AMCD Multicultural Counseling Competencies I. Counselor Awareness of Own Cultural Values and Biases A. Attitudes and Beliefs 1. Culturally skilled counselors believe that cultural self-awareness and sensitivity to one's own cultural heritage is essential. 2. Culturally skilled counselors are aware of how their own cultural background and experiences have influenced attitudes, values, and biases about psychological processes. 3. Culturally skilled counselors are able to recognize the limits of their multicultural competency and expertise. 4. Culturally skilled counselors recognize their sources of discomfort with differences that exist between themselves and clients in terms of race, ethnicity and culture. B. Knowledge 1. Culturally skilled counselors have specific knowledge about their own racial and cultural heritage and how it personally and professionally affects their definitions and biases of normality/abnormality and the process of counseling. 2. Culturally skilled counselors possess knowledge and understanding about how oppression, racism, discrimination, and stereotyping affect them personally and in their work. This allows individuals to acknowledge their own racist attitudes, beliefs, and feelings. Although this standard applies to all groups, for White counselors it may mean that they understand how they may have directly or indirectly benefited from individual, institutional, and cultural racism as outlined in White identity development models. 3. Culturally skilled counselors possess knowledge about their social impact upon others. They are knowledgeable about communication style differences, how their style may clash with or foster the counseling process with persons of color or others different from themselves based on the A, B and C, Dimensions ,and how to anticipate the impact it may have on others. C. Skills 1. Culturally skilled counselors seek out educational, consultative, and training experiences to improve their understanding and effectiveness in working with culturally different populations. Being able to recognize the limits of their competencies, they (a) seek consultation, (b) seek further training or education, (c) refer out to more qualified individuals or resources, or (d) engage in a combination of these. 2. Culturally skilled counselors are constantly seeking to understand themselves as racial and cultural beings and are actively seeking a non racist identity. II. Counselor Awareness of Client's Worldview A. Attitudes and Beliefs 1. Culturally skilled counselors are aware of their negative and positive emotional reactions toward other racial and ethnic groups that may prove detrimental to the counseling relationship. They are willing to contrast their own beliefs and attitudes with those of their culturally different clients in a nonjudgmental fashion. 2. Culturally skilled counselors are aware of their stereotypes and preconceive ...

1. AMCD Multicultural Counseling Competencies
I. Counselor Awareness of Own Cultural Values and Biases
A. Attitudes and Beliefs
1. Culturally skilled counselors believe that cultural self-
awareness and sensitivity to one's own
cultural heritage is essential.
2. Culturally skilled counselors are aware of how their own
cultural background and experiences
have influenced attitudes, values, and biases about
psychological processes.
3. Culturally skilled counselors are able to recognize the limits
of their multicultural competency
and expertise.
4. Culturally skilled counselors recognize their sources of
discomfort with differences that exist
between themselves and clients in terms of race, ethnicity and
culture.
B. Knowledge
1. Culturally skilled counselors have specific knowledge about
their own racial and cultural
heritage and how it personally and professionally affects their

2. definitions and biases of
normality/abnormality and the process of counseling.
2. Culturally skilled counselors possess knowledge and
understanding about how oppression,
racism, discrimination, and stereotyping affect them personally
and in their work. This allows
individuals to acknowledge their own racist attitudes, beliefs,
and feelings. Although this standard
applies to all groups, for White counselors it may mean that
they understand how they may have
directly or indirectly benefited from individual, institutional,
and cultural racism as outlined in White
identity development models.
3. Culturally skilled counselors possess knowledge about their
social impact upon others. They
are knowledgeable about communication style differences, how
their style may clash with or
foster the counseling process with persons of color or others
different from themselves based on
the A, B and C, Dimensions ,and how to anticipate the impact it
may have on others.
C. Skills
1. Culturally skilled counselors seek out educational,
consultative, and training experiences to
improve their understanding and effectiveness in working with
culturally different populations.
Being able to recognize the limits of their competencies, they
(a) seek consultation, (b) seek
further training or education, (c) refer out to more qualified
individuals or resources, or (d) engage
in a combination of these.

3. 2. Culturally skilled counselors are constantly seeking to
understand themselves as racial and
cultural beings and are actively seeking a non racist identity.
II. Counselor Awareness of Client's Worldview
A. Attitudes and Beliefs
1. Culturally skilled counselors are aware of their negative and
positive emotional reactions
toward other racial and ethnic groups that may prove
detrimental to the counseling relationship.
They are willing to contrast their own beliefs and attitudes with
those of their culturally different
clients in a nonjudgmental fashion.
2. Culturally skilled counselors are aware of their stereotypes
and preconceived notions that they
may hold toward other racial and ethnic minority groups.
B. Knowledge
1. Culturally skilled counselors possess specific knowledge and
information about the particular
group with which they are working. They are aware of the life
experiences, cultural heritage, and
historical background of their culturally different clients. This
particular competency is strongly
linked to the "minority identity development models" available
in the literature.

4. 2. Culturally skilled counselors understand how race, culture,
ethnicity, and so forth may affect
personality formation, vocational choices, manifestation of
psychological disorders, help seeking
behavior, and the appropriateness or inappropriateness of
counseling approaches.
3. Culturally skilled counselors understand and have knowledge
about sociopolitical influences
that impinge upon the life of racial and ethnic minorities.
Immigration issues, poverty, racism,
stereotyping, and powerlessness may impact self esteem and
self concept in the counseling
process.
C. Skills
1. Culturally skilled counselors should familiarize themselves
with relevant research and the latest
findings regarding mental health and mental disorders that
affect various ethnic and racial groups.
They should actively seek out educational experiences that
enrich their knowledge,
understanding, and cross-cultural skills for more effective
counseling behavior.
2. Culturally skilled counselors become actively involved with
minority individuals outside the
counseling setting (e.g., community events, social and political
functions, celebrations,
friendships, neighborhood groups, and so forth) so that their
perspective of minorities is more
than an academic or helping exercise.

5. III. Culturally Appropriate Intervention Strategies
A. Beliefs and Attitudes
1. Culturally skilled counselors respect clients' religious and/ or
spiritual beliefs and values,
including attributions and taboos, because they affect
worldview, psychosocial functioning, and
expressions of distress.
2. Culturally skilled counselors respect indigenous helping
practices and respect help~iving
networks among communities of color.
3. Culturally skilled counselors value bilingualism and do not
view another language as an
impediment to counseling (monolingualism may be the culprit).
B. Knowledge
1. Culturally skilled counselors have a clear and explicit
knowledge and understanding of the
generic characteristics of counseling and therapy (culture
bound, class bound, and monolingual)
and how they may clash with the cultural values of various
cultural groups.
2. Culturally skilled counselors are aware of institutional
barriers that prevent minorities from
using mental health services.
3. Culturally skilled counselors have knowledge of the potential
bias in assessment instruments

6. and use procedures and interpret findings keeping in mind the
cultural and linguistic
characteristics of the clients.
4. Culturally skilled counselors have knowledge of family
structures, hierarchies, values, and
beliefs from various cultural perspectives. They are
knowledgeable about the community where a
particular cultural group may reside and the resources in the
community.
5. Culturally skilled counselors should be aware of relevant
discriminatory practices at the social
and community level that may be affecting the psychological
welfare of the population being
served.
C. Skills
1. Culturally skilled counselors are able to engage in a variety
of verbal and nonverbal helping
responses. They are able to send and receive both verbal and
nonverbal messages accurately
and appropriately. They are not tied down to only one method or
approach to helping, but
recognize that helping styles and approaches may be culture
bound. When they sense that their
helping style is limited and potentially inappropriate, they can
anticipate and modify it.
2. Culturally skilled counselors are able to exercise institutional
intervention skills on behalf of
their clients. They can help clients determine whether a
"problem" stems from racism or bias in
others (the concept of healthy paranoia) so that clients do not
inappropriately personalize

7. problems.
3. Culturally skilled counselors are not averse to seeking
consultation with traditional healers or
religious and spiritual leaders and practitioners in the treatment
of culturally different clients when
appropriate.
4. Culturally skilled counselors take responsibility for
interacting in the language requested by the
client and, if not feasible, make appropriate referrals. A serious
problem arises when the linguistic
skills of the counselor do not match the language of the client.
This being the case, counselors
should (a) seek a translator with cultural knowledge and
appropriate professional background or
(b) refer to a knowledgeable and competent bilingual counselor.
5. Culturally skilled counselors have training and expertise in
the use of traditional assessment
and testing instruments. They not only understand the technical
aspects of the instruments but
are also aware of the cultural limitations. This allows them to
use test instruments for the welfare
of culturally different clients.
6. Culturally skilled counselors should attend to as well as work
to eliminate biases, prejudices,
and discriminatory contexts in conducting evaluations and
providing interventions, and should
develop sensitivity to issues of oppression, sexism,
heterosexism, elitism and racism.
7. Culturally skilled counselors take responsibility for educating
their clients to the processes of
psychological intervention, such as goals, expectations, legal

8. rights, and the counselor's
orientation.
Arredondo, P., Toporek, M. S., Brown, S., Jones, J., Locke, D.
C., Sanchez, J. and Stadler, H. (1996)
Operationalization of the Multicultural Counseling
Competencies. AMCD: Alexandria, VA
AMCD Multicultural Counseling CompetenciesI. Counselor
Awareness of Own Cultural Values and BiasesA. Attitudes and
BeliefsB. KnowledgeC. SkillsII. Counselor Awareness of
Client's WorldviewA. Attitudes and BeliefsB. KnowledgeC.
SkillsIII. Culturally Appropriate Intervention StrategiesA.
Beliefs and AttitudesB. KnowledgeC. Skills
GENITALIA ASSESSMENT
Episodic SOAP Note
Patient Initials: A.B. Age:
21 Gender: Female
CC: “I have bumps on my bottom that I want to have checked
out.”
HPI: A.B., a 21-year-old WF college student reports to your
clinic with external bumps on her genital area. She states the
bumps are painless and feel rough. She states she is sexually
active and has had more than one partner over the past year. Her
initial sexual contact occurred at age 18. She reports no
abnormal vaginal discharge. She is unsure how long the bumps
have been there but noticed them about a week ago. Her last Pap
smear exam was 3 years ago, and no dysplasia was found; the
exam results were normal. She reports one sexually transmitted
infection (chlamydia) about 2 years ago. She completed the
treatment for chlamydia as prescribed.
Subjective:

9. Onset: unsure
Location: genital area
Duration: she knows at least a week
Character: painless but rough
Alleviating/Aggravating Symptoms: Nothing aggravates or
alleviates
Treatment: No medications tried
Severity: 0 out 10 on pain scale
Medications:
Symbicort 160/4.5mcg – 2 puffs twice a day
Singulair 10mg by mouth daily
Zyrtec OTC-one tablet by mouth as needed
Allergies: NKDA, seasonal allergies
PMH: Asthma, hx of chlamydia
Past Surgical History (PSH): Hernia repair in 2011
FH: No hx of breast or cervical cancer, Father hx HTN, Mother
hx HTN, GERD
Social: Denies tobacco use; occasional ETOH, married, 3
children (1 girl, 2 boys). She reports more than one sexual
partner over the past year. Last pap was 3 years ago, visits the
dentist twice a year, and gets eye exam every 2 years. She states
she
General: Denies weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: Denies visual loss, blurred vision, double
vision or yellow sclera. Ears, Nose, Throat: Denies hearing loss,
sneezing, congestion, runny nose or sore throat.
Skin: intact with no lesions except on her genital area
Cardiovascular: Denies chest pain, chest pressure or chest

10. discomfort. No palpitations or edema.
Respiratory: Denies shortness of breath, cough or dyspnea.
Gastrointestinal: Denies any abdominal pain, nausea, vomiting
diarrhea, or constipation. Positive for lesion on genital area that
is rough but painless.
GU: Denies dysuria, incontinence, hesitancy, frequency or other
abnormalities when voiding. Last pap smear was 3 years ago
and showed no dysplasia. She denies any abnormal vaginal
discharge but does have rough, painless bumps on genital
area.
Neurological: Denies headaches, dizziness, syncope, paralysis,
ataxia, numbness or tingling in the extremities, seizures, of
falls. No change in bowel or bladder control.
Musculoskeletal: Denies any muscle, back pain, joint pain or
stiffness. Full ROM in all extremities, no muscle or back pain.
Denies fatigue
Hematologic: Denies any bleeding or bruising.
Lymphatics: Denies enlarged nodes. No history of splenectomy.
Psych: Denies depression or anxiety. Normal affect
Endocrine: Denies sweating, cold or heat intolerance. Denies
polyuria or polydipsia. Denies any endocrine symptoms or
hormone therapies.
Sexual/Reproductive History: Heterosexual female who is
married with 3 children. 2 are boys ages 3 and 1. 1 daughter
who is 2. She is not monogamous with her husband and has had
more than one sexual partner in the past year. She does not use
contraceptives. She begins menstruation at age 16. She states
that she has a 4-day menstrual cycle with no changes in the past
year.
Allergies: Reports seasonal allergies, NKDA, denies hives,
eczema or rhinitis. Positive for asthma
Objective:
General: AAO x 4, denies weakness, denies fatigue, well
groomed, well nourished.

11. VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
HEENT: Head is normocephalic. PERRLA. Tympanic
membranes are intact with no drainage. Denies any congestion
or nasal discharge.
Neck: Has smooth, controlled, full range of motion of neck.
Thyroid gland non-visible but palpable with swallowing.
Trachea is midline. Lymph nodes nonpalpable.
Chest: There is symmetry in chest wall expansion and
diaphragmatic
excursion. Respirations 16/minute, relaxed and even without use
of ancillary muscles
Heart: RRR, no murmurs, carotid pulse equal bilaterally, 2+. No
bruits auscultated over carotids. Apical pulse 92 beats/minute,
regular rhythm, with S1 heard best at apex, S2 heard best at
base
Lungs: CTA, chest wall symmetrical. Breath sounds clear to
auscultation in all lung fields.
Peripheral Vascular: Arms are equal in size, no swelling,
pinkish skin tone, no clubbing of finger tips. Capillary refill
time less than 2 seconds. Radial and brachial pulses strong
bilaterally, Legs are warm bilaterally and pink in color from
toes with normal distribution of hair. No ulcers or edema
present. Femoral, popliteal, dorsalis pedis, and posterior tibial
pulses strongly palpated bilaterally
Genital: Normal female hair pattern distribution; no masses or
swelling. Urethral meatus intact without erythema or discharge.
Perineum intact with a healed episiotomy scar present. Vaginal
mucosa pink and moist with rugae present, pos for firm, round,

12. small, painless ulcer noted on external labia
Abd: soft, normoactive bowel sounds, neg rebound, neg
murphy’s, neg McBurney
Musculoskeletal: (CN II-XII grossly intact)Has upright posture
and steady gait. He can maintain a heel toe walking. Full ROM
of TMJ with no pain, tenderness, clicking, or crepitus. Normal
curves of cervical, thoracic, and lumbar spine. Full ROM of
cervical and lumbar spine. Full smooth ROM against gravity
and resistance.
Neurological: Identifies correct scents. Vision 20/20. Full
visual fields intact. PERRLA. Patient able to identify light,
sharp, and dull touch to forehead, cheek, and chin. Ability to
smile, frown, wrinkle forehead, show teeth, purse lips, and raise
eyebrows. Gag reflux present, equal shoulder shrug against
resistance, and able to turn head in both directions against
resistance.
Diagnostics:
HSV specimen obtained
Pap smear
HPV testing
Gonorrhea/Chlamydia testing
HIV testing
Pregnancy test
Assessment:
· Chancre
Differential Diagnoses
1. Condyloma Acuminate
Condyloma acuminate are also known as genital warts and are
caused by the human papillomavirus (HPV). It is considered a
sexually transmitted disease and can be dormant for months to

13. years after exposure. They may be the same color as the skin or
reddish and are usually painless and occur on the labia, the
vestibule, or the perianal area (Ball, Dains, Flynn, Solomon, &
Stewart, 2019). Smaller lesions tend to cause less symptoms
but as the lesions become larger, they can bleed and become
painful. Genital warts can be a precursor to genital cancer and
can occur in the vagina, cervix, anus, or perineum (Dains,
Baumann, & Scheibel, 2016).
2. Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) occurs after a hair follicle
becomes obstructed and an infection of the follicle arises. These
follicles become aggravated and if not treated, can become
extremely painful. This conditions most often occurs in the
axillary, inguinal, and genital areas and some research has
suggested an infectious component (Parikh, Ferenczi, Finch,
2017). This diagnosis is an option due to bumps but is
eliminated due to no pain being identified even after a week.
Also, there is no inflammation or redness noted.
3. Molluscum Contagiosum
Molluscum contagiosum are papules that are sexually
transmitted. They are usually found on the labia, perineum, and
anal areas and are approximately two to five millimeters and
flesh-toned (Dains, Baumann, & Scheibel, 2016). Molluscum
contagiosum are cause by a virus that occurs with genital
lesions after a cultivation period. They are typically painless
and are diagnosed based on its appearance (Ball, Dains, Flynn,
Solomon, & Stewart, 2019). Interviewing the patient about the
spread of the bumps over the past week will help to eliminate or
confirm this diagnosis.
4. Herpes (Simplex II)
Herpes simplex II is almost exclusively sexually transmitted,
causing infection in the genital or anal area (Dains, Baumann, &
Scheibel, 2016). The bump is described as firm and starts off as
one lesion. The lesion are often painful and can burn with the
patient often complaining of burning with urination. A.B. does
not complain of any pain with urination or any pain from lesion

14. therefore, this could likely be ruled out.
5. Herpes with Asymptomatic Chlamydia
Unlikely but due to A.B.’s prior history of chlamydia and her
current sexual habits and the fact that chlamydia can be
asymptomatic, I believe the possibility of her having chlamydia
with herpes should be taken into consideration. The physical
exam may aid in ruling this out.
An order for a rapid test would help deliver
a definitive diagnosis (Dains, Baumann, & Scheibel, 2016)
PLAN: This section is not required for the assignments in this
course (NURS 6512) but will be required for future courses.
Analyses of and Additional Subjective Data
When interviewing a patient, it is important to ask pertinent
questions. A.B. does not mention any pain nor does he state if
the pain radiates. An advanced practice nurse must inquire
about these things. Knowing if there is anything that aggravates
her bumps or increases the appearance of the bumps is
necessary as well. Another question to aid in this assessment is
what made her notice the bumps a week ago? The patient further
reports that she is sexually active and has had more than one
partner in the past year which could lead to her having a
sexually transmitted disease. She also reports of no abnormal
virginal discharge which indicates that she is not suffering from
an infection which mostly causes the abnormal discharge
(Dains, Baumann, & Scheibel, 2016). Further medical history
indicates that she last had a Pap smear exam over 3 years ago
where the results were normal. However, it is possible that the
patient could be having cancerous cells that have occurred
within the last three years. Some genital sores could be
noncancerous cysts that may not require any treatment and can
be easily removed in case they are bothersome. Other types of
bumps could be cancerous and that would enable the doctor to
develop an effective treatment. AB did provide information to
her complaint. She provided pertinent information for a genital
concern which includes gynecological background, family
history, sexual history, general and specific risk factors, and

15. surgical history (LeBlond, Brown,& DeGowin, 2014). But we
should also inquire whether the bumps have been changed in
size, if it affected her sexual life, and if she has noticed any
increase or decrease in bumps in the past week. Critical
information that should have been included in this assessment is
whether the patient has used contraceptives and what types as
the bumps could be as a result of these contraceptives.
Analysis of Objective Data
What the provider observes, vital signs, a general assessment of
the patient, physical examination findings, and results from
laboratory or diagnostic studies are all objective information
(Sullivan, 2019). The objective data collected was in normal
limits. The only body system that revealed abnormalities was
the genital examination. An observation of the client’s genital
area shows that there are normal conditions in terms of
distribution of hair patterns and no abnormal discharge. There is
the presence of a healed episiotomy scar which cannot be
attributed to have caused the bumps. However, the pink virginal
mucosa can also indicate an infection in the urethra. Also, it is
important to understand that the patient has small and painless
ulcers on the external labia. This indicated that the bumps were
unrelated to the ulcer which could have been caused by sexual
activities rather than an infection. This objective data aids in
confirming the diagnosis of a chancre.
Diagnostic Tests
The additional diagnostic test helps to rule out different
possible diagnosis. An HSV specimen is recovered by swabbing
mucocutaneous genital lesions and from previously involved
mucocutaneous sites in patients with asymptomatic infection
(Singh, Preiksaitis, Ferenczy, & Romanowski, 2005). HSV
Specimen for Viral Culture – most specific results can take 1 to
7 days (Dains, Baumann & Scheibel, 2018). Specimens
obtained from vesicular lesions within the first three days after
their appearance are the specimens of choice, but other lesion
material from older lesions or swabs of genital secretions
should be obtained if suspicion of HSV infection is high (Singh,

16. Preiksaitis, Ferenczy, & Romanowski, 2005). A pap smear is a
diagnostic tool to examine a patient for viral infections like
human papilloma virus (HPV) infection and Herpes can also be
detected (Dixit, Bhavsar, & Marfatia, 2011). Gonorrhea is often
asymptomatic in females (Piszczek, St Jean, & Khaliq, 2015).
Due A.B. having a previous STD and being with multiple
partners. It is a good idea to screen her for gonorrhea,
chlamydia, and HIV.
Accept or Reject Diagnosis
In regard to the diagnosis of chancre, I do feel as if it is
supported by the information given. The assessment is
supported by the subjective and objective information provided
by the patient and provider. A chancre is an ulcer that occurs in
primary syphilis at the location of initial exposure to the disease
(Henao-Martínez & Johnson, 2014). Syphilis usually causes a
single lesion, or chancre, unless the patient is
immunocompromised (Dains, Baumann, & Scheibel, 2016). A
chancre lesion may sometimes be found internally. The lesion is
raised, usually 1-2 centimeters in diameter, and with an
indurated border (Riaz & Wei, 2017). Chancre- consist of
painless ulcerative lesion or sores, usually seen near the genital
region. The disease is contagious, lasting 1-5 weeks, and spread
from skin to skin contact with open lesions or sores
(Wolujewicz & Bates, 2016).
A.B. is at high risk of contracting sexually transmitted diseases
due to her sexual activity with multiple partners as well as
being married. We should encourage her on to use condoms to
prevent the development of STD’s and decrease the risk of
certain cancers such as cervical which can make one more prone
to genital warts (Dains, Baumann, & Scheibel, 2016). painless
ulcer suggests syphilis which can appear as a solitary lesion or
more than one chancre, especially if the patient is
immunocompromised (Dains, Baumann, & Scheibel, 2016).
Examination of the genital notes a firm, round, small, painless
ulcer on external labia which supports the assessment.
Conclusion

17. Genital and rectal complaints can be a very sensitive topic for
patients. It is important that as an advanced practitioner, that we
provide accurate subjective and objective examinations. In this
case study we must treat our patient and coincidentally
potentially two others based on her diagnosis.
References
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced
health assessment and clinical diagnosis in primary care (5th
ed.). St. Louis, MO: Elsevier Mosby.
Dixit, R., Bhavsar, C., & Marfatia, Y. S. (2011). Laboratory
diagnosis of human papillomavirus
virus infection in female genital tract. Indian journal of sexually
transmitted diseases and
AIDS, 32(1), 50-2. doi: 10.4103/2589-0557.81257
Henao-Martínez, A. F., & Johnson, S. C. (2014). Diagnostic
tests for syphilis: New tests and new
algorithms. Neurology. Clinical practice, 4(2), 114-122.
LeBlond, R. F., Brown, D. D., &DeGowin, R. L. (2014).
DeGowin’s diagnostic examination
(10th ed.). New York, NY: McGraw Hill Medical
LeGoff, J., Péré, H., & Bélec, L. (2014). Diagnosis of genital
herpes simplex virus infection in
the clinical laboratory. Virology journal, 11, 83.
doi:10.1186/1743-422X-11-83
Piszczek, J., St Jean, R., & Khaliq, Y. (2015). Gonorrhea:
Treatment update for an increasingly

18. resistant organism. Canadian pharmacists journal : CPJ = Revue
des pharmaciens du
Canada : RPC, 148(2), 82-9.
Riaz, A. & Wei, G. (2017). Chancre of primary syphilis. Journal
of Education and Teaching in
Emergency Medicine, 2(4), V33. doi:
https://doi.org/10.21980/J83342
Singh, A., Preiksaitis, J., Ferenczy, A., & Romanowski, B.
(2005). The laboratory diagnosis of
herpes simplex virus infections. The Canadian journal of
infectious diseases & medical
microbiology = Journal canadien des maladies infectieuses et de
la microbiologie
medicale, 16(2), 92-8. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095011/
Sullivan, D.D. (2019). Guide to clinical documentation (3rd ed.)
Philadelphia, PA: F.A. Davis
Wolujewicz, A. & Bates, C. (2016). Syphilis on the face in
primary care: a rare sign of an
increasingly common problem. The British Journal of General
Practice: the journal of
the Royal College of General Practitioners. doi:
10.3399/bjgp16X686065
Exercise 2.2 Making Ethical Decisions
Review the situations below, and then using the moral
principles identified in the chapter, Corey’s models of ethical
decision-making, and your knowledge of legal and professional

19. issues decide on your probable course of action. Share your
answers with the rest of the class.
Situation 1: A graduate-level mental health professional with
no training in career development is giving interest inventories
as she counsels individuals for career issues. Can she do this?
Is this ethical? Professional? Legal? If this professional
happened to be a colleague of yours, what, if anything, would
you do?
Situation 2: During the taking of some routine tests for
promotion, a company learns that there is a high probability that
one of the employees is abusing drugs and is a pathological
liar. The firm decides not to promote him and instead fires him.
He comes to see you for counseling because he is depressed.
Has the company acted ethically? Legally? What responsibility
do you have toward this client?
Situation 3: An African-American mother is concerned that her
child may have an attention deficit problem. She goes to the
teacher, who supports her concerns, and they go to the assistant
principal requesting testing for a possible learning disorder.
The mother asks if the child could be given an individual
intelligence test that can screen for such problems, and the
assistant principal states, “Those tests have been banned for
minority students because of concerns about cross-cultural
bias.” The mother states that she will give her permission for
such testing, but the assistant principal says, “I’m sorry, we’ll
have to make do with some other tests and with observation.”
Is this ethical? Professional? Legal? If you were a school
counselor or school psychologist and this mother came to see
you, what would you tell her?
Situation 4: A test that has not been researched to show to be
predictive of success for all potential graduate students in social
work is used as part of the program’s admission process. When
challenged on this by a potential student, the head of the
program states that the test has not been shown to be biased
and the program uses other, additional criteria for admission.
You are a member of the faculty at this program. Is this

20. ethical? Professional? Legal? What is your responsibility in
this situation?
Situation 5: An individual who is physically challenged and
wheelchair bound applies for a job at a national fast-food
chain. When he goes in to take the test for a mid-level job at
this company, he is told that he cannot be given this test
because it has not been assessed for its predictive ability for
individuals with his disability. You are hired by the company
to do the testing. What is your responsibility, if any, to this
individual and to the company?
Neukrug, Edward S.. Essentials of Testing and Assessment: A
Practical Guide for Counselors, Social Workers, and
Psychologists, Enhanced (p. 37). Cengage Learning. Kindle
Edition.
Corey, Corey, Corey, and Callanan Ethical Decision-Making
Model
In addition to the moral model just noted, a number of other
ethical decision-making models exist (Neukrug, 2016). One
hands-on, practical, problem-solving model espoused by Corey,
Corey, and Corey (2019) suggests that the practitioner go
through the following eight steps when making complex ethical
decisions: 1. Identify the problem or dilemma 2. Identify the
potential issues involved 3. Review the relevant ethical
guidelines 4. Know the applicable laws and regulations 5.
Obtain consultation 6. Consider possible and probable courses
of action 7. Enumerate the consequences of various decisions
8. Decide on what appears to be the best course of action
Finally, in addition to the moral and practical models mentioned
earlier, some suggest that regardless of the approach one takes
in ethical decision-making, the ability to make wise ethical
decisions may well be influenced by the clinician’s level of
ethical, moral, and cognitive development (Lambie, Hagedor, &
Ieva, 2010; Levitt & Moorhead, 2013) (see Exercise 2.1).
Those who are at higher levels of cognitive development, they

21. state, view ethical decision-making in more complex ways than
others. Certainly, this has broad implications for the training
that takes place in clinical programs, as it would be hoped that
students are challenged to make decisions that are
comprehensive and thoughtful (McAuliffe & Eriksen, 2010).
Neukrug, Edward S.. Essentials of Testing and Assessment: A
Practical Guide for Counselors, Social Workers, and
Psychologists, Enhanced (p. 28). Cengage Learning. Kindle
Edition.