Counseling Same-Sex Couple

Select a case study in chapter 11, Issues and Ethics in the Helping Profession, all of which are concerned with a family or couples issue. Write a 500-to 750-word paper identifying the ethical issue or issues. Describe the ethical issues that confront you, as the caseworker. Describe how you are going to help resolve these issues while maintaining ethical standards. Cite the principle(s) or core areas you are applying from the AAMFT Code of Ethics. Format your paper consistent with APA guidelines. Include the chapter/identifying case study information on the Title Page. Be sure to cite in-text and then include any cited sources on your Reference Page. The Case of Emily and Lois. Emily and Lois, lesbian partners, were married in San Francisco when it was legal. They have now moved to a state that prohibits same-sex marriages and fi nd themselves scorned and threatened by their neighbors. In addition, Emily had a child through in vitro fertilization, and Emily’s parents have fi led a petition in court to obtain custody of the child. The parents believe that the two women are unfi t to raise a child because of their sexual/affectional orientation. Emily and Lois recognize that they need a support system that works for them, and they hope a counselor can help them sort out what is best for their family. Much of the practice of couples and family therapy rests on the foundation of systems theory, which views psychological problems as arising from within the individual’s present environment and the intergenerational family system. Symptoms are believed to be an expression of dysfunctions within the system, which are passed along through numerous generations. Professionals who conduct family therapy generally adopt a systemic perspective as the foundation of their practice. 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. 450 Chapter 11 The idea that the identify client’s problem might be a symptom of how the system functions, not just a symptom of the individual’s maladjustment and psychosocial development, was a revolutionary notion. For therapists accustomed to Western cultural ideals, Bitter (2009) notes that the family systems perspective demands a major paradigm shift away from the values associated with individualism, autonomy, and independence. Key collectivism, interdependence, family embeddedness and connectedness, hierarchies of relationship, and multigenerational perspectives are more familiar concepts in Eastern cultures. Goldenberg and Goldenberg (2008) encourage therapists to view all behavior, including the symptoms expressed by the individual, within the context of the family and society. Although traditional approaches to treating the individual have merit, expanding the perspective to consider clients as members of their family, community, and society may enhance therapists’ understanding. The Goldenbergs claim that a systems orientation does not preclude dealing with the individual but does broaden the traditional emphasis to address the roles individuals play in the family. In other words, a systemic perspective broadens the context of the individual’s problem and shapes and defi nes the problem. The systems perspective views the family as a functioning entity that is more than the sum of its members. The family provides the context for understanding how individuals behave. Actions by any individual member infl uence all the other members, and their reactions have a reciprocal effect on the individual. For instance, a child who is acting-out may be expressing deep confl icts between the mother and the father and may actually be expressing the pain of an entire family. Family therapists often work with individuals, the couple, and parents and children to get a better understanding of patterns that affect the entire system and to develop strategies for change. Even when the focus is on an individual, Wilcoxon, Remley, Gladding, and Huber (2007) point out that the individual’s actions are analyzed in terms of how they affect other members of the relationship system, as well as how other members’ actions reciprocally affect and shape the individual. The majority of family therapists integrate concepts and techniques from various theoretical orientations to produce their own blend of methods based on their training, personality, and the population of families they serve (Hanna, 2007). Bitter (2009) maintains that family therapy is moving toward integration. Thus, it does not make sense to study only one model and to neglect the insights of others. Bitter offers a structure for assisting students of family therapy in developing an integrative model that will guide their practice. Many of the ethical issues we have already discussed take on special significance when therapists work with more than one client. Most graduate programs in couples and family therapy now require a separate course in ethics and the law pertaining to this specialization, with an increased emphasis on ethical, legal, and professional issues unique to a systems perspective. 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. The professional practice of couples and family therapy is regulated by state laws, professional specialty guidelines, ethics codes, peer review, continuing education, managed care, and consultation (Goldenberg & Goldenberg, 2008). Some specifi c areas of ethical concern for couples and family therapists that we discuss in this chapter include the following: ethical standards of practice, therapist values, therapist responsibility, gender sensitivity, confi - dentiality, informed consent, and the right to refuse treatment. Ethical Standards in Couples and Family Therapy The AAMFT Code of Ethics (2001) provides a framework for many of the ethical issues we consider in this chapter, but practitioners are required to know and follow the ethics codes of their own professional affi liation on matters related to couples and family therapy. In addition to the AAMFT code, useful resources for issues involving couples and family therapy are the Ethical Casebook for the Practice of Marriage and Family Counseling (Stevens, 1999); the American Association for Couples and Family Therapy Ethics Casebook (Brock, 1998); Ethics in Marriage and Family Therapy (Woody & Woody, 2001); Professional Regulation in Marital and Family Therapy (Stukie & Bergen, 2001); and “Virtue, Ethics, and Legality in Family Practice” (Kleist & Bitter, 2009). In addition, many states have their own professional organizations that outline ethical standards for the practice of couples and family therapy. We begin our discussion by considering the AAMFT’s (2001) code in each of eight core areas, followed by a brief discussion of what this means for therapists. Responsibility to Clients Marriage and family therapists advance the welfare of families and individuals. They respect the rights of those persons seeking their assistance, and make reasonable efforts to ensure that their services are used appropriately. (Principle I.) As the focus of therapy shifts from the individual to the family system, a new set of ethical questions arises: Whose interests should the family therapist serve? To whom and for whom does the therapist have primary loyalty and responsibility: the client identifi ed as being the problem, the separate family members as individuals, or the family as a whole? By agreeing to become involved in family therapy, the members can generally be expected to place a higher priority on the goals of the family as a unit than on their own personal goals. Balancing the rights and well-being of the individuals with the family as a whole is one of the most challenging aspects of ethical family practice. 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. 452 Chapter 11 Confi dentiality Marriage and family therapists have unique confi dentiality concerns because the client in a therapeutic relationship may be more than one person. Therapists respect and guard confi dences of each individual client. (Principle II.) The principle of confi dentiality as it applies to couples and family therapists entails that practitioners not disclose what they have learned through the professional relationship except (1) when mandated by law, such as in cases of physical or psychological child abuse, incest, child neglect, abuse of the elderly, or abuse of persons with a disability; (2) when it is necessary to protect clients from harming themselves or to prevent a clear and immediate danger to others; (3) when the family therapist is a defendant in a civil, criminal, or disciplinary action arising from the therapy; or (4) when a waiver has previously been obtained in writing. If therapists use any material from their practice in teaching, lecturing, and writing, they take care to preserve the anonymity of their clients. For therapists who are working with families, any release of information must be agreed to by all parties. However, there is an exception to this policy when a therapist is concerned that a family member will harm him- or herself, or will do harm to another person (Green, 2003). Another exception occurs when the law mandates a report. Professional Competence and Integrity Marriage and family therapists maintain high standards of professional competence and integrity. (Principle III.) Responsible clinicians keep abreast of developments in the fi eld through continuing education and clinical experiences. A single course or two in a graduate counseling program is inadequate preparation for functioning ethically and effectively as a couples or family practitioner. Indeed, many family counselors and therapists feel that their preparation for professional work really begins when they enter postgraduate training, usually at a family therapy institute with a specifi c orientation to practice. Competence in working with couples and families only comes with years of training and supervision. Family therapists continue to improve their skills through interactions with other therapists (see Hoffman, 2001; Minuchin, Lee, & Simon, 1996). Here are some questions that can be productively explored: How can therapists know when their own personal problems are hampering their professional work? What are some ways in which therapists can best maintain a level of competence? How can therapists use their values in a constructive fashion? Responsibility to Students and Supervisees Marriage and family therapists do not exploit the trust and dependency of students and supervisees. (Principle IV.) 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. Ethical Issues in Couples and Family Therapy 453 Practitioners are cautioned to avoid multiple relationships, which are likely to impair clinical judgment. As you saw in Chapters 7 and 9, perspectives differ on how best to handle dual relationships and avoid exploiting the trust and dependency of clients, students, and supervisees. Most family therapy training programs encourage genogram work and other processes designed to engage students with their own family-of-origin issues. In such programs, trainers will sometimes engage in therapeutic interventions with their students. What are your views about multiple relationships as they apply to couples and family therapy? Can you think of a possible multiple relationships that could lead to exploitation? What concerns do you have about multiple relationships between couples and family therapists and their students or supervisees? Responsibility to Research Participants Investigators respect the dignity and protect the welfare of research participants, and are aware of federal and state laws and regulations and professional standards governing the conduct of research. (Principle V.) Researchers must carefully consider the ethical aspects of any research proposal, making use of informed consent procedures and explaining to participants what is involved in any research project. At universities and in clinical settings, researchers are required to follow certain rules and regulations, which include procedures for meeting HIPAA requirements. Even when functioning outside of a university or clinical setting, marriage and family therapists must meet standards of ethical research practice when working with couples or families. If there is a confl ict between research purposes and therapeutic purposes, how would you resolve it? What are some multicultural considerations in doing research in this area? What obstacles do you see to doing research with families? Responsibility to the Profession Marriage and family therapists respect the rights and responsibilities of professional colleagues and participate in activities that advance the goals of the profession. (Principle VI.) Ethical practice requires measures of accountability that meet professional standards. Among other things, it is expected that couples and family therapists will not accept clients seeing other therapists without consulting with that therapist; will report people practicing without a license; and will contribute time to the betterment of society, including donating services. What are some specifi c actions you would take to contribute to the betterment of society? What do you see as your ethical obligation to advance the goals of your profession? 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. Financial Arrangements Marriage and family therapists make fi nancial arrangements with clients, third party payers, and supervisees that are reasonably understandable and conform to accepted professional practices. (Principle VII.) Couples and family therapists do not accept payment for making referrals and do not exploit clients fi nancially for services. They are truthful in representing facts to clients and to third parties regarding any services rendered. Ethical practice dictates a disclosure of fee policies at the onset of therapy. What steps would you take to inform your clients about your fee policies? Would you charge for missed appointments? What if you missed an appointment with a client? What are some ways in which clients can be exploited fi nancially? Are there any circumstances in which you might barter with clients who need your services? Advertising Marriage and family therapists engage in appropriate informational activities, including those that enable the public, referral sources, or others to choose professional services on an informed basis. (Principle VIII.) Ethical practice dictates that practitioners accurately represent their competence, education, training, and experience in couples and family therapy. Therapists do not advertise themselves as specialists (for example, in sex therapy) without being able to support this claim by virtue of their education, training, and supervised experience. How would you advertise your services? How might you promote yourself as a couples and family practitioner? Special Ethical Considerations in Working With Couples and Families Why do people seek couples therapy? This question was the basis of a survey of 147 married couples seeking marital therapy. Doss, Simpson, and Christensen (2004) reported that the most common reasons for seeking couples therapy were problematic communication and lack of emotional affection. Other reasons included the desire to improve the relationship for the sake of the children (19% of couples) and positive feelings for their spouse or relationship (22% of couples). A number of ethical considerations are unique to couples and family therapy. Because most couples and family therapists focus on the family system, potential ethical dilemmas needing immediate clarifi cation can arise even in the fi rst session. Therapists who work with cohabitating couples or multiple family members, for example, often encounter dilemmas that involve serving one member’s best interest at the expense of another member’s interest. Such ethical dilemmas multiply when the therapist has unresolved familyof- origin issues, thereby increasing the potential for countertransference. 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. Ethical Issues in Couples and Family Therapy 455 In their interventions, therapists need to be sure that the status of one partner or family member does not improve at the expense of the other partner or another family member. Therapists can respond to ethical dilemmas over confl icting interests of multiple individuals by identifying the couple or family system rather than a single individual the “client” (Kleist & Bitter, 2009; Wilcoxon et al., 2007). Therapists who function as an advocate of the system avoid becoming agents of any one partner or family member. Fisher (2009) proposes that we stop asking “Who is the client?” and reframe this question to consider our ethical responsibilities to everyone involved. Working within a framework that conceptualizes change as affecting and being affected by all family members, practitioners are able to defi ne problems and consider plans for change in the context of the family system and all its members. Wilcoxon and colleagues (2007, p. 122) list a number of ethical questions faced by couples and family counselors: �� In what ways are ethical principles unique for the practice of marriage and family therapy? �� Can therapists automatically assume the right to defi ne presenting problems of couples and families in terms of their own therapeutic orientation? �� How much concerted effort can therapists exert in bringing together all the signifi cant family members for therapy sessions? �� Under what situations, if any, should therapists impose their control on couples and families? If so, to what extent should they impose it in seeking change in the relationship system? �� How can working with couples and families within the larger context of service agency constraints be pursued ethically? �� What nontraditional family structures raise unique ethical concerns for marriage and family therapists? Contemporary Professional Issues In this section we identify a few of the current professional issues in the practice of couples and family therapy. These include the personal, academic, and experiential qualifi cations necessary to practice in the fi eld. Personal Characteristics of the Family Therapist In Chapter 2 we addressed the signifi cance of the personal characteristics of the therapist as a major factor in creating an effective therapeutic alliance. Bitter (2009) identifi es the following personal characteristics and orientations of effective family practitioners: presence; acceptance, interest, and caring; assertiveness and confi dence; courage and risk taking; openness to change; paying attention to goals and purposes of a family; working in patterns; appreciating the infl uence of diversity; being sincerely interested in 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. 456 Chapter 11 the welfare of others; tending to the spirit of the family and its members; and involvement, engagement, and satisfaction in working with families. Self-knowledge is particularly critical for family therapists, especially with regard to family-of-origin issues. When therapists work with a couple or a family, or with an individual who is sorting out a family-of-origin issue, their perceptions and reactions are likely to be infl uenced by their own familyof- origin issues. Therapists who are unaware of their own vulnerabilities are likely to misinterpret their clients or steer clients in a direction that will not arouse their own anxieties. Therapists who are aware of their own emotional issues are less likely to get entangled in the problems of their clients. Many trainers of family therapists believe that a practitioner’s mental health, as defi ned by relationships with his or her family of origin, has implications for professional training. It is assumed that trainees can benefi t from an exploration of the dynamics of their family of origin because it enables them to relate more effectively to the families they will meet in their clinical practice. From an ethical perspective, it is incumbent upon training programs to inform students prior to admission of the personal nature of their training. Getz and Protinsky (1994) believe personal growth is an essential part of training for couples and family counselors and that knowledge and skills cannot be separated from a helper’s internal dynamics and use of self. They write: “Trainees can and should be referred for personal therapy, but their issues, when identifi ed as affecting their work, are addressed preferably in training” (p. 183). Getz and Protinsky point to growing clinical evidence that a family-of-origin approach to supervision is a necessary dimension of training for therapists who want to work with families. They contend that the reactions of therapists to their clients’ stories tend to reactivate therapists’ old learned patterns of behavior and unresolved problems. Through studying their own family of origin, students are ultimately able to improve their ability to counsel families. In writing on the personal training of family therapists, Aponte (1994) describes his person/practice model, which is based on the premise that therapy is a personal encounter within a professional framework. Although he acknowledges that theory and technique are essential to the professional practice of family therapy, he stresses that the process is affected wholly through the relationship between therapist and client. For Aponte, training the person of the therapist calls for trainees to examine their personal issues in relation to the therapy they do: “The touching of therapists’ and clients’ lives in therapy beckons therapists to gain mastery of their personal selves in their clinical relationships” (p. 4). Many master’s programs in counseling now offer a specialization in relationship counseling or couples and family therapy. Components of the training program include the study of systems theory, an examination of family of origin, and an emphasis on ethical and professional issues specifi c to 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. Ethical Issues in Couples and Family Therapy 457 working with couples and families. All couples and family training programs acknowledge that both conceptual knowledge and clinical skills are necessary to become a competent family therapist. As training programs have evolved, major didactic and experiential components have been identifi ed. Family therapy training programs use three primary methods of training: (1) didactic course work, (2) direct clinical experiences with families; and (3) regular supervision by an experienced family supervisor who, together with trainees, may watch the session behind a one-way mirror or through videotaped sessions (Goldenberg & Goldenberg, 2008). In addition to these methods of training, trainees are now likely to be exposed to a variety of current issues in the fi eld of family therapy. Some of these include gender awareness, cultural sensitivity, and an understanding of the impact of larger systems on family functioning (Bitter, 2009; Goldenberg & Goldenberg, 2008). It is essential for students to gain experience in working with a variety of families from different ethnic and socioeconomic backgrounds who have various presenting problems. A program offering both comprehensive course work and clinical supervision provides the ideal learning situation. Experiential Qualifi cations for Family Therapy In training couples and family therapists, primary emphasis must be given to the quality of supervised practice and clinical experience. Academic knowledge comes alive in supervised practicum and internship experiences, and trainees learn how to use and sharpen their intervention skills. Clinical experience with families is of limited value without regularly scheduled supervisory sessions. It is through direct clinical contact with families, under close supervision, that trainees develop their own styles of interacting with families. Goldenberg and Goldenberg (2008) indicate that a variety of supervisory methods can be employed to assist trainees in learning by doing, including the use of videotapes, written process notes, corrective feedback by telephone, and calling the trainee out of the family session for consultation. Live supervision can be conducted by a supervisor who watches and guides the sessions behind a one-way mirror and offers useful feedback and consultation to trainees on how they are working with a family. Family therapy trainees can also profi t from the practice of co-therapy, which provides trainees with opportunities to work closely with a supervisor or a colleague. A great deal of the supervision can take place immediately after and between sessions. Experiential methods include both personal therapy and working with issues of one’s own family of origin. A rationale for personal therapeutic experiences is that such exploration enables trainees to increase their awareness of transference and countertransference, which allows trainees to relate more effectively to the families they meet in their clinical practice. If clinicians are seeing families as part of their work, and if their program did not adequately prepare them for competence in intervening with families, they are vulnerable to a malpractice suit for practicing outside the boundaries of their competence. Those practitioners who did not receive specialized 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. 458 Chapter 11 training in their program need to involve themselves in postgraduate in-service training or special workshops. �� The Case of Ludwig. Ludwig is a counselor whose education and training has been exclusively in individual counseling. Ella comes to him for counseling. After more than a dozen sessions with Ella, Ludwig realizes that much of her diffi - culty lies not just with her but with her entire family system. By this time Ludwig has established a strong working relationship with Ella. Because he has no experience in family therapy, he decides to refer Ella to a colleague who is trained in family therapy, but he realizes that doing so could have a detrimental effect on her. One of Ella’s problems has been a sense of abandonment by her parents. He wants to avoid giving her the impression that he, too, is abandoning her. He decides to stay with her and work with her individually. Much of the time is spent trying to understand the dynamics of the family members who are not present. �� Do you agree with Ludwig’s clinical decision? Do you agree with his rationale? �� From your perspective, would it have made a difference if he had consulted with Ella? Would it have made a difference if he had consulted with or obtained supervision from a colleague? �� What if Ludwig had decided to see the entire family and attempted to do family therapy for the benefi t of his client, even though he was not trained as a family therapist? �� What if Ludwig had been trained in family systems but, when he suggested family sessions to Ella, she refused? What would you do if faced with such a dilemma? Commentary. Once Ludwig determined that Ella needed family therapy, which he was not qualifi ed to provide, he had an ethical responsibility to refer her for family therapy. Whenever a therapist makes a referral, it is important to communicate to the client that the referral is related to the therapist’s limitations rather than making the client responsibility for the diffi culty. Ludwig could suggest that he continue to see Ella for individual therapy for the problems not involving the family if Ella chose to do so. By supporting Ella in this way, her feelings of abandonment may be abated. Values in Couples and Family Therapy In Chapter 3 we explored the impact of the therapist’s values on the goals and direction of the therapeutic process. We now consider how values take on special signifi cance in counseling couples and families. Values pertaining 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. to marriage, the preservation of the family, divorce, traditional and nontraditional lifestyles, gender roles and the division of responsibility in the family, child rearing, and extramarital affairs can all infl uence therapists’ interventions. Therapists may take sides with one member of the family against another; they may impose their values on family members; or they may be more committed to keeping the family intact than are the family members themselves. Conversely, therapists may have a greater investment in seeing the family dissolve than do members of the family. The value system of the therapist has a crucial infl uence on the formulation and defi nition of the problems the therapist sees in a family, the goals and plans for therapy, and the direction the therapy takes. Counselors who, intentionally or unintentionally, impose their values on a couple or a family can do considerable harm. Ethical issues are raised in establishing criteria of psychosocial dysfunction, assessing the problems of the identifi ed patient in the family context, and devising treatment strategies. It is not the function of a family therapist to decide how members of a family should change, although Haley and Richeport-Haley (2007) would disagree with this position. We believe that the role of the therapist is to help family members see more clearly what they are doing, to help them make an honest evaluation of how well their present patterns are working for them, and to encourage them to make the changes they deem necessary. Couples and family therapists assist couples and families in negotiating the values they want to retain, modify, or discard. What values and experiences of yours might infl uence how you would work with couples and families? To assist you in formulating your personal position, consider two cases that raise value issues that could affect the course of therapy. 460 Chapter 11 and as a couple. She sees it as unethical to push her clients toward a defi nite course of action, and she lets them know that her job is to help them be honest with themselves. �� What are your reactions to this counselor’s approach? �� What values of yours could interfere with your work with Frank and Judy? Counselor B. This counselor has been married three times herself. Although she believes in marriage, she is quick to maintain that far too many couples stay in their marriages and suffer unnecessarily. She explores with Judy and Frank the confl icts that they bring to the sessions. The counselor’s interventions are leading them in the direction of divorce as the desired course of action, especially after they express this as an option. She suggests a trial separation and states her willingness to counsel them individually, with some joint sessions. When Frank brings up his guilt and reluctance to divorce because of the welfare of the children, the counselor confronts him with the harm that is being done to them by a destructive marriage. She tells him that it is too much of a burden to put on the children to keep the family together. �� What, if any, ethical issues do you see in this case? Is this counselor exposing or imposing her values? �� Do you think this person should be a marriage counselor, given her bias? �� What interventions made by the counselor do you agree with? What are your areas of disagreement? Counselor C. At the fi rst session this counselor states his belief in the preservation of marriage and the family. He believes that many couples give up too soon in the face of diffi culty. He says that most couples have unrealistically high expectations of what constitutes a “happy marriage.” The counselor lets it be known that his experience continues to teach him that divorce rarely solves any problems but instead creates new problems that are often worse. The counselor urges Frank and Judy to consider the welfare of their three dependent children. He tells the couple of his bias toward saving the marriage so they can make an informed choice about initiating counseling with him. �� What are your personal reactions toward the orientation of this counselor? �� Do you agree with him stating his bias so obviously? �� If he kept �� The Case of Emily and Lois. Emily and Lois, lesbian partners, were married in San Francisco when it was legal. They have now moved to a state that prohibits same-sex marriages and fi nd themselves scorned and threatened by their neighbors. In addition, Emily had a child through in vitro fertilization, and Emily’s parents have fi led a petition in court to obtain custody of the child. The parents believe that the two women are unfi t to raise a child because of their sexual/affectional orientation. Emily and Lois recognize that they need a support system that works for them, and they hope a counselor can help them sort out what is best for their family. Counselor A. This counselor says that she cannot even imagine what it must be like for them to have to face the reactions of the neighbors and of Emily’s parents on a daily basis. She indicates that she will make every effort to support and assist them in working through their situation. �� What are your reactions to this counselor’s approach? �� Do you think the support the counselor is offering is enough in this case? Counselor B. This counselor lets Emily and Lois know that they must have seen the problems inherent in returning home to a community 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. 462 Chapter 11 that has a very strong anti-gay bias. He informs them that the best approach to the problem is to relocate to a more liberal community, at least for the sake of the child. �� What, if any, ethical issues do you see in this response? Is this counselor imposing his values? �� What interventions made by the counselor do you agree with? What are your areas of disagreement? Counselor C. This counselor feels a bit overwhelmed, especially in trying to defi ne the problem. Is it a marriage problem? A problem pertaining to their sexual orientation? A community problem? �� What are your personal reactions toward this counselor? �� Do you see any ethical issue in the counselor’s reaction? �� If you felt overwhelmed with this situation, how would you handle it? Commentary. This case demonstrates the necessity for counselors to be prepared to deal with complex situations. Counselors need to know in advance where to fi nd consultation and what resources are available. We like Counselor A’s affi rming approach and hope that this would be a fundamental response for any mental health professional. Counselor B seems to have given up before he has even begun, and Counselor C needs to make an appropriate referral for these clients due to an apparent lack of experience with such complex issues. In counseling this couple, we would begin by recognizing the complexity of the case and showing our support for the diffi culty Emily and Lois are facing. We would ask their permission to consult with legal, ethical, and clinical experts so that we could better assist them. We would probably ask Emily and Lois’s thoughts on having a family session with the extended family of each of them. If Emily and Lois expressed an interest in family therapy, we would make an appropriate referral. Rebecca Farrell (personal communication, March 20, 2009) points out that this case also involves custody issues that are challenging when counseling a same-sex couple. For example, in Virginia in a custody battle, the maternal grandparent contended that her daughter was unfi t to raise her child due to her sexual orientation. The court ruled in favor of the grandparent who was given custody of her grandchild because the mother was in a lesbian relationship. Counselors need to know their state’s laws and consider their ethical obligations when deciding on a course of action. Some states (for example, Kentucky) are introducing bills to prohibit same sex couples from adopting or fostering children. Cultural norms and 9781133705451, Issues and Ethics in the Helping Professions, Gerald Corey - © Cengage Learning. This is what I have I hope it helps.