Theory and Practice of Couples and Family Counseling. James Robert Bitter
ethics, virtue ethics can be challenged for their cultural relevance. Bersoff (1996) acknowledged the social construction and social embeddedness of virtues and community wisdom, the very foundation of a virtue ethics perspective. Think of the virtues that you hold dear. Where did they come from? Do you have any idea of the history of these virtues in your own cultures? The very nature of multiple cultures means that there will be diverse perspectives on what is defined as virtue and virtuous behavior.
The teachability of virtue ethics is an additional dilemma (Bersoff, 1996; Kitchener, 1996). Can the virtues of the helping professions be taught within a 2- or 3-year program? What about the nurtured habits that you developed within your family of origin? What if some values nurtured in you from the time you were an infant do not fit well with the virtues of the helping professions? Would you be willing to give up values you have held all your life and adopt the values supported by your profession? What would that mean for you within your own family life? If professionally congruent virtues cannot be taught and learned during a graduate program, those programs may have to adopt the difficult position of choosing candidates who already possess professionally desirable attributes and values (Bersoff, 1996). What are the problems that accompany this idea? The problems would be even more complex if members of a profession had to agree on a set of professional virtues and then create a means of assessing candidates during the interview process. Impossible, you say! Maybe, but some preparation programs are currently attempting to do exactly that.
Participatory Ethics
Another perspective on ethics is grounded in postmodern philosophy, thought, and sensibilities: It is called participatory ethics. Postmodernism is based on a multiplicity of realities and truths; it values people’s meaning-making processes as they create narratives of experience, and it examines dominant cultures that impede the self-agency of people who have only marginal participation in society. Feminism, social constructionism, and multiculturalism have all embraced this shift away from the modern to the postmodern. Participatory ethics invites families to be cocontributors to the ethical decision-making processes in family practice (Rave & Larsen, 1995). Postmodernists have critiqued family counseling and therapies based in modernist philosophy as attempts to colonize clients by viewing family practitioners as the keepers of knowledge and the people responsible for any decision related to counseling or therapy (see Hoffman, 1985). Participatory ethics seeks to include and value the knowledge brought to counseling or therapy by families. Client feedback on the processes of family practice is encouraged. That is, client input is valued as expert in relation to how individuals, couples, and families experience their own lives, and practitioner expertness is related to leadership of the therapeutic process.
For our family with the 14-year-old child, how might their stories of lived experience be prized? How, if at all, has the dominant discourse in which this family is situated oppressed their self-agency? Their self-determination? A family practitioner adopting participatory ethics might invite and emphasize the family’s experience and meaning-making processes in interactions with the dominant culture or the stories told by the court system about child neglect and how such stories influence the preferred view of the family. As participatory ethics attends to the marginalized, the voice of the 14-year-old child might be encouraged and amplified. The family counselor could work with the parents to help them imagine themselves through the eyes of their child, to imagine what the experience of the situation might be like and what the child’s preferred choices might be. The postmodern shift to participatory ethics can be quite powerful: In this model, the family practitioner’s position of power is counterbalanced by honoring the family’s own power in their process of living.
We have introduced three perspectives on ethics: principle, virtue, and participatory ethics. Take a moment to reflect on the essence of each of these perspectives and your emotional reaction to them. With principle ethics, you have externally derived guidelines based on at least six principles to guide your professional actions. Virtue ethics calls on you and the helping professions to examine the character traits essential to family practice and how these characteristics may impact ethical processes. Last, participatory ethics takes you to the space between you and your clients, to the relationship in which clinical decisions are coconstructed and negotiated with families. What are the potential positives in each that you see? What are the problems? What does your gut tell you about your thoughts and feelings about each? Now look at your answers to these questions. What do they say about you and your work with families? If you are not satisfied by one and only one perspective on ethics, then which blend fits for you? How would you integrate that blend into a functional model? Continue to ponder such questions as we now move through various models of decision-making.
Ethical Decision-Making
Understanding principles and virtues alone does not resolve an ethical dilemma. Some process is necessary that uses these principles and virtues. What follow are descriptions of three models of ethical decision-making related to the three ethics models we have already presented. These three models do not represent all available models of ethical decision-making. They are simply used to demonstrate how different perspectives might be applied.
Models of Ethical Decision-Making
The ACA Code of Ethics (ACA, 2014) states “when counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a carefully considered ethical decision-making process” (p. 3). This same code goes on to note that “counselors are expected to use a credible model of decision making that can bear public scrutiny of its application” (p. 3). None of the other helping profession codes state the importance of understanding and using models of ethical decision-making so explicitly. Because no model of decision-making has been shown to be better than any other, the responsibility is on the practitioner to demonstrate and justify publicly the value of solving an ethical dilemma in a particular way.
The Critical-Evaluation Model
Kitchener’s (1984) critical-evaluation model is based on the ethical principles of autonomy, beneficence, nonmaleficence, and justice. Today we would include the principles of fidelity and veracity in this list and use eight steps in the critical-evaluation model (Corey et al., 2019). They are as follows:
1 Identify the problem or dilemma: ethical, moral, and legal dimensions.
2 Identify potential issues, stakeholders, stakeholders’ responsibilities, and the competing principles involved in the situation.
3 Review ethical guidelines of the profession against your own moral perspective on the situation.
4 Know the applicable laws and regulations of the state in which you practice.
5 Consult.
6 Consider possible courses of action, and the actions of all parties involved.
7 Enumerate possible consequences of various decisions for all stakeholders.
8 Decide which option is the best choice. (pp. 19–23)
Wheeler and Bertram (2019) recommended careful documentation of the ethical decision-making process used to arrive at a course of action, including the options considered and ruled out. It is important to document the outcome and to include any additional actions that were taken to resolve the issue. This is where reviewing your notes can be particularly helpful in assessing the process. To obtain the most accurate picture, involve your client in this process when appropriate.
Let us walk through each step of the critical-evaluation model with the family whose child has leukemia that the parents are addressing with prayer. For the sake of brevity, we provide only brief examples here and not the complete process.
1 Step 1: Identify the problem. From an ethical standpoint, we have concerns regarding breaching client confidentiality and the welfare of the clients, including the child. Morally speaking you may be wondering about the safety and welfare of the child and about your tolerance for the parents’ autonomous decision-making.
2 Step