The virtues, then, come neither by nature nor against nature, but nature gives the capacity for acquiring them, and this is developed by training. Aristotle, in Nicomachean Ethics
As our profession continues to solidify, California recently became the 50th state to grant licensure to professional counselors. I echo the claim of many, in that we ought to pause and reassess our approach to the practice of counseling. Virtue and ethics should be at the core of examining our profession, as they are the pillars upon which we can build and sustain our professional personhood.
The Aristotelian idea that moral virtues are not innate, but acquired, rings true to me. We are equipped by nature with what is needed to be moral, but it is upbringing and social influence that helps us create meaning and moral codes to guide us. We become ethical professionals by practicing moral virtues (i.e. committing courageous, just, caring acts to benefit clients). There are many layers of ethical consideration in the character formation of an integral counselor. By integral counselor I mean a professional whose decisions are informed by a wide variety of moral virtues, and the moral conviction of “above all, do no harm.” Our moral virtues (honesty, duty, good, honor, justice, liberty, love, prudence, temperance, wisdom, just to name a few) get tested on a regular basis as we interact with the world at large, and more specifically as we interact with the mechanisms of managed care.
The challenges have many faces. For instance, the bureaucratic demands of complying with managed care is one face, which can at times be insurmountable for counselors, but it is at the time of despair that we have to remember the principles of ethics and virtue that guide our profession and let them direct our way through the overwhelm. Some managed care companies seem to be in a rush to discourage requests for services. The number of forms, phone calls, and other logistics involved not only takes time away from focusing on treatment, but also drains the energy of even the most competent among us. I do acknowledge that managed care became as guarded as it is due at least in part to the practice of beating the system, in which organizations retain patients until their insurance runs out. The bureaucracy we experience today exists for a variety of reasons, including both past and present abuse.
Another aspect of this conundrum is how managed care’s monitoring of mental health services births several ethical dilemmas, such as those that emerge around record keeping, length of services and maintaining confidentiality according to managed care’s requirements. The need to pay close attention to these ethical problems is imperative. I could venture to say that a good solution to ethical issues related to managed care would be for counselors not to be part of it, but such a decision confronts us with a new ethical dilemma: we would be abandoning a great number of individuals who otherwise could not afford the services as private pay is not affordable to them. The ideal setting will be one in which licensed professional counselors can establish a working relationship with managed care where appropriate. Such a working relationship will only be established if we strategically demand and advocate for it.
Among the moral virtues that should guide our personhood is honesty. One way to enhance each counselor’s contribution to the appropriate resolution of ethical dilemmas is to make every effort to ensure the provision of honest services. First of all, we must properly discuss and ensure clients understanding of informed consent. The discussion of informed consent and subsequent clarification of the information, such as the purpose of treatment, goals, counselor’s orientation and background, limitations of the therapeutic encounter, as well as potential risks and benefits of the services are just a few examples of honesty, manifested through love and great care for our clients.
Along the same lines, prudence calls for helping clients understand diagnosis and alternatives to treatment so they can make informed decisions about the trajectory of their counseling experiences. It is our duty to keep clients involved in the counseling plan, making them integral voices in the design of treatment and subsequent revisions, to ensure we are addressing their needs and not just justifying services for the sake of reimbursement.
Learning about the different cultures that surround us, making ourselves versed, to the extent possible, in our clients’ cultures and societal practices are just as important as writing accurate progress notes or designing appropriate treatment plans. We ought to honor clients’ individuality and cultural backgrounds, while also honoring who we are by making it part of the conversation—letting clients know where our observations stem from. It is important to remind clients that our input is filtered by our own cultural lenses, to help them understand how crucial their feedback is.
Last but not least, as counselors we have an ethical responsibility to use our knowledge and wisdom to discern appropriate affiliations and memberships with organizations. We ought to be on the watch for inappropriate policies and practices in our surroundings, attempting to effect changes in such policies as our code of ethics calls for. By denouncing improper actions and hindering practices we demonstrate care, and our commitment to justice. My license plate is framed by the words, “Work for peace and social justice,” as a reminder of my duty. Again, nature has given us everything we need to be moral and to practice virtue. Wisdom calls for our ongoing revision of how it is that we sustain the responsibility bestowed on us when we are granted the professional identity of Licensed Professional Counselor, and a corresponding examination of the moral codes that guide and inform our professional personhood.
Marianela Medrano-Marra is a counselor and Dominican writer living and practicing in Naugatuck, CT. She writes poetry, essays, and creative non-fiction; with publications including essays and four books of poetry.