
? Sexual confusion ? including traumatic memories, avoidance of sex or compulsive sex
? Impaired ability to trust ? others and themselves for having trusted the therapist
? Identity, boundary and role confusion ? harm is done to the sense of a separate self and the ability to establish and maintain boundaries
? Emotional liability ? strong feelings including anxiety or depression that can overwhelm
? Suppressed rage
? Increased suicidal risk
? Cognitive dysfunction ? especially with attention and concentration

These affects are very similar to the affects of early trauma, rape and assault.

Approaching sexual feelings in counselling

The intimacy inherent in counselling gives rise to strong feelings ? positive and negative. Sexual feeling can be particularly problematic as:

? issues of sexuality are often neglected on counsellor training courses
? the problem is often downplayed or denied amongst professionals
? discomfort inhibits or blocks conversation about the sexual feelings that commonly arise for practitioners. For instance, research has shown supervisees are often reticent to talk about sexual feelings arising in their work in supervision (Webb and Wheeler 1998)

References

Norris, D., Gutheil, T. and Strasburger, L. (2003) ?This Couldn?t Happen to Me: Boundary Problems and Sexual Misconduct in the Psychotherapy Relationship? in Pyschiatric Services http://psychservices.psychiatryonline.org. Vol. 54. No.4.

Pope, K. (1988). ?How Clients are Harmed by Sexual Contact with Mental Health Professional: The Syndrome and its Prevalence? in Journal of Counselling and Development. Vol 67.

Webb, A. and Wheeler, S. (1998) ?How honest do counsellors dare to be in the supervisory relationship?: an exploratory study? in British Journal of Guidance and Counselling. Vol. 26. No. 4.

? Sarah Hawtin 2007

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Handout 8

Boundaries and the therapeutic framework

What are boundaries? What might they look like in the counselling relationship? Why are they important?

Boundaries form the limits of therapy and include time, place and emotional, psychological and sexual limits. Boundaries include the recognition that practitioner and client may well have different expectations and hopes about what is possible.

? Time/place ? expectations may be influenced by prior ideas about counselling; feelings of needing help and/or feeling able/unable to cope; implications of what is offered ? short term/long term; time limited and open ended

? Emotional, psychological and sexual limits ? need to recognise the constellation of feelings that cluster around relationships past and present; need, dependency, love, desire, security, frustration, abandonment, fear/anxiety, hate, jealousy etc etc

A practitioner needs to convey their commitment, understanding and willingness to help without becoming involved in a ways that:

? perpetuates the state/s a client is seeking to resolve
? primarily serves the counsellor
? undermines the client?s capacity to build trust in themselves, their feelings and their ability to act

Contracts

Contracts are mutually agreed limits ? usually including time, place, duration, confidentiality, payment and goals (do more of this in the working alliance weekend). Forming a contract is part of an open exploration of expectations and hopes. It makes boundaries transparent, therefore suppporting a client?s autonomy and helps with negotiation.

Boundaries and confidentiality ? the ideal and the actual

The most idealistic image of therapy is of the closed door, sealed against any intrusion. This can be taken literally and symbolically i.e. the idea of dedicated time, free from outside interference and with the total focus being the client. However, the reality is there are duties that may conflict. For instance, the duties of confidentiality and care may collide if there is a likelihood of self-harm or harm to another.

Mark Aveline (2001) has highlighted the professional, ethical, legal and employment obligations that are part of therapeutic working (see Figure 1 below). The responsible practitioner cannot ignore the realities of those institutions or individuals who are potentially affected by counselling.

Figure 1 ? Possible stakeholders in the counselling process.

The function of the therapeutic framework

The therapeutic framework is the constellation of boundaries or limits to working. This is always ?holding? (providing consistency, safety and in some instances a reparative relationship) and may also be illuminating (highlighting patterns of behaviour and feeling).

The use of the therapeutic framework varies between approaches:

? person-centred ? has a reputation for flexible boundaries, including variable length sessions. This needs to be understood as a proactive process of negotiation in reponse to client need, rather than being reactive.
? psychodynamic ? the framework is more consciously encorporated, because of wanting to ?use? the frame as a way of coming to understand a client more fully. The emphasis on transference also raises the need for appropriate and safe holding.

References

Aveline, M. (2001). ?Complexities of practice: psychotherapy in the real world? in eds. Palmer Barnes, F. and Murdin, L. Values and Ethics in the Practice of Psychotherapy and Counselling. Buckingham: Open University Press.

? Sarah Hawtin 2007
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Handout 9

Working with Transgender Clients
Tina Livingstone
B.Ed Hons, Dip Couns
Introduction
For the purposes of this document I shall refer to the client group as T, rather
than transvestite, transgender or transsexual, partly because counselling may
precede any clinical diagnosis and partly because it is an inclusive, though not
ideal, identifier for a rainbow of trans-identities that seems too diverse to
quantify into a tripartite system.
I write from the perspective of a non ?Trans, Client Centred counsellor with 15
years personal experience within the trans-community. Currently working in
private practice, my T clients are from all areas and walks of life, and include
those who self identify as transsexual, transvestites, and transgendered
people, those with clinical diagnosis of transsexualism, people pre- and post
gender transition, pre and post reassignment surgery, those struggling with
gender issues and indeed those struggling with other issues.
N.B
It is wrong to assume that T clients always come to counselling with gender
based issues, though there is no doubt that these can provide another layer of
difficulty even when the source of the struggle lays elsewhere
As with the rest of the population contact with myself as a counsellor often
occurs at a crossroads / dilemma junction or is the result of cumulative stress;
in the case of T clients such need may occur pre-, during, and/or post clinical
treatment. My clients come to me through advertisement and on
recommendation within the trans-community itself.
My professional experience is that the relevance of counselling to the
emotional and psychological health of T people is both significant and diverse.
The emotional / psychological pressure of being in a socially stigmatised
minority being one of the primary pressures.
It is my belief that ideally those who work with T clients should have some
grounding in the issues arising, relevant legislation, and current clinical
treatment, thus enabling connection with the clients frame of reference and
facilitating informed practice. (It can be off putting for a client to be met as a
curiosity or questioned about process and equally challenging for the
counsellor not to know what the client is talking about – detracting from
therapeutic process in both cases)
My experience is that the Humanistic approaches, acknowledging the right to
self autonomy, and providing a suitably empathic and non judgemental basis
for therapeutic process, are most useful with these clients.

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