Ethical Principles in Counseling
Ethical standards are particularly important in the counseling profession and are used to guide the professional actions of counselors. These often are universal standards applied across a variety of professions. In the case of counseling, the American Counseling Association (ACA) has put together a code of ethics to help members of the profession make responsible and ethical decisions about their professional practice. Professional organizations tend to have some level of overlap within the strictness of their ethical standards. As such, the ACA’s ethical standards are similar to several professional counseling association codes of ethics that are workable options for all professional counselors.
There are several reasons ethical standards are so important when it comes to counseling. For one, counseling is often a person’s first experience with therapy or treatment for their particular issue, so they often enter into the counseling experience expecting their counselor to be a trustworthy source of support for whatever issue they are facing. Their vulnerability makes it even more important for counselors to follow ethical standards . Additionally, clients also rely heavily on the expertise of their counselors to provide them with the best possible support for their various issues. These issues can be deeply personal and sensitive. Ethical standards help build trust between the counselor and the patient while also educating clients on what to expect from their counseling experience.
All obligations counselors have to their clients are based on the ethical standards of their profession. In analyzing the ethical obligations of counselors, some different aspects must be reviewed, including basic social values and legal considerations. On top of that, ethical standards go beyond basic social values and legal considerations and can be subjective in some situations. This subjectivity can be overwhelming for some counselors and, if not addressed, can lead to burnout, professional shame and decreased effectiveness as a counselor. The ethical standards outlined by associations such as the ACA should help address those concerns by helping them avoid situations where their values may clash with the social values of their clients. Counselors should be careful when reading their own values into their treatment and making decisions based on those values.
What Every Counselor Needs to Know Regarding the Law
Counselors must be familiar with certain legal responsibilities, particularly around disclosure. Ethical disclosure must not be compromised for the legal concept of confidentiality and trust. According to the ACA Code of Ethics, the client’s autonomy must still be respected while violations of confidentiality must be avoided unless mandated by law or court order. Counselors must also take care to responsibly disclose material that could be potentially damaging to a client, depending on the circumstances.
These legal parameters apply to any information disclosed by the client: A counselor’s duty to warn (or duty to protect) extends beyond mental health professionals, under statutes of Tarasoff v. Regents of the University of California and its descendants in other states. The counselor must break confidentiality if there is clear and imminent emotional or physical danger to some other person or group. Counselors must also disclose information that would prevent a major crime when the state has enacted a duty to warn law under those circumstances.
There are certain information-sharing practices that may be beneficial; for example, a statutory regulation may allow counselors to share information with external parties when providing services to clients who have been to mental health institutions. In cases where a minor is seeking counseling, counselors must share any details of an abuse report to the relevant authorities.
Court cases like Tarasoff help guide obligations to disclose, but those cases differ from state to state, so it’s important that counselors do review applicable laws in their area. For example, Missouri has a mandatory reporting obligation that can be found in the Revised Statutes of Missouri, section 610.015.
If you’re unsure of what to disclose, you may want to ask your client to agree to release information, either verbally or in writing, authorizing you to notify the relevant people of a dangerous situation. In certain high-risk situations, for example, psychologists treating clients for suicidal ideation, ethically and legally it may be acceptable to break confidentiality if a family has to be notified of a potentially dangerous situation.
Violations of client confidentiality could lead to loss of licensure or disciplinary action. Examples include:
Not complying with disclosure obligations under federal and state laws Disclosure of confidential information obtained during a family counseling session to the head of the family against the wishes of other family members Failure to disguise the identity of clients in a dissertation where their information is being used inappropriately Failure to inform clients of the limits of confidentiality in writing Disclosure of client information for publicity purposes when the client has not provided consent Coercing a client to disclose confidential information on the grounds that protection of the confidentiality will be broken if the client does not cooperate, without doing so because such disclosure could reasonably be expected to harm the client or another identifiable person Disclosing information obtained from a client’s file to a news reporter upon request Disclosure of confidential information obtained during a therapy session, which were not made public by the client, to the head of a family or other authority (e.g., an organ), in violation of the rules governing guardianship Failure to adhere to ethical guidelines governing confidentiality, in particular those pertaining to parents’ awareness of circumstances and risk to life Disclosure to third parties of confidential information of clients who were selected from representative samples of the general population and agreed to participate.
Counselor Responsibilities as Professional Practitioners
In the field of counseling and psychotherapy, the development of ethical and professional boundaries between the counselor and the client is a critical component. Andrew Penn, in his 2011 discussion of ethical principles in counseling and healthcare systems, observes that "An ethical counselor has a clear sense of responsibility to the client and the responsibility to other areas of practice" (Penn, p. 409, 2011). If the counselor does not maintain clear ethical accountability, there is the potential for a number of detrimental consequences including emotional harm to the client and loss of work for the counselor due to legal actions or malpractice (Ibid, Nesvold, 2010).
Unfortunately, there are a number of factors that create the potential for boundary issues. First, there is the ability to cross physical and emotional boundaries when the counselor is seeing the same clients in a community setting (for example, volunteering for a local charity that has clients). It can be difficult to keep a professional separation from a patient who is in a community setting if they are seen on a regular basis.
Second, one must consider the potential for emotional boundaries to be crossed. Where a counselor becomes emotionally involved with a client, there can be two problems, a lack of professional distance or a lack of objectivity. If the counselor is too involved with the client, it can become difficult to provide treatment objectively (Ibid).
There are several approaches that can help to maintain professional boundaries between counselor and client. First, I recommend that there be clear lines of demarcation as to the different areas of work (for example, if the counselor sees the same client in a social setting, there should be clear boundaries as to their professional relationship). If the counselor runs into the client outside of the office setting, it may be beneficial to have a code that instructs the counselor as to whether it is appropriate to speak with the client (for example, if the client has indicated that it is a personal environment, the counselor should step away). Second, there should be a formal record-keeping program that prevents breaches with respect to hazards such as confidentiality (such as electronic files and/or secure filing cabinets).
Overall, it is necessary that counselors exercise strong discretion in the handling of boundary issues. The counselor must balance between being an empathetic and understanding therapist, and an emotionally detached objective professional.
Dealing with Ethical Issues Within the Counselor-Client Relationship
Ethical dilemmas frequently arise in the course of counseling practice. Commonly encountered dilemmas include boundary issues between the counselor and the person seeking services; informed consent for particular aspects of treatment or types of treatment; and financial arrangements, such as professional fees and fee-splitting with other counselors.
Some ethical dilemmas are relatively straightforward. For instance, you enter into a counseling arrangement with a person seeking services without knowing that this person is also seeking services from three other counselors. This may become an issue if, as the counseling sessions progress, the person says that he/she is also seeing one of your colleagues. Your first duty is to the therapeutic relationship. Tell your client that you understand your colleague may have told him/her that it’s inappropriate to see more than one counselor at the same time. Ask your client to ask this colleague to confirm his/her views. When your client does this, you will both realize it’s time for him/her to choose one counselor to whom he/she will confine his/her attention.
Other ethical dilemmas are more complex and more difficult to address. While the ethical codes of the counseling profession are generally similar, when you compare the ethical codes of the American Psychological Association (APA) with that of the American Counseling Association (ACA), there are some notable differences. For example, the APA "suggests" that psychologists do not engage in sexual intimacies with former clients for a period of two years after cessation of therapy. The ACA states that counselors shall not engage in sexual intimacies with former clients for at least five years after cessation of therapy.
In the above situation , the first step is to avoid action that will create bias and prejudice. For example, if you use the ACA code, you should not state that you "recommend" this larger window than recommended by the APA. The second step is to assure your client that he/she is welcome to pursue services with another counselor, if that’s his/her choice.
Such ethical dilemmas are most effectively addressed by following a systematic decision-making model. There are many different decision-making models, but the model put forth by the American Counseling Association in their Code of Ethics is perhaps the most comprehensive.
A careful review of the ACA model reveals that, in the above example, the first step is to identify the fundamental issues at play. In our example, the fundamental issues are your client is willing to abide by either the APA or the ACA code of ethics. The second step in the ACA model would be to review the relevant facts. In our example, the relevant facts would be, under the APA code, a two-year window and, under the ACA code, a five-year window.
The third step is to apply the relevant ACA code and ethics. In our example, the ACA code suggests a five-year window. The fourth step is to consider the applicable law and the implications of your option for your license. In our example, licensure laws vary state by state, but in many states, the legislature has enacted laws establishing a two year window. If you use the ACA code provision, you could be held liable to the law of the state, even if you successfully argue the ACA code provision when challenged professionally on this matter. The fifth step is to consult with other professionals. It’s always a good idea to involve trusted colleagues in your career.
The final step is to conduct your decision and document your final decision.
Issues of Competency and Education for Counselors
In addition to licensure, counselors are required to maintain their competence in the profession and the best way to accomplish that is through continuing education. 5 AAC 10.220 requires professionals to both maintain core competencies and achieve new ones. Competencies for counseling can be found at specific licensing boards, though each board has slightly different requirements. Counselors can also refer to the American Counseling Association, the ACA Code of Ethics, the ACA Continuing Education Provider Manual, the Code of Federal Regulations: 34 CFR 364.3, the Indian Health Service and specific state and local counseling boards for more information on counselor competence.
The professional development requirements for psychologists and social workers are similar. There is an ethical obligation to maintain competence and the ability to stay on top of changing roles, even in a state with relatively low CE requirements. OAR 848-060-0050 requires licensees to participate in professional activities that have substantial intellectual or practical content and maintain current knowledge of professional, legal and ethical standards. For psychologists, OAR 858-020-0000 outlines the competence process as well as the general requirements for professional development activities.
There are many professional development opportunities that help counselors maintain their competence. Professional organizations, including the American Counseling Association, the Oregon Counseling Association, and the International Association of Marriage and Family Counselors, All-Pro Counseling and many others, offer local, state and national networking and training opportunities including conferences and regional workshops. 5 AAC 10.220 describes the eight core competencies of counseling practice:
Practice Competence: Specialized Knowledge
Professional Disposition: Ethics and Integrity
Professional Availability: Sustained Effort and Accountability
Communication: Interpersonal and Team Skills
Diversity: Respect, Fairness, and Inclusivity
Professional Relationship: Kindness, Caring and Trust
Responsible Practice: Professional Standards
Professional Development: Continuous Improvement
Rights of the Client and Responsibilities of the Counselor
Client Rights and Counselor Responsibilities: Section 5. Neither the ACA Code of Ethics nor any other model code provides an explicit and detailed description of client rights. However, the concept of client rights permeates every section of the ACA Code of Ethics. Client rights are fundamental and transcend all areas of counseling. Standard C.2.a. states "clients have the right to be informed of the qualifications of a counselor." This is basically a client’s right to know the professional background, education, experience, and credentials of the counselor that they will be working with. This right also entails other informant’s such as the mode and style in which the counselor will be working, their licensure credentials, the scope of their practice, as well as insurance coverage benefits to expect in counseling. Once a client has been provided this information, they can make an educated and informed decision about their choice of counselor. Counselors also have an ethical responsibility to make sure they are providing this information to their clients and following the rules that govern the profession. The client’s right to know is not negotiable, and the ethical responsibility of the counselor is absolute.
It is important to remember that contrary to some previous disposition, the ACA is a private voluntary association and does not provide any specific authority over licensed professional counselors. Their right to write and enforce their Code of Ethics resides in the fact that their members voluntarily sign the document, and therefore, it is a contract. In order to bind an individual, a contract must be clear, unambiguous , and not open to multiple reasonable interpretations. It is clear and not ambiguous that a member must adhere to the Code of Ethics as adopted by the American Counseling Association. Professional counselors need to apply these principles to their own practice by remembering that clients have a right to be informed of their qualifications, their licensure status, their membership status in professional association, their mode and style of clinical practice, their usual fee schedule, how often they will be meeting in counseling sessions, and any issues that may impact their ability to provide treatment. Only then can the client be assured that they are informed and equipped to make a choice. A right to talk privately with another counselor for personal support is not based on a Code of Ethics but on the rules of civil society. This right should be afforded to clients and respected by counselors. Professional counselors are aware that many clients have fears or concerns when initially beginning treatment that will prevent them from disclosing everything that impacts their ability to understand their issues. This is a common and expected behavior in treatment and does not in any way prevent the counselor from assuring confidentiality that is provided to clients. All other informed consent rights and responsibilities between the counselor and client are based on the common law tradition and are also based on their ability to make an informed and educated decision about what it is they expect from their counselor. Of course, the configurations of their rights can be complicated, but they need to be made as simple as possible. By simplistically breaking down each part of the right, explaining what it means, and how it is an absolute duty is the best way for the counselor to provide it.