This article describes a counselor educator's experience teaching a course on ethical decision making. The goal was to help students reconcile conflicts between personal values and professional ethics.
Observations showed students initially saw little conflict between their values and ethics. Through assignments analyzing ethical dilemmas, students' skills developed over time. Early on, students identified relevant ethics codes but struggled with principles and personal values. Later, students used more factors in decisions and showed greater awareness of professional judgment required. The educator observed growth in students' tolerance for ambiguity, awareness of how values influence decisions, and emphasis on client welfare when making ethical choices.
2. (Handelsman, Gottlieb, & Knapp, 2005). To facilitate this
movement, training programs need to help students develop
the “philosophical sophistication” to reconcile personal and
professional values (Mintz et al., 2009, p. 644). Similarly,
Basche, Anderson, Handelsman, and Klevansky (2007) noted
that students enter graduate programs with preexisting ideas
of right and wrong professional behavior, based in large part
on their own backgrounds. For students, learning to make
ethical decisions is a developmental process of acculturat-
ing to the ethics of the profession and eventually integrating
professional ethics with their own values and beliefs.
Handelsman et al. (2005) adapted Berry’s (2003) model
of social or ethnic acculturation to describe four strategies
Irene Mass Ametrano, Department of Leadership and
Counseling, Eastern Michigan University. Correspondence
concerning this
article should be addressed to Irene Mass Ametrano,
Department of Leadership and Counseling, Eastern Michigan
University, 304
Porter Building, Ypsilanti, MI 48197 (e-mail:
[email protected]).
Teaching Ethical Decision Making:
Helping Students Reconcile Personal
and Professional Values
Irene Mass Ametrano
Because conflicts between personal and professional values can
interfere with ethical decision making, a goal of
counselor education must be helping students reconcile such
conflicts. This article describes one counselor educator’s
experience teaching ethical decision making and the effects on
student learning. Growth was observed in increased
tolerance for ambiguity, awareness of how values influenced
3. decision making, use of multiple factors in decision mak-
ing, and emphasis on the welfare of clients. Implications for
teaching and future research directions are discussed.
Keywords: ethical decision making, professional ethics, values,
teaching ethics, value conflicts
(marginalization, separation, assimilation, and integration)
that students use as they try to adapt to a new professional
culture that may differ significantly from the values and beliefs
of their cultures of origin. Each strategy reflects a high or low
level of identification with the culture of origin and with the
new professional culture. To illustrate how a counselor facing
an ethical dilemma might use these acculturation strategies,
consider a counselor faced with a 16-year-old client who
is threatening to commit suicide and is pleading with the
counselor not to tell her parents.
Marginalization reflects low identification with both old
(personal) and new (professional) cultures, without either a
well-developed personal moral sense or a sense of profes-
sional ethics (Handelsman et al., 2005). A counselor using a
marginalization strategy in this scenario would not be aware
of personal values or beliefs about suicide, the parents’ right
to know, or an adolescent’s ability to make such a decision.
This person would also not have an understanding of the
profession’s stance on the ethical issues raised by the case,
such as a counselor’s responsibility to keep the client safe.
A separation strategy (Handelsman et al., 2005) describes
someone who has a well developed personal, moral sense but
does not identify with the values of the profession. In this
case, the counselor would be aware of his or her personal
values or beliefs about suicide (e.g., suicide is a personal
choice and people have a right to commit suicide), but would
not be influenced by the profession’s ethical stance (e.g., do
4. no harm/keep clients safe). Decision making would be based
only on personal beliefs about suicide.
The assimilation strategy (Handelsman et al., 2005) re-
flects complete adoption of the new culture’s values while
discarding the values of the culture of origin. Thus, a coun-
selor who entered the profession believing strongly in the
right to commit suicide may decide to inform the client’s
parents about the suicide threat because the profession’s code
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Teaching Ethical Decision Making
of ethics gives the counselor the responsibility to judge the
seriousness of a threat and protect the client from serious
and foreseeable harm. This counselor would work to protect
the client and prevent suicide, no longer acknowledging the
previously held personal belief that people have a “right to
commit suicide.”
Finally, the integration strategy (Handelsman et al.,
2005) reflects adoption of the new profession’s values while
retaining important aspects of one’s personal values. In the
aforementioned scenario, the counselor would consider the
specifics of this case, along with the profession’s values to
protect the client and involve family when appropriate. No
conflict is experienced because this counselor can set aside,
but maintain, personal beliefs about suicide and act in a way
that is consistent with professional ethics and standards.
From an acculturation perspective, the process of train-
ing counselors to engage in sound ethical decision making
5. requires that they learn to reconcile their personal, culture-
of-origin values with the counseling profession’s values.
Basche et al. (2007) proposed that the goal of ethics training
is to help students move toward integration strategies, first by
helping them “identify, clarify, and challenge personal values,
individual needs, and ethical perspectives” (p. 62) and then
by helping them recognize these changes.
Others have also discussed the need for counselors to
be aware of their values and beliefs in order to make sound
ethical decisions. Most of the ethical decision making mod-
els reviewed by Cottone and Claus (2000) include steps in
which decision makers must consider personal values and/
or their beliefs about the ethical principles of autonomy,
nonmaleficence, beneficence, justice, and fidelity. Garcia,
Cartwright, Winston, and Borzuchowska (2003) noted that
counselors’ awareness about their own cultural identities
and role socialization can affect not only how they view a
dilemma, but also whether they view a situation as an ethical
dilemma. Mattison (2000) argued that the value system of the
decision maker is a prominent factor in how ethical dilemmas
are resolved and that biases, even those of which the decision
maker is unaware, will influence behavior. Thus, in the earlier
scenario, a counselor who lacks awareness of his/her belief
about a person’s right to commit suicide may never seriously
consider ways to protect the client, for example by involving
the client’s parents.
If awareness of one’s values is an essential step in making
an ethical decision, and if a central goal of ethics training is
to help students reconcile personal and professional values,
it follows that a goal of counselor education should be to in-
crease students’ awareness of the role their values play in their
ethical decisions. As Mintz et al. (2009) noted, professionals
are not expected to be without bias, but they are expected to
engage in a process of self-examination so that their biases
6. can be evaluated, wrestled with, and ultimately reconciled
with the standards of the profession.
Teaching Counseling Ethics
The content and design of counseling ethics courses is ad-
dressed extensively throughout the literature, with widespread
agreement that the complex process of learning how to make
ethical decisions requires much more than information about
the profession’s ethical standards. Although didactic informa-
tion about codes of ethics, ethical principles, ethical decision-
making models, and legal issues must be presented, significant
emphasis must also be placed on increasing students’ aware-
ness of their own values, motivations, and behaviors (Corey,
Corey, & Callanan, 2005; Jordan & Stevens, 2001; Remley
& Herlihy, 2010; Urofsky & Sowa, 2004). This may be ac-
complished by having students apply information in case
studies, role-playing, discussion and interaction with peers,
and self-reflection. Similarly, Kaczmarek (2001) noted that
experiential activities and class discussion are key to helping
students gain the higher order cognitive skills necessary for
ethical decision making. Neukrug et al. (1996) referred to
this as “cognitive development in the moral domain” (p. 104).
The Ethics Course
With the literature on ethical decision making in mind, I
designed the course, Ethical, Legal, and Professional Issues
in Community/Clinical Mental Health Counseling. Students
take this class after they have completed much of their course
work and, for many, while they are working under supervi-
sion with their first “real” clients. The overarching goal of
the course is to help students move beyond knowledge of the
ethical code to understanding the complexities of the ethical
decision-making process. Ideally, students learn that there
are few clear-cut answers but that they can be systematic in
their decision making and learn to recognize better choices.
7. A primary goal for me, as a counselor educator, was
to make my students’ learning visible (Bernstein, 2008).
I wanted to better understand the process that students go
through as they learn to make ethical decisions. The com-
ponents of ethical decision-making models served as the
foundation for specific course objectives, which included
the following:
1. In making decisions that involve ethical dilemmas,
students will identify relevant ethical standards and
laws, ethical principles, and personal values.
2. Students will use multiple components (ethical stan-
dards, laws, personal values, ethical principles) of
decision-making models.
3. Students’ awareness of how they are making decisions
will improve. They will be able to explain how they
use these components in their decisions.
4. Students will move toward integration of personal
values and professional ethics. They will begin to
reconcile their own values with professional ethics.
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As a counselor educator, I was interested in whether
students’ perceptions of their learning differed from their
“performance” (on papers, in small group discussions) and/
or from my perceptions. I also wanted to know what factors
they viewed as most helpful to their learning.
8. Course Content and Activities
Early class sessions and required readings focused on ethical
decision making, covering principle ethics, virtue ethics, and
several practice-based models. The role that counselor values
play in ethical decision making was discussed in readings and
in class. Early in the semester, they read Kitchener’s (1984)
seminal article on ethical decision making and Handelsman
et al.’s (2005) work on the acculturation model of learning to
be an ethical professional.
Following coverage of these foundational concepts, each
class session focused on a section of the ACA Code of Ethics
(American Counseling Association [ACA], 2005). I began
with a presentation/discussion of the topic, followed by small
group discussions of ethical dilemma scenarios, and then a
large group discussion. I moved back and forth between small
groups to identify key issues that I wanted to discuss when
students returned to the large group. After every class meeting,
I recorded my thoughts and reactions about what had transpired.
Assignments
The goal of course assignments was to help students examine
their decision-making process when confronted with an ethi-
cal dilemma. At the beginning of the course, students wrote
an “ethics autobiography” (Basche et al., 2007) in which they
responded to questions about the personal values, cultural
background, and beliefs that they brought to this course. The
purpose of this assignment was to raise students’ awareness of
the personal beliefs and values that they brought to the study of
professional ethics. At the end of the course, students wrote a
fi-
nal reflection paper (Ethics Autobiography Revisited) in which
they responded to questions about their development during
9. the semester and what had been most helpful in that process.
Throughout the course, students wrote papers in which
they discussed how they would handle counseling situa-
tions that posed ethical dilemmas. An ethical dilemma was
defined as “a problem for which no course of action seems
satisfactory. The dilemma exists because there are good, but
contradictory ethical reasons to take conflicting and incom-
patible courses of action” (Kitchener, 1984, p. 43). Students
were required to identify the ethical dilemma/problem and
the relevant ethical standards, laws, ethical principles, and
personal values/beliefs that were relevant to making a deci-
sion. Next, they were asked to describe how they used these
factors in deciding how they would proceed with the clients.
Observations About Student Learning
I developed an evaluation rubric reflecting the components
and development of ethical decision making. The components
consisted of ethical standards and principles, laws, and personal
values; development consisted of reconciliation of personal
with professional values, and use of multiple factors in deci-
sion making. For every ethical dilemma paper, I evaluated the
components and the development of ethical decision making as
insufficient, developing, or proficient. I also identified
recurring
themes in the ethics autobiographies and in my journal. For a
more extensive discussion of the rubric and the observations
reported here, see Ametrano (in press).
Self-perceptions: Ethics autobiographies. For the most
part, students came into the course knowing the beliefs that
they held about right and wrong and the significant formative
experiences that accounted for these beliefs. It was also clear
that they understood the values underlying the ACA Code of
10. Ethics (ACA, 2005). A recurring theme in these early papers
was the belief (or knowledge) that counselors should not
“impose” their values on clients, whose autonomy should be
respected. Most students implied that this would be relatively
easy, perhaps because another recurring theme was the per-
ception that their own values were quite congruent with the
underlying values of the profession (e.g., treating clients with
dignity and respect regardless of their behaviors and beliefs,
promoting the welfare of the client, doing no harm). At this
point in the course, many saw themselves in Handelsman et
al.’s (2005) integration stage. They anticipated little conflict
between their own values and the Code of Ethics and/or the
law. Given what they knew about the profession’s ethical
code and their own beliefs and values at the beginning of the
course, many underestimated the challenges they would face
in integrating personal values and beliefs with the ethics of
the profession (Basche et al., 2007).
Students’ behavior/performance. From the beginning,
students correctly identified the most relevant ethical stan-
dards and laws in the scenarios. Initially, they had difficulty
identifying ethical principles (autonomy, nonmaleficence,
beneficence, justice, fidelity), but, over the course of the se-
mester, most improved in doing this. At the beginning, only
a few students recognized the role that their values played in
ethical decision making, but, as the semester progressed, more
were able to identify the personal values and beliefs that came
up as they considered the ethical dilemmas.
The most noticeable changes evident during the semester
were in students’ strategies for making ethical decisions. They
used more factors in decision making, were able to more clearly
articulate how those factors contributed to their decisions, and
demonstrated greater awareness that the ACA Code of Ethics
(ACA, 2005), and even state law, leave room for counselor
judgment and choice. As the semester progressed, students were
11. more aware of their struggles, and they began to discuss how
they tried to reconcile conflicting factors in making decisions.
I now discuss how these changes were illustrated in the ethical
dilemma papers submitted throughout the semester.
The scenario in the first assignment described a counselor
who had not provided the client with adequate information at
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Teaching Ethical Decision Making
the beginning of counseling. After the client revealed that she
struggled with depression, the counselor’s inexperience with
depression and inability to ever see suicide as an option led
her to refer the client abruptly and without explanation. Most
students were quite articulate in describing how they would
handle this situation more effectively, reflecting awareness
of relevant ethical standards on informed consent and proper
termination and referral procedures. However, in discussing
how they decided what to do, most relied on one decision-
making component, either the ACA Code of Ethics (ACA,
2005; “Due to the ethical standards, I never have to wonder
how long my informed consent should be.”) or personal values
(“I would have concerns about letting down a client who was
going through such distress. . . . It was more my personal
values that influenced my decision.”). These responses illus-
trate Handelsman et al.’s (2005) assimilation and separation
strategies. However, few recognized the counselor’s reliance
on her needs and values in decision making as unethical.
In the second scenario, a 15-year-old client, referred for
counseling by his parents, told the counselor that he smoked
12. marijuana often, although he told his parents that he had
stopped. At that point, he reminded the counselor that confi-
dentiality had been promised unless he was in danger. It was
clear that strong personal values played a role in how students
approached this case, but most stopped short of explaining
how those values factored into their decisions or how they rec-
onciled those values with ethics and state law. Several students
neglected to note that Michigan law allows a 15-year-old to
be in counseling for a limited period of time without parental
permission or notification; they focused, instead, on the ethical
standards that support family involvement and allow a breach
of confidentiality. They did not acknowledge how their own
values, such as a parent’s right to know or their belief that
marijuana use by an adolescent is dangerous, affected how
they used the ACA Code of Ethics (ACA, 2005) and state law
to make their decisions. One student who viewed the client’s
marijuana use as “an issue of possible harm to self ” stated,
“at age 15, it seems unethical to not have his parents involved,
especially when they brought (him) to counseling.” However,
she did not identify an ethical standard that supported this
contention. Another said, “I consider drugs to be harmful and
dangerous. If his parents knew before, I do not feel it would be
a problem telling them again.” Although these students were
aware of their own beliefs, they stopped short of discussing
how they reconciled those with ethics and the law. For many
students, Handelsman et al.’s (2005) separation strategy was
operative. Only one student was able to describe how he
considered multiple factors and reconciled his values with
the profession’s ethics:
Morally, I do not agree with the client’s drug use or the fact
that he has told his parents that he is not using marijuana when
he is. Although I would like for the parents to be informed and
involved in the discussion . . . based on the ACA Code of Eth-
ics and Michigan law I cannot do this without [his] consent.
13. I believe that involving the family can be helpful, but under
the current circumstances is not an option (because, based
on my assessment, he is not a danger to self).
The third scenario described a 65-year-old depressed
client who was seriously considering suicide and asked the
counselor not to inform her daughter, who brought her for
counseling and with whom she lived. The client was not ter-
minally ill, but she felt like a burden to her daughter. Many
discussions reflected students’ struggles to reconcile their
own values and beliefs with the profession’s ethical stance,
which would point to the counselor’s responsibility to prevent
suicide. One student described her struggle:
My personal value is that life is precious and it’s a gift. Even
when it’s hard and seemingly overwhelming and full of de-
spair, I am of the belief that there is hope. So, honestly and
somewhat embarrassedly I admit, the hardest struggle for me
about the whole suicide issue is accepting this kind of idea
that when it comes to suicide, that I know exactly what’s best
for the client, and that is that they should want to live.
One student could not quite reconcile the profession’s Code
(ACA, 2005) with the principle of autonomy, so she was left
feeling conflicted and asking new questions:
However, if after further assessment I did not believe that [she]
could remain safe, I would most likely break confidentiality
by telling [her] daughter. So much of counseling is about be-
ing with the client, understanding from their perspective and
being nonjudgmental. Yet, the ACA Code of Ethics has woven
this one value (preserving life) into its body of guidelines and
I question, if it is my place not to impose my values upon
others, what makes this situation different?
Another student’s comments illustrated an important
14. change reflected in several papers—the decision to maintain
client confidentiality despite the possibility that the client
could commit suicide. This decision points to a new under-
standing of the choices counselors have within the ACA Code
of Ethics (ACA, 2005), along with a willingness to assume
some risk.
The most difficult aspect of this case is the underlying concern
that despite my assessment of no immediate risk and steps
taken to prevent suicide, there is still a chance that [she]
could take her own life. I would not want to be quick to break
confidentiality . . . but not telling the daughter . . . could leave
me feeling responsible if she did commit suicide.
In the next scenario, the counselor witnessed a client roughly
grabbing his son’s arm and slapping him across the face in
the clinic’s waiting room. As students discussed whether they
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Ametrano
had a legal obligation to report this client for suspected child
abuse, a recurring theme was their consideration that the client
was from a minority culture, noting that the law’s definition
of abuse was dominant-culture bound. As one student noted,
“A child can be physically disciplined without crossing over
to abuse.” Although nearly all students recognized their own
negative reactions to the client’s behavior and their own
aversion
to physical punishment, they were willing to consider that this
client’s behavior may not have been abusive. Most discussed
trying to reconcile state law, the ACA Code of Ethics (ACA,
15. 2005), and their own values. For example,
Not in any way do I agree with slapping a child across the
face as appropriate. It strikes me as abusive and degrading to
the child . . . law requires reporting abuse of children and our
ethics code may support breaking a client’s right to privacy
[confidentiality] in such a case. Physical discipline may be
considered appropriate in [his] culture. I would handle this
case by respecting [parents’] right to privacy in how they
discipline their children.
It is noteworthy that, at this midsemester point, students were
seeing that neither the ACA Code of Ethics (ACA, 2005) nor the
law provide clear-cut, black-and-white answers. At this point,
it seemed clear that students were struggling to move toward
Handelsman et al.’s (2005) integration stage. Only one student
out of 10 expressed an inability to reconcile the law with her
judgment that the client’s behavior did not represent abuse.
Toward the end of the semester, the scenarios did not
pose the same kinds of challenges as the life-and-death
cases, but they provided illustrations of how students began
to integrate personal values and professional ethics. In one,
a limited-licensed counselor who is required to work under
supervision receives minimal supervision from a supervisor
who offers to “sign off ” on her full licensure application
when the time comes. Students accurately cited the relevant
standards and the state law that requires supervision, but
they also relied on ethical principles and personal values to
emphasize why supervision is important. The profession’s
stance on this issue was becoming their own (integration).
As one student described, “my personal value in preparing
myself . . . coincides with moral and ethical principles as a
counselor. I would not feel comfortable working with clients
without having the proper and required training as this . . .
could put a client in danger.” Another student used the profes-
16. sion’s ethical standards and ethical principles to express the
importance of supervision for her:
My personal values would also impact how I would handle
the situation. Supervision is a very important element of
counseling, especially for new professionals. Personally, it
is important for me to have feedback. I think it is critical to
my growth as a professional.
In another scenario, a counselor’s husband asks her to so-
cialize with a new friend and his wife; the counselor quickly
realizes that the friend’s wife is one of her clients. This case
raises the question of how the counselor will decide whether
to enter a nonprofessional relationship with a client. As in the
previous case, the majority of students’ decisions reflected an
integration strategy. They expressed little conflict between the
profession’s stance that dual relationships should be entered
with extreme caution and their beliefs that such relationships
are usually not beneficial for clients. Despite the fact that the
ACA Code of Ethics (ACA, 2005) does allow these relation-
ships, many students found the Code’s caution to be consistent
with their own beliefs:
It is likely the dynamics in the counseling relationship will
change after interacting socially, and I cannot know how that
would affect the client. Knowing that in our Code of Ethics
that . . . nonprofessional relationships should be avoided
would further influence me. My personal values that come
into play in this case include not being comfortable with
integrating my professional life with my social life.
Instructor’s observations. After each class, I recorded my
observations, thoughts, and feelings about what had transpired
in large- and small-group discussions of ethical dilemmas.
During the earliest small-group discussions, I noticed confu-
sion in students’ perceptions of their professional roles and
17. responsibilities and their search for direction. They looked for
laws that would tell them what to do. Students had knee-jerk
reactions that reflected Kitchener’s (1984) intuitive level of
analysis. Although they knew that they should not “impose”
their values on clients, they were not clear on how their values
were influencing their perceptions of these situations. This
awareness was beginning when one student exclaimed, “Our
values are really guiding what we want to do!”
By midsemester, students had been given many opportu-
nities to discuss ethical dilemmas in class and had received
feedback on papers. They became more willing to struggle
aloud and, as they began to grapple with some of the most
challenging issues (suicide, threats to others, HIV transmis-
sion, child abuse), I began to see significant changes in class
discussions. It was at this point that one student noted, “We’re
putting our values on by preventing suicide . . . and we’ve
always been taught not to do that . . . but the profession is
telling us to do that here.” In discussing these life-and-death
issues, students were clearer on how personal morals come
into play. Most would not seriously consider not trying to
prevent a client’s suicide, but they began to examine questions
such as, Who am I to interfere? Do we have an “obligation”
to break confidentiality? Maybe that’s not necessarily the
only option. Similarly, in discussing possible child abuse,
they began to consider not reporting parents when the family
was in counseling. They began to consider the ACA Code of
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Teaching Ethical Decision Making
Ethics (ACA, 2005) and the law in the context of what was
18. in the best interests of the client and the family. This was a
striking change from early in the semester when they would
have interpreted the law narrowly (“you have no choice but to
report”) and looked for an ethical standard that would point
them in the same direction.
By semester’s end, I was seeing another important change.
In discussing nonprofessional (dual) relationships with clients
(i.e., a counselor socializes with a client), students recognized
that, although the ACA Code of Ethics (ACA, 2005) cautions
against these relationships, counselors have the responsibility
for judging whether or not such relationships would be benefi-
cial for clients. Class discussions reflected movement toward
thinking about these situations from many perspectives, with
increasing emphasis on the client’s welfare. Students began
to question what seemed to them like an arbitrary 5-year pro-
hibition against sexual or romantic relationships with former
clients. So, on a point where the Code is very clear, students
began to challenge the absolute “answers” they desperately
sought earlier in the semester.
Students’ final perceptions. In their final reflection papers,
students discussed new insights about the profession’s Code
of Ethics (ACA, 2005) and ethical decision making, how their
own values aligned with the Code, and aspects of the class
that were most helpful in facilitating their learning. Three
themes were evident in these papers. All discussed learning
that the ACA Code of Ethics is not black and white. They used
terms such as “grey,” “ambiguity,” “a guide,” and “does not
give clear answers.” Most made it clear that, despite their
prior familiarity with the ACA Code of Ethics, they began
the course with an expectation that it would provide clear,
definitive answers and ended the course knowing that it does
not. One student summed it up by saying, “At the begin-
ning of the course, I viewed the ACA Code of Ethics as the
counselor’s rulebook making everything clear-cut and giving
19. a counselor a form of directives. . . . This class gave me an
eye-opening experience.”
Along with the realization that the ACA Code of Ethics
(ACA, 2005) is not black and white came the new perspective
that counselors do have choices when ethical dilemmas arise.
As one student put it, “I think that the grey areas in the code
allow me as a professional to determine how to best proceed.”
The understanding that decision making can be systematic
was also expressed:
I have learned to think through all the possible choices and the
outcomes. I learned that as long as you have rationally thought
through a decision and it aligns with the professional codes
and state law, then there isn’t necessarily a wrong decision.
Several themes in the final reflection papers revolved
around the role that a counselor’s personal values, beliefs, and
experiences play in ethical decision making. Despite the fact
that so many discussed the importance of not imposing their
values on clients early in the semester, it was not until later
that they realized what this really means: first, awareness of
one’s values is key to not imposing those values on the client;
second, ethical decisions often involve value choices. Without
saying so, they realized that getting to Handelsman et al.’s
(2005) integration stage is not easy. One student discussed
a new awareness of her priorities: “I realized through this
interaction that I do place a higher value on the counseling
relationship and confidentiality with my client than I may
have originally thought.” Others said, “ultimately, I learned
that keeping my personal feelings and bias in check is not as
easy as I once thought”; “I need to be aware of my personal
values and how they affect the decision”; and “an essential
component of recognizing and working through an ethical
dilemma is discussing my beliefs and values, motivations,
20. feelings.”
Finally, students seemed to gain a new awareness of what
“promoting client welfare” really means. In their first papers,
many discussed this as an important cornerstone of the Code
of Ethics (ACA, 2005). By the end of the course, it had gained
new meaning. As two students noted, “Ultimately, ethical
considerations must hinge upon what is best for the client . .
. what does the least harm” and “How can one truly know if
the interaction is beneficial for the client?”
Implications for Teaching
These observations clearly reflect growth in how students
approached ethical decision making. This growth is best de-
scribed as students’ increased tolerance for ambiguity (in the
ACA Code of Ethics [ACA, 2005] and the decision-making
process), greater awareness of how their values influenced
the decision-making process, willingness to use multiple
factors in decision making, and increased emphasis on the
welfare of the client. Also evident was increased willingness
to verbalize their struggles in reconciling their values with
the values of the profession.
In their final reflection papers, I asked students to discuss
the most beneficial aspects of the course. Every student
identified the small-group discussions as being central to
their learning. They described these discussions as helpful
because they provided opportunities to problem-solve with
others. Hearing others’ views gave students ideas they may
not have considered before and provided them with new ways
to think about the cases. One step in most ethical decision-
making models is consultation with other professionals, and
students did note how useful consulting with their peers could
be. They need to hear many diverse perspectives.
During the semester, as I observed how useful the small-
21. group discussions were, I increased students’ time in small
groups and decreased lecture time. I grew confident that the
students would learn from each other, and I had to decide what
Journal of Counseling & Development ■ April 2014 ■ Volume
92160
Ametrano
was essential for me to convey to them. Commenting later
in the class about the themes I was hearing was more useful
than giving them information at the beginning of class. What
I knew theoretically, I began to know in a more convincing,
experiential way. I stressed things like the uncertainty of ethi-
cal decision making and the importance of remaining aware
of how their own issues and values may have been coloring
their decisions. I had to be very careful not to imply what I
would do or what I thought was the best course of action,
something I noticed myself doing early in the semester. I
became convinced that I would be more effective by serving
as the facilitator of their learning instead of the director of
their learning, or, as Weimer (2003) put it, I moved from being
teaching-centered to being learning-centered.
Many students discussed the benefits of writing the ethical
dilemma papers, which required them to work through all of
the possibilities for each case, think through all of the possible
choices and outcomes, and research each issue carefully. This
told me that I could reduce the amount of time I spend giving
them information. If I provided useful readings and assign-
ments, they would learn the information as they struggled to
address these dilemmas.
It is clear that students need sufficient class time to process
22. with others. As Neukrug (1996) noted, we need to support and
challenge their schemas so that they move to more complex
ways of viewing ethical dilemmas and to more effective deci-
sion making. The in-class comments that students identified
as having the greatest impact were those that challenged their
black-and-white schemas. Perhaps, as they accepted this
ambiguity, they grew more open to exploring and challeng-
ing their beliefs and values and the role those played in their
decision-making process—a critical step toward reconciling
deeply held values with the profession’s values. It seems more
apparent than ever that one goal of counselor education ought
to be facilitating this difficult process. Mintz et al. (2009)
stated, “As a profession we do not mandate personal values,
but we can articulate and expect professional values that orient
one to being able to wrestle deeply with any personal values
that preclude performing professional duties (which include
serving the needs [of] oppressed groups and clients different
from oneself)” (p. 670).
Conclusion
The identified changes in how students approached ethical
decision making were based on data from three perspectives:
students’ self-reported perceptions of their development,
students’ decision-making behavior as reflected in their case
study papers, and my observations of students’ development
as demonstrated in class discussions. Although these chang-
es do reflect movement toward what the literature describes
as sound ethical decision making, there are limitations that
preclude generalizing these observations to other groups.
The extent to which the ethical decision-making literature
colored my observations and evaluations is unknown. Although
students submitted papers and feedback about their own de-
velopment anonymously, with assurances that these would not
affect their grades, it is possible that students were still influ-
enced by being in a class in which they would receive grades.
23. Although the conclusions describe broad changes observed in
the majority of the students, these conclusions are not based on
sound qualitative research methodology. Finally, the sample on
which these conclusions are based was quite small.
To address possible student and instructor bias, future
researchers should use objective raters and study participants
outside a traditional classroom setting in which grades might
influence students’ behavior and self-reports. Although it is
important to use actual counseling students as participants,
it is also important to avoid any possible effects of course
evaluation and instructor familiarity with desired changes.
The role that individual differences likely play in students’
development warrants examination, as does the effect of
teaching different decision-making models. The develop-
ment of sound ethical decision making, which includes the
ability to reconcile personal and professional values, is a
critical aspect of counselor education. Qualitative research
studies focusing on this process will allow counselor educa-
tors to better understand the elements involved in effectively
supporting student development of ethical decision-making
skills, knowledge, and attitudes.
References
American Counseling Association. (2005). ACA code of ethics.
Alexandria, VA: Author.
Ametrano, I. M. (in press). Learning ethical decision-making:
Reflections on the process. In J. L. Bernstein (Ed.), Spiraling
upward. Ypsilanti, MI: Bruce K. Nelson Faculty Development
Center, Eastern Michigan University.
Basche, A., Anderson S. K., Handelsman, M. M., & Klevansky,
R.
(2007). An acculturation model for ethics training: The ethics
24. autobiography. Professional Psychology: Research and Practice,
38, 60–67.
Bernstein, J. L. (2008). Introduction: Making learning visible to
whom? In J. L. Bernstein (Ed.), Making learning visible: The
scholarship of teaching and learning at EMU (pp. 1–13). Ypsi-
lanti, MI: Bruce K. Nelson Faculty Development Center,
Eastern
Michigan University.
Berry, J. W. (2003). Conceptual approaches to acculturation. In
K. M. Chun, P. B. Organista, & G. Marin (Eds.), Accultura-
tion: Advances in theory, measurement, and applied research
(pp. 17–37). Washington, DC: American Psychological As-
sociation.
Corey, G., Corey, M. S., & Callanan, P. (2005). An approach to
teach-
ing ethics courses in human services and counseling.
Counseling
and Values, 49, 193–207.
Journal of Counseling & Development ■ April 2014 ■ Volume
92 161
Teaching Ethical Decision Making
Cottone, R. R., & Claus, R. E. (2000). Ethical decision-making
models: A review of the literature. Journal of Counseling &
Development, 78, 275–283.
Garcia, J. G., Cartwright, B., Winston, S. M., & Borzuchowska,
B.
(2003). A transcultural integrative model for ethical decision
25. making in counseling. Journal of Counseling & Development,
81, 268–277.
Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005).
Train-
ing ethical psychologists: An acculturation model. Professional
Psychology: Research and Practice, 36, 59–65.
Jordan, K., & Stevens, P. (2001). Teaching ethics to graduate
stu-
dents: A course model. The Family Journal: Counseling and
Therapy for Couples and Families, 9, 178–184.
Kaczmarek, P. (2001). Experiential teaching strategies applied
to
an ethics and professional issues course. Paper presented at the
annual meeting of the American Psychological Association, San
Francisco, CA.
Keeton v. Anderson-Wiley, No. 1:10-CV-00099-JRH-WLB, 733
F.
Supp. 2d 1368 (S.D. Ga., Aug. 20, 2010).
Kitchener, K. S. (1984). Intuition, critical evaluation and
ethical
principles: The foundation for ethical decisions in counseling
psychology. The Counseling Psychologist, 12, 43–55.
Mattison, M. (2000). Ethical decision making: The person in the
process. Social Work, 45, 201–212.
Mintz, L. B., Jackson, A. P., Neville, H. A., Illfelder-Kaye, J.,
Win-
terowd, C. L., & Loewy, M. I. (2009). The need for a counseling
psychology model training values statement addressing
diversity.
27. Mandatory Counseling: Clinical Beneficence
or Malevolence?
GERALD AMADA
City College of San Francisco (Retired), San Francisco,
California, USA
Mandatory counseling is a widespread and commonly accepted
practice on college campuses throughout the nation. This prac-
tice bestirs heated controversy and ethical challenges when col-
lege administrators require students to undergo counseling in
instances of misconduct that pose little danger to self or others.
Apparently many counselors actively and approvingly under-
take mandatory therapy with students; others take exception and
decline to undertake involuntary counseling; and still others
acquiesce by undertaking mandatory counseling with students
despite their ethical objections to this coercive clinical practice.
This article will highlight the rationales for ethical objections to
mandatory counseling.
KEYWORDS coercive clinical measures, ethical challenges,
ethi-
cal compromises, mandatory counseling
The massacre that took place at Virginia Polytechnic Institute
and State
University on April 16, 2007, sent shock waves throughout the
college cam-
puses of our nation. In the wake of this heinous crime, repeated
reference
has been made to how this staggering shock to our collective
psyches will
be a “wake-up call” to empower us to take the right and sensible
mea-
sures to make colleges and universities safer institutions. Many
28. colleges have
made evident progress in the aftermath of Virginia Tech in
marshalling a
multiplicity of on-campus strategies and resources (such as risk-
assessment
teams comprised of clinical, instructional, judicial, and
administrative staff)
to identify and quell the insubordination of highly disruptive
and potentially
dangerous students.
Address correspondence to Gerald Amada, PhD, 185 Mt. Lassen
Drive, San Rafael, CA
94903, USA. E-mail: [email protected]
284
Mandatory Counseling 285
At the same time, however, increasing numbers of nervous
colleges
have arbitrarily engineered their students into mandatory
counseling and
psychotherapy without due regard for the constitutional rights
of these
students. For example, the Foundation for Individual Rights in
Education
(FIRE) investigated and reported the case of a student at
Valdosta State
University (VSU) in Georgia who was expelled for being “a
clear and
present danger” and was mandated to submit certifications of
his men-
tal health and ongoing therapy as conditions of his readmission
to the
29. college because the student peacefully protested the school’s
decision to
construct two new parking decks on campus and posted flyers
detail-
ing potential alternatives. The University of Georgia System’s
Board of
Regents reversed the expulsion of the student after he filed a
federal law-
suit against VSU for violating his constitutional rights.
Although the student
was officially reinstated, he refused to return to the campus,
considering the
university to be a hostile environment (Foundation for
Individual Rights in
Education, 2010).
Similarly, the Review Panel of the Governor of Virginia in its
document
titled Mass Shootings at Virginia Tech recommended: “The
troubled student
should be required to participate in counseling as a condition of
contin-
ued residence in campus housing and enrollment in classes”
(“Report of the
Virginia Tech Review Panel,” 2007, p. 54). This sweeping,
generic use of
the term “troubled” could serve as grounds for shanghaiing into
counseling
virtually any Virginia college student who evinces the slightest
unconven-
tionality in speech or behavior that just happens to upset a thin-
skinned
instructor or administrator.
Mandatory college counseling and assessment has become com-
mon practice on college campuses. According to the National
30. Survey of
Counseling Center Directors (Gallagher, 2009), 34% of the
centers accept
mandated referrals from judicial boards or administrators for
both assessment
and counseling. Based on my own observations I tend to believe
that many
of these colleges conflate the terms “assessment” and
“counseling”; in other
words, mandatory assessments are often extended and
transformed into
mandatory counseling sessions because many colleges, wishing
to carefully
monitor the ongoing progress of mandated students and thereby
minimize
their risk potential, prefer to keep them in open-ended
counseling sessions
as long as necessary. It is worth noting that this survey also
reports that
64% of counseling directors are ambivalent about mandatory
counseling
but acknowledge that some students can be helped in this way.
This par-
ticular statistic raises some fascinating questions of
considerable heuristic
value. If some counseling center directors are accepting
mandatory referrals
despite their ethical qualms, it would be worth knowing what
political, insti-
tutional, and clinical factors have compelled them to make
quiescent ethical
compromises of this kind. Identifying and elucidating these
factors might in
time enable college counselors to discover and assert effective
alternatives
31. 286 G. Amada
to the practice of accepting ethically questionable demands for
mandatory
counseling.
I believe it is fair and necessary to forewarn readers that this
article is a
polemic, a set of rationales and arguments used to debunk,
combat, and, if
at all possible, abolish the practice of mandatory psychotherapy
on college
campuses when it is enlisted by administrators to deal with
students who
pose no imminent danger to self or others—an administrative
practice that
has become quite prevalent throughout our nation’s colleges.
INVOLUNTARY COUNSELING: WHY IT’S UNNECESSARY
I will here begin by stating the obvious: no counselor with an
ounce of sense
can legitimately object to the practice of mandatory counseling
and assess-
ment for persons who pose an imminent danger to themselves or
others or
are gravely psychologically disabled. However, I am entirely
convinced on
the basis of consultations I have had with over 130 colleges and
universities
nationwide that the imposition of mandatory therapy on college
campuses
is most often used to deal with students who have engaged in
some form of
32. nondangerous misconduct, such as disruptions in the classroom
or dormi-
tory. For the remainder of this paper my remarks about
mandatory therapy
will exclusively relate to nondangerous cases of disruptive
misconduct rather
than those that pose an imminent danger to self or others, the
former clearly
constituting the majority of cases referred for mandatory
counseling.
Administrators Passing the Buck
The institutional source of referrals for most cases of mandatory
counseling is
most often the office of a college administrator, who usually has
not referred
the student because he or she is demonstrably dangerous but
rather because
the administrator is attempting to avoid the use of a disciplinary
sanction in
dealing with a disruptive student. The reasons administrators
turn to col-
lege counselors with requests for the imposition of mandatory
therapy are
many and certainly require analysis and elucidation. Some
administrators
are averse to administering discipline—even though this
unsavory task is
an integral part of their job—because they feel guilty or anxious
about a
disciplinary procedure they mistakenly believe is inherently
punitive. As a
result, they refer the disruptive student to a counselor in the
fanciful belief
that counseling is necessarily a kinder and gentler procedure
33. while casu-
ally disregarding the strong possibility that many students,
especially highly
disruptive, “externalizing” students who are being shunted into
treatment
under a disciplinary cloud, are in great dread of undergoing a
counseling
experience that requires a requisite capacity for intimacy, self-
disclosure,
introspection, and psychological sophistication. Clearly, many
disruptive
Mandatory Counseling 287
students would much prefer incurring a one-time disciplinary
sanction such
as a warning than undergoing intensive counseling.
Some administrators request that counselors carry out
mandatory coun-
seling because they fear that disciplining the student will cause
him or her to
wreak revenge on the college with a lawsuit or an act of
retaliatory violence.
Although their fears may not be entirely unfounded, this
motive—the avoid-
ance of litigation or violence—is clearly not a sufficient or
legitimate basis for
relinquishing their administrative authority to carry out
warranted discipline,
and, therefore, this practice strongly deserves the derogatory
appellation that
has been widely applied to it: CYA (cover your ass).
34. Administrators Unqualified to Determine Who Needs
Counseling:
Ethical Dilemmas
When administrators require students to meet with counselors
and coun-
selors to meet with students, a generally overlooked and
misunderstood
institutional anomaly takes place. These administrators are, ipso
facto, car-
rying out the clinical role of determining when, how, whether,
and for
how long a student should participate in counseling, a role that
normally
requires extensive clinical training, skills, and acumen.
Regrettably, most
administrators have not acquired this set of skills during the
course of their
career. Its counterpart in the corporate world is the situation of
having
clinically untrained gatekeepers working in managed care who
dictate the
duration and modality of treatment to professionally trained
psychothera-
pists. As well, when administrators determine that disruptive
students must
undergo mandatory counseling, they are unilaterally and often
quite illog-
ically redefining a behavioral problem into a mental health or
psychiatric
problem. After all, behavioral problems presumably require
disciplinary
measures; psychological problems are apt to require treatment.
Nothing
other than the administrators’ power and authority gives them
the right to
35. use such sleight-of-hand measures to effect a transmutation of a
behavioral
problem into a psychological problem simply to avoid the use of
legally
based disciplinary measures.
College counselors who receive directives from administrators
to under-
take mandatory counseling with disruptive students are faced
with a
formidable ethical challenge. First, if they surmise that the
directive is moti-
vated by the administrators’ intention to divest themselves of
disciplining
the disruptive student by transferring the disciplinary role (in
the form of
mandatory counseling) to counselors, counselors may question
whether the
assumption of such a quasidisciplinary role is compatible and
consistent
with the ethical codes of their profession. In other words, can
counselors
reasonably expect to fulfill their primary professional
obligation to heal
and guide students while at the same time wielding the weapon
of disci-
pline (in the form of a threat of expulsion for a student’s
noncompliance
288 G. Amada
with the requirement of mandatory therapy) without making
serious ethical
compromises? Second, counselors who assume a
36. quasidisciplinary role by
undertaking mandatory therapy with a disruptive student may
also question
the matter of their own basic professional loyalties. They might
legitimately
ask themselves: Am I, by carrying out an administrative
directive to under-
take mandatory therapy, truly serving the student, or am I
largely serving
the administrator and the institution? Can I really serve all three
equally well
in this endeavor or will one of them—the student, most likely—
get a short
shrift by having his or her civil rights abridged? If his or her
rights are being
abridged in counseling, how do I justify being actively
complicit in such
a scheme?
Many years ago, Thomas Szasz (1973) raised this very point in
his article
titled “The Psychiatrist as Double Agent.” Szasz had created a
straw man by
positing his argument in a way that ineluctably situated college
therapists in
the cross fire of a nasty clash between students and college
administrators
that inevitably led to serious ethical compromises on the part of
the thera-
pists, at times to the detriment of students. I was determined to
not let this
happen to me in my college work, and I discovered there really
was a quite
navigable pathway I could use in my college practice to avoid
such a con-
sequence. I took a quite intransigent stand against mandatory
37. counseling
and made it known to all segments of the campus community—
students,
academic counselors, administrators, and instructors—that our
clinic would
not be accepting such referrals (except, of course, in cases of
demonstrable
imminent danger to self or others). At the same time I
persistently expressed
to anyone making such a referral my eager willingness to meet
with them,
as often and as long as necessary, in order to discuss effective
alternatives
to mandatory counseling, such as the use of proportionate and
clearly war-
ranted disciplinary measures. This tack—respecting and actively
fostering
the rights and prerogatives of instructors and administrators to
use essen-
tial disciplinary sanctions rather than relinquish them to
counselors who
could not execute mandatory therapy without straying into
serious ethical
compromises—became a highly serviceable and respected
paradigm that
worked splendidly for many years, just not at first, of course.
Several of the
old guard, benighted administrators, many who were trained and
educated
at authoritarian colleges, took umbrage with me over my refusal
to follow
their orders to conduct mandatory therapy. On several occasions
I was even
informed that I was not doing my job, and there were even
intimations that
my employment at the college might be in jeopardy. But over
38. the ensuing
years the old guard was eventually replaced by a more
enlightened coterie
of administrators who embraced the concept and practice of
cleanly separat-
ing the psychological service from the college’s disciplinary
system, and the
result was an exemplary mutual respect and a clear and
effective delineation
of respective responsibilities between college therapists and
administrators
in the handling of disruptive incidents.
Mandatory Counseling 289
Pitfalls for Counselors
College therapists who accede to administrators’ directives to
conduct manda-
tory therapy are wont to justify their acquiescence on several
rather spurious
grounds. For example, one of the pitfalls of mandatory
counseling is that it
is usually not confidential. (I used to naively think that
confidentiality was
an essential cornerstone of standard psychological treatment.)
The referring
administrator ordinarily requests or requires some form of
feedback from the
therapist following a mandatory session (“Did the student show
up? Is he
dangerous?”). Ordinarily, the therapist then arranges for the
student to “vol-
untarily” sign a form consenting to mandatory counseling and
39. the therapist’s
release of “pertinent” information to the administrator regarding
his or her
counseling sessions, especially his or her attendance record.
This, such ther-
apists argue, is a humane and voluntary procedure.
Unfortunately, therapists
who make this argument are either extraordinarily naive,
ethically tone deaf,
or are disingenuously lying. When students are confronted with
the “choice”
of signing or not signing such forms they are being offered a
“Hobson’s
choice” (referring to Thomas Hobson [1541–1631], an English
keeper of a liv-
ery stable who required that customers take either the horse
nearest the stable
or none at all). In other words, students are given a “choice”
offering only
one option—the student will either sign the confidentiality-
breaching form
or, like Mr. Hobson’s customers, hit the road on foot (suffer an
ignominious
suspension or expulsion). In such an entrapping situation the
entire matter
of choice is clearly illusory and dishonest.
A rather curious defense of mandatory therapy that is sometimes
advanced by its proponents is based on the fact that
psychotherapists in this
country are prevalently providing treatment to their clients on a
mandatory
basis in prisons and under mandates imposed by the criminal
justice sys-
tem in such programs as anger management, alcohol treatment,
and spousal
40. abuse. Proponents who enlist the specious argument that
widespread prece-
dents for these compulsory programs within the criminal justice
system
provide the imprimatur of legitimacy for establishing them on
college cam-
puses are, to put it bluntly, perpetrating a nasty hoax on their
clients. The last
time I looked, colleges were not prisons (even though some
administrators
and counselors arrogate to themselves wardenlike prerogatives
and tactics),
nor did they have the legal authority to adjudicate cases of
criminality. Yes,
they certainly are endowed with and wield considerable
disciplinary author-
ity, but in no wise are colleges and universities allowed to serve
as a proxy
for the criminal courts of our country. It is very interesting, I
think, that some
exponents of mandatory counseling would actually enlist as
their clinical
guide and model a practice that is endemic within the
authoritarian culture
of prisons and criminal justice systems. Is this perhaps a stark,
albeit uncon-
scious, acknowledgement and reflection of their own
authoritarian values
and clinical philosophy?
290 G. Amada
Gore Vidal, the noted playwright and novelist, in a television
interview
41. many years ago on the topic of pornography, was asked to
recommend
remedies for the harmful effects of pornography. He replied, “I
think it
might be more socially beneficial to study the psyches of the
rabid censors of
pornography than its alleged harmful effects.” Analogously, I
would suggest
that it is more socially and clinically productive to
comparatively study the
psyches of college counselors and administrators who support or
oppose
mandatory counseling, particularly with respect to their
respective levels of
authoritarian beliefs and personality traits, than to assume that
mandatory
counseling is both ethically acceptable and socially beneficial.
Another argument adduced by advocates of mandatory
counseling
relates to its supposed unimportance when compared with other
forms of
ethical infractions and compromises that abound in our venal
society. Of all
the arguments used to defend and prettify mandatory counseling
it is this
one that I find most offensive. If college counselors are
knowingly compro-
mising their ethical principles by resorting to mandatory
counseling simply
because it is not as monumental a moral transgression as, say, a
massive
Ponzi scheme or CIA waterboarding, they should undertake
some serious
soul-searching to repair their malfunctioning moral compasses.
42. This discussion of ethical relativism is evocative, for me, of a
scene in
the film Judgment at Nuremberg in which Burt Lancaster,
playing the role of
a convicted Nazi war criminal, asks Spencer Tracy, playing the
part of one of
the trial judges, how he (Lancaster) could have known as a trial
judge himself
under the Hitler regime that his judicial rulings might lead to
the horrors of
the Holocaust. Tracy, somber in mien and voice, says (I am
paraphrasing),
“You should have known the first time you sentenced an
innocent person
to prison.” I am not suggesting, of course, that mandatory
therapy will be
a precursor to such cataclysmic events as a Holocaust. I am
suggesting,
however, that proponents and purveyors of coercive counseling
have no
control over how much their willingness to violate the rights of
students
to refuse therapy will ultimately result in greater, more
egregious ethical
abuses at some indeterminate point in the future. It is a
historical truism, I
believe, that almost all large-scale human rights abuses are the
culmination
of a natural, inexorable trajectory that begins with small-scale,
seemingly
innocuous rights’ violations and ends with horrifically
catastrophic ones.
Invalid Justifications
Another argument that is sometimes adduced in favor of
43. mandatory therapy
is that it is unconscionable for a college or university to expel
untreated,
violent students who will, on their return to society, prey on
unwary
members of their community. When I first came across this
argument I
thought it merely laughable. Upon further scrutiny, I have come
to the
regrettable conclusion that this argument, when translated into
pragmatic
Mandatory Counseling 291
institutional practices and policies, often becomes a potent
engine of odi-
ous and ungovernable outcomes. For example, my extensive
research of the
pivotal events leading up to the 2007 tragedy at Virginia Tech
clearly shows
that the preponderance of faculty and administrators who had
been continu-
ally frightened by the conduct of Mr. Cho, the perpetrator,
habitually leaned
in favor of shoehorning him into counseling as the preferred
remedy for
his frightening misconduct while decelerating the use of such
disciplinary
measures as an expulsion from the college. As we now know,
Mr. Cho pre-
dictably eschewed counseling and gained a grandiose and
dangerous sense
of entitlement from the cowed deference of the college staff.
44. Of course it could be argued that, had Mr. Cho learned he would
be
expelled, he might have sought retribution even sooner by
wreaking even
greater devastation. But we must face the fact that colleges and
universi-
ties are definitely not sanctuaries for violent students whose
very presence
on campus poses an imminent danger to staff and students. We
also must
face the fact that counseling sessions (whether conducted on a
voluntary or
mandatory basis) with truly dangerous students are definitely
not a panacea
or safeguard that provides the campus with adequate protection
from their
victimizing behavior. It is extremely irresponsible for college
counselors to
provide mandatory counseling to disruptive or dangerous
students if at the
same time they are fully aware that their colleagues and other
students are
deeply suffering from the consequences of these students’
continued enroll-
ment on campus, enrollment that is based, in many cases, on the
very fact
that the student’s counseling sessions are administratively
treated as a mit-
igating and protective extenuation. There is much that colleges
can do to
help such expelled students (and the community to which they
will return)
by reaching out to the students’ families and community
agencies. Such
efforts require considerable creativity and resources, but they
can provide
45. worthwhile results.
Therapy Is Not a Substitute for Judicial Process
Administrators and counselors who opt to use mandatory
therapy rather than
the college’s judicial system to deal with disruptive students are
disregarding
and denigrating (probably unwittingly) the essential value and
efficacy of the
college’s disciplinary system. A sound judicial system is
ordinarily prepared
to deal immediately and effectively with acts of misconduct.
Disciplinary
sanctions will need to be proportionate and just, and they should
be meted
out only by those persons who are bureaucratically authorized
to adminis-
ter discipline—designated administrators and/or judicial affairs
officers, not
counselors. Ordinarily, students who are disciplined through the
use of sanc-
tions that deprive them of their academic privileges, sanctions
such as a
suspension or expulsion, will, or should, learn that their acts of
serious mis-
conduct will entail dire consequences and that failure to respect
the rights
292 G. Amada
of others is not an acceptable way to matriculate or live one’s
life. These
are the values that undergird a just code of student conduct and
46. a sound
disciplinary system. When students are required to undergo
counseling in
lieu of a disciplinary sanction a very different moral message is
usually con-
veyed. The message, if it were transmitted to the student in
writing, might
read as follows:
We will not use the code of student conduct and its
undergirding values
to discipline you. Instead, we will force you into counseling by
semanti-
cally morphing your disruptive behavior into a psychological
disorder of
some kind, whether you like it or not. We do this in your own
interest,
of course, in order to help you avoid a harsh and blemishing
disci-
plinary sanction and because we believe counseling is a kinder
and
gentler approach to your problems. We ask that you see it our
way even
if we are using coercive measures to achieve our goals. We also
request
that you regard the consent forms we ask you to sign that enable
us
to violate your confidentiality to be a legitimate means of
providing you
with a fair and reasonable choice, even if the “choice” is a
palpable sham.
If we can accept that the characterization in this mock letter
reasonably
reflects the deeper, labyrinthine dynamics of a typical
mandatory therapy
47. arrangement, we should be able to infer from it some of the
salient values
that undergird mandatory counseling and easily distinguish
them from the
values undergirding the judicial system of a college. The values
underlying
mandatory therapy are, inter alia, “might makes right” (the
might of the insti-
tution and its administrative minions), due process procedures
protecting
disruptive students’ civil rights are largely irrelevant and need
not be par-
ticularly respected, the goal of this involuntary endeavor is not
reasonable
conformity to the code of student conduct but rather some
amorphous but
identifiable form of psychological progress, and, finally,
involuntary clients
must find ways to blind and inure themselves to the sham
aspects of this
procedure if they are to remain in college and derive any benefit
from the
unwelcome help they will receive. Should college therapists be
complicit in
any clinical enterprise that advances such values?
Mandatory Counseling Encourages Subpar Counselors
Mandatory therapy by definition requires that students must see
therapists
with no particular regard for any lamentable misalliance that
might take
place between them. I hope my colleagues will agree that there
are psy-
chotherapists working in colleges and other settings who have
atrocious
48. clinical skills and judgment. The comedian George Carlin once
made the
tragicomic gag that in our country there is a worst doctor and at
this very
moment there is a patient in his or her office. By the same
token, there is
Mandatory Counseling 293
assuredly a worst college psychotherapist on a campus
somewhere and at
this very moment a student is being mandatorily treated in his
or her office.
What happens to students there on a mandatory basis? Will such
students
be given another bogus choice to remain with that therapist or
leave the
college? What if students refuse to enter mandatory therapy
because they
understandably believe that any therapist who is willing to
engage in this
questionable practice is not someone they can trust?
Therapy Is Not the Sole
Solution
Based on my experience as a visitor to many colleges and
49. universities, I
have repeatedly come across a rather disquieting pattern of
concerted effort
to coerce disruptive students into psychotherapy rather than
simply and pro-
portionately discipline them for their behavioral infractions.
The pattern is
usually as follows: A highly disruptive student will, for
example, be fright-
ening roommates with her repeated threats of suicide. For
understandable
reasons the student is referred to a campus therapist on a
voluntary or
involuntary basis. In many, if not most such instances, the
student is not
threatened with a disciplinary sanction for behavior that is
frightening and
undermining the welfare of her roommates. Intensive efforts are
made by
the clinical staff to protect the suicidal student from herself, but
little effort
is put into protecting her roommates from her toxic presence in
the dorm
because her suicidal behavior is not deemed unacceptable or
actionable
50. under the code of student conduct. The student then
conscientiously keeps
her therapy appointments but because her suicidal misconduct
was never
deemed interpersonally sanctionable she returns to her room
each night to
repeat her suicidal threats with impunity. Why? Because the
student oppor-
tunistically chooses to meet the college’s sole stated and
explicit expectation:
mandatory therapy. This scenario is an all-too-common one and
reflects the
tendency of many colleges to lavish attention and services on
the identified
patient in crisis while neglecting to protect the rights and
emotional well-
being of other students. It is perfectly understandable that such
students
can remain in therapy for extended periods of time while they
continue to
be a public nuisance in the residence halls and elsewhere on
campus. I can
only hope that colleges that use mandatory counseling will not
abandon dis-
ciplinary measures as an alternative when counseling has failed
51. to protect
other students from the interpersonally destructive behavior of
the individual
in treatment.
CONCLUSION
Why do some college therapists agree to undertake mandatory
therapy with
students? Well, I assume some therapists simply savor power
and have no
294 G. Amada
ethical compunctions about using it in this manner. Far more
common, how-
ever, are cases of college counselors who agree to undertake
mandatory
counseling with students because they have been asked or
ordered to do
so by administrators who exercise control over their budgets
and their very
jobs. Such administrators feel more protected, physically and
52. legally, if they
can transfer the responsibility for evaluating the disruptive
student to college
counselors. I have spoken with hundreds of college counselors
who have
been placed in this position, and most seem to resent and object
to it on
ethical grounds, yet most acquiesce because they do not wish to
risk a con-
flict that might jeopardize their program and their job. It is
important, then,
to recognize that the ethical dilemmas wrought by the taxing
demands of
college administrators for mandatory therapy are more a
political than clini-
cal phenomenon. The quintessentially political nature of
mandatory therapy
is based on the power imbalance between college administrators
and coun-
selors. This means that those who seek to abolish this practice
(except in
cases of demonstrably dangerous students) will need to meet
this challenge
by generating the requisite moral courage to say no to those
administra-
53. tors who seek to impose such ethical compromises on them.
Otherwise, I’m
afraid we will have to wait until some disgruntled students lead
the way by
successfully suing colleges for violating their civil rights with
the despotic
ferule of mandatory counseling.
REFERENCES
Foundation for Individual Rights in Education. (2010). [Home
page.] Retrieved from
http://www.thefire.org/.
Gallagher, R. P. (2009). National survey of counseling center
directors. Pittsburgh:
School of Education, University of Pittsburgh.
Report of the Virginia Tech Review Panel. (2007, August).
Presented to Timothy
M. Kaine, Governor, Commonwealth of Virginia. Retrieved
from http://
www.vtreviewpanel.org/report/index.html.
Szasz, T. (1973). The psychiatrist as double agent. In Anselm L.
54. Strauss (Ed.), Where
medicine fails. New Brunswick, NJ: Transaction Books.
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![(Handelsman, Gottlieb, & Knapp, 2005). To facilitate this
movement, training programs need to help students develop
the “philosophical sophistication” to reconcile personal and
professional values (Mintz et al., 2009, p. 644). Similarly,
Basche, Anderson, Handelsman, and Klevansky (2007) noted
that students enter graduate programs with preexisting ideas
of right and wrong professional behavior, based in large part
on their own backgrounds. For students, learning to make
ethical decisions is a developmental process of acculturat-
ing to the ethics of the profession and eventually integrating
professional ethics with their own values and beliefs.
Handelsman et al. (2005) adapted Berry’s (2003) model
of social or ethnic acculturation to describe four strategies
Irene Mass Ametrano, Department of Leadership and
Counseling, Eastern Michigan University. Correspondence
concerning this
article should be addressed to Irene Mass Ametrano,
Department of Leadership and Counseling, Eastern Michigan
University, 304
Porter Building, Ypsilanti, MI 48197 (e-mail:
[email protected]).
Teaching Ethical Decision Making:
Helping Students Reconcile Personal
and Professional Values
Irene Mass Ametrano
Because conflicts between personal and professional values can
interfere with ethical decision making, a goal of
counselor education must be helping students reconcile such
conflicts. This article describes one counselor educator’s
experience teaching ethical decision making and the effects on
student learning. Growth was observed in increased
tolerance for ambiguity, awareness of how values influenced](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)