Running head: ETHICAL ISSUES AND MULTICULTURAL POPULATIONS

Ethical Issues and Multicultural Populations Shawna Sjoquist University of Calgary

Ethical Issues and Multicultural Populations The ethical issues pursuant to working with multicultural populations is a multifaceted topic area filled with vast speculation and debate with many arguments founded in emotion, spirituality, culture, virtue, socialization and reflection. As a professional body, we seek to promote ethical practice with our client population. In order to develop and maintain appropriate ethical practice as a discipline we must acknowledge and seek to rectify concerns where they arise. Working professionals look to principles, codes and standards throughout their ethical multicultural endeavours for guidance and support, however there have been many challenges to the very essence of this supportive framework. Watson, Herlihy & Pierce (2006) point out that many of the persistent criticisms of ethical practice with regard to multicultural populations postulate that the very principles that inspire many codes are not universally endorsed by all cultures. When considering multicultural practice one must acknowledge that both the counsellor and the client will present their own individual culturally acquired psyche as well as their familial, social and communal norms and values, their hopes, aspirations and their fears, their dreams and their nightmares, their art, music, literature and everything that was an integral part of their culture. (Laungani, p. 250, 2005). Given that we are products of all that we bring to an interaction, one must consider whether or not we have equal capacity to counsel individuals from different social, cultural and ethnic backgrounds with the same ethical affluence as we would in counselling a client from our own culture. (Laungani, 2005). Multicultural competence is a skill that must be continually evaluated and strengthened if we are to produce equivalent ethical practice that crosses cultural borders. Counsellors that infuse themselves into a variety of cultures benefit from an enrichment of intellectual, emotional, artistic, spiritual, humanitarian, and moral visions (Luangani, p. 3, 2005). Concerns

with multicultural competence and ethical practice arise when counsellors limit the development of multicultural ethics to rote use of the ethical principles and standard presented by a code of ethics (Watson et al., 2006). The Canadian Code of Ethics for Psychologists makes specific reference to non-discrimination (CPA, 2000). While the code directly identifies several areas that out rightly link to multicultural practice, it is a mistake to limit consideration of only those principles and standards that make specific reference to such obvious culturally relevant terms (Watson et al., 2006) as an individual endeavours toward multicultural competence. Proper development of multicultural competence involves awareness of information conveyed through a code of ethics, but more importantly proper development of multicultural competence in the discipline involves counsellor commitment to and demonstration of multicultural competence (Watson et al., 2006). Sensitivity to diversity must extend past simple awareness of obvious culturally relevant standards. Moreover, proper development of multicultural competence and sensitivity to diversity must include the inherent application of cultural sensitivities to the interpretation of all of the ethical standards present in the code (Watson et al., 2006). Some of the ethical issues that may be present when working with multicultural populations stem from the sheer reactive nature of the ethical code itself. The code is a document that reacts to the ever changing environment we live in. As individual culture, virtue, and socialization trends change, over time the codes adjust to accommodate. For instance, in the late 1800s there existed the belief that psychological differences among the races were based on hierarchy, in which people of European descent were presumed to represent the ideal of human development and individuals of other descent groups were seen as deficient by comparison (Watson et al., p.100, 2006). Given that considerations of cultural diversity are infused into ethical principles and their corresponding standards overtime, when there are significant changes

to society ethical codes run the risk of becoming antiquated (Watson et al., 2006). Thus, we must be careful to watch for the presence of cultural bias and account for the possibility of an antiquated ethical code. For instance, Henriksen & Trusty (2005) offer that an example of what would constitute harm may be viewed differently when viewed from the perspective of a poor Latina woman than from the perspective of an upper-middle class white man (Henriksen & Trusty, 2005). If we are attempting to apply a code of ethics universally then we must be careful to ensure that the working definitions both explicitly and implicitly used by the code are culturally universal. It has been argued that this is not always the case. For instance, ethical guidelines often urge counsellors to establish clearly defined regimented personal boundaries and to promote client independence while these behaviours are valued primarily by the dominant group (Wihak & Merali, 2007). Likewise, ethical codes may often be seen to infuse the counselling profession with a value system that emphasizes individual needs rather than the needs of the collective (Henriksen & Trusty, 2005). Ethical issues in working with multicultural populations become most apparent when exemplified by recurrent ethical dilemmas. Wihak & Merali (2007) presented a qualitative study of psychologists returned from practicing in remote locations. Results from the Wihak & Merali (2007) study revealed that the most commonly encountered ethical challenges experienced were situations where by their values conflicted with the values of their clients, there was a conflict between the pursuit of client individual wishes and the pursuit of clients family wishes and/or there were concerns with the application of assessment approaches that had been developed with dominant cultural norms (Wihak & Merali, 2007). In addition, psychologists also identified three major themes of ethical dilemmas: relaxing personal and professional boundaries, establishing confidentiality and redefining child maltreatment (Wihak & Merali, p.174, 2007).

The issue of competence also comprises an important ethical issue when considering practice with multicultural populations. Watson et al. (2006) state that it is unethical for counsellors to provide clinical service to clients who are culturally different from themselves if the counsellors are not competent to work effectively with these clients (Watson et al., p.99, 2006). It is ethically relevant to ensure that professionals working with multicultural populations establish and maintain multicultural competence. In order for a professional to be culturally competent they must be actively involved in a reflective process of their own personal assumptions regarding human behaviour, values, beliefs, biases, preconceived notions and personal limitations (Henriksen & Trusty, p. 183, 2005). If we are to speak of ethical responsibility it may be said that it is a professionals responsibility to become personally aware of their own culturally relevant biases including race, ethnicity, sexual orientation, socioeconomic class, age, gender, disability status and other cultural variables (Watson et al., 2006). Concern of self-awareness is another ethically relevant issue that pertains to working with a multicultural population. If a professional practices with a lack of self-awareness the professional runs the risk of inadvertently applying their own personal values and beliefs to the client (Henriksen & Trusty, 2005). A counsellor must acquire an awareness of self before they can intentionally account for their own personal influences and successfully claim cultural competence. The ethical responsibility to maintain self-awareness is identified in the Canadian Code of Ethics for Psychologists. The code acknowledges the professionals responsibility to gain self-awareness in its standards that require counsellors to become aware of their own values, attitudes, beliefs and behaviours (CPA, 2000) and encourages professionals to apply these to a diverse society (CPA, 2000). To gain self-awareness in order to provide the best possible multicultural service delivery is a process that takes time. A psychologist interviewed as part of

Wihak and Merali qualitative study stated when youre working cross culturally, you have to be paying attention to peoples reactions and your behaviour. It takes a while before the right responses become natural (Wihak & Merali, p.175, 2007). Counsellors must be cognizant that their own values often serve as the basis for the development of treatment goals, interventions and outcomes (Henriksen & Trusty, 2005). As the psychologist above has identified, counsellors must take care to be able to identify and account for their own personal influences as well as being able to focus and incorporate the values of their clients. The best practice for working with multicultural populations includes the development of treatment goals, interventions and outcomes that are relevant and sensitive to the specific needs of the client in addition to being aligned with the specific cultural and life experiences of the individual client (Henriksen & Trusy, 2005). The same may be said if we are too not only consider the cultural and life experiences of the individual client, but also consider and understand all of the societal factors, to date, that have come to create the individuals experience. It has been suggested that use of the word empathy may be used to mean not only awareness and understanding of the unique individualbut also the broad array of cultural and historical factors that may underlie individual experiencing (Frame & Williams, p.169, 2005). As it has been identified that there are several ethical issues pursuant to working with multicultural populations, it must also be identified that a debate exists with regard to how to produce consistent ethical behaviour across cultures. Where individual practice may encounter ethical issues when working with diverse cultures, the ethical guidelines themselves also meet a dilemma with regard to the multicultural population. Pedersen (1989) framed the debate when he questioned should the guidelines be based on the unique, separate and sometimes exotic perspective of different cultural groups or should they be based on the generally human and

intuitively understandable presumption that all human beings are alike (Pedersen, p.643, 1989). As we seek to identify and rectify ethical issues in working with diverse cultures one might question the presence and/or possibility of ethical universalism. Is there one universal code of ethics that unites all cultures and all individuals? Those that align themselves with ethical universalism seek to identify cross cultural manifestations that both differ from and coordinate with one another in an effort to link cultural context universally (Frame & Williams, 2005). To universally link cultural context is an endeavour that may lead to the development of universal principles that serve to aide professional as they encounter ethical issues in working with multicultural populations. Fame & Williams (2005) postulate that the universal principle of altruism may help professionals to reflect on both the cultural strengths and social weaknesses that exist for diverse populations. The principle of responsibility also has the potential for universal application. Responsibility is said to consist of the formation of problems and associated solutions that include the mutual involvement of cultural groups (Frame & Williams, 2005). The principle of responsibility may be seen in the Canadian Code of Ethics for Psychologists. The codes principle of Responsible Caring (CPA, 2000) requires that psychologists recognize the impact of society in creating and maintaining the problems and issues faced by persons who are perceived as different from the norm of mainstream society (CPA, 2001). In addition, the principle of Respect for the Dignity of Persons (CPA, 2000) state psychologists do not impose the dominant cultural world view on those who are different (CPA, 2001). Proponents of ethical universalism also regard justice, protecting against exploitation and promoting evenhanded counselling relationships, and caring, providing service to all clients of all cultures despite potential consequences (Frame & Williams, 2005).

While ethical universalism coincides with the Canadian Code of Ethics for Psychologists in some regard there are fundamental dissimilarities between the ethical lens apparent in the code and the lens utilized by universalists. Universalists believe that a behavioural code is morally right if the consequences of adopting it result in the greatest good for the greatest number of people (Frame & Williams, p. 166, 2005). The principle of Respect for the Dignity of Persons (CPA, 2000) requires psychologists in practice, teaching and research actively demonstrate a belief that each person should be treated primarily as a person or an end in him/herself, not as an object or a means to an end (CPA, 2001). However, where there are disconnects between the code and universalism a psychologist that applies the behavioural expectations as outlined in the code with repeated unadulterated application is in effect adhering to a form of universalism. The absolutist approach to ethical decision making and application would see the same rules applied across cultures with an inflexible perspective (Frame & Williams, 2005). The ethical issue with regard to multicultural populations and such an absolutist perspective is that many of the codes that serve to support ethical behaviour are developed from and for the mainstream culture. Where a universal code of ethics would undoubtedly help to alleviate many, if not all, of the ethical issues that correspond to working with multicultural populations there are clear ethical difficulties in generating such a document. The argument exist that universal ethical and moral judgements may be found that cross cultures. There also exists the argument that ethical and moral judgements are germane to an individuals upbringing, intelligence, personality and above all the culture which one is born and socialized into (Laungani, p.257, 2005). Therefore, if the basis from which ethical constructs are created is ceded in the individuals experience of socialization and culture can there be universal application of ethical behaviour that spans the cultures? Ethical relativism puts forth the perspective that moral principles and standards are

founded in social custom (Frame & Williams, 2005). From this perspective it ethically irresponsible to appraise the practices of those cultures we do not fully understand. Here in lies a further area of ethical difficulty in working with members of diverse populations. Professionals that adhere to a personal value that mirrors ethical relativism would find it difficult to apply a principle or standard generated from and for the dominant culture to a client from another culture. The professional has an undeniable influence over many of the ethical issues that may be experienced in working with multicultural populations. The manner in which a case is conceptualized has a profound effect on the ethical dilemma experienced by the professional. Frame & Williams (2005) posited that the impact of therapists racial socialization on case conceptualization, their predisposition to explore or avoid racial and cultural issues, and their understanding of what constitutes culturally competent practice are critical ethical issues requiring systematic attention (Frame & Williams, p. 172, 2005) provided by the use of an ethical decision making process. Case Illustration: Redefining Child Maltreatment As a psychologist based out of a small mental health clinic in a remote northern Canadian community, you are challenged with the responsibility of providing psychological services to the members of the small community in which you live. You have recently relocated from an area in which it was mandatory for professionals to report child abuse. A family consisting of two parents and four children arrive at the clinic for therapy. The four children range in ages from three to ten years. You have obtained appropriate consent that included a discussion of all appropriate consent related information including limitations to confidentiality and consent. You

have just concluded the third session of therapy with the family. You are returning home late at night and witness several of the small children you saw earlier that day in therapy playing alone near the harbour. It is nearly one a.m. and you do not see any adults nearby that appear to be supervising the small children. Case Resolution: Redefining Child Maltreatment The case illustration demonstrates an ethical issue that may be experienced by a professional working with diverse cultures. Case resolution utilizing the ethical decision making process as expressed in the Canadian Code of Ethics for Psychologists begins by identifying those that are involved in the dilemma. The individuals or groups that will be affected are the parents, the children and secondarily the community members of the small northern Canadian community. Several ethical values from the Canadian Code of Ethics for Psychologist are relevant to this case illustration. There are three ethical values identified by the principle Respect for the Dignity of Persons (CPA, 2000) which includes identified standards under freedom of consent, privacy and confidentiality (CPA, 2000). There is the possibility that the family may become discontent with the outcome of the case resolution the psychologist must be prepared to respect a decision to discontinue therapy (CPA, 2000). Given that the psychologist witnessed an act that may be potentially classified as child neglect or abuse outside of the therapeutic setting the psychologist is, in effect, collecting information for which it is not likely that consent has been given. On the other hand, the information collected may be required and/or justified by law. If what the psychologist witnessed is deemed to be proof of child neglect and/or abuse the information collected, even though outside of therapeutic service, will be required by law. Ethically the

psychologist should act responsibility in an endeavour to respect the families right to personal privacy (CPA, 2000). As the psychologist witnessed the act in question outside of the therapeutic environment, there exists the argument that to act based on the witnessed event, granted the witnessed event is not deemed to be evidence of child neglect and/or abuse, would be an encroachment on the clients right to privacy. As the psychologist is operating within a culture that is presumably different from their own it would be advisable to pursue consultation with either a community member, such as an elder, or another psychologist that is fluent in the cultural society in which the psychologist is immersed. If the case resolution includes such consultation shared confidential information will only be ethical if either consent to do so is granted or the information is shared in a manner that protects the identity of the family (CPA, 2000). As the psychologist is operation in a small community setting it may be exceedingly difficult to protect the identity of the family. There are four ethical values identified by the principle of Responsible Caring (CPA, 2000) which include identified standards under general caring, competence and self-knowledge, risk benefit analysis and offset/ correct harm (CPA, 2000). The psychologist must be prepared to take responsibility for the consequences resulting from the chosen case resolution (CPA, 2000). During the process of case resolution the psychologist must take care to secure self-awareness and incorporate this awareness into case resolutions in an effort to benefit and not harm the family (CPA, 2000). The psychologist comes from a culture and society where it would be seen as neglectful to permit children under the age of ten to be playing in a potentially dangerous area unsupervised late at night. In the past, the psychologist has taken mandated action to report such actions to the appropriate authorities. These experiences, culture, past social context, attitudes and values are relevant to the chosen case resolution (CPA, 2000). The psychologist must take

care to evaluate the family and community involved in this situation adequately enough to be able to discern appropriately both what is considered neglectful action (CPA, 2000). Given the changes in northern day light hours it may be culturally appropriate for children to play at what would be perceived as late at night by other societal standards. Also, the psychologist must evaluate the community involvement involved in this situation. Even though the psychologist may not have witnesses the parents near the children at play it may be culturally appropriate for the community to take on the supervisory role of all community children. On the other hand, if the action the psychologist witnessed is decided to be of concern the psychologist must do everything reasonably possible to stop or offset the consequences of actions by others when these actions are likely to cause serious physical harm or death (CPA, 2000). There are three ethical values identified under the principle Integrity in Relationships (CPA, 2000) and two ethical values identified under the principle Responsibility to Society (CPA, 2000). The ethical values are objectivity/lack of bias, straightforwardness/ openness, reliance on the discipline and beneficial activities and respect for society (CPA, 2000) respectively. As the psychologist witnessed the action in question while presumably involved in a public activity they must take care to clarify whether they are acting as a private citizen or a psychologist when they take action through the case resolution (CPA, 2000). If it is decided that the situation the psychologist witnessed is not deemed to be proof of child neglect and/or abuse by northern cultural standards it may indicate the necessity for a change of procedures that benefit society (CPA, 2000). The study conducted by Wihak and Merali (2007) of northern counsellors would support the potential for a possible redefinition of child maltreatment in northern communities. Counsellors initial assumptions about possible child neglect or abuse in

the critical incidents described where culturally biased because they were based on dominant culture definitions of harm to child (Wihak & Merali, p.179, 2007). The case resolution has the potential to heave not only ethical conflicts but also potential conflicts between personal and professional values in addition to the potential for further for personal dissonance in other areas. If I am to offer my own personal opinion based on this case resolution there exist areas of value conflict and personal dissonance for me as I reflect on this case illustration. For instance, I personally value child safety and protection. This case illustration ignited in me a sense of reactive anger as I feel that children should be supervised and provided the security of a consistent routine that includes an appropriate sleep schedule. Professionally I value the well- being of my clients so much so that internally I often struggle with a strong sense of advocacy for those that I come to meet in practice. Thus, part of the dilemma that exists for me is a battle between my personal and professional values. In addition, culturally I am accustomed to certain common practices when it comes to child rearing and individualism. I have been socialized to think from the perspective of the individual and as such would initially assume that care of children is the responsibility of the individual family unit instead of the communal responsibility of the community. As such, should this case illustration have taken place in a cultural setting that I am familiar with I would have personally had an easier time generating a case resolution for this dilemma. The pursuit of the case resolution, as it stands, would continue on with the generation of alternative courses of action that includes an evaluation of any relevant short-term and long-term risks and benefits associated with each alternative. Given that the psychologist is the only professional providing service to the small northern community the psychologist must take care to choose a resolution that respects the community culture, promotes the welfare of the family,

helps to establish the psychologist as a respected community member and ensures that community members continue to seek needed help through the psychological services offered by the mental health clinic. As such, the case resolution would include consultation with an elder that takes care to protect the privacy of the family. To pursue extended consent and disclose to the family that I wish to seek consultation would likely lead to the degradation my relationship with the family. After a thorough evaluation of cultural norms and practices with regard to child rearing I would choose not to report the witnessed situation as indication of child abuse or neglect. The witness action included only potential harm that, after control for cultural bias, seemed less harmful. Case resolution would include documentation of the general ethical dilemma and decision making process including consultation with a colleague. Case resolution would conclude with potential contribution to the discipline that may support a process of redefining child maltreatment in northern Canadian communities. Case Illustration: Professional Boundaries As a psychologist operating out of a small mental health clinic it is your responsibility to provide psychological services to the community members of the small Mexican community in which you have lived for the past five years. A single female adult woman comes to you stating that she has been feeling stressed, apprehensive and has recently been retreating from friends, family and activity that she previously had been devoutly engaged. You complete your first therapeutic session with the young woman when she shares with you that she has been struggling with a decision to move away from her home to, as she states find herself or to follow the wishes of her family and stay living in the small Mexican community. The young woman states that her family is not happy that she has chosen to attend counselling and requests that you come

to her home to attend a family function, meet her family and hopefully ease the trepidation her family has for counselling. Case Resolution: Professional Boundaries The case illustration demonstrates another ethical issue that may be experienced by a professional working with diverse cultures. The individuals or groups that will be affected by the case resolution in order of primary responsibility are the young woman, her family and possibly members of the small Mexican community. Several ethical values from the Canadian Code of Ethics for Psychologist are relevant to this case illustration. There are four ethical values under the principle Respect for the Dignity of Persons (CPA, 2000), four ethical values under the principle Responsible Caring (CPA, 2000), two ethical values under the principle Integrity in Relationships (CPA, 2000) and one ethical value under the principle Responsibility to Society (CPA, 2000). The main ethical dilemma is produced out of a discrepancy between the psychologists responsibility to abstain from dual relationships and maintain professional boundaries and promoting the well-being of the client. The key to promoting the well-being of the client and, in effect, protecting against harm may well be engaging in the dual relationship and breaking the professional boundary. A large culture related factor that helps to create this ethical dilemma is the fact that the types of psychologist-client relationship and/or psychologist behaviour that is demonstrated and ethically appropriate for the dominant culture may not be as ethically sound when applied to members of multicultural populations (Luangani, 2003). In fact, some concede that dual relationships may be appropriate in three circumstances: when the relationship would reduce a power differential enabling the psychologist to obtain community member status, fulfill cultural expectations and/or when the relationship is a prerequisite for the client maintaining continued engagement in therapy (Wihak & Merali, 2007).

The case resolution also calls for the integration of personal and professional values, beliefs, experiences as well as any personal dissonance that may have been elicited by the ethical dilemma at hand. If I am to apply and evaluate my own personal opinions as part of the ethical decision making process leading to case resolutions I would identify that I would have a conflict in several personal and professional values. I have a strong professional view in maintaining strong professional boundaries. It is my belief that in order to maintain professionalism and appropriate levels of self-care it is important to make clear definitions between personal and professional activities and relationships. This professional value meets conflict in me as I also value doing what I can to promote client well-being. In addition, as a young woman myself that once had to make the difficult decision to leave a home community for the pursuit of other aspirations I can personally relate to the clients strife. If the case illustration had presented a family that encouraged counselling this dilemma may not have been as difficult. Case resolution would continue with an analysis of with the generation of alternative courses of action that includes an evaluation of any relevant short-term and long-term risks and benefits associated with each alternative. As the psychologist is providing service to a small community they must take care to elect a resolution that promotes the well-being of the young woman, the well-being and cultural respect of the family and helps to establish the psychologist as a respected community member. Case resolution would include agreeing to attend the young womans home in an effort to establish understanding and alleviate any apprehension the family may have with regard to the psychologist support of the young woman. The resolution is based on an evaluation of cultural influence, promotion of the clients well-being and safeguarding the young womans maintained connection to therapeutic support. Following the resolution the

psychologist will evaluate resolution results, assume responsibility for consequences where appropriate and take action to alleviate, where possible, future similar dilemmas (CPA, 2000). Conclusion There are many salient ethical issues pursuant to working with multicultural populations that have yet to be resolved. Research, the sharing of experiential knowledge, self-assessment and ethical review may well help to strengthen the ethical practice when working with members of diverse cultures. It would appear that ethical decision making on the part of multicultural counsellors often includes context specific assessment of individual application of ethical standards (Wihak & Merali, 2007). As a discipline we must take action to foster appropriate practice that includes relevant and perceptive treatment approaches that meet the needs of the culturally diverse as fluently as they do members of our own society.

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Roland, A. (2005). Commentary on building multicultural counselling bridges. Counselling Psychology Quarterly, 18(4), 283-285. doi:10.1080/09515070500469822. Watson, Z., Herlihy, B., & Pierce, L. (2006). Forging the Link Between Multicultural Competence and Ethical Counseling Practice: A Historical Perspective. Counseling & Values, 50(2), 99-107. Retrieved from Academic Search Complete database. Wihak, C., & Merali, N. (2007). Adaptations of Professional Ethics Among Counselors Living and Working in a Remote Native Canadian Community. Journal of Multicultural Counseling & Development, 35(3), 169-181. Retrieved from Academic Search Complete database.