AMERICAN COUNSELING
ASSOCIATION
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Copyright © 2015 by the American Counseling Association. All rights reserved.
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American Counseling Association
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Associate Publisher Carolyn C. Baker
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Copy Editor Kay Mikel
Editorial Assistant Catherine A. Brumley
Cover and text design by Bonny E. Gaston.
Library of Congress Cataloging-in-Publication Data
Herlihy, Barbara, author, editor.
ACA ethical standards casebook/Barbara Herlihy, Gerald Corey.—Seventh edition.
p. ; cm.
American Counseling Association ethical standards casebook
ACA ethical standards casebook / Barbara Herlihy, Gerald Corey [editors].
Includes bibliographical references and index.
ISBN 978-1-55620-321-3 (pbk. : alk. paper)
I. Corey, Gerald, author, editor. II. American Counseling Association, issuing
body. III. American Counseling Association. ACA ethical standards casebook.
Preceded by (work): IV. Title. V. Title: American Counseling Association ethical
standards casebook.
[DNLM: 1. American Counseling Association. 2. Counseling—standards—
United States—Practice Guideline. 3. Ethics, Professional—United States—Practice
Guideline. WM 55]
BF637.C6
174’.91583—dc23
2014008225
To our student readers—the next generation of
counseling professionals who will guide us
through uncharted waters.
Table of Contents
Acknowledgments
About the Authors
About the Contributors
Making the Best Use of the Casebook
Part I Introduction
ix
xi
xiii
xvii
1
Evolution of the ACA Ethical Standards
and the Casebook
Perry C. Francis
Foundations of Codes of Ethics
Barbara Herlihy and Gerald Corey
Developing a Personal Ethical Stance
The Ethical Decision-Making Process
4
12
15
15
A Review of Ethical Decision-Making Models
16
Melissa D. Deroche, Emeline Eckart, Earniesha Lott,
Candace N. Park, and Latrina Raddler
Elements of Ethical Decision Making
Barbara Herlihy and Gerald Corey
20
Enforcement of the ACA Code of Ethics
23
An Inventory of Your Attitudes and
Beliefs About Ethical Issues
25
Part II ACA Code of Ethics With Illustrative Vignettes 33
Section A
The Counseling Relationship
•v•
37
Table of Contents
Section B
Confidentiality and Privacy
55
Section C
Professional Responsibility
66
Section D
Relationships With Other Professionals
78
Section E
Evaluation, Assessment, and Interpretation
82
Section F
Supervision, Training, and Teaching
93
Section G
Research and Publication
114
Section H
Distance Counseling, Technology,
and Social Media
125
Section I
Resolving Ethical Issues
133
Part III Issues and Case Studies
Chapter 1
Client Rights and Informed Consent
Gerald Corey and Barbara Herlihy
Case Study 1: Keep Kendra’s Secret, or Not?
Kelly L. Wester
Case Study 2: A Minor (?) Client
J. Scott Young
139
143
147
150
Chapter 2
Social Justice and Counseling Across Cultures 155
Courtland C. Lee
Case Study 3: She’s Done This Before
162
William B. McKibben and Jodi L. Bartley
Case Study 4: Working With an
Immigrant Family
164
Laura M. Gonzalez
Chapter 3
Confidentiality
Barbara Herlihy and Gerald Corey
Case Study 5: The Slap—How to
Best Help Hope
Chris C. Lauer
• vi •
169
176
Table of Contents
Case Study 6: A Supervisee Feels Betrayed
Adria Shipp
Chapter 4
Competence
Gerald Corey and Barbara Herlihy
Case Study 7: I Feel Exhausted
Isabel A. Thompson
Case Study 8: Couples Counseling
Gone Wrong
Jennifer M. Johnson
Chapter 5
Managing Value Conflicts
Barbara Herlihy and Gerald Corey
Case Study 9: I’m Stuck
Anneliese A. Singh
Case Study 10: A Parental Dilemma:
Hastening the Death of a Child
Karen Swanson Taheri
Chapter 6
Counseling Minor Clients
Mark Salo
Case Study 11: A Legal Guardian Presses
for Confidential Information
Amanda Crawford
Case Study 12: A Pregnant Teenager:
A School Counselor’s Quandary
Danielle Shareef
Chapter 7
Managing Boundaries
Gerald Corey and Barbara Herlihy
Case Study 13: Disputing Unhealthy Beliefs
or Imposing Values?
Craig S. Cashwell and Tammy H. Cashwell
Case Study 14: If You Will Excuse Me
Matthew L. Lyons
179
183
187
189
193
198
202
205
207
211
215
223
226
Chapter 8
Working With Clients Who May Harm Themselves 231
James L. Werth Jr. and Jennifer Stroup
Case Study 15: Suicide or a Well-Reasoned
End-of-Life Decision?
237
James L. Werth Jr. and Jennifer Stroup
• vii •
Table of Contents
Case Study 16: A Suicidal Teenager
Robert E. Wubbolding
240
Chapter 9
Technology, Social Media, and
Online Counseling
245
Martin Jencius
Case Study 17: Making Social Media Decisions
for an Agency
254
Martin Jencius
Case Study 18: A Client’s Friend Request
256
Martin Jencius
Chapter 10
Supervision and Counselor Education
259
Barbara Herlihy and Gerald Corey
Case Study 19: Poor Supervision or
Impaired Student?
264
Edward Neukrug and Gina B. Polychronopoulos
Case Study 20: An Imposition of Values?
268
Alwin E. Wagener
Chapter 11
Research and Publication
Richard E. Watts
Case Study 21: Expert Review of a
Research Study
Richard E. Watts
Case Study 22: A Question of Authorship
Richard E. Watts
273
275
277
Chapter 12
The Intersection of Ethics and Law
281
Burt Bertram and Anne Marie “Nancy” Wheeler
Case Study 23: A Student Commits Suicide
283
Burt Bertram and Anne Marie “Nancy” Wheeler
Case Study 24: Good Intentions Go Awry
286
Burt Bertram and Anne Marie “Nancy” Wheeler
Highlights of Ethical Practice
References
Index
• viii •
289
293
303
Acknowledgments
This seventh edition of the Casebook is truly the product of the collaborative efforts of many people over time.
Many individuals contributed to the development of the 2014 ACA Code
of Ethics. The ACA Ethics Revision Taskforce, chaired by Perry C. Francis,
worked from 2011 through 2013 to develop proposed revisions to the 2005
Code of Ethics. Many ACA members also gave helpful input during the
comment period for the draft of the Code. Although we cannot thank them
all by name, this is their book too.
We thank the following doctoral students at the University of New
Orleans who contributed many of the illustrative vignettes that appear
in Part II: Drew David, Melissa D. Deroche, Emeline Eckart, Angela E.
James, Earniesha Lott, Panagiotis Markopoulos, Candace N. Park, Latrina
Raddler, and Karen Swanson Taheri. They updated numerous vignettes
for standards that appeared in the 2005 Code of Ethics and created new
vignettes for standards that appeared for the first time in the 2014 Code,
particularly in Section H.
We appreciate the prerevision review of the prior edition of this book
with helpful feedback that we considered in the revision of this 7th edition. These people were Jane Rheineck, Dale-Elizabeth Pehrsson, and
Mee-Gaik Lim.
It has been a joy to work with the capable and conscientious publications
staff at ACA. Carolyn Baker’s prompt and careful attention throughout
the production process is greatly appreciated, as always. We thank Kay
Mikel for her skillful editing of this edition.
• ix •
About the Authors
Barbara Herlihy, PhD, LPC, LPC-S, is University Research Pro-
fessor in the Counselor Education graduate program at the University
of New Orleans. She has served on the ACA Ethics Committee as chair
(1987–89) and as a member (1986–87, 1993–94) and as a member of the
taskforces to revise the 1995 and 2005 ACA codes of ethics.
Dr. Herlihy is the coauthor of several books on ethical issues in counseling: Ethical, Legal, and Professional Issues in Counseling (2014) with
Ted Remley; the ACA Ethical Standards Casebook, 5th and 6th editions
(1996, 2006), Dual Relationships in Counseling (1992), and Boundary Issues in Counseling: Multiple Roles and Relationships, 2nd and 3rd editions
(2006, 2015), all with Gerald Corey; and the ACA Ethical Standards Casebook, 4th edition (1990) with Larry Golden. She is also the author or
coauthor of more than 65 journal articles and book chapters on ethics,
social justice and multicultural counseling, feminist therapy, and other
topics. She is the recipient of the Southern Association for Counselor
Education and Supervision Courtland Lee Social Justice Award and the
Association for Counselor Education and Supervision Distinguished
Mentor Award. She is a frequent presenter of seminars and workshops
on ethics across the United States and internationally, most recently in
Malta, Venezuela, and Mexico.
Gerald Corey, EdD, ABPP, NCC, is a Professor Emeritus of Human
Services and Counseling at California State University at Fullerton. He
is a Diplomate in Counseling Psychology, American Board of Professional Psychology; a licensed counseling psychologist; and a Fellow of
the American Counseling Association, the Association for Specialists
• xi •
About the Authors
in Group Work (ASGW), and the American Psychological Association,
in both Division 17 and Division 49. He is the recipient (with Marianne Schneider Corey) of both the Lifetime Achievement Award from
the American Mental Health Counselors Association in 2011 and the
ASGW’s Eminent Career Award in 2001.
Dr. Corey has authored or coauthored 15 textbooks in counseling that
are currently in print, has made five educational DVD programs on
various aspects of counseling, and has written numerous journal articles and book chapters. Some of his coauthored books include Issues
and Ethics in the Helping Professions (2015) with Marianne Schneider Corey, Cindy Corey, and Patrick Callanan; Becoming a Helper (2016) and I
Never Knew I Had a Choice (2014), both with Marianne Schneider Corey;
and Groups: Process and Practice (2014) with Marianne Schneider Corey
and Cindy Corey. Some of his other books include Theory and Practice
of Counseling and Psychotherapy (2013) and Theory and Practice of Group
Counseling (2016). In the past 40 years the Coreys have conducted group
counseling training workshops for mental health professionals at many
universities in the United States as well as in Canada, Mexico, China,
Hong Kong, Korea, Germany, Belgium, Scotland, England, and Ireland.
• xii •
About the
Contributors
Jodi L. Bartley, MA, MEd, is a doctoral student in the Department of
Counseling and Educational Development at the University of North
Carolina at Greensboro.
Burt Bertram, PhD, is in private practice in Orlando, Florida, and is an adjunct faculty member in the Graduate Studies in Counseling Program
at Rollins College in Winter Park, Florida.
Craig S. Cashwell, PhD, is Professor in the Department of Counseling
and Educational Development at the University of North Carolina at
Greensboro.
Tammy H. Cashwell, PhD, is Visiting Assistant Professor at Wake Forest
University.
Amanda Crawford, MS, is a middle school counselor who works in Acadia, Montana.
Melissa D. Deroche, MEd, is a doctoral student in the Counselor Education Program at the University of New Orleans.
Emeline Eckart, MS, is a doctoral student in the Counselor Education
Program at the University of New Orleans.
Perry C. Francis, EdD, is Professor and Counseling Clinic Coordinator at
Eastern Michigan University.
Laura M. Gonzalez, PhD, is Assistant Professor in the Department of
Counseling and Educational Development at the University of North
Carolina at Greensboro.
Martin Jencius, PhD, is Associate Professor of Counseling at Kent State
University.
Jennifer M. Johnson, PhD, is Assistant Professor in the Counselor Education Program at the University of New Orleans.
• xiii •
About the Contributors
Chris C. Lauer, MS, is a graduate student in the master’s degree program
in counseling at the University of New Orleans.
Courtland C. Lee, PhD, is Professor in the Department of Counselling at
the University of Malta.
Earniesha Lott, MEd, is a doctoral student in the Counselor Education
Program at the University of New Orleans.
Matthew L. Lyons, PhD, is Assistant Professor in the Counselor Education Program at the University of New Orleans.
William B. McKibben, MS, is a doctoral student in the Department of
Counseling and Educational Development at the University of North
Carolina at Greensboro.
Edward Neukrug, EdD, is Professor of Counseling and Human Services
at Old Dominion University.
Candace N. Park, MA, is a doctoral student in the Counselor Education
Program at the University of New Orleans.
Gina B. Polychronopoulos, MS, MSEd, is a doctoral student in counselor
education and supervision at Old Dominion University.
Latrina Raddler, MEd, is a doctoral student in the Counselor Education
Program at the University of New Orleans.
Mark Salo, MEd, is a counselor at Sacajewea Middle School in Bozeman,
Montana.
Danielle Shareef, MEd (deceased), was a doctoral candidate in the Counselor Education Program at the University of New Orleans.
Adria Shipp, PhD, is an Adjunct Professor in the Department of Counseling and Educational Development at the University of North Carolina
at Greensboro.
Anneliese A. Singh, PhD, is Associate Professor in the Department of
Counseling and Human Development Services at the University of
Georgia.
Jennifer Stroup, MS, is a doctoral student in counseling psychology at
Radford University.
Karen Swanson Taheri, MA, is a doctoral student in the Counselor Education Program at the University of New Orleans.
Isabel A. Thompson, PhD, is Assistant Professor in the Mental Health
Counseling Program at the Center for Psychological Studies at Nova
Southeastern University.
Alwin E. Wagener, MS, is a doctoral student in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.
Richard E. Watts, PhD, is University Distinguished Professor and Director of the Doctoral Program in Counselor Education at Sam Houston
State University.
James L. Werth Jr., PhD, is Behavioral Health and Wellness Services Director for Stone Mountain Health Services headquartered in Pennington Gap, Virginia.
• xiv •
About the Contributors
Kelly L. Wester, PhD, is Associate Professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.
Anne Marie “Nancy” Wheeler, JD, is an attorney who operates the Risk
Management Service for the American Counseling Association; she
also is an affiliate faculty member with the Pastoral Counseling Graduate Program at Loyola University Maryland.
Robert E. Wubbolding, EdD, is Professor Emeritus of Counseling at Xavier University, Cincinnati, Ohio, and Director of the Center for Reality
Therapy; he was Director of Training, William Glasser Institute, 1988
to 2011.
J. Scott Young, PhD, is Professor of Counselor Education in the Department of Counseling and Educational Development at the University of
North Carolina at Greensboro.
• xv •
Making the Best Use of
the Casebook
We hope students and seasoned practitioners of counseling will find this Casebook to be a valuable resource. We believe the Casebook can be utilized effectively
in an ethics course or in a practicum or internship experience to help future
members of our profession learn about their ethical responsibilities and ways
to address ethical dilemmas. The vignettes that illustrate the standards help to
clarify their intent and provide examples of appropriate practice.
The 12 chapters in this book examine an array of ethical issues: client
rights and informed consent; social justice and counseling across cultures;
confidentiality; competence; managing value conflicts; counseling minor
clients; managing boundaries; working with clients who may harm themselves; technology, social media, and online counseling; counselor education and supervision; research and publication; and the intersection of
ethics and law.
Each of the 12 chapters is followed by two case studies that illustrate
some of the issues examined in the chapter. Each case study presents an
ethical dilemma and is followed by questions for thought and discussion,
an analysis of the case, and additional questions for further reflection. Students have often told us that they had never thought about certain ethical
questions until they were confronted with cases that raised difficult issues
or posed dilemmas that could not be neatly resolved. This Casebook gives
students an opportunity to examine many ethical issues before they confront them in practice. As you read each of the case studies, put yourself
in the role of a consultant to the professional described in the case. If this
person were to consult you regarding the case, what would you want to
say? You can also assume the role of the counselor, student, supervisor, or
professor in the case and reflect on how you might deal with the situation.
• xvii •
Making the Best Use of the Casebook
For experienced counselors, we hope the Casebook serves as a vehicle
for continuing education and that you use the material to further your aspirational ethics. As you read, reflect, and discuss the material with your
colleagues, ask yourselves: “How can I best monitor my own behavior?”
“How can I apply relevant standards to situations I encounter?” “How can I
develop increased ethical sensitivity?” “How can I ensure that I am thinking
about what is best for my clients, my students, or my supervisees?”
We believe that ethics is best viewed from a developmental perspective.
We may look at issues in one way as students; later, with time and experience, our views are likely to have evolved. Ethical reasoning takes on
new meaning as we encounter a variety of ethical dilemmas. Professional
maturity entails being willing to question ourselves, to discuss our doubts
with colleagues, and to engage in continual self-monitoring.
• xviii •
Part I
Introduction
•1•
Introduction
Perry C. Francis, Gerald Corey,
and Barbara Herlihy
Counselors may rely on the ACA Code of Ethics to guide them in their work
without having given much thought to why, when, and how the Code
came into being. Students, as well, may learn the Code without realizing
that it has a developmental history that spans more than 50 years. Take a
moment to reflect on how you would answer these questions:
• Why does the counseling profession need a code of ethics? What
purposes does it serve?
• Who created the ACA Code of Ethics?
• Why does the Code change periodically? How often is it revised?
Who makes the revisions?
• How can an ethical dilemma best be resolved? What is the best process for ethical decision making?
• How is the ACA Code of Ethics enforced?
Answers to these questions are offered in this introductory section of the
Casebook to provide a context for the more detailed examination of the
ACA Code of Ethics that follows. We begin with a brief “history lesson” by
Perry C. Francis (Chair, 2014 ACA Ethics Revision Taskforce), that illuminates how and when the counseling profession first recognized the need
for a formal code of ethics, how it came into existence, and how it has
evolved over time. This history will help you gain an appreciation for the
extensive process that goes into creating and updating the Code.
•3•
ACA Ethical Standards Casebook
Evolution of the ACA Ethical Standards
and the Casebook
Perry C. Francis
The creation and continuing revision of a code of ethics are part of the
natural development of any profession. A code of ethics is a living document that changes as the profession grows and changes. As the counseling profession has evolved from its early roots in the field of guidance,
counselors have developed an increasingly sophisticated understanding
of their interactions with clients and the boundaries of those interactions
(Herr, 2011). This evolution is reflected in the successive iterations of our
ethical standards, which have existed for more than 50 years.
In 1953, Donald Super, then president of the newly formed American
Personnel and Guidance Association (APGA), recognized that a group
of practitioners cannot fully develop into a profession without an established code of ethics (Francis & Dugger, 2014). Super appointed a committee to develop an ethics code for the emerging counseling profession.
Eight years later (1961), the first Code of Ethics for the APGA was adopted
by its governing body. Shortly after that, in 1963, the APGA Ethics Committee began to collect case examples and incidents that could illustrate
the standards of care that were becoming the norm for the practice of
the profession. The collected information formed the basis for the first
edition of the Ethical Standards Casebook, which was published in 1965.
One constant in our world today is change, and the ACA Code of Ethics
is no exception. As society has changed and the counseling profession has
responded to those changes and redefined the boundaries of competent
practice, the Code of Ethics has also evolved. Including the 1961 Code, the
American Counseling Association (ACA) and its previous incarnations
(APGA and the American Association for Counseling and Development
[AACD]) has had seven different codes of ethics (published in 1961, 1974,
1981, 1988, 1995, 2005a, 2014). Each has reflected the changing nature of
society, the growing body of knowledge about counseling, and the changing requirements within the profession. With each subsequent revision
also came a revision of the Casebook.
The codes developed by the APGA and AACD from 1961 through
1988 were generic in nature and did not reflect the many specialties that
had developed within the profession (such as school, group, and mental
health counseling). By 1993, 7 of the 16 ACA divisions (ASCA, ARCA,
ASGW, AMHCA, ACPA, ACES, and IAMFC) and two national certification boards (NBCC and CORE) had promulgated their own ethics codes
(Herlihy & Remley, 1995), and this proliferation of codes caused confusion among professional counselors and state licensure boards. A new,
broader code of ethics was needed that could address the diverse spe-
•4•
Introduction
cialties within the field, incorporate the many concerns and standards
of each specialty, and include new areas of ethical concern that were not
included in the previous codes. The result was the Code of Ethics and Standards of Practice (ACA, 1995).
Over time, a pattern developed in which the Code of Ethics and Casebook
were being revised about every 7 to 10 years. In 2002 the president of ACA
(David Kaplan) appointed Michael M. Kocet as the chair of the 2005 Ethics
Revision Taskforce. The taskforce invited ACA members as well as divisions,
state licensure boards, and accrediting agencies to give input into the first
draft and feedback after the release of this draft. Two town hall meetings also
were held at the ACA conventions in 2004 and 2005 to give members the opportunity to directly address the entire Ethics Revision Taskforce and offer
their input and feedback. In 2005, after approval of the Governing Council of
the ACA, the new Code of Ethics was released. In contrast to the original (1961)
Code of Ethics, which was five pages long and had no glossary, the 2005 Code
was 24 pages long and had an 18-word glossary. The sixth edition of the Casebook was published the following year (Herlihy & Corey, 2006).
Six years following approval of the 2005 ACA Code of Ethics, Marcheta
Evans, president of ACA, started the revision process that led to the current 2014 Code. A taskforce was appointed in 2011 and work was begun. As
with the previous revisions, input was invited from the members of ACA,
ACA divisions, state licensing boards, and national certification bodies.
Numerous meetings and conference calls were held, along with town hall
meetings at the ACA Conference & Expo in 2012 and 2013. At the same
time, the editors of the sixth edition of the Casebook were contracted to
produce the seventh edition to ensure that a relevant casebook would be
available to illustrate the application of the newly adopted Code.
The 2014 ACA Code of Ethics Revision Process
Each revision of the ACA Code of Ethics is a reflection of the changing nature of our profession; the continued expansion of our profession’s body
of knowledge; the evolving expectations we have placed upon ourselves
as we work with clients, students, and one another; and the changes in the
world in which we live and work. As with any revision, work must begin
with an examination of the previous document, in this case the 2005 Code
of Ethics. I wish to acknowledge the fine work of our predecessors who
provided the foundation of the 2014 taskforce’s revision.
Building on the 2005 Code, the taskforce for the 2014 Code expanded
the glossary; added a new section specifically addressing distance counseling, social media, and technology-related issues that previously were
addressed only in Section A; and sought to address and clarify the many
issues that have arisen since publication of the 2005 Code. In doing so we
sought to provide our profession with an up-to-date document that will
provide direction and guidance until the next revision.
•5•
ACA Ethical Standards Casebook
The Charge to the Taskforce
The revision process began with the selection of the taskforce. Eleven
professionals were chosen from a large pool of applicants. They included
counselor educators, practitioners, and one student. Each had an extensive background in the field through service, publications and presentations, and/or practice. A balance was sought to ensure that the members’
backgrounds represented the many subspecialties in our field (including
mental health, rehabilitation, school, college, addictions). Members were
Perry C. Francis (Chair), Jeannette Baca, Janelle Disney, Gary Goodnough,
Mary Hermann, Shannon Hodges, Lynn Linde, Linda Shaw, Shawn Spurgeon, Richard Watts, and Michelle Wade (student). They were joined by
ACA staff members David Kaplan (ACA Chief Professional Officer) and
Erin Martz (ACA Ethics Director), who served as liaisons. Our task was
not only to update the 2005 Code of Ethics but to address the ethical issues
surrounding the changing nature of how we provide services through
the use of technology. The continued expansion of technology required
us to develop standards beyond those that were offered in the 2005 Code.
We sought to clarify how professional counselors can ethically navigate
the intersection of the values and moral principles of our profession, the
personal values of the counselor, and the values of the client within the
counseling session and beyond. Finally, we addressed issues that had
been identified as needing additional clarification or revision since the
previous revision (e.g., values-based referrals, managing boundaries, endof-life care).
The Revision Process
The taskforce met monthly via conference calls and held additional faceto-face meetings at three ACA conferences and four other times in Alexandria, Virginia. In between the conference calls and face-to-face meetings,
the members regularly communicated with one another via email and listserv posts. Working groups were created to focus on each specific section
of the Code to identify, discuss, and offer recommendations to the larger
taskforce during its regularly scheduled meetings. In addition, a working
group was assigned to create a new section of the Code dealing specifically
with technology, social media, and distance counseling. Each working
group was also assigned the task, where appropriate, of addressing the
use of technology within each section of the Code to ensure that technology, social media, and distance counseling were infused throughout the
Code. The entire taskforce reviewed, discussed, and debated each change,
addition, and deletion suggested by the working groups as well as the
work of the group as a whole until the final draft was created.
No revision is accomplished in a vacuum. The taskforce sought feedback and suggestions from multiple sources through multiple means.
ACA members were invited to offer feedback and suggestions through
•6•
Introduction
a dedicated page on the ACA website as the revision process began. The
members were also invited, through the same process, to offer feedback
on the first draft of the revision. As noted previously, the taskforce held
two town hall meetings at each ACA conference (San Francisco, 2012, and
Cincinnati, 2013) prior to the release of the final draft. Many members
used each opportunity to offer (in some cases passionately) information,
suggestions, criticism, and accolades about the direction the revisions
were taking. This feedback was very influential in the creation of the new
section, the revision of existing sections, and the overall direction of the
revision process. Suggestions and feedback were also sought from each
division of the ACA, state licensing boards, and ethical and legal scholars who had expertise in particular areas under review. Many members
of the taskforce, as well as counselor educators across the country, used
the revision process as a tool in their courses. This provided an excellent
opportunity for students to examine in detail the first draft of the Code,
and it provided the taskforce with students’ perspectives on the revisions.
These future professionals reminded the taskforce that the Code needs to
be understandable not only to the seasoned professional but also to the
new professional entering the field.
This process was not without its bumps and its smooth patches. Each
member of the taskforce held strong opinions, had an in-depth knowledge
of the practice of counseling as well as the ethical foundations of why we
do the things we do, and was not afraid to voice her or his opinion. When
we lacked information, we consulted with others who had the knowledge
we needed and incorporated their suggestions into our work. At no time
was a voice not heard and respected, an opposing opinion not deeply considered, or the views of the many different specialties of counseling not
measured. In the end, strong friendships were made, old friendships were
strengthened, and a new Code was drafted.
The 2014 Code of Ethics is not solely the work of 13 people. It is also the
work of hundreds of others who offered their wise guidance, fervent opinions, researched suggestions, and years of experience in the field to create
a Code that will guide the profession of counseling in the years ahead. At
the same time, the next revision will be unofficially in the works even as
we begin to use the 2014 Code. Our body of knowledge will grow, methods
of service delivery will change, and the profession will continue to evolve.
That evolution will require future revisions of the Code of Ethics and the
Casebook as we continue to support the work of professional counselors.
Major Changes in the 2014 ACA Code of Ethics
From 1995 to 2014, the ACA Code of Ethics contained eight major sections,
plus a Preamble; in 2014, a new section was added on distance counseling,
technology, and social media. The specific standards included under each
section are presented in detail in Part II of the Casebook. Here, I introduce
•7•
ACA Ethical Standards Casebook
the major sections of the 2014 Code, briefly describe their contents, and
highlight three of the major issues the new Code addresses.
Preamble and Purpose
Describes the six main purposes of the Code, discusses ethical decision making, and articulates the professional values of the counseling profession.
Section A: The Counseling Relationship
Addresses ethical practice in initiating, conducting, and ending the
counseling relationship. Includes standards related to client welfare, informed consent, clients served by others, avoiding harm and
imposing values, relationship boundaries, advocacy, working with
multiple clients and groups, fees and business practices, and termination and referral.
Section B: Confidentiality and Privacy
Presents standards related to protecting the client’s privacy and maintaining confidentiality. Includes exceptions to confidentiality, working
with groups and families and clients who lack the capacity to give informed consent, record keeping and documentation, and consultation.
Section C: Professional Responsibility
Includes ethical obligations related to competence, accurate representation of qualifications, nondiscrimination, responsibilities to the
public and other professionals, and treatment modalities.
Section D: Relationships With Other Professionals
Offers guidelines for relationships with colleagues, employers, and
employees and for providing consultation services.
Section E: Evaluation, Assessment, and Interpretation
Provides standards for the use and interpretation of assessment instruments; informed consent in assessment; release of data; diagnosis;
selecting, administering, scoring, interpreting, constructing, and
securing assessment instruments; attending to multicultural issues
in assessment; and forensic evaluation.
Section F: Supervision, Training, and Teaching
Presents standards related to counselor supervision; responsibilities
of supervisees, students, and counselor educators; student welfare,
evaluation, and remediation; roles and relationships; and multicultural competence.
Section G: Research and Publication
Offers guidance on rights and responsibilities of researchers and
participants; managing boundaries; reporting results; and publications and presentations.
Section H: Distance Counseling, Technology, and Social Media
This new section covers informed consent, privacy, and security of
electronic communications; distance counseling; web and records
maintenance; and social media.
•8•
Introduction
Section I: Resolving Ethical Issues
Describes the relationship of ethical standards and the law, dealing
with suspected violations, and cooperation with the ethics committee.
There are numerous differences between the 2005 and 2014 ACA Code of
Ethics. For those of you familiar with the 2005 Code, I offer a brief description of major changes in three selected areas: distance counseling, technology, and social media; professional versus personal values; and the counseling relationship (boundaries).
Distance Counseling, Technology, and Social Media
In the early 1990s, the counseling profession was just beginning to address
the advent of email, chat rooms, and websites in the delivery of services.
Social media (such as Facebook and Twitter) and related applications are
now ubiquitous in our world and are often used by counselors to provide
a professional presence on the Internet. Counselors use virtual reality environments, among other electronic platforms and programs, to provide
counseling services to clients within their state, across state lines, and, in
some cases, in other countries. This advancement in computer technology
has gone beyond what could have been anticipated just a few years ago.
The 2005 Code addressed the use of technology applications within the
“Counseling Relationship” section. That subsection now has its own section
and has been updated and expanded to reflect current issues when using
electronic means to provide services, store records, advertise services, and
communicate with clients. The 2014 taskforce made the decision not only
to create a separate section for distance counseling, technology, and social
media but also to infuse it into several other sections. Although technology
is not a new issue for the counseling profession, the speed at which technology is changing our world and the way we provide counseling services will
challenge the application of the 2014 Code in the years ahead.
Values
One cannot study ethics without understanding the role of professional
and personal values in the art and science of counseling. To begin to understand values, I offer two definitions:
• “Value (noun): A moral, social, or aesthetic principle accepted by an
individual or society as a guide to what is good, desirable, or important” (American Psychological Association, 2007, p. 975).
• Values: “principles, or criteria, for selecting what is good (or better,
or best) among objects, actions, ways of life, and social and political institutions and structures. Values operate at the levels of individuals,
or institutions and entire societies” (Schwartz, 1990, p. 8, as quoted
in Kelly, 1995, p. 648).
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ACA Ethical Standards Casebook
As part of the revision process, the taskforce sought to revise the professional values statement in the Preamble of the 2005 Code, which stated,
“Professional values are an important way of living out an ethical commitment. Values inform principles. Inherently held values that guide
our behaviors or exceed prescribed behaviors are deeply ingrained in
the counselor and developed out of personal dedication, rather than the
mandatory requirement of an external organization” (p. 3). This statement
pointed to the professional values of counseling but did not define them.
One purpose in revising the preamble to identify the basic values of the
counseling profession and provide the definition of counseling (as presented by the 20/20 Future of Counseling Taskforce) was to help those
seeking to enter the profession to develop a “professional ethical identity”
(Handelsman, Gottlieb, & Knapp, 2005, p. 59). This development is part of
acculturating our students to the expectations of the profession. Handelsman and colleagues (2005) point out that this acculturation does not stop
with ethics. It includes all that we do (education, practice, supervision) as
we prepare to enter practice and continue on as professionals.
The taskforce sought to provide more direction and clarification in the
Preamble and elsewhere in the Code because questions had arisen during
court challenges to the Code of Ethics (e.g., Ward v. Wilbanks, 2010; Keeton
v. Anderson-Wiley, 2010). By identifying the basic values of counseling, the
taskforce sought to strengthen the foundation for other sections of the Code
that deal with referrals, competence, discrimination, and the prohibition of
the imposition of personal values on our clients. A new standard (ACA, 2014,
Standard A.11.b.) specifically instructs counselors to refrain from making referrals based solely on a personal values conflict the counselor may have with
the client’s values, behavior, or lifestyle. This issue is specifically connected in
the Code to our nondiscrimination stance as a professional association as well
as to issues of competency and respect for diversity.
The Counseling Relationship
The 2005 Code of Ethics acknowledged and contributed to the paradigm
shift that was taking place with respect to how we conceptualize our relationships with our clients and students. We were now required to carefully think through, for example, how the simple act of attending a client’s
life ceremony (such as a graduation or wedding) could be beneficial or
harmful to the therapeutic process. No longer do we have the luxury of
simply saying that all dual relationships are forbidden; we are now challenged to work with clients to examine the ramifications of those complex
connections. The 2014 revision sought to provide clarification about those
difficult connections. To whom, for example, can a counselor provide services within a client’s extended family? What must a counselor educator consider before initiating a nonacademic relationship with a former
student? The taskforce had long and fruitful discussion as they worked
through these and other issues.
• 10 •
Introduction
The taskforce also struggled with how to protect the potential client’s
right to confidentiality prior to the initiation of the counseling process.
Protecting the potential client’s confidentiality had to be weighed against
the question of when a person officially becomes a client.
A Personal Reflection
I distinctly remember the day Marcheta Evans, then president of ACA, called
to inform me that not only was I being named to the Ethics Revision Taskforce, I was being appointed as the chair. It took several days for the news to
sink in. It was even more overwhelming when I reviewed the list of names of
those who had also been appointed. As the process moved forward and the
group began to coalesce, I realized I would not so much be leading as I would
be providing structure to an experienced, erudite, and enjoyable group of
professionals who would quickly become friends who had been brought together with the singular focus of providing the ACA membership with a Code
revision that would move us forward as a profession.
At times, as we discussed the finer points of ethics and practice, I would
sit back in my chair and marvel at the quality of the dialogue, the genuine
respect that was extended to all, and the willingness to listen to others
who disagreed with a stated opinion. That is not to say we did not have
animated discussions or that we always had unanimous agreement. Quite
the contrary, but more often than not we enjoyed one another’s company
while working together on the task at hand.
At times we found ourselves becoming overly academic or too focused
on minor points. Inevitably, a taskforce member would ask the assembled
group how a proposed standard would be lived out by the professional
counselor in the field. When we seemingly found a solution to a particularly difficult issue, we would ask ourselves how our solution would affect the practice of the professional counselor in a rural area, a school, or
a small private practice. We worked to ensure that the revision provided
appropriate guidance to the profession as inclusively as possible.
As the process moved forward, I was also deeply moved by the quality
of the feedback received from the membership of ACA, the many passionate responses and reactions to the first draft of the 2014 Code, and the depth
of knowledge and experience the membership provided to the taskforce. I
remember in particular one woman at a town hall meeting who was commenting on the issue of discriminatory values and referrals. Although she
and I would disagree, it was clear that she cared deeply about her clients
and truly wanted to ensure that they received the best care available to
help them improve their lives and decrease their suffering. On another
occasion, I became frustrated as I read another member’s feedback to the
taskforce that disagreed with my concepts about a particular point in the
revised Code. As I reflected upon my emotional response, I came to realize that I was not so much frustrated that the respondent disagreed with
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ACA Ethical Standards Casebook
me but that his comments had merit, were worthy of consideration and
discussion, and required me to widen my own understanding about that
particular issue. This became an opportunity for my own growth and understanding and benefited me personally as well as professionally.
I will miss my regular meetings with this group of colleagues. In the
almost 3 years of our work together we have not only discussed the finer
points of ethical principles and practice but have formed close relationships, shared some joys and sorrows, and learned from one another for the
benefit of ourselves, our students, and our professional colleagues. It has
been one of the highlights of my professional career.
Foundations of Codes of Ethics
Barbara Herlihy and Gerald Corey
Ethics codes of organizations of mental health professionals serve a number of purposes. They communicate to members of the organization, as
well as to the public, the professional identity and commonly held collective values and principles of the profession, the basic norms and expectations for practitioners, and “the normative orientation to the service
of others and a commitment to protect the welfare of clients” (Francis &
Dugger, 2014, p. 131). One of the basic functions of a code is to educate
members about sound ethical conduct. As professional counselors, we
rely on the ethical standards of ACA to guide us in our work. Reading and
reflecting on the standards can help us to expand our awareness, clarify
our personal and professional values, and subsequently inform our clients
about our professional responsibilities. For example, the 2014 ACA Code of
Ethics challenges counselors to reflect on the values of the profession by
listing the “core professional values of the counseling profession” (Preamble) and later reinforcing that “Counselors are aware of—and avoid
imposing—their own values, attitudes, beliefs, and behaviors” (Standard
A.4.b.). When applying the standards to our own practices, significant
questions may be raised, most of which will not have simple or definitive
answers. Applying the ethical guidelines to particular situations demands
a keen ethical sensitivity and an open mind.
A second function of ethical standards is to provide a mechanism for
professional accountability. The ultimate end of a code of ethics is to protect the public. ACA, through enforcement of its Code of Ethics, holds its
members accountable to the standards it has set forth. In addition, the
Code of Ethics seeks to provide guidance that informs the practice of counseling provided by all professional counselors and counselors-in-training.
As professional counselors, we have an obligation not only to monitor our
own behavior but to encourage ethical conduct in our colleagues, whether
or not they are members of ACA.
• 12 •
Introduction
Codes of ethics also serve as a catalyst for improving practice. No ethics code, no matter how lengthy or precisely worded, can address every
situation counselors might encounter in their work. Therefore, it is crucial
that we read the Code with an eye to both its letter and its spirit and that
we strive to understand the intentions that underlie each standard. This
requires us to consider both mandatory and aspirational ethics. There is a
very real difference between merely following the Code of Ethics and living
out a commitment to practice with the highest ideals.
Mandatory ethics describes a level of ethical functioning at which
counselors act in compliance with minimal standards. By complying with
these basic musts and must nots, counselors can meet the letter of the ethical standards of their profession. A rule-based approach to ethics is very
limited in providing meaningful assistance to counselors who are concerned with making a difference and practicing ethically.
Aspirational ethics describes the highest standards of conduct to which
professional counselors can aspire, and it requires that we do more than what
is minimally required. To practice according to aspirational ethics, counselors
need to understand the spirit behind the Code and the principles on which it
rests and to have a process for reasoning through the ethical dilemmas they
encounter. Knapp and VandeCreek (2012) write about positive ethics, which
focuses not only on how to avoid harming clients but on how counselors can
best help clients. Instead of focusing on a remedial approach to dealing with an
ethical issue, positive ethics is based on an aspirational level of practice. Positive
ethics shifts the emphasis away from a focus on unethical behavior and disciplinary actions and toward an articulated vision of the highest level of practice.
Two very different but complementary ways of reasoning about ethics
are principle ethics and virtue ethics. Principle ethics traditionally has been
espoused in the fields of medicine and bioethics (Cottone & Tarvydas, 2007)
as well as by the counseling profession. In this approach, certain moral
principles—or generally accepted assumptions or values in society—are
seen as fundamental to ethical reasoning. They are viewed as prima facie
binding; that is, they must always be considered when counselors work to
resolve an ethical dilemma. Principle ethics asks the question “What shall I
do?” when faced with an ethical dilemma. Virtue ethics focuses on the actor
rather than the action and addresses the question “Who shall I be?” Virtue
ethicists believe that professional ethics involves more than moral action; it
also involves traits of character, or virtues, such as discernment or prudence,
respectfulness, integrity, and self-awareness (Jordan & Meara, 1991; Meara,
Schmidt, & Day, 1996). Virtuous counselors recognize the role of emotion in
judging ethical conduct and the importance of connectedness to the community. Incorporating virtue ethics provides a more culturally sensitive approach to ethical decision making than reliance on principle ethics alone.
Professional values are an integral aspect of the counseling profession.
In the Preamble to the 2014 ACA Code of Ethics, the following professional
values are identified:
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ACA Ethical Standards Casebook
1. enhancing human development throughout the life span;
2. honoring diversity and embracing a multicultural approach in support of
the worth, dignity, potential, and uniqueness of people within their social
and cultural contexts;
3. promoting social justice;
4. safeguarding the integrity of the counselor–client relationship; and
5. practicing in a competent and ethical manner.
These professional values provide a conceptual basis for the ethical principles discussed next and for ethical behavior and ethical decision making.
The following six moral principles have been developed over time.
They have expanded from the original four (autonomy, nonmaleficence,
beneficence, and justice) identified in biomedical ethics (Beauchamp &
Childress, 1979) to include fidelity (Kitchener, 1984) and veracity (Remley
& Herlihy, 2014) and generally are seen as being essential to counseling
practice.
• Autonomy refers to promoting an individual’s independence and
self-determination. Under this principle, counselors respect the freedom of clients to choose their own directions within their social and
cultural framework, make their own choices, and control their own
lives. Counselors have an ethical obligation to decrease client dependency and foster independent decision making and client empowerment. Ethical counselors refrain from imposing goals, avoid being
judgmental, and are accepting of different values.
• Nonmaleficence means to do no harm, which includes avoiding actions that put clients at risk of being harmed. Counselors must take
care that their actions do not risk hurting clients, even inadvertently.
• Beneficence means working for the good of the individual and society
and actively promoting the mental health and wellness of clients
within their cultural context.
• Justice involves treating all individuals equitably and fostering fairness and equality. Justice includes consideration of such factors as
quality of services, allocation of time and resources, establishment of
fees, and access to counseling services.
• Fidelity means that counselors make honest promises and honor
their commitments to clients, students, and supervisees. This principle involves creating a trusting and therapeutic climate in which
people can search for their own solutions and taking care to avoid
deception or exploitation of clients.
• Veracity means that counselors are truthful in their professional actions and conduct with their clients, supervisees, and colleagues.
Counselors are aware that trust is the cornerstone of the counseling
relationship and other professional relationships.
• 14 •
Introduction
Developing a Personal Ethical Stance
As we have noted, counselors practicing aspirational ethics require more
of themselves than simply following the letter of the Code of Ethics (ACA,
2014). Their decisions are not motivated mainly by a desire to avoid charges of unethical or unprofessional conduct, but rather by a desire to provide
the best possible services to clients, students, or supervisees. Although it is
important for us to thoroughly familiarize ourselves with the Code of Ethics, it is also necessary for each of us to develop a personal ethical sense.
We need to examine our own practices, looking for subtle ways that we
might not be acting as ethically as we could be. Gross unethical conduct
can be detected, and enforcement is possible. Yet there are many less obvious situations in which counselors may fail to do what is appropriate.
Here are a few examples of ways counselors might engage in ethically
questionable behavior that would be difficult for others to detect and,
thus, difficult to enforce:
• Prolonging the number of counseling sessions to satisfy the counselor’s emotional or financial needs
• Being unaware of countertransference reactions to a client, student,
or supervisee and thereby inadvertently increasing uncooperative
behavior and thwarting growth
• Imposing values, goals, or strategies on clients that are not congruent
with their cultural background
• Using techniques or strategies that are comfortable for the counselor
rather than those that are aimed at helping clients achieve their therapeutic goals
• Practicing with little enthusiasm or tolerating boredom and apathy
• Ignoring self-care practices and thus not being able to practice effectively
The work of the counselor is fraught with ambiguities. When we find
ourselves navigating in waters not clearly charted by the code of ethics
of our profession, we must be guided by an internal ethical compass.
We hope that you use the 2014 ACA Code of Ethics, and this Casebook, as a
means to further your own aspirational ethics. The Code of Ethics can help
to guide us, but in the final analysis each of us is responsible for her or
his own actions. We must be willing to grapple with the gray areas, raise
questions, discuss our ethical concerns with colleagues, seek supervision
when necessary, obtain further education, and monitor our own behavior.
The Ethical Decision-Making Process
Determining the appropriate course to take when faced with a difficult
ethical dilemma can be challenging, and counselors need to have a sys-
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ACA Ethical Standards Casebook
tematic process or a model to guide their ethical reasoning. According to
the ACA Code of Ethics (ACA, 2014), counselors “are expected to engage
in a carefully considered ethical decision-making process” (Purpose). The
Code also states:
When counselors are faced with an ethical dilemma, they use and document, as appropriate, an ethical decision-making model that may include,
but is not limited to, consultation; consideration of relevant ethical standards, principles, and laws; generation of potential courses of action; deliberation of risks and benefits; and selection of an objective decision based on
the circumstances and welfare of all involved. (Standard I.1.b.)
No particular ethical decision-making model has been shown to be the
most effective or to be more practical, useful, or widely applicable to all
situations, and empirical validation of the models is nonexistent. Nonetheless, “counselors are expected to use a credible model of decision making that can bear public scrutiny of its application” (Purpose).
Several ethical decision-making models are described in the next section. We urge you to study the literature on each one. Then select a model,
or combination of models, that works best for you.
A Review of Ethical Decision-Making Models
Melissa D. Deroche, Emeline Eckart, Earniesha Lott,
Candace N. Park, and Latrina Raddler
The counseling literature offers numerous theoretical, practice-based, and
specialized ethical decision-making models. The six models we describe
present a range of perspectives.
Kitchener’s (1984) principle ethics has been described as the seminal
work that constructed the bridge between philosophy and counseling
(Urofsky, Engels, & Engebretson, 2008) and could be considered the foundation on which most models have been built. Kitchener’s model is based
on five ethical principles that were described earlier: autonomy (freedom
of choice), beneficence (doing good), nonmaleficence (do no harm), justice
(being fair), and fidelity (loyalty). Her principle ethics have become an
integral part of the way ethics is understood in counseling.
A Practitioner’s Guide to Ethical Decision Making (Forester-Miller & Davis,
1996) was introduced by the ACA Ethics Committee in an earlier version
of the Casebook. The model is based on the five moral principles proposed
by Kitchener, and users of the model are urged to determine how each of
the five principles can be applied to the ethical problem they are currently
facing. Forester-Miller and Davis (1996) emphasized that there is rarely
one way to solve an ethical dilemma and that a model is intended to help
• 16 •
Introduction
counselors make the best decision they can in a situation rather than to
provide the “right” answer.
The Practitioner’s Guide contains seven steps to decision making. The first
step is to identify the problem and gather all relevant information related
to the problem. The next step is to refer to the ACA Code of Ethics (ACA,
2014) to determine whether the problem is addressed there; if so, resolution of the problem may occur. If resolution is not reached, the third step
involves breaking down the problem into its dimensions. The counselor,
in implementing this step, might consider the five moral principles, review
professional literature, consult with colleagues, and consult with professional associations. In the fourth step the practitioner determines possible
courses of action, and in the fifth step the consequences of those actions are
considered. The sixth step is to choose and evaluate a course of action to
ensure that new ethical dilemmas will not occur as a result of the action.
The final step is to implement the chosen action. Implementation can be difficult, so the focus is on finding the ego strength to follow through with the
action. This model has been criticized for not including multicultural issues
(Garcia, Cartwright, Winston, & Borzuchowska, 2003).
The social constructivist model was proposed by Cottone (2001) in response to a lack of decision-making models that were grounded in theory
or based in the relational view of reality. Social constructivism represents
a shift in thinking to consider both the psychological and the systemicrelational paradigms and to honor the relativity of truth. To understand
the social constructivist approach to ethical decision making, it is vital to
recognize that decision making does not occur within an individual. Other
models place the responsibility for decision making on the individual who
has the dilemma. However, according to the social constructivist model,
decision making occurs in the social matrix, also seen as the environment
in which truth is determined.
Cottone’s (2001) approach entails several steps: “(a) obtain information
from those involved, (b) assess the nature of the relationships operating
at that moment in time, (c) consult valued colleagues and professional
expert opinion (including ethics codes and literature), (d) negotiate when
there is a disagreement, and (e) respond in a way that allows for a reasonable consensus as to what should happen or what really occurred”(p. 43).
Within the social constructivist model, each relationship involved in the
dilemma is assessed for links to other systems, particularly adversarial
systems, and for conflicting opinions.
The feminist model for ethical decision making was developed by Hill,
Glaser, and Harden (1995) with the intent of establishing a dual decisionmaking process. They suggested that mental health professionals should
adhere to the rational-evaluative process found in most models but should
also incorporate a feeling-intuitive process to acknowledge the emotional
experience of the clinician, recognize the power differential in the therapeutic relationship, and identify and address any potential cultural bias-
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ACA Ethical Standards Casebook
es present in the decision-making process. This model contains several
steps as well: recognizing a problem, defining the problem, developing
solutions, choosing a solution, reviewing the process, implementing and
evaluating the decision, and continuing to reflect. Throughout the process, clinicians move back and forth between a cognitive analysis of the
situation and an internal assessment of their emotional experience of the
dilemma. Although the model is presented in a linear fashion, the steps
do not have to be executed in sequence, and some steps may need to be
returned to, depending on the dilemma.
The transcultural integrative model was proposed by Garcia et al. (2003)
for use when working with clients from diverse backgrounds. They combined elements of virtue ethics and integrative models and then added a
multicultural component. The model is based on the premise that counselors need to possess certain attitudes, or virtues, including reflection
on their own feelings, attention to the context of the dilemma, balancing
the perspectives of all individuals involved in the dilemma, collaborating
with all individuals involved, and tolerance of diversity.
The transcultural integrative model consists of four major steps, with
each step having a number of considerations. The first step is to engage in
thorough fact finding, which includes determining who is involved and
how different worldviews may affect the individuals involved. In this step
counselors reflect on their own worldview and how this affects their interpretation of the dilemma. Step 2 entails the process of forming a decision to
resolve the ethical dilemma. This includes considering any discriminatory
laws that may be present, consulting with cultural experts if necessary,
and considering whether the action being considered reflects the different
worldviews of the individuals involved. The course of action should be
one on which all individuals involved agree. In Step 3 counselors reflect
on the course of action and how values and culture have influenced that
course of action. This additional step is intended to ensure multicultural
awareness and reflection on personal biases and values. The final step is
to follow through with the course of action and evaluate that action. Consideration should be given to multicultural concerns that arise once the
plan of action is implemented. This model emphasizes consideration of
cultural components that are not addressed in many other models.
The culturally sensitive ethical decision-making model was offered by
Frame and Williams (2005), who took into consideration the changing
demographics of society. They were concerned that the Code of Ethics and
Standards of Practice (ACA, 1995) in effect at that time did not adequately
address the needs of non-White, non-Western clients. They saw a need
for a model that was “based on a universalist philosophy, an ethic of
care (Gilligan, 1982; Kidder, 1995; Ponterotto & Casas, 1991), the context
of power (Hill, Glaser, & Harden, 1995), and the process of acculturation” (Frame & Williams, 2005, pp. 165–166). The steps in this model are
to identify and define an ethical dilemma, explore the context of power,
• 18 •
Introduction
assess acculturation and racial identity development, seek consultation,
generate alternative solutions, select a course of action, and evaluate the
decision. The third step, assessing acculturation and racial identity development, sets this model apart from other models in that it directly
assesses for the worldview and acculturation level of both the client and
the counselor.
Specialized Models
Despite the existence of multiple ethical decision-making models, new
models have continued to appear in the literature. The emerging trend
seems to be the development of decision-making models that are focused
on specialty areas of counseling or particular ethical issues such as boundaries (Herlihy & Corey, 2015; Pope & Keith-Spiegel, 2008), the practice of
play therapy (Seymour & Rubin, 2006), the treatment of eating disorders
(Matusek & O’Dougherty, 2010), and the integration of spirituality and religion into psychotherapy (Barnett & Johnson, 2011). Although these newer
models are intended for use in specialized situations or with specific client
populations, they present points that are applicable to the general ethical
decision-making process as well.
Seymour and Rubin’s (2006) model for play therapists, like many
other models, relies on Kitchener’s ethical principles, noting that these
principles “lend objectively to ethical decision making, giving a balance
to the excesses of moral relativism and the individual moral intuition
of the therapist” (p. 106). Seymour and Rubin also emphasize the importance of “voices” in the decision-making process, with the first and
primary voice being that of the client. Collateral voices such as those of
the family members, community members, and other professionals are
also important to include.
Pope and Keith-Spiegel’s (2008) model is intended to assist professionals in determining whether a specific boundary crossing is likely to be
supportive of or disruptive to the client or to the counseling relationship;
consideration of whether a decision is likely to be supportive or disruptive to the therapeutic relationship is important in any ethical dilemma.
Matusek and O’Dougherty’s (2010) ethical decision-making model was
created to address complex issues in the treatment of eating disorders,
such as imposed treatment, enforced feeding, use of coercive behavioral
strategies, and management of treatment resistance. An implication is that
counselors might consider any unique circumstances related to a dilemma
and modify the decision-making process accordingly. Barnett and Johnson (2011) proposed an ethical decision-making model based on the recognition that religion and spirituality are important in the lives of many
clients. With this in mind, counselors might consider assessing the client’s
spiritual/religious beliefs to determine whether these might affect the
resolution of an ethical dilemma.
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ACA Ethical Standards Casebook
Similarities Among Models
Although no two models are alike, there are a number of similarities.
The majority of the models are presented in a step-by-step format, consisting of three to nine steps. Most models are intended to be conducted
in a linear fashion, but some approaches emphasize the need to revisit
stages at times. For example, Barnett and Johnson (2011) recommend a
return to previous stages when new information becomes available or
when consultation changes one’s perspective. Most models begin their
decision-making process by identifying or describing a problem, followed
by information gathering, if it is not included as part of the problem identification. Considering options, as well as potential consequences to the
identified options, is a typical step. Consultation is usually included and
is not limited to colleagues but extends to the literature and to the ACA
Code of Ethics (ACA, 2014). Finally, most models recommend identifying
and implementing a course of action and evaluating the chosen course of
action. A common theme among newer models is incorporation of “the
context,” which can have a different meaning depending on the model. In
conclusion, it is clear that a wealth of models exist, all of which can help
counselors be proactive and deliberative as they work to resolve the ethical dilemmas with which they are confronted.
Elements of Ethical Decision Making
Barbara Herlihy and Gerald Corey
As our guest contributors have just illustrated, there are many ethical
decision-making models, and no two are alike. We believe they all have
merit, and we do not recommend one as being preferable to the others.
What we offer, instead, are some components, or steps, that are included
in many models. When faced with an ethical dilemma, we suggest that
you review these steps, some or all of which might be applicable to your
situation and provide you with guidance:
• Identify the problem. The first steps in resolving an ethical dilemma
are to recognize that a problem exists and then to gather as much
information as possible about the situation. Ask yourself whether
this is an ethical, legal, professional, or clinical problem, or perhaps
a combination of these. If a legal question exists, it may be necessary to consult an attorney. Try to examine the problem from several
perspectives and avoid searching for simplistic solutions. It is good
practice to begin a collaborative process with your client at this initial
stage. This collaboration continues throughout the process of working toward an ethical decision, as does the process of documenting
your decisions and actions.
• 20 •
Introduction
• Examine the relevant codes of ethics and the professional literature. Once
you have clarified the problem, consult relevant ethics codes to see if
the issue is addressed there. If there is an applicable standard or several standards and they are specific and clear, following the course
of action indicated may lead to a resolution of the problem. To apply
the ethical standards, it is essential that you have read them carefully
and that you understand their implications. In addition, reading the
recent literature on the particular ethical issue at hand will help ensure that you are using the most current professional knowledge and
thinking as you work to resolve the dilemma.
• Consider the moral principles of autonomy, nonmaleficence, beneficence,
justice, fidelity, and veracity. Decide which principles apply to the situation, and keep in mind that the moral principles can compete with
each other and thus suggest different courses of action. In theory,
each principle is of equal value, which means that it is your challenge to determine which one takes priority for you in this case.
• Consult with colleagues, supervisors, or experts. Colleagues can be extremely helpful in raising other issues relevant to the situation and
in providing a perspective you may have overlooked. They may be
able to identify aspects of the dilemma that you are not viewing objectively. Consultation also serves as an important element of your
defense in court if your decision is later challenged legally. Consultation is important in court cases because it illustrates an attempt to
adhere to community standards by finding out what your colleagues
in the community would do in the same situation. It is wise to document your consultations.
• Attend to your emotions. Consider what emotions you are experiencing as you contemplate the situation. Check to see whether you are
being influenced by feelings such as fear, self-doubt, frustration,
disappointment, or an overwhelming sense of responsibility. Being
aware of your emotions can help you assess whether you are seeing
the situation accurately.
• Involve your client in the decision-making process. This should occur
throughout the process of resolving the dilemma, to the extent possible. Walden (2015) reminds us that the client is an integral part of
the ethical community of the counseling relationship and that counselors should avoid making decisions for the client rather than with
the client. Clients are empowered when they are active partners in
the decision-making process.
• Consider the cultural context. Many of the newer models of ethical
decision making emphasize that your worldview will affect your
perceptions and interpretation of the dilemma and that the client’s
worldview, values, and culture may differ from your own. The
resolution for the dilemma must not only feel right for you but be
appropriate for the client.
• 21 •
ACA Ethical Standards Casebook
• Identify desired outcomes and generate potential courses of action. Even
after the most thoughtful consideration, a single desired outcome
rarely emerges in an ethical dilemma. You may find that you want
to achieve a number of outcomes; some may be essential and others may be desirable but not necessary. Brainstorm as many possible
courses of action as possible. Enlist colleagues to help you generate
possibilities that may not have occurred to you.
• Consider the potential consequences of all options and determine a course
of action. Consider the information you have gathered and the priorities you have set, evaluate each option, and assess the potential consequences for all parties involved. Ponder the implications of each
course of action for the client, for others who will be affected, and for
yourself as a counselor. Eliminate the options that clearly do not give
the desired results or cause even more problematic consequences.
Review the remaining options to determine which option or combination of options best fits the situation and addresses the priorities
you and your client have identified.
• Evaluate the selected course of action. Review the selected course of
action to determine whether it presents any new ethical considerations. Stadler (1986) suggests applying three simple tests to ensure
that the selected course of action is appropriate. In applying the test
of justice, assess your own sense of fairness by determining whether
you would treat others the same in this situation. For the test of publicity, ask yourself whether you would want your behavior reported
in the press. The test of universality asks you to assess whether you
could recommend the same course of action to another counselor in
the same situation. If you can answer in the affirmative to each of
these three tests and are satisfied that you have selected an appropriate course of action, you are ready to move on to implementation. If
the course of action you have selected seems to present new ethical
issues, you need to go back to the beginning and reevaluate each
step of the process. Perhaps you have chosen the wrong option or
identified the problem incorrectly.
• Implement the course of action. Taking the appropriate action in an ethical dilemma is often difficult. The final step involves strengthening
your ego to allow you to carry out your plan. After implementing
your course of action, it is a good practice to follow up on the situation to assess whether your actions had the anticipated effect and
consequences.
The steps we have described should not be thought of as a simple linear way to reach a resolution on ethical matters. Ethical decision making
is a process that involves a great deal of reflection, collaboration with the
client, consultation with colleagues, and the courage to make a decision
based on this process. There is rarely one right answer to a complex ethical
• 22 •
Introduction
dilemma. However, if you follow a systematic model, you can be assured
that you will be able to give a professional explanation for the course of
action you chose.
Enforcement of the ACA Code of Ethics
All ACA members are required to know and adhere to the ACA Code of Ethics
(ACA, 2014), which serves as the basis for processing complaints of ethical
violations against members. The ACA Ethics Committee is responsible for adjudicating complaints. Because this aspect of the committee’s work is strictly
confidential, many ACA members may not be aware of how the committee
performs this function. The process of dealing with complaints of unethical
behavior is briefly described here. The complete document, ACA Policies and
Procedures for Processing Complaints of Ethical Violations (ACA, 2005b), is available on the ACA website (www.counseling.org/knowledge-center/ethics).
Dealing With Complaints
The Ethics Committee will consider a complaint if the individual who is
the subject of the complaint is a current member of ACA or was a member
when the alleged violation(s) occurred. The committee has no jurisdiction
over nonmembers; thus, those who file complaints against nonmembers
are advised of alternative avenues for addressing their complaints. If any
legal action is filed after a complaint has been accepted, all Ethics Committee actions are stayed until the legal action has been concluded.
The Ethics Committee does not act on anonymous complaints. Only
written complaints, signed by complainants, are considered. Any individuals who have reason to believe that ACA members have violated the Code
may initiate complaints.
If you believe that an ACA member has acted or is acting unethically,
you have an ethical responsibility to take action (ACA, 2014, Standard
I.2.b.). Your first step should be to try “to first resolve the issue informally
with the other counselor if feasible, provided such action does not violate
confidentiality rights that may be involved” (Standard I.2.a.). If informal
resolution is not feasible or if it is attempted without success, you should
write a letter to the Ethics Committee outlining the nature of the complaint, sign it, and send it in an envelope marked “confidential.” You will
receive a formal complaint form identifying the ACA ethical standards
that may have been violated if the accusations are true. You are asked
to sign the complaint (or suggest modifications if needed) and a releaseof-information form. With your authorization, the accused member then
receives copies of the formal complaint and any evidence or documents
you have submitted in support of the complaint.
After the accused member has responded to the charges and all pertinent materials have been gathered, the Ethics Committee deliberates and
• 23 •
ACA Ethical Standards Casebook
decides on the complaint. Each complaint is given the most careful consideration. Most complaints are complex, alleging violations of multiple
standards and often including a considerable amount of documentation,
and discussions of each case are typically lengthy and involved. All perspectives are fully examined before a decision is reached. Decisions are
rendered based on the evidence and documents provided by the complainant, accused member, and others. The Ethics Committee has the following options for disposition of a complaint: (a) dismiss the complaint or
dismiss charges within the complaint, or (b) determine that ethical standards have been violated and impose sanctions.
Possible sanctions include remedial requirements, a reprimand, probation or suspension for a specified period of time subject to Ethics Committee review of compliance, permanent expulsion from ACA membership,
or other corrective action such as successful completion of specific education or training, supervision, and evaluation or treatment. A decision to
expel a member requires a unanimous vote. Members found to be in violation may appeal the decision, but only on specific grounds. An Appeals
Panel reviews such cases. After the appeals process has been completed or
the deadline for appeal has passed, the sanctions of suspension and expulsion are published to the membership.
What to Do If a Complaint Is Filed Against You
Few events can be more distressing for counselors than to learn that they
have been formally charged with an ethics violation. Although most counselors spend their lifelong careers without having to deal with this situation, it is wise to be prepared for such an event and know how to respond.
First, take the complaint seriously. Although you may believe the charges
are unwarranted, it is not in your best interest to ignore them or to respond in a casual manner. Occasionally we have heard counselors make
these statements: “Why worry about an ethics complaint to the professional association? The worst that could happen is that I would lose my
membership.” It is true that the most severe sanction available to the ACA
Ethics Committee is permanent expulsion from the association; however,
when a sanction of suspension or expulsion is imposed, notifications are
made to counselor licensure, certification, or registry boards; other mental health boards; the ACA Insurance Trust; and other entities. This could
very well trigger an investigation by a state licensing board that could
result in loss of license to practice.
Second, respond fully to the charges. You are required to cooperate with
the Ethics Committee in its investigation (ACA, 2014, Standard I.3.). Keep
in mind that the Ethics Committee members who will be deciding the
outcome of the complaint do not know you personally and can deliberate
only on information they have before them. We suggest that you write
your response as deliberately and dispassionately as possible. Although
• 24 •
Introduction
you may be tempted to write an emotional, impassioned defense, the
committee must deal with the factual material provided. The Ethics Committee is charged to compile an objective, factual account of the dispute
and make the best possible recommendation for its resolution.
In attending to the details of the complaint, gear your response to the
specific charges, addressing each section of the ACA Code of Ethics you have
been accused of violating and submitting documentation. For instance,
if you have utilized a powerful or relatively new technique with a client
who has filed a complaint, it is useful to submit documentation that you
are trained in the specific technique, are working under supervision, have
consulted about the case with an expert in the technique, and/or have taken
other precautions to prevent harm as specified in the Code of Ethics.
Third, even if you are surprised that a client or colleague has made an
accusation against you, do not attempt to contact the complainant to discuss
the situation. Despite your best intentions, the contact could be interpreted as an attempt to coerce or unduly influence the client or colleague. Immediately notify your professional liability insurance carrier that a complaint has been made.
Fourth, it is prudent to consult with an attorney who can help you prepare your response and provide you with legal counsel. Although an ethics committee is not a court of law, an attorney who is familiar with due
process and is skilled at formulating responses to charges of wrongdoing
can be a helpful resource. Follow the attorney’s advice once you receive
it. Having the assistance of an attorney will be crucial if the allegations in
the ethical complaint are later used as the basis of a lawsuit against you
(Chauvin & Remley, 1996).
Finally, it is vital that you take care of yourself emotionally throughout
the process. Your reactions to learning that you are the subject of an ethics complaint may include strong emotions such as shock and disbelief,
indignation and anger, and fear. Your first impulse may be to unburden
yourself to a family member, friend, or colleague for emotional support.
If you do this, take care not to divulge the details of the complaint. Remember, you are bound by the same confidentiality requirement toward
the accuser as is required with any other client (Chauvin & Remley, 1996).
Processing your own emotional reactions with your supervisors or seeking personal counseling (without discussing the details of the complaint)
can be important steps in helping you survive the ordeal with your selfconfidence and emotional well-being intact.
An Inventory of Your Attitudes and Beliefs
About Ethical Issues
As a way to encourage you to think critically about the ACA Code of Ethics
(ACA, 2014), we have created a self-inventory to help you examine your
reactions to many of the ethical issues that are addressed by the Code. This
• 25 •
ACA Ethical Standards Casebook
inventory is intended to promote critical thinking and to help you identify
and assess your beliefs about ethical guidelines. There is no one correct
answer to any of the items. For every item, circle each choice indicating
your level of agreement/disagreement using the following scale:
A = agree
U = unsure
D = disagree
1. I am ethically obligated as a counselor to
A U D practice within professional guidelines and avoid a
malpractice suit.
A U D avoid doing harm to a client, even unintentionally.
A U D safeguard the client’s confidentiality.
A U D respect the dignity and promote the welfare of the client.
2. When I am working with a client whose cultural background is
very different from my own, I have a responsibility to
A U D refer the client when working with him or her would
exceed my boundaries of competence.
A U D learn as much as I can about the client’s culture.
A U D respect our differences.
A U D work under supervision or seek consultation to ensure
that I provide competent services.
3. I provide my clients with informed consent because
A U D clients have the right to know the limits of confidentiality.
A U D it is vital that clients have information about counseling
explained to them.
A U D clients need to know whether counseling is likely to be
helpful to them.
A U D clients need enough information to choose me as their
counselor.
4. It is important that my informed consent practices include
A U D thoroughly explaining informed consent during my
first session with a client.
A U D treating informed consent as an ongoing process.
A U D getting informed consent in writing from each client.
A U D explaining counseling in language that the client can
understand.
5. With respect to the role of my personal values in counseling,
I believe that
A U D sometimes it is necessary for me to explain my values
to clients.
A U D it is essential for me to understand how my values
influence the counseling process.
A U D I should not attempt to work with clients who hold
values that conflict with my values.
A U D it is imperative that I understand how my values and
beliefs apply in a diverse society.
• 26 •
Introduction
6. When I am considering entering into another relationship with a client (such as also being the client’s friend, employer, or supervisor),
A U D I should avoid these relationships whenever possible.
A U D I should consider that these relationships are fraught
with possibilities for exploitation.
A U D I would suspend the counseling relationship while
interacting with this person as a friend, employer, or
supervisor.
A U D I would decide whether to enter into the other
relationship on a case-by-case basis, by balancing
potential risks and benefits.
7. Sexual intimacies with former clients
A U D are almost always unethical.
A U D may result in a counselor’s loss of license to practice.
A U D may be acceptable if sufficient time has passed since the
counseling relationship terminated.
A U D are inadvisable and represent poor judgment on the
part of the counselor.
8. When I provide group counseling, I have an ethical obligation to
A U D conduct a screening interview with potential group
members.
A U D protect clients against physical and psychological
trauma resulting from interactions within the group.
A U D provide follow-up assistance after termination, if
needed.
A U D implement safety measures when using experimental
methods.
9. In establishing fees for counseling services, I make it a practice to
A U D consider the financial status of clients in the local area.
A U D decide how much I want to charge and charge the same
fee consistently to all clients.
A U D provide a list of free and reduced-fee referral sources
for clients who cannot afford my fee.
A U D enter into bartering arrangements with clients who can
not afford the fee.
10. If I determine that I am unable to be of professional assistance to a client,
A U D ethical practice dictates that I terminate the relationship.
A U D I refer the client.
A U D I discuss the situation with the client.
A U D I continue seeing the client if the client declines my
suggested referral.
11. I would terminate a counseling relationship when
A U D it is reasonably clear that the client is no longer benefiting.
A U D counseling services are no longer necessary.
A U D counseling no longer serves the client’s needs or interests.
A U D the client does not pay the fees charged.
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ACA Ethical Standards Casebook
12. I demonstrate my respect for the privacy of my clients by
A U D avoiding unnecessary disclosures of confidential
information.
A U D realizing that the right to privacy belongs to counselors
and may be waived if it is in the best interests of the
client.
A U D consulting with another mental health professional
when I am unsure about legal exceptions to confidentiality.
A U D securing the client’s written permission before making
any disclosure of confidential information.
13. With respect to keeping records of my counseling sessions, I
A U D have no ethical obligation to maintain unnecessary
records.
A U D must maintain records that are necessary to render
quality service to clients.
A U D am legally required keep records for the amount of time
required by my agency and/or by state laws and
licensure requirements.
A U D must obtain the client’s permission to disclose or
transfer records to third parties.
14. I am obligated to practice within my boundaries of competence,
which implies that I
A U D should develop a clearly defined specialty area.
A U D take steps to maintain competence in the skills I use.
A U D consult with other professionals when I have concerns
about ethical and professional practice.
A U D must practice strictly within the scope of my education
and training.
15. When I am experiencing personal problems or conflicts that are
likely to lead to harm to a client or clients, I
A U D seek counseling for my own problems.
A U D limit, suspend, or terminate my relationship with a
client or clients.
A U D am honest with the client(s) about my difficulties and
self-disclose about my problems.
A U D consult with other professionals about the matter.
16. When I refer a client to a fellow professional,
A U D I split fees with the other professional.
A U D I expect to receive a one-time referral fee from the other
professional.
A U D I do not accept fees for referring clients.
A U D I can expect to receive referrals in return.
17. When I select assessment instruments, I
A U D recognize the effects of age, culture, disability, gender,
and race on assessment results.
A U D treat all clients alike to ensure uniformity of practice.
• 28 •
Introduction
A U
18.
19.
20.
21.
22.
D
explain to the client the nature and purposes of the
assessment.
A U D let clients know how I plan to use the results of the
assessment.
When I provide a DSM-5 diagnosis, I
A U D recognize that culture affects the manner in which
clients’ problems are defined.
A U D am aware of the historical and social prejudices in
misdiagnosing and pathologizing clients from
marginalized societal groups.
A U D consider both the positive and negative implications
of the diagnosis.
A U D am willing to revise the diagnosis to ensure that the
client’s health insurance provider will reimburse for
my services.
When I conduct forensic evaluations (evaluations for legal proceedings), I
A U D provide objective findings that are supported by my
examination of the individual and/or my review of
records.
A U D obtain the informed consent of the individual being
evaluated.
A U D do not evaluate former or current clients or their family
members.
A U D explain to the individual being evaluated that
information shared will not be confidential and will be
reported to the court.
As a student, in my relationships with counselor educators I expect
them to
A U D serve as role models for professional behavior.
A U D be aware of the power differential and take steps to
minimize any risks to me and my fellow students.
A U D explain to me and fellow students the potential for
relationships that extend beyond the classroom to
become exploitive.
A U D maintain strict professional boundaries.
Information that counselor education programs should provide to
prospective students should include
A U D the subject matter that is covered in the program.
A U D training components that encourage or require selfgrowth and self-disclosure as part of the training
process.
A U D the differences between counseling and other mental
health professions.
A U D up-to-date employment prospects for graduates.
I believe counselor education programs have a responsibility to
A U D present varied theoretical positions.
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ACA Ethical Standards Casebook
A U
23.
24.
25.
26.
27.
D
teach a single theoretical position to minimize
confusion among students about how theory translates
into practice.
A U D expect students to master a single theoretical
orientation during their practicum/internship experience.
A U D provide information about the scientific bases of
professional practice.
Regarding self-growth experiences as part of a training program, I
believe it is
A U D not ethical to grade students on how self-disclosing and
genuine they are in their interpersonal relationships in
the classroom.
A U D important to develop safeguards so that risks to
students are minimized.
A U D essential to have clear purposes in mind for these
experiences and maintain appropriate boundaries.
A U D poor practice to require these experiences because students
can be put into situations that are uncomfortable for them.
When I am conducting research involving use of human participants,
ethical practice demands that I
A U D am sensitive to diversity issues with special populations.
A U D use deception only when my research design indicates
its value.
A U D seek consultation and develop safeguards to protect the
rights of research participants.
A U D obtain informed consent from my research participants.
It is appropriate for me to require involuntary participation in a
research project only when
A U D I can demonstrate that participation will have no
harmful effects on participants.
A U D it is essential to my investigation.
A U D my participants are paid.
A U D I am studying ways that involuntary participation
might influence outcomes.
When I report results of my research, ethical practice requires me to
A U D present accurate results.
A U D report unfavorable results.
A U D disguise the identities of those who participated in the study.
A U D make available enough information so that other
researchers can replicate the study.
When I am providing distance counseling services (counseling using
the Internet), my informed consent must include
A U D the anticipated time it will take for me to respond to
client messages.
A U D the physical location of my practice and my contact
information.
• 30 •
Introduction
A U
28.
29.
30.
31.
32.
D
an explanation of the risks and benefits of engaging in
distance counseling.
A U D an explanation of my policy regarding contact with
clients via social media.
My procedures to protect clients who are using my distance counseling services must include
A U D a method for verifying client identity.
A U D encryption methods to prevent unauthorized access to
transmissions or records.
A U D efforts to ensure that clients are capable of using the
applications.
A U D considering the differences between face-to-face and
electronic communication.
When I participate in social media such as Facebook, I need to
A U D maintain a separate presence for professional use.
A U D respect my clients’ privacy by not viewing their social
media pages without their permission.
A U D take precautions to avoid disclosing confidential
information through social media.
A U D inform my clients that I will not respond to their
communications via my personal social media site.
When I have reason to believe that another counselor is violating an
ethical standard and a client may be harmed, an appropriate first
step is to
A U D seek informal resolution by talking privately to the
counselor.
A U D report the counselor’s behavior to his or her supervisor.
A U D report the suspected violation to an ethics committee.
A U D contact clients of this counselor to discover more details
about the suspected behavior.
If I confront a colleague about a suspected ethical violation and this does
not resolve the situation, the appropriate course for me to follow is to
A U D respect the differences of opinion with the colleague.
A U D report the colleague to an ethics committee.
A U D seek consultation from my supervisor.
A U D continue talking with the colleague in hopes of
changing his or her behavior.
I believe that counselors who refuse to offer pro bono services by
giving some of their time and talent to endeavors for which there is
little or no financial return
A U D should be considered unethical.
A U D should cancel their membership in ACA.
A U D are motivated by self-interest and financial gain and are
inappropriate for the counseling profession.
A U D should not be expected to provide pro bono services if
they are financially stressed.
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ACA Ethical Standards Casebook
33. My position on bartering with a client in exchange for counseling
services is that
A U D it depends on the circumstances of the individual case.
A U D I would consider bartering if a client had no way to pay
for my continued services and was making progress in
counseling.
A U D bartering is fraught with potential problems, and I will
not agree to barter with a client.
A U D I would seek consultation before agreeing to barter.
34. If a client were to offer me a gift, I would
A U D usually accept it, so that I would not offend the client
by refusing it.
A U D not accept it under any circumstances.
A U D explore with the client the meaning of the gift.
A U D accept the gift if gift giving is expected in the client’s
culture.
35. Regarding the role of spiritual and religious values, as a counselor I
would be inclined to
A U D avoid bringing these values into the counseling session
so I would not impose my own beliefs on my clients.
A U D consider the client’s spirituality to be an important
aspect of diversity.
A U D avoid bringing up the topic unless my client initiated
such a discussion.
A U D assess my client’s spiritual and religious beliefs during
the intake session.
36. My position on counseling clients who are exploring end-of-life
decisions is that I would
A U D always use the principle of a client’s self-determination
as the key in any decision about this issue.
A U D provide appropriate referral information to ensure that
clients receive the necessary help.
A U D examine the options of breaking confidentiality to
protect the client or not breaking confidentiality to
respect the client’s wishes.
A U D encourage my client to find meaning in life, regardless
of his or her psychological or medical condition.
• 32 •
Part II
ACA Code of Ethics
With Illustrative Vignettes
This section of the casebook presents the revised ACA Code of Ethics (American Counseling Association [ACA], 2014), adopted by the association in
March 2014, together with illustrative vignettes. Before the vignettes are
presented, the stated Preamble and Purpose to the Code are provided. Then,
each of the individual ethical standards that compose the Code is followed
by a vignette that clarifies the meaning of the standard. The vignettes are
not intended to be comprehensive examples and do not address every aspect of each standard. In reviewing the vignettes, it is important to keep in
mind that the individual standards are very much interrelated.
A series of questions (Study and Discussion Guide) is presented at the
beginning of each major section of the Code of Ethics. We hope these questions will stimulate thought and discussion with fellow students or colleagues. They are designed to guide you in thinking through the application of the standards to your own practice.
Vignettes that are new and revised in this edition were contributed by
Drew David, Melissa D. Deroche, Emma Eckart, Angela E. James, Earniesha
S. Lott, Panagiotis Markopoulos, Candace N. Park, Latrina Ray Raddler,
and Karen Swanson Taheri.
• 33 •
2014
ACA Code of Ethics
ACA Code of Ethics Preamble
The American Counseling Association (ACA) is an educational, scientific,
and professional organization whose members work in a variety of settings and serve in multiple capacities. Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.
Professional values are an important way of living out an ethical commitment. The following are core professional values of the counseling profession:
1. enhancing human development throughout the life span;
2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts;
3. promoting social justice;
4. safeguarding the integrity of the counselor–client relationship; and
5. practicing in a competent and ethical manner.
These professional values provide a conceptual basis for the ethical
principles enumerated below. These principles are the foundation for ethical behavior and decision making. The fundamental principles of professional ethical behavior are
• autonomy, or fostering the right to control the direction of one’s life;
• nonmaleficence, or avoiding actions that cause harm;
• beneficence, or working for the good of the individual and society by
promoting mental health and well-being;
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ACA Ethical Standards Casebook
• justice, or treating individuals equitably and fostering fairness and
equality;
• fidelity, or honoring commitments and keeping promises, including
fulfilling one’s responsibilities of trust in professional relationships;
and
• veracity, or dealing truthfully with individuals with whom counselors come into professional contact.
ACA Code of Ethics Purpose
The ACA Code of Ethics serves six main purposes:
1. The Code sets forth the ethical obligations of ACA members and
provides guidance intended to inform the ethical practice of professional counselors.
2. The Code identifies ethical considerations relevant to professional
counselors and counselors-in-training.
3. The Code enables the association to clarify for current and prospective members, and for those served by members, the nature of the
ethical responsibilities held in common by its members.
4. The Code serves as an ethical guide designed to assist members in
constructing a course of action that best serves those utilizing counseling services and establishes expectations of conduct with a primary
emphasis on the role of the professional counselor.
5. The Code helps to support the mission of ACA.
6. The standards contained in this Code serve as the basis for processing
inquiries and ethics complaints concerning ACA members.
The ACA Code of Ethics contains nine main sections that address the following areas:
Section A:
Section B:
Section C:
Section D:
Section E:
Section F:
Section G:
Section H:
Section I:
The Counseling Relationship
Confidentiality and Privacy
Professional Responsibility
Relationships With Other Professionals
Evaluation, Assessment, and Interpretation
Supervision, Training, and Teaching
Research and Publication
Distance Counseling, Technology, and Social Media
Resolving Ethical Issues
Each section of the ACA Code of Ethics begins with an introduction. The
introduction to each section describes the ethical behavior and responsibility to which counselors aspire. The introductions help set the tone for
each particular section and provide a starting point that invites reflection
• 36 •
ACA Code of Ethics With Illustrative Vignettes
on the ethical standards contained in each part of the ACA Code of Ethics.
The standards outline professional responsibilities and provide direction
for fulfilling those ethical responsibilities.
When counselors are faced with ethical dilemmas that are difficult to
resolve, they are expected to engage in a carefully considered ethical decision-making process, consulting available resources as needed. Counselors acknowledge that resolving ethical issues is a process; ethical reasoning includes consideration of professional values, professional ethical
principles, and ethical standards.
Counselors’ actions should be consistent with the spirit as well as the
letter of these ethical standards. No specific ethical decision-making model is always most effective, so counselors are expected to use a credible
model of decision making that can bear public scrutiny of its application.
Through a chosen ethical decision-making process and evaluation of the
context of the situation, counselors work collaboratively with clients to
make decisions that promote clients’ growth and development. A breach
of the standards and principles provided herein does not necessarily constitute legal liability or violation of the law; such action is established in
legal and judicial proceedings.
The glossary at the end of the Code provides a concise description of
some of the terms used in the ACA Code of Ethics.
Section A
The Counseling Relationship
Study and Discussion Guide
• Client Welfare: What are the most important steps you can take to
ensure that the welfare of your client is the guiding principle for
your practice?
• Informed Consent: What types of information do prospective clients
need to receive to make an informed decision to enter a counseling
relationship? What procedures should you use to inform prospective
clients about the nature of counseling?
• Counselor’s Personal Values: What are some of your strongly held
personal values, beliefs, and attitudes? How will you avoid imposing these values on your clients, even inadvertently?
• Relationship Boundaries: Why do you think counselors generally
should avoid counseling family members, friends, or people with
whom they have (or formerly had) a romantic or sexual relationship?
• Sexual Intimacies With Current and Former Clients: What might
you say to a client who told you that she and her previous counselor had been involved in a sexual relationship for several months
before she terminated the professional relationship? What would
you do? What are your thoughts on the matter of sexual intimacies
with former clients?
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ACA Ethical Standards Casebook
• Advocacy: As a counselor, what are some ways you can advocate for
your clients at the individual, institutional, and societal levels?
• Group Work: What do you consider to be the main ethical issues in
working with groups?
• Establishing Fees: How might you determine an appropriate fee
structure for your counseling practice? What are some ways you
might meet your ethical obligation to provide some pro bono service?
• Termination and Referral: What might you do if you thought you
could not help a client, yet the client wanted to continue seeing you?
What action might you take if this client refused to accept a referral?
What ethical issues are involved in termination with clients?
Section A
The Counseling Relationship
Introduction
Counselors facilitate client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy
relationships. Trust is the cornerstone of the counseling relationship,
and counselors have the responsibility to respect and safeguard the
client’s right to privacy and confidentiality. Counselors actively attempt to understand the diverse cultural backgrounds of the clients
they serve. Counselors also explore their own cultural identities and
how these affect their values and beliefs about the counseling process.
Additionally, counselors are encouraged to contribute to society by devoting a portion of their professional activities for little or no financial
return (pro bono publico).
A.1. Client Welfare
A.1.a. Primary Responsibility
The primary responsibility of counselors is to respect the dignity and
promote the welfare of clients.
Mary, age 78, suffered a stroke that has left her with halting speech that
can be difficult to understand. Although she moves slowly, she has regained
much of her mobility. She seeks counseling at a community agency for help
in deciding whether to sell her home and move into an assisted living facility. Alex, the counselor, listens patiently and checks to ensure that he understands Mary accurately. He learns that Mary prizes her independence,
which she has gained over 20 years as a widow, takes great joy in her flower
garden, and looks forward to having her neighbors stop by to visit. Alex
helps Mary clarify how important it is to her to remain in her home. Together they explore options that would further this goal, such as having a
hot meal delivered daily by a local organization, hiring a gardener to help
her, and arranging for a speech therapist to make home visits.
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A.1.b. Records and Documentation
Counselors create, safeguard, and maintain documentation necessary for
rendering professional services. Regardless of the medium, counselors include sufficient and timely documentation to facilitate the delivery and
continuity of services. Counselors take reasonable steps to ensure that
documentation accurately reflects client progress and services provided.
If amendments are made to records and documentation, counselors take
steps to properly note the amendments according to agency or institutional policies.
Yolanda, a licensed professional counselor in private practice, keeps careful
records pertaining to each of her clients, including dates and length of sessions, types of services provided, progress notes, diagnoses rendered, and
billing and payment information. She routinely leaves time between client
sessions to maintain her records so that she can write them while her memory is fresh. When she makes additions or changes to her records after she
writes them, she dates and initials these changes. She keeps the complete
records of adult clients for 7 years as required by her state’s licensure law.
A.1.c. Counseling Plans
Counselors and their clients work jointly in devising counseling plans that
offer reasonable promise of success and are consistent with the abilities,
temperament, developmental level, and circumstances of clients. Counselors and clients regularly review and revise counseling plans to assess their
continued viability and effectiveness, respecting clients’ freedom of choice.
Sarah, a high school counselor, works with students who have been referred
to her because their individual education plans may include the need to address disruptive classroom behavior. After collaborating with the school’s
diagnostician and teachers, she works with her clients to determine their
goals and which aspects of their behavior they are able and willing to
change. Once they identify specific thoughts and actions, she works collaboratively with them in designing individualized action plans. Sarah helps
them develop plans that are clear, attainable, and realistic and works to ensure that these plans are their plans. She teaches her clients how to monitor
their plans and modify them as needed. With clients’ permission, she enlists
the cooperation of teachers and parents to help clients succeed in meeting
their goals.
A.1.d. Support Network Involvement
Counselors recognize that support networks hold various meanings in the
lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members,
friends) as positive resources, when appropriate, with client consent.
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Bill has been seeing Marlene, a licensed professional counselor (LPC), to deal
with his depression. Through the counseling process, he has become aware that
he has been so involved in meeting the needs of his wife and children that he
has lost touch with his own needs. With Marlene’s assistance, he realizes that
he wants to develop some aspects of his life that are separate from his family.
Bill and the counselor decide together to invite his wife and children to a family
session in which Bill can feel supported as he expresses his feelings and wishes.
They also discuss the importance to Bill of his church community, and they decide to enlist the support of his pastor in involving him in church activities.
A.2. Informed Consent in the Counseling Relationship
A.2.a. Informed Consent
Clients have the freedom to choose whether to enter into or remain in a
counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review
in writing and verbally with clients the rights and responsibilities of both
counselors and clients. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship.
Iman, who has never sought counseling before, comes to an initial session
with Carla, a counselor in private practice. Iman describes her reservations
about coming to see a counselor who does not share her Middle Eastern heritage and her fears that Carla may harbor some of the prejudices that Iman
encounters in her daily life. She adds that she came anyway, though, because a
friend who is a former client of Carla’s had highly recommended Carla. Carla
explores these concerns with Iman and provides her with information about
herself and how she generally conducts the counseling process. Together they
review Carla’s professional disclosure statement, which describes client rights
and responsibilities. Carla gives Iman copies of both documents to take home.
At the end of the session, Iman, with some hesitation, tells Carla that she believes she can be comfortable in this counseling relationship. Hearing her
hesitation, Carla schedules a second appointment and also suggests that Iman
think over her decision for a few days and call her. She adds that if, at that
time, Iman has decided to look for a different counselor, Carla will assist her in
finding a counselor who either is of Middle Eastern origin or has considerable
experience in working with clients with this cultural heritage.
A.2.b. Types of Information Needed
Counselors explicitly explain to clients the nature of all services provided.
They inform clients about issues such as, but not limited to, the following:
the purposes, goals, techniques, procedures, limitations, potential risks, and
benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the in-
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capacitation or death of the counselor; the role of technology; and other pertinent information. Counselors take steps to ensure that clients understand
the implications of diagnosis and the intended use of tests and reports. Additionally, counselors inform clients about fees and billing arrangements,
including procedures for nonpayment of fees. Clients have the right to confidentiality and to be provided with an explanation of its limits (including
how supervisors and/or treatment or interdisciplinary team professionals
are involved), to obtain clear information about their records, to participate
in the ongoing counseling plans, and to refuse any services or modality
changes and to be advised of the consequences of such refusal.
Arnold seeks counseling at a community counseling and training center where
services are provided by licensed professional counselors and by counselor
interns from a local counselor education program. Arnold’s intake session is
with Donna, a counselor intern. During the session, Donna provides Arnold
with information about the counseling services provided at the center and
explains that even if she completes her internship before Arnold is ready to
terminate counseling, center policy is that he will continue to receive counseling from one of the counselors on staff. Together, they review Donna’s professional disclosure statement, which describes Donna’s qualifications, approach
to counseling, and, in general terms, the goals of counseling, techniques, and
risks and benefits. Donna also discusses how the center uses technology to improve counseling services. She reviews confidentiality and the limitations that
are created by her status as an intern. They discuss possible diagnoses and
use of any tests or reports that might be a part of the counseling process, and
how the center’s sliding fee scale will be applied for Arnold. When discussing payment, Donna ensures that Arnold understands the center’s nonpayment policy. Donna also explains to Arnold that he will be an active partner
in establishing the counseling goals and plans and discusses the roles of her
supervisor and interdisciplinary treatment team.
A.2.c. Developmental and Cultural Sensitivity
Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and understandable
language when discussing issues related to informed consent. When clients
have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for a qualified interpreter or
translator) to ensure comprehension by clients. In collaboration with clients,
counselors consider cultural implications of informed consent procedures
and, where possible, counselors adjust their practices accordingly.
Danielle, a counselor in a community college counseling center, meets for the
first time with Guillermo, an 18-year-old freshman. Guillermo is from Guatemala; he came to the United States with his family 8 months ago. He speaks
English haltingly and struggles to find words to express himself. Danielle
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speaks no Spanish and is uncertain whether Guillermo fully comprehends
her explanations of the counseling process. With Guillermo’s permission, she
enlists Juan, another counselor at the center who is fluent in Spanish, to sit in
on their session. At the end of the session, Juan explains to Danielle that Guillermo’s English comprehension skills are excellent although his expressive
skills are developing more slowly. Guillermo states that he wants to continue
in counseling with Danielle but that he wants his family to know about and
approve of his decision. They arrange for Juan to translate Danielle’s disclosure statement into Spanish for Guillermo to take home and share with his
family. Danielle and Juan also tell Guillermo that they are willing to arrange to
have a counseling session that includes his family, if Guillermo wishes.
A.2.d. Inability to Give Consent
When counseling minors, incapacitated adults, or other persons unable to give
voluntary consent, counselors seek the assent of clients to services and include
them in decision making as appropriate. Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent
or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf.
Danny is an 11-year-old prospective client who is brought by his mother to
Adriane’s office for counseling. Even though Danny is too young to give legally valid informed consent, Adriane includes Danny along with his mother
in a verbal explanation of all information contained in her disclosure statement, using language that Danny can understand. Adriane is careful to check
to ensure that Danny comprehends the information and to ascertain his willingness to participate in counseling. At the end of the session, Adriane asks
both Danny and his mother to sign the written disclosure statement.
A.2.e. Mandated Clients
Counselors discuss the required limitations to confidentiality when working with clients who have been mandated for counseling services. Counselors also explain what type of information and with whom that information
is shared prior to the beginning of counseling. The client may choose to refuse services. In this case, counselors will, to the best of their ability, discuss
with the client the potential consequences of refusing counseling services.
Andrea conducts a weekly group for clients who are court-mandated to attend counseling as part of their diversion program. George has been referred
as a potential group participant. Before George enters the group, Andrea
meets with him individually to perform an intake assessment. She explains
to George that participation in the group requires that he sign a release of
confidentiality allowing her to communicate with his diversion officer. She
informs George that the only information reported to the diversion officer
is a monthly report that is securely faxed and indicates only his attendance
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at the group sessions. Andrea also informs him that he has a choice about
whether to attend the diversion group and that failure to attend may result
in further consequences through the justice system.
A.3. Clients Served by Others
When counselors learn that their clients are in a professional relationship
with other mental health professionals, they request release from clients
to inform the other professionals and strive to establish positive and collaborative professional relationships.
Jorge offers a group counseling experience through a community mental
health agency. Elizabeth requests to join the group and reveals during her
screening interview that she is currently seeing a counselor at another agency for individual counseling. Jorge requests permission to contact the other
counselor, and Elizabeth agrees. Jorge and the individual counselor agree
that concurrent group and individual counseling would be advisable for
Elizabeth. They also agree that, with Elizabeth’s permission, they will communicate with each other as needed to help ensure that the best possible
services are provided.
A.4. Avoiding Harm and Imposing Values
A.4.a. Avoiding Harm
Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.
Tim, a counselor in private practice, has been seeing Ellen for several months
related to issues surrounding her divorce. At the beginning of today’s session, Tim remarks to Ellen that she seems to be losing weight and asks if this
concerns her because she is quite thin. Ellen discloses that she feels desperate to lose weight rapidly to look better and begin dating again. Ellen also
discloses that on several occasions she has eaten much more than she should
have and purged immediately to rid herself of the calories. In addition to
self-induced vomiting, she has started taking laxatives and has spent several
days fasting. Tim realizes that Ellen is exhibiting behaviors related to an eating disorder. Tim has very limited training in working with eating disorders,
and he informs Ellen that he will need to refer her to someone specializing in
eating disorders. Ellen says that she already trusts Tim and would prefer to
keep working with him. Tim explains the reasons for the referral and helps
her to make an appointment with another counselor who has training and
experience in working with eating disorders.
A.4.b. Personal Values
Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients,
trainees, and research participants and seek training in areas in which
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they are at risk of imposing their values onto clients, especially when the
counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.
Katy, a counselor in a school that serves children in Grades K–3, is told that there
will be an opening for a counselor next year at the district’s high school. She
would prefer to work with adolescents, but she has no experience with counseling older students, who may be sexually active and who may seek counseling
for issues related to birth control and pregnancy. Katy is a member of a religious community that opposes premarital sex, birth control, and abortion. She
is keenly aware that her religious values have the potential to enter into counseling relationships with adolescent clients. She learns that a workshop addressing values conflict in counseling is being offered in her locality. She attends the
workshop, does extensive reading about managing conflicts between personal
and professional values, and discusses these issues on an ongoing basis with
her supervisor. She also decides that, if she applies for and is awarded the high
school position, she will request more intensive supervision of her work with
students who present with issues that relate to her religious values.
A.5. Prohibited Noncounseling Roles and Relationships
A.5.a. Sexual and/or Romantic Relationships Prohibited
Sexual and/or romantic counselor–client interactions or relationships
with current clients, their romantic partners, or their family members are
prohibited. This prohibition applies to both in-person and electronic interactions or relationships.
Donté, a counselor at a mental health rehabilitation agency, works primarily
with children. In his personal life, he is single and has an account with a popular
dating website. He is discomfited when Marco, the father of one of his clients,
contacts him through this website. Marco suggests that they meet, communicating that he finds Donté attractive and would like to explore a relationship.
Donté uses his business phone to contact Marco and inform him that a relationship is not possible. He takes time to explain his ethical obligations and why
he must avoid entering into romantic relationships with parents of his clients.
A.5.b. Previous Sexual and/or Romantic Relationships
Counselors are prohibited from engaging in counseling relationships with
persons with whom they have had a previous sexual and/or romantic
relationship.
Pete is a professional counselor who is in private practice. While attending
a wedding reception, he encounters Serena, an ex-girlfriend who has just
moved back into town. Serena asks Pete for one of his business cards, stating
that she would like to call him to set an appointment for counseling. Pete explains that it is not ethical for him to counsel individuals with whom he has
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been sexually or romantically involved. He suggests that she contact him at
his office on Monday if she would like for him to provide her with a list of
counselors in the community.
A.5.c. Sexual and/or Romantic Relationships
With Former Clients
Sexual and/or romantic counselor–client interactions or relationships
with former clients, their romantic partners, or their family members are
prohibited for a period of 5 years following the last professional contact.
This prohibition applies to both in-person and electronic interactions or
relationships. Counselors, before engaging in sexual and/or romantic interactions or relationships with former clients, their romantic partners, or
their family members, demonstrate forethought and document (in written
form) whether the interaction or relationship can be viewed as exploitive
in any way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids
entering into such an interaction or relationship.
Susan served as Frank’s counselor for 6 months. While in counseling, Frank
worked on his fears of intimacy and learned assertiveness skills in asking
for what he wanted. Nearly 3 years after counseling ended, Susan and Frank
meet on an online dating site. Frank communicates to Susan that he wants to
strike up a personal relationship. He feels that enough time has passed since
their professional relationship ended and states that he is sexually attracted
to her. Susan responds that, although she finds Frank to be a very interesting person, she feels uncomfortable in pursuing a personal relationship at
any time because of the nature of their former relationship. She explains the
ethics of her counseling profession and her personal beliefs about keeping
her personal and professional lives separate. She lets Frank know that a personal relationship between them will not be possible.
A.5.d. Friends or Family Members
Counselors are prohibited from engaging in counseling relationships with
friends or family members with whom they have an inability to remain
objective.
Shanna is a licensed professional counselor who works at an agency specializing in counseling survivors of physical and sexual abuse. Shanna is one
of the few therapists who is paid through grant monies, so she sees most of
her clients free of charge. Shanna gets a call from a good friend, David, who
asks if he can bring his daughter for counseling because of suspected abuse.
Shanna is the godmother of this child and often spends holidays and special
events with the family. David is desperate for Shanna’s help and cannot afford services for which he would have to pay. Shanna informs David that,
because of the personal nature of her relationship with his daughter, even
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though she and the child are not blood relatives, she cannot remain objective
in counseling. Shanna informs David about other agencies where his daughter can receive free services.
A.5.e. Personal Virtual Relationships With Current Clients
Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (e.g., through social and other media).
Marlo is an LPC working in a private practice setting. In her declaration
of practices (disclosure statement), she addresses her policies regarding her
personal social media and personal web presence. Her declaration states
that she does not engage in any social or virtual relationships with current
and/or past clients. She also discusses this policy with each client prior to
beginning a counseling relationship. Marlo has been providing counseling
services to Casey for the past few weeks, and Casey has verbalized a clear
understanding of Marlo’s office policies. When Marlo discovers that she and
Casey belong to the same Internet dating site, she reminds Casey of her policies regarding social and/or virtual relationships and reiterates that interactions between them on the Internet dating site are not possible.
A.6. Managing and Maintaining Boundaries and
Professional Relationships
A.6.a. Previous Relationships
Counselors consider the risks and benefits of accepting as clients those
with whom they have had a previous relationship. These potential
clients may include individuals with whom the counselor has had a
casual, distant, or past relationship. Examples include mutual or past
membership in a professional association, organization, or community.
When counselors accept these clients, they take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and
no exploitation occurs.
Phillip is the only licensed professional counselor in private practice in a rural area. He receives a phone call from Jerry, who identifies himself as a new
client seeking counseling services. Phillip recognizes the voice and realizes
he and Jerry had attended the same yoga class a year ago and had chatted
before and after class occasionally. Phillip considers the nature of the past
relationship and then initiates a discussion about the casual relationship
they shared in yoga class. Phillip emphasizes the differences between the
past relationship and a new professional relationship and ensures that Jerry
understands that, once they engage in the counseling relationship, they will
not be able to renew their previous, casual relationship.
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A.6.b. Extending Counseling Boundaries
Counselors consider the risks and benefits of extending current counseling
relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or
graduation), purchasing a service or product provided by a client (excepting
unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional
precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs.
Sheri, a licensed marriage and family counselor, has been invited to the wedding of a couple she has been counseling for the past 6 months. She considers potential breaches of confidentiality that could occur if she attends, and
she consults with a licensed professional counselor and her former supervisor. At the couple’s next session, Sheri informs them that she will attend the
ceremony but not the reception and will be attending alone because she sees
attending the ceremony as a part of the therapeutic process.
A.6.c. Documenting Boundary Extensions
If counselors extend boundaries as described in A.6.a. and A.6.b., they
must officially document, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly
involved with the client or former client. When unintentional harm occurs
to the client or former client, or to an individual significantly involved
with the client or former client, the counselor must show evidence of an
attempt to remedy such harm.
Carlos, a licensed marriage and family therapist, began counseling Paul and
Daniel about 6 months ago. The couple entered counseling because they
wanted to remain together but were experiencing significant conflict in their
relationship. Paul and Daniel have now met their counseling goals, and they
invite Carlos to their commitment ceremony. They express their gratitude to
Carlos and state that his presence at the ceremony is important to them. Carlos agrees to attend and explains potential risks in attending the ceremony
(such as being asked by someone how he knows the couple). Carlos documents the potential benefits and risks of his attendance and the rationale for
his decision.
A.6.d. Role Changes in the Professional Relationship
When counselors change a role from the original or most recent contracted
relationship, they obtain informed consent from the client and explain
the client’s right to refuse services related to the change. Examples of role
changes include, but are not limited to
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1. changing from individual to relationship or family counseling, or
vice versa;
2. changing from an evaluative role to a therapeutic role, or vice versa;
and
3. changing from a counselor to a mediator role, or vice versa.
Clients must be fully informed of any anticipated consequences (e.g.,
financial, legal, personal, therapeutic) of counselor role changes.
Mai-Jing, an LPC in private practice, works part time under contract with
the Juvenile Probation and Parole Department to provide counseling services to court-referred youth. In this role, she is asked to counsel Kendra,
a 15-year-old girl who has received deferred adjudication after being apprehended for shoplifting. When meeting with Kendra for the first time,
Mai-Jing is careful to explain that she is required to make a report to the
court regarding Kendra’s progress in counseling. Kendra agrees to this
condition, and they meet for the court-mandated eight sessions. During
the final session, Kendra asks if she can continue to see Mai-Jing in MaiJing’s private practice. Mai-Jing explains to Kendra the changes in the
counseling relationship this would entail, including differences in confidentiality, reporting, and payment arrangements. Kendra agrees to allow
Mai-Jing to contact her legal guardian to arrange for Kendra to become a
client in Mai-Jing’s private practice.
A.6.e. Nonprofessional Interactions or Relationships
(Other Than Sexual or Romantic Interactions
or Relationships)
Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the
interaction is potentially harmful to the client. This applies to both inperson and electronic interactions or relationships.
Lakiesha, a school counselor, worked with Tyrone, a fourth grader, in
individual counseling for several weeks after Tyrone was referred by
his teacher because his academic performance had deteriorated suddenly. Through the counseling process, Lakiesha learns that Tyrone’s
parents are divorced and that his father, with whom he lives, has recently remarried. One evening, at a political function, Lakiesha is approached by a woman who introduces herself as Tyrone’s stepmother.
The woman thanks Lakiesha for being so helpful to Tyrone and then
suggests that the two of them go out for a drink after the function ends
and talk about ways they could work together to further the political
causes in which they are both interested. Lakiesha thanks the woman
for the invitation, but thinking ahead to the potential complexities involved, she declines.
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A.7. Roles and Relationships at Individual, Group,
Institutional, and Societal Levels
A.7.a. Advocacy
When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients.
Paul is a college counselor who specializes in career counseling. Martín
comes to see Paul to discuss career options. Martín reports that he has always dreamed of getting a degree in computer science but doesn’t believe
this is an option for him. Martín is legally blind, and he explains how this
disability affects all areas of his life, including his ability to make career
choices. Martín states that his adviser in the computer science department
has encouraged him to change majors to something that doesn’t require as
many visual tasks. Martín adds that he explained to the adviser that accommodative equipment is available that would enable him to see the computer
screen and that if the department would provide this, he would be able to
complete the course work easily. However, the adviser didn’t believe the department had the financial resources to purchase the equipment. Paul assists
Martín in contacting Student Disability Services on campus, and together
they find that this equipment can be provided. Paul organizes a taskforce
to examine how the needs of students with disabilities are being met on
campus. Paul also collaborates with other counselors in the center to begin
offering diversity training to professors at the university.
A.7.b. Confidentiality and Advocacy
Counselors obtain client consent prior to engaging in advocacy efforts on
behalf of an identifiable client to improve the provision of services and to
work toward removal of systemic barriers or obstacles that inhibit client
access, growth, and development.
Claudia is a rehabilitation counselor working in a veterans’ hospital. She notices that one of her clients, John, is not receiving proper medical care. John
complains that he is constantly in pain; he reports that he usually receives
his medicine late and sometimes does not receive it at all. Claudia discusses
the matter with John, focusing on his rights as a patient in this facility. John
states that he needs help, but he does not have any family members who
can speak to the hospital administration about the quality of his care. Claudia
agrees to be an advocate for John, with his consent. Claudia explains to John
exactly with whom she will be speaking and what information will be disclosed. They discuss possible outcomes of these actions and how John might
be affected. John agrees that this is the best course of action and signs a
waiver of confidentiality so that Claudia can begin taking steps to see that
he receives proper care.
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A.8. Multiple Clients
When a counselor agrees to provide counseling services to two or more
persons who have a relationship, the counselor clarifies at the outset
which person or persons are clients and the nature of the relationships the
counselor will have with each involved person. If it becomes apparent that
the counselor may be called upon to perform potentially conflicting roles,
the counselor will clarify, adjust, or withdraw from roles appropriately.
A marriage and family counselor agrees to see Linda and Tom for marriage
counseling. The counselor explains at the outset that she will begin working
with them conjointly but may wish at times to see each of them individually.
She secures their understanding and agreement that she will not divulge to either of them what the other has said in individual sessions. Several weeks into
the counseling process, during an individual session, Linda voices her suspicion that Tom is having an affair. Linda asks the counselor to tell her whether
Tom has said anything in his sessions that might confirm this. The counselor
reiterates her policy regarding confidentiality of individual sessions and explores with Linda the possibility of expressing her concern directly to Tom.
A.9. Group Work
A.9.a. Screening
Counselors screen prospective group counseling/therapy participants. To
the extent possible, counselors select members whose needs and goals are
compatible with the goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience.
Several women apply to join a group being formed at a counseling center
for women over 30 who are searching for educational, occupational, or personal alternatives to their present situation. Danica, the counselor who will
facilitate the group, interviews and gives a personality inventory to each applicant. The inventory suggests that one woman who has applied is experiencing symptoms of major depression. Danica meets with her and suggests
that her needs might be better filled by other services that are offered at the
counseling center. Arrangements are made for a referral.
A.9.b. Protecting Clients
In a group setting, counselors take reasonable precautions to protect clients
from physical, emotional, or psychological trauma.
Martin, an LPC, is facilitating the first session of a growth group. This first
session is a “trial” session that individuals may attend to help them decide
whether they want to make a commitment to the group. At one point, a
member expresses some personal concerns that indicate he may have serious emotional problems. Martin guides the group focus away from that
member. After the group session, Martin meets privately with the member
and refers him for individual counseling.
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A.10. Fees and Business Practices
A.10.a. Self-Referral
Counselors working in an organization (e.g., school, agency, institution)
that provides counseling services do not refer clients to their private
practice unless the policies of a particular organization make explicit
provisions for self-referrals. In such instances, the clients must be informed of other options open to them should they seek private counseling services.
Rahma is a school counselor who also has a part-time private practice. In her
private practice, she counsels children who have experienced various types
of abuse. Rahma meets with a child in the school setting who discloses that
she has experienced sexual abuse. She talks with the child’s mother, who
requests outside counseling services for her child. Rahma provides the parent with a brochure that describes local resources. The brochure does not list
Rahma’s private practice.
A.10.b. Unacceptable Business Practices
Counselors do not participate in fee splitting, nor do they give or receive
commissions, rebates, or any other form of remuneration when referring
clients for professional services.
Jose and Mike have been friends since middle school. Jose is a licensed professional counselor and Mike is a family lawyer. Jose recently became qualified as a child custody evaluator and asks Mike if he can think of ways he
might expand this new area of his practice. Mike proposes that the two of
them refer clients to each other when possible and split the fees 50-50. Jose
tells Mike that it would be unethical for him to split fees, but he will add
Mike to his list of referrals.
A.10.c. Establishing Fees
In establishing fees for professional counseling services, counselors consider the financial status of clients and locality. If a counselor’s usual
fees create undue hardship for the client, the counselor may adjust fees,
when legally permissible, or assist the client in locating comparable,
affordable services.
Nathan is a licensed professional counselor working in a group practice.
The clinicians base their fees on their expertise and ensure that the fees are
comparable to those of other mental health professionals in the area. Nathan
offers a sliding scale fee to clients who do not have mental health insurance
coverage and are not able to afford his full rate. When a client is unable to
pay Nathan’s sliding scale rate, Nathan refers the client for comparable services at no or minimal cost.
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A.10.d. Nonpayment of Fees
If counselors intend to use collection agencies or take legal measures to
collect fees from clients who do not pay for services as agreed upon, they
include such information in their informed consent documents and also
inform clients in a timely fashion of intended actions and offer clients the
opportunity to make payment.
Jennifer is an LPC in private practice. A couple, Debbie and Malcolm, have attended nine counseling sessions with Jennifer. During the intake session, Jennifer explained her payment and nonpayment procedures. She also discussed
her standard time frame for payment and explained that if payment was not
received within 30 days of the last session, the bill would be transferred to a collection agency. Jennifer allowed the couple to postpone paying for the last three
sessions because they were having financial difficulties. Debbie and Malcolm
did not return to counseling after the ninth session and left an outstanding balance. Jennifer attempts to contact the couple by telephone, but they do not return her calls. She sends a letter informing them that they have 30 days to remit
payment before the debt will be transferred to a collection agency.
A.10.e. Bartering
Counselors may barter only if the bartering does not result in exploitation
or harm, if the client requests it, and if such arrangements are an accepted
practice among professionals in the community. Counselors consider the
cultural implications of bartering and discuss relevant concerns with
clients and document such agreements in a clear written contract.
Brian is undergoing an expensive divorce and tells Sandra, his counselor, that
he will have to terminate his weekly counseling sessions unless they can make
other financial arrangements. Brian has noticed that Sandra’s office is furnished
with period furniture and some inexpensive antiques. Because he owns an antiques and collectibles shop, he asks if she might be willing to exchange counseling services for some furniture she could select at the shop. Bartering is not
customary among professionals in the area where Sandra practices. Sandra explains to Brian the potential problems she sees with his proposal. Although she
declines the offer to barter, she does agree to reduce her fee and suggests that he
come for counseling every other week for the time being.
A.10.f. Receiving Gifts
Counselors understand the challenges of accepting gifts from clients and
recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors
take into account the therapeutic relationship, the monetary value of the
gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift.
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ACA Code of Ethics With Illustrative Vignettes
Bonita has been counseling David on a weekly basis for 3 months. The counseling process has been successful in helping David achieve the goals he had
set for himself. During their session last week, Bonita and David had agreed
that today’s session would be their termination session. David arrives at
today’s session carrying a potted plant, which he offers to Bonita as a gift for
her office and as a way of thanking her for her assistance. Bonita considers
David’s motivation for offering this gift, the fact that David can easily afford
to give it, and the fact that this is their final session together. She decides to
accept the gift.
A.11. Termination and Referral
A.11.a. Competence Within Termination and Referral
If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral
resources and suggest these alternatives. If clients decline the suggested
referrals, counselors discontinue the relationship.
Rafael, a counselor for the juvenile court system, is assigned to work with
a young man who has serious problems relating to authority figures. This
client constantly ridicules and insults police, administrators, and other authority figures with whom he interacts. After making several unsuccessful attempts to develop rapport with the client and after consulting with
his clinical supervisor, Rafael determines that he is not able to establish a
therapeutic relationship with this young man. With the client’s permission, he refers the client to another counselor who has a record of success
in working with challenging young people who have difficulty relating to
authority figures.
A.11.b. Values Within Termination and Referral
Counselors refrain from referring prospective and current clients based
solely on the counselor’s personally held values, attitudes, beliefs, and
behaviors. Counselors respect the diversity of clients and seek training in
areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals
or are discriminatory in nature.
Jonathan is a counseling student in his first semester of internship. He tells
his site supervisor that he has been seeing an interracial couple for the past 2
weeks, but he feels a bit uncomfortable because he was raised to believe that
interracial marriage is wrong. He asks his supervisor to observe his sessions
to determine if his bias is present while he is counseling and to give him
feedback. He also registers for an intensive weekend workshop in multicultural counseling to help increase his awareness.
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A.11.c. Appropriate Termination
Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to
benefit, or is being harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client or by another
person with whom the client has a relationship, or when clients do not pay
fees as agreed upon. Counselors provide pretermination counseling and
recommend other service providers when necessary.
Gary has been in individual counseling with Loretta for almost 7 months.
For the first few months, he was making steady gains toward meeting his
goals. However, for the past month, Loretta has felt that Gary has been doing very little, either in the sessions or outside of them. Loretta has shared
her reactions with Gary, but he has been reluctant to consider terminating
the counseling relationship. Finally, Gary acknowledges that he is not really interested in making more changes and that he has been avoiding the
uncomfortable feelings that he knows will come with termination. After further discussion, they agree to have two more sessions devoted to preparing
for termination.
A.11.d. Appropriate Transfer of Services
When counselors transfer or refer clients to other practitioners, they ensure
that appropriate clinical and administrative processes are completed and
open communication is maintained with both clients and practitioners.
Lauren is a counselor who has been working with Alex for some time. When
Alex tells her that he is moving to another city, they make a termination
plan that includes Lauren helping Alex locate a qualified counselor in his
new city. Lauren obtains the proper releases from Alex so that she can share
information with his new counselor.
A.12. Abandonment and Client Neglect
Counselors do not abandon or neglect clients in counseling. Counselors
assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and
following termination.
Mary Lou knows that she is going to spend 4 weeks in Europe during
the summer. She informs her clients in February and lets them know that
it will be possible for them to see one of her colleagues during her absence. Early in the spring, she informs prospective clients who call her
that she will not be accepting any new clients until she returns from her
trip, and she gives them the names and telephone numbers of several
well-qualified counselors.
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Section B
Confidentiality and Privacy
Study and Discussion Guide
• Explaining Confidentiality: What information should you give clients
about the nature and purpose of confidentiality, and how should you
present it?
• Exceptions to Confidentiality: What do you see as the major exceptions to confidentiality? Do you think informing clients about the
limits to their confidentiality increases or decreases trust?
• Confidentiality With Groups, Families, and Minor Clients: Are
confidentiality requirements different when counseling groups
and families than when counseling individuals? When counseling
minors?
• Cultural Considerations: How might a client’s culture affect his or
her views about and expectations of confidentiality in counseling?
• Sharing Confidential Information: Under what circumstances
would it be ethically acceptable to share confidential information
about a client with a third party?
• Records: What kinds of counseling records do you need to maintain? How would you respond if a client asked to see the records you
have kept of your counseling sessions with him or her?
Section B
Confidentiality and Privacy
Introduction
Counselors recognize that trust is a cornerstone of the counseling relationship. Counselors aspire to earn the trust of clients by creating an ongoing partnership, establishing and upholding appropriate boundaries, and
maintaining confidentiality. Counselors communicate the parameters of
confidentiality in a culturally competent manner.
B.1. Respecting Client Rights
B.1.a. Multicultural/Diversity Considerations
Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views
toward disclosure of information. Counselors hold ongoing discussions
with clients as to how, when, and with whom information is to be shared.
Patrice works as a counselor in a community agency. She goes to the reception area to greet her new client, Fatima, who is waiting with her husband.
Fatima introduces Patrice to her husband and asks the counselor to allow
her husband to sit with her through the intake session. Fatima explains that
in her native culture it is unacceptable for a wife to have secrets from her
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husband and that she would not be comfortable in the session without him
there. The intake session is held with the couple. Patrice suggests that future
sessions be conducted with Fatima alone so that the counseling process can
be focused on the concerns that prompted Fatima to call for an appointment. Patrice explains that the confidentiality of information shared during
sessions belongs to Fatima and that she may share information with her
husband whenever she wishes.
B.1.b. Respect for Privacy
Counselors respect the privacy of prospective and current clients. Counselors request private information from clients only when it is beneficial
to the counseling process.
Ron, a counselor in an elementary school, has been asked to see Tawana, a
second grader the referring teacher describes as being withdrawn and inattentive lately. Tawana’s father is a well-known professional athlete whose
name has been in the news recently because of a sex scandal allegedly involving several members of the sports team. Although Ron is curious about
what may be happening with Tawana’s father, he begins his counseling session with her by focusing on the reason for the referral. His intention is to
discuss family problems with Tawana only if she introduces the subject.
B.1.c. Respect for Confidentiality
Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification.
Arnetta, an elementary school counselor, conducts several short-term groups
with children. The principal tells Arnetta that, because of a district push
for accountability, he needs to know what progress each child in each of her
groups is making. Arnetta explains to the principal the reasons it would not
be appropriate or ethical for her to comply with this request. She offers, however, to summarize some key themes and general concerns of children in the
groups, taking care to ensure that no individual child can be identified, and
give this information to the principal. Arnetta also assures the principal that
she will continue to comply with the school district policy requiring that the
principal be notified if a child makes a credible threat to harm self or others.
B.1.d. Explanation of Limitations
At initiation and throughout the counseling process, counselors inform
clients of the limitations of confidentiality and seek to identify situations
in which confidentiality must be breached.
Joe, an 18-year-old high school senior, was arrested for possession of a controlled substance, was given deferred adjudication, and is now on proba-
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tion. One condition of his deferred adjudication is a requirement that he
participate in counseling with a substance abuse counselor. When Joe meets
with Thalia, the counselor, she explains confidentiality and its limitations.
She emphasizes that she will be required to make a report to the court when
they complete their sessions, and she outlines the types of information her
report must include.
B.2. Exceptions
B.2.a. Serious and Foreseeable Harm
and Legal Requirements
The general requirement that counselors keep information confidential
does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity
of an exception. Additional considerations apply when addressing
end-of-life issues.
Mark, a college freshman, comes to the university counseling center. In his
first session with Renee, the counselor, he discloses that he is feeling despondent over breaking up with his girlfriend. He reveals that the previous evening he attempted to slash his wrists but stopped when he began to
draw blood. After exploring his current emotional state, Renee suggests that
he consider admitting himself to the student health center. Mark refuses,
although he admits that he cannot be sure he will not attempt self-destructive
behavior again. Renee assesses Mark as being at continuing high risk to
himself, and she contacts the psychiatrist at the student health center after
informing Mark of her intent to do so.
B.2.b. Confidentiality Regarding End-of-Life Decisions
Counselors who provide services to terminally ill individuals who are
considering hastening their own deaths have the option to maintain confidentiality, depending on applicable laws and the specific circumstances of
the situation and after seeking consultation or supervision from appropriate professional and legal parties.
Mary is a counselor who is working with Daniel, age 22, who has been diagnosed with a terminal illness. During a session, Daniel informs Mary that
he is considering taking his own life so as not to be a burden to his family.
After consulting with her supervisor and with an attorney who represents
terminally ill clients, Mary has a conversation with Daniel in which she expresses her concern for his welfare and explains to him that she would like
him to talk to his family about this matter. She offers to be a part of the family discussion to help Daniel and his family members express their feelings
and find a resolution.
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B.2.c. Contagious, Life-Threatening Diseases
When clients disclose that they have a disease commonly known to be both
communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if the parties are known to be
at serious and foreseeable risk of contracting the disease. Prior to making
a disclosure, counselors assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party. Counselors adhere to relevant state laws
concerning disclosure about disease status.
Jolie is a professional counselor at a community clinic that services individuals with HIV-related illnesses. She has been counseling Jane, who
tested HIV positive 6 months ago. Jolie learns that Jane recently has become sexually involved with a man she considers her boyfriend. When
Jolie asks, Jane reports that she is not going to inform her boyfriend that
she is HIV positive because “it will only make things complicated.” Jolie
explains the law and explains to Jane that her decision is against the law.
However, Jane refuses to change her decision. Jolie then explains that
she must adhere to the state law and her ethical requirement to exercise
her duty to warn an endangered third party. After further discussion,
Jane agrees to give Jolie the boyfriend’s contact information so Jolie can
inform him, without giving Jane’s name, that he may be at risk for HIV
and should be tested.
B.2.d. Court-Ordered Disclosure
When ordered by a court to release confidential or privileged information
without a client’s permission, counselors seek to obtain written, informed
consent from the client or take steps to prohibit the disclosure or have it
limited as narrowly as possible because of potential harm to the client or
counseling relationship.
The court orders Johann, an LPC, to release the records of a minor client who
is the subject of a custody suit. Because the child is highly anxious about
being placed in the middle of his parents’ conflict in court, Johann does not
believe it will be in the child’s best interest to disclose the specific content of
the counseling sessions. Johann requests to the court that the child’s records
not be released and explains the importance of preserving the child’s confidentiality and the counseling relationship.
B.2.e. Minimal Disclosure
To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed.
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ACA Code of Ethics With Illustrative Vignettes
Francesca, who has a history of violent behavior when intoxicated, begins seeing a counselor at a mental health center soon after she completes an inpatient
treatment program for addiction to alcohol. She maintains her sobriety for
several months. Then one evening, obviously intoxicated, she calls the counselor. She threatens to kill her mother. Although the client is incoherent, the
counselor discerns that she has a gun. The counselor attempts to explain his
obligation to breach confidentiality in order to warn and protect someone in
danger, but the client is not receptive. The counselor calls the mother but is
unable to reach her. He then calls the police, telling them only the specific
nature of the threat and the names and addresses of the client and her mother.
B.3. Information Shared With Others
B.3.a. Subordinates
Counselors make every effort to ensure that privacy and confidentiality of
clients are maintained by subordinates, including employees, supervisees,
students, clerical assistants, and volunteers.
New clerical staff members are hired to work in a counseling agency. The
agency director presents a training program for them that includes a discussion of the importance of confidentiality in counseling. Appropriate management of case files to protect client confidentiality is emphasized. The staff
members are instructed not to reveal information about clients in response to
inquiries made by phone, by letter, or in person. They are told to channel such
inquiries to the director of the agency.
B.3.b. Interdisciplinary Teams
When services provided to the client involve participation by an interdisciplinary
or treatment team, the client will be informed of the team’s existence and composition, information being shared, and the purposes of sharing such information.
Mahmoud, who works in an inpatient facility, informs his clients that certain members of the treatment staff will have access to his records. He also
tells clients that case conferences take place on a regular basis and assures
them that the team approach is designed to include a variety of perspectives
in providing services to clients. He encourages his clients to ask questions
throughout their stay at the facility.
B.3.c. Confidential Settings
Counselors discuss confidential information only in settings in which they
can reasonably ensure client privacy.
Roberto works as a counselor in the oncology unit of a hospital. He has spent
much of his morning playing “telephone tag” with the unit’s social worker
in an attempt to coordinate services for one of the patients with whom they
both are working. As he is leaving the unit for lunch, Roberto steps into a
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crowded elevator and runs into the social worker. They both say simultaneously, “I’ve been trying to reach you!” They step out of the elevator, go into
Roberto’s office, and close the door behind them to confer.
B.3.d. Third-Party Payers
Counselors disclose information to third-party payers only when clients
have authorized such disclosure.
Norman, a counselor in private practice, has entered into a contractual agreement with a managed care company. During his initial sessions with new clients who have been referred by the company, he devotes considerable time to
discussing the specific limits that are placed on confidentiality by company
policies and procedures. He tells them that he will release information to the
managed care company only after clients have given him written authorization to do so. He further explains that their refusal to provide requested information could cause the company to deny claims for reimbursement.
B.3.e. Transmitting Confidential Information
Counselors take precautions to ensure the confidentiality of all information transmitted through the use of any medium.
Yitzhak, an LPC, receives a telephone call from a former client. The client tells
Yitzhak that he has moved to another state and asks that his records be sent to the
clinic where he plans to resume his counseling. Yitzhak explains that his policy is
to secure written permission before releasing records, and he offers to send the client a written form that would grant authorization to have his records transferred.
The client agrees to this procedure and returns the form with his signature. Yitzhak
includes with the records a cover letter that explains their confidential nature.
B.3.f. Deceased Clients
Counselors protect the confidentiality of deceased clients, consistent with
legal requirements and the documented preferences of the client.
Tonga, a professional counselor, receives a call from the mother of a 19-yearold man who was formerly her client. The young man had sought counseling
after being diagnosed with leukemia but had discontinued counseling when
his disease went into remission. The mother now informs Tonga that her son
passed away 2 weeks ago. The mother wants to obtain a copy of her son’s
counseling records for insurance purposes. Tonga informs the mother that,
during his last counseling session, the son had provided Tonga with a written request that his records not be released to anyone if he were to die. Tonga
explains to the mother that, by law, she cannot release the records without a
court order. Tonga explains that, although she understands the need for the
mother to obtain the records, she must adhere to legal requirements.
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B.4. Groups and Families
B.4.a. Group Work
In group work, counselors clearly explain the importance and parameters
of confidentiality for the specific group.
Quentin, a high school counselor, regularly conducts groups. He informs
students from the outset that confidentiality cannot be guaranteed and discusses the exceptions to confidentiality. He emphasizes to group members
the importance of respecting one another’s confidences and explains that
trust will not develop in the group unless confidentiality is maintained.
From time to time, he reminds the members of how easy it would be to
breach confidentiality unintentionally, and he clarifies this point using examples that are realistic for the students.
B.4.b. Couples and Family Counseling
In couples and family counseling, counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality. Counselors seek agreement and document in writing such agreement
among all involved parties regarding the confidentiality of information.
In the absence of an agreement to the contrary, the couple or family is
considered to be the client.
Cheong, a marriage and family counselor, tells all couples at the outset of
the counseling relationship that she usually will work with them as a couple
in conjoint sessions, but occasionally she will wish to see each of them
individually. She explains that it is important that they not keep secrets from
each other because secrets work against the purposes of relationship counseling. She explains that her focus is on helping them as a couple rather than
on assisting them to deal with concerns that are individual to either of them.
B.5. Clients Lacking Capacity to Give Informed Consent
B.5.a. Responsibility to Clients
When counseling minor clients or adult clients who lack the capacity to give
voluntary, informed consent, counselors protect the confidentiality of information received—in any medium—in the counseling relationship as specified by
federal and state laws, written policies, and applicable ethical standards.
Carol, a private practitioner, is counseling a child named Jonathan. When
Jonathan’s father comes to pick him up after a session, the father wants to
know how his son is progressing. Carol reminds the father of their discussion held during the intake session, when she explained the importance
of confidentiality as well as its limitations when working with minors. In
Jonathan’s presence and with Jonathan’s permission, she gives the father a
general idea about Jonathan’s progress. The father demands more specific
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examples and, again with Jonathan’s permission, Carol invites him to participate in the second half of Jonathan’s next session. Carol realizes that the
father may have a legal right to the information he has requested, but she
hopes she will be able to first talk with Jonathan about what he is willing to
share with his father and to persuade the father to accept the information
Jonathan is willing to disclose.
B.5.b. Responsibility to Parents and Legal Guardians
Counselors inform parents and legal guardians about the role of counselors
and the confidential nature of the counseling relationship, consistent with
current legal and custodial arrangements. Counselors are sensitive to the
cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians regarding the welfare of their children/charges
according to law. Counselors work to establish, as appropriate, collaborative relationships with parents/guardians to best serve clients.
Jose is an elementary school counselor whose school district is experiencing
an increase in enrollment of children whose parents have recently migrated
from one South American country. Part of his job is to provide individual
counseling to first and second graders who have been identified by their
teachers as having adjustment problems. Typically, after Jose meets with a
child and gains the child’s consent, he invites the parents to a conference
to talk about the best ways to proceed with the child. He realizes that his
work with young children will be enhanced if the parents provide informed
consent and collaborate in helping the child meet counseling goals. Jose explains to the parents the importance of confidentiality as the foundation for
trust in the counseling relationship.
B.5.c. Release of Confidential Information
When counseling minor clients or adult clients who lack the capacity to give
voluntary consent to release confidential information, counselors seek permission from an appropriate third party to disclose information. In such instances, counselors inform clients consistent with their level of understanding and take appropriate measures to safeguard client confidentiality.
Rowena is a counselor in a United Way–funded agency that provides services to clients with chronic mental illnesses. About once every 3 or 4 months
over the past 3 years she has seen Samantha, who suffers from chronic
schizophrenia and has been living with her adult son. The primary focus of
their counseling sessions has been to ensure that Samantha continues to take
her antipsychotic medications and to monitor the progression of her illness.
Today, Rowena receives a telephone call from Samantha’s son, who requests
Samantha’s counseling records. The son explains that Samantha’s condition
has deteriorated to the point where he can no longer care for her in his home
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and that he plans to place her in a residential facility. Rowena tells the son
that she will need a signed release of confidential information form. If Samantha
cannot sign it, his signed release must be accompanied by documentation
that he has legal authority to make decisions on Samantha’s behalf.
B.6. Records and Documentation
B.6.a. Creating and Maintaining Records and Documentation
Counselors create and maintain records and documentation necessary for
rendering professional services.
Scott, an addictions counselor, conducts an intake interview with Jeremiah,
who is experiencing severe issues with substance abuse. During their first
session, Scott shares with Jeremiah that he will be keeping notes during
each of their sessions and that he takes these notes to help him render the
best possible services. Scott also explains that, directly after each of their
sessions, he will be transferring handwritten notes to an electronic word
document format and these notes will be stored in a password-protected
file. He adds that these notes are available to Jeremiah upon request any
time he wants to review them, and he explains that the notes are confidential within the limits required by his professional ethical standards and
the law.
B.6.b. Confidentiality of Records and Documentation
Counselors ensure that records and documentation kept in any medium
are secure and that only authorized persons have access to them.
Ahmad, a school counselor, has stressed to his principal the importance of
his maintaining control over his counseling session notes. The principal has
provided a separate locking file for Ahmad’s office. This permits the counseling notes to be kept confidential and separate from students’ educational
records, which are accessible to others under provisions of the Family Educational Rights to Privacy Act.
B.6.c. Permission to Record
Counselors obtain permission from clients prior to recording sessions
through electronic or other means.
Qi-Ling is a master’s degree student completing her internship in a counseling agency. She explains to each of her clients at the first session that she is a
trainee and is working under supervision. She asks for permission to audiotape the sessions, explaining that she will be reviewing the tapes to assess
her work and that her supervisor will also listen to portions of the tapes and
provide her with feedback.
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B.6.d. Permission to Observe
Counselors obtain permission from clients prior to allowing any person
to observe counseling sessions, review session transcripts, or view recordings of sessions with supervisors, faculty, peers, or others within the training environment.
Ellen is working toward her master’s degree and is serving her internship
in an agency that has an observation facility. Her on-site supervisor periodically observes from behind the one-way mirror. During each intake session
with a client, Ellen informs the client that she is an intern and is being supervised. She explains how the supervisor uses observations to provide her
with feedback on her performance as an intern, and she obtains the client’s
permission before proceeding with the counseling session.
B.6.e. Client Access
Counselors provide reasonable access to records and copies of records when
requested by competent clients. Counselors limit the access of clients to their
records, or portions of their records, only when there is compelling evidence
that such access would cause harm to the client. Counselors document the request of clients and the rationale for withholding some or all of the records in
the files of clients. In situations involving multiple clients, counselors provide
individual clients with only those parts of records that relate directly to them
and do not include confidential information related to any other client.
Malouf receives a call from Marcia, a former client whom he saw individually for 3 months. Marcia’s husband also attended sessions. Marica tells Malouf that she and her husband are divorced, she is moving to another state,
and she wants a copy of her records. Malouf agrees to send her a copy of
the records of her individual sessions and explains that he cannot release
those portions of the records that include confidential information about her
former husband without his consent.
B.6.f. Assistance With Records
When clients request access to their records, counselors provide assistance
and consultation in interpreting counseling records.
Margaret is a 40-year-old client who has been seeing Caroline, a counselor in
private practice. Margaret asks to look at the records the counselor is keeping of their sessions. When Caroline asks why she wants to examine the
records, Margaret explains that she had a bad experience with a former boss
who wrote negative comments about her and placed them in her file. Since
that incident, she tends not to be very trusting about what is recorded about
her. Caroline makes a copy of the records for Margaret and reviews their
contents with her. Caroline checks to ensure that Margaret understands the
content and meaning of the records.
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B.6.g. Disclosure or Transfer
Unless exceptions to confidentiality exist, counselors obtain written
permission from clients to disclose or transfer records to legitimate third
parties. Steps are taken to ensure that receivers of counseling records are
sensitive to their confidential nature.
Wayne, an LPC, receives a letter from a psychiatrist requesting the records of
a former client. The psychiatrist’s written request includes a written authorization from the client. Wayne sends the records with a cover letter stating
that the records are confidential.
B.6.h. Storage and Disposal After Termination
Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with federal and state
laws and statutes such as licensure laws and policies governing records and
dispose of client records and other sensitive materials in a manner that protects client confidentiality. Counselors apply careful discretion and deliberation before destroying records that may be needed by a court of law, such as
notes on child abuse, suicide, sexual harassment, or violence.
Naomi routinely keeps her counseling records as specified by her state and
federal laws. After the statutory period has passed, she shreds the original
records, keeping on a secure database only basic information such as client
name and contact information, dates seen and services rendered, diagnoses,
and a summary of the counseling process. She takes care, however, not to
destroy any client files for which litigation might be anticipated, such as any
type of abuse or potential harm to self or others.
B.6.i. Reasonable Precautions
Counselors take reasonable precautions to protect client confidentiality in
the event of the counselor’s termination of practice, incapacity, or death
and appoint a records custodian when identified as appropriate.
Oliver is in a group private practice with three other LPCs. He has made a
contractual arrangement with one of his partners that the partner will assume his client load and provide continuing counseling services if Oliver
should die, become incapacitated, or terminate his practice. The partner has
agreed to assume responsibility for maintaining clients’ confidentiality as
well as to serve as records custodian if needed.
B.7. Case Consultation
B.7.a. Respect for Privacy
Information shared in a consulting relationship is discussed for professional purposes only. Written and oral reports present only data germane
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to the purposes of the consultation, and every effort is made to protect
client identity and to avoid undue invasion of privacy.
Germaine, an LPC in private practice, conducts a diversity sensitivity workshop for all the teachers in a particular elementary school. When she meets
with the principal and is asked for information that might help him increase
his teachers’ ability to relate to students who are culturally different from
themselves, she provides only general information about strategies to increase multicultural competence among educators, taking care to avoid
sharing information that might identify any particular teacher who participated in the workshop.
B.7.b. Disclosure of Confidential Information
When consulting with colleagues, counselors do not disclose confidential information that reasonably could lead to the identification of a client or other person or organization with whom they have a confidential
relationship unless they have obtained the prior consent of the person
or organization or the disclosure cannot be avoided. They disclose information only to the extent necessary to achieve the purposes of the
consultation.
Jacqueline, an LPC in private practice, has begun counseling a man who is
well known in her small community because he is a prominent politician.
He comes to counseling only reluctantly after he has been unable to manage
his symptoms of depression and is concerned about maintaining the privacy
of counseling. Progress is slow, and Jacqueline decides it might be helpful to
consult with a colleague. She contacts a fellow counselor from whom she received clinical supervision in the past. They consult, and Jacqueline is careful not to share any details that might reveal the client’s identity.
Section C
Professional Responsibility
Study and Discussion Guide
• Boundaries of Competence: How do you determine where your
boundaries of competence lie? If you wanted to develop and practice in a new specialty area, how would you go about obtaining the
appropriate education, training, and supervised experience?
• Maintaining Expertise: What steps do you need to take to maintain
competence in the skills you use and to keep current with new
developments?
• Impairment: How do you recognize early signs of burnout or impairment in yourself? What would you do if you became aware that
a condition was beginning to negatively affect your work?
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• Advertising: What information would you need to include on your
professional website or in other forms of advertising to ensure that
prospective clients have the information they need to make an informed choice about what counselor to choose?
• Sexual Harassment: What are some steps you can take to prevent
sexual harassment from occurring in your workplace?
• Clients Served by Others: If you discovered that one of your clients
was also seeing another mental health professional, and the client
did not want you to contact the other professional to coordinate services, what would you do?
• Innovative Practices: What safeguards do you need to put in place
when you use counseling techniques that are new or innovative?
Section C
Professional Responsibility
Introduction
Counselors aspire to open, honest, and accurate communication in dealing with the public and other professionals. Counselors facilitate access
to counseling services, and they practice in a nondiscriminatory manner
within the boundaries of professional and personal competence; they
also have a responsibility to abide by the ACA Code of Ethics. Counselors
actively participate in local, state, and national associations that foster
the development and improvement of counseling. Counselors are expected to advocate to promote changes at the individual, group, institutional, and societal levels that improve the quality of life for individuals
and groups and remove potential barriers to the provision or access of
appropriate services being offered. Counselors have a responsibility to
the public to engage in counseling practices that are based on rigorous
research methodologies. Counselors are encouraged to contribute to society by devoting a portion of their professional activity to services for
which there is little or no financial return (pro bono publico). In addition,
counselors engage in self-care activities to maintain and promote their
own emotional, physical, mental, and spiritual well-being to best meet
their professional responsibilities.
C.1. Knowledge of and Compliance With Standards
Counselors have a responsibility to read, understand, and follow the ACA
Code of Ethics and adhere to applicable laws and regulations.
Abdullah is a counselor in a group private practice with four other counselors. When the 2014 revision to the ACA Code of Ethics is published, he reads
it carefully. He asks his partners in the practice to also read the document
and requests that the five of them meet to discuss their understanding of the
standards and how they apply to their practice.
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C.2. Professional Competence
C.2.a. Boundaries of Competence
Counselors practice only within the boundaries of their competence,
based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.
Whereas multicultural counseling competency is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent
counselor in working with a diverse client population.
Daniel recently received his license to practice counseling and began working in a community agency that serves a culturally diverse client population.
Realizing that he has limited knowledge of some of the cultural groups with
whom he works, he attends several workshops dealing with specific needs
of these client groups. Aware that his graduate training did not equip him to
effectively meet all the challenges he is now facing, Daniel seeks supervision
from a colleague who has extensive experience working with client populations similar to those served by Daniel’s agency.
C.2.b. New Specialty Areas of Practice
Counselors practice in specialty areas new to them only after appropriate
education, training, and supervised experience. While developing skills
in new specialty areas, counselors take steps to ensure the competence of
their work and protect others from possible harm.
Willene is asked to facilitate a support group for survivors of sexual abuse.
Although she has attended several workshops on counseling for trauma and
sexual abuse and has done extensive reading in journals and books on the
subject, she has limited experience working directly with survivors. She arranges to cofacilitate the group for the first 3 months with a colleague who
has experience counseling survivors of sexual abuse. She also seeks ongoing
supervision of her work.
C.2.c. Qualified for Employment
Counselors accept employment only for positions for which they are qualified given their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.
Counselors hire for professional counseling positions only individuals
who are qualified and competent for those positions.
Yin-Li, the director of a community counseling agency, has placed an advertisement seeking a counselor to staff its satellite center in a small community
about 2 hours’ drive from the main office where Yin-Li works. The person
hired to staff the satellite center will need to work independently, with only
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minimal supervision from the director. Yin-Li interviews a man who recently completed his master’s degree. Although she is favorably impressed with
the applicant, she does not hire him because she realizes that this recent
graduate lacks sufficient experience to work without closer supervision.
C.2.d. Monitor Effectiveness
Counselors continually monitor their effectiveness as professionals and
take steps to improve when necessary. Counselors take reasonable steps to
seek peer supervision to evaluate their efficacy as counselors.
Javier practices in a city whose population has expanded dramatically due
to an influx of immigrants from Central American countries. Javier’s parents
immigrated from Mexico, and he is fluent in Spanish, but he grew up in the
United States and has little knowledge of Central American cultures. As he
begins to see more clients who are recent immigrants, he seeks peer supervision regarding his work with these clients.
C.2.e. Consultations on Ethical Obligations
Counselors take reasonable steps to consult with other counselors, the
ACA Ethics and Professional Standards Department, or related professionals when they have questions regarding their ethical obligations or
professional practice.
Mustafa, a counselor who works on an army base, encounters an ethical
dilemma in working with a servicewoman and her family. He consults with
two different professionals who have expertise in family counseling to explore his options for dealing with the dilemma. Both consultants offer similar suggestions, and he follows their advice. He documents the consultations in his case notes.
C.2.f. Continuing Education
Counselors recognize the need for continuing education to acquire and
maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. Counselors maintain their
competence in the skills they use, are open to new procedures, and remain
informed regarding best practices for working with diverse populations.
Peter is a counselor who has had no specialized training or course work in
counseling gay and lesbian clients. He does not want to deny counseling
services to this population, but he is concerned that because he was raised in
a fundamentalist faith that considers nonheterosexual behavior to be sinful,
he may carry some biases of which he is unaware. He also realizes that his
limited knowledge may hamper his effectiveness. Peter reads journal
articles on counseling lesbian, gay, bisexual, and transgender (LGBT) people, and he purchases a book on counseling with this client population. He
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attends a professional development institute on counseling gay and lesbian
clients and participates in several meetings of a local organization of gay
and lesbian mental health professionals. Peter realizes that he needs to be
open to learning and that he will need to work under supervision for a while
as he begins to counsel LGBT clients.
C.2.g. Impairment
Counselors monitor themselves for signs of impairment from their
own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired. They seek assistance for problems that reach the level of professional impairment,
and, if necessary, they limit, suspend, or terminate their professional
responsibilities until it is determined that they may safely resume
their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and
assistance when warranted with colleagues or supervisors showing
signs of impairment and intervene as appropriate to prevent imminent harm to clients.
Rhonda is a counselor in private practice who facilitates grief groups
two evenings a week. She suffers the unexpected loss of both of her
parents in an auto accident. As a result, she does not feel that she can
provide competent counseling services for the group members. She informs them of the situation and, with their approval, makes arrangements for another qualified professional to conduct the sessions. Recognizing that she needs to practice self-care, she makes an appointment
to see a counselor in a neighboring town who specializes in counseling
for grief and loss.
C.2.h. Counselor Incapacitation, Death, Retirement,
or Termination of Practice
Counselors prepare a plan for the transfer of clients and the dissemination
of records to an identified colleague or records custodian in the case of the
counselor’s incapacitation, death, retirement, or termination of practice.
Katherine is planning to retire from her private practice in counseling. Because Katherine has the best interests of her clients as a central concern, she
has begun planning over a year in advance of her intended retirement date.
Her advance planning includes making arrangements for the maintenance,
custody, security, and transfer of her clients’ records. She sends a letter to all
of her current and former clients announcing her upcoming retirement, and
she discusses with her current clients how they can receive continuity of care
if they have not terminated their counseling relationship with her before she
retires. She also declines to accept any new clients.
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C.3. Advertising and Soliciting Clients
C.3.a. Accurate Advertising
When advertising or otherwise representing their services to the public,
counselors identify their credentials in an accurate manner that is not
false, misleading, deceptive, or fraudulent.
After working for several years in a community agency and obtaining his LPC,
Enrico decides to establish his own private practice. He places advertisements in
the yellow pages and the newspaper, mails announcements to local professionals, and establishes a professional website. The advertisements and his website
provide Enrico’s name, address, and telephone number and accurately state that
he has a master’s degree in counseling (which he received from a fully accredited
state university) and is licensed as a professional counselor in the state.
C.3.b. Testimonials
Counselors who use testimonials do not solicit them from current clients,
former clients, or any other persons who may be vulnerable to undue influence. Counselors discuss with clients the implications of and obtain
permission for the use of any testimonial.
Tasha is a counselor at an inpatient substance abuse rehabilitation center. On
the center’s website there is a link to video-recorded testimonials of clients
who have reached sobriety through treatment. After 3 months of inpatient
care, Levi is graduating from the program. Levi approaches Tasha and informs her that he would like to share his experience with potential helpseekers by recording a videotape for inclusion on the center’s website. Tasha
explains the potential outcomes of Levi disclosing his experience, emphasizing the fact that he will be forfeiting his confidentiality. Tasha secures his
written permission to post his testimonial on the website and assures Levi
that he can withdraw his testimonial at any time if he so chooses.
C.3.c. Statements by Others
When feasible, counselors make reasonable efforts to ensure that statements
made by others about them or about the counseling profession are accurate.
Luanne is a licensed professional counselor in private practice. She is sometimes mistakenly labeled as a psychologist by prospective clients and members of the community. Whenever this occurs, Luanne carefully explains her
credentials to clarify the distinction.
C.3.d. Recruiting Through Employment
Counselors do not use their places of employment or institutional affiliation to recruit clients, supervisors, or consultees for their private practices.
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Lupe, a licensed counselor with a private practice, also teaches two counseling courses in a master’s degree program at a state university. In her teaching, she draws from her years of experience in working with individuals,
couples, and families in her private practice. Whenever she uses clinical cases as examples in class, she is careful to disguise details to protect her former
or current clients. Lupe takes care to avoid using her role as an instructor to
promote her practice, either directly or indirectly. She is well respected as an
instructor and at times students have approached her requesting personal
counseling. Lupe declines to accept any student as a counseling client because she does not want to engage in a dual relationship with students and
she does not want to use her classroom as a way to recruit clients. She does,
however, provide students with information about the university’s counseling center, and upon request she provides a list of professional counselors
in the community.
C.3.e. Products and Training Advertisements
Counselors who develop products related to their profession or conduct
workshops or training events ensure that the advertisements concerning
these products or events are accurate and disclose adequate information
for consumers to make informed choices.
James is a counselor who conducts parent effectiveness training workshops,
using training materials that he has developed. In his promotional material,
he includes the purpose, content, and format of the training, along with a
description of the materials that are required reading for the participants.
He is careful to clarify that the cost of all required materials is included in
the workshop fee.
C.3.f. Promoting to Those Served
Counselors do not use counseling, teaching, training, or supervisory relationships to promote their products or training events in a manner that
is deceptive or would exert undue influence on individuals who may be
vulnerable. However, counselor educators may adopt textbooks they have
authored for instructional purposes.
Raynette, a counselor educator, teaches a multicultural counseling course.
The required textbook is one that she has coauthored. She provides students
with articles written by others, invites guest speakers to class, and presents
a variety of viewpoints to ensure students receive a balanced perspective.
C.4. Professional Qualifications
C.4.a. Accurate Representation
Counselors claim or imply only professional qualifications actually completed and correct any known misrepresentations of their qualifications
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by others. Counselors truthfully represent the qualifications of their professional colleagues. Counselors clearly distinguish between paid and
volunteer work experience and accurately describe their continuing education and specialized training.
Tanya is a counselor who holds a master’s degree. She acquires licensure in
her state and also seeks specialized additional training and receives certification as a chemical dependency counselor. A continuing education program
at a university hires her to conduct a weekend workshop on drug abuse prevention with adolescents. The promotional flyer designed by the continuing
education program incorrectly refers to Tanya as “Dr.” Fortunately, Tanya
asked to see the flyer prior to mailing so that she could give her comments.
She immediately informs the program that she does not have a doctoral degree and asks them to change this before mailing the flyer.
C.4.b. Credentials
Counselors claim only licenses or certifications that are current and in
good standing.
Edna has a part-time private practice in counseling. She has earned licenses as a
professional counselor and as a clinical social worker, and her business cards list
both credentials. She allows her license as a social worker to lapse and immediately destroys her business cards and orders new ones that advertise only her
LPC status. She updates her professional website as well as all written materials
she gives to clients, such as her professional disclosure statement.
C.4.c. Educational Degrees
Counselors clearly differentiate between earned and honorary degrees.
Wilma earned a doctorate in counseling psychology from a program approved by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). She later became an assistant professor,
teaching counseling courses in a graduate program. She is very active in
community work. After years of setting up programs in the community
and serving with distinction to develop a coordinated response to a major
environmental disaster that occurred in her community, she is granted an
honorary doctorate in humane letters by her alma mater. On her résumé she
describes her education and lists her undergraduate and graduate degrees.
She also lists that she was granted an honorary doctorate.
C.4.d. Implying Doctoral-Level Competence
Counselors clearly state their highest earned degree in counseling or a
closely related field. Counselors do not imply doctoral-level competence
when possessing a master’s degree in counseling or a related field by
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referring to themselves as “Dr.” in a counseling context when their doctorate is not in counseling or a related field. Counselors do not use “ABD” (all
but dissertation) or other such terms to imply competency.
Jim is a licensed professional counselor who has worked full time while pursuing his doctoral degree in counselor education and supervision. He has
completed all of his doctoral course work except his dissertation research. His
business card and other forms of advertising that he does for his counseling
practice announce only his master’s degree in counseling and his state license.
C.4.e. Accreditation Status
Counselors accurately represent the accreditation status of their degree
program and college/university.
Vanessa recently earned a master’s degree in a CACREP-accredited counseling program at a regionally accredited university. She is now applying for a
position as a counselor in a community agency. On her résumé she lists her
degree, the name of the university and its accreditation status, and the fact
that the program is CACREP accredited.
C.4.f. Professional Membership
Counselors clearly differentiate between current, active memberships and
former memberships in associations. Members of ACA must clearly differentiate between professional membership, which implies the possession of at least a master’s degree in counseling, and regular membership,
which is open to individuals whose interests and activities are consistent
with those of ACA but are not qualified for professional membership.
Celeste is a special education teacher. She earned her master’s degree in
counseling several years ago and maintains her professional membership
in ACA, but she has decided that she would rather remain in the classroom.
She does occasional consulting and decides to have business cards printed.
On her cards, she describes herself as a “Teacher and Consultant.” She does
not mention her ACA membership to avoid any possibility of giving the impression that she is a practicing counselor. However, on her résumé she lists
membership in ACA as well as in other organizations.
C.5. Nondiscrimination
Counselors do not condone or engage in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/partnership
status, language preference, socioeconomic status, immigration status, or
any basis proscribed by law.
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Lori is a 29-year-old counselor who has worked for 3 years on an inpatient
unit of a psychiatric hospital. She has received very positive annual evaluations from the unit director, a fact she attributes largely to the positive mentoring she has received from Marie. Marie, who is in her early 60s, has been
a counselor on the same unit for more than a decade. When the unit director
is promoted, he recommends that Lori succeed him in that position. Lori believes Marie is better qualified to become unit director and that the only reason Marie was not recommended was because of her age. Lori explains her
concern to the hospital administrator, who agrees to reopen the search to fill
the position and to interview Marie along with other qualified candidates.
C.6. Public Responsibility
C.6.a. Sexual Harassment
Counselors do not engage in or condone sexual harassment. Sexual harassment can consist of a single intense or severe act, or multiple persistent or pervasive acts.
Miguel is cofacilitating a daylong personal growth group for young adults.
As the group progresses through its morning session, Miguel notices that his
cofacilitator is being flirtatious with a group member and hugs her during
breaks in a way that seems inappropriate. At the first opportunity, Miguel
confronts the cofacilitator and explains his objections to this behavior. The
cofacilitator ceases his unprofessional behavior.
C.6.b. Reports to Third Parties
Counselors are accurate, honest, and objective in reporting their professional activities and judgments to appropriate third parties, including
courts, health insurance companies, those who are the recipients of evaluation reports, and others.
Steve receives a court-ordered subpoena for all his records concerning a client. His case notes of early sessions reveal that his initial diagnosis was inaccurate. The notes also show that both the diagnosis and treatment plan were
later revised to address more accurately the client’s concerns and needs.
Although Steve is somewhat embarrassed that officers of the court will be
reading his records and will see his early error, he submits the records to the
court in their entirety as required.
C.6.c. Media Presentations
When counselors provide advice or comment by means of public lectures,
demonstrations, radio or television programs, recordings, technologybased applications, printed articles, mailed material, or other media, they
take reasonable precautions to ensure that
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1. the statements are based on appropriate professional counseling literature and practice,
2. the statements are otherwise consistent with the ACA Code of Ethics,
and
3. the recipients of the information are not encouraged to infer that a
professional counseling relationship has been established.
Irene, a counselor in private practice, has accepted an invitation from a radio
station to talk about one of her popular self-help books on combating depression. During her talk, Irene emphasizes that her general suggestions are
not to be taken as a substitute for counseling. She avoids giving simplistic
solutions for people suffering from depression.
C.6.d. Exploitation of Others
Counselors do not exploit others in their professional relationships.
Sharon is a mental health counselor in private practice. Her client, Suzie,
informs her that she can no longer afford to come for counseling because she
has unexpectedly lost her job. Suzie proposes to Sharon that she work for
Sharon as a nanny, which would allow her to continue her counseling and
pay her bills as well. Sharon is looking for a nanny for her young child but
explains to Suzie that she cannot hire her as a nanny. Sharon agrees, instead,
to see Suzie on a pro bono basis for a month while Suzie is looking for a job.
C.6.e. Contributing to the Public Good (Pro Bono Publico)
Counselors make a reasonable effort to provide services to the public for
which there is little or no financial return (e.g., speaking to groups, sharing
professional information, offering reduced fees).
Gregory is a licensed professional counselor in an area where many of the residents live below the poverty line. Once a month, he volunteers at the local public health clinic where he conducts a psychotherapy group for at-risk youth.
C.7. Treatment Modalities
C.7.a. Scientific Basis for Treatment
When providing services, counselors use techniques/procedures/
modalities that are grounded in theory and/or have an empirical or
scientific foundation.
Hannah attends a weekend workshop on an innovative body-oriented therapy. Because the workshop is experiential and aimed at personal growth for
the participants, Hannah leaves with new insights into how she can prevent
herself from expressing some painful emotions. Although she benefits from
her experience at this workshop, she refrains from introducing this innova-
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tive technique in the weekly group counseling sessions she conducts. She is
aware of its lack of proven efficacy with the population with whom she is
working. She also realizes that she would need considerably more supervised training before she uses this body-oriented approach.
C.7.b. Development and Innovation
When counselors use developing or innovative techniques/procedures/
modalities, they explain the potential risks, benefits, and ethical considerations of using such techniques/procedures/modalities. Counselors work
to minimize any potential risks or harm when using these techniques/
procedures/modalities.
Satou is developing a new behavior modification technique to treat anxiety
that she hopes to incorporate into her private practice. In her brochures, she
describes the technique and clearly explains that the technique is still in the
development stage and that she is, therefore, unaware of all potential risks.
When a client requests that she utilize the technique, she again explains its
experimental nature. She requires the client to give written permission for
her to video record the session so she can continue to evaluate the technique.
She displays contact information for her state licensing board should participants have any concerns.
C.7.c. Harmful Practices
Counselors do not use techniques/procedures/modalities when substantial evidence suggests harm, even if such services are requested.
Marta has been counseling a married couple for 6 weeks when they tell her
their teenage daughter has entered into a romantic relationship with another
teenage girl. The parents tell Marta that initially they thought this relationship was “just a phase.” Now they are very concerned that it is not. They
request conversion therapy for their daughter. Marta explains that she does
not provide this type of therapy, nor can she recommend a conversion therapist because this therapy has been shown to be harmful to clients. She provides the parents with literature and position papers on conversion therapy
published by major mental health organizations, including ACA. Marta offers to continue to counsel the couple if they want to explore their concerns
about their daughter’s sexuality.
C.8. Responsibility to Other Professionals
C.8.a. Personal Public Statements
When making personal statements in a public context, counselors clarify
that they are speaking from their personal perspectives and that they are
not speaking on behalf of all counselors or the profession.
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Boyd, a public offender counselor, attends a community meeting designed
to deal with the problem of gang violence on the streets. Boyd is a wellknown and respected member of the community. When he gives his input
on the issues being discussed, he emphasizes that these are his personal
views and that he is not representing the counseling profession.
Section D
Relationships With Other Professionals
Study and Discussion Guide
• Interdisciplinary Team Work: If you were a member of a treatment
team in an institution or agency that included a psychologist, psychiatrist, clinical social worker, and psychiatric nurse, what kind of
professional relationship would you want to have with them?
• Defining Roles: What problems have you encountered, or do you
anticipate that you might encounter, in defining your professional
role to your employer? What might you do if your employer expected you to perform functions that you viewed as incompatible with
your role?
• Discrimination: If you became aware that another professional in
your work setting was discriminating against individuals based on
their religion, what might you say or do? What if it were discrimination based on sexual orientation?
• Exploitive Relationships: If you became aware that a colleague was
engaging in exploitive behavior toward his or her supervisees, what
might you do?
• Consultation: What should you tell a client when you want to seek
consultation with other professionals to discuss the client’s case?
Section D
Relationships With Other Professionals
Introduction
Professional counselors recognize that the quality of their interactions with
colleagues can influence the quality of services provided to clients. They
work to become knowledgeable about colleagues within and outside the
field of counseling. Counselors develop positive working relationships and
systems of communication with colleagues to enhance services to clients.
D.1. Relationships With Colleagues, Employers, and Employees
D.1.a. Different Approaches
Counselors are respectful of approaches that are grounded in theory and/
or have an empirical or scientific foundation but may differ from their
own. Counselors acknowledge the expertise of other professional groups
and are respectful of their practices.
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Gayle is a counseling psychologist who teaches in an interdisciplinary human services program at a university. She teaches an introductory “helping skills” course for undergraduate students who may eventually choose
careers as counselors, social workers, school psychologists, or marriage and
family therapists. In her classes she includes perspectives from all of these
disciplines and demonstrates a respectful attitude toward a variety of helping professions. Gayle also presents basic concepts from the traditional psychoanalytic, humanistic, cognitive behavioral, and systems orientations, as
well as newer postmodern and constructivist approaches.
D.1.b. Forming Relationships
Counselors work to develop and strengthen relationships with colleagues
from other disciplines to best serve clients.
Anthony, a licensed counselor, is the director of an agency-based community
program. He is committed to having a group meeting of the professional staff
on a weekly basis. These sessions give team members an opportunity for coordinated treatment planning; they also talk about how their work in the agency
is affecting them personally and how they might better manage the stresses
associated with their work. On this team are a social worker, a nurse, a clinical psychologist, a recreational therapist, and a counselor. The team members
identify ways they can work with one another collaboratively and how they can
enhance the treatment program to best meet the needs of clients.
D.1.c. Interdisciplinary Teamwork
Counselors who are members of interdisciplinary teams delivering multifaceted services to clients remain focused on how to best serve clients.
They participate in and contribute to decisions that affect the well-being
of clients by drawing on the perspectives, values, and experiences of the
counseling profession and those of colleagues from other disciplines.
Members of a treatment team in a psychiatric hospital meet on a regular
basis to share perspectives on client care. At each meeting, on a rotational
basis, a different team member is in charge of structuring the agenda and
facilitating the meeting. As a group, these professionals identify program
needs and what they can do to improve conditions both for those being
served and for the team members.
D.1.d. Establishing Professional and Ethical Obligations
Counselors who are members of interdisciplinary teams work together with
team members to clarify professional and ethical obligations of the team as
a whole and of its individual members. When a team decision raises ethical
concerns, counselors first attempt to resolve the concern within the team.
If they cannot reach resolution among team members, counselors pursue
other avenues to address their concerns consistent with client well-being.
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The members of a treatment team meet to discuss their decision to provide
an initial DSM-5 diagnosis at the first meeting with a client. This decision
was the result of some pressure from the agency director, who made it
clear that establishing a diagnosis and formulating a treatment plan were
required by the HMO. On ethical grounds, some of the professional staff objected to the pressure to formulate a diagnosis and specific treatment plan at
the initial session. Others on the staff did not share the same ethical concerns
and believed some policies could not be changed. Because the team did not
have a unified view of this policy that affected practice, they asked for time
to discuss their concerns with the agency director.
D.1.e. Confidentiality
When counselors are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, they clarify role expectations and the parameters of
confidentiality with their colleagues.
Jeffrey is a member of the clinical staff and is also the program director of a
community health center. In addition to his clinical duties providing direct
services to individuals and families, he participates in hiring and evaluating
other members of the treatment team. Jeffrey is a clinical colleague, but he
is also expected to conduct regular evaluations of others on the team. He
strives to clearly state what is expected of him in his roles of providing clinical services and evaluating others in the professional staff. He has clarified
with his colleagues the parameters of confidentiality in each role.
D.1.f. Personnel Selection and Assignment
When counselors are in a position requiring personnel selection and/or
assigning of responsibilities to others, they select competent staff and assign responsibilities compatible with their skills and experiences.
Martha opened her private practice office a year ago, and her practice has grown
to the point where she needs to hire a full-time receptionist/clerical assistant. She
advertises the position and interviews an applicant who has had considerable
experience working as a receptionist for a group of medical doctors. This applicant has a good grasp of office procedures and understands the importance of
maintaining patient confidentiality. Her references are excellent, and she is very
amenable to further training and supervision. Martha hires the applicant.
D.1.g. Employer Policies
The acceptance of employment in an agency or institution implies that
counselors are in agreement with its general policies and principles. Counselors strive to reach agreement with employers regarding acceptable
standards of client care and professional conduct that allow for changes in
institutional policy conducive to the growth and development of clients.
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Vaughn is employed as a counselor in a residential facility for juvenile offenders. The new director of the facility institutes a policy that involves
administering what Vaughn sees as harsh consequences for residents who
break the rules. Vaughn consults with the director about his ethical opposition regarding such methods. The director agrees to call a meeting of all staff
counselors to discuss the policy.
D.1.h. Negative Conditions
Counselors alert their employers of inappropriate policies and practices.
They attempt to effect changes in such policies or procedures through
constructive action within the organization. When such policies are potentially disruptive or damaging to clients or may limit the effectiveness
of services provided and change cannot be affected, counselors take appropriate further action. Such action may include referral to appropriate
certification, accreditation, or state licensure organizations, or voluntary
termination of employment.
Miriam, an employment counselor, finds that so much of her time is needed
to contact prospective employers and get information about job openings
that she doesn’t have enough time to update the files on the qualifications
and interests of clients. Miriam informs her supervisor of this concern and
provides the supervisor with documentation of the amount of time she is
spending contacting prospective employers. The supervisor refuses to make
any changes to current policies and procedures, so Miriam decides to seek
employment elsewhere.
D.1.i. Protection From Punitive Action
Counselors do not harass a colleague or employee or dismiss an employee
who has acted in a responsible and ethical manner to expose inappropriate employer policies or practices.
At a meeting, Marquita raises objections to the fact that a weekly support
group for the professional staff has been terminated at the agency because
of budget cuts. Marquita states the reasons for her concerns and suggests
alternatives because so many of the staff highly valued this support group.
Her supervisor takes measures to see that Marquita will not be subjected to
retaliation because of her vocal opposition to a decision that was made at the
administrative level.
D.2. Provision of Consultation Services
D.2.a. Consultant Competency
Counselors take reasonable steps to ensure that they have the appropriate
resources and competencies when providing consultation services.
Counselors provide appropriate referral resources when requested or
needed.
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Chandra is a professor who is offered a position as a consultant to a research
project. She is told that her role will be to help with the statistical analysis of
the data for the study. She asks to meet with the researchers to define further
the parameters of her role. During this meeting, it becomes clear that she will
be expected to provide technical help with a particular computerized statistical package in which she does not have expertise. She declines the consultant
position and suggests the names of other well-qualified consultants.
D.2.b. Informed Consent in Formal Consultation
When providing formal consultation services, counselors have an obligation to review, in writing and verbally, the rights and responsibilities of
both counselors and consultees. Counselors use clear and understandable
language to inform all parties involved about the purpose of the services
to be provided, relevant costs, potential risks and benefits, and the limits
of confidentiality.
Deanna is hired by a private psychiatric hospital to provide stress management training for the staff who work there. She informs the staff that she will
be expected to provide the director of the hospital with feedback about what
they find stressful about working in the facility. Although she will provide
the director with information about sources of stress, she lets the staff know
she will take care to protect the identities of specific individuals.
Section E
Evaluation, Assessment, and Interpretation
Study and Discussion Guide
• Competence: How can you determine whether you are competent to
use a particular assessment instrument?
• Informed Consent: Prior to using an assessment with clients, what
information do you need to give them about the nature and purposes of the assessment? In what ways do you attempt to involve your
clients in the assessment process?
• Administering Assessments: What factors do you need to consider
when you are planning to administer an assessment to a client or a
group of clients to ensure that the assessment is properly administered?
• Diagnosis: What ethical issues are involved in making a diagnosis?
What are your own views about counselors participating in the diagnosis of mental disorders?
• Cultural Sensitivity: What role do you think clients’ socioeconomic
and cultural experiences have in the diagnosis they might receive?
How can you take into consideration the cultural and environmental
variables that might pertain to clients’ concerns?
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• Assessment and Testing: When might you make use of assessment
instruments as a part of the counseling process? What factors do you
need to take into account in selecting, administering, scoring, and
interpreting tests? What are the ethical considerations in testing
diverse client populations?
• Forensic Evaluation: What do you see as the counselor’s role in forensic evaluation (evaluation for legal proceedings)? How is the role
of the counselor different from the role of a forensic evaluator?
Section E
Evaluation, Assessment, and Interpretation
Introduction
Counselors use assessment as one component of the counseling process,
taking into account the clients’ personal and cultural context. Counselors
promote the well-being of individual clients or groups of clients by developing and using appropriate educational, mental health, psychological,
and career assessments.
E.1. General
E.1.a. Assessment
The primary purpose of educational, mental health, psychological, and
career assessment is to gather information regarding the client for a variety of purposes, including, but not limited to, client decision making,
treatment planning, and forensic proceedings. Assessment may include
both qualitative and quantitative methodologies.
Melody, a private practitioner, administers a depression scale to one of her
clients. The instrument has been extensively field-tested and has been found
to be reliable and valid. She carefully explains the purpose of the assessment and how the results will be used in the therapeutic process to better
understand her client’s current mental health needs and formulate an individualized treatment plan. She also explains to her client that the results of
the scale will be considered within the context of other assessments, both
qualitative and quantitative.
E.1.b. Client Welfare
Counselors do not misuse assessment results and interpretations, and they
take reasonable steps to prevent others from misusing the information provided. They respect the client’s right to know the results, the interpretations
made, and the bases for counselors’ conclusions and recommendations.
Nancy is a high school counselor. A week before the administration of
achievement tests to the sophomore class, she visits classrooms to explain
the purpose of this test series. When the results become available, she meets
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with each sophomore to interpret the results. She sends the parents a letter
that provides information about how test scores should be interpreted and
invites the parents to call her if they have any questions regarding the test results. She puts a copy of this letter in the mailbox of each sophomore teacher.
E.2. Competence to Use and Interpret Assessment Instruments
E.2.a. Limits of Competence
Counselors use only those testing and assessment services for which they
have been trained and are competent. Counselors using technology-assisted test interpretations are trained in the construct being measured and
the specific instrument being used prior to using its technology-based application. Counselors take reasonable measures to ensure the proper use
of assessment techniques by persons under their supervision.
The director of a mental health agency asks Luz, an LPC employed at the agency, to administer the Minnesota Multiphasic Personality Inventory–II to a client.
Luz is not trained in the administration and interpretation of this newer version
of the test. She explains this to the director, and they agree that another counselor who recently received training will administer the test. The director also
makes arrangements for Luz to receive training to administer the instrument.
E.2.b. Appropriate Use
Counselors are responsible for the appropriate application, scoring, interpretation, and use of assessment instruments relevant to the needs of the
client, whether they score and interpret such assessments themselves or
use technology or other services.
William, a client in career counseling, wants to become a nurse. He has some
doubt, however, about whether this is really the right field for him. The
counselor administers a vocational interest test. The results do not support
his interest in the nursing field. The counselor explains that although the
test shouldn’t be the only factor in his decision, the results do indicate that
William’s interests are different from those of a recent sample of men who
are in the nursing profession.
E.2.c. Decisions Based on Results
Counselors responsible for decisions involving individuals or policies that are
based on assessment results have a thorough understanding of psychometrics.
Sherlene is a school counselor who frequently serves on admission, review,
and dismissal (ARD) committees. An ARD committee evaluates a wide
range of information, including test data, and then decides if a child qualifies for special education services. Sherlene has a thorough understanding of
testing and measurement. She is able to help other committee members see
the test results in proper perspective and use them in making wise decisions.
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E.3. Informed Consent in Assessment
E.3.a. Explanation to Clients
Prior to assessment, counselors explain the nature and purposes of assessment and the specific use of results by potential recipients. The explanation will be given in terms and language that the client (or other legally
authorized person on behalf of the client) can understand.
Two community college counselors work to develop a computer program
to assist entering students choose the most appropriate freshman English
course. They want to design the software so that students can complete the
program without assistance. Over a period of 2 years, the program is pilot tested, and validation studies are conducted. The counselors also enlist
the cooperation of the Disability Services Office on campus to field-test the
program to ensure that it is accessible to students with any type of disability. When the program is completed, the manual carefully describes how to
interpret and use the results, in language that the students can understand.
During the first two semesters of use, the counselors meet individually with
student users of the program to ensure that the students understand how to
use it properly.
E.3.b. Recipients of Results
Counselors consider the client’s and/or examinee’s welfare, explicit understandings, and prior agreements in determining who receives the
assessment results. Counselors include accurate and appropriate interpretations with any release of individual or group assessment results.
Meg develops a computer application designed to help individuals identify their life stressors. She carefully explains the nature of the assessment,
including its uses and limitations. Whenever clients opt to complete the assessment, she sits at the computer with them while they log on and begin
completing the assessment to make sure they understand how to use the
technology. In discussing results, she carefully describes how to interpret
results and other factors that might suggest the need for further counseling
for stress management.
E.4. Release of Data to Qualified Personnel
Counselors release assessment data in which the client is identified only
with the consent of the client or the client’s legal representative. Such data
are released only to persons recognized by counselors as qualified to
interpret the data.
Craig, a licensed counselor, specializes in the assessment and counseling of
children. He administers a projective test to a 7-year-old child who refuses to
speak. The results indicate an unusual pattern, and the counselor is unsure
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how to best interpret this. With the written consent of the child’s parents,
he reviews the test protocol with a professor who is an expert in child assessment and requests the professor’s assistance in understanding how to
interpret the child’s results.
E.5. Diagnosis of Mental Disorders
E.5.a. Proper Diagnosis
Counselors take special care to provide proper diagnosis of mental disorders. Assessment techniques (including personal interviews) used to
determine client care (e.g., locus of treatment, type of treatment, recommended follow-up) are carefully selected and appropriately used.
Mel is an intake counselor in a psychiatric hospital. Each time a new patient
is admitted, Mel is responsible for formulating an initial diagnosis and suggesting an appropriate course of treatment. Although he uses a standardized
intake assessment questionnaire as required by hospital policy, he schedules
further sessions as needed with each client so that he can ensure an accurate
diagnosis. He collaborates with the client’s treatment team to formulate a
treatment plan.
E.5.b. Cultural Sensitivity
Counselors recognize that culture affects the manner in which clients’
problems are defined and experienced. Clients’ socioeconomic and cultural experiences are considered when diagnosing mental disorders.
Sean is a counselor who works in a culturally and racially diverse school. As
a certified special education counselor, he is responsible for diagnosing students who may need to be placed in special education classes. He proceeds
cautiously, taking into consideration each student’s cultural context when
formulating his diagnoses.
E.5.c. Historical and Social Prejudices in the
Diagnosis of Pathology
Counselors recognize historical and social prejudices in the misdiagnosis
and pathologizing of certain individuals and groups and strive to become
aware of and address such biases in themselves or others.
Chandrelle comes for counseling at a community agency located in an urban, low-income neighborhood. During her intake session Chandrelle describes symptoms of depression, including difficulty sleeping, weight loss,
and feelings of helplessness and hopelessness. Chandrelle has a full-time job
at minimum wage and is raising three children on her own. She has sought
counseling twice before for similar symptoms and was given a diagnosis of
Major Depressive Disorder, Recurrent. She was referred for antidepressant
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medication that, according to Chandrelle, helped her through the “rough
times.” Sally, the intake counselor, recognizes that women are more likely
than men to be diagnosed with depression and that the economically disadvantaged are more likely to be given severe diagnoses. She works with
Chandrelle to develop an overall treatment plan that includes counselor
advocacy to help empower Chandrelle to deal with environmental conditions that are contributing to (and to some extent causing) her depression.
Sally also advocates with her supervisor to arrange for in-service training on
counseling clients in low-income urban areas to be provided for the professional staff at the agency.
E.5.d. Refraining From Diagnosis
Counselors may refrain from making and/or reporting a diagnosis if they
believe that it would cause harm to the client or others. Counselors carefully consider both the positive and negative implications of a diagnosis.
Sidney is a counselor who works in a for-profit substance abuse treatment
facility. The facility offers inpatient treatment, day treatment, and aftercare
services. The marketing director asks Sidney to conduct an assessment of
Jeremiah, a potential client. The director tells Sidney that the census is low
on the inpatient unit and that Jeremiah’s health insurance will pay for inpatient treatment if Jeremiah is diagnosed with a substance use disorder. Sidney meets with Jeremiah and determines that Jeremiah suffers from social
anxiety and drinks only to self-medicate when he attends large social gatherings. Sidney considers the possible implications for Jeremiah if given the
diagnosis suggested by the marketing director and refrains from diagnosing
substance use disorder. He refers Jeremiah to an anxiety disorders clinic for
appropriate treatment.
E.6. Instrument Selection
E.6.a. Appropriateness of Instruments
Counselors carefully consider the validity, reliability, psychometric limitations, and appropriateness of instruments when selecting assessments
and, when possible, use multiple forms of assessment, data, and/or
instruments in forming conclusions, diagnoses, or recommendations.
Melvin, an LPC who specializes in child and adolescent counseling, is
contacted by Julia, who wants her daughter Britney tested for attentiondeficit/hyperactivity disorder. During the initial session with Julia and
Britney, Melvin explains that he can administer formal assessments as
part of the evaluation process. He also makes it clear that these instruments present only a partial picture and that a complete evaluation
entails obtaining information about Britney’s behavior from multiple
sources, including parents, teachers, and Britney herself.
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E.6.b. Referral Information
If a client is referred to a third party for assessment, the counselor provides
specific referral questions and sufficient objective data about the client to
ensure that appropriate assessment instruments are utilized.
Nora is a marriage and family counselor who has been counseling Janine
and Jeff, a young couple who are having marital difficulties. They have
brought their 2-year-old child with them to most of the counseling sessions.
As counseling progresses, it becomes apparent to Nora that a major source
of stress in the couple’s marriage is their fear that their child may have a
developmental disability. Because of this fear, the couple has avoided having the child tested. After exploring these fears, Janine and Jeff agree that
the child should be tested, and with their permission, Nora arranges for the
child to be assessed by a specialist in early childhood developmental disorders. Nora provides the specialist with objective information about the
child, clearly indicating what information is based on her own observations
and what information has been reported by the parents.
E.7. Conditions of Assessment Administration
E.7.a. Administration Conditions
Counselors administer assessments under the same conditions that were
established in their standardization. When assessments are not administered under standard conditions, as may be necessary to accommodate
clients with disabilities, or when unusual behavior or irregularities occur
during the administration, those conditions are noted in interpretation,
and the results may be designated as invalid or of questionable validity.
During the administration of a standardized test to the juniors in a high
school, a malfunction in the timer causes the time to be 4 minutes short for
a subtest. The problem is discovered a week later when the timer is used
again. The principal is reluctant to report the matter to the national testing
center, but the counselor insists that it be reported, pointing out how this
could adversely affect the total test results. After discussing the matter, they
agree that they will report the problems that occurred. They also agree that
they will follow the instructions of the national testing center regarding how
to explain the problem to the students who were tested, as well as to their
parents, and will caution them about interpreting the results.
E.7.b. Provision of Favorable Conditions
Counselors provide an appropriate environment for the administration of
assessments (e.g., privacy, comfort, freedom from distraction).
Karen, an LPC and certified sex therapist, starts a private practice with two
family counselors. Karen recognizes that some of the questions on her intake
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assessment may need to be discussed verbally. She offers a private assessment room for couples and uses noise-canceling machines for each counseling room to ensure the privacy of her clients.
E.7.c. Technological Administration
Counselors ensure that technologically administered assessments function properly and provide clients with accurate results.
Kyle, a counselor at a vocational-technical college, plans to use a computeradministered and scored test with a client. He goes through the entire testtaking and scoring process himself to ensure that the computer program
works properly.
E.7.d. Unsupervised Assessments
Unless the assessment instrument is designed, intended, and validated
for self-administration and/or scoring, counselors do not permit unsupervised use.
Leticia, an elementary school counselor, is administering a timed, individually administered test designed to detect learning disabilities. She takes
precautions to prevent interruptions during the testing session so as not to
disturb the child’s concentration or invalidate the test results.
E.8. Multicultural Issues/Diversity in Assessment
Counselors select and use with caution assessment techniques normed on
populations other than that of the client. Counselors recognize the effects
of age, color, culture, disability, ethnic group, gender, race, language preference, religion, spirituality, sexual orientation, and socioeconomic status
on test administration and interpretation, and they place test results in
proper perspective with other relevant factors.
Gregorio, a Mexican American transfer student, is recommended for a lowability class placement based on his poor performance on a mental ability
test. The school counselor learns that Mexican Americans are not represented in the norm group for the test and that Gregorio performed well academically when he attended school in Mexico. The counselor puts together
a variety of more appropriate measures to use as a basis for placement.
E.9. Scoring and Interpretation of Assessments
E.9.a. Reporting
When counselors report assessment results, they consider the client’s personal and cultural background, the level of the client’s understanding of
the results, and the impact of the results on the client. In reporting assessment results, counselors indicate reservations that exist regarding validity
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or reliability due to circumstances of the assessment or inappropriateness
of the norms for the person tested.
Joey, a licensed professional counselor, works for an agency that has multiple
locations in a large city. The site where Joey works serves a number of clients for
whom English is their second language. It is agency policy that several quantitative assessments be used throughout the course of treatment to measure client progress. Prior to sharing results with clients, Joey assesses the ability of
each client to understand the results and also how the client’s individuality and
cultural background might affect the interpretation of the results. Joey informs
clients that the data are based on normative values that may or may not be generalizable, valid, or reliable.
E.9.b. Instruments With Insufficient Empirical Data
Counselors exercise caution when interpreting the results of instruments
not having sufficient empirical data to support respondent results. The specific purposes for the use of such instruments are stated explicitly to the
examinee. Counselors qualify any conclusions, diagnoses, or recommendations made that are based on assessments or instruments with questionable
validity or reliability.
Francois is the director of a career counseling center at a community college. He
is contacted by a testing company that wants to use college freshmen as a sample in field-testing a new career inventory. Francois agrees to help and explains
to student volunteers that they are participating in the development of this test.
Although students will receive a printout of career interests at the completion of
the test, Francois cautions them that the results are not reliable because the test
is still being developed.
E.9.c. Assessment Services
Counselors who provide assessment, scoring, and interpretation services
to support the assessment process confirm the validity of such interpretations. They accurately describe the purpose, norms, validity, reliability,
and applications of the procedures and any special qualifications applicable to their use. At all times, counselors maintain their ethical responsibility to those being assessed.
Valerie, an LPC in private practice, is hired as a consultant to a large department
store. She is asked to determine which job applicants are prone to tardiness and
absenteeism due to hypochondriacal tendencies (calling in sick). Valerie proposes a
correlational study comparing results from instruments that measure hypochondriacal tendencies with actual employee promptness and attendance over a 10-month
period. She secures written agreement from the consultee that any data collected
from actual employees will be kept confidential and will not be shared with the
consultee. Valerie explains that until and unless sufficient correlation can be found
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between actual employee performance and test data, no applicant’s test result can
be considered relevant to potential problems of tardiness and absenteeism.
E.10. Assessment Security
Counselors maintain the integrity and security of tests and assessments
consistent with legal and contractual obligations. Counselors do not appropriate, reproduce, or modify published assessments or parts thereof
without acknowledgment and permission from the publisher.
Kamran is promoted to the position of director of the intensive outpatient
program for a substance abuse treatment facility. He wants to improve the
assessment process the facility uses in screening potential clients to determine whether to recommend intensive outpatient or inpatient treatment. He
finds a journal article describing an assessment instrument that seems ideal
for this purpose. Kamran contacts the publisher to ask for permission to
reproduce it and administer it to potential clients.
E.11. Obsolete Assessments and Outdated Results
Counselors do not use data or results from assessments that are obsolete or
outdated for the current purpose (e.g., noncurrent versions of assessments/
instruments). Counselors make every effort to prevent the misuse of obsolete measures and assessment data by others.
Harriet is hired as a counselor in a university admissions office. She notices
that Graduate Record Exam results are routinely used as a criterion for admission to graduate programs without giving consideration to the date of
the testing. She calls to the attention of her director that results more than
10 years old should not be used for this purpose, and the director agrees to
make the needed change in procedures.
E.12. Assessment Construction
Counselors use established scientific procedures, relevant standards, and
current professional knowledge for assessment design in the development, publication, and utilization of assessment techniques.
Ramon is a counselor educator who has specialized knowledge in test construction. As he is designing a new assessment instrument, he takes specific
steps to reduce bias against certain cultural groups that may be assessed
using the instrument once it is developed. He makes use of current professional knowledge and also has other experts evaluate the instrument.
E.13. Forensic Evaluation: Evaluation for Legal Proceedings
E.13.a. Primary Obligations
When providing forensic evaluations, the primary obligation of counselors is to produce objective findings that can be substantiated based on
information and techniques appropriate to the evaluation, which may
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include examination of the individual and/or review of records. Counselors form professional opinions based on their professional knowledge
and expertise that can be supported by the data gathered in evaluations.
Counselors define the limits of their reports or testimony, especially when
an examination of the individual has not been conducted.
Olivia is a counselor who conducts court-ordered child custody evaluations. She has been asked to evaluate 6-year-old Tiffany, who is the subject
of a custody dispute. Tiffany currently lives with her mother and her livein boyfriend and stays with her father every other weekend. Both parents have made allegations of physical abuse: The father has accused the
mother’s boyfriend, and the mother has accused the father. Olivia holds a
series of counseling sessions with Tiffany, using age-appropriate play therapy techniques. Olivia also conducts individual interviews with all three
adults involved in the dispute and visits both homes. When she writes
her report, she states her professional opinion based on data collected
throughout her evaluation.
E.13.b. Consent for Evaluation
Individuals being evaluated are informed in writing that the relationship
is for the purposes of an evaluation and is not therapeutic in nature, and
entities or individuals who will receive the evaluation report are identified. Counselors who perform forensic evaluations obtain written consent from those being evaluated or from their legal representative unless
a court orders evaluations to be conducted without the written consent
of the individuals being evaluated. When children or adults who lack the
capacity to give voluntary consent are being evaluated, informed written
consent is obtained from a parent or guardian.
Harry, age 22, has made a court appearance after being arrested for driving under the influence of alcohol. The court has referred Harry for drug
and alcohol screening and assessment. Samuel, the counselor who receives
Harry’s case, is informed that his report will be considered as a factor in
determining Harry’s sentence. When Samuel meets with Harry, he explains that the purpose of their meeting is to gather information for an
evaluation and does not include counseling services. He also tells Harry
that he will be making a report to the judge and clarifies what types of
information the report will include. He obtains Harry’s written consent to
conduct the assessment.
E.13.c. Client Evaluation Prohibited
Counselors do not evaluate current or former clients, clients’ romantic
partners, or clients’ family members for forensic purposes. Counselors do
not counsel individuals they are evaluating.
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Quiana, a marriage and family counselor, receives a telephone call from Annie, a former client whom Quiana had seen with her husband in couples
counseling a year ago. Annie states that she and her husband have initiated divorce proceedings and are embroiled in a custody dispute over their
children. Annie’s attorney has advised her to obtain an evaluation of her
fitness as a parent. Annie states that, because Quiana already knows what a
dedicated and caring parent she is, Annie would like Quiana to conduct the
evaluation. Quiana declines and explains her reasons for doing so.
E.13.d. Avoid Potentially Harmful Relationships
Counselors who provide forensic evaluations avoid potentially harmful professional or personal relationships with family members, romantic partners, and close friends of individuals they are evaluating or have
evaluated in the past.
Lawrence is a counselor employed by the juvenile court system. He recently
completed six court-mandated counseling sessions with Amanda, a 15-yearold who had been apprehended for shoplifting. He receives an email message from Amanda’s parents thanking him for making a fair report to the
court and offering to take him out to dinner as a token of their appreciation.
Lawrence declines the offer and explains his reasons to the parents.
Section F
Supervision, Training, and Teaching
Study and Discussion Guide
• Client Welfare: How do you think a supervisor can balance the need
to protect client welfare with encouraging a supervisee to gain experience and stretch his or her boundaries of competence?
• Counselor Supervision Competence: How are the qualifications needed to be a clinical supervisor different from the qualifications needed to
be a counselor? How can supervisors acquire knowledge and skills that
will enable them to address diversity issues with their supervisees?
• Online Supervision: What is your opinion about conducting clinical
supervision online? What do you see as the potential advantages of
distance supervision? The potential problems?
• Supervisory Relationship: How can appropriate relationship
boundaries between supervisors and supervisees be determined?
What ethical, professional, and social relationship boundaries between supervisors and supervisees do you see as important? Can
you think of examples of nonprofessional interactions between supervisors and supervisees that could be beneficial?
• Informed Consent in Supervision: As a supervisee, what kinds of information would you most want to have at the outset of supervision?
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• Professional Disclosure: If you were a student or counselor intern
working under supervision, what information do you think you need
to give your clients about your status as a student/intern/supervisee?
• Counseling for Students and Supervisees: What do you see as the
rationale for prohibiting counselor educators or supervisors from
serving as counselors to students or supervisees?
• Teaching Ethics: How do you think ethics can best be taught? How
can counselor educators and supervisors help students to develop a
sense of ethical selfhood?
• Orientation to a Program: As a student, what would you want to
know about the program to which you are applying prior to admission? What kinds of information do you need to receive at the beginning of your training program?
• Self-Growth Experiences: What role should therapeutic experiences
play in a graduate counseling program? Do you see any problems
in combining experiential training experiences with didactic course
work? What guidelines might you like to see regarding students’
levels of self-disclosure?
• Promoting Diversity Competence: Counselor educators and supervisors are ethically bound to actively infuse multicultural competency
into their training and supervision practices. How do you think this
can best be done?
• Evaluation and Remediation: If a counseling student has failed to
acquire required skills and competencies, what remediation procedures should counselor educators and supervisors implement to assist the student to become competent?
Section F
Supervision, Training, and Teaching
Introduction
Counselor supervisors, trainers, and educators aspire to foster meaningful and respectful professional relationships and to maintain appropriate boundaries with supervisees and students in both face-to-face and
electronic formats. They have theoretical and pedagogical foundations
for their work; have knowledge of supervision models; and aim to be
fair, accurate, and honest in their assessments of counselors, students,
and supervisees.
F.1. Counselor Supervision and Client Welfare
F.1.a. Client Welfare
A primary obligation of counseling supervisors is to monitor the services
provided by supervisees. Counseling supervisors monitor client welfare
and supervisee performance and professional development. To fulfill
these obligations, supervisors meet regularly with supervisees to review
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the supervisees’ work and help them become prepared to serve a range of
diverse clients. Supervisees have a responsibility to understand and follow the ACA Code of Ethics.
Greta holds licensure as an LPC-S (Licensed Professional Counselor, Supervisor) in her state. She provides supervision to four counselors who
are working toward licensure. She meets individually with each supervisee once a week and meets with them as a group once per month. The
supervisees are required to submit videotapes of their counseling sessions through a secure website. So that Greta may provide appropriate
feedback, she reviews these videotapes before she meets with the supervisees or they review them together. Supervision sessions also focus
on supervisees’ self-awareness, especially of countertransference issues
that might interfere with effective counseling, as well as adherence to the
ACA Code of Ethics.
F.1.b. Counselor Credentials
Counseling supervisors work to ensure that supervisees communicate
their qualifications to render services to their clients.
Shelley, a counseling supervisor, requires all of her supervisees to inform
their clients that they are interns and to discuss with clients their qualifications to provide the services they will render.
F.1.c. Informed Consent and Client Rights
Supervisors make supervisees aware of client rights, including the protection of client privacy and confidentiality in the counseling relationship. Supervisees provide clients with professional disclosure information and inform them of how the supervision process influences the
limits of confidentiality. Supervisees make clients aware of who will
have access to records of the counseling relationship and how these records will be stored, transmitted, or otherwise reviewed.
Sayuri requires her supervisees to develop a written informed consent
document to give their clients and discuss with them at the beginning of
the counseling relationship. The contents of this document include a summary of the supervisee’s education and training; disclosure of the trainee
status of the supervisee along with the implications for confidentiality; a
statement pertaining to regular meetings with a supervisor; and information regarding who will have access to the records and how records will be
stored, transmitted, and reviewed. After the supervisees have written their
informed consent documents, they role-play to demonstrate how they
would verbally address key topics of the consent process. Sayuri gives supervisees the opportunity to discuss any concerns about implementing the
informed consent process.
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F.2. Counselor Supervision Competence
F.2.a. Supervisor Preparation
Prior to offering supervision services, counselors are trained in supervision methods and techniques. Counselors who offer supervision services
regularly pursue continuing education activities, including both counseling and supervision topics and skills.
Diane, a counselor educator, supervises doctoral students who serve as
practicum supervisors to master’s-level students. She teaches a supervision
course that the doctoral students must take before they function as supervisors. In addition, she meets with these doctoral students each week in a
small group. In these meetings, the students discuss what they are learning,
and Diane helps them with any problems they encounter in providing supervision. Diane herself attends continuing education workshops on both
counseling and supervision, and she keeps up to date by reading textbooks
and journal articles on clinical supervision.
F.2.b. Multicultural Issues/Diversity in Supervision
Counseling supervisors are aware of and address the role of multiculturalism/
diversity in the supervisory relationship.
As a counseling supervisor, Norman is aware that the range of differences
between him and his supervisees may affect their working relationship. To
promote a discussion of salient aspects of diversity, Norman has included
a section on dealing with diversity in the supervisor relationship in the informed consent materials he uses as part of the orientation process with all
supervisees. He encourages his supervisees to discuss any aspect of diversity that is important to them. In addition to addressing the role of diversity
in his relationship with each of his supervisees, which he models, he asks
his supervisees to discuss in their supervisory sessions how they deal with
diversity in their relationships with their clients. He encourages students to
focus on those aspects of diversity that are especially challenging for them.
Norman does not provide simplistic solutions when his supervisees face
challenges in dealing with diversity. Instead, he asks them to state how they
are addressing issues and how they evaluate what they are doing.
F.2.c. Online Supervision
When using technology in supervision, counselor supervisors are competent in the use of those technologies. Supervisors take the necessary
precautions to protect the confidentiality of all information transmitted
through any electronic means.
Julie is a board-approved supervisor in her state, and she regularly conducts
supervision with those seeking licensure. She requires that her supervisees
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send her one video recording prior to the first supervision meeting of each
month. Julie takes steps to ensure that all electronic transmissions are sent
through encrypted means. After each supervision session, Julie erases the
recorded session and requires that her supervisee do the same.
F.3. Supervisory Relationship
F.3.a. Extending Conventional Supervisory Relationships
Counseling supervisors clearly define and maintain ethical professional,
personal, and social relationships with their supervisees. Supervisors consider the risks and benefits of extending current supervisory relationships
in any form beyond conventional parameters. In extending these boundaries, supervisors take appropriate professional precautions to ensure that
judgment is not impaired and that no harm occurs.
The counselor educators and supervisors in a counselor training program
recognize that they play multiple roles in the supervisory relationship. As
part of their informed consent process with all supervisees, they summarize
in writing the various roles they may play, such as teacher, mentor, consultant, adviser, and evaluator. They explain these roles to supervisees at an orientation session and invite questions and discussion. The supervisors also
explain the importance of establishing appropriate boundaries and provide
examples of both appropriate and inappropriate nonprofessional interactions. Whenever situations occur in which the supervisors consider extending the stated boundaries, the supervisors first consult with their colleagues
and document these consultations.
F.3.b. Sexual Relationships
Sexual or romantic interactions or relationships with current supervisees
are prohibited. This prohibition applies to both in-person and electronic
interactions or relationships.
Monica, a counseling supervisor, gives all of her supervisees written informed
consent materials to educate them about the process of supervision, including
the rights and responsibilities of both supervisor and supervisee. A short section is devoted to boundary issues as they apply to the supervisory relationship. It specifically mentions nonprofessional relationships, including online
interactions, and how these might be addressed in supervisory sessions. A
specific statement is made that sexual relationships are prohibited in the supervisory relationship. Monica reviews this material with her supervisees and
encourages them to ask questions about their relationship with her.
F.3.c. Sexual Harassment
Counseling supervisors do not condone or subject supervisees to sexual
harassment.
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Sylvia, a counselor supervisor, includes in the supervision agreement she
gives all new supervisees a written statement pertaining to sexual harassment. She specifically references the standards in the ACA Code of Ethics
that address sexual harassment. During her initial meeting with new supervisees, Sylvia discusses these standards to ensure that the supervisees
understand what may constitute sexual harassment and encourages them to
discuss their perceptions of harassment.
F.3.d. Friends or Family Members
Supervisors are prohibited from engaging in supervisory relationships
with individuals with whom they have an inability to remain objective.
Herb is the clinical training coordinator in a counselor education program in
a small private college, and he supervises all counseling students who complete their practicum and internship semesters in the on-campus clinic. The
college is located in a small town, and the nearest counselor education program is in a city that is a 3-hour drive away. Herb’s cousin Teresa wants to
enroll in the program and consults Herb about any potential problems. Herb
explains to Teresa that ethically he cannot accept close relatives as supervisees. Therefore, he will make arrangements with a licensed counselor in the
community who supervises trainees in a community agency to function as
her supervisor. This arrangement is made in collaboration with the chair of
the department, who is willing to work closely with Teresa’s supervisor and
monitor the process.
F.4. Supervisor Responsibilities
F.4.a. Informed Consent for Supervision
Supervisors are responsible for incorporating into their supervision the
principles of informed consent and participation. Supervisors inform supervisees of the policies and procedures to which supervisors are to adhere and the mechanisms for due process appeal of individual supervisor
actions. The issues unique to the use of distance supervision are to be included in the documentation as necessary.
As a part of the orientation process for counselor interns in a counselor education program, students have a group meeting with all the supervisors before they begin their field placements. At this meeting, students are given a
written contract between the supervisor and supervisee that spells out the
scope and expectations of supervision. This contract is designed to assist the
supervisor and supervisee in establishing clear expectations about the supervisory sessions, the relationship, and the evaluation process. The written
informed consent materials describe how regular feedback and evaluation
will be provided. Policies and procedures for conducting ongoing evaluations are described, along with the appeals process. At this orientation meet-
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ing, supervisors go over all parts of the contract as a way to ensure informed
consent. Because supervision meetings occasionally are held via Skype,
procedures are carefully articulated for ensuring confidentiality of supervision sessions that are not held face to face. Students are given opportunities
to ask questions about these written materials and about how supervision
works. The aim is to ensure that supervisees become active participants in
the supervisory process and understand what is expected of them and what
they can expect of their supervisor.
F.4.b. Emergencies and Absences
Supervisors establish and communicate to supervisees procedures for
contacting supervisors or, in their absence, alternative on-call supervisors
to assist in handling crises.
As a part of the supervision contract, Betty lists all the ways her supervisees
can contact her, including her cell phone number and her pager. She also
provides names of colleagues who have agreed to assist the supervisees in
case she cannot be reached.
F.4.c. Standards for Supervisees
Supervisors make their supervisees aware of professional and ethical
standards and legal responsibilities.
Robin, a counselor educator, provides group supervision to students who
are engaged in their first fieldwork placement. At the first meeting with the
group, she gives them a copy of the ACA Code of Ethics. She asks them to read
it and select the areas that are of most concern to them as beginning supervisees. She allocates the second meeting strictly for discussion of the Code
and ethical issues. She lets them know that if they have concerns pertaining
to ethical or legal issues at any time, they should bring them into the group
supervisory sessions.
F.4.d. Termination of the Supervisory Relationship
Supervisors or supervisees have the right to terminate the supervisory relationship with adequate notice. Reasons for considering termination are
discussed, and both parties work to resolve differences. When termination
is warranted, supervisors make appropriate referrals to possible alternative supervisors.
Warren is a counselor intern who tells Wilma, his supervisor, that he wants
to be assigned to a different supervisor because of some major personality
differences that he thinks are negatively affecting their working relationship. Wilma appreciates the fact that Warren has told her of his desire to
terminate their relationship and find a new supervisor. Wilma and Warren
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discuss the strains in their interpersonal relationship to see if they can improve their relationship, but to no avail. They agree to have a second discussion with a third party present who can serve as a mediator. After this
second discussion, Warren still believes the differences will negatively affect
his supervision, so he and Wilma decide that they will terminate the supervisory relationship and that Wilma will give him contact information for
some other potential supervisors.
F.5. Student and Supervisee Responsibilities
F.5.a. Ethical Responsibilities
Students and supervisees have a responsibility to understand and follow
the ACA Code of Ethics. Students and supervisees have the same obligation
to clients as those required of professional counselors.
Madelyn is about to begin her internship in counseling. She carefully reviews the ACA Code of Ethics before she reports to her internship site. She
reviews with her site supervisor her ethical obligations as they pertain to her
internship work. Over the course of the semester, Madelyn brings into her
supervision sessions any ethical dilemmas she encounters.
F.5.b. Impairment
Students and supervisees monitor themselves for signs of impairment from
their own physical, mental, or emotional problems and refrain from offering
or providing professional services when such impairment is likely to harm
a client or others. They notify their faculty and/or supervisors and seek assistance for problems that reach the level of professional impairment, and, if
necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work.
Adriane is serving her internship working with hospice patients. Adriane
has been experiencing a great deal of stress balancing her regular work
schedule with her course work at the university and her internship. She
has been having personal difficulties in dealing with people who are dying
and is finding it a challenge to maintain objectivity. Adriane learns that her
mother has been diagnosed with pancreatic cancer and probably has about
2 months to live. Now that she is confronted with her mother’s illness and
impending death, Adriane is highly anxious, finds it difficult to stay focused
on her studies, and is constantly upset at her internship site. She realizes that
she needs to take action for the sake of her clients and her own psychological
and physical health. She talks to her clinical supervisor about the difficulties
she is experiencing, and he helps Adriane find a counselor to deal with her
personal crisis and its effect on her personally, in her internship work, and
in her studies. She arranges to take an “incomplete” in most of her courses,
and her supervisor works with her to terminate her internship placement
for this semester.
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F.5.c. Professional Disclosure
Before providing counseling services, students and supervisees disclose
their status as supervisees and explain how this status affects the limits
of confidentiality. Supervisors ensure that clients are aware of the services
rendered and the qualifications of the students and supervisees rendering
those services. Students and supervisees obtain client permission before
they use any information concerning the counseling relationship in the
training process.
Frieda is a counseling student who is about to begin her internship at a community agency. Prior to reporting to the site, she meets with her university
supervisor, and they review the informed consent procedures Frieda is expected to implement. Frieda understands that she will need to let each of her
clients know of her intern status, her qualifications, and the fact that she is
working under supervision. She is also required to videotape her counseling
sessions and to gain client permission before taping. She will inform clients
that she will be reviewing the tapes with her supervisor and will erase them
immediately after they are reviewed.
F.6. Counseling Supervision Evaluation, Remediation,
and Endorsement
F.6.a. Evaluation
Supervisors document and provide supervisees with ongoing feedback
regarding their performance and schedule periodic formal evaluative sessions throughout the supervisory relationship.
Students are informed before they enter a counseling program that they will
be expected to demonstrate counseling skills during their practicum and
internship experiences. Throughout enrollment in practicum and internship, students are provided with informal formative evaluation on a regular
basis. A formal, written evaluation is completed each semester at midterm
and at the end of the semester. When evaluations indicate that a student is
not meeting performance expectations, the student is provided with specific
behavioral feedback regarding the identified areas of skill deficiency and
how to improve performance.
F.6.b. Gatekeeping and Remediation
Through initial and ongoing evaluation, supervisors are aware of supervisee limitations that might impede performance. Supervisors assist supervisees in securing remedial assistance when needed. They recommend
dismissal from training programs, applied counseling settings, and state
or voluntary professional credentialing processes when those supervisees
are unable to demonstrate that they can provide competent professional
services to a range of diverse clients. Supervisors seek consultation and
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document their decisions to dismiss or refer supervisees for assistance.
They ensure that supervisees are aware of options available to them to
address such decisions.
Rachel, a counselor educator, observes Ken as he counsels clients in his first
practicum. She becomes concerned about his lack of counseling skills. Despite feedback, Ken fails to improve. He maintains rigid control of the interview and sometimes seems angry and responds with sarcasm when clients
are not receptive to his suggestions. In response to suggestions from Rachel
that he explore his anger by seeking personal counseling, Ken becomes defensive and refuses to consider the idea. Rachel, after informing Ken of her
intentions, asks two other clinical supervisors to observe his counseling sessions. They agree that his counseling skills are deficient, and in consultation
with Ken, they develop a written remediation plan that is signed by all parties. Ken is told that he will be dismissed from the graduate program if he
fails to complete the plan. He is provided with information on how to appeal
such a decision.
F.6.c. Counseling for Supervisees
If supervisees request counseling, the supervisor assists the supervisee in
identifying appropriate services. Supervisors do not provide counseling
services to supervisees. Supervisors address interpersonal competencies
in terms of the impact of these issues on clients, the supervisory relationship, and professional functioning.
Ben, a student, approaches Sarah, one of his counseling professors. Ben says
that he would like to talk with her about his lack of self-confidence and
doubts about becoming a counselor. Sarah sees Ben during an office hour
and explores with him how his doubts are getting in the way and may be
negatively affecting his performance in his courses. At the end of the discussion, Ben expresses his gratitude and asks Sarah if he could come in for
weekly sessions to work on his problems. He tells her that he really trusts
her and that this one session has helped him gain focus. Sarah lets Ben know
that she appreciates his desire to get counseling for his personal problems
but that, ethically, she cannot be his professor and counselor at the same
time. She discusses the resources available at the university counseling center and encourages Ben to take advantage of these counseling services.
F.6.d. Endorsements
Supervisors endorse supervisees for certification, licensure, employment,
or completion of an academic or training program only when they believe
that supervisees are qualified for the endorsement. Regardless of qualifications, supervisors do not endorse supervisees whom they believe to
be impaired in any way that would interfere with the performance of the
duties associated with the endorsement.
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Steve is a master’s student in counseling who is enrolled in his first semester
of internship. Although Steve earned high grades in his academic courses,
certain personality patterns are interfering with his ability to form good relationships with the staff and his clients at the agency where he is serving
as an intern. The university supervisor meets with Steve and his on-site supervisor to identify specific areas of concern. Together they develop an action plan aimed at modifying some of Steve’s behaviors. They plan to meet
periodically to evaluate how the plan is working. The university supervisor
makes it clear that Steve will be supported in his efforts to successfully complete the internship, but it is essential that he remediate the interpersonal
areas of concern before he will be allowed to continue into his second semester of internship.
F.7. Responsibilities of Counselor Educators
F.7.a. Counselor Educators
Counselor educators who are responsible for developing, implementing,
and supervising educational programs are skilled as teachers and practitioners. They are knowledgeable regarding the ethical, legal, and regulatory aspects of the profession; are skilled in applying that knowledge; and
make students and supervisees aware of their responsibilities. Whether
in traditional, hybrid, and/or online formats, counselor educators conduct counselor education and training programs in an ethical manner and
serve as role models for professional behavior.
Ellen teaches a variety of courses, including practicum, family therapy, counseling techniques, and multicultural counseling. As a member of the counseling department, she is partly responsible for the admission of students to
the program, and she participates in the process of evaluating students for
retention at various points in the program. In all of her classes, she combines
experiential and didactic components. She strives to make theory come alive
by focusing on practical applications. Because of her approach to teaching,
she learns a good deal about her students’ values, attitudes, and life experiences. For example, in her family therapy class, her students explore how
their family-of-origin experiences influence them today. In her multicultural
class, she challenges students to examine their cultural biases and prejudices
and how these might affect their work with culturally diverse populations.
To model professional behavior, Ellen explains to her students her basis for
evaluation in teaching her courses and her role in serving on the admissions
and retention committee. She is aware of the differential in power and clarifies how she functions in various roles.
F.7.b. Counselor Educator Competence
Counselors who function as counselor educators or supervisors provide
instruction within their areas of knowledge and competence and provide
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instruction based on current information and knowledge available in the
profession. When using technology to deliver instruction, counselor educators develop competence in the use of the technology.
Malik, a faculty member in a counselor education program, is interested
in teaching a special topics course focusing on counseling military veterans. He prepares a proposal and a prospective syllabus. To highlight his
qualifications, Malik describes in the proposal his own military experience
as well as his dissertation, which focused on the mental health needs of
actively enlisted soldiers. He receives approval with the stipulation that
he infuse more Internet-based resources in the syllabus. Malik signs up for
a workshop that will provide guidance on how to use a variety of technological instructional tools.
F.7.c. Infusing Multicultural Issues/Diversity
Counselor educators infuse material related to multiculturalism/
diversity into all courses and workshops for the development of professional counselors.
Patricia regularly offers continuing education workshops to mental health
professionals on clinical supervision. In her written workshop materials,
sections are devoted to issues of diversity as they pertain to supervision. In
her daylong workshops, Patricia gives participants several opportunities to
form small discussion groups to identify areas of concern to them, with a
special focus on diversity issues. She initiates role-playing situations when
participants identify an area of cultural difference with their supervisees
that has caused them to struggle.
F.7.d. Integration of Study and Practice
In traditional, hybrid, and/or online formats, counselor educators establish education and training programs that integrate academic study and
supervised practice.
The faculty who teach in a master’s degree program in counseling hold a
retreat to assess their program’s balance between didactic and experiential
learning. They identify the components in required courses that provide
students with opportunities for supervised practice and conclude that
their students need more skill-building opportunities before they enter
practicum and internship. They make a commitment that full-time faculty
will teach the introductory core courses and will infuse role-play and other
opportunities to translate theory into practice. They also decide to add to
the curriculum an advanced counseling techniques course, with emphasis
on supervised practice, that students will take after completing the theories course.
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F.7.e. Teaching Ethics
Throughout the program, counselor educators ensure that students are
aware of the ethical responsibilities and standards of the profession and
the ethical responsibilities of students to the profession. Counselor educators infuse ethical considerations throughout the curriculum.
During the introductory course in a counselor education program, class time
is devoted to studying the ACA Code of Ethics. A formal ethics course is also
required, and specialized applications of ethics are addressed in other courses,
such as research methods, psychometric procedures, group process, multicultural counseling, diagnosis and treatment planning, and practicum. Finally,
during their internships, students meet weekly with their supervisors in a
small-group format to discuss cases and explore any problems they might be
encountering in their field placements. At the initial meeting, the supervisors
ask supervisees to carefully review the ACA Code of Ethics. They encourage supervisees to bring to the weekly meetings any concerns they have, especially
as they apply to ethical concerns they are confronting at their field placements.
F.7.f. Use of Case Examples
The use of client, student, or supervisee information for the purposes of
case examples in a lecture or classroom setting is permissible only when
(a) the client, student, or supervisee has reviewed the material and agreed
to its presentation or (b) the information has been sufficiently modified to
obscure identity.
Paulette has agreed to conduct a workshop that addresses common challenges experienced by new counselor supervisors. She wants participants
to have the opportunity to discuss how they would approach specific challenges, so she develops case examples from her experiences as a counselor
educator and supervisor. She changes all identifiable demographic information and limits the amount of detailed description included in the case examples to ensure that the identity of any students or supervisees on whom
the examples are based cannot be discerned.
F.7.g. Student-to-Student Supervision and Instruction
When students function in the role of counselor educators or supervisors,
they understand that they have the same ethical obligations as counselor
educators, trainers, and supervisors. Counselor educators make every effort
to ensure that the rights of students are not compromised when their peers
lead experiential counseling activities in traditional, hybrid, and/or online
formats (e.g., counseling groups, skills classes, clinical supervision).
As one component of their practicum in group counseling, graduate
students colead a self-exploration course in the undergraduate program.
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The groups they lead are supervised by an instructor with whom they meet
weekly for group supervision. The supervisor emphasizes the importance of
ethical and professional behavior and makes time in the group supervision
sessions to discuss any challenging situations the students are facing in facilitating their groups. Ethical issues such as informed consent, confidentiality, and appropriate use of techniques are discussed regularly at the weekly
meetings. The supervisor emphasizes that the same ethical standards apply
to other experiential counseling activities and to online supervision.
F.7.h. Innovative Theories and Techniques
Counselor educators promote the use of techniques/procedures/modalities
that are grounded in theory and/or have an empirical or scientific foundation.
When counselor educators discuss developing or innovative techniques/procedures/modalities, they explain the potential risks, benefits, and ethical considerations of using such techniques/procedures/modalities.
When Bernadine teaches her graduate course on counseling theories and
techniques, she discusses evidence-based treatments with her students. She
explains that empirically supported techniques fit well with behavioral and
cognitive behavioral approaches but that some theories of counseling do not
stress an empirical foundation for techniques. She encourages her students
to think about the rationale for any technique they employ and suggests that
they have clear therapeutic purposes for the techniques they use, even if
the techniques have limited empirical support. Bernadine also discusses the
emergence of innovative techniques that may not yet be evidence based. She
facilitates discussion regarding ethical considerations when using these techniques and the potential risks and benefits. Bernadine tells her students that
it is sound practice to talk with their clients about the potential risks of any
clearly innovative techniques they use and to secure client permission.
F.7.i. Field Placements
Counselor educators develop clear policies and provide direct assistance
within their training programs regarding appropriate field placement and
other clinical experiences. Counselor educators provide clearly stated
roles and responsibilities for the student or supervisee, the site supervisor,
and the program supervisor. They confirm that site supervisors are qualified to provide supervision in the formats in which services are provided
and inform site supervisors of their professional and ethical responsibilities in this role.
Cassandra is the practicum and internship coordinator for her university’s
counseling program. Prior to each semester she sends to the master’s-level
students a list that contains potential practicum and internship sites. This list
is composed of information about sites at which previous students completed
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their fieldwork. Before the semester begins, she sends students an updated
copy of the practicum/internship handbook, which contains information on
the roles and responsibilities of the master’s-level students, the university supervisors, and the on-site supervisors. The supervisees and site supervisors
sign an agreement that they will comply with the stated roles and responsibilities throughout the semester. Occasionally, a student asks permission to
complete her or his fieldwork experience at a site that has not been previously
approved by the university. Before granting permission, Cassandra conducts
a site visit and meets with the site supervisor to discuss the supervision format, credentials of the site supervisor and previous supervision experience,
and professional and ethical responsibilities of the site supervisor.
F.8. Student Welfare
F.8.a. Program Information and Orientation
Counselor educators recognize that program orientation is a developmental process that begins upon students’ initial contact with the counselor
education program and continues throughout the educational and clinical training of students. Counselor education faculty provide prospective
and current students with information about the counselor education program’s expectations, including
1. the values and ethical principles of the profession;
2. the type and level of skill and knowledge acquisition required for
successful completion of the training;
3. technology requirements;
4. program training goals, objectives, and mission, and subject matter
to be covered;
5. bases for evaluation;
6. training components that encourage self-growth or self-disclosure as
part of the training process;
7. the type of supervision settings and requirements of the sites for required clinical field experiences;
8. student and supervisor evaluation and dismissal policies and procedures; and
9. up-to-date employment prospects for graduates.
Prospective students who indicate an interest in applying to a counseling
program are provided with an informational pamphlet that describes the
philosophy of the program; admission, retention, and dismissal policies and
procedures; skill and knowledge acquisition required for graduation; and the
curriculum. A section details evaluation procedures and identifies training
components that include self-growth and self-disclosure as being separate
from graded components. A section pertains to informed consent involving experiential learning in components of courses such as group counseling, practicum, and courses where family-of-origin issues are likely to be ex-
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plored. The pamphlet describes the required field experiences and explains
the program’s criteria for selecting sites and site supervisors. At the end of the
pamphlet, results of a recent follow-up study of graduates are summarized to
give readers information about their employment prospects after graduation.
Students who apply for admission are asked to view a videotape created by
the program faculty and students that provides similar information.
F.8.b. Student Career Advising
Counselor educators provide career advisement for their students and
make them aware of opportunities in the field.
Joe, a counselor educator, has built an online database for his master’s degree students. The database is housed under the counseling department’s
main web page. Joe has contacted all of his students via email to inform
them about this resource. The database, which Joe updates regularly, enables his students to receive current information about job opportunities,
doctoral programs, and employment trends in the mental health arena.
F.8.c. Self-Growth Experiences
Self-growth is an expected component of counselor education. Counselor
educators are mindful of ethical principles when they require students to
engage in self-growth experiences. Counselor educators and supervisors
inform students that they have a right to decide what information will be
shared or withheld in class.
Barry, a counselor educator, teaches a master’s-level counseling course on
diversity, social justice, and advocacy. Barry informs his students on the first
day of class, and in the syllabus he provides, that students are required to
participate in class discussion as part of their grade. Although students are
encouraged to share personal experiences related to course content, Barry
emphasizes that students are not graded on the type of information they
choose to contribute to class discussions.
F.8.d. Addressing Personal Concerns
Counselor educators may require students to address any personal concerns that have the potential to affect professional competency.
Arnold is a counselor educator at a local university. One of his students, Gabriella, has recently been disclosing an extensive amount of information to
her clients at her practicum site. Arnold requests a meeting with Gabriella to
discuss distinctions between appropriate and inappropriate self-disclosure.
Gabriella states that sometimes she just feels like she “totally gets” where
the clients are coming from and likes to share her personal experience; however, Gabriella agrees to use better judgment with future disclosures. Arnold
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continues to monitor the video recordings from Gabriella’s practicum site
and notices that the self-disclosure has increased and has extended to a more
personal level. Arnold meets with Gabriella again and creates a remediation
plan that includes the requirement that Gabriella seek personal counseling
to help her work through any personal concerns that may affect future counseling relationships. He gives her information on how to receive free counseling services at the university counseling center.
F.9. Evaluation and Remediation
F.9.a. Evaluation of Students
Counselor educators clearly state to students, prior to and throughout the
training program, the levels of competency expected, appraisal methods,
and timing of evaluations for both didactic and clinical competencies.
Counselor educators provide students with ongoing feedback regarding
their performance throughout the training program.
Students are informed before they enter a counseling program that they will
be expected to acquire competency in group work, and that although experiential learning in this skill area will be required, self-disclosure will not
be graded. A full-time faculty member teaches the didactic component of
the group counseling course, and her syllabus clearly indicates the grading requirements. An adjunct professor teaches the experiential component,
which involves the students leading a small group in which they explore
some of their own personal concerns. The adjunct professor supervises these
groups and offers feedback but does not evaluate (grade) students on their
performance as group members or leaders or on their level of self-disclosure
in the groups.
F.9.b. Limitations
Counselor educators, through ongoing evaluation, are aware of and address the inability of some students to achieve counseling competencies.
Counselor educators do the following:
1. assist students in securing remedial assistance when needed,
2. seek professional consultation and document their decision to dismiss or refer students for assistance, and
3. ensure that students have recourse in a timely manner to address
decisions requiring them to seek assistance or to dismiss them and
provide students with due process according to institutional policies
and procedures.
When members of the counseling faculty evaluate students, they are aware
of the importance of giving students feedback on their clinical skills and interpersonal characteristics that influence their ability to function effectively
as counselors-in-training. The faculty have developed a rating form for the
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evaluation of students’ interpersonal and professional competencies. Areas
that are evaluated include counseling skills, professional responsibility, and
personal responsibility. Each student is assessed at the completion of the
counseling skills and group counseling courses, prior to internship, and at
the end of each semester of the two-semester internship. Students are made
aware when they enter the program that they will be regularly evaluated
on these competencies. If certain competencies have not been met, faculty
advisers assist students in designing action plans to remediate the situation.
Students understand that unmet competencies will need to be met before
they finish the program. At the orientation session prior to admission to the
program, students are informed that action will be taken, including possible
dismissal from the program, if they demonstrate dysfunctional interpersonal behavior, serious unresolved conflicts, or unethical behavior. Students
are given specific, written information about the policies and procedures for
dismissing students for nonacademic reasons, as well as policies pertaining
to appeals and due process procedures. Students are also informed that dismissal from a program is a last resort.
F.9.c. Counseling for Students
If students request counseling, or if counseling services are suggested as
part of a remediation process, counselor educators assist students in identifying appropriate services.
Lorelei is a master’s student in her second year of full-time study in the program. She has been experiencing some personal problems that she realizes
are starting to negatively affect her performance in class. She approaches
one of her professors and asks where she might go for counseling, adding
that she has very limited financial resources. The professor informs her that
she can receive up to six counseling sessions at no cost at the university’s
counseling center. The professor also gives her the names and contact information of two local counselors in private practice and two agencies that
accept clients on a pro bono basis or offer reduced fees on a sliding scale.
F.10. Roles and Relationships Between Counselor Educators
and Students
F.10.a. Sexual or Romantic Relationships
Counselor educators are prohibited from sexual or romantic interactions
or relationships with students currently enrolled in a counseling or related
program and over whom they have power and authority. This prohibition
applies to both in-person and electronic interactions or relationships.
Mark is a professor in a counseling program. He has recently gone through a
painful divorce. He feels emotionally vulnerable and finds himself attracted
to one of his students. He and this student have mutual friends on a popular
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social media website. Mark has set his privacy so that students cannot contact
him, but he finds that he could easily contact the student through this site.
Mark acknowledges to himself that contacting the student would be inappropriate, and he seeks personal counseling to deal with his feelings. Mark is
careful to maintain appropriate professional boundaries with this student and
all other students.
F.10.b. Sexual Harassment
Counselor educators do not condone or subject students to sexual harassment.
Students receive a handbook at their orientation session prior to admission
to a counseling program. It explicitly addresses sexual harassment and includes a statement that such behavior is not condoned in the program. Examples are given of what is meant by sexual harassment. In addition, the
handbook provides the name and telephone number of the office on campus
that students can contact if they believe they are being subjected to sexual
harassment by a peer or a faculty member.
F.10.c. Relationships With Former Students
Counselor educators are aware of the power differential in the relationship between faculty and students. Faculty members discuss with former
students potential risks when they consider engaging in social, sexual, or
other intimate relationships.
Nobu is a counselor educator in a doctoral program. He served as the chair
of the dissertation committee of one of his former students, Judith. Three
years after Judith graduated from the program, she is hired in this same program. Judith and Nobu will be teaching in the same program, and both are
interested in developing a social relationship. They talk about how their former student–professor relationship might influence their roles as colleagues
in the same department and how their intended social relationship might
affect their professional work together.
F.10.d. Nonacademic Relationships
Counselor educators avoid nonacademic relationships with students in which
there is a risk of potential harm to the student or which may compromise the
training experience or grades assigned. In addition, counselor educators do
not accept any form of professional services, fees, commissions, reimbursement, or remuneration from a site for student or supervisor placement.
Ruth, a counselor educator, makes it a practice to mentor doctoral students
by coauthoring journal articles and copresenting at state and regional conferences with them. When this occurs, they frequently meet for lunch to discuss writing projects or prepare for presentations. At conferences, they also
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attend many of the same conference-related social functions. Ruth discusses
with students, prior to forming a mentoring relationship, the potential benefits and risks of such a relationship. She clearly states her expectations about
the division of work when they are involved in writing projects, follows
ACA guidelines regarding credit for coauthorship, and clarifies the parameters of socializing during conferences. Before agreeing to mentor students,
Ruth discusses how this relationship might affect other aspects of their involvement in the program. If a student has reservations about any aspect of
a potential mentoring relationship and such reservations cannot be resolved
to their mutual satisfaction, such a relationship is not initiated.
F.10.e. Counseling Services
Counselor educators do not serve as counselors to students currently
enrolled in a counseling or related program and over whom they have
power and authority.
Virginia teaches a practicum course and other courses that involve experiential activities. She often conducts live demonstrations in class with students who volunteer to become “clients” for couples counseling, individual
counseling, and group counseling. Generally, she prefers that student “clients”
discuss genuine concerns they have. At times, she also asks students to roleplay a difficult client to demonstrate her approach to working with this situation. Students consistently have given feedback that they find these live
demonstrations to be helpful, both personally and for learning how to apply
counseling techniques. In Virginia’s courses, students often identify some
personal concerns that they would like to explore, either during the course
or once the course is completed. Virginia makes it clear that she does not
provide counseling for any current student and that she does not accept
former students as clients. She informs students about various resources
available to students for personal counseling, both on campus and within
the community.
F.10.f. Extending Educator–Student Boundaries
Counselor educators are aware of the power differential in the relationship between faculty and students. If they believe that a nonprofessional
relationship with a student may be potentially beneficial to the student,
they take precautions similar to those taken by counselors when working with clients. Examples of potentially beneficial interactions or relationships include, but are not limited to, attending a formal ceremony;
conducting hospital visits; providing support during a stressful event; or
maintaining mutual membership in a professional association, organization, or community. Counselor educators discuss with students the rationale for such interactions, the potential benefits and drawbacks, and the
anticipated consequences for the student. Educators clarify the specific
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nature and limitations of the additional role(s) they will have with the student prior to engaging in a nonprofessional relationship. Nonprofessional
relationships with students should be time limited and/or context specific
and initiated with student consent.
Neela is a student in Vernon’s school counseling course. During the fifth
week of the semester she is involved in a serious auto accident. She is told
that she will fully recover, but she must spend 3 weeks in a rehabilitation facility. When Neela arrives at the facility, she contacts Vernon, asking if there
is any way she can remain enrolled in the class while she is recovering. At
Neela’s request, Vernon arranges for her to attend class via Skype and confers with her online to review the course material Neela has missed while
hospitalized.
F.11. Multicultural/Diversity Competence in
Counselor Education and Training Programs
F.11.a. Faculty Diversity
Counselor educators are committed to recruiting and retaining a diverse
faculty.
A counseling department announces an opening for a faculty position. The
department actively recruits qualified candidates representing a variety of
cultural and ethnic backgrounds. The faculty meet to discuss how to assist
all tenure-track professors toward tenure and promotion. Tenured professors volunteer to assist their colleagues, especially in preparing their research and writing agendas.
F.11.b. Student Diversity
Counselor educators actively attempt to recruit and retain a diverse student body. Counselor educators demonstrate commitment to multicultural/diversity competence by recognizing and valuing the diverse cultures
and types of abilities that students bring to the training experience. Counselor educators provide appropriate accommodations that enhance and
support diverse student well-being and academic performance.
The faculty in a counselor education program make it a regular practice to speak
in selected psychology, social work, sociology, and human services undergraduate classes in their university for the purpose of informing students about the
graduate program in counseling. They send brochures describing the program
to other universities with diverse student bodies. They work with the campus
Disability Student Services Office to ensure that all students with disabilities are
provided with needed accommodations, and they initiate a student-to-student
mentoring program to support students, including international students, who
may find the university culture unfamiliar and confusing.
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F.11.c. Multicultural/Diversity Competence
Counselor educators actively infuse multicultural/diversity competency in their training and supervision practices. They actively train students to gain awareness, knowledge, and skills in the competencies of
multicultural practice.
Faculty members in a counseling program participate in a weekend faculty retreat. They spend time exploring ways to effectively infuse diversity perspectives into all aspects of the program. During this weekend
retreat, the faculty members each talk about what they are doing to
infuse multicultural competencies into their courses and increase their
students’ multicultural awareness, knowledge, and skills. They share
the content of their courses, the ways they use community resources,
and their methods for incorporating multicultural awareness, knowledge, and skills. They also examine how they can increase their own
multicultural competence.
Section G
Research and Publication
Study and Discussion Guide
• Research Responsibilities: If you were designing a research project
to assess the effectiveness of counseling with clients, what ethical
considerations might guide your project?
• Informed Consent: What might you want to tell clients who
were participating in a research study designed to test counseling outcomes? What steps might you take to obtain informed
consent?
• Reporting Results: What steps do you need to take in reporting
results to ensure that you give accurate information and minimize
misleading results?
• Explanations to Participants: As a researcher, what obligations do
you have to share your findings with those who participated in your
study? With entities that have sponsored your research?
• Publication: If you were preparing and submitting a journal article
for publication, what ethical considerations might you need to address? What issues might you need to take into account if you had a
coauthor?
• Case Examples: What are the ethical considerations involved in using case examples when reporting research results? What safeguards
do you need to put in place before using case examples?
• Contributors to Research: What types of credit should be given to
students or colleagues who contribute to a research project? To those
who have done previous work on the topic?
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Section G
Research and Publication
Introduction
Counselors who conduct research are encouraged to contribute to the
knowledge base of the profession and promote a clearer understanding
of the conditions that lead to a healthy and more just society. Counselors support the efforts of researchers by participating fully and willingly
whenever possible. Counselors minimize bias and respect diversity in designing and implementing research.
G.1. Research Responsibilities
G.1.a. Conducting Research
Counselors plan, design, conduct, and report research in a manner that is
consistent with pertinent ethical principles, federal and state laws, host
institutional regulations, and scientific standards governing research.
Joanne is a counselor educator who is conducting a research study. Her research protocol requires that participants remain engaged for an extended
period of time, and for some this experience may be very fatiguing and
frustrating. She arranges the procedure so that there is a brief rest period
at the end of each hour. At the recommendation of the university’s institutional review board (IRB), she adds ample time to confer with participants
after they finish to offer support, answer questions, and provide information about the study.
G.1.b. Confidentiality in Research
Counselors are responsible for understanding and adhering to state, federal, agency, or institutional policies or applicable guidelines regarding
confidentiality in their research practices.
Ali is a doctoral student preparing to conduct his dissertation research.
He consults the university IRB website to ensure that he is adhering
to the policies and guidelines regarding the confidentiality of research
participants. He completes the required online IRB training, which addresses elements of research participant informed consent, including
confidentiality.
G.1.c. Independent Researchers
When counselors conduct independent research and do not have access
to an institutional review board, they are bound to the same ethical principles and federal and state laws pertaining to the review of their plan,
design, conduct, and reporting of research.
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Ellis is an LPC who practices in a community agency. He designs a research study to compare the effects of two techniques for treating panic
disorder. Because his agency does not have a mechanism for reviewing
research protocols, he contacts the faculty member who chairs the IRB at
his local university and asks her to carefully review his protocol.
G.1.d. Deviation From Standard Practice
Counselors seek consultation and observe stringent safeguards to protect the rights of research participants when research indicates that a
deviation from standard or acceptable practices may be necessary.
Christine, a counselor educator, is conducting research to assess the impact of certain techniques on establishing trust and developing cohesion in
group counseling. She questions whether one of the techniques she wants
to use is consistent with standard practices. Before implementing the technique, she seeks peer consultation and obtains approval from the IRB at
her university.
G.1.e. Precautions to Avoid Injury
Counselors who conduct research are responsible for their participants’ welfare throughout the research process and should take reasonable precautions to avoid causing emotional, physical, or social harm
to participants.
Winston, the director of a community mental health agency, wants to study
the personality traits and presenting symptoms of clients seeking services.
All clients are asked to complete an extensive test battery as part of the intake procedure. Clients who complete the battery are given a full explanation of the purpose of the testing and are carefully monitored to ensure that
they experience no adverse effects.
G.1.f. Principal Researcher Responsibility
The ultimate responsibility for ethical research practice lies with the principal researcher. All others involved in the research activities share ethical
obligations and responsibility for their own actions.
The administrators of a school district grant permission to a researcher from the local university to study the impact of parental divorce on
achievement test scores of elementary school children. The researcher
has secured approval to conduct the study from her university’s IRB. The
study requires the assistance of the school counselors on each campus. Before agreeing to help, the school counselors read the proposal carefully
to be sure the study falls within ethical guidelines and that their student
clients’ rights are protected.
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G.2. Rights of Research Participants
G.2.a. Informed Consent in Research
Individuals have the right to decline requests to become research participants. In seeking consent, counselors use language that
1. accurately explains the purpose and procedures to be followed;
2. identifies any procedures that are experimental or relatively untried;
3. describes any attendant discomforts, risks, and potential power differentials between researchers and participants;
4. describes any benefits or changes in individuals or organizations
that might reasonably be expected;
5. discloses appropriate alternative procedures that would be advantageous for participants;
6. offers to answer any inquiries concerning the procedures;
7. describes any limitations on confidentiality;
8. describes the format and potential target audiences for the dissemination of research findings; and
9. instructs participants that they are free to withdraw their consent
and discontinue participation in the project at any time, without
penalty.
Melissa, a counselor educator, obtains two groups of student volunteers as
participants for an experiment in group process. She carefully explains the
study’s purpose and procedures, potential risks and benefits, and limitations that the group format places on confidentiality. She explains that there
are no alternative procedures for the study but that participants are free to
drop out of the experiment without penalty at any time, including before
the study begins. Melissa discusses the relationship between researcher and
participants and the potential power differentials that might exist. She explains that she plans to disseminate her research findings at a professional
conference and hopes to publish an article describing the study in a professional journal. She assures potential participants that their identities will be
fully disguised in both formats.
G.2.b. Student/Supervisee Participation
Researchers who involve students or supervisees in research make clear to
them that the decision regarding participation in research activities does
not affect their academic standing or supervisory relationship. Students or
supervisees who choose not to participate in research are provided with an
appropriate alternative to fulfill their academic or clinical requirements.
Damien, a professor who teaches a course in group dynamics, designs a
study to investigate students’ behavior in small task-oriented groups. His
students would be suitable participants for the study. Damien offers them
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the opportunity to participate in the task groups and explains that their participation is strictly voluntary. He further explains that their decision to participate or not will not affect their grade in the course.
G.2.c. Client Participation
Counselors conducting research involving clients make clear in the informed
consent process that clients are free to choose whether to participate in research activities. Counselors take necessary precautions to protect clients
from adverse consequences of declining or withdrawing from participation.
Mary Lou, a practicing counselor, wants to study the depth of self-disclosure
that occurs in a therapy group. Because the experience of participating in
such a group can be emotionally intense, Mary Lou decides that only volunteer participants will be used. All potential participants will be informed of
the nature of the experiment and the potential risks. As additional precautions, Mary Lou will screen each volunteer for sufficient ego strength and
emotional stability and will offer the option of individual counseling with
another counselor to those who withdraw from the group.
G.2.d. Confidentiality of Information
Information obtained about research participants during the course of research is confidential. Procedures are implemented to protect confidentiality.
Kimberly, a doctoral student, plans to review client files as part of her research project investigating the content of session notes. Counselors who
have agreed to participate in the project are instructed to use pseudonyms or
false initials for clients when writing the records. They are also instructed to
explain to clients the nature and purpose of the research, the procedures for
protecting their confidentiality, and the possibility that they might inadvertently include the client’s name in the records. Clients are assured that only
the researcher, who shares the counselor’s ethic of confidentiality, will see
the records. The records of only those clients who have given their informed
consent are used in the research study.
G.2.e. Persons Not Capable of Giving Informed Consent
When a research participant is not capable of giving informed consent, counselors provide an appropriate explanation to, obtain agreement for participation from, and obtain the appropriate consent of a legally authorized person.
Phil, a doctoral student, plans to conduct research with first graders. After
obtaining permission from the principal to conduct the study, he explains
the research procedures to the children’s parents and obtains their written
consent. He provides the children with an explanation about the project in
language they can comprehend and obtains their assent.
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G.2.f. Commitments to Participants
Counselors take reasonable measures to honor all commitments to
research participants.
Lorna is a counselor educator who teaches the Introduction to Counseling
course. Some of the students in her class volunteer to participate in a study
that involves their completing a paper-and-pencil inventory of attitudes toward
ethical behaviors. Lorna tells the participants that when the study is completed
she will provide them with a summary of the results. After she analyzes the
data, she gives each student a description of her findings and conclusions.
G.2.g. Explanations After Data Collection
After data are collected, counselors provide participants with full clarification of the nature of the study to remove any misconceptions participants
might have regarding the research. Where scientific or human values
justify delaying or withholding information, counselors take reasonable
measures to avoid causing harm.
Abe, a counselor educator, conducts a research study using undergraduate
students in a human services program as volunteer participants. He provides them with general information about the nature and purpose of the
study. After the study is completed, he conducts a debriefing session to fully
explain the study and correct any possible misperceptions that participants
may have held.
G.2.h. Informing Sponsors
Counselors inform sponsors, institutions, and publication channels regarding research procedures and outcomes. Counselors ensure that appropriate
bodies and authorities are given pertinent information and acknowledgment.
The director of a community mental health agency gives permission to Hal,
a graduate student, to conduct a research study on how agency counselors
determine which clients to refer to a psychiatrist for evaluation for psychotropic medication. When Hal completes his study, he provides the director
with a description of his procedures, findings, and conclusions. Hal submits
a manuscript describing his study to a professional journal for publication
consideration. In the manuscript, he acknowledges the assistance of the
agency and the director in making the study possible.
G.2.i. Research Records Custodian
As appropriate, researchers prepare and disseminate to an identified colleague or records custodian a plan for the transfer of research data in the
case of their incapacitation, retirement, or death.
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Pedro, a research professor at a university, has collected data for a research
study that he is conducting. Pedro is nearing retirement age, and when his
institution offers an early retirement incentive package, he considers taking
advantage of this opportunity. He arranges to transfer his research data to a
colleague so that the research project can be concluded after he retires.
G.3. Managing and Maintaining Boundaries
G.3.a. Extending Researcher–Participant Boundaries
Researchers consider the risks and benefits of extending current research
relationships beyond conventional parameters. When a nonresearch interaction between the researcher and the research participant may be potentially beneficial, the researcher must document, prior to the interaction (when feasible), the rationale for such an interaction, the potential
benefit, and anticipated consequences for the research participant. Such
interactions should be initiated with appropriate consent of the research
participant. Where unintentional harm occurs to the research participant,
the researcher must show evidence of an attempt to remedy such harm.
Althea, a counselor educator, is conducting a qualitative research study that
involves three rounds of individual interviews with selected participants.
After the second round of interviews is completed, she receives an email
message from one of the participants requesting to postpone her third interview for a couple of weeks because of a death in her family. Althea decides to call the participant to express her condolences and reschedule the
interview. She also sends a sympathy card to the participant. Althea documents her actions and the potential benefits and consequences of making the
phone call and mailing a sympathy card to the research participant.
G.3.b. Relationships With Research Participants
Sexual or romantic counselor–research participant interactions or relationships with current research participants are prohibited. This prohibition
applies to both in-person and electronic interactions or relationships.
Crystal is a counselor educator who is conducting a longitudinal study of the
career paths of beginning faculty members. Joe, one of the participants in Crystal’s study, expresses his attraction to her through a social networking site. He
suggests to her that they could communicate solely via social media until the
conclusion of the study. Crystal declines, explaining that a romantic relationship
between them is not possible while they have a researcher–participant relationship and that electronic interactions or relationships are prohibited as well.
G.3.c. Sexual Harassment and Research Participants
Researchers do not condone or subject research participants to sexual
harassment.
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Shannon, a doctoral student, is a member of a research team that is observing the group process as it unfolds in an undergraduate class. During the
class break, Shannon overhears Louis, a fellow member of the research team,
make sexually suggestive comments to one of the undergraduates. The undergraduate student seems very uncomfortable with Louis’s remarks. Shannon takes Louis aside and tells him that she will not condone sexual harassment of a research participant and that he must cease this behavior.
G.4. Reporting Results
G.4.a. Accurate Results
Counselors plan, conduct, and report research accurately. Counselors do
not engage in misleading or fraudulent research, distort data, misrepresent data, or deliberately bias their results. They describe the extent to
which results are applicable for diverse populations.
Becky is a researcher who is well known for espousing a particular theoretical position. She conducts an experiment that only partially supports
her point of view. In the discussion section of her report on the experiment,
Becky interprets the data first in light of support of her favored theory, then
in light of support for an opposing theory. She states that the choice of interpretation may depend on the reader’s own theoretical orientation. She urges
readers to consider the applicability of either interpretation to working with
the diverse client populations they serve.
G.4.b. Obligation to Report Unfavorable Results
Counselors report the results of any research of professional value. Results that reflect unfavorably on institutions, programs, services, prevailing opinions, or vested interests are not withheld.
Yi, a high school counselor, conducts a study to determine whether seniors have
engaged in unprotected sex. The administration in this district takes particular
pride in the sex education program that has been offered to middle school students for the past 7 years. The results of Yi’s study show that an unexpectedly
high number of students appear to be oblivious to the threat of sexually transmitted diseases. The results are made available in a pamphlet to other counselors, to
students, and to parents. The administration decides to revise the sex education
curriculum to reemphasize the prevention of sexually transmitted diseases.
G.4.c. Reporting Errors
If counselors discover significant errors in their published research, they
take reasonable steps to correct such errors in a correction erratum or
through other appropriate publication means.
The guidance director and a counselor in a school system collaborate on
a research study investigating school dropout rates. The guidance director
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summarizes the data on the past year’s dropouts and publishes the results
in a report to the school board. The counselor learns that some schools have
included summer dropouts in their reports whereas others have not. The
counselor tells the guidance director about this discrepancy. They revise the
data analysis and submit a corrected report to the school board.
G.4.d. Identity of Participants
Counselors who supply data, aid in the research of another person, report
research results, or make original data available take due care to disguise
the identity of respective participants in the absence of specific authorization from the participants to do otherwise. In situations where participants self-identify their involvement in research studies, researchers take
active steps to ensure that data are adapted/changed to protect the identity and welfare of all parties and that discussion of results does not cause
harm to participants.
Tara plans to submit an article for publication in a state journal. The article
will be based on a workshop she conducted at the state’s annual professional counselors’ conference. The manuscript contains direct quotes from some
of the workshop participants. Even though Tara has used pseudonyms to
disguise participant identities, she realizes that some readers of the journal
may know who attended the workshop. She sends each participant a copy
of the proposed article and asks for feedback to ensure that they are comfortable with its content. She obtains the written permission of each participant
before submitting the article to the journal.
G.4.e. Replication Studies
Counselors are obligated to make available sufficient original research information to qualified professionals who may wish to replicate or extend
the study.
A counselor education department has a policy that all theses and dissertations completed by students in that department must include sufficient
information so that another investigator might be able to perform a different
analysis or replicate the study. The data must be presented in a way that
protects the confidentiality of participants.
G.5. Publications and Presentations
G.5.a. Use of Case Examples
The use of participants’, clients’, students’, or supervisees’ information for
the purposes of case examples in a presentation or publication is permissible only when (a) participants, clients, students, or supervisees have reviewed the material and agreed to its presentation or publication or (b) the
information has been sufficiently modified to obscure identity.
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Nguyen has a private practice in counseling and also teaches part time at a local
university. She is in need of vignettes for her classroom discussion and believes
the cultural background of one of her current clients, Zander, would create useful discussion among her students. Nguyen asks Zander if she can use his case
for teaching purposes and shows him the information she would like to use in
the classroom presentation. She has not included any identifying information in
her vignette. Zander has no objections to her using it as a teaching tool.
G.5.b. Plagiarism
Counselors do not plagiarize; that is, they do not present another person’s
work as their own.
Maurice, a doctoral student, is writing the literature review for his dissertation. Working meticulously, he provides accurate citations for the sources
of the material. He is careful to avoid any inferences that he is the author of
work that others have produced.
G.5.c. Acknowledging Previous Work
In publications and presentations, counselors acknowledge and give recognition to previous work on the topic by others or self.
Corinne, a counselor educator, submits a manuscript to a professional journal for publication consideration. In the manuscript and in her cover letter
to the journal editor, Corinne acknowledges that a portion of the material is
based on an article that she has published previously.
G.5.d. Contributors
Counselors give credit through joint authorship, acknowledgment, footnote
statements, or other appropriate means to those who have contributed significantly to research or concept development in accordance with such contributions. The principal contributor is listed first, and minor technical or professional contributions are acknowledged in notes or introductory statements.
Three counselor educators write an article that describes a study they have conducted on the effectiveness of brief solution-focused therapy. In the manuscript
they submit for publication, all three counselor educators are listed as coauthors. The order of presentation of their names is determined by the relative
contribution of each of them to the project. In a footnote, they acknowledge the
assistance of a statistician who helped them interpret a portion of the data.
G.5.e. Agreement of Contributors
Counselors who conduct joint research with colleagues or students/
supervisors establish agreements in advance regarding allocation of tasks,
publication credit, and types of acknowledgment that will be received.
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Aidan, a counselor educator, plans to conduct a research study that involves
interviewing counselor supervisors and their supervisees. Aidan enlists the
assistance of three doctoral students to conduct the interviews, using an
interview protocol he has developed. He meets with the doctoral students
before the project begins. At this meeting, clear agreement is reached regarding the allocation of tasks, timelines for completion, and methods for
proceeding. It is agreed that Aidan will be listed first as senior author on
the manuscript that will be submitted for publication and that the students’
names will follow in alphabetical order.
G.5.f. Student Research
Manuscripts or professional presentations in any medium that are substantially based on a student’s course papers, projects, dissertations, or theses are
used only with the student’s permission and list the student as lead author.
Sophia approached Xavier, her faculty adviser, about coauthoring a paper she
had written for one of her course assignments. Xavier agreed to provide Sophia
with guidance and feedback and agreed to contribute to the further development of the manuscript. Xavier also informed Sophia that she will be credited as
lead author because the manuscript will be based on her original work.
G.5.g. Duplicate Submissions
Counselors submit manuscripts for consideration to only one journal at a
time. Manuscripts that are published in whole or in substantial part in one
journal or published work are not submitted for publication to another publisher without acknowledgment and permission from the original publisher.
Sylvia, a counselor educator, draws heavily on a previously published journal article on adolescent development in a manuscript she is preparing. She
contacts the journal’s publisher and obtains permission to reproduce tables
from the journal article in her article. She acknowledges the author of the
journal article in appropriate citations throughout the manuscript. She submits it to a professional journal and identifies a second journal to which she
may submit it if the article is rejected.
G.5.h. Professional Review
Counselors who review material submitted for publication, research, or
other scholarly purposes respect the confidentiality and proprietary rights
of those who submitted it. Counselors make publication decisions based
on valid and defensible standards. Counselors review article submissions
in a timely manner and based on their scope and competency in research
methodologies. Counselors who serve as reviewers at the request of editors or publishers make every effort to only review materials that are within their scope of competency and avoid personal biases.
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Irvin, a school counselor, serves on the editorial board of a professional journal. All manuscripts are subjected to blind review; that is,
the editorial board members do not know the identity of authors of
manuscripts. Irvin receives a manuscript that is of great interest to
him because he is scheduled to present a workshop in 2 weeks on the
very topic addressed in the manuscript. Although he believes that his
workshop presentation could be strengthened by including material
from the manuscript, he realizes that it would be unethical for him to
appropriate the material. He reviews the manuscript promptly and
returns it to the journal editor.
Section H
Distance Counseling, Technology,
and Social Media
Study and Discussion Guide
• Burgeoning Technologies: What are some of the ethical issues that
arise along with the increasing use of technology in the counseling
profession?
• Informed Consent: What issues unique to the use of distance counseling, technology, and social media need to be included in the
informed consent process with clients?
• Risks and Benefits of Technology: How can the use of technology
be beneficial to the profession and the counseling relationship?
What do you see as the major risks of using technology?
• Distance Counseling: What do you see as the benefits and limitations of distance counseling compared to face-to-face counseling?
What ethical concerns might arise when counseling clients over
the Internet?
• Legal Considerations in Distance Counseling: If you were conducting distance counseling with a client who lived in another
state, would you need to be licensed to practice in your state, in
the state where the client lives, or both? What would you do if you
were concerned that a distance client might be at risk of harming
self or others? What additional legal issues can you identify that
pertain to distance counseling?
• Records: How can you ensure the confidentiality of records you
maintain electronically?
• Professional Boundaries: What problems might arise if a counselor were to maintain both a professional social media site and a
personal social media site? How can the counselor ensure that
boundaries are respected by both clients and friends?
• Social Media: How would you respond if one of your clients sent
you a friend request on your social media page?
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Section H
Distance Counseling, Technology,
and Social Media
Introduction
Counselors understand that the profession of counseling may no longer
be limited to in-person, face-to-face interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to
distance counseling, technology, and social media and how such resources may be used to better serve their clients. Counselors strive to become
knowledgeable about these resources. Counselors understand the additional concerns related to the use of distance counseling, technology, and
social media and make every attempt to protect confidentiality and meet
any legal and ethical requirements for the use of such resources.
H.1. Knowledge and Legal Considerations
H.1.a. Knowledge and Competency
Counselors who engage in the use of distance counseling, technology,
and/or social media develop knowledge and skills regarding related
technical, ethical, and legal considerations (e.g., special certifications, additional course work).
Claire, a licensed professional counselor, has become skilled in working with
a very specific population—individuals predisposed to genetic illnesses. Because of the small number of clinicians who specialize in counseling this
client population, Claire researches distance counseling via technology as a
means to meet the needs of clients who struggle with genetic predispositions
across the country. To prepare for beginning to practice as a distance counselor, Claire attends a number of workshops; seeks consultation; reviews the
ACA Code of Ethics Section H on distance counseling, technology, and social
media; and researches possible ethical dilemmas she may face when counseling clients located in other states and jurisdictions. Claire plans to seek
continued supervision when she begins her practice of distance counseling.
H.1.b. Laws and Statutes
Counselors who engage in the use of distance counseling, technology, and
social media within their counseling practice understand that they may be
subject to laws and regulations of both the counselor’s practicing location
and the client’s place of residence. Counselors ensure that their clients are
aware of pertinent legal rights and limitations governing the practice of
counseling across state lines or international boundaries.
Steve is a licensed professional counselor who routinely practices distance
counseling and uses technology and social media in his practice. Steve is a
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solo practitioner and has reviewed the laws in his jurisdiction. He makes it a
practice to review relevant laws and regulations in a potential client’s jurisdiction before initiating a therapeutic relationship. He also periodically reviews his state laws as well as laws in states where he may provide distance
counseling services. Steve makes his clients aware of their legal rights and
the risks and limitations of distance counseling, both in a written informed
consent document and via a thorough discussion at the onset of the counseling relationship.
H.2. Informed Consent and Security
H.2.a. Informed Consent and Disclosure
Clients have the freedom to choose whether to use distance counseling,
social media, and/or technology within the counseling process. In addition to the usual and customary protocol of informed consent between
counselor and client for face-to-face counseling, the following issues,
unique to the use of distance counseling, technology, and/or social media,
are addressed in the informed consent process:
• distance counseling credentials, physical location of practice, and
contact information;
• risks and benefits of engaging in the use of distance counseling, technology, and/or social media;
• possibility of technology failure and alternate methods of service
delivery;
• anticipated response time;
• emergency procedures to follow when the counselor is not available;
• time zone differences;
• cultural and/or language differences that may affect delivery of services;
• possible denial of insurance benefits; and
• social media policy.
Jeffrey is an LPC who has a private practice and provides distance counseling.
When prospective clients view Jeffrey’s website, they are directed to read his
disclosure (informed consent) statement that explains how distance counseling works. The disclosure statement also thoroughly explains informed consent and problems that could occur, including technology failure, failure to
consider time zone differences, and communication difficulties due to cultural
and language differences. Before a counseling relationship is initiated, clients
are required to electronically sign and submit documentation that they have
read and agree to the provisions in the disclosure statement.
H.2.b. Confidentiality Maintained by the Counselor
Counselors acknowledge the limitations of maintaining the confidentiality
of electronic records and transmissions. They inform clients that individuals
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might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists).
Wanda, an LPC, works at a community agency and is completing an initial
intake online with a client. During the intake process Wanda explains that
records are confidential and are released to individuals outside the agency
only when the client signs a release or if the records are subpoenaed by the
courts. Wanda explains that individuals within the agency, such as employees, supervisors, and information technologists, might have authorized or
gain unauthorized access to electronic records.
H.2.c. Acknowledgment of Limitations
Counselors inform clients about the inherent limits of confidentiality
when using technology. Counselors urge clients to be aware of authorized
and/or unauthorized access to information disclosed using this medium
in the counseling process.
Joni is an LPC who has expanded her private practice to include distance
counseling. On her informed consent document, she has included a statement that explains the limitations to confidentiality when using video conferencing or other forms of virtual meeting technology. At the beginning of
each counseling session, Joni reminds the client of the possibility of unauthorized access to the session.
H.2.d. Security
Counselors use current encryption standards within their websites and/
or technology-based communications that meet applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality
of information transmitted through any electronic means.
José is a counselor in private practice who wants to create an electronic filing
system to maintain documentation for his clients. However, he is not completely familiar with encryption and how to protect files. José seeks continuing education to better understand the legal requirements for technologybased communications. He purchases a filing system with the most current
encryption standards and regularly checks the system for updates so that his
system will remain current.
H.3. Client Verification
Counselors who engage in the use of distance counseling, technology,
and/or social media to interact with clients take steps to verify the client’s identity at the beginning and throughout the therapeutic process.
Verification can include, but is not limited to, using code words, numbers,
graphics, or other nondescript identifiers.
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Arria, a licensed professional counselor, offers online counseling services
through her private practice. She has received a new online client request in
her HIPAA-compliant business email. Arria responds to the request, offering several possible intake appointment times and dates, and also provides
the client with initial intake forms. She asks the client to read her online
informed consent document, which provides information regarding online
counseling procedures, including the use of video technology for counseling. Arria also asks the client to verify his or her identity and specifies that
counseling services will not be initiated until the verification has been completed. She asks the client to send two forms of identification (one is stipulated to include a photograph, such as a state-issued identification card).
Arria also informs the client that she will begin each online session by asking
the client to log in through a secure system and provide a code word.
H.4. Distance Counseling Relationship
H.4.a. Benefits and Limitations
Counselors inform clients of the benefits and limitations of using technology applications in the provision of counseling services. Such technologies
include, but are not limited to, computer hardware and/or software, telephones and applications, social media and Internet-based applications and
other audio and/or video communication, or data storage devices or media.
Gary provides online counseling to some clients who request it as an alternative to face-to-face counseling. In his online disclosure statement, he
explains the potential advantages and disadvantages of participating in online counseling. One benefit he discusses is the ability to receive counseling services without having to leave the comfort of home. Gary also clearly
communicates potential limitations, such as not being able to guarantee the
security or privacy of the client’s computer software, telephone, email accounts, or place of service.
H.4.b. Professional Boundaries in Distance Counseling
Counselors understand the necessity of maintaining a professional relationship with their clients. Counselors discuss and establish professional
boundaries with clients regarding the appropriate use and/or application
of technology and the limitations of its use within the counseling relationship
(e.g., lack of confidentiality, times when not appropriate to use).
Thomas is a licensed counselor who provides web-based counseling services. In his informed consent statement, he includes a section describing
the limits of confidentiality and sets professional boundaries specific to the
use of technology. Although his computer is equipped with security and
encryption software, he explains that there is a potential for unexpected/
unintended security failures. In his informed consent statement, Thomas
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also specifies that he does not engage in the use of social media with clients,
and he will not respond to attempts to communicate through online social
websites or community forums.
H.4.c. Technology-Assisted Services
When providing technology-assisted services, counselors make reasonable efforts to determine that clients are intellectually, emotionally, physically, linguistically, and functionally capable of using the application and
that the application is appropriate for the needs of the client. Counselors
verify that clients understand the purpose and operation of technology
applications and follow up with clients to correct possible misconceptions, discover appropriate use, and assess subsequent steps.
Javier works as a career counselor at a local university. After completing an
initial intake with Maria, he thinks she may benefit from completing some
career interest inventories. He informs Maria that these inventories are generally completed via computer application software. Javier explains the purpose
of the inventories and their benefits and limitations. He also inquires about
Maria’s comfort level using a computer and asks her to demonstrate that she
can use the software by completing the sample questions on the inventory.
H.4.d. Effectiveness of Services
When distance counseling services are deemed ineffective by the counselor or client, counselors consider delivering services face-to-face. If the
counselor is not able to provide face-to-face services (e.g., lives in another
state), the counselor assists the client in identifying appropriate services.
Christopher is a licensed professional counselor and a distance credentialed
counselor who delivers web-based professional counseling services to his
client, George. During their online sessions, George experiences issues with
low Internet speed, which makes the communication between him and
Christopher very difficult. Christopher suggests that distance counseling is
not turning out to be a viable option for George. Because George lives a considerable distance from Christopher’s office, Christopher provides George
with a list of professional counselors who practice in George’s locality, and
George agrees to seek face-to-face counseling services.
H.4.e. Access
Counselors provide information to clients regarding reasonable access to
pertinent applications when providing technology-assisted services.
Gwen, a licensed professional counselor, is developing a website for her
private practice that will describe the online counseling services she offers.
Realizing that not all prospective clients are technologically sophisticated,
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Gwen develops a website that is user friendly. On the website’s home page
she presents a step-by-step video and voice tutorial to assist potential clients
in navigating the website.
H.4.f. Communication Differences in Electronic Media
Counselors consider the differences between face-to-face and electronic
communication (nonverbal and verbal cues) and how these may affect the
counseling process. Counselors educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and
voice intonations when communicating electronically.
Akil is a licensed professional counselor who offers online counseling services. He is mindful of the differences between face-to-face and electronic
communication, and he develops an online tutorial to educate his clients
about the potential misunderstandings that can arise when visual cues are
lacking and voice intonation cannot be heard.
H.5. Records and Web Maintenance
H.5.a. Records
Counselors maintain electronic records in accordance with relevant laws
and statutes. Counselors inform clients on how records are maintained
electronically. This includes, but is not limited to, the type of encryption
and security assigned to the records, and if/for how long archival storage
of transaction records is maintained.
Samuel is a private practitioner. When he opened his practice, he contacted
his state board to determine the legal requirements for records maintenance
and storage. He maintains his client records through HIPAA-compliant
software that uses an Advanced Encryption Standard, and he stores clients’
records for 5 years in accordance with state law. He explains to his clients
how he encrypts and stores their records and requires that his clients create
a secure account to communicate with him.
H.5.b. Client Rights
Counselors who offer distance counseling services and/or maintain a professional website provide electronic links to relevant licensure and professional certification boards to protect consumer and client rights and
address ethical concerns.
Stuart has recently expanded his counseling services to include distance counseling. His website, in the section describing his credentials, contains a link to his
state licensing board. In his “Frequently Asked Questions” section, he explains
how clients can file complaints and express ethical concerns, and again he
provides the link to his state licensing board as well as to the ACA Code of Ethics.
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H.5.c. Electronic Links
Counselors regularly ensure that electronic links are working and are professionally appropriate.
Lana, a counselor at a university, is responsible for the web page for the
counseling center. So that she can provide the most thorough assistance to
clients, Lana has included links to other resources on campus that are available to students. Before the beginning of each semester, Lana contacts each
department to make sure the hyperlink addresses remain the same. In addition, she consults with departments to ensure that their web pages are up
to date. At the bottom of the counseling center’s web page, she adds a time
stamp to display when the page was last updated.
H.5.d. Multicultural and Disability Considerations
Counselors who maintain websites provide accessibility to persons with
disabilities. They provide translation capabilities for clients who have a
different primary language, when feasible. Counselors acknowledge the
imperfect nature of such translations and accessibilities.
Mark, a licensed professional counselor, has moved to a migrant farming
community to provide counseling services. Most of the members of the community are English speaking, but English is their second language. Mark sets
up a website to explain the services he provides. He provides the same information in the primary language of the community members, and he embeds a
link to allow clients to translate any information on the website. He sets up the
site in a “no frames” format to allow easier accessibility. Finally, he provides
contact information for anyone who may have difficulty reading his website.
H.6. Social Media
H.6.a. Virtual Professional Presence
In cases where counselors wish to maintain a professional and personal
presence for social media use, separate professional and personal web
pages and profiles are created to clearly distinguish between the two
kinds of virtual presence.
Karen is an LPC in private practice who created a social media page for
her practice. On her business site she includes a statement that this is her
professional page and that personal contacts should not be initiated via this
site. Karen also manages a personal social media page on which she states,
similarly, that it is her personal page and that she should not be contacted on
this site for professional or counseling-related issues.
H.6.b. Social Media as Part of Informed Consent
Counselors clearly explain to their clients, as part of the informed consent
procedure, the benefits, limitations, and boundaries of the use of social media.
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Harry is a counselor whose informed consent document includes a paragraph explaining the risks and benefits associated with social media. During
initial sessions with new clients, he explains his professional web presence
and the risks of choosing to engage in his professional social media site.
Harry informs clients that it is their choice to visit, like, and share on the professional site; however, there are risks involved, including loss of anonymity
due to the possibility of others assuming his relationship with the “liked”
services. Harry further explains that the social media account is for information and marketing purposes only and that he should not be contacted
through this site for crisis or for counseling consultation.
H.6.c. Client Virtual Presence
Counselors respect the privacy of their clients’ presence on social media
unless given consent to view such information.
Sofia is a counselor at a university counseling center. Many of her clients
have referred to the “drama” on their social media pages. Although Sofia
is curious about the interactions occurring on these sites, she does not look
at the clients’ personal sites, as she wants to respect their personal privacy.
H.6.d. Use of Public Social Media
Counselors take precautions to avoid disclosing confidential information
through public social media.
Anna creates an account on a social media website as an additional means for
networking as a professional counselor and clinical supervisor. In her profile,
she states that she will not provide any counseling, consultation, or supervision services via this account. She requests that any potential clients or supervisees contact her directly through the business number listed in her profile.
Section I
Resolving Ethical Issues
Study and Discussion Guide
• Ethical Responsibilities: What ethical responsibilities do you have
when you become aware of the unethical behavior of a colleague?
• Ethical Decision-Making Models: What are the essential elements
of an ethical decision-making model? What model do you use when
confronted with an ethical dilemma?
• Informal Resolution: If you had reasonable cause to believe that another professional was violating an ethical standard, how might you
try (at least initially) to resolve the issue informally?
• Consultation: When might you seek consultation regarding a suspected ethical violation by another professional?
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• Using the Code of Ethics to Resolve Ethical Dilemmas: What are
some ways you can use the ACA Code of Ethics to assist you in resolving ethical dilemmas?
• Conflict Between Ethics and Law: If you were faced with a situation
in which you believed there was a conflict between the ethical and
the legal course of action, what would you do?
Section I
Resolving Ethical Issues
Introduction
Professional counselors behave in an ethical and legal manner. They are
aware that client welfare and trust in the profession depend on a high
level of professional conduct. They hold other counselors to the same
standards and are willing to take appropriate action to ensure that standards are upheld. Counselors strive to resolve ethical dilemmas with
direct and open communication among all parties involved and seek
consultation with colleagues and supervisors when necessary. Counselors incorporate ethical practice into their daily professional work and
engage in ongoing professional development regarding current topics in
ethical and legal issues in counseling. Counselors become familiar with
the ACA Policy and Procedures for Processing Complaints of Ethical
Violations and use it as a reference for assisting in the enforcement of the
ACA Code of Ethics.
I.1. Standards and the Law
I.1.a. Knowledge
Counselors know and understand the ACA Code of Ethics and other applicable ethics codes from professional organizations or certification and
licensure bodies of which they are members. Lack of knowledge or misunderstanding of an ethical responsibility is not a defense against a charge
of unethical conduct.
Karen is a professional member of ACA and is a licensed professional
counselor in the state where she practices. She specializes in sex education and therapy, and she is a member of the American Association of Sex
Educators, Counselors, and Therapists (AASECT). When the 2014 ACA
Code of Ethics is published, she reads the document carefully to ensure
that she understands it. She reviews the codes of ethics of AASECT and
her state licensure body and compares their standards to those of ACA.
She notes that, according to the ACA Code of Ethics, counselors are expected to contribute a portion of their activity to pro bono service. Although
the other two codes do not mention pro bono work, Karen decides to
offer a series of free educational seminars for parents on how to talk to
their teenagers about sex.
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I.1.b. Ethical Decision Making
When counselors are faced with an ethical dilemma, they use and document, as appropriate, an ethical decision-making model that may include,
but is not limited to, consultation; consideration of relevant ethical standards, principles, and laws; generation of potential courses of action;
deliberation of risks and benefits; and selection of an objective decision
based on the circumstances and welfare of all involved.
Jamal, a counselor educator and supervisor, encounters an ethical dilemma with a colleague. Faced with this ethical quandary, Jamal refers to an
ethical decision-making model to help him reason through the dilemma.
Following the model, Jamal seeks consultation from colleagues at another
institution as well as from his own personal supervisor, reviews relevant
standards in the ACA Code of Ethics, considers the potential harm and benefit to all possible actions, and decides on an appropriate and ethically
sound course of action. Jamal documents the process by which he has arrived at his decision.
I.1.c. Conflicts Between Ethics and Laws
If ethical responsibilities conflict with the law, regulations, and/or other
governing legal authority, counselors make known their commitment to
the ACA Code of Ethics and take steps to resolve the conflict. If the conflict
cannot be resolved using this approach, counselors, acting in the best interest of the client, may adhere to the requirements of the law, regulations,
and/or other governing legal authority.
Christian, a play therapist, is contacted by the mother of a 5-year-old girl.
The mother states that the family has recently gone through a child custody
dispute and the judge has recommended mental health counseling for her
daughter. Christian informs the mother that his policy when working with
children is that both parents are involved in the counseling process and that
he requires an intake session with both parents unless there are extreme circumstances or it is unsafe for one parent to be present. The mother agrees to
counseling and states that she will attend the intake for the first half hour,
and her ex-husband will attend the second half hour, as she does not wish
to be present with him.
After a month of counseling Christian informs the mother that he would
like to conduct a session with each parent to discuss the counseling progress. The mother states that her ex-husband is delinquent on his child custody payments, so she is currently not letting him see his daughter, nor does
she want him to be involved in the counseling process. Christian is unsure
whether he is required to report that one parent is prohibiting visitation with
the other parent. He consults with a family law attorney to obtain advice on
whether he needs to report denied visitation.
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I.2. Suspected Violations
I.2.a. Informal Resolution
When counselors have reason to believe that another counselor is violating or has violated an ethical standard and substantial harm has not occurred, they attempt to first resolve the issue informally with the other
counselor if feasible, provided such action does not violate confidentiality
rights that may be involved.
Pat and Eugene, now professional counselors, attended the same graduate
program and received their master’s degrees at the same time. Two years
later, they meet at a professional conference. As they converse, they discover a shared professional interest in learning more about hypnotherapy.
Pat offers to send Eugene a copy of some materials. Eugene hands her one
of his new business cards. Later Pat reads the card and realizes that it contains misleading information about the degree that Eugene earned. She calls
Eugene and expresses her concerns. Eugene agrees to destroy his business
cards immediately and obtain a new set that advertises accurately.
I.2.b. Reporting Ethical Violations
If an apparent violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal
resolution or is not resolved properly, counselors take further action depending on the situation. Such action may include referral to state or national committees on professional ethics, voluntary national certification
bodies, state licensing boards, or appropriate institutional authorities. The
confidentiality rights of clients should be considered in all actions. This
standard does not apply when counselors have been retained to review
the work of another counselor whose professional conduct is in question
(e.g., consultation, expert testimony).
Toni learns that an ACA member, Enoch, who teaches psychology part time
at a local community college, has been recruiting his students as clients for
his private practice. She calls Enoch and attempts to express her concern,
but he refuses to discuss it with her. Toni then informs him that she plans
to talk to the chair of the psychology department about his behavior. Enoch
still says he will not discuss the issue with her. Toni then arranges to meet
with the department chair to discuss her concerns about Enoch’s behavior.
I.2.c. Consultation
When uncertain about whether a particular situation or course of action
may be in violation of the ACA Code of Ethics, counselors consult with other counselors who are knowledgeable about ethics and the ACA Code of
Ethics, with colleagues, or with appropriate authorities, such as the ACA
Ethics and Professional Standards Department.
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Xavier is a counselor for a private rehabilitation counseling service. The
director of the service has instituted a new set of record-keeping procedures, and Xavier questions whether the procedures are ethical. He
consults with his former ethics professor. He also calls a colleague who
served for many years on the ethics committee of the state rehabilitation
counseling association.
I.2.d. Organizational Conflicts
If the demands of an organization with which counselors are affiliated
pose a conflict with the ACA Code of Ethics, counselors specify the nature
of such conflicts and express to their supervisors or other responsible officials their commitment to the ACA Code of Ethics and, when possible, work
through the appropriate channels to address the situation.
Norton, an LPC who works in an agency, determines after consultation that
the new record-keeping procedures developed by the agency director may
violate ethical standards. He takes his concerns to the director, pointing out
the ethical standards in question and describing the results of his consultations. The director agrees to appoint a committee to review the procedures
and modify them if necessary and asks Norton to serve on the committee.
I.2.e. Unwarranted Complaints
Counselors do not initiate, participate in, or encourage the filing of ethics
complaints that are retaliatory in nature or are made with reckless disregard or willful ignorance of facts that would disprove the allegation.
Alan is a counselor educator at a state university. He consults with Vicky, who
works at a private university in the same city, about his anger at his department chair, who is an ACA member. Recently, Alan and his department chair
had a disagreement about research initiatives, and Alan believes the chair did
not respect his ideas. Alan says he believes that the department chair is unethical, and he is considering filing a complaint with the ACA Ethics Committee.
It is apparent to Vicky that Alan’s anger has nothing to do with the department chair’s ethical conduct, although it may be justified for other reasons.
She shares her perception of the situation with Alan and encourages him to
take appropriate action rather than file an unwarranted complaint.
I.2.f. Unfair Discrimination Against Complainants
and Respondents
Counselors do not deny individuals employment, advancement, admission to academic or other programs, tenure, or promotion based solely on
their having made or their being the subject of an ethics complaint. This
does not preclude taking action based on the outcome of such proceedings
or considering other appropriate information.
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Gretchen is a counselor educator who teaches group counseling courses in a
master’s program in counseling. One of her students files a complaint with
the ACA Ethics Committee because of his objection to being required to participate in an experiential group as part of the group course. The student
also complains about his grade of B, stating he thinks the instructor downgraded him for not engaging in meaningful self-disclosure. In her written
response to the Ethics Committee, Gretchen emphasizes the measures she
took to inform students about expectations of the course from the first day.
Her course outline states that students are not graded on the experiential
aspect of the course but are graded on other bases, such as papers and tests.
The complaint is dismissed. When Gretchen comes up for review for tenure
and promotion, the chair of the counseling department does not consider
information pertaining to her being the subject of an ethics complaint.
I.3. Cooperation With Ethics Committees
Counselors assist in the process of enforcing the ACA Code of Ethics. Counselors cooperate with investigations, proceedings, and requirements of the
ACA Ethics Committee or ethics committees of other duly constituted associations or boards having jurisdiction over those charged with a violation.
Candace is shocked to learn that a former client has filed a complaint against
her with the ACA Ethics Committee. Although Candace firmly believes the
complaint is unjustified, she takes the matter seriously. She reads the ACA
Policies and Procedures for Processing Complaints of Ethical Violations, consults
with an attorney, and writes a response that gives the fullest possible description of the events in question. She submits documentation to support
her response.
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Part III
Issues and Case Studies
Part III presents 12 chapters that highlight key ethical issues counselors encounter in their work. We wrote most of these chapters, and experts on particular topics contributed others. The chapters address the following issues:
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Client rights and informed consent
Social justice and counseling across cultures
Confidentiality
Competence
Managing value conflicts
Counseling minor clients
Managing boundaries
Working with clients who may harm themselves
Technology, social media, and online counseling
Counselor education and supervision
Research and publication
The intersection of ethics and law
Each chapter is followed by two case studies in which counselors
confront ethical dilemmas related to the issue discussed and make decisions—sometimes wisely, sometimes unwisely. The case studies are more
detailed than the vignettes in Part II and more illustrative of the complex
realities of actual practice. These are not actual cases from the Ethics Committee files, which are confidential, but they have been written by professionals who are particularly knowledgeable about ethics. Each case study
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includes an analysis of the case that explains how the dilemma might be
resolved and ways the counselor’s actions complied with or violated the
Code. Applicable ACA Code of Ethics (American Counseling Association
[ACA], 2014) standards are cited to enable you to easily find more specific
information on the topic under discussion. To the extent possible, these
cases are representative of the types of cases typically encountered by the
Ethics Committee and by practitioners in the field.
As we noted in the introduction, formal complaints to the ACA Ethics
Committee rarely allege a single violation of the Code of Ethics. Rather, cases typically involve claims of violation of multiple standards and involve
multiple ethical issues. In this respect, the case studies presented here are
also quite realistic, as each one raises a number of interrelated ethical issues that need to be studied in light of more than one standard. For example, Case Study 1, Keep Kendra’s Secret, or Not? is found in Chapter 1
on client rights and informed consent; yet the case also addresses issues
related to confidentiality (Chapter 3), competence (Chapter 4), counseling
minor clients (Chapter 6), and working with clients who may harm themselves (Chapter 8). Some of the issues counselors encounter frequently in
their work and that arise in multiple case studies follow:
Advocacy, social justice, and cultural diversity issues must be considered in
resolving most ethical dilemmas and feature prominently in Case
Studies 3, 4, 5, 9, and 20.
Boundaries and dual relationships are addressed in Chapter 7 and also arise
in Case Studies 18, 19, and 24.
Competence, impairment, and referral often become issues when counselors
encounter clients or situations with which they have limited experience or expertise, as is reflected in Case Studies 1, 2, 4, 6, 9, 10, 15,
19, and 20.
Confidentiality issues frequently create ethical dilemmas and must be factored into counselor decision making in Case Studies 1, 4, 11, 12, 13,
14, 15, and 16.
Evaluation, interpretation, and assessment, the focus of Section E of the Code
of Ethics, are key elements in resolving ethical dilemmas in Case
Studies 2, 3, 5, 9, 13, 15, and 16.
Family and couples counseling can involve unique ethical considerations,
as is illustrated in Case Studies 1, 2, 4, 8, 10, and 11.
Legal issues often must be addressed along with ethical dimensions of
a dilemma, as is true for the counselors in Case Studies 4, 5, 10, 11,
and 12.
Minor clients present some of the most complex ethical issues that counselors encounter and are featured not only in Chapter 6 but also in
Case Studies 1, 2, 4, and 16.
Relationships with other professionals can complicate ethical decision making and must be considered by the counselors in Case Studies 3, 13,
14, 17, and 23.
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Suicide risk, the focus of Chapter 8, also must be assessed and addressed
by the counselors in Case Studies 1, 3, and 23.
Supervision can be vital in reasoning through ethical dilemmas, as is
illustrated in Case Studies 3, 6, 7, 8, and 9.
Values and value conflicts are addressed in Chapter 5 and arise in conjunction with other issues in Case Studies 1, 12, 13, and 20.
Ethical dilemmas rarely involve a single issue. We invite readers to
grapple with the complexities of the cases presented in this section of the
Casebook and to discuss and debate the issues they raise.
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Chapter 1
Client Rights and
Informed Consent
Gerald Corey and Barbara Herlihy
The counseling relationship is founded on trust, which is a deeply personal experience that defines the counseling relationship and provides a
context for the therapeutic process (Pope & Vasquez, 2011). Counseling is
a collaborative endeavor in which counselor and client form a partnership
to attain goals the client has chosen. For these reasons, the counselor has
the responsibility for teaching clients about their rights. Clients need to receive the information that will enable them to become active participants
in the therapeutic relationship.
Informed consent is perhaps the most basic right of clients in counseling.
Clients have a right to know what they are getting into when they come
for counseling (Remley & Herlihy, 2014). The ACA Code of Ethics (American
Counseling Association [ACA], 2014) specifies that “clients have the freedom to choose whether to enter into or remain in a counseling relationship”
(Standard A.2.a.). To make this decision, clients need to understand how the
counseling process works. The process of securing clients’ informed consent
begins when the counseling relationship is initiated and continues throughout the relationship. Even when counselors are careful and conscientious
in discussing informed consent at the outset of the counseling relationship,
unforeseen situations may arise during the counseling process, necessitating that informed consent be revisited. The first case study presented at the
end of this chapter (Keep Kendra’s Secret, or Not?) provides an excellent
illustration. In this case, after several counseling sessions a minor client
reveals that she is engaging in self-harm behaviors, and questions arise
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regarding what the counselor explained about the limits to confidentiality
as part of the initial informed consent discussion.
The Code specifies the types of information counselors need to provide
to clients, including the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, and experience; how services will be continued if the
counselor dies or becomes incapacitated; the implications of diagnosis;
the intended use of tests and reports; and fees and billing arrangements.
Clients also have the right to know the limits of confidentiality, to obtain
clear information about their case records, to participate in their ongoing
counseling plans, and to refuse any recommended services or modality
change and be advised of the consequences of doing so. Other factors that
may affect the client’s decision to enter the therapeutic relationship are the
responsibilities of the counselor and of the client, legal and ethical parameters that could define the relationship, and the approximate duration of
the counseling relationship.
Obviously, informed consent is not a simple procedure. The challenge
for counselors is to strike a balance between giving clients too much or
too little information. Too much information can be overwhelming, but
it is too late to disclose information after a problem has arisen (G. Corey,
Corey, Corey, & Callanan, 2015). It seems to us that some counselors tend
to err in one direction or the other depending on the setting in which they
work. For example, in inpatient psychiatric facilities, clients are often required to sign an array of consent documents before being admitted to the
hospital. However, they are likely to be under great stress and may have
diminished capacity to make well-considered decisions at this time. They
may be receiving too much information, in detailed medical language, for
them to effectively be able to understand in the circumstances. Conversely, student clients in the school setting may not receive sufficient information. Some school counselors may provide only the briefest explanation
of such elements of informed consent as the limits of confidentiality or
the purposes and potential uses of tests. The second case study in this
chapter (A Minor (?) Client) illustrates the problems that can occur when a
counselor fails to provide just one element of informed consent: a detailed
explanation of the implications of diagnosis.
Types and amount of information, as well as the style of presentation,
are governed by many factors. Some of these include legal requirements
(such as due process), system policies and procedures (many agencies and
institutions have standard forms), the capacity of clients to understand
the information, and whether the client is an adult or a minor. It is important to provide clients with opportunities to ask questions, and information should be provided in clear language that is understandable to them.
Counselors are obligated to “communicate information in ways that are
both developmentally and culturally appropriate” (ACA, 2014, Standard
A.2.c.). It is important for counselors to take the cultural implications of
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Client Rights and Informed Consent
informed consent procedures into account and to adjust their practices
accordingly.
In addition to following the letter of the Code of Ethics, counselors will
do well to consider the spirit that underlies the informed consent guidelines in deciding what to tell their clients. Clients should be provided with
enough information to enable them to make wise choices. This includes
choosing whether to enter into counseling, selecting their counselor, and
making choices about their treatment plan.
Clients need to be active participants in the therapeutic relationship,
yet they are often unaware of their rights. In addition, they may not have
given any thought to their own responsibilities in solving their problems.
In seeking the expertise of a professional, clients may unquestioningly accept whatever their counselor suggests, without realizing that the success
of this relationship depends largely on their own investment in the process. Providing clients with information about what to expect from the
counseling process can demystify the process and ensure that clients become active partners in defining the counseling relationship.
It is important to address clients’ expectations of the counseling process.
Clients often ask how long counseling will last. Although counselors cannot
give a specific amount of time, we can address clients’ concerns and provide
appropriate information. Clients are sometimes unaware that they are likely
to experience uncomfortable emotions associated with counseling, and they
may harbor expectations of quick relief and happiness.
Putting informed consent information in writing is a good method to
help ensure client understanding. Clients can take this information home
and bring to the following session any questions or concerns they may
have. Under the provisions of the Health Insurance Portability and Accountability Act (HIPAA), which went into effect in 2003, counselors in all
settings are now required to provide clients with written disclosure statements or informed consent documents.
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Informed Consent With Families
Informed consent issues take on new complexity when applied to counseling with families or groups. When working with families, several questions arise: Who gives consent for the family? Which family members are
actively seeking counseling, and who in the family is a reluctant participant? Are there differences among family members in their capacity to
understand what the counseling process may involve? How can family
counselors adequately address, at the outset, the reality that there may be
difficult interactions during sessions, and how can counselors describe the
ways they will deal with these events? It is not a simple task for counselors
to give clear information to individual clients regarding the life changes
they might anticipate in counseling; it is a real challenge for family counselors to describe potential changes in family relationships as well as
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Issues and Case Studies
changes that individual family members might make in conjunction with
shifts in the system.
Before each individual agrees to participate in family therapy, it is essential that the family counselor provide information regarding the purpose of therapy, procedures that may be used, the potential benefits and
risks of participating in family therapy, the fee structure, the rights and
responsibilities of each family member, what can be expected from the
counselor, and the limits of confidentiality. Kleist and Bitter (2014) note
that specific applications of confidentiality and its limitations need to be
discussed early and frequently during the course of family therapy. The
family counselor and the family members need to agree not only on the
specific limitations to confidentiality that are mandated by law but also
on the limitations the family counselor may establish for effective treatment. Family members should have opportunities to raise questions and
know as clearly as possible what they are getting involved in when they
enter family therapy. The more thorough and clear the informed consent
process is, the easier it is for members of the family to decide whether to
participate in therapy and for families to make decisions regarding their
treatment. When counselors take the time to obtain informed consent from
everyone, they convey the message that no one member will be viewed as
the “identified patient” (the source of all the family’s problems).
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Informed Consent With Groups
Informed consent is particularly important in groups because group counseling involves a unique set of rights and responsibilities. Potential participants
need to have adequate information to decide whether they want to join the
group. If counseling is mandated, for instance by a court, participants need
to understand the limitations to confidentiality and what information will be
shared with others, such as a judge or probation officer. Group counselors
have the task of ensuring that individuals become aware of both their rights
and their responsibilities. Potential risks in participating in a group, along
with safeguards, should also be addressed. Scapegoating, undue pressure or
coercion, and inappropriate confrontation are among the possible risks for
those who participate in a group. Securing informed consent is both a preliminary task during the orientation process and an issue that needs to be revisited during the first group session. Counselors need to explain the nature,
goals, and purposes of the group; the leader’s (and, if applicable, coleader’s)
qualifications; the group’s format, procedures, and rules; and fees and arrangements for payment, if any. Group counselors also should be prepared to
assist prospective participants to clarify their personal goals for participating
and to discuss ways the group may be congruent or incompatible with their
cultural beliefs and values (M. Corey, Corey, & Corey, 2014).
The ACA Code of Ethics (ACA, 2014) is not truly comprehensive with respect to specific issues that need to be addressed when practitioners work
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Client Rights and Informed Consent
with multiple clients. Counselors who work with families and groups
are advised to familiarize themselves with these codes and guidelines:
AAMFT Code of Ethics (American Association for Marriage and Family
Therapy [AAMFT], 2012), the “Ethical Code for International Association
of Marriage and Family Counselors” (International Association of Marriage
and Family Counselors, 2005), the “Best Practice Guidelines” (Association
for Specialists in Group Work [ASGW], 2008), and the Multicultural and
Social Justice Competence Principles for Group Workers (ASGW, 2012).
These guidelines can be be kept in mind when reading the two case
studies that follow. Both cases illustrate the complexities of the informed
consent process. Informed consent also arises as an issue in other cases
that appear in later chapters; for instance, in Case Study 15 the counselor
wrestles with questions of informed consent while working with a client
around end-of-life decision making.
Case Study 1
Keep Kendra’s Secret, or Not?
Kelly L. Wester
Kendra is a 15-year-old female. Her mother, Lashawna, brought Kendra in
for counseling after Kendra ran away from home, which was a culminating event to the past year of angry behavioral outbursts, negative attitude,
and declining grades, as reported by her mother. In the intake session
Kendra barely talks or shares any information, but Lashawna is very talkative and appears to be exhausted and worried about her daughter. During this intake session, the counselor reviews the basic paperwork, including client consent and limitations to confidentiality. Lashawna continues
to provide information about Kendra’s negative attitude and behaviors,
including slamming doors, screaming and yelling when she doesn’t get
her way, and bullying her younger sister. Lashawna indicates that Kendra and her sister used to be close, but her sister doesn’t really want to
be around Kendra any longer because of the negative attitude and angry
outbursts. Lashawna reports that she had no indication that Kendra was
going to run away and that it caught her by complete surprise. Lashawna
was very worried when Kendra was missing, but now that she is home
Lashawna can’t help but be angry that Kendra put her through this event.
While Lashawna is reporting her anger and worry, Kendra sits silently.
When the counselor asks her for her side of the story, or what she would like
to talk about, she simply shrugs and says nothing. At the end of the first session, the counselor and Lashawna determine that, with Kendra’s reluctant
consent, the counselor will work with Kendra in individual sessions.
When Kendra comes back the following week and the counselor meets
with her individually, she opens up more without her mom in the room.
Kendra reports that she ran away from home because “home sucks.” She
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states that her mom is always working and is never there. She adds that
she is so angry because she feels like all she ever does is go to school,
take care of her younger sister, and help around the house. She receives
no thanks and no rewards, and she is tired of taking care of the family, as
she feels that it should be her mom’s job. Kendra indicates that her mom
misunderstands her, always jumping to negative conclusions about Kendra’s behaviors and intentions. Kendra reports that her mom blames her
for everything in the house, but she is “not the only culprit living there.”
The amount of anger that Kendra houses is evident. When she talks, her
voice becomes agitated, her pace of speech becomes more rapid, and her
expression becomes a scowl. Kendra fidgets, with her foot bouncing up and
down, revealing additional anger and agitation. When the counselor asks,
Kendra hesitantly shares that she really doesn’t do much to cope but tends
to listen to her music and sometimes talks to a friend. She momentarily
stares off at the far wall and then looks directly at the counselor and asks,
“What I say here stays in here, right?” The counselor replies, “Yes, with the
exceptions of the limitations I talked about last week.” Kendra remains quiet for another moment, then looks down at her hands and quietly states that
what really helps her get her anger under control is when she cuts herself.
Questioning from the counselor reveals that Kendra tends to cut when she
is really angry or when she feels lonely, which she quietly reports is “often.”
When the counselor asks if she wants to or had wanted to kill herself, she
denies any suicidal thoughts or attempts to commit suicide.
Although she is cutting now, Kendra reports that she used to engage in other
forms of self-harm. Approximately a year ago, she accidentally cut herself on a
rock while walking in her driveway and realized that when she looked at the
cut she was not angry any longer. She experimented with pulling out her hair
on her arms and legs, which created a prickling feeling; then she graduated
to burning herself with lighters. She realized, however, that those sensations
did not have the same effect as the cut of the rock in helping her feel better.
She started cutting herself in places that others couldn’t see, most commonly
her upper arms so that it could be hidden by short-sleeved shirts. Currently,
Kendra indicates she cuts with any object she can find, which has included
safety pins, knives, razor blades, and sharp rocks. She is cutting multiple times
a week and sometimes almost daily. She does this in her room because rarely
does anyone come to her room, as she usually “does something to piss them
off” before she retreats there. She quickly indicates that her mom is not aware of
her cutting and she doesn’t want her to know. Kendra adds that she has no desire to decrease her frequency of cutting, and doesn’t want to really talk about it
in counseling, as it has been the only thing that has worked for her.
Questions for Thought and Discussion
1. If you were the counselor in this case, would you talk about the cutting behavior with Kendra’s mom? What are the conditions that lead
you to make your decision?
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2. Would you make decreasing or extinguishing Kendra’s self-harm
behavior (cutting) a goal in counseling? Why or why not?
3. What may be important to have included or discussed in the informed consent process during the initial session with the client and
her mother?
Analysis
Self-harm is not considered an adaptive coping method, and there are several factors to consider in making choices in moving forward with this
client. First, given that this client is a minor, the counselor needs to have
some additional information before making the decision to report the
self-harm to her mother. Reporting could be a breach of confidentiality;
however, depending on answers to some important information related
to self-harm, as well as what was discussed in the informed consent and
limitations to confidentiality, reporting may be required.
Informed consent and the limitations to confidentiality that were discussed in the intake session must be considered first. What did the counselor indicate as the reasons why confidentiality would be broken? The
counselor was ethically obligated to provide Kendra with “adequate information about the counseling process” (ACA, 2014, Standard A.2.a.) at
the outset so that Kendra could make an informed choice regarding what
she chose to reveal. It is important to know what the counselor’s informed
consent statement specifies. For example, if the statement indicates that
abuse, neglect, and a desire to kill oneself will be reported, then Kendra’s
form of cutting with no intent to die and no suicidal thoughts does not fit
what was originally described to Kendra and her mom; therefore, reporting could be a breach of confidentiality. However, if the counselor indicated that abuse, neglect, and danger of harm to self would be reported,
then the counselor may be required to report.
The ACA Code of Ethics contains two additional standards that are relevant to this case: Standard A.1.a., Primary Responsibility, and Standard
A.4.a., Avoiding Harm. Both of these standards stress the importance of
the counselor respecting the dignity of the client, avoiding client harm,
and promoting client welfare. The counselor needs to consider whether
reporting Kendra’s cutting behavior would be more harmful than helpful.
For example, if Kendra’s life is not at mortal risk, even due to an accident
when cutting, would it be more helpful to keep Kendra’s confidence and
allow her to talk about her anger, frustration, and sense of being alone in
order to alleviate the reasons she engages in cutting behaviors in the first
place? The counselor will need to carefully balance Kendra’s ethical rights
to make her own choices and her mom’s legal right to protect Kendra and
make decisions on her behalf (Standard A.2.d.).
Other aspects to consider when deciding whether Kendra’s cutting, or
any other self-harm behavior, should be reported or becomes a goal in
counseling include exploring how impulsive Kendra is when she makes
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Issues and Case Studies
other choices and whether she self-harms while under the influence of
substances. Both of these factors increase the risk of accidental death.
The answers to all of these questions would determine whether decreasing Kendra’s cutting behavior would become a counseling goal even
if she stated she did not want to stop cutting. If Kendra is at risk for
accidental death, even though suicidal ideations and thoughts are not
present, then decreasing self-harm would necessarily become a counseling goal. The counselor will need to determine, however, whether the goal
of decreasing self-harm behavior arises from the client’s need or the counselor’s own personal reactions and values related to self-harm behavior.
Counselors must be aware of and avoid imposing their own personally
held values on clients (Standard A.4.b.).
Questions for Further Reflection
1. If you were Kendra’s counselor and decided not to inform her mother, what boundaries would you set around the cutting behaviors at
this point in counseling? In other words, when would you inform
the mother? What factors would you see as vital to consider?
2. What are your own responses to cutting or other forms of self-harm
behaviors? Would you be inclined to challenge Kendra to talk about
the meaning of her cutting behavior in her sessions with you? Why
or why not?
3. What do you see as your boundaries of competence in working with
clients who engage in self-harming behaviors? What would you need
to do to increase your perception that you are competent to effectively
assist clients whose behavior puts them at risk for harm to self?
4. If you were Kendra, what would you want your counselor to do?
Case Study 2
A Minor (?) Client
J. Scott Young
Tommy, age 17, is brought by his parents to see Ben, a counselor in private practice. During the intake session with the parents and Tommy, the
parents tell Ben that they are concerned about Tommy’s performance in
high school as well as his overall social adjustment. Tommy had been an
athlete throughout middle and high school, but about 6 months ago he
was dismissed from the baseball team by the coach and school administrators. The situation that led to the dismissal involved an incident during a practice in which Tommy had an argument with a teammate. After
practice, he got into a fight with the same teammate and another player in
the locker room. Tommy was viewed by the coaching staff as the instigator of the argument, and observers supported this view. Tommy believed
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the coach did not like him and was singling him out, as other players had
argued and scuffled without serious consequences. Within a few days of
the fight, Tommy got into a verbal altercation with a teacher over a grade.
These combined events led to him being dismissed from the team and
suspended from school for a week.
Tommy’s school performance has declined from grades of A and B to
failing or barely passing most classes. He also has changed his group of
friends, spending his time with individuals his parents view as troublemakers and drug users. In fact, his parents have caught Tommy drinking
and smoking marijuana several times, and they suspect additional drug
use. He has become increasingly defiant with his parents by withdrawing
from his family, staying out far beyond his curfew, and hanging out in
dangerous areas of town.
Ben meets with Tommy individually after completing the intake with
the parents present. Tommy denies that he is using any drugs except marijuana and states that he believes his parents are overreacting. He describes
his drug use as “normal high school stuff.” He says that he plans to return
to school, pull up his grades, and graduate on time and that he hopes to
play baseball at a college or university. When Ben asks Tommy if he wants
to continue in counseling, Tommy says that he does. When Ben gently
questions whether Tommy’s response is motivated more by a desire to
avoid further dissention with his parents than by a sincere desire to receive counseling, Tommy denies this.
During the next six weekly sessions, Tommy remains marginally engaged in the counseling process: He answers questions and carries on a
conversation but will not actively explore his internal struggles, feelings,
or actions that led to his current situation. Ben structures some sessions
as family sessions and sometimes sees Tommy individually. In both situations, Tommy maintains the same stance: “I’m fine, my parents are simply
overreacting.” By contrast, Tommy’s parents believe his substance abuse
is more serious than he admits. They have removed all alcohol from the
house to prevent him from drinking it and report that they discovered
he has used Xanax recreationally. Also, they state that Tommy was once
involved in a situation in which someone pulled a gun on him and friends
when (the parents assumed) they were at a house to purchase drugs. Taking into account the parents’ report, Ben diagnoses Tommy with a substance use disorder and submits paperwork for reimbursement to the
family insurance company. Ben also includes a diagnosis of an adjustment
disorder with conduct disturbance.
When the family receives notification from their insurance company
about the claim, they are upset to learn that a diagnosis of a substance
use disorder was given. They are concerned that such a label will follow
Tommy and negatively affect his future. Tommy, also, is very concerned,
fearing that such a diagnosis might prevent him from being able to play
baseball at a college or university. Tommy is particularly upset because
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Issues and Case Studies
he disagrees with the diagnosis, maintaining that his substance use is
“normal” and that he isn’t “stupid enough to get into trouble with drugs.”
A complicating factor in the case is that Tommy turned 18 during the 6
weeks he was in counseling, making him legally responsible for remaining in counseling and confounding the question of who gives consent for
treatment. Initially, Tommy’s parents had reviewed and signed the consent for treatment documents, and Tommy had given his assent. The parents had paid for counseling services. Ben was unaware of the birthday,
although the information was in the client file.
Questions for Thought and Discussion
1. What steps should the counselor have taken to ensure clear informed
consent from all parties involved, given how close Tommy was to
legal adulthood? Following his 18th birthday, what additional steps
were needed?
2. What information related to diagnosis should the counselor have
discussed with Tommy and his parents before he submitted the
diagnosis?
Analysis
The case of Tommy raises several interrelated issues related to informed consent and diagnosis. It appears that Ben, the counselor, adhered to proper ethical procedures by providing a consent to treatment document that the parents
read and signed, thus ensuring that informed consent was obtained and documented (ACA, 2014, Standard A.2.a.). It was also an ethically sound procedure for Ben to obtain Tommy’s assent. When counseling minor clients, counselors are required to “seek the assent of clients to services and include them
in decision making as appropriate” (Standard A.2.d.). By obtaining Tommy’s
assent, Ben was attempting to balance Tommy’s ethical right to make choices
with his parents’ legal right to make decisions on his behalf (Standard A.2.d.).
Ben was remiss, however, when he failed to attend to his obligation to make
informed consent “an ongoing part of the counseling process” (Standard
A.2.a.). Had Ben revisited the issue of assent/consent periodically as he was
counseling Tommy, he might have been alerted to the fact that Tommy had
become a legal adult and likely could have avoided the problems that occurred after he submitted his diagnosis to the insurance company.
It appears that Tommy has experienced a notable change in both behavior and mood in recent months, and both Tommy and his parents confirm
that he uses substances. However, the extent of his use is unclear. Furthermore, the issue of diagnosing Tommy with a substance use disorder raises
important questions.
It is unclear from the case whether Ben had a conversation with Tommy
or his parents about the fact that a diagnosis would be made as a part of
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filing the insurance claim or whether he provided a thorough explanation of the services to be offered, including “the implications of diagnosis”
(Standard A.2.b.). Good ethical practice would have consisted of an open
discussion of the importance of proper diagnosis as well as the implica=
tions of a diagnosis as a permanent part of Tommy’s record that will remain salient in the future.
=
A question also exists as to whether the diagnosis was appropriate, given the discrepancies in information about Tommy’s drug use. Is this a case
of “up-coding,” or giving a more serious diagnosis than is warranted, to
maximize the opportunity that more sessions will be approved by the insurance company? Has Ben met his ethical obligation to “take special care
to provide proper diagnosis” (Standard E.5.a.) in working with Tommy?
Another ethical issue related to diagnosis is the counselor’s experience
with diagnosing and treating substance use disorders. Counselors “practice only within the boundaries of _
their competence” (Standard C.2.a.).
_
Given the conflicting information that is present in this case, Ben should
have taken steps to ensure that a proper diagnosis was given and that
everyone involved was aware of the implications of the diagnosis. These
steps include the use of assessment to determine the levels of depression
and/or anxiety present in Tommy as well as more targeted assessments
such as the Substance Abuse Subtle Screening Inventory (n.d.; see also
Miller, 1999), which would provide information about his substance use.
If Ben is not trained to provide such assessments, then a referral to a practitioner who is qualified to give such measurements is warranted so that
proper evaluation can occur. Consultation with colleagues that is documented in the case notes would be another important step in this case to
ensure that treatment decisions are carefully thought through. If it is determined that there is a need for substance abuse treatment and Ben lacks
the needed competence, then he should offer to refer Tommy to a program
or practitioner specializing in substance abuse treatment.
Questions for Further Reflection
1. What level of training is needed in a common mental health issue
such as substance abuse in order for a counselor to be able to properly diagnose and provide treatment?
2. What steps might you take to ensure that changes in client status
(such as age, relationship, legal complications, residency) are not
overlooked?
3. If you were Tommy’s counselor, considering that Tommy’s parents
initiated counseling, are paying for your services, and are genuinely
concerned for his well-being, how might you navigate communication with them following Tommy’s 18th birthday?
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Chapter 2
Social Justice
and Counseling
Across Cultures
Courtland C. Lee
Professional counselors are confronted with many challenges to ethical
practice in the globally interconnected world of the 21st century. Among
the most significant of these challenges is addressing the concerns of clients
from increasingly diverse cultural backgrounds. According to the United
Nations Educational, Scientific, and Cultural Organization (UNESCO,
2009), cultural diversity refers to the wide range of distinct cultures that can
be readily distinguished on the basis of ethnographic observation. These
cultures are often seen through the lenses of race/ethnicity, gender, sexual
orientation, socioeconomic status, religion/spirituality, ability status, and
age. Ethnographic observations reveal that people throughout the world
have diverse views with respect to many aspects of life, including language use, relationships with self and others, gender role socialization,
and relationships with the physical world. Awareness of such diversity
in worldviews has become much more widespread, facilitated by global
communications and increased cultural contacts (UNESCO, 2009).
Counseling practice, both in the United States and beyond, has been
greatly affected by the increased contact among people from diverse cultural backgrounds. It has become imperative that counselors become
culturally competent in their approaches to promoting human growth and
development. Cultural competency defines a set of attitudes and behaviors
indicative of the ability to establish, maintain, and successfully conclude
a counseling relationship with clients from diverse cultural backgrounds
(Lee & Park, 2013). The concept of multicultural or cross-cultural
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competency has received significant attention in the counseling literature (Arredondo et al., 1996; Roysircar, Arredondo, Fuertes, Ponterotto, &
Toporek, 2003; Sue, Arredondo, & McDavis, 1992). Ideally, counselors who
are culturally competent have a heightened awareness and an expanded
knowledge base, and they use helping skills in a culturally responsive
manner. Cultural competency evolves through a developmental process
that encompasses a number of critical factors, including self-awareness,
global literacy, knowledge of counseling theory, ethical sensitivity, crosscultural theoretical knowledge, personal and professional cross-cultural
encounters, and cross-cultural counseling skills (Lee & Park, 2013).
Knowledge of ethical standards is foundational to the process of developing cultural competency. Indeed, the integrity of counseling as a
profession rests on ethical aspirations and their translation into practice.
The counseling literature underscores the relevance of ethical standards
to counseling across cultures (Delgado-Romero, 2003; Lee & Kurilla, 1997;
Pack-Brown & Williams, 2003; Ridley, Liddle, Hill, & Li, 2001). This literature suggests that counselors who are culturally competent increase their
chances of practicing ethically with diverse client groups. Counselors who
are not aware of cultural dynamics and their impact on client development risk engaging in unethical conduct.
The ACA Code of Ethics (American Counseling Association [ACA], 2014)
provides a framework that outlines the parameters of ethical behavior and
serves to delineate best practice in counseling. In the multicultural society
of the United States in the 21st century, such a framework has implications
for cross-cultural counselor–client interactions. The Code explicitly states
that counselors have an ethical responsibility to honor diversity and embrace “a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts”
(Preamble). Given this important responsibility, counselors are obligated
to protect clients from potential harm or prevent harm when possible (beneficence), but they are equally responsible for not inflicting harm on clients (nonmaleficence). There can be little doubt that harm can be inflicted
when counselors do not competently engage the dynamics of culture in all
aspects of counseling practice.
Professional counselors must address the implicit and explicit challenges of diversity in a manner that is both culturally competent and ethically
responsible. According to the ACA Code of Ethics (ACA, 2014), counselors
should aspire to engage in the following behaviors:
←
#
F-
• Actively attempt to understand the diverse cultural backgrounds of
the clients they serve (Section A: Introduction)
• Explore their own cultural identities and how these affect their values
and beliefs about the counseling process (Section A: Introduction)
• Communicate the parameters of confidentiality in a culturally competent manner (Section B: Introduction)
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l
• Use assessment as one component of the counseling process, taking
into account the clients’ personal and cultural context (Section E:
Introduction)
• Minimize bias and respect diversity in designing and implementing
research (Section G: Introduction)
• Recognize that support networks hold various meanings in the lives
of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/ spiritual/community leaders,
family members, friends) as positive resources, when appropriate,
with client consent (Standard A.1.d.)
• Communicate information in ways that are both developmentally
and culturally appropriate (Standard A.2.c.)
• When clients have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for
a qualified interpreter or translator) to ensure comprehension by clients (Standard A.2.c.)
• In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly (Standard A.2.c.)
• Are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors (Standard A.4.b.)
• Respect the diversity of clients and seek training in areas in which
they are at risk of imposing their values onto clients (Standard A.11.b.)
• Understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and
gratitude (Standard A.10.f.)
• Maintain awareness and sensitivity regarding cultural meanings of
confidentiality and privacy . . . [and] respect differing views toward
disclosure of information (Standard B.1.a.)
• Gain knowledge, personal awareness, sensitivity, dispositions,
and skills pertinent to being a culturally competent counselor in
working with a diverse client population (Standard C.2.a.)
• Do not condone or engage in discrimination against prospective or
current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/partnership status, language preference, socioeconomic status, immigration
status, or any basis proscribed by law (Standard C.5.)
• Recognize that culture affects the manner in which clients’ problems are
defined and experienced. Clients’ socioeconomic and cultural experiences are considered when diagnosing mental disorders (Standard E.5.b.)
• Recognize historical and social prejudices in the misdiagnosis and
pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others
(Standard E.5.c.)
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t
• Carefully consider the validity, reliability, psychometric limitations,
and appropriateness of instruments when selecting assessments
and, when possible, use multiple forms of assessment, data, and/or
instruments in forming conclusions, diagnoses, or recommendations
(Standard E.6.a.)
• Select and use with caution assessment techniques normed on populations other than that of the client. Counselors recognize the effects
of age, color, culture, disability, ethnic group, gender, race, language
preference, religion, spirituality, sexual orientation, and socioeconomic status on test administration and interpretation, and they
place test results in proper perspective with other relevant factors
(Standard E.8.)
• [As supervisors,] are aware of and address the role of multiculturalism/diversity in the supervisory relationship (Standard F.2.b.)
• [As counselor educators,] infuse material related to multiculturalism/diversity into all courses and workshops for the development
of professional counselors (Standard F.7.c.)
• [As counselor educators,] actively attempt to recruit and retain a diverse student body, . . . demonstrate commitment to multicultural/
diversity competence by recognizing and valuing the diverse cultures and types of abilities that students bring to the training experience, . . . [and] provide appropriate accommodations that enhance
and support diverse student well-being and academic performance
(Standard F.11.b.)
• [In the informed consent process] issues, unique to the use of distance counseling, technology, and/or social media, are addressed
. . . [including] cultural and/or language differences that may affect delivery of services (Standard H.2.a.)
• [In maintaining websites,] provide accessibility to persons with disabilities . . . [and] translation capabilities for clients who have a different primary language, when feasible (Standard H.5.d.)
Inherent in these ethical standards is the obligation that counselors take
the necessary precautions to ensure that they are aware of any cultural
biases and/or prejudices they may have and that their cultural values
and biases do not enter into their counseling practices in ways that would
have a negative impact on clients. Traditional counseling practice often reflects values inherent in European/Euro-American culture (Lee, 2013; Sue
& Sue, 2013), so the potential for disregarding or misunderstanding the
importance of the values and beliefs of culturally diverse clients is great.
The welfare of clients from diverse cultural backgrounds may be at risk
even though counselors’ actions are well intended. Questionable or unethical conduct with individuals from culturally diverse backgrounds is
often due to a counselor’s lack of cultural competency. However, cultural
ignorance should be no excuse for unethical counseling practice. When
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counselors lack cultural competency, providing counseling services to clients from diverse cultural backgrounds is unethical practice.
Social Justice and the Ethics of Counseling
Across Cultures
As cross-cultural counseling has continued to evolve as a discipline, it has
spawned critical thinking about important issues of access and equity in
counseling. As a result, the concept of social justice has emerged as an important dimension to counseling practice (Lee, 2007; Ratts, D’Andrea, &
Arredondo, 2004). Social justice involves promoting access and equity to
ensure full participation in the life of a society, particularly for those who
have been systematically excluded on the basis of race/ethnicity, gender,
age, physical or mental disability, education, sexual orientation, religion, socioeconomic status, or other characteristics of background or group membership. Social justice is based on a belief that all people have a right to
equitable treatment, support for their human rights, and a fair allocation of
societal resources (Lee, 2007; Miller, 1999; Ratts, Lewis, & Toporek, 2010).
As a theoretical construct, social justice focuses on issues of oppression,
privilege, and social inequities. The forces of oppression and privilege often converge to perpetuate inequities where groups of people are marginalized in a society. Counseling for social justice implies that counselors
must be competent as agents of social change at both the micro and macro
levels. A social justice perspective suggests that counselors should employ
their expertise to help individuals while challenging the profound social,
cultural, and economic inequities that plague the quality of life for scores
of people (Lee, 2007) and that professional counselors are called to action
to assist those experiencing marginalization and/or oppression. This call
to social action is underscored by a core professional value embedded in
the ACA Code of Ethics (ACA, 2014)—promoting social justice. In addition
to roles at the individual and group levels, the Code delineates important
counselor roles at the institutional and societal levels:
• When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles
that inhibit access and/or the growth and development of clients.
(Standard A.7.a.)
• Counselors obtain client consent prior to engaging in advocacy efforts
on behalf of an identifiable client to improve the provision of services
and to work toward removal of systemic barriers or obstacles that inhibit client access, growth, and development. (Standard A.7.b.)
Ethical and culturally competent counseling practices in the contemporary culturally diverse and globally interconnected social context encompass the ability to intervene, not only in the lives of clients to help with
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problem resolution or decision making but in the social context that affects
those lives as well. Counseling for social justice is based on the premise
that the environment is the key factor in determining behavior. Problematic behavior often can be traced to the negative effects of the environment
on cognitive and affective functioning. Client issues may be merely reactions or symptoms to deep-seated problems in the social environments
in which people must interact on a daily basis. Ethical practice, therefore,
implies that counselors have a professional and moral responsibility to
address profound social, cultural, and economic challenges that have the
potential to negatively influence psychosocial development. To illustrate
how social justice principles can be applied to counseling practice, two
case examples are offered along with a discussion of each case.
Case 1
Mrs. Abayomi, a recent immigrant from Nigeria, has been in counseling with
Marina for the last 2 months. The sessions have been very helpful to Mrs.
Abayomi. At the end of the most recent session, Mrs. Abayomi presents Marina with a small wooden animal that was carved in her country as a token
of appreciation. Marina explains to Mrs. Abayomi that she is very appreciative, but she cannot accept the gift for professional reasons. Because of this
rejection, Mrs. Abayomi leaves the session very upset with her counselor.
Discussion
For a long time it was considered unethical to receive gifts from clients.
However, in many cultures giving a gift is considered to be the highest form
of praise and appreciation, and to refuse a gift is considered rude or insensitive. It might be argued that Marina was acting in a professional manner,
attempting to avoid a dual relationship by not accepting Mrs. Abayomi’s
gift. However, she appears to lack the knowledge that in some cultures the
presentation of small gifts is an important gesture of appreciation. The rejection of such a gesture is often seen as an insult. It also appears that Marina
is not aware that the ACA Code of Ethics (ACA, 2014) recognizes this cultural
difference. In a culturally competent manner, Marina could have accepted
the gift after asking herself questions such as “How will accepting the gift
affect our counseling relationship?” “What is the possible value of the gift?”
“Why is Mrs. Abayomi giving me the gift?” “Why am I accepting the gift?”
Accepting the gift would have demonstrated Marina’s understanding of the
nature and purpose of gift giving and its importance in many cultures.
==
Case 2
Ms. D is a 35-year-old African American woman who has been referred to
counseling for depression. She is a wage-reliant worker who holds down
two jobs. Ms. D’s 12-year-old son recently died from a bacterial infection in
his brain. The infection had spread to his brain from an abscess in his tooth.
Ms. D states that she had no health insurance and her Medicaid coverage
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had temporarily lapsed when her son’s toothache started. Because of this,
she could not afford to pay the $80 that it would have cost for a visit to the
dentist. She is now trying to cope with the loss of her son and continue to
provide for his younger brother. She states that she is ashamed of the fact
that neither of her sons has ever received dental attention.
Discussion
Ms. D’s case presents the counselor with issues and challenges at a number
of important levels. The first is to address her depression in the aftermath
of her son’s death. This might entail grief counseling, which would address
her issues at the individual or micro level. Second, the counselor can ensure
that Ms. D and her surviving son get the services they need from school and
community representatives. The counselor may need to act as a systems advocate both with and for Ms. D’s family.
Perhaps the greatest challenge for this counselor is to move beyond the
client and systems level and translate concern for Ms. D’s family into action
that will have a far-reaching impact. It is unrealistic and naive to think that
her family is the only one facing this crisis in dental care. The counselor
must decide whether he or she has the awareness, knowledge, and skills
to engage in social/political advocacy for all socioeconomically disadvantaged children and their families who lack health care. This form of advocacy speaks to a counselor’s sense of social responsibility and involves taking
stands on social/political issues as well as working to eradicate systems and
ideologies that perpetuate discrimination and disregard human rights. The
counselor must be willing to assume an advocacy role that is focused on influencing public opinion, public policy, and legislation. Counselors acting as
advocates in the public arena must understand that they are acting on behalf
of a constituent group. Ms. D’s counselor, acting to help poor or workingclass families who lack dental care, must find ways to consult frequently
with this constituency group as forces are mobilized to act on their behalf.
Opportunities to promote social justice and to advocate for and with
clients are evident in many, if not most, counseling relationships when
counselors consider the environmental factors that are affecting a client’s
conditions of living. The two case studies that follow are very different
from each other but illustrate the need for a social justice perspective and
advocacy in resolving ethical dilemmas. In Case Study 3 (She’s Done This
Before), a counselor intern is concerned that a potentially suicidal client is
about to be discharged from the hospital and is stymied in his efforts to
advocate for this client. Case Study 4 (Working With an Immigrant Family)
describes a school counselor’s quandary when she believes she cannot effectively assist her student client without also advocating for the student’s
family. Issues surrounding social justice and advocacy run as a consistent
thread throughout the case studies in this book and must be considered
when working to resolve many ethical dilemmas, such as those presented
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in Case Study 5 (The Slap—How to Best Help Hope) and Case Study 9
(I’m Stuck), among others.
Case Study 3
She’s Done This Before
William B. McKibben and Jodi L. Bartley
Jenna is a 23-year-old White female who was recently admitted to the hospital emergency room for alcohol withdrawal symptoms. When she was
brought to the emergency room, Jenna was very agitated and repeatedly
screamed obscenities at staff members. At one point, the hospital security
department was summoned to restrain her to her bed. A treatment team
consisting of a case worker, a psychiatrist, and a nurse has been assigned
to be responsible for her care.
Once Jenna is relatively stable and no longer a threat to herself or others, she is invited to participate in group counseling, which is offered once
a day by Keith, a counseling intern (not assigned to Jenna’s treatment
team) who works throughout the hospital. When Jenna declines to participate in the group, Keith follows up with her, realizing that she is about to
be discharged. Jenna describes her situation in detail when she talks with
Keith. She describes her current feelings of depression and her struggles
with addiction. Keith perceives her mood to be depressed, as evidenced
by tearful affect. She seems to be ambivalent about leaving the hospital,
as she says that her family members do not support her, she recently lost
her job, and she is homeless. Keith determines that he needs to assess for
suicide. Jenna states that if she is discharged from the hospital she plans to
run into the middle of a busy interstate highway and kill herself. Further
questioning from Keith reveals that Jenna has a history of multiple suicide
attempts of varying potential lethality and that she has a detailed plan.
She can think of no scenario or turn of events that would keep her from
following through with this plan. Keith knows that Jenna has met with the
staff psychiatrist to discuss her discharge, so he asks if she revealed her
plan to the psychiatrist. Jenna replies that the psychiatrist never asked her
about suicide, and she did not want to tell him.
Because the hospital staff members work as a treatment team, Keith
immediately reports the client’s suicidality to the staff members. He documents in Jenna’s chart her distress and suicidal intent and asks to attend
the treatment team meeting. When the treatment team meets, they are
ambivalent in their reactions to Keith’s report. They tell Keith that Jenna
has expressed suicidal intentions in the past as a way to stay in the hospital because she has nowhere else to go; in addition, they are concerned
about the safety of other patients given her initial outbursts. One of the
team members comments, “She’s done this before.” The psychiatrist states
that, without direct knowledge of Jenna’s suicidal ideation and given the
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consensus of the team, he intends to discharge her with a list of available
homeless shelters in the area. The team moves on to discuss other cases.
As Keith leaves at the end of the meeting, he remains concerned about the
client’s safety if she is released and is unsure how to proceed.
Questions for Thought and Discussion
1. If you were the counselor intern, what would your next step be?
What is your role in this scenario? Do you think the intern should
advocate for this client?
2. What ethical issues (both for the specific case and from a systemic
perspective) can you identify in this case?
Analysis
This scenario presents multiple ethical considerations, including imminent suicidality, counselor role ambiguity, and advocacy. Keith, the counseling intern, has conducted a suicide risk assessment and believes he
has enough information to conclude that this client is at risk of harming
herself if released from the hospital. The client reported active suicidal
thoughts, a clear suicide plan with intent to follow through, multiple risk
factors (impulsive behavior, addiction, homelessness, unemployment,
history of attempts), highly lethal and accessible means, and an inability
to contract for safety if released. The intern is obligated ethically to act
with the client’s safety in mind. If the intern were working in a community or outpatient setting, his task would be to assist the client in finding
immediate crisis care (inpatient hospitalization). Because the client in this
case is already in a hospital emergency room but is about to be released,
the situation is more complicated.
Further complicating this case is the ambiguous role of the counselor
intern. The intern, Keith, is not assigned specifically to this client’s hospital treatment team, but he has interacted directly with the client and
now believes he has important information relevant to the client’s care
and safety. Although he has expressed his concerns to the members of the
treatment team, their response seems to suggest that they have a different
interpretation of the client’s expressed suicidal intent. Keith, unlike the
other members of the team, is not a permanent employee of the hospital,
nor is he a licensed and experienced professional. It is important for him
to be respectful of the views of the treatment team members and to acknowledge their expertise (ACA, 2014, Standard D.1.a.), which is based on
their credentials and experience.
Because the client is about to be discharged and Keith continues to be
concerned for her safety, it would be wise for Keith to consult with his
site supervisor at the hospital and with his university supervisor (Standard
C.2.e.) He has taken an appropriate first step by notifying the treatment
= =
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F
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Issues and Case Studies
team of his concerns and his assessment of the client’s suicidality (Standard D.1.c.). He might now consider how he can advocate for this client (Standard A.7.a.). He can use the ACA Advocacy Competencies (Ratts,
Toporek, & Lewis, 2010) to help guide him.
The intern may be concerned that the client’s voice (both directly and
through him) is not being heard by staff in this case as evidenced by their
intent to discharge her, and it appears that the client cannot guarantee her
own safety. Keith can advocate for and with the client by helping her effectively express her own concerns and needs to hospital staff. He could talk
with Jenna and provide her with information regarding who she needs to
talk to and what she needs to highlight to ensure she receives the help she
needs. Jenna might be empowered and her autonomy would be promoted
in a situation where she currently feels helpless. Keith’s supervisors may
also be able to advise him on how to navigate through this delicate situation in a way that enables him to continue to advocate for Jenna. His site
supervisor, in particular, as a colleague and peer of the members of the
treatment team, may have a stronger voice in the hospital system. Keith
should explain in detail to the supervisor his suicide assessment and his
clinical impressions of Jenna’s condition. Later, when Keith has earned his
degree and his licensure, if he continues to work in an inpatient setting, he
can continue to advocate on a systemic level.
Questions for Further Reflection
1. If you were the intern’s supervisor, what would you do? What advice would you give the intern?
2. How far should this intern go as an advocate for the client in this situation? What are the potential consequences, for the intern, the client,
and the hospital system, if he takes an active role as an advocate?
3. How do you view your own role as an advocate?
Case Study 4
Working With an Immigrant Family
Laura M. Gonzalez
Esmerelda is a 15-year-old girl who lives in a rural southern town with her
family and three younger siblings. Her parents were born in El Salvador but
came to the United States in the 1990s when they were at the point of starvation in their home country and heard rumors about a better life up north.
Esmerelda and her siblings were born in the United States. Her mother and
father each work several shifts at a poultry processing plant, so Esmerelda
has taken on more responsibilities in the home, taking care of her younger
siblings, cooking, cleaning, and opening the mail and making sure her parents know which bills they need to pay by the end of the week.
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Esmerelda’s school counselor, Frances, has noticed that Esmerelda appears tired during the day. When asked about her apparent exhaustion,
Esmerelda briefly mentions nightmares about her parents being deported
that disrupt her sleep. However, she makes it clear that she does not want
to discuss that topic further. Frances consults with Esmerelda’s teachers
and receives varying impressions: She is quiet and sleepy in her geometry
class, unable to focus and pay attention in English class, and withdrawn
and “not very social” in history class. However, none of the teachers state
that they are overly concerned about Esmerelda.
Frances decides that she needs clarification about what is going on with
Esmerelda, and she asks Esmerelda to stop by for a conversation. Frances asks if she can invite one of Esmerelda’s parents to join them as well,
but Esmerelda indicates their English is not strong enough to participate
in the meeting. When Esmerelda comes to the counseling office, Frances
begins by inquiring about Esmerelda’s wellness and learns that she is usually forgoing her breakfast so that her younger siblings will have enough
to eat. Although the family would most likely qualify for free or reduced
lunch at school, they have not completed the necessary paperwork, and
Esmerelda declines to take the application home. Esmerelda also admits
to having headaches and stomachaches often while at school and to being distracted by persistent and intrusive thoughts. She cannot identify a
support system outside of her family, and she says that her classmates still
tease her about her family’s origins, incorrectly and inappropriately calling her a “dirty Mexican” even though she is a fully bilingual U.S. citizen.
Although Esmerelda has described all of this with a stoic look on her face
and in a low, quiet voice, she finally breaks into anguished tears as she
touches on the topic of the deportation dream. For a few moments, the
two sit quietly together as Esmerelda sobs, unable to find any more words
for her grief and fears. Frances realizes she does not know anything about
immigration law or whether it is probable that this nightmare could come
to pass. After a few moments, she asks if Esmerelda would like to have a
social worker check in on her family. Esmerelda abruptly leaves the room.
Frances decides to consult with the school interpreter, Jorge, guessing
that he might have more information than she does about immigrant families and legal status. He confirms that several students in the school have
already had parents deported because of immigration raids at some of the
factories in the community. Jorge tells Frances that his standard practice
is to not inquire about legal documentation, as he has seen the state laws
go back and forth about whether school personnel must report the presence of undocumented individuals to the government. “I just would not
want to be in the position of choosing whether to tear a family apart or be
in contempt of court,” he says. When Frances asks whether Jorge has met
either of Esmerelda’s parents, as she is considering reaching out to them
about her concerns for their daughter, he advises her to restrict her attention to what is happening in school. “Besides,” he says, “if the family is
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Issues and Case Studies
afraid to speak to us, terrified of seeking services in the community, and
unable to pay or get insurance coverage, there is not much we can do for
them.” Francis feels torn between her growing concerns about Esmerelda’s
mental and physical health and her helplessness to be an effective advocate around complicated legal issues with which she is unfamiliar.
Questions for Thought and Discussion
1. How might a school counselor think about confidentiality in a case
like this, involving a minor in an educational setting? At what point
might a school counselor feel compelled to involve school administrative staff, teachers, or parents?
2. If you were the school counselor, where would you start in attempting to sift through the cultural, ethical, and legal aspects of Esmerelda’s
case?
3. Does Frances have ethical responsibilities to all members of Esmerelda’s
family or only to Esmerelda?
Analysis
A counselor in this situation could reasonably consider several ethical and
legal issues as relevant. First, Esmerelda, the presenting client, may be experiencing anxiety and related somatic symptoms, may have basic food needs
that are unmet, may be experiencing discrimination within the school setting, and could be further thrust into a “head of household” role if her worst
fears about the deportation of her parents come true. Second, Esmerelda’s
younger siblings, who attend other schools, may be having similar problems that have not been detected or addressed. Third, Esmerelda’s parents
may not be receiving resources from the school or other sources because
of language barriers, fears about being reported as undocumented, lack of
familiarity with the structure of social services in the United States, cultural
norms around help seeking, and lack of support systems (e.g., separated
from extended family, low income, uninsured). All of these issues would
affect Esmerelda as a member of this immigrant family system, so resolving
only the school-based portion of the problem would likely be insufficient.
The guiding ethical principles of justice and beneficence would apply, as Frances has identified a vulnerable family that is not receiving fair
treatment and is in need of a service provider to actively promote their
well-being. In addition, Frances should consider autonomy and nonmaleficence. Do Esmerelda’s parents have the right to make their own choice
about not applying for free and reduced lunch, for example? Would Frances inadvertently make this family’s situation worse if she continued to
inquire about their unknown legal status?
A response in this complex situation could be made at many levels.
In the school environment, Frances could focus on Esmerelda and steps
"
€
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to improve her quality of life during the school day. This could include
an offer to assist her with her anxiety by processing her terrifying dream,
with Esmerelda’s permission. Frances could make further efforts to involve Esmerelda’s parents. Frances has an ethical responsibility to establish “collaborative relationships with parents/guardians to best serve [her
minor client]” (ACA, 2014, Standard B.5.b.). Esmerelda’s parents may not
fully understand the free and reduced lunch policy, and they might be
willing to consider it if they have complete information and a chance to
discuss their concerns (which the counselor could provide through
Esmerelda or directly to the parents via an interpreter). These steps would
honor the school counselor’s commitment to her client’s welfare, would
allow Esmerelda freedom of choice in whether to participate in therapeutic
sessions at school, and would be inclusive of the family. Frances might
make an effort to include Esmerelda’s parents via an interpreter or translated documents because Esmerelda is a minor. Multicultural competence
would suggest that family members should not be pressed to translate for
each other, so Esmerelda should not be coerced into that role.
A second level of ethical response to this case could be for Frances to take
an advocacy role. “When appropriate, counselors advocate . . . to address
potential barriers and obstacles that inhibit access and/or the growth and
development of clients” (Standard A.7.a.). If Frances decides to take on this
role, she should proceed carefully because of her lack of information about
immigration law and her potential limits of competence in that area. Consultation is advisable for Frances. The National Immigration Law Center
(http://www.nilc.org) is a trusted source for up-to-date information about
the constantly shifting national and state policy environment.
Advocacy could include reaching out to the school counselor at the
siblings’ schools to assess for their wellness, asking Esmerelda’s teachers to show extra consideration in their work with her, initiating antidiscrimination programs in the school as a whole, convening a professional
development workshop for teachers and school administrators to learn
about relevant state immigration law, or identifying bilingual community
mental health providers who would work on a sliding scale or accept pro
bono clients. Certainly, counselors working in states with restrictive immigration laws and policies need to be aware of those statutes in order to
practice within both ethical and legal boundaries. In some cases, counselors may need to make preemptive statements to clients about their duty
to report legal status should it be disclosed during a session so that clients
are informed prior to starting therapeutic work.
=I-_
Questions for Further Reflection
1. If you were the counselor, which level of response would be most
comfortable for you, and which would be most congruent with your
own ethical stance?
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2. How can counselors ensure they are practicing in a multiculturally
competent manner, especially if their clients are culturally dissimilar
to them?
3. What are the risks to counselors and their clients when there are
legal as well as ethical components to a dilemma?
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Chapter 3
Confidentiality
Barbara Herlihy and Gerald Corey
Counselors believe that confidentiality is essential to the counseling relationship. For genuine therapeutic work to occur, clients need to feel free to
explore their fears, hopes, fantasies, hurts, and other intimate and private
aspects of their lives. They need to know that their counselor is trustworthy and will treat their revelations with respect. The ACA Code of Ethics
(American Counseling Association [ACA], 2014) describes this obligation
to trustworthiness: “Trust is the cornerstone of the counseling relationship, and counselors have the responsibility to respect and safeguard the
client’s right to privacy and confidentiality” (Section A: Introduction).
Counselors are committed to earning this trust by creating a collaborative
partnership, establishing and maintaining appropriate boundaries, and
respecting the confidentiality and privacy of their clients.
Confidentiality is both one of the most basic of our ethical obligations
and, at the same time, one of the most problematic. Professional counselors increasingly confront confidentiality issues created by complex legal
requirements, developing technologies, health care service delivery systems (such as health maintenance organizations and preferred provider
networks), and a culture that places greater and greater emphasis on the
rights of service recipients. Confidentiality considerations arise in many of
the case studies presented throughout Part III; this reflects the frequency
with which counselors confront ethical dilemmas related to confidentiality.
An entire section (Section B) of the Code of Ethics is devoted to confidentiality and privacy. Standard B.1.a. states that counselors must be aware
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of and sensitive to the “cultural meanings of confidentiality and privacy.”
It is important to remember that not all clients share a Western, individualist notion of personal privacy. Some clients may want confidential
information shared with members of their family or community. Counselors should discuss with clients, at the outset of the relationship, when,
what, how, and with whom information can be shared so that any cultural
differences can be discovered and procedures can be adjusted.
The Code of Ethics states that “counselors disclose information only with
appropriate consent or with sound legal or ethical justification” (Standard
B.1.c.). Some counselors have taken their confidentiality obligation so
literally that they believe they should maintain a client’s confidentiality
even when the client asks them to share information with others. It is important to remember that confidentiality belongs to the client, not to the
counselor, and may be waived only by the client (or the client’s authorized
representative).
The counselor’s role as an advocate for clients has implications for confidentiality: Counselors are ethically obligated to advocate for their clients
by working to remove “potential barriers and obstacles that inhibit access
and/or the growth and development of clients” (Standard A.7.a.). The
standard that follows reminds counselors that they must “obtain client
consent prior to engaging in advocacy efforts on behalf of an identifiable
client to improve the provision of services and to work toward removal
of systemic barriers or obstacles that inhibit client access, growth, and development” (Standard A.7.b.). Ethical dilemmas can emerge when clients
are unable or unwilling to give consent for the counselor to advocate on
their behalf, as was seen in Chapter 2 in Case Study 4 on working with an
immigrant family.
Exceptions to Confidentiality
The exceptions and limitations to confidentiality need to be discussed
with clients when counseling is initiated and throughout the relationship
as needed (Standard B.1.d.). Counselors have an obligation to tell clients
that what they reveal in the counseling relationship will be kept confidential, except in certain circumstances. Confidentiality is not absolute, and other
obligations may override the pledge. Some exceptional circumstances
include sharing information to provide the best possible services, to protect someone in danger, when counseling groups or families, when counseling minors, and to obey court orders. Conscientious counselors must
constantly navigate through a complicated array of exceptions, some legal
and others ethical. It is important for counselors to understand the difference between confidentiality, which is an ethical obligation, and privileged
communication, which is a legal concept that protects clients from having
their confidential communications revealed in court without their permission. Remley and Herlihy (2014) state that there are at least 15 exceptions
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to confidentiality and privileged communication. They underscore the
importance of consultation and documentation whenever counselors are
in doubt about their obligations regarding confidentiality or privileged
communication.
Sharing Information to Improve Services to Clients
Sometimes it is permissible to share information with others in the interest
of providing the best possible services to clients. Here are some situations
in which confidential information may be shared:
•
•
•
•
•
Clerical or other assistants may handle confidential information.
A counselor may consult with experts or peers.
A counselor may be working under supervision.
Other professionals may be involved in coordinating client care.
Other mental health professionals may request information, and the
client may give consent to share.
Clerical assistants and other employees or subordinates of the counselor
may handle confidential client information, and there is no ethical problem in their doing so. However, counselors need to be aware that they
are responsible for any breach of confidentiality by someone who assists
them. This speaks to the importance of training subordinates about confidentiality and carefully monitoring office procedures.
Counselors are certainly encouraged to consult with colleagues or
experts when they have questions or concerns about their work with a
client. If possible, consultation should be managed without revealing the
identity of the client, and the client should be informed beforehand of the
counselor’s intention to seek consultation.
Supervision raises a different circumstance, one in which the client’s
identity cannot be concealed. The supervisor needs to have access to client
records, may observe an actual counseling session through a one-way mirror,
or may review audio- or videotapes of sessions. Again, though, the purpose is
to ensure quality service, and the ethical obligation is to inform the client fully
that supervision is taking place. Counselor interns who are working under
supervision need to be aware that limitations to confidentiality exist in the
relationship between supervisee and supervisor as well. The supervisor has
an ethical obligation to protect the clients of the supervisee by serving as a
gatekeeper to the profession. When this obligation is not made clear, problems can arise in the supervisory relationship; this circumstance is depicted in
Case Study 6 (A Supervisee Feels Betrayed) at the end of this chaper.
In inpatient settings, treatment teams routinely work together in providing services to clients. In these instances, the benefits of coordinating
the efforts of various professionals are obvious, but clients have a right to
be informed of what is being shared, with whom, and for what purposes.
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Finally, confidential information may be shared with other helping
professionals who are not members of a treatment team when the client
requests it or gives permission. This often occurs when a client (or counselor) moves to a different location and records are sent to a new therapist.
All of these exceptions are ethically acceptable. It is important to
remember that it is the counselor’s obligation to ensure that clerical
assistants or other subordinates, supervisors, students, and consultants
maintain the confidentiality and privacy of information shared with them
(ACA, 2014, Standard B.3.a.). In addition, Standard B.3.b. reminds counselors that when interdisciplinary teams are involved in treatment, “the
client will be informed of the team’s existence and composition, information being shared, and the purposes of sharing such information.”
Duty to Protect Clients or Others
Sometimes it is permissible to breach confidentiality to protect someone
who is in danger. Counselors who suspect abuse or neglect of a child, an
older person, a resident of an institution, or others who have limited ability to care for themselves must break confidentiality to help that person. In
addition, when the client’s condition poses a clear and imminent danger
to self or others, the counselor is also required to act to prevent harm.
Some people are dependent on others to intervene on their behalf because they are unable to protect themselves from harm because of their
youth or diminished capacity. For this reason, both federal and state laws
mandate reporting suspected child abuse or neglect, and statutes often
include a requirement to protect others who may have diminished capacity to care for themselves, such as the frail elderly or developmentally
disabled. This reporting obligation is clear and leaves little room for judgment calls by counselors. At the same time, determining whether or not
certain behaviors (such as some methods of disciplining a child) constitute “abuse” calls for clinical judgment on the part of the counselor. Case
Study 5 (The Slap—How to Best Help Hope) illustrates how these kinds
of situations can create difficult ethical and legal dilemmas for counselors.
Confidentiality “does not apply when disclosure is required to protect
clients or identified others from serious and foreseeable harm or when legal
requirements demand that confidential information must be revealed”
(Standard B.2.a.). A legal duty to warn and protect an identifiable or foreseeable victim may exist when a client threatens violence toward another
person or persons. This duty, which arose out of the Tarasoff v. Regents of
the University of California (1974) case in California, has created considerable consternation among helping professionals. The Tarasoff precedent
has been applied in some states, but there is variation on several dimensions, such as whether a counselor may warn or must warn, to whom a
warning should be given, and under what circumstances. As counselors,
we must disclose when legal requirements demand it, and it is essential
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that we consult with other professionals when we are uncertain. Counselors must be familiar with their state laws regarding a duty to warn and
should not hesitate to consult with an attorney as well as with experts
when they are in doubt. As a matter of practice, counselors should document any consultations and the actions they took (or did not take) based
on these consultations.
A duty to warn also may exist when a client is suicidal and poses a
danger to self. Counselors struggle with the demands of deciding when
to take a client’s threats or hints seriously enough to report the condition.
A difficult and sensitive issue is whether counselors should breach confidentiality when working with terminally ill clients who are considering
hastening their own death. Ethical issues in working with clients who may
be suicidal and in end-of-life decisions are further addressed in Chapter 8.
Mental health professionals have questioned whether an ethical duty
to warn may exist when a client is HIV positive or has AIDS and may be
putting others at risk. The 2014 ACA Code of Ethics (ACA, 2014) contains a
revised standard that addresses this matter:
When clients disclose that they have a disease commonly known to be both
communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if the parties are known to be
at serious and foreseeable risk of contracting the disease. Prior to making a
disclosure, counselors assess the intent of clients to inform the third parties
about their disease or to engage in any behaviors that may be harmful to an
identifiable third party. Counselors adhere to relevant state laws concerning
disclosure about disease status. (Standard B.2.c.)
Note that counselors should not take action until they have assessed
the client’s intent to inform endangered parties or to engage in behaviors
that may be harmful to others. It is vital that counselors know their state
laws regarding reporting around this issue.
Situations in Which Confidentiality Cannot Be Guaranteed
In some situations, counselors must clarify that confidentiality cannot be
guaranteed. These circumstances include when counseling couples, families, and groups, or whenever there are more than two people in the room.
Also, confidentiality cannot be guaranteed when the client is a minor.
When clients are minor children, their parents or guardians may have
rights to certain information. Counselors are ethically obliged to respect
the privacy of minor clients and maintain confidentiality, yet this obligation may be in conflict with laws regarding parental rights to be informed
about the progress of treatment and to decide what is in the best interests of their children. The American School Counselor Association (2010)
guidelines state that school counselors “recognize their primary obligation
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for confidentiality is to the student but balance that obligation with an
understanding of the parents’/guardians’ legal and inherent rights to be
the guiding voice in their children’s lives” (A.2.d.). Counselors have an
ethical obligation to safeguard the confidentiality of minors to the extent
that it is possible. Although counselors may be required to provide certain
information to parents, they need to do so in a manner that minimizes
intrusion into the child’s or adolescent’s privacy and in a way that demonstrates respect for the minor client. At times, the counseling process can
be enhanced by including parents or guardians. Counselors are advised
to strive to establish collaborative relationships with parents or guardians
(B.5.b.). (For more on confidentiality with minors, see Chapter 6, “Counseling Minor Clients.”)
Confidentiality takes on a special meaning in group counseling. The
legal concept of privileged communication generally does not apply in
a group setting, unless there has been a statutory exception. Therefore,
counselors are responsible for informing members of the limits of confidentiality within the group setting. The ACA Code of Ethics (ACA, 2014)
provides some guidelines for handling the issue of confidentiality in
groups: “In group work, counselors clearly explain the importance and
parameters of confidentiality for the specific group” (Standard B.4.a.). Although counselors are expected to stress the importance of confidentiality
and set a norm, they also must inform members about its limits. Members
need to understand that the group leader cannot guarantee confidentiality. Leaders can pledge confidentiality on their own part but cannot guarantee the behavior of group members. Also, if members pose a danger
to themselves or to others, the counselor would be ethically and legally
obliged to breach confidentiality.
Counselors who work with couples and families also encounter some
unique confidentiality dilemmas. The ACA Code of Ethics Standard B.4.b.
states, “In couples and family counseling, counselors clearly define who is
considered ‘the client’ and discuss expectations and limitations of confidentiality. Counselors seek agreement and document in writing such agreement
among all involved parties regarding the confidentiality of information.”
Standard B.4.b. of the Code also advises that, unless an agreement has been
made to the contrary, “the couple or family is considered to be the client.”
This statement reflects the systems perspective taken by most couples and
family counselors.
The challenges to confidentiality increase exponentially, say Kleist and Bitter (2014), when practitioners work with multiple people in one room. They
add that ethical issues regarding confidentiality become more complex and
extremely difficult in the practice of family counseling. Some of these ethical concerns involve conceptualizing the client(s) served, providing informed
consent, and handling relational matters in an individual context.
Counselors have differing perspectives on the role of confidentiality when working with couples or families. One view is that counselors
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should not divulge in a family session any information given to them by
individuals in private sessions. In counseling couples, some practitioners
may see each spouse for individual sessions, and in this case, information given to them by one partner is kept confidential. Other practitioners
refuse to see any member of the family separately, claiming that doing so
fosters unproductive alliances and promotes the keeping of secrets. Part
of informing couples or family members from the beginning of the professional relationship involves clarifying the limits of confidentiality. This
often involves addressing the problem of secrets. Many therapists maintain that a “no secrets” policy is basic to effective therapy. They explain to
clients why such a policy is necessary, both verbally and in writing. The
main reason for this policy is to clearly inform the participants that the
counselor’s primary obligation is to appropriately and effectively treat the
couple or the family unit. The participants need to know that this policy is
designed to prevent a conflict from arising between an individual family
member and the unit being treated. Some counselors tell family members
that they will exercise their own judgment about what to disclose from an
individual session in a couples or family session (G. Corey et al., 2015).
Court-Ordered Disclosures
Counselors, like all citizens, must obey orders given to them by a judge or an
official of the court—which creates an exception to our confidentiality pledge.
However, when counselors are required to release confidential or privileged
information without a client’s permission, they are expected to “obtain written, informed consent from the client or take steps to prohibit the disclosure
or have it limited as narrowly as possible because of potential harm to the client or counseling relationship” (ACA, 2014, Standard B.2.d.) and involve the
client in the disclosure decision-making process (Standard B.2.e.). When disclosure is required, “only essential information is revealed” (Standard B.2.e.).
Whether a counselor will be able successfully to request in court to withhold information may depend on the privileged communications provisions in the state where the counselor practices. Confidential or privileged
information should not be shared in a court until an attorney representing
the counselor has advised this course of action (Remley & Herlihy, 2014).
State laws vary considerably with respect to which mental health professionals’ communications are privileged and under what circumstances.
Counselors must know the laws in their own states.
Records
We need to remember that not only are clients’ communications confidential but so are their counseling records. Practitioners need to balance
client care with legal and ethical requirements for record keeping. Drogin,
Connell, Foote, and Sturm (2010) state that “records may serve as useful
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roadmaps for treatment, documenting the need for services, the treatment
plan, the course of treatment, and the process of termination” (p. 237).
Although keeping records is a basic part of a counselor’s practice, Remley and Herlihy (2014) contend that maintaining records should not consume too much time and energy. They add that it is wise for counselors
to document actions they take when they are carrying out ethical or legal
obligations, yet it is not appropriate for them to write excessive notes that
are basically self-protective, to the detriment of client care.
Standard B.6. sets forth several guidelines for maintaining, storing,
transferring, sharing, and disposing of records. This section reminds
counselors of their obligation to store records in a secure place and to exercise care when sending records to others by mail or through electronic
means. Despite counselors’ best efforts, it is possible for the confidentiality
of records to be inadvertently breached, particularly when counselors are
not aware of the confidentiality implications of new technologies.
Counselors should remember that clients have a legal right to obtain
copies of their records. Counselors should write their clinical case notes
carefully, always with the assumption that someone else will read them at
a later time (Remley & Herlihy, 2014).
Case Study 5
The Slap—How to Best Help Hope
Chris C. Lauer
Hope, a 28-year-old single African American woman, attends weekly
therapy sessions at the No Aids Task Force (NATF) in New Orleans. Hope
is HIV positive, in good health, and compliant with her medications for
HIV and depression. Hope has a 4-year-old daughter named Angela.
Hope proactively sought an HIV test 4 years ago in response to a public service campaign targeting the African American community. Shortly
after she learned of her status, she sought medical help at the taskforce
facility. Six months ago, during a medical appointment with her doctor,
Hope appeared anxious and possibly depressed. At the recommendation
of her doctor, Hope agreed to speak with one of the on-staff psychiatrists.
The psychiatrist administered the Beck Depression Inventory (Beck,
Steer, & Brown, 1996) and the Beck Anxiety Inventory (Beck & Steer, 1990);
Hope’s scores indicated both moderate depression and moderate anxiety.
After discussing these results with the psychiatrist, Hope decided that she
would begin taking an antidepressant and would see a counselor at NATF.
The psychiatrist prescribed an inexpensive antidepressant and asked to
see her in 3 weeks.
Presently, Hope is seeing Patrick, a counselor at NATF. She has been
attending counseling weekly for 5 months. Her presenting issue was that
she feels entrapped by her circumstances. Hope lives in a newer subsidized
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housing development in the central city called Hidden Oaks. She reports
that she does not feel connected to the neighborhood and its residents because her family, with the exception of her aunt, chose to remain in Chicago
after Hurricane Katrina. Before the storm, she socialized with her neighbors, sitting and chatting with them on their front porches, but Hidden
Oaks’ covenants do not allow people to congregate on their front porches.
Hope feels torn, unable to figure out how to care for her daughter, maintain
her $10 per hour job at a small hotel, and manage her health. Hope wants
more but sees little opportunity to improve her life given her modest income, lack of a high school diploma or GED, HIV status, and being a single
mom.
Hope loves her daughter, Angela, and appears to cater to her physical and
emotional needs as best she can. Hope also likes to have fun and has reported
“living it up,” drinking and smoking pot, on occasion, at her local bar.
Today is the third time in 5 months that Hope has brought Angela to
her counseling session because neither her aunt nor a neighbor could sit
with Angela. During the session Angela begins to whine. Hope stands up,
walks over to Angela, and slaps her. The slap isn’t overly hard, but neither
is it soft. Angela begins to cry.
Questions for Thought and Discussion
1. Does this slap constitute child abuse? Should Patrick, the counselor,
report the incident to his supervisor or to Child Protective Services?
What do you think would be the consequences to the counseling
relationship for Hope and for her daughter Angela if he reports the
incident? What might be the consequences for Patrick, and for Hope
and Angela, if he does not report?
2. If you were Hope’s counselor, what goals would you have in working
with her? Do you think it is important to consider issues in Hope’s
life that may have contributed to the incident in which she slapped
Angela? If so, how might you go about addressing these issues?
Analysis
Patrick may feel torn between what appear to be conflicting legal and
ethical obligations. He knows that counselors are legally required to report child abuse, yet from an ethical perspective, he may want to continue
working with Hope to help her relieve some of her stress and improve her
parenting skills. Hope appears to be a good, caring mother and the single
incident (the slap) provides only minimal evidence that she is putting her
child at risk. It is possible that he may not have a legal duty to report; the
legal definition of child abuse is determined by each state. Patrick will
need to research the law regarding what constitutes child abuse in the
state of Louisiana. If the law does not provide a clear definition, Patrick
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will need to rely on his clinical judgment. He might consider reporting
the incident to his supervisor but not reporting the incident to Child Protective Services at this time. He should document his actions to manage
potential legal liability.
If Patrick takes a social justice perspective to resolving his dilemma, his
focus will be on the best interests of the family. He will need to consider the
possible repercussions to both Hope and Angela if he were to report. Given
staffing and budgets of agencies such as the Office of Child Services, it is
unlikely that slapping a child would be viewed with a sense of urgency,
and disrupting Hope and Angela’s life could destabilize Angela’s environment and result in negative, long-term consequences for the child.
Whether the slap constituted child abuse is subjective and dependent
on the perspective of the counselor. Patrick needs to reflect on his personal values regarding child rearing and discipline and on how his own
upbringing and his experiences of privilege may be affecting his perceptions of the problem. He would be justified in being concerned that Hope’s
reaction was an immediate, first response. A question he might ask himself
is, “If Hope will slap her daughter in front of a mental health professional,
how might she be disciplining Angela in the privacy of their own home?”
It would have been advisable for Patrick to have conducted an assessment
immediately after the incident, perhaps saying “I noticed how you just interacted with your daughter” to initiate a discussion. Patrick’s goals in the
assessment should be to better understand Hope’s coping skills and the
frequency of behaviors like the slap. Assuming that Hope would like to
change, she and Patrick can develop longer term goals such as identifying
better coping skills and more appropriate parenting skills.
Patrick’s response to the incident needs to be culturally sensitive, not
judging Hope’s behavior and not allowing his own belief system and
attitudes to intrude into the counseling process. Patrick should strive to
understand the circumstances, culture, and parenting beliefs that Hope
experienced within her own family and community. He can ask Hope how
she was raised and disciplined and whether she was slapped or spanked.
Research shows that Black children are more likely to be spanked than
their non-Black peers (Zolotor, Theodore, Runyan, Chang, & Laskey,
2011). Patrick should not assume that Hope views her actions toward
Angela as abusive.
Many opportunities are available to Patrick as he works to assist Hope
in adopting more effective coping and parenting skills. These opportunities lie not only at the individual therapeutic level but also as an advocate
by helping Angela identify resources such as child care to address and
relieve some of the day-to-day parental challenges she faces as a single
mom with limited resources.
It is in the best interest of the child and the family to address this issue
in the counseling relationship rather than through the law, yet catering
to the needs of Angela and Hope must be balanced with managing the
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risk and reputation of the counselor and the agency. Documentation, accurate case notes, and consultation are imperative to protect Patrick and
the agency.
Questions for Further Reflection
1. “Intersectionality” describes the various ways in which social forces
interact to shape a person’s experience. How do you view the intersectionality of race, gender, and socioeconomic status as they relate
to Hope and her circumstances? What assumptions and biases do
you think you brought to your reading of the case study due to your
own race, gender, and socioeconomic status?
2. In the case description, it was stated that Hope likes to have fun
and has reported “living it up,” drinking and smoking pot at her
local watering hole. Did this knowledge influence your assumptions
about Hope and her fitness as a mother?
3. Beyond helping Hope find child care, what are some other ways Patrick
could advocate for and with Angela?
Case Study 6
A Supervisee Feels Betrayed
Adria Shipp
Karen is a second-year student in her master’s counseling program. She is
enrolled in two academic courses and her practicum, which entails a field
placement. As a practicum student, she spends 5 to 10 hours per week at a
local counseling agency where she observes her site supervisor and counsels two to three clients per week. She meets with her university and site
supervisors on a weekly basis for an hour of individual supervision. Luellen, her university supervisor, is a part-time faculty member and adjunct
instructor in the master’s program.
One week, during a regularly scheduled supervision session with Luellen, Karen discloses that she is “struggling to keep her head above water”
while trying to balance the responsibilities of graduate school, her family
obligations, and her part-time job. Luellen asks her to say more about her
struggle. Karen explains that she works part time at a local coffee shop
during the evenings, and this is making it difficult for her to do a good job
on her school assignments. Lately, she has needed to pick up more shifts
at the coffee shop because her roommate moved out unexpectedly, leaving
Karen responsible for all of the bills. In addition, Karen’s mom was
recently diagnosed with breast cancer. Although treatment seems to be
going well and her mom has encouraged her not to worry and to “focus
on school and building a life,” Karen says she is distracted by her mother’s
illness. She worries that she is not spending enough time at home, which
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is 2 hours away from where she is living and attending grad school. Karen
reports that she tries to talk to her mom on a daily basis and has been
spending weekends at her parents’ house.
Karen and Luellen spend about half of their supervision hour discussing Karen’s situation and brainstorming possible solutions, such as Karen
approaching her adviser about the possibility of changing her enrollment
status from full time to part time, seeking individual counseling, or postponing her graduate studies until her mother’s health is more stable.
During the remainder of the supervision session, Karen and Luellen
discuss ways that Karen’s personal situation may be affecting her clients
at her practicum site. Karen reports being distracted to the point of sometimes “zoning out” during counseling sessions. She also mentions that her
site supervisor has observed that Karen’s appearance is occasionally disheveled, making comments like, “Did you forget to brush your hair this
morning?” At the end of the supervision meeting, Karen acknowledges
that external factors are having an impact on her work with clients.
The next week, the counselor education faculty members gather for their
student review and retention meeting. At this meeting, which is held once
each semester, decisions are made regarding students’ applications to enter or continue their field experiences. Karen’s application to proceed from
practicum to internship is among the stack to be reviewed. When Karen’s
application is brought forward, Luellen brings up the conversation she had
with Karen. Luellen expresses her concern that Karen may not be ready for
a full-time internship experience at this point, citing examples from their supervision meeting as reasons for her concern. The faculty decides to inform
Karen that her application to enroll in internship the next semester will not
be approved at this time because of concerns about her practicum performance. When Karen receives a letter from her adviser notifying her of this
decision, Karen feels betrayed by her supervisor and is angry that content
from their supervision session was shared without her permission.
Questions for Thought and Discussion
1. What can graduate students expect in terms of confidentiality in
their supervision sessions?
2. If you were Karen, how would you feel about your supervisor’s actions?
3. What factors do supervisors need to consider when deciding what
information should be shared with others (such as members of a
review and retention committee) who serve as gatekeepers to the
counseling profession?
Analysis
It is understandable that this practicum student would be upset when she
received the letter notifying her of the decision made by the faculty during their review and retention meeting. Karen may believe that she was
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behaving appropriately in disclosing her struggles to Luellen. Students
are encouraged to be open and genuine in all supervision. Supervisees are
expected to monitor themselves for signs of impairment and to notify their
supervisors “when such impairment is likely to harm a client or others”
(ACA, 2014, Standard F.5.b.). However, although Karen acknowledged
that she is distracted and sometimes “zones out” during sessions, it is not
clear that her performance has deteriorated to the point of impairment.
A question that arises in this case is whether Karen understood that supervision relationships differ from counseling relationships in that there
is no expectation of confidentiality in the supervisory relationship. Did
Luellen and Karen have a supervision contract? Such a contract would
have outlined supervisor qualifications, expectations during supervision,
the evaluation process, and potential actions the supervisor might take if
expectations are not met. Best practice would dictate that a supervision
contract be provided and be signed by the supervisor and supervisee at
the beginning of the supervisory relationship.
Luellen, in deciding to share her concerns about Karen during the review and retention meeting, may have been guided by her awareness
of several ethical responsibilities of supervisors. One of her primary
ethical obligations as a supervisor is to monitor the welfare of the clients
(Standard F.1.a.) who are being served by Karen. In her role as supervisor, she is functioning as a gatekeeper to the profession (Standard F.6.b.).
She decided that the information Karen had shared would be useful to
the faculty as they made a determination about whether or not Karen was
successfully completing her current program requirements. Yet the fact
that what was shared was personal information about Karen’s struggles
raises a second question: Did Luellen cross the boundary between supervision and counseling? Although the ACA Code of Ethics (ACA, 2104) is
clear in stating that “supervisors do not provide counseling services to
supervisees” (Standard F.6.c.), the Code also encourages supervisors to address interpersonal competencies of supervisees in terms of their impact
on clients and on professional functioning (Standard F.6.c.). It appears that
Luellen did redirect the supervision session after Karen self-disclosed her
personal situation, as they spent the second half of the session discussing
how Karen’s struggles might be affecting her clients at her practicum site.
She also explored with Karen some possible ways of addressing the problem, including the possibility that Karen might seek personal counseling.
For supervisors and counselor educators, fulfilling their gatekeeping
responsibilities can be one of the most unpleasant aspects of the work.
Yet supervisors and counseling programs have a responsibility to all future clients of the students whom they graduate from their programs. It
is imperative that supervisors pay close attention to any information they
receive about a student’s well-being and emotional state. This protects future clients, the university, and the integrity of the profession. In this case,
the decision not to approve Karen’s progress toward her internship may
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have been necessary, although it is unclear why Luellen did not inform
Karen of her decision to share information they had discussed in their
supervision session. Karen has a right to receive ongoing feedback about
her performance (Standard F.9.a.) and remedial assistance (Standard
F.9.b.) from her supervisor and the faculty in her program. Had Luellen
discussed her concerns and her intended actions with Karen, Karen might
not have felt betrayed.
Questions for Further Reflection
1. Why do you think it is important that the supervisory relationship not
entail the same level of confidentiality as the counseling relationship?
2. As a supervisee, what information would you want to have provided to you during the informed consent process?
3. When a supervisor has concerns about a supervisee’s competency,
what are some actions the supervisor can take that are in the best
interests of both the supervisee and the supervisee’s clients?
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Chapter 4
Competence
Gerald Corey and Barbara Herlihy
Trust is a key element in any discussion of competence because it defines
the context in which clients enter into a therapeutic relationship. Pope and
Vasquez (2011) aptly note that when clients seek professional assistance
they trust that the practitioner will be competent. Clients place themselves
in a vulnerable position, allowing their counselors to hear their most personal secrets and learn about their most private struggles. The trust that
clients bestow on counselors is a source of power that must not be abused;
clients need to be able to rely on their counselor’s competence as a helper.
The ACA Code of Ethics (American Counseling Association [ACA], 2014)
states that counselors have an ethical obligation to practice “only within
the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” (Standard C.2.a.). Cultural competence is a
vital aspect of this obligation, in that counselors are required to “gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent
to . . . working with a diverse client population” (Standard C.2.a.). Remley
and Herlihy (2014) discuss competence as an ethical and legal concept. They
point out that competence is not a simple either/or matter; rather, it is a
complex concept with many possible levels along a continuum. From an
ethical perspective, competence implies that counselors do no harm to clients.
Although counselors may not intend to harm their clients, incompetence
often is a contributing factor in causing harm. From a legal perspective,
counselors who are incompetent are vulnerable to malpractice suits.
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Counseling is a very broad profession, and counselors work with a
wide spectrum of clients and client concerns in very diverse settings that
require different skills and competencies. None of us can be competent
with all client populations and settings, in every aspect of potential practice, or with all skills and techniques (Barnett & Johnson, 2015). Appropriate education, training, and experience in working with children does not
qualify us to work with older adults; expertise in working with clients
who are experiencing mild and transitory adjustment disorders does not
qualify us to work with clients who suffer from chronic psychotic disorders; and competence in individual counseling does not qualify us to
conduct groups or work with families, as is discovered by the counselor
in Case Study 8 (Couples Counseling Gone Wrong). G. Corey et al. (2015)
emphasize that striving for competence is a lifelong endeavor. Rather than
thinking of competence as a goal that counselors eventually attain, competence is best viewed as an ongoing process. In short, competence at one
point in a career does not ensure competence at a later time. It is essential
for counselors to take active steps to develop and refine skills and to acquire new knowledge.
How can the boundaries of competence be determined and assessed?
Mental health professionals have long struggled with this question, and
their efforts have taken varied forms, including the development of standards for training, credentialing, continuing education, and new specialty
areas of practice, as well as self-monitoring. For counselors to determine
their level of competence, they must engage in an ongoing process of selfmonitoring, self-assessment, and self-reflection (Johnson, Barnett, Elman,
Forrest, & Kaslow, 2012). The ACA Code of Ethics (ACA, 2014) recommends
consultation (Standard C.2.e.) and peer supervision (Standard C.2.d.) as
means to evaluate one’s ongoing effectiveness as a counselor.
Obviously, training is a basic component in developing competence to
counsel. Although graduate students in counselor education programs
may be excited about the knowledge and skills they are learning, they must
avoid agreeing to counsel others until they are fully qualified to do so.
Key issues in training include determining who should be selected for
admission to counselor education programs and by what selection methods, what should be taught and by which methods, and what procedures
should be used to ensure that only competent counselors are graduated
from training programs. Ethical issues in training and supervision are
more fully addressed in Chapter 10, but one reality particularly germane
to the development of competence is that training institutions may vary
considerably in the quality of training provided. The Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2009)
is one organization that provides national standards for training counselors. CACREP is an independent body that accredits programs that have
undergone a rigorous review. Graduates of CACREP-accredited programs
can be reasonably assumed to possess certain competencies. However,
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Competence
many competent counselors are graduates of training programs that are
not CACREP accredited.
Credentials are presumed to be a tangible indicator of accomplishment
with implications for assessing the competence of the credential holder.
The state counselor licensure movement, which has been successful in all
50 states, has been significant in this respect. Licensure assures clients that
their counselors have completed minimal educational requirements, have
had supervised experience, and have successfully completed an examination or other form of screening. Licensure requirements vary from state to
state, however, and the possession of a license does not ensure that practitioners will competently do what their credential permits them to do.
Licensure laws typically require that professionals complete continuing education requirements to renew their licenses. Ongoing training and
continuing education, which are an ethical obligation, should be sought
throughout the duration of a counselor’s career. Counselors recognize
the need for continuing education to keep abreast of current information and developments, and this obligation is stated in the ACA Code of
Ethics (ACA, 2014): “Counselors maintain their competence in the skills
they use, are open to new procedures, and remain informed regarding
best practices for working with diverse populations” (Standard C.2.f.). As
with other means of assessing competence, there are limitations to what
continuing education requirements can accomplish. It is difficult to monitor the quality of continuing education offerings or their relevance to a
particular counselor’s needs. The number of clock hours obtained may
have little relation to how much the counselor has actually learned and
integrated into practice. The focus of continuing education should be on
maintaining competence rather than simply on accumulating the required
hours to maintain licensure (Johnson et al., 2012).
Without an agreed-upon definition of competence, it is difficult for
ethically conscientious counselors to determine exactly where their
boundaries of competence lie and to recognize when they are in danger
of exceeding them. In the absence of formal criteria for evaluating competence in specific practices or specializations, counselors must carefully
assess whether they should accept or continue to work with certain
clients or refer them. The ACA Code of Ethics (ACA, 2014) makes it clear
that consultation with other professionals in these situations is a prudent
and ethically appropriate measure (Standard C.2.e.). While learning skills
in new specialty areas, “counselors take steps to ensure the competence
of their work and protect others from possible harm” (Standard C.2.b.).
Working under supervision while stretching one’s boundaries of competence is perhaps the best way to prevent harm.
Chapter 2 emphasizes the importance of multicultural competence,
and we want to reemphasize that multicultural competence is essential
for counselors who practice in today’s diverse society. Although early versions of the ACA Code of Ethics did not address multicultural competence
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as an ethical obligation, the need for multicultural awareness, knowledge,
and skills is emphasized throughout the current Code. The counseling profession has reached consensus that counselors who provide services to
clients who are culturally different from them have an ethical duty to be
competent to work effectively with these clients.
Because competence is so difficult to define and assess, careful selfmonitoring may be the most effective method for counselors to ensure
that they are providing the highest quality of services. Counselors are
ethically obligated to “continually monitor their effectiveness as professionals and take steps to improve when necessary” (Standard C.2.d.). On
this point, Johnson and colleagues (2012) express doubts as to whether
a professional has either the capacity or the determination to accurately
assess his or her own competence across a lifetime of ever-changing job
demands, life stressors, personal problems, and declining abilities due to
aging. They recommend ongoing peer consultation and state that “periodic recertification of competence should become a requirement of licensure
renewal” (p. 566).
It is incumbent on each of us to strive to maintain self-awareness and
to be alert to any signs of burnout or impairment. Impaired professionals
are unable to effectively cope with stressful events, and they are unable to
competently perform their professional duties. Stebnicki (2008) coined the
term empathy fatigue, which shares some similarities with concepts of other
fatigue syndromes such as compassion fatigue, vicarious traumatization, and
burnout. Stebnicki believes that counselors who are psychologically present for their clients often pay the price of being profoundly affected by
clients’ problem-laden stories. The counselor in Case Study 7 (I Feel
Exhausted) seems to be paying just such a price. Counselors who experience empathy fatigue may be on a path toward professional burnout and
must engage in self-care to develop resilience in working with people at
intense levels of interpersonal functioning. Skovholt (2012) believes that
counselors need to achieve empathy balance, which involves the ability to
enter the client’s world without getting lost in that world. Whereas too little empathy results in the absence of caring, too much empathy may result
in counselors losing themselves in the stories of their clients. It is vital that
counselors recognize how their level of personal functioning influences
their ability to maintain their professional competence.
Counselors’ obligations to clients necessitate that they seek assistance
for their own problems that are interfering with their professional effectiveness and that, “if necessary, they limit, suspend, or terminate their
professional responsibilities until it is determined that they may safely
resume their work” (ACA, 2014, Standard C.2.g.). Counselors can take the
initiative to reach out to their colleagues as a source of support when they
are feeling stressed. The importance of maintaining a connectedness with
peers cannot be overemphasized in this regard. Peer consultation groups
can provide a source of support to counter the loneliness that is often
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Competence
associated with the work of the counselor, especially the private practitioner. Peers can help us see our blind spots, offer new perspectives on
ethical and practice issues, and provide us with opportunities to share
information about resources and effective therapeutic procedures.
We need to remind ourselves that self-care is not a luxury; rather, it is an
ethical mandate. If we do not practice self-care, eventually we will not have
the stamina required to be present with our clients. “Becoming and being a
resilient practitioner is about wellness. Our own wellness is necessary so we
can marshal the enormous energy necessary for the work with our clients”
(Skovholt, 2012, p. 140). Self-care is vital to optimal and effective functioning, and it is integrally related to being a competent practitioner.
The ultimate answer to maintaining competence most likely lies in our
ability to explore our own motives and relationships insightfully and to
make self-care an integral part of our lifestyle. Retaining our vitality, both
personally and professionally, is critical to our ability to function ethically
and competently. Development of competence is an ongoing process that
is never really completed.
Case Study 7
I Feel Exhausted
Isabel A. Thompson
Elaine, age 25, was delighted when she landed a counseling position at a
community mental health center right after she graduated, even though it
meant moving to another state. She is now in her first year of postmaster’s
counseling practice and is working toward independent licensure. Her
professional goal after becoming licensed is to gain a leadership role to
help create positive change in the community. She left her friends behind
when she moved, and many of her day-to-day contacts are at work.
Elaine’s large caseload includes many individuals who are experiencing
multiple life stressors. When she first moved to the new state and started
her job, Elaine felt energized with the thrill of moving and working with
new clients. After a few weeks, things changed. She tells an old friend over
the phone, “At first I was starting something new and was excited to make
a difference, but now it seems as if there is a cloud hanging over me, and
I feel exhausted most of the time.” Many of her clients struggle to meet
their basic needs, and their problems seem overwhelming. Elaine is not
yet familiar with the community’s resources, and she has trouble asking
her coworkers for support.
Elaine is often so tired that she spends most of her free time watching TV. She used to eat a balanced diet, but now she frequently eats fast
food and orders meals to be delivered. She used to exercise regularly, but
now she does not have the time or energy. Since she moved, Elaine feels
less connected to her old friends, and sometimes she doesn’t pick up the
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Issues and Case Studies
phone when they call. Moreover, she does not ask her family for support,
as she feels they are overwhelmed with her mother’s chronic illness. Realizing that she felt lonely, she recently adopted a Yorkshire terrier and
enjoys spending time with her pet after work.
Elaine sometimes wonders whether she has what it takes to be a good
counselor. She believes that her greatest asset is that she truly cares about
people. She decides to refocus at work and discover local resources to help
her clients, but she still struggles when she gets home from work. She
thinks about her clients’ problems, has trouble sleeping, and occasionally
but with increasing frequency has a drink to help her get to sleep.
Lately, some client issues have been particularly challenging for Elaine.
One of her clients is a young woman around her own age, who shared how
she was abused during childhood. In session, Elaine believed she handled
the situation well, even though it reminded her of personal trauma. The
client’s story stuck in her mind. She tells her clinical supervisor that “it
kept replaying over and over again in my mind, almost as if it had happened to me.” More and more frequently, client issues distress Elaine. She
adds, “It feels like there are so many people suffering in the world, and
everything I try to do is only a drop in the bucket.” Elaine meets with her
clinical supervisor weekly, and her supervisor notes that Elaine has been
guarded and has not self-disclosed as frequently or in as much depth as
she did when she began supervision.
Questions for Thought and Discussion
1. What concerns do you have for Elaine? What concerns do you have
for her clients?
2. What strengths does Elaine demonstrate?
3. How could Elaine use clinical supervision more effectively to help
her cope with work demands?
4. Is Elaine’s professional competence affected by the stressors she is
experiencing?
Analysis
Counselors have an ethical responsibility to monitor their level of wellbeing to prevent impairment (ACA, 2014, Standard C.2.g.). Elaine is monitoring herself and trying to be effective in her role as a counselor. However,
she is experiencing individual and contextual stressors, including a large
client caseload and a perceived lack of resources Elaine is replaying client
traumatic material and having difficulty sleeping, which could be signs of
compassion fatigue. These symptoms could affect her professional functioning if left unaddressed.
Some of Elaine’s attempts to cope with work stress are ineffective,
and she is neglecting her own self-care. Because Elaine is altruistically
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motivated, exploring the connection between self-care and effective care
for others could be transformative. From a person-centered perspective,
Elaine would be in greater congruence if she applied to herself the same
level of care and compassion she demonstrates for her clients.
Elaine’s general feeling of being worn down could be indicative of
burnout. Elaine does not feel she is supported by her coworkers, which is
unfortunate because this type of support may help protect counselors from
emotional exhaustion (Ducharme, Knudsen, & Roman, 2008). Moreover,
she has a large caseload and has experienced a lack of resources, factors
that may increase her risk of burnout (Lawson 2007; Maslach, 2003). Taking
proactive steps to address some of these factors might be helpful in reducing Elaine’s risk of burnout.
Elaine demonstrates commitment to her profession by attempting
to make positive changes to improve her work performance. However,
instead of sharing her struggles with her supervisor, she is trying to resolve
things on her own. In addition, client issues seem to have triggered her
previous trauma.
Elaine may need to take steps to effectively address her work stress
and the potential unhealthy consequences of this stress. If she continues
down her current path, she is at risk of becoming impaired and will need
to “limit, suspend, or terminate [her] professional responsibilities until
it is determined that [she] may safely resume [her] work” (ACA, 2014,
Standard C.2.g.). Such measures are indicated when there is a threat of
harm to clients.
Questions for Further Reflection
1. What are some proactive steps Elaine could take to address personal
and contextual stressors?
2. If you were Elaine’s colleague at work, and you realized she was
experiencing difficulties that were affecting her performance, what
would you do?
3. Do you have concerns for Elaine’s clients? Should Elaine limit, suspend, or terminate services to clients? Why or why not?
4. How would you distinguish among stress, compassion fatigue,
burnout, and impairment?
Case Study 8
Couples Counseling Gone Wrong
Jennifer M. Johnson
Alayah is a licensed professional counselor and national certified counselor
who graduated with a specialization in clinical mental health counseling.
She has experience working in a variety of settings, including inpatient
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residential facilities and nonprofit agencies. Over the past year, Alayah
has been building a private practice and has received multiple referrals
from clients based on advertising through social media, local newspapers,
churches, and nonprofits. Many of her clients are seeking assistance with
depression, self-esteem issues, and work–life balance, and Alayah feels
confident in utilizing her theoretical orientation to assist these clients.
She receives a phone call from a couple. They are seeking marital counseling, which is unchartered territory for her. The couple was referred
by their friend, who was a previous client of Alayah’s. The friend spoke
highly of Alayah, and the couple is desperate for help. During the phone
consultation, the wife mentions that normally they would not consider
counseling, but she and her husband are open to it because of the friend’s
recommendation. As Alayah is starting a new practice, she does not want
to turn away any potential clients, so she schedules an appointment with
the couple.
To prepare, Alayah reviews material from a workshop she attended
on the basics of couples therapy. She comes to the session prepared with
assessments and other standard forms for the clients to complete. The session starts off well with Alayah discussing informed consent, confidentiality,
and her role as the therapist and obtaining a history of the couples’ relationship. However, midway through the session, the discussion goes downhill.
The couple become irate and very argumentative as they talk about the
wife’s demanding job and the husband’s infidelity. Alayah feels lost; it
seems to her that she is acting more like a “referee” at a shouting contest
than a counselor. Eventually, however, she is able to redirect the couple,
and she ends the session by scheduling an appointment for the upcoming
week. As they are rescheduling, both the husband and wife state that they
are grateful for the session and felt “heard for the first time in a long while.”
Despite this positive feedback, Alayah feels conflicted about her ability and
competence working with the couple.
That afternoon, after much reflection, Alayah calls Rose, her former
clinical supervisor and mentor, for guidance. They agree to meet the
following day. During their meeting, Alayah states that she felt “like a
fish out of water” with the couple she saw yesterday. She acknowledges
that she has expertise in clinical mental health settings but that she
feels “inadequate” with this new client population. She adds that she
has always had an interest in working with couples and wants to learn
effective techniques. Rose encourages Alayah to elaborate, and Alayah
mentions that she “thoroughly enjoyed a graduate course on couples
therapy,” but she knows she needs more information and tools to be successful. Rose and Alayah also discuss Alayah’s motivation behind agreeing to meet with the couple. Alayah admits she felt an “obligation” to
help the couple because they were referred by a previous client and were
open to seeking therapy because of the friend. Alayah acknowledges
that her decision was also selfish because she wants to build her client
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base. She shares that, because she is a licensed professional counselor,
she feels ashamed that she might need to refer a client when she “should
know how to work with the couple effectively.” Rose processes these
expectations with Alayah and remarks that professional counselors are
constantly learning. Rose also normalizes Alayah’s experience by selfdisclosing her own ongoing areas of growth.
After speaking with Rose, Alayah feels relieved and optimistic. However, she is still faced with deciding whether to continue working with
the couple or refer them to another clinician. After further reflection and
another conversation with Rose, Alayah decides to (a) continue working
with the couple under the clinical supervision of Rose (who is a licensed
professional counselor and marriage and family therapist), (b) not accept
any new couples clients at the moment, and (c) audit a graduate-level
course on marriage and family counseling. Rose and Alayah schedule
ongoing supervision. Rose offers to let Alayah borrow some reading
materials related to couples therapy.
Questions for Thought and Discussion
1. If you were the counselor in this scenario, would you continue to see
the couple or refer them to another clinician? Why or why not?
2. What issues could arise when working with the couple that Alayah
may not anticipate?
3. Aside from the steps Alayah has already identified, can you think of
additional ways she might increase her competency level in couples
therapy?
4. Because Alayah questions her competence in working with couples,
is it ethical for her to continue seeing this couple while she takes
steps to enhance her competence, including getting supervision?
Analysis
Situations like the one encountered by Alayah, in which counselors see
clients for issues with which the counselors have limited experience, are
common within the counseling profession. When counselors are faced
with the decision of whether to accept or continue to work with a client
whose issues may stretch their boundaries of competence, the client’s
welfare, or whether the client will be harmed in the therapeutic relationship, should be the first consideration (ACA, 2014, Standard A.4.a.). In this
case, Alayah was self-reflective of her strengths and areas of growth. She
and Rose, during their consultation, determined to the best of their ability
that the couple would not be at risk for harm by continuing counseling
with Alayah under Rose’s supervision. Alayah was aware that she needed
additional supervision, despite being a licensed professional counselor,
to be effective in working with the couple and to practice ethically. This
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highlights the importance of having an established mentor and/or clinical
supervisor when counseling difficult or new client populations. Alayah
acted in accordance with her ethical standards in recognizing her boundaries of competence (Standard C.2.a.) and in seeking supervision and
additional training (Standard C.2.b.).
Although Alayah did not misrepresent her credentials, it is worth noting that clinicians in private practice need to be mindful of how they advertise their credentials (Standard C.3.a.). Practicing counselors are advised
to review their profiles in counseling directories and specify populations
and presenting issues that they are competent to treat. When accepting
or continuing to work with a client would exceed the counselor’s boundaries of competence, the counselor should refer the client. “Counselors
are knowledgeable about culturally and clinically appropriate referral
resources and suggest these alternatives” (Standard A.11.a.). Networking
with other counselors can provide resources for referrals and support and
consultation when necessary.
Questions for Further Reflection
1. How can counselors determine whether they are competent to work
with a client or client population with which they have limited or no
experience?
2. If Alayah had worked in a mental health agency rather than in private practice, would the dilemma and its resolution have been any
different?
3. If you were Alayah’s supervisor, would you encourage her to refer
this couple because she needs to acquire more knowledge and skills
in this area?
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Chapter 5
Managing
Value Conflicts
Barbara Herlihy and Gerald Corey
Counseling is defined in the ACA Code of Ethics (American Counseling
Association [ACA], 2014) as “a professional relationship that empowers
diverse individuals, families, and groups to accomplish mental health,
wellness, education, and career goals” (Preamble). In exploring the role of
values in counseling, key terms in this definition are professional, empower,
and goals. Counseling is a professional relationship that differs from other
close relationships, such as friendships. Friends provide each other with
mutual support, whereas the counseling process is focused on providing
support and help to one party in the relationship—the client. The purpose
of counseling is to empower clients to determine and work to achieve their
own goals (Dobmeier, Reiner, Casquarelli, & Fallon, 2013).
Counselors rarely question this definition when they are working with
clients whose goals and values are aligned with values that the counselors
also espouse. Sometimes, however, clients think, believe, and behave in
ways that run counter to the personal values of their counselors. In these
instances, counselors may struggle with how to manage the conflicts between their values and the client’s values. Counselors are not expected to
agree with the values of their clients, but they must respect the right of
clients to hold different values (G. Corey et al., 2015).
The Code states that “counselors are aware of—and avoid imposing—
their own values, attitudes, beliefs, and behaviors” (ACA, 2014, Standard
A.4.b.). Although this ethical standard may seem simple and straightforward, it can be difficult—if not impossible—to uphold in practice (Remley &
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Herlihy, 2014). Levitt and Moorhead (2013) contend that values inevitably
enter the counseling relationship and can significantly affect many facets
of the counseling process. Counselors are expected to be able to set aside
their personal beliefs and values when working with a diverse range of
clients. It takes effort and vigilance for counselors to remain aware of how
their values and beliefs may be subtly entering into a counseling session.
As Francis and Dugger (2014) point out, counselors can communicate their
personal values in many indirect ways: through nonverbal responses, by
focusing on and responding to some elements of a client’s story while
ignoring others, and through the suggestions they make and the interventions they select. Because of the power differential that exists in the
counseling relationship, clients are in a vulnerable position, and “even the
most subtle communication of personal values has a likelihood of swaying a client to act in accordance with the counselor’s values rather than
facilitating the client’s exploration of his or her own values”(p. 132). Some
research has found that clients tend to change in ways that align with their
counselors’ values and adopt the values of their counselors (Zinnbauer &
Pargament, 2000).
Although the values of both the counselor and the client are inevitably
present in the counseling session, counselors will be less likely to impose
their values, even inadvertently, if they are keenly aware of their values,
beliefs, biases, and assumptions. It is particularly important that counselors
clarify how their own values and beliefs might affect their therapeutic work
with clients who present with value-laden issues. When this happens, counselors must set their personal values aside during the counseling session, a
process Kocet and Herlihy (2014) call “ethical bracketing.”
When conflicts arise between the strong, deeply held values and beliefs of
some counselors and the values and beliefs of certain clients, counselors may
object to working with these clients and may want to refer them to another
counselor. However, referring a client because of a value conflict constitutes
a discriminatory referral, which is unethical. Value conflicts have been at the
heart of a series of court cases that have generated controversy in recent years.
The first court case that captured the attention of the counseling profession was Bruff v. North Mississippi Health Services (2001). A similar case,
Walden v. Centers for Disease Control and Prevention (2010), occurred about a
decade later. These cases are briefly summarized here (for a more detailed
discussion, see Herlihy, Hermann, & Greden, 2014). The plaintiff in each
case was an employment assistance counselor who referred a lesbian client
who had asked for assistance with improving her relationship with her partner. Both Bruff and Walden considered homosexuality to be immoral based
on their religious beliefs. Although Bruff’s and Walden’s employers tried to
accommodate their religious beliefs, both counselors were eventually terminated from employment. Each sued, claiming religious discrimination
against them. The courts in each case upheld the termination of employment but based their decisions on the finding that the counselors had been
“inflexible” in responding to their employers’ attempts to accommodate
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their religious beliefs. These cases raised, but did not resolve, the question
of whether counselors can use their religious beliefs as the basis for refusing
to provide affirmative counseling to nonheterosexual clients.
Two other widely publicized court cases involved master’s-level school
counseling students who were dismissed from their training programs
(Keeton v. Anderson-Wiley, 2010; Ward v. Wilbanks, 2010, 2012). These cases
presented challenges to the ACA Code of Ethics (ACA, 2014). In the first
case, Jennifer Keeton, a counseling student at Augusta State University
(ASU), stated that she “condemned homosexuality” based on her interpretation of the Bible’s teachings and that she approved of reparative or
conversion therapy. The second case involved Julea Ward, who was a
student enrolled in her counseling practicum at Eastern Michigan University (EMU) when she was assigned a client whose records indicated
that she had previously sought counseling to discuss same-sex relationship issues. Ward informed her practicum supervisor that her religious
beliefs prevented her from providing “gay-affirmative” counseling
(Ward v. Wilbanks, 2010, p. 34), and the client was reassigned to another
counselor. The counseling faculties at both ASU and EMU offered to assist the students in learning to set aside their own belief systems while
counseling diverse clients, but neither student completed a remediation
plan. Both Keeton and Ward eventually were dismissed from their degree
programs, and they brought suit against the faculties and the universities
appealing their dismissals. The legal process has been concluded in both
cases: The Court in Keeton upheld the decision of the faculty at ASU, and
the Ward case was settled to the mutual satisfaction of the parties prior to
trial in 2012 (Dugger & Francis, 2014). (If you are interested in learning
about these cases in more detail, see the special section of the Journal of
Counseling & Development, April 2014). All of these cases have illuminated
an important question: What is the ethically appropriate way to resolve
conflicts between personal values and professional ethical standards?
As we discuss in the Introduction to the Casebook, the taskforce that created the ACA Code of Ethics (ACA, 2014) was aware of the questions that
had arisen because of the court cases. As a result, revisions to the Code
provide direction and clarification regarding values-related issues. The
professional values statement in the Preamble spells out the professional
values of enhancing human development, honoring diversity, promoting
social justice, safeguarding the integrity of the counseling relationship,
and practicing with competence and ethical diligence. These values are
presented as a way to strengthen the foundation for other sections of the
Code that deal with values and related issues of referrals, competence,
and discrimination. To add more guidance to the standard that counselors must be “aware of—and avoid imposing—their own values, attitudes,
beliefs, and behaviors” (Standard A.4.b.), a new standard was added
that specifically prohibits making referrals “based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors” (Standard
A.11.b.). Counselors are advised to “seek training in areas in which they
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are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory
in nature” (Standard A.11.b.).
In previous versions of the Code, it was not clear that referrals must be
based on lack of competence rather than value conflicts. Not only must
counselors practice within the boundaries of their competence (see Chapter
4), they must develop multicultural competency in working with a diverse
client population (Standard C.2.a.). Multicultural competence is addressed
in an additional standard that notes that “counselors do not condone or
engage in discrimination . . . based on age, culture, disability, ethnicity, race,
religion/spirituality, gender, gender identity, sexual orientation, marital/
partnership status, language preference, socioeconomic status, immigration
status, or any basis proscribed by law” (Standard C.5.). This last standard
serves as a reminder that value conflicts can occur around many issues.
Counselors may struggle with the behaviors of clients regarding abortion, the right to die and end-of-life decision making, child or elder abuse,
genetic engineering, premarital and extramarital sex, and religion and spirituality (G. Corey et al., 2015; Remley & Herlihy, 2014). The four court cases
described earlier revolved around clashes between the religious beliefs
and values of counselors and counselors-in-training and the chosen goals
of their clients that were related to the clients’ sexual orientation. In Case
Study 10 (A Parental Dilemma: Hastening the Death of a Child), presented
at the end of this chapter, the counselor must be aware of and bracket his
personal values regarding end-of-life decision making so that he can be
effective in assisting the parents of a terminally ill child.
Any consideration of values needs to include both the personal values
of a counselor and the professional values of the counseling profession. The
Preamble to the Code of Ethics (ACA, 2014) communicates the collective
values of the counseling profession (Francis & Dugger, 2014) that “are an
important way of living out an ethical commitment.” Ethical problems
can occur when the personal values of a counselor are in conflict with the
professional values of counseling and this conflict is not resolved. Individuals who aspire to become counselors need to be able to embrace the
professional values that are articulated in the Code and to integrate professional ethics with personal values (Handelsman et al., 2005). Ametrano
(2014) describes how students learn, throughout their enrollment in an
ethics course, to become more aware of how their values influence ethical
decision making and reconcile their values with the values of the profession. Sometimes, when counselors-in-training become aware of personal
values that may interfere with their ability to work effectively with a client
whose values, beliefs, or behaviors conflict with their own values, they
struggle to learn how to work effectively with the client. If they are open
to learning new cultural competencies and a process for setting aside their
personal values, opportunities will be provided throughout their training
program. In Case Study 9 (I’m Stuck), such a scenario is depicted when a
student experiences a values conflict during a role-play counseling session.
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The case describes some of the learning opportunities provided to her as
she works to resolve this conflict.
Working at the intersection of personal and professional values can be
particularly difficult for counselors and counselors-in-training who hold
strong personal beliefs or values, but the ethical mandates of the profession
must be upheld regardless of the counselor’s personal values (Granello
& Young, 2012). If you are a student and, during your training experiences, you find it difficult to work with clients whose behaviors conflict
with your values, it is vital for you to learn to promote the welfare of your
clients by assisting them in finding their own way (Remley & Herlihy,
2014). G. Corey et al. (2015) capture the essence of this learning when they
state: “Counseling is about working with clients within the framework of
their value system. If you experience difficulties over conflicting personal
values, the ethical course of action is to seek supervision and learn ways
to effectively manage these differences” (p. 73). They further add: “The
counseling process is not about your personal values; it is about the values
and needs of your clients. Your task is to help clients explore and clarify
their beliefs and apply their values to solving their problems” (p. 73). It
may be helpful to use the decision-making model offered by Kocet and
Herlihy (2014) to learn how to work through personal and professional
value conflicts.
Clearly, the issue of values in the counseling relationship is complex. Values are always present in the counseling relationship and arise visibly in a
number of the case studies that appear in different chapters. In Case Study
1 (Keep Kendra’s Secret, or Not?), the counselor needs to reflect on the goals
for counseling a teenager who is engaging in cutting behavior, to ensure
that the goals are not based on her own personal reactions and values
related to self-harm behavior. In Case Study 5 (The Slap—How to Best Help
Hope), the counselor needs to be aware of his own values and beliefs related
to child rearing and discipline so that he does not judge his client’s behavior according to his own values. The counselor in Case Study 12 (A Pregnant Teenager: A School Counselor’s Quandary) recognizes the necessity of
reflecting on his own values regarding teen pregnancy and abortion. Two
case studies present values issues related to religious beliefs. In Case Study
13 (Disputing Unhealthy Beliefs or Imposing Values?), a counselor must be
aware of her views that a client’s religious beliefs may be an impediment to
progress in counseling, so that she will be able to work within the client’s
belief system. In Case Study 20 (An Imposition of Values?), a college counselor struggles with what to do when she perceives that a client’s religious
beliefs are contributing to the client’s mental health problems. Values issues
are pervasive in counseling, and they present some of the most troubling
ethical dilemmas that counselors encounter.
As counseling students begin to work directly with clients, it is likely
that the value conflicts we describe in this chapter will emerge in some
fashion. When that happens, keep in mind that your counselor educators
and supervisors will respect your values and will not ask you to “give
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them up.” Rather, they will expect you to be aware of your personal values
and to monitor how your values are influencing your counseling work. If
you have difficulty in maintaining objectivity regarding a certain value,
consider this as being your problem rather than the client’s. If you cannot
bracket, or set aside, your values so that you can listen to the client’s agenda, then you might want to consider whether counseling is the right profession for you. Your ethical responsibility is to be open to further learning
and supervision, and perhaps personal counseling, to understand how
your personal values are intruding in your professional work.
Case Study 9
I’m Stuck
Anneliese A. Singh
Larissa, age 26, is enrolled in a master’s degree program in counseling
with the goal of becoming a school counselor. She is a full-time student
who is now in her second semester. One of the courses she is taking is
Advanced Counseling Methods. In this course, students are assigned to
counsel a “client” for six sessions. Each “client” is a doctoral student in
the counselor education program who has been instructed to role-play the
same client throughout the six counseling sessions. The course instructor,
Dr. Charles, observes each session and provides feedback to the student.
Larissa’s “client” is Tamara, who is role-playing a 16-year-old African
American high school student. As the first session begins, Tamara presents
as distraught and tearful and states that she is seeking counseling because
she is experiencing conflict in a romantic relationship. When Larissa asks
her to say more about the relationship, Tamara describes a series of misunderstandings within the relationship that have left her with hurt feelings
and wondering whether this is the “right” relationship for her. As she talks,
she refers to the other person in the relationship as “this person,” “my significant other,” and “my so-called partner.” Larissa attempts to reflect back
to Tamara her understanding of what Tamara has expressed by stating, “It
sounds as though you are questioning whether it’s even worth it, to keep
trying to work things out with him.” Tamara looks at her for a long moment,
and then says, “It’s not a ‘him,’ it’s a ‘her.’ I’m a lesbian.” There is a lengthy
silence, and then Larissa turns to Dr. Charles and says, “I’m stuck.”
Dr. Charles begins processing the aborted session by asking Larissa to
reflect on what was happening with her when she got stuck and asks if
Larissa had been assuming that her client’s romantic relationship had been
a heterosexual one. Larissa acknowledges that she had been making that
assumption and was taken by surprise, but she believes she will do a better
job in the next session. She says she will work on checking her assumptions.
During the second role-play session, Tamara again expresses her distress
over the conflict in her relationship with her girlfriend. Larissa inquires
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about Tamara’s support system and asks whether she has “come out” to her
parents and her friends. Tamara responds that she has kept the relationship
a secret, but if it works out, she plans to be open about it with friends and
family and would like some help with handling the process of coming out.
Larissa then attempts to explore Tamara’s history of romantic relationships,
asking if she has dated or been attracted to boys. The remainder of the session does not go well; Tamara withdraws and is minimally responsive.
When Dr. Charles processes this second session with Larissa, Larissa admits that she realizes the session was not productive. She thinks it would
help her if she could be clear about the goals for counseling this client. She
says that she believes it would be therapeutic for the client to explore her
sexual orientation because “she’s young, and she could change.” She tells
Dr. Charles that she has heard of “conversion therapy” and would like to
learn more about it before the next session. Dr. Charles reminds her that
the counseling goals must be set by the client, not the counselor, and that
the client has expressed goals of resolving conflict in her current relationship and coming out as lesbian. At this point, Larissa says, “I just don’t
know how to work with this client. I grew up in a very religious family,
and it was ingrained in me that homosexuality is a sin.” She adds, “I know
I need to learn how to work with sexual orientation issues if I am going to
work effectively with teenagers.”
Questions for Thought and Discussion
1. If you were the course instructor, where would you start in helping
Larissa learn to be a more effective counselor?
2. Do you think Larissa can learn to counsel clients with different sexual orientations, given her religious beliefs? If so, what would be the
best ways to help her learn?
Analysis
This master’s student seems to be open to learning how to counsel lesbian,
gay, bisexual, transgender, queer, and questioning (LGBTQQ) clients. She
is only in her second semester, and she will have many opportunities to
develop her competencies. First, she will need to focus on increasing her
self-awareness. Dr. Charles might ask her to construct a spiritual/
religious timeline to explore her developmental process. Larissa might
talk with her pastor or a counselor who shares her faith to clarify whether
there is room for acceptance of differences within its belief system or, if
not, whether she feels the interior freedom to question the beliefs with
which she was raised.
Constructing a sexual orientation development timeline (Dobmeier et al.,
2013) might also help Larissa to recognize the sexual orientations of others
as normal. Because the United States is a heteronormative society (i.e.,
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heterosexual norms are advantages), a first step toward LGBTQQ-affirmative
counseling is for counselors to actively self-reflect on their own gender, sex,
and sexual orientation. Larissa could ask herself questions such as: “How did
I learn to perform my gender?” and “What were the consequences for stepping outside of norms ascribed to my gender, sex, and sexual orientation?”
This may help her to identify her internalized stereotypes that can affect her
work with LGBTQQ clients. Counselors who have not identified these stereotypes will be operating on assumptions that can mask the actual issues and
needs LGBTQQ people bring to counseling.
Second, Larissa will need to learn how to set aside her personally held
values and beliefs so that she does not impose them in the counseling relationship (ACA, 2014, Standard A.4.b.). It will be important for Dr. Charles
to clarify to Larissa that the counseling faculty will not ask her to change
her beliefs, only to learn to bracket them so they do not enter into the
counseling relationship (Kocet & Herlihy, 2014). She will need to learn
how to respect the diversity of clients and avoid imposing her own values.
Larissa’s “client,” the doctoral student who is role-playing Tamara, can
give her feedback on how she experiences Larissa as a counselor during
their sessions. This may help to increase Larissa’s awareness of how her
values and assumptions affect the client and the counseling process.
Third, Larissa needs to gain knowledge and skills in working with diverse populations, and with LGBTQQ clients in particular. Larissa will
need to develop facility with language that is affirmative and understand
the definitions, similarities, and differences among words such as sex and
gender. Society has previously understood sex as being defined as “male”
or “female,” whereas we now know there are multiple configurations of
sex. Most important, counselors should know that sex is assigned at birth
and that no one is “born a girl” or “born a boy.” In addition, counselors
should know that gender identity has expanded from terms such as man
and woman to include transgender and genderqueer. Counselors who work
with young LGBTQQ people should be prepared to hear language to
describe one’s gender identity that may be evolving and new (e.g., gender
blender, gender fluid). The goal for ethical treatment around issues of identity and language is for counselors to be open and ask LGBTQQ clients
which words and pronouns they use to best describe their identities.
Larissa will need to become familiar with language related to these
identities. Transgender people, for instance, may have been assigned a sex
at birth that does not align with their gender identity and expression. Cisgender people do identify with the sex they were assigned at birth, as it is
in alignment with their gender identity and expression. Transgender and
cisgender people have sexual orientations that may range from gay (typically male-identified people attracted to other male-identified people) to
lesbian (typically female-identified people attracted to other female-identified
people) and bisexual or queer (attracted to a range of gender identities and
expressions). Because the LGBTQQ community is dynamic and vibrant,
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counselors should seek to become aware of constantly evolving terms to
use in working with LGBTQQ clients.
As Larissa continues to gain knowledge, she will learn that LGBTQQ
people are not a monolithic group; they have a diversity of identities related to race/ethnicity, age, gender identity and expression, migration status, social class, ability status, and religious/spiritual affiliation (Chun &
Singh, 2010). When counselors assume that all LGBTQQ people have the
same values, feelings, experiences, and behaviors, there is risk for a rupture
in the counseling process. As Larissa continues her role-play sessions with
Tamara, who as an African American lesbian encounters multiple forms of
oppression, she will need to develop a strong understanding of intersectionality theory, which asserts the interdependence of multiple identities
(Warner, 2008). LGBTQQ clients of color, for instance, may have very different value systems and experiences than White LGBTQQ clients because
of the intersection of racism and heterosexism in their lives (Singh, 2013).
Even after Larissa has developed increased self-awareness and knowledge related to working with a diversity of LGBTQQ clients, she may find
it challenging to work with the “coming out” process. Counselors need to
have skills in creating a safe space for LGBTQQ clients to explore issues of
coming out related to friends and family at home, in the workplace, and
at school. Larissa’s client expressed a desire for assistance in coming out,
so Larissa will need to become competent in carefully and collaboratively
assessing the variety of issues that LGBTQQ clients may face in the coming out process. Because issues of homophobia, transphobia, and biphobia are embedded in U.S. society, LGBTQQ youth face numerous negative
consequences from this societal discrimination, such as being kicked out
of their homes (Haas et al., 2011) and being bullied at school. The skills
counselors need in supporting LGBTQQ people in coming out include
being able to connect clients with resources to support systems such as
support groups, online resources, and media. Research has shown that
LGBTQQ youth and adults face significant societal discrimination that
affects well-being and has negative consequences such as suicidal ideation,
substance abuse, unsafe sexual practices, homelessness, and job loss (Haas
et al., 2011; Singh, 2010). Counselors should be prepared to conduct a thorough assessment of suicidal ideation, self-injury, and other behaviors and
environments that place clients at risk for harm. LGBTQQ people have
developed multiple strategies of resilience related to navigating this oppression (Singh, 2010, 2013). Therefore, any assessment of safety and risk
for LGBTQQ clients should also include an assessment of resilience and
strengths clients may use to increase their well-being.
Another issue to be addressed is related to Larissa’s comment to Dr. Charles
that she had heard of and wanted to learn more about “conversion therapy”
or “reparative therapy,” which attempts to “change” a person’s gender identity and gender expression and/or sexual orientation. Dr. Charles can make
Larissa aware of the positions of the major helping profession organizations
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Issues and Case Studies
(such as ACA and the American Psychological Association) that have deemed
these types of therapy as harmful to LGBTQQ clients. As Larissa continues
her studies, she will learn that counselors do not use techniques “when substantial evidence suggests harm, even if such services are requested” (ACA,
2014, Standard C.7.c.). Larissa will need to develop the ability to talk with
LGBTQQ clients and others about the importance of LGBTQQ-affirmative
counseling, as research has supported the benefits of this approach for the
well-being of LGBTQQ people. Addressing issues of heterosexism and exploring the ways this heterosexism has been internalized become the goals of
ethical LGBTQQ-affirmative counseling practice.
As Larissa moves through her training program, she will learn that a
central component of ethical and affirmative practice with LGBTQQ clients includes becoming an ally for this group across the life span. When
working with family members who are struggling with supporting their
LGBTQQ child, the counselor should be able to ally with the child and
provide helpful educational resources on the natural diversity that exists
across sexual orientation and gender identity. When Larissa completes
her field experiences, and when she practices as a school counselor, ally
behavior will include assessing her work environment to determine the
extent to which her counseling office is safe for LGBTQQ students. What
these student clients see in the counseling environment (books, media, a
Safe Zone sticker) signals to them the presence of affirmative support.
Questions for Further Reflection
1. How would you assess your own competence to work with diverse
client populations?
2. What personally held values and beliefs do you hold that you might
inadvertently impose on clients?
Case Study 10
A Parental Dilemma:
Hastening the Death of a Child
Karen Swanson Taheri
Naomi and Roger are the parents of a 4-year-old son, Markus. They have
been married for 10 years and sought counseling approximately 1 year
ago after their son had experienced several medical issues. Naomi and
Roger felt a need for support from an individual outside of their family,
and they explained that their initial goal for counseling was to “learn how
to better cope with Markus’s health problems and to have some extra support throughout his medical treatments.”
During their initial session with their counselor, Trevor, the parents
stated:
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We have been through so much trying to figure out what is going on with his
health so we can help him get better. We’ve been financially strained because
we cannot really afford all of the medical bills we have been receiving, and
we are so stressed! At the very least, we want to know what is going on with
his health. We’ve been to three doctors, and no one has been able to give us
a straight answer. He has been sick off and on since he was very young, but
lately he has had a high fever and seems to get infections much more easily.
Shortly after the couple began therapy, Markus was diagnosed with leukemia. He has undergone two rounds of chemotherapy and has never entered remission. About 4 weeks ago, Markus’s oncologist informed Naomi
and Roger that Markus’s leukemia had progressed beyond treatment and
gave Markus a 6-month prognosis, contingent on Markus continuing to
receive regularly scheduled blood transfusions. In addition to the transfusions, the doctor recommended a morphine and benzodiazepine regimen
and stated that he would steadily increase the dosage of both medications
to ensure Markus’s comfort as death approached.
Naomi and Roger disagree about what medical treatment is best for
their son. Naomi, who strongly believes in utilizing medication only
when it is absolutely necessary for curative purposes, does not want
Markus to receive pain medications that could potentially hasten his
death. She views the morphine and benzodiazepine regimen as one such
combination and states that she has read several articles online that describe the possibility that higher dosages of this combination of drugs
can hasten death in terminally ill patients. Naomi also communicates
that she does not want Markus to continue receiving blood transfusions
because, from her perspective, these transfusions may be prolonging unnecessary suffering in her child by extending his life “for a short while.”
Roger wants to keep Markus “alive as long as possible” to lengthen the
time he has with his son. Roger also would like Markus to be “as comfortable as possible” throughout the dying process, even if it means his death
is hastened by the pain medication. Roger has declared several times, “I
do not want my son to suffer unnecessarily, and I think his not receiving
the morphine would be harmful to him.”
Both parents have repeatedly communicated their sadness regarding
Markus’s impending death, and neither is ready to say goodbye to their son.
Questions for Thought and Discussion
1. If you were the counselor for this couple, how might your own values contribute to or hinder your ability to remain effective throughout the counseling process?
2. Do you consider yourself competent to provide counseling to the
couple throughout the end-of-life decision-making process for their
son? How would you determine your competence? If you do not
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consider yourself competent to continue to work with them, how
would you proceed?
3. What is your role as the counselor for this couple? Is it necessary
to redefine the goals of counseling now that Markus has received a
terminal diagnosis?
4. Considering the moral principle of “do no harm,” what do you
think would constitute harm to each individual (Naomi, Roger, and
Markus) in this situation? How does each of Markus’s parents define
harm? If your definition differs from theirs, how would you handle
that difference as their counselor?
5. Does the term neglect apply to this situation? Under what circumstances might neglect apply?
Analysis
When it comes to deciphering whether to break confidentiality because
someone may cause “serious and foreseeable harm” to another, the ACA
Code of Ethics (ACA, 2014) states that “additional considerations apply when
addressing end-of-life issues” (Standard B.2.a.). Standard B.2.b. addresses
confidentiality regarding end-of-life decisions and provides guidelines for
working with terminally ill clients, but it provides no guidance for working
ethically with parents or caregivers who are the end-of-life decision makers
for a terminally ill patient. Refusal of medical treatments for terminally ill
minors legally may be considered to be neglect, so Trevor will need to consult the law in his state and consult with other mental health professionals
who work with terminally ill children.
Naomi and Roger are the legal guardians of Markus, and because of
Markus’s legal status as a minor, he is unable to consent to his own medical treatment. The decision regarding medical treatment belongs to Markus’s
legal guardians. In this case, Trevor’s role is to be with the parents as they
come to a decision about Markus’s end-of-life care and to provide a safe and
supportive environment for Naomi and Roger to consider all of their options.
It is extremely important that Trevor remain aware of his own personal
values regarding the end-of-life treatment of Markus and that he maintain appropriate boundaries throughout the counseling process. It is not
Trevor’s role to sway one parent or the other but to provide a supportive
environment for the couple to explore this dilemma together.
Questions for Further Reflection
1. How might cultural considerations come into play in this situation
or in other situations regarding the end-of-life decision-making process for minors?
2. If Markus was 13 years old instead of 4 years old, would your intervention be different? If so, how?
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Chapter 6
Counseling
Minor Clients
Mark Salo
Counselors work with minor clients in myriad settings, including in public and private schools, inpatient treatment facilities, private practice,
community agencies, and youth law enforcement. They counsel children
across a wide range of developmental stages and ages, from as young as
3 or 4 years old through the age of legal majority (18). Adding to this complexity is the fact that, except in very specific circumstances, minor clients
have few legal rights apart from those of their parents or guardians (Remley & Herlihy, 2014). Relevant laws vary greatly from state to state, and
in many situations statutes do not address specific circumstances. Exceptions in statutes are exemplified in Virginia, where the law gives minors of
any age the right to consent to outpatient treatment. In Michigan, children
who are at least 14 years old can receive up to 12 weeks of counseling
without parental consent.
Counselors can feel pulled between their minor clients and the wellintentioned adults in children’s lives, such as parents, teachers, social
workers, and grandparents. In addition, court rulings by judges can set
precedents as laws are interpreted and reinterpreted in an ever-changing
legal system. As a result, counselors who find themselves in confusing or
“gray” situations often look to ethical standards for support and guidance. The case could be made that therapeutic work with minor clients
is the counseling specialty area in which ethical and legal issues are most
likely to arise.
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The primary ethical and legal issue arising from working with children
is confidentiality. When, and with whom, is it appropriate to share information that has been revealed in a counseling relationship with a child?
Does it make a difference if the person requesting information is a parent/
guardian or a teacher? Glosoff and Pate (2002) note that situations involving confidentiality are more complex when counseling minors than when
counseling adults. Laws vary greatly from state to state. For example, in
California, Chapter 10 of the Education Code specifically states that “any information of a personal nature disclosed by a pupil 12 years of age or older
in the process of receiving counseling from a school counselor as specified
in Section 49600 is confidential.” This statute recognizes the importance of
counseling services being available for minor students as young as 12, and it
acknowledges that confidentiality is crucial to the counseling process. There
also has been continued legal support in many states to permit minors to
seek medical advice and treatment for sexually transmitted diseases, birth
control, and abortion without parental consent (G. Corey et al., 2015; Welfel, 2013). The reasoning behind these statutes is that if parental permission
for services were required by law, some minors would choose not to seek
treatment. Not surprisingly, this has led to legal conflicts between parents
and the professionals involved in these medical matters. Both of the case
studies at the end of this chapter bring into bold relief the types of quandaries counselors face when weighing the ethical confidentiality rights of
minor clients against the legal rights of parents or guardians to receive requested or needed information. In Case Study 11 (A Legal Guardian Presses
for Confidential Information), a 13-year-old client wants and seems to need
a safe place to discuss troubling issues, yet her legal guardian insists that
information be shared. In Case Study 12 (A Pregnant Teenager: A School
Counselor’s Quandary), a host of ethical issues arise for a counselor who is
working with a pregnant 17-year-old client.
Counselors of minor clients often straddle an ethical fence, caught between allegiance to their minor clients and the legal reality of parental
rights. The ACA Code of Ethics (American Counseling Association [ACA],
2014) requires counselors to act in the best interest of the client, but just who
is the client when the parent is paying for services? How does a counselor
respond when asked by a parent or legal guardian for specific information
about progress in counseling? Unfortunately, counselors may find themselves legally obligated to provide such information but ethically admonished against sharing this information. School counselors do their best to
create and maintain collaborative relationships with both their minor clients
and their parents or guardians as the ACA Code of Ethics requires:
Counselors inform parents and legal guardians about the role of counselors
vand the confidential nature of the counseling relationship, consistent with
current legal and custodial arrangements. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities
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of parents/guardians regarding the welfare of their children/charges according to law. Counselors work to establish, as appropriate, collaborative
relationships with parents/guardians to best serve clients. (Standard B.5.b.)
A counselor’s work setting will often determine the types of ethical
issues that are encountered. For counselors in private practice, parental
permission for counseling is usually required, so an agreement is signed
with confidentiality expectations and other ramifications of the counseling experience clearly spelled out. However, there may be exceptions to
this practice.
Children in inpatient treatment facilities will most likely have been
placed there by a parent or by Child Protective Services. These minors,
regardless of their age, will be deemed largely incapable of making crucial
decisions for themselves. The caregivers are assumed to be working “in
the child’s best interest.” Parents and other adults may be consulted over
the course of treatment, often as part of a treatment team. It is important
to clarify the roles of everyone involved at the beginning of treatment to
avoid misunderstandings, especially with regard to sharing information.
School settings provide another arena in which questions of privacy in
the counseling relationship are tested. State law usually does not require a
school counselor to contact a parent for consent before counseling occurs,
although some schools have adopted such a policy. School counselors are
available to all students, much like a school nurse, and availability is paramount in their position. School counselors need to be careful to remain
loyal to their students’ interests when pressed for information.
Dual relationships in the school setting are a real possibility, and counselors need to be vigilant to see that harm is not done inadvertently.
School counselors may also teach classes or coach sports, which can lead
to confusion. Herlihy and Corey (2015) note that, as the responsibilities
and expectations of one role diverge from those of another role, the potential for harm increases.
In summary, counseling minor clients can be ambiguous work (Salo &
Shumate, 1993). Ethical standards cannot be written that cover all possible
scenarios and situations. Ethical standards, common sense, and a desire to
do what is right for the minor client can guide practitioners in their work
with minor clients.
Case Study 11
A Legal Guardian Presses
for Confidential Information
Amanda Crawford
Nicole works as a comprehensive school and community treatment (CSCT)
therapist in a school. This public school program provides mental health
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services in rural communities throughout the state of Montana. The CSCT
therapist position differs from that of a school counselor, although there are
many similarities. Both CSCT therapists and school counselors are located
in the school and work with teachers, administrators, and school personnel.
Nicole, as a CSCT therapist, works with students who have been identified
as suffering from a serious emotional disturbance. This program functions
similarly to an outpatient facility, yet it is housed in the school.
Nicole began working with a student, Lauren, and her aunt, Maria. At
the initial consultation with Maria, with whom Lauren lives full time,
Nicole was informed of Lauren’s recent risky behavior both at home and
in school. Lauren was struggling in school and at home as evidenced by
loss of temper, arguments with adults, compulsive lying, withdrawal
from her adult relationships, missing curfew, blaming, anger, and spiteful
behavior. Maria reported that she is Lauren’s legal guardian and has the
legal right to enroll Lauren in the CSCT program. Maria signed the consent to treat form and all necessary paperwork.
Nicole met regularly with Lauren in individual, group, and family
therapy sessions for 8 weeks. During this time rapport was built between
Lauren and Nicole. Lauren disclosed information about relationship
struggles, feelings underlying her recent withdrawal from adult relationships, and her current struggles with her sexual orientation. During an
individual therapy session 8 weeks after Lauren began counseling, Lauren asked for clarification of confidentiality and then shared that she is
sexually attracted to females and is in an experimental relationship with
another girl.
Soon after Lauren’s disclosure of her sexual orientation and discussion
about her sexual experimenting, Maria came to the office for a treatment
plan update meeting. Maria shared that she has noticed that Lauren has
continued to spend more and more time with a girl friend down the street.
Maria became insistent that she be informed of all information Lauren is
sharing during sessions. Although Nicole was amiable and professional
during the treatment plan meeting with Maria, Nicole was aware of increasing discomfort as Maria persisted in trying to obtain information
that Nicole believed to be confidential within the therapeutic relationship.
Maria insisted that she had the right to be informed of everything Lauren
was sharing in session because Lauren is a minor. During the conversation, Maria alluded several times to getting her attorney involved and
threatened to file a complaint with the ACA Ethics Committee if Nicole
failed to comply with her request. Although Nicole finished the discussion by reiterating the importance of confidentiality within a therapeutic
relationship, Maria continued to insist on more detailed information.
A follow-up family therapy session with Maria and Lauren confirmed
Lauren’s desire to have a space where she can discuss feelings and where her
revelations will not be shared with her aunt. Maria stated that she did not
believe a 13-year-old should have “secrets” that she kept from her caregiver.
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Questions for Thought and Discussion
1. If you were in this counselor’s shoes, how do you think you might react
when pressed by Maria to reveal information shared by Lauren during
individual counseling sessions? What would you say to Maria?
2. What do you think of the way Nicole handled the situation? What, if
anything, might you have done differently, and why?
Analysis
Nicole’s dilemma involved ethical considerations related to the confidentiality of information gained in counseling sessions that were compounded
by the fact that Lauren was a minor. Nicole feared that revealing information to the aunt could be damaging to both Lauren and Maria, as well as
to the rapport built between Lauren and Nicole. Nicole’s ultimate goal
was to behave in an ethically responsible and legally sound manner while
supporting the needs of the client.
Nicole reviewed the ACA Code of Ethics (ACA, 2014) for guidance and
found Standard B.1.c. to be significant and important in her predicament. The standard states that “counselors disclose information only with
appropriate consent or with sound legal or ethical justification.” Nicole
recognized that Lauren was the client and had not given her consent for
information revealed during her sessions to be shared with her aunt.
Nicole considered that Maria had been informed of the confidential nature
of the relationship and that it was in Lauren’s best interest for the information to remain confidential until she decides to share it. Nicole planned
to reiterate this informed consent discussion with Maria, reinforcing the
importance of the trust that has been built within the therapeutic relationship. Nicole was also aware that maintaining a positive working relationship with Maria would ultimately benefit Lauren, making this a delicate
and challenging situation.
Additional standards in the Code provided Nicole with direction in
dealing with her ethical dilemma. For example:
When counseling minor clients or adult clients who lack the capacity to
give voluntary, informed consent, counselors protect the confidentiality of
information received—in any medium—in the counseling relationship as
specified by federal and state laws, written policies, and applicable ethical
standards. (Standard B.5.a.)
Nicole knew that it was her ethical responsibility to maintain Lauren’s
confidentiality; however, she needed further direction and insight into
how to manage the limits of confidentiality due to Lauren being a minor.
Nicole would be prudent to also review any applicable state statutes.
Standard B.5.c. addresses the release of confidential information:
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Issues and Case Studies
When counseling minor clients or adult clients who lack the capacity to
give voluntary consent to release confiential information, counselors seek
permission from an appropriate third party to disclose information. In such
instances, counselors inform clients consistent with their level of understanding and take appropriate measures to safeguard client confidentiality.
Lauren had already indicated her desire not to have information released to
her aunt. Nicole knew that if she did disclose information she would need
to inform Lauren before the information was provided, and she was aware
of the potential damage to the therapeutic relationship this could cause.
Nicole understood that Maria is a legally recognized guardian, which
raises the possibility that a judge might rule in her favor if she continues
to pursue the confidential records. Nicole realized, after consultation with
her supervisor and the company’s attorney, that if the case went to court
it would be decided by the judge. Standard B.2.d. advises counselors that,
“when ordered by a court to release confidential or privileged information
without a client’s permission, counselors . . . take steps to prohibit the disclosure or have it limited as narrowly as possible because of potential harm
to the client or counseling relationship.” In the event that a judge ordered
the record to be revealed, this standard would guide Nicole’s response,
and she would try to adhere to the caution that “when circumstances
require the disclosure of confidential information, only essential information is revealed” (Standard B.2.e.). To the extent possible, clients should
be informed before confidential information is disclosed and should be
involved in the disclosure decision-making process. Nicole decided that
she would reveal only essential information and would inform Lauren
before making the disclosure.
This case illustrates how Nicole used the ACA Code of Ethics to guide
her decision-making process in an ethical dilemma. It is important to remember that the Code is not a legal document and that federal, state, and
local laws supersede its guidelines. If a judge orders Nicole to release her
records, she should do so after stating her objections. The ACA Ethics
Committee would not find a counselor in violation of the standards for
complying with a court order.
Questions for Further Reflection
1. Suppose a caring and concerned teacher approached you as a counselor working in the school and asked for information about a student’s home situation to help her better understand the student’s
academic and behavior problems. What might you tell the teacher?
2. Would your response to Maria’s demand for more information be
different if the client were 9 years old rather than 13? If she were 17?
How do ethical responsibilities regarding confidentiality change as a
client matures?
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Case Study 12
A Pregnant Teenager:
A School Counselor’s Quandary
Danielle Shareef
Michael works as a school counselor for alternative programs in a rural
high school with a student population of 1,300. He is assigned to work
with “at-risk” students whose home environments may be affected by
poverty, absentee parents, drug exposure or use, or domestic violence.
Michael conducts weekly group and individual counseling sessions with
these students. As a married father of two adolescent girls, Michael often
finds himself counseling students with issues he hopes his daughters will
never encounter.
One morning Jenny, a 17-year-old sophomore, walks into Michael’s
office distraught. She explains that she requested to be excused from
class to see a counselor because she was involved in a verbal altercation with another student and didn’t want to get into a fight. Jenny says
lately she gets into a lot of arguments at school. As Michael talks with
Jenny, he learns that she has been dealing with stress at home as a result
of mistrust and disobedience issues between her and her mother. Jenny
also reveals that she is approximately 6 weeks pregnant and that her
aunt had taken her to the doctor for confirmation without her mother’s
knowledge.
Michael surmises that dealing with the pressure of concealing her
pregnancy from her mother probably is contributing to Jenny’s emotional reactions at school. After further discussion, Jenny says that she
refuses to tell her mother because she is uncertain whether she wants
to have the baby. If she chooses not to have it, then her mother will
never know she was pregnant. If she tells her mother about her condition, Jenny believes her mother will not allow her to have an abortion.
Jenny asks to end the session, stating that she has to take an English
test. Michael, aware that he is experiencing some strong emotional
reactions as he talks with Jenny, agrees to her request and asks her to
come back and talk with him some more at the end of the school day.
Jenny agrees to do so.
After the session, Michael processes his feelings, values, and personal
beliefs about teen pregnancy and abortion. He is not a staunch supporter of abortion, but he believes every adult woman has the right to choose
whether she wants to give birth. However, he doesn’t think this position
applies to minors. He is totally against teen pregnancy and does not believe
that young girls should be having and raising babies. He wants to strike a
balance in his work with Jenny, providing her with support in her decision
making without implying that Jenny should have an abortion. He is also
concerned about whether he has a legal obligation to notify her parents.
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Issues and Case Studies
Questions for Thought and Discussion
1. If you were the counselor in this case, how might you react to Jenny’s
revelation that she is pregnant?
2. Given Michael’s values, what approach should he take to assist Jenny
in her decision of whether to continue or terminate the pregnancy?
3. Do you think Michael should inform Jenny’s parents about her condition? Why or why not?
Analysis
Counselors need to be aware of their personal biases and values so they can
be nonjudgmental and convey unconditional positive regard in the counseling relationship. Michael is conscious of his personal beliefs regarding
teen parenthood and abortion, yet he didn’t anticipate the strong feelings
that Jenny’s disclosure would arouse in him. His concern is intensified by
his uncertainty about whether Jenny’s parents need to be notified. Because
she is a minor, it may seem to Michael that her parents should be involved
in such a critical decision, but he may not have ethical or legal justification
to inform her parents.
Michael looks to the ACA Code of Ethics (ACA, 2014) and finds several
standards that seem relevant to the situation. Michael understands his ethical obligation to avoid imposing his own personally held values and beliefs
(Standard A.4.b.), and he wants to adhere to his commitment to respect the
diversity of clients. Michael knows that socioeconomic factors and cultural
views of morality influence people’s perspectives on teen parenthood and
that, as a middle-class White male, his beliefs may differ from those of Jenny
and her family. He is appropriately concerned that these differences and his
values might affect his counseling interventions with Jenny.
Michael is uncertain whether he has either an ethical or a legal obligation (or both) to notify Jenny’s parents. He looks to the Code and notes that
“counselors disclose information only with appropriate consent or with
sound legal or ethical justification” (Standard B.1.c.). Jenny has made it
clear that she does not want her mother to be informed about her condition,
and Michael is not sure just what would constitute “sound legal or ethical
justification” to inform Jenny’s mother against her wishes. He looks to the
section of the Code that deals with exceptions to confidentiality and learns
that “the general requirement that counselors keep information confidential
does not apply when disclosure is required to protect clients or identified
others from serious and foreseeable harm” (Standard B.2.a.). It seems to him
that Jenny, a healthy 17-year-old, is not placed in “serious” physical harm
by her pregnancy. But, he wonders, what about harm to the fetus if she were
to decide to have an abortion? Michael quickly realizes that this is a highly
controversial and divisive issue in American society at large and that he
certainly does not have a definitive answer to that question.
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Michael then searches through the Code for guidance on working with
minor clients. He finds that he may enlist others, including family members, “as positive resources, when appropriate, with client consent” (Standard A.1.d.). But Jenny has not given her consent. He also reads that he
should “respect the inherent rights and responsibilities of parents/guardians regarding the welfare of their children/charges according to law”
(Standard B.5.b.). This standard suggests to Michael that his quandary has
both legal and ethical dimensions. What he knows about applicable law
is that, in his state, parental consent is required to terminate a pregnancy
of a minor under the age of 18. However, if a judge deems the minor to
be mature enough and reasons are justifiable, the judge can grant permission to terminate a pregnancy without parental consent. Michael wonders
whether it would be appropriate for him to share this information with
Jenny. If he did so, would he be, in effect, giving legal advice?
Michael thinks the answer to his dilemma may be in his school district’s
policy manual. He peruses the manual to see whether the district has a
policy regarding parental notification of student pregnancy. To his chagrin, he finds that his district does not have a written policy. He remains
uncertain of what he should do in continuing to work with Jenny.
Michael’s reflections have enabled him to identify a number of issues:
the possibility that his personal values may interfere with his ability
to counsel Jenny effectively, the ethical question of whether he should
respect the confidentiality of Jenny’s disclosure or inform her parents,
and legal questions regarding the rights of minors and the rights of
their parents. Before he meets with Jenny at the end of the school day,
he would be wise to consult with a fellow school counselor whose judgment he trusts to address both his personal values issues and his ethical
questions about the limitations of confidentiality. He should approach
his principal and, without revealing Jenny’s identity, ask the principal
to get advice from the school district’s attorney on his legal obligations
in counseling a pregnant student. If Michael decides that his personal
feelings may make it difficult to maintain his objectivity in counseling
Jenny, he should be prepared to facilitate a referral to another counselor.
If he decides to continue to counsel Jenny, his course of action will
be affected by the legal opinion he receives. If he is required to notify
Jenny’s parents, he will need to inform Jenny before he does so. If he is
not required to notify the parents, his task will be to assist her in considering her choices and to encourage her to inform her parents when and
if she is ready to do so.
Questions for Further Reflection
1. What risks might Michael be taking if he continues to counsel Jenny
and does not inform her parents of her pregnancy? What are the
risks involved in telling them?
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Issues and Case Studies
2. What are the potential benefits of involving the parents? What benefits might come from respecting Jenny’s confidentiality?
3. What personal values and beliefs do you hold that could interfere
with your ability to counsel a pregnant teenager effectively?
• 214 •
Chapter 7
Managing Boundaries
Gerald Corey and Barbara Herlihy
Boundaries provide structure to the counseling relationship and serve
to protect the welfare of clients who are in a vulnerable position in the
relationship. When counselors set boundaries, or clearly define the roles
of the participants in the counseling relationship, the resulting structure
helps to create a safe space for clients. Although counseling sessions can
involve considerable emotional intimacy for clients as they self-disclose
their struggles with personal and interpersonal issues, counseling is a professional relationship that has limits that differ from those of a personal
or social relationship. Although this rationale for setting boundaries may
seem simple and straightforward, dealing with boundary issues in actual
practice can be extremely complicated. Questions related to boundaries
have been controversial and have been hotly debated in the professional
literature for many years.
Putting Boundaries in Perspective
Boundary issues traditionally have been framed in terms of dual relationships or multiple relationships, although recent iterations of the ACA Code
of Ethics (American Counseling Association [ACA], 2005a, 2014) have
used the term nonprofessional relationships. A dual or multiple relationship
(or nonprofessional relationship) exists when a counselor takes on two
or more roles simultaneously or sequentially with a help seeker (Herlihy
& Corey, 2015). Counselors create a dual or multiple relationship when
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Issues and Case Studies
they combine the role of counselor with another professional relationship
(such as supervisor, employer, teacher, pastor, or business partner) or with
a personal relationship (such as friend, lover, or relative; Remley &
Herlihy, 2014). The literature typically has distinguished between sexual
and nonsexual dual relationships, and for clarity we will use these terms
as we explore the topic.
Sexual Dual Relationships
Sexual relationships with clients are among the most serious of all ethical
violations because they involve an abuse of power and a betrayal of trust
that can have devastating effects on clients. Engaging in sexual relationships with clients is universally recognized as being unethical and illegal
(Remley & Herlihy, 2014). This has not always been the case. For a long
time, sexual relationships between (usually male) helping professionals
and (usually female) clients were fairly common, and they were not addressed by professional organizations or acknowledged in the literature.
Thanks to the courageous efforts of a small number of psychiatrists, psychotherapists, and counselors, the problem was brought to light. Today
virtually all codes of ethics categorically state that sexual relationships
with clients are unethical, and licensure regulations and various state legislatures have added the force of law to ethical sanctions.
It may be surprising to learn that, despite these clear prohibitions of sexual
contact, one of the most common allegations in malpractice lawsuits against
mental health professionals remains sexual misconduct (Pope & Vasquez,
2011). Courts now recognize that clients are vulnerable in a counseling relationship and are likely to suffer serious emotional distress when they have
engaged in a sexual relationship with their therapist (G. Corey et al., 2015).
The ACA Code of Ethics (ACA, 2014) contains several standards that speak
to sexual dual relationships with current and former clients. Counselors are
prohibited from engaging in sexual or romantic “interactions or relationships with current clients, their romantic partners, or their family members”
(Standard A.5.a.). This prohibition extends to former clients as well for a
period of at least 5 years after the last professional contact (Standard A.5.c.).
A professional relationship should not turn into a romantic or sexual one,
nor should a sexual or romantic relationship turn into a professional one.
“Counselors are prohibited from engaging in counseling relationships with
persons with whom they have had a previous sexual and/or romantic relationship” (Standard A.5.b.). “This prohibition applies to both in-person and
electronic interactions or relationships” (Standard A.5.c.).
Former Clients
The Code requires that at least 5 years pass before counselors enter into
sexual or romantic relationships with former clients, the clients’ romantic
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Managing Boundaries
partners, or the clients’ family members. Although the question of
whether sexual intimacies with former clients are ever acceptable has been
extensively debated, mental health professionals now agree that the fact
that a counseling relationship has been terminated does not, in and of
itself, present an adequate justification for changing a therapeutic relationship to a sexual one.
Some professionals believe that the counselor–client relationship continues in perpetuity and that sexual relationships between counselors and
former clients are never ethical. One rationale for this is that the seeds of
the sexual attraction were planted during a therapeutic relationship in
which information tends to flow one way, with clients being vulnerable
and counselors disclosing little about themselves. Thus there will continue to be an asymmetry of power that will put former clients at risk.
Other professionals argue that we need to remain aware of the potential
for harm that exists due to residual transference and the continuing power
differential, but that we also need to consider the wide range of circumstances that exist in the counseling field. They point to the real differences
between long-term, intense, personal counseling relationships and brief
academic, career-oriented, or other types of counseling. If a counselor
enters into a sexual relationship with a former client even after many years
have passed, the burden of demonstrating that there has been no exploitation clearly rests with the counselor, who is required to “demonstrate
forethought and document (in written form) whether the interaction or
relationship can be viewed as exploitive in any way and/or whether there
is still potential to harm the former client” (Standard A.5.c.). If former
clients could be exploited or harmed, counselors are expected to avoid
entering into sexual relationships.
Nonsexual Dual or Multiple Relationships
The prohibitions are clear with respect to sexual relationships with clients
and former clients, but questions related to nonsexual dual or multiple
relationships are still debated. Some counselors have argued that dual or
multiple relationships should be avoided whenever possible. According
to Zur (2007), the rationale behind this stance involves the possibility of
counselors misusing their power to influence and exploit clients for their
own benefit and to the clients’ detriment. Although counselors should not
place their personal needs above the needs of their clients by engaging in
more than one role with clients to meet their own financial, social, or emotional needs, most mental health professionals now agree that a blanket
condemnation of engaging in multiple relationships is not justified. It is
not always possible for counselors to play a singular role in their work,
nor is it always desirable. Counselors need to develop strategies for
balancing multiple roles and responsibilities in their professional relationships (Herlihy & Corey, 2015).
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Counselors of various theoretical orientations have differing views of
dual relationships or boundary issues. Traditional psychoanalysts believe
it is necessary to maintain a detached and neutral stance with clients to
best analyze and deal with transference (Lazarus & Zur, 2002). Counselors
working from a humanistic, feminist, existential, or behavioral theoretical orientation will likely conceptualize boundaries in their relationships
with clients in different ways. Depending on their theoretical orientation,
counselors may consider interventions such as self-disclosure either as an
important and effective part of a treatment plan or as a type of boundary
violation.
The reality is that multiple relationships cannot always be avoided, especially for counselors who live and work in small communities (Herlihy
& Corey, 2015; Schank, Helbok, Haldeman, & Gallardo, 2010). Counselors who work in small communities face far greater challenges in dealing with multiple relationships than do practitioners who work in urban
areas. They often must blend several professional roles and functions, and
there may be overlap between their personal and professional lives. Counselors who live or work in the military face many of the same challenges
as those who live in rural communities (Johnson, Ralph, & Johnson, 2005).
The same is often true for counselors who live in urban areas and who are
part of ethnic minority, feminist, deaf, gay, or religious communities.
Although most of our professional literature has focused on the harm
that can result from sexual relationships with clients, nonsexual dual
relationships (or nonprofessional relationships) can also pose a threat to
the well-being of clients. Examples of possible nonsexual relationships
with clients include combining the roles of teacher and counselor or
supervisor and counselor; bartering for goods or services; lending money
to a client; providing counseling to a friend, an employee, or a relative;
becoming friends with clients or someone close to them; and going into a
business venture with a client.
The potential for harm in certain types of dual relationships is recognized, and “counselors are prohibited from engaging in counseling
relationships with friends or family members with whom they have an
inability to remain objective” (ACA, 2014, Standard A.5.d.). The Code
provides for more flexibility and professional judgment in other types of
potential dual relationships, when they are sequential rather than simultaneous. Standard A.6. addresses how to manage and maintain boundaries. Counselors are advised to “consider the risks and benefits of accepting as clients those with whom they have had a previous relationship.
These potential clients may include individuals with whom the counselor has had a casual, distant, or past relationship” (Standard A.6.a.).
If counselors determine that the benefits outweigh the risks and accept
these individuals as clients, precautions must be taken to ensure that no
harm occurs (such as ensuring informed consent, seeking supervision or
consultation, and documenting carefully; Standard A.6.a.). This section
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of the Code also addresses special circumstances in which the usual
boundaries might be extended:
Counselors consider the risks and benefits of extending current counseling
relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or
graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the
hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and
documentation to ensure that judgment is not impaired and no harm occurs.
(Standard A.6.b.)
Note that counselors are still responsible for weighing the potential
benefits to clients against the potential harm. It may be helpful in weighing benefits versus risks to distinguish between boundary crossings and
boundary violations (Gabbard, 1995; Gutheil & Gabbard, 1993; D. Smith
& Fitzpatrick, 1995). A boundary crossing is an exception to commonly
accepted practice that is made to benefit a particular client in a particular
circumstance. A boundary violation is a serious breach that causes harm
(such as a sexual relationship with a client). Even in potentially beneficial interactions such as those involved in boundary crossings, we
recommend that counselors consider a number of factors, including the
personal history and current mental status of the client, the nature of
the counseling relationship, possible effects on the client of attending
or not attending an event, and risks involved in taking the therapeutic
venture beyond the confines of the office.
Flexible Boundaries and Managing Multiple Roles
Most professionals now agree that flexible boundaries can be clinically
helpful when applied ethically and that boundary crossings need to be
evaluated on a case-by-case basis (Gottlieb & Younggren, 2009; Herlihy &
Corey, 2015; Knapp & VandeCreek, 2012; Lazarus & Zur, 2002; Moleski &
Kiselica, 2005; Speight, 2012; Zur, 2007, 2008). Traditional views of boundaries need to be expanded when counselors are involved in working in
the community and in social justice advocacy. Social justice and advocacy
entails adopting a broader framework, focusing on changing societal factors rather than an individual client’s dynamics. With this being said, role
blending can be problematic. Most professionals agree that mixing more
significant roles, such as counselor and employee or counselor and lover,
is clearly not appropriate. Whenever counselors play multiple roles, there
is potential for a conflict of interest, loss of objectivity, damage to the
counselor–client relationship, and exploitation of or harm to those persons who have sought help.
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Issues and Case Studies
Speight (2012) presents a cultural perspective on boundaries. She believes
the traditional approach to understanding boundaries is very limited in
terms of practicing effectively with various cultural groups. Speight calls for
a reexamination of how we understand boundaries, the counselor’s role, and
the counseling relationship. Working with many African American clients,
Speight has found that many of her clients expect a warm, reciprocal, and
understanding relationship and perceive therapists’ objective detachment as
a lack of caring and involvement. Speight proposes the concept of solidarity,
rooted in the ties within a society that bind people together, as a culturally
congruent way of understanding and managing boundaries. She advocates
for learning how to tolerate complexity in establishing boundaries and for
developing role flexibility in therapeutic situations.
After reviewing the literature on the topic of managing boundaries and
multiple relationships, Herlihy and Corey (2015) concluded that there is no
clear consensus regarding nonsexual multiple relationships in counseling.
It is the responsibility of counselors to monitor themselves and to examine
their motivations for engaging in any form of multiple relationship. Counselors should be cautious about entering into more than one role with a
client unless there is a clinical justification for doing so. Of course, when
such relationships are unavoidable, counselors should document precautions they take to protect clients.
Relationships With Others Who Are Not Clients
Many counselors engage in professional relationships, other than the
counselor–client relationship, where there is a power differential and
thus a potential for exploiting those who are in a vulnerable, subordinate
position. Counselors may serve as employer, superior in the workplace,
supervisor, or professor. Several ACA Code of Ethics (ACA, 2014) standards
address the potential for exploitation in these relationships. Sexual harassment is prohibited (Standard C.6.a.). There are separate sexual harassment
standards pertaining to supervisors and supervisees (Standard F.3.c.) and
to counselor educators and students (Standard F.10.b.).
The Code addresses the issue of nonprofessional relationships and
potentially beneficial relationships with students and supervisees. “Counselor educators avoid nonacademic relationships with students in which
there is a risk of potential harm to the student or which may compromise
the training experience or grades assigned” (Standard F.10.d.). With respect
to extending the usual boundaries, “counselor educators are aware of the
power differential in the relationship between faculty and students. If they
believe that a nonprofessional relationship with a student may be potentially beneficial to the student, they take precautions similar to those taken
by counselors when working with clients” (Standard F.10.f.). In addition,
“nonprofessional relationships with students should be time limited and/
or context specific and initiated with student consent” (Standard F.10.f.).
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Many professionals consider mentoring counselor trainees or beginning
counselors to be an integral part of their role. Mentors establish close working relationships, share research projects, coauthor articles, and engage their
protégés in social or business networks. Although there are a number of
clear benefits associated with mentoring relationships, the complexity and
multidimensional nature of dual relationships should be carefully explored,
and potential risks must be weighed against benefits. Potential ethical issues
need to be discussed throughout the course of a mentoring relationship.
The primary focus of mentoring needs to be kept on the protégé’s professional development (Casto, Caldwell, & Salazar, 2005).
Friendships With Clients or Former Clients
Interpersonal boundaries are not static; they undergo redefinition over time.
Practitioners are presented with the challenge of managing boundary fluctuations and dealing effectively with overlapping roles. Given how closely counselors and clients work together, the idea of developing a friendship could
be tempting. Similarly, most counselors have been faced with close friends
or relatives who have problems and who try (intentionally or not) to place
the counselor in the role of their therapist. The problem is that the underlying dynamics of friendships and therapeutic relationships are not the same.
Friendships are built on mutual disclosure and support—on sharing joys and
problems and being there for each other. Counselors are obligated to avoid
entering into counseling relationships with friends (ACA, 2014, Standard
A.5.d.). If a client is also a friend, the friendship might make it difficult for
the counselor to confront the client when it would be clinically beneficial to
do so. The client might struggle with honesty and openness as well. Most
clients occasionally are concerned that they may disclose something about
themselves of which their counselor may disapprove. If their counselors are
also their friends, clients may be even more reluctant to disclose for fear that
they will lose both their friend and their counselor. They may decide to withhold information that is important to their progress or growth.
Does developing a friendship with former clients present ethical problems? Although counselors are not legally or ethically prohibited from
entering into a nonsexual relationship with a client after counseling has
terminated, the practice could result in problems for both the client and
the counselor. The imbalance of power may change very slowly or not at
all. Counselors should be aware of their own motivations, as well as the
motivations of their clients, when they allow a professional relationship
to evolve into a personal one, even after termination. Another point to
consider is that clients may want to return for further counseling sessions
after they terminate a professional relationship. If a friendship is in the
picture, this opportunity for follow-up counseling is foreclosed. When all
things are considered, the safest policy is probably to avoid developing
social relationships with former clients (G. Corey et al., 2015).
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Issues and Case Studies
Bartering
Bartering, or trading goods or services in exchange for counseling services, is generally discouraged, although counselors are often motivated to
do so for benevolent reasons, typically to help clients who cannot afford to
pay for services. According to the ACA Code of Ethics (ACA, 2014), “counselors may barter only if the bartering does not result in exploitation or
harm, if the client requests it, and if such arrangements are an accepted
practice among professionals in the community” (Standard A.10.e.). Zur
(2011) contends that bartering can be a dignified form of payment for those
who are cash-poor but talented in other ways and that bartering is a norm
in many cultures. He suggests that bartering can be part of a clearly articulated treatment plan and, like other interventions, must be considered in
light of the client’s needs, desires, situation, and cultural background.
Even with these altruistic intentions, bartering carries the potential for
conflicts. On the one hand, bartering is an accepted practice in some communities and cultures. On the other hand, bartering may lead to resentment
on the part of the client or the counselor. Services offered by clients often are
not as monetarily valuable as counseling, which could present problems in
bartering. A client may also believe that counseling is not working and that,
therefore, the counselor is not holding up his or her end of the bargain. Likewise, counselors may be dissatisfied with the timeliness or quality of goods
or services delivered by clients and may feel that they are giving more to the
exchange than they are receiving. A good practice in questionable circumstances is to seek consultation from a trusted colleague who can provide an
objective evaluation of the proposed arrangement in terms of equity, clinical
appropriateness, and the potential risks.
Receiving Gifts
Counselors are sometimes confronted with a situation in which a client
offers them a gift, and the ACA Code of Ethics (ACA, 2014) provides no
“hard-and-fast rule” as to whether the gift should be accepted or declined.
Standard A.10.f. reminds counselors “that in some cultures, small gifts are
a token of respect and gratitude.” When determining whether or not to
accept a gift from a client, several factors need to be considered: the quality of the therapeutic relationship, the clinical implications of accepting
or rejecting the gift, the stage of counseling when the offering of a gift is
occurring, the monetary value of the gift, a client’s motivation for giving
the gift, and the counselor’s motivation for wanting or declining the gift.
Conclusions
There are few simple and absolute answers that neatly resolve dilemmas pertaining to multiple or nonprofessional relationships with clients,
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students, or supervisees. It is a somewhat daunting but necessary task for
conscientious counselors to be familiar with the ACA Code of Ethics (ACA,
2014) and to keep current with the professional literature. Some multiple
or nonprofessional relationships can be avoided if potential problems
are foreseen, but others cannot. It is not always possible for counselors
to play a singular role in their work, nor is it always desirable. It is likely
that counselors will have to wrestle with balancing more than one role in
their professional relationships. It is critical that counselors give careful
thought to potential complications before they get entangled in ethically
questionable multiple relationships and that they take steps to safeguard
clients by making use of informed consent, consultation, supervision, and
documentation.
The two case studies in this chapter highlight some of the complexities
of decisions that involve boundary setting. In Case Study 13 (Disputing Unhealthy Beliefs or Imposing Values?), the counselor wonders whether she
might be more effective in assisting a client if the boundaries of the counseling relationship are extended to include the client’s pastor. In Case Study 14
(If You Will Excuse Me), a counselor provides counseling services to the
congregation of a church. The pastor does not seem to understand boundaries and the limits of confidentiality, creating an awkward social situation.
Case Study 13
Disputing Unhealthy Beliefs
or Imposing Values?
Craig S. Cashwell and Tammy H. Cashwell
Carl, a 55-year-old White male, is in counseling with Gina, a licensed
professional counselor in private practice, to support his early recovery
from alcoholism. He has just returned home from a 30-day residential program. He had suffered from alcoholism for more than 30 years but finally
decided to enter recovery after his wife of 25 years left him and both of his
daughters refused to talk to him. Carl’s parents have died within the past
5 years, and Carl, alone for the first time in his life, nearly drank himself
to death in a binge drinking weekend. After barely surviving this binge,
he entered recovery.
On his initial intake form, Carl indicated that religion/spirituality was
very important (ranking this as a “5” on a 5-point scale) but that he did not
want to talk about this in counseling. Although it was atypical for a client
to say that religion was so important but not want to talk about it, Gina
respected this request as the focus of counseling initially was building rapport, developing coping skills, and finding a support community to assist
in Carl’s sobriety. After these had been established, Gina gently pointed out
that Carl had initially indicated that religion was “very important” to him
but that he did not want to talk about it in counseling. Gina transparently
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Issues and Case Studies
disclosed her conflict around wanting to empower Carl by respecting his
request to not talk about religion but also wondering whether she might be
missing important information.
With this gentle invitation, Carl began to talk at great length about his
religious life. He grew up in a highly religious family and had been very active in his church since childhood. He was an ordained deacon, had taught
Sunday school for 25 years, and even had preached on occasion. He spoke
at length about the “Jekyll and Hyde” experience of being so active in his
religious community while keeping secret the shame of his addiction.
When Gina asked how he practiced his religion, Carl looked down and
hesitantly responded, “Well, I used to pray every day, but not any more.”
When asked to say more about this, Carl quoted a passage of scripture: “The
Lord is far from the wicked, but he hears the prayer of the righteous.” He
spoke haltingly of all the damage he had done in the world, adding that
there was no point in praying as he had pushed the Lord so far away that
his prayers could not be heard. Although Gina was aware of her desire, as
she listened, to reassure Carl that the Lord loves sinners, she set this aside
and kept the focus on Carl. She helped Carl talk about how sobriety had led
him to reflect on all the bad things he had done, which he reported included
physically and emotionally abusing both his ex-wife and two daughters,
along with engaging in numerous one-night stands over the years. He
reported that he had missed his second daughter’s wedding, where he was
supposed to walk her down the aisle, because he was too drunk to attend.
Carl concluded, “The Lord has a lot to worry about, so why waste my time
lifting up prayers to Him when He is so far from the wicked?”
Carl further described what it was like growing up in a conservative
religious family in which he was punished severely for any misbehavior,
often with threats of incurring God’s wrath and going to hell. Carl told a
particularly emotional and poignant story of being punished severely for
having a wet dream as a teenager, with the punishment of being spanked
in an age-inappropriate manner and lectured about the wickedness and
immorality of sex.
Questions for Thought and Discussion
1. Is it appropriate for Gina to focus on Carl’s religious beliefs?
2. What are your personal beliefs about Carl’s statements about religion and spirituality? How might these beliefs influence your work
with Carl?
3. If you were the counselor in this case, what interventions might you
consider implementing?
Analysis
Clients’ spiritual issues and beliefs can be among the trickiest for counselors, largely because such beliefs form a core part of one’s identity.
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On the one hand, Gina has to be aware of her own personal beliefs, biases, and predilections about spirituality. In this case, Gina’s religious
background was not entirely dissimilar to Carl’s, but she was aware
that her beliefs were far more liberal, and she had to be mindful of
her impulse to “reassure” Carl that he was not beyond redemption.
Although the belief that one’s actions can be forgiven is psychologically sound, to push this belief on Carl may constitute an imposition of
counselor values.
On the other hand, Carl is describing a spiritual practice (prayer) that
historically has served as a great source of hope and support for him but
that he has abandoned for what might be considered an irrational belief.
If Carl’s belief that he is unloveable and unforgiveable was not related to
his Higher Power, the counselor likely would gently challenge this belief.
Should Gina, as Carl’s counselor, shy away from this issue simply because
the relationship is Divine rather than human?
How can Gina address Carl’s belief that he is beyond forgiveness and
redemption and encourage him to resume a healthy spiritual practice?
Gina must not blur the boundary between counselor and spiritual director/
clergy, nor can she disempower Carl by making his religious life a focus
of counseling when Carl has indicated that this is not what he wants from
counseling.
One approach to addressing the issue in a supportive manner would
be to involve Carl’s support network (ACA, 2014, Standard A.1.d.). Gina
could ask Carl for permission to talk with the pastor of his church to
better understand his religious beliefs. With written permission from
Carl, Gina could talk to the pastor and communicate Carl’s thoughts that
God does not hear his prayers because of past actions. In this conversation, Gina could get a sense of whether the pastor would reinforce this
belief or would emphasize forgiveness, grace, and mercy in Carl’s situation. If the former is true, the conversation with the pastor would likely
remain simply a consultation to better understand Carl’s belief system.
If the latter is true, Gina might ask if the pastor would be willing to meet
with Carl to discuss forgiveness and mercy. Gina could emphasize to
the pastor that Carl grew up in a religiously authoritative family and
that it might be important to engage in discussion with Carl to empower
his evolving belief system rather than “lecturing” or “preaching” about
what is right, which runs the risk of recapitulating the authoritative style
of his parents.
If the pastor is willing and if Carl begins to meet with the pastor, Gina
could use her counseling skills to process with Carl anything from the meetings with his pastor that Carl wished to discuss while still keeping the
boundaries clear in the counseling relationship. The hope, then, would be
that Carl could receive the spiritual guidance he needs while also engaging in the important work of recovery and that the two components would
synergistically reduce the shame and guilt associated with his addiction.
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Issues and Case Studies
Questions for Further Reflection
1. What would you do if Carl did not give you permission to talk to his
pastor?
2. What would you do if Carl’s pastor emphasized a shame-based religion and agreed with Carl’s conceptualization that God would not
hear his prayers because of his past actions?
3. How can a counselor work most effectively with other professionals
(such as pastors) to assist a client without violating boundaries or client
confidentiality? What steps need to be taken to ensure client welfare
before entering into these kinds of collaborative relationships?
Case Study 14
If You Will Excuse Me
Matthew L. Lyons
Dwight is an experienced counselor who has been asked to join the staff of
a local church to provide professional counseling services to its members.
The Senior Pastor approached Dwight with the idea, wanting to address
what he called a “rising need for mental health services among our people.” The church congregation is large and employs 15 staff people. The
Senior Pastor wants all staff to be able to refer to Dwight any congregation
members in need of counseling.
Dwight is aware that the church setting poses some unique challenges.
He is careful to ensure that the Senior Pastor and other leaders understand what it means to offer professional counseling. After several months
of discussions regarding confidentiality, boundaries, office space, money,
and other details, Dwight joins the church staff. Dwight, the Senior Pastor, and other leaders of the congregation agree to a launch date that is
8 weeks away to ensure that Dwight has sufficient time to address the
logistics of this new endeavor. Dwight begins working immediately.
Two weeks before the scheduled launch date, the Senior Pastor calls Dwight
and asks if he will see his friend Wayne and Wayne’s wife Lisa, who are in
need of marriage counseling. The Pastor clarifies that Wayne and Lisa are
just his friends and do not attend or belong to the church. Dwight expresses
his preference to wait until after the agreed-upon start date to meet with the
couple. After some urging from the Senior Pastor, however, Dwight suggests
that the couple call him the next day to schedule an appointment. Dwight arrives at his office the next day, finds a message from Wayne, returns the call,
and schedules an appointment for the following week. The same afternoon
Dwight runs into the Pastor in the hallway. The Pastor asks, “Hey, did you
hear from Wayne yet?” Dwight deflects the question and continues walking.
A week later, Dwight meets with Wayne and his wife Lisa for the first
time. Wayne and Lisa are both in their mid-50s. They have been married for
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34 years and report ongoing struggles, including infidelity, substance abuse,
and depression. Wayne expresses his appreciation for the Pastor’s referral
and elaborates on his close friendship with the Pastor. Wayne is a sales rep
for a golf club manufacturer. He met the Pastor at a golf outing, and they
have since become good friends. Wayne adds that he recently helped the
Pastor get a good deal on a new set of golf clubs. Wayne and Lisa are very
open about the challenges facing them. After sharing their reasons for seeking counseling, they inquire about confidentiality and emphasize that they
do not want the Pastor to know the content of their sessions.
Two days after Wayne and Lisa’s first session, Dwight is attending a
community social event. He is talking with a group of people, including the Senior Pastor and several other church staff members. The topic
turns to golf and favorite golf clubs. Dwight does not play golf, but he
listens with interest. At one point the Pastor describes his new golf clubs
and brags about the price he paid. As others express their appreciation
of his purchase, the Pastor puts his hand on Dwight’s shoulder and says,
“Our buddy Wayne really hooked me up. It helps to know people, doesn’t
it, Dwight?” The question hangs as the Pastor’s hand continues to rest
on Dwight’s shoulder. Those involved in the conversation, not knowing
to whom the Pastor is referring, look to Dwight for a response. Dwight,
knowing that the Pastor is referring to his client, feels time stand still as
he considers his options. Choosing a course of action, Dwight subtly lifts
his glass and says with a chuckle, “I don’t know much about golf, but I
do know that I am thirsty. If you will excuse me, I’m headed for a refill.”
Dwight dismisses himself from the conversation and leaves the social
gathering as quickly as he can.
Questions for Thought and Discussion
1. What do you think of the way Dwight handled the situation at the
social gathering? Was removing himself from the conversation and
from the gathering the best option?
2. What are the larger issues involved with Dwight’s new position that
need to be addressed?
Analysis
There are two primary ethical issues in this scenario. First, Dwight had to
carefully handle the immediate situation when he was put on the spot in
the conversation. Dwight likely felt very uncomfortable at the mention of
his client’s name. His primary responsibility is to protect his client’s confidentiality and well-being. However, Dwight may also want to respect the
Senior Pastor in this conversation and use the opportunity to promote collegiality. The other staff members involved in the conversation know that
Dwight is new to the area and to the staff. They are well aware of his position
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Issues and Case Studies
as a counselor. Dwight realizes that some may be wondering how the
Pastor and Dwight are both connected to Wayne. Dwight, realizing this,
may have been concerned that either acknowledging or denying that he
knows Wayne and remaining in the conversation would have had further
ramifications. His choice to divert the subject and remove himself from the
situation seems appropriate.
The second important ethical issue is one of boundaries in the relationships among the Senior Pastor, Dwight, and his clients. Dwight is to
be commended for his work prior to joining the staff to ensure they all
understood confidentiality and boundaries. Nonetheless, this situation
and others leading up to it clearly suggest that the Pastor does not understand the role of the professional counselor and the confidential nature of
the counseling relationship. Although Dwight seems to have chosen the
most appropriate course of action at the social event, it is clear that he cannot ignore the Pastor’s actions.
Once Dwight is removed from the social situation, he may be tempted
to let it go, but inaction would be inappropriate. As an employee of the
church, he has an ethical obligation to “strive to reach agreement with” his
employer [the Pastor] as to “acceptable standards of client care and professional conduct” (ACA, 2014, Standard D.1.g.). It is imperative that Dwight
clearly communicate his concerns about the conversation to the Pastor.
Often, professionals outside the counseling profession are not aware of
the ramifications of casual conversation and may not be as cognizant of
the need to uphold professional boundaries. It seems likely that the Pastor
will be open to learning from the incident and using it to reshape future
communications.
Dwight might consult the ACA Code of Ethics, looking for guidance
on how to handle his situation, but his unique situation is not directly
addressed. Standard A.6. elaborates in some detail the counselor’s responsibilities related to managing and maintaining boundaries and professional relationships but states only that counselors need to “consider the
risks and benefits of accepting as clients those with whom they have had
a previous relationship” (Standard A.6.a.). It was the Pastor, not Dwight,
who had a prior relationship with Wayne and Lisa before Dwight agreed
to serve as their counselor. Standard A.6.b. cautions against extending
counseling boundaries “beyond conventional parameters,” but again,
Dwight met with the couple only within the boundaries of an established
appointment in his office. Perhaps the most relevant advice for Dwight
that can be found in the Code is the requirement to consider “anticipated
consequences” (Standard A.6.c.) and “take appropriate professional precautions” (Standard A.6.b.) when dealing with situations that present
potential boundary issues.
Dwight may find himself questioning his ability to provide professional counseling in this venue. He knew the church environment would
provide some unique challenges. He realizes now more than ever that
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Managing Boundaries
all staff must uphold the ethics that guide the counseling relationship.
Furthermore, Dwight realizes that the Senior Pastor sets the tone for the
rest of the staff and if the Pastor does not respect the ethics surrounding
the counseling relationship, it may be hard to convince others. Dwight
may find that it is a continual struggle to uphold his professional ethics
in this setting.
At the very least, the events that have occurred should cause Dwight to
question the basic setup of the counseling practice. Part of the challenge
in this scenario is the Pastor’s involvement from the beginning. Dwight
will need to spend more time ensuring that the structure protects the confidentiality and well-being of his clients and training the other staff to do
the same.
Questions for Further Reflection
1. One of the best ways to be prepared for the unexpected occasion
when someone asks about or mentions a client is to plan for it. What
steps might Dwight have taken to prevent the incident described in
the scenario?
2. Providing professional counseling in a church or other nontraditional venue introduces unique challenges. How can risks be minimized
when multiple relationships exist among the people involved in a
counseling practice?
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Chapter 8
Working With Clients Who
May Harm Themselves
James L. Werth Jr. and Jennifer Stroup
Clients who have the desire to harm themselves present special challenges
that could have both professional and legal consequences. Clients who
may be at risk for self-harm are often a source of anxiety and confusion
for counselors. It is impossible to constantly monitor clients’ actions, and
there is significant pressure to make the “right” decision because the outcome of mismanagement can be devastating for all parties involved. In
reality, clients could seriously harm themselves even under the best therapeutic conditions. However, the risk of a negative outcome can be significantly reduced if counselors practice in accordance with professional
standards of care.
In working with clients who may harm themselves, counselors may
have questions such as these: “What are my ethical responsibilities to
the client?” “How will I know if the client is at an increased risk for
self-harm?” “Should I break confidentiality to prevent self-harm, and
if so, when?” Fortunately, the ACA Code of Ethics (American Counseling
Association [ACA], 2014) provides guidance in the areas of informed
consent, confidentiality, counselor competence, and consultation that
can assist counselors in making decisions about the assessment and
treatment of high-risk clients. The Code also addresses some issues associated with terminally ill clients. This chapter highlights standards
that can affect working with clients who are at risk for self-harm and
clients who are making end-of-life decisions.
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Issues and Case Studies
The Code states that the general requirement of confidentiality “does
not apply when disclosure is required to protect clients or identified others
from serious and foreseeable harm” (Standard B.2.a.). Counselors should be
aware that a wide range of behaviors could be considered to place clients at
risk for harm, including cutting, self-mutilation, and suicide. Some authors
have conceptualized self-harm as occurring along a continuum of types from
nonsuicidal self-injury (NSSI) to suicide (Muehlenkamp & Gutierrez, 2007).
Fourteen types of NSSI have been identified, including skin cutting, scratching, and burning, in which the person deliberately inflicts bodily injury
without suicidal intention (Glenn & Klonsky, 2009). Although not all individuals who self-injure will attempt suicide, they do appear to be at greater
risk (Muehlenkamp & Gutierrez, 2007). Joiner (2005) developed a model in
which the act of self-injury allows an individual to become desensitized to
fears and physical pain associated with self-injury, increasing the person’s
capacity to engage in lethal acts of self-harm. Although this discussion
focuses on suicidal behavior, the ethical standards and techniques discussed
can be generalized to other behaviors on the self-harm continuum.
Informed Consent
Counselors may be hesitant to discuss issues of self-harm with a client,
especially if the client does not bring them up. Some counselors may fear
that they will introduce the idea of self-harm or that the therapeutic relationship could be damaged if there is a serious concern and confidentiality
needs to be broken. Counselors can ease the discomfort of addressing the
issue of self-harm by discussing it within the context of informed consent.
“Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship” (ACA, 2014, Standard A.2.a.).
The informed consent discussion is used to educate the client about
the counseling process, including agency policies, expectations about
counseling, and confidentiality. Limitations of confidentiality need to
be explained “at initiation and throughout the counseling process, [and]
counselors inform clients of the limitations of confidentiality and seek to
identify situations in which confidentiality must be breached” (Standard
B.1.d.). It is important to clarify for clients that session material will be held
confidential with some exceptions, including “when disclosure is required
to protect clients or identified others from serious and foreseeable harm or
when legal requirements demand that confidential information must be
revealed” (Standard B.2.a.). Explaining this exception provides counselors
with a way to explore to what degree “serious and foreseeable harm” is
present, which can aid in the decision about whether to break confidentiality. It also informs clients that, if there is concern about serious risk,
confidentiality could be broken and further safety precautions, such as
hospitalization, might be taken.
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Counselors also should provide clients with information regarding
treatment options because clients have a right to “refuse any services or
modality changes and to be advised of the consequences of such refusal”
(Standard A.2.b.). This does not mean that clients can override counselors’ clinical judgment and refuse to go to the hospital when it appears
that a suicide attempt is imminent. Rather, clients should be informed that
involuntary hospitalization may be necessary if other crisis intervention
strategies are not effective.
Assessment
If clients do not voluntarily self-disclose intentions to harm themselves,
counselors may need to ask directly. Factors that could increase clients’
risk for self-harm include severe mental illness, substance abuse, recent
loss, and acute medical conditions (Bongar & Sullivan, 2013). The client
may be experiencing high levels of negative thoughts and emotions such
as feelings of shame, helplessness, hopelessness, or depression; have increased levels of self-hatred or loathing; and may have lost pleasure or
interest in life. To gain a complete picture of the level of risk of self-harm,
counselors need to assess the client’s ideation, plan, and means.
When assessing for ideation, counselors want to learn about the content
and frequency of thoughts about self-harm: “Have you felt bad enough
that you have considered harming yourself?” If the client indicates
this may be true, the counselor should determine when this occurred. If
ideation existed in the past, the counselor should ask about that incident
and its outcome. If the client indicates the thoughts are current, it is important to assess their purpose. For example, clients who cut themselves
may not be suicidal because behaviors have different meanings for different clients. Clients may want to cut to release anxiety or tension, to
come out of a dissociative experience, to regain a sense of self-control,
to manipulate attention from other people, or to indulge in self-hatred,
vent anger, or alter sexual feelings. It is possible, however, that individuals
who are self-injuring and experiencing a lack of motivation, feelings of
apathy, and a lack of future orientation may be at an increased risk for
suicide (Muehlenkamp & Gutierrez, 2007). Other research has suggested
that adolescents who self-injure in isolation compared to socially may be
at an increased risk for suicide (Glenn & Klonsky, 2009). Keep in mind that
even if the client is participating only in self-injurious activities, it is still
possible that the counselor would have to take additional steps to protect
the client, depending on the severity of the behaviors.
If clients indicate that they do have suicidal ideation or other thoughts
of harming themselves, counselors need to further explore to determine
the level of risk: “Do you have a plan?” “Have you thought about how you
would do it?” These are both good questions to determine how serious
clients are about acting on their thoughts. If a client has a well-formulated
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plan, the level of risk may increase. In some situations, the client may have
a plan, but the plan is not practical because there is no access to the means
to carry it out. For example, if a client states she or he would only use a
gun, the counselor needs to ask, “Do you have access to a gun?” If the client has ideation, a concrete plan, and easy access to the means by which to
carry out the plan, there is a heightened risk of harm to self.
Counselors also may want to consider psychological factors such as
the client’s current sense of crisis, mental status, level of psychopathology,
personality, and perception of the therapeutic relationship to determine
the urgency of risk (Bongar & Sullivan, 2013; Linehan, Comtois, & WardCiesielski, 2012). Formal assessment tools may be helpful in collecting
information about these intrapsychic factors and in monitoring the client’s
progress; however, the counselor must be trained in the proper use and
interpretation of these instruments (ACA, 2014, Standard E.2.a.).
Treatment Planning
Developing a good treatment plan can help counselors protect the client
from “clear and imminent danger,” and conducting a thorough assessment can help counselors decide if or when it would be necessary to break
confidentiality. Disclosure may not be needed if crisis intervention is successful and the client is willing to work with the counselor to remain safe.
Options for treatment could include increasing social support, individual
or family therapy, substance abuse treatment, medication, access to the
therapist or crisis hotline for times between sessions, and relapse prevention strategies (Bongar & Sullivan, 2013). Some writers recommend having
the client sign a “no-harm contract” (NHC); however, it should be understood that this intervention does not provide counselors with any legal
protection and may actually be used against them in court (Walsh, 2006).
There is no research demonstrating that NHCs are efficacious in preventing self-injurious behaviors (Lewis, 2007; McMyler & Pryjmachuk, 2008;
Walsh, 2006). Although we do not want to encourage the use of NHCs,
we encourage readers to see Hyldahl and Richardson (2011) for key considerations if they choose to use NHCs with clients who self-injure. These
authors provided several recommendations, such as the need for an ongoing therapeutic relationship, ongoing risk assessment, collaboration, and
use of positive coping skills. We believe that using the informed consent
framework to discuss treatment options, the choices clients could make
regarding the course of treatment, and the consequences of those choices
is a better option than relying on a contract. This framework allows the client to actively participate in treatment and does not provide the counselor
with a false sense of security (Miller, 1999).
If the client does not respond to crisis intervention attempts and there
is an imminent risk of harm to self, confidentiality may need to be broken
(ACA, 2014, Standard B.2.a.). In addition, “counselors consult with other
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professionals when in doubt as to the validity of an exception” to ensure
that it would be appropriate and necessary to break confidentiality (Standard B.2.a.). Before disclosure occurs, the counselor should make an effort
to keep the client involved in the therapeutic process. Sometimes clients
will agree to go to the hospital because the counselor would not be revealing the information to outside sources and thus clients could maintain
some control over confidentiality of information. At other times, the counselor may decide to break confidentiality. “To the extent possible, clients
are informed before confidential information is disclosed and are involved
in the disclosure decision-making process. When circumstances require
the disclosure of confidential information, only essential information is
revealed” (Standard B.2.e.). Informing clients before releasing information not only is ethically recommended but can help keep clients actively
involved in treatment.
End-of-Life Decisions
The Code states that “counselors who provide services to terminally ill
individuals who are considering hastening their own deaths have the
option to maintain confidentiality, depending on applicable laws and the
specific circumstances of the situation and after seeking consultation or
supervision from appropriate professional and legal parties” (Standard
B.2.b.). Previously, a counselor may have been obligated to break confidentiality even with a terminally ill client who was considering going off
a ventilator because this could be construed as “imminent danger to the
client.” Now, after receiving consultation or supervision, counselors may
decide not to divulge such information to others. Although this option is
potentially controversial, the Code provides counselors with latitude when
such clients have a desire for death.
The functions of the counselor in end-of-life situations, including those associated with assisted death, are to help clients have their
needs met, maximize client self-determination, help clients engage in
informed decision making, and conduct an evaluation or refer clients
to receive a thorough assessment regarding their capacity to make endof-life decisions. It should be emphasized that cultural issues may affect
what “self-determination” and “informed decision making” mean for
different individuals considering end-of-life decisions (Herlihy & Watson, 2004; Werth, Blevins, Toussaint, & Durham, 2002). Furthermore, it
can be important to consider whether the patient comes from a culture that
embraces Western individualist values or more collectivist values (McCormick, 2011). It may be the norm for health care decision making to be
based on a family orientation rather than patient autonomy in some cultures (Kagawa-Singer & Blackhall, 2001).
Counselors need to be able to conduct a thorough and culturally competent assessment or refer a client to a competent provider. The literature
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Issues and Case Studies
provides guidelines for competence in these situations (Chu et al., 2013;
Werth, 1999b) as well as for what would be involved in a comprehensive
evaluation (e.g., Werth, 1999a; Werth, Benjamin, & Farrenkopf, 2000; Werth
& Rogers, 2005; Working Group, 2000). Such an assessment can be useful
with any dying person who is making end-of-life decisions. This is consistent with discussions that do not differentiate among various types of
end-of-life decisions (e.g., Werth & Kleespies, 2006; Werth & Rogers, 2005).
It has been suggested that the same type of assessment could be conducted for people with suicidal ideation as for those who are making endof-life decisions (Werth & Rogers, 2005). Some authors have asserted that
the same issues may be involved when individuals want to kill themselves
through a deliberate overdose, hanging, or using a gun as when someone
wants to go off a ventilator, discontinue dialysis, or have a physician help
the person die. Just as clinical depression, hopelessness, and social isolation may contribute to a person’s suicidality, these conditions might also
be part of a terminally ill individual’s end-of-life decision making.
Throughout the process of working with clients who are at risk for
harm to self, including those making end-of-life decisions, counselors
should consider taking three additional steps. First, counselors should
consult with other professionals: “Counselors take reasonable steps to
consult with other counselors, the ACA Ethics and Professional Standards
Department, or related professionals when they have questions regarding their ethical obligations or professional practice” (ACA, 2014, Standard C.2.e.). Consultation helps to ensure that counselors are practicing
within the standard of care, making informed decisions about the exceptions for confidentiality, and accessing all of the current treatment options.
Second, counselors should determine whether they have the competency
and training to work with such a client: “Counselors practice only within
the boundaries of their competence, based on their education, training,
supervised experience, state and national professional credentials, and
appropriate professional experience” (Standard C.2.a.). Counselors who
do not think they can work competently with a client should seek supervision from a professional who has these skills or make the appropriate
referral. Finally, counselors need to appropriately document the assessment, consultation, and treatment planning that occurred. It is important
to document the steps of the decision-making process, including which
interventions were chosen, the rationale for the decision, and why certain
treatment options were not chosen.
In summary, when clients are making decisions that may affect the
length of their lives, counselors can use the guidance in the ACA Code
of Ethics to assist them in providing appropriate informed consent and
then making decisions about how best to proceed. As is the case in any
potentially controversial situation, counselors working with such clients
may want to consult with other professionals and will definitely want to
carefully document their assessment, decision making, and interventions.
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The first case study in this chapter, Case Study 15 (Suicide or a WellReasoned End-of-Life Decision?), illustrates how suicidality and end-oflife decisions can be interrelated and the important role of assessment
in such situations. In Case Study 16 (A Suicidal Teenager), the counselor
faces a variety of ethical issues when working with a 17-year-old client.
Case Study 15
Suicide or a Well-Reasoned
End-of-Life Decision?
James L. Werth Jr. and Jennifer Stroup
Jason is a 38-year-old gay man with AIDS. In his counseling session, he
presents with concerns about dealing with the progression of his illness
and uncertainty about his future. He reports that he has struggled with
depression and anxiety for much of his life and was suicidal during adolescence when he was coming to realize he was gay. He has been estranged
from his family of origin (parents, older brother, and younger sister) since
he came out to them when he was in his early 20s. He also was rejected
by his church and believes that “God turned His back on me, so I turned
my back on Him.” He does have some friends in his local gay community
and in the HIV support group he attends once a week, but he has not been
able to maintain a significant relationship since learning of his HIV status.
Jason learned he was HIV positive 8 years ago, but based on how sick
he was when he was tested, he reports that his physicians think he has
been infected for at least 15 years. He started on medications immediately,
but he has developed resistance to most of them because of an admitted
lack of adherence. During a recent medical exam, Jason was told that the
combination of medications he is now taking seems to be holding the HIV
in check. However, he does not appear to be getting any better, and there
are no other options for him at this point. His physician told him that she
could not predict how much longer these medications would continue
working but that it could be years and that new types of drugs are coming out on a regular basis. Jason thinks his quality of life is poor right now
because of the side effects of the medications and the advanced state of his
HIV infection, with his daily symptoms including night sweats, nausea,
diarrhea, fatigue, and numbness or pain in various extremities. He has
been unable to work on a plant assembly line for the last 6 years because
of the HIV and associated problems. Even if he could work, he doesn’t
think he would be able to find a job given his condition and the job market
in the area.
Jason is not sure he wants to continue living this way, especially because
he has seen several of his friends in the HIV support group and in the larger
gay community die terrible deaths related to HIV disease. Because it looks
like he is going to die anyway, he says that he might as well have a good
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quality of life the last few months and has seriously considered stopping
his medications so the side effects go away. When he mentioned to his physician the idea of a “drug holiday,” which has been discussed in the HIV
magazines he reads, his doctor said that if he stopped the medication he
would not be able to start it again because the virus would be resistant to the
drugs. There are no new medications for him to try if he wants to start back
on medication, so he faces the very real possibility of dying.
In addition to the HIV medication, Jason is taking two types of antidepressants that help some with his anxiety. He has a prescription for an
additional anxiolytic, which he reports taking more frequently recently
because of his increased anxiety when he goes out in public. Jason thinks
his HIV-positive status is more apparent now and that people are staring
at him and judging him. Jason also has a prescription for sleeping pills, a
narcotic pain medication, and a prescription for the nerve condition he has
developed. In addition, he is taking medications to counter the side effects
of the other medicines, so he also has pills for nausea and diarrhea. As a
result, Jason may take 20 or more pills a day, depending on how bad his
symptoms are, and he is getting tired of having to do this day in and day
out. Another side effect of all this medication is that he has little appetite
and nothing tastes good. He smokes marijuana on a regular basis, both
to increase his appetite and to help with the nausea. Although he admits
that he used to drink every day, he stopped using alcohol and other recreational drugs (other than marijuana) when he began his HIV medications.
At the end of the session Jason says that he has appreciated talking and
that it has helped him to look at everything he is facing in his life and what
his future holds. He says that after listening to himself, he has decided
that it makes the most sense to stop taking his HIV medication and enjoy
the little time he has left by traveling. He wants to see parts of the country
he has never explored instead of being stuck at home or at least close to a
bathroom because of the side effects of the medications. He indicates that
he may as well cash in his life insurance policy and pay for everything
with his few remaining credit cards. It will not matter if he ruins his credit
rating, and there is no one to whom he wants to leave his insurance money. Finally, he says that he does not think he needs another session because
he will either be really sick or be on the road in the next few weeks.
Questions for Thought and Discussion
1. If you were the counselor in this case, what components of informed
consent would you want to review with Jason?
2. How could you determine if you are competent to treat Jason?
3. What decision-making process would you use for Jason’s treatment
planning? How could you keep Jason involved in this process?
4. What factors contribute to Jason’s risk of harm to self? If you were
Jason’s counselor, under what conditions would you consider maintaining or breaking confidentiality?
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Analysis
Depending on how the counselor interprets Jason’s current situation and
his past experiences, the counselor could consider him to be suicidal or
to be making a well-reasoned end-of-life decision. Without further information that would be gathered during a thorough assessment, we believe
the counselor could justify leaning either toward intervention or toward
letting him leave. For the interventionist, Jason does have a history of depression and suicidal ideations, has few social supports, has no religious
faith, is unemployed, is having health problems, has seen negative experiences in friends who had his illness, is using at least one illegal substance, and has medication on hand that could be used for suicide. For the
noninterventionist, Jason is taking antidepressants, is in a support group,
has considered his options, has consulted with his physicians, does have
severe physical problems that do not appear ameliorable in the foreseeable
future, does not appear to have loved ones who would be traumatized by
his death, and does have a right to stop medical treatment.
Whatever decision the counselor makes should not come as a surprise
to Jason. Counselors should have a thorough written and verbal informed
consent policy and process that begins at the beginning of the counseling
relationship and continues throughout the sessions. Counselors who work
with people with terminal conditions need to be careful and specific about
what they tell clients about intervening in the event that they consider
harm to self to be a possibility. Clients deserve to know that it is safe to talk
about something such as stopping medication and that such disclosures
will not automatically be considered harm to self, initiating potentially
forceful interventions. Counselors need to know their obligations under
state law; unless there is a specific directive to intervene, they have options.
The ACA Code of Ethics (ACA, 2014) does not require intervention when
terminally ill clients are considering their end-of-life choices.
A thorough evaluation of Jason will help the counselor determine
whether he has impaired judgment or whether any ameliorable conditions are negatively affecting his quality of life. A good assessment will
help the counselor determine whether Jason’s decision seems to be more
similar to suicidality or to a considered end-of-life decision. In either case,
we would recommend that the counselor review the literature, consult
with others, and document what was done and not done, and why.
Questions for Further Reflection
1. If you were a consultant in this case, what advice would you give the
counselor, and why?
2. How do cultural factors come into play in this case and in general
when thinking about suicide and end-of-life decision making?
3. What would you do if you were in Jason’s situation, and why? What
would you want your counselor to do?
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Case Study 16
A Suicidal Teenager
Robert E. Wubbolding
Frank, age 17, has been referred to a counselor in private practice because
of recent changes in his behavior. He is withdrawn and is uncharacteristically irritable with his parents. He has been an average student, but his
grades have fallen recently. He has also given away some of his prized
possessions, including a baseball that was very valuable to him because he
caught it in the stands at a major league game. Other gifts to friends have
included a pair of boots, a school jacket, and a cherished set of baseball
cards. His parents don’t understand his behavior and are concerned about
him, telling the counselor that Frank is given to expressions of hopelessness and anger. They connect these feelings with the fact that his girlfriend
recently dropped him in favor of a more popular student at school.
During the first session, the counselor helps Frank describe why he has
been sent. He freely describes his unhappiness at home and school, stating
that he is fed up and very angry that his girlfriend dropped him. He says
that she’ll be sorry when it becomes impossible for her to get back with
him, adding that soon he will be free of all this agony. The counselor asks
how he has handled disappointments in the past. Frank relates that he
always gets upset when he can’t get his way and that if people don’t like
him he finds little ways to get even. He then feels overwhelmed with guilt
over his reactions. The way he chooses to deal with the guilt, hurt, and
ubiquitous pain is to get high with a few friends. He adds that his parents
are unaware of his drug use, which he denies is a problem. Subsequent
discussion between the counselor and Frank goes like this:
Counselor: Frank, you said earlier that you had a solution to your
problems.
Frank: Yeah, I guess so.
Counselor: Tell me more about your thoughts on ways you might best
solve your problems.
Frank: Well, I’ve thought of things. . . . I just don’t want to struggle so
much anymore.
Counselor: Are you exhausted from the stress of struggling?
Frank: Yeah, sort of.
Counselor: Feeling down in the dumps?
Frank: That describes it.
Counselor: Maybe you’ve gone down as far as you’re going? Do you
want to come out of the dumps?
Frank: I sure would.
Counselor: I believe I can help you start to climb.
Frank: I’ve already found the best answer to my problems.
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Counselor: I routinely ask people a simple question when they are upset
about something. Are you thinking of killing yourself?
Frank: One of my classmates did that last year.
Counselor: Was this classmate a friend?
Frank: Yeah, kind of.
Counselor: Do you miss him?
Frank: I sure do.
Counselor: What are your thoughts about moving on and making other
friends?
Frank: I don’t want to be bothered.
Counselor: Have you thought about joining your friend?
Frank: I think it would be a good idea.
Counselor: Is that a “yes”?
Frank: Yes, I’ve thought a lot about it.
Counselor: Have you ever talked about this with anyone?
Frank: No. This is the first time I’ve said it out loud.
Counselor: Sometimes it helps just to talk about it. I’ve found that people
feel better if they are willing to talk about what is on their mind. I’d
like to ask you some more questions about your thoughts on dying.
Is that OK?
Frank: Sure, it’s OK.
Counselor: Have you tried to injure yourself or to commit suicide in the
past?
Frank: One time, about a year ago, I took a razor and cut my arm. But I
got scared when I saw the blood, and I stopped.
Counselor: Have there been any other times?
Frank: No, that’s the only one.
Counselor: If you were to try to kill yourself again, how would you do it?
Frank: I was thinking I’d drive my car into a busy intersection at 4:00
p.m. on Route 12 when the 18-wheelers are out on the road. It would
be quick and would look like an accident.
Counselor: I see. So you’ve thought about a plan and you have your own
car?
Frank: Yes, I’ve had it for about a year.
Counselor: Frank, I believe I can help you feel better. I think I can offer
you the possibility of getting past this misery. Would you be interested in thinking about some of these ideas before you make this
final decision?
Frank: I might. . . .
Counselor: To put it another way, do you think you can do the work
involved? It would be something you could handle.
Frank: I’d like to try.
Counselor: Good. First, I want to ask you if you can agree to make a firm
commitment, not to me, but to yourself, to stay alive for a while?
Frank: Yeah, I think so. I haven’t tried anything yet.
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Counselor: For how long?
Frank: What do you mean?
Counselor: Can you agree to stay alive, not to kill yourself accidentally
or intentionally, for a week? a month? or how long?
Frank: I can do it for a month. What did you mean by accidentally?
Counselor: Like driving recklessly or accidentally pulling out in front of
an 18-wheeler.
Frank: I see what you mean. Yeah, I won’t kill myself.
Counselor: Is there anyone around you with whom you could talk if you
start to feel like killing yourself?
Frank: I have an uncle who might listen. I can’t talk to my parents.
Counselor: Would you be willing to talk to him if you seriously start to
want to kill yourself?
Frank: Yeah, that’s OK.
Counselor: Frank, how do you feel right now, after you’ve talked about
this for a few minutes?
Frank: I feel a little better.
Counselor: One more thing, Frank. Would it be OK with you if I talk to
your uncle? I’d like to get to know him a little bit. I would not want
him to become overly upset if you called him. My job is to do everything I can so that no harm comes to you.
Frank: Sure, that would be OK.
Counselor: What we’ve said shows that life can be better, that you are
able to do some things, make plans, and take actions that result in
feeling better. Would you be willing to work in that direction?
Frank: Yes, I’m willing. . . . Do you really think my life can be better?
Counselor: I really think so. I firmly believe that your life can take a
turn-around.
Questions for Thought and Discussion
1. What are the arguments for and against using a no-harm agreement?
If you were to use one in this case, what components do you think
would be helpful to include? Does it need to be in writing?
2. Should Frank be referred for a psychiatric assessment?
3. Frank has said that he can’t talk to his parents. If the parents are
brought in, what is the risk that Frank will feel angry and betrayed
and that the counseling relationship will be destroyed?
4. What is your responsibility to the parents when counseling a 17-yearold student?
Analysis
Counselors recognize that the ultimate decision to intervene or not is
subjective and often entails resolving the pull of apparently opposing
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responsibilities. Counselors who function at the highest level of ethical
behavior ask specific questions of clients who express suicidal ideation.
They know how to assess the lethality of the threat and determine the proximity of rescue. In assessing dangerous behavior on Frank’s part, the counselor needs to determine the seriousness of the threat: Is there a plan? Has
the person seriously thought about death? Does he have the means available to kill himself? Who could stop him? What kind of emotional support
is available in the family, at home, or elsewhere? The counselor asks these
questions calmly, clearly, and unambiguously after having established rapport with Frank. It is important for the counselor to express confidence
that Frank will feel better without minimizing the problems. The counselor
tries to instill a sense of hope but avoids making a guarantee.
The counselor will want to consult with a colleague (ACA, 2014, Standard B.2.a.) and to document the consultation. In documenting, quotes
from the counselor and consultant are helpful in ensuring that the assessment was both thorough and comprehensive.
Standard B.5.b. states that “counselors work to establish, as appropriate,
collaborative relationships with parents/guardians to best serve clients.”
Frank’s counselor is aware of the importance of proceeding with counseling related to other issues. After the crisis has passed and throughout the
counseling process, the counselor can begin to explore Frank’s drug use,
how he handles stress, the roots of his unhappiness, rational and irrational
thinking, self-evaluation, effective fulfillment of needs, personal goals, interpersonal relationships, and myriad other issues. Because of the limited
value of a self-care contract or no-suicide agreement, the counselor will
emphasize Frank’s problem-solving skills and social activities as a means
to address Frank’s internal and environmental stressors. At some later
point, the counselor may want to involve the parents in family counseling
sessions if Frank is in accord with this decision. In addition, the possibility
of the use of medication may be discussed.
In Frank’s case, two sets of competing needs seem apparent: a responsibility to protect Frank from harm versus his right to privacy, and a possible need
to intervene beyond providing counseling versus a need to keep the client
engaged in the counseling process. The fact that Frank, at 17, is still legally a
minor is a complicating factor. Confidentiality requirements do “not apply
when disclosure is required to protect clients or identified others from serious
and foreseeable harm or when legal requirements demand that confidential
information must be revealed” (Standard B.2.a.). In this case, after a careful
assessment, Frank’s counselor made the judgment that danger was not imminent. In addition, the counselor engaged Frank in the decision-making process: “When counseling minors, incapacitated adults, or other persons unable
to give voluntary consent, counselors seek the assent of clients to services and
include them in decision making as appropriate” (Standard A.2.d.).
As G. Corey et al. (2015) have noted, the crux of the dilemma in dealing with suicidal clients is knowing when to take a client’s hints or
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verbalizations seriously enough to report the condition. The burden of
responsibility to make the right decision is heavy, and the ethically conscientious counselor will need to call upon a combination of skill and
training, careful assessment of risk, consultation and documentation,
and sound professional judgment.
Questions for Further Reflection
1. How well do you manage your own stress and deal with the awesome sense of responsibility that can attend working with clients
who pose a danger to themselves or others?
2. Sometimes clients do commit suicide. When this happens, survivors
may look for someone to blame and bring suit against the counselor
for malpractice. What steps do counselors need to take, as they work
with suicidal clients, to minimize the risk that such a suit could be
successful?
3. What steps do counselors need to take to deal with feelings of loss
and failure they may experience when a client commits suicide?
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Chapter 9
Technology, Social Media,
and Online Counseling
Martin Jencius
One of the most dramatic changes we have seen in the counseling landscape over the last decade has been the development of technology. Advances in technology and their impact on how we practice counseling
have occurred so rapidly that professional codes of ethics have not been
able to keep pace. Two decades ago, the Code of Ethics and Standards of
Practice (American Counseling Association [ACA], 1995) contained only
one relatively brief standard related to technology applications (Standard
A.12.). A decade later, in 2005, this standard was expanded considerably
to address a number of specific ethical considerations in using technology;
technology and computing issues were also mixed throughout the document. However, the 2005 Code contained no standards related to social
media in counseling, as it was just an emerging platform at that time.
The development of Web 2.0 technologies (social networking, microblogging and blogging, synchronous messaging, virtual worlds) began
to come into prominence in 2004 with the development of Facebook and
similar social networks. Social media includes sites such as Facebook,
MySpace, Google + (social networking), Twitter (microblogging), Blogger
and Wordpress (blogging), Yahoo Messenger, WhatsApp, Viber, Kik (synchronous messaging), and Second Life (virtual worlds). The growth in the
use of social media has been exponential since Web 2.0 platforms became
available. People spend approximately 25% of their online time using
some form of social media (Shallcross, 2011). As of September 2013, Facebook had 728 million daily active users and 1.19 million monthly active
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users (Facebook, 2013). Twitter had 100 million daily active users with
500 million tweets sent per day (C. Smith, 2013). WhatsApp, a popular
new global instant messaging system purchased by Facebook in February
2014, has more than 350 million users. Second Life, a virtual world environment where members can take on lifelike avatars, has more than 36
million registered residents, with 12,000 new daily signups and 1 million
active users (SecondLife.com, 2013).
The 2014 ACA Code of Ethics (ACA, 2014) addresses social media as a
new platform and emphasizes informed consent and the need for counselors to develop a social media policy. The new Code reflects the shift
from stand-alone computing, where the counselor or client works on an
isolated computer, to interconnected services where the counselor and client can have access to a social world or interactions. Counselors are now
provided with the opportunity “to deliver services remotely, eliminating
many of the limitations imposed by an office-based environment” (Harris & Younggren, 2011, p. 413). The Code places emphasis on the virtual
relationship between counselor and client and how counselors can safely
maintain a virtual presence.
Section H of the Code contains standards that are very direct and
unambiguous with regard to the use of technology, relationships established through computer-mediated communication, and social media as a
delivery platform. Major subsections in Section H address competency to
provide services and the laws associated with distance counseling, components of informed consent and security (confidentiality, limitations, and
security), client verification, the distance counseling relationship (access,
accessibility, professional boundaries), maintenance of records and accessibility of websites, and aspects of the use of social media.
A host of ethical and legal issues are associated with these new technologies. Issues such as self-disclosure, confidentiality, and relationship
boundaries can become more complicated when technology is involved,
and counselors are challenged to make ethical decisions about ways of
delivering services via the Internet.
Concerns Related to Distance Counseling
and Social Media Use
Professional literature that has appeared since the last revision of the ACA
Code of Ethics (ACA, 2014) has addressed general ethical concerns regarding online counseling and social media as well as applications of ethically
sound practice using technology. Manhal-Baugus (2001) provided one of
the earliest historic overviews of ethics and online e-therapy, inclusive of
services via email, video conferencing, virtual reality technology, and chat
technology. Manhal-Baugus examined the then-current ethics codes of the
ACA, National Board for Certified Counselors (NBCC), and International
Society for Mental Health Online with an emphasis on confidentiality,
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establishing relationships, legal considerations, informed consent, competence, structure of services, initial screening, records maintenance, and
emergency procedures. Shaw and Shaw (2006) surveyed websites of therapists who were advertising e-therapy to assess whether they included
ethical content for client care using the Ethical Intent Checklist. The Ethical Intent Checklist includes items that address full disclosure of the counselor’s name, state of practice, location and contact information, licensure,
and degree(s) and the college where they were obtained. The checklist
also screens for website statements that tell prospective clients that online
counseling may not be appropriate for them, that it is not the same as faceto-face counseling, instances when confidentiality can be breached, and
referral suggestions for clients. Shaw and Shaw also looked for statements
on websites that indicated the existence of an intake procedure before
counseling would begin; that the client would have to execute a waiver
about online services; and that client information on location, age, and
date of birth would be confirmed before proceeding. They reviewed 88
sites and found that less than half of the online counselors were following
the accepted practice on eight of the 16 items.
Finn and Barak (2010) surveyed online counselors from a variety of
professional backgrounds regarding their experience with legal and ethical issues. Although concerns were varied, issues that were raised included confidentiality, consumer identity, mandatory reporting, at-risk clients,
and practice jurisdiction. Similar findings were reported by Kaplan, Wade,
Conteh, and Martz (2011), who reviewed the legal and ethical issues surrounding social media in counseling. They identified boundary, confidentiality, confirmability, and informed consent issues as possible concerns
for counselors who use social media with clients. Kaplan and his colleagues also surveyed state licensure laws to determine which state laws
address counselor use of social media in practice and if it is condoned or
forbidden. At the time of their research, four states did not specifically
support electronic communication under their scope of practice, 10 states
had guidelines that regulated it, and 24 states reported the absence of any
law or rule addressing the use of the Internet with clients.
The Online Therapy Institute (OTI; 2010), established by Anthony and
Nagel, offers a framework for the ethical and legal use of social media by
mental health professionals. OTI addresses issues related to social media
that are relevant to client care, including confidentiality, multiple relationships, personal client testimonials, informed consent, not disclosing confidential information, not contacting through public forums, and
documentation of client records. The OTI website also discusses social
media interactions and encourages taking care when making posts that
could be read by nonprofessionals, dealing with friending and follow
requests, and utilizing search engines for collecting client information.
OTI cautions practitioners to work within their scope of practice and
know the specific laws related to Internet services in their own and their
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clients’ jurisdictions. It is recommended that practitioners seek training
in a variety of forms, including formal training, informal training (conferences and workshops), books, peer-reviewed literature, and clinical
consultation.
Another trend in the literature related to ethical issues in social media
and distance counseling has been to attempt to identify what constitutes
ethically sound practice. Alemi et al. (2007) demonstrated the effective use
of therapeutic emails to substance abuse clients. They provided examples
of the structure and content of the emails and contended not only that the
email platform did not interfere with the therapeutic success but that the
content of the emails had the most impact on treatment. Bradley, Hendricks, Lock, Whiting, and Parr (2011) compared email communications
of mental health counselors to the AMHCA and ACA ethical standards.
They addressed the ways in which emails enhance the relationship and
the practical ethical issues created by using this medium. Kolmes (2012)
gave examples of psychologists using social media in marketing, use while
off duty and on duty, as an adjunct for practice, and as a main means
of provision of care. Kolmes also raised issues related to social media in
clinical training and called for an updated ethics code for psychologists to
reflect the change in social media use.
Other writers have addressed social media and online ethical issues
from an organizational or educational frame of reference. DiLillo and Gale
(2011) examined the ethical implications of graduate students using the
Internet to access personal information about their clients. Although most
students understood that the process of surfing for client information was
unacceptable, 98% of them reported having searched for client information in the past year. DiLillo and Gale suggested that client privacy online be addressed as part of counselor preparation. In a similar vein, Cain
(2011) identified a need for employee education and an organizational
policy related to social media that would address privacy, productivity,
and reputation in the organization. The consensus related to organizational use of social media is that proactive training of employees is needed in
combination with the development of social media policies.
Ethical Concerns When Using
Computer-Mediated Communication
In this section, suggestions are offered to counselors who want to ensure
that their practices are ethically and legally sound when they use various
technology applications.
Legal Considerations
Counselors need to consider their state jurisdiction and their client’s state
jurisdiction when determining the legality of providing computer-mediated
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services. Regulations for providing and receiving Internet-based counseling services vary from state to state (Kaplan et al., 2011; NBCC, 2012). Of
additional concern is the use of computer-mediated communication with
minors and the varying state regulations regarding parental consent when
working with minors. Federal regulations such as Health Insurance Portability and Accountability Act (HIPAA) call for protection of client information and for secure storage and transmission of mental health records.
Counselors could potentially violate HIPAA regulations if they store and
transmit files that are not encrypted (Kaplan et al., 2011). It is sound practice for counselors to seek permission from clients and to inform them of
any potential risks involved when electronically transmitting case-sensitive information (NBCC, 2012); ensure that their software and services are
HIPAA compliant; and offer a Business Associate Agreement, which states
that they and their hired entities will abide by HIPAA regulations.
Competence
Before using technologies, it is recommended that counselors complete
training that affirms their ability to provide services in the method and
platform that they are using (Haberstroh, 2009). Harris and Younggren
(2011) emphasize competence as a basic ethical issue when practitioners
provide remote services:
Competence in remote interventions will require considerably more knowledge of electronic communication portals than that used in traditional
psychotherapy practice. It also requires a frank assessment of one’s understanding of, comfort with, and competence to understand the electronic
technologies one is utilizing. (p. 417)
From a risk management perspective, counselors need to demonstrate
competence in both the services they offer and the technology they are using to render services. Online counselors should consider obtaining training through organizations such as OTI (onlinetherapyinstitute.com) and
complete certificate programs such as the Distance Credentialed Counselor offered through the Center for Credentialing and Education (http://
www.cce-global.org/dcc).
Boundaries
Kaplan and colleagues (2011) raise the issue of the potential for dual
relationships to occur when counselors are using computer-mediated
communication. Potentially, clients can be exposed to personal aspects of
the counselor’s life if they were to find a digital trace of the counselor’s
personal social media sites. It should be kept in mind, though, that not all
dual relationships are harmful, and it is possible that a dual relationship
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could enhance a client’s wellness. Social media contact with clients has the
potential to enhance and support client improvement. Having a clearly
written social media policy for your practice can help to clearly define
the boundaries. Although the boundaries of social media contact may be
clear to the counselor, the client’s understanding of appropriate boundaries may not be equally clear. Counseling professionals who use social
media can support boundary limits by separating their personal digital
footprint from their professional digital footprint. This includes keeping
separate Twitter accounts, Facebook accounts, and email accounts for use
with friends and with clients. Counselors need to be diligent in learning
about security controls and know who is allowed access to their personal
sites and contact information. It is important to keep in mind that clients
may be curious about our private lives, so we need to take the extra step
to learn how to lockdown permissions and secure our digital private lives.
For counselors who are considering using Facebook, a host of ethical
concerns arise about boundaries, dual relationships, confidentiality, and
privacy. In addressing the challenges practitioners are encountering in the
digital age, Reamer (2013) comments on the boundary confusion that can
ensue after friending clients:
Clients who have access to social workers’ social networking sites may learn a
great deal of personal information about their social worker (such as information about the social worker’s family and relationships, political views, social
activities, and religion), which may introduce complex transference and countertransference issues in the professional–client relationship. (p. 168)
You will likely have to deal with friend or follow requests from a client
or supervisee. How you choose to respond and the rationale for accepting or not accepting such a request may have implications for your client
or supervisee relationship. Establish a social media policy that directly
addresses what you will or will not do should you get a friend request
from a client or supervisee, and then stick with your policy.
Accessibility Issues
Counselors are advised to be sensitive to the use of technologies that may
create problems for clients who have sensory limitations (NBCC, 2012).
Check the software you are using to ensure that it can be modified easily
for those who have visual and auditory acuity problems. Both Windows
and Mac computing platforms have user options that will assist those
with accessibility issues in making changes to their screens for sensory
accommodation. Software used for online counseling should adjust under
those settings. The design of websites should be compliant under the Web
Accessibility Initiative (W3C, 2012), and multimedia should be Section 508
compliant (HowTo.gov, 2013).
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Screening and Verification
Counselors who practice online need to develop methods to verify the
identity of their online clients, whether through face-to-face meeting, picture identification, or alternative methods of online verification. Once a
client is verified, counselors screen for the appropriateness of online services for clients and the potential issues they bring to the professional relationship. If computer-mediated services are not appropriate for the client
or if the counselor is not adequately trained to resolve the problem, the
counselor must be prepared to make an appropriate referral to a qualified
counselor in the client’s geographical region. If counseling services are to
continue past screening, counselors and clients need to establish an “identification word” to verify one another’s identity with every engagement in
Internet-based communication.
Structure of Services
Counselors using technology-based intervention should consider how
these services will be offered to clients, the parameters for the services,
and how the service fits into their current fee structure. Will text messaging or emailing your client be a charge-for-service, or it will be included in
your established fee? If you are providing video-conferencing with clients,
what is the fee schedule for that type of service? How often can the client
expect contact from you, and what is your typical response time? These
structures of service are all part of a well-outlined client contract and an
informed consent for services.
Informed Consent and Contract for Services
All ethical service providers utilize informed consent and have a statement of contracted services for clients. Incorporating computer-mediated
communication into your practice requires additional considerations for
inclusion in these documents. The informed consent should include the
distance counseling credentials of the counselor, the risks and benefits of
using computer-mediated communication, what to do in case of technology failure, anticipated response time, emergency procedures, cultural
differences, time zone differences, and potential denial of benefits for this
service. You should include in the informed consent your social media
policy. NBCC (2012) suggests that counselors connecting with clients online include the following components in their informed consent document: (a) links to all professional certification sites to facilitate consumer
protection, (b) procedures for contacting the counselor off line, (c) an indication of how often email will be checked, (d) what to do in case of
technology failure, (e) how to deal with misunderstandings as a limit of
the medium, and (f) information about local assistance and emergencies.
It is also suggested that counselors include a “waiver to hold harmless”
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Issues and Case Studies
statement regarding issues that are unique to the online platform, such as
the client’s email being breached by a partner, a “text message” mistake
(instead of to private), and a hardware or Internet crash. As in all informed
consent statements, you should explain that counselors have legal and
ethical obligations to break confidentiality if there are safety issues or as
mandated by the court. The contract for services, whether part of the informed consent document or separate, should include clear information
on fees for service, including computer-mediated service.
Social Media Policy
Counselors who use social media as an adjunct to therapy with clients are
advised to create a social media policy and be proactive about sharing it
with clients from the start. This will minimize any misgivings that could
arise and set boundaries on appropriate relational use of social media. One
of the most cited examples of a social media policy was created by Kolmes
(2010), who has made it available for professionals to see online (http://
drkkolmes.com/for-clinicians/social-media-policy/). Kolmes’s policy includes her positions with clients on friending, fanning, and following; her
preferences for communicating; her policy that she does not utilize search
engines for client information; and ethical restrictions on the solicitation
of client testimonials (which business listing sites may request). Kolmes
(2012) encourages practitioners to develop a social media policy if they are
going to use computer-mediated communication with clients.
Records Maintenance
Utilizing encryption methods for files and password security on all electronic devices is essential for the protection of confidential information.
Jencius (2013) provides recommendations and resources for how to make
“strong” passwords to secure information. NBCC (2012) asks counselors
to consider the online medium they are using and make decisions about
what digital data are kept as part of the client record, how the data will
be preserved and for how long, and how to address requests for release
of information.
Consultation
Given how easy it is to access other professionals using the Internet, and
how our perceptions of privacy are conflated by the medium, it is unwise
for counselors to seek consultation on cases without the same secure protection, contractual arrangement, and verification of their supervisor that they
apply to client enrollment. Professional listservs should not be used for case
consultation and referral that would expose a client’s details to an unknown
group (and possibly be read by your client; Kaplan et al., 2011).
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Emergency Procedures
Clients need to know what to do when they have an emergency and they
are not in your immediate area. For client quality of care, online counselors
have the responsibility to investigate and know resources in the client’s
geographical location should the client require face-to-face assistance in
an emergency. Similarly, clients should be schooled on those services and
what action they should take locally should they find themselves in a
mental health crisis.
Technology Failure
Counselors who use computer-mediated communication need to prepare
clients for the possibility of technology failure, what to do should that
happen, and what alternative methods can be used to contact the counselor. Computer-mediated communication is dependent on continuous contact, and the Internet is subject to occasional failure. Unknowing clients
might assume that the counselor had intentionally stopped the session, or
vice versa, when it was really a technical failure. Should an Internet crash
occur, steps need to be established that client and counselor will take to
reconnect the session or alternatives given they can pursue that do not
involve computer-mediated communication.
Conclusion
With the advancements in computing, the methods by which we interact
through digital devices have changed for both the counselor and the client. In the last 10 years, computing has become more ubiquitous. We are
no longer so aware that we are interacting with a device but instead feel
we are interacting with the person or people at the other end of the device.
Computing is now part of a simultaneous universe (Pendergast, 2004) in
which we no longer input and wait for output; the interaction with another person or group occurs in synchrony. Both ubiquity and synchrony,
key components to social media, have made computing much more like
human interaction. Clients are incorporating computing into how they
form and maintain relationships, so it is not surprising that they are expecting the same types of relationships with their counselors. In light of
these changes, counselors need to create a virtual presence that is effective, legal, and ethical.
The two case studies that follow highlight some of the complexities of
responding to technologies that are changing so rapidly. In Case Study 17
(Making Social Media Decisions for an Agency), a counselor is faced with
developing social media for a group of practitioners who vary widely in
their level of knowledge of and comfort with social media and its uses
in professional practice. In Case Study 18 (A Client’s Friend Request),
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boundary concerns are raised for a counselor who receives a friend request from a former client.
Case Study 17
Making Social Media Decisions
for an Agency
Martin Jencius
Jack is a 32-year-old licensed professional counselor in a small private
practice group with other human service professionals. In addition to
Jack, the group consists of Will, a 50-year-old psychologist whose focus
is primarily on testing; Cynthia, a 32-year-old clinical social worker; Janice, a 26-year-old newly graduated licensed professional counselor; Kia, a
45-year-old well-established marriage and family therapist; and Hannah,
a 35-year-old licensed professional counselor who specializes in treating
adolescents. They work as a group, and all decisions regarding the practice are made as a group. Recently they have had a discussion about augmenting their clinical work with social media.
At their clinical staff meeting, Jack is taking the pulse of the group
members on what they think of using social media and how they might
incorporate it in the group. Will is perplexed as to whether and how the
group might best use social media. He is fairly familiar with platforms like
Facebook and Twitter, but he has never used them and is not sure how the
practice might benefit or the ethics involved in using them with clients.
Cynthia has a Facebook page but has never used any other social media.
Like Will, she is uncertain how to use social media in a clinical practice,
but she is less reluctant than Will to consider it at this point.
Janice weighs in with an opinion that is on the opposite end from that
of Will. She is an avid user of social media who makes regular use of Facebook and Twitter and occasionally uses other social networks. Janice used
social media throughout her graduate program and has used it for developing counseling resources. The question for Janice is how she would convert or protect her current use from her professional use. Kia is aware of
social media platforms, as many of the families she sees discuss Facebook
information in sessions. She has a personal Facebook page and has made
an effort to lock it down to prevent clients from searching for her personal
information. Hannah is very familiar with social media because of her
work with adolescents. She has had to learn about social media because
many of her clients use it to communicate with their friends and maintain
social relationships. She also has seen social media being used by teens in
a very cruel way. She sees the benefit of using social media in the practice
as an adjunct to reaching her clients, but knowing how extensively her
clients use social media, she is concerned about the time it will take and
how to effectively set boundaries. Because Jack brought this issue to the
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group, he has been tasked with coming back with information and a possible process for adding social media to the practice’s tools.
Questions for Thought and Discussion
1. How might the varied disciplines of the members of the practice lead
to differences of opinion regarding their ethical adoption of social
media?
2. What steps might Jack suggest for the practice if they want to adopt
the use of social media?
3. How might each of the members of the practice contribute to the
adoption of safe and ethical use of social media?
Analysis
This case brings to light many of the issues associated with social media
and its regulation and adoption by counselors working for practices or
agencies. Jack’s task is to search for resources that can assist his partners
in making decisions about their use of social media with clients. Given the
range of practitioners and their varying levels of experience with social
media, Jack has considerable work to do to ensure safe and ethical adoption. In addition to the ACA Code of Ethics (ACA, 2014), it may be wise
for Jack to look into the code of ethics of the American Association for
Marriage and Family Therapy for Kia, the National Association of Social
Workers for Janice, and the American Psychological Association for Will
to see what, if anything, is included in their codes regarding computermediated practice.
Standard H.6. of the ACA Code of Ethics (ACA, 2014) relates directly
to the use of social media and addresses issues relevant to Jack’s task,
including maintaining a unique virtual professional presence (Standard
H.6.a.), addressing social media in the informed consent process (Standard H.6.b.), respecting the client’s digital footprint (Standard H.6.c.), and
taking precautions that what is broadcast protects the client’s confidentiality in case someone gets access to the client’s device (Standard H.6.d.).
Jack might also consider other standards in Section H because his partners
have not all had formal training in distance counseling methods (Standard H.1.a.). Has the practice considered the laws and statutes (Standard
H.1.b.) of the states/locales where they operate and where their clients
reside? If they are going to use private text messaging or email with their
clients, will these messages be part of a clinical record, and how will those
records be securely maintained (Standard H.5.a.)?
Jack and his fellow practitioners need to consider what types of social
media or computer-mediated communication they will use in their practice. Beyond marketing their services electronically through a website or
noninteractive Facebook page, will they provide distance counseling in
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which the majority, if not all, of the client work is provided through computing devices? Or are they going to use digital communications as an
adjunct to their in-office work with clients? Should they choose to include
a distinct distance counseling approach to working with clients, they will
need to have considerable training and online counseling and technology
experience to execute it safely, securely, and ethically. If they are focusing
on using one or two forms of social media, the learning curve for the less
experienced members of the practice will not be as steep. These choices,
and their implications, will require further discussion among the members of the practice.
Of greatest concern for the practice is creating a social media policy that
will instruct computer-mediated communication behavior for both the
practitioners and their clients. Their social media policy should be incorporated as part of the informed consent and disclosure statement (Standard
H.2.a.), and it can be included as a separate document for posting at the
practice and for handing out to clients (Kolmes, 2010). The practice members will want to look at other examples of social media policies that include
specific issues of friending, fanning, and following, along with verification
passwords, response time, and nonconfidential communication.
Questions for Further Reflection
1. Beyond the suggestions in this analysis regarding what should be
included in agency social media policies, are there other policies that
should be considered?
2. Can you envision conditions, clients, or scenarios in which social
media could be helpful in providing counseling services? Situations
where it could be a hindrance?
3. How should an agency deal with violations of social media policy?
What is an agency’s obligation to train employees?
Case Study 18
A Client’s Friend Request
Martin Jencius
Robin is a 42-year-old chemical dependency counselor and licensed professional counselor working at a county comprehensive addictions agency
as an intensive outpatient counselor. She works with groups of clients who
have successfully completed their detoxification and have moved into the
intensive outpatient portion of their program. She is a recovering addict
with 15 years sobriety and continues her 12-step work through regular attendance at Alcoholics Anonymous (AA). After completing her degree in
counseling 6 years ago, Robin started her work as a chemical dependency
counselor. One of her past intensive outpatient group members is Jamal.
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Jamal, now 32 years old, was admitted 2 years ago to the treatment
center where Robin works for treatment for a combination of alcohol
and pain killer addiction. After successfully completing detox, Jamal
moved to Robin’s intensive outpatient group, where he remained until
his completion of formal treatment after 3 months. His treatment stay
was unremarkable, and he dealt successfully with some trigger incidents. During treatment and posttreatment, he remained active with
regular attendance at AA, found a sponsor to work with him, and began
to build a new social community. Although Robin and Jamal have differing schedules for AA attendance, differing sponsors, and differing home
groups, they do occasionally run into each other at meetings. They are
cordial, and Robin refrains from any discussion or disclosure about their
history in treatment.
Robin has a personal Facebook page and has received a request from
Jamal to friend him, which would expose him to some of her contacts,
photos, and posts. Robin does have other recovering friends associated
with her Facebook account, whom she has met through her years in AA,
but she questions whether she should accept Jamal’s request to be Facebook friends because of their past treatment history.
Questions for Thought and Discussion
1. Is it advisable to engage in social media friending with a current client? What about a former client? Would you consider Jamal to be a
“current” or “former” client?
2. Does Jamal’s and Robin’s recovery relationship compromise their
professional relationship?
3. If you were supervising Robin and she came to you with this issue,
what would you recommend to her?
Analysis
This case raises issues about social media and appropriate boundaries between counselor and client or, in this case, a client who has been released
from treatment but still has ties to his counselor. A starting place for reasoning about this situation may be to explore the issue of dual or multiple
relationships between counselor and client. Kaplan and colleagues (2011)
noted that ethical guidelines related to dual relationships have changed
over time, and nonprofessional relationships with clients are now permitted as long as they are supportive and beneficial. Kaplan and colleagues
suggest that social media could be a beneficial type of nonprofessional
relationship.
Standard H.6.a. (ACA, 2014) directs counselors to take care to separate their personal from their professional social media presence. Robin
has established a personal virtual presence with her Facebook account but
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without the intention of using her personal virtual presence to make professional contacts. Although Jamal is a former client, he is still addressing
issues related to his previous professional relationship with Robin. Perhaps Jamal feels that his professional relationship has ended and that he
is making this offer as a recovering associate. He knows that others whom
he has met in AA circles have friended Robin. In fact, it was through another AA member’s Facebook contacts that he was able to find and contact
Robin on Facebook. The content currently on Robin’s Facebook page may
reflect on her professional role in a way that she would not want people to
see. Even if she is not concerned about this overlap between her personal
and professional lives, she may not wish to be that open with Jamal because of their previous professional relationship.
This case raises the issue of how transparent counselors can or should
be with their clients. We are trained as counselors to be transparent to our
clients so they can see us as genuine, congruent, and offering unconditional positive regard. In the past, professional boundaries were generally clear; however, computer-mediated communication has changed the
permeability of our lives. Modern generations have grown up with much
more exposure and openness to what was once private. Does this new
transparency now extend into our virtual presence? Individual counselors
might draw their boundary lines differently based on their own beliefs
about the counselor–client relationship and how they see the role of the
counselor in client change. Without specific guidance from Robin’s agency, the answer to her dilemma is unclear.
Proactive guidance in the form of a social media policy would be helpful to Robin and her agency. If the agency policy were stringent and stated
that no counselor should form a social media contact with a client or former client, then Robin would have a clear direction and a rationale for not
friending Jamal. Even if the policy stated that friending was permitted
when it was supportive and beneficial for the client or past client, Robin
would not be compelled to do so and could set her personal boundaries
at “no friending.”
Questions for Further Reflection
1. Do you think the boundaries regarding faculty–student social media
friending differ from the boundaries related to counselor–client interactions? If so, in what ways?
2. What policies and practices do you need (or will you need in the
future) for regulating your social networking to maintain your personal and professional boundaries?
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Chapter 10
Supervision and
Counselor Education
Barbara Herlihy and Gerald Corey
In the ACA Code of Ethics (American Counseling Association [ACA], 2014)
Section F addresses areas of supervision, training, and teaching. For the
most part, other sections of the Code emphasize the counselor–client relationship; Section F is centered on the unique relationships between supervisors and supervisees and between counselor educators and students.
Guidance for ethical practice is also available in a set of best practice
guidelines for supervision developed by the Association for Counselor
Education and Supervision (ACES). “Best Practices in Clinical Supervision” (ACES, 2011) provides a comprehensive examination of informed
consent, goal setting, ongoing feedback for supervisees, effective supervision, the supervisory relationship, diversity and advocacy considerations,
documentation, supervision format, and the supervisory role.
Supervision
Supervision is a vital element in training counselors. It is equally important for practicing counselors to work under supervision periodically to
remain current and to maintain and extend their boundaries of competence. Supervision has a dual purpose: to increase and monitor the skill
development of counselors, and to protect client welfare while counselors
are learning new skills and competencies.
Having a good supervisor is key to developing professional competence.
Supervisors serve as role models for professional behavior and must be
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skilled at the specific tasks involved in supervision. In the past, it was generally assumed that a good counselor would also be a good supervisor. As a result, most supervisors had little formal training to prepare them for the roles
and responsibilities involved in clinical supervision. Today the standard for
qualifying to be a clinical supervisor includes formal course work and supervision of one’s work with supervisees. Professionals who offer clinical
supervision services need to have specific training in supervision methods
and techniques and regularly pursue continuing education activities in both
counseling and supervision (ACA, 2014, Standard F.2.a.). Supervisors are
aware of and address multicultural and diversity issues in the supervisory
relationship (Standard F.2.b.). If supervisors are not aware of diversity issues
in supervision, they run the risk of inadvertently reinforcing any existing
biases and prejudices that their supervisees may have. Supervisors are
responsible for intitiating discussion with their supervisees of diversity and
cultural differences (G. Corey, Haynes, Moulton, & Muratori, 2010). If supervisors do not raise these issues, supervisees will get the message that diversity is a taboo topic in supervision (Remley & Herlihy, 2014). In Case Study
20 (An Imposition of Values?), a counselor’s limited understanding of cultural differences related to religious values has caused the client to terminate
counseling and complain to the counselor’s supervisor.
Competent supervisors understand that the supervisory relationship
is key to effective supervision as well as to the personal growth and development of the supervisee (ACES, 2011). Supervisors work to create an
environment in which there is an appropriate balance of challenge and
support. Open and honest communication is necessary for the supervisee
to obtain the maximum benefit from supervision. Sometimes counselorsin-training are reluctant to openly discuss with their supervisors mistakes
they have made in their practicum or internship. However, it is critical for
supervisees to talk directly with their supervisors about their doubts and
their fears as counselors in order to rectify mistakes and learn from them,
and supervisors must encourage their supervisees to be open about the
concerns they are having in working with clients.
Supervisors serve as gatekeepers to the profession and must monitor
and evaluate supervisees’ performance (G. Corey et al., 2010) both formally and informally. As gatekeepers, supervisors hold the key to their supervisees’ entrance into the profession. Supervisees need to know that their
supervisors will be evaluating their knowledge and skills, clinical performance, and interpersonal behaviors at various points during the experience. Supervisors “provide supervisees with ongoing feedback regarding
their performance” (ACA, 2014, Standard F.6.a.). When supervisee performance does not meet expected standards, supervisors must help the
supervisees to secure remedial assistance (Standard F.6.b.). “Supervisors do
not endorse supervisees whom they believe to be impaired in any way
that would interfere with the performance of the duties associated with
the endorsement” (Standard F.6.d.).
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Just as securing informed consent is required prior to initiating a counseling relationship, supervisors are expected to engage in sound informed
consent practices in the initial supervision session and to clearly state the
parameters for conducting supervision (ACES, 2011). Supervisors are
responsible for incorporating principles of informed consent into their
supervision, including (if applicable) “issues unique to the use of distance
supervision” (ACA, 2014, Standard F.4.a.). Distance or online supervision
is becoming more common. Supervisors must be competent in the use of
these technologies and “take the necessary precautions to protect the confidentiality of all information transmitted through any electronic means”
(Standard F.2.c.). From the outset of the supervisory relationship, supervisors need to address how to balance the rights and responsibilities of clients,
the supervisee, and the supervisor. Having this kind of discussion can empower supervisees to express their expectations and concerns, make decisions, and become active participants in the supervisory process.
Within the supervisory relationship, it is critical to pay special attention
to issues involving relationship boundaries and role changes. Some types
of boundaries are clear: Supervisors do not engage in sexual or romantic
relationships with current supervisees (Standard F.3.b.), nor do they serve
as supervisor to friends or family members (Standard F.3.d.). Beyond those
basic prohibitions, determining and maintaining appropriate boundaries in
supervision can be a challenge. Although supervisors should avoid nonprofessional relationships with supervisees that could compromise objectivity,
supervisors are likely to encounter their supervisees in social settings and
community activities. Even within the supervisory relationship, supervisors play multiple roles, functioning at various times as teachers, consultants, and in a role that resembles that of a counselor. However, there are
important differences between counseling and supervision.
Supervision always involves evaluation. Supervisors do not become
counselors to their supervisees. Although supervisors may address personal issues in supervision, the focus is on the “impact of these issues
on clients, the supervisory relationship, and professional functioning”
(Standard F.6.c.). At times it may be necessary to address a supervisee’s
personal issues in supervision, especially if these concerns are having an
impact on his or her ability to work effectively with clients. When helping the supervisee to identify and understand how personal issues may
be interfering with effectively delivering services, the challenge is to maintain appropriate boundaries so that the supervisory relationship does not
become a therapy relationship. If a supervisee requests personal counseling, “the supervisor assists the supervisee in identifying appropriate services” but will not serve as the counselor (Standard F.6.c.). The supervisor
in Case Study 19 (Poor Supervision or Impaired Student?) is confronted
with a dilemma when her supervisee is struggling with personal issues.
Supervisors exercise sound ethical judgment when extending the
boundaries of the supervisory relationship beyond customary parameters
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and are careful “to ensure that judgment is not impaired and that no harm
occurs” (Standard F.3.a.). Boundaries do evolve in the supervisory relationship and take on a more collegial tone, and supervisors can be tempted to relax the boundaries as supervisees near the end of the supervisory
relationship and are about to become the supervisors’ peers (Remley &
Herlihy, 2014). Still, because the evaluation component is present, a power
differential remains in the relationship.
To summarize, the role of the supervisor involves a careful blend of
engaging supervisees in both personal self-reflection and clinical skill development. Supervisors must be attuned to the importance of practicing
ethically because they serve as role models for their supervisees. Supervision relationships change over time as supervisees gain competence and
autonomy, and supervisors and their supervisees need to work jointly in
appropriately bringing closure to the supervisory relationship.
Counselor Education and Training
Counselor educators are knowledgeable about ethics (ACA, 2014, Standard
F.7.a.) and are aware of emerging ethical issues facing the profession. They
make students aware of the many potential ethical issues that counselors
are likely to encounter, including culture and diversity, technology, and
boundary issues as contextual factors that affect the resolution of ethical dilemmas. Counselor educators have a responsibility to ensure that students
become familiar with the ethical standards of the profession, and they take
steps to actively infuse ethical considerations (Standard F.7.e.) and multicultural and diversity issues (Standard F.7.c.) throughout the curriculum.
When using case examples, counselor educators take care to ensure that
permission to use the material has been secured or that “the information has
been sufficiently modified to obscure identity” (Standard F.7.f.).
In addition to teaching ethics, faculty “serve as role models for professional behavior” (Standard F.7.a.) and teach students how to integrate
ethics into professional decision-making skills in a variety of contexts and
settings. Because ethical dilemmas are not always clear cut, it is important
for counselors-in-training to learn to deal with ethical situations that may
have no clear “answers.” Becoming ethically competent involves being
open to complexity and ambiguity.
“Counselor educators promote the use of techniques/procedures/
modalities that are grounded in theory and/or have an empirical or scientific foundation. When counselor educators discuss developing or innovative techniques . . . , they explain the potential risks, benefits, and
ethical considerations of using such techniques” (Standard F.7.h.). Counselor educators include a wide range of perspectives on issues that affect
the work of counselors.
Informed consent regarding policies, practices, and expectations of the
program is of the utmost importance for students. This process begins when
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prospective students receive application materials. Faculty should make clear
to incoming students that becoming a competent counselor involves more
than acquiring knowledge and skills; a critical variable in effective counseling is the ability of trainees to establish a working alliance with their clients,
which depends largely on their own personality characteristics and behavioral attributes. Prospective students need to know that they will be affected
personally in many of their courses, that their program will be challenging
to them on both academic and personal levels. Their participation in courses
and fieldwork will likely be an emotional experience at times. Most counseling programs combine academic and personal learning, weave together
didactic and experiential approaches, and integrate study and practice.
Admissions requirements typically involve both traditional and nontraditional criteria. Compared to other types of graduate programs that may
only look at test scores, undergraduate grade point average, and work
experience, most counseling programs also examine applicants’ ability to
demonstrate self-awareness, emotional stability, and interpersonal skills
(Remley & Herlihy, 2014). After being admitted to a program, students
can expect to receive ongoing orientation to the program and information
about what will be expected of them, including
1. the values and ethical principles of the profession;
2. the type and level of skill and knowledge acquisition required for successful completion of the training;
3. technology requirements;
4. program training goals, objectives, and mission, and subject matter to
be covered;
5. bases for evaluation;
6. training components that encourage self-growth or self-disclosure . . . ;
7. the type of supervision settings and requirements of the sites for
required clinical field expereiences;
8. student and supervisor evaluation and dismissal policies and procedures; and
9. up-to-date employment prospects for graduates. (Standard F.8.a.)
A critical component of most counseling training programs is an
emphasis on students engaging in self-growth experiences that foster
awareness of self and others. Students must be made aware “that they
have a right to decide what information will be shared or withheld in class”
(ACA, 2014, Standard F.8.c.). Faculty members will not determine a student’s grade or evaluation based on the student’s level of self-disclosure.
Through formal and informal mentoring relationships, engaging in research projects, attendance at professional conferences, and day-to-day
interactions, counselor educators have a tremendous impact on the lives
of students. Counselor educators are mindful that they have the power to
either positively or negatively influence the lives of students.
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Boundaries exist to protect students in counselor training programs.
Counselor educators do not engage in “sexual or romantic interactions or
relationships with students currently enrolled in a counseling or related
program and over whom they have power and authority. This prohibition applies to both in-person and electronic interactions or relationships”
(Standard F.10.a.). “Counselor educators are aware of the power differential in the relationship between faculty and students. If they believe that a
nonprofessional relationship with a student may be potentially beneficial
to the student, they take precautions similar to those taken by counselors
when working with clients” (Standard F.10.f.). If boundaries are extended beyond the customary parameters, nonprofessional relationships are
“time limited and/or context specific and initiated with student consent”
(Standard F.10.f.). Some examples of boundary extensions that could be
beneficial are attending a ceremony such as a wedding, visiting an ill student in the hospital, providing support during a stressful event, or maintaining mutual membership in a professional association or organization
(Standard F.10.f.). Counselor educators maintain appropriate boundaries
in their professional relationships with students and discuss any concerns
or issues that arise that may affect the academic preparation or well-being
of students. They avoid nonacademic relationships with students when
there is a risk of potential harm to students or when the training experience or grades could be compromised (Standard F.10.d.).
Finally, counselor educators have responsibilities with respect to fostering diversity. They attempt to “recruit and retain a diverse student body”
(Standard F.11.b.) and faculty (Standard F.11.a.). They recognize that students bring diverse cultures and types of abilities to the training process
and provide accommodations that enhance and support the performance
and well-being of diverse students (Standard F.11.b.).
Case Study 19
Poor Supervision or Impaired Student?
Edward Neukrug and Gina B. Polychronopoulos
Terri, a 32-year-old Caucasian female, has worked for 7 years as a licensed
professional counselor, primarily in outpatient mental health and community agency settings. Terri also teaches as an adjunct professor in a
master’s-level counseling program and clinically supervises counseling
students who are completing their practicum or internship experiences
each semester. In addition, she is a research team member on several projects with other faculty members and students in the program and is the
faculty adviser of her school’s chapter of Chi Sigma Iota (CSI), a counseling
honor society and service organization. This semester, Terri is supervising five master’s-level students who are completing their practicum and
internship experiences at different sites.
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Caitlin, a 30-year-old Caucasian female, is in the mental health track of
the counseling program and is completing her internship at a local agency where Terri has worked in the past. The counseling program’s clinical coordinator has assigned Terri to be Caitlin’s university supervisor for
her internship based on Terri’s experience and knowledge of the site and
population where Caitlin was placed. Caitlin and Terri share many clinical
and research interests, and Caitlin had taken a class in which Terri was the
instructor and served on a research team with Terri in previous semesters.
Caitlin is also an active member of the university chapter of CSI and has
been assisting Terri in developing a number of social get-togethers for the
organization. At these events, there is generally a “party” attitude and
most of the students, including Caitlin, have been doing a fair amount
of drinking. Although Terri has attempted to maintain some semblance
of a student–teacher relationship with Caitlin and other students at these
events, it is clear that on a number of occasions she has “let her guard
down,” sharing personal stories about her life that she normally would
not share with students.
As Terri begins to supervise Caitlin during internship, she initially is
cognizant of the fact that she has come close to crossing boundaries with
Caitlin during the CSI events, as well as the fact that Caitlin has known
Terri in other capacities at school. She reflects on those events and wonders if her sharing of personal information, and if her having been in
other roles with Caitlin, will have a negative impact on their supervisory
relationship. As supervision continues, all seems to be going well, and
Terri’s concerns begin to dissipate. Terri realizes that because they have
worked together in various settings over the past year, and because of
their shared interests and scholarly activities, they were able to quickly
develop a strong rapport.
After a few more weeks of supervision, Terri’s suspicion about the supervisory relationship being tainted comes up again. Terri begins to think
that Caitlin should be revealing more about herself than she is. It seems
to Terri that Caitlin is unwilling to share important aspects of herself that
may have a negative impact on the clients with whom Caitlin is working.
Considering Terri’s ongoing feelings about Caitlin’s lack of openness in
the supervisory relationship, Terri decides to broach the subject with her.
During a session she says to Caitlin, “You know, as we have continued in
this supervisory relationship, I have a gnawing sense that you are not being as open or as revealing as perhaps you can or should be. Do you have
any thoughts on that?” At that point, Caitlin bursts into tears and states,
“I thought that we were friends, and I was hoping that once I finished the
program we could have a friendship. I’m afraid that if I talk about what I
really want to talk about, you won’t like me.”
Terri, who has felt a special closeness to Caitlin, reflects on this and secretly thinks Caitlin would be a nice friend to have. However, she decides
to put aside those feelings and says to Caitlin, “You know, what is most
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important is your work with your clients. I hope you can share whatever it
is you have to share with me, so that you can be the most effective counselor
with your clients that is possible.” At that point, Caitlin looks at Terri and
with tears in her eyes begins to share that she has had a lifelong struggle
with overeating and with depression. She says that on some days her overeating is so bad she feels sick and has trouble focusing on what the clients
are saying. She notes that although she is not currently feeling suicidal, she
has frequently felt suicidal in the past, and she is afraid that such deep feelings of depression, hopelessness, and low self-esteem may affect her work
with clients. She looks at Terri and says, “What should I do?”
Questions for Thought and Discussion
1. Terri has a number of roles other than clinical supervisor, including research team member, adjunct faculty member, and CSI adviser.
Should clinical supervisors have other roles in a counseling program
that could potentially cause a blurring of their role as supervisor?
2. What do you think of Terri’s decision to go out on social events,
sponsored by CSI, with students?
3. If Terri believes that Caitlin cannot be an effective counselor, what
responsibility does she have to report Caitlin’s struggles to the program? What responsibility, if any, did the program have to try and
help Caitlin prior to her being in internship?
Analysis
It is typical in counseling programs for clinical supervisors to have other
roles (in addition to supervision), such as teaching courses or being a program adviser. However, as this case demonstrates, this can create problems.
Ultimately, it is the program’s responsibility to ensure that there is not a
blurring of roles in the supervisory relationship. To achieve this, it would
be best if supervisors did not have additional roles. One way to accomplish this might be to hire adjunct faculty whose sole responsibility is to
supervise students. However, practically speaking, this is difficult because
programs often cannot locate enough trained adjuncts to take on this role.
Core faculty often end up supervising students, and they generally take
on multiple roles.
Supervisors should define and maintain appropriate boundaries with
their supervisees (ACA, 2014, Standard F.3.a.), as a lack of such boundaries can have a negative impact on the supervisory relationship. In this
case, Terri’s decision to go out with the students, and in particular to let
her guard down, was inappropriate because she knew she might end
up supervising one or more of the students. The social interactions Terri
engaged in with Caitlin resulted in Terri having difficulty remaining unbiased while supervising Caitlin. Having other professional relationships,
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such as teacher and researcher, also could affect the supervisory
relationship and should be avoided, if possible. Terri should take steps to
avoid such multiple relationships with students, and the counseling program structure should support this separation when possible.
Ultimately, clinical supervisors need to ensure that their supervisees
can provide adequate services to their clients. If psychological issues
exist that are preventing supervisees from being effective with their
clients, supervisors should assist supervisees to find counseling services.
“Supervisors do not provide counseling services to supervisees” (Standard F.6.c.). If supervisors believe that the limitations of the supervisee are
such that he or she needs to be dismissed from a training program, then
supervisors should report the student to the appropriate individuals in
the program to initiate such action.
Counseling programs should provide students with opportunities for
self-growth and professional consultation well before their internship. It
is important that counseling students understand the nature of programs,
which typically include self-growth experiences and self-disclosures
throughout their course work and assignments, and students must be
aware of the potential ramifications of such disclosures (Standard F.8.c.).
Although we do not know if this was the case in Caitlin’s situation, if
such opportunities were not made available, Caitlin would certainly have
a strong argument that the program did not do what was necessary to
ensure her psychological growth.
However, Caitlin also has the responsibility to ensure that she can work
effectively with clients. She should have been addressing her emotional
well-being since she entered the program. Students must “monitor themselves for signs of impairment” (Standard F.5.b.).
Caitlin is responsible for recognizing whether her emotional well-being
might interfere with her work as a counselor-in-training; however, the
program should be set up in a way that her teachers and clinical supervisors are able to recognize such impairment as well. Steps can then be taken
to address Caitlin’s needs, such as referring her to outside counseling or
setting up a remediation plan, rather than dismissing her before remediation could occur.
Supervisors are ultimately responsible for the welfare of the clients of
their supervisees. “A primary obligation of counseling supervisors is to
monitor the services provided by supervisees. Counseling supervisors
monitor client welfare and supervisee performance and professional
development” (Standard F.1.a.).
Because students work under their clinical supervisors’ credentials and
licensure, supervisors must take steps to ensure that students are counseling in an ethical and professional manner. Inadequate clinical work on the
part of supervisees must be addressed in supervision. Supervisors must
intervene when necessary and document what has occurred. Caitlin needs
to be assisted to receive help with her personal struggles and be given
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opportunities to develop the needed competencies as a counselor. In the
interim, the welfare of Caitlin’s clients must be protected.
Questions for Further Reflection
1. How can the tension be resolved between a supervisee’s obligation
to be open and honest in supervision and a supervisor’s obligation
to act as a gatekeeper to the profession? Is it fair to Caitlin that she
could be dismissed from the program because she opened up to her
supervisor?
2. Is Terri’s challenging of Caitlin to open up a double-edged sword for
Caitlin? If Caitlin opens up, she may end up being dismissed from
the program, but if she does not open up, she is not able to receive
adequate supervision.
3. How can students monitor their own wellness as they move through
their training? How can counselor educators assist them in learning
to self-monitor?
Case Study 20
An Imposition of Values?
Alwin E. Wagener
Mary Ann is a 19-year-old college student from the southeastern United
States who has sought counseling services at her college counseling center.
Her assigned counselor, with whom she has met for a month, is Marcus,
who is also from the southeastern United States. Mary Ann’s expressed
reasons for pursuing counseling are feelings of depression and a desire
to perform better on school assignments. Her college is in her hometown,
and she still lives at home. Mary Ann is very religious and regularly
attends a small Christian evangelical church. She speaks often of being
sinful but desires to be a good religious person. She describes her family
as very religious and says their faith is the most important aspect of their
lives. She speaks proudly of her older brother, who is pursuing education
in a seminary, and says she used to want to work in the church too but
feels it is no longer her path. Mary Ann states that her grades are mostly
Bs and Cs, but she believes she could do better if she had more energy. She
reports sleeping 10 to 12 hours per night, feeling sad most of the time, and
having trouble feeling motivated to do her work despite wanting to do
well in school. She says she has no thoughts of harming herself or others
but sometimes wishes she could disappear and not exist.
During the course of counseling, she has revealed that she has intense
negative feelings about herself because of her past experience of being
raped as a teenager by a childhood friend, which she kept secret from
everyone. She states she had an abortion in secret after the rape and believes
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she is a murderer. She reports that her pastor has stated many times to the
congregation that women who have abortions are murderers. Even knowing that, she had an abortion because she couldn’t stand the thought of
having her rapist’s baby and did not want anyone to know she had sex. She
says she believes she will go to hell because she had an abortion. She says
her church is her extended family, and she cannot tell anyone her secret
because they would reject her. She also states that the life she used to want
was to work in the church, get married, and have children, but since the
rape and abortion she feels those goals are impossible.
Mary Ann’s willingness to share her secrets with Marcus has convinced
him that they are developing a strong therapeutic relationship. Marcus believes Mary Ann’s religious beliefs are a major contributing factor to her
depression, related to her need to keep her experiences secret and her fear
of going to hell. Because Marcus is convinced that Mary Ann’s religious
beliefs are integral to her problem and must be reframed before she can
make progress toward her counseling goals, he decides to introduce some
alternative interpretations of the Bible. In hopes of helping to ease Mary
Ann’s feelings of shame and fear of going to hell, he encourages her to
explore her faith from other perspectives and try attending churches with
different views on abortion. Mary Ann says she will think about it but does
not return to counseling. She later sends a letter to Marcus and Dr. Peters,
Marcus’s supervisor (who is the clinical director of the counseling center),
stating that it was inappropriate for Marcus to try to change her religious
beliefs and that she wanted to change her depression, not her faith.
Marcus and Dr. Peters meet to discuss the letter and Marcus’s counseling
sessions with Mary Ann. Marcus explains that he was attempting to support the client and decrease her depressive symptoms while acknowledging
and supporting her religious beliefs and community. Marcus acknowledges
that he sought to introduce alternative beliefs because he thought Mary
Ann’s present beliefs were barriers to her counseling goals. He also states
that he recognizes her family and religious community are paradoxically
both supporting her and contributing to her shame and depression. Marcus
says he is surprised at her reaction and had thought she seemed open to
exploring her beliefs. The supervisor states that Marcus might have pushed
the client too hard and says that, in the future, he should consult on issues
that involve religious beliefs before introducing interventions.
After meeting with Dr. Peters, Marcus remains unsure as to how he might
have been more effective in counseling Mary Ann. He is unsure how to address clients’ cultural and religious beliefs in a way that both connects clients
to their families and faith communities and addresses mental health problems. He believes he did the right thing by trying to help Mary Ann and
continues to believe that her religious beliefs were a major contributor to her
depressive symptoms. Though he will consult about religious issues with
clients in the future, Marcus feels confused about his work with Mary Ann
and what he will do in the future when confronted with similar situations.
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Questions for Thought and Discussion
1. What can counselors do when clients hold strong religious and cultural beliefs that seem to be contributing to or exacerbating their
mental health concerns?
2. How might Marcus have better understood the extent of Mary Ann’s
willingness to explore changes in her beliefs before implementing an
intervention?
Analysis
Marcus clearly wanted to help Mary Ann meet her goals of decreasing
feelings of depression and performing better at school, but he did not approach the topic of her religious beliefs with sufficient sensitivity. It can
be difficult for counselors to work within clients’ spiritual and religious
beliefs when those beliefs appear to be contributing to clients’ problems.
Marcus’s introduction of an intervention with the goal of changing Mary
Ann’s religious beliefs was not in compliance with the ACA Code of Ethics
(ACA, 2014), which states, “Counselors and their clients work jointly in
devising counseling plans that offer reasonable promise of success and
are consistent with the abilities, temperament, developmental level, and
circumstances of clients” (Standard A.1.c.). Marcus did not sufficiently
understand the circumstances of Mary Ann’s situation and did not work
jointly with her in formulating an appropriate intervention.
Marcus remains confused and wants to better understand how to work
with clients who present with concerns similar to those of Mary Ann. As
a starting place, he might look to the ACA Code of Ethics for guidance.
The Introduction to Section A states that “counselors actively attempt to
understand the diverse cultural backgrounds of the clients they serve.”
Mary Ann’s response to Marcus’s intervention and Marcus’s failure to
anticipate Mary Ann’s response are indicators that Marcus lacked understanding of Mary Ann’s religiously based cultural background. Understanding and respecting a client’s cultural background and religious
beliefs does not preclude discussing beliefs or introducing alternative
views, but such discussions require sensitivity and vigilance in respecting the client’s autonomy.
How might Marcus have worked with Mary Ann and have remained
more in accordance with the ACA Code of Ethics? A first step might have
been to spend more time gaining an understanding of her beliefs, family,
and community. If Marcus had further explored these topics with Mary
Ann, it seems likely that he would have realized that directly suggesting
different religious beliefs and churches would not be well received by her.
It is also possible that increasing his understanding would have allowed
Marcus to assess whether he had the competence to effectively counsel
Mary Ann from within her belief system.
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Reflecting on, and perhaps discussing with his supervisor, additional
standards in the Code might be helpful to Marcus. The Introduction to
Section A advises counselors to “explore their own cultural identities and
how these affect their values and beliefs about the counseling process.”
Another standard related to values states that “counselors are aware of—
and avoid imposing—their own values, attitudes, beliefs, and behaviors”
(Standard A.4.b.). Based on a better understanding of Mary Ann and recognition of his own beliefs and values, Marcus might have researched and
provided a referral to counselors in the area who share Mary Ann’s belief
system. If Marcus had determined that he lacked the competence to be
of professional assistance to Mary Ann, it would have been appropriate
for him to suggest a referral (Standard A.11.a.). It would have been his
responsibility to be “knowledgeable about culturally and clinically appropriate referral resources” (Standard A.11.a.). However, a referral may or
may not have been possible or appropriate based on a variety of considerations, including Mary Ann’s ability to access alternative services and the
availability of alternatives in the area.
Dr. Peters’s role as supervisor in this case begins with the letter from
Mary Ann. Dr. Peters has a responsibility to “monitor client welfare and
supervisee performance and professional development. To fulfill these
obligations, supervisors meet regularly with supervisees to review the
supervisees’ work and help them become prepared to serve a range of
diverse clients” (Standard F.1.a.). It appears that the supervisor may not
have been aware of Marcus’s counseling challenges and perhaps had not
been providing adequate supervisory oversight. After discovering the
problem, Dr. Peters met with Marcus and required Marcus to consult
on future issues concerning client religious beliefs. Future consultations
might involve supporting Marcus’s efforts to increase self-awareness of
his own beliefs and values, helping him explore his role as a counselor and
his ability to provide counseling services to people of differing cultural
backgrounds, and assisting him to develop a decision-making process for
determining when to refer clients.
Questions for Further Reflection
1. How can counselors avoid imposing their personal or religious beliefs on clients, even inadvertently?
2. Is it ever appropriate to challenge a client’s religious beliefs? If so,
under what circumstances?
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Chapter 11
Research
and Publication
Richard E. Watts
Ethical behavior related to research and publication is covered in Section G
of the 2014 ACA Code of Ethics (American Counseling Association [ACA],
2014). This section addresses ethical issues that clearly resonate with other
aspects of the Code (e.g., informed consent, confidentiality, professional
boundaries, integrity, and veracity), yet the section is unique because the
focus is on ethical concerns related to counselors’ practice of research and
publication and the professional relationships involved.
Counseling professionals may think that the ethical standards addressing research and publication have no significance for them because they
do not conduct research or seek to publish in professional journals or other professional venues. Given current demands for accountability, however, counselors are increasingly expected to demonstrate that their work
with clients is effective and is making a difference. Thus the likelihood
of counselors, regardless of their work settings, engaging in research and
publishing the results of their studies is increasing significantly (Remley
& Herlihy, 2014).
Institutional Review for Research
Most of the ethical requirements regarding research delineated as Research
Responsibilities (ACA, 2014, Standard G.1.), Rights of Research Participants (Standard G.2.), Managing and Maintaining Boundaries (Standard
G.3.), and Reporting Results (Standard G.4.) are legal requirements as
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well. All institutions that receive any federal funding (including universities, research or training institutes, public schools, and mental health clinics) are required to create and maintain committees that review research
proposals for the protection of human participants. They are often called
institutional review boards (IRBs) or human subjects committees. A thorough review protocol by an IRB typically addresses most, if not all, of the
ethical mandates mentioned in these sections of the Code. But what about
counselors who do not work for federally funded institutions, and/or do
not have access to IRBs? According to Standard G.1.c.:
When counselors conduct independent research and do not have access to
an institutional review board, they are bound to the same ethical principles
and federal and state laws pertaining to the review of their plan, design,
conduct, and reporting of research.
When researchers do not have access to a formal IRB, they should enlist
one or more mental health professionals with expertise in research review
protocols to serve as reviewers for the research proposal; and, as with institutional reviews, independent researchers need to carefully document
the review process. Case Study 21 (Expert Review of a Research Study)
illustrates a researcher’s difficulties in understanding the complexities of
IRB requirements.
Publication: Plagiarism and Authorship
The Code also contains several standards related to publications. Credit
must be given to those who have done previous work. “In publications
and presentations, counselors acknowledge and give recognition to previous work on the topic by others or self” (ACA, 2014, Standard G.5.c.).
“Counselors do not plagiarize; that is, they do not present another person’s work as their own” (Standard G.5.b.). This statement addressing plagiarism seems rather straightforward, yet some nuances are commonly
misunderstood. In addressing plagiarism, the American Psychological
Association (APA) publication manual (American Psychological Association [APA], 2010) suggests that the focal principle is that “authors do not
present the work of others as if it were their own work. This can extend to
ideas as well as written words” (emphasis added, p. 16). Obviously, if one
quotes verbatim the work of another author, the quote should be identified as such. The notion of an author’s ideas, however, is often overlooked.
If an author uses the work or ideas of another in any manner, the work of
the original author should be cited; this includes personal communication. The absence of a citation is tantamount to plagiarism.
Counselors must also avoid plagiarizing their own work. Recall that
the ACA Code of Ethics (ACA, 2014) Standard G.5.c. states that “counselors acknowledge and give recognition to previous work on the topic by
others or self” (emphasis added). Not only do counselors not plagiarize the
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work of others, they also do not self-plagiarize; that is, they do not present
previous publications as if they were not previously published. Authors
can avoid self-plagiarism in the same manner as they avoid plagiarism of
other authors, via careful attention to and citation of an author’s work.
Two standards address authorship issues. The topic of authorship credit
can generate divisiveness. Authorship should be determined early in the
research or authorship process and should be based on level of contribution
(ACA, 2014, Standard G.5.e.). If levels of contribution change in the research
and publication process, the collaborators may need to “reassess authorship
credit and order [of authors as listed on the manuscript] if changes in relative contribution are made in the course of the project (and its publication)”
(APA, 2010, p. 18). Students’ rights regarding their research are addressed
as well in the 2014 ACA Code of Ethics (ACA, 2014) in Standard G.5.f. This
standard includes not only the authorship issues mentioned previously but
also the right of students to control the use of their work.
As noted earlier, delineation of author credit can be a divisive issue, particularly because of potential power issues. Senior researchers and authors
may expect or demand to be lead author on a manuscript because of their
senior status or rank, even though their contributions to the project do not
merit first authorship. Conversely, less experienced researchers and authors
may expect or demand to be lead author because of the research and publication requirements at their institution for career success. This power differential can be particularly troubling for students when working with faculty.
A faculty mentor may expect or demand to be lead author on a manuscript
that is “substantially based” on a student’s work. The student may not feel
sufficiently empowered to address the issue with the professor or may be
concerned that the professor will respond in a punitive manner. In Case
Study 22 (A Question of Authorship), a student discovers how difficult it
can be to address authorship issues with a former professor.
With the current emphasis on accountability, conducting research and
publishing results is increasingly expected of counselors across various
work locations; it is no longer expected only of counselor educators in
university settings. The 2014 Code more clearly delineates the expectations
and responsibilities of counselors in conducting research and submitting
manuscripts for publication. Therefore, it is important for all counselors,
regardless of their work setting, to become familiar with the research and
publication standards addressed in Section G.
Case Study 21
Expert Review of a Research Study
Richard E. Watts
Jayni Lee recently graduated with her PhD in counselor education and
supervision and has decided to continue working in a large outpatient
clinical setting for 2 years before she seeks a faculty position as a counselor
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educator. During that 2-year period, she wants to continue the research
she began with her dissertation.
Her dissertation study examined the relationship between clients’ core
dysfunctional schemas and the influence of early childhood family environments. She used quantitative instruments with participants at the
outpatient clinic where she worked to assess both clients’ schemas and
childhood family influence. Prior to gathering data for her study, she
was required to submit a research proposal to the director of the outpatient clinic where she works and to her university’s IRB. The clinic director briefly reviewed the study and gave approval to use the clinic for the
study. The proposal was then reviewed by the university IRB and, after
a few revisions, was approved. Although Jayni found some relationship
between dysfunctional schema and early childhood family influence, as
measured by the instruments, she was disappointed because she expected
the results to indicate a much greater relationship. Thus she decided to
continue researching this topic.
After graduation, Jayni talked to the clinic’s director and indicated that
she would like to continue her research at the clinic. She noted that she believed using mixed-method methodology—adding qualitative interviews
to the quantitative instruments used previously—would result in much
better results. She stated that the interviews would focus on clients’ perceived early childhood family influences. She asked the director about the
approval process: “My previous study was approved by the university’s
institutional review board, and because I’m still looking at dysfunctional
core schema and early childhood family influences, can I do this study
with different clients at the clinic?” The director, although not a research
expert, told her that because the research was so similar, he thought the
previously approved review would suffice and approved the study.
Questions for Thought and Discussion
1. Do you see any ethical concerns in this case?
2. Does Section G of the ACA Code of Ethics provide any guidance?
Analysis
There are several key concerns in this case study. The overarching concern,
and one that may well encompass all others, is the disregard of the review
process for the new study. It is unacceptable to use the university IRB proposal for this study. Even if the new study was identical to the previous
one, the fact remains that the researcher is no longer conducting research
as part of her graduate work at the institution that originally provided
IRB approval. That being said, the methodology for the new study is significantly different and, therefore, the study itself is significantly different
as well; it is not the same study. Jayni will need to develop a research
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proposal for the new study and have it reviewed by one or more persons
with expertise in the institutional review process (ACA, 2014, Standard
G.1.c.). Clearly, the director of the clinic does not have adequate expertise
for approving a research proposal and should not have given approval for
the study.
Although the topic is essentially similar, there will be new participants
and the addition of new, and possibly more emotionally evocative, methodology. Even though the previous research proposal could be used as
a guide, the proposal requires significant revision. At a minimum, the
methods section of the proposal would need to include discussion of
mixed-methods research and qualitative interviewing and a copy of the
interview protocol, including an explanation or justification for its use.
Finally, information describing the informed consent process for participants must be revised to clearly and accurately describe the study and
the role and potential concerns regarding the research interview processes
(Standard G.2.a.).
Questions for Further Reflection
1. If you were to provide consultation to Jayni as she redesigns her
study to include qualitative interviews that would address potentially emotionally evocative topics, what steps might you suggest
she take to safeguard participant welfare?
2. Why do you think the ethical standards in Section G are so stringent
in terms of ensuring that proposed research studies are reviewed by
experts?
Case Study 22
A Question of Authorship
Richard E. Watts
Dr. Sealy requires each student in his qualitative research course to prepare a manuscript based on the qualitative study the student conducted
for the class. At the end of the class each year, Dr. Sealy tells students who
conducted strong research projects and prepared superior manuscripts
that they should submit their manuscript to a professional counseling
journal. Because he has edited their manuscripts and will suggest a journal for submission, he tells them he expects to be listed as second author
on the manuscript.
Jill took the qualitative research class and was told by Dr. Sealy that her
manuscript was “outstanding” and he was certain it would be accepted
for publication. Dr. Sealy also reminded Jill of his policy of being listed as
second author. Jill assumed that this was standard procedure and, therefore, agreed to the authorship listing.
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Jill asked Dr. Sealy about revising the manuscript for submission, and
he stated that she should revise the manuscript based on the comments
he provided on the manuscript she submitted for the course. Jill had difficulty with the revision process and, when she contacted Dr. Sealy for assistance, found that he was consistently “unavailable.” After several more
attempts and after months had passed, Jill got discouraged and decided to
put the manuscript revision on hold. She sent Dr. Sealy an email indicating her decision but did not receive any reply.
Almost 9 months after she decided to delay the revision process, Jill
received an email from a friend in another state congratulating her on the
recent publication of her article in the journal published by her friend’s
state professional counseling association. Jill asked her friend to scan the
article and send it to her. The article was the manuscript she had prepared
for Dr. Sealy’s class. To her even greater dismay, she found that Dr. Sealy
had listed himself as first author and Jill as second.
At her earliest opportunity, Jill went to Dr. Sealy’s office to confront him
about the article’s publication and the reverse authorship listing. Dr. Sealy
replied, “Because you delayed so long revising the manuscript, I decided
to do you a favor and do the revision myself and submit it for publication. I didn’t tell you because I wanted to surprise you. Because I did all
the work on the revision and submission of the manuscript, I believe I’m
well within my rights to list myself as first author. I thought you would be
pleased with having a manuscript published.”
Questions for Thought and Discussion
1. What is your initial reaction to this case study?
2. What specific standards in Section G of the ACA Code of Ethics address the ethical issues you see in this case?
3. If you were in Jill’s place, what would you do next? What issues or
concerns do you think she may face in dealing with the situation?
Analysis
There are two major issues in this case. First, Dr. Sealy’s requirement that he
be listed as second author because he edited the student’s paper and will suggest a potential journal for manuscript submission seems to conflict with the
requirements of ACA Code of Ethics (ACA, 2014) Standard G.5.d. Providing
editorial suggestions regarding a student’s class paper could be considered
to be a normal expectation within an instructor’s responsibility and does
not warrant that instructor’s inclusion as a manuscript coauthor. The manuscript’s author might include a footnote expressing gratitude for guidance
regarding an appropriate venue for publication, but providing such a suggestion does not warrant inclusion as a coauthor. Furthermore, given the power
differential in the relationship between faculty members and students, Dr.
Sealy’s requirement could also be viewed as a misuse of power.
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Research and Publication
The second major issue in this case has two aspects: submission of the
manuscript and authorship. Manuscripts substantially based on a student’s work “are used only with the student’s permission and list the
student as lead author” (Standard G.5.f.). Although Dr. Sealy claimed to
be doing the student “a favor,” he clearly made an unethical decision by
submitting the manuscript without securing the student’s permission. Regarding the issue of authorship, Dr. Sealy stated that, given that he did the
work required for revising the manuscript and submitting it for publication, he should be listed as first author. In other words, he believed he
should be listed as the principal contributor to the manuscript because
of his revision work (see Standard G.5.d.). However, according to Standard G.5.e., Standard G.5.f., as well as a closer reading of Standard G.5.d.,
Sealy’s rationale is unfounded and his behavior is ethically inappropriate.
The manuscript was based significantly on the student’s work. She was
clearly the primary contributor and should be listed as first author.
Questions for Further Reflection
1. If you were a fellow student in Jill’s counselor education program
and she asked for your advice, what would you say to her? What options do you think Jill has, and what are the pros and cons of each?
How would your awareness of the power differential between students and professors influence your decision making?
2. Do you think students should be encouraged, or even required, to
attempt to publish work they have completed in their courses? If
so, what safeguards need to be put into place so students are treated
fairly?
• 279 •
Chapter 12
The Intersection of
Ethics and Law
Burt Bertram and Anne Marie “Nancy” Wheeler
Counselors are guided in their daily decision making by codes of ethics.
These codes evolve as the profession matures and society changes. Because of the fluid nature of ethics codes, counselors will always want to
refer to the most recent version of the ACA Code of Ethics (American Counseling Association [ACA], 2014) to guide them in their decision making
and help them solve ethical dilemmas.
Ethical standards are separate from, but heavily influenced by, the law.
For example, when the seminal case of Tarasoff v. Regents of the University
of California (1976) was decided and similar lawsuits followed in many
states, various national and state mental health professional associations
adapted their codes of ethics to permit their members to take action that
may have been considered unethical before Tarasoff. Tatiana Tarasoff was
killed by a college student named Prosenjit Poddar, who had been seeing a psychologist at the university and had told the psychologist that he
intended to harm Tarasoff. The lawsuit that ensued has resulted in the
understanding that counselors can breach a client’s confidentiality when
they need to “warn and protect” an intended victim. Certain breaches of
confidentiality are permitted:
The general requirement that counselors keep information confidential does
not apply when disclosure is required to protect clients or identified others
from serious and foreseeable harm or when legal requirements demand that
confidential information must be revealed. (ACA, 2014, Standard B.2.a.)
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Issues and Case Studies
Besides judicial, or “case law” decisions, laws created by state legislatures
also influence the creation of new ethics standards. For example, following Tarasoff and similar cases, mental health groups around the country
lobbied their state legislatures to pass statutes that would provide them
with immunity from civil suit if they took certain actions (e.g., warning,
notifying law enforcement) to protect potential victims when their clients
or patients threatened harm to others.
A related example involves the reporting of abuse. Every state now
has a statute mandating reports of child abuse by certain professionals,
including counselors. In addition, virtually every state has a statute requiring reporting abuse of elderly or vulnerable adults. If the report is
not made by a counselor or other mandated reporter, the penalties may
range from a criminal offense (misdemeanor) to potential loss of licensure,
depending on the specifics of state law. Ethics codes have been adapted
to uphold these laws and recognize the significant policy issues involved
in protecting both children and vulnerable adults, which are viewed as
overriding potential client confidentiality concerns. Many of the codes
have also required counselors to inform clients at the outset, through the
informed consent process, of the various limits of confidentiality.
Federal law may also influence the evolution of codes of ethics. Most
mental health practitioners are familiar with the acronym HIPAA. The
HIPAA Privacy Rule, developed to implement the Health Insurance Portability and Accountability Act of 1996 (HIPAA), was the first comprehensive national attempt to create federal privacy protections for protected
health information (Wheeler & Bertram, 2012). As mental health associations such as the ACA revise their codes of ethics, HIPAA is certainly taken
into account in addressing such issues as client access to records and confidentiality of client records and communications, whether in hard copy
form or in an electronic format.
State licensing of mental health professionals (including licensed counselors, marriage and family therapists, social workers, and psychologists)
has brought a host of legal requirements to these practicing professionals.
Complaints by clients or their family members regarding the professional
behavior of mental health professionals have become commonplace. Licensure statutes dictate broad legal requirements for the practice of the specific
profession; the implementing regulations provide the details of how a counselor or other mental health professional must operate to stay within the
bounds of the law. These regulations cover the specifics of graduate education requirements, supervised prelicensed experience, disciplinary actions
(ranging from fines to revocation of license), specialty designations, and
other issues (such as confidentiality and maintenance of records) that overlap with codes of ethics. Furthermore, ethics codes may be incorporated
into state statutes, giving the ethics codes the full force of law.
Although ethics and law are not synonymous, they are certainly related.
Another associated factor that plays into counselors’ decisions in solving
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The Intersection of Ethics and Law
complex ethical dilemmas is institutional policy. One important legal
precedent involving school counselors—the case of Eisel v. Board of Education of Montgomery County (1991)—demonstrates the weight that institutional policy may carry in legal decisions. In Eisel, the Maryland Court of
Appeals (the state’s highest court) held that school counselors have a duty
to use reasonable means to prevent a suicide (including, in this case, warning the parent) when they are on notice of a child or adolescent student’s
suicidal intent. The appellate judge who wrote the decision specifically
pointed to school policy in effect at the time that advised school personnel
to notify the school administration and parents when a student was determined to be suicidal. The appellate court reversed the lower court’s grant
of summary judgment and left it to the jury in a subsequent trial to decide
whether the duty in this case included warning the parents.
As professionals, counselors are subject to malpractice lawsuits (civil
suits) if their actions create a breach of duty that does not meet the “standard of care” and causes damage to their clients. Civil damages can be
extensive in cases where loss of life resulted from counselors’ negligence.
For this reason, and because attorneys’ fees can be expensive even when
the counselor is exonerated, counselors should obtain professional liability insurance from a reputable carrier. Counselors will usually want to
choose coverage that also covers attorneys’ fees in licensure board actions.
In short, when counselors are faced with complex dilemmas, they
should be aware of the applicable ethics, laws, and institutional policies
that may apply. The ACA Code of Ethics (ACA, 2014) mandates that counselors know and utilize a reputable decision-making model when faced
with an ethical dilemma. Several models are available to practitioners,
including our legal/ethical decision-making model (Wheeler & Bertram,
2012). One of the most important aspects included in all decision-making
models involves consulting with colleagues and obtaining legal advice
when needed. The two case studies that follow, Case Study 23 (A Student Commits Suicide) and Case Study 24 (Good Intentions Go Awry),
illustrate how legal and ethical considerations can intersect to produce
complex ethical dilemmas.
Case Study 23
A Student Commits Suicide
Burt Bertram and Anne Marie “Nancy” Wheeler
Meredith is a school counselor who works in a public high school. Jason, a
15-year-old student, came to see Meredith and expressed that he was feeling somewhat depressed. Jason asked Meredith not to call his mother because she was still grieving over her husband’s suicide last year. Meredith
usually doesn’t give her cell phone number to students because school
policy forbids texting with students, but she made an exception for Jason
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Issues and Case Studies
because she knew she’d be out of school at a mandatory staff training the
next day and she was concerned about Jason.
The following afternoon, while Meredith was at the training, the speaker
asked everyone to turn off their cell phones. Meredith complied. Two hours
later, Meredith checked her messages during a break and saw that she had
missed a text message from Jason. She was alarmed to see his message, which
read, “Sorry, but I’ve had it. You’ve been really nice, but I can’t go on.” She
tried to reach Jason but couldn’t get through to him. She called the principal,
who told her not to call Jason’s mother and that he’d take care of trying to
find Jason and call her. Later that evening, Meredith received a call from the
principal informing her that Jason had stayed late at school and had hanged
himself in the bathroom 2 hours after school had been dismissed.
Questions for Thought and Discussion
1. What should Meredith do now?
2. If you were Meredith, would you have made any different decisions from
the outset of counseling? If so, what would you have done differently?
3. Assume that Jason’s mother subsequently files suit against the school
for failure to supervise and protect Jason. Meredith is not named as a
defendant but receives a witness subpoena. How should she proceed?
4. Assume that Jason’s math teacher calls Meredith after the suicide
and tells her that she’s the one who referred Jason to Meredith.
She wants to know if Jason ever saw Meredith in counseling. How
should Meredith respond?
Analysis
As Meredith is faced with the tragic news of Jason’s suicide, she should first
consider obtaining consultation. She may want to place a call to her personal
local attorney and possibly the risk management service associated with her
professional liability insurance program. This is also the time to call a trusted
colleague to help her review her past actions and anticipated future actions.
She should talk to the colleague without revealing the identity of the client.
Meredith will likely need to meet with the principal to see if outreach has
been made to Jason’s mother and what the school plans to do next. She may
also wish to review any school policy relevant to the situation.
At the outset of counseling, Meredith should have been clear regarding
how she could be reached in the event of an emergency as well as what other resources would be accessible to Jason when Meredith was unavailable.
If Meredith disagreed with school policy regarding use of text messages,
perhaps that could have been taken up with the administration before a
crisis ever developed. If a particular school policy is unworkable, it should
be brought to the attention of the administration while changes can still be
made before an incident. If a lawsuit is subsequently brought, the school
may not support the counselor if the counselor defied school policy.
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The Intersection of Ethics and Law
If Meredith believed she had an independent duty to notify the mother,
she could have stressed to the principal why she should call and alert
the mother to Jason’s message. Although a school counselor should not
typically countermand a principal’s directive, she must exercise the professional discretion she believes is necessary in the situation.
Meredith might have decided to silence her cell phone without turning
it off completely. Better yet, she could have left a message on her phone
and notified Jason in advance of what to do in case of an emergency. If she
did decide to engage in text messaging, she could have instructed Jason in
advance what to do in an emergency. Counselors should carefully consider the potential pitfalls in using text messaging for real clinical issues (as
opposed to merely setting or changing appointments). It sets up a possible
expectation that clients’ concerns will be dealt with immediately.
If Meredith receives a subpoena in a subsequent lawsuit against the
school, she should immediately call her professional liability insurance
company and request legal representation. If she already has her own
attorney, she may wish to consult that person too. Her interests may not
be identical to the school’s interest, so she should probably not rely on the
school district attorney to advise her. Although there are variations among
state laws, if the counselor cannot obtain client authorization to release
information, typically the counselor should seek to have legal counsel file
a “motion to quash” or “motion for protective order,” which may lead to
a court (judicial) order on whether the counselor–client privilege may be
waived. Because of state law differences, Meredith should not attempt to
figure this out without legal consultation. In this case, Meredith could be
named as an additional defendant in the suit against the school, and this is
one more reason she should be represented by her own attorney.
Regarding the request from Jason’s math teacher, although the teacher
may be very well intentioned, Meredith should respond to the teacher by
thanking her for providing information but tactfully letting the teacher
know that confidentiality laws and ethics preclude her from discussing
whether Jason had followed up on a counseling recommendation. At
this point, Jason is deceased, and discussing Jason’s counseling with the
teacher is inappropriate. It would be a different matter if the client (and/
or the parent, in some states) had authorized information to go from counselor to teacher to help with the child’s instruction. If a communication
with the teacher before Jason’s death could have prevented harm to
Jason, Meredith may have been able to release limited, appropriate information to the teacher.
Questions for Further Reflection
1. Sometimes clients do commit suicide, even when counselors have
worked competently and diligently to assist these clients. When this
happens, conscientious counselors can feel devastated. What are some
self-care strategies that counselors can use in these circumstances?
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Issues and Case Studies
2. What obligations does a school counselor have to the other students in
the school, and to teachers and staff, when a student commits suicide?
Case Study 24
Good Intentions Go Awry
Burt Bertram and Anne Marie “Nancy” Wheeler
Don Brown, MA, LPC, is in private practice. He has been counseling Sonia,
age 45, for 3 months. In a session 6 weeks ago, Sonia disclosed to Don that
she had informed her husband she wants a divorce and that violent screaming episodes between Sonia and her husband have become the norm at
home. She is concerned about exposing her children (Karen, 19, and Sammy,
16) to this behavior and is looking for a place for both of them to live while
she and her husband sort through the decision to divorce. Sonia says, “It’s
just no place for children. Even though my daughter is 19, she shouldn’t be
exposed to this kind of ugly behavior between her parents. Sammy can live
with a family friend, but I can’t afford to rent an apartment for Karen.”
Sonia appears to be quite desperate to find a safe place for daughter
Karen to live. Don is concerned about how Sonia will handle the stress
and turmoil of the divorce and knows that her concerns about Karen are
only making this worse. Don tells Sonia that he has a small cottage on his
property that is close to the community college Karen attends. He tells
Sonia he would be willing to rent the apartment to Sonia for a reduced fee.
Karen moves into the cottage. Over the next 6 weeks, Don and Karen
begin a casual and platonic friendship. Don enjoys her company but is
careful not to disclose confidential information about Sonia or their counseling relationship. One night, long after midnight, Karen frantically
knocks on Don’s door; she is distraught. She just learned that her father
has been having an affair. Don comforts Karen and then she requests permission to sleep on his couch.
Questions for Thought and Discussion
1. How should Don respond to Karen’s request to sleep on his couch?
What are the potential risks of his response, whether or not he agrees
to the request?
2. In what ways has Don extended the boundaries of his counseling
relationship with Sonia? Do you see any possible ethical or legal
ramifications for Don in this scenario?
Analysis
Mismanaged boundary issues are often referred to as the “royal road to
licensure board complaints.” Don’s offer to rent the cottage to his client
was a clear boundary crossing; in fact, it could be reasonably argued that
renting the cottage constituted a boundary violation (see Chapter 7). What
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The Intersection of Ethics and Law
is absolutely clear is that not only is Don standing in the doorway of his
home—he is standing on the threshold of a serious, perhaps career damaging, boundary violation. Depending on a host of factors that we can
only imagine, he could be on the verge of committing sexual misconduct.
He has already demonstrated very poor professional judgment; we can
only hope he will come to his senses and do the following:
• Go outside (don’t allow Karen to come in)
• Decline Karen’s request to sleep on his couch
• Ensure her safety by contacting someone (perhaps her mother or a
responsible friend) who can come and be with her
• Obtain consultation as soon as possible
Don is licensed and in private practice; therefore, he may not have a supervisor to contact. As an alternative, he should contact a trusted senior practitioner
and give serious consideration to speaking with an attorney. In both instances,
he should completely and honestly describe what has occurred. Among the
many topics he and his consultants should consider are the following:
• The impact these events may have on the counseling relationship
with his client, Sonia
• How he should approach his client and whether that interaction
should involve a third-party facilitator
• Whether the fights between Sonia and her husband were violent
enough to trigger a mandatory child abuse report
• What should be documented in the file to respond to a licensure
board complaint should that occur
In the event that Sonia is unwilling to continue in the counseling relationship, Don should be prepared to consider the likelihood that she will file a
complaint with the licensure board.
If Don allowed Karen to sleep on the couch and/or if there were some
inappropriate contact between them, he should immediately consult with
an attorney and contact his professional liability insurance carrier. Whether
there was inappropriate contact or not, managing this alone, without an outside perspective, is foolhardy and is exactly how he got into this problem in
the first place. Had he consulted with a trusted colleague before offering to
rent the cottage, he would have been awakened to the ethical and legal risks.
Finally, Don should seek counseling for himself. It seems clear that he
has some issues he needs to identify and address.
Questions for Further Reflection
1. If Don were to be sued, or brought before his licensure board on
charges of inappropriate conduct, and you were asked to testify,
what would you say?
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Issues and Case Studies
2. If a counselor like Don were to seek counseling from you, what do
you think should be the goals of the counseling process?
• 288 •
Highlights of
Ethical Practice
In these concluding comments, we summarize much of the material in
the Casebook by focusing on some principles we believe are important for
counselors to review throughout their professional lives. The emphasis is
on considering the cultural context of ethical decision making. Multiculturalism, diversity, and social justice were addressed in detail in Chapter
2, “Social Justice and Counseling Across Cultures,” by Courtland C. Lee.
Because we work in a pluralistic society, it is essential that we increase our
consciousness of ways to apply the ethical standards from a perspective
that recognizes and respects diversity.
Ethics From Multicultural and Diversity Perspectives
Issues of multiculturalism and diversity are addressed throughout the
2014 ACA Code of Ethics (American Counseling Association [ACA], 2014).
Cultural considerations are specifically addressed in numerous standards,
including those that deal with the counseling relationship, informed consent, bartering, accepting gifts, confidentiality and privacy, professional
responsibility, assessment and diagnosis, supervision, and education and
training programs.
Respecting diversity means that you are committed to acquiring the
knowledge, skills, personal awareness, and sensitivity that are essential
to working effectively with diverse client populations. According to Lee
and Park (2013), the ever-increasing diversity in American society means
that counseling theory and practice can no longer be considered within
the context of a single cultural perspective. Rather, cultural diversity addresses broader issues, including age, ethnicity, race, religion/spirituality,
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Highlights of Ethical Practice
gender, gender identity, sexual orientation, disability, marital or partnership status, language preference, socioeconomic disadvantage, and immigration status.
Working with culturally diverse client populations requires that counselors possess the awareness, knowledge, and skills to effectively address
the concerns of their clients. Counselors who are not aware of cultural
dynamics and who do not address the impact of culture on counseling
are likely to engage in unethical conduct. Counselors must address the
challenges of diversity in a manner that is both culturally responsive and
ethically responsible (Lee & Park, 2013).
In the following pages, we highlight some of key themes addressed in
this Casebook.
• Become aware of your own personal needs, values, and worldview. It is your
responsibility to consider any prejudices or biases you may have, even
though many of them may be subtle. Self-exploration about your own
cultural heritage provides a pathway for understanding and appreciating differences in others. A counselor’s cultural self-awareness is
essential for effective and culturally relevant counseling.
• Honestly examine your own assumptions, expectations, and attitudes about
the counseling process. To some extent, we all are culture bound, and
it takes a concerted effort for us to monitor our biases and beliefs so
that they do not impede our work with a wide range of clients. If you
are open to learning, you will find ways to avoid getting trapped in
provincialism, and you will be able to challenge the ways in which
you may be culturally encapsulated (see Wrenn, 1962).
• Acquire training in counseling persons from diverse backgrounds. If you
have not received adequate training in counseling persons from diverse backgrounds, realize that ethical practice demands that you
find a way to acquire this competence. If you are not adequately prepared to work with diversity, it will not be ethical for you to provide
direct counseling services to clients from diverse backgrounds. Of
course, this does not mean that you need to have expertise in every culture or subculture, but you do need to have a comprehensive
grasp of general principles for working successfully with cultural
diversity. The reality of working in a pluralistic society entails learning a variety of perspectives to meet the unique needs of clients.
• Know when to make referrals. When you do not have the competencies to work with a particular client, make referrals to appropriate
resources. Consider offering a referral only when you are not able to
deliver competent service. Avoid the temptation to refer all clients
who may be challenging for you, especially if the challenge is due to
a conflict between your values and the client’s behaviors or goals.
• Seek consultation to expand your knowledge base. Seeking consultation
is an excellent way to increase your knowledge and skills in mul-
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Highlights of Ethical Practice
ticultural and cross-cultural counseling. You may need to acquire
specialized training in working with persons from diverse backgrounds; such as individuals from various socioeconomic groups;
lesbian, gay, bisexual, transgender, queer, and questioning clients; or
clients from different religious backgrounds. Understanding the role
of gender socialization is also critical in the counseling process.
• Participate in continuing education on diversity. Continuing education
is a pathway toward achieving competence in working with diversity. Professional development opportunities might include activities
that examine cultural, social, psychological, political, economic, and
historical dimensions.
• Realize that understanding the social justice perspective is an integral part
of becoming a diversity competent counselor. The social justice perspective is based on the premise that oppression, privilege, and social
inequities do exist and have a negative impact on the lives of many
persons. Becoming aware of social injustice is only part of the picture. We are called upon to translate this awareness into various
forms of social action, which involves advocating for change. With
the increasing globalization of counseling, counselors will need to
learn how to advocate for change, not just in our society but across
the world at individual, group, institutional, and societal levels.
• Continue to infuse the counselor training process with diversity training.
In the teaching, training, and supervision of counselors, it is essential that those responsible for counselor education programs infuse
material related to human diversity into all courses. This includes
material related to cultural, ethnic, racial, gender, sexual orientation,
socioeconomic, and other types of differences. The implications of
these differences need to be explored as they pertain to counseling
practice and research, as well as training. Ethical practice demands
that counselor educators discuss the cultural limitations and biases
associated with traditional counseling theories, techniques, and research findings.
As we noted in the Introduction, there is a difference between mandatory ethics and aspirational ethics. Becoming an ethical and competent
counselor entails striving for the highest level of ethical functioning rather
than practicing mainly from a risk management perspective. All of the
standards in the 2014 ACA Code of Ethics (ACA, 2014) can be interpreted
against a framework of diversity.
The Challenge of Developing Your Personal Ethics
As a professional counselor, you are expected to know the ethical standards of your professional organizations, and you are also expected to
exercise good judgment in applying these principles to particular cases.
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Highlights of Ethical Practice
You will find that interpreting the ethical standards and applying them to
particular situations demand the utmost ethical sensitivity. Even responsible practitioners differ over how to apply established ethical principles
to specific situations. You will be challenged to deal with questions that do
not always have obvious answers. You will need to decide how to act in
ways that will further the best interests of your clients.
Resolving the ethical dilemmas you will face requires a commitment to
questioning your own behavior and motives. A sign of your good faith is
the willingness to share your struggles openly with colleagues or fellow
students. Such consultation can be of great help in clarifying issues by giving you other perspectives. Keep yourself informed about laws affecting
your practice, keep up to date in your specialty field, stay abreast of developments in ethical practice, reflect on the impact your values have on your
practice, and be willing to engage in honest self-examination.
It is our hope that you will continue to think about the guidelines and
principles explored in this Casebook, apply them to yourself, and attempt
to formulate your own views and positions on the topics we have raised.
As you have seen, ethical thinking is not a simple matter of black-or-white
categorization; there are gray areas in most of the ethical dilemmas you
will face. Developing your sense of professional and ethical responsibility
is a task that never really ends.
• 292 •
References
Alemi, F., Haack, M. R., Nemes, S., Aughburns, R., Sinkule, J., & Neuhauser, D. (2007). Therapeutic emails. Substance Abuse Treatment, Prevention
& Policy, 2, 7–18. doi:10.1186/1747-597X-2-7
American Association for Marriage and Family Therapy. (2012). AAMFT
code of ethics. Washington, DC: Author.
American Counseling Association. (1995). Code of ethics and standards of
practice. Alexandria, VA: Author.
American Counseling Association. (2005a). ACA code of ethics. Alexandria,
VA: Author.
American Counseling Association. (2005b). ACA policies and procedures for
processing complaints of ethical violations. Alexandria, VA: Author.
American Counseling Association. (2014). ACA code of ethics. Alexandria,
VA: Author.
American Personnel and Guidance Association. (1961). Ethical standards.
Washington, DC: Author.
American Personnel and Guidance Association. (1974). Ethical standards.
Washington, DC: Author.
American Personnel and Guidance Association. (1981). Ethical standards.
Washington, DC: Author.
American Psychological Association. (2007). APA dictionary of psychology.
Washington, DC: Author.
American Psychological Association. (2010). Publication manual of the
American Psychological Association (6th ed.). Washington, DC: Author.
American School Counselor Association. (2010). Ethical standards for school
counselors. Alexandria, VA: Author.
• 293 •
References
Ametrano, I. M. (2014). Teaching ethical decision-making: Helping students reconcile personal and profesional values. Journal of Counseling &
Development, 92, 154–161.
Arredondo, P., Toporek, M. S., Brown, S., Jones, J., Locke, D. C., Sanchez, J., &
Stadler, H. (1996). Operationalization of the Multicultural Counseling Competencies.
Alexandria, VA: Association for Multicultural Counseling and Development.
Association for Counselor Education and Supervision. (2011). Best practices in clinical supervision. Retrieved from www.acesonline.net/
wp-content/uploads/2011/10/ACES-Best-Practices-in-clinicalsupervision-document-FINAL.pdf
Association for Specialists in Group Work. (2008). Best practice guidelines.
Journal for Specialists in Group Work, 33, 111–117.
Association for Specialists in Group Work. (2012). Multicultural and social
justice competence principles for group workers. Retrieved from http://
www.asgw.org/
Barnett, J. E., & Johnson, W. B. (2015). Ethics desk reference for counselors
(2nd ed.). Alexandria, VA: American Counseling Association.
Barnett, J. E., & Johnson, B. W. (2011). Integrating spirituality and religion
into psychotherapy: Persistent dilemmas, ethical issues, and a proposed decision making process. Ethics and Behavior, 21, 147–164.
Beauchamp, T. F., & Childress, J. F. (1979). Principles of biomedical ethics.
New York, NY: Oxford University Press.
Beck, A. T., & Steer, R. A. (1990). Beck Anxiety Inventory manual. San Antonio,
TX: The Psychological Corporation.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory
manual. San Antonio, TX: The Psychological Corporation.
Bongar, B., & Sullivan, G. R. (2013). The suicidal patient: Clinical and legal standards
of care (3rd ed.). Washington, DC: American Psychological Association.
Bradley, L. J., Hendricks, B., Lock, R., Whiting, P. P., & Parr, G. (2011). Email communication: Issues for mental health counselors. Journal of
Mental Health Counseling, 33, 67–79.
Bruff v. North Mississippi Health Services, 244 F.3d 495 (5th Cir. 2001).
Cain, J. (2011). Social media in health care: The case for organizational
policy and employee education. American Journal of Health-System Pharmacy, 68(11), 1036–1040. doi:10.2146/ajhp100589
Casto, C., Caldwell, C., & Salazar, C. F. (2005). Creating mentoring relationships between female faculty and students in counselor education:
Guidelines for potential mentees and mentors. Journal of Counseling &
Development, 83, 331–336.
Chauvin, J. C., & Remley, T. P. (1996). Responding to allegations of unethical conduct. Journal of Counseling & Development, 74, 563–568.
Chu, J., Floyd, R., Diep, H., Pardo, S., Goldblum, P., & Bongar, B. (2013).
A tool for the culturally competent assessment of suicide: The Cultural
Assessment of Risk for Suicide (CARS) measure. Psychological Assessment, 25(2), 424–434.
• 294 •
References
Chun, K. Y. S., & Singh, A. A. (2010). The bisexual youth of color intersecting identities development model: A contextual approach to understanding multiple marginalization experiences. Journal of Bisexuality,
10(4), 429–451.
Corey, G., Corey, M. S., Corey, C., & Callanan, P. (2015). Issues and ethics
in the helping professions (9th ed.) Belmont, CA: Brooks/Cole, Cengage
Learning.
Corey, G., Haynes, R., Moulton, P., & Muratori, M. (2010). Clinical supervision in the helping professions: A practical guide (2nd ed.). Alexandria, VA:
American Counseling Association.
Corey, M., Corey, G., & Corey, C. (2014). Groups: Process and practice (9th
ed.). Belmont, CA: Brooks/Cole, Cengage Learning.
Cottone, R. R. (2001). A social constructivism model of ethical decision
making in counseling. Journal of Counseling & Development, 79, 39–45.
Cottone, R. R., & Tarvydas, V. M. (2007). Ethical and professional issues in
counseling (3rd ed.). Upper Saddle River, NJ: Merrill/Prentice-Hall.
Council for Accreditation of Counseling and Related Educational Programs. (2009). CACREP standards. Alexandria, VA: Author.
Delgado-Romero, E. (2003). Ethics and multicultural competence. In D.
B. Pope-Davis, H. L. K. Coleman, W. M. Liu, & R. L. Toporek (Eds.),
Handbook of multicultural competencies in counseling and psychology (pp.
313–329). Thousand Oaks, CA: Sage.
DiLillo, D., & Gale, E. B. (2011). To Google or not to Google: Graduate
students’ use of the Internet to access personal information about clients. Training and Education in Professional Psychology, 5(3), 160–166.
doi:10.1037/a0024441
Dobmeier, R. A., Reiner, S. M., Casquarelli, E. J., & Fallon, K. M. (2013,
January). Overcoming the schism between spiritual identity and sexual
orientation. Counseling Today, 49–52.
Drogin, E. Y., Connell, M., Foote, W. E., & Sturm, C. A. (2010). The American Psychological Association’s revised “record keeping guidelines”:
Implications for the practitioner. Professional Psychology: Research and
Practice, 41(3), 236–243.
Ducharme, L. J., Knudsen, H. K., & Roman, P. M. (2008). Emotional exhaustion and turnover intention in human service occupations: The
protective role of coworker support. Sociological Spectrum, 28(1), 81–104.
Dugger, S. M., & Francis, P. C. (2014). Surviving a lawsuit against a counseling program: Lessons learned from Ward v. Wilbanks. Journal of Counseling & Development, 92, 135–141.
Eisel v. Board of Education of Montgomery County, 597 A.2d 447 (Md. 1991).
Facebook. (2013). Facebook reports third quarter 2013 results. Retrieved from
http://investor.fb.com/releasedetail.cfm?ReleaseID=802760
Finn, J., & Barak, A. (2010). A descriptive study of e-counsellor attitudes,
ethics, and practice. Counselling & Psychotherapy Research, 10(4), 268–
277. doi:10.1080/14733140903380847
• 295 •
References
Forester-Miller, H., & Davis, T. E. (1996). A practitioner’s guide to ethical decision making. Alexandria, VA: American Counseling Association.
Frame, M. W., & Williams, C. B. (2005). A model of ethical decision making from a multicultural perspective. Counseling and Values, 49, 165–179.
Francis, P. C., & Dugger, S. M. (2014). Professionalism, ethics, and valuebased conflicts in counseling: An introduction to the special section.
Journal of Counseling & Development, 92, 131–134.
Gabbard, G. O. (1995, April). What are boundaries in psychotherapy? The
Menninger Letter, 3(4), 1–2.
Garcia, J. G., Cartwright, B., Winston, S. M., & Borzuchowska, B. (2003). A
transcultural integrative model for ethical decision making in counseling. Journal of Counseling & Development, 81, 268–277.
Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press.
Glenn, C. R., & Klonsky, E. D. (2009). Social context during non-suicidal selfinjury indicates suicide risk. Personality and Individual Differences, 46, 25–29.
Glosoff, H. L., & Pate, R. H. (2002). Privacy and confidentiality in school
counseling. Professional School Counseling, 6, 20–27.
Gottlieb, M. C., & Younggren, J. N. (2009). Is there a slippery slope? Considerations regarding multiple relationships and risk management.
Professional Psychology: Research and Practice, 40(6), 564–571.
Granello, D. H., & Young, M. E. (2012). Counseling today: Foundations of
professional identity. Boston, MA: Pearson.
Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and risk-management dimensions. American
Journal of Psychiatry, 150(2), 188–196.
Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D.,
D’Augelli, A. R., . . . Clayton, P. J. (2011). Suicide and suicide risk in
lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10–51.
Haberstroh, S. (2009). Strategies and resources for conducting online
counseling. Journal of Professional Counseling: Practice, Theory & Research,
37(2), 1–20.
Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical
psychologists: An acculturation model. Professional Psychology: Research
and Practice, 36(1), 59–65.
Harris, E., & Younggren, J. N. (2011). Risk management in the digital
world. Professional Psychology: Research and Practice, 42(6), 412–418.
Health Insurance Portability and Accountability Act of 1996 (HIPAA),
Pub. L. No. 104–191.
Herlihy, B., & Corey, G. (2006). ACA ethical standards casebook (6th ed). Alexandria, VA: American Counseling Association.
Herlihy, B., & Corey, G. (2015). Boundary issues in counseling: Multiple
roles and responsibilities (3rd ed.). Alexandria, VA: American Counseling Association.
• 296 •
References
Herlihy, B., Hermann, M. A., & Greden, L. R. (2014). Legal and ethical implications of using religious beliefs as the basis for refusing to counsel
certain clients. Journal of Counseling & Development, 92, 148–153.
Herlihy, B., & Remley, T. P., Jr. (1995). Unified ethical standards: A challenge
for professionalism. Journal of Counseling & Development, 74, 130–133.
Herlihy, B., & Watson, Z. E. (2004). Ethical issues in assisted suicide. In D.
Capuzzi (Ed.), Suicide across the life span (pp. 163–184). Alexandria, VA:
American Counseling Association.
Herr, E. (2011). Theoretical and historical foundations of the counseling
profession. In S. Nassar-McMillan & S. Niles (Eds.), Developing your
identity as a professional counselor: Standards, settings, and specialties (pp.
3–36). Belmont, CA: Brooks/Cole, Cengage Learning.
Hill, M., Glaser, K., & Harden, J. (1995). A feminist model for ethical decision making. In E. J. Rave & C. C. Larsen (Eds.), Ethical decision making in
therapy: Feminist perspectives (pp. 18–37). New York, NY: Guilford Press.
HowTo.gov. (2013). Making multimedia Section 508 compliant and accessible.
Retrieved from http://www.howto.gov/web-content/accessibility/508compliant-and-accessible-multimedia
Hyldahl, R. S., & Richardson, B. (2011). Key considerations for using noharm contracts with clients who self-injure. Journal of Counseling & Development, 89, 121–127.
International Association of Marriage and Family Counselors. (2005). Ethical code for International Association of Marriage and Family Counselors. The Family Journal, 1, 73–77.
Jencius, M. (2013). My password is not “password.” Counseling Today,
55(11), 26–27.
Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., & Kaslow, N. J.
(2012). The competent community: Toward a vital reformulation of professional ethics. American Psychologist, 67(7), 557–569.
Johnson, W. B., Ralph, J., & Johnson, S. J. (2005). Managing multiple roles
in embedded environments: The case of aircraft carrier psychology.
Professional Psychology: Research and Practice, 36, 73–81.
Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
Jordan, A. E., & Meara, N. M. (1991). The role of virtues and principle in
moral collapse: A response to Miller. Professional Psychology: Research
and Practice, 22, 107–109.
Kagawa-Singer, M., & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life. Journal of the American Medical Association, 286,
2993–3001.
Kaplan, D. M., Wade, M. E., Conteh, J. A., & Martz, E. T. (2011). Legal and
ethical issues surrounding the use of social media in counseling. Counseling and Human Development, 48(3), 1–6.
Keeton v. Anderson-Wiley, No. 1:10-CV-00099-JRH-WLB, 733 F. Supp. 2d
1368 (S.D. Ga., Aug. 20, 2010).
• 297 •
References
Kelly, E. W. (1995). Counselor values: A national survey. Journal of Counseling & Development, 73, 648–653.
Kidder, R. M. (1995). How good people make tough choices: Resolving the dilemmas of ethical living. New York, NY: Fireside.
Kitchener, K. S. (1984). Intuition, critical evaluation, and ethical principles:
The foundation for ethical decisions in counseling psychology. The
Counseling Psychologist, 12(3–4), 43–55.
Kleist, D., & Bitter, J. R. (2014). Virtue, ethics, and legality in family practice. In J. R. Bitter, Theory and practice of family therapy and counseling (2nd
ed., pp. 71–93). Belmont, CA: Brooks/Cole, Cengage Learning.
Knapp, S. J., & VandeCreek, L. (2012). Practical ethics for psychologists: A positive
approach (2nd ed.). Washington, DC: American Psychological Association.
Kocet, M. M., & Herlihy, B. J. (2014). Addressing value-based conflicts
within the counseling relationship: A decision-making model. Journal of
Counseling & Development, 92, 180–186.
Kolmes, K. (2010). My private practice social media policy. Retrieved from
http://www.drkkolmes.com/docs/socmed.pdf
Kolmes, K. (2012). Social media in the future of professional psychology. Professional Psychology: Research and Practice, 43(6), 606–612.
doi:10.1037/a0028678
Lawson, G. (2007). Counselor wellness and impairment: A national survey.
Journal of Humanistic Counseling, Education and Development, 46, 20–33.
Lazarus, A. A., & Zur, O. (Eds.). (2002). Dual relationships and psychotherapy.
New York, NY: Springer.
Lee, C. C. (Ed.). (2007). Counseling for social justice. Alexandria, VA: American Counseling Association.
Lee, C. C. (Ed.). (2013). Multicultural issues in counseling: New approaches to
diversity (4th ed.). Alexandria, VA: American Counseling Association.
Lee, C. C., & Kurilla, V. (1997). Ethics and multiculturalism: The challenge
of diversity. In Hatherleigh Editorial Board (Ed.), The Hatherleigh guide to
ethics in therapy (pp. 235–248). Long Island City, NY: Hatherleigh Press.
Lee, C. C., & Park, D. (2013). A conceptual framework for counseling
across cultures. In C. C. Lee (Ed.), Multicultural issues in counseling: New
approaches to diversity (4th ed., pp. 3–12). Alexandria, VA: American
Counseling Association.
Levitt, D. H., & Moorhead, H. J. H. (Eds.). (2013). Values and ethics in counseling: Real-life ethical decision making. New York, NY: Routledge.
Lewis, L. M. (2007). No-harm contracts: A review of what we know. Suicide
and Life-Threatening Behavior, 37, 50–57.
Linehan, M. M., Comtois, K. A., & Ward-Ciesielski, E. F. (2012). Assessing
and managing risk with suicidal individuals. Cognitive and Behavioral
Practice, 19, 218–232.
Manhal-Baugus, M. (2001). E-therapy: Practical, ethical, and legal issues. CyberPsychology & Behavior, 4(5), 551–563. doi:10.1089/109493101753235142
Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12(5), 189–192.
• 298 •
References
Matusek, J. A., & O’Dougherty, A. (2010). Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative
ethical decision-making model. European Eating Disorders Review, 18,
434–452.
McCormick, A. J. (2011). Self-determination, the right to die, and culture:
A literature review. Social Work, 56(2), 119–128.
McMyler, C., & Pryjmachuk, S. (2008). Do “no-suicide” contracts work?
Journal of Psychiatric and Mental Health Nursing, 15, 512–522.
Meara, N. M., Schmidt, L. D., & Day, J. D. (1996). Principles and virtues: A
foundation for ethical decisions, policies, and character. The Counseling
Psychologist, 24, 4–77.
Miller, M. C. (1999). Suicide-prevention contracts: Advantages, disadvantages, and an alternative approach. In D. G. Jacobs (Ed.), The Harvard
Medical School guide to suicide assessment and intervention (pp. 463–481).
San Francisco, CA: Jossey-Bass.
Moleski, S. M., & Kiselica, M. S. (2005). Dual relationships: A continuum
ranging from the destructive to the therapeutic. Journal of Counseling &
Development, 83, 3–11.
Muehlenkamp, J. J., & Gutierrez, P. M. (2007). Risk for suicide attempts
among adolescents who engage in non-suicidal self-injury. Archives of
Suicide Research, 11, 69–82.
National Board for Certified Counselors. (2012). NBCC policy regarding the
provision of distance professional services. Retrieved from http://www.
nbcc.org/Assets/Ethics/NBCCPolicyRegardingPracticeofDistanceCounselingBoard.pdf
Online Therapy Institute. (2010). Ethical framework for the use of social media
by mental health professionals. Retrieved from http://onlinetherapyinstitute.com/ethical-framework-for-the-use-of-social-media-by-mentalhealth-professionals/
Pack-Brown, S. P., & Williams, C. B. (2003). Ethics in a multicultural context.
Thousand Oaks, CA: Sage.
Pendergast, D. (2004). Nu Xs: Is it 2 L8 4 family? Journal of the HEIA, 11(2),
2–12.
Ponterotto, J. G., & Casas, J. M. (1991). Handbook of racial/ethnic minority
counseling research. Springfield, IL: Charles C Thomas.
Pope, K. S., & Keith-Spiegel, P. (2008). A practical approach to boundaries
in psychotherapy: Making decisions, bypassing blunders, and mending fences. Journal of Clinical Psychology, 64, 638–652.
Pope, K. S., & Vasquez, M. J. T. (2011). Ethics in psychotherapy and counseling: A practical guide for psychologists (4th ed.). Hoboken, NJ: Wiley.
Ratts, M., D’Andrea, M., & Arredondo, P. (2004, July). Social justice counseling: ‘Fifth force’ in the field. Counseling Today, 28–30.
Ratts, M. J., Lewis, J. A., & Toporek, R. L. (2010). Advocacy and social justice:
A helping paradigm for the 21st century. In M. J. Ratts, R. L. Toporek, &
J. A. Lewis (Eds.), ACA advocacy competencies: A social justice framework for
counselors (pp. 3–10). Alexandria, VA: American Counseling Association.
• 299 •
References
Ratts, M. J., Toporek, R. L., & Lewis, J. A. (Eds.). (2010). ACA advocacy competencies: A social justice framework for counselors. Alexandria, VA: American Counseling Association.
Reamer, F. G. (2013). Social work in a digital age: Ethical and risk management challenges. Social Work, 58(2), 163–172. doi:10.1093/sw/swt003
Remley, T. P., & Herlihy, B. (2014). Ethical, legal, and professional issues in
counseling (4th ed.). Upper Saddle River, NJ: Pearson.
Ridley, C. R., Liddle, M. C., Hill, C. L., & Li, L. C. (2001). Ethical decision
making in multicultural counseling. In J. G. Ponterotto, J. M. Casas, L.
A. Suzuki, & C. M. Alexander (Eds.), Handook of multicultural counseling
(2nd ed., pp. 165–188). Thousand Oaks, CA: Sage.
Roysircar, G., Arredondo, P., Fuertes, J. N., Ponterotto, J. G., & Toporek, R.
L. (2003). Multicultural counseling competencies 2003: Association for Multicultural Counseling and Development. Alexandria, VA: Association for
Multicultural Counseling and Development.
Salo, M. M., & Shumate, S. G. (1993). Counseling minor clients. Alexandria,
VA: American Counseling Association.
Schank, J. A., Helbok, C. M., Haldeman, D. C., & Gallardo, M. E. (2010).
Challenges and benefits of ethical small-community practice. Professional Psychology: Research and Practice, 41(6), 502–510.
SecondLife.com. (2013). Everything else. Retrieved from http://community.secondlife.com/t5/Everything-Else/how-many-players-does-Secondlife-currently-have/qaq-p/1925555
Seymour, J. W., & Rubin, L. (2006). Principles, principals, and process (P3):
A model for play therapy ethics problem solving. International Journal of
Play Therapy, 15(2), 101–123.
Shallcross, L. (2011). Finding technology’s role in the counseling relationship.
Counseling Today. Retrieved from http://ct.counseling.org/2011/10/
finding-technologys-role-in-the-counseling-relationship/
Shaw, H. E., & Shaw, S. F. (2006). Critical ethical issues in online counseling: Assessing current practices with an ethical intent checklist. Journal
of Counseling & Development, 84, 41–53.
Singh, A. A. (2010). It takes more than a rainbow sticker! Using the ACA
Advocacy Competencies with queer clients. In M. Ratts, J. Lewis, & R.
Toporek (Eds.), Using the ACA Advocacy Competencies in counseling (pp.
29–41). Alexandria, VA: American Counseling Association.
Singh, A. A. (2013). Transgender youth of color and resilience: Negotiating
oppression and finding support. Sex Roles, 68, 690–702.
Skovholt, T. M. (2012). Becoming a therapist: On the path to mastery. Hoboken,
NJ: Wiley.
Smith, C. (2013). By the numbers: 68 amazing Twitter stats. Retrieved from
http://expandedramblings.com/index.php/march-2013-by-the-numbers-a-few-amazing-twitter-stats/#.UqmXy2RDtBQ
Smith, D., & Fitzpatrick, M. (1995). Patient-therapist boundary issues: An
integrative review of theory and research. Professional Psychology: Research and Practice, 26(5), 499–506.
• 300 •
References
Speight, S. L. (2012). An exploration of boundaries and solidarity in counseling relationships. The Counseling Psychologist, 40(1), 133–157.
Stadler, H. A. (1986). Making hard choices: Clarifying controversial ethical
issues. Journal of Counseling and Human Development, 19, 1–10.
Stebnicki, M. A. (2008). Empathy fatigue: Healing the mind, body, and spirit of
professional counselors. New York, NY: Springer.
Substance Abuse Subtle Screening Inventory (SASSI). (n.d.). Retrieved
from http//pubs.niaaa.nih.gov/publications/AssessmentAlcohol/InstrumentPDFs/66_SASSI.pdf
Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of
Counseling & Development, 70, 477–486.
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and
practice (6th ed.). New York, NY: Wiley.
Tarasoff v. Regents of the University of California, 13c.3D177, 529 p.2D553; 118
California Reporter, 129 (1976).
United Nations Educational, Scientific and Cultural Organization. (2009).
UNESCO world report: Investing in cultural diversity and intercultural dialogue. Paris, France: Author.
Urofsky, R. I., Engels, D. W., & Engebretson, K. (2008). Kitchener’s principle ethics: Implications for counseling practice and research. Counseling and Values, 58, 67–78.
W3C. (2012). Web accessibility initiative (WAI). Retrieved from http://www.
w3.org/WAI/
Walden, S. (2015). Inclusion of the client’s voice in ethical practice. In B.
Herlihy & G. Corey, Boundary issues in counseling: Multiple roles and responsibilities (3rd ed., pp. 63–69). Alexandria, VA: American Counseling
Association.
Walden v. Centers for Disease Control and Prevention. No. 1:08-cv-02278JEC (United States District Court for the Northern District of Georgia,
March 18, 2010).
Walsh, B. W. (2006). Treating self-injury: A practical guide. New York, NY:
Guilford Press.
Ward v. Wilbanks, No. 09-CV-11237, Doc. 139 (E.D. Mich., Jul. 26, 2010).
Ward v. Wilbanks, No. 10-2100/2145 (6th Cir. Court of Appeals, Jan. 27, 2012).
Warner, L. R. (2008). A best practices guide to intersectional approaches in
psychological research. Sex Roles, 59(5–6), 454–463.
Welfel, E. R. (2013). Ethics in counseling and psychotherapy: Standards, research, and emerging issues (5th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.
Werth, J. L., Jr. (1999a). Mental health professionals and assisted death:
Perceived ethical obligations and proposed guidelines for practice. Ethics and Behavior, 9, 159–183.
Werth, J. L., Jr. (1999b). When is a mental health professional competent
to assess a person’s decision to hasten death? Ethics and Behavior, 9,
141–157.
• 301 •
References
Werth, J. L., Jr., Benjamin, G. A. H., & Farrenkopf, T. (2000). Requests for
physician assisted death: Guidelines for assessing mental capacity and
impaired judgment. Psychology, Public Policy, and Law, 6, 348–372.
Werth, J. L., Jr., Blevins, D., Toussaint, K., & Durham, M. R. (2002). The influence of cultural diversity on end-of-life care and decisions. American
Behavioral Scientist, 46, 204–219.
Werth, J. L., Jr., & Kleespies, P. M. (2006). Ethical considerations in providing psychological services in end-of-life care. In J. L. Werth Jr. & D.
Blevins (Eds.), Psychosocial issues near the end of life: A resource for professional care providers (pp. 57–87). Washington, DC: American Psychological Association.
Werth, J. L., Jr., & Rogers, J. R. (2005). Assessing for impaired judgment
as a means of meeting the “duty to protect” when a client is a potential harm-to-self: Implications for clients making end-of-life decisions.
Mortality, 10, 7–21.
Wheeler, A. M., & Bertram, B. (2012). The counselor and the law: A guide to
legal and ethical practice (6th ed.). Alexandria, VA: American Counseling
Association.
Working Group on Assisted Suicide and End-of-Life Decisions. (2000).
Report to the Board of Directors. Washington, DC: American Psychological Association. Retrieved from http://www.apa.org/pubs/info/reports/aseol.aspx
Wrenn, G. (1962). The counselor in a changing world. Washington, DC: American Personnel and Guidance Association.
Zinnbauer, B. J., & Pargament, K. I. (2000). Working with the sacred: Four
approaches to religious and spiritual issues in counseling. Journal of
Counseling & Development, 78, 162–171.
Zolotor, A., Theodore, A., Runyan, D., Chang, J., & Laskey, A. (2011). Corporal punishment and physical abuse: Population-based trends for
three-to-11-year-old children in the United States. Child Abuse Review,
20, 57–66.
Zur, O. (2007). Boundaries in psychotherapy: Ethical and clinical explorations.
Washington, DC: American Psychological Association.
Zur, O. (2008). Beyond the office walls: Home visits, celebrations, adventure
therapy, incidental encounters and other encounters outside the office walls.
Retrieved from www.zurinstitute.com/outofofficeexperiences.html
Zur, O. (2011). Bartering in psychotherapy and counseling: Complexities, case studies
and guidelines. Retrieved from www.zurinstitute.com/bartertherapy.html
• 302 •
Index
A
AACD (American Association for
Counseling and Development), 4
AAMFT (American Association for
Marriage and Family Therapy), 147
Abandonment of clients, 54. See also
Termination of services
Abortion, 211, 212
Absence procedures in supervision, 99
Abuse, reporting of, 172–173, 177–178,
282
ACA. See American Counseling
Association
Academic settings. See Education and
training; Research; Supervision
Accreditation status, 74
Accuracy
in advertising, 71, 72, 192
in assessment, 90
in qualifications, 72–73, 74
in reports and documentation, 39,
75
of research results, 121
ACES (Association for Counselor
Education and Supervision), 259
Action plans, 39
Addiction. See Substance use disorders
Adolescents. See Minor clients
Advertising, 71, 72, 192
Advocacy, 49, 159–161, 164, 167, 170,
219
Advocacy Competencies (ACA), 164
Affirmative counseling, 195, 200, 202
Aging clients, 172, 282
Agreements
bartering, 52
Business Associate Agreements, 249
informed consent, 251–252
no-harm contracts (NHCs), 234
no-suicide agreements, 243
role changes in professional
relationship, 47–48
self-care contracts, 243
supervisory relationships, 98–99, 181
AIDS/HIV, 173, 237–239
Alcohol use, 151, 223–224
Alemi, F., 248
American Association for Counseling
and Development (AACD), 4
American Association for Marriage
and Family Therapy (AAMFT), 147
American Counseling Association
(ACA). See also Code of Ethics
Advocacy Competencies, 164
membership in, 74
Policies and Procedures for Processing
Complaints of Ethical Violations, 23
American Personnel and Guidance
Association (APGA), 4
• 303 •
Index
American Psychological Association
(APA), 274
American School Counselor
Association, 173–174
Ametrano, I. M., 196
Appeals process, 24
Aspirational ethics, 13, 15
Assessment. See Evaluation and
assessment of clients
Association for Counselor Education
and Supervision (ACES), 259
Association for Specialists in Group
Work (ASGW), 147
Augusta State University (ASU), 195
Authorship credits, 123–124, 275,
277–279
Autonomy of clients, 14, 21, 35, 39
Avoiding harm, 43
B
Barak, A., 247
Barnett, J. E., 19, 20
Bartering, 52, 222
Beliefs. See Values and beliefs
Beneficence, 14, 21, 35
“Best Practice Guidelines” (ASGW), 147
“Best Practices in Clinical Supervision”
(ACES), 259
Biases in diagnosis, 86–87. See also
Cultural diversity; Discrimination;
Values and beliefs
Billing. See Fee structures
Bisexual clients, 194–195, 198–202
Bitter, J. R., 146, 174
Boundaries, 215–229. See also
Confidentiality; Former clients;
Sexual or romantic relationships
in advocacy and social justice, 219
bartering and, 52, 222
case studies, 223–229, 286–288
in counseling relationships, 46–48
crossings and violations, 219
cultural diversity and, 220
in distance counseling, 129–130
in educator–student relationships,
112–113, 264
ethical decision-making models
for, 19
extension of, 47, 219
flexibility in, 219–220
gifts from clients and, 52–53, 160, 222
nonprofessional interactions,
44–46, 48, 112–113, 215, 217–222
previous relationships and, 46,
216–217, 221
of professional competence, 68,
183, 184, 190–192
religious and spiritual issues,
223–225
with research participants, 120
role changes, 47–48
with supervisees, 97–98, 220–221,
261–262
technology applications and,
249–250
Bradley, L. J., 248
Bruff v. North Mississippi Health Services
(2001), 194–195
Burnout, 186, 189
Business Associate Agreements, 249
Business practices in counseling
relationships, 51
C
CACREP (Council for Accreditation of
Counseling and Related Educational
Programs), 184–185
Cain, J., 248
Career counseling, 108
Case records. See Records and documentation
Certification, 73. See also Qualifications
and credentials
Charity work. See Pro bono work
Checklists
Ethical Intent Checklist, 247
Children. See Minor clients
Cisgender clients, 200
Civil suits. See Lawsuits against counselors
Clients. See also Boundaries; Confidentiality; Counseling relationships;
Evaluation and assessment of clients;
Informed consent
abandonment and neglect of, 54
access to records, 64
advertising and soliciting to, 71, 72,
192
autonomy of, 14, 21, 35, 39
• 304 •
Index
collaboration with, 20, 22, 37, 41,
143
participation in research, 118
protecting, 50
respect for rights of, 55–56
screening, 50, 128–129, 251
threats from, 172
verification of, 128–129, 151
virtual presence of, 133
welfare of, 38–40, 83–84, 94–95
Code of Ethics (AAMFT), 147
Code of Ethics (ACA)
changes in current version, 9–11
on confidentiality, 55–66, 169–182.
See also Confidentiality
on counseling relationships, 37–54.
See also Counseling relationship
on distance counseling, technology,
and social media, 125–133,
245–258. See also Distance
counseling; Social media;
Technology applications
enforcement of, 23–25
on evaluation and assessment of
clients, 82–93. See also
Evaluation and assessment of
clients
foundations of, 12–14, 35–36
origins and evolution of, 4–5
preamble, 8, 10, 13–14, 35–36,
196
on professional relationships,
78–82. See also Professional
relationships
on professional responsibilities,
66–78. See also Professional
responsibilities
purpose of, 8, 12–13, 36
on research and publication,
114–125, 273–279. See also
Research
on resolving ethical issues, 133–
138. See also Resolving ethical
issues
revision process for, 5–7, 11–12
section overview, 7–11, 36–37
on supervision, training, and
teaching, 93–114, 259–271. See
also Education and training;
Supervision
Collaboration
with clients, 20, 22, 37, 41, 143
with colleagues, 43. See also
Consultations; Professional
relationships
with parents and guardians, 62, 206–207
Colleagues. See also Consultations;
Professional relationships
collaboration with, 43
professional responsibilities to,
77–78
relationships with, 78–82
Coming out process, 199, 201
Communication issues, 54, 131. See also
Informed consent
Compassion fatigue, 186, 188
Competence. See Professional
competence
Complaints of unethical behavior,
23–25, 136–138. See also Resolving
ethical issues
Compliance with standards, 67
Comprehensive school and community
treatment (CSCT) therapists, 207–208
Computer-mediated communication.
See Technology applications
Confidentiality, 55–66, 169–182
advocacy and, 49, 170
case studies, 176–182
in consultations, 65–66, 171
court-ordered disclosures and, 58, 175
cultural considerations, 55–56, 156,
157, 169–170
deceased clients and, 60
disease risk and, 58, 173
in distance counseling, technology,
and social media, 127–128, 133
end-of-life decisions and, 57, 173,
204, 235
in group work, 61, 174–175
harm and legal requirements in, 57,
172–173
interdisciplinary teams and, 59,
171, 172
limitations and exceptions to,
56–59, 128, 170–175, 281–282
minimal disclosure and, 58–59
minors and those unable to give
consent, 61–63, 173–174, 206–210
(Continued)
• 305 •
Index
Confidentiality (Continued)
overview, 8, 55
prior to counseling process, 11
in professional relationships, 80, 172
of records and documentation,
63–65, 175–176
in research, 115, 118
respecting client rights, 55–56
self-harm and, 232, 234–235
settings and, 59–60, 226–229
sharing information with others,
59–60, 171–172
subordinates and, 59, 171
supervision and, 101, 171, 179–182
third-party payers and, 60
transmitting information, 60
waiver of, 49
Conflict resolution. See Resolving
ethical issues
Connell, M., 175–176
Consultations. See also Professional
relationships
competence and, 69, 81–82, 185,
186–187
confidentiality in, 65–66, 171
in decision-making process, 21
on ethical obligations, 69
on ethical violations, 136–137
informed consent in, 82
technology applications for, 252
Conteh, J. A., 247
Continuing education, 69–70, 185, 291
Contracts
bartering, 52
Business Associate Agreements, 249
informed consent, 251–252
no-harm contracts (NHCs), 234
no-suicide agreements, 243
role changes in professional
relationship, 47–48
self-care contracts, 243
supervisory relationships, 98–99,
181
Conversion therapy, 77, 195, 199,
201–202
Corey, G., 184, 197, 207, 220, 243–244
Correction erratum, 121
Cost of services. See Fee structures
Cottone, R. R., 17
Council for Accreditation of Counseling
and Related Educational Programs
(CACREP), 184–185
Counseling. See also Distance counseling;
Group work
acculturation into, 10
affirmative, 195, 200, 202
career, 108
defined, 35, 193
for family and couples, 61,
145–146, 174–175, 190–191
moral principles of, 14, 21, 35–36
professional values of, 10, 13–14, 35
Counseling plans, 39
Counseling relationships, 37–54. See
also Referrals; Termination of services
advocacy in, 49, 159–161, 164, 167,
170, 219
avoiding harm and imposing values,
43–44
boundaries in, 19, 46–48
changes in current version of Code,
10–11
clients served by other professionals,
43
in decision-making process, 21, 37
developmental and cultural
sensitivity in, 41–42
in distance counseling, 129–131
documentation of, 39
fees and business practices, 51–53
friends or family members as
clients, 45–46
in group work, 50
informed consent in, 40–43, 143–145
mandated clients and, 42–43
with multiple clients, 50
nonprofessional relationships,
44–46, 48, 112–113, 215, 217–222
overview, 8, 38
role changes in, 47–48
sexual/romantic relationships with
clients, 44–45, 216–217
support network involvement in,
39–40, 225
trust in, 38, 55, 143, 169, 183
virtual relationships with clients,
46
welfare of clients in, 38–40, 83–84
• 306 •
Index
Counselor education. See Education
and training
Couples counseling. See Family and
couples counseling
Court-ordered disclosures, 58, 175
Court-ordered evaluations, 92
Credentials. See Qualifications and
credentials
CSCT (comprehensive school and
community treatment) therapists,
207–208
Cultural diversity, 155–168
boundaries and, 220
case studies, 160–161, 162–168
competency and, 68, 155–156,
158–159, 183, 185–186, 196
confidentiality and, 55–56, 156, 157,
169–170
in counseling relationships, 41–42
in decision-making process, 21
defined, 155
in diagnosis of mental disorders,
86, 157
in evaluation and assessment of
clients, 89, 158
immigration issues and, 164–167
importance of recognizing, 289–290
in informed consent, 41–42,
144–145, 157
nondiscrimination responsibilities,
74–75, 157
social justice perspective and,
159–162, 178, 219, 291
standards of practice and, 156–158
strategies for practice, 290–291
supervision and, 96, 158, 260
technology and, 132
in training programs, 104, 113–114,
158, 264, 290, 291
Culturally sensitive ethical decisionmaking model, 18–19
Cutting, 148–150, 233
D
Danger. See Harm
Data from assessments, 85–86, 89–90
Davis, T. E., 16–17
Death of counselors, 70, 119–120
Deceased clients, 60
Decision making. See Ethical decision
making
Declaration of practices. See Informed
consent
Degrees. See Qualifications and credentials
Developing treatment modalities, 77
Developmental sensitivity, 41–42
Diagnosis of mental disorders, 86–87,
152–153, 157
Digital services. See Technology
applications
Dignity of clients, 38
Dilemmas, resolving. See Resolving
ethical issues
DiLillo, D., 248
Disabled persons, 132
Disclosure. See Confidentiality;
Informed consent
Discontinuation of services. See Referrals;
Termination of services
Discrimination. See also Cultural
diversity
of complainants and respondents,
137–138
professional responsibilities
against, 74–75
in referrals, 11, 194, 196
sexual orientation and, 194–195,
201
Disease risk and confidentiality, 58, 173
Disposal of records, 65
Distance counseling. See also Technology
applications
benefits and limitations of, 129
boundaries in, 129–130
changes in current version of Code,
9, 246
client verification in, 128–129
competency and legal considerations,
126–127
confidentiality in, 127–128
counseling relationship in, 129–131
effectiveness of, 130
ethical and legal framework,
246–248
informed consent in, 127
overview, 8, 126
Diversity. See Cultural diversity
• 307 •
Index
Doctoral-level competence, 73–74
Documentation. See Records and documentation
Drogin, E. Y., 175–176
Drug use, 151
Dual decision-making process, 17–18
Dual relationships, 215–216. See also
Boundaries; Relationships
Dugger, S. M., 194
Duplicate submission of manuscripts,
124
Duty to warn/protect, 172–173,
177–178
E
Eastern Michigan University (EMU),
195
Eating disorders, ethical decision-making models and, 19
Economic issues. See Fee structures
Education and training, 103–114. See
also Professional competence; Subordinates; Supervision
career counseling and, 108
competence and, 103–104, 184–185
cultural diversity in, 104, 113–114,
158, 264, 290, 291
educator responsibilities, 103–107
evaluation and remediation in,
109–110
field placements and, 106–107
innovative theories and techniques,
106, 262
integration of study and practice,
104
overview, 8, 94
peer instruction, 105–106
program information and orientation,
107–108, 262–263
roles and relationships, 110–113,
262, 264
self-growth experiences and, 108,
263
student welfare and, 107–109
Eisel v. Board of Education of Montgomery
County (1991), 283
Elderly clients, 172, 282
Electronic records, 131–132, 252
Electronic resources. See Technology
applications
Emails, therapeutic, 248
Emergency procedures in supervision,
99
Emotions, in decision-making process, 21
Empathy balance, 186
Empathy fatigue, 186
Employees. See Subordinates
Employment issues for counselors
policies of employer, 80–81
recruiting clients while employed,
71–72
relationships with colleagues, 78–82
EMU (Eastern Michigan University), 195
End-of-life decisions, 57, 173, 202–204,
235–236, 237–239
Endorsement of students and
supervisees, 102–103
Errors in reporting data, 121–122
E-therapy. See Distance counseling
Ethical bracketing, 194
“Ethical Code for International Association of Marriage and Family
Counselors,” 147
Ethical decision making. See also
Resolving ethical issues
culturally sensitive approach to, 13
elements of, 20–23, 135
foundation for, 35–36
legal considerations in, 21, 281–288
models for, 15–20, 37
professional values and, 14
Ethical Intent Checklist, 247
Ethical reasoning, 13, 16, 37
Ethics Committee, 23–25, 138, 140
Ethics Revision Taskforce, 5–7, 11–12
Ethnicity. See Cultural diversity
Evaluation
in decision-making process, 22
of students, 109–110
of supervisees, 101
Evaluation and assessment of clients,
82–93
administration conditions, 88–89
client welfare and, 83–84
competence in, 84
data, release and reporting of,
85–86, 89–90
• 308 •
Index
design and construction of
instruments, 91
diagnosis of mental disorders,
86–87
forensic evaluations, 91–93
informed consent in, 85
LGBTQQ clients, 201
multicultural issues in, 89, 158
obsolete and outdated assessments
and results, 91
overview, 8, 83
purpose of, 83
scoring and interpretation, 89–91
security considerations, 91
selection of instruments for, 87–88
self-harm behaviors and, 233–234
technological administration of, 89
unsupervised, 89
Evans, Marcheta, 5, 11
Exploitation. See also Power imbalance
bartering and, 52, 222
professional responsibility and, 76
F
Facebook, 245–246, 250, 257–258
Faculty. See Education and training;
Supervision
Family and couples counseling, 61,
145–146, 174–175, 190–191
Family Educational Rights to Privacy
Act of 1974, 63
Family members
counseling relationships with, 45–46
as supervisees, 98
Fatigue syndromes, 186, 188, 189
Feelings, in decision-making process, 21
Fee structures
bartering, 52, 222
establishing, 51
fee splitting, 51
gifts as payment, 52–53, 222
nonpayment procedures, 52
Feminist model for ethical decision
making, 17–18
Fidelity, 14, 21, 36
Field placements, 106–107
Financial issues. See Fee structures
Finn, J., 247
Flexible boundaries, 219–220
Foote, W. E., 175–176
Forensic evaluations, 91–93
Forester-Miller, H., 16–17
Former clients
confidentiality of records for, 65
deceased, 60
friendships with, 221
sexual/romantic relationships
with, 45, 216–217
testimonials from, 71
Frame, M. W., 18–19
Francis, Perry C., 11–12, 194
Freedom of choice. See Autonomy of
clients
Free treatment. See Pro bono work
Friends
counseling relationships with, 45–46
former clients as, 221
as supervisees, 98
G
Gale, E. B., 248
Gatekeeper role of supervisors,
101–102, 171, 181, 260
Gay clients, 194–195, 198–202
Gender vs. sex, use of term, 200
Gifts from clients, 52–53, 160, 222
Glaser, K., 17
Glosoff, H. L., 206
Group work
confidentiality in, 61, 174–175
counseling relationships in, 50
informed consent in, 146–147
Guardians. See Parents/guardians
H
Handelsman, M. M., 10
Harassment. See Sexual harassment
Harden, J., 17
Harm. See also Self-harm by clients;
Suicidal clients
counselors acting to avoid, 43
duty to warn/protect, 172–173,
177–178, 282
(Continued)
• 309 •
Index
Harm (Continued)
as exception to confidentiality, 57,
172–173
threats from clients, 172
Harris, E., 249
Health Insurance Portability and Accountability Act of 1996. See HIPAA
Health of counselors. See Self-care
practices
Hendricks, B., 248
Herlihy, B., 170–171, 176, 183, 194, 197,
207, 220
Hill, M., 17
HIPAA (Health Insurance Portability
and Accountability Act of 1996), 145,
249, 282. See also Confidentiality;
Informed consent
HIV/AIDS, 173, 237–239
Homosexual clients, 198–202
Hospitalization, involuntary, 233
Human subjects committees. See
Institutional review boards (IRBs)
Hyldahl, R. S., 234
I
Identity of research participants, 122
Illness of counselor, arrangements
during, 54
Immigration issues, 164–167
Impairment of counselors, 70, 100,
186–187, 188–189
Implementation, in decision-making
process, 22
Inappropriate relationships. See
Boundaries
Incapacitated clients, 42, 61–63
Incapacitated counselors, 70, 119–120
Independence. See Autonomy of clients
Independent researchers, 115–116
Individualized action plans, 39
Informed consent, 143–153. See also
Confidentiality
advocacy and, 49
case studies, 147–153
in consultations, 82
in counseling relationships, 40–43,
143–145
developmental and cultural
sensitivity in, 41–42, 144–145, 157
diagnosis of mental disorders and,
152–153
in evaluation and assessment of
clients, 85
with families, 145–146
in forensic evaluations, 92
with groups, 146–147
information involved in, 40–41,
144–145
mandated clients and, 42–43
minors and those unable to give
consent, 42, 61–63, 92, 118, 149, 152
in research, 117, 118
for role changes, 47–48
self-harm and, 232–233
in supervision, 95, 98–99, 101, 261
technology applications and, 127,
132–133, 251–252
Innovative approaches
in education and training, 106, 262
in treatment modalities, 77
Inpatient treatment, 144, 162–164,
171–172, 207
Institutional review boards (IRBs), 115,
116, 273–274, 276–277
Instruments. See Evaluation and assessment of clients
Interdisciplinary teams, 59, 79, 171,
172
International Association of Marriage
and Family Counselors, 147
International Society for Mental Health
Online, 246–247
Internet. See Technology applications
Interpreting assessments, 89–91
Intersectionality theory, 201
Intimate relationships. See Sexual or
romantic relationships
Inventory of attitudes and beliefs on
ethical issues, 25–32
Involuntary hospitalization, 233
IRBs. See Institutional review boards
J
Jencius, M., 252
Johnson, W. B., 19, 20, 186
Joiner, T. E., 232
Justice
in decision-making process, 21, 22
• 310 •
Index
defined, 14, 36
social justice perspective, 159–162,
178, 219, 291
Juveniles. See Minor clients
K
Kaplan, David, 5, 247, 249, 257
Keeton, Jennifer, 195
Keith-Spiegel, P., 19
Kitchener, K. S., 16
Kleist, D., 146, 174
Knapp, S. J., 13
Knowledge of standards, 67, 134, 156
Kocet, Michael M., 5, 194, 197
Kolmes, K., 248, 252
L
Language fluency and translation, 41,
132, 157, 158
Lawsuits against counselors, 25, 216, 283
Lee, C. C., 289
Legal considerations. See also
Confidentiality; Informed consent
duty to warn/protect, 172–173, 177–178
in ethical decision making, 21, 281–288
forensic evaluations, 91–93
immigration issues, 164–167
lawsuits against counselors, 25, 216,
283
minor clients and, 205
reporting requirements, 172–173,
177–178, 282
in technology applications,
126–127, 248–249
Lesbian, gay, bisexual, transgender,
queer, and questioning (LGBTQQ)
clients, 194–195, 198–202
Levitt, D. H., 194
Liability insurance, 283
Licensure, 73, 185, 282. See also Qualifications and credentials
Lock, R., 248
M
Malpractice. See Lawsuits against
counselors
Mandated clients, 42–43
Mandatory ethics, 13
Mandatory reporting laws, 172–173,
177–178, 282
Manhal-Baugus, M., 246–247
Manuscript submissions, 124
Martz, E. T., 247
Matusek, J. A., 19
Media presentations, 75–76
Mental disorders, diagnosis of, 86–87,
152–153, 157
Mentoring relationships, 221. See also
Education and training; Supervision
Minimal disclosure, 58–59
Minor clients, 205–214
case studies, 207–214
confidentiality and, 61–63, 173–174,
206–210
informed consent and, 42, 61–63,
92, 118, 149, 152
legal rights of, 205
teen pregnancy, 211–214
Minorities. See Cultural diversity
Mistakes in reporting data, 121–122
Moorhead, H. J. H., 194
Moral principles of counseling
practice, 14, 21, 35–36
Multicultural and Social Justice
Competence Principles for Group Workers
(ASGW), 147
Multicultural issues. See Cultural
diversity
Multiple clients, 50, 174. See also Group
work
Multiple relationships, 215–216. See
also Boundaries; Relationships
N
National Board for Certified Counselors (NBCC), 246–247, 251, 252
National Immigration Law Center, 167
Neglect
of clients, 54
reporting requirements, 172–173,
177–178, 282
Networks of support, 39–40, 225
No-harm contracts (NHCs), 234
Nondiscrimination responsibilities,
74–75, 157
• 311 •
Index
Nonmaleficence, 14, 21, 35
Nonpayment of fees, 52
Nonprofessional relationships, 44–46,
48, 112–113, 215, 217–222
Nonsuicidal self-injury (NSSI), 232
“No secrets” policy, 175
O
Observation of counseling sessions,
63–64
Obsolete assessments and results, 91
O’Dougherty, A., 19
Online counseling. See Distance counseling
Online supervision, 96–97
Online Therapy Institute (OTI),
247–248
Organizational conflicts, 137
Outdated assessments and results, 91
P
Parents/guardians
collaboration with, 62, 206–207
informed consent and, 42, 61–63,
92, 118
Park, D., 289
Parr, G., 248
Participants in research, rights of,
117–120, 121
Passwords, 252
Pate, R. H., 206
Pathology diagnosis, 86–87, 152–153, 157
Payment for services. See Fee structures
Peer groups, 105–106, 186–187. See also
Professional relationships
Permission to record or observe, 63–64
Personal ethical stance, development
of, 15, 291–292
Personal public statements, 77–78
Personal values, 43–44, 193–194,
196–197
Personal virtual counselor–client relationships, 44–45
Person-centered perspective, 189
Personnel. See Subordinates
Plagiarism, 123, 274–275
Plans, counseling, 39
Play therapy, ethical decision-making
models in, 19
Poddar, Prosenjit, 281
Policies and Procedures for Processing
Complaints of Ethical Violations (ACA),
23
Pope, K. S., 19, 183
Positive ethics, 13
Power imbalance. See also Boundaries;
Exploitation
in counseling relationships, 17, 194,
217, 220, 221
in educator–student relations, 111,
112, 220, 264, 278
in research, 117, 275
in supervisory relationships, 262
A Practitioner’s Guide to Ethical Decision
Making (Forester-Miller & Davis),
16–17
Preamble to Code, 8, 10, 13–14, 35–36, 196
Pregnancy, teen, 211–214
Prejudices in diagnosis, 86–87. See also
Cultural diversity; Discrimination;
Values and beliefs
Presentation of research, 122–125,
274–275, 277–279
Presentations, media, 75–76
Pretermination counseling, 54
Principal researchers, 116
Principle ethics, 13, 16
Privacy. See Confidentiality
Privileged communication, 170–171,
174, 175. See also Confidentiality
Pro bono work, 38, 67, 76
Professional competence, 183–192
boundaries of, 68, 183, 184, 190–192
case studies, 187–192
consultations and, 69, 81–82, 185,
186–187
continuing education and, 69–70,
185, 291
cultural competence, 68, 155–156,
158–159, 183, 185–186, 196
doctoral-level competence, implying,
73–74
in evaluation and assessment of
clients, 84
monitoring of, 69
in new specialty areas, 68, 190–192
• 312 •
Index
preparation for dissemination of
records, 70
qualifications and, 68–69, 72–75, 95,
184–185
self-monitoring and, 70, 100,
186–187, 188–189
supervision and, 96–97, 191–192
technology applications and,
126–127, 249
in termination and referral, 53, 70
training and, 103–104, 184–185
Professional disclosure statements. See
Informed consent
Professional ethical identity, development
of, 10
Professional liability insurance, 283
Professional memberships, 74
Professional relationships, 78–82. See
also Consultations
approaches to, 78–79
confidentiality in, 80, 172
employer policies, 80–81
establishing professional and ethical
obligations, 79–80
forming, 79
interdisciplinary teams, 59, 79, 171,
172
negative conditions affecting, 81
overview, 8, 78
personnel selection and assignment,
80
protection from punitive action in,
81
Professional responsibilities, 66–78. See
also Professional competence
in advertising and soliciting clients,
71, 72, 192
to colleagues, 77–78
in education and training, 103–107
exploitation of others and, 76
knowledge of and compliance with
standards, 67, 134, 156
media presentations and, 75–76
nondiscrimination, 74–75, 157
overview, 8, 67
pro bono work, 38, 67, 76
public responsibilities, 75–76
qualifications and, 68–69, 72–75, 95,
184–185
sexual harassment and, 75
in supervision, 98–101
in third party reports, 75
in treatment modalities, 76–77
Professional review, 124–125
Professional values, 10, 13–14, 35, 195,
196–197
Promotion of products and services,
71–72
Prospective clients, confidentiality
and, 56
Protect and warn, duty to, 172–173,
177–178
Psychometrics. See Evaluation and
assessment of clients
Publication of research, 122–125,
274–275, 277–279
Publicity test, in decision-making
process, 22
Public responsibilities, 75–76
Public statements, 77–78
Purpose section of Code, 8, 12–13, 36
Q
Qualifications and credentials, 68–69,
72–75, 95, 184–185
Queer clients, 194–195, 198–202
Questioning clients, 194–195, 198–202
R
Race. See Cultural diversity
Reamer, F. G., 250
Recommendation of students and
supervisees, 102–103
Records and documentation
of boundary extensions, 47
client access to, 64
confidentiality and, 63–65, 175–176
of counseling relationships, 39
creating and maintaining, 63
of decision-making process, 21
disclosure or transfer of, 65, 70
electronic, 131–132, 252
interpreting for clients, 64
permission to record or observe, 63–64
storage and disposal of, 65
• 313 •
Index
Records custodians, 65, 70, 119–120
Recruiting clients, 71–72
Reduced fee treatment. See Pro bono
work
Referrals. See also Termination of
services
competence within, 53, 70
discriminatory, 11, 194, 196
self-referrals, 51
transfer of services, 54
values within, 53
Refraining from diagnosis, 87
Regulations. See Legal considerations
Relationships. See also Boundaries
with colleagues, 78–82. See also
Consultations; Professional
relationships
counseling, 37–54. See also
Counseling relationships
mentoring, 221
nonprofessional, 44–46, 48,
112–113, 215, 217–222
with research participants, 120–121
romantic. See Sexual or romantic
relationships
with supervisees, 97–98, 220–221,
261–262, 264–268
Release of assessment data, 85–86
Religion and spirituality. See also
Values and beliefs
boundary issues and, 223–225
case study, 268–271
ethical decision-making models
and, 19
values conflicts and, 194–195
Remediation for students and
supervisees, 101–102, 109–110
Remley, T. P., 170–171, 176, 183
Remote counseling services. See
Distance counseling
Remuneration. See Fee structures
Reparative therapy, 195, 201–202
Replication studies, 122
Reporting
of abuse and neglect, 172–173,
177–178, 282
assessment data, 89–90
errors in, 121–122
ethical violations, 136
research results, 121–122
self-harm by clients, 148, 149–150
to third parties, 75
Research, 114–125, 273–279
case studies, 275–279
confidentiality in, 115, 118
informed consent in, 117, 118
institutional review for, 115, 116,
273–274, 276–277
overview, 8, 115
participants, rights of, 117–120, 122
publication and presentation of,
122–125, 274–275, 277–279
relationships and boundaries in,
120–121
reporting results, 121–122
responsibilities in, 115–116, 119–120
Resolving ethical issues, 133–138. See
also Ethical decision making
competency of standards, 67, 134,
156
complexity of, 140
conflicts between ethics and laws,
135
consultations and, 136–137
discrimination against
complainants and respondents,
137–138
ethics committees, cooperation
with, 138
informal resolutions, 136
organizational conflicts, 137
overview, 9, 134
reporting violations, 136
unwarranted complaints, 137
Respect for client rights, 55–56
Responsibilities. See Professional
responsibilities
Retirement of counselors, 70, 119–120
Review
professional, 124–125
of research proposals, 115, 116,
273–274, 276–277
Revision process, 5–7, 11–12
Richardson, B., 234
Role ambiguity, 163
Role blending, 219
Role changes, 47–48
Romantic relationships. See Sexual or
romantic relationships
Rubin, L., 19
• 314 •
Index
S
Sanctions for unethical behavior, 24
School counselors, 144, 173–174,
206–208, 283
Scientific basis for treatment modalities,
76–77
Scoring assessments, 89–91
Screening clients, 50, 128–129, 251
Second Life, 246
Security considerations
assessment instruments and, 91
in technological applications, 128,
131, 250, 252
Self-care practices, 67, 187, 188–189
Self-growth experiences, 108, 263
Self-harm by clients, 231–244. See also
End-of-life decisions; Suicidal clients
case studies, 237–244
challenges for counselors, 231
confidentiality and, 232, 234–235
cutting, 148–150, 233
evaluation and assessment of,
233–234
informed consent, 232–233
nonsuicidal self-injury, 232
reporting, 148, 149–150
treatment planning, 234–235
Self-inventory of attitudes and beliefs
on ethical issues, 25–32
Self-monitoring by counselors, 70, 100,
186–187, 188–189
Self-plagiarism, 274–275
Self-referrals, 51
Settings and confidentiality, 59–60,
226–229
Sexual harassment
of clients, 75
of research participants, 120–121
of students, 111
of supervisees, 97–98
Sexual orientation, 194–195, 198–202.
See also Cultural diversity
Sexual or romantic relationships
with clients, 44–45, 216–217
with research participants, 120
with students, 110–111, 264
with supervisees, 97, 261
Sex vs. gender, use of term, 200
Seymour, J. W., 19
Shaw, H. E., 247
Shaw, S. F., 247
Skovholt, T. M., 186
Sliding scale fees, 51
Social activism. See Advocacy
Social constructivist model for ethical
decision making, 17
Social justice perspective, 159–162, 178,
219, 291. See also Advocacy
Social media. See also Technology
applications
boundaries and, 249–250
case studies, 254–258
changes in current version of Code,
9, 246
client virtual presence on, 133
competency and legal considerations,
126–127
confidentiality and, 127–128, 133
ethical and legal framework,
246–248
growth of, 245–246
informed consent and, 127, 132–133
overview, 8, 126
policies regarding, 250, 251, 252
verification of clients on, 128–129
virtual professional presence on, 132
Socioeconomic status. See Cultural
diversity
Soliciting clients, 71–72
Solidarity, 220
Specialty areas of practice, 68, 190–192
Speight, S. L., 220
Spirituality. See Religion and spirituality
Stadler, H. A., 22
Staff. See Subordinates
Standardization of assessments, 88
Standards of practice. See also
Legal considerations; Professional
responsibilities
competency on, 67, 134, 156
cultural diversity and, 156–158
for supervisees, 99
State licensure, 247, 282
Statements, public, 77–78
Stebnicki, M. A., 186
Storage of records, 65
Students. See Education and training;
Supervision
Sturm, C. A., 175–176
• 315 •
Index
Subordinates. See also Education and
training; Supervision
confidentiality requirements for,
59, 171
counseling for, 102, 110, 112
selection and assignment of, 80
sexual harassment and, 97–98
Substance Abuse Subtle Screening
Inventory, 153
Substance use disorders, 151–152,
223–224
Suicidal clients, 162–163, 173, 233–234,
240–244, 283–285
Super, Donald, 4
Supervision, 93–103. See also Education
and training; Subordinates
case studies, 264–271
client welfare and, 94–95
competence and, 96–97, 191–192
confidentiality and, 101, 171,
179–182
cultural diversity and, 96, 158, 260
emergency and absence procedures,
99
evaluation, remediation, and
endorsement, 101–103
informed consent in, 95, 98–99, 101,
261
online, 96–97
overview, 8, 94
peer supervision, 105–106
preparation for, 96
purpose of, 259–260
relationships with supervisees,
97–98, 220–221, 261–262,
264–268
responsibilities in, 98–101, 260
standards for supervisees, 99
termination of, 99–100
Support networks, 39–40, 225
Systems perspective, 174
T
Tarasoff v. Regents of the University of
California (1974), 172, 281
Teaching. See Education and training
Team treatment. See Interdisciplinary
teams
Technology applications, 125–133,
245–258. See also Distance counseling;
Social media
accessibility issues, 250
assessment administration and, 89
boundaries and, 249–250
case studies, 254–258
changes in current version of Code,
9, 246
client capability for using, 130
competency and, 126–127, 249
confidentiality and, 127–128
for consultations, 252
emergency procedures and, 253
failure of, 253
growth of, 245–246
informed consent and, 127,
132–133, 251–252
legal considerations, 126–127,
248–249
multicultural and disability
considerations, 132
online supervision, 96–97
overview, 8, 126
records and web maintenance,
131–132, 252
screening and verification of
clients, 128–129, 251
security considerations and, 128,
131, 250, 252
structure of services and, 251
test interpretations and, 84
therapeutic emails, 248
Teen pregnancy, 211–214
Terminally ill clients, 57, 173, 202–204,
235–236, 237–239
Termination of services. See also Referrals
competence within, 53
reasons for, 54
storage and disposal of records
after, 65
of supervisory relationships,
99–100
values within, 53
Testimonials, 71
Testing. See Evaluation and assessment
of clients
Text messaging, 251, 252
Therapeutic emails, 248
• 316 •
Index
Third-parties, confidentiality and, 60, 75
Threats from clients
confidentiality and, 56, 59
duty to warn/protect, 172–173,
177–178, 282
of self-harm, 243
Training. See Education and training
Transcultural integrative model for
ethical decision making, 18
Transfer of records, 65, 70
Transfer of services. See Referrals
Transgender clients, 194–195, 198–202
Translation. See Language fluency and
translation
Transmitting confidential information,
60
Treatment modalities
development and innovation in, 77
harmful practices of, 77
professional responsibilities in,
76–77
scientific basis for, 76–77
for self-harm by clients, 234–235
Trust in counseling relationships, 38,
55, 143, 169, 183
Twitter, 246, 250
U
United Nations Educational, Scientific,
and Cultural Organization
(UNESCO), 155
Universality test, in decision-making
process, 22
Unsupervised assessments, 89
Unwarranted complaints, 137
Up-coding, 153
V
Vacations, counselor arrangements
during, 54
Values and beliefs, 193–204. See also
Religion and spirituality
case studies, 198–204
defined, 9
managing conflicts in, 193–194,
195–198
personal, 43–44, 193–194, 196–197
professional, 10, 13–14, 35, 195,
196–197
within termination and referral,
53
VandeCreek, L., 13
Vasquez, M. J. T., 183
Veracity, 14, 21, 36
Verification of clients, 128–129, 251
Vicarious traumatization, 186
Violence. See Harm
Virtual counselor–client relationships,
44–45, 132–133
Virtue ethics, 13
Vocational counseling, 108
Voluntary consent. See Informed
consent
W
Wade, M. E., 247
Waiver of confidentiality, 49
Walden, S., 21
Walden v. Centers for Disease Control and
Prevention (2010), 194–195
Ward, Julea, 195
Warn and protect, duty to, 172–173,
177–178
Web Accessibility Initiative of 2012,
250
Web maintenance, 131–132
Web 2.0 technologies. See Technology
applications
Welfare
of clients, 38–40, 83–84, 94–95
of counselors. See Self-care practices
of students, 107–109
WhatsApp, 246
Whiting, P. P., 248
Williams, C. B., 18–19
Y
Younggren, J. N., 249
Z
Zur, O., 217, 222
• 317 •
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