Ethical dilemmas experienced by counseling psychologists in Taiwan

ABSTRACT

A two-part survey was conducted, where respondents reported ethically challenging incidents encountered in the previous two years and actions taken to address them. 132 certified counseling psychologists participated and reported 136 ethical dilemmas. The top categories of dilemmas pertained to breaking confidentiality between respondents and clients, including mandatory reporting, collaborating with education associates, and interjecting by the authority. 82% of the respondents took actions to address the dilemmas. These actions ranged from steering a middle course, upholding professional ethical standards, seeking consultation to taking no actions. Potential environmental contributors to the dilemmas and actions taken to address them were explored.

KEYWORDS:

• Counseling psychologist
• ethical standard
• mandatory reporting
• school counseling
• sociocultural factor

INTRODUCTION

Counseling professionals adhere to ethical standards to ensure that the clients’ best interests are protected. Ethical dilemmas arise when ethical standards governing professionalism are challenged, but no solution seems completely satisfactory (Kitchener, 2000). A counseling psychologist’s awareness of such conflict prompts self-reflection or self-introspection before a decision is made on what actions (including no actions) to take to resolve the dilemmas (Pompeo & Levitt, 2014). Studies have shown that it is not uncommon that counselors fail to recognize ethical dilemmas (Neukrug et al., 2001; Welfel, 2010). Failing to identify ethical dilemmas in itself becomes an ethical problem because counseling professionals are less likely to honor their professional commitment to clients’ privacy and rights and serve as trustworthy partners.

Ethical dilemmas vary according to their type and severity. For instance, the dilemma triggered by mandatory reporting and pertaining to suspected child sexual abuse may be perceived as more serious than the dilemma over the prospect of serving multiple roles in relation to a former client. For practitioners employed in institutions, the ethical standards governing their professional practices may not be fully compatible with the policies or cultures of employers at times. In Taiwan, cheating in examinations, stealing, and engaging in underage sex are considered violations of school policies, particularly in elementary and middle schools. Thus, when counseling psychologists become suspicious of their clients committing these behaviors, they may feel torn between complying with the school policy (e.g., notifying the administration) and honoring clients’ right to privacy and confidentiality as stipulated in the ethical guidelines for counseling psychology.

The American Psychological Association (APA) published its first ethical code entitled “Ethical Standards of Psychologists” in 1953. Four decades later, Pope and Vetter (1992) employed the critical incident technique to survey the contemporary ethical terrain. Members randomly selected using the 1989 APA Directory were asked to “describe, in a few words or more detail, an incident that you or a colleague faced in the past year or two that was ethically challenging or troubling to you” (p. 398). A total of 679 members reported experiencing ethical dilemmas. The top five categories of dilemmas emerging from the survey were confidentiality (18%), dual or conflicting relationships (17%), payment sources (14%), rendering services in academic settings (8%), and forensic psychology (dilemmas encountered by psychologists when serving as expert witnesses in court) (5%).

Interest has also grown in examining ethical dilemmas at a more global level to explore similarities across countries and promote international understanding (Pettifor & Sawchuk, 2006). In 1995, a group of psychologists from various countries who attended the European Congress of Psychology decided to replicate the research of Pope and Vetter (Pettifor & Sawchuk, 2006) and carried out studies in Canada, Finland, Mexico, New Zealand, Norway, South Africa, Sweden, and the United Kingdom. Pettifer and Sawchuck’s research duplicated Pope and Vetter’s method and collected data from eight countries. They found that 76% of the dilemmas were the same as those found by Pope and Vetter. Confidentiality and dual relationships ranked as top categories in these countries, also consistent with the finding by Pope and Vetter. Other similar sources of dilemmas included competence, colleagues’ conduct, assessment, harmful intervention, payment source, and sexual issues. Some country-specific dilemmas surfaced in Finland, Sweden, Mexico, and South Africa and were related to factors such as the client population, nature of practice, and method of payment. For instance, in Sweden, the dilemma category of “client population” was rooted in upholding the rights of mentally challenged individuals as required by laws. In Finland, up to 80% of Finish psychologists were employed in the public sector and often found themselves serving dual roles of therapist and administrator (an authoritative figure), illustrating dilemmas triggered by the “nature of practice.” Pettifor and Sawchuk (2006) acknowledged the lack of representation of non-Western countries (including indigenous peoples) in these studies.

Ethical standards for counseling psychologists in Taiwan

Modeled after the guidelines of the APA, the first set of ethical standards for counseling in Taiwan was published in 1989 by the Chinese Guidance Association (CGA) of Taiwan – later renamed the Taiwan Guidance and Counseling Association (TGCA)—to govern the counseling services provided by its members. These standards were revised in 2001 in response to changing societal needs (e.g., the emergence of the Internet provided both an additional venue and potential challenges for delivering counseling services) and the increasingly recognized importance of certification of counseling psychologists. Seven aspects of the professional practice of counseling were covered: counseling relationships, responsibilities, consultation, testing and assessment, research and publishing, teaching and supervision, and counseling provided via the Internet (Taiwan Guidance and Counseling Association, 2001). Given that serving students and collaborating with their significant others were recognized as key considerations, guidelines pertaining specifically to student counseling services were formulated by incorporating the ethical codes of the American Counseling Association (ACA) and the American School Counselor Association (ASCA) (Taiwan Guidance and Counseling Association, 2015).

The standards created by the TGCA inspired other local professional organizations to develop their own ethical standards, such as the Taiwan Counseling Psychology Association (C. H. Wang, 2020). By 2010, the Taiwan Counseling Psychologist Union (TCPU) was formed, which later modeled its ethical standards (published in 2012) on those of the TGCA. The TCPU currently has 12 regional guilds and 2881 members (Taiwan Counseling Psychologist Union, 2020).

The Psychologists Act was enacted in 2001 in Taiwan, which, among other clauses, stipulates the ethical requirements for the counseling profession (Article 19, Chapter 2). The Act further requires the inclusion of ethical standards in the guidance document that governs the operation of all professional unions (Article 57) and authorizes these unions to establish enforcement mechanisms for violations of professional ethics (Article 58) (The Psychologists Act, 2020). The licensure system for counseling psychologists was also established following the passage of the Psychologists Act. To be certified, a counseling psychologist must have a minimum of master’s degree with a major in counseling psychology, finished coursework encompassing at least seven core areas (including ethics), completed one year of internship, and passed the national certification examination (The Regulations for Senior Qualification Examination for Professional and Technical Personnel for the category of psychologists, 2018). The examination is conducted once a year by the Ministry of Examination in Taiwan and includes, as an official subject, “the practice of counseling & psychotherapy and professional ethics.” Once certified, licensed counseling psychologists must complete at least 12 hours of continuing education every six years in the areas of professional ethics and related laws and regulations. Professional ethics has also become a requirement in all training programs conducted in the field of counseling psychology.

Mandatory reporting required by laws when providing counseling services in Taiwan

The Student Guidance and Counseling Act, legislated in 2014, created a three-tier guidance system in Taiwan: a) teachers (first tier); b) counseling centers located in primary and secondary schools and staffed by school counselors and counseling psychologists (second tier); and c) city/county counseling centers that manage transferred cases from primary and secondary schools and are staffed by counseling psychologists (third tier). The Act also requires that counseling psychologists work collaboratively with all other professionals to achieve the optimal health of their student clients (Proposition 6.3).

Separately, a number of laws have been established to guard the well-being and welfare of minors. For example, psychologists employed in educational settings, where the great majority of Taiwanese counseling psychologists are employed (Tu & Jin, 2016), are required to notify the authority if the following occur to their underage clients: a) experiencing domestic violence (Domestic Violence Prevention Act), b) being sexually exploited (Child and Youth Sexual Exploitation Prevention Act) or sexually assaulted (Sexual Assault Crime Prevention Act, Regulations on the Prevention and Handling of Sexual Assault, Sexual Harassment, or Sexual Bullying on Campus), c) being bullied (Regulation on School Bullying Prevention), or d) engaging in delinquent behaviors that might hurt them physically or mentally (such as underage sex and drug abuse) (Protection of Children and Youths Welfare and Rights Act). Counseling psychologists are to report any existing or imminent harm to their youth clients within 24 hours of such suspicion, with or without the consent of their clients. Failing to do so could incur penalties such as fines or even suspension of the license.

Therefore, the ethical standards of the TCPU not only stipulate that its members abide by professional ethics standards but also emphasize that it is essential to comply with mandatory reporting in cases specified by laws when interacting with clients. However, mandatory reporting of child maltreatment and other child protection incidents has resulted in relational ruptures between mental health professionals and their clients (Tufford et al., 2019; Yen, 2019) and created ethical challenges for these professionals.

Current research

As noted earlier in this report, there was a lack of representation of non-Western countries in the multi-country studies carried out in 1995. Meanwhile, with the adoption of ethical standards by professional associations and the passing of the Psychologists Act, Taiwanese counseling psychologists found themselves experiencing an increasing number of ethical dilemmas. Therefore, a two-pronged study was undertaken with the aim of investigating 1) the types of ethical dilemmas encountered by Taiwanese counseling psychologists by applying the method of Pope and Vetter (1992) and 2) the actions taken by counseling psychologists in response to these dilemmas.

METHODS

Participants

One hundred and forty-two certified counseling psychologists voluntarily and anonymously responded to the surveys, representing approximately 5% of the total population of counseling psychologists in Taiwan, which is larger than the minimum sample size of 100 suggested by Hair et al. (2018). As shown in Table 1, four-fifths of the respondents were female. The average age of the respondents was approximately 36 years, and the average number of years of service in the field was slightly longer than five years. Approximately 90% of the respondents had a master’s degree in counseling psychology (which is the minimum requirement to be licensed in Taiwan).

Table 1. The demographics and professional background of study participants.

Characteristics	n	Percent (%)	Mean (SD)
Age	132		35.89 (9.51)
Years of service	132		5.24 (5.11)
Gender
Male	25	19%
Female	107	81%
Education
PhD	17	13%
Master	115	87%
Employment
University Counselling Center	56	42%
High, middle, or elementary school	43	32%
City/County Counselling Centre (Transferred casesfrom high, middle & elementary schools)	31	23%
Social/welfare institution	11	8%
Medical/community health center	8	6%
Private practitioner	6	4%

Instrument

A two-part questionnaire was administered. Part I was modeled after the questions asked in the study by Pope and Vetter (1992), where respondents described one or more incidents in the previous two years that were ethically challenging or troubling to them or a colleague. In Part II, respondents recounted the actions taken in response to the dilemmas.

Based on purposeful sampling, surveys were distributed via webmail or regular mail to gatekeepers (staff coordinators) at student counseling centers and professional associations of counseling psychologists in Taiwan. These gatekeepers disseminated the surveys to counseling psychologists in their respective organizations. The participants were encouraged to send out the surveys to other psychologists. Two rounds of surveys using the same questionnaire were conducted from March 2014 to July 2015 and from December 2018 to June 2019. The second round was initiated to collect more up-to-date information. As the categories of dilemmas emerging from both surveys were similar, data analysis was conducted by combining both sets.

Data analysis

Content analysis was performed to analyze the dilemmas and actions collected, starting with the creation of a standard codebook. To create the codebook, the first author of this report coded each incident and assigned suitable categories, and the second author reviewed the categories suggested by the first author. Together, the two coders reached a consensus and finalized the classification. Using C72 as an example, “A client appeared overly emotional and unstable. The school administration then asked me to generate a psychological assessment recommending that the client stay home instead of coming to school.” The first author tagged this case with two categorical themes: interjecting by authority and the client’s right. The second author reviewed the two categories suggested, and, together, the two coders assigned the final category of “interjecting by authority” to this case. The same process was repeated for all incidents until a list of the standard categories for the codebook was completed.

Both coders then categorized all incidents separately according to the codebook, yielding a kappa value of .67. The coders reviewed the definitions of each category and discussed their differences. Both coders then undertook a second round of categorization (again independently). The kappa value for this round was .88, indicating an acceptable inter-rater reliability. Finally, the percentages of dilemma and action categories were computed.

RESULTS

Ethical dilemmas experienced by counseling psychologists

Nine of the 142 respondents reported no ethical dilemmas experienced, and one reported “too many” without noting event specifics. Excluding these 10 respondents, a total of 136 dilemma situations provided by the remaining 132 respondents were analyzed and presented in this report. The types and distributions (in percentage) of the ethical dilemmas experienced by the participating counseling psychologists are shown in Table 2.

Table 2. Types of ethical dilemmas experienced by respondents.

Dilemma Category	n	% of Total	Subcategory
Mandatory reporting	35	26%	Sexual events & domestic violence (16%) Hurting self or others (10%)
Collaborating with education associates	24	18%	Teachers (16%) Other school staff (2%)
Interjecting by the authority in work settings	23	17%
Multiple relationships	13	10%
Keeping and releasing counseling information	12	9%
Misconduct of other counseling psychologists	11	8%
Maintaining professional standards & service quality	10	7%
Client’s right to autonomy	8	6%
Total dilemmas reported*	136

Note: *Four respondents reported two dilemmas.

Mandatory reporting

Twenty-six percent (n = 35) of the dilemmas arose from having to comply with the legal requirements of reporting under which client-professional confidentiality would be broken. A number of prevalent themes emerged from the incidents in this category.

Sexual events and domestic violence

Sixteen percent of the respondents faced the dilemma of whether to report these incidents because of clients’ reticence or even threat to end the counseling if the respondents proceeded with the reporting. For example, respondent C47‘s client, a college student, accidentally revealed that she was raped at her childhood. She refused to discuss the incident further, nor did she permit C47 to file a report. Similar experiences were shared by respondents C24, C58, C48, C84, and C136. Respondents C2 and C20 struggled with whether to report on their young clients, as both clients were students and did not consent to such reporting-one had consensual sex with an adult (C20) and the other with an underage partner (C2). The clients of C53, C59, C96, and C139 were traumatized by domestic violence but prohibited from reporting to the authority to protect their parents or partners. C53‘s client was afraid that such reporting would lead to her losing her husband. C59 hesitated to report a case of domestic violence, as she acknowledged that it could be within the care duty of a father to discipline his child.

Hurting self or others

In these cases (10%), the respondents were torn between the obligation to inform the authority and respect for the clients’ will. In most of these cases, the clients were students who engaged in self-hurting or suicidal behaviors. For instance, C41’s client “stabbed himself to express his anger from being abused by his parents but forbad me from reporting, although he wouldn’t promise to stop, either.” Some respondents debated with themselves whether to report clients’ suicidal thoughts as thoughts could be a precursor of actions. For example, C1 found herself caught between a rock and a hard place when “the client had suicidal thoughts and threatened to commit suicide if I wrote a report.” C86 reported that a student client “made some dangerous stuff which might hurt others. I do not know if it was real or not. So, should I report?” C12, C112, and C128 shared similar dilemmas.

Collaborating with education associates

The ethical code of the TGCA stipulates that psychologists should collaborate with education associates. However, requests from associates such as teachers, campus military instructors, school counselors, paraprofessional counselors, and other staff had thrust 18% (n = 24) of the respondents into difficult ethical situations. For example, “the client’s teacher wanted to know what’s wrong with the client” (e.g., C13, C28, C33, C34, C37, C39, and C42). Other dilemmas were triggered by the misconduct of colleagues of clients’ teachers, who divulged personal information of respondents’ student clients during casual conversations with other students or teachers (C56, C62, and C77) or engaged in inappropriate acts that could negatively impact the well-being of the respondents’ clients (C78, C87, and C10). C16 struggled with whether to share information with the client’s school counselor because her client lied about being abused by the schoolteacher.

Interjecting by the authority

Approximately 17% (n = 23) of the respondents reported that authoritative figures, such as directors and school principals, tried to interfere in the counseling process, which inflicted pressure on respondents to break client confidentiality. C14, C21, C43, and C65 learned afterward that the records of their clients had been sent to the principals without their consent. C66 and C67 were approached by their superiors who wanted to be present during the counseling session or to review the session records because of superiors’ extra concern about the respondents’ clients. C138 was asked by her superior – at a corporation – to share the counseling record of one employee. In the cases of C35 and C72, the school administration hinted at having them carry out a psychological assessment to be cited as the justification for requesting respondents’ rebellion-prone clients to stay home instead of returning to school. C109 shared that counseling services were sometimes forced on students. C73 and C118 discovered that their counseling records became part of their own performance review: “So I had to send part of the counseling records to the school administration for review. This made me feel bad because it was not ethical.”

Multiple relationships

Ten percent (n = 13) of the dilemmas were related to multiple relationships that could lead to the blurring of professional roles. The former clients of C85 and C117 applied for positions of assistants at the counseling centers where the respondents worked. Both respondents felt uncomfortable about having former clients as colleagues because of their knowledge of the history of these former clients. Moreover, they acknowledged these former clients’ right to pursue employment opportunities at will. C49, C97, and C99’s students in their classrooms sought personal counseling from them. C31 found out that the client of the counseling intern whom she supervised was one of her graduate advisees. The colleagues of C4 and C17 in school – both colleagues were teachers – sought counseling from them as personal favors.

Keeping and releasing counseling information

Another 9% (n = 12) of the respondents were concerned about revealing clients’ information to third parties. For example, parents of clients of C22, C63, and C68 demanded that the counseling psychologists share the counseling information of their underage clients. Prosecutors’ requests for clients’ information (C69, C113) and releasing clients’ psychological test results to schoolteachers (C134) also created ethical dilemmas for respondents. The presence of a translator during counseling sessions (C46) and keeping and archiving clients’ records (C127, C132) are additional examples of the ethical challenges experienced by respondents.

Misconduct of other counseling psychologists

Misconduct by other counseling psychologists was observed by 8% (n = 11) of the respondents, including failing to follow the standard procedure when administering a psychological test (C29), providing counseling services in an open area (C11) or over the Internet (e.g., Facebook) without using encryption (C143), transferring an unwanted client to another colleague without an advance notification (C108), referring clients from the workplace to their own private practice (C98, C124), or becoming sexually involved with clients (C23).

Maintaining professional standards and service quality

Seven percent (n = 10) of the respondents reported that the quality of their services could suffer as a result of additional administrative tasks demanded of them, as these tasks might dilute the professional boundaries critical to ensuring that the counseling services provided met professional standards as codified in professional ethics. For instance, C32 “had to provide counseling to both the abuser and the victim in the same incident” because she was the only psychologist in her institution.

Other respondents faced the dilemma of whether to accept minor gifts from clients or parents, afraid that doing so might trample on professional ethics (C40, C104, C125, and C142). There were also reports of incidents in which counseling interns failed to perform competently. For instance, C26 suspected that an intern client was sexually abused by her boyfriend. However, the intern “has no further information for a proper professional judgment to be made.” While supervising interns at a counseling center of a local university, C19 faced the dilemma of whether to remove cases from one intern because of the intern’s persistent underperformance.

Clients’ right to autonomy

Approximately 6% (n = 8) of the ethical dilemmas reported pertained to the client’s right to autonomy. For instance, C91 suspected that one of his clients suffered a mental illness that had caused trouble for other students in the dormitory. However, the client turned down C91‘s suggestion to seek medical help or for C91 to contact the client’s parents. C137‘s client wanted to terminate the counseling sessions due to financial constraints. However, the client’s family wanted the sessions to continue, which they would sponsor secretly.

Counseling psychologists’ responses to dilemmas

Approximately 82% of the counseling psychologists took actions to mitigate or resolve the dilemmas they experienced, while 18% took no actions. Respondents’ actions in response to dilemmas generally fell into one of the following categories (Table 3).

Table 3. Survey participants’ responses to the ethical dilemmas encountered.

Type of Response	N	Percentage
Steering a middle course	50	37%
Upholding professional ethical standards	37	27%
No actions	25	18%
Seeking consultation (From senior counseling psychologists or deferring decision-making to superiors)	15	11%
Complying with mandatory reporting	9	7%
Total responses*	136	100%

Steering a middle course

Approximately one-third (37%) of the respondents circumvented the requirements or directives without grossly violating professional ethical standards. For example, when clients harbored suicidal thoughts or threatened to hurt others, respondents (e.g., C12, C41, C86, C112, C114, and C133) showed more leniency toward clients’ reticence to consent to mandatory reporting. They relayed the reporting requirement to clients and gave clients a warning without proceeding to inform the authority. When approached by principals or the authority with unreasonable requests, C14, C21, C43, C140, and C142 compiled a less-than-full report about their clients. Thus, they felt that they at least protected some of their clients’ rights without rejecting outright the request from their supervisors. To navigate between maintaining a cordial working relationship with teachers and honoring their own commitment to clients’ rights, respondents C13, C28, C39, C42, C76, and C79 explained to teachers the confidentiality requirement in the professional guidelines for counseling and providing teachers with appropriate consultations instead of sharing the counseling records of their clients requested by the teachers.

Upholding professional ethical standards

27% of the respondents followed professional ethical guidelines by explaining the ethics to third parties and/or turning down their requests that would lead to violations of such standards. For example, some survey respondents, despite feeling torn, turned down the authority’s demands and instead presented professional ethical standards, laws, and regulations related to confidentiality (e.g., C66, C67, C151, C73, C36, and C52). Finding themselves having to serve multiple roles in relation to their clients or students, C17, C31, C38, C99, and C117 opted for direct communication by informing their clients or students of professional ethical boundaries.

Taking no actions

Less than one-fifth (18%) of the respondents took no actions in response to the dilemmas encountered. For instance, despite feeling conflicted upon discovering that their clients’ teachers were engaged in inappropriate behaviors with their clients, C7, C37, C87, and C147 chose not to respond and took no actions. C11, C44, C74, C85, C98, and C124 took no actions toward their colleagues despite the latter’s misconduct or unethical relationships with the respondents’ former clients, so they would not risk imperiling their own relationships with their colleagues.

Seeking consultation

A small percentage (11%) of the respondents sought consultations from clinical supervisors or senior-ranking counseling psychologists. For example, when clients resisted mandatory reporting, a few respondents deferred the reporting decision to their supervisors or consulted with senior-ranking counseling psychologists (e.g., C58, C59, C90, C107, C116, and C120). C10, C108, C110, and C121 turned to their administration supervisors for guidance on dilemmas pertaining to their colleagues or interns, so they would not have to confront their colleagues and create ill feelings.

Complying with mandatory reporting

Nine respondents (7%), that is, C24, C53, C71, C82, C84, C96, C106, C126, and C131, abided by what was required by laws and reported on their clients as their cases pertained to sexual events and domestic violence, while feeling a sense of defeat by not advocating client-professional confidentiality. However, they worked with clients to help reduce or manage potential negative impacts on clients, which might result from such reporting.

DISCUSSION

Similar to the participant demographics in the national survey conducted by Tu and Jin (2016), an overwhelming majority of the respondents in our survey were employed in school settings (primary, secondary, and tertiary schools). This also reflects the employment distribution among counseling psychologists in Taiwan in general (Taiwan Counseling Psychologist Union, 2017). Unsurprisingly, the most prominent dilemmas emerging from the survey were also the most prevalent in these settings.

Confidentiality as a top dilemma category mirrors previous findings, particularly in educational settings

More than half of the dilemmas experienced by counseling psychologists in the current study pertained to potentially breaking confidentiality between them and their clients (Table 2). This generally resonated with findings from the research by Pope and Vetter (1992) among the APA members, as well as studies conducted in eight countries and summarized by Pettifor and Sawchuk (2006).

In particular, high rankings in our survey were associated with subcategories related to educational settings or student clients. This finding echoed observations from earlier investigations of similar client populations (i.e., students) and practice settings (i.e., educational settings). For instance, Sivis-Cetinkaya (2015) found that the major ethical concerns among Turkish school counselors were confidentiality and privacy conflict with school principals, multiple relationships, and maintaining professional boundaries. Akfert (2012) reported that, in addition to privacy issues (which ranked the highest), psychological counselors working at universities and schools found themselves wrestling with issues related to the teaching environment and clients’ rights. The survey by Bodenhorn (2006) among school counselors uncovered similar ethical struggles for counselors when it comes to handling student confidentiality, parents’ rights, and whether to act upon information, which suggested that students might pose danger to themselves or others. Conflicts with administrators (Dailor & Jacob, 2011) and collaborations with teachers (Froeschle & Crews, 2010; Lazovsky, 2008; Moyer & Sullivan, 2008) have also been identified as sources of ethical dilemmas.

Regulatory mandates “collide” with practice principles of counseling psychology and precipitate professional ethical dilemmas

Approximately one-quarter of the dilemmas shared by respondents arose from the pressure of mandatory reporting for cases related to sexual events, domestic violence, and hurting oneself or others. Mandatory reporting was enacted as a social reform to deliver social justice by ensuring the protection of children and victims and make early intervention (Ho, 2007). The current ethical guidelines of the TGCA and TCPU also stipulate that members report such cases as exceptions to the general guideline of safeguarding clients’ rights and privacy. However, Chi (2018) pointed out that mandatory reporting, especially within a stringent time frame, can trigger ethical issues for supporting psychologists in cases such as sexual harm and domestic violence, particularly when clients are not ready to confront their traumas, as found in respondents’ feedback in our study.

The complicated crisscrossing relationship between legal mandates and the ethical guidelines formulated by professional organizations of counseling psychology in Taiwan has contributed to some of the most challenging dilemmas experienced by counseling psychologists, particularly for those serving minors. Counseling psychology remains a young profession in Taiwan. As the profession matures and becomes more established, a more desirable end state will be governing the practice of counseling psychology through formalized ethical guidelines crafted by counseling psychologists themselves with accompanying enforcement mechanisms. Unlike laws, professional ethical guidelines are structured with more built-in accommodation for professional judgment and flexibility (while laws are generally binary in nature, ethics is more nuanced). With this evolutionary shift where professional ethical guidelines become the key driver with supplementary support from rules and regulations (where needed to prevent the most egregious violations), protection can be rendered to minors through complementary instead of competing designs, but in the condition of well-intended practice for clients within the framework of regulatory and professional ethics.

The ecosystem fostered by the school guidance system also becomes a fertile ground for professional ethical dilemmas

In Taiwan’s three-tier guidance system, teachers play a primary role in assisting students with physical, behavioral, mental, and emotional issues. Counseling psychologists are encouraged to work with teachers, school principals, and significant others in schools and families when counseling student clients (Student Counseling and Guidance Act, 2014). Therefore, even though teachers do not outrank counseling psychologists hierarchically, counseling psychologists are keen to maintain a productive and positive working relationship with teachers.

On the other hand, executives (school principals) and directors holding counseling offices also consider students’ mental health as part of their responsibility, which is also clearly stated in the Student Guidance and Counseling Act (Tu & Wang, 2017). However, these administrative leaders are often untrained counseling professionals (Yeh, 2013).

Partnering with teachers and school administrators may involve information sharing, which could encroach upon client-professional confidentiality at times (L. F. Wang et al., 2008). With their responsibilities sanctified within the current regulatory framework, teachers in Taiwan may instinctually feel entitled to being privy to the counseling services provided to their students. By doing so, they could unintentionally create ethical dilemmas for counseling psychologists. Similarly, as found by Tu and Wang (2017), directors at school counseling offices favored psychologists who shared information and discussed, with the office heads, their counseling strategies on how to help the student clients. Thus, the leading voices in the counseling profession in Taiwan have been advocating for years appointing trained professionals to lead the counseling team (Yeh, 2013).

Most respondents exercise professional autonomy by steering a middle course or upholding professional ethical standards

Approximately one-third of the respondents opted to steer a middle course to address the dilemmas faced. Huang et al. (2008) reported that, as a way of managing relationships with superiors or authorities, Taiwanese might “pay a lip service” to superiors’ wish or command without carrying out such wish or command fully or do so half-heartedly, if they were not in total agreement with such wish or command. Chen (2017) further elaborated that Taiwanese counseling professionals, when serving clients, have found themselves caught between maintaining harmony in their collegial relationships, as expected by the local culture, and honoring their own professional development and objectives (as they were trained in the theories and practices of counseling psychology that originated mostly from the West). According to Chen (2017), the ability to maintain a level of harmony in relationships that at least partly satisfies one’s own needs without totally jeopardizing one’s interpersonal relationships is considered key to better mental health and social adjustment for Taiwanese.

More than four-fifths of the respondents took actions in response to the dilemmas they encountered (Table 3); this is evidence that the respondents exerted professional autonomy to actively mitigate or resolve dilemmas, instead of feeling helpless. The respondents might have been “emboldened” by an increasingly progressive zeitgeist, which has been gradually reshaping the young profession of counseling psychology in Taiwan. For example, the Suicidal Prevention Act of Taiwan was enacted in 2019. While reporting suicide attempts, but not thoughts, is still mandated, failing to do so no longer incurs a legal penalty.

Sociocultural considerations are likely factored in counseling psychologists’ responses to dilemmas

In addition to the more immediate environmental factors, such as the extant regulatory mandates and the school guidance system, this study shows that counseling psychologists might also be influenced by sociocultural factors at the macro level. As Bronfenbrenner illustrated in his ecological systems theory (Bronfenbrenner, 1979), multiple systems collectively and simultaneously impact each societal member, with the effects of some being more visible and the effects of others being more latent.

Wu-Ren Doctrine – the cardinal tenet in Confucianism – where “Wu” denotes “five” and “Ren” denotes ethics and obligations, remains the guiding principle for social behaviors among Taiwanese (Ho, 1995). The doctrine defines how societal members should navigate through five of their most important relationships: governor-subordinate, parent-child, husband-wife, siblings, and friends. Filial piety and respect for authorities (superiors and teachers are revered as authoritative figures) are still deemed critical in contemporary Taiwan (Huang & Chu, 2012). Aspects such as relationships, hierarchy of authority, kinship, and how one is perceived by the collective are frequently considered as Taiwanese engage in social exchange (Yang, 2004). Hence, the finding that respondents resort to a middle course to mitigate ethical dilemmas suggests that the cultural trait of “relational Confucianism,” as dubbed by Hwang (2017), appears to have an effect on respondents’ actions. The goal of counseling and psychotherapy in Taiwan has traditionally been to restore homeostasis between clients and their relationship networks.

Study limitations and future studies

First, when extrapolating findings from the current study, caution is warranted, as the types of dilemmas and responses to them may vary among different cohorts. For example, Gilligan (1982) found that women were more likely to value responsibility and relationships when making moral choices (approximately four-fifths of the respondents in our study were female). Second, the categories of dilemmas and participants’ responses to them, for example, interjecting by authority, may be, at least partly, overemphasized because the respondents were young in their service years.

Through more stringent sampling, follow-up studies can recruit counseling psychologists from a wider variety of backgrounds to examine the importance of years of experience as practitioners and employment types in the ethical dilemmas experienced and responses to them. Through a systematic review, Grace et al. (2020) showed that professionals’ level and type of experience could impact their ethical decisions, while acknowledging that more generalizable empirical evidence is still needed in the field.Sociocultural constructs that may have potentially underpinned the dilemmas identified in this study and participants’ responses can be explored through follow-up surveys and/or in-depth interviews to gain insights into the environmental factors affecting psychologists’ decision making when facing ethical dilemmas. Further evidence can be obtained from cross-cultural comparisons to better understand the impact of sociocultural contexts (national and/or regional) when developing standards and regulations to govern and advance professional ethics.

Mullen et al. (2017) observed that psychologists who encounter ethical dilemmas also experience mental stress. Therefore, a number of worthy topics can also be considered in future research: a) the psychological and/or interpersonal consequences resulting from dilemmas and/or counseling psychologists’ actions to resolve them; b) counseling psychologists’ level of satisfaction with the actions taken or the outcome of taking no actions; and c) the impact of counseling psychologists’ responses to the dilemmas faced on future responses to dilemmas and the impact of their responses on the field of counseling psychology more broadly.

Implications

Given the relatively short history of the School Guidance Act (established in 2014), the ethical standards for school counseling psychologists (officialized into the TGCA’s guidelines in 2015), and the field of counseling psychology as a distinct profession in Taiwan (the passing of the Psychologists Act approximately 20 years ago), ethical dilemmas appear to be part of the “growing pain” as both practicing counseling psychologists and the field of counseling psychology as a whole are ramping up their respective learning to progress toward an individual’s professional maturity and the field’s collective maturity, respectively. The survey in our study revealed that 82% of the counseling psychologists who experienced dilemmas took actions in response to the pressure challenging them to compromise their professional ethical standards. This demonstrates psychologists’ keen ability to recognize ethical dilemmas, as well as their sense of urgency to actively seek solutions – an encouraging evolution of counseling psychology as a young profession in Taiwan. The findings of this study testify to the “progressiveness” that has been gradually taking hold among Taiwanese counseling psychologists. They are becoming more confident and striving to more deftly (as shown by the actions that they took) walk through the “mine field” of being caught between responding to demands from multiple stakeholders when serving as ardent advocates for their clients’ rights and managing the potentially negative impact on their own relationships with these stakeholders. Varied responses to dilemmas from the participating counseling psychologists in our study illustrate the contemporary landscape of counseling psychology in Taiwan, where the local regulatory environment, sociocultural characteristics, and counseling psychologists’ professional ethical standards intersect. This landscape is likely to continue to evolve. We intend to continue documenting how ethical dilemmas and counseling psychologists’ responses to them change over time. In the meantime, professional organizations (training institutions, professional unions, associations, etc.) can play an active role in supporting counseling psychologists by conducting situational training for junior psychologists on making ethical judgments and taking actions, as well as providing consultations for those who face ethical dilemmas. These organizations can also promote awareness in schools and local communities regarding the roles and functions of counseling psychologists.

Finally, the findings of our research can facilitate and advance dialog between different stakeholders. Professional ethical dilemmas can thus be first acknowledged and then brainstormed or resolved collectively through collaboration among stakeholders.

DATA AVAILABILITY

Data supporting the findings of this study are available from the corresponding author upon reasonablerequest.

ACKNOWLEDGMENTS

We would like to express our deepest gratitude to Dr. Rodney Goodyear for initiating the project entitled “Ethical Issues Asian Psychologists Encounter: Self-Reports from Japan, Korea, and Taiwan” in which the lead author of this study participated and from which part of the findings of the current study were derived. We are also grateful to Dr. Li-Fei Wang for her input to the design of the current study. In addition, we thank Cathy Wu for the expert editing of this study.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Ministry of Science and Technology of Taiwan (Grant Number 108-2410-H-033-028-MY2).