[acb-hsp] Transcultural Model of Ethical Decision-Making

[J.Rayl]

A transcultural integrative model for ethical decision making in counseling.

by Jorge G. Garcia , Brenda Cartwright , Stacey M. Winston , Barbara Borzuchowska

Studying the role of culture in counseling theory and practice became the focus of

researchers and scholars about 30 years ago. A case can be made today that this work

has resulted in significant changes in the assumptions underlying counseling theory,

as well as an enrichment of traditional counseling approaches such as psychodynamic,

humanistic, and cognitive-behavioral approaches (Ivey, Ivey, & Simek-Morgan, 1997).

Some assumptions that have been challenged include the concept of normality, the

focus on the individual, the goal of independence, the universality of linear thinking,

and the reliance on verbal communications (Sue & Sue, 1999). Many counseling researchers

now agree that what may be the norm for one group is not necessarily the norm for

another group, that interdependence may be a desirable goal, that many groups use

associative thinking, and that nonverbal communications are essential in counseling

people from different cultures (Pedersen, 1994).

At the theoretical level, Bowlby (1988) and Ainsworth (1979), in their development

and validation of attachment theory in a variety of cultural situations, have advanced

psychodynamic theory by stressing the importance of context and environment in child

development. Taub-Bynum (1984) also contributed to integrating culture into psychodynamic

theory through the concept of the family and multicultural unconscious. Humanistic

theory has undergone extensive developments to include culture systematically. The

work of Bingswanger (1963) and Boss (1963) translated the existential premise of

being-in-the-world into specific counseling and therapy strategies. Miller (1991)

emphasized the concept of self-in-relation that focuses on the individual in context.

In cognitive-behavioral theory, authors like Cheek (1976) and Kantrowics and Ballou

(1992) have pioneered the inclusion of culturally relevant practices. Cheek adapted

traditional assertiveness training for African American clients who view rights differently.

Kantrowics and Ballou shifted their behavioral theory approach from an individualistic

focus to one reflecting feministic reappraisals. A more recent proposition by Sue,

Ivey, and Pedersen (1996) advocated for a culture-centered meta-theory that would

preserve the integrity of different counseling approaches while organizing their

theoretical and philosophical assumptions in one cultural framework.

The aforementioned theoretical shift illustrated has resulted in the emergence and

continuous refinement of so-called multicultural counseling competencies. These concepts

have been summarized in writings by Sue and Sue (1999), Ivey et al. (1997), and Pedersen

(1994), among others. These competencies have evolved from basic communication styles

and self-awareness techniques to more specific strategies addressing particular cultural

characteristics of racial/ethnic (C. C. Lee, 1997), disability (W. M. L. Lee, 1999;

Sue & Sue, 1999), family (Flores & Carey, 2000; Sciarra, 1999), gender (Julia, 2000),

gay and lesbian (Fu & Stremmel, 1999; W. M. L. Lee, 1999), youth (Aponte & Wohl,

2000), and older adult groups (W. M. L. Lee, 1999; Sue & Sue, 1999). Ramirez (1999)

stated the need to train counselors to understand problems of maladjustment as a

cognitive and cultural mismatch between individuals and their environments. Axelson

(1999) added particular issues that counselors need to attend to in social, educational,

work, and career development and in personal growth. In addition, Reynolds (1995)

summarized different multicultural training modalities and suggested the appropriateness

of using the multicultural change intervention matrix developed by Pope (1993) that

focuses on competency changes at the individual, group, and institutional level.

Responding to these theoretical advancements, professional associations such as the

American Psychological Association (1993) have developed competence guidelines for

its members. These guidelines stipulate the need to be cognizant of relevant research

about the culture of the clients served, to establish the validity of assessment

instruments, to consider the clients' cultural beliefs and values, to respect religious

and spiritual values, and to determine the counselor's own biases or racism.

ETHICS AND MULTICULTURAL COUNSELING

As the theoretical and professional foundations of multicultural counseling have

progressed, a natural evolution has been the development of ethical standards to

help regulate the practice of multicultural counseling. Ibrahim and Arredondo (1986)

authored a proposal to develop specific ethical standards regarding multicultural

counseling in the areas of education, research, assessment, and practice. LaFromboise

and Foster (1989) extended this discussion by bringing attention to other issues

related to ethics in multicultural counseling that involved participants in research

and right to treatment.

Responding to this need, in the 1995 revision of the ethical standards, the American

Counseling Association (ACA) included specific excerpts requiring counselors to respect

diversity, avoid discrimination, and demonstrate cultural sensitivity when engaging

in direct client services, research, education, testing, computer applications, public

communications, and relationships with employers and employees (ACA, 1995). Moreover,

within the section on professional competence, it requires them to show a commitment

to gain knowledge, awareness, and skills related to serving a diverse clientele.

Diversity is defined in the ACA Code in terms of age, culture, disability, ethnic

group, gender, race, religion, sexual orientation, marital status, and socioeconomic

status.

Furthermore, researchers have stated the need to prepare professionals to become

more skillful in dealing with ethical dilemmas, particularly those involving multicultural

issues in the area of rehabilitation (Falvo & Parker, 2000), mental health services

(Remy, 1998), and gender (Steiner, 1997). Baruth and Manning (1999) alluded to this

need by saying that the ethical dilemmas faced by counselors are complex and become

even more complex when working with persons who have different worldviews. As stated

by LaFromboise and Foster (1989), the challenge then becomes the development of ethical

decision-making models that reflect a convergence of our current knowledge about

multicultural counseling theory and ethical reasoning.

In examining the available ethical decision-making models published in the field,

we found minimal reference to culture or how to integrate culture into ethical decision-making

process systematically. The purpose of this article is to review the current models

and offer a model that can be used by counseling practitioners facing ethical dilemmas

involving clients from diverse backgrounds. Adapted primarily from the original Integrative

Model developed by Tarvydas (1998), also drawing from the Social Constructivist Model

(Cottone, 2001) and the Collaborative Model (Davis, 1997), this proposed model is

titled the Transcultural Integrative Ethical Decision-Making Model (hereafter referred

to as the Transcultural Integrative Model). In terms of ethical theory, this proposed

model is founded in both principle (or rational) ethics (Kitchener, 1984) and virtue

ethics (Freeman, 2000; Jordan & Meara, 1995). These models and theories are discussed

in the following section.

REVIEW OF AVAILABLE ETHICAL DECISION-MAKING MODELS FROM A CULTURAL PERSPECTIVE

As mentioned earlier, Baruth and Manning (1999) stated that ethical decision making

can be difficult, but it is necessary, particularly when counselors face complex

situations or work with clients who have differing worldviews. Moreover, Remley and

Herlihy (2001) pointed out that ethical decisions seldom involve a simple answer

and usually are the result of a complex process. In addition, it is difficult to

guarantee that actions will have the desired outcome. Remley and Herlihy also stated

legal reasons for the need to have models of ethical decision making. For example,

counselors may be required to appear as witnesses in litigation hearings or, what

would be the greater concern, may be charged with malpractice, if the counselor is

accused of unethical action. They argue that the latter is somewhat avoidable if

counselors practice ethical decision making.

Researchers, educators, and practitioners seem to have understood this necessity

and, thus, over the years have proposed a variety of models to aid counselors in

ethical decision making. A traditional model is one disseminated by ACA (Forester-Miller

& Davis, 1995), which can be categorized as a rational model based on an analysis

of the ethical principles involved in a dilemma. Some models offered by ethics scholars

include Jordan and Meara's (1995) Virtue Ethics Model, Cottone's (2001) Social Constructivism

Model, Davis's (1997) Collaborative Model, and Tarvydas's (1998) Integrative Model.

A brief review of whether or not these models contain a specific analysis of cultural

aspects that may play a role in ethical dilemma resolution is provided.

Rational Model

This type of model is based primarily on principle ethics (Kitchener, 1984). Once

the principles in conflict have been identified, the professional chooses the best

course of action. This choice is based on a rational evaluation of the advantages

and disadvantages of choosing one course of action over another. In following this

model, a professional must use rational justification to choose which of the conflicting

ethical principles should prevail (Bersoff, 1996). The essentials of this model have

been described by Forester-Miller and Davis (1995) in these seven steps: (a) identify

the problem, (b) refer to the code of ethics and professional guidelines, (c) determine

the nature and dimensions of the dilemma, (d) generate potential courses of action,

(e) consider the potential consequences of all options and then choose a course of

action, (f) evaluate the course of action, and (g) implement the course of action.

An examination of the narrative under each of the steps just listed yields the conclusion

that with this model no cultural variables are included in the analysis of a dilemma.

The assumption may be that one set of values applies to all cultures, as stated by

Pedersen (1997).

Welfel (2002) offered a similar extended, nine-step model of rational ethical decision

making. This model serves its purpose as a general model, but for specific dilemmas

involving clients from diverse cultures, professionals would have to fill in the

gaps or perhaps adapt the model to suit her or his cultural perspectives, because

a cultural analysis is not provided.

Virtue Ethics Model

Advocates for a virtue ethics model, Jordan and Meara (1995) relied on the personal

characteristics and wisdom of the professionals making an ethical decision, instead

of the ethical principles involved. Proponents of this model claim that it is very

difficult to reach an agreement on which principle should prevail over another in

a particular situation. Instead, they state that the primary factor in arriving at

a decision is the professionals' moral or personal beliefs. Central virtues mentioned

under this model include integrity, prudence, discretion, perseverance, courage,

benevolence, humility, and hope. This approach has not been formulated into a format

with specific steps, and, again, cultural analyses or implications have not been

included in this model.

Freeman (2000) defined virtue ethics as addressing "who one is, what one ought to

become, and what form of action will bring one from the present to the future" (p.

90). The virtue of self-understanding based on honesty, openness, and willingness

to take responsibility for one's life would allow counselors to conclude who they

are in terms of character. Self-understanding, symbolization, and imagination would

allow counselors to determine who they ought to become in terms of a conceptualization

of change. Finally, Freeman stated that prudent judgment would allow counselors to

change or become the person they ought to be. Thus, virtue ethics represents a shift

from appraisal of the act to the appraisal of the one acting. This would mean that

an action is right when it reflects what a counselor with virtuous character would

do in a particular situation. Freeman said that it is necessary to define what humans

perceive as being "good" and what human traits are considered "virtuous" before a

determination can be made regarding the "right" thing to do in a given set of circumstances.

It does not seem possible to determine a definite number of virtue traits that counselors

need to have because it seems to depend on specific situations. For example, Tarvydas

(1998) determined that reflection, balance, collaboration, and attention to context

were counselor-essential virtues working within the framework of the Integrative

Model. Freeman (2000) emphasized other virtues, such as self-understanding, openness,

honesty, and prudent judgment. Because none of these authors who discussed virtue

ethics addressed specific counseling dilemmas involving differing cultural worldviews,

the virtues they mentioned do not necessarily reflect specific virtues that might

be needed for cases of that nature. It is to address this omission that the transcultural

model we propose in this article includes the virtue of tolerance, which involves

accepting diverse worldviews, perspectives, and philosophies (Welfel, 2002).

Social Constructivism Model

Cottone (2001) proposed a social constructivism model that crosses both the psychological

and systemic-relational paradigms of mental health services. It is based on Maturana's

(1970/1980) biology of cognition theory, which states that what is real evolves through

personal interaction and agreement as to what is fact. The core structure of this

model entails the notion that decisions are externally influenced. Basically, decisions

are made with interactions involving one or more individuals, which means that decisions

are not compelled internally but socially. Central decision-making strategies used

under this model include negotiating, consensus seeking, and arbitrating.

With the understanding that this model is social in nature, the role of culture would

intertwine nicely in this theory. Unfortunately, culture is only vaguely mentioned,

and apparently no attempt has been made to deal with this variable more thoroughly

in this model.

Collaborative Model

Davis (1997) criticized the existent rational model by asserting that in the current

professional world, a model based on a group perspective would be superior to one

founded on an individual perspective. Davis deemed his decision-making strategy a

collaborative ethics model based on values of cooperation and inclusion. This relational

approach uses a sequence of four steps: (a) identifying the parties who would be

involved in the dilemma; (b) defining the various viewpoints of the parties involved;

(c) developing a solution that is mutually satisfactory to all the parties, based

on group work focusing on expectations and goals; and (d) identifying and implementing

the individual contributions that are part of the solution. However, cultural components

are not elaborated systematically in this model, other than reflecting a theoretical

compatibility with the collectivist values underlying multicultural counseling.

Integrative Model

A fourth type of model used in resolving ethical dilemmas is an integrative model

that incorporates elements of both principle ethics and virtue ethics (Tarvydas,

1998). Tarvydas described a four-stage integrative decision-making model that combines

an analysis of the morals, beliefs, and experiences of the individuals involved,

along with a rational analysis of the ethical principles underlying the competing

courses of action. This model requires professionals to use reflection, balance,

attention to the context, and collaboration in making decisions involving ethical

dilemmas.

Stage I (Interpreting the Situation Through Awareness and Fact Finding) implies that

counselors closely examine the situation and be aware of what types of situations

constitute an ethical dilemma. If the counselor is not aware of the latest information

in his or her field of expertise, it is his or her responsibility to gather the relevant

information. This stage calls for an increase in sensitivity and awareness in the

counselor's field of specialization. The fact-finding process assists the counselor

to label a situation as an ethical dilemma and to determine the individuals directly

affected by these types of situations. If a dilemma occurs, the counselor is not

only aware of the situation but also recognizes the parties affected and their ethical

stance in the situation.

Stage II (Formulating an Ethical Decision) is no different from the typical rational

decision-making model described earlier (Forester-Miller & Davis, 1995). First, counselors

review the problem specifically to determine what ethical codes, standards, principles,

and institutional policies are pertinent to this type of situation. Second, after

a careful review and consideration of these regulations, they generate a list of

potential courses of action along with the positive and negative consequences for

following each course of action. Third, counselors are urged to consult with supervisors

or other knowledgeable professionals to determine the most ethical course of action.

Finally, the best ethical course of action is selected based on a rational analysis

of the principles involved. This entails making a rational decision as to which ethical

principle should supersede the other competing ethical principles in this case.

Stage III (Selecting an Action by Weighing Competing Nonmoral Values) implies analyzing

the course of action from the perspective of personal competing values and contextual

values (e.g., institutional, team, collegial, and societal/cultural). The assumption

here is that counselors and others involved in the situation may encounter "personal

blind spots" or levels of prejudice that need to be addressed before affirming the

final course of action.

In Stage IV (Planning and Executing the Selected Course of Action), the counselors

determine the concrete actions that need to be taken, with consideration given to

the potential obstacles to taking that course of action. It is key under this stage

to anticipate personal and contextual barriers to the effective implementation of

the course of action.

Because of its analysis of contextual variables, competing personal values, and involvement

of stakeholders, this model seems compatible with traditional elements of multicultural

theory and practice. This model also uses virtue ethics and an emphasis on behavioral

strategies, which is consistent with a multicultural approach as well. Some counselor

virtues that would seem particularly useful when counselors face cultural ethical

dilemmas are tolerance, sensitivity, openness, and collaboration. Although the integrative

model contains several advantages as described earlier, it is still limited in its

analysis of cultural variables that might play a role in the process of ethical decision

making. There are specific cultural variables and strategies that can fit under each

one of the stages of the integrative model that have not been considered. See Table

1 for a summary of the characteristics of the different models discussed in this

article, across four categories: conceptual origins, structure, strengths, and weaknesses.

THE PROPOSED TRANSCULTURAL INTEGRATIVE ETHICAL DECISION-MAKING MODEL

The Integrative Transcultural Model is based primarily on Tarvydas's (1998) Integrative

Model in that it comprises the four basic stages identified under this model. However,

it adds to the original Integrative Model by incorporating elements of the Social

Constructivism and Collaborative Models, by including the strategies of negotiating,

arbitrating and consensus seeking, and using a relational approach. The characteristics

of the model are outlined in the form of steps and tasks under each step (see Table

2). To preserve the basic elements of Tarvydas's model while at the same time illustrate

the added multicultural elements, the steps have been divided into general (those

pertaining to the original model) and transcultural (the multicultural addition to

the general or original step).

As a preamble to Table 2, counselors need certain attitudes (or virtues) that will

provide a framework for engaging in ethical decision making under the proposed model.

These include reflection, attention to context, balance, collaboration, and tolerance

(Tarvydas, 1998). Reflection concerns counselors' awareness of their own feelings,

values, and skills, as well as understanding those of the other stakeholders involved

in the situation. Attention to context involves being attentive to the factors that

may play a role in the situation, namely the team, institutional policy, society,

and culture. Counselors maintain balance by weighing each of the issues and perspectives

presented by all individuals involved. Collaboration means that counselors must maintain

the attitude of inviting all parties to participate in the decision to whatever extent

possible. Counselors display tolerance by being accepting of the diverse worldviews,

perspectives, and philosophies of the different stakeholders (Welfel, 2002).

Description of the Transcultural Integrative Model

Step 1 depicted in the model is awareness and fact finding, which under the original

model meant the following: enhancing sensitivity and awareness about the potential

dilemma, reflecting on whether there is actually a dilemma, determining the parties

or stakeholders involved, and engaging in a thorough process of fact finding. Step

1 is particularly relevant in the practice of multicultural counseling. Enhancing

sensitivity and awareness means not only being aware of the ethical component of

a dilemma but also how a dilemma may affect the different stakeholders involved who

may have different or even opposing worldviews. Various stakeholders may give different

meanings to a situation involving a dilemma, and it is the responsibility of the

counselor to understand those different meanings during this awareness and fact-finding

step.

Counselors' awareness about their own cultural identity, acculturation, and role

socialization may affect their view of the dilemma and the extent to which they perceive

a situation as a dilemma. For example, a counselor with strong affiliation to family

interdependence values can perceive the situation of a client with HIV who recently

immigrated to this country and who is seeking vocational services as one that requires

advising the client to return to his original country, where he would find family

support. For this counselor, there would not be a dilemma. However, for another counselor,

this situation may pose a conflict in which the client's freedom of choice (autonomy)

could be in opposition to what the counselor believes would be best for the client.

In the latter case, the counselor contemplates both conflicting courses of action,

which constitutes the dilemma.

Similarly, if the client was a woman, a feminist counselor and a nonfeminist counselor

may view the dilemma differently, depending on the extent to which they consider

the client's gender role socialization. The client's culture may elicit particular

emotional reactions in the counselor, depending on how much the client's values or

behaviors contradict those of the counselor. Again, this emotional reaction may affect

the perception of a particular situation.

Sensitivity to intragroup differences is another important consideration. Counselors

need to ascertain the extent to which a client is actually representative of the

cultural patterns of the referent group (Sciarra, 1999). Sciarra described a process

whereby individuals can change their referent group during an interaction based on

age, socioeconomic class, religion, gender, national origin, or disability. In fact,

the concept of cultural identity formation applies not only to race but also to gender,

sexual orientation, or disability (Julia, 2000; W. M. L. Lee, 1999; Sue & Sue, 1999).

A simple example is the following: A counselor responds to the principle of beneficence

by helping the client obtain a job at a grocery store against the client's wish to

stay at home (supported by the principle of autonomy), ignoring the upper socioeconomic

status of the client. Class-bound values (Sue & Sue, 1999) may explain the preference

expressed by the client. Finally, the theoretical orientation of the counselor may

affect the perception of a dilemma as well. For example, a counselor working under

a family system approach would be more likely to define the dilemma as one affecting

others and not only the individual client.

Step 2 involves the formulation of an ethical decision. This is primarily a rational

process, similar to the rational model outlined by Forester-Miller and Davis (1995).

However, the integrated Transcultural Integrative Model incorporates specific cultural

elements under each one of the strategies to complete this step. This means that

counselors need to (a) review all cultural information gathered in Step 1, (b) review

potential discriminatory laws or institutional regulations, (c) make sure that the

potential courses of action reflect the different worldviews involved, (d) consider

the positive and negative consequences of opposing courses of action from the perspective

of the parties involved, (e) consult with cultural experts if necessary, and (f)

select a course of action that best represents an agreement of the parties involved.

In the case presented previously that involves a client living with HIV, laws that

apply to immigrants who have this diagnosis are particularly relevant because they

may be discriminatory and present the counselors with a conflict between the law

and the ethical standards of the profession.

Considering that agreement among all parties is not always attainable, Cottone (2001)

offered a three-step interpersonal process that included negotiating, consensualizing,

and arbitrating. Negotiating means the discussion and debate of an issue about which

two or more individuals disagree. Consensualizing describes a process of agreement

and coordination between two or more individuals on a specific issue. This is an

ongoing verbal and nonverbal interactive process rather than a final outcome. The

parties involved may seek arbitration if the disagreement persists; Cottone suggested

seeking a negotiator, a consensually accepted arbitrator, who then can make the final

judgment. Consensualizing is the primary means of preventing disagreement because

consensualizing implies the process of "socially constructing a reality [i.e., between

counselors and clients]" (p. 42).

The use of relational methods (Davis, 1997) and social constructivism techniques

(Cottone, 2001), as described earlier in this article, is a key element of the Transcultural

Integrative Model because these are particularly applicable to situations that require

reaching an agreement among parties who may hold potentially conflicting cultural

worldviews. Step 3 in Table 2 refers to weighing potentially competing, nonmoral

values that may interfere with the execution of the course of action selected. Cultural

values are particularly relevant here; again, the counselors' cultural identity,

acculturation level, and gender role socialization may be crucial in uncovering these

values. For example, the execution of a particular course of action may imply a level

of client competence in dealing with the health care system that is not consistent

with his or her acculturation level, or the course of action selected may contradict

the female client's learned gender role.

Another task under this step is to identify contextual influences that may constitute

a barrier for the implementation of the course of action selected. The original integrative

model includes collegial, professional, institutional, and societal levels. The Transcultural

Integrative Model adds a specific cultural level. Again, this is critical in dilemmas

found in multicultural counseling because the counselors' values may contradict the

clients' values or the contextual values. For example, in the case of the client

with HIV depicted in this section, counselors need to be aware of potential prejudice

against persons with HIV/AIDS as well as against immigrants from particular ethnic

groups. In recommending a course of action that involves a vocational goal, counselors

should consider the client's disposition to face such attitudes as well as anticipate

possible reactions from employers and even vocational service providers.

Last, Step 4, is to carry out that plan, document, and carefully evaluate the consequences

of the ethical decision. From a cultural standpoint, this involves securing resources

that are culturally relevant for the client and involves developing countermeasures

for the potential contextual barriers identified earlier. For example, in the case

of the client with HIV, it could mean securing future employers and service providers

who match the client's cultural identity, level of acculturation, and gender role

socialization, among other factors. In addition, the counselor should consider preparing

the client and other stakeholders to deal with potential biases, discrimination,

stereotypes, and prejudices. Because this step involves the development and implementation

of a plan involving different stakeholders, the counselor should be familiar with

the relational and social constructivism methods cited earlier in this article because

these strategies can facilitate the achievement of common goals.

It must be reiterated that Tarvydas's (1998) Integrative Model is inclusive of a

virtue-ethics approach as well. Tarvydas recommended that counselors adhere to the

virtues of reflection, attention to context, balance, and collaboration. Under our

proposed Transcultural Integrative Model, this list of virtues or personal characteristics

of counselors should be extended to include tolerance, sensitivity, and openness

as suggested earlier in this article. These virtues are essential for implementing

the steps we outlined within this model that require understanding and listening

to people from cultures that differ from that of the counselor.

Potential Applications

Providing an extensive case illustration of the use of the Transcultural Integrative

Model exceeds the scope, of this article. However, a point can be made about its

potential applicability in a variety of settings. Garcia et al. (1999) conducted

a confirmatory factor analysis study that showed the complexity of ethical dilemmas

faced by counselors working with HIV/AIDS populations. They found that counselor

ratings of the dilemmas loaded onto eight categories, namely, disclosure, family/social,

legal, health, death, vocational, sexual, and counselor/client relationship issues.

This study also examined demographic characteristics of counselors that could predict

their ratings of the extent to which they face those dilemmas. Three predictors were

found to be significant: previous training in HIV/AIDS, age, and sexual orientation.

An argument can be made that the latter two variables involve culture as a source

of variability. The authors of this study concluded that counselors addressing dilemmas

encountered in their work with this population need to be competent in dealing with

the cultural aspects involved.

Moreover, Garcia, Forrester, and Jacob (1998) wrote an extensive article on why an

integrative model of ethical decision making was best suited for counselors working

in this setting, and they suggested that cultural modifications of the Integrative

Model (Tarvydas, 1998) were necessary. The transcultural model was a response to

that statement and seems particularly suited to use in HIV/AIDS counseling settings.

Herlihy and Corey (1995) examined a broader set of possible dilemmas that included

issues related to informed consent, competence, multicultural counseling, multiple

clients, working with minors, dual relationships, suicidal clients, counselor training

and supervision, and the interface between law and ethics. They presented a series

of case studies illustrating the nature of the dilemma and a potential solution based

on an analysis of the code of ethics. An argument can be made that the transcultural

ethical dilemma resolution presented here could add specific tools to deal with those

issues, particularly those related to multicultural counseling, competence, dual

relationships, counselor training and supervision, and serving multiple clients.

Other authors have presented case examples that involve cultural factors in counseling

women, women in prisons, and individuals with disabilities. Pitman (1999) provided

cases involving lesbian clients who faced rigid societal values and prejudices concerning

their sexual desire, sexual behavior, and physical appearance. Bruns and Lesko (1999)

analyzed the complexities of working with women in prisons, where counselors face

dilemmas related to working in an oppressive, racist, and patriarchal institution.

Olkin (1999) described dilemmas encountered by professionals working with people

with disabilities. Central dimensions associated with those dilemmas include value

and quality of life, morality, normality and deviance, justice, interdependence,

and mortality. Again, most of these aspects imply differing cultural values and worldviews,

which is the focus of a transcultural ethical model.

The aforementioned studies examined provide a nonexclusive sample of settings in

which the model proposed in this article could be of benefit. Surely, other studies

will appear in the future when other researchers begin to focus more closely on this

subject.

SUMMARY AND CONCLUSION

The focus of this article was to propose a transcultural integrative model of ethical

dilemma resolution for counselors facing ethical dilemmas in which cultural factors

may play an important and perhaps definitive role. To undertake this task, we first

reviewed the current multicultural counseling literature to evaluate how the main

counseling theories and approaches have integrated cultural variables into their

conceptual framework. Different authors (Ivey et al., 1997; Sue & Sue, 1999) summarized

these advances in psychodynamic theory (Ainsworth, 1979; Bowlby, 1988; Taub-Bynum,

1984), cognitive-behavioral theory (Cheek, 1976; Kantrowics & Ballou, 1992), existential

theory (Bingswanger, 1963; Boss, 1963; Miller, 1991), and a culture-centered meta-theory

(Sue et al., 1996). Second, we studied relevant ethical decision-making models available

for counselors today. These included the rational (Forester-Miller & Davis, 1995),

Virtue Ethics (Jordan & Meara, 1995), Social Constructivist (Cottone, 2001), Collaborative

(Davis, 1997), and Integrative (Tarvydas, 1998) models. This review showed that despite

the extensive advances in adding a cultural perspective to counseling theory, these

conceptualizations have not necessarily been taken into account in the development

of ethical decision-making models.

However, these ethical models offered a number of conceptual and procedural strengths

that could make them compatible with a multicultural perspective in ethical dilemma

resolution. The Rational Model involves a seven-step linear method that gives counselors

specific critical-evaluative tools for ethical reasoning; the Virtue Ethics Model

implies a focus on the moral qualities or virtues of counselors who can then transform

these qualities into actions that help solve a dilemma; the Social Constructivist

Model is a nonlinear model that allows counselors to engage in an ongoing social

interaction conducive to discrepancy reduction; the Collaborative Model includes

a four-step linear sequence that aims at establishing collaboration between the parties

in conflict; and the Integrative Model combines both principle and virtue ethics

philosophies as well as an analysis of the institutional and societal context that

affects the ethical dilemma and the stakeholders involved.

We combined the strengths of each of these models and the main cultural tenets of

counseling theories into a four-step transcultural model aimed at providing counselors

with a reference model to address issues or dilemmas faced in their interaction with

clients from differing cultural backgrounds. Primarily the model uses an adaptation

of the four-stage Integrative Model by adding a transcultural dimension under each

of those stages. In addition, the model incorporates elements of the collaborative

and social constructivist approaches under Steps 2 and 4 that consider collaboration

to reach an agreement and implementation of the final resolution. Principle and virtue

ethic philosophies are reflected primarily in Steps 1 and 2, which involve counselor

sensitivity and awareness and using a rationale for reaching a final course of action.

At this stage, we consider the proposed Transcultural Integrative Ethical Decision-Making

Model as preliminary. Further research is needed to validate its components and applicability

with counselors working with diverse populations. We are pursuing an empirical validation

strategy that uses a sample of counselors working in agencies that serve diverse

clients (e.g., counselors working in public rehabilitation agencies). These counselors

receive training on specific ethical decision-making models (e.g., rational, integrative,

transcultural) in a modality that best fits their learning needs (e.g., online, face-to-face).

Pre-post data are collected on a measure of competence to solve an ethical dilemma

with cultural characteristics (evaluated by national experts who are blind to the

purpose of the research), and postdata are collected through a rating scale that

involves asking the participant to rate each model regarding format, theory, self-efficacy,

and applicability aspects of each model. Under this strategy it is also possible

for researchers to use an experimental group design, because some participants may

be randomly assigned to an experimental group receiving training on the transcultural

model and other participants may be randomly assigned to one or more control groups.

We hope that this line of research will yield a model that counselors can use as

a reference when encountering dilemmas that cannot readily be solved with the current

models available.

TABLE 1

Comparison Chart of Selected Ethical Decision-Making Models

Variable Rational Virtue Ethics

Conceptual Based primarily on Theory of virtue and the

foundations principle ethics virtues of the one

acting (e.g.,

counselor)

Structure Seven-step linear Nonlinear, three-level

progression appraisal of the one

acting

Strengths It involves a systematic, It involves self-

critical-evaluative level understanding and

of analysis of the judgment about who

dilemma based on one is and ought to

specific ethical become in dealing with

principles, standards, a particular dilemma,

and laws.

Weaknesses An analysis of cultural Virtues that would be

elements of the most applicable to

dilemma is not dilemmas involving

articulated in any of individuals with

the seven formulated differing worldviews

steps. are not specifically

defined.

Social

Variable Constructivism Collaborative

Conceptual Biology of cognition Relational approach

foundations theory based on group

perspective

Structure Nonlinear social Four-step linear

interaction progression

Strengths Because it is based on Because it is based on

an ongoing social collaboration, the

interaction, the opportunity to reach

potential for counselor/ a mutually satisfac-

client discrepancy is tory solution is

diminished while enhanced.

consensus is

emphasized.

Weaknesses The process of Even though it is

dilemma resolution is based on a group

vague as it relates to perspective, authors

the cultural aspects of of this model did not

the social interaction elaborate on the

and structure. cultural variables of a

relational approach.

Variable Integrative

Conceptual Blending of rational and

foundations virtue ethics

Structure Four-stage linear

progression

Strengths Because it combines

rational and virtue

ethics, users of this

model focus on both

the dilemma and the

character of the

counselor while

considering contex-

tual factors.

Weaknesses Although it considers

counselor character-

istics and contextual

factors, it does not

include specific

cultural variables.

TABLE 2

Transcultural Integrative Model of Ethical Dilemma Resolution in

Counseling

Step 1: Interpreting the Situation Through Awareness and Fact Finding

A. Enhancement of sensitivity and awareness

General: Emotional, cognitive sensitivity and awareness of needs and

welfare of the people involved

Transcultural: Counselor attitudes and emotional reactions toward

cultural groups; counselor knowledge of client's culture; counselor

awareness of own and the client's cultural identity, acculturation,

and role socialization; counselor awareness of own multicultural

counseling competence skills.

B. Reflection to analyze whether a dilemma is involved

General: A dilemma occurs when counselors have opposing options.

Transcultural: Determining whether the identification of the courses

of action involved in the dilemma reflects the counselor's worldview,

the client's, or both

C. Determination of major stakeholders

General: Identification of the parties who are affected and their

ethical and legal relationships to the client.

Transcultural: Determining the meaningful parties involved based on

the cultural values of the client.

D. Engagement in the fact-finding process

General: Reviewing and understanding current information as well as

seeking new information.

Transcultural: Gathering relevant cultural information such as

immigration (history, reasons, and patterns), family values, and

community relationships

Step 2: Formulating an Ethical Decision

A. Review the dilemma.

General: Determine whether the dilemma has changed or not in light of

the new information gathered in Step 1.

Transcultural: Ensure that the cultural information gathered in Step 1

was considered when reviewing the dilemma.

B. Determine relevant ethical codes, laws, ethical principles,

institution policies, and procedures.

General: Determine the ethics laws and practice applicable to the

situation.

Transcultural: Examine whether the ethics code of your profession

contains diversity standards; examine potential discriminatory laws,

institutional policies and procedures; estimate potential conflict

between laws and ethics resulting from a cultural perspective.

C. Generate courses of action.

General: List all possible and probable courses of action.

Transcultural: Make sure courses of action selected reflect the

cultural worldview of the parties involved. Use relational method and

social constructivism techniques (negotiating, consensualizing, and

arbitrating) as appropriate to reach agreement on potential courses of

action. (a)

D. Consider potential positive and negative consequences for each

course of action.

General: List both positive and negative consequences under each of

the courses of action selected above.

Transcultural: Consider the positive and negative consequences of each

course of action from within the cultural worldview of each of the

parties involved. Again, consider using a relational method and social

constructivism techniques to reach agreement on analyzing consequences.

E. Consultation

General: Consult with supervisors and other knowledgeable professionals.

Transcultural: Consult with supervisors and professionals who have

pertinent multicultural expertise.

F. Select the best ethical course of action.

General: Based on a rational analysis of the consequences and ethical

principles underlying the competing courses of action, determine the

best course of action.

Transcultural: Based on a relational method and a cultural analysis of

the consequences of each selected course of action, choose the course

of action that best represents an agreement between the cultural

worldview of the client and that of the other parties involved. Use

social constructivism techniques to choose a course of action mutually

satisfying to key parties.

Step 3: Weighing Competing, Nonmoral Values and Affirming the Course

of Action

A. Engage in reflective recognition and analysis of personal blind

spots.

General: Identify counselors' nonmoral values that may interfere with

the implementation of the course of action selected.

Transcultural: Identify how the counselors' nonmoral values may be

reflecting a culture different from the clients' culture.

B. Consider contextual influences on values selection.

General: Consider contextual influences on values selection at the

collegial, professional team, institutional, and societal levels.

Transcultural: In addition to the levels mentioned above, counselors

consider values selection at the cultural level.

Step 4: Planning and Executing the Selected Course of Action

A. Develop a reasonable sequence of concrete actions.

General: Divide that course of action into simple sequential actions.

Transcultural: Identify culturally relevant resources and strategies

for the implementation of the plan.

B. Anticipate personal and contextual barriers and counter measures.

General: Anticipate and confront personal and contextual barriers to

successful implementation of the plan of action and counter measures.

Transcultural: Anticipate cultural barriers such as biases,

discrimination, stereotypes, and prejudices. Develop effective and

relevant culture-specific counter measures, for instance, culturally

sensitive conflict resolution and support.

C. Implementation, documentation, and evaluation of the course of

action

General: Execute course of action as planned. Document and gather

valid and reliable information and evaluate accuracy of the course of

action.

Transcultural: Use a relational method and social constructivism

techniques to identify measures and data sources that include both

universal and culture-specific variables.

Note. Adapted from Table 6-1 in Ethical and Professional Issues in

Counseling (p. 147), by R. R. Cottone and V. M. Tarvydas, 1998, Upper

Saddle River, NJ: Prentice Hall. Copyright 1998 by Pearson Education,

Inc. Adapted with permission.

(a) Relational Model as described in Davis (1997), and Social

Constructivism Model as described by Cottone (2001).

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Jorge G. Garcia, Stacey M. Winston, and Barbara Borzuchowska, Department of Counseling,

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-1-

Questia, a part of Gale, Cengage Learning. www.questia.com

Publication Information:

Article Title: A Transcultural Integrative Model for Ethical Decision Making in Counseling.

Contributors: Jorge G. Garcia - author, Brenda Cartwright - author, Stacey M. Winston

- author, Barbara Borzuchowska - author. Journal Title: Journal of Counseling and

Development. Volume: 81. Issue: 3. Publication Year: 2003. Page Number: 268+. COPYRIGHT

2003 American Counseling Association; COPYRIGHT 2003 Gale Group

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