Culturally Responsive Ethical Decision-Making During COVID-19

By Rebecca Randall, Sunanda Sharma and Matthew Tirrell

Department of Counseling, Montclair State University

ACA Graduate Student Ethics Competition – Doctoral Category

Faculty Advisor: Dr. Dana Heller Levitt

Abstract

The COVID-19 pandemic imposes novel conditions on counseling supervisors and extends the boundaries of ethical considerations. Remote supervision of counselors-in-training, as described in the current case, poses unique challenges to the supervisory triad. To evaluate the proposed scenario for potential ethical dilemmas, the authors consulted and applied the Transcultural Integrative Model (TIM) for ethical decision-making (Garcia et al., 2003). The authors identified several concerns that involve the stakeholders in the case, including: client welfare, counselor impairment, the supervisory relationship, the praxis of virtual supervision during COVID-19, and professional gatekeeping. The case content was examined from a multicultural lens and assessed for congruence with the foundational principles and standards of the counseling profession. Proposed courses of action include remediation for the counselor-in training, support for the supervisor-in-training, and collaborative, culturally responsive communication among the stakeholders.

Culturally Responsive Ethical Decision-Making During COVID-19

COVID-19 prompted professional counselors to adapt to rapidly changing circumstances with no advanced preparation. Despite this, the counseling profession responded by shifting: how counseling services are delivered, how counselor educators and supervisors are preparing counselors-in-training, and how counselors-in-training are working with clients under these challenging circumstances (Bray, 2020). In this context, Caila, a doctoral level supervisor and student, encounters a number of ethical concerns which impact several stakeholders. We will assess the case and offer recommendations for the most appropriate course of action through use of the Transcultural Integrative Model (TIM) for ethical decision-making (Garcia et al., 2003).

Transcultural Integrative Model of Ethical Decision-Making

The TIM is an ethical decision-making model that accounts for personal, professional, and collaborative perspectives on ethical dilemmas (Garcia et al., 2003). The TIM is the most conducive model to explore the various dimensions of this case, due to its focus on cultural context and its utilization of social constructivist strategies to collaboratively formulate an ethical response. Caila’s intersecting identities (e.g., race, gender, ability status) and the issues of power and privilege between all the stakeholders inform a number of concerns within this case. We will use the Multicultural and Social Justice Counseling Competencies (MSJCC) to examine each stakeholder’s positionality with respect to their marginalized and privileged identities (Ratts et al., 2016). We will analyze this case through a multicultural lens, informed by the MSJCC, which will permeate our use of the TIM: interpreting the situation, formulating an ethical decision, weighing competing nonmoral values, and planning and executing the selected course of action (Garcia et al., 2003; Ratts et al., 2016).

Interpreting the Situation Through Sensitivity, Awareness, and Fact-Finding

The first step in the TIM (Garcia et al., 2003) is to seek a deep understanding of the potential ethical dilemmas posed in the case. Identification begins with a close examination, informed by the cultural perspectives of each stakeholder, attention to the foundational ethical principles of the profession, and commitment to accurate interpretation (Garcia et al., 2003). There are several ethical considerations in this case: client welfare, counselor impairment, the supervisory relationship, virtual supervision during COVID-19, and professional gatekeeping. The stakeholders in this case are Kyle, Caila, Dr. Smith, Kyle’s clients, and the site supervisor.

Client Welfare

Kyle reported to Caila that his site is not following recommended COVID-19 safety guidelines, which puts his clients at risk. Although Caila attempted to contact the site, her inability to conduct a live site visit precludes her from effectively evaluating client well-being. Caila did not inform Dr. Smith of Kyle’s safety concerns, which exacerbates the clients’ vulnerability. Dr. Smith’s lack of awareness exposes problematic relational patterns in the supervisory triad that may further threaten client well-being.

Counselor Self-Awareness and Self-Advocacy

Counselors are called to grow in self-awareness and to self-monitor for potential impairment (ACA, 2014). Caila has not been fully transparent in her supervisory relationships about her compromised self-efficacy amid the stress of quarantine. Similarly, as counselors and supervisors are charged with advocating for client welfare, they are also called to self-advocate for their wellness. Caila’s difficulty with self-monitoring and self-advocacy is a significant concern with implications for her supervisory relationships and client welfare.

Supervisory Relationships

Transparency and cultural awareness in the supervisory relationship, which appear to be challenges for these stakeholders, are essential to competent supervision and counseling (ACES, 2011). Kyle and Dr. Smith met for supervision without informing Caila, and Caila withheld critical information from Dr. Smith regarding her tenuous mental and physical states. Additionally, ​Kyle draws on commonly used microaggressions against Black women (Moody & Lewis, 2019), which warrants an exploration of his intent and meaning.​ ​Culturally-informed ethical concerns extend to Caila and Dr. Smith’s relationship as well, given its cross-cultural and hierarchical nature. Attention to sociocultural positionality and power differentials appears to be of concern in the supervisory relationship dynamics.

Informed Consent in Virtual Supervision

Supervisors must provide comprehensive informed consent to supervisees prior to engaging in virtual supervision. It is unknown to what extent Caila has met this responsibility. It is unclear if Caila communicated her decision to conduct virtual supervision exclusively in her professional disclosure statement, as suggested by Kyle’s reported dissatisfaction with the absence of in-person supervision.

Gatekeeping

Caila and Dr. Smith are responsible for monitoring Kyle’s patterns of behavior to ensure adherence to professional and ethical counseling standards (ACA, 2014). Dr. Smith is also obligated to continually assess Caila’s competence as a supervisor. Caila’s and Dr. Smith’s struggle to communicate transparently about their respective responses to Kyle’s resistance (e.g., his hesitance to address safety concerns at his site and his response to Caila’s feedback) raises concerns about their efficacy as gatekeepers. Ultimately, Dr. Smith is responsible for ensuring both Caila and Kyle act in ways that safeguard their clients’ well-being.

Formulating an Ethical Decision

Once counselors have fully engaged in a thorough process of exploration, reflection, and fact-finding, they review the ethical dilemma, guided by the ACA ​Code of Ethics​ (2014) and other pertinent guidelines, and seek collegial consultation (Garcia et al., 2003). A review of all of these resources inform possible courses of action.

Relevant Ethical Standards

A.1.a. Primary Responsibility.​ ​Congruent with the fundamental principles of beneficence and nonmaleficence, the primary responsibility of counselors is to “respect the dignity and promote the welfare of clients” (ACA, 2014). Perhaps the most significant concern in this case is client welfare at Kyle’s site. All of the stakeholders in this case have a responsibility to act in the best interest of their clients and ensure their safety.

A.7.a. Advocacy.​ ​Counselors and supervisors are responsible to act as advocates when they identify barriers to clients’ and supervisees’ well-being. Kyle identifies safety concerns at his site and is called to advocate on his clients’ behalf, yet he is hesitant to do so. Likewise, Dr. Smith is responsible for inquiring into the well-being of and advocating for his students and supervisees.

F.5.b. Impairment. Supervisors hold the dual responsibility of ensuring client welfare and fostering supervisee growth. Caila must engage in ongoing self-reflection and self-monitoring to recognize how COVID-related challenges have compromised her ability to carry out her supervisory responsibilities.

F.2.b. Multicultural Issues/Diversity in Supervision.​ ​Supervisors are responsible for broaching issues related to multiculturalism and diversity in their work with supervisees. Given the differences in their racial identities, as well as the hierarchical nature of the supervisory relationship, Caila must broach cultural differences with Kyle, as well as issues pertaining to power and privilege, in order to model effective broaching in the counseling relationship.

F.4.a. Informed Consent for Supervision.​ ​In their use of virtual platforms, counselors and supervisors maintain the responsibility to adhere to established standards of care. As Caila decided to utilize online supervision, it is imperative that she discuss this choice, as well as its implications, in the ongoing process of informed consent with Kyle.

F.6.a. Evaluation and F.6.b. Gatekeeping and Remediation.​ ​As a supervisor-in-training, Caila has the responsibility to give Kyle concrete feedback about his performance and to keep her faculty supervisor apprised of challenges she experiences. As a counselor educator and faculty supervisor, Dr. Smith is responsible for supporting and empowering Caila in her work with supervisees. He will further attend to his supervisees’ developmental needs and tailor his interventions accordingly.

Possible Courses of Action

Once counselors have identified and explored the implications of professional standards, they generate potential courses of action, attending to the positive and negative consequences of each, and engage in consultation (Garcia et al., 2003). Caila is the catalyst for an ethical course of action because, as the case stands, Dr. Smith and Kyle have decided to work together without consulting her. Possible courses of action either include Caila not taking action or addressing Kyle or Dr. Smith separately. ​Caila’s inaction maintains the status quo, leaves Kyle’s clients at risk, and misses an important opportunity for her and Kyle to grow as culturally responsive advocates and counselors.​ Another consequence of Caila’s inaction might be that Kyle would not receive remediation necessary for his development, and he will be at risk of “gateslipping”, a phenomenon in which counseling students who require additional support and education continue through their program without remediation (Gaubatz & Vera, 2006). If Caila chooses to address Dr. Smith or Kyle individually, there would be limited accountability for ethical action and remediation. It is possible Caila will encounter resistance by enacting an ethical course of action; however, there is overwhelming positive value if she chooses to address the identified concerns.

Planning and Executing the Selected Course of Action

Caila, Dr. Smith, Kyle, and Kyle’s site supervisor have contributed to the issues in this case in different ways, and each party will have varied ethical responsibilities. There are common factors to each party’s action: transparent communication, consultation, critical reflection, broaching race and culture, safeguarding client welfare, and documentation. The concrete actions outlined for each stakeholder are based on considerations from the TIM (Garcia et al., 2003).

Caila

COVID-19 pandemic conditions necessitate that counselors “practice what they preach” by engaging in self-care and protecting their health, just as they would recommend to their clients (Bray, 2020, p. 21). As an individual at higher risk, Caila is conducting her work remotely in order to remain safe; however, she is not impervious to the psychological toll of the pandemic. It is imperative for Caila to reflect upon how her marginalized intersecting identities as a Black woman with compromised health inform her worldview, value system, and actions (Chan et al., 2018; Fickling et al., 2018) through the pandemic. ​The contrast between Caila’s sociocultural status and her positional authority in her evaluative role as a supervisor-in-training (Rapp et al., 2018) may have led to a tentative approach to her gatekeeping responsibilities.​ C​ aila must reflect upon why she is reticent to disclose her emotional struggles and recognize that her silence jeopardizes her standing in her doctoral program, her supervisory relationships, and the welfare of her supervisees’ clients.

Caila will benefit from consultation with a departmental advisor or mentor to receive support as she navigates this process and so she may receive guidance about how to engage Dr. Smith and Kyle in a productive dialogue. Caila should schedule a virtual meeting with Dr. Smith to disclose how COVID-related challenges have impacted her supervisory practice. Caila must also address Dr. Smith’s decision to supervise Kyle without consulting her, suggest a meeting between the three of them to address concerns in their supervisory relationship, and work collaboratively with the field placement coordinator to investigate COVID-related concerns at Kyle’s site.

Dr. Smith and the remediation committee at the university will determine specific interventions for Caila; however, crucial components to be infused throughout are: increasing her personal awareness (Roach & Young, 2007), implementing strategies to aid in her development as a supervisor and gatekeeper, (Henderson & Dufrene, 2017; Rapp et al., 2018), and learning how to broach race and culture (Day-Vines & Holcomb-McCoy, 2013). In order to become a culturally responsive counselor educator and supervisor, Caila must acknowledge that effective counseling begins with her self-awareness (Day-Vines & Holcomb-McCoy, 2013). She must recognize how cultural context impacts clients’ concerns and how important it is to model broaching race and culture with her supervisees (Day-Vines & Holcomb-McCoy, 2013). Through her critical reflection and professional development process, Caila will take steps to protect client welfare at Kyle’s site, strengthen her self-monitoring skills, and further develop her identity as a supervisor (Fickling et al., 2018).

Dr. Smith

Dr. Smith can engage in critical reflection using the MSJCC (Ratts et al., 2016) to increase his self-awareness about his power and privilege in his roles as a male counselor educator, supervisor, gatekeeper, and faculty member (Chan et al., 2018). It is crucial for him to respond to his diverse students’ needs and leverage his privilege to support the stakeholders in this case (Chan et al., 2018; Fickling, et al., 2019). Dr. Smith must also reflect on what contributed to his decision to circumvent Caila by offering Kyle supervision, rather than empowering them to address their working alliance directly (Rapp et al., 2018). After this reflection process, Dr. Smith must meet with Caila to follow-up about her experience in quarantine, how she is balancing her responsibilities, and how he can support her. Dr. Smith and Caila should also schedule a meeting with Kyle to: address the challenges in Kyle and Caila’s working alliance, collaboratively create an action plan with the field placement coordinator to address the challenges at Kyle’s site, and integrate the MSJCC into the counseling and supervisory relationships (Fickling et al, 2018).

Dr. Smith should inform Caila and Kyle that he will approach the remediation committee to create plans that are grounded in guidelines such as the ACA​ Code of Ethics​ (2014), the CACREP (2016) standards, and the university’s gatekeeping policies in the student handbook (Shuermann et al., 2018). Dr. Smith must ensure that the plans address Caila’s and Kyle’s specific needs in a way that fosters their professional development (Henderson & Dufrene, 2017). Finally, as a counselor educator and faculty member, Dr. Smith has an ethical duty to advocate for his diverse students. As he engages in critical reflection, recommends remediation, and documents this process from his perspective, it is incumbent upon Dr. Smith to share his experience with his colleagues, department chair, and university officials to implement more inclusive policies that support Black and minoritized counselor education doctoral students like Caila (Henfield et al., 2013).

Kyle

Kyle’s contribution to his personal and professional growth will depend on his personal “reflective stance,” defined as the counselor’s willingness to seek self-reflection opportunities and openness to change (Pompeo & Levitt, 2014, p.85). Accordingly, Kyle will agree to meet with Caila and Dr. Smith to discuss their concerns. Through a balance of challenge and support, Caila and Dr. Smith will guide Kyle’s process of critical reflection to promote his self-awareness. Kyle must reflect on his reluctance to advocate for his clients. Caila and Dr. Smith can validate his fear of negative evaluation but firmly remind him of his primary ethical responsibility and commitment to the foundational principles of the profession.

Cultural responsiveness is an ethical mandate for counselors, and therefore Kyle must reflect more on his cultural identities and how his assumptions, values, and biases inform his decision-making as a counselor and supervisee. For example, Dr. Smith and Caila can challenge Kyle to reflect more on his resistance to Caila’s feedback, as well as his inappropriate response to it (e.g., enlisting Dr. Smith for supervision without Caila’s knowledge). Some resistance to supervisors’ critical feedback is normative (Bernard & Goodyear, 2019), but it is curious that Kyle initially was unable to provide concrete examples of what he reports as “aggressive and too critical.” Such terms are examples of gendered racial microaggressions often applied to Black women in work and school settings (Moody & Lewis, 2019), and Kyle must reflect upon his statements to determine if they accurately represent his work with Caila. The depth of Kyle’s critical reflection, as well as his responsiveness to the specific actions recommended by the remediation committee, will encourage his ethical development.

Site Supervisor

Finally, the proposed action plan must include consideration of Kyle’s internship site. Dr. Smith, Caila, and the department’s field placement coordinator should collaborate on the creation of a plan for addressing the COVID-related safety concerns at Kyle’s site. At minimum, this plan should designate a field coordinator or faculty supervisor who can conduct an in-person investigation. Based on these findings, additional measures can be discerned. Dr. Smith or Caila will further communicate to the site supervisor the importance of open and timely communication. Optimally, faculty, students, and site supervisors will commit to “collaborative gatekeeping” (Dean et al., 2019), which helps to prevent “gateslipping” (Gaubatz & Vera, 2006), in addition to meeting counselors’ fundamental responsibility: to respect client dignity and promote client welfare.

Conclusion

Caila, Dr. Smith, and Kyle are involved in a case with myriad issues, and there are serious ramifications if proper ethical action is not taken. Although COVID-19 has posed several challenges, counselors, supervisors, and counselor educators must still promote ethical practice through transparent communication and collaborative supervision in service of client welfare. We have identified the ethical concerns and the relevant standards from the ACA ​Code of Ethics (2014), and we have proposed an ethical course of action using the TIM (Garcia et al., 2003). The course of action was rooted in foundational counseling principles, racial and cultural awareness, and the counseling literature. Caila, Dr. Smith, and Kyle may all learn from this situation and grow in their professional development which will serve them and their future students, clients, and supervisees well.

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