Ethical Issues in Counselling and Health in Primary Care

Primary care is the first contact with the health service for patients and is thus the meeting point for people with different perspectives on emotional and psychological issues. The counselling model needs to examine the moral problems posed by these difficulties, and its own differences from the standard health care model, where cure and symptomatic relief rather than personal growth may be the aim. Key situations and relationships are examined against a background of accepted ethical principles (respect for autonomy, the duty to care, minimising harm, and being fair) from the viewpoint of all involved in the encounter, with particular reference to conflicts, responsibilities, confidentiality, and methods of referral and joint working.     

Ethical Issues in Counselling in Education

It is suggested that there are two quite distinct Systems of ethics and practice in use by counsellors in education: the integrated model, which emphasises viewing the counsellor-institution relationship as theprimary ethical perspective; and the differentiated model, which emphasises the counsellor-client relationship as the starting point for an ethical understanding of the counsellor's role. The implications of these two perspectives for ethical issues relating to sources of referrai, issues of confidentiality, accountability for resources, the implications of role diffusion, and the outcomes of counselling, are examined. The ethical consequences of viewing the two Systems as reconcilable or incompatible are explored.     

Ethical Issues in Counselling at Work

Providing counselling in the workplace can challenge the ethical principles on which counselling is based. A series of questions is identified designed to focus attention on aims, outcomes, referrals, confidentiality and resources. It is concluded that confronting ethical dilemmas is a continuous responsibility for counsellors. Frequently issues are managed rather than resolved. However, in confronting and managing these issues, the values underpinning organisational life can be challenged and, perhaps, changed.     

Ethical Issues in Marital and Sexual Counselling

RELATE's marital and sexual counselling generates ethical issues relating to the welfare of client couples and to the policy and public profile of the organisation itself. These issues are interactive and create a unique context within which volunteer counsellors work. Clients' private lives and relationships remain the prime focus of that work, but special attention is paid to the private aspects of relationships which impinge on the realities and the obligations of social living.     

Pastoral Counselling

The beginnings of the modern pastoral-care and counselling movement in the 1960s are reviewed, in particular, the attempt to integrate theology with the behavioural sciences, and the theories born of that integration with the practice of pastors and religious leaders. The developments of the last ten years are explored and the tensions of the movement analysed. Pastoral counsellors' contribution to counselling in general in the United Kingdom, and to pastoral ministry both here and overseas, is assessed.     

Ethical Issues in Counselling and Psychotherapy: The Background

Ethical issues have their roots in the belief systems of individuals and society. Codes of ethics are seen as attempts to ensure that behaviour accords with these belief systems. An outline model is presented which highlights some aspects of beliefs, feelings and conscious and unconscious processes, and their effects upon the conscious behaviours of the individual. Aspects of social change and context are briefly considered, together with the subsequent effects upon beliefs and ethics, and issues of responsibility.     

Ethical Issues in Family-Centered Primary Care

In 1969 a new primary care medical specialty, family practice, was formally created. One element in the development of this specialty from the roots of general practice was an understanding of the importance of family process in health and health care. Family physicians are now trained to work with families in the provision of primary medical care, and many provide some formal family counseling and therapy. The family physician who works with families faces many of the same ethical conflicts with which family therapists are confronted. The primary relationship of the family physician to his or her patients, however, as the provider of continuing health care, modifies these conflicts and creates new and vexing problems.     

Coming Issues in the Pastoral Care of the Aged

In the context of a growing aging population, this paper begins with the notion that the traditional resources of pastoral care will remain relevant, cffective and basic. However, the Church must redefine its images of "successful" ministry to emphasize the inhercnt value of the gray church. Gerontological stud~es need to become integrated in the whole enterprise of theological education and should be recognized as both presenting a special opportunity for female clergy and for developing a new model of m~nistry. Discussed are three needs for adequate preparation for the pastoral care of the aged: (1) Training in group process, (2) Skills in conflict resolution, and (3) A theology of aging that rests on Grace rather than works and that separates aging as a process distinct from death and dying. Finally, the author insists upon the involvement of the aged as a prerequisite for authenticity in each of these areas.     

Issues in Pastoral Care and Counseling for the Fourth Quarter of Life

Issues and risks for pastoral care and counseling from the perspective of old age (here, ages 75 to 100) include identification of old age as a problem and its association with death in a death-denying culture. Two elements are fundamental: existential experiential deficits between the old and their younger caregivers (e.g., age cohort experiences, health status, gender, culture, privilege, etc.); and boundary issues that push the old, and pastoral care, to the edge of experience, where choices must be made between creativity and negativity (e.g., moving to dependent living, disability, etc.). Loss of doing (versus being) as a viable option is a major edge experience. The resulting sense of emptiness carries with it the potential for a sacramental awareness in which absence of doing becomes an outward and visible sign of an inward and spiritual grace.     

Stewardship Models of Pastoral Care,Counselling and Supervision: The Commonians Meet Ricoeur at Worship

The common factors debate in psychology and, more recently, marriage and family therapy is slow to erupt in pastoral care and counselling. This article introduces the common factors debate into pastoral science by proposing the Stewardship Models of Pastoral Ministry and Supervision. The model integrates common factors research and pastoral practice using Ricoeur’s “economy of the gift” ethic. The model’s focus is pastoral care, counselling and supervision in congregations, a unique community context in search of an adequate pastoral praxis.     

Some Legal Issues in Counselling and Psychotherapy

Although substantial legal difficulties can face anyone trying to recover compensation from counsellors for breach of their legal duties, such claims can in principle succeed. Counsellors ought to take particular care to provide a physically safe setting for the counselling session. Advice given to the client can lead to liability both to the client and to third parties who may be affected. The impact of the client's actions on third parties can justify, and less often compel, departures from confidentiality. The importance of keeping client records has to be balanced against legal obligations imposed on counsellors in various situations to make such records available for inspection by the client or third parties.     

Ethical,Legal, and Psychosocial Issues in Care of Transgender Adolescents

SUMMARY

Complete care for transgender adolescents must be considered in the context of a holistic approach that includes comprehensive primary care as well as cultural, economic, psychosocial, sexual, and spiritual influences on health. Not all transgender adolescents have gender dysphoria or wish to undergo sex reassignment. In this article we focus on general care of transgender adolescents by the non-specialist working in primary care, family services, schools, child welfare, mental health, and other community settings.     

Pastoral Care and Medical Education

This essay describes how contemporary medical education and pastoral care share historical roots, confront similar pressures and objectives in the formation of future professionals, and address common concerns in the area of bioethics. The essay concludes with a summary of ideas regarding the present and future relationship between medical education and pastoral care. The essay is dedicated to the memory of David P. Rogers, M.D., whose vision of medical education and medical practice embodied a rare passion for justice.     

Counselling in general practice: Issues and opportunities

The results are reported of a survey of GP counsellors and primary health care teams concerning the role and contribution of counsellors in primary care. Most of the literature argues the value of this service, which has been growing very quickly. This survey identified the principal tasks of GP counsellors, their relationship with the host team, and some of the organisational and professional dilemmas which need to be addressed. A great deal of variation wasfound in ail of these areas, which suggests the value of a protocol for GP counselling to establish minimum standards and promote best practice.     

Pastoral Care in Aged Care Settings: Role and Challenges

Journal of Religion and Health - This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral...     

Counselling older adults: Issues and awareness

This paper explores understanding and awareness among counsellors and counselling psychologists, of work with older people. The result of a piece of reasarch on this topic are presented. These tentatively confirm a relative lack of interest and insight into work with this age group and indicate that an age bias may exist among therapists. The reasons for this lack of awareness are explored and it is suggested that issue of the therapists' countertransference is crucial and that work with older persons may raise complex emotional issues for the counsellor. Possible future directions for research are discussed.     

Pastoral Care: Myth and Reality

The increase in pastoral-care systems in secondary schools over the last fifteen years is examined. It is suggested that pastoral care is more effective in allaying the anxieties of teachers and their organisations than it is in meeting the social and personal needs of pupils. It is also suggested that pastoral-care systems assume responsibilities which are more properly those of the family, and that the best way schools can offset the effects of poor home environments is via good subject teaching and increased pupil involvement in schools.