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

[Baracco, Andrew W]

Hi Jessie,

 

Thanks for this.  I shared it with a few coworkers.

Andy

 

 

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Sent: Friday, June 29, 2012 4:03 AM
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Subject: [acb-hsp] Transcultural Model of Ethical Decision-Making

 

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,

Human and Organizational Studies, The George Washington University;
Brenda Cartwright,

Department of Counselor Education, University of Hawaii. Correspondence
concerning

this article should be addressed to Jorge G. Garcia, Department of
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and Organizational Studies, The George Washington University, 2134 G
Street Washington,

DC 20052 (e-mail: Garcia at gwu.edu).

-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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