ETHICS
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CANADIAN
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COUNSELLING
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PSYCHOTHERAPY CONTEXT
Editors
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MICHAEL N. SORSDAHL, ROBERTA A. BORGEN, WILLIAM A. BORGEN
ETHICS
IN A
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MICHAEL N. SORSDAHL
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Editors
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CANADIAN
COUNSELLING
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PSYCHOTHERAPY
ROBERTA A. BORGEN
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WILLIAM A. BORGEN
CONTEXT
ADOBE STOCK
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All rights reserved
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Copyright © 2023 by the Canadian Counselling and Psychotherapy Association
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Canadian Counselling and Psychotherapy Association
202 - 245 Menten Place
Ottawa, ON K2H 9E8
Cover image copyright © 2020 iStockphoto LP/Bodhan Kotoshchuk
Graphic Design by Michael Partridge
ISBN: 978-0-9952097-8-7
Printed in Canada
CONTENTS
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ABOUT THE EDITORS, AUTHORS, AND CONTRIBUTORS
ACKNOWLEDGEMENTS
OVERVIEW
CHAPTER ONE
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Contextualizing Ethical Practice for Today’s
Section 1 Counsellors / Therapists
1 LEGAL / REGULATORY IMPLICATIONS FOR ETHICAL PRACTICE 21 Bo
THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
Within the Canadian Counselling and Psychotherapy Association
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CHAPTER TWO
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ETHICAL DECISION- MAKING MODELS
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Section 2 Ethical Areas of Practice
CHAPTER FOUR
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PROFESSIONAL RESPONSIBILITY
CHAPTER FIVE
77 COUNSELLING / THERAPY RESPONSIBILITIES CHAPTER SIX
95 ASSESSMENT AND EVALUATION
CHAPTER SEVEN
115 PROFESSIONAL RESEARCH AND KNOWLEDGE TRANSLATION 
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CONTENTS
CHAPTER EIGHT
CLINICAL SUPERVISION SERVICES 129 CHAPTER NINE
CHAPTER TEN
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CONSULTATION SERVICES
COUNSELLOR / THERAPIST EDUCATION AND TRAINING
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CHAPTER ELEVEN
USE OF ELECTRONIC AND OTHER TECHNOLOGIES
CHAPTER TWELVE
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INDIGENOUS PEOPLE, COMMUNITIES AND CONTEXTS
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Section 3 Bringing it All Together
CHAPTER THIRTEEN
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ETHICAL COMPLEXITY IN PRACTICE
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Section 4 Working Through Ethical Dilemmas
CHAPTER FOURTEEN
ETHICAL DILEMMAS
APPENDIX - A
CODE OF ETHICS (Excerpt)
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ABOUT THE EDITORS, AUTHORS,
AND CONTRIBUTORS
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EDITORS
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Dr. Michael N. Sorsdahl, CCC, RCC, GCDFi, has over 20 years of experience in group, family, couples, and individual counselling/psychotherapy. Michael is the current chair of the Canadian Counselling and Psychotherapy Association (CCPA) Ethics Committee – Complaints Division, and
is a past-president of the Counsellor Educators and Supervisor’s Chapter.
Michael has served as an instructor with several institutions in their counselling programs including University of Victoria, University of British Columbia, University of Lethbridge, and Yorkville University. Michael is also
a registered psychologist in BC and Alberta in private practice based on his
MA in counselling psychology.
Dr. Roberta A. Borgen (Neault), CCC, CCDP, GCDFi, has over 30
years of experience in career and employment counselling, counsellor-education, and program and curriculum development. Roberta has served as
a instructor within a variety of counselling programs including Athabasca
University, Simon Fraser University, Trinity Western University, the University of Lethbridge, and the University of British Columbia. Additionally,
she’s served as a core faculty member and Associate Dean within the Faculty
of Behavioural Sciences at Yorkville University. Roberta has served on the
executives of several CCPA chapters including the Counsellor Educator and
Supervisors Chapter, Career Counsellors Chapter, and the BC Chapter.
Dr. William A. Borgen, is a professor of Counselling Psychology at the
University of British Columbia. He has extensive experience conducting research and developing programs regarding life transitions and career development. His work has been translated and adapted for use in a number of
countries. The University of Umea awarded him an honorary doctorate for
his leadership in counsellor education in Sweden. Dr. Borgen is a past-President of CCPA and has co-chaired the CACEP since 2003. He is an Honorary Life Member of CCPA and a Fellow of the Canadian Psychological
Association. He was elected President of the International Association for
Counselling in May 2019.
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INVITED AUTHORS
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In several chapters, the editorial team invited chapter contributions
from experienced counsellors/psychotherapists, counsellor educators, and
researchers.
Andrea Rivera and Sherry Law, TISC, have been members of the executive for the Technology and Innovative Solutions Chapter of the Canadian
Counselling and Psychotherapy Association since 2018 and 2016 respectively. They have their own private practices in the Maritimes. They have
both taken interest in learning about relevant technologies in practice as
well as emergent technologies and their ethical applications.
Dr. Glenn Sheppard is a President Emeritus of CCPA and was a president of the CCPA Counsellor Educators Chapter. He was a counsellor
educator for 25 years at Memorial University of Newfoundland. Glenn is
co-author of the book Counselling Ethics: Issues and Cases and author of the
Collection of Notebooks on Ethics, Legal Issues, and Standards of Practice for
Counsellors and Psychotherapists. He lead the development and writing of
the CCPA Code of Ethics (1999) and Standards of Practice for Counsellors
(2001) and contributed to subsequent revisions of them including to the
latest editions (2020).. Glenn initiated and maintains the Cognica Notebook
on Ethics, Legal Issues, and Standards of Practice for Counsellors and Psychotherapists. He has served as Chair the CCPA Ethics Committee and chaired
the CCPA Adjudication Complaints Tribunal and currently serves as CCPA
Ethics Amicus. Glenn was co-chair of the CCPA National Working Group
on Labour Mobility 2008-2011 and its three national symposia (2008,2009
and 2011). He lives in St. John’s and works in private practice.
Kim Bayer (Métis) is a registered clinical counsellor practicing in Vancouver and Coast Salish territory. She has worked nationally, provincially, and in community-based roles in health and social services sectors. As
a lifelong learner, Kim draws from holistic Indigenous ways, being, and
knowing, as well as Western therapeutic tools to facilitate psycho-education
groups, talking circles, and individual counselling.

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Lawrence Murphy is the founder of Worldwide Therapy Online, the
world’s first online clinical practice, established in 1994. He received his MA
in Counselling Psychology from UBC in 1995. During the pandemic Lawrence delivered 140 webinars to more than 15,000 mental health professionals across the country. Mr. Murphy and his team publish regularly in the
academic literature, and he is widely considered one of the world’s foremost
experts in online counselling. Lawrence also teaches in the Department of
Psychology at Wilfrid Laurier University and in the School of Continuing
Studies at the University of Toronto.
Pamela Patterson PhD., R. Psych. (She/Her) is a professional member of CCPA. She is in private practice in Vancouver, BC on the traditional, ancestral and unceded territories of the Musqueam and Tsleil-Waututh
nations. She teaches and provides supervision at the University of British
Columbia and Adler University. She is a member of CCPA’s CACEP Board
and the advising committee for CACEP. She is a writer and author. She participates locally and internationally in counselling supervision. She is part of
a peer consultation group and she both employs and provides consultation
with counsellors and psychologists.
Sharon E. Robertson is Professor Emerita and Faculty Professor at the
Werklund School of Education, University of Calgary, where she taught in
the Counselling Psychology program and served as Director of Training
for many years. She is a registered psychologist in Alberta and served as
CCPA President (1991-93). She has been Co-Chair of the CCPA Council on
Accreditation of Counsellor Education Programs (CACEP) since 2001 and
co-authored the 2002 and 2022 accreditation standards. Her main research
interests centre on counsellor education and supervision; program quality
assurance; psychosocial, cross-cultural, and life transitions; stress, coping,
and social support.
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LIST OF CONTRIBUTERS
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Throughout the duration of this project, the editorial team sourced
contributions from counsellors/psychotherapists who described ethical dilemmas they are grappling with and/or employed ethical decision-making
models to illustrate approaches for working through those cases. Their brief
biographies are included here:
Charlena Marcuccio, is a student with Yorkville University in their
Masters of Arts and Counselling Psychology (MACP) program and expecting to graduate in December 2023. She has been working as a student liaison
with CCPA for the Spirituality Chapter.
Dr. Colleen Haney, Associate Professor (Emeritus), Educational and
Counselling Psychology, and Special Education (ECPS); Faculty of Education, UBC; Registered Psychologist, BC; Member of College of BC Teachers; Past Director of Clinics and Practicum in ECPS. Currently focusing on
An Equine Program to Reduce PTSD and Anxiety Symptoms in Veterans
and First Responders.
Gail Smillie, has worked in the area of child and family counselling for
the past 40 years, and has been a member of the CCPA for the past 20 years
and a member of the CCPA Ethics Committee, Complaint Division since
October 2019. While working in BC she was a Registered Clinical Counsellor with BCACC working with Kamloops Youth Resources, Kamloops
Head Injury Society, University of Victoria, and as a mental health therapist
with the Ministry for Children & Families. In Alberta, she specialized in
trauma and attachment working with adoptions, kinship, early childhood
development, and family therapy. Gail is currently in private practice in
Canmore, AB doing counselling, consultation & clinical supervision.
Laura Crossley, MA, CCC-Q, is a counsellor and also Male to Female
Transgender, working with adults and youth seeking possible gender transition. Member of the World Professional Association for Transgender Health
(WPATH) and strong advocate for Trans Healthcare in BC.
Laurie Ponsford-Hill, CCC, Clinical Director, has been the Clinical
Director of The Counselling House for the past 15 years. As a clinical supervisor for art therapists, social workers, marriage and family therapists,
and psychotherapists, Laurie has had the opportunity to work through
many ethical dilemmas with her supervisees. Laurie has been a member
of the ethics complaints committee for the CCPA for the past 4 years and
has learned a tremendous amount while working through a wide range of
complaint issues.

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Dr. Lorraine Smith-MacDonald, is a Postdoctoral Fellow at the University of Alberta. Her research specializes in spirituality and moral injury
and how it intersects with other stress-related psychological injuries in military, veteran, and public safety personnel.
Marita Poll, RCC, M.Ed worked at BC Cancer for over 19 years as
a Clinical Counsellor, with the last 5 years as the Practice Leader for the
counselling department as well. In semi-retirement now, Marita is using
her training in Somatic Psychotherapy and Emotion-Focused Therapy to
provide counselling services for Healthcare professionals, family caregivers,
and the bereaved.
Dr. Marla Buchanan is a Professor in the Counselling Psychology Program in the Faculty of Education at the University of British Columbia. She
is the co-ordinator for the School Counselling Program and her research
interests are in the field of traumatic stress studies.
Meghan Scott, RCT-C, CCC, works largely with couples using the Gottman method of couples counselling, although she is integrative and flexible
in her approach. Meghan also works with individuals experiencing numerous presenting issues including, but not limited to: trauma, mood disorders,
stress management, and personality disorders. Meghan has worked mostly
in private practice but has also worked for a non-profit. Meghan has been
licensed for about a year and a half. The majority of her clientele are adults
who self-refer, although she also occasionally works with teenagers and individuals who have been mandated to attend counselling.
Dr. Michele P. Mannion, LCPC, ACS, has 25 years of graduate teaching
experience, in addition to extensive experience supervising graduate students, both in onsite clinical settings and as a faculty supervisor. A member
of CCPA, she has taught for 15 years in the Counselling Psychology program at Yorkville University. Michele has clinical experience across a wide
variety of settings, including community mental health, college counselling,
and school-based clinical services. Presently in private practice, she utilizes
an existential-humanistic approach in her work with clients.
Monica Verbosky, MACP, has 20+ years of experience in technology
worldwide, and currently is sitting as Technology and Innovative Solutions
Chapter (TISC) President and Member at Large for the Spirituality Chapter
of CCPA.
In addition, several contributors served as chapter reviewers.
Angela Grier, Piiohksopanskii (Singing Loudly Far Away) is from the
Piikani Nation, of the Blackfoot Confederacy. She is the Indigenous Initiatives Lead for CCPA’s National Office and a Registered Provisional Psychologist in Alberta. Angela has been working with advocacy issues for over 25
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years at First Nation, regional, provincial, and national levels. Her career
has explored the impacts of colonization, Indigenous cultural revitalization,
systemic decolonization, environmental and Indigenous rights advocacy,
and post-secondary involvement. Her graduate publication explored Blackfoot spirituality as a framework for wellness towards the decolonization of
counselling. Angela resides in her traditional territory of the Blackfoot people.
Dawn Schnell, MA, CCC, CCDP has been a counsellor for over 35
years. She has worked for non-profit agencies and educational institutions
and has volunteered with the CCPA on a variety of chapter boards. Dawn
specializes in the uses of technology in counselling and psychotherapy and
career counselling.
Fiona J. Trend-Cunningham, MEd, MA, CCC, has been a mental
health practitioner in Newfoundland and Labrador for over 20 years. Her
training and experience in both counselling and clinical psychology, as well
community, academia, and public and private practice settings. She is a researcher of posttraumatic growth and women’s health and has presented
research internationally. Her clinical work is focused on women’s mental
health and supporting diverse neurotypes in adult women. Her clinical
work is from a post-modern feminist perspective and her anti-oppression
work includes the accessibility of psychology training practices and the
teaching of psychology.
Michele Mani, M.Ed., RP, CCC, is a Registered Psychotherapist and
Clinical Supervisor with decades of experience providing (asynchronous
and synchronous) virtual and online therapy as well as supervising qualifying and fully registered therapists. Michèle has a private practice where
she is honored to support therapists and clients; is a Board Member of the
CCPA TISC Chapter, and collaborator for the CCPA Supervisory Circle of
Practice.
Lastly, our Copy Editor
Lisa Vanderstelt completed a BA in Psychology and English and an
MA in Vocational Rehabilitation Counselling at the University of British
Columbia. Since completing her master’s degree, Lisa has worked in disability management for over 10 years. She is known for her compassionate and
empathic approach and her desire to make a positive difference in the lives
of others. She is also known for the excellence of her writing and her keen
attention to detail.

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ACKNOWLEDGEMENTS
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The editorial team would like to acknowledge the commitment of Canadian Counselling and Psychotherapy Association (CCPA) in financially
supporting the development of a relevant, timely, and thorough ethical resource to meet the needs of counsellors and psychotherapists, educators,
and supervisors. This project wouldn’t be possible without the leadership
and guidance of CCPA. In addition, the availability and willingness of the
invited authors to lend their expertise and insights to the chapter contributions were essential in developing a rich resource rooted in the realities of
practice. The final compilation represents a true collaboration amongst diverse thought leaders to meet the needs of equally diverse contexts in which
Canadian counsellors and psychotherapists work, learn, and grow.
The editorial team would also like to thank the countless counsellors/
psychotherapists who provided their input during the consultation and
conceptualization phase of this publication – sharing their insights into the
ethical landscape they’re traversing, providing case examples of ethical dilemmas, and agreeing to illustrate ethical decision-making processes and/or
reviewing chapters, cases, and/or ethical decision- making responses. Special gratitude to the members of the CCPA’s ethics review committee (Mary
Hernandez, Daniel Nadon, Laurie Ponsford-Hill, Patricia Jones, Patricia
Wentzell, and Gail Smillie) who also played an integral role with the ethical
decision-making vignette solution review process.
Lastly, we’d like to acknowledge our amazing administrative team (Cassie Taylor, Desiree Carlson, Leor Elizur, and Michael Partridge) who worked
closely with editors, authors, and contributors throughout the research, development, writing, and design phases of this project.
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OVERVIEW
About this Book
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In conceptualizing the revision of the Canadian Counselling and Psychotherapy Association’s (CCPA) ethics casebook and in consultation with
CCPA members, the editorial team saw the value of creating a practical
resource addressing complex, relevant ethical challenges of counsellors/
therapists in training, practicing counsellors/therapists in a wide variety of
employment settings (e.g., private practice, multidisciplinary offices), and
educators and supervisors of counsellors/therapists. The resulting hybrid
textbook and casebook is intended to deepen readers’ understanding of
counselling ethics in practice while attending to the complexity of the clients we serve, the professionals we work with, and the society we are part of.
In recognition of the cultural complexity of individual clients, counsellors/psychotherapists, counsellors-in-training, and counsellor-educators,
all of whom influence and are influenced by a dynamic world, the editors
have invited contributions from individuals with diverse backgrounds and
perspectives, demonstrating how the application of the CCPA (2020) Code
of Ethics and Standards of Practice (CCPA, 2021) can look different amongst
practitioners.
Through this edition of CCPA’s casebook, the editorial team sought to
counter the tendency to jump too quickly to what is perceived as “right”
without working through an ethical decision-making process. The resulting
collaboration invites readers to engage fully within the context of ethically
informed practice where “solutions” are rarely black and white, but rather
shades of grey. Provided throughout this book are recommended practices
to help inform ethical decision-making, while always considering the CCPA
Code of Ethics and Standards of Practice.
The book is divided into 4 sections:
Section 1 presents the historical evolution of ethics in counselling/therapy, legal and regulatory considerations within the Canadian context, and
ethical decision-making models. It provides an important overview of the
ethical landscape that counsellors/psychotherapists operate within.
Section 2 explores each article from CCPA’s (2020) revision of the Code
of Ethics within a dedicated chapter. Through applying systems thinking
and a social justice lens relevant for today’s counsellors/therapists, each

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chapter concludes with thoughtful discussion prompts and relevant case examples. We invite you to work through the case examples using an ethical
decision-making model of your choosing, referring to Part IV, to compare
and contrast potential solutions.
Section 3 provides additional, multidimensional and complex cases to
stimulate further reflection and discussion as you gain familiarity with ethical decision-making processes. We invite you to refer to these cases to deepen your understanding of ethical practice and to gain experience in applying
the decision-making models.
Section 4 presents alternative approaches to conceptualizing, analyzing, and resolving dilemmas related to those cases introduced within Part II.
We invite you to review and learn from alternative approaches to working
through ethical dilemmas by using the ethical decision-making models to
explore different viewpoints.
Writing the Book
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With CCPA’s support, the editorial team reached out to the membership
to gather input on the structure and content of the revised publication. The
feedback supported the hybrid textbook and casebook structure to provide
adequate contextual information for the practical realities of today’s Canadian counsellors and psychotherapists.
With a clear vision for the book in place, the editorial team invited several authors to contribute to chapters which aligned to their expertise. The
team also issued a call for ethical case contributions, and demonstrations
of how to apply the four ethical decision-making models provided in the
CCPA (2020) Code of Ethics. In addition, a call for reviewers was issued so
that all contributions to the book were reviewed by the editorial team and,
where possible, an independent reviewer.
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Using this Book
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This hybrid text and casebook seeks to address the needs of counsellor educators & supervisors, counsellors-in-training, as well as practicing
counsellors and psychotherapists.
Counsellor Educators & Supervisors: As a textbook, this book serves
as a valuable, comprehensive, Canadian resource that addresses the full
spectrum of ethical constructs. It can be easily integrated into curriculum
and supervision plans with thoughtful discussion questions to deepen students’ reflections. The book also offers diverse examples of ethical dilemmas to which different ethical decision-making models have been applied,
illustrating more than one perspective for each case.
Counsellors-in-Training: This book invites you to dive deeply into
ethical principles, standards, dilemmas, and practice implications with specific links to CCPA’s (2020) Code of Ethics and Standards of Practice (CCPA,
2021). Leave with a deepened understanding of ethical practice grounded
in recommendations drawn from experienced counsellors/psychotherapists
across diverse settings.
Practicing Counsellors/Psychotherapists: Beyond providing a refresher for ethical practice, this book presents tools for self-reflection that
can extend and improve your ethical practice. The case examples with corresponding ethical decision-making model illustrations and, also, the section with complex cases will be particularly useful.
I believe that a different therapy must be
constructed for each patient because each has a
unique story.
Irvin D. Yalom

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SECTION
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Contextualizing Ethical
Practice for Today’s
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CHAPTER ONE
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THE HISTORICAL
EVOLUTION OF
ETHICAL PRACTICE
Sharon E. Robertson
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Within the Canadian Counselling
and Psychotherapy Association
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INTRODUCTION / CONTEXT
The purpose of this chapter is to trace the evolution of ethical practice
within counselling in Canada through the Canadian Counselling and Psychotherapy Association (CCPA), given the significant role CCPA has played
in the development of counselling in this country. Not only does this provide a historical record of that evolution, but it will also allow counsellors/
therapists to familiarize themselves with the historical evolution of ethical
practice.
An important milestone in the history of the development of counselling in Canada was the formation of the Canadian Guidance and Counselling Association (CGCA) at a conference in Niagara Falls, Ontario in 1965
(Robertson & Borgen, 2016a). In 1999, the Board of Directors approved a
THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
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change in the name to the Canadian Counselling Association (CCA), and
in 2009, this was changed to the Canadian Counselling and Psychotherapy
Association (CCPA). In this chapter, I trace the evolution of ethical practice
within this professional association as documented primarily within CCPA
publications, including the Association’s bilingual newsletter, COGNICA.
Brief synopses of these developments are provided by decades across time
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Following the formation of CGCA in 1965, The cornerstones of the Association were laid at the first truly
national conference in Quebec City, in 1967. The first issue of
The Canadian Counsellor was published at that time by Myrne
Nevison of the University of British Columbia. The second
President of CGCA, Aurele Gagnon, promoted the Association’s
constitution, ensuring truly national representation as well as
bilingualism. (Paterson et al., 1979, p. 37)
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CGCA held its second national conference in Edmonton in 1969 and
by 1971, the Association had developed a set of Guidelines for Ethical Behaviour, which “are intended as the basis for the conduct of persons engaged
in providing guidance services” (CGCA, n.d., as cited in Van Hestern, 1971,
p. 171). “In addition to dealing with general standards to be met by Canadian guidance professionals, specific standards relating to counselling, testing, and research are outlined” (Van Hestern, 1971, p. 171). The Association
also developed its newsletter, COGNICA, early on. During its early stages,
CGCA recognized the importance of professional ethics and the need to
establish ethical guidelines and standards for its members. The guidelines
developed were in keeping with our understanding of professional ethics at
that time. They served as the basis from which further work evolved.
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An important initiative undertaken by CGCA in the early 1980s resulted in a document, Guidelines for Ethical Behaviour, which was published in
1981 under the authorship of Mike Springer (Kelly, 1983). This document
outlined guidelines in four areas (General, Counsellor-Counsellee Relationships, Measurement and Evaluation, and Research and Publication),
with a total of 46 guidelines” (W. E. Schulz, 2000, p. 3). In 1987, at the request of CGCA, Dr. Bill Schulz revised the 1981 guidelines, resulting in new Guidelines for Ethical Behaviour, published in 1989
(W. E. Schulz, 2000). The 1989 guidelines were grounded in three basic
principles: “the respect of the dignity and integrity of persons, responsible caring in counselling relationships and responsibility to society” (W. E.
Schulz, 1994, p. 185). The revisions included replacement of two existing areas (measurement and evaluation; research and publication) with one area
(testing, research, and publication) and the addition of two new areas (consulting and private practice; counselling preparation). The 1989 guidelines
then focused on five areas (General [i.e., professional behaviour]; Counselling Relationships; Testing, Research and Publication; Consulting and Private Practice; and Counsellor Preparation), with a total of 63 ethical articles
overall (W. E. Schulz, 1994). During the 1980s the process of refining and extending the existing ethical guidelines was well underway and CGCA had established some foundations for developing better ethical practice.
The 1990s
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The 1990s was a decade in which CCPA moved ahead with new initiatives in the ethics portfolio. During this decade, it enhanced its role in monitoring ethical behaviour, extended its efforts in educating members about
ethical practice, changed its name, and revitalized its guidelines for ethical
behaviour. Recognizing a need to educate its membership about professional ethics
and to become more active in monitoring the professional conduct of its
members, CGCA formed an Ethics Committee in 1992. The role, functions,
and composition of the committee, as well as procedures for submitting and
processing alleged violations of the CGCA Guidelines for Ethical Behaviour,
were outlined in a document, Procedures for Processing Complaints of Ethical Violations (W. E. Schulz, 1994, pp. 185-187). THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
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As part of the responsibility of the Ethics Committee was “to educate the
CGCA membership regarding ethical guidelines, ethical issues and violations of counselling ethics” (W. E. Schulz, 1994, p. 3), CGCA authorized Dr.
Bill Schulz, Chair of the Ethics Committee, to develop an ethical standards
casebook that “would provide examples of ethical and unethical behaviour
as well as essays on key ethical issues such as boundary violations, confidentiality, and counsellor preparation” (Schulz & Martin, 2015, p. 3). This
work culminated in the publication of the Counselling Ethics Casebook (W.
E. Schultz, 1994), which included a chapter on ethical decision-making and
additional chapters illustrating how the 1989 ethical guidelines would apply
in actual situations in counselling practice, as well as 10 essays dealing with
ethical issues, contributed by counsellor-educators from across Canada. Another important educational initiative spearheaded by Dr. Bill Schulz,
while Chair of the CGCA Ethics Committee, was the introduction of a
counselling ethics cases column in the 1994 July-August issue of COGNICA.
“The intent of this column is to discuss ethical issues related to counselling.
Members of the CGCA Ethics Committee will be writing this column, and
we are very willing to address any ethical cases or dilemmas that readers
wish to introduce.” (B. Schulz, 1994a, p.10). In this first issue, Dr. Schulz
modelled how submissions to the column might be written. Beginning by
considering factors that make ethical decision-making difficult at times, he
later explained the concepts of confidentiality and privileged information
and how they relate to professional ethics and ethical decision-making.
Drawing on several legal cases, he also explained the limits to confidentiality
and privileged communication for counsellors. Although the major focus of
the column was to be on ethical issues, in the next issue (B. Schulz, 1994b),
he focused on two cases demonstrating how legal statues and case law can
raise both ethical and legal questions for counsellors. Bill Schulz led the
way with these two excellent columns about ethics issues and cases in COGNICA, but it was several issues later after his term as Chair of the CGCA
Ethics Committee ended, when the new Chair, Lorne Hoag, picked up on
Bill Schulz’s lead and contributed to the column while Chair from 19951997. Topics covered in the Ethics column in COGNICA during that time
included suicide threats, counsellor recognition of limits to competence and
misrepresentation of professional qualifications, and the use of tests. Dr.
Glenn Sheppard, Chair of the CGCA Ethics Committee, from 1997-2001,
continued the tradition of having an ethics casebook in COGNICA. Beginning in the January/February 1998 issue of COGNICA, he became the main
contributor to this initiative, addressing both ethical and legal issues over
many years, well beyond his term as Ethics Chair. Topics he covered in the
remaining 1990 issues of COGNICA included student files and “privileged”
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communication including the Wigmore criteria for establishing privileged
communication, and informed consent (e.g., dealing with requests for information). The Ethics Notebook also contained a draft preamble of a new
Code of Ethics, a copy of the CGCA. Procedures for Processing Complaints
of Ethical Violations, and an invitation to review and provide feedback on
a draft of the new CGCA Code of Ethics. In the July 1999 Ethics Notebook
column in COGNICA, Dr. Glenn Sheppard (1999) noted:
The past two years has been a very busy period for the CGCA
Ethics Committee. There has been a considerable increase in
the number of consultations with the Committee by members
concerned about ethical issues. Some members were seeking
information or clarification with respect to related articles of the
current Guidelines on Ethical Behaviour. Others needed assistance with clarifying or resolving their position with respect to
some ethical challenges with which they were faced. (p. 8) Ka
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The ethical issues on which consultations took place during the prior 24
months pertained to dual relationships, access to records, and responsibility
for files and clients when leaving a private practice partnership. The Ethics Committee dealt with three complaints made against CGCA members
during that 24-month period. The Committee also received queries about
CGCA accountability provisions for members with counsellor certification
status (Sheppard, 1999). Overall, the ethics column in COGNICA not only
served an educational function but also served as a means through which
the Ethics Committee could communicate directly with CCPA members
and vice-versa.
In addition to setting up the Ethics Committee, publishing the Ethics
Casebook, and beginning the Ethics: Issues and Cases column in COGNICA, several other important initiatives pertaining to ethics were undertaken
within CGCA in the 1990s. One of these was the appointment of a regionally based ethics committee to act as consultants and to assist in processing
any complaints. The Committee was made up of members from every province in Canada (Borgen, 1995). Another professional development initiative
related to ethics was initiated by Drs. Bill Schulz and Max Uhleman. They
developed a 2-day ethics workshop that could be offered by CGCA in different regions of the country and would be eligible for CGCA Continuing
Education Credits. Indeed, the workshop outline, including the course description and objectives, instructional format, requirements and expectations, required text, and a list of topics with approximate time allocated, was
published in COGNICA (W. E. Schulz, 1995).
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In the late 1990s, there was a growing movement to make counselling a
regulated profession in various provinces in Canada. CGCA was represented on many provincial and national committees established to investigate
moving in this direction and CGCA members took an active role in addressing the many issues associated with this initiative. One of the impacts on
CGCA internally was pressure to tighten up its own ethical and regulatory
processes. An example of this was the establishment of a CGCA national
committee, with Dr. Glenn Sheppard and Dr. Bill Schulz as Co-Chairs, “to
revise and expand its Code of Ethical Behaviour for Counsellors” (Sheppard, 1998a, p. 17), likely referring to 1989 Guidelines for Ethical Behaviour
(W. E. Schulz, 1994). In the Ethics Notebook in the September 1998 issue
of COGNICA, CGCA members were invited to provide feedback on a draft
of the preamble of the revised CGCA Code of Ethics, which was included
in that issue (Sheppard, 1998b). Later, the Ethics Committee shared a copy
of proposed guidelines they had developed for members who own and/or
work as counsellors at private counselling agencies (CGCA, 1999). In keeping with the growing areas of practice of its members, in May
1999 CGCA approved a change in its name from the Canadian Guidance
and Counselling Association to the Canadian Counselling Association
(CCA). The CGCA Board also approved the new Code of Ethics, which had
been developed by Glenn W. Sheppard, William E. Schulz, and Sylvia-Anne
McMahon (Sheppard et al., 1999). The preamble contained an explanation
of what the code of ethics entailed, its purpose, member responsibilities
with respect to the code, the purpose and nature of a complaints process,
and limits of the code (Sheppard et al., 1999). The following ethical principles identified as underlying the code were: (a) respect for the dignity of
persons, (b) not wilfully harming others, (c) integrity in relationships, (d)
responsible caring, (e) responsibility to society, and (f) respect for self-determination. Further, a six-step CCA process of ethical decision-making was
outlined (Sheppard et al., 1999). The new Code of Ethics had six major sections (Professional Responsibility; Counselling Relationships; Consulting
and Private Practice; Evaluation and Assessment; Research and Publication;
Counsellor Education, Training, and Supervision) with a total of 70 articles
(Sheppard et al., 1999). The organization of the Code of Ethics into these six
major sections remained unchanged until the next edition was published
in 2020. Overall, there was evidence of greater clarity and specificity as to
what sections might entail. For example, when compared with the 1989
Guidelines for Ethical Behaviour (W. E. Schulz, 2000), there were more major changes in three sections: General became Professional Responsibility;
Testing, Research and Publications was split into two sections (Evaluation
and Assessment; Research and Publication); and Counsellor Preparation
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became Counsellor Education, Training, and Supervision. The change to
Counsellor Education, Training, and Supervision in the 1999 Code of Ethics
(Sheppard et al., 1999) is noteworthy as it was in keeping with CCA’s growing interest in that area more broadly and presaged further developments to
come in subsequent decades. To summarize, during this decade, CGCA had established an Ethics
Committee, with both educational and monitoring responsibilities. It had
developed policies and procedures for dealing with complaints regarding
ethical violations and established a committee of consultants to draw on
for ethics matters. It had published an ethics casebook to supplement the
1989 ethical guidelines and subsequently published a code of ethics in 1999.
Besides that, it had established an ethics column in COGNICA and begun
offering ethics workshops. In short, by the end of the decade, CCA had
moved a long way forward in instituting policies and procedures related to
ethics that are fundamental to professional organizations.
The 2000s
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The decade of the 2000s was marked by continued work on another
counselling ethics casebook, new standards of practice, a revised code of
ethics, and the counselling ethics column in COGNICA. In keeping with
the ongoing need to help educate counsellors, counsellor educators, and
counselling researchers about counselling ethics, ethical issues, and ethical
decision-making and to clarify some of the ethical issues and dilemmas that
could not be fully addressed in the 1999 Code of Ethics, CCA published
another edition of the counselling ethics casebook in 2000. This second edition of the Counselling Ethics Casebook (W. E. Schulz, 2000) focussed on the
principles, values, and articles outlined in the 1999 code, provided 280 case
examples of both positive and negative ethical behaviour, and included a
range of essays to clarify ethical issues pertaining to the articles. For example, the following essays provided greater clarity around issues in counselling relationships: (a) Confidentiality: Dialogue and Discernment; (b) The
Counsellor as Custodian: Protecting Our Clients’ Personal Information; (c)
The Duty to Protect; and (d) Boundary Violations in Counsellor-Client Relationships (W. E. Schulz, 2000). A new development during the 2000s was the introduction of standards
of practice to accompany the CCA code of ethics. A code of ethics consists of
a set of principles and values that underly a profession and that are designed
to facilitate ethical decision-making. Standards of practice, on the other
hand, are designed to accompany a code of ethics and indicate the mini-
THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
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a) Beneficence
Being proactive in promoting the client’s best interests
Honouring commitments to clients and
maintaining integrity in counselling
relationship
Not wilfully clients and refraining from
actions that risk harm
Respecting the rights of clients to
self-determination
Respecting the dignity and just treatment of all persons
Respecting the need to be responsible
to society
(CCPA, 2007, p. 2)
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mum standards of professional behaviour and ethical conduct expected of
members (Truscott & Crook, 2013). In 2000, a CCA Committee, chaired by
Dr. Glenn Sheppard, was working on developing standards of practice to
serve as a companion for the new 1999 CCA Code of Ethics (Sheppard et al.,
1999). A segment from the Committee’s draft on standards for the establishment and maintenance of counselling records was included in COGNICA
with the invitation for members to provide the Committee with feedback on
it (Sheppard, 2000). Similarly, in a later issue of COGNICA, members were
invited to provide the Committee with feedback on the proposed standards
for counsellor education, training, and supervision (B. Schulz et al., 2001).
The first Standards of Practice was produced in 2001 (CCPA, 2008) with
standards being provided to match each article in the 1999 Code of Ethics
(Sheppard et al., 1999). In 2005, the CCA Code of Ethics underwent a revision. Drs. Glenn Sheppard and William Schulz revised the 1999 document, updating the ethical
principles and clarifying the ethical decision-making process. In this edition, the following ethical principles were identified as underlying the code: c) Nonmaleficence
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d) Autonomy
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e) Justice
f ) Societal Interest
Although the six main sections (Professional Responsibility; Counselling Relationships; Consulting and Private Practice; Evaluation and Assessment; Research and Publication; Counsellor Education, Training, and
Supervision) containing the articles in the code were maintained from the
1999 edition, the following three new articles were added: (a) Responsibility to Clients; (b) Delivery of Services by Telephone, Teleconferencing,
and Internet and (c) Use of Confidential Information for Didactic or Other
Purposes. This resulted in a total of 73 articles in the new Code. Articles were
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then cross-referenced with one another as appropriate (W. E. Schulz et al.,
2006). According to Schulz and his colleagues (2006, p. 20), a CCA Code of
Ethics was produced in 2006 and the document (CCA, 2006) was referenced
in their book. According to CCPA (2007), a copy of the revised document
was approved by the CCA Board of Directors and published in 2007. Both
documents refer to the same content as a copy of the same 73 ethical articles
appears in both W. E. Schulz et al. (2006, pp. 338-348) and CCPA (2007). In 2006, CCA also published a new ethics casebook (W. E. Schulz et
al., 2006) to accompany the new Code of Ethics. This book was divided into
two sections: an ethical issues section and a cases section. It was intended
to serve not only as a casebook, but also as a textbook for courses in counselling ethics. The ethical issues section included chapters in the following
six areas: (a) client rights, counsellor responsibilities, and informed consent; (b) privacy, confidentiality, and privileged information; (c) managing
boundary issues; (d) diversity issues; research and publication issues; and
(f) counsellor education, training, and supervision issues. These chapters
reflected critical emerging ethical issues in counselling and a growing recognition of their increasing complexity and scope. The second part of the
book contained cases organized according to each of the six main sections
in the new Code of Ethics. It is noteworthy that in this version of the casebook, significant attention was given to diversity issues through the chapter
on counselling in a culturally diverse society and through the many cases
involving diversity in the second section of the book. This focus was timely
and imperative as counsellors were being challenged and continue to be
challenged to provide contextually sensitive counselling “taking into consideration the client’s culture, race, religion, [gender], sexual orientation,
disabilities, ethnic background and any other characteristics that are generally viewed as somewhat unique” (W. E. Schulz et al., 2006, p. i). In addition, the increased focus on ethical issues in counsellor education, training,
and supervision corresponded with another CCA initiative at the time, the
development of standards and processes for the accreditation of master’s
level counsellor education programs in Canada and the establishment of
the CCA Council on Accreditation of Counsellor Education Programs (CACEP) in 2002 (Robertson & Borgen, 2016b). The casebook also included
copies of the CCA Code of Ethics, the National Board of Certified Counselors’ The Practice of Internet Counseling, and CCA Procedures for Processing Complaints of Ethical Violations. In this and the previous version of the
code of ethics and the counselling ethics casebook, there appeared to be a
growing momentum towards internet counselling, precipitating a need to
develop ethical guidelines/articles in this area. THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
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In 2008, a committee consisting of Glenn Sheppard, Bill Schulz, Blythe
Shepard, Ron Lehr, and Lorna Martin revised and updated the 2001 version
of the CCA Standards of Practice to bring them into alignment with the 2007
Code of Ethics. These standards of practice, approved by the CCA Board of
Directors in 2008, “were directed primarily at the professional conduct of
counsellors” in Canada (CCPA, 2008) “to provide direction and guidelines
to enable them to conduct themselves in a professional manner consistent
with the CCPA [CCA] Code of Ethics” (CCPA, 2008, p. v). Consistent with
the 2007 Code of Ethics, the standards were divided into the six sections
(Professional Responsibility; Counselling Relationships; Consulting and
Private Practice; Evaluation and Assessment; Research and Publications;
and Counsellor Education, Training, and Supervision). Two new sections
were added to address ethical guidelines for (a) dealing with subpoenas and
court orders and (b) conducting custody evaluations. The practice guidelines were not in the 2007 Code of Ethics. Ethical guidelines are usually
developed to guide competent and ethical member practice in critical or
complex areas such as those identified here. Finally, throughout the 2008
edition, short notes were included to draw attention to “some core ethical
concepts, an ethical principle, or a concept from case law, and so forth”
(CCPA, 2008, p. v). Articles in the Ethics Notebook in COGNICA during this decade also
continued to serve as another source of information regarding ethical and
legal matters for counsellors in Canada. The articles addressed a range of
ethical and legal issues pertaining to topics such as confidentiality and right
to privacy, informed consent, counsellor record keeping and notes, access to
information, duty to report, statutory regulation of counselling in Canada,
ethical use of e-mail, practicing culturally sensitive counselling, and boundaries of competence.
There was also a further change to CCA itself. In keeping with the ongoing movement toward making counselling a regulated profession in various
provinces in Canada and the desire to define itself more clearly as part of
the helping/health professions in Canada, in 2009, CCA changed its name
to the Canadian Counselling and Psychotherapy Association (CCPA).
To summarize some of the work on ethics that had gone on during the
2000s, by the end of the decade CCA/CCPA had published two documents,
an ethics casebook and the first standards of practice, both of which were
aligned with the 1999 Code of Ethics. Also, CCA/CCPA had revised the 1999
Code of Ethics, publishing a new version in 2006/2007. Two documents, a
counselling ethics casebook and a revised set of standards of practice, both
based on the 2006/2007 Code of Ethics, were also produced. Furthermore,
CCA had changed its name. It was a very busy and productive decade with
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significant advancement in CCA/CCPA professional ethics policies and
procedures. The 2010s
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Moving into the next decade, there was considerable momentum provincially in the establishment of regulatory processes for counselling with
great variation in the title assigned to those who engaged in providing such
services. Given the generic nature of the term, “counselling,” in May 2011,
CCPA adopted the following definition:
Counselling is a relational process based upon the ethical use of specific
professional competencies to facilitate human change. Counselling addresses wellness, relationships, personal growth, career development, mental
health, and psychological illness or distress. The Counselling process is characterized by the application of recognized cognitive, affective, expressive, somatic, spiritual, developmental, behavioural, learning, and systemic principles. (CCPA, 2013). From 2010 to 2015, work on revising and updating the CCPA Standards
of Practice and developing a new ethics casebook continued. Revision of
the 2008 Standards of Practice resulted in a new document in 2015. In this
edition of the Standards, “all of the standards of practice were pinned to
the generic entry-to-practice level as determined by the nationally validated
competency profile for the counselling profession in Canada” (CCPA, 2015,
p. 1).
Another counselling ethics casebook, Canadian Counselling and Psychotherapy Experience: Ethics-Based Issues and Cases, was also published
by CCPA in 2015. This book, edited by Drs. Lorna Martin, Blythe Shepard,
and Ron Lehr, was based on the 2006 CCA Code of Ethics. The book was
organized into the two-part structure (an ethical issues section followed by
a cases section) that was used in the previous casebook (W. E. Schulz et al.,
2006). At the same time, in this edition the number of essay chapters was
increased, to provide a more contextualized approach to ethical issues and
cases and to cover many areas that had not been focussed on previously.
The chapters highlighted the interaction between “specific ethical codes and
standards of practice in various contexts of counselling, such as working in
rural or remote areas, via electronic platforms, in private practice, and with
a variety of client groups” (Martin et al., 2015, p. 6), taking into account
diversity in client culture, race, religion, gender, sexual orientation, disabilities, ethnic background; counselling couples, families, children, youth, and
THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
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persons with diminished capacity). There were also chapters that addressed
professional identity and the evolution of the profession as reflected in the
movement toward the establishment of regulatory colleges across Canada,
the development of common competencies across programs, standards and
guidelines for specialty areas such as career counselling and school counseling, and the credentialing of supervisors. In the cases section, brief case
studies in most of the topics covered in the essays were provided. Overall,
this very comprehensive casebook reflected the many ongoing and emerging ethical and legal issues in counselling in Canada at the time.
Topics covered in the Ethics Notebook in COGNICA during the 2010s
included issues such as private practice, professional wills, confidentiality,
breaches of privacy, counsellor notes, counselling records, statutory regulation, standards of care and malpractice, professional misconduct, and
e-mail communication with clients.
To summarize, during this decade, CCPA developed a definition of
counselling to guide the profession. It also revised the CCPA 2008 Standards
of Practice, producing a new 2015 version. It also published another ethics
casebook aligned with the 2006 CCA Code of Ethics. The casebook diverged
from previous versions in providing more emphasis on diversity.
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Three major CCPA undertakings came to fruition with new editions of
the CCPA Code of Ethics in 2020, the revised CCPA Standards of Practice in
2021, and the Council on Accreditation of Counsellor Education Programs
(CACEP) Accreditation Procedures and Standards for Counselling Education
Programs at the Master’s Level in 2022. In all three of these documents, there
is an increased focus on diversity, indigeneity, supervision, and technology.
The revisions in the 2020 Code of Ethics and 2021 Standards of Practice were
prepared by CCPA Committees chaired by Dr. Lorna Martin.
As noted in the preamble to the new Code, “Since the last revision of the
CCPA Code of Ethics, there have been major shifts in the use of technology
in the counselling and psychotherapy profession as well as changes in Canadian demographics and social, political, economic, and cultural awareness”
(CCPA, 2020, p. iii). Taking this into account in the development of the
new code resulted in a revitalized emphasis on these aspects as well as those
related to “social justice, self-reflection, and diversity” (CCPA, 2020, p. iii).
Particular attention was given to incorporating important concepts and
contexts addressed by the Truth and Reconciliation Commission, “to ensure
that CCPA members understood the ethical imperative to seek knowledge
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and understanding and commit to self-reflection before engaging with Indigenous clients and communities.” (CCPA, 2020, p. iii). In the 2020 edition of the Code of Ethics, the ethical principles and ethical decision-making processes remained essentially the same as those in the
2006 code. The ethical principles were as follows:
Being proactive in promoting the best
interests of clients
b) Fidelity
Honouring commitments to clients and
maintaining integrity in counselling
relationships
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a) Beneficence
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c) Nonmaleficence Refraining from actions that risk harm
and not willfully harming clients
d) Autonomy
Respecting the rights of clients to agency and self-determination
e) Justice
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Respecting the dignity of all persons
and honouring their right to just treatment
Upholding responsibility to act in the
best interests of society
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f ) Societal Interest
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(CCPA, 2020, p. 2)
An important change to the CCPA ethical decision-making process was
the addition of the “wise practices lens” model of decision-making (Wesley-Esquimaux & Snowball, 2010, p. 230 as cited in CCPA, 2020, p. 5). Counsellors/therapists are encouraged to approach all ways of
knowing when engaging in decision-making. Using Etuaptmunk
(two-eyed seeing) is of immense assistance. This way of perceiving situations refers to “learning to see from one eye with the
strengths of Indigenous knowledges and ways of knowing and
from the other eye with the strength of Western knowledges
and ways of knowing...and learning to use both eyes together
for the benefit of all.” (Marshall, A., 2004, http://www.integrativescience.ca/Principles/TwoEyed Seeing/ as cited in CCPA, 2020, p.
5) THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
13
Also, some existing articles were bolstered, and some new ones were
developed to clarify concerns pertaining to the following areas:
• Working with Indigenous clients and communities;
Working with persons who identify (for a variety of reasons) as marginalized vulnerable, or disadvantaged;
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Working with clients using new technologies;
•
Working with or as a supervisor or consultant.
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(CCPA, 2000, p. iii)
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The revised document contained nine sections with 102 articles overall.
The nine sections are as follows:
A. Professional Responsibility
B. Counselling/Therapy Responsibilities
C. Assessment and Evaluation
D. Professional Research and Knowledge Translation
E. Clinical Supervision Services
F. Consultation Services
G. Counsellor/Therapist Education and Training
H. Use of Electronic and Other Technologies
I. Indigenous Peoples, Communities and Contexts.
(CCPA, 2020)
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The section on counsellor education, training, and supervision was divided into two separate sections in the new standards: E. Clinical Supervision Services and G. Counsellor/Therapist Education and Training. Also,
two new sections were added: H. Use of Electronic and Other Technologies
and I. Indigenous Peoples, Communities and Contexts. As noted previously, although some aspects of the 2006 Code of Ethics
remained the same in the 2020 document, there were also extensive major
and minor changes as well as new additions in the new Code. An equivalency chart comparing the two codes, article by article, may be found on the
CCPA website at https://www.ccpa-accp.ca/wp-content/uploads/2020/05/
Equivalencies-Chart-2007-2020-CoE-June-01-2020-aligned-to-French.pdf.
A revised Standards of Practice (CCPA, 2021), based on the new Code
of Ethics (CCPA, 2020, followed shortly afterwards. The CCPA Standards of
Practice are directly aligned to but distinct from the CCPA Code of Ethics.
They contain a set of broad professional values and principles from which
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counsellors/therapists make professional judgments and decisions. The
CCPA Standards of Practice provide action-based guidelines. Counsellor/therapists are expected to adhere to both the CCPA Code of Ethics and
CCPA Standards of Practice. (CCPA, 2021, p. ix) A particularly innovative aspect of the new Standards is that they may
be viewed through multiple overarching lenses such as those of “social justice, self-reflection and diversity” (CCPA, 2021, p. ix), as well as the use of
electronic and other technology for the delivery of various counselling-related services. Furthermore, counsellors/therapists are strongly encouraged
to view the standards through multiple overarching lenses to be able to situate and understand them within a larger context. It is also important to note
that the 2021 standards represent an effort to begin the process of addressing the Calls to Action by the Truth and Reconciliation Commission (2015)
and those of the United Nations Declaration of Rights of Indigenous Peoples
(UNDRIP, 2007). “Approaching all clients with humility and from a place of
not-knowing is a core value reflected in these standards” (CCPA, 2021, p. x).
In keeping with the changes to the Code and the Standards, revised accreditation standards were approved by the CCPA Board of Directors in
August 2022. Major changes to the CACEP standards include emphasis on
culturally responsive education (social justice and diversity) and acknowledgement of the Truth and Reconciliation Commission of Canada: Calls to
Action, acceptance of diversity of program delivery methods given technological advances and resources (on and off campus), and the consideration
of core content areas and competencies, including (supervised) practice
within a changing regulatory environment (CCPA, 2022).
The issues addressed in CCPA’s recent code of ethics, standards of practice, and accreditation standards are in keeping with the directions being
taken by other professional counselling and psychotherapy associations in
North America. The issues have been highly prominent in codes of ethics,
standards of practice, and accreditation standards published by the American Psychological Association, the American Counselling Association, the
Canadian Psychological Association, and Career Development Professionals (CDP) – Canada (2021). The Ethics Notebook in COGNICA from 2020 – 2023 included discussion of topics such as counsellor impairment, access to records, protecting
privacy and confidentiality in the virtual world, statutory regulation, and
title protection in keeping with the changing status of counselling as a regulated profession. To summarize, since the beginning of the decade, CCPA had produced
three documents that diverge from the past in major ways. The three documents include a code of ethics, standards of practice, and accreditation
THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
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standards. In keeping with ongoing changes in society and technology, all
three are more comprehensive and have an increased focus on diversity,
indigeneity, technology, and supervision.
CONCLUSION
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Overall, it is clear that CCPA has come a long way in its development as
a professional organization since its early beginnings in 1965. Throughout
its history, it has continued to promote the development of counselling and
psychotherapy as a profession within the Canadian context. During that
time, it has strongly supported the development of ethical codes and standards of practice with recent changes placing it at the cutting edge of this
field. As noted in the next chapter and the rest of the book, the ethical issues
identified here are also given prominence in this casebook.
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DISCUSSION QUESTIONS
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1. Reflect on any insights or surprises that came up as you read about
the expansion and evolution of the ethical issues seen to be important
across the decades.
2. Discuss the notion that a code of ethics is a dynamic, living document
and how that is illustrated throughout this chapter. What changes to the
Code of Ethics or Standards of Practice do you anticipate might be considered in the next revisions? Why do you perceive these as important?
3. Reflect on how best to use the Code of Ethics, both in training and in
practice. Consider some of the ways that counsellors/therapists and students in the field can be introduced to the contents of the Code?
4. Imagine serving on an ethics committee for your professional association or regulatory college. What do you think you would enjoy about
the role? What might you find difficult?
5. Reviewing the Table of Contents and the structure of this book, what are
you most looking forward to reading and learning more about? Why?
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counsellors. COGNICA, XXX(2), January/February, 17. Sheppard, G. (1998b). Ethics notebook. COGNICA, XXX(4), September/October, 14.
Sheppard, G. (1999). Ethics notebook.. COGNICA, XXXl(3), July, 8-9.
Sheppard, G. (2000). Notebook on ethics, legal issues, and standards in the
practice of counselling, COGNICA, XXXII(2), 16-17, 20.
Sheppard, G. W., Schulz, W. E., & McMahon, S. (1999). Code of ethics
(ED457492). ERIC. https://files.eric.ed.gov/fulltext/ED457492.pdf.
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THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE
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Truscott, D., & Crook, K. H. (2013). Ethics for the practice of psychology in
Canada. The University of Alberta Press.
Van Hestern, F. N. (1971). Foundations of the guidance movement in Canada. (Unpublished doctoral dissertation). University of Alberta, Edmonton, AB.
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CHAPTER TWO
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LEGAL / REGULATORY
IMPLICATIONS FOR
ETHICAL PRACTICE
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Michael N. Sorsdahl & Glenn W. Sheppard
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INTRODUCTION / CONTEXT
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The fundamentals of ethics for the counselling profession and for the
law are interconnected. However, it is important to keep in mind that the
law does not dictate ethical practice, it only informs it (Fisher, 2022). To be
found in violation of an ethical code does not mean that a person is legally
liable for their actions, and just because a person is found not to be legally
liable for their actions in a court of law does not mean they acted ethically
in the view of a college or an association to which they belong. Nevertheless,
many elements of the Canadian Counselling and Psychotherapy (CCPA)
Code of Ethics (2020) and Standards of Practice (2021) have evolved over
time based on what occurs in law in order to bring ethical practices in line
with the legal expectations for the profession. Counsellors/therapists have
overlapping legal and ethical obligations by the nature of their work, which
includes their responsibility to clients, their employers, society, and their
certifying regulatory college or association. Understanding those responsibilities, and understanding how to navigate the challenges that emerge,
becomes a major consideration in everything they do. A sensitivity to all
the relevant laws that impact the profession helps to maintain professional
integrity (Fisher, 2022).
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Much of the influence of the law on the profession of counselling comes
from case law, both civil and criminal, and is based on a body of cases in
which decisions have been made in a court of law. Common law in Canada
is based on precedent, which comprises previous decisions made on cases.
Many of the legal influences on the counselling profession come from common law. These cases come out of both provincial and federal courts, each
with different scopes of influence. This is why there can be some differences
across provinces and territories with respect to expectations based in laws
that guide professional behaviour.
Another type of law that influences the counselling profession is statute
law, which refers to the laws written by legislative bodies. Many of these laws
set out expectations and requirements for citizens in general; others apply
specifically to professional practitioners such as counsellors/therapists. So,
it is important for all helping professionals to be knowledgeable about all
such statutes that apply to their professional work, in the jurisdiction(s) in
which they work. Although many of the statutory laws are similar across
jurisdictions, there are differences that make it important to become very
familiar with them.
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Working Across Jurisdictions / Roles / Modalities
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Working across jurisdictions in the counselling/therapy profession is
certainly changing since regulation of the counselling profession has been
occurring in many provinces. There are specific requirements that each
regulatory college has when a practicing counsellor/therapist is working in
their jurisdiction but is not registered with them. Some colleges require an
application and fee for a temporary licence, while others allow counsellors/
therapists to practice as long as they acknowledge and abide by the provincial laws. As CCPA is a national association, it is reasonable to expect that
members will work remotely in many different provinces that allow them
to do so; however, understanding the rules and laws around practicing in
those different jurisdictions remains the responsibility of the practitioner.
In some cases, counsellors/therapists work in different professions concurrently; this, too, can have important implications in terms of the necessity to abide by the ethical and legal expectations for each of those professions.
For example, if a counsellor/therapist is also a naturopath, coach, or massage therapist, the work that is done with respect to each of these services
must be clearly separated in advertising, the actual performance of the service, and the billing. Some regulatory colleges/associations have stipulated
that each should be identified as separate businesses in order to ensure there
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is no crossover. Combining services that are regulated by different colleges/
associations can create complications regarding what professional service is
being offered, and under which licencing. There are legal and ethical implications that occur around merging services that would typically belong to
different regulated professions.
Professional Malpractice / Negligence
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Counsellors and psychotherapists have a fiduciary duty to provide their
clients with an appropriate standard of care. Failure to perform this duty
because of negligence can result in a charge of malpractice. Malpractice is a
label for civil suits against professional practitioners when negligence in carrying out their professional responsibilities or duties causes harm to their
clients. Under civil law, such charges are adjudicated as unintentional torts.
“Torts” refers to legal offences or wrongs against one individual by another.
The test for liability or guilt in civil law is somewhat less rigorous than for
criminal law. It is based on the balance of probabilities rather than guilty
beyond a reasonable doubt, as is required in criminal law. Negligence is
connected to a specific act or decision that the counsellor/therapist takes,
and does not speak to incompetence to practice. If someone is found to
be incompetent, which means the person is unable to meet the standards
of their profession, then it can result in disciplinary action by the college/
association that the practitioner belongs to and being fired by an employer for cause, which means immediate termination without pay. To prove
professional malpractice, the plaintiff must demonstrate that these related
elements occurred: duty, breach, causation, and damages.
1. Duty:
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Did the counsellor/therapist have a professional duty to provide a standard of care? In this instance the answer will very likely be yes. A counselling
relationship is a fiduciary one in which we commit ourselves to fulfilling a
fiduciary duty. This duty is an ethical one that has also been recognized in
law. It is stated in the CCPA Standards of Practice as follows:
Fiduciary Relationship:
A fiduciary relationship is one founded on trust or confidence
relied on by one person in the integrity and fidelity of another.
A fiduciary has a duty to act primarily for the client’s benefit in
matters connected with the undertaking and not for their own
personal interest. (Garner, 2004, as cited in CCPA, 2021, p. 11).
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2. Breach:
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Given that there is such a duty, was this duty breached by the counsellor’s/therapist’s failure to provide a normal standard of care? In considering
this question it will be necessary to determine what that standard should
have been. Should it have been a normal standard or one at the highest level
possible? This question appears to have been answered a long time ago in
the following court decision from 1838 [as this is a direct quote, original
pronouns have been retained representing the era of the original publication]:
Standard of Care:
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Every person who enters into a learned profession undertakes to bring to the exercise of it a reasonable degree of care
and skill. He does not undertake, if he is an attorney, that at all
events you shall gain your cause, nor does a surgeon undertake
that he will perform a cure; nor does he undertake to use the
highest possible degree of skill. There may be persons who have
a higher education and greater advantages than he has, but he
undertakes to bring a fair, reasonable, and competent degree of
skill... (Lamphier v. Phipos, 1838)
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The court will approach its decision in this matter by having an “expert”
member of the profession testify in court as to what the normal standard of
conduct for dealing with the client issues should have been. This witness
will not judge the case before the court but only establish criterion against
which the counsellor’s/therapist’s professional behaviour will be judged.
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3. Causation:
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The plaintiff must prove causation. This is sometimes called a proximate cause. It means that the counsellor’s/therapist’s failure to provide an
appropriate standard of care is sufficiently related to the client’s harm to be
considered its cause. This is the biggest challenge in malpractice cases and
often very difficult to prove.
4. Damages:
If all of these conditions are proven in court and the counsellor/therapist
is found liable for the harm to the client, then the court must decide how to
bring judicial relief for these consequences. Often the only relief possible is
a monetary one which can include both compensatory and punitive costs.
Counsellors and psychotherapists are usually in double jeopardy when
facing a malpractice suit because if they are found liable, their regulatory
college or certifying agency will likely sanction them for ethical misconduct
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as well. Malpractice can result from many different examples of negligence
and can occur in the following types of circumstances:
• A breach of confidentiality.
• The treatment used by the counsellor/therapist was outside the area
of accepted professional practice.
• The counsellor/therapist failed to warn about the imminent risk of
serious harm by a client.
• Informed consent was not obtained.
• The counsellor/therapist failed to inform the client of the possible
consequences of a particular counselling procedure.
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Consent
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When considering the legal aspects of consent, we think about who
is giving consent to whom and for what. There are specific principles for
consent, which come from legislative acts that practitioners need to know
and understand (Solomon, 2023). As these acts are approved provincially,
exploring what the principles of consent are, and the legal limits of consent
within your province, becomes essential in properly conducting this aspect
of the counselling process. If there are no acts that govern the process of
consent (e.g., the Health Care Consent Act in Ontario), then the common
law principles of consent apply (Solomon, 2023).
Signed consent is only one way of capturing the act of gaining consent,
for legal purposes, and is only one piece of evidence to support that consent was gained before any treatment was provided. It is also important to
note that consent is only as good as the information on the consent form,
and therefore careful consideration of what is listed in the informed consent
form is essential. Having clients sign a waiver that would indicate that they
forgo the right to complain or sue does not protect the practitioner from the
repercussions and consequences of their practice (Solomon, 2023).
Age of consent can vary across provinces, and this is important to consider when gaining consent from a client. However, it is also important to
consider who is capable of giving consent to whom and for what. In general,
individuals are capable of consenting if if they have the cognitive capacity
to understand information concerning treatment, including understanding
both the benefits and the reasonably foreseeable consequences (Solomon,
2023). This capacity can change over time, and depending on the nature of
the treatment, someone may be able to consent to some kinds of treatments
and not others (Fisher, 2022). What is important to remember is that it is
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up to the counsellor/therapist to decide if their potential client is capable
of giving informed consent, unless there is a statute within the province of
jurisdiction that overrules this concept (Solomon, 2023).
Substitute consent only occurs if the counsellor/therapist determines
that their potential client is unable to provide consent themselves (Solomon,
2023). For example, if a child does not have the cognitive capacity to understand the benefits and risks of therapy, then the parent with legal guardianship has the right to provide consent on behalf of their child. There are a few
known ways that a person may obtain authority to make decisions around
counselling/therapy for an incapable individual. These include obtaining
consent from court-appointed guardians, power of attorney for personal
care, spouse/partner, custodial parent, access parent, sibling, or any relative
by blood, marriage, or adoption (Solomon, 2023). With respect to consent
for children, it is important to make a distinction between physical custody
and legal custody. Solomon (2023) explained that this clarification could be
found in a separation agreement or by a court decision. Both the “biological” father and mother of a child have entitled custody of a child unless the
separation agreement or court order says differently (Solomon, 2023). Each
parent has the rights and responsibilities as a parent and to make decisions
in their child’s best interest. According to Solomon (2023), when parents live
separately, and the child lives with only one parent, then the other parent’s
right to custody (not access) would be considered suspended. Either parent
with custody may consent on behalf of themselves and the other parent, and
the counsellor/therapist can rely on reasonable appearances to believe that
the other has given consent (Solomon, 2023). When there is equal shared
custody, Solomon (2023) explained that the law is not clear on whether one
parent can provide consent, which creates ambiguity. Having clear communication about what the situation is with the consenting parent becomes
paramount to ethical decision making in such circumstances.
Documentation (Recordkeeping)
The legal responsibility of a counsellor/therapist to maintain proper
client records cannot be overstated. The record itself can be considered evidence and is admissible in a legal proceeding where the practitioner can
rely on a client’s record to give testimony (Solomon, 2023). Solomon (2023)
explained further that the practitioner’s credibility is influenced by the clarity and state of the clinical record, and the clinical record could be critical
in litigation processes as there is rarely physical or objective evidence. Many
health professionals have been the recipient of professional disciplinary
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consequences due to not maintaining clear, complete, and reliable records.
The CCPA Standards of Practice (2021, B6) has some specific information
about what should be included in counselling records. Some guidelines to
follow include: remaining objective and within the sphere of competence of
the practitioner, the entries should be chronological and legible, ensure the
name of the practitioner is on each record, have no omissions, information
included must be relevant to the client’s treatment, and recording the information should occur as soon as practical after the session is complete.
Clients have access to their records, so ensuring completeness is essential. It is important to note, however, that there are circumstances when
counsellors/therapists can withhold records from clients. Solomon (2023)
outlined two examples of when it may not be necessary to release records to
clients: 1) if by doing so it would create a risk of serious harm to the client
or another, or 2) the release of information would reasonably be expected
to reveal the identity of a third party who provided information in confidence. If the records are for a group, family, or couple, it must be clear to
all involved and documented how these files will be managed and released
(Fisher, 2022). In the Supreme Court’s decision in McInerney v. MacDonald
it was determined that clients have a general right to access their treatment
records unless a specific statute indicates differently.
For legal purposes regarding format and content of records, the first
step is to review any statute regulations on the matter in your area of jurisdiction. Solomon (2023) explained that the content of those records should
generally speak to statements of facts only, and if there is inclusion of statements of opinions or other non-factual material, it must be clear that it is an
opinion and not fact. Solomon (2023) explained that information provided
by a client about a third party without the third party’s consent would only
be recorded if it is relevant to the treatment plan. Likewise, information
provided by a third party about a client without the client’s consent may be
recorded if it is relevant to treatment and if it is not otherwise available from
the client. These records must be kept securely for however long the statute
that governs your health profession in your province or territory requires.
For example, in Ontario and Alberta it is 10 years, while in BC it is 7 years.
Regardless of such local requirements members of the Canadian Counselling and Psychotherapy Association are advised to keep counselling records
for a minimum of 7 years, as that is the minimum that any provincial or
territorial statutes direct.
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Confidentiality and Disclosure
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Confidentiality is a core ethical duty of counsellors and psychotherapists to protect their clients’ private communication with them. Respect for
their clients’ trust in them to do so requires the maintenance of practices
and vigilance to ensure this confidence is safeguarded. Although it is a significant covenant with clients, it cannot be an absolute guarantee because
there are exceptional circumstances under which it may have to be breached
and clients must know of these exceptions. These are: when the client provides informed consent to do so, when the release of information is required
by child protection laws, when there is a threat of imminent harm to self or
others, and when compelled by law to do so.
Confidentiality is an ethical concept while the concept of privilege is a
legal one such as the communication between a lawyer and a client receiving legal advice and support with litigation. Such communication is called
“privileged” because it is protected from the reach of the courts and therefore inadmissible as evidence in a court case.
Despite the differences between confidentiality and privilege, judges
appear to understand the importance of confidentiality to the counselling
profession and are reluctant to require a breach of it during judicial proceedings. One significant example of such a deep judicial understanding was
expressed by Supreme Court Justice, Claire L’ Heureaux Dube’ in the case R
v Mills, 1999. She said:
That privacy is essential to maintaining relationships of trust
was stressed to this Court by the eloquent submissions of many
interveners in this case regarding counselling records. The
therapeutic relationship is one that is characterized by trust, an
element of which is confidentiality. Therefore, the protection
of the complainant’s reasonable expectation of privacy in her
therapeutic records protects the therapeutic relationship. Even
the trust that this confidentiality may be breached affects the
therapeutic relationship.
Another example of a judicial appreciation for maintenance of confidentiality was expressed by Judge Joyce in British Supreme Court case RCL
v. Scf, 2011 when he stated the following view:
I find there is great public interest in encouraging victims of
abuse to seek counselling and to be assured of the confidentiality of that communication. The public interest is served if that
confidentiality is fostered to the greatest possible degree.
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It does appear that judges usually require a compelling reason to require
a counsellor/therapist to breach confidentiality. Fortunately, they have available to them a general framework for adjudicating any such consideration.
It is called the Wigmore Criteria. John Henry Wigmore (1863-1943) was an
American jurist and an expert on the law of evidence. He presented the following four requirements for jurists when determining if a particular communication is confidential and the factors to be considered when deciding
to protect it or compel its disclosure:
1. The communications must originate in a confidence
that they will not be disclosed.
2. This element of confidentiality must be essential to the
full and satisfactory maintenance of the relation between the parties.
3. The relationship must be one that, in the opinion of the
community, ought to be sedulously fostered.
4. The injury to the relationship that disclosure of the
communications would cause must be greater than the
benefit gained for the correct disposal of the litigation.
(Emphasis in original)
Here are a number of cases in which the Wigmore criteria was used to
render a court decision regarding the disclosure of counselling records.
1. In RCL v. SCF (2011) before the Supreme Court of British Columbia,
the judge had to decide whether or not to require the disclosure of the
plaintiff’s counselling records from the Elizabeth Fry Society where he
had gone for counselling. He decided that the counselling met the Wigmore Criteria 1 to 3. With respect to Criterion 4 he denied access to the
counselling records for the following reasons:
“the defendant already knows that the plaintiff was abused
as a child; that this caused him emotional pain; that he attempted
suicide; that he sought help from the Elizabeth Fry Society...” He
concluded “I am not satisfied that these records will assist in proving any material fact.”
2. In R. v. Gruenke (1991, 3 SCR 263) Gruenke and Fosty were convicted
of first-degree murder. They were appealing based on an argument that
Gruenke’s disclosure of the murder to a church spiritual counsellor and
to the pastor were privileged communications. The court decided that
it was not privileged. Applying the Wigmore criteria, it concluded that
there was not an expectation of confidentiality at the time of the disclosure and there were compelling reasons to allow it as evidence. The
appeal was dismissed.
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3. In the Supreme Court of Canada (SCC) decision in the Globe and Mail
v. Canada (2010, 2 SCR 592) journalist Daniel LaBlanc was asking for
journalistic–source privilege to protect his sources with respect to information about what became known as the sponsorship scandal. The
court dismissed all arguments in support of such a privilege. However,
it did apply the Wigmore criteria and concluded that maintaining the
confidentiality of the source in this case was in the public interest, but
it directed Mr. LaBlanc to answer questions about the matter before the
court provided it did not reveal identity of his source.
4. In R. v. M (1992) the New Brunswick provincial court dealt with a matter involving school counselling records. In this case a voir dire was held
to decide whether or not a trial for a young offender should be heard
in an adult court. The court applied the Wigmore criteria in deciding
whether or not to permit disclosure of his school counselling record. It
decided that criteria 1 to 3 were met, and with respect to criterion 4 it
denied access to the record because such information was not essential
to its decision. A very similar decision was made by a Newfoundland
judge; however, he did require disclosure of the offender’s student cumulative record. A reminder that such a record should never contain
counselling notes.
5. In the Children’s Aid Society of Ottawa v. S(N) (2005) involving a child
protection matter the Ontario Supreme Court denied the mother access
to her child’s school counselling record. It concluded that the child’s
counselling relationship with the guidance counsellor met all the Wigmore criteria. It concluded that the mother had sufficient information
and that it was “in the child’s best interest” not to permit the mother to
question the guidance counsellor about the counselling notes.
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Breaches of confidentiality can have significant unintended consequences for clients. For example, a psychotherapist left a message for a client on
a telephone answering service providing his name and requesting a return
call. The client’s abusive partner accessed the message and knew that she
was in therapy, something that was prohibited. Another breach occurred
when a clinic receptionist answered a telephone call to the clinic in which
the caller said something like, “My friend Judy is seeing a therapist there;
can you please tell me who the therapist is so that I can leave a message.”
The receptionist replied, “Her therapist is Dr. Philpott; I can give him your
message,” making a serious mistake of confirming the identity of a client.
Such a disclosure or confirmation should not be provided to any caller. This
prohibition should apply regardless of the status of the caller including lawyers, physicians, law enforcement personnel, and others.
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A CBC news report in April 2014 revealed that some Canadians were
denied access to the United States when their mental health records were
shared with the US Department of Homeland Security. Canadian police officers apparently take notes when they apprehend a person in response to a
911 call. These notes can contain personal information including any history of mental illness and suicide attempts. Such notes may be entered in the
Canadian Police Information Centre which is accessible to some American
authorities.
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Personal Information Protection and Electronics Documents
Act (PIPEDA)
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Information about PIPEDA is found from the Privacy Commissioner of
Canada, which can be reviewed at http://www.priv.gc.ca. PIPEDA is a federal legislation that is administered by the federal Privacy Commissioner,
who has the authority to adjudicate violations of the Act and/or refer serious cases to Federal Court (PIPEDA, 2015). A number of provinces operate
with their own privacy legislation, equal to or more robust than PIPEDA.
PIPEDA “sets out the ground rules for the collection, use and disclosure of
personal information in the course of commercial activities...(and) balances
an individual’s right to privacy with an organization’s needs for personal
information for legitimate business purposes.” (para 3).
PIPEDA (2015) further explained that: organizations must gain an individual’s consent when they use or collect personal information, the person has a right to access their personal information and to challenge its
accuracy, and the information can only be used for the purposes for which
it was collected. All information must be protected by safeguards including measures such as locked cabinets, computer passwords, or encryption
(PIPEDA, 2015).
The types of personal information covered by the new rules include:
• age, name, ID numbers, income, ethnic origin or blood type;
• opinions, evaluations, comments, social status or disciplinary actions;
• employee files, credit records, loan records, medical records, existence of a dispute between a consumer and a merchant, or intentions (for example, to acquire goods or services, or to change jobs.)
The legislation applies to all counsellors working in private practice.
This is because it applies to all commercial activity but not to activities in
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the public domain. For example, it does not apply to public educational
institutions, hospitals, local governments, and so forth.
The following are a few questions for reflection by counsellors and psychotherapists:
• Have you ever left a clinic file on your desk with a client name on
the lip of it? Any visitor to your office could see the name. Having
a numbering system for such files will help avoid a breach of confidentiality.
• Have you ever taken a voice message from your answering service
in a way that a visitor could hear the name of a client?
• Are your files always kept secure in a locked system to which only
you have access?
• If you have a home office, do you have an answering service, filing system, and computer system that is secure from use by family
members?
• With your home office, have you arranged for access so that your
clients will not meet your family members as they come and go?
• Have you ever acknowledged to a family member that an individual
appearing on television, radio, or other social media is one of your
clients?
• Has one of your clients ever met a co-worker in your waiting room?
• What protocol do you use to avoid this from happening?
• Do you share the names of your clients with your partner? Is this
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Mandatory Reporting Obligations and the Duty to Warn
Understanding the ethical expectations and legal requirements regarding mandatory reporting and the duty to warn is essential to the professional duties of counsellors/therapists. According to the the Criminal Code of
Canada there is no obligation to report past or future crimes, unless it is
treason (Solomon, 2023). However, nothing prevents counsellors/therapists
from reporting crimes to the police as long as the report does not breach
the confidentiality requirements with clients. Lying to the police is a federal
offence, so although you may be held in confidence by your client, what you
say in response to police questioning must be truthful (Solomon, 2023). For
this reason, understanding how to say no to the police, and managing the
interaction so that confidentiality is maintained with your client, including
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who your clients are, is essential in navigating this difficult situation. The
specific obligations for mandatory reporting may differ within the various
provincial statutes, so all practitioners must understand the mandatory reporting requirements for the jurisdiction in which they work. Common
examples of mandatory reporting include reporting suspected abuse of
children or adults under care, or the duty to warn if a counsellor/therapist
is aware that a client’s intention could place a specific person in clear and
imminent danger.
CONCLUSION
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This chapter has outlined some major areas of counsellor/therapist professional responsibilities that intersect with the law. A common theme is that
ignorance in understanding the laws within the practitioner’s jurisdiction
is not an excuse, and so it behooves all practitioners to become very conversant with what those laws and precedents are, and how they influence
ethical decision-making. As was noted at the beginning, law does not direct
ethics; however, it does inform ethics. CCPA provides many supportive documents within their resources that speak to some of the specifics we have
noted here. Ethics, Legal Issues and Standards of Practice for Counsellors and
Psychotherapists by Glenn Sheppard (2017) is a useful resource that goes
into further detail and provides examples of how to deal with some of these
difficult challenges.
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DISCUSSION QUESTIONS
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1. What are the specific provincial and territorial acts that impact the practice of counselling/therapy in your jurisdiction, and how do they differ
from other jurisdictions?
2. How would you try to reconcile a conflict between laws and ethics if
they emerge?
3. Consider how you might navigate requests for information from police,
or other authorities, during an investigation about your client. What
would you do or say?
4. Consider what your steps would be if you were subpoenaed to court
about a client, and what you might feel unprepared for. What can you
do to help prepare for that possibility?
5. When breaking confidentiality with a client due to mandatory reporting
situations, if your client does not want you to, consider how would you
do this and also maintain the therapeutic relationship.
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REFERENCES
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CCPA (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf
CCPA (2021). Standards of practice. https://www.ccpa-accp.ca/wp-content/
uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Webfile.pdf Fisher, C. B. (2022). Decoding the ethics code: A practical guide for psychologists (5th ed.). SAGE.
Garner, B. A. (Ed.) (2004). Black’s law dictionary (9th ed.). West Publishing
Company.
Lamphire V Phipos 8 C P 475 (High Court England and Wales, 1838).
The Personal Information Protection and Electronic Documents Act (2015).
Privacy Commissioner of Canada. https://laws-lois.justice.gc.ca/eng/
acts/P-8.6/page-1.html#docCont
Sheppard, G. W. (2017). Collection of notebooks on ethics, legal issues & standards of practice for counsellors and psychotherapists. Dr. Glenn Sheppard Psychological Services.
Solomon, R. (2023, May). It’s the law! Understanding legal issues in counselling and psychotherapy. Leading Edge Seminars.
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CHAPTER THREE
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ETHICAL DECISIONMAKING MODELS
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Roberta A. Borgen, William A. Borgen, and Michael N. Sorsdahl
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INTRODUCTION / CONTEXT
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Ethical decision-making for counsellors/therapists is one of the major
pillars for ethical practice. Understanding the ethical codes, standards of
practice, codes of conduct, and other sources of guidance and directions
within a profession is only the first step. Learning how to effectively apply
them becomes the cornerstone of ethical conduct and practice. Burkholder
et al. (2020) found that when counsellors/psychotherapists were not wellversed in ethical decision-making models (EDMs) and processes, they felt
both insecure and, at times, overly confident in their ethical decisions. Many
counsellors/therapists reported that, although their formal education/training emphasized their professional responsibility to ensure ethical practice,
the depth of their understanding was insufficient to help them navigate the
ethical dilemmas and challenging situations they ultimately found themselves in when entering practice (Levitt et al., 2015).
Corey et al. (2023) explained that one of the major challenges when
entering into a profession guided by EDMs is that most people want clear
guidance about the right answers to the dilemmas or situations they are
faced with. Unfortunately, as associations and regulatory colleges in the
helping field have such a diverse and nuanced focus on human interactions,
there are no codes of ethics, standards of practice, codes of conduct, or oth-
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er source of direction that could provide the specific answers to all the situations that counsellors/therapists may find themselves in. This is why the
EDMs were created, and why the articles within CCPA Code of Ethics (2020)
and Standards of Practice (2021) speak to information that is important to
consider and used to make decisions, as opposed to a list of standard procedures to follow. Another consideration around the use of EDMs is that they
can be applied to many different codes of ethics, standards of practice, and
codes of conduct that you may need to follow, as it is essential to consider and abide by all of the codes and standards that govern your work. For
example, if you belong to multiple counselling/therapy associations and/
or regulatory colleges, then it is imperative that you are aware of, carefully
consider, and abide by all of the pertinent governing codes from all sources
during the EDM process.
A significant consideration when applying EDMs in counselling/therapy practice is differentiating between an ethical issue and an ethical dilemma. An ethical issue is any issue that is ethical by nature yet does not require
you to decide between different priorities, ethical codes, or ways of conduct.
There are many of these kinds of situations that come up in practice, and although they are important to work through, they do not result in a position
where you have competing ethical codes between associations/regulatory
colleges, competing articles within the same code, or even competing principles between work organization policies and ethical codes. In the latter
situation, which forms an ethical dilemma, a decision has to be made where
you must prioritize one way of handling a situation over another, where
there is no clear direction that you can take that would satisfy both. Contemplate when, in the performance of your duties, you have an obligation to
the courts and an obligation to your client, and they are in conflict. There
would be consequences to either action, where sometimes one decision is
more appropriate over another based on the situation. Consider whether
or not your code of ethics, standards of practice, or code of conduct clearly
outlines which ethical principles have a higher priority over the others. For
CCPA’s Code of Ethics (2020) and Standards of Practice (2021) there is no
directed priority between the six ethical principles outlined. Whether or not
you are facing an ethical issue or an actual dilemma, using EDMs is recommended to help figure out what course of action to take, and ultimately to
explain the rationale for that decision.
When practitioners do not use EDMs when moving through ethical
issues or dilemmas, several challenges can arise. Burkholder et al. (2020)
explained that more experienced counsellors/therapists tend to self-reflect
on their decisions and use EDMs more consistently, understanding the nuance and complexity within their decisions; less experienced counsellors,
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on the other hand, have a tendency to feel confident in their actions, believing that their approach was the “right” one. An added challenge highlighted
by Burkholder et al. (2020), that occurs when EDMs are not incorporated
into practice, is that counsellors tend to make decision-making shortcuts
by going with “what feels right”; however, this can create biased and problematic decisions through prioritizing personal values instead of the values
of the profession. Another ethical issue can occur when counsellors/therapists or trainees have values conflicts with their clients that impact their
work (Kocet & Herlihy, 2014). By working through the ethical issues and
dilemmas that you are faced with, you are better able to systematically move
through important considerations, facilitating a more rounded and robust
decision-making process, that helps promote better ethical practice over the
long-term.
EDMs clearly help counsellors/therapists to navigate the vagueness
and ambiguity inherent in the profession that occur through interactions
with clients, supervisees, trainees, and other professionals. Understanding
that there are different approaches to ethical-decision making is also going
to be helpful in working through ethical issues and dilemmas. Choosing
amongst the different models can be influenced based on preference as well
as situation, and more often a combination of the two factors. CCPA (2020)
highlights four EDMs in the Code of Ethics - Principle-Based Ethical Decision-Making, Virtue-Based Ethical Decision-Making, Quick Check, and
Wise Practices Lens - which will be explained below and then applied to
the following vignette to illustrate the similarities and differences in ethical
decisions when using these different EDM approaches.
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APPLYING FOUR ETHICAL
DECISION-MAKING MODELS
Shayna is a therapist working in a small-town clinic that serves local
residents as well as people from the surrounding rural area, which includes
several First Nations communities. She moved here after completing her
practicum, seeking a change of pace from the “big city” where she was born
and raised. Although she’s centrally located and primarily works onsite at
the clinic, Shayna travels to the surrounding communities from time to
time, for outreach activities and to support clients in crisis. Due to the remoteness of some communities, it’s not uncommon for clients to miss or reschedule appointments because of transportation issues or other challenges
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that come up. Many clients struggle to follow through when referred to other service providers. This has been particularly challenging for Shayna who
likes to take a collaborative, multi-disciplinary approach.
Shayna is committed to learning more about her local area, and has
recently begun taking an Indigenous language course at the community
centre in town; she is looking forward to being able to greet her Indigenous
clients and community members by using a few words in their language.
As it’s a small town and her clinic is the only one in the area, Shayna often
encounters clients in her off-work interactions. On her first day of class in
the language course, she discovered that one of her classmates, Steve, is the
clinic receptionist’s nephew, who also happens to be a relatively new client
of hers at the clinic.
During a recent session, Shayna’s client, Steve, an Indigenous member
of one of the local First Nations communities, shared that he’s getting a lot
of contradictory advice from his family regarding an emerging concern with
his son at school. The school has recommended his son complete a “battery
of assessments” to see what supports, if any, they can offer. His wife is supportive, but his mother and father are deeply opposed and it’s leading to a
lot of tension in the family and has recently triggered a panic attack for him.
The client said that he’d like to bring everyone together into a session with
Shayna to discuss the assessment recommendation. However, he noted that
it would be challenging for his ailing mother to travel to the clinic in town
so it would be best for Shayna to meet with them at his home in one of the
nearby First Nations communities.
Although Shayna encourages a collaborative approach, she’s concerned
about this request because she does not know much about school-based
assessments, doesn’t know who will be doing the assessment, and is unfamiliar with the risks and benefits of having the assessment done, especially
within an Indigenous context. As the clinic director, Kam, is also Shayna’s
clinical supervisor, she approaches him to debrief the situation. Together,
they work through an ethical decision-making process to decide how to respond to the client’s request for Shayna to come to the community to meet
with his family about the assessment request from the school.
Principle-Based Ethical Decision-Making
CCPA’s (2020) Principle-Based Ethical Decision-Making model offers
a 6-step approach. In Step 1, the counsellor/psychotherapist is directed to
identify key issues in the situation and then, in Step 2, to identify relevant
articles from the Code of Ethics (CCPA, 2020) as well as any policies, laws,
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regulations, or other sources of guidance. Step 3 requires identification and
prioritization of the most relevant ethical principles and may also involve
consultation. The next step (4) is to consider how the articles and standards
can be applied to the situation and how any conflicts between ethical principles might be resolved. Risks and benefits of the potential solutions are
carefully examined at this stage before moving on, in Step 5, to examining
how the potential solution fits with your intuitions and how you’d feel about
proceeding in that way. In the final step (6), a plan of action that appears to
be most helpful is enacted and then the outcome is evaluated, and any needed adjustments are recommended – either to optimize the current situation
or to maximize effectiveness of the solution should something similar come
up again.
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Applying the 6-step Principle-Based Ethical Decision-Making model
(CCPA, 2020), Shayna and her supervisor, Kam, first identify what they
see as the key issues in this situation: Shayna’s limited scope of competency
with school-based assessments; her multiple relationships with Steve (client, classmate, nephew of her receptionist); travel time to the First Nations
community to accommodate Steve’s mother; limited understanding of the
risks and benefits of the assessment, especially within a First Nations context; and acknowledging the general lack of follow-through if a referral is
made to another service provider.
Shayna and Kam next turn to CCPA’s (2020) Code of Ethics, identifying
the following most relevant articles, although many others also seemed to
apply:
A3. Boundaries of Competence
» Neither Shayna nor Kam have been trained in school-related
assessment for children, nor have they seen assessment reports
from such assessments.
A4. Supervision and Consultation
» They wonder if there is someone with more competence to
whom they can reach out for support; they identify a lack of
competence in school-based assessment, in culturally appropriate assessment, and in the use of culturally appropriate assessment tools within schools (i.e., the intersection of these two
competency areas).
A7. Responsibility to Counsellors / Therapists and Other Professionals
» They are concerned about facilitating a debate about a recommendation made by the school, especially as that debate is be-
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yond their competence to argue.
A8. Responsibility to Address Concerns About the Ethical Conduct of
Another Professional
» On the other hand, they also wonder if the recommended assessment process is culturally appropriate, so they have an underlying concern that administering a standard “battery of assessments” might be unethical.
A9. Supporting Clients When Ethical Concerns Arise
» If there are concerns that the assessment process may be unethical, Shayna and Kam have a responsibility to support the client
in filing a complaint.
A12. Diversity Responsiveness
» Many aspects of diversity need to be considered – Steve’s Indigeneity, rural setting, and potentially limited educational background; the child’s strengths and limitations; and access to supportive school-based funding that is dependent on assessment
results.
B1. Primary Responsibility
» They need to work collaboratively with Steve, their client, to
make a plan that fits with his context and culture.
B4. Client’s Rights and Informed Consent
» Should Shayna and Kam choose to consult or seek supervision,
especially within a community where multiple relationships
abound, it will be important to secure Steve’s fully informed
consent.
B8. Multiple Relationships
» Given that the clinic receptionist has become a close friend of
Shayna and Kam and is Steve’s aunt, it’s important to Shayna to
clarify roles with Steve and document that conversation. Shayna
would also like to invite Steve to discuss his preferences about
how to handle conversations when they are at the community
centre for their language classes.
B9. Respecting Inclusivity, Diversity, Difference and Intersectionality
» Shayna and Kam recognize a limit to their knowledge about
“historical and current contexts” (CCPA, 2020, p. 11) for assessments of Indigenous children within the local schools.
B10. Consulting with Other Professionals
» To gather more information about the assessment process,
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it would make sense to talk with the school psychologist, for
which they have Steve’s consent.
B13. Multiple Clients
» If the family meeting proceeds, it will be important to clarify
who the primary client is (i.e., Steve) and the purpose of the
meeting, as well as to discuss confidentiality, the risks and benefits of the meeting, and what information will be shared (and
with whom) after the meeting.
B15. Group Counselling / Therapy
» Although the proposed meeting isn’t being characterized as
group therapy, as there will be a group involved and emotions
seem to be running high on the topic, it will be important to
discuss rights, responsibilities, and confidentiality, and to facilitate setting some group norms.
C6. Appropriateness of Assessment and Evaluation
» Shayna and Kam wouldn’t be involved in administering or
scoring the assessment tools, and can’t ethically speak to the
appropriateness of the proposed approach as they’ve identified school-based assessments to be beyond their professional
competency. Consulting with the school psychologist to better
understand the psychologist’s theoretical orientation, cultural
competence, and approach to assessment could prepare them
for a more general psycho-educational discussion with the family about common issues in culturally appropriate assessment.
C10. Sensitivity to Diversity When Assessing and Evaluating
» Again, although not in the role of the assessors, Shayna and
Kam recognize the need to be particularly cautious if the local
community isn’t represented in the norm groups of the standardized assessment tools.
E4. Welfare of Clients and Protection of the Public
» As Shayna’s supervisor, Kam has some additional considerations. Despite Shayna’s limited competency specific to assessment, she has built a trusting working relationship with Steve
and, together, they have responsibility for Steve’s wellbeing (the
panic attacks are a concern) as well as the wellbeing of his child
(i.e., will the potential benefits of the assessments outweigh the
risks?). Kam has a long history in the area of knowing that referrals generally aren’t followed up on, so supporting Shayna to
work with Steve and his family may be the most viable option.
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E5. Welfare of Supervisees
» Kam has an additional responsibility to care for Shayna’s wellbeing. He recognizes that she is feeling overwhelmed about facilitating an offsite meeting in Steve’s community with his family.
E6. Boundaries of Competence
» Kam recognizes his own limited experience and competence
with assessment and his need for “supervision of supervision”
(CCPA, 2020, p. 22) in this case.
E12. Diversity Responsiveness
» Although the Indigeneity of Steve and his family are the primary diversity consideration, Kam also realizes that Shayna is relatively new to small-town life and, as such, recognizes the need
to help her to understand how to handle overlapping relationships, the realities of limited resources, the importance of funding to support accommodations within schools, the intergenerational trauma from residential school experiences that may
potentially be impacting concerns about assessment, and local
experiences (both positive and negative) with assessments.
H4. Technology-Based Service Delivery
» One possibility for facilitating a family meeting without Steve’s
mother needing to travel to town could be to “Zoom” her in, depending on access to technology within the community and her
comfort with using it. If this is a viable option, then H1 (Technology-Based Administrative Functions) and H2 (Permission
for Technology Use) would also be relevant.
I1. Awareness of Historical and Contemporary Contexts
» Although Shayna was somewhat aware of the history of residential schools in the area, she hadn’t yet worked with a residential school survivor or experienced, first-hand, some of their
post-traumatic reactions, nor the intergenerational trauma that
has resulted. Kam, in his role as supervisor, recognizes a gap in
Shayna’s knowledge and the need to help her fill that gap – although Steve hadn’t specifically mentioned to Shayna that his
parents were residential school survivors, Kam is aware of this
background and wonders if it may be impacting their concerns
about the assessment of their grandchild.
I2. Reflection on Self and Personal Cultural Identities
» To work effectively with Steve and his family, Shayna needs to
understand her own identity and how it relates to colonization,
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racism, privilege, assumptions, and her previous learning.
I4. Respectful Awareness of Traditional Practices
» Both Shayna and Kam recognize the important role that elders
play in the local First Nations communities. They recognize a
need to learn more about why Steve’s parents are opposed to
the assessment – is this an example of wisdom from Elders, fear
from residential school survivors, grandparental concern based
on experiences with other family members, or something else?
Shayna and Kam wonder if there might be other Elders within
the community with whom they could consult to untangle these
possibilities before holding a family meeting. Before such consultation proceeds, it would be important to get consent from
Steve and the members of his family whom Steve would like to
invite to the family meeting.
I6. Strengths-Based Community Development
» Kam is aware that Steve’s First Nation has worked very hard
to generate additional funding and support for their children
in the local schools. Funding for assessments is one of the significant outcomes of their advocacy – the hope is that better
targeted supports for children in elementary schools will equip
more of them to succeed in high school and eventually move on
to post-secondary education and meaningful, sustainable work.
I8. Relationships
» The opportunity to include Steve’s parents in a counselling
meeting about Steve and his son may strengthen relationships
between the clinic and Steve’s community. Steve’s aunt is a receptionist at the clinic – Kam wonders what insights she may
have and whether or not it would be appropriate to talk with
her about this.
I11. Honouring Client Self-Identification
» As Kam and Shayna identify relevant articles from the Code of
Ethics, this last one really makes them pause and reflect. When
asked by Kam, Shayna realizes that she and Steve have never
really talked about his identity. Although she had made some
assumptions based on his registration for the Indigenous language classes, and Steve ticked off “First Nations” on the intake
form, she doesn’t really know whether he participates in traditional or cultural practices and how that might impact the
proposed meeting with his family.
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In Step 3 of applying this ethical decision-making model, Shayna and
Kam turn to the six ethical principles (CCPA, 2020, p. 2). They identify, as
most relevant to this situation, the principles of beneficence (i.e., promoting clients’ best interests), nonmaleficence (i.e., not harming clients), justice
(i.e., respecting the dignity of all involved and facilitating just treatment),
and societal interest (doing what would be in the best interests of society – in
this case the school and community).
At this point, Shayna and Kam recognize some gaps in their knowledge
related to the assessment battery and process, Steve’s family background
regarding residential schools and intergenerational trauma, the risks and
benefits to the child and family of taking or refusing the assessments, Steve’s
mom’s comfort with technology, and any traditions or protocols that might
be important should the meeting be held onsite within the First Nations
community.
In Step 4 of the ethical decision-making process, Kam and Shayna systematically work through applying the relevant articles and principles to
Steve’s request for Shayna to facilitate a meeting with his family about the
recommendation for his son to be assessed. Although they acknowledge
their limited assessment competencies (A3, E6) and specific gaps in knowledge (B9, C6, C10), they recognize that due to the local context (A12) and
the trusting relationship that Shayna has built with Steve (B1, I8), referring
to others to conduct the requested meeting was not an appropriate option.
That said, they also realize that they could consult with others (A4, B10, I4),
both formally and informally, to become better informed about the residential school history of the community and assessments within the schools and
that Kam could arrange for supervision of his supervision of Shayna (E6),
as an extra layer of support. As part of Shayna’s ongoing training and development as a therapist, Kam could offer to co-facilitate the meeting with her
(E4, E5) and, in preparation, could share examples of similar experiences
from his years of local practice (E12, I1).
Kam and Shayna also understand that they need to check their assumptions about Steve’s self-identification as Indigenous and the amount of
consideration he wants given to that aspect of his and his family’s cultural
identity when discussing the proposed assessments (I11). If Steve indicates
strong ties with his First Nations community and traditional practices (I4),
then it may also be important to further explore his parents’ concerns about
the assessment process, consult with Elders in the community, and learn
about any protocols or practices that might support an effective meeting
with the family. It may also be helpful to consult with their receptionist,
Steve’s aunt, about Steve’s family and their community – however, such a
discussion would require Steve’s fully informed consent (I8, B4).
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Although Kam knows that many other children from the community
have previously been assessed and that the school district has embraced
trauma-informed care and cultural safety practices, before engaging in any
discussions with Steve’s family about the assessment battery, both Kam and
Shayna need more information about the cultural appropriateness of the
assessment approach and confirmation that the results will be interpreted with cultural humility and sensitivity (C6, C10). Unfortunately, Kam
is aware that past assessments, conducted by a few different psychologists,
have varied in this regard. Therefore, Kam and Shayna will need to secure
Steve’s informed consent for gathering information (B4) and explain the
risks of unintentionally breaching confidentiality due to the multiple relationships within the clinic team and broader community (B8), even if an
attempt is made not to reveal any identifying information. After a general
conversation with the school psychologist and the principal (A7), should
Shayna and Kam have any ethical concerns about the assessment process,
they realize they will need to address those concerns with Steve, the professionals involved, and perhaps the other professionals’ association or regulatory college (A8, A9).
After becoming more informed about the proposed assessments and
the community history with intergenerational trauma related to residential
schools, both Kam and Shayna will need to reflect on their own cultural
identities (I2) and how their power, privilege, assumptions, and prior experiences might be impacting their decisions and approach. They will also be
better able to situate the assessment within a larger perspective of building
a stronger and healthier community (I6) as it is hoped to provide direction and support for better accommodating the unique needs of Steve’s son,
contributing to his future success in school, at work, and as a community
member.
Shayna has, to this point in her career, had no experience with counselling couples or families (A3, B8, B13, B15) so this is another area where she
will require close supervision (A4). This is an area that Kam has extensive
experience in, so he feels quite confident in his ability to guide and supervise
the family meeting, especially if he is onsite with Shayna as a co-facilitator.
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Although Kam and Shayna briefly discussed the possibility of Zooming
in Steve’s mother to an onsite meeting, or Zooming in the whole family
(H4), based on Kam’s extensive experience in the community this didn’t
seem like a great idea. It wouldn’t have been putting the client(s)’ needs first
(B1), wasn’t as likely to strengthen relationships with the family or community (I8), and wouldn’t provide as rich of a learning opportunity for Shayna
(E12). If meeting in the client’s home doesn’t seem like the best option, it
may be possible to arrange a room in the community centre or other common space that offers privacy.
Shayna, with Kam’s supervision and guidance, decides to speak with
Steve about her questions and concerns, gather more information about the
assessment process and Steve’s family and community, and, with Steve’s informed consent, co-facilitate (with Kam) a family meeting in Steve’s home
with whomever he might choose to include. The risks, of course, included further upsetting Steve’s parents and triggering another panic attack in
Steve. However, with Kam also onsite and his extensive experience and very
positive reputation working with members of the community, it didn’t feel
unsafe to proceed (and, just in case, Shayna and Steve developed a safety
plan should a panic attack occur). The benefits, on the other hand, could be
multi-dimensional. If the family decided to proceed with the assessments,
they have the potential to identify the necessary accommodations to help
Steve’s son succeed in school. The meeting could surface, respect, and perhaps alleviate Steve’s parents concerns and reduce tension within the family.
It could strengthen relationships with key members of the community and
support broader reconciliation efforts between members of the First Nations
community and residents of the small town in which the clinic is located.
In Step 5 of the Principle-Based Ethical Decision-Making model, Kam
prompts Shayna to check in with her intuitions and feelings, asking, “What
feels like the right thing to do?” Shayna reflects for a moment, realizing that
she feels more calm, less overwhelmed, and confident that, with Kam’s support, they have made a realistic plan. She was a bit surprised to find that she
was even starting to feel excited about the meeting.
Step 6 involves deciding on a plan of action. First, Shayna plans to
schedule a meeting with Steve to go over some of the questions that had
surfaced for her (e.g., his self-identification with his First Nations culture
and practices; his family history with residential schools and intergenerational trauma; his willingness for her to consult with others, including his
aunt who works as the receptionist). She would ensure his fully informed
consent before proceeding. Next, Shayna would consult with the school to
learn more about their assessment batteries and the risks and benefits of the
assessment process. She would also set up at least two supervision meetings
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with Kam to learn more about the historical context within the community,
and also to gain from Kam’s experience in working with family groups. She
would also prepare a brief letter of introduction for Steve to give to his wife
and parents (and other family members he’d like to include) to invite them
to the family meeting. She would schedule a meeting with Steve and Kam
in her office a few days after the family meeting to debrief the outcome and
discuss any needed next steps. Finally, she would book another supervision
session with Kam to discuss what worked well, what didn’t, and what they
might do differently in a similar situation in the future.
Virtue-Based Ethical Decision Making
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The Virtue-Based Ethical Decision-Making model (CCPA, 2020) offers
five prompts to guide reflection and decision-making, beginning with an
intentional awareness of your emotions and intuition as you consider the
dilemma, listening carefully to what they are telling you to do. Next, you are
prompted to consider how your values would guide you to best care for the
client. The third prompt extends your attention to how your decision might
affect other relevant individuals. Next, you are prompted to consider what
might happen if your decision were to be publicized – would you be more
comfortable with one decision over another being publicly associated with
your name and professional identity? Finally, you are prompted to consider
your decision within cultural/intercultural contexts – would one decision
better reflect who you are, personally and professionally?
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Virtue-Based Solution Example
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1. What emotions and intuition am I aware of as I consider this ethical
dilemma and what are they telling me to do?
The first reaction that I experience is concern that the client is experiencing a great deal of distress regarding his family members’ different
reactions regarding the assessment proposed by his son’s school (B2, B5,
I1-11). I am also aware of the need for Shayna to continue to learn about
Indigenous cultures that provide the context of her work (A1, A2, A3, A4,
A12, B9, I2), and to navigate the dual relationships that have arisen and will
likely continue to emerge in such a small rural community (B8). I also am
aware of the harm that has been done to First Nations members by results
of assessments that are not normed on their cultural contexts (C3, C4). In
addition, there is a lack of information regarding the specific challenges that
her client’ s son is experiencing and the extent to which the school his son
is attending is embedded in the local First Nations perspectives. As a result,
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I am left with feelings of uncertainly regarding how to procced and believe
that I need a lot more information from Shayna’s client, from his family, and
from the school (A3, I1-11).
2. How can my values best show care for the client’s wellbeing?
My values here centre on the need to help the client manage the stress
experienced from juggling the differing perspectives of him and his wife
compared with those of his parents (B2). I believe that the situation also
calls for coming from a perspective of deep cultural humility in approaching
the range of views held by the client’s family and the broader community,
given Shayna’s emerging understanding of the cultural context in which she
is working (and my own), and her likely need for professional development
in that area (A3, A4, I1-11). Another strong value for me is based on my
experience of institutional policies and procedures bringing harm to individuals who don’t fit institutional norms, so that is a perspective that I would
bring to obtaining information from the school (C3, C4).
3. How will my decision affect other relevant individuals in this ethical
dilemma?
My decision will affect many of the individuals involved in the dilemma. First, it would involve Shayna consulting regarding the situation to discuss the dual relationships she is experiencing, and more broadly to help
her develop a sense of the extent to which confidentiality may be upheld
in this rural culture and among members of the First Nations communities
involved (B2, B8, I4). Second, with the permission of her client, I would
encourage Shayna to contact the school regarding the assessment and, if it
seemed worthwhile, to arrange a meeting of Shayna’s client, his wife, and
parents and, if it seemed appropriate, her client’s son, to discuss how the
assessment would contribute to the son’s increased level of success in school
(C2, C6, C10).
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4. What decision would I feel best about publicizing?
I would feel best about publicizing a decision to hold a meeting where
the school and the family joined forces to support their son and grandson in
school (I1, I6, I8), highlighting the school’s respect for the cultural perspectives of the family (I7, I9) and Shayna’s increased ability to manage ongoing
dual relationships in a small rural community (B8).
5. What decision would best reflect who I am as a person and practitioner within cultural/intercultural contexts?
As noted in Step 4, the decision to work toward hearing all perspectives
with respect and understanding, and as result the stress on Shayna’s client
being dramatically reduced (A1, A2, B9, C10, I10, I3, I4, I6).
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Solution Using Quick Check and Wise Practices Lens
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In looking at CCPA’s (2020) Quick Check and the Wise Practices Lens
decision-making models, you can see they approach the decision-making
process through a reflective stance. Whether these models are used to guide
the counsellor/therapist’s reflection on the situation to make a decision,
or as a post-decision review before implementation, both ways incorporate CCPA’s (2020) Code of Ethics and Standards of Practice (CCPA, 2021)
to guide those decisions. In this example, first a solution will be provided
based on CCPA’s Code and Standards, followed by reviews of that solution
by applying the Quick Check method and then the Wise Practices Lens.
Solution
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There are a number of ethical considerations in making a decision on
how to proceed in this instance. There is the concern around A3 (Boundaries of Competence) and C3 (Assessment and Evaluation Competence) as
Shayna does not have the expertise around school-based assessments. Although Shayna is not administering the assessments to the child, as she is
being asked to work in the role of consultant to the family about the use of
assessments or not for the client’s child, these are still considerations. Another ethical concern is around A4 (Supervision and Consultation), where
consideration is needed as to how the supervisor will be involved in this
situation. B1 (Primary Responsibility) would also need to be considered,
as Shayna is working with the client to devise the best approach to counselling/therapy, which seems to be involving the client’s family in this instance, and is connected to understanding the cultural aspect of family decision-making. B8 (Multiple Relationships) is also a concern here as her client
is a fellow student in a language course, and is the clinic receptionist’s nephew. Counsellors/therapists are advised to avoid, or at least address, multiple
relationships in order to clarify understanding of the various roles and how
they impact the counselling relationship. F1 (General Responsibility) explains that counsellors/therapists only provide consultative practices and
services they have competency in through their education and experience,
and as Shayna is being asked to help the client with their family around decision-making about the use of assessments with the client’s son, this must
be considered. I9 (Culturally Embedded Relationships) is another article in
the code that is important to consider, as it speaks to how there are distinct
cultural differences regarding dual relationships and multiple relationships
that exist, and that this takes priority over rule-based contexts.
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When considering all of these articles of the code, the most prudent
decision is to work with the client to discuss the best approach while understanding the limitations of competence around school-based assessments,
and the potential to bring in someone with more knowledge and understanding of the use of Western school-based assessments with First Nations
children. There are limitations and cautions that would need to be considered if school-based assessments are normed on non-First Nations children; Shayna would need to have a clearer understanding of this. If Shayna’s
supervisor or anyone else was going to be involved in this situation, then
getting informed consent from her client, Steve, is required in advance of
consulting or involving other practitioners. If bringing in more experienced
therapists in the use of school-based assessments is possible in this situation, and is acceptable to Steve, then getting the agreement of the family
to meet all together is the next step of informed consent in this process.
If only consultation is the option, then this can still be an appropriate approach where Shayna consults and receives supervision on the recommended school-based assessments, so that she can speak from an informed place
with the family. Understanding restrictions of movement of the family, yet
the importance of the family and their influence on the client, would mean
that working with the family around this issue would indeed be best served
by connecting at a location that works for everyone, which in this case is the
client’s home.
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Quick Check
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Although the Quick Check approach can appear quite simple at first
glance, the three prompts encourage you to carefully consider the impact of
your decision at multiple levels. The first prompt relates to publicity, asking
you to reflect on how comfortable you would be to see your decision become front-page news! Next, you are prompted to consider the universality
of your decision – both locally (i.e., would you be able and willing to make
the same decision for all of the people you serve) and more globally (i.e.,
what would happen if every counsellor/psychotherapist were to make a similar decision?). Finally, you are prompted to consider your decision through
the lens of justice, asking if everyone would be treated fairly as a result of the
decision you are contemplating.
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Quick Check Example
Applying the Quick-Check approach, a look at this decision from three
perspectives is necessary.
Publicity – If this decision was reported as front-page news, it does
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take into consideration the appropriate ethical articles from the
CCPA Code of Ethics (2020) and Standards of Practice (2021), and
works to find a solution that considers the competing elements.
Universality of Decision – This is a bit more complicated of a perspective, as not everyone comes from the same culture. This being
said, in this case, for anyone seeking help to involve their family in
a complicated situation where that family influence is important to
the client, this action would fit – especially around the involvement
of someone to consult, supervise, or even assist in further understanding school-based assessments. From a global perspective, if
every counsellor made this decision, it would still be grounded in a
clear ethical decision-making process.
Justice – I believe everyone is being treated fairly in this decision, upholding the principles of beneficence and nonmaleficence.
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In the CCPA (2020) Code of Ethics, a fourth EDM was included – the
Wise Practices Lens encourages use of Etuaptmumk (two-eyed seeing; Wesley-Esquimaux & Snowball, 2010), examining problems from both Indigenous and Western bodies of knowledge and ways of knowing and benefiting
from both perspectives. This approach also emphasizes the importance of
the relationships between all things and is based on the seven sacred values of courage, honesty, humility, respect, truth, love, and wisdom, which
are each expanded upon in the case example in this chapter. Although this
model was originally designed for use with Indigenous clients, many counsellors have found it helpful in examining ethical dilemmas involving members of diverse cultures and communities.
The Wise Practices Lens is drawn from the Canadian Aboriginal Aids
Network (CAAN) that speaks to a model that can be used to address mental
health and wellness concerns with First Nations, Metis, and Inuit communities (Wesley-Esquimaux & Snowball, 2010). This lens focuses on natural
wisdom and speaks to the seven values that need to be understood, considered, and implemented in all elements of social service practices (Wesley-Esquimaux & Snowball, 2010). Although the lens was originally proposed to
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look at mental health and wellness services themselves, it can be viewed
as a relevant way to explore ethical dilemmas and issues that arise within
counselling/psychotherapy settings, which is why it is presented as an EDM
by CCPA (2020). Wesley-Esquimaux and Snowball (2010) explained that
the foundation of wise practices comes from the Seven Sacred Values, or
Grandfather Teachings, which are:
Courage – to speak, to reveal, to reach out, to be open, to be introspective
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Honesty – to know yourself and your own values, biases and beliefs,
to speak from the heart and soul, to allow yourself to truly be
seen, known and be known
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Humility – we are all in this together and all have inherent value, no
one person is greater than any other in spirit, we are all ordinary and extraordinary beings, our greatest task is to learn to
be of service
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Respect – coming together and honouring each [other’s] place and
space, knowing that this is something you must give to get,
honouring the smallest to the oldest, walking in beauty
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Truth – our truth is not the only truth, there are many paths to home,
we are created equal, no matter how much we learn, there is
much we do not know
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Creating Love – unconditional acceptance of self and other, accepting and embracing difference, allowing, and gracefully giving
everything we are
Wisdom – providing an expansive and inclusive view of the world.
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(p. 396)
Using these Seven Sacred Values as an EDM requires the ethical dilemma or issue to be considered through each value before deciding which
courses of action to take. The values are not seen as steps, differing from
all of the other EDMs presented above that are derived from the Western
philosophy of ethical decision making. Rather, they provide a holistic way
to view the situation and inform decisions. When making ethical decisions
using this model, it is important to explore concepts in relation to the CCPA
(2020) Code of Ethics and Standards of Practice (CCPA, 2021), and consultation with other professionals is still important.
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Wise Practices Lens Example:
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When looking at the decision from a Wise Practices Lens, there are Seven Sacred Values to consider.
Courage – In this decision, the focus was on collaboration and consultation to best help the client. Being open to acknowledging limited
competence to self and client, going to the client’s home, to reflect
on what concerns come up, and to consider the risks and consequences, all speak to this value.
Honesty – by sharing the client’s concerns, consulting with the supervisor and other experts, and being open about the limits of the
counsellor’s competency, this allows all concerns to be seen clearly
and understood from multiple perspectives.
Humility – this value is best considered through the acknowledgement
that the client is clear about what he needs, and the counsellor listens to that, as opposed to applying hard and fast rules that do not
serve both of them. In addition, the acknowledgement of the limitations of knowledge in assessment and working with First Nations
populations, and the desire to seek support in making this decision
speaks to this value.
Respect – by listening to the needs of the client, and understanding the
counsellor’s limits of knowledge, there is a respect for both people.
In addition, respect for the importance of the family, and the incorporation of them into therapy to help the client, is clear. There is
sense of building of community that supports the family’s perspectives as well as the client’s in this decision, that honours the importance of all perspectives as opposed to privileging one.
Truth – the counsellor acknowledging limitations of knowledge, as
well as hearing the truth and importance of family and the circumstances that the family are in considering how best to help the client
speaks to honouring this value.
Love – the counsellor worked to accept herself and what is important to
her, by exploring the concerns and voicing them both to the client
and the supervisor, as well as still honouring the needs of the client
in this circumstance.
Wisdom – being open to different paths of wellness and the need to
support the client, as well as honouring the situation of all parties
involved, allows for a greater view of the world, which speaks to
this value.
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DISCUSSION QUESTIONS
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1. Choose one of the ethical dilemmas provided throughout Section 2 or 3
from the text or one from your own practice. Apply two of the EDMs to
your dilemma. Discuss the similarities and differences in the decisions
made using different models.
2. Reflect on which of the four models from the CCPA Code of Ethics
(2020) you’ll likely turn to as your first choice when an ethical dilemma
arises. Why? What might be the down side in regularly applying this
approach?
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REFERENCES
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Burkholder, J., Burkholder, D., & Gavin, M. (2020). The role of decisionmaking models and reflection in navigating ethical dilemmas. Counseling and Values, 65(1), 108-121. https://psycnet.apa.org/doi/10.1002/
cvj.12125
Canadian Counselling and Psychotherapy Association (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Corey, G., Corey, M. S., & Corey, C. (2023). Issues and ethics in the helping
professions (11th ed.). Cengage.
Kocet, M. M., & Herlihy, B. J. (2014). Addressing value-based conflicts within the counseling relationship: A decision-making model. Journal of
Counseling & Development, 92(2), 180-186. https://psycnet.apa.org/
doi/10.1002/j.1556-6676.2014.00146.x
Levitt, D. H., Farry, T. J., & Mazzarella, J. R. (2015). Counselor ethical reasoning: Decision-making practice versus theory. Counseling and Values, 60(1), 84-99. https://doi.org/10.1002/j.2161-007X.2015.00062.x
Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, mental illness and addiction through a Wise Practices lens. International Journal of Mental Health and Addiction, 8, 390-407. https://doi.
org/10.1007/s11469-009-9265-6
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SECTION
2
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Ethical Areas of Practice
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Counsellors/therapists are expected to conduct themselves with integrity, professionalism, and ethical care in all
aspects of their work with clients, clients’ families, colleagues,
communities, and the public. This responsibility includes engaging in appropriate, contextualized professional development and self-care practices to maintain optimum capacity.
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A1. General Responsibility
A2. Respect for Rights
A3. Boundaries of Competence
A4. Supervision and Consultation
A5. Representation of Professional Qualifications
A6. Professionalism in Advertising
A7. Responsibility to Counsellors/Therapists and Other Professionals
A8. Responsibility to Address Concerns About the Ethical
Conduct of Another Professional
A9. Supporting Clients When Ethical Concerns Arise
A10. Third Party Reporting
A11. Sexual Harassment
A12. Diversity Responsiveness
A13. Extension of Ethical Responsibilities
A14. Professional Will and Client File Directive
CHAPTER FOUR
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PROFESSIONAL
RESPONSIBILITY
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Michael N. Sorsdahl
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INTRODUCTION / CONTEXT
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According to the Canadian Counselling and Psychotherapy Association
(2020) Code of Ethics, counsellors/therapists have a professional responsibility to demonstrate integrity, professionalism, and ethical care in all aspects
of their work. This responsibility is not limited to working with clients; it
extends to all those with whom they come into professional contact. Professionalism is what brings counsellors/therapists together as a community
and identifies them as fundamental contributors to mental health support
services in Canada. Before looking at the services provided to clients, it is
essential to consider what being a professional in this field requires.
Being a professional is not a simple task, especially in a developing field
such as counselling. In Canada, statutory regulation of many professions is
under the jurisdiction of provinces or territories, and the roles of many mental health professionals (e.g., in the fields of psychology, social work, and
psychiatry) are regulated within each province (Martin et al., 2015). Counselling/psychotherapy, as a growing mental health profession in Canada has
become regulated in many provinces (i.e., Alberta, New Brunswick, Nova
Scotia, Ontario, Prince Edward Island, Quebec), and is in various stages of
the creation of regulation in the other provinces. The trend in Canada towards regulation of this profession will help solidify its identity, important
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both for the protection of the public, and for supporting the professionals
who work within it. The ethical principles focused on guiding Professional
Responsibility are necessary to navigate the diversity of practices within the
counselling profession and inform ethical decision making.
As you review the CCPA (2020) Code of Ethics and Standards of Practice
(CCPA, 2021), in the Professional Responsibility section you will find many
issues to consider. There are articles about your general responsibilities as
a professional, as well as how to advertise ethically, present yourself to the
public, create a supportive environment, conduct administrative responsibilities, and recognize the impact of your behaviour on others.
With so many things to consider, it is difficult to imagine being able
to remember and manage them all. It is important to acknowledge that all
counsellors/therapists experience ethical dilemmas. The expectation that
you would know everything is unrealistic, and as the profession evolves, so
do the recommended practices and ethical codes/standards of practice that
guide it. We encourage you to stay humble and open, not trying to figure out
challenging ethical dilemmas on your own. The importance of consulting
as part of the ethical decision-making process cannot be overstated. Hiding
complex and challenging situations and dealing with them in isolation may
only make the situation worse and must be avoided to ensure ongoing ethical practices that demonstrate professional responsibility.
Recommended Practices
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When it comes to Professional Responsibility recommended practices,
consider the behaviours and approaches that will help you to integrate each
of the articles in this section into your practice. Although some articles have
specific expectations outlined in the CCPA (2021) Standards of Practice,
many are left to you to decide how to best apply them. Consultation can help
you to better understand the current recommended practices in applying
these articles to inform ethical decision making. The recommended practices are not meant to be prescriptive, as there are always differences based on
context and situation; however, they offer a good place to begin.
General Responsibility & Self-Care
The first article (A1: General Responsibility) within the Professional
Responsibility section of the CCPA (2020) Code of Ethics provides an overview of the subsequent items in this section. It states the importance for all
counsellors/therapists to maintain high standards of competence and ethical behaviour in their professional roles, to continue to develop and grow as
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practitioners, and to engage in self-care. As the subsequent review of these
articles and recommended practices will get into specifics, this section on
recommended practices will be on professional responsibility related to
your self-care.
Self-care for counsellors/therapists is an ethical imperative and cannot be overstated as an indispensable piece of maintaining competence. As
Steele (2020) pointed out, burnout, compassion fatigue, vicarious trauma,
and stress are all natural consequences of therapeutic work. Understanding the symptoms and behaviours associated with these conditions can
help you to be more reflexive and proactive in countering those effects and
finding balance (Neimeyer & Taylor, 2019). It is not only essential to engage in healthy activities to help strengthen your body and mind against
the impacts of being in helping relationships; you must also incorporate
enjoyable activities (Butler et al., 2019). Another way to look at it is that the
healthy activities (e.g., exercise, proper eating, sleeping, avoiding negative
coping mechanisms/behaviours) are like strengthening the container that
holds your resources; however, that is not sufficient to fill that bucket with
the energy needed to deal with the demands of your work. We encourage
you to find ways to remain self-full as explained here, which looks very different from being selfish or selfless. Activities that you truly enjoy need to
be incorporated into your everyday living to help fill your bucket of energy
resources, in addition to being healthy.
Respect the Rights of People, Sexual Harassment,
and Diversity Responsiveness
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One of the recommended practices to help fulfill this part of the Code
of Ethics is to become familiar with the Universal Declaration of Human
Rights1, the UN Convention on the Rights of the Child2, and the UN Declaration on the Rights of Indigenous Peoples3, as outlined in the CCPA (2021)
Standards of Practice. Smith et al. (2019) outlined some very important concepts for practitioners to consider when it comes to sexual harassment and
coercion. They explained the #MeToo movement in a way that outlines the
challenges of past behaviour that, although once considered normal, is now
understood as having always been problematic. One of the ways promoted
by Smith et al. (2019) to help navigate these social justice issues is to consistently respect the rights of all clients, students, supervisees, and colleagues.
Similar to understanding the documents listed above that govern people’s
1
https://www.un.org/en/about-us/universal-declaration-of-human-rights
2
https://www.unicef.org/child-rights-convention/convention-text
3
https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples.
html
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rights, it is necessary for you to be aware of current views regarding social
justice issues.
Sexual harassment by a counsellor/therapist is not tolerated within a
professional relationship. Understanding what sexual harassment is, and
how it can be eliminated, becomes a continued source of development and
education. For example, Morris et al. (2020) explained how easily micro-aggressive behaviours were directed towards transgender clients, where the
professionals might have been unaware of their impact. Therefore, recognizing, and continually striving to learn more about sexual harassment is a
beneficial strategy for creating a supportive environment that respects the
rights of all people.
When it comes to diversity responsiveness and having a nuanced understanding of the needs and perspectives of others, recommended practices
require you to develop awareness of your own self-location, biases, and cultural influences (Kottler & Balkin, 2017; Young, 2021). Addressing power
differences directly with clients, supervisees, or trainees helps to mitigate
the impact of those differences and to reduce the potential for disrespectful
behaviour to occur (Trevino et al., 2021).
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Boundaries of Competence, Expanding Practice,
and Supervision/Consultation
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These articles of the Code of Ethics (CCPA, 2020) speak to the importance of limiting counselling practice to the areas for which you have adequate training and experience. One of the recommended practices to facilitate this is to get training and supervision/consultation on any expansion of
your practice (DeAngelis, 2018). Steele (2019) also outlined the importance
of understanding boundaries of competence, so that practitioners do not
find themselves out of their depth when working with social justice issues.
Counsellor/therapist education provides the essential skills and knowledge
for entry-level practice; however, your basic training is insufficient to ensure
competency in all areas of counselling/psychotherapy. Many counselling/
psychotherapy professional associations and colleges require continuing
education to maintain certification and there are several courses, webinars,
certificate programs, and other training opportunities available to help you
meet the requirements for ongoing professional development.
Remember that no counsellor/therapist can be all things to all clients, so
reviewing goodness of fit is an important component of initial assessment.
As a professional, you need to be very clear and forthright about what limits
there are to the services you can provide; it is imperative to have that discussion with clients before beginning any therapeutic process. Pinner and
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Kivlighan (2018) explained that it is difficult to measure competence, and
that self-report is biased. Regularly monitoring outcomes and progress towards goals is helpful to see if your approach is working. If what the client
needs or wants is not within your scope or competence, or if therapeutic
interventions are not working, then assisting a client to find someone who
can work effectively with them would be the next step. If, due to extenuating
circumstances, a referral cannot be made, then arranging for clinical supervision to support effective work in a new area of focus would be considered
the recommended practice (Frank et al., 2020; McMahan, 2014).
Supervision and consultation throughout your entire professional life
are key components of continued counsellor/therapist competence and
learning (CCPA, 2021). When expanding competence, it is crucial to choose
a competent supervisor that is a good fit within the area of expansion desired, and ensure a clear contract and structure is in place that explains the
relationship, as well as how that relationship will be explained to clients
(Smout, 2020). Ongoing professional growth and development is also an
expectation for all counsellors/therapists (Young, 2021). Therefore, abiding
by the concept of working within competence is not intended to suggest
that you should not work to expand your skills and abilities; rather, when
you do, taking the most appropriate actions to build that competence while
working safely and effectively with your clients is expected.
Considering the unique challenges of remote locations is also necessary
(Rowen et al., 2022). Creating strong structures that incorporate supervision and consultation can mitigate risks to clients. In some areas, and even
in some organizations with the rapid expansion of practice online, there is
limited local support available; in such cases, it may be essential to bring
in external supports, sometimes using virtual technologies. Creating and
sustaining a community of support that includes access to consultation and
supervision, no matter your specific place of employment, is a valuable part
of the process of ensuring competence and continued development.
Professional Qualifications and Advertising
The CCPA Code of Ethics (2020) and Standards of Practice (CCPA,
2021) provide guidelines regarding how to represent professional qualifications as well as how to advertise. The recommended practice when it comes
to these concepts is to be as honest and transparent as possible (Good Therapy, 2020). Paramount, however, is that whatever you are trying to explain
must be understandable to your clients, supervisees, or trainees. One way
to confirm that the public will understand your advertisements is to ask
non-counsellors/therapists for feedback on advertising and/or website content. Everything about representing yourself to the public must be accurate
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and professional. Wording is very important in advertising, so ensuring that
advertisements are accurate and do not violate regulated terms is recommended practice.
Responsibility Around Ethical Conduct of Other Professionals
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This chapter has, until now, emphasized the importance of maintaining
your own ethical conduct. However, you also have professional responsibilities regarding the conduct and ethical practice of others. When concerns
arise with another professional, a first step is to contact that individual to
speak to them about the behaviour or conduct in question, to find an informal way of supporting their professional development (O’Connor, 2008).
However, when you become aware of the unethical conduct or behaviour of
another professional and cannot resolve it informally with them, then check
with the regulatory bodies or professional associations that oversee their
practice to discover their procedures for reporting ethical concerns. When
reporting, there is a significant distinction between whether or not you have
direct knowledge of the unethical behaviour or conduct. Direct knowledge
requires that you have personally witnessed or have direct proof or evidence
of the unethical behaviour. There is a difference between direct knowledge
and third-party knowledge (i.e., information that has come from an external
source such as a client), which impacts what is considered recommended
practice. For example, if a client told you about another professional’s ethically questionable behaviour, although you may still report it, depending
on the organization, they may not be able to proceed to investigate the complaint. This does not mean that you are to push clients to report issues themselves; however, as part of the process of therapy, you offering to support the
client’s report of the complaint is recommended practice.
Third-Party Reporting
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Whenever working with a third-party referral source for clients, it is
necessary to be very clear on the nature of that relationship, and how confidentiality works with the clients, the practitioner, and the organization. This
information must be fully explained and agreed upon by the client before
services are provided. Having conversations with the client around what
they want released to the third-party, as opposed to either sharing all or
none of the records, is a valuable aspect of this conversation. Transparency,
and even providing a preview to the client(s) of what will be released to the
third-party can help in ensuring that what is provided is understood by the
client. The client may not be clear about what type of information is in their
records, or what will be released to the third-party. So, when they agree to
sharing of information between their counsellor/therapist and a third-party,
explaining what options exist, and being clear on both the way the infor-
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mation will be provided (e.g., progress notes, summary letters, telephone
discussions), as well as what kind of information will be held and/or shared
through those methods becomes an important aspect of informed consent.
Your responsibility to abide by the CCPA Code of Ethics (2020) and Standards of Practice (CCPA, 2021) remains even if there are requirements by
the third-party organization that would result in you violating those codes
and standards. When agreeing to work with a third-party, from the very
beginning it is necessary to review all the operating procedures and look for
any potential conflicts.
Pitfalls/Challenges
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One of the major challenges that counsellors/therapists face is the internal struggle between desiring to help others, and ensuring that they have
the capacity and competency to work with the people they wish to help. It
is not unusual for the demands of the organization, or even their clients,
to put them in a position where they sacrifice their own well-being to help
others, or they begin working in areas in which they are not yet competent.
Being self-reflective is one of the key skills you will need (Kottler & Balkin,
2017; Young, 2021); this includes understanding what is occurring within
yourself as you interact with others. Self-reflection can foster self-care and
will identify where and how to build competence. You are not alone; there
are supportive communities that can help you to navigate ethically challenging situations.
One common challenge for many counsellors/therapists is working
outside of their competence, often because they simply “don’t know what
they don’t know”; this is especially true for novices at the beginning of their
careers. Unfortunately, this can place practitioners in very challenging situations that lead to potential violations. A recommended practice, therefore,
is to have access to a supervisor or consultant who can help you navigate potentially challenging situations, even when you may not be aware that they
are evolving. Talking with a supervisor about the goals and focus of counselling and what has been happening in client sessions can help to identify
areas that may be out of your boundaries of competence; you can then work
on expanding competence with the aid of an appropriate supervisor and/
or training. One specific example of a competence challenge is conducting
custody evaluations; as explained in the CCPA (2021) Standards of Practice,
counsellors/therapists must be able to show evidence of competence to engage in these kinds of evaluations, which typically require specific training
and supervision.
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Professional impairment is another important issue to watch for, when
you are no longer able to provide competent services to clients, supervisees, or trainees due to your own limitations (CCPA, 2021). This once again
speaks to the importance of self-reflection, being aware of the impacts of
what is happening to you due to the professional and personal factors in
your life. The push to put others’ needs before your own can often lead to
over-extension, stress, compassion fatigue, or burnout. When you are not
capable of continuing service due to any type of limitation, it is essential to
seek supervision and/or consultation, and to limit/suspend services until
you recover.
When it comes to advertising your credentials and services to the public,
there are a few pitfalls to avoid. Using a degree or an affiliation to an association to imply certification in counselling is problematic. As counselling/
psychotherapy is not a regulated profession in all provinces, but psychology
is regulated across Canada, it is imperative not to mislead the public about
credentials; educating clients and the public through accurate advertising is
required. Another major advertising-related pitfall is the use of testimonials by clients, former clients, or relatives/friends of clients. Within CCPA’s
(2020) Code of Ethics, using testimonials in advertising is not permitted unless the testimonial has been provided by an organization that refers clients.
A related challenge comes from public sites that may have comments made
on them that are not controlled by the practitioner. If you find a testimonial
about you on such a site, it is incumbent upon you to do your best to have it
removed by making a request to whoever controls that site. Confirming the
expectations around advertisement and limits as expressed by your regulatory association or college is a significant aspect of due diligence.
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CASE EXPLORATION
Case 4.1
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Cassandra and Gabe are a couple, but not living together. Cassandra has two young children from a previous relationship; Gabe has no children. Cassandra sent her
counsellor a message saying that Gabe had disclosed very
distressing information to her and that she would like to
meet to process some emotions around this information.
Cassandra and the counsellor then had an individual session in which Cassandra disclosed that Gabe revealed to
her that he has been and is currently watching Hentai porn
(a Japanese animated pornography type) that specifically
depicts images of minors. Cassandra explained that Gabe
only told this to her because Child Protective Services (CPS)
had become involved in her family, due to a referral from
a teacher of one of her children, reporting that the young
child was displaying sexually aggressive behaviours at
school. Cassandra stated that Gabe is never alone with her
children and that her children would have no way of ever
viewing this porn. She was unsure how to feel about it as
it was depicting minors; however, it was doing so in a cartoon form. The counsellor was also unsure whether or not
this would be considered child porn and whether it was
reportable. After research, the counsellor concluded that,
federally, hentai involving depictions of minors is considered child porn. Seeing that CPS was involved and a minor
was displaying these concerning behaviours, the counsellor decided to report this to the appropriate parties.
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Case 4.2
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An inquiry to the counsellor came via email from a
trans woman. The potential client had been working with a
counsellor for 7 years, and conveyed that for the past several months, boundaries within the therapeutic relationship
became “weird.” The potential client reported she socialized
with the counsellor (i.e., dinner with the counsellor and her
partner), went on walks, and met the counsellor’s family;
the potential client expressed that nothing sexual occurred
and that she could not imagine this happening. Recently,
the counsellor “gently pressured” the potential client to end
the therapeutic relationship and is “pulling back” from what
is identified as a friendship. Extreme pain and confusion
are expressed by the potential client, and she would like
to process her experience with a new counsellor. However, the potential client is asking for a “guarantee” that anything conveyed about this situation remains confidential.
She reports being very attached to her previous counsellor and would be devastated if anything happened professionally to her previous counsellor due to a report made to
a professional body. The potential client is employed in a
research-oriented field and conveyed she has conducted
extensive research on boundary issues, dual relationships
in post-therapy time frames, and professional duty to report. She indicated she contacted another counsellor who
agreed they could guarantee confidentiality; however, another counsellor conveyed they could not. Frustration is
reported by the potential client, given the honesty shared
about her situation with potential new counsellors. Additionally, based on her research, she reported counsellors
either assign a label of BPD to clients in her situation (i.e.,
who bring circumstances on themselves) or have a desire
to report the “bad” counsellor and prevent them from practicing. The potential client communicated that she feels she
has nowhere to turn for help.
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Case 4.3
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Iris is a Southeast Asian first generation Canadian; she
identifies as female. She has been progressively getting
more anxious and depressed. She feels that this is for two
main reasons: Her family has become increasingly out of
balance with their chosen religion and harsher with her as
a result, and she doesn’t feel she can confide in anyone at
her place of worship or in her family about her struggles,
which they are shrugging off with greater regularity. Iris is
hurt and angry with God over her situation, her perceived
rejection from her family, and her isolation and mistrust of
the leadership that cannot offer her the psychotherapy that
she needs, nor the spiritual support she desires, leaving
her feeling that she would be judged if she expressed her
thoughts and feelings.
Iris comes to counselling to see Rose for depression
and anxiety. Rose has been told by her supervisor to stay
away from any religious or spiritual topics even for the purpose of understanding the correlation to the client’s presenting issues and if they are related to the main struggle
of the client. Rose understands and respects the need for
the client to lead in this area but is struggling with her supervisor’s guidance not to explore the associated anger,
isolation, betrayal, and loneliness potentially related to the
client’s experience with spirituality and faith in the session.
Her supervisor’s guidance has left little room to explore pros
and cons on the issue. Rose’s training taught her that such
exploration could reveal either spiritual injury or conversely
spiritual gain (e.g., spirituality, in many adults, can contribute to improved personal resiliency and mental health).
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Rose would like to ask about Iris’s main triggers to feeling depressed and anxious even if her answers open up a
religious or spiritual conversation and Rose clearly indicates
that her area of competence is in dealing with anxiety and
depression, not deep spiritual guidance, though this is a
safe and judgement-free space. She further indicates that
her approach would be client led, not directive spiritual
guidance, though any topic Iris needs to discuss is welcome
there.
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A new employee at a well-established and long-standing adoption agency in a large Canadian city became aware
that the CEO of the agency had used this new employee’s
social work registration number to submit an insurance
claim for services for a child and their adoptive parents. The
CEO had been with the agency for about 10 years. The new
employee approached the CEO about this issue and the
CEO said she has been doing this for years, using the registration numbers of her staff who have master’s degrees,
as she only has a bachelor’s degree, to perform adoptions
business when clinical staff are busy. The CEO said that she
had checked with the agency lawyer and that it was legitimate and okay for her to do this.
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DISCUSSION QUESTIONS
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1. What self-care strategies do you use to keep yourself healthy (physically
and mentally), and what strategies do you use to bring yourself enjoyment? How can you make these more part of your routine by creating
a structure that is specific enough to implement (i.e., includes duration,
frequency, and periodicity) and flexible enough to accommodate the
unexpected changes in your schedule and capacity?
2. What is your understanding of the social justice issues relevant to counselling/psychotherapy, and what are the steps you can take to increase
your awareness and approaches? How would you address power differentials in the therapy setting?
3. Consider what your boundaries of competence are, and how you could
begin to expand your practice into other areas. How would you work
with a client and a supervisor when expanding your practice?
4. Consider how you are advertising, or will advertise, yourself as a counsellor/therapist and create a strategy to minimize confusion.
5. How would you approach another counsellor/therapist when you have a
concern about their ethical practice?
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REFERENCES
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Butler, L. D., Mercer, K. A., McClain-Meeder, K., Horne, D. M., & Dudley, M. (2019). Six domains of self-care: Attending to the whole person.
Journal of Human Behavior in the Social Environment, 29(1), 107-124.
CCPA. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf
CCPA. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/
wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENGSept-29-Web-file.pdf
DeAngelis, T. (2018, May). What should you do if a case is outside your skill
set? CE Corner, 49(5). https://www.apa.org/monitor/2018/05/ce-corner
Frank, H. E., Becker-Haimes, E. M., & Kendall, P. C. (2020). Therapist
training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. Clinical Psychology:
Science and Practice, 27(3), Article e12330. https://doi.org/10.1111/
cpsp.12330
Good Therapy. (2020. May). Advertising your therapy practice: Do’s and
don’ts. https://www.goodtherapy.org/for-professionals/marketing/digital-marketing/dos-donts-advertising-therapy-practice
Kottler, J. A., & Balkin, R. S. (2017). Relationships in counseling and the
counselor’s life. American Counseling Association.
McMahan, E. H. (2014). Supervision, a nonelusive component of deliberate
practice toward expertise. American Psychologist, 69, 712-713. 10.1037/
a0037832
Martin, L., Shepard, B., & Lehr, R. (Eds.). (2015). Canadian counselling
and psychotherapy experience: Ethics-based issues and cases. Canadian
Counselling and Psychotherapy Association.
Morris, E. R., Lindley, L., & Galupo, M. P. (2020). “Better issues to focus
on”: Transgender microaggressions as ethical violations in therapy.
Counseling Psychologist, 48(6), 883-915.
Neimeyer, G. J., & Taylor, J. M. (2019). Advancing the assessment of professional learning, self-care, and competence. Professional Psychology: Research and Practice, 50(2), 95–105. https://doi.org/10.1037/
pro0000225
O’Connor, M. F., (2008). Intervening with an impaired colleague. APA.
https://www.apaservices.org/practice/ce/self-care/intervening
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Pinner, D. H., & Kivlighan, D. M. III. (2018). The ethical implications and
utility of routine outcome monitoring in determining boundaries of
competence in practice. Professional Psychology: Research and Practice, 49(4), 247–254. https://doi.org/10.1037/pro0000203
Rowen, J., Giedgowd, G., & Baran, D. (2022). Effective and accessible telephone-based psychotherapy and supervision. Journal of Psychotherapy
Integration, 32(1), 3–18. https://doi.org/10.1037/int0000257
Smith, R. D., Holmberg, J., & Cornish, J. E. (2019). Psychotherapy in the
#MeToo era: Ethical issues. Psychotherapy, 56(4), 483.
Smout, M. (2020, October). Can supervision improve therapist competence?
https://www.drmatthewsmout.com/blog/2020/10/30/can-supervision-improve-therapist-competence
Steele, W. (2020). Reducing compassion fatigue, secondary traumatic stress,
and burnout. Routledge.
Trevino, A. Y., Tao, K. W., & Van Epps, J. J. (2021). Windows of cultural
opportunity: A thematic analysis of how cultural conversations occur
in psychotherapy. Psychotherapy.
Young, M. E. (2021). Learning the art of helping: Building blocks and techniques (7th ed). Pearson.
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The specific responsibilities of counsellors/therapists
vary across time and multiple geographic, environmental,
social, cultural, economic, and political contexts. Despite the
variety of situations in which counsellors/therapists may find
themselves, their responsibility for safeguarding the welfare
of clients, maintaining their trust, and protecting their personal data is constant across time and consistent across contexts.
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B1. Primary Responsibility
B2. Confidentiality
B3. Duty to Warn
B4. Client’s Rights and Informed Consent
B5. Children and Persons with Diminished Capacity
B6. Maintenance of Records
B7. Access to Records
B8. Multiple Relationships
B9. Respecting Inclusivity, Diversity, Difference and Intersectionality
B10. Consulting with Other Professionals
B11. Relationship with Former Clients
B12. Sexual Contact
B13. Multiple Clients
B14. Multiple Helpers
B15. Group Counselling/Therapy
B16. Referral
B17. Closure of Counselling/Therapy
B18. Mandated Clients and Systems Approaches
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INTRODUCTION / CONTEXT
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The central focus of Section B of CCPA’s (2020) Code of Ethics is on all
of the factors that come into play when the counsellor works for the client.
It includes:
• the orientation and context that both the client and the counsellor
bring to the work that they do together,
• the responsibility of the counsellor for the psychological safety of
the client,
• the competence of the counsellor in working with the issues presented by the client, and
• the importance and limitations to the confidentiality of all written
and verbal communication involved in their work together.
Your level of understanding regarding the complexities and nuances of
each aspect of this section of the code will play a large part in determining
your ability to engage in best practices in your work with clients, and to
minimize the challenges you encounter in navigating your work with them.
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This is described well in the introduction to Section B of the code
(CCPA, 2020):
The specific responsibilities of counsellors/therapists vary across
time and multiple geographic, environmental, social, cultural,
economic, and political contexts. Despite the variety of situations in which counsellors/therapists may find themselves, their
responsibility for safeguarding the welfare of clients, maintaining their trust, and protecting their personal data is constant
across time and consistent across contexts. (p. 9)
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Best practices for each of the articles will be presented in the next section, followed by the pitfalls and challenges for each in the subsequent section. The articles have been clustered into topical areas that include: Primary Responsibility (B1); Administration and Logistics (B2 – B7); Multiple
Relationships (B8); Respecting Inclusivity, Diversity, Difference, and Intersectionality (B9); Consulting With Other Professionals (B10); Relationships With Former Clients (B11 – B12); Multiple Clients and/or Helpers
(B13 – B15); Referral (B16); Closure of Counselling/Therapy (B17); and
Mandated Clients and Systems Approaches (B18).
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RECOMMENDED PRACTICES
Primary Responsibility
The first article of this section of the code (B1: Primary Responsibility)
illustrates the complexity of what you need to consider in promoting the
welfare of your clients.
Best practice here involves ensuring that the approach to counselling
that you are able to offer will accommodate the range of needs that clients
may bring. These are often determined by a number of personal and contextual variables that may not be readily apparent to you.
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Administration and Logistics
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The next articles of the code, B2 – B7, focus on administrative and logistical considerations that the counsellor/therapist needs to take into account
when working with a client.
Articles B2 and B3 focus on the confidential nature of all verbal and
written material and specify limits to that confidentiality. Best practice involves making informed and justified decisions regarding when confidentiality needs to be maintained, and when it needs to be broken. As noted
in the CCPA Standards of Practice (2021), “Confidentiality belongs to the
client, not the counsellor” (p. 15).
Articles B4 (Informed Consent) and B5 (Children and Persons with Diminished Capacity) both highlight the ethical considerations in securing
truly informed consent (Blease et al, 2020). Respecting every client’s right
to provide informed consent (B4) also presents another set of complex requirements. Often, the discussion regarding informed consent occurs in
initial sessions, along with providing information about limits to confidentiality. However, Article B4 makes it clear that gaining informed consent is
an ongoing process across sessions, and includes informing clients about
the nature of counselling/therapy offered, along with information about potential risks and benefits, and inviting the client to collaborate in decisions
regarding the goals for, and the interventions involved in, the counselling/
therapy offered. The aim is to try to ensure that the client is making an informed decision in working with you. (See also CCPA Standards of Practice
Section K: Obtaining Ongoing Informed Consent, 2021, p. 101). It is also
important for the client to know that they have a right to a second opinion
or not to engage in a specific aspect of the service being offered, along with
the consequences of that decision.
Informed consent becomes more complex when your client is a minor
or a person of diminished capacity (B5). In those cases, consent can be provided by a parent or guardian, and assent by the client, corresponding to the
ability of the client to provide it. As noted in the code: “These dual processes
of obtaining parental/guardian informed consent and client assent apply to
assessment, counselling/therapy, research participation, and other professional activities” (CCPA, 2020, p. 10). As with all other clients there is the
same requirement, to continue to check that consent/assent is provided as
counselling/psychotherapy proceeds. In addition, when working with children it is essential to be informed by the CCPA (2021) Standards of Practice
section on Children and Confidentiality (p. 16), in determining the child’s
right to confidentiality and a parent’s right to know.
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Articles B6 and B7 highlight ethical responsibilities related to maintaining and providing access to clients’ records. In terms of maintaining your
records, it is key that records have enough detail so the nature and progress
of the service offered can be understood, and that they are in accordance
with relevant legal, regulatory, and employer requirements. Article B6 also
stresses the need to keep and dispose of files according to all confidentiality
requirements in the CCPA Code of Ethics.
Article B7 points to the care that needs to be taken in providing access
to client records. Counsellors/ psychotherapists need to have a transparent
and accessible process for clients to see their records and, with the client’s
permission, for others to see their records. The exception is when there is a
legal requirement to release client records. The processes that counsellors/
psychotherapists create should conform to the privacy/freedom of information laws that exist in the province/territory in which they work. For
this article of the code, it is important that you receive legal advice about
the records access processes you are developing or have in place. (See also
CCPA, 2021; Standards of Practice Section L: Guidelines for Dealing with
Subpoenas and Court Orders).
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Article B8 points to the perils of dual relationships that may affect your
judgement in a way that could cause harm to the client. The challenge here is
to be able to distinguish between dual or multiple relationships that may be
benign and those that represent conflicts of interest (Brownlee et al., 2019).
In either case, it is necessary to consider how those involved may view the
situation as well as considering the potential views of those not involved. As
noted in the code: “Multiple relationships are avoided unless justified by the
nature of the activity, limited by time and context, and entered into with the
informed consent of the parties involved after assessment of the rationale,
risks, benefits, and alternative options” (CCPA, 2020, p. 10).
Respecting Inclusivity, Diversity, Difference and
Intersectionality
In the recent past, a lot of emphasis was on developing specific competencies in working with underserved minority groups. A challenge with
the competence approach is that it may assume that there is homogeneity
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within and across groups of people in their life experiences and in their
responses to those experiences (Beagan, 2018). In the current and emerging
context, it is critical to develop a broader understanding of a range of people
whose life experience and values are different from yours, especially those
who may have experienced marginalization and/or discrimination. With
this perspective in mind, your focus is on approaching clients with a sense
of cultural humility. This leads to an openness to learning from their perspectives, the ability to focus on issues as they have experienced them, and
collaborating with them to deepen your and their understanding of these
issues and ways to move forward (Mosher et al., 2017). As noted in the Code
of Ethics (CCPA, 2020), that frame of reference allows you to “seek awareness and understanding of client identities, identification, and historical and
current contexts,” (p. 11) which facilitates your ability to remain empathic,
and not fall into sympathy on one hand, or judgement on the other. In either
of those situations, your ability to help the client identify their strengths can
be compromised, and your judgement about any advocacy activities that
may be needed to support the client may be impaired.
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Consulting with Other Professionals
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The focus of Article B10 is on consulting with other professionals, including other counsellors/therapists, when you believe that you need support and another perspective on your work with a client. This can occur
for a number of reasons including when client sessions seem to be stalled
despite your best efforts, when client issues have shifted to the point that
you wonder if you are moving out of your areas of competence, or when
the client’s issues begin to trigger an area of hurt or a blind spot for you. In
any situation where you may be starting to question your competence with
a client, it may be time to consult with another professional, with the client
not identified, unless you have the client’s explicit permission to share identifying information.
Relationships with Former Clients
Articles B11 and B12 consider relationships with former clients, with
B11 focussing on any in-person or electronic relationships and B12 specifically on sexual contact. In both cases, the code makes clear that: “Counsellors/therapists remain accountable for any relationships established with
former clients” (CCPA, 2020, p. 11). Regarding non-sexual relationships
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with former clients the code directs you to be “thoughtful and thorough”
(p. 11) and to seek supervision or consultation before entering into such
relationships. Regarding B12, the code is clear that counsellors/therapists
“avoid any type of sexual contact with clients and they do not counsel persons with whom they have or have had a sexual or intimate relationship”
(p. 11). The code indicates that this prohibition is for 3 years, unless the
client is of diminished capacity or is subject to being sexually exploited. In
those cases, the prohibition is indefinite. The code is also clear that you
need to seek documented consultation to obtain objective verification that
the former client is able to “freely enter a relationship or have sexual contact
without impediment” (p. 11). It is also assumed that the consultant has no
conflict of interest with you or the client that would impair their objectivity.
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Articles B13-15 focus on the complexity of situations where there are
multiple clients or multiple counsellors/therapists. Article B13 discusses issues where you are seeing two or more clients who have relationships with
one another (e.g., partners, parents and children). In these cases you need
to be transparent with each of your clients about the other relationship(s),
clarifying what information will be shared across clients, and under what
circumstances. This will help clients make a more informed choice about
entering into a counselling relationship with you. The main challenge for
you will be seeing each client as an individual and not having information
from one client influence your perception of the other one(s).
Article B14 presents the issues and challenges associated with having
more than one counsellor/psychotherapist working with an individual client. In this situation, as pointed out in the code, it will be important to have
a discussion with the client about the benefits and drawbacks of entering
into a counselling relationship with you or continuing to work with you.
With the client’s permission, talking with the other counsellor/psychotherapist involved may assist in making that decision.
Article B15 presents issues that arise with multiple clients in group
counselling/psychotherapy. Here it is fundamental that clients be screened
prior to entering the group to help ensure that the needs of the client correspond with the goals of the group, and that the client does not have other issues that would make participating in a group setting too challenging.
Clients also need to be informed about the activities in the group and the
level of self-disclosure that could be involved. It is also paramount that you
explain to the client that norms of confidentiality, safety, and respect will be
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established at the beginning of the group, and that members and the leader
will be expected to speak and behave accordingly.
Referral
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Article B16 is focused on situations where you need to consider whether
you are able to be of assistance to a client. This can arise when you are considering beginning to work with a client or, as counselling /psychotherapy
proceeds and you do not seem to be able to work effectively with them. As
the code indicates, you have a number of alternatives to consider in obtaining support, including co-counselling, consultation, or supervision. If none
of these seem, or prove to be, effective you can opt to refer the client to a
professional you believe may be able to better serve their needs.
Closure of Counselling / Therapy
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Article B17 centres on your responsibilities when your work with a client is ending. This typically occurs when the goals of the counselling/therapy have been met and you and the client have agreed that it is a good time
to stop. It can also occur, as noted in B16, when the client is not benefiting
from the counselling/psychotherapy, when they are no longer able to pay,
when the maximum allowed number of sessions in your setting has been
reached, or when the client or their situation presents a threat to you (Erickson Cornish et al., 2019). In any of these cases, it is important to engage
in the termination process with clarity and compassion.
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Mandated Clients and Systems Approaches
The issues involved in Article B18 are concerned with mandated clients
for whom it may be necessary to share session notes or impart information
regarding client progress to the system that mandated the client. Here it is
crucial that the client be fully informed of that likely occurrence, particularly if they don’t attend sessions, meaningfully engage in them, or do not
make expected progress.
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PITFALLS / CHALLENGES
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This is a complex and foundational section of the Code and many of
the pitfalls and challenges are unique to each section. Therefore, as in the
previous Recommended Practices section, each article will be addressed
separately.
As highlighted in Article B1 regarding Primary Responsibility, the extent to which you can bring a sense of cultural humility and openness to
difference in working with your clients will likely largely determine how
successful you are in addressing the other articles of this section of the code.
Articles B2 (Confidentiality) and B3 (Duty to Warn) present a number of
challenges. When you believe there is a need to break confidentiality, you
can feel particularly vulnerable and may need to consider several questions:
Did I clearly inform the client of the limits of confidentiality and do I have
any evidence that the client understood what actions I would need to take?
Have I used clear and defensible criteria in concluding that there is a clear
and imminent danger to the client or others?
Articles B4 and B5, related to informed consent, can present a number
of potential challenges and questions. Did I assume that I had a blanket
client/guardian consent for all services following a conversation in an early
session? Did I clearly explain the connection between client goals and the
techniques that I have employed; that is, was I up to date with the client/
guardian in terms of their consent? How did I constructively address a client’s reluctance to engage with some of the services that I suggested? If I
administered any tests, did I make the client/guardian aware of the purpose
and use of the results – within, and potentially outside, their counselling/
therapy sessions? In situations where a guardian is giving consent, issues can
be even more complex. For example, when working with a young person,
who then is considered a mature minor, the process of moving the youth
from providing assent to giving his or her own consent will need to be negotiated. Regarding mature minors, the CCPA (2021) Standards of Practice
indicates that “there is a sufficient body of common law in Canada which is
fairly clear in stating that regardless of age, a minor is capable of consenting
or refusing consent to medical treatment if he or she is able to appreciate the
nature and purpose of the treatment and the consequences of giving or refusing consent” (p. 21). Similarly, with an adult who has been incapacitated,
as they are recovering, there will need to be a formal process for allowing
them to provide their own consent.
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Other challenges and potential pitfalls relate to Articles B6 and B7, that
provide ethical considerations related to maintaining client records and
providing access to them when necessary. Regarding your client notes (B6),
one question to ask yourself is, if I state an inference about the client in my
notes, have I provided evidence prior to stating the inference to make it
credible to a third party, including if I was called to defend it in court? For
B7, regarding access to notes, an important question to consider is whether
you have obtained legal advice about the client records access processes you
are developing or have in place. Issues of importance here include appropriately redacting files before releasing them, ensuring that they are sent
securely, and storing all files in a secure environment. When your records
are requested for legal proceedings, please refer to CCPA (2021) Standards
of Practice Section L: Guidelines for Dealing with Subpoenas and Court
Orders (p. 103).
In smaller communities/rural areas, or in situations where there are
small groups that are connected in multiple ways, such as in the LGBTQIA2+
community, ethnic groups, or other minority or marginalized groups, as
highlighted in Article B8, dual or multiple relationships may be difficult or
impossible to avoid. As noted in the code, when entering into these relationships, boundaries and time limits need to be set, and there needs to be
regular check-ins with everyone involved. Even with these safeguards, it is
necessary to ask yourself if the client feels free to state their concerns, given
the perceived power differential between the two of you.
The focus of Article B9 is on diversity, equity, inclusion, and intersectionality. Questions that are helpful to ask here are: How much can I identify
with the situations of oppression that clients may bring to me? How can I
recognize times when I am in danger of projecting my own life experience
on to them? How susceptible am I to going into rescue mode on the one
hand, or judgement mode on the other, especially if the values expressed
are very different from mine? In any of these challenging situations, how do
I know when I am off track and need to consult for assistance, or refer the
client to someone else?
Of course, Consulting with Other Professionals (B10) can be challenging as well. It is possible that when you identify the need to consult you
will feel embarrassed or somehow lesser, rather than seeing it as learning
opportunity or as a way to expand your band of competence. The major
danger here is to give in to the feelings of fear and continue to stagnate or to
move out of your area of competence without knowing it, and potentially do
harm. In this situation, it is essential to seek consultation to help you avoid
the pitfalls associated with your biases and blind spots. Questions to ask
here are: When I am feeling less than competent with a client, what are the
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signs that I notice? Am I open to seeing consultation as a way to increase my
range of competence – from a position of strength, knowing there is always
more to learn?
Articles B11 and B12 offer ethical considerations about entering into
relationships with previous clients, whether personal or professional (other
than counselling).
Questions to ask yourself here include: What are my motivations for
entering a more personal, business, or community-related relationship with
a former client, such as joining a choir or band that a former client is in or
playing on the same sports-team or volunteering on a committee together? What are the benefits and pitfalls for both you and the client? Since
you were the other person’s professional helper, can it be a relationship of
equals? The questions are similar for intimate or sexual relationships, but
the level of vulnerability for both you and your former client is much higher.
As highlighted in Article B13, it can be particularly challenging to work
individually with clients who have a relationship with each other (e.g., partners, parent-child, co-workers, employee and supervisor). A main question
to ask yourself here is how you can keep the information from one client
from influencing your perceptions of the other client – that is, how you
restrain yourself from taking sides. Do you have a way to be aware of doing
that and, if so, what do you do to mitigate the risk of it happening, or the
damage to one or more clients that can result?
Article B14 addresses ethical considerations when clients are working
with more than one counsellor/therapist at the same time. There are potential challenges with this, so valuable questions to ask here include: If the
relationship with me pre-dated the one initiated with the other counsellor/
therapist, what led to contact with the other professional? The same question is relevant if you are the second professional contacted. Another question can be: Are the issues that I am discussing with the client quite different
from those that are being considered with the other professional? In addition, what if any ongoing communication should be arranged with the other
counsellor/psychotherapist to better serve the needs of the client? Pitfalls to
avoid here are the potential for working at cross-purposes or with incompatible approaches, where work with one of the counsellors might contradict
work with the other.
There can be many challenges and complexities in working with
groups, as outlined in Article B15. Important questions here include: Have
I planned the group activities in such a way as to maintain a balance between (a) safety in protecting members and (b) challenge in terms of having
them entertain new perspectives, as the group begins and trust in the leader
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and other group members evolves and grows? In the initial session, have I
helped the group to develop norms for their interactions that allow them to
feel safe and accepted enough to be contributing group members? If a group
member violates a group norm, do I have ways to effectively address the resulting challenges for the other members related to a feeling and experience
of safety or a sense of inclusion ?
A fundamental challenge related to Article B16 (Referral) may be to not
blame yourself or the client, but to use it as an opportunity for reflection on
the possible learning opportunities it may present in considering what made
it so difficult to help the client progress - was it something about you, the
client, or the context for one or both of you? In addition, were you able to
discuss it with the client so they felt supported acting on the referral?
Except in situations where the goals of counselling/psychotherapy have
been reached, the challenges involved in ending therapy (B17) often involve
weighing your needs with those of the client, and in looking for referral
sources that are accessible to them. In making a referral it is not sufficient
to pull a name out of a counsellor directory or to provide a list of resources.
Rather, it would be better for the counsellor/therapist to be able to provide
some information about the referral, including areas of expertise, length of
waitlist, approaches to counselling/therapy, and location (including whether or not e-counselling is available).
The challenge related to Article B18 (Mandated Clients and Systems
Approaches) is for you to understand that you have two clients – the person
referred and the system referring them. You also need to be aware of the limits of freedom your client has in their decision to be your client, or to what
they disclose. It is also important to expect that the situation may influence
the level of trust you are able to develop with your client, and the effectiveness of the work you can do with them.
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CASE EXPLORATION
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Case 5.1
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Sam is a counsellor who has been in private practice
for 1 year. Sam has facilitated support groups for years—
always for free and in service of her community. Recently,
Sam noticed that many of her clients were feeling increasingly isolated, so she decided to start a free support group
facilitated via Zoom. She invited a combination of her close
friends and clients, as she knew that all of these individuals had been seeking connection and community. Sam’s
friends became friends with her clients, and towards the
end of the 8-week group, Sam created a WhatsApp group
with all members (with their consent) so that they could
stay connected.
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A Grade 4 foster boy tells his foster mother that his
principal at his new school touched him in his privates
while the class was watching a movie together. The mother
called the school counsellor and they together approached
the principal. The principal reassured the mother saying
that the boy was troubled. When the counsellor spoke with
the principal after the mother left the meeting, concerned
that she must report the incident to child protection, the
principal insisted that he was to be notified of everything
that happens in the school and must approve any persons
coming into the school.
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A counsellor is working with a 17-year-old teen who
identifies with the LGBTQIA2+ community. The parents of
the teen are strict Christian and the teen does not feel accepted by their family or their community; however, they
continue to live at home. The teen is suicidal and safety
planning must be done. The teen is begging the counsellor
to not involve their parents – as this would worsen the situation that is the main issue for the teen.
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Case 5.4
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The courts ordered a specific parenting course for the
parents of an 18-month-old child who was removed from
the parents for emergency life-saving surgery. The parents
are members of a religious sect that does not believe in
blood transfusions. The mother is a practicing doctor and
the father a well-educated professional. The parents are
currently suing almost everyone involved - the social workers (front line and supervisor), the lawyer who represents
Child Protection, other counsellors who have worked with
these parents, as well as a psychologist who consulted on
the case). Despite the many difficulties in the case, the goal
is to return the child to the parents’ care. The courts would
like some assurance that these parents will cooperate with
the providers of the parenting course.
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A private practice counsellor is approached by a
mother distressed that her child has been abused by her
husband. The mother and father are in the early throes of
separation. The mother brings her child, age 7, to the therapist for consult. The counsellor is empathetic to the intense
situation and agrees to see the child because the mother is
in distress. According to the mother, there is a police investigation in process. The mother has stopped access to the
father because of her concerns.
After seeing the child for a few sessions, the therapist
receives a notice from the father advising her that he has
the right to be consulted about the care provided to his
child.
The therapist does not respond because she has a
signed consent to see the child by the mother, and since
there is no separation paperwork believes that it is within
her right and best practice to continue to see the child.
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DISCUSSION QUESTIONS
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1. This section of the code is comprehensive in indicating what is required
in providing a safe and confidential service to clients. In considering the
range of contextual and counselling process questions, which ones are
the most challenging for you and which ones seem to be automatic? In
reflecting on that question, what personal and professional perspectives
and issues arise for you?
2. Do you encounter any challenges in making decisions about when you
need to decide on whether a young client can be considered to be a mature minor? What do you do in those situations?
3. How do you reconcile the need to feel like a competent professional
with the feelings of vulnerability you may experience by being culturally
humble with a client whose life experience is very different from yours?
4. When you realize that you are in a dual relationship with a client or
former client, what steps do you take to decide whether to continue
contact with them?
5. When working with a mandated client, how do you balance your obligations as counsellor to your client with the obligations for reporting to
the agency that referred the client to you?
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REFERENCES
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Beagan, B. L. (2018). A critique of cultural competence: Assumptions, limitations, and alternatives. In C. Frisby & W. O’Donohue, W. (Eds.),
Cultural Competence in Applied Psychology. Springer. https://doi.
org/10.1007/978-3-319-78997-2_6
Blease, C. R., Walker, J., Torous, J., & O’Neill, S. (2020). Sharing clinical notes
in psychotherapy: a new tool to strengthen patient autonomy. Frontiers
in Psychiatry, 11, 1095. https://doi.org/10.3389/fpsyt.2020.527872
Brownlee, K., LeBlanc, H., Halverson, G., Piché, T., & Brazeau,
J. (2019). Exploring self-reflection in dual relationship decision-making. Journal of Social Work, 19(5), 629-641. https://doi.
org/10.1177/1468017318766423
Canadian Counselling and Psychotherapy Association. (2020). Code of
ethics.https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Erickson Cornish, J. A., Smith, R. D., Holmberg, J. R., Dunn, T. M., & Siderius, L. L. (2019). Psychotherapists in danger: The ethics of responding
to client threats, stalking, and harassment. Psychotherapy, 56(4), 441.
https://doi.org/10.1037/pst0000248
Mosher, D. K., Hook, J. N., Captari, L. E., Davis, D. E., DeBlaere, C., &
Owen, J. (2017). Cultural humility: A therapeutic framework for engaging diverse clients. Practice Innovations, 2(4), 221–233. https://doi.
org/10.1037/pri0000055
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Assessment and evaluation are foundational components of counselling/therapy.
These may be undertaken formally and informally, and
in structured and unstructured formats. Ethically congruent
assessment and evaluation require counsellors/therapists
to be particularly attentive to informed consent processes, confidentiality and third-party sharing of information,
boundaries of competence, and diversityǂ. When employing
standardized measures in formal assessment and evaluation,
counsellors/therapists must ensure that they are adequately
trained to select and administer appropriate measures, to interpret and report on the results, and to seek consultation or
supervision when unsure.
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C1. General Orientation
C2. Informed Consent for Assessment and Evaluation
C3. Assessment and Evaluation Competence
C4. Administrative Conditions and Procedures
C5. Technology in Assessment and Evaluation
C6. Appropriateness of Assessment and Evaluation
C7. Reporting Assessment and Evaluation Results to Clients
C8. Reporting Assessment and Evaluation Results to Third
Parties
C9. Integrity of Instruments and Procedures
C10. Sensitivity to Diversity when Assessing and Evaluating
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INTRODUCTION / CONTEXT
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In Covey’s (2020) famous habits for highly effective people, “begin with
the end in mind” is almost top of the list. Within counselling/therapy, this
is particularly important when it comes to integrating assessment tools and
approaches into your practice. There are hundreds, perhaps thousands, of
formal and informal counselling-related assessment tools to choose from –
in some cases, freely available online; in other cases, available for a fee to the
general public; and, for specialized tools, restricted for purchase by only test
users with specific qualifications.
Foundational to the ethical use of assessment tools and processes in
counselling/therapy is adequate training (CCPA, 2020; 2021; C1). Although basic psychometric assessment training is provided in most graduate programs in counselling/therapy, it may be necessary for counsellors/
therapists to access specific training and/or supervision when adding new
tests to their toolkits. Many test publishers use a standard coding system,
where “A-Level” assessment tools are available for purchase without specialized training, “B-Level” tools require graduate-level training in tests and
measurements, and “C-Level” tools generally require advanced training and
supervision, typically at a doctoral level (CLSR, n.d.; MHS, n.d.; PAR, n.d.;
Pearson, n.d.; Psychometrics, n.d.; Sigma Assessment Systems, n.d.). Most
counsellors who have graduated with a Masters degree in counselling psychology or a closely related area have access to B-Level assessment tools.
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However, access (or qualifications to purchase) a tool, does not necessarily equate to competency in using it. Another important component of
assessment competency is knowledge and experience in the area being assessed. Within Canada, for example, “diagnosis” is typically a reserved act
for psychologists. Counsellors/therapists don’t diagnose but may screen for
specific concerns (e.g., depression, anxiety, stress, substance use, eating disorders; Hays, 2017).
Depending on work settings, counsellors/therapists may use assessment tools to gather information at intake, to screen for mental health concerns (and to measure changes after interventions), to support career decision-making, to identify coping resources for managing stress, to screen
for learning differences, to identify personal styles, to assess interpersonal
relationships, and/or to assess levels of emotional intelligence, among many
other possibilities (Hays, 2017). Often, such assessment tools are used to
facilitate self-understanding (e.g., clients respond to the questionnaire and
the results support a deeper understanding of their strengths, weaknesses,
and personal preferences). However, in some cases, a more objective assessment is required. For example, a counsellor might be asked to contribute to a comprehensive assessment of a child’s functioning at home and in
school; such assessments are typically completed by psychologists and may
result in diagnosis of specific learning disabilities. However, counsellors
might use similar tools to help families learn how to better support a child
with learning differences or behavioural concerns – beyond asking the individual being assessed for input, such comprehensive assessment processes
may request input from teachers, parents, and others with whom the child
interacts. Within workplace settings, counsellors/therapists may be hired
to facilitate teambuilding workshops or to consult with a human resource
professional or supervisor/manager about how to work effectively with a
specific individual. In such cases, formal assessment tools can offer a shared
language to discuss individual differences that may contribute to tension or
conflict on the job, resulting in clearer communication about what conditions each party may require to work at their best.
Sometimes assessment tools and processes are used for more than gathering information to support decision-making; there may be criteria set for
entry into a specific opportunity or role as is the case with assessments that
inform university admissions or hiring decisions. Counsellors may also be
asked to conduct or contribute to capacity assessments (e.g., Does a 14-yearold child have the capacity to consent to counselling without parental consent, as a “mature minor”? Does a parent have the capacity to provide a
safe home and supervision for a child?). Given the many potential applications of assessment and evaluation, it is important to consider the risks and
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benefits of using formal or informal assessment tools or processes. This is
where Covey’s (2020) “Begin with the end in mind” habit is especially relevant. How will the results of the assessment process be used? What potential
harm could come to the client based on the assessment results? Does the
potential for a positive outcome outweigh the risk of a negative outcome?
Another important type of assessment that counsellors/therapists often
conduct, at times quite informally, is suicide risk assessment. This, however,
is not without controversy. Fowler (2012) emphasized the importance of
suicide risk assessments within the safety of a strong therapeutic alliance,
rather than administering an assessment on, or to, the client, it’s important
to collaborate with the client to assess risk. Smith (2022) also discussed how
the client’s autonomy may be breached unintentionally (i.e., if a client is
unaware of being screened for suicide risk, how can informed consent be
given?) Although training in suicide risk assessment is beyond the scope
of this chapter, which is focused on ethical considerations to do with assessment and evaluation, such assessment is an important competency for
counsellors/therapists to develop.
Finally, counsellors may use assessment tools to evaluate their own progress with clients. This process falls under the umbrella of “routine outcome
monitoring” (ROM) and there are many different tools available to support
this (Muir et al., 2019). As with all aspects of assessment and evaluation in
counselling, there are pros and cons to consider. Muir et al. (2019) reported that ROM outperformed clinical judgement in determining whether or
not clients are on track for success in achieving their counselling goals and
ROM-based feedback also resulted in improved client outcomes and helped
clinicians to better understand, and also to expand, their band of professional competence. However, it can be difficult to encourage clinicians to
embed ROM into their practice; as a result, it may be used inconsistently
or, in some cases, not at all, despite an agency investing in a robust ROM
system.
Although assessment and evaluation are ongoing processes throughout
counselling, the following sections on Recommended Practices and Pitfalls/
Challenges will address considerations within three stages: before the assessment or evaluation begins, during the assessment or evaluation process, and
after the assessment or evaluation has been completed.
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RECOMMENDED PRACTICES
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At all stages of the assessment process, the foundational principles of
beneficence, fidelity, nonmaleficence, autonomy, justice, and social interest
(CCPA, 2020, p. 2) remain relevant. It is your role, as the counsellor, to ensure that the assessment/evaluation tools and processes maximize benefit to
your clients while minimizing the risk of harm (C1). As with every aspect
of counselling, securing informed consent is an ongoing process (C2) – it’s
never “one and done.” Specific considerations relevant to informed consent
will be addressed within the sections below, along with considerations related to competence (C3), administrative conditions and procedures (C4),
technology (C5), appropriateness (C6), reporting (C7, C8), maintaining the
integrity of instruments and procedures (C9), and sensitivity to diversity
(C10).
Before Assessment / Evaluation
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As previously mentioned, assessment and evaluation are ongoing processes throughout counselling/therapy. They begin on first contact with
a client and they end with reflection on the counselling/therapy process
after the counselling relationship concludes. In this chapter, however, our
focus will primarily be on more structured or intentional assessment within
counselling/therapy, regardless of whether the tools or approaches used are
formal or informal.
A starting place is to know the limits of your own competency (C1).
Based on your training, experience, and access to training or supervision,
there will be some types of assessments that you can confidently offer your
clients, as appropriate, and others that you may deem helpful but would
need to refer out for, or to seek supervision or additional training before
proceeding (C3).
For assessment tools and processes that you are competent to use, the
next step is to choose wisely from amongst the many available options, including the choice of not to assess (C6). Carefully evaluate the pros and
cons of assessment, what tools or approaches you have access to, costs of
each (and the potential return on investment), and the implications of any
required third-party reporting (C6, C8). If assessment results are to be released to a third party, this must be discussed with the client and informed
consent secured before the assessment process began. Sometimes assessments are requested (and paid for) by a third party, resulting in a potential
multiple client situation (B13).
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It’s also important to consider any unique characteristics of the client
that may impact the assessment process or results (C10); such considerations may include the client’s age, level of education, cultural background,
ethnicity, literacy, technical competency, and familiarity with the language
in which the assessment is written or conducted. Counsellors/therapists are
called to be sensitive to cultural differences and other aspects of diversity
when selecting assessment tools and processes (C10); however, the good
news is that recent research has found that most standardized achievement
and aptitude tests are not culturally biased (Reynolds et al., 2021). Not all
assessment and evaluation tools have been standardized, however, so it’s
essential that you carefully evaluate the appropriateness of any tool you are
considering for the specific client/groups you will be assessing – for example, tools that are developed for youth may be inappropriate for older adults
(and vice versa) and tools designed for use with Indigenous populations in
remote rural communities may be inappropriate for immigrants who are
newcomers to Canada in a large urban community (C10).
After careful consideration of assessment pros and cons, it will be important to discuss options with your client (including information about
costs, time commitments, value added by testing, and how information will
be scored or transmitted electronically) and secure their informed consent
(C2, C5). Including information from multiple sources, rather than relying
on a single assessment tool, will provide a more holistic picture of your client (C6).
Should you choose to move forward with formal assessments, it will
then be important to consider where and how to proceed (C4, C5). Depending on your purpose for assessment, your client’s capacity to work independently, and the complexity of the assessments being administered, it
may be possible to simply send your client some online codes and instructions to proceed on their own after discussing the assessments with you
and giving their informed consent; this may be appropriate, for example,
for some self-assessment tools designed to support deeper self-awareness
or career decision-making. However, other assessment tools (e.g., aptitude
or achievement tests) require a standardized administration under supervision. If the client can’t be onsite with you, you may need to arrange supervision (sometimes called “proctoring”) in a remote location. In some
cases, videoconferencing may also be an option for test administration in
remote locations, with the test-taker either completing an online assessment
or a paper-based format which has been sent securely in advance. Such arrangements can’t be arranged on the spur of the moment, so thinking ahead
about your assessment process is very important.
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“Practice makes perfect” is a useful adage when adding assessments to
your counselling/therapy toolkits. It can be very helpful to complete a newto-you assessment tool yourself before administering it to a client; this can
help you to anticipate where clients may have problems with instructions,
language level, or format.
Reading manuals and technical guides is also important before you begin assessments with published tools, as is checking your supplies for all the
necessary materials (e.g., test booklets, response forms, test kits, pencils,
Internet access, software loaded on a computer or tablet). Of course, this
may also require you to order assessment materials and wait for delivery, so
planning ahead for adding assessments to your toolkit, as well as for administering any that you typically have on hand, is essential!
Manuals and technical guides, as well as published peer-reviewed articles, can provide important information about the psychometric qualities of
the assessment tools you are considering (C9). Is the tool valid for your purpose (i.e., does it measure what it intended to measure)? Is it reliable (i.e.,
does it produce consistent results – across time or contexts as applicable)?
Was the client you are assessing represented in the norm group when the
assessment tool was standardized? Do you have access to the most recent
revisions of the assessment tool?
For standardized assessment tools, it is important to securely store the
testing materials, restricting access only to qualified users (C9). As you can
imagine, an aptitude or achievement test would soon be useless if the public
had access to the specific questions and could study for them as that wasn’t
an intended approach in the standardization process and would make results invalid when compared to test-takers who did not have the ability to
study in a similar way.
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During Assessment / Evaluation
As you can see from the lengthy previous section, the process of assessment is much like an iceberg; there is a lot to consider below the surface
(i.e., before the actual assessment begins). However, there are also many
considerations during the assessment process for ensuring an ethical administration of assessment tools. Assessment within counselling, like any
other aspect of counselling, still requires an effective therapeutic alliance,
keeping the client’s wellbeing as the priority (B1, C1). Reaffirming informed
consent (C2) as the assessment process begins is also important; it is not
unusual for clients to have questions come up at the last minute or to be
confused about why the assessment is being conducted and how the results
will be used.
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Although you may have carefully planned ahead for an appropriate
space in which to conduct the assessments (C4), unexpected changes may
be required at the last minute. In the real world of assessment, I have had
clients:
• realize they were allergic to the building
» we moved outdoors to the parking lot to conduct the assessments
• unable to sit at a table
» we moved into an office that had a filing cabinet at the right
height for the client to write on
• reveal an inability to read
» we had an assistant read the questions for self-assessment tools
and write the responses or type them on a computer
• walk into a room where a group was completing assessments, only
to find an ex-spouse’s new partner sitting at the table
» we arranged a private office, and allowed extra time for the
trauma reaction to subside
• struggling with test anxiety
» we took extra time to discuss the purpose and use of assessment
and began with less “test-like” tools, such as card sorts
• acknowledge after completing a standardized aptitude assessment
that they didn’t recognize the mathematical symbol indicating “divided by” as it was different in Europe than in North America
» we took that into consideration in interpreting the assessment
results on scales impacted by that difference.
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Aside from last minute client considerations, I have also had what
should have been a very quiet space without distractions become the exact
opposite – with a jackhammer starting up right outside the ground-floor
window! All these examples serve to illustrate that, no matter how prepared
you may be, you will also require flexibility and professional discernment
in what types of accommodations may be needed and ethically appropriate.
In the cases of self-assessment tools, there is typically more room to adjust
than with standardized assessment tools. With the latter, it may be necessary to reschedule the assessment, using a different “form” of the tool (many
standardized assessment tools come with a Form A and a Form B that can
facilitate a fresh start if needed).
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When administering a “new-to-you” assessment tool, especially under
standardized conditions, it may be helpful to have onsite supervision (C4);
in some clinics, this can be arranged unobtrusively by having the supervisor
watch the assessment administration via a camera in the room (of course,
with the client’s informed consent). In other cases, co-administration (with
the supervisor or a colleague) might be an option, with two of you in the
room to ensure that the process goes smoothly.
In situations where supervising the client is necessary (i.e., you need to
know that the person being assessed or evaluated is the person you intended
to assess/evaluate and not a stand-in), if you are unable to be in the same
room together, it may be necessary to arrange for the client to complete the
assessment, under supervision, in a remote location (C4, C9). As discussed
in the “Before Assessment” section, arrangements will need to be made in
advance. Sometimes this can be done through a local college, library, school,
or civic centre. The “proctor” will provide a quiet space without distractions,
ensure that the individual has access to all of the required materials (and no
access to unauthorized materials, include the Internet on the client’s phone
or computer), and check the client’s identification. Assessment materials
will be securely sent to the counsellor for scoring and reporting the results.
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After Assessment / Evaluation
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Although some counsellors administer and debrief one assessment tool
at a time, over several sessions, this can create a primacy effect, perhaps resulting in an unintended bias in the client’s understanding of the results. For
example, in career assessments, if you administer and interpret an interest
inventory first, all of the subsequent results (e.g., measuring values, skills,
personal style, emotional intelligence, occupational stress) will be compared
to the results that were first presented to the client. The client may tend to
either discount results that don’t fit with the first ones or question the credibility of the overall process if the results from various tools seem to contradict each other. It can be helpful, therefore, to administer all the assessment
tools first, then interpret the results holistically, presenting the client with
an integrated summary, followed by the individual assessment scores (C7).
Before reviewing assessment results with a client, revisit the informed
consent process (C2), this time with a focus on how the results might be
used, with whom they will be shared, and limitations to the assessment process and results. It may also be useful at this point to contextualize the process (C7), reminding the client that the assessment results reflect a moment
in time and that there may be value in re-engaging in the assessment process
in the future.
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If assessment results will be shared with a third party, clarify with the
client exactly what may be shared and how (C8). In some cases, a high-level
integrated summary will be sufficient; in other cases, the third party (perhaps who requested and paid for the assessment process) may expect a more
detailed report, including scores, profiles, and/or graphs). It is the counsellor/assessor’s ethical responsibility not to release test materials that are to
be kept secure (e.g., the question booklets) and also to ensure that reports
are written in such a way to be understandable and easily interpreted by the
third party (e.g., a different level of technical language would be appropriate
for a teenaged client, the client’s parents, a teacher, an employer, or a psychologist). Assessment reports should also provide relevant context to aid in
accurate interpretation by readers (C8).
According to the CCPA (2021) Standards of Practice, there are also
times when the most ethical choice will be not to release assessment results
at all. This includes when the results may be harmful to the client (or others), the data may be misused, the client refuses to sign a release form, or the
person intended to receive the report is not qualified to use the results in a
way that will benefit the client (C8).
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PITFALLS / CHALLENGES
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Although many of the pitfalls and challenges with assessment and evaluation have already been mentioned directly or implied, the following sections will highlight a few considerations to help you avoid common problems and navigate the assessment process more smoothly.
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Before Assessment / Evaluation
Although you may have become comfortable with conducting assessments/evaluations, the process may be very new, and quite intimidating, for
your clients. Rushing through informed consent (C2) without an effective
working alliance will not be productive. Based on your previous experience,
you might find it helpful to anticipate questions and potential challenges,
discussing them with your clients.
Another pitfall relates to competence and training (C3). Many counsellors/therapists complete an assessment course as part of their program
but the types of assessment tools that they are introduced to, and have the
opportunity to practice with, can vary greatly. At the end of their program,
they may be qualified to purchase and administer “B-Level” tools but may
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have no training or supervision with hundreds of assessment tools within
that qualification category. Alternatively, either as part of their program or
as ongoing professional development, some counsellors/therapists may be
trained to administer and interpret specific assessment tools in isolation.
However, an element that may have been missed in their training is how to
integrate and interpret assessment results that come from multiple sources.
Seeking supervision and training specifically for that purpose may be helpful.
At some point, you may also be asked to administer and interpret assessment tools with which you are unfamiliar. It is essential to know the boundaries of your competency (C3) and ensure that you are up-to-date with the
latest changes/revisions in tools that are familiar to you (C1). Respecting
copyright is also crucial (C5, C9) – not all office administrative assistants (or
managers/supervisors in some cases) may be aware that published assessment tools are copyrighted and can’t simply be photocopied when supplies
run low!
Also, when an assessment is requested, whether directly by a client or by
a third party, counsellors/therapists need to consider if formal assessments
will add value and whether there might be informal approaches that could
be more efficient, less expensive, or more easily customized (C6). Similarly,
whether working with new (to you) assessment tools or using familiar tools
with a client who may not be represented in the norm group, attention must
be paid to validity, reliability, and cultural appropriateness (C9). It can be
tempting to simply translate an assessment tool to make it accessible for
clients who are more fluent in another language. However, in essence, this
creates a new tool that would need to be evaluated for validity and reliability once again (C3) – one can’t assume that a standardized tool will be the
same after translation or any other adaptation or customization of either the
content or process (C6).
Some assessment and evaluation processes can be quite subtle and informal (e.g., conducting a suicide risk assessment through conversational
questioning; evaluating competency through observation in a natural environment). Consider the ethical implications of proceeding with the assessment and/or evaluation in the absence of truly informed consent (i.e.,
if the client is unaware that assessment or evaluation is underway, what the
risks and benefits of it may be, and how the outcomes may have long term
implications; C2).
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During Assessment / Evaluation
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During the assessment/evaluation process, you may notice your client
struggling – perhaps with the level of language, the amount of reading required, unfamiliar cultural references, or the amount of time the testing is
taking. Consider whether the planned assessment process can be adjusted
to make it more manageable, maximizing the chances of getting meaningful
assessment results. Counsellors/therapists are to “refrain from [testing] . .
. that may reasonably have the potential to produce harmful or invalid results” (CCPA, 2021, p. 38; C4) – examples may include clients with recent
exposure to test items; severe test anxiety; conducting an assessment after
an accident or injury or other stressful events such as a death in the immediate family; or testing someone when it seems likely that the “results will be
used to violate the fundamental rights of the client or others” (CCPA, 2021,
p. 38).
Some clients may be triggered by the notion of being tested or the similarity of aptitude/achievement assessment tools to what they had struggled
with in school (C4, C6). Clients may also find back-to-back assessments
overwhelming – be sure to allow time for breaks and energizing activities
and, where possible, vary the type of assessment to keep your clients interested and engaged.
After Assessment / Evaluation
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Check in with your clients about their assessment experience. Sometimes clients will reveal (after the assessment has been completed) that they
hadn’t slept well the night before, had been ill, or had been distracted by an
upsetting life event. In such cases, interpret the assessment results with caution, mentioning the reason for caution within your report (C7). If results
seem inconsistent or otherwise irregular, consider administering some additional assessment tools for a cross-check and/or omitting the results from
some of the assessments in your final analysis.
It is important to engage clients in interpreting assessment results (C7).
When clients question findings or declare that the results “don’t sound like
me,” take time to probe to fully understand the underlying concerns and to
surface alternate explanations for the results. I once worked with a client
who scored very low on a “methodicalness” scale and was surprised by the
results. The client went on to describe indicators of methodicalness such
as alphabetized tin cans in kitchen cupboards and bookshelves ordered by
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author. At work, a favourite task was labelling items in the supply cupboard
and organizing them by colour and size. Further discussion revealed a prior
diagnosis of obsessive-compulsive disorder (OCD). When we looked back
together at the assessment questions that had produced such puzzling results, we saw items like “I’m not as tidy as I should be” – a question that
someone diagnosed with OCD would respond to in a polar opposite way
than would someone from a non-clinical population (and this assessment
tool had been normed for use with non-clinical clients).
Whether assessment tools are scored by the counsellor/therapist or an
assistant, by hand or electronically, the counsellor/therapist is ultimately responsible for ensuring that the results (and any related profiles or reports)
are accurate and presented with reference to their limitations (C5). Computer-generated assessment reports can seem very personalized and persuasive, often written in compelling language that doesn’t reflect the tentative
way that a counsellor might frame results in terms of their potential measurement errors.
After debriefing assessment results with clients (C7), they may reconsider who they want to share the results with (C8). It may be important to
reiterate the risks and benefits of sharing results and to revisit, once again,
informed consent (C2). In other cases (i.e., where a third party requested
and paid for the assessment process and the client, with informed consent
in place, had agreed to the process and to releasing the results), it may not be
possible to withhold the assessment report. However, as a counsellor/therapist, you can be intentional about what to include in a report, providing
relevant context along with factual results, and omitting unnecessary detail.
Ensure that reports are written in “plain” language, with sufficient explanation to be interpreted accurately by the end user.
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CONCLUSION
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Assessment and evaluation in counselling/therapy is both an art and a
science. It’s essential to have solid foundational training, ongoing access to
relevant supervision, and a commitment to continuing professional development as you add assessment tools to your professional toolkit or as the
tools you’ve become familiar with are revised or critiqued. Ensuring that
your clients fully understand their options regarding assessment, including
the risks, benefits, and added value for each option, is crucial. Especially when using standardized assessment tools, ensure testing conditions are
appropriate and closely follow all required procedures. Present assessment
results tentatively, integrating information from multiple sources, and ensure that reports and other related communication explain results in plain
language and with sufficient context to maximize understanding and minimize risk of misinterpreting or overinterpreting the findings. Engage clients
in making sense of their assessment results and choosing to whom to release
information. Keep all standardized testing materials secure to preserve their
integrity. Finally, carefully attend to the intersectionality of diversity and its
impact on assessment and evaluation results.
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CASE EXPLORATION
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Case 6.1
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A 17-year-old transgender male on the autism spectrum comes to counselling and decides they want gender affirming healthcare. Current guidelines suggest, “The
adolescent has demonstrated a long-lasting and intense
pattern of gender nonconformity or gender dysphoria
(whether suppressed or expressed).” The dilemma is, “What
is the definition of long-lasting and intense?” The client has
stated they felt this way for the past 5 months and before
they identified as trans, they were non-binary, and before
that they were gender variant. The client has done extensive research and answers all the standard questions about
Hormone Replacement Therapy (HRT) very well. But when
asked non-standard questions about HRT they are lost. The
client knows a doctor that will prescribe HRT without a
formal assessment. The client has unrealistic expectations
about HRT and wants top surgery as soon as they can at 18.
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Case 6.2
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Mr. Thomas works within a middle school supporting
students preparing to transition into high school. Over the
years, he’s worked closely with Adrian, a student who was
eligible for a special vocational school as he repeated Grade
8 and struggled within the regular classroom structure. Mr.
Thomas was confident the vocational school pathway was
a suitable option for Adrian as he demonstrated strong motivation and persistence over the years. Adrian and his caregiver were excited about this opportunity; however, Adrian had been pushing for an IQ test every time he saw Mr.
Thomas – during their appointments and in the hallways.
After months of requests, Mr. Thomas concedes this would
be advantageous to support his case for referral to the vocational school.
When Mr. Thomas reviews the results, he’s surprised to
see that they make Adrian a candidate for the school for
those who are developmentally delayed. Mr. Thomas worries that if Adrian does not go to the vocational school that
he will not complete school at all. Mr. Thomas is certain the
vocational school is the best path forward and he consults
with the school doctor regarding Adrian’s case. She agrees
to back Mr. Thomas’s decision.
Mr. Thomas proceeds with the referral to the vocational school for Adrian but recently received an email from the
school asking him to send over Adrian’s assessment results.
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Case 6.3
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Collin was recently hired by a company that does vocational assessments to help with career decision-making for
youth and return-to-work planning for adults who are returning to work after illness or injury. Collin, a recent graduate from a Masters in counselling program was excited to put
into practice all the learning from the assessment course in
the program; what had been most interesting in that course
was selecting assessment tools that were “fit for purpose” choosing a customized battery to fill in the gaps from what
the counsellor had picked up through the intake and interview process. Collin was disappointed to discover that the
new agency seemed to have a “one-size-fits-all” approach;
most concerning was that Collin was expected to conduct
aptitude and interest assessments, ewven for clients who
had a solid school performance history and seemed very
self-aware. Also, Collin had been taught that the aptitude
and achievement tests being used were “C” level - although
students had been introduced to them in class and administered them to peers under the professor’s supervision,
Collin’s understanding was that the Master’s program only
qualified them to use “B Level” tools independently. Collin’s
first assignment was to fly in to a remote First Nations community to assess two Grade 11 students to help with career
decision-making about what post-secondary training to
enroll in after Grade 12 (and to select appropriate Grade 12
courses to prepare for that). Collin was also asked to assess
another member of the community - someone who was in
recovery from addiction, couldn’t read beyond recognizing
his name and other short words by sight, and had never
worked for more than 2 weeks at a time for pay.
Collin was expected to travel to the community alone,
arriving the night before the assessment was scheduled,
and was told to administer the standard battery of assessments to all three clients. Collin was expected to write up
reports for each of the three clients the following day and
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then, on the third day, before flying home, to provide the
assessment results in three 1.5-hour meetings (one for each
test-taker, to include the test-taker, family members, and at
least one elder from the community). Collin has never delivered assessment results to third parties before.
When raising concerns with the agency director, Collin
was told not to worry - they had been successfully using
this standard battery for years, mostly in the city but at least
twice before in this community, and the instructions in the
manual were really easy to follow.
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Routine Outcome Monitoring (ROM) was recently added for practicum students at one agency in town but is
not commonly used at the other sites. Based on ROM, one
student is not making adequate progress with a particular
client. She only needs 3 more hours with the client to complete her required practicum hours. Her site supervisor says
it’s too late in the term to start a new client so recommends
that she just continue with this one for three more sessions
and then she can refer the client to someone else to continue counselling.
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DISCUSSION QUESTIONS
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1. As you reflect on your own level of training in assessment and evaluation, what do you perceive to be your current strengths and challenges?
2. What areas of assessment and evaluation are you interested in growing
in? Conduct a web search to identify at least three formal assessment
tools that you’d be interested in adding to your toolkit. What additional
training, supervision, and/or practice would you require before considering yourself competent to use these assessment tools with your clients?
3. Which suicide risk assessment approaches have you been trained in as
part of your program. What suicide risk assessment training is available
to you in your region?
4. Discuss how you might proceed with getting informed consent to conduct a suicide risk assessment with a new client who didn’t reveal suicidal ideation or previous attempts at intake but is presenting with some
risk factors now that have raised your concern.
5. Have you had the opportunity to use Routine Outcome Monitoring
(ROM)? Ask students ahead of you in your program – is ROM used in
their counselling clinics or practicum sites? Discuss the pros and cons
of ROM for counsellors/therapists-in-training and recent graduates as
well as for more experienced counsellors/therapists.
6. Choose one formal assessment tool that interests you. If possible, access the manuals/technical guides (e.g., online through the publisher or
through a university “test library”). Critique this tool for its appropriateness for use with a specific vulnerable population or minority group
member.
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REFERENCES
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CCPA (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf
CCPA (2021). Standards of practice. https://www.ccpa-accp.ca/wp-content/
uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf Career Life Skills Resources (n.d.). Ordering information. https://www.clsr.
ca/ordering-information/
Covey, S. (2020). The 7 habits of highly effective people: 30th anniversary
edition. Simon & Schuster.
Fowler, J. C. (2012). Suicide risk assessment in clinical practice: Pragmatic
guidelines for imperfect assessments. Psychotherapy, 49(1), 81.
Hays, D. G. (2017). Assessment in counseling: Procedures and practices (6th
ed.). American Counseling Association. https://psycnet.apa.org/record/2017-25892-000
Multi Health Systems (n.d.). Ordering from MHS. https://mhs.com/ordering-from-mhs/
Muir, H. J., Coyne, A. E., Morrison, N. R., Boswell, J. F., & Constantino,
M. J. (2019). Ethical implications of routine outcomes monitoring for
patients, psychotherapists, and mental health care systems. Psychotherapy, 56(4), 459.
Pearson. (n.d.). Qualifications. https://www.pearsonclinical.ca/en/ordering/how-to-order/qualifications.html
Psychological Assessment Resources. (n.d.). Qualification levels. https://
www.parinc.com/Support/Qualification-Levels
Psychometrics (n.d.). Qualification levels. https://www.psychometrics.com/
qualification-levels/
Reynolds, C. R., Altmann, R. A., & Allen, D. N. (2021). The problem of bias
in psychological assessment. In Mastering modern psychological testing
(pp. 573-613). Springer.
Sigma Assessment Systems. (n.d.). Testing qualification levels. https://www.
sigmaassessmentsystems.com/place-an-order/testing-qualification/
Smith, M. (2022). Suicide risk assessments: A scientific and ethical critique.
Journal of Bioethical Inquiry, 19, 481-493. https://doi.org/10.1007/
s11673-022-10189-5.
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Critical to the expansion of the evidence-informed foundation for the practice of counselling/therapy is the undertaking of scholarly research and knowledge translation.
Counsellors/therapists adhere to the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, using
Ownership, Control, Access, and Possession (OCAP) principles
for Indigenous Peoples, and demonstrate ethical congruence
as they engage in research and share research findings in oral,
written and visual formats. (See also Section I)
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D1. Researcher Responsibility
D2. Welfare of Research Participants
D3. Voluntary Participation
D4. Informed Consent of Research Participants
D5. Research Participant Right to Confidentiality
D6. Research Data Retention
D7. Research Sponsors
D8. Review of Scholarly Submissions
D9. Reporting Research Results
D10. Acknowledging the Contribution of Others
D11. Submission for Publication
CHAPTER SEVEN
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PROFESSIONAL
RESEARCH AND
KNOWLEDGE
TRANSLATION
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William A. Borgen
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INTRODUCTION / CONTEXT
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Our profession has gained credibility over the years by increasingly engaging in evidence-based and evidence-informed counselling and therapy
practice. Ongoing research programs and projects have provided a broad
range of information that has increased our understanding of what makes
our work effective.
The purpose of Section D of the Canadian Counselling and Psychotherapy Association’s Code of Ethics (CCPA, 2020) is to point out key ethical issues that need to be addressed from the point of considering and developing
a research idea, to conducting the research and disseminating the results.
You will note that the overarching aims of this section of the code are to
protect the confidentiality and psychological safety of research participants
throughout the research process, and to help you make ethical decisions
regarding appropriate recognition of members of the research team.
Research is often conducted within postsecondary institutions that have
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a requirement for submitting all research proposals for ethical review by the
institution in which the researcher works. Section D of the Code of Ethics
(CCPA, 2020) closely mirrors many of the requirements of these institutional ethical reviews.
Individuals and groups outside of institutions also conduct research.
These research endeavors are subject to the same ethical requirements. This
section of the code provides an excellent roadmap to help you make defensible ethical decisions in planning and implementing your research.
As counsellors and therapists conduct, consume, and share research,
maintaining the ethical principles as described in CCPA’s Code of Ethics
(CCPA, 2020); the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (Government of Canada); First Nation’s Principles of Ownership, Control, Access, and Possession (First Nations Information Governance Centre, 2022).; and institutional research guidelines is an
essential step in Professional Research and Knowledge Translation.
This chapter will consider how the articles from Section D of the CCPA
Code of Ethics (2020) are relevant to Professional Research and Knowledge
Translation from the perspectives of recommended practices as well as challenges and questions.
Section D of the code (CCPA, 2020) is introduced with the following
paragraph that points to the importance of closely following ethical principles and processes in formulating, implementing and disseminating the
results of all research projects that you undertake.
Critical to the expansion of the evidence-informed foundation
for the practice of counselling/therapy is the undertaking of
scholarly research and knowledge translation. Counsellors/
therapists adhere to the Tri-Council Policy Statement: Ethical
Conduct for Research Involving Humans, using Ownership, Control, Access, and Possession (OCAP) principles for Indigenous
Peoples, and demonstrate ethical congruence as they engage in
research and share research findings in oral, written and visual
formats (p. 17).
Similarly, the Canadian Counselling and Psychotherapy Association’s
Standards of Practice (CCPA, 2021) is an excellent source for examples of
issues that often arise in engaging in recommended practices for each article
in Section D, as well as questions that you should ask yourself to avoid pitfalls and challenges in conducting research with ethical integrity.
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RECOMMENDED PRACTICES
Researcher Responsibility
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Article D1 elaborates and makes more specific the responsibilities of
researchers by stating:
Counsellors/therapists plan, conduct, and report on research
in a manner consistent with relevant ethical principles, professional standards of practice, federal and provincial laws,
institutional regulations, cultural norms, and, when applicable,
standards governing research with human participants. These
ethical obligations are shared by all members of the research
team, each of whom assumes full responsibility for their own
decisions and actions. Before engaging in any study involving
human participants, the principal researcher seeks independent
ethical review and approval. (See also A2, A3, I3, I6, I8, I9, I10;
CCPA, 2020, p. 45).
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The 10 articles that follow in Section D can be grouped into three general clusters: Articles D2 and D3 focus on the ethical issues regarding welfare
of the participants in your research; Articles D4 – D6 are concerned with
the rights of your participant; Articles D7 – D11 provide guidance regarding
the ethical care that you need to take in the activities that result from your
research, including storage of research data and the activities involved in
disseminating your results – that is, in how to ethically participate in research communities.
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Welfare of Participants
Articles D2 and D3 (CCPA, 2020) focus on the welfare of research participants, particularly their psychological safety. When thinking about the
participants in your study it is important to consider the extent to which
the topic of your study, along with the quantitative measures or qualitative
interviews that you will use, may cause them distress (D2). If there is a possibility that your study may create difficulties for some potential participants
you need to create strategies to mitigate these effects. This can involve reviewing the measures or interviewing approach that may be used; reconsidering who to recruit for your study; considering the way data is collected
so that support is available if a participant is in distress; making it clear to
participants that their participation is voluntary, and that they are free to
PROFESSIONAL RESEARCH AND KNOWLEDGE TRANSLATION
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withdraw from the study at any time, or for any reason; and having a list of
support services available to participants, if needed (D3).
Participant Rights
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Articles D4 (Informed Consent of Research Participants), D5 (Research
Participant Right to Confidentiality), and D6 (Research Data Retention) extend the issues of concern regarding protection of the welfare and rights of
research participants (CCPA, 2020). Ethical issues in these three articles
are similar to the corresponding articles for clients receiving counselling/
therapy. Regarding informed consent, as with clients, it is understood to be
a process rather than a one-time event. In order for research participants to
be able to provide informed consent they must be made aware of all aspects
of the research, possible risks, level of disclosure required and limits to confidentiality (D4). The process of obtaining informed consent should involve
a discussion with the participant rather than a one-way process of information giving. The process should be repeated for components of the research
that may pose a higher level of risk for participants, or if the participant
seems to be reluctant to continue. These are also times where the participant
should be reminded that their participation is voluntary and they can withdraw from the study, should they choose to do that.
In some cases, research review boards may be open to consider waiving
the informed consent if, for example, deception is used to mask the aim of
the study and there is no apparent risk to participants in the study. In these
cases, the risk factor must be minimal and the guarantee of confidentially
must be very strong. As an example, a researcher wanted to see if counsellors reacted differently to seeing clients based on the implied culture of
their name. The research involved potential clients contacting counsellors
by email and tracking the number of call backs from the counsellors.
Regarding the right of research participants to confidentiality (D5), this
extends to all aspects of the research being conducted, including masking
participants’ names and identities and maintaining their anonymity in any
knowledge dissemination activities. In some instances, participants do not
want to be anonymous. When this occurs, it is vital to inform participants
about the possible range of publicity that may occur, so they are able to make
an informed decision. It is also important to be sure that all communication
with these participants is in written form, and includes their signatures.
Similar requirements for client confidentiality arise regarding research
data retention (D6). It is imperative that paper copies of all written material
be kept in a deidentified format in a locked filing cabinet in a safe location,
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or in an encrypted digital format for the number of years required by law or
the institution that provided ethical approval for the study to be conducted.
It then needs to be destroyed. One reason for retaining the raw data for a
number of years is that this information may be useful to other researchers
who are interested in replicating the study’s finding or research processes.
Ethical Participation in Research Communities
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Articles D7 – D11 (CCPA, 2020) centre on information regarding recommended actions in the context of being involved in a research community. Article D7 stresses the importance of acknowledging financial and other
resources received to support your research, in all knowledge dissemination
activities, including publications, presentations and on digital platforms. It
is also vital to report to supporting agencies in the manner that they require.
Also emphasized is the importance of ethical integrity in reviewing
grant applications or manuscripts (D8). It is necessary to keep the content
of the applications confidential and to understand that the authors own the
material being reviewed.
Article D9 (CCPA, 2020) focuses on ethical reporting of research results. Reporting should include the context and rationale for your study, the
gap in the literature or research that led to the study, the aim of the study,
the research question, the methodology suited to address the research question, the results, and a discussion of the results that includes the limitations
of the study. This will provide sufficient detail to allow other researchers to
critique the study and to replicate the research.
Article D10 is focused on the ethical decision making that is needed
in acknowledging the contributions of everyone involved in the research
that has been conducted. It is very helpful to have a discussion with your
research team to discuss guidelines that will help determine first or co-authorship, or a note regarding contributions made to the study in any resulting publications or other knowledge dissemination activities. It is also important to acknowledge previous research publications that have provided
a foundation for your study. It is recognized that if a publication is based on
a student’s thesis or dissertation, that the student is the first author of the
resulting publication. Not doing this has been cited as an ethical violation.
Article D11 (CCPA, 2020) examines the ethical issues involved in submitting a manuscript for publication. These most often include not submitting the same or a very similar paper to two different publishers, or submitting a previously published paper only with the permission of the journal
that published it.
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PITFALLS / CHALLENGES
At times you may be challenged in following the practices just outlined
from the CCPA Code of Ethics (2020) and Standards of Practice (2021). This
section of the chapter outlines some of the pitfalls and challenges that can be
experienced in implementing recommended practices.
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Adhering to the CCPA’s Code of Ethics (CCPA, 2020); the Tri-Council
Policy Statement: Ethical Conduct for Research Involving Humans; First
Nation’s Principles of Ownership, Control, Access, and Possession; and
institutional research guidelines is essential in Professional Research and
Knowledge Translation (D1). These documents may provide a number of
content and procedural requirements that are new to you. If that is the case,
it is important to take preventive action in gaining the required knowledge
and skills before you proceed, and consult with individuals and groups who
can mentor and guide you. It is also crucial to understand that any conflicts
in the requirements set out in the CCPA’s Code of Ethics (CCPA, 2020);
the Tri-Council Policy Statement: Ethical Conduct for Research Involving
Humans; First Nation’s Principles of Ownership, Control, Access, and Possession; and institutional research guidelines need to be reconciled by the
researcher, and that the researcher is held responsible for the decisions that
are made.
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Welfare of Participants
As the possible risk to participants increases, so does the need to consider Articles D2 and D3 in the code (CCPA, 2020). A possible challenge
can involve collecting your quantitative or interview data remotely. With
quantitative data you may not know if the participant was experiencing a
challenge that will require assistance. With an interview study conducted
remotely, you will not be present to offer assistance and may not know of
local resources to recommend. Regarding Article D3, participants may feel
hesitant to withdraw from the study and you may not want to lose them as
part of your study. The message here is to watch for signs of distress so it can
be discussed with the participant, and so you can remind them that they are
free to withdraw without penalty.
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Participant Rights
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Common challenges involving informed consent (D4) include considering it to be a one-time event or treating it as a one-way information session, instead of involving the potential participant in a conversation where
they are encouraged to ask questions. If it is not treated as an ongoing process, the researcher may be vulnerable to not engaging in due diligence to
ensure ongoing informed consent, and be open to challenge. In terms of
the participants’ right to confidentiality (D5), issues can arise if their names
and identities are not masked throughout the data collection, data analysis, and knowledge dissemination phases of the research. This can happen
as easily as having a member of the research team use a participant’s real
name in discussing a surprising result of the research with a colleague, or
during a presentation of the results. It can also happen if a member of the
team meets a participant at a social gathering. Regarding D6, participants’
anonymity can be compromised if sufficient care is not utilized in deidentifying their identity in research files, if research materials are not stored in
a safe or sufficiently encrypted space, or if the information is not destroyed
at the required time. It can be a challenge to retain research file information
in a locked and safe space for the required number of years so that other
researchers have access to it. In institutional settings it is less of a problem,
since there is likely a process in place for storing this material. For those not
in institutional settings, storing research materials along with your other
confidential files is a good option. In practice, if you have published your
study, the publication itself will likely provide all of the information they
may need, so requests for your research files should be minimal.
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Ethical Participation in Research Communities
As Article D7 (CCPA, 2020) highlights, in receiving funding, it is important to know if there are any conditions associated with it that may compromise your ability to disseminate your results. For example, if you receive
a contract rather than a grant, it will be essential to see who owns the data
and who has control regarding publication.
Article D8 (CCPA, 2020) is relevant for manuscript reviewers; when
reviewing an application or a manuscript that is close to your own research,
or questions results you have obtained, you may find yourself in a conflict
of interest that will make it difficult to provide an arms-length review of the
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material. If that occurs, it is imperative you notify the agency that invited
you to provide an assessment of the material and recuse yourself from being
a reviewer.
In disseminating your research results, it is necessary to report elements
of your study that may have influenced your results (D9). These can include
the demographic characteristics of your participants and the way they were
selected, which will restrict the generalizability of your results. There is a
tendency for studies that report significant results to be published, so this
may also influence how you choose to present your study.
In discussions regarding contributions to a study, there may be a perceived or real power imbalance (D10). This may make it difficult for those
who see themselves in less powerful positions, such as graduate assistants
working on a faculty member’s program of research, to voice their views
about the recognition of their contributions.
Although not submitting a manuscript to more than one journal concurrently (D11) may seem fairly straightforward, if a journal is taking a very
long time to provide a review of your paper, and you are under pressure to
produce a number of publications, it may be tempting to submit it to another publisher to see if you can have your manuscript accepted for publication.
It would be necessary, instead, to withdraw your manuscript from consideration by the first journal before submitting it elsewhere.
Following ethical guidelines for researchers can help to anticipate and
avoid all of these pitfalls and challenges; and applying CCPA’s (2020) ethical
decision-making models, just as in other aspects of your work as a counsellor/therapist, can support resolution when you encounter research-related
ethical dilemmas.
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CASE EXPLORATION
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Case 7.1
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Quincy recently submitted a journal article to a well-respected, peer-reviewed academic journal in his area of expertise. As part of his graduate studies, Quincy worked as a
research assistant exploring disordered eating in men and
has published before but was a fourth or fifth author. This
time, however, will be the first time he’s the primary author.
He’s excited to extend the knowledge base with a novel
approach to addressing the challenges of men struggling
with disordered eating.
Quincy was excited to receive feedback from the reviewers but was surprised to find that some of the feedback was unclear and contradictory. It’s a blind review, so
he doesn’t know who provided the feedback but one of the
reviewers seems to be privileging one specific researcher
and approach, one that hasn’t been as inclusive to the specific challenges of men. Although Quincy is familiar with
this research and approach, he isn’t quite sure how to integrate the feedback. His study specifically sought to take
an alternative approach which one reviewer seems to be
supportive of; the other was critical.
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Case 7.2
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June is a counsellor working independently within
private practice with children of diminished capacity. It’s
been years since she conducted any research; however,
she’s developed a new approach for her work and wants
to provide evidence of the positive impact it’s had with her
clients. She believes a qualitative approach would be best
and she wants to add a brief exit interview to her final appointment. The information would support refinement of
her approach.
As an independent practitioner, she doesn’t have access to a formal ethics review board at a university. Given
the nature of her clients, she sees this as an important step.
June is aware of independent ethics review boards; however, when she looks into the process, it’s very intensive
and expensive – more than she thought. June reconsiders
whether an ethics review is necessary at all.
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Case 7.3
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Hassan works with military members dealing with
PTSD and would like to conduct a study examining their
experiences. Although he continues to get regular referrals
from the base, has a good rapport with his contacts within
the military, and everyone seems to agree, at least off the
record, that the potential outcome of the study would lead
to service improvements, he’s finding it challenging to get
formal approval to proceed. He’s getting a lot of hesitation
and has been advised that the research would need to be
vetted at every step, including the analysis and dissemination of results.
Hassan would like to have the military’s support, but
he’s worried that inviting them into the process would
compromise the integrity of the research, especially if participants had negative things to say about the military. He
doesn’t want to be restricted about what he can release and
doesn’t want to relinquish control over how the research is
conducted. However, he’s adamant that this research would
be important and fill a real gap for this vulnerable group.
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DISCUSSION QUESTIONS
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1. As a practicing counsellor/therapist, identify how this part of the code
can provide you with a map that can guide you to ethically engage in
research, in a similar way that other parts of the code assist you with
your clinical work.
2. Are there any sections in this part of the code that will make conducting
research particularly challenging for you?
3. As part of a research team, what would make it difficult for to voice your
concerns about the level of recognition you are receiving compared to
the amount of work you are doing? What would be needed to change
that?
4. What could you do if participants in your study wanted their identities
to be known?
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REFERENCES
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Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
First Nations Information Governance Centre (2022). First Nation’s principles of ownership, control, access, and possession. https://fnigc.ca/ocap-training/
Government of Canada (2018). Tri-council policy statement: Ethical conduct for research involving humans. tcps2-2018-en-interactive-final.pdf
(ethics.gc.ca)
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Counselling/therapy practice; (d) fulfilling sanctions imposed by an ethical or other professional body; or (e) choosing to participate in clinical supervisionǂ and consultationǂ as a
valued and valuable practice across the career span.
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E1. General Responsibility
E2. Informed Consent
E3. Ethical Commitment
E4. Welfare of Clients and Protection of the Public
E5. Welfare of Supervisees
E6. Boundaries of Competence
E7. Relational Boundaries
E8. Program Orientation
E9. Fees
E10. Due Process and Remediation
E11. Self-Care
E12. Diversity Responsiveness
CHAPTER EIGHT
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CLINICAL
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Pamela Patterson & Michael N. Sorsdahl
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INTRODUCTION / CONTEXT
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The ethical standard of clinical supervision services, as laid out by
the CCPA Code of Ethics (2020) in Section E, provides a comprehensive
structuring of ethical practice in clinical supervision. Although this standard primarily addresses the work of the supervisor, there is a network of
stakeholders in supervision. The ethical standards of clinical supervision
services concern the supervisor, the supervisee, the client, the welfare of the
public, and the representation of the profession in terms of ethics and legal
accountability, as well as the policies and conduct of personnel at the site
where the supervision is conducted.
Shepard (2020) referred to clinical supervision as a “carefully orchestrated relationship.” (p.2). Describing the supervisor/supervisee/client relationship specifically. Shepard summarized the work:
Clinical supervisors oversee quality control of supervisees’
work by regularly monitoring and reviewing their client work.
Certainly, a substantial part of the supervisory function is to
make sure that supervisees grow and develop into the best
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practitioner they can be. However, guiding and supporting
supervisee competency development is complementary to the
commitment to client safety and wellbeing. Client oversight is
always a priority. Supervisors must be vigilant and aware of any
issues that arise in the supervisory and/or therapeutic relationship that could result in clients receiving inadequate service or
being harmed by the therapeutic process. Supervisors must do
everything within their power to ensure that their supervisees
are not harming clients.
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Clinical supervision is a formal role between two professionals
in which the supervisee is obligated to follow the recommendations and advice of the supervisor. The supervisor is expected
to evaluate the competence of the supervisee as well as confer
responsibility on the supervisee accordingly. (p. 2)
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Considering the dynamic implications and complexity of supervisory
work, it is evident that familiarizing themselves with the ethical articles and
associated standards of practice surrounding clinical supervision services
is critical for all stakeholders: supervisors, site supervisors, and supervisees. Note that this section of the code is not entitled Clinical Supervision,
but Clinical Supervision Services, indicating the range of accountability and
stakeholder interests that support this important work.
Clinical supervision is a specialty area within counselling/psychotherapy practice; hence, specific training and certification are available and highly recommended for all individuals offering supervision services. Clinical
supervision is not the same as consultation, coaching, or mentorship roles;
in the latter, there is not a clear and direct responsibility towards the supervisee or clients. Supervision services act as a gatekeeper for the profession
of counselling/therapy.
As the professional landscape of counselling/psychotherapy practice
in Canada evolves, the use of supervision in professional practice is moving
towards becoming an expectation for ethical practice. This evolution is a
product of the role of clinical supervision as a professional resource, an important means of networking, and a highly recommended practice throughout the career of counsellors/therapists.
A contemporary area of growth in clinical supervision services, as in
counselling/psychotherapy more broadly, is the incorporation of multicultural and social justice pedagogy and practice “through which a supervisor
and supervisee develop personal and professional awareness and competency regarding various identities, communities and social structures” (Peters et al., 2022, p. 511). Infusing supervisory practices with multicultural
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and social justice priorities has broad implications that are discussed in this
section of the code, including professional identity development, informed
consent practices, and relational boundaries and evaluation procedures.
There are many reasons why one might supervise or become a supervisee. The possibilities include: basic training in counselling/therapy, addressing the requirements for membership in regulatory bodies or associations,
achieving additional certification and training, updating specialized skills,
or as the result of ethical sanctions by a regulatory body. Further, various
work settings may require supervision as a regular practice, perhaps due
to specialized services or populations. Even experienced counsellors/therapists are encouraged to access supervision throughout their career span.
The approach and format of the supervision service is designed according
to the specific purpose of the supervision and, in this sense, it may vary
widely.
As the supervision purpose varies, so do the dynamics of power and responsibility in the supervisor and supervisee relationship. The articles within this section of the code provide guidelines for ethical clinical supervisory
services to support the supervisee’s professional development. In an environment of anti-oppression and decolonization, the thoughtful integration
of these ethical standards requires reflection and intention on the part of all
interested stakeholders to appropriately engage within the given dynamics
of power inherent in the supervisor/supervisee relationship (Peters et al.,
2022).
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RECOMMENDED PRACTICES
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The following discussion reviews ethical practice in Clinical Supervision Services as laid out in the CCPA (2020) Code of Ethics and Standards of
Practice (CCPA, 2021). The first article, General Responsibility (E1), provides a broad overview of what this work is about. Following this broad
introductory article, the subsequent articles look more closely at facets of
ethical supervision services. For the reader, this means a continuous circling
of some of the same material, considering increasingly detailed aspects of
what is involved. For example, some of the themes you may see examined
repeatedly include: expectations of the supervisor, the supervisor/supervisee relationship, and/or the incorporation of diversity. The sum of these
articles is a thorough work-up of this critical practice which will serve as a
reliable resource and premise for effective clinical supervision processes.
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General Responsibility and Self-Care
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The General Responsibility article (E1) introduces the responsibility of
the clinical supervisor for ethical conduct including a thorough familiarity
with this specific section of the code and the related standards of practice.
It begins: “Clinical supervisors demonstrate professionalism, integrity, and
respect for the rights of others, with priority accorded to the welfare of supervisees’ clients and more generally the protection of the public” (CCPA,
2020, p. 20). The clinical supervisor actively works towards personal growth
and awareness, as well as towards minimizing the needs for control and
power. The supervisor’s personal integrity and respect is a fulcrum of ethical
conduct in this work (Cruikshanks & Burns, 2017).
Although this part of the Code of Ethics (CCPA, 2020) is brief, the Standards of Practice (CCPA, 2021) reviews the work of supervision in more
depth, providing an overall summary and introduction to the articles and
indicating the diverse considerations involved in supervision. Included in
this section is an explanation of: the clinical supervisor’s scholarly as well
as applied preparation and experience for the given task in supervision, familiarity with regulatory and professional requirements including the Code
of Ethics and Standards of Practice, competency in the designated practice
of counselling/psychotherapy, the boundaries of professional relationship
including the infusion of multicultural and diversity responsiveness in practice and supervision (Schultz et al., 2020), the support of a supervisee’s development of their professional identity (Anderson & Handelsman, 2021;
Cruikshanks & Burns, 2017), negotiating conflicts of interest, the need to
understand the learning needs of supervisees, and the use of documentation
for all the different purposes of supervision. The discussion of this article
in the Standards of Practice provides a specific recommendation for a supervision agreement including typical contents for the agreement and how
to incorporate it throughout the supervisory relationship. This article is an
important orientation to Section E of the code, highlighting the complex
and interwoven responsibilities of ethical practice involved in clinical supervision services.
As discussed elsewhere in the Code of Ethics (CCPA, 2020), self-care
(E11) is an essential practice to support the welfare of counselling/psychotherapy practitioners and their clients. The supervisor’s role includes supporting the supervisee’s self-awareness development, promoting the safe
and effective use of self within the counselling session, and professional
identity development (Cruikshanks & Burns, 2017). The Standards of Practice (CCPA, 2021) identify that self-care practice is also the responsibility of
supervisors. This is especially the case in situations where supervisors and/
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or supervisees practice in remote or northern-based communities where
there may be reduced access to professional development opportunities and
supervision.
Another important consideration is the fact that a supervisor is not
counselling their supervisee; rather, they are educating supervisees regarding the necessity and practices of self-care. Supervisors can encourage supervisees to engage in personal counselling and professional supervision
throughout their career because these are worthwhile self-care and personal
development activities. By incorporating these activities, counsellors/therapists are participating in the development of competencies, professional
networking, and growth in self-efficacy and personal wellbeing, with related benefits for practice and the welfare of clients and society.
As supervision is a specialty area of professional practice that requires
the time and skill of an identified professional, payment for this service is
relevant. The CCPA Code of Ethics and Standards of Practice, combined,
lay out ethical considerations that may inform decision-making regarding
a suitable fee. In the formation of the supervisory relationship, identifying
a fee may entail consideration of the supervisee’s ability to pay and whether
fees could be a barrier to obtaining supervision. Sliding scale fees for supervision can be one way to allow for greater access to supervision. In any case,
the recommended ethical practice is to come to an agreement about fees,
capturing this in the informed consent form in order to properly track and
record it. An agreement needs to clearly indicate the regularity of supervision sessions, the amount, method of payment, and due date for payment of
fees. The importance of this article is the identification of an ethical process
for identifying and forming a fee structure for clinical supervision in a manner that is transparent and accountable.
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Informed Consent and Administrative Considerations
The Supervisor has a range of responsibilities towards the supervisee
and the client, in addition to protecting the public. For Clinical Supervision
Services, informed consent refers to the supervisee’s knowledgeable participation in the supervision process and spans the duration of the supervisory
relationship. The supervisee needs to be made aware of their responsibilities
pertaining to the supervisory process including what is expected of them,
in what manner they will be evaluated, and who will have access to records.
The supervisee’s clients also need to be advised and provide informed
consent to the supervisory process. They need to understand who the supervisor is, how to contact them, and the nature and purpose of the super-
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visory relationship. It is useful for the client to understand the respective
responsibilities of the supervisor and supervisee in the counselling process.
The processes of evaluation and documentation in the supervisory relationship may also be relevant to discuss with the client. Finally, if any part of the
supervision fee is to be passed on to clients, clarity regarding the breakdown
of the fee structure as it pertains to the supervisor’s part in the counselling
relationship is an important consideration to discuss with the client.
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Boundaries of Competence
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The Standards of Practice (2021) address the issue of competence that a
supervisor needs to have. Supervisor competence pertains to the theory and
practice of counselling/therapy as well as supervision. In addition, supervisors need to understand the continually expanding processes of teaching
and learning as well as ethics, and the personal and relational implications
of diversity. For example, with the infusion of multicultural and social justice considerations in counselling/therapy and supervision, pedagogical
tools and participation in the supervisor/supervisee relationship must incorporate expanding complexity and awareness (Cohen et al., 2022; Schultz
et al., 2020).
Supervisors also need to understand their suitability for the work at the
site where supervision will take place. Different sites have particular requirements for supervision. For each situation, supervisors must understand the
supervision needs and dynamics of the supervisees (Cook & Sackett, 2018).
For example, the supervision needs of a student in training are substantially different from those of a mature practitioner independently seeking
supervision for development into a new area of practice. The supervisor
must understand these differences and respond accordingly. To this end,
the supervisor should prepare a statement regarding their competence incorporating the specific needs of the site and supervisee, which can then be
shared and discussed with the supervisee and others who have an interest in
the supervisory process.
Gatekeeping
Ethical Commitment (E3) highlights the central importance of ethical practice spanning counselling/therapy practice as well as supervision.
“Clinical supervisors are conversant with ethical, legal and regulatory issues
relevant to the practices of counselling/therapy and clinical supervision”
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(CCPA, 2020, p. 21). As discussed, supervisors model ethical behavior and
engage in ethical decision-making processes, actively incorporating their
awareness of diversity and individual differences in these actions. Clinical
supervisors ensure that supervisees are also knowledgeable regarding the
relevant codes, standards, and other documents, recognizing personal and
professional responsibility for ethical commitment in all their activities.
Through this process of education and supervision, the supervisor acts as
a gatekeeper to the profession, ensuring that supervisees understand their
professional obligations.
Although conducting a supervisory review of client sessions is an important component to ensuring the supervisee meets all the required competencies, it is not recommended as an exclusive focus of supervision. Incorporating regular reviews of the ethical code and standards of practice,
legal requirements and case law, ethical decision-making processes (beyond
what is relevant in a session review), and skill development makes for a
richer experience for the supervisee and helps to ensure a clear assessment
of competency for entry into practice. This allows for a more comprehensive
professional identity development approach to supervision (Cruikshanks et
al., 2017).
Welfare of the Client and Protection of the Public (E4) identifies that the
supervisor has a primary responsibility to protect society and must exercise
their role as gatekeeper in their oversight and assessment of the supervisee. The supervisor is required to continually determine the competency of
supervisees by responsibly identifying whether or not they are reliable and
prepared to engage in the work of counselling/therapy. The supervisor educates, models, and demonstrates competent engagement as a counsellor/
therapist. A supervisor may be required to redirect or overrule supervisees’
activities with clients in order to mitigate the risk of harm to those clients or
to protect the public.
Supervisors must address the personal growth and unique training
needs of supervisees. Due Process and Remediation (E10) outlines this requirement of supervisors and how to negotiate such challenges ethically.
There can be complex and difficult circumstances to negotiate when specific training limitations, or ethical or practice violations, are identified in
a supervisee’s practice of counselling/therapy. In these circumstances, the
supervisor formulates remediation requirements that support the supervisee’s development in specific areas. This article provides guidelines and suggestions regarding responsibilities, tasks, documentation, and remediation
plans.
Supervisors also provide supervisees with opportunities for self-disclosure and self-growth which support the development of professional
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identity and clinical practice (Vance et al., 2021). Due consideration to the
ethical processes outlined in this standard (E10) is required. Informed consent, confidentiality, and safeguarding against harmful effects are guidelines
that govern ethical responsibilities. This article identifies the necessity of
close engagement with the supervisee’s personal and professional growth
in a manner that is respectful, accountable, ethical, and well attuned to the
supervisee’s learning needs (Cook et al., 2018; Schultz et al., 2020).
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Relational Boundaries
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Ethical Commitment (E3) is an active relational practice of supervisor
and supervisee. Article E3 specifies the need to discuss the triadic and dyadic relationships of supervisor, supervisee, and client with thoughtful attention to risk management. As an example, the CCPA (2021) Standards of
Practice state “[c]ounsellor/therapist clinical supervisors must, at all times,
keep in mind that they are ultimately responsible for the actions of their
supervisees, and the welfare of clients must be their main concern” (p. 62).
The supervisor continuously engages the supervisee using informed consent and ongoing assessment to address the learning needs of supervisees,
but their primary responsibility is the welfare of the client. In situations
where the supervisor must act to protect the client’s welfare, the supervisor
and supervisee must be clear regarding the supervisor’s primary responsibility. Ethical Commitment (E3) highlights the necessity for supervisor and
supervisee to actively engage with the CCPA (2020) Code of Ethics and Standards of Practice (CCPA, 2021) in order to effectively execute the divergent
responsibilities of supervisor and supervisee in clinical supervision services.
Ethical Commitment (E3) also addresses the necessity of intentionality
regarding boundaries in supervisory relationships. Relational boundaries
can be breached when there is blurring of personal and professional boundaries of the supervisor and supervisee. For example, the supervisor and supervisee can become too friendly, creating conflict or uncertainty in some
of the responsibilities or evaluations that they must engage in. Alternatively,
it could refer to multiple roles that are adopted, for instance when there is
a co-existing business relationship between supervisor and supervisee, or
when both the supervisor and supervisee serve on a community board or
outside organization. In these situations, the supervisory relationship may
be affected by competing relationships. Dedicated attention to maintaining
an appropriate relational boundary is required for the benefit of the supervisory task. This is similar to the challenge of multiple relationships in counselling/therapy, where a careful review of ethical practice and clarity of roles
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must be explored. It is recommended that such clarifications and boundary
discussions be denoted in a supervision contract and agreed to in writing.
Article E3 also accommodates those situations when it is appropriate to
bring human compassion, understanding, and support into the supervisory
relationship. Ethical intentionality in the relationship does not mean rigidity. The focus and intent of this article is important because it highlights
the necessity of relational limits in the supervisory relationship, balanced
against the needs of the situation.
Welfare of Supervisees (E5) highlights the clinical supervisor’s responsibility to prioritize the supervisee’s wellbeing and success through the supervisory process. While striving to facilitate and guide the supervisee’s
work, the supervisor aims to “foster a reciprocal sense of safety, trust, and
predictability” (CCPA, 2020, p. 21). Suggestions are provided in the Standards of Practice (CCPA, 2021) regarding how to approach difficulties that
may arise in this process including: revising the supervision plan or forming
a remedial plan, personal counselling, mediation, taking a break, or transferring supervision to another supervisor. The supervisor’s attention to the
wellbeing of the supervisee aids in the development of the supervisee and
models the importance of a caring dynamic between the supervisee and
their clients.
Program Orientation (E8) addresses the formation of transparency and
collaboration between supervisor and supervisee regarding the responsibilities and obligations of supervision. The supervisor is responsible for orientation of the supervisee about the requirements of the supervisory process.
Continuing discussion can address informed consent including reporting to
licensing agencies, the dynamics of the professional relationship, the means
to address serious concerns, the supervisee’s rights to privacy, as well as the
requirement of self-disclosure and self-growth activities. The CCPA (2021)
Standards of Practice recommend a supervisory contract which outlines
the functional and supportive structure of the supervisory process. Such a
contract includes practical details such as the schedule and timeline for supervision, the means of monitoring and evaluation, protocols pertaining to
the use of technology, and considerations such as how to handle absences,
emergencies, or evening shifts. Supervisory policies, expectations, responsibilities, documentation, fees, written processes for evaluation, remediation,
dismissal, and due process are to be included in the consent and fully addressed with the supervisee.
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Diversity Responsiveness
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The final article in this standard (E12) addresses the responsibility of
supervisors to be continually growing in their awareness and understanding of diversity and its importance for sensitive engagement across personal
differences and diverse contexts including cultural, historic, environmental,
and community contexts. The CCPA (2021) Standards of Practice identify
ethnicity, language, gender identity and expression, sexual/affectional orientation, and religion as examples to be expanded on in practice. Supervisors and supervisees engage and promote awareness of diversity through
self-awareness, relational awareness, thoughtful professional practice,
and supervision. The understanding of the impact of diversity is infused
throughout clinical supervision services, including professional preparation
for supervision, supervisee engagement, service delivery, evaluation, and
documentation. Peters et al. (2022) discussed the complexity of incorporating multicultural, social justice, and ecological awareness in the supervisory process. There is a continuous responsibility to grow in awareness,
sensitivity, and humility regarding human diversity, continually working to
incorporate this understanding in clinical and supervisory practice.
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Summary of Major Themes for Recommended Practice in
the Provision of Clinical Supervision Services
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In surveying Clinical Supervision Services as they are presented in the
CCPA (2020) Code of Ethics and Standards of Practice (CCPA, 2021), three
overarching broad areas of recommended practice can be highlighted: the
preparation and competence of the supervisor for the given context of supervision; formative and ongoing discussions between supervisor and supervisee; and the preparation and use of documentation.
The Supervisor as the Key Proponent in the Provision
of Clinical Supervision Services
The essential first premise of this section of the code is the identification of a suitable, competent clinical supervisor. This standard relies on the
training, experience, personal maturity, and ethical practice of the clinical
supervisor. The General Responsibility article (E1), highlights the necessary
capacity of the clinical supervisor for self-understanding, and a personal
growth orientation including continuing growth in the understanding of
diversity and clarity regarding the use of control and power. The code iden-
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tifies the necessity of an appropriate and scholarly preparation of the clinical
supervisor and the demonstration of excellence in clinical practice. Clinical
supervision as a distinct practice in counselling/therapy requires specific
training. The supervisor requires familiarity with the CCPA (2020) Code of
Ethics and Standards of Practice (CCPA, 2021) in order to understand their
ethical roles and responsibilities. The clinical supervisor should be able to
identify their competence as it relates to the supervisory requirements of
their supervisees, the needs of the supervisory context, and the needs of the
client population. This recommended practice is the backbone of effective
provision of clinical supervision services because the supervisor requires
depth and range to engage the myriad relationships and responsibilities of
supervision. Clearly supervision is a demanding and specialized role requiring training and experience. Supervision certification can be sought through
CCPA (https://www.ccpa-accp.ca/membership/supervisor-certification/).
To support the supervisor in this demanding role, a recommended practice is for the supervisor to access supervision for themselves while engaging in the supervision of others (i.e., supervision of supervision). Because
this work relies so centrally on a range of personal competencies and an
emerging supervisory relationship, the provision of supervision for supervisors can enhance understanding as well as support supervisors in working
through the complexities that are likely to emerge in this relational process.
This recommended practice is in line with the principle that supervision
itself is an ongoing component of maintaining and growing counselling
skills; therefore, for those engaging in supervision of counsellor/therapists,
continued development and growth through supervision is ideal.
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Initial and Continuing Discussion between
Supervisor and Supervisee
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A second recommended practice to be taken from examining this section of the code pertains to initial discussions with supervisees to clearly
establish the terms of the supervisory relationship. This is followed by continuing related discussions throughout the supervisory relationship. Reviewing the CCPA (2020) Code of Ethics and Standards of Practice (CCPA,
2021) with the supervisee is an ethical responsibility, but it can also support
the supervisee to better understand the nature of the relationship and the
respective responsibilities of supervisor and supervisee, especially with regards to the supervisor’s primary responsibility for the welfare of the client
and protection of the public. This preliminary conversation aids in the establishment of the supervisory relationship by forming a shared foundation
of understanding as well as providing an opportunity for the discussion of
intersectional identities of supervisor and supervisee (Peters et al., 2022). It
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also supports the supervisee’s development of personal agency by providing
an opportunity for informed consent and clarifying with them the nature of
their work, their rights, and their responsibilities throughout the supervisory process. A careful overview of the supervisory process is a recommended
practice including regulatory requirements, site policies and procedures,
expectations, scheduling, and fees. Evaluation and assessment are sensitive
and important features of the supervisory relationship that should be discussed frankly and openly. The supervisee’s right to privacy and the supervisor’s duty to report to licensing agencies should be understood. In addition,
the supervisor’s responsibility to support the personal and professional development of the supervisee and the boundaries of professional relationship
should be discussed from the outset of supervision.
As the supervisory relationship continues, ongoing discussion pertaining to aspects of informed consent is a recommended practice. The supervisor models, as well as discusses with the supervisee, the processes of ethical decision making, growth in the understanding of diversity, self-care,
personal growth, and relational boundaries; as well as issues pertaining
to ongoing assessment, evaluation, and when necessary, remediation. The
optimal result of thoughtful, intentional, and ongoing discussion between
supervisor and supervisee is an open and collaborative relationship which
serves the best interests of all involved, prioritizing the welfare of the client
and the protection of the public.
Documentation for Ethical Clinical Supervisory Services
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A third recommended practice is the preparation of documentation.
The articles of this standard indicate several forms that can be used including a supervisor’s statement regarding their competency for the particular
clinical supervisory situation, informed consent for both supervisee and
client, a contract that lays out the specifics of the program of supervision,
and the supervisee’s statement of their goals and objectives for the supervisory program. Documentation provides a guideline for discussion, decision
making, and clarity regarding the processes of the supervisory task. When
documentation is functioning effectively, supervisor and supervisee are
freed to act collaboratively in accordance with their understanding of their
work in the supervisory process. Maintaining clear supervisory contracts,
documentation of supervisory sessions, and understanding of expectations
between supervisor, supervisee, and clients aid in mitigating any ethical issues that may emerge.
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PITFALLS / CHALLENGES
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The challenges or pitfalls of the Clinical Supervision Services section
in the CCPA (2020) Code of Ethics relate to the central task of an orchestrated relationship. Although there may be many reasons for challenges to
emerge in the supervisory process, the supervisory relationship becomes
the site of most of these challenges. Issues identified through the standard
may include: the supervisor’s lack of competence for the role, their misunderstanding of their primary responsibilities to the welfare of the client and
the protection of the public, or their failure to understand their responsibility in engaging and educating the supervisee. For the supervisee, a lack of
clarity regarding procedures such as what to do in a clinical emergency, how
to handle absences, or how to conduct themselves in an ethical manner with
clients can lead to mishaps and misunderstanding. Relationally, confusion
can arise around the processes of assessment and evaluation or there can
be breaches in the supervisory relationship. Ensuring that these issues and
potential concerns are discussed, and also explained within the supervisory contract, helps to mitigate misconceptions and misunderstandings. The
CCPA (2021) Standards of Practice among other sources (e.g., Cohen et al.,
2022; Peters et al., 2022) provides helpful content for such a discussion.
Perhaps the key pitfall in Clinical Supervision Services is the neglect
of familiarity with the CCPA (2020) Code of Ethics and the Standards of
Practice (CCPA, 2021) because they provide a key representation of the dimensions and responsibilities of the supervisory task. Failures of the supervisor and/or supervisee to understand their ethical and professional roles
and responsibilities can lead to failure in the supervisory process. A lack of
engagement in the activities of growth, understanding of diversity, self-care
practices, or commitment to building and protecting a collaborative relationship between supervisor and supervisee can undermine the potential of
the supervisory process. When the provision of clinical supervision services
is not working well, there is a poor working relationship between supervisor
and supervisee; the supervisee may be working with insufficient oversight
by the supervisor, processes of assessment and evaluation are underutilized,
there is a lack of ethical accountability, and the welfare of clients and the
protection of the public are at risk. When supervisor or supervisee do not
recognize the primary responsibility of the supervisor towards the welfare
of the client and the protection of the public, there is a risk of a gross ethical
failure.
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CONCLUSION
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The provision of Clinical Supervision Services is a complex endeavor,
with capacity and responsibility as guide and gatekeeper for the work of
counselling/psychotherapy. As supervision is recognized for its value as a
key resource throughout the career of counselling/therapy professionals, it
will continue to expand as a specialized practice. Familiarity with the CCPA
(2020) Code of Ethics and Standards of Practice (CCPA, 2021) can foster a
productive and valuable process which enhances the continually developing
work of counselling and psychotherapy in Canada.
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CASE EXPLORATION
Case 8.1
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John is an intern preparing for his review with his
professor and site supervisor; the call is expected to go
smoothly in light of the recent written review John received.
However, the site supervisor arrives to the call angry and
fairly incoherent about her business and liability insurance
troubles. Neither John nor the professor totally understand
what the main issue is, and the professor proceeds to try to
get the meeting back on track to discuss performance. The
site supervisor again confirms that John’s performance as
an intern has been solid, identifying no problems with performance. However, the site supervisor states that the centre cannot support interns anymore. When the call ends,
John immediately writes a note to the site supervisor asking when he can transfer clients since he has 21 people in
his active caseload. John doesn’t receive any response from
the site supervisor that day or all weekend. John attempts
to log in to see his schedule for the week so that he can
at least start letting people know, but his credentials don’t
work and he cannot log in. However, he does still have clinic
email access; checking it, there is still no response from the
site supervisor. John wonders if it would be ethical to reach
out to his clients by email to explain that he is no longer
able to work with them.
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Case 8.2
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During clinical supervision of a CCPA counsellor in a remote northern community in BC, the counsellor disclosed
that she had knowledge of a client having an affair with the
husband of another client. The husband was the only RCMP
in the small town and the counsellor was concerned that
the town would lose him.
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DISCUSSION QUESTIONS
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1. Which of the articles of this section of the code and standards do you
consider to be the most important? Why? Would your opinion change
depending on whether you were a supervisor or a supervisee? In what
way(s)?
2. What are the best supervision experiences you have had? Discuss what
made them work. (Also discuss what are the worst supervision experiences you have had and why they did not work.) 3. What are your thoughts about the responsibilities of the supervisor?
Would you want these responsibilities? Why or why not?
4. How does the supervisor/supervisee relationship differ from a relationship with a colleague, a client, or an office administrator? How are they
the same?
5. What would you consider in a situation where you disagreed with a
supervisor’s remediation plan for you? What actions would you take?
What do you need to know?
6. What are your thoughts about supervision as an exercise in self-care?
Under what circumstances does it make sense? When would it be inappropriate?
7. If you are supervising someone who is being disciplined by their regulatory body, what steps would you take in preparing for supervision?
Who are you accountable to and in what way? What relationship considerations would you think are important? What are your thoughts
about your responsibility to the regulatory body?
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REFERENCES
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Anderson, S. K., & Handelsman, M. M. (2021). Positive ethics for mental
health professionals: A proactive approach. John Wiley & Sons.
Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Cohen, J. A., Kassan, A., Wada, K., Arthur, N., & Goopy, S. (2022). Enhancing multicultural and social justice competencies in Canadian counselling psychology training. Canadian Psychology, 63(3), 298-312.
Cook, R. M., & Sackett, C. R. (2018). Exploration of prelicensed counselors’
experiences prioritizing information for clinical supervision. Journal of
Counseling & Development, 96(4), 449-460.
Cruikshanks, D. R., & Burns, S. T. (2017). Clinical supervisors’ ethical and
professional identity behaviors with postgraduate supervisees seeking independent licensure, Cogent Psychology, 4(1), 1373422. DOI:
10.1080/23311908.2017.1373422
Peters, H. C., Bruner, S., Luke, M., Kipre, K., & Goodrich, K. (2022). Integrated supervision framework: A multicultural, social justice, and ecological approach. Canadian Psychology, 63(4), 511-522.
Schultz, T., Baraka, M. K., Watson, T., & Yoo, H. (2020). How do ethics
translate? Identifying ethical challenges in transnational supervision
settings. International Journal for the Advancement of Counselling,
42(3), 234-248.
Shepard, B. (2020). Clinical supervision handbook for counselling and psychotherapy profession: Fundamentals for supervisors and supervisees.
Canadian Counselling and Psychotherapy Association.
Vance A., Thériault, A., & Gazzola, N. (2021) Psychotherapist use-of-self in
clinical supervision: A qualitative investigation of supervisor experiences. British Journal of Guidance & Counselling, 49(4), 603-616. DOI:
10.1080/03069885.2020.1867702
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ADOBE STOCK
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There are a number of contexts in which counsellors/
therapists may offer consultationǂ services. They may undertake a consultative role a) informally with colleagues or
peers, b) formally with agencies or institutions, c) as a private
practice service, andd) informally or formally on an ad hoc
and/or pro bono basis. In all cases, despite counsellors/therapists are not engaging in counselling/therapy in the consultative role, they are nonetheless responsible for adhering to
the professional Code of Ethics for counsellors/therapists in
the consultative role.
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F1. General Responsibility
F2. Undiminished Responsibility and Liability
F3. Consultative Relationships
F4. Conflict of Interest
F5. Sponsorship and Recruitment
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SERVICES
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Michael N. Sorsdahl & Pamela Patterson
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INTRODUCTION / CONTEXT
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The CCPA (2020) Code of Ethics and Standards of Practice (CCPA,
2021) clarifies consultation services due to the prevalence of consultation
within the counselling/psychotherapy profession, with very little previous
direction on the ethical conduct of this practice. Consultation services, as
defined by this section of the code, make take many forms; “[counsellors/
therapists] may undertake a consultative role a) informally with colleagues
or peers, b) formally with agencies or institutions, c) as a private practice
service, and d) informally or formally on an ad hoc and/or pro bono basis”
(CCPA, 2020, p. 23). Informal consultation includes any time information
is shared between two practitioners, about their thoughts or opinions about
a specific issue (client issues or professional issues). The person consulting
and the person being consulted are not in any formal arrangement that requires the consultee to follow the advice/recommendations of the consultant. A formal consulting arrangement is where there is a clear agreement
regarding expectations of service being provided by the consultant. This
type of consultation requires a formal arrangement and agreements, and
is what is more spoken to within the Consultation Services section of the
CCPA (2020) Code of Ethics and Standards of Practice (CCPA, 2021).
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Informal Consultation
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Most counsellors/therapists engage in informal consultation, seeking
out advice or support from other practitioners on specific subjects without
having a formal arrangement or agreement in place. This form of consultation has been called the hallway consultation practice, where a practitioner
gives a very brief and general depiction of a question or challenge they are
having and seeks feedback from their colleagues. Balderman (2022) highlighted the importance of this form of informal consultation in clinical practice, and how it helps practitioners work through difficult situations with clients and organizations when working outside of a professional supervisory
relationship. As one reads the CCPA (2020) Codes of Ethics and Standards
of Practice (CCPA, 2021), many references to consultation are used, that
mostly speak to this form of informal consultation.
Many counsellors/psychotherapists informally employ consultation
services through their peers. Peer consultations are recommended especially for counsellors-in-training and novice practitioners as they move out
of a more formal supervisory relationship and into unsupervised practice.
Rantanen and Soini (2018) found that trainees improved in their effectiveness in working with clients when participating in a peer group consultation
experience. The research highlights the importance of consultation, both
within training programs and post-graduation. Given the value of peer consultation, the CCPA (2020) Code of Ethics and Standards of Practice (CCPA,
2021) provides guidelines to help formalize that practice so that everyone in
a peer consultation relationship understands their roles as well as the limits
of what can be achieved given the expertise of participants.
Although the informal consultative method of providing and receiving
advice and recommendations can appear innocuous, it can create a very
challenging situation where there may be uncertainty about when a line has
been crossed and a more formal process is needed. As there is “undiminished
responsibility and liability” (CCPA, 2020, p. 23) for being a counsellor/therapist engaged in activities related to the profession (including consultation
services), it is essential that practitioners are aware of the legal and ethical
rules for consultation. Once the consulting arrangement becomes more formal, then it is important to document using a consent form to ensure clear
professional and ethical boundaries are maintained. An example of formal
consultation services is when a counsellor/therapist is being consulted by an
organization on their knowledge about stress management techniques to be
used by their employees. For the purposes of this chapter, the focus will be
on formal consultation as it is addressed by Section F: Consultation Services
of the CCPA (2020) Code of Ethics and Standards of Practice (CCPA, 2021).
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Supervisory Services Compared to Consultation Services
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Another important distinction is that neither formal nor informal cosultation services are the same as supervision services; this will be further
addressed below. Although the term consultation has been used in reference
to supervisory services in counselling and psychotherapy practice, there
are key differences that are important to identify. Supervision refers to a
continuing relationship between a supervisor and supervisee which is organized within a specific service context and addresses the welfare of the
client and the protection of the public. Supervision is a distinct practice
within counselling/therapy that benefits from educational training/courses
that help better prepare practitioners to provide this service. Consultative
services, on the other hand, are much less delineated. The Code of Ethics
(CCPA, 2020) notes that specific training and expertise is required in the
counselling/psychotherapy area(s) in which one practices consultation, but
the possibilities here are more broad ranging, unlike the specified training
and certification currently available for the role of supervision. Review of
these two separate roles as outlined in the Code of Ethics and Standards of
Practice will clarify further meaningful differences.
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Formal Consultation Services
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The CCPA (2021) Standards of Practice presents important considerations when conducting formal consultation. These standards emphasize
the need for clarity to avoid confusion or misunderstandings regarding
clinical liability issues, confidentiality, and clients. As consultation is not
supervision, the consultant does not hold direct liability or responsibility for clients. When a practitioner engages in consultation, the specifics
around clients or access to clients’ files is not a component of it. Moreover,
the professional accessing consultation may or may not act on the recommendations or information provided by the consultant. According to Article
F2 in the Code of Ethics (CCPA, 2020), a counsellor/therapist acting as a
consultant or who is consulting another has “undiminished responsibility
and liability” (p. 24) for their practice and services, which means they have
sole responsibility for decisions or actions pertaining to their part of the
consultation process. This clear separation of responsibility is an important
distinction between supervision and consultation and ensures transparency.
Another important consideration about formal consultation is that
those services should only be provided by a practitioner who has expertise
and competence to address the issue for which they are being consulted. Any
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practitioner offering consultation services is bound by the ethical codes and
standards of practice of their profession to have the knowledge and expertise
to provide those services. Giving an opinion that is beyond someone’s clear
scope of practice is in violation of the code. Furthermore, consistent with
other areas of counselling/psychotherapy, provision of formal consultation
needs to be informed by cultural humility and sensitivity to diversity. When
the consultant has the experience and knowledge to provide their perspective on a situation, the benefits to the person seeking consultation and their
clients or organizations can be significant. Studies have shown that consultation improves the training and efficacy of counsellors and psychotherapists in their practice (Beidas et al., 2012). As such, consultation supports
the promotion and growth of competence within the profession.
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RECOMMENDED PRACTICES
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Although informal consultation is encouraged and is viewed as an
important component of ethical practice for counsellors/psychotherapists,
the recommendations in this section will focus on more structured formal
consultation services.
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Informed Consent and Documentation
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Formal consultation should include both the use of informed consent
as well as documentation of the consultation. Informed consent should be
properly documented using an informed consent form between the practitioner and the consultant, outlining all the particulars around expertise,
focus of consultation, fee arrangement, and so on. Similar to any other form
of professional counselling service, it is both a legal and ethical requirement
to have both parties enter into a clear and transparent understanding of the
relationship around what services are being offered, boundaries of that relationship, and a full understanding of the nature and risk of the service.
These agreements are typically captured in keeping the appropriate documentation.
It is also recommended practice for both parties participating in the
consultation to document their conversation(s) as well as their understanding that the consultant has undiminished responsibility for their conduct
related to the services they are providing as a consultant to the consultee,
however is not directly responsible for work done with clients or others by
the consultee. For example, a trained and certified counsellor may seek con-
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Record Keeping/Management
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sultation from someone with more experience working with a specific client
group. The consultation note should include: with whom (and perhaps why
that specific consultant was selected), about what specific topics, and key
takeaways from the conversation. The consultant may similarly document
the date, information about the individual seeking consultation, topics addressed, and any suggested clinical recommendations or referral.
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Another important consideration is how to manage the consultation record keeping and maintenance of privacy for all involved. The CCPA (2021)
Standards of Practice offer specific recommendations to encourage practitioners to have a clear process in place with regards to managing their consultation services. Practitioners are encouraged to consider: (1) How will
consultation records be maintained? (2) What is included in the records?
(3) How will they be stored and destroyed in alignment with provincial
regulations? Consultation services comprise part of the services that counsellors/therapists provide, and so therefore fall under the purview of the
Freedom of Information and Protection of Privacy Act.
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PITFALLS / CHALLENGES
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Consultation services and supervision services can both face similar
challenges. However, consultation services are unique services provided
by counsellors/therapists that are distinct from supervisory services. Two
major areas of challenge in offering these services include administrative
pitfalls and working outside of one’s scope of competence.
Administrative Pitfalls
One of the major pitfalls for practitioners providing any informal services (including information consultation) is to treat them so informally that
they would not be considered professional services. Consultation, however,
is a service that is within the scope of practice of counsellors/therapists and,
therefore, subject to the ethical codes, legal requirements, and standards of
practice of the professional. Ignorance of the requirements for the provision of consultation is insufficient to defend against improper or unethical
practice. Being aware of the expectations of consultation services, having
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Scope of Competence
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clear written agreements, and conducting the service to the same standard
as when providing supervision or direct client counselling/therapy will help
maintain ethical practice.
Offering consultation without being aware of potential conflict of interests or the use of consultation to recruit future clients represent other areas
of administrative challenge. Section F of both CCPA’s (2020) Code of Ethics
and Standards of Practice (CCPA, 2021) speaks to these specifics and what
must be avoided. The professional is urged to recall that even if there was
no intention to create a conflict of interest, or to gain a client through the
provision of service, the practitioner is not absolved from the impact of that
consequence. Actively considering potential conflicts of interest and how to
avoid problematic fallout from providing consultation services must be part
of the practitioner’s ethical decision-making process.
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It is essential that the professional provides consultation only within
their scope of practice and expertise. Article F1 (CCPA, 2020) emphasizes
that consultants only provide services for which they are trained and competent. When seeking out consultation, it is imperative to consider who is
going to be retained for this service (whether paid or otherwise). If providing
this consultation service, it is essential to outline the focus of competence
and expertise, and to clearly explain the limits. Only provide consultation
services within current areas of expertise and avoid offering consultation for
issues that are beyond that boundary.
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CASE EXPLORATION
Case 9.1
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A counsellor/psychotherapist is in private practice, and
has been for 6 years, specializing in their work with families
and couples. They are asked by a social services organization to consult the organization regarding their work with
families in order to provide a better approach and system
for their clients.
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Jazpreet is a counsellor/psychotherapist for the last 10
years, who is in her 5th year of recovery from her treatment
for breast cancer. She is asked to consult by the local cancer
agency regarding clients who experience cancer treatment.
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Case 9.3
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A counsellor/psychotherapist named Alex, who has
just completed a graduate training in counselling and has
become recently certified to practice, presented their thesis
results that focused on eating disorders at their university’s
research presentation conference to the public. Following
their presentation, an attendee asks Alex whether they
would be willing to work with their daughter who they believe has an eating disorder.
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DISCUSSION QUESTIONS
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1. What is the difference between supervision and formal consultation?
2. What is the difference between formal consultation and informal consultation?
3. What makes a good consultation arrangement, and what does someone
look for in a good consultant?
4. What can you do to improve your skills as a consultant within the counselling/psychotherapy profession?
5. What are the legal considerations when providing consultation services,
and how can the risks associated with them be mitigated?
6. What are some important considerations and practices in starting a
peer consultation group?
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REFERENCES
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Balderman, L. Why clinical consultation is important for therapists. (2022,
April 15). Linkedin. Retrieved from https://www.linkedin.com/pulse/
why-clinical-consultation-important-therapists-lisa-balderman-lcswr?trk=public_profile_article_view
Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically
supported treatment: A randomized trial. Psychiatric Services, 63(7),
660-665.
Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Rantanen, A. P., & Soini, H. S. (2018). Changes in counsellor trainee responses to client’s message after
peer group consultation (PGC) training. British Journal of Guidance &
Counselling, 46(5), 531-542. https://doi.org/10.1080/03069885.2016.1
277381.
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Practitioners who undertake the responsibility of counsellor/therapist education
and training are tasked with roles that include mentorship, teaching, supervisionǂ, assessment, feedback, evaluation, reporting, and fiduciary dutiesǂ. They engage aspiring
counsellors/therapists in comprehensive, evidence-supported education and training that fosters the development of
theoretical, conceptual, clinical, relational, ethical, and diversityǂ knowledge and skills. The primary goal of counsellor/
therapist education and training is to ensure that graduates
are well-prepared to embark on counselling/therapy career
paths as caring, confident, and competent professionals.
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G1. General Responsibility
G2. Boundaries of Competence
G3. Ethical Orientation
G4. Clarification of Roles and Responsibilities
G5. Program Orientation
G6. Relational Boundaries
G7. Confidentiality
G8. Self-Development and Self-Awareness
G9. Dealing with Personal Issues
G10. Self-Growth Activities
G11. Sexual Contact with Students and Trainees
G12. Sexual Intimidation or Harassment
G13. Scholarship
G14. Establishing Parameters of Counselling/Therapy Practice
CHAPTER TEN
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COUNSELLOR
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EDUCATION AND
TRAINING
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INTRODUCTION / CONTEXT
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Effective counselling, regardless of theoretical orientation, is a process
that facilitates desired changes in clients. Teaching this process, and providing opportunities for supervised practice, is the role of counsellor educators
– this group of counselling and psychotherapy professionals is the focus of
this chapter. Counsellor educators are bound by the same ethical principles
and standards that guide their own counselling practices but, as outlined in
Section G of CCPA’s (2020) Code of Ethics, they also have additional roles
and responsibilities.
Counselling diverse individuals who are experiencing complex problems within dynamic and interconnected systems is inherently messy. Effectively training students to perform this role to at least a minimal standard
requires a systematic, comprehensive, scaffolded approach. Educational
psychologist, Vygotsky (1978), introduced the notion of scaffolding to describe how a safe space for learning complex concepts can be constructed,
COUNSELLOR / THERAPIST EDUCATION AND TRAINING
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with the learning chunked into manageable pieces and guidance provided
by someone who has already mastered the skill being taught.
Within counselling psychology programs, this scaffolding is, in part,
provided by the scope and sequence of courses within the program. In some
programs, for example, students must complete pre-requisite courses in
psychology and essential helping skills before they can even apply. Once
accepted into the program, they complete a counselling skills course where
they can practice skills with their peers, under the supervision of an instructor or teaching assistant. Later in the program, they move on to a clinic and
practicum where they continue to practice the skills they’ve learned with
“real” clients from the community. These clients are typically carefully prescreened to ensure that the complexity of their problems is an appropriate
fit for the competency of the counsellor-in-training. As time goes on, some
of the scaffolding is removed as the students become more competent as
counsellors and can begin to work independently.
Students who complete their master’s training as counsellors and go on
to a doctoral program in counselling psychology will typically take on two
distinct roles. They may work under the supervision of a clinic instructor or
practicum/internship supervisor to deepen their own counselling expertise,
working with more complex clients or developing an area of specialization.
They may also begin to supervise students at the master’s level, becoming
part of the scaffolding themselves.
Going back to the notion of the inherent messiness of counselling, it
is impossible for counsellor educators or supervisors to perfectly scaffold
the learning experience of their students or counsellors-in-training. That’s
why a solid understanding of the Code of Ethics (CCPA, 2020) and ethical
decision-making models is crucial. It’s relatively easy to teach the “black and
white” of counselling practice; far more challenging is to equip our students
to navigate the unending “shades of grey” that they are sure to encounter.
In this chapter we’ll explore the complex, and sometimes contradictory,
roles of counsellor educators. These roles include teaching core concepts,
assessment and evaluation of competencies, support, supervision, mentorship, and serving as the gatekeepers of our profession.
Recommendations for ethical best practices for counsellor educators,
and for mitigating risk when encountering challenges and pitfalls, are presented in the following sections.
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Counsellor educators are ethically responsible for facilitating safe and
respectful spaces for learning, providing clear and transparent orientations
to their programs and courses, maintaining their own competence as counsellors and educators, ensuring the competence of any individuals to whom
they delegate responsibilities, protecting the public, engaging in reflection
and self-care, and engaging fairly and equitably in scholarly activities. Recommendations related to all of these topics are provided below.
Safe and Respectful Learning Spaces
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Article G1 (General Responsibility) in CCPA’s Standards of Practice
(2021) calls on counsellor/therapist educators “to respect the people whom
they educate and train” (p. 76). Respecting your students is such an important foundation for creating a safe learning space where counselling students
can challenge themselves to learn and grow. Numerous responsibilities relate to this article (and are expanded upon in the Standards of Practice);
these include developing the overall program and specific courses, with
attention to the standards set by the Council on Accreditation of Counsellor Education Programs (CACEP; CCPA, 2023). Counsellor/therapist educators have responsibilities to ensure that their graduates are prepared for
future workplaces and meet or exceed requirements for registration in the
provinces where counselling/psychotherapy is regulated or for the voluntary certification/registration programs offered by professional associations.
Such preparation includes a focus on cultural humility and diversity competencies, infused across the program rather than solely in a dedicated course;
this, of course, also requires a focus on recruiting and retaining diverse faculty, which is a work-in-progress in many Canadian programs. An interesting study by Giordano and colleagues (2018) examined how religiosity, spirituality, and political beliefs impacted counselling students’ experience of
psychological safety in their learning environments; the authors cautioned
educators to bracket their own beliefs and values to honour their students’
diversity, creating safe and inclusive learning spaces and also modelling how
counsellors/therapists can similarly bracket their personal views to create
safe and inclusive spaces for their clients.
Article G2 focusses on Boundaries of Competence for counsellor educators. This includes competence in both teaching and practice – either alone
is insufficient for meeting this ethical mandate and standard. Staying cur-
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rent in teaching requires competence with technologies, facilitating teaching or supervising online as needed (the sudden shift to e-learning during
the COVID-19 pandemic was a good example of how being proactive is important – some educators were more immediately ready than others to make
that unanticipated transition). Haddock et al. (2020) compared traditional
and online counsellor-training programs and highlighted the importance of
counsellor-educator competency in program design, and teaching counselling skills and supervising practice in virtual environments.
Best practices for teaching also include keeping course syllabi and reading lists up to date, attending to the most recent publications, offering examples of current evidence-based practice, and exploring emerging, although
not yet fully supported, practices – clearly distinguishing between the two.
Attending conferences, webinars, and workshops are additional ways to ensure your competencies as an educator are current. Educators also ought to
be teaching within their boundaries of competence and/or areas of specialization, helping students to make clear links between theory and practice
and, as previously mentioned, facilitating scaffolding for students to become
competent counsellors/therapists. On occasions where an educator is required to teach a course that feels like a stretch, then providing scaffolding
at a faculty level through supervision, consultation, co-teaching, and other
means of support is essential.
As highlighted in Article G3, counsellor/therapist educators must provide a solid grounding for students in the code(s) of ethics and standards of
practice that will guide their future professional practice, as well as ensuring
that they are informed about relevant case law, regulatory college requirements, and statutes and laws that may impact their work. This requires educators to stay informed about changes in counsellor/therapist regulation,
in a rapidly changing Canadian and global context. This responsibility goes
beyond instructors of ethics courses; every instructor in a counsellor education program needs to be familiar with, and effectively model, ethical practice, standards, and decision-making. Such modelling of ethical practice
amongst the faculty of counsellor education programs is crucial; students
notice disrespectful and dysfunctional interactions between their instructors, program administrators, and other stakeholders within the university
and professional community. Such interactions detract from the credibility
and professionalism of the counselling/psychotherapy sector.
The inherent messiness of the roles and responsibilities of counsellor/
therapist educators has already been mentioned. Article G4 speaks to the
importance of clarifying these roles, acknowledging the multiple responsibilities of teaching and evaluating core course content, supervising practice
(and in some cases research) alongside providing safe spaces for self-re-
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flection and personal growth. It is considered good practice not to grade
self-disclosure and self-growth activities – students need to be confident
that sharing their vulnerabilities, biases, and areas for growth will not be
held against them.
As highlighted in Articles G4 and G6, educators need to be aware of
their positions of power and privilege, and intentionally use those positions
to benefit their students and supervisees. Similar to the process of securing
informed consent before beginning to work with clients, counsellor/therapist educators need to clearly inform students about their respective responsibilities and requirements, and to address power differentials, especially
in cases where there may be multiple relationships in place. For example,
a student may be taught by a faculty member, employed as a research or
teaching assistant by that individual, travel to conferences as a member of
a research team (often involving social events), receive clinical supervision
from the same individual in a practicum course, and also serve with that
individual on a university committee or a community board. Such multiple
relationships can offer important professional development and networking
opportunities to students but, as discussed in previous chapters regarding
multiple relationships with clients, must be managed well to be effective
and not unintentionally harm the student. Transparency in roles, and responsibilities within those roles, becomes a helpful recommended practice.
Transitioning roles from one form to another is another area of focus for
counsellor/therapist educators; as students graduate, the roles can change.
Clarity about roles and responsibilities is especially important in practicum courses and clinics where instructors have dual responsibilities as clinical supervisors (ensuring clients receive appropriate care) and evaluators
(i.e., grading students, identifying when remediation may be necessary, and
determining whether or not students have demonstrated sufficient competency and self-awareness to pass the course and, in some cases, to continue
in the program). Counsellors/therapists use themselves as the primary tool
in working with their clients. The counsellor competency framework endorsed by the College of Regulated Psychotherapists of Ontario makes several references to “safe and effective use of self” (SEUS; CRPO, n.d.; CRPO,
2017). One approach to handling training clinics and practicum courses
safely and effectively is to run them in a similar way as counselling groups –
setting group norms and clearly acknowledging each participant’s roles and
responsibilities.
Part of safe and effective learning spaces and educator-student relationships is the confidence that boundaries will be maintained and respected
across contexts. The Code of Ethics (2020) specifically mentions in Article
G11 that “Counsellor/therapist educators do not engage in intimate contact
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of a romantic and/ or sexual nature with current students/trainees/supervisees” (p. 27) and that such relationships with former students/trainees/supervisees could only begin “after thoughtful and thorough consideration of
the potential influence of power and privilege imbalances and the potential
for perceived or actual pressure or coercion, lack of objectivity, exploitation,
and harm” (p. 27) - in other words, even post-graduation, there is a recognition that the previous power imbalance has the potential to make sexual/
romantic relationships problematic.
Aside from engaging directly in sexual or romantic relationships, any
type of sexual intimidation or harassment is also considered ethically unacceptable (G12) and yet research reports it as prevalent (Welfel, 2016).
Counsellor educators have a responsibility to proactively educate students/
supervisees about what constitutes intimidation and harassment, including
in person or via such technologies as text messaging, email communication,
telephone calls, or social media.
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Counselling programs, by their very nature, are structured quite differently from other graduate programs within most universities. Therefore, beginning right at the point of recruiting prospective students, and
throughout the program orientation process, Article G5 highlights the importance of being transparent about both admission and graduation criteria
so that applicants are fully informed about program and entry-to-practice
expectations. Depending on the program, such expectations may include
self-disclosure requirements in simulation activities, students engaging in
personal counselling, students securing their own practicum placements,
and students being open to addressing serious personal issues that interfere
with their ability to develop and demonstrate the necessary competence to
work effectively as counsellors/therapists. Prior to applying to the program,
students should have access to realistic information about their chances of
being admitted (i.e., not just the formal minimum standards to be met, but
information about the typical profile of students who have been recently
admitted). Once admitted, and before the program begins, an orientation
to the full program is essential. This should include information on course
sequencing, implications of dropping a course or taking a leave, graduation requirements, and the types of employment that program graduates are
likely to achieve.
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Several counsellor education programs in Canada are accredited
(CCPA, 2023); CACEP-accredited programs are subject to regular external reviews and must meet specific standards. If you are teaching in an accredited program, it will be important to understand the CACEP standards
and requirements that impact your courses and the students you are supervising, especially before making any modifications to course syllabi or students’ study plans. Regardless of whether or not your program is accredited,
your syllabi serve as contracts between you and your students; they must
align to the stated description of the course and the learning objectives set
by the program, and the evaluation criteria must clearly measure the learning outcomes of the course.
Students must also be informed early on about limits to confidentiality
and how information will be shared amongst the program team. Similar to
securing informed consent with counselling clients, students need to know
the reporting requirements associated with any threats of harm to others,
when protection of a child or vulnerable adult warrants it, or when legally
required. Beyond this, however, they also need to fully understand how the
faculty/instructional/supervisory/administrative team works together to
contribute to students’ development and, ultimately, to protect the public.
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Clearly, the primary purpose of counsellor/therapist education and
training is to develop and maintain the requisite counselling competencies
(CRPO, 2017; FACTBC, 2019; NSCCT, 2020). Although there are nuanced
differences between approaches to training and various competency frameworks (e.g., although CRPO and NSCCT both use the term “safe and effective use of self,” FACTBC refers to “awareness of self” and “safety” but
doesn’t explicitly link the two), CCPA’s (2021) Standards of Practice (G14)
highlights the important role that counsellor educators play in providing
opportunities for students to practice counselling under supervision, with
the fully informed consent of their clients. It also emphasizes that students
are not asked to engage in counselling activities that are beyond their developmental level (i.e., clinical and practicum experiences must be carefully
scaffolded and supervised to protect both students and their clients). Vetting
potential clients through a thorough intake process is particularly important. Finding innovative ways to train students without putting vulnerable
clients at risk is also important; emerging technologies may offer effective
solutions. Demasi et al. (2019), for example, developed a “CRISISbot” to
support the training of crisis counsellors, drawing from counsellor role-play
transcripts to simulate a suicide hot line visitor for counsellors to practice
with.
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Aside from clinical training, counsellor educators are also responsible
for keeping their curriculum current, reflecting current societal changes,
theoretical perspectives, and ethical codes and standards. As previously discussed in this book, many professional associations and regulatory bodies
have made recent changes to their codes that reflect our changing understanding of power and privilege, the lasting impact of colonization, sexual
orientation and gender identities, and the importance of cultural humility.
If course readings aren’t concurrently updated to reflect current ethics and
standards, students will be receiving mixed and confusing messages about
what will be expected of them in their future counselling practices. Hays et
al. (2021), for example, conducted a systematic review of the properties and
assumptions of various assessment tools related to “Whiteness.” Being aware
of such reviews and incorporating relevant tools into various course curricula can help to develop the self-awareness and cultural humility required of
counsellors today. Another emerging focus is “relational depth” as discussed
by Ray et al. (2021). Integrating current research (in this case a phenomenological study of 10 doctoral students in counselling) can help to ensure
that counsellor educators are teaching evidence-based practices, to develop competent future counsellors/therapists. Also, within Canada, there is
an evolving landscape of the regulation of counselling and psychotherapy
across provinces (CCPA, n.d.). It is essential for counsellor educators to stay
current about changes in regulation of the profession, understanding the
differences across provinces and internationally.
Another crucial role for counsellor educators is to protect the public.
That’s one of the main reasons that close supervision is required during
clinical courses or practicum placements. It’s also why it is important to
have a careful selection and approval process in place for external practicum
site supervisors, as well as for sessional or adjunct instructors for clinics or
practicum courses. It’s essential for educators to work closely with site supervisors – ultimately, it is the clinical or practicum course instructor who is
responsible for ensuring that program requirements are met before students
complete courses and, ultimately, graduate. Instructors are also responsible
for developing remediation plans as required – and ensuring that the remediation was effective, and that the student has gained sufficient self-awareness and competence to continue their work with vulnerable clients.
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Counsellor educators also need to support their students’ self-development and self-awareness (G8), as well as support students who are dealing
with personal issues (G9). Most graduate students in counsellor education
programs are adults with full and complex lives. Aside from raising awareness of their assumptions, biases, and privilege, which are all important to
consider in developing counselling competence, a focus on self-care is also
essential. Counselling students, and counsellors-in-practice, need to understand their capacity limits and take preventative action to avoid compassion fatigue, vicarious trauma, or burnout. It is typical not to grade personal
reflections or self-awareness activities but, rather, to create a safe learning
environment in which students can reflect and continue to grow.
When personal issues arise for your students, it’s essential to differentiate between your own competency and training as a counsellor/therapist
and your specific role as an educator or clinical supervisor. You can offer
support through referrals and can normalize the value of counsellors engaging in their own personal counselling (G9).
Students, understandably, may have questions about future career possibilities as counsellors/therapists. As mentioned previously, it is helpful if
counsellor educators stay connected to their professional associations, attend conferences (where possible, inviting students to co-present), and have
a good understanding of the types of work that alumni from the program
have been able to secure. For a more general coverage of careers within
counselling psychology, see “Applications and careers for counsellors and
counselling psychologists” (Borgen & Neault, 2019).
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Although research, writing, and conference presentations are addressed
in more detail in other parts of this book, counsellor educators sometimes
find themselves wearing multiple hats with their students (e.g., teaching a
required course to a student who is also in your research lab and working
as a teaching assistant for another course). Mentoring students into the fullness of their potential future roles as counsellors can be the most rewarding
part of a counsellor educator’s job (G13) but it needs to be carefully structured, ensuring fairness and equity.
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PITFALLS/CHALLENGES
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In each of the areas previously discussed as recommended practices,
there are many pitfalls and challenges to be aware of and avoid. Examples
abound of faculty members who have been removed from their teaching
responsibilities through course buyouts, research grants, and administrative
responsibilities – sometimes for many years. Due to other responsibilities,
many faculty members have not established or maintained a clinical practice; others have established their professional identities as psychologists
rather than counsellors/therapists, rendering them out-of-touch with recent changes in counselling standards and codes – in all of these cases, their
competency to teach specific courses may be compromised (G2).
It can also be tempting, especially when feeling overworked as a counsellor educator, to simply pass a student rather than engaging in a comprehensive evaluation process (G4) – a process that may risk the possibility
of a time-consuming challenge, grievance, or poor course evaluation that
could impact promotion or tenure. However, part of counsellors’ and counsellor educators’ responsibility to protect the public involves ensuring that
the students they teach are adequately prepared with entry-to-practice competencies. There is a significant difference between scaffolding a student’s
learning to build competence and overlooking a lack of competence that
could harm future clients. CACEP-accredited programs require that a student continuation / remediation plan be developed for students who are
struggling to meet course requirements or demonstrate clinical competencies; such a plan must clearly outline the required steps to successfully complete the program.
With the almost overnight shift to e-teaching and e-counselling during
the COVID-19 pandemic, many counsellor educators found themselves
working outside of their competency and experience in trying to teach
and assess counselling skills in an e-learning environment (Haddock et al.,
2020); it’s important to recognize the need for consultation and competency
development when shifting to virtual environments for teaching and counselling.
Counsellor educators, just as in their practice as counsellors/therapists,
have an ethical responsibility to preserve their clients’ confidentiality (B2);
this also extends to preserving the confidentiality of their students’ clients
(G7) as well as their students. However, many counsellor educators use examples from their practice as they teach – an approach welcomed by many
students that can offer wonderful learning opportunities. In such cases, it is
essential to disguise identifying details; there are many examples of people
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recognizing enough key elements of a story that they can identify the individuals involved! Counsellor educators can caution students to use pseudonyms for clients in case presentations and written assignments and also, as
part of the informed consent process, to let clients know with whom their
information will be shared. In clinical and practicum courses, counsellor
educators hold the ultimate responsibility for ensuring safe storage of videos
(and that those videos are erased at the end of the course or an agreed-upon
time), locked or password-protected storage of case notes and client files,
and that online correspondence (e.g., email) is encrypted and on a secure
system.
Another significant challenge for counsellor educators can be the multiple roles and relationships between them and their students (G6). It can
be problematic to juggle the role of supporter/encourager with the responsibility to assess and evaluate competency, for example. Other potentially
challenging multiple relationships may include employer/instructor, thesis
supervisor/instructor, or even serving on university committees or community boards together. As previously described, such roles, relationships, and
responsibilities can be managed effectively with clear boundaries and open
communication. However, recognizing the difference between boundary
crossings and boundary violations is important here. Many multiple relationships, such as working closely with a faculty member as a thesis supervisor, being employed as a teaching assistant by that same individual,
and travelling to an international conference to present with that professor and network with internationally recognized experts in the field can
offer incredibly important professional development support to a student.
Although this could result in boundary crossings at times, they would not
necessarily be problematic. Boundary crossings become violations and, as
such, serious ethical concerns, when the power imbalance leads to exploitation, compromises the supervisor’s/instructor’s objectivity, or causes harm
to the student or others.
Particularly problematic is when a counsellor educator uses an inherent position of privilege and power to take advantage of students (e.g., only
taking thesis students who fit the instructor’s specific research agenda; taking information from students’ course assignment submissions to shortcut
the educator’s own research, without permission or crediting the students’
work; assignment structures and grading criteria that are focussed more on
the instructor’s need to minimize workload than on the course learning objectives or students’ need for feedback; only providing reference letters to
students who volunteer on the instructor’s research projects). Of course,
sexual harassment and romantic relationships between counsellor/therapist
educators and their students are never considered appropriate – very sim-
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ilar to the prohibition against romantic relationships between counsellors/
therapists and their clients. Despite this, several research studies involving
counselling/psychology educators and their students have reported sexual
contact (Hammel et al., 1996; Pope, 1979; Welfel, 2016).
There are other, systemic, challenges that counsellor educators may encounter. For example, faculty members sitting on admissions committees
may grapple with inconsistencies between stated values related to equity,
diversity, and inclusion that conflict with funding models that privilege
applicants with more traditional academic backgrounds (i.e., is the potential student likely to be able to secure large enough research grants to cover
their costs?). Another systemic challenge is the over-dependence on sessional instructors, resulting in limited core faculty interaction with graduate
students, inconsistent course design and revisions, and minimal oversight
of what is actually going on in the classrooms. Finally, although the scientist-practitioner model tends to be valued in counsellor/therapist training
programs, an over-emphasis on research for core faculty members may result in them having limited recent experience as counsellors. Conversely, for
sessional instructors bringing practical field experience to their classrooms,
their exposure to the research literature and evidence-based practice may be
out-dated.
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CASE EXPLORATION
Case 10.1
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David is a recent graduate who has made an ethical
decision based on what he was taught within his training
program. His supervisor has challenged that decision and
David now must justify his decision.
David is working with a child of divorced parents, one
parent who supports conversion therapy and the other
who doesn’t. David shows his supervisor evidence of working through an ethical decision-making model and has provided articles to support his decision. In David’s opinion it’s
in the “best interest” of the child not to alienate the relationship with either parent. David provides evidence that conversion therapy may be a valid approach when considering
religious freedoms.
His supervisor contends that because the laws for
considering the “best interests” of the child when working
with children of divorced parents has changed, specifically
within their jurisdiction in BC, that David’s decision is out
of date. He adds that the research supporting conversion
therapy is now greatly outweighed by that condemning it.
An internet search for current laws on Conversion Therapy
suggest that it is not legal in Canada, including BC.
Although David isn’t a supporter of conversion therapy, he feels ill equipped to discuss the matter given the one
parent’s outspoken and strong opinion on the matter. He
worries that the one parent will pull the child out of therapy
and great harm will come from this.
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Case 10.2
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Dr. Janson is a faculty member at a university with a
Masters of Counselling program and also runs a research
lab employing several students. Mimi worked in the research lab throughout the first year of her graduate studies
and has recently taken on a small part-time contract with
Dr. Janson’s private practice and consulting business.
Dr. Janson is the only instructor scheduled to teach
the mandatory courses within Mimi’s second year; however, university policy states that Dr. Janson isn’t permitted to
instruct Mimi while she is also employing her. This means
that Mimi will need to delay her course enrollment, practicum position, and ultimately her graduation. Mimi insists
that this is “no big deal” but recently overheard the other
research lab students discussing how unfair the situation is
and that Mimi is making a huge mistake.
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Case 10.3
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Dr. Rolland instructs an online course within the Masters of Counselling Psychology program. As it’s one of the
first courses students take in the program, many of the students struggle to meet the grading expectations and end
up having to retake the course or withdrawing from the
program entirely. Due to its high enrollment, the marking
load is similarly high. With the majority of the assignments
due near the end of the course, Dr. Rolland struggles to provide feedback and grades for one assignment before the
next is due.
Recently, one of Dr. Rolland’s students expressed her
frustration over the assignment expectations and schedule. She questioned how anyone can be successful in the
course and accused Dr. Rolland of intentionally withholding feedback to support her reputation as a program gatekeeper. Dr. Rolland feels she’s communicated the course
expectations and flow early on in the course adequately
to students. She’s appalled to find an influx of poor evaluations by students at the end of the course.
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A student approaches you about a problematic practicum site location and supervisor. The student reported
that the practicum supervisor berated her in front of the
other staff about her inability to connect with clients. As
a sessional faculty member, you don’t have a history with
this practicum site, but you are aware that they’ve been a
long-standing supporter of students providing multiple
placements each semester.
You know that this student had been at risk of getting
expelled from the program before and aren’t sure how to
proceed. You ask around and none of the other faculty indicated issues with the site location.
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DISCUSSION QUESTIONS
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1. As a student, what characteristics do you appreciate in counsellor educators?
2. Think of a counsellor educator with whom you have multiple relationships (e.g., course instructor / research supervisor; thesis supervisor /
employer). How has this individual structured a safe and effective environment for you to work together in these multiple ways?
3. Describe your favourite learning experience as you’ve been training to
become a counsellor/therapist. What made that experience so memorable and meaningful?
4. As you reflect on this chapter, and the complex responsibilities of a counsellor educator, what new insights do you have about why programs are
structured as they are, or why specific course/program requirements are
in place?
5. It could be argued that becoming a counsellor educator requires a
unique set of competencies. What additional training might you require
before you would feel ready to teach or train others in this field?
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REFERENCES
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Borgen, W. A., & Neault, R. A. (2019). Applications and careers for counsellors and counselling psychologists. In M. E. Norris (Ed.), The Canadian Handbook for Careers in Psychological Science. eCampus Ontario.
https://ecampusontario.pressbooks.pub/psychologycareers/chapter/
applications-and-careers-for-counsellors-and-counselling-psychologists/
Canadian Counselling and Psychotherapy Association. (n.d.). The profession & regulation: Who are counsellors/psychotherapists? https://www.
ccpa-accp.ca/profession-and-regulation/
Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Canadian Counselling and Psychotherapy Association. (2023). Accreditation. https://www.ccpa-accp.ca/accreditation/
College of Registered Psychotherapists of Ontario. (n.d.) Definitions. https://
www.crpo.ca/definitions/
College of Registered Psychotherapists of Ontario. (2012). Entry-to-practice
competency profile for registered psychotherapists. https://www.crpo.ca/
wp-content/uploads/2017/08/RP-Competency-Profile.pdf
Demasi, O., Hearst, M. A., & Recht, B. (2019). Towards augmenting crisis
counselor training by improving message retrieval. In Proceedings of
the Sixth Workshop on Computational Linguistics and Clinical Psychology, 1-11.
Federation of Associations for Counselling Therapists in British Columbia.
(2019). Entry-to-practice competency profile for counselling therapists.
https://www.cctpei.ca/sitefiles/Documents/External/2019-Counselling-Therapist-Competency-Profile-approved-2019-Nov-15.pdf
Giordano, A. L., Bevly, C. M., Tucker, S., & Prosek, E. A. (2018). Psychological safety and appreciation of differences in counselor training programs: Examining religion, spirituality, and political beliefs. Journal of
Counseling & Development, 96(3), 278-288.
Haddock, L., Cannon, K., & Grey, E. (2020). A comparative analysis of traditional and online counselor training program delivery and instruc-
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tion. Professional Counselor, 10(1), 92-105.
Hammel, G. A., Olkin, R., & Taube, D. (1996). Student-educator sex in clinical and counseling psychology doctoral training. Professional Psychology Research and Practice, 27(1), 93-97. 10.1037/0735-7028.27.1.93
Hays, D. G., Bayne, H. B., Gay, J. L., McNiece, Z. P., & Park, C. (2021). A systematic review of Whiteness assessment properties and assumptions:
Implications for counselor training and research. Counseling Outcome
Research and Evaluation, 1-17. 10.1080/21501378.2021.1891877
Nova Scotia College of Counselling Therapists. (2020). Entry-to-practice
competency profile. https://nscct.ca/wp-content/uploads/2021/01/
Competency-Profile-R-00.0-2020.pdf
Pope, K. S., Levenson, H., & Schover, L. R. (1979). Sexual intimacy in psychology training: Results and implications of a national survey. American Psychologist, 34(8), 682-689. 10.1037//0003-066X.34.8.682
Ray, D. C., Lankford, C. T., Malacara, A. B., Woehler, E., & McCullough, R.
(2021). Exploring counselor experiences of training in relational depth:
An interpretative phenomenological inquiry. Journal of Counseling &
Development, 99(1), 84-95.
Vygotsky, L. S. (1978). Mind in society. Harvard University Press.
Welfel, E. R. (2016). Ethics in counseling & psychotherapy: Standards, research, and emerging issues (6th ed.). Cengage Learning.
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ADOBE STOCK
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Recent decades have witnessed global growth in technology-based, electronic, and online communication. This
expansion of technology in both personal and professional
domains has been accompanied by developments in the
counselling/therapy profession. Programs and services may
be assisted, supported, or delivered by technology. For example, counselling/therapy may involve synchronous approaches such as phone conversations or online meetings, and
asynchronous approaches such as text and email correspondence, any of which may take place across vast distances.
Foundational ethics for the counselling/therapy profession remain at the cornerstone of all actions; however,
counsellors/therapists face additional considerations when
utilizing technology for administrative and/or therapeutic
purposes, including public health and privacy acts.
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H1. Technology-based Administrative Functions
H2. Permission for Technology Use
H3. Purpose of Technology Use
H4. Technology-based Service Delivery
H5. Technology-based Counselling/Therapy Education
H6. Personal Use of Technology
H7. Jurisdictional Issues
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Andrea Rivera, Sherry Law, and Lawrence Murphy
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INTRODUCTION / CONTEXT
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Technology has transformed the practice of counselling/psychotherapy,
making it more convenient and open to clients and counsellors/therapists
(Bakshi & Goss, 2019). You must have the technical literacy of the technologies you are employing, be able to use these tools effectively, understand the
inherent benefits and drawbacks of employing technologies in your practice, and be able to troubleshoot typical problems (Johnson, 2017). These
are ongoing requirements because technology continues to develop and
take on a bigger role in the delivery of therapy services. This chapter will
draw from Section H of the Canadian Counselling and Psychotherapy Association’s (CCPA, 2020) Code of Ethics and Standards of Practice (CCPA,
2021), with a specific focus on four key factors: cybersecurity, social media
impacts, technology impacts on therapeutic relationships and preparedness, and how to address fast-changing technological developments.
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RECOMMENDED PRACTICES
Cybersecurity
Confidentiality and Privacy
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The COVID-19 pandemic has forced the world to adjust to a digital
working environment. Zoom calls, Teams meetings, and Slack groups now
dominate the workplace. Counselling therapy is no different. Some of you
are working in clinics while others maintain a private practice. No matter
what the setting, it is likely that the ethical use of technology remains largely
a mystery. As technology continues to advance, it is becoming increasingly
common for counsellors/therapists to incorporate hardware technologies,
such as laptops, smartphones, and tablets, into their practice. However, although these technologies can bring many benefits, they also raise important ethical considerations that counsellors/therapists must understand.
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Article H1 highlights ethical considerations related to the administrative
functions of e-counselling, Article H2 emphasizes the importance of securing informed consent from clients before using technology with them, and
Article H3 refers to clearly explaining both policies and purposes related to
any technology being used. One of the key ethical considerations in all of
these articles is the confidentiality and privacy of client information. With
the widespread use of technology, it can be challenging to ensure that client
information is kept confidential and secure. For example, digital files and
data may be vulnerable to hacking, data breaches, or unauthorized access.
This can have serious consequences for the client’s privacy and well-being,
and it is the counsellor’s responsibility to ensure that client information is
protected. In addition, you must have a good understanding of Canadian
privacy laws, such as the Personal Information Protection and Electronic
Documents Act (PIPEDA; Office of the Privacy Commissioner in Canada,
2019), and how they apply to the use of technology in practice.
Understanding cybersecurity in its totality is an insurmountable task,
even for cybersecurity experts! The point of this section is not to inundate
you with recommendations that you must adhere to, as we are counsellors/
therapists and not tech experts. Nonetheless, there are ways to ethically approach your technology use. Here are some questions to consider.
1. What are all the devices you use for work purposes?
2. Are these devices password protected?
3. Who has the passwords?
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Are you storing files on a cloud server?
Are you storing your files on a jump/thumb drive?
Are your files or the jump/thumb drive encrypted?
Do you know what two-step verification is and what it can do?
There are many questions that can be helpful in making better ethical
choices as a counselling therapist and more still as these technologies continue to advance. CCPA has dedicated resources in the form of guidelines
to help counsellors to evaluate appropriate technological solutions (Schell,
2019). Remember that these guidelines are not meant to be laws. Not every
single security measure must be perfect. As a matter of fact, it can’t be. Even
experts can make mistakes.
No matter what protocol or guide you use, what matters is that you take
time to approach technology thoughtfully. Research has shown that a major
vector of security breaches is human error (Liginlal et al., 2009). Therefore, people’s electronic security often becomes compromised not because
of hardware or software issues, but because people click on links, or divulge
sensitive information to others willingly.
Jurisdiction
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4.
5.
6.
7.
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Another issue that comes up regularly is the question of jurisdiction;
when we are online where can we practice? There is no simple answer to
this question, and the reality is that, over the last 2 decades, the goalposts
have moved often. Part of the reason for this is that Canadian law generally
continues to face significant challenges in determining jurisdiction.
Article H7 describes how the counsellor/therapist may be subject to the
laws and regulations of where the counsellor/therapist is located as well as
where the client resides. A third issue sometimes comes into play when, for
example, a resident of Ontario is visiting family in Alberta and, suddenly,
requires our services. Here the location of the client may also be relevant.
Further, the location of the server where data is stored or passed through
may also be relevant (Johnson, 2017).
The recommended strategy for counsellors/therapists to take is to contact both their professional association/college and their liability insurance
provider. The latter will always have clear explicit rules about what you can
and cannot do. For example, one of the authors who runs a counselling and
training practice was told that one of their therapists who spent a good deal
of time in the USA (she was Canadian and had married an American) could
teach courses and provide supervision from the United States regardless of
the location of the student or counsellor. However, when she was delivering
counselling, she had to cross the border into Canada for the duration of the
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online session. The insurance company was unconcerned about the location
of the client.
Your provider will have their own rules and it is worth shopping around.
Different insurance providers regularly have different policies in this area.
What is also important not to ignore is the policies and direction provided
by your association/college, as many do have very explicit rules around jurisdiction, while others are less clear. In general, professional colleges have
much more explicit policies and rules around where their registrants can
practice while working online, and even directive procedures that explain
what you must do to work outside of your normal jurisdiction.
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The use of social media has become ubiquitous in our daily lives and
has revolutionized how we communicate, interact, and share information.
Article H6 provides some guidance on the personal use of technology by
counsellors/therapists (e.g., monitoring the style/content of their messages for ethical congruity and professionalism; attending to privacy/security
considerations). Social media can help individuals connect from all over the
world with the click of a button and customize their community experience.
However, although social media can have many benefits, it can also have a
profound impact on the therapeutic relationship between a client and their
counsellor.
Social media may seem like a personal experience where information
about you can be shared freely with those you love. Some even use these
platforms as a way of sharing the play-by-play of their thoughts and experiences throughout the day. Though it may be true that sharing details on
a private network, especially with security settings, can provide some measure of privacy, it has become common practice for people to be verified and
vetted through social media and other Internet platforms. In addition, what
a person shares on their social media could be unwittingly shared to a public
network through friends, family, and strangers where it can become visible
to anyone. This creates a permanent record of a person’s thoughts, opinions,
and ideas that could be misconstrued or taken out of context. It is also important to consider whether or not your personal opinions, thoughts, and
ideas can be connected to your professional life, as this is a growing challenge for health practitioners to ensure they remain speaking within their
competence, and not have the information skewed in a way that brings unintended potential ethical violations.
Social media also has a way of changing people’s behaviour. Engaging
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with social media thoughtlessly can skew a person’s perceptions. Communities within social media platforms can quickly become echo chambers
where opinions, attitudes, and claims are repeated and often weaponized
(purposefully or not). We are likely all familiar with platforms and apps
which create a filter on pictures and videos, often slimming the face, widening the eyes, and uplifting the brows to create a type of look. These filters,
when used and consumed often, can set an unrealistic standard of beauty
for people.
As such technology becomes more sophisticated, you may find yourself
working with a client whose video image is slightly, or even entirely, different from their real appearance. Even their voice may be altered. In-person,
a client’s appearance can give us clues to their physical and mental health
(e.g., whether they look haggard or well-rested, whether the pallor of their
skin is notable, whether their eyes are bloodshot or pupils dilated). The ability to hide such facial aspects could get in the way of us doing our best work
for our clients. If in doubt, it is worth broaching the subject.
In the same way, communities that amplify certain opinions may lead
one to believe that the world agrees, or that the opinion is popular when
it might be the case that these opinions are unpopular, harmful, or even
dangerous. Joining these communities can happen naturally, whether one is
a counsellor/therapist or a client, and can become an increasingly involved
extension of our lives. For example, if we love our pets and are concerned
about animal welfare, it is natural to gravitate to communities that share
similar values. We take advice from community members, request feedback,
and build trust overall over time. When these communities develop more
polarizing beliefs and share posts making claims that are not verified, it is
easy for members to get swept up emotionally into those beliefs and perpetuate inaccurate or inflammatory stances. It is helpful to learn about the different communities that our clients may be a part of (in the physical world
as well as digitally) so we can support them in managing their wellness outcomes. It is also just as important that we are mindful of what communities
we decide to engage in as practitioners and how they may impact our biases
and judgment. Creating healthy boundaries with technology can help us
to disentangle from potentially harmful digital communities. However, it is
still important to keep abreast of what these communities can look like and
feel like so we can best understand and support those in our care.
Social media can also be used to spread misinformation about mental
health and therapy. This can lead to clients self-diagnosing, seeking treatment for conditions that they do not have, or refusing to seek treatment for
conditions that they do have. This can have serious consequences for the client’s mental health and overall well-being. Though many practitioners can-
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not diagnose or inform clients of diagnoses, it is helpful to guide our clients
to speak to people in the healthcare system who are qualified to conduct assessments to verify any condition the client feels they may or may not have.
It is therefore important for counsellors to be aware of the potential
impact of social media on their clients and themselves. They should take
steps to educate themselves about the use of social media and its potential
consequences, and they should encourage their clients to be mindful of the
information that they view and share online.
Impacts of Technology on the Therapeutic Relationship
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Article H5 outlines several considerations for the use of technology in
therapy (e.g., counsellor competence with technology, client preparedness,
digital security). Although convenient and effective, technology-based service delivery presents a unique set of challenges to establishing and enhancing the therapeutic alliance. Given that clients regularly come in vulnerable
states to receive services, therapists must be equipped to handle unexpected
situations such as Internet connection issues or technical difficulties with
software or hardware. Beyond preparedness, you also need to be able to
communicate properly and maintain healthy boundaries in your use of
technology (Drum & Littleton, 2014). Clients rely on therapists’ effective
communication to feel that they will be safe and receive a positive therapy
experience. Being able to handle technical difficulties is an important aspect
of fulfilling a professional responsibility. It can help to build trust and rapport with clients, as they can see that the counsellor/therapist is professional
and competent in their practice. This, in and of itself, enhances the therapeutic alliance.
It is also crucial for you to be able to provide clear instructions and
guidance to clients who may not be familiar with the technology if you plan
to use this in your practice. This can include how to use the platform, how
to participate in a session, and how to maintain privacy and confidentiality
during the session. If a therapist is unable to communicate these instructions effectively, it can create confusion and frustration for the client, which
can negatively impact the therapeutic relationship. An example here would
be understanding how the platform selects audio outputs; a client may have
some struggles as they want to maintain their privacy by using a Bluetooth
headset so no one else in their home hears much of the conversation, but
they may be having issues navigating your platform. This is when it would
be important for you to know how your platform works, to guide them on
what to do so they may maintain the confidentiality they desire.
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Therapists need to have the ability to effectively use technology to
communicate with their clients. This can look very different depending on
which technology is being used; however, in all instances, verifying the true
identity of the client is important (Johnson, 2017), especially when working
with youths to verify the age for consent (Teufel-Prida et al., 2018) which,
when not done properly, can have heavy ethical impacts. Some referral
sources provide identifiers. In absence of that, some counsellors request ID
at the first session (e.g., a driver’s license) or, if working over the phone,
hold the first session via video-conferencing to verify that the person is of
age to consent to counselling. To confirm location, some counsellors ask clients to take their laptop or phone outside to show, via videocam, the address
number on the building, ensuring it matches the address on the intake form.
However, caution is recommended on becoming overly strict on confirming
identity that could interfere with building the therapeutic relationship. As
long as the person who presents as the client appears to be telling the truth
and demonstrates capacity to provide consent to counselling then, legally,
the counsellor/psychotherapist has done what was reasonably expected to
confirm the identity and capacity of the client.
The strategies one would use for communicating over the phone with a
client will be very different from communication using video-conferencing
software or texting. For example, phone counselling lacks non-verbal communication and text-based counselling lacks both non-verbals and tone of
voice (Harris & Birnbaum, 2014). This can lead to miscommunications, and
misunderstandings of the intent of the message (Bakshi & Goss, 2019). Understanding how (and when) to compensate for these missing components
is critical to good communication and to establishing and enhancing the
therapeutic alliance. Even video is not immune to these considerations. Sit
at your computer and look at a colleague with whom you’re video chatting.
You typically cannot see below the middle of their body. Non-verbals that
are off-camera (e.g., the anxious tapping of a leg or the wringing of hands)
may well be critical to understanding the client’s state of mind. By not seeing
them, we (unintentionally) ignore them.
Technology use also risks blurring boundaries. Drum and Littleton
(2014) highlighted three main boundaries that can easily be broken: time,
setting (i.e., where the session is being held), and personal boundaries of
therapists. They provided nine recommendations to support the healthy
growth of therapeutic relationships, confidentiality, and ethical care:
1. Maintain professional hours and respect the timing of
sessions.
2. Ensure timely and consistent feedback and manage
excessive communications.
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3. Ensure a private, consistent, professional, and culturally
sensitive setting.
4. Ensure the privacy of non-clients and prevent unintentional self-disclosures.
5. Ensure that telecommunication technologies used convey professionalism.
6. Model appropriate self-boundaries.
7. Ensure privacy of the therapist’s work.
8. Use professional language and consider alternative
interpretations.
9. Ensure competence in the practice of telepsychology.
(pp. 8 – 11)
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The use of technology in therapy has brought about a range of benefits
and advantages, but it also requires therapists to be prepared for the unique
challenges and ethical considerations that come with it. In addition, as
counsellor-education programs begin to incorporate fully online or blended instruction components, Article H5 provides ethical guidance on these
modes of delivery.
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The quick advancement of technology is not new. Consider the last time
you used a flip phone and then recall when the first touchscreen phone came
about - not so far apart in time! Technology changes quickly, and people
depend on it more and more for communication, efficiency, and support.
Psychological flexibility as “the capacity to persist or to change behaviour
in a way that includes conscious and open contact with thoughts and feelings, appreciates what the situation affords, and is guided by one’s goals and
values” (McCracken & Morley, 2014, p. 8) can support you greatly in maintaining your skills and adjusting to developments regarding the changes in
technology. As such, it’s important to look inwards and build awareness of
the idea of maintaining your skills in an ever-growing and ever-changing
environment. This is true for both the delivery of services (Article H4) and
the education and training of counsellors/therapists (Article H5).
A clear example was how quickly counsellors/therapists had to adapt to
the use of technology to be able to continue supporting their clients through
COVID-19 closures (Comer, 2021). Those who adapted quickly were able to
support their clients in one of the most difficult moments in current history. Having that flexibility allowed many to use technologies they had never
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used before; both hardware and software. However, some were blindsided
by this drastic change and were seriously challenged in their ability to provide services to their clients. And, of course, this also affected clients in various ways as many did not have the skills to manage the shift from in-person
sessions to e-counselling.
The ability to maintain psychological flexibility and adaptability in the
face of rapidly changing technology is a crucial skill for counsellors/therapists. By staying up-to-date with the latest developments and advancements
in technology, you can ensure that you are equipped to provide the best possible care to your clients, regardless of the challenges and obstacles that you
may face. The COVID-19 pandemic has shown all of us just how important it is to be flexible and adaptable in the face of change (Prudenzi et al.,
2022), and has highlighted the need for us to continue learning and growing
as professionals. By embracing the opportunities that technology provides,
you can continue to help your clients navigate their mental health journeys
with confidence, competence, and compassion. To maintain a high level of
ethical proactivity in areas such as informed consent, confidentiality, and
data privacy, you will likely need to seek out ongoing training in these areas.
Clients deserve nothing less.
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Counsellors/therapists are not typically cybersecurity experts and, as
such, they face several challenges when dealing with cybersecurity issues.
For one, they may not have the knowledge or training necessary to identify
potential cybersecurity risks or to make informed decisions about how to
best protect their clients’ information. This can lead to a sense of paralysis
by analysis, where counselling therapists may feel overwhelmed by the complexity of the issues and unsure of what steps to take. Additionally, therapists
may also be constrained by factors such as budget and time, which can further complicate their ability to address cybersecurity concerns. To mitigate
these challenges, technological considerations will have to be incorporated
with the modules introduced in the standard curriculum across Canada.
Until these curriculum changes have been made, it will be up to you to empower yourself to take cybersecurity and other issues technologies present
into your own hands. Through doing so, help to build the landscape for
change in our profession. This is most easily done by accessing available
training in e-counselling and associated issues.
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It is the case that counsellors/therapists were forced to adjust their practices to be able to provide services through online means or via telephone
as a result of COVID-19 restrictions. But it begs the question of how many
people had the proper training to provide such services at the outset of the
pandemic and whether they have received the necessary education to continue to provide such services post-pandemic.
CCPA’s (2020) Code of Ethics includes H4 - Technology-based Service
Delivery. This section highlights that counsellors/therapists need to have
demonstrated and documented competence through appropriate and adequate education, training, and supervised experience to incorporate technology into their practice. It is of utmost importance to maintain a level of
awareness of the deficits that therapists may currently have due to a lack of
ongoing education (Bakshi & Goss, 2019) and the rapid changes in technology. This is also true for counsellor educators (Article H5). It is necessary
to maintain awareness and understanding to use the technologies efficiently and effectively both in sessions and out of sessions (e.g., administrative
tasks). The code requires that, at a minimum, we demonstrate “sound clinical judgment and the rationale [for the selection of technologies being]
documented” (CCPA, 2020, p. 29). Keeping training up-to-date also helps
counsellors/therapists to provide high-quality security of electronic health
documents, maintain good cybersecurity practices, and recognize the impacts that technology can have on the development of a healthy therapeutic
alliance and awareness of technology-based treatment options.
Just as any other aspect of counselling/psychotherapy requires continuing education to maintain high ethical standards, so does the use of technology in your services. Remember that the CCPA, often with the support
of the Technologies and Innovative Solutions Chapter (TISC), provides ongoing educational opportunities in this area. That said, counsellors/therapists are encouraged to go above and beyond what is provided through the
CCPA. It is the job of a counsellor/therapist to do their due diligence and
keep their education up to date.
Another pitfall that counsellors/therapists may face is that of lack of preparedness. Consider the following questions:
1. How well do you know how to work with your hardware and its corresponding software?
2. Do you know how to adjust your camera’s lens and focus?
3. Do you know what software you need to update to make sure your camera does its job correctly?
4. Do you know how to troubleshoot problems concerning sound that you
may face within therapy sessions?
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5. What is your plan if your client answers their call and someone else is
there with them?
6. Whom do you contact if you are impacted by a hack or malware and
your files are corrupted?
These considerations impact both cybersecurity and the clinical aspects
of sessions. We need not only to know the tools we are working with but also
to be prepared to troubleshoot situations and circumstances as they arise. In
this our grandmothers were right: an ounce of prevention equals a pound
of cure.
It is important to also note that with the continuous advancement of
technology, you need to be mindful of the possible ethical considerations
these advancements may take and how these may impact your work. An example of this is the current discussion surrounding biases within algorithms
used in various technologies that lead to the notion of nonmaleficence as
needing further consideration. (e.g., What human biases have been built
into algorithms? How might computer dependence impact individuals?;
Fiske et al., 2019). You need to be cautious when recommending tools to
clients, such as apps that may support clients’ journal habits or emotional
tracking. Although these apps can enhance the counselling relationship and
support the client’s goals, you also need to be mindful of how these apps
may not be affiliated with mental health professionals or associations, and
in other cases lack resources to support clients in emergencies, which could
jeopardize their safety. (Palmer & Burrows, 2021). A great pitfall here is to
not be well informed about these tools, particularly if you are planning to
use them in your work with clients.
One final consideration, which falls slightly outside ethical considerations but overlaps, is the clinical impact of these online environments. We
have briefly referenced the fact that the lack of tone of voice needs to be
compensated for in text-based communication. And we have noted that
non-verbals need to be focused on in all online methods, video included.
But there is more.
Online environments alter human behaviour. One example of this
is what we call disinhibition (Bakshi & Goss, 2019), wherein individuals
engage in behaviours online that they would not normally engage in in-person. Online we tend to be more open and forthright. We tend to be more
willing to speak our truth and say what is on our minds. Within the comfort
of their homes, people may be more open to sharing emotions that they
might not in a different setting (Teufel-Prida et al., 2018).
In some ways, this can be a good thing therapeutically in that clients
will disclose earlier and more completely in online environments. But they
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may also disclose more than they intended to and suddenly find themselves
more vulnerable and exposed than they wanted to be. It requires awareness
of these phenomena, best learned through training, to be able to anticipate
such situations and mitigate the risks.
Disinhibition also affects counsellors/therapists. For example, before
we engage in some form of immediacy, it is worth reflecting on whether
our comfort in self-disclosure comes from a place of clinical judgment or
whether it is a consequence of disinhibition.
As indicated through this chapter, knowledge, preparedness, and training are the best antidotes to what can be a complex and confusing area of
our field.
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CASE EXPLORATION
Case 11.1
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Suzie has been a counsellor for 25 years. They have
been working at the same agency for their entire career,
and recently a new executive director has come on board.
The agency is looking to make changes and digitize business processes. The executive director seems excited about
this switch as it will produce more clients locally and across
provinces as well as improve efficiencies in the administrative, bookkeeping and client record processes. The executive director seems focused on increasing client volume, has
no background in ethical health management, and is focusing on the financial aspect of the organization. Additionally, the executive director wants to expand service provision
across provinces and internationally to gain more financial
resources for the agency. The executive director wants to
have a conversation with the counsellors in the agency to
understand the impact that these changes may have on
the counsellors, and to find ways to support them so they
may go through the changes rapidly and effectively. Suzie is grateful for the upcoming meeting. However, Suzie is
unsure about the changes, feeling uncomfortable with being responsible for client booking, communications, record
keeping, and invoicing digitally since they were previously
only responsible for these processes in paper form. Suzie is
also unfamiliar with all the platforms associated with this
switch, such as social media pages, websites, and management systems. They are nervous about talking to their employer about their discomfort and they don’t know their
responsibilities or how to approach the topic. Suzie is also
concerned about the timelines as these changes will occur
rather quickly. Suzie is aware that they are not the only one
concerned about these changes; other counsellors in the
agency have expressed concerns too. Suzie is afraid of losing their job and feels entirely out of their depth.
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Case 11.2
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Violet is a private practitioner who has chosen a cloud
provider for her client records. The servers sit within the
country of Canada and the company she has chosen to use
is reputable and even used by her supervisor. This software
is probably even more robust than what she needs for her
practice, but she wanted to enhance client experience and
keep all her records (e.g., Customer Relationship Management [CRM], invoicing, client’s progress notes) in one place.
Violet gets a cyber-attack and it comes with a threat.
They want money for the release of all her client records
back to her. She doesn’t have that kind of money and the
threat of her clients’ confidential records making it onto the
web has her panicked.
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DISCUSSION QUESTIONS
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1. How many devices are you using? Do you have 2-factor authentication
on the most important accounts?
2. Do you know what a backup is? Do you back up the files for your private
practice?
3. Do you know what your liability insurance says about remote work with
clients and across jurisdictions?
4. Do you know if your province is regulated for counselling therapy? Do
you know what your regulatory body says about technology use and
remote clients?
5. What would be some appropriate methods of storing client notes digitally? Hard drive, cloud storage, USB devices? Is each file encrypted?
Why or why not? Explore.
6. Do you have an alternative plan in case your online platform (e.g.,
Zoom, Owl, Jane) is out of service for a period of time? What are the
steps you need to take to provide sessions and inform your clients of the
changes?
7. What are the steps you need to take in case your computer becomes
compromised (hacked)?
8. What are the steps you need to take in case your online platform holding your electronic health records is compromised?
9. When did you last review that your online platform holding your electronic health records is PHI and PIPEDA compliant? How have you
recorded this information?
10. What is your organization/private practice policy on liability for being
hacked?
11. What is the last time you received training on cybersecurity and best
practices?
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REFERENCES
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Bakshi, A.J., & Goss, S. (2019). Trends related to ethics, technology, counselling and careers. British Journal of Guidance & Counselling, 47(3),
265-273. https://doi.org/10.1080/03069885.2019.1630603
Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf Comer, J. S. (2021). Rebooting mental health care delivery for the COVID-19
pandemic (and beyond): Guiding cautions as telehealth enters the
clinical mainstream. Cognitive Behavioural Practice, 28(4), 743-748.
https://doi.org/10.1016/j.cbpra.2021.09.002
Drum, K. B., & Littleton, H. L. (2014). Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Professional Psychology: Research and Practice, 45(5), 309-315. https://doi.
org/10.1037/a0036127
Schell, D. (2019). Guidelines for uses of technology in counselling and
psychotherapy. CCPA - TISC Guidelines. https://www.ccpa-accp.ca/
wp-content/uploads/2019/04/TISCGuidelines_Mar2019_EN.pdf
Fiske, A., Henningsen, P., & Buyx, A. (2019). Your robot therapist will see
you now: Ethical implications of embodied artificial intelligence in
psychiatry, psychology, and psychotherapy. Journal of Medical Internet
Research, 21(5). https://doi.org/10.2196/13216
Harris, B. & Birnbaum, R. (2014). Ethical and Legal Implications on the
Use of Technology in Counselling. Clinical Social Work Journal, 43,
133–141. https://doi.org/10.1007/s10615-014-0515-0
Johnson, S. M. (2017). E-counselling: A review of practices and ethical considerations. Antistasis, 7(1), 38.
Liginlal, D., Sim, I., & Khansa, L. (2009). How significant is human error as a cause of privacy breaches? An empirical study and a framework for error management. Computers & Security, 28(3-4), 215–228.
doi:10.1016/j.cose.2008.11.003
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McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches
to chronic pain management. Journal of Pain, 15(3), 221–234. doi:
10.1016/j.jpain.2013.10.014
Office of the Privacy Commissioner in Canada (2019). PIPEDA in brief.
https://www.priv.gc.ca/en/privacy-topics/privacy-laws-in-canada/the-personal-information-protection-and-electronic-documents-act-pipeda/pipeda_brief/
Palmer, K. M., & Burrows, V. (2021). Ethical and safety concerns regarding
the use of mental health–related apps in counseling: Considerations for
counselors. Journal of Technology in Behavioral Science, 6(1), 137-150.
Prudenzi, A., Graham, C. D., Rogerson, O., & O’Connor, D. B. (2022).
Mental health during the COVID-19 pandemic: Exploring the role of
psychological flexibility and stress-related variables. Journal of Social
Psychology, 162(3), 239-255. https://doi.org/10.1080/08870446.2021.2
020272
Teufel-Prida, L. A., Raglin, M., Long, S. C., & Wirick, D. M. (2018). Technology-assisted counseling for couples and families. The Family Journal, 26(2), 134-142.
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This section is designed to focus on ethical constructs
related to counsellors/therapists working with Indigenous
Peoples, communities and contexts. It is based on the premise that counsellors/therapists approach Indigenous Peoples, communities and contexts from a place of humility and
not-knowing. It is based on being respectful of the unique
history of the land now known as Canada. It is designed as
CCPA’s initial response to the Truth and Reconciliation Commission’s Calls to Action in relation to ethics and standards
of practice. CCPA recognizes that this section is a first step
in the journey of a shared understanding that requires the
involvement of a grassroots, Indigenous community-driven
exploration of Indigenous-based ethics in order to inform the
ongoing development of a national Codes of Ethic and Standards of Practice for the Association.
There are multiple situations in which counsellors/therapists may be involved with Indigenous Peoples, their communities and contexts. The importance of recognizing and
acknowledging the unique history, present-day echoes of
that history, and ongoing experiences of Indigenous Peoples is critical to respectful and supportive work. Also of
importance is the mindfulness of counsellors/therapists in
acknowledging the diversityǂ of Indigenous Peoples, communities and contexts in Canada and the degree to which
clients may or may not have lived experience of their culture
and language. Counsellors/ therapists must also be attentive
to clients who may identify as Indigenous but are not from
lands now known as Canada. All counsellors/therapists acknowledge the unique historical trauma as well as the resiliency and persistent cultural vibrancy of Indigenous Peoples
and communities. (See also A12, B9, B10, C6, Section D, E12)
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I1. Awareness of Historical and Contemporary Contexts
I2. Reflection on Self and Personal Cultural Identities
I3. Recognition of Indigenous Diversity
I4. Respectful Awareness of Traditional Practices
I5. Appropriate Participation in Traditional Practices
I6. Strength-Based Community Development
I7. Relevant Cross-Cultural Practice
I8. Relationships
I9. Culturally Embedded Relationships
I10. Appropriate Use
I11. Honouring Client Self-Identification
CHAPTER TWELVE
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INDIGENOUS
PEOPLES,
COMMUNITIES, AND
CONTEXTS
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INTRODUCTION / CONTEXT
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This chapter expands upon Section I of the CCPA (2020) Code of Ethics,
which stressed the importance for counsellors/therapists, including trainees
and supervisors, to deepen their understanding of, strengthen their respect
for, and engage in meaningful ways with Indigenous Peoples, Communities
and Contexts.
As the author, I write from the traditional, ancestral, and unceded
territory of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish),
and səlilwətaɬ (Tsleil-Waututh) Nations. I am an uninvited guest here as
my mother’s family settled on Coast Salish territory after Métis land scrip
policies removed our ancestors from land near the Red River, Manitoba.
They lived in Edmonton, Alberta before coming to the Westcoast of British
Columbia in 1948. After leaving Germany in the 1930s, my father’s family
also settled near Winnipeg, Manitoba before moving to the coast in 1938.
Connected with cultural history and family, my heart lies with commu-
INDIGENOUS PEOPLES, COMMUNITIES, AND CONTEXTS
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nity-based work that helps to heal cultural wounds and bring Indigenous
families together. As one voice, I offer this chapter from lived experience
and from work as a registered clinical counsellor. With gratitude for the opportunity to gather from the literature on current counselling/therapy and
traditional healing work with Indigenous peoples in Canada, I recognize
this work is one iteration of ongoing work in the field of practice ethics.
The aim of this chapter is to gather relevant themes that inform ethical counselling/therapy practices with Indigenous communities in Canada.
Approached with humility and recognition of Indigenous diversity, the literature clearly articulates that ethical practice involves ongoing and lifelong
education, relationship building, collaboration, and critical reflection. For
example, a scan of the health and wellbeing literature highlights a noticeable
trend toward statistical data, which often casts a negative light on Indigenous peoples in Canada (see Statistics Canada, 2023). On the one hand,
these data link present day health and wellbeing outcomes to structural and
systemic colonization. On the other, for counsellors/therapists who have
not yet developed relationships with Indigenous communities, it perpetuates and upholds a negative view and overshadows strengths and resiliency.
Therefore, it must be emphasized that despite historical circumstances, the
majority of Indigenous peoples have a high degree of resiliency (Ross, 2009,
in Linklater, 2011). Collectively, Indigenous Peoples have endured intergenerational trauma; however, “ancestral resilience, survivance, strengths [and]
gifts” (Fellner, 2016, p. 217) must be acknowledged.
This chapter also emphasizes two important implications for counselling/therapy practice. First, that ethical practice with Indigenous peoples
is not carried out with an intention to “carve out separate Indigenous domains” as this is contrary to Indigenous worldviews that recognize that all
things are interrelated (Gray et al., 2016, pp. 4-5). Second, that ethical counselling/therapy with Indigenous communities must be undertaken as a form
of anti-oppression and decolonization work. In other words, it must offer a
social and political correction (Dei & Asgharzadeh, 2001) through meaningful, actionable, and decolonizing counselling/therapy practices.
To begin, counsellors/therapists deepen their understanding of the impacts of colonization through education and knowledge of the intersectionality of the structural, systemic, and institutional forces of oppression on
Indigenous communities, families, and individuals. Likewise, Indigeneity,
trauma, resistance, and renewal are considered in relationship to both historical and contemporary forms of colonization (Mitchell, 2017). Conversely, without this knowledge and understanding, counsellors/therapists risk
perpetuating colonial oppression and, therefore, causing harm. As well, reliance on non-Indigenous perspectives continues the web of oppression and
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colonization for Indigenous peoples (Duran, 2006). Moreover, when counsellors/therapists impose a different worldview on the Indigenous client it
“can be understood as a form of violence against the [client’s] knowledge
life-world” (Duran, 2006, p. 9).
This chapter comprises four sections, each focusing on several articles
from Section I. Indigenous Peoples, Communities, and Contexts from the
Code of Ethics (CCPA, 2020): History and Context (I1); Relationships and
Cross-Cultural Practice (I7, I8, I9); Traditional Practices: Respect, Participation, and Appropriate Use (I4, I5, I10); and Identity, Diversity, and Community Development (I2, I3, I6, I11). This chapter is constructed differently
than the other chapters in the text due to the nature and intent behind the
ethical codes, which emphasize a need to create relationships that do not
perpetuate colonization and systemic oppression. As the themes are presented, a Case Scenario is provided to help understand the practice considerations in applying the ethical codes and standards of practice. Questions are provided for your consideration, to encourage self-reflection about
knowledge limits, and to help highlight the Recommended Practices. This
chapter is designed to provide ethical considerations and practice approaches when working with Indigenous clients and communities; however, it is
not designed to be an instruction manual on how to work with Indigenous
clients.
HISTORY AND CONTEXT
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“Walking in two worlds” (Fish et al., 2020, p. 3) metaphorically appreciates the ways in which Indigenous peoples draw from traditional knowledges and ways of knowing and being, as well as Western influences, to fully live
their lives. In the fields of counselling and psychotherapy, which are overrepresented by Euro-Western traditions, theories, and practices, there is a
need to shift the lens to avoid doing harm. As such, Fish et al.’s (2020) Indigenous reconfiguration of Bronfenbrenner’s (1979) ecological systems model
connects Indigenous culture and history to present-day experiences. In other words, the Indigenous individual is at the centre of the model, closely in
relationship to macrosystems (cultural influences) and chronosystems (life
events, changes over time, and sociohistorical events). The reconfiguration
then places the Indigenous individual in connection to microsystem experiences (immediate environment), mesosystems (connectedness between systems), and exosystems (external, indirect environments; Fish et al., 2020).
However, it is important for counsellors/therapists to understand that even
when an Indigenous client is not connected to their culture they are still im-
INDIGENOUS PEOPLES, COMMUNITIES, AND CONTEXTS
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pacted by colonization (e.g., racism, loss of language and/or land, or a sense
of belonging). All Indigenous people have, in some way, been impacted by
colonial policies and practices (Holmes & Hunt, 2017).
RECOMMENDED PRACTICES
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Key practices that demonstrate counsellor/therapist Awareness of Historical and Contemporary Contexts (I1) include ongoing professional development to understand the impacts of colonization such as intergenerational
trauma by assimilation policies (e.g., residential schools), and practicing
in ways that decolonize (e.g., drawing from a lens of anti-oppression, such
as locating and linking sources of oppression to the present). This also includes knowledge of the Canadian Constitution (Sec. 35) (Government of
Canada, 1982), which recognizes the distinct identity of First Nations, Inuit,
and Métis peoples.
Additionally, working in culturally safe ways with Indigenous clients
involves ongoing counsellor/therapist efforts to deprivilege Western approaches, respect for the client’s proximal and local Indigenous practices,
and practice with knowledge and understanding of cultural safety; for example, as outlined by the College of Psychologists of British Columbia (2018),
recognizing the diversity between and within Indigenous groups, the role
of the social determinants of health (e.g., colonial systems and policies continue to negatively impact Indigenous peoples), and client preferences (i.e.,
the choice of Indigenous clients to participate in cultural healing practices,
or not; Western approaches; or combinations of both ways of knowing and
doing).
Knowledge and understanding of cultural safety practice-related issues
is also important (College of Psychologists of British Columbia, 2018; see
the reference section for a link to this cultural safety work), including attention to client/therapist values and beliefs, particularly when rooted in
Western values and approaches, conscious and unconscious biases and stereotypes about Indigenous peoples, as well as the role of cultural humility in
creating safe therapeutic space for Indigenous clients. Cultural humility involves approaching each new relationship with openness (e.g., to learning,
self-reflection, and challenging cultural biases). It also involves addressing
power imbalances in practice and in the profession, as well as institutional
accountability (Waters & Asbill, 2013).
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Article A12 of the CCPA (2020) Code of Ethics speaks to the ethical responsibility of all counsellors/therapists to enhance their diversity awareness, sensitivity, responsiveness, and competence with respect to their own
self-identities and those of their clients. Article B1 speaks to the role of
counsellors/therapists to respect the integrity of, promote the welfare of,
and work collaboratively with clients to devise counselling/therapy plans
consistent with client needs, abilities, circumstances, values, and their cultural or contextual background. In practice, this involves minimizing the
impulse to privilege Western forms of training that place the counsellor/
therapist in the expert role. Colonial policies and practices were instituted to assimilate Indigenous peoples and this continues to be reinforced in
Western practices, while undermining Indigenous culture (Rogers et al.,
2019). In response, with Indigenous clients, ethical counsellors/therapists
place Indigenous ways of being and knowing first.
Similarly, Article B9 emphasizes the importance of respecting inclusivity, diversity, difference, and intersectionality, and for counsellors/therapists
who conduct clinical supervision, Article E12 emphasizes the importance
of continually seeking to enhance their diversity awareness, sensitivity, responsiveness, and competence, and to explore with their supervisees the
various aspects of cultural diversity. Although these diversity-related parts
of the Code are not specific to working with Indigenous peoples, knowledge
of the impacts of intersectionality will be a key indicator of ethical practice; for example, it is important to recognize the oppression and inequality
Indigenous peoples face because of structural, institutional, and systemic
biases. Also, as highlighted in Article I3, there is significant diversity within Indigenous individuals and communities. Curiosity, openness, and responding with cultural humility, listening to needs, and respecting Indigenous interests, values, and practices, are a few ways to begin this work.
PITFALLS / CHALLENGES
One of the major pitfalls that counsellors/therapists face is practicing
without cultural humility – in other words, without active listening for the
client’s sense of cultural self, the creation of a safe space, and efforts to check
for bias and stereotypes that create client mistrust. Similarly, another pitfall
is not consistently recognizing cultural diversity both within and between
groups. Clients who identify from shared Nations or cultures will have
unique identities, connections, and experiences. Key pitfalls to avoid are
practices that generalize knowledge about one culture to another; that is,
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Case Scenario
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not listening for the unique identity, cultural expression, and connection of
each Indigenous client. Likewise, missing knowledge, skills, or understanding from the abovementioned Recommended Practices section could indicate that the counsellor/therapist is not practising respectfully to the ethical
principles of Indigenous Peoples, Communities, and Contexts.
Additionally, Article A3 (Boundaries of Competence) has relevance
here for potential pitfalls/challenges (CCPA, 2020). In line with recognizing
boundaries of professional competence, it causes harm to Indigenous clients when counsellors/therapists practice without cultural knowledge and
respect for diversity (e.g., it replicates invisibility). There is a shared history
of colonization, yet Indigenous peoples must be understood in their unique
contexts of culture, language, geography, politics, and social, jurisdictional,
and legal conditions. What’s more, it is the ethical responsibility of counsellors/therapists and their supervisors, trainees, and educators, to practice
with Awareness of Historical and Contemporary Contexts (I1), as well as to
deepen their understanding and strengthen their knowledge about Indigenous cultures.
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A 42-year-old Indigenous student, who has returned
to post-secondary studies in education after a 20-year absence from school, seeks out counselling. The student, an
intergenerational residential school survivor, is feeling triggered by the course content, a few classmates, and one of
the program instructors. They are finding it hard to sleep,
instead overthinking and processing the events of the day,
feeling anxious and overwhelmed, and increasingly doubt
whether they can complete the program. They have considered meeting with program administrators but are held
back by fear. Consequently, with this immense stress they
are falling into old patterns of alcohol misuse.
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Questions to Consider
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As a counsellor/therapist working ethically, consider these questions:
• How can you create cultural safety and respond with humility as
you begin work with this client?
• How do you formulate your initial understanding of the problem?
• What biases have you identified in trying to understand the problem?
• The client is Indigenous but their cultural connection has not been
shared. How will you as a counsellor/therapist approach the client’s
Indigeneity (e.g., identity and their relationship to Indigenous culture)?
• What are the historical impacts (e.g., intergenerational trauma
through residential school) that might be impacting the client?
• How does the client describe the complexity of the issues? (e.g., student life, current triggers and anxiety, historical trauma and triggers, fear of asking administrators for help, and alcohol misuse).
• How might the client and you as the counsellor/therapist collaborate to contextually understand the problem?
• What strengths does the client draw from (e.g., the client’s wellbeing practices, advocacy, and/or agency toward the problem)?
• How might the client and you as the counsellor/therapist collaborate to explore responses to the problem?
• How will you as the counsellor/therapist assess whether the client
felt heard, respected, and supported in this session?
• How will you as the counsellor/therapist:
» assess cultural safety and humility as the session ends?
» create space for session feedback from the client?
» integrate this feedback into future sessions and/or ways of practicing?
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RELATIONSHIPS AND CROSSCULTURAL PRACTICE
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This section explores three articles: I7. Relevant Cross-Cultural Practice, I8. Relationships, and I9. Culturally Embedded Relationships. The
health of Indigenous peoples as they walk in Two Worlds, as referenced
above, is understood from factors beyond social determinants, including
geographic place, connection to land, language, spiritual, historical, and genealogical influences, along with culture, gender, age, and structural factors
Recommended Practices
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(Greenwood et al., 2015, in Holmes & Hunt, 2017).
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Counselling/therapy practice considerations include integrating multidisciplinary approaches to Western healthcare with Indigenous healing
practices. Arguments for, at minimum, traditional healing modalities and
integrated Western approaches for individuals of diverse, ethnic, and cultural backgrounds are supported in the research literature. In line with health
care practices, mental health practitioners also acknowledge the value of traditional healing practices with mainstream practices (Oulanova & Moodley,
2017).
However, key differences emerge and indicate an ethical focus for counsellors/therapists. Specifically, traditional Indigenous ways of healing draw
from holistic worldviews and recognize the interrelationship between mind,
heart, body, and spirit. This departs from Western psychological theories
and practices which generally focus on mental and emotional components
(Duran, 1990, in Oulanova & Moodley, 2017). Moreover, this view can be
distilled further into four considerations as “the conceptualization of wellness and healing, the place of spirituality, the nature of the therapeutic relationship, and the role of the client’s environment” (Oulanova & Moodley,
2017, p. 92). Accordingly, as counsellors/therapists develop integrative approaches they consider the following practice anchor points, as highlighted
by Oulanova and Moodley (2017), ensuring that:
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•
the approach is holistic, trauma-informed, oppression-informed, and culturally-based;
•
mainstream education is ongoing (training in counselling/therapeutic techniques);
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referral involves collaboration (Indigenous Elders, traditional healers, and mainstream mental health practitioners); as well as ongoing learning about:
•
Indigenous communities (learning and respecting
local protocols and Elders’ teachings)
•
the role of ancestors (learning and respecting the role
of traditional self-care and family helpers)
•
traditional elements (healing practices, plant medicines, on the land/out of office settings).
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Pitfalls / Challenges
(p. 92)
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Challenges and pitfalls emerge where there is a lack of respect and consideration for “centering Indigenous voices” (Fellner, 2016, in Beech, 2021,
p. 24). More specifically, in some situations, counsellors/therapists lack engagement and avoid efforts to decolonize practice through lifelong learning
(e.g., as a first step, learning the truth about Indigenous histories). Devaluing holistic approaches and Indigenous ways of knowing, and losing sight
of Two-Eyed ways of being (Fish et al., 2020), which draws from Indigenous
approaches and Western modalities (Beech, 2021), is another common pitfall.
A third pitfall arises when counsellors/therapists attempt to build relationships from a place of practitioner as expert, and a deficit view, which
often leads to focus on “pathology, dysfunction, and victimization” (Linklater, 2011, p. 41), instead of resiliency. A lens of resiliency is strength-based,
recognizing protective factors such as family and community support, while
simultaneously regarding the conditions Indigenous clients may be enduring (Linklater, 2011).
In terms of relationships, a fourth pitfall/challenge has relevance for
rural communities because there may be situations where dual relationships exist (e.g., community members holding multiple roles that require
engagement or collaboration). Boundary issues can also emerge where there
are limited mental health resources to meet community needs, and where
counsellors/therapists, social and health practitioners, and community
members, as mentioned, take on multiple roles.
Probing this further and following a call for literature on opportuni-
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ties for counselling and mental health in northern Canada, O’Neill et al.
(2016) completed a 3-year research project. The findings determined that,
to address complex problems, place-based approaches are critical. Due to a
lack of specialists in the north, and given the reliance on generalist practice,
counsellors/therapists working in northern regions need to respect and value the knowledge of Elders. Relationship-building is an essential component
of this work, as counsellors/therapists work with and alongside Elders and
local knowledge-keepers who practice traditional forms of healing (O’Neill
et al., 2016). These findings have relevance for other northern, rural, and/
or remote communities, highlighting the need for counsellors/ therapists
to practice as generalists (to meet a range of needs), to be knowledgeable
around local contexts, and to be willing to work collaboratively with Elders,
knowledge keepers, and local health and wellbeing practitioners.
Case Scenario
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A 23-year-old Indigenous individual initially sought
counselling/therapy for past trauma and family issues.
After the first session, the client cancelled the follow-up
session. A brief counsellor/therapist phone call to the client brought to light additional information: The client said
they felt uncomfortable in the counsellor/therapist’s office,
describing the surroundings as “clinical” not cultural, and
the counsellor/therapist’s lack of knowledge about their
culture and history led them to feel it was not a “good fit.”
They also felt uncomfortable when the counsellor/therapist
focused on past clinical diagnoses, minimized their desire
to explore dreams and stories, and emphasized immediate problem-solving through cognitive behaviour therapy
(CBT) exercises.
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Questions to Consider
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As a counsellor/therapist, what are your initial ethical responses to
the client deciding not to follow through with sessions?
How can you ethically:
» make your office a culturally safe place?
» ensure cultural sensitivity in your office space without appropriating culture (e.g., taking, extracting culture for personal gain)?
» find the balance between the client’s cultural ways of healing
with mainstream approaches (e.g., psychoeducation)?
» respectfully collaborate and develop relationships with Indigenous Elders/knowledge keepers/healers/helpers? How will you
learn about the local protocols to begin this work?
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TRADITIONAL PRACTICES:
RESPECT, PARTICIPATION, AND
APPROPRIATE USE
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This section explores three articles that have relevance for traditional practices and appropriate use: I4. Respectful Awareness of Traditional
Practices, I5. Appropriate Participation in Traditional Practices, and I10.
Appropriate Use. Indigenous clients who seek counselling might also be
engaged with traditional healing practices. Therefore, it is important for
counsellors/therapists to recognize that there is no universal application of
traditional healing practices, either between or within cultures. Teachings
pass through generations, from Elders and knowledge keepers, and have
local applications. In other words, “there is no single source on traditional
healing” (Reeves & Stewart, 2017, p. 126).
However, several themes weave across traditional practices: Concepts
of wholeness, relationships, interrelationships, connectedness, growth, balance, and harmony as well as respect for land, water, nature, animals, plants,
and elements such as sun and moon (Hart, 2002; Reeves & Stewart, 2017).
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Recommended Practices
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Distance or disconnection from traditional teachings can have negative
health impacts. For example, healing is a process, a journey of the bringing
together of the whole aspects of self (mind, heart, body, and spirit), working to balance and integrate these aspects. Healing is also a fluid process, a
circular journey, as we consistently respond to the need for balance. Balancing and healing work often begins with grounding practices, such as prayer,
ceremony, connecting with values, or calling upon the energies of love,
thankfulness, and/or gratitude (Bear Hawk Cohen, in Reeves & Stewart,
2017). Also important is emphasizing that, in healing and cultural contexts,
ceremony is relationship: “The purpose of any ceremony is to build stronger
relationships or bridge the distance between our cosmos and us” (Wilson,
2004, p. 251).
Traditional healing also draws from holistic ways of being (as mentioned, the mind, heart, body, and spirit), with practices that may involve
herbal (plants), ceremonial practices, physical, and counselling medicines
(Reeves & Stewart, 2017). Collective practices may involve talking circles,
sharing circles, healing circles, or spiritual circles, which brings together
participants for various forms of healing. Contemporary group work might
also engage in land-based cultural healing, such as a group joining together
in ceremony or a sharing circle (Hart, 2002). As mentioned, each Indigenous client chooses wellbeing practices in their own way; however, it is
recognized that healing and wellness occur in relationship to other contexts
because, as above, all things are connected (families, communities, and natural systems).
Collaborative cross-cultural work draws from the above-described cultural elements as well as Western paradigms such as cognitive restructuring,
social justice approaches that locate sources of oppression and their impact
on individual lives and communities, as well as problem solving approaches
and self-awareness work (Reeves & Stewart, 2017). With this work, rather than a theoretical lens, a discursive framework can lead to meaningful
engagement. Discursive frameworks draw from “post-colonial psychology
theories, an overarching feminist anticolonial prism” (Waterfall et al., 2017,
p. 4). Feminist systemic therapy is for all genders, providing a framework
for locating the impacts of systemic oppression within individual lives. This
aligns with Indigenous psychologist Royleen J. Ross (2022), who draws
from a feminist lens, asserting that “one-size-fits-all models do not work
and seek to continue the oppressive perpetuation of unfairness and injustice” (p. 301). As such, a discursive approach “opens up space” for inclusion
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and is client-indicated, moving from topic to topic, for the exploration of
social realities (Dei, 2000, in Waterfall et al., 2017, p. 4). The purpose of this
approach is to respect client agency and explore ways that oppression has
impacted the client’s life, moving to reclaim agency and self-determination,
while viewing personal narratives from a social justice lens. In other words,
the feminist discursive lens recognizes that the counsellor/therapist is not
the expert in the lives of Indigenous clients. Similarly, one way to begin this
work is by “centering the traditional mutual-aid paradigm and traditional
healing ways and practices” (Waterfall et al., 2017, p. 4) – more specifically,
to begin the work by inviting Indigenous collaboration, as indicated by the
client.
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Counsellors/therapists may be invited to witness or participate in Indigenous community events, ceremonies, circles, or other cultural activities,
including arts, music, and wellness events and activities. Subsequently, this
experience does not imply counsellor/therapist ownership or possession
of these knowledges, teachings, or practices. Respect for Indigenous protocol is a paramount ethical concern. Indigenous teachings and practices
are passed through the generations often with oral traditions, and it is not
for outsiders or guests to translate or share this information (Waterfall et
al., 2017). The Intellectual Property Issues in the Cultural Heritage Project
(2015) defined appropriation as “taking something that belongs to someone
else for one’s own use. In the case of heritage, appropriation happens when
a cultural element is taken from its cultural context and used in another”
(p. 2). Similarly, issues of appropriation arise when non-members of Indigenous communities take, extract, and/or share knowledge, teachings, and
practices for personal gain, especially financial gain. For example, attending
a medicine bag making workshop and, in turn, offering the workshop for a
fee would be cultural appropriation.
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Case Scenario
Questions to Consider
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A 56-year-old Indigenous woman reached out for
counselling/therapy after grieving the deaths of three family members during the pandemic. After the loss, she reconnected with her cultural practices and teachings. As she
describes her connection to community-based recovery
circles, Medicine Wheel teachings, and smudging practices,
the counsellor/therapist realizes he is in unfamiliar territory.
Cultural terms such as the “Red Road,” “Four Directions,” and
“Ceremony” are also unfamiliar to him, although he is open
to learning about grief, loss, and recovery groups from the
client’s Indigenous lens.
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As a counsellor/therapist working ethically, consider these questions:
• What are some of the ways that you can learn about traditional Indigenous cultural practices?
• How can you show respect for the client’s traditional Indigenous
cultural practices?
• Are you aware of any personal negative biases towards Indigenous
cultural practices?
• Are these specific cultural practices accessible to you? For example,
where can you collaborate and integrate practices with the invitation of an Indigenous healer, cultural knowledge keeper, or Elder?
What are the protocols around this invitation?
• Describe “appropriate use” of traditional cultural knowledge and
practices in counselling/therapy.
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IDENTITY, DIVERSITY, AND
COMMUNITY DEVELOPMENT
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This section explores four articles that call for counsellors/therapists to
reflect upon their own identity, and recognize and honour cultural diversity
with strengths-based approaches: I2. Reflection on Self and Personal Cultural Identities, I3. Recognition of Indigenous Diversity, I6. Strengths-Based
Community Development, and I11. Honouring Client Self-Identification. It
is essential to recognize that approaches to Indigenous knowledge are contextual, developmental, dynamic, and relational (Fellner, 2016). This also
includes counsellors/therapists taking time to reflect on Self and Personal
Cultural Identities (I2), particularly in relationship to clinical work with Indigenous clients regarding “their locations with current colonial contexts
and question, challenge and discard beliefs that reinforce colonial ideals”
(Fellner, 2016, p. 48).
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Beginning from a place of humility, counsellors/therapists build relationships with Indigenous clients through a balance of self-disclosure (locating themselves in the work), openness to client spirituality, and client-directive therapeutic approaches, and with caution regarding assessments
and diagnostic information. Additionally, ethical practice, as noted above,
derives from a social justice lens (e.g., recognizing social inequities); values
storytelling, humour, and dreamwork; works with family and community;
as well as offers flexibility with times and locations (Fellner, 2016).
Ethical practice also centres around the principles of relationality (e.g.,
the Indigenous client’s relationship with their identity and sense of belonging, their place in community and wider contexts, such as living away
from their home community); similarly, it validates and facilitates the Indigenous client’s gifts and purpose (Fellner, 2016). Counselling/therapy
that is grounded in these approaches is more likely to lead to collaborative
strength-based community development.
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Pitfalls / Challenges
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Case Scenario
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Following Fellner (2016), pitfalls and challenges emerge when counsellors/therapists do not engage in self-reflection regarding their “cultural
misconceptions of normalcy and patronizing attitudes toward Indigenous
clients” (p. 48). Pitfalls/challenges also emerge when counsellors/therapists
have defensive reactions to current and historical socio-political realities
experienced by Indigenous peoples, are disconnected from Indigenous
communities, have fears around working with complex trauma, and focus
on mainstream approaches and “treatment scripts” (Fellner, 2016, p. 323).
Other problematic practice areas include counsellor/therapist internalized
oppression, as well as lateral violence (Fellner, 2016). Lateral violence,
also known as internalized colonial or internalized oppression, is linked
to cycles of abuse, colonization, oppression, and intergenerational trauma.
Feeling powerless against the forces of oppression, community member or
colleague reactions are pitted laterally, toward each other (NWAC, 2011).
Additional practice pitfalls and challenges include a lack of personal reflection on self-location, stereotypes, judgments, and racist beliefs and practices, and questionable motivations (e.g., is the counselling/therapy work in
the best interests of the community?; Fellner, 2016).
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Prior to a scheduled appointment, a counsellor/therapist reviews intake notes for a new client. The client is a
21-year-old Indigenous man who grew up in the care of
children and family services. His parents were also formerly in government care. The client was diagnosed with
ADHD and complex trauma and contacted the counsellor/
therapist for support with anxiety. He is also feeling overwhelmed by housing and employment issues. The intake
notes report his engagement with traditional healing practices as well as brief work with a psychiatrist, psychologist,
and social worker/therapist case management team (public
mental health services).
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Questions to Consider
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What is your familiarity and competence level regarding work with
complex trauma?
How will a strengths-based approach inform your work together?
How will knowledge about cultural diversity inform your work with
Indigenous clients – more specifically, in your work with this Indigenous client?
If you are the counsellor/therapist:
» how would you consider your location in relation to the Indigenous community and its history?
» what is your relationship to the systems and structures of oppression?
» how would you consider the Indigenous client’s relationship to
the systems and structures of oppression?
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One significant challenge in the overall field of psychology is the underrepresentation of Indigenous practicing and/or teaching psychologists
in Canada, which, in 2018, was less than 12 psychologists (Ansloos et al.,
2019). As the counselling psychology field and counselling/psychotherapy
professions are so similar, it is expected that this underrepresentation would
be similar. Ethical questions then emerge around the relevance of professional training in counselling and psychology programs as graduates begin
to work in Indigenous communities, particularly with limited/or without
training on Indigenous worldviews. Said another way, health is then understood as a “political construct and not a biological or technical process”
(Shah & Stewart, 2011, in Ansloos et al., 2019, p. 272). More specifically,
academic and training institutes hold decision-making power in terms of
who has access to training as well as who develops and teaches curriculum
content. Probing into the issue further and following the concise reflections
of eight Indigenous psychologists in Canada, several issues emerge. These
issues bring to light ethical concerns, including, at minimum, training in the
field of psychology that explores the impact of colonization on Indigenous
peoples. Additional shared reflections centred around educational concerns (underrepresentation of Indigenous students and faculty), geographic
and mobility concerns (as most training is in urban settings), theoretical
knowledge that moves beyond Western sources (is inclusive of Indigenous
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knowledges), as well as structural and systemic barriers (e.g., accessibility
barriers). Strengths noted, however, included the growing presence of Indigenous peoples in psychology (Ansloos et al., 2019).
A second challenge arises from the findings of a 2018 working group organized by the Canadian Counselling Psychology Conference. Following the
Truth and Reconciliation Commission of Canada’s Calls for Action (2015),
the purpose of the group was to gather reconciliation efforts regarding roles,
responsibilities, perspectives, and recommendations. This work produced a
document that has relevance for the CCPA as the report concluded that “the
field of psychology has failed to meet ethical guidelines in all four areas for
Indigenous people: “Respect for the rights of dignity of persons and people,
responsible caring, integrity in relationships, and responsibility to society”
(CPA & PFC, 2018, in Fellner et al., 2020). These findings speak to the need
for much more collective work. However, Wendt et al. (2022) cautioned
that there are no simple solutions. Broad recommendations cannot account
for diversity and require local applications. Yet, approached with cultural
humility, the gathering points for ethical counselling/therapy work with
Indigenous peoples involve conversation, consultation, collaboration, and
implementation. Common factors of psychotherapy can also be culturally
adapted for traditional and grassroots practices and thus recognized as valuable tools for counselling/therapy work with Indigenous peoples (Wendt et
al., 2022). After all, in consideration of the significant mental health needs in
Indigenous communities and historical inequities “all psychologists should
be prepared to support Indigenous clients and communities at some stage of
their career, and it is vital that they should be educated in ways that enhance
their likelihood to provide better quality of service to Indigenous peoples”
(Ansloos et al., 2022, p. 556). The same would be true for counsellors/therapists practicing in Canada; they need to prioritize skill development; for
example, as outlined by the College of Psychologists of British Columbia
(2018). See References for a link to this work, which involves ongoing work
to create collaborative and respectful working relationships with Indigenous
clients, and to engage in conversations around diversity and differences between counsellor/therapist and Indigenous clients.
As a starting point for ongoing skill development, additional reports
and information resources that focus on Indigenous communities and contexts, including social determinants of health, ADHD, anxiety disorders,
childhood, family, family violence, parenting, PTSD, cultural safety, substance use, trauma, culture, and healing, can be found on the website of the
National Collaborating Centre for Indigenous Health (NCCIH, n.d.).
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CASE EXPLORATION
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Case 12.1
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Mr. Xi is a school counsellor who is currently supporting an Indigenous 10-year-old boy who is in foster care.
Mr. Xi has met the foster mom, Naomi (35-year-old Black
women; non-Indigenous) and was happy to see she was
invested in supporting the student. The student tends to
run away from school whenever he is challenged and this
behaviour is becoming more frequent. As the school is centrally located in a busy city, it’s particularly dangerous for
the student when he does run away. Sometimes he hides
out in alleyways; sometimes he gets an older friend from a
previous foster placement to pick him up.
Mr. Xi is debriefing a recent incident with Naomi. The
student ran away from school and was found by Naomi
downtown at a bus loop. Because the student informed the
bus driver that Naomi had kidnapped him, they were hesitant to turn him over, the police were called, and Naomi
was handcuffed before the case worker was able to intervene. Naomi is furious with the school, the police, and the
student. She shares with Mr. Xi that she doesn’t need the
aggravation. Mr. Xi worries about the fit of the foster care
placement but knows that the student has been through
multiple homes just within the last few months.
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Case 12.2
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After being removed from his Indigenous biological
parents at 3 years old, James, who is now in his 40s, spent
several years in foster homes before being adopted at 7
years old into a White family. He was grateful to his adoptive parents but always felt a bit like a “fish out of water”
compared to the other two older biological children. James
really struggled to find his way through school and, in comparison to his siblings, he hasn’t established a “good” career
in the eyes of his father.
Now, as an adult, James is seeking to reconnect with
his Indigenous roots and has found his biological father
who lives in the nearby First Nations community. When he
brought this up to his adoptive parents, his mother seemed
supportive, but his father was angry. His father regularly
scoffs at James, saying he’s just using his Indigeneity as a
crutch to explain why he isn’t as successful as his siblings.
To make matters worse, James’ father is now sending him
Facebook memes about how Indigenous groups just complain.
James comes to Georgina to try to work through this
family dynamic conflict. However, Georgina has very limited experience working with Indigenous clients in situations
like this.
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Case 12.3
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Levi is a therapist working within a community organization. His client, Sonia, is an Indigenous mother of one
young girl. Sonia is working through finding out a friend
of hers died by suicide after being trapped in an abusive
relationship. Sonia, herself, is a survivor of intimate partner
violence. Because Sonia’s child is so young, she often brings
her to her appointments and she’s able to play in the children’s corner within the office.
Levi is noticing more and more that Sonia’s child is
coming in clothes that look unclean and is concerned about
Sonia’s ability to care for her.
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DISCUSSION QUESTIONS
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Based on the Code of Ethics and Standards of Practice as well as the
practice considerations in this chapter, how might a non-Indigenous counsellor/therapist:
• begin to think about the physical environment in which to welcome
the new Indigenous client?
• introduce themselves to the client? (relationship-building)
• make space for the Indigenous client to introduce themselves and
begin sharing their story?
• self-reflect for bias and misconceptions toward Indigenous clients?
(critical reflection; balancing Western counselling/therapy conceptualizations and client descriptions)
• respect the client’s ways of being and agency
• learn and follow up on the client’s wellbeing practices and therapeutic preferences (education)
• connect to Indigenous community(ies)? (collaboration while respecting protocols)
These questions have relevance and prompt reflection for the chapter as
a whole as counsellors/ therapists engage and collaborate with Indigenous
Peoples, Communities and Contexts.
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REFERENCES
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Ansloos, J., Day, S., Peltier, S., Graham, H., Ferguson, A., Gabriel, M.,
Stewart, S., Fellner, K., & DuPré, L. (2022). Indigenization in clinical
and counselling psychology curriculum in Canada: A framework for
enhancing Indigenous education. Canadian Psychology, 63(4), 545–
568. https://doi.org/10.1037/cap0000335
Ansloos, J., Stewart, S., Fellner, K., Goodwill, A., Graham, H., McCormick,
R., Harder, H., & Mushquash, C. (2019). Indigenous peoples and professional training in psychology in Canada. Canadian Psychology,
60(4), 265–280. https://doi.org/10.1037/cap0000189
Beech, L. (2021). “I’m not the expert”: Ways mental health providers decolonize their practice [Doctoral dissertation, University of Saskatchewan].
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Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press. https://doi.
org/10.2307/j.ctv26071r6
Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
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College of Psychologists of British Columbia. (2018). Cultural safety checklist. http://collegeofpsychologists.bc.ca/docs/psc/PS12%20-%20Indigenous%20Cultural%20Safety%20Checklist.pdf
Dei, G. J. S., & Asgharzadeh, A. (2001). The power of social theory: The
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Duran, E. (2006). Healing the soul wound: Counseling with American Indians and other native peoples. Teachers College Press.
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Fish, J., Hirsch, G, & Syed, M. (2020, May 1). “Walking in two worlds.”
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GreyWolf, I., & Ross, R. (2022). Pathfinding to social justice: Interweaving
our personal journeys as Indigenous feminist psychologists. Women &
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Hart, M. (2002). Seeking mino-pimatisiwin: An Aboriginal approach to helping (2nd ed.). Fernwood Books.
Holmes, C., & Hunt, S. (2017). Indigenous communities and family violence:
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Intellectual Property Issues in Cultural Heritage Project. (2015). Think before you appropriate. Things to know and questions to ask in order to
avoid misappropriating Indigenous cultural heritage. Simon Fraser University. https://www.sfu.ca/ipinch/sites/default/files/resources/teaching_resources/think_before_you_appropriate_jan_2016.pdf
Linklater, R. (2011). Decolonising trauma work: Indigenous practitioners
share stories and strategies [Doctoral dissertation, University of Toronto]. https://hdl.handle.net/1807/31696
Marshall, A., & Stewart, S. (2017). Counselling Indigenous peoples in
Canada. In S. Stewart, R. Moodley, & A. Hyatt (Eds.). Indigenous
cultures and mental health counselling: Four directions for integration with counselling psychology (pp.73-89). Routledge. https://doi.
org/10.4324/9781315681467
Mitchell, T. (2017). Colonial trauma and political pathways to healing. In S. Stewart, R. Moodley, & A. Hyatt (Eds.). Indigenous cultures and mental health counselling: Four directions for integration
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Native Women’s Association of Canada. (2011). Aboriginal lateral violence:
What is it? https://nwac.ca/assets-knowledge-centre/2011-Aboriginal-Lateral-Violence.pdf
O’Neill, L., Koehn, C., George, S., & Shepard, B. (2016). Mental health provision in northern Canada: Practitioners’ views on negotiations and
opportunities in remote practice. International Journal for the Advancement of Counseling, 38(2), 123-143. doi10.1007/s10447-016-9261-z
Oulanova, O., & Moodley, R. (2017). Lessons from clinical practice. Some
of the ways in which Canadian mental health professionals practice
integration. In S. Stewart, R. Moodley, & A. Hyatt (Eds.). Indigenous
cultures and mental health counselling: Four directions for integration with counselling psychology (pp.141-154). Routledge. https://doi.
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Reeves, A., & Stewart, S. (2017). Historical perspectives on Indigenous
healing. In S. Stewart, R. Moodley, & A. Hyatt (Eds.). Indigenous
cultures and mental health counselling: Four directions for integration with counselling psychology (pp.125-140). Routledge. https://doi.
org/10.4324/9781315681467
Rogers, B. J., Swift, K., van der Woerd, K., Auger, M., Halseth, R., Atkinson,
D., et al. (2019). At the interface: Indigenous health practitioners and
evidence-based practice. National Collaborating Centre for Aboriginal
Health.
https://www.nccih.ca/495/At_the_interface__Indigenous_
health_practitioners_and_evidence-based_practice.nccih?id=249
Statistics Canada. (2023). Indigenous peoples. Health and well-being. https://
www150.statcan.gc.ca/n1/en/subjects/indigenous_peoples/health_
and_wellbeing
Truth and Reconciliation Commission of Canada. (2015). Calls to action.
https://ehprnh2mwo3.exactdn.com/wp-content/uploads/2021/01/
Calls_to_Action_English2.pdf
Waterfall, B., Smoke, D., & Smoke, M. (2017). Reclaiming grassroots traditional indigenous healing ways and practices within urban indigenous
community contexts. In S. Stewart, R. Moodley, & A. Hyatt (Eds.). Indigenous cultures and mental health counselling: Four directions for integration with counselling psychology (pp.3-16). Routledge. https://doi.
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Waters, A., & Asbill., L. (2013, August). Reflections on cultural humility.
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Wendt, D. C., Huson, K., Albatnuni, M., & Gone, J. P. (2022). What are the
best practices for psychotherapy with indigenous peoples in the United
States and Canada? A thorny question. Journal of Consulting and Clinical Psychology, 90(10), 802-814. doi10.1037/ccp0000757
Wilson, S. (2004). Research as ceremony: Articulating an Indigenous research paradigm [Doctoral dissertation, Monash University]. https://
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SECTION
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Bringing it All Together:
Ethical Complexity in Practices
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CHAPTER THIRTEEN
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BRINGING IT ALL
TOGETHER
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Ethical Complexity in Practice
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INTRODUCTION
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The following section contains additional cases containing ethical situations and dilemmas for exploration and discussions. These cases do not
have proposed solutions in Section 4, and at times contain more complex
scenarios than seen in the cases presented throughout Section 3. We invite
you to review the process of using the ethical decision-making models in
Chapter 3 of this text to remind you how to explore the cases from different
models while using the CCPA (2020) Code of Ethics and Standards of Practice (CCPA, 2021).
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Parker the Practicum Student
Parker, a 40-year-old Caucasian practicum student in
counselling, was committed to learning more about how
to work effectively with Indigenous clients, completing a
significant amount of extra course work, volunteer experience, and independent research during his master’s program to support this goal. His practicum was onsite in an
Indigenous community in northern Canada; aside from his
counselling practicum, Parker spent many hours at com-
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munity events and learning from the Elders, gaining the respect of many community members and leaders. Although
there was an Indigenous psychologist onsite, she was not
Parker’s practicum supervisor. The supervisor, for Parker on
his practicum and for the psychologist and other counsellors, was a licensed psychologist who had immigrated to
Canada 10 years ago. The supervisor had very limited community connections and worked exclusively offsite, supervising Parker via Zoom meetings and by reviewing video
recordings of some of his sessions.
Parker presented as very confident about his knowledge, highly committed to ethical practice, and yet also
culturally humble; very open to learning more about how
to better serve the Indigenous community. He developed a
strong relationship with the onsite psychologist, but struggled to work effectively with his assigned supervisor – in
part because of that supervisor’s lack of connection to the
community and apparent lack of interest in, or concern
about, the community’s culture and values. A breaking
point in their relationship revolved around the supervisor’s
insistence on video-recording every session regardless of
the client’s perspective (i.e., if the client refused to have
the session video-taped, Parker was not allowed to provide
counselling).
Parker, with support from the onsite psychologist and
two Elders, decided to honour one client’s request not to
be videorecorded. The onsite psychologist, based on previous experience in her own training, stated that debriefing
the session within 24 hours, along with detailed case notes,
would be sufficient. The Elders agreed.
The next day, Parker was called into a meeting with his
offsite supervisor (surprisingly onsite) and the office manager. The practicum placement was terminated immediately with no option for remediation. The stated reason was
that the student presented too much of a risk to vulnerable clients and acted against the explicit requirements of
the site supervisor, under whose liability insurance he was
working.
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Parker raised several ethical concerns with his practicum course instructor, wondering whether or not the supervisor could or should be reported for ethical violations
related to lack of an opportunity for remediation, improper
termination of counselling with vulnerable clients, and inappropriate use of power by the supervisor given his own
vulnerability as a student. He stated that ethical moral concerns superseded respect for the supervisor’s authority.
Parker reported not feeling safe with the site supervisor;
interestingly the site supervisor had also used those same
words when debriefing with the practicum course instructor – not feeling safe with Parker.
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Molly, a private practitioner with 8 years of counselling
experience and her Canadian Certified Counsellor (CCC)
designation but no previous supervision experience or
specific training in supervision, approached the university
she had graduated from to offer to take on two practicum
students. After a meeting with her accountant about the
need to grow her business to make it financially viable,
Molly thought about how practicum students could offer
a way to serve some of the folks she was turning away because they couldn’t afford her fees; she also thought this
would be helpful for practicum students, remembering her
own experience of trying to secure a practicum site with
little support from her university. She thought that offering
counselling with a student at 75% of her regular fees would
attract new clients, provide a much-needed site for the students, and, even accounting for her supervision time, would
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bring in significant additional money to her company.
Molly shared this idea with another counsellor in the
community, hoping for referrals. The counsellor, however,
raised several ethical concerns.
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Sam’s First Day
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Sam, on Day 1 of the first practicum, was seeing the
very first client. With the client’s permission, the session
was being recorded for later review with the site supervisor. Within the first 15 minutes of the session, the client began to speak about suicide – including several previous attempts and a plan that was more failsafe for next time. Sam
was alarmed but didn’t know how to ask for help. The site
supervisor, after showing Sam the counselling room in the
morning, mentioned heading offsite to a meeting. The front
desk receptionist was a temp, in for his first day as well.
When the supervisor later reviewed the recording
of the session, it clearly hadn’t gone well. The supervisor
phoned Sam’s practicum course instructor, complaining
about Sam’s lack of preparedness and requesting a different, more equipped, practicum student. A remediation plan
was developed for Sam by the practicum instructor.
From an ethical perspective, however, should there be
any consequences for the site supervisor or the practicum
instructor approving the placement?
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Double-Dipping
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To increase the number of practicum sites for students,
a masters in counselling program decides to pay site supervisors a specific stipend/honorarium for each student supervised. In this program, students also pay the supervisor
directly for their supervision hours, at a reduced rate.
Protecting the Public: Counselling “Fit”
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A university is well known for accepting students into
the masters in counselling program who have excellent
academic ability. They all tend to have very high grades
throughout the academic and theory-based courses in the
program – although grade inflation has been questioned, it
has been ruled out. The students have earned their grades
and achieved the learning outcomes for each course.
Isra, however, is struggling with the clinical courses in
the program. This became apparent in the first skills course,
which focused on active listening and empathy – both
of which Isra, despite lots of one-on-one instruction and
coaching, was unable to master. Isra, concerned by a lower
grade on the first assignment, requested accommodation
for a learning disability and was referred to the appropriate department at the university. An accommodation letter
was created and presented to the instructor, stating nothing specific about the learning disability but that Isra would
require extra time to complete course requirements.
As the term progressed, the clinical course instructor
became increasingly concerned about Isra’s suitability for
counselling, noting that other students in the class were of-
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ten offended by Isra and that Isra behaved like “the boss”
rather than a learner, often telling others (usually incorrectly) what to do.
The instructor brought these concerns to an in-camera
meeting of the program faculty, many of whom had previously taught Isra and had noticed some “odd” behaviours
but nothing of real concern. Isra’s grades were consistently
in the A to A+ range, reinforcing to Isra how well the program was going.
Isra progressed to the practicum course, with an A
average still intact. The practicum site supervisor raised
concerns immediately, which the practicum course instructor, not a core faculty member, brought back to another
in-camera faculty meeting. The message from that meeting
was simply to mentor Isra; no remediation was suggested.
By the midterm of the practicum, the site supervisor was
convinced that Isra was not going to become an effective
counsellor. Isra’s placement was terminated. However, Isra’s
practicum instructor was told by the program director to
develop a remediation plan and to support Isra to find another placement.
Isra’s practicum instructor agreed with the site supervisor that Isra would not make an effective counsellor. Considering this an ethical dilemma, the instructor wondered
how to proceed – feeling a responsibility to a student who
had been in the program for 2+ years and was now in the
final course and yet also feeling a responsibility to protect
the public (and the reputation of the counselling profession). The instructor was especially concerned about the clients the student had been seeing – very vulnerable clients
who had received inadequate counselling; the site supervisor, relieved to have Isra gone, didn’t indicate any plans to
follow up with the clients who hadn’t returned, concerned
about “opening a can of worms.”
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Counsellor Training and Regulation
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A university that offered a masters in counselling program primarily online was, not surprisingly, quite attractive
to counsellors trained in other countries who had recently
immigrated to Canada. Students were based in all Canadian
provinces and territories. The program website offered links
to various regulatory colleges and professional associations
for counsellor/therapists but, in the fine print, indicated
that they did not represent the colleges or associations and
that it was important for students to do their own research
to fully understand the requirements for registration, certification, or licensing within their regions.
To recruit students to the program, advisors often
waived specific courses based on transcripts from international programs. The advisors implied (but were careful
not to state directly) that all program graduates would be
eligible for registration/certification/licensing across Canada. Upon completing their required program components,
many graduates were surprised to find that their chosen
regulatory college or association still didn’t recognize their
education or counselling experience.
Asha, a recent program graduate who had previously
worked as a counsellor in India for 10 years, raised her concerns with the professional association she had applied to,
questioning the ethics of the university taking her money
under false pretenses.
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Legal Considerations: Provincial Differences
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Dan and Jim were in the midst of a messy divorce and a
protection order temporarily restrained Jim from unsupervised access to their three adopted children, aged 4, 5, and
8. Dan arranged for individual counselling for the three children to help them adjust to living alone with him and only
seeing Jim for brief visits each week at their aunt’s home.
Jim strongly objected to the children seeing a counsellor
and had his lawyer send a letter to the counsellor stating
that counselling must be discontinued as Jim hadn’t given
consent for it to proceed and he still had rights as a parent. The counsellor consulted two lawyers – one through
the professional association and another representing the
agency. Both said the protection order limited Jim’s rights
to make day-to-day decisions regarding the children’s care,
so the counselling continued. The protection order was lifted around that time and Jim again requested that counselling be discontinued.
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The Ethics of Accepting Gifts
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Sebastien, a counsellor working in a remote Indigenous community in Eastern Canada, was highly respected
by community members, including the Elders. After Sebastien had worked over a period of 2 years with a multigenerational family of eight artists, individually and, at times,
as a family, the family joined together to create a customized piece of art for him, with each member’s contribution
symbolizing a meaningful moment in their work together.
As several of the artists were well known internationally,
the art piece did potentially have monetary value; however, this piece was created uniquely for Sebastien and was
a symbolic gift of love and respect. Sebastien’s employer
strictly forbade acceptance of any gifts with a monetary
value of over $10, especially given that most members in
this Indigenous community were living on incomes far below the poverty line.
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Ravneet’s Academic Struggles
Ravneet comes to a post-secondary counselling service for “guidance,” and completes the typical informed
consent for the centre. She came from India alone at age
18 to study Computer Programming because the agent her
family was working with said it would guarantee her Permanent Residency. She feels a lot of responsibility for her
family’s future, because the plan in sending her to study in
Canada is that she will immigrate and then sponsor family
members to join her here.
She is in her second semester of the program, and she
Ethical Complexity in Practice
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is struggling academically. She failed one course last semester and she’s trying to make it up while completing the
expected regular course load. In addition, she is looking for
a better part-time job than the one she has now. She says
that she wants to quit school, but knows her parents will be
extremely angry and disappointed. She wants the counsellor to help her convince her parents that quitting is the best
thing to do.
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Ivan the Intern
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Ivan is a brand-new intern at a multi-disciplinary clinic.
He is about to make his first screening appointment to see
if he can help the incoming client, Sally. He has read Sally’s
file as she has given permission to do so and discovers his
client has a sexual addiction of some kind. In their first distance therapy session together, the client refuses to turn on
the camera and confirms that she has a sexual addiction.
She proceeds to also say that she asks herself, often when
she is around children, whether her thoughts are normal
or not. She says she has never acted on these thoughts or
touched a child inappropriately. She goes by two different
names in two different provinces for unapparent reasons.
Ivan requests that Sally, the client, turn on her camera;
Sally refuses. Having done some research in preparation for
the appointment, Ivan suggests a peer group for sexual addicts to supplement treatment as he is not a sexual therapy
expert and would like to find another individual counsellor
better suited to treat Sally but that will take some time in
the face of limited resources. The client refuses the referral.
She states that she would like to stick to a male counsellor
but only once a month and is not interested in doing homework in between sessions, just exploring ideas.
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Narrative vs. CBT
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Counsellor works primarily from a narrative orientation
and is assigned a counselling intern as a supervisee who
insists on only working from a CBT orientation.
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Supervising Tallie
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Shania is working with a group of supervisees who
have been progressing well and are in the 8th month of a
12-month supervision program. However, Tallie, one of the
supervisees, has been arriving late for client appointments,
participates minimally in group supervision discussions,
and consistently arrives unprepared for individual supervision. Shania has noticed that Tallie’s skills have not progressed in a satisfactory manner. In contrast to this, Tallie
is frequently proclaiming at the end of their counselling
sessions that they “nailed it!”, referring to their evaluation
of their work in the counselling session. In watching Tallie
at work, Shania is increasingly concerned at Tallie’s tendency to be directive with clients; for example, although the
client states that they are feeling like they’re doing “okay,”
Tallie highlights to them that they are “really struggling”
and need ongoing counselling. Most recently Shania was
observing while Tallie laid out a client’s “problems” for them
concluding, “You need to be much more assertive with
your partner.” As the final few months of this training are
approaching, Shania is wondering what her supervisory responsibilities are and what she should do.
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Amrit the Supervisee
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Amrit is a 25-year-old South Asian supervisee working
in a community counselling centre. She is presenting her
work involving a new client from her home country. The
client is attending counselling because a social worker has
referred her for her depression. The client is an older female
who insists on chatting with Amrit about Amrit’s family,
her studies, and her experience in Canada. She recently
brought Amrit some traditional baked goods. Amrit states
to her supervisor that she is in a dilemma about how to negotiate some cultural concerns with her client. She says that
it is impolite in her culture to talk about personal concerns,
especially as a younger woman with an older woman. She
also wonders if she should address the client as “Auntie” as
would be the custom in her home country. Discuss the considerations of the 45-year-old Western White male supervisor.
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Addictions Therapist
A rural community addictions therapist is asked to consult on a medical case for a physician’s client who is experiencing mental health issues related to addiction. The physician is a friend of the therapist, but the community and
neighboring communities only have one therapist who
specializes in addiction.
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Western-Designed Instruments
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Prior to a scheduled appointment, a counsellor/therapist reviews intake notes for a new client. The client is a
24-year-old Indigenous man, a full-time college student,
who has been experiencing anxiety and depression. The
intake form, the Counseling Centre Assessment of Psychological Symptoms (CCAPS) indicates high levels of generalized anxiety, social anxiety, and academic distress. The
counsellor/therapist is thinking about ways to begin the
session and about whether the CCAPS, a Western-designed
instrument, will be helpful or culturally biased in the conceptualization process.
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SECTION
4
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Working Through Ethical
Dilemmas
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CHAPTER FOURTEEN
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WORKING THROUGH
ETHICAL DILEMMAS
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INTRODUCTION
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The following section contains several examples of ways to work
through the cases located throughout Section 2 of the book using the different ethical decision-making models presented in Chapter 3. It is important
to remember that these are examples of solutions from different perspectives and are not intended to be interpreted as the “right” way of dealing
with the situations. We first recommend familiarizing yourself with the ethical decision-making models in Chapter 3 as well as the relevant chapter in
Section 2 before reviewing these solutions. Ideally you would use these possible solutions to compare and contrast your own solutions in order to enhance your own decision-making process. Although all of the solutions have
been reviewed by members of the CCPA Ethics Committee – Complaints
Division and found to be sound, this does not suggest that there could not
be other considerations and ways to resolve the solutions.
WORKING THROUGH ETHICAL DILEMMAS
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CHAPTER 4
Case 4.1
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Cassandra and Gabe are a couple, but not living together. Cassandra has two young children from a previous relationship; Gabe has no children. Cassandra sent her
counsellor a message saying that Gabe had disclosed very
distressing information to her and that she would like to
meet to process some emotions around this information.
Cassandra and the counsellor then had an individual session in which Cassandra disclosed that Gabe revealed to
her that he has been and is currently watching Hentai porn
(a Japanese animated pornography type) that specifically
depicts images of minors. Cassandra explained that Gabe
only told this to her because Child Protective Services (CPS)
had become involved in her family, due to a referral from
a teacher of one of her children, reporting that the young
child was displaying sexually aggressive behaviours at
school. Cassandra stated that Gabe is never alone with her
children and that her children would have no way of ever
viewing this porn. She was unsure how to feel about it as
it was depicting minors; however, it was doing so in a cartoon form. The counsellor was also unsure whether or not
this would be considered child porn and whether it was reportable. After research, the counsellor concluded that, federally, hentai involving depictions of minors is considered
child porn. Seeing that CPS was involved and a minor was
displaying these concerning behaviours, the counsellor decided to report this to the appropriate parties.
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Work Through A: Virtue-Based
The following text is a breakdown of the ethical dilemmas and ethical
actions relevant to the case of Cassandra and Gabe (clients) using the Virtue-Based Ethical Decision-Making Model (CCPA, 2020), while also incorporating relevant ethical articles from the CCPA (2020) Code of Ethics.
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What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
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I firstly feel concerned that Gabe is watching Hentai porn that specifically depicts minors. While human sexuality and preferences come in every
variety, and sexual preferences outside of the conventional norm are subject to much controversy and judgement that at times can inject harmful
grief into otherwise innocuous personal preferences, the intentional act of
searching for porn involving minors, even in cartoon form, feels worrisome
to me. Although the potential for Gabe’s preference to suggest that Gabe is
attracted to minors and is actively engaging himself in societally deleterious
sexual fantasies is a fear response arising in me, when it comes to the safety
of minors, erring on the side of caution is necessary. This concern is telling
me that time-sensitive investigation and support from professionals experienced in this domain is necessary.
I next feel appreciation for the therapist’s investigation into whether the
porn in question was in fact considered child porn. Legal investigation is
necessary for the protection of the rights of clients (CCPA, 2020, A2), which
extends to any children involved when any form of child abuse is in question
(CCPA, 2020, B2). Moreover, ensuring professional action in accordance
with the law is, of course, necessary for professional protection. Given that
the therapist in question was unsure as to whether Gabe’s behaviour was
criminal, an additional ethical safeguard of seeking consultation seems appropriate to ensure sufficient support through exploring this ethical dilemma (CCPA, 2020, A4).
Next, I feel relieved that the therapist acted out of caution and in accordance with the law in reporting Gabe (CCPA, 2020, B2), but I also feel
some concern regarding her approach; as mentioned, I feel that this is a
time-sensitive matter given the possibility that Gabe’s behaviour may be
inflicting harm on Cassandra’s children. However, an invitation for Cassandra to collaborate with the therapist regarding next steps in reporting
Gabe would fulfill articles B1 and B3 of the Code of Ethics (CCPA, 2020). To
expand on this, B1 mentions that “therapists respect the integrity and promote the welfare of their clients [and] work collaboratively with clients to
devise therapy plans consistent with the needs . . . [and] circumstances . . . of
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clients” (p. 9). Although the act of reporting may or may not be considered
a part of a “therapy plan,” it is directly linked to the issue that Cassandra
has brought to therapy; ultimately, Cassandra has no choice about whether
the therapist reports Gabe, but inviting her to collaborate and keeping her
involved is an act of respect for Cassandra and the therapeutic relationship.
In terms of Article B3, therapists are to use “reasonable care to give . . . warnings as are essential to avert foreseeable dangers [when they become aware
of the potential of clients to place others in clear and imminent danger]”
(p. 9). Although Gabe is not a client, the circumstances suggest that Gabe’s
behaviour has the potential to place Cassandra’s children in danger, if it has
not already. Explaining this to Cassandra as an act of “duty to warn” ensures
that the intent of this clause is respected, and again respects Cassandra’s welfare as Gabe’s partner and her children’s mother, as well as the therapeutic
relationship.
How can my values best show care for the client’s wellbeing?
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I value human well-being on all dimensions: emotionally, mentally,
spiritually, physically, relationally, and any others. This encompasses the
protection of vulnerable individuals so that they may be, and continue to
develop, in good health. I also value human autonomy, respect for all living
things, and a curious and compassionate approach in all cases, including
in the face of potential “evil.” These values demonstrate care for Cassandra,
my client, in maintaining an open, honest, supportive, and collaborative
approach to the necessary reporting of her partner, Gabe. Not only is Cassandra in the midst of a confusing and uncomfortable situation with her
child’s behaviour at school, the involvement of Child Protective Services,
and her partner’s confession of concerning interests and behaviours, but the
intensity of her situation is about to increase (as a transitionary stage) with
the reporting of Gabe. As discussed in the previous section, the reporting of
Gabe is necessary at this time for the protection of her children (and potentially others in the community), and remaining present, connected, understanding, and respectful of Cassandra throughout this process is supportive
towards Cassandra’s wellbeing and that of her children.
How will my decision affect other relevant individuals in this
ethical dilemma?
My decision to report Gabe will of course impact Gabe’s life negatively,
hopefully as a transitionary period. Although Gabe’s behaviour of engaging with child porn is in fact illegal, the connection of Gabe’s behaviour to
Cassandra’s child’s behaviour has yet to be confirmed. Although remaining
completely non-judgemental towards Gabe contradicts the decision to re-
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port him based on his actions, remaining open and curious while accepting
that Gabe’s behaviours pose a threat to children and require investigation
and potentially treatment, as well as intending to be a supportive therapeutic presence for Cassandra, decreases the chance of my personal preconceived notions adding unnecessary intensity to the situation, which affects
Gabe and all others involved.
Cassandra’s children will also be affected by my decision; reporting
Gabe may prevent the worst-case scenario (i.e., that Gabe has directly or
indirectly harmed them) from occurring or continuing. The children may
also be affected by Cassandra’s stress resulting from my decision, as well as,
potentially, by the absence of Gabe in their lives. Offering an understanding,
supportive, and respectful therapeutic space for Cassandra may indirectly
lessen the negative impact of my necessary and protective decision on Cassandra’s children.
What decision would I feel best about publicizing?
The decisions as outlined here are what I would feel best about publicizing.
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What decision would best reflect who I am as a person and practitioner within cultural/intercultural contexts?
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The decisions as outlined here are what I feel best reflect who I am as a
person and a practitioner within cultural and intercultural contexts.
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Work Through B: Principle-Based
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Step One – There are potentially several key ethical issues:
As the counsellor, my qualifications to work through an issue that I
am unsure about. I may need to consult a supervisor or ethics committee
(CCPA, 2020; A3, A4, B10, B16).
Informed consent, including limits to confidentiality. I did inform Cassandra before the revelation that one specific limit to confidentiality is if
children may be in need of protection (B2iii).
Client’s rights, including collaboration (B4). In the vignette, the counsellor seems to have decided to report this directly. I’m left wondering
whether any effort was made to support the client in reporting this concern
herself? Could they have reported it together?
Step Two – Potential child abuse must be reported – protecting children is our collective responsibility as citizens, not just as counsellors. Rel-
WORKING THROUGH ETHICAL DILEMMAS
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evant articles from CCPA’s Code of Ethics, as noted in the key issues section
(Step One) include: A3, A4, B2iii, B4, B10, and B16.
Step Three – Most important ethical principles: Beneficence, Nonmaleficence, Autonomy, Justice, and Societal Interest.
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Step Four – In this specific circumstance, immediate consultation with
a supervisor or ethics board is the first step. Second, since this is a possible
child abuse situation, possible child abuse needs to be reported to a government agency. If I choose to report this directly, it may conflict with the
client’s right to Autonomy. However, if I help the client to understand the
need to report and offer to support her in disclosing her partner, Gabe’s,
revelation of his use of hentai (considered to be child porn), our collaboration may be less harmful to Cassandra while still protecting the children
and, potentially, others.
Step Five – My feelings tell me that I do not have the experience to solve
this on my own and I need to seek supervision or consult. My feelings are
also that Gabe’s use of hentai is unrelated to the suspicion of abuse, but it is
not my role to investigate or pass judgement but, rather, simply to report the
information. My intuition is that Cassandra came to me because she knows
she needs to report this. Based on the trust she has in me, my sense is that we
can work through reporting this together and that I can continue to support
Cassandra as she navigates this challenging time with her children and her
partner.
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Step Six – The most helpful plan would be to consult with a supervisor
and then to explain to Cassandra the need to report and collaborate with
her, if she’s willing, on how I could support her to make that report or how
we could do it together. Reporting the suspicion of child abuse is a legal requirement – I will need to report, even if Cassandra chooses not to, but the
best-case scenario would be supporting her to do it.
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Case 4.2
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An inquiry to the counsellor came via email from a
trans woman. The potential client had been working with a
counsellor for 7 years, and conveyed that for the past several months, boundaries within the therapeutic relationship
became “weird.” The potential client reported she socialized
with the counsellor (i.e., dinner with the counsellor and her
partner), went on walks, and met the counsellor’s family;
the potential client expressed that nothing sexual occurred
and that she could not imagine this happening. Recently,
the counsellor “gently pressured” the potential client to end
the therapeutic relationship and is “pulling back” from what
is identified as a friendship. Extreme pain and confusion
are expressed by the potential client, and she would like
to process her experience with a new counsellor. However, the potential client is asking for a “guarantee” that anything conveyed about this situation remains confidential.
She reports being very attached to her previous counsellor and would be devastated if anything happened professionally to her previous counsellor due to a report made to
a professional body. The potential client is employed in a
research-oriented field and conveyed she has conducted
extensive research on boundary issues, dual relationships
in post-therapy time frames, and professional duty to report. She indicated she contacted another counsellor who
agreed they could guarantee confidentiality; however, another counsellor conveyed they could not. Frustration is
reported by the potential client, given the honesty shared
about her situation with potential new counsellors. Additionally, based on her research, she reported counsellors
either assign a label of BPD to clients in her situation (i.e.,
who bring circumstances on themselves) or have a desire
to report the “bad” counsellor and prevent them from practicing. The potential client communicated that she feels she
has nowhere to turn for help.
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Work Through A: Quick Check
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Prior to using the Quick Check Ethical-Decision Making Model (CCPA,
2020), I will outline my ethical decision and my process of coming to that
decision, referencing ethical articles referred to in CCPA’s (2020) Code of
Ethics. The ethics of this case are discussed chronologically as presented in
the case description.
The first ethical issue that is apparent in this case is the violation of Article B8 (CCPA, 2020) by the potential client’s previous therapist of 7 years.
According to B8, multiple relationships (in this case, friendship alongside
the professional therapist’s role) are to be avoided unless justified; this is to
avoid therapists’ impairment of objective and professional judgement and/
or to increase the risk of exploitation or harm of clients. Beyond complicating their professional relationship, the previous therapist has caused the
client pain and confusion in the “pulling back” in their friendship and seems
to be attempting to inappropriately end the therapeutic relationship, which
doesn’t follow the process described in Article B17 (CCPA, 2020).
The ethical dilemma of this case is the conflict between preserving client confidentiality (CCPA, 2020; B2) and the prospective therapist’s responsibility to address concerns about the ethical conduct of the previous therapist (CCPA, 2020; A8). This potential client’s request for confidentiality may
be within the bounds of the limits to confidentiality outlined in Article B2,
unless we consider the past therapist’s behaviour as demonstrating potential
to place others in danger. Given that this past therapist is working with vulnerable populations, their irresponsible relational behaviour may very well
pose real relational threat and danger to the well-being of their current and
future clients. The reasons our client wishes to avoid reporting her previous
therapist is understandable and likely more nuanced than what is presented
in the case description. Under Article A8, therapists are obligated to respectfully address concerns of unethical behaviour in other helping professionals, and this can be done informally first, which may be more appealing to
the potential client as it opens the possibility that she can receive the support she needs without putting her prospective therapist at risk of unethical
behaviour (A8), gives her past therapist the chance to address and amend
their past unethical and unprofessional behaviour without being reported to
a professional body, and decreases the likelihood that future clients of this
past therapist will suffer the undue harm that this therapist has inflicted on
the prospective client.
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Ultimately, as I have not dealt with an issue like this personally, I would
seek consultation on this case with professionals who have experienced similar situations (CCPA, 2020, A4). In responding to the prospective client, I
would express remorse for what they have experienced with their past therapist and validate their desire to work through what they experienced with
a therapist. I would let them know that I would love to be that therapist,
but I do however have some ethical concerns regarding specific parts of
our Code of Ethics (CCPA, 2020) and I would be interested in collaborating
with them alongside supervision or consultation in attempting to determine
the best actions forward for all involved (support for the prospective client,
protection of my professional and ethical conduct, and protection of the
public from unprofessional and unethical behaviour of the past therapist,
hopefully in a fashion that respects the client’s wishes). I would highlight
that we can discuss the situation, and if they do not give permission for me
to disclose the situation, I would maintain that confidence. I would explain
the conflict between ethical obligations to report the unethical behaviour of
other counsellors (A8) and respecting client confidentiality (B2), but I do
respect the complexity of the situation that the client is facing and would be
interested in collaborating with them if they are interested. I would discuss
with my potential client that there are other ways for me to still uphold the
ethical requirement to work to correct unethical behaviour of fellow professionals while also maintaining the confidentiality of the content of work.
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Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
If I look at this case as black and white (which it is not), one option is
that I could tell the client that I cannot work with them unless I am able to
confront their past therapist given the potential for the therapist’s unethical
behaviour to harm current and future clients (A8). However, that decision
will likely result in the prospective client being left without service, and with
the public still at risk given that the prospective client is the only one who
knows who their previous therapist was.
If I were, on the other hand, to perceive that the client’s right to confidentiality is maintained in this case (i.e., the past therapist’s actions do not
pose imminent danger to the public at the severity implied by the clause),
and that I can provide the service requested without sufficiently confronting the past therapist, then I risk unethical conduct in violating Article A8
and the public may be at risk. As such, the decision to transparently explain
my concerns surrounding this dilemma to the prospective client, while expressing my desire to support them with additional support for me through
consultation, seems to me, at this time, the scenario I would feel most com-
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fortable being announced on the front page of a major newspaper.
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Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
Regardless of socioeconomic status, gender, race, and all other aspects
intersectionality, I would make this same decision for everyone.
If every therapist determined and thoughtfully reflected on the conflicting ethical articles in CCPA’s (2020) Code of Ethics relevant to this situation;
remained transparent with the client about the boundaries and obligations
surrounding ethical and professional practice; expressed the desire to provide support and collaborate on determining actions that offer due respect,
care, and protection to all involved; and consulted professionals experienced in similar situations to aid in the collaboration between the client and
the therapist, I do believe it would be a good thing.
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Justice: Is everyone being treated fairly by my decision?
The client is being treated fairly in receiving understanding, no judgement, and transparent communication as to what I can and cannot do; they
are treated with respect and informed as to my position so that they can
make an informed decision as to whether to work with me or not.
I am treated fairly in that I have clearly outlined what I can and cannot
do for the prospective client, and discussing the case with experienced professionals also fairly provides me with support as I address this dilemma.
The public is being treated fairly in my acknowledgement of the potential harm that the past therapist’s behaviour may cause to them, and my
transparency with the prospective client regarding my desire to respect Article A8 ensures that I do not subvert the protection of the public to appease
the current wishes expressed by the prospective client.
The past therapist is treated fairly in that they are confronted by me if
the prospective client decides to share the past therapist’s details. Not addressing their unethical behaviour would be unfair to the public, other professionals, as well as the past therapist; they are part of a community, and
our respect for them entails holding them to the necessary professional and
ethical standards that they are capable of. While I do have some concerns
about addressing this professional myself rather than reporting them to the
college (such as my lack of ability to hold them accountable), it’s possible
that my consultation with experienced professionals will provide necessary
guidance in this regard. More importantly, maintaining confidentiality is of
a higher importance, as without the client’s permission to disclose information, I cannot unless I am aware of someone specific at risk of harm.
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Work Through B: Principle-Based
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Step One – Possible key ethical issues of concern. Responsibility and
support to client who reported dual relationship with a previous counsellor
via email. CCPA (2020) Articles A8 and A10. Confidentiality and Informed
Consent (B2 and B4).
Step Two – Articles from the CCPA (2020) Code relevant to this situation: A8 (Responsibility to Address Concerns About Another Professional),
A10 (Third-Party Reporting), B2 (Confidentiality), and B4 (Informed Consent). Other relevant articles include B10 (Consulting with Other Professionals), B8 (Multiple Relationships), and B11 (Relationships with Former
Clients). B11 is relevant because, for example, many regulations in the area
state that, due to power issues, counsellors refrain from initiating personal relationships with clients for at least 3 years after therapy has stopped.
The dilemma involves whether the apparent boundary breach by the first
counsellor is serious enough to report them, despite the prospective client’s
request that the counsellor not be reported.
Step Three – Most important Ethical Principles: Beneficence, Nonmaleficence, Social Interest.
Step Four – In this specific circumstance, it is unclear if there has been
actual contact or interaction including the signing and explaining of confidentiality and informed consent with the person who sent the email. If this
is a prospective client, it is likely that the formal steps of obtaining consent
within the context of the limits of confidentiality have been taken.
The potential client does not want the previous counsellor to be reported but does not feel comfortable continuing with the counsellor and
is reaching out for support. Part of the ethical conflict is that the client has
been given mixed messages – one counsellor saying they would maintain
confidentiality another saying they could not guarantee confidentiality. This
creates further uncertainty for the client.
One way to reduce this uncertainty is to get the informed consent and
limits of confidentiality signed and listen to the client’s issues without judging them. I would also make sure there had been no inappropriate sexual advances (which does not seem to be the case). One solution would be
for the new counsellor to seek consultations without identifying the client
and informing the client that this is ethical and common behaviour. The
results of the consultation will inform the conversation with the client about
whether to report the first counsellor.
Step Five – Most of the intuitions I have are addressed in Step 4. It is
important for counsellors to consult with colleagues and/or supervisors in
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order to provide the best treatment options.
Step Six – The plan of action most helpful for the client is to not only
feel supported and trusted but to be aware that consulting with another
professional confidentially is important for all counselling relationships in
order for counsellors to provide the best possible practice. The client also
needs to feel valued and not feel guilty or insecure about talking about a
previous counsellor.
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Case 4.3
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Iris is a Southeast Asian first generation Canadian; she
identifies as female. She has been progressively getting
more anxious and depressed. She feels that this is for two
main reasons: Her family has become increasingly out of
balance with their chosen religion and harsher with her as
a result, and she doesn’t feel she can confide in anyone at
her place of worship or in her family about her struggles,
which they are shrugging off with greater regularity. Iris is
hurt and angry with God over her situation, her perceived
rejection from her family, and her isolation and mistrust of
the leadership that cannot offer her the psychotherapy that
she needs, nor the spiritual support she desires, leaving
her feeling that she would be judged if she expressed her
thoughts and feelings.
Iris comes to counselling to see Rose for depression
and anxiety. Rose has been told by her supervisor to stay
away from any religious or spiritual topics even for the purpose of understanding the correlation to the client’s presenting issues and if they are related to the main struggle
of the client. Rose understands and respects the need for
the client to lead in this area but is struggling with her supervisor’s guidance not to explore the associated anger,
isolation, betrayal, and loneliness potentially related to the
client’s experience with spirituality and faith in the session.
Her supervisor’s guidance has left little room to explore pros
and cons on the issue. Rose’s training taught her that such
exploration could reveal either spiritual injury or conversely
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spiritual gain (e.g., spirituality, in many adults, can contribute to improved personal resiliency and mental health).
Rose would like to ask about Iris’s main triggers to feeling depressed and anxious even if her answers open up a
religious or spiritual conversation and Rose clearly indicates
that her area of competence is in dealing with anxiety and
depression, not deep spiritual guidance, though this is a
safe and judgement-free space. She further indicates that
her approach would be client led, not directive spiritual
guidance, though any topic Iris needs to discuss is welcome
there.
Work Through A: Quick Check
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Rose decided to speak with her supervisor again, to address their different perspectives of an ethical approach to this situation. Rose identified
several articles from the CCPA (2020) Code of Ethics to support her belief
that she should work with Iris “where she’s at” even if that might raise some
topics related to religion or spirituality. Specifically, Rose acknowledged her
supervisor’s ultimate responsibility for Rose’s clients (E4) and Rose’s own
need to follow the supervisor’s guidance and restrictions. She also respected
the supervisor’s recognition of her own boundaries of competence (E6) as
well as Rose’s boundaries of competence (A3). Rose made it clear in her
discussion with her supervisor that she didn’t see herself in the role of a spiritual advisor or guide and, should she be permitted to proceed with Iris, she
would ensure that Iris was aware of those limitations and gave her informed
consent to proceed (B4). However, Rose argued, this situation seemed more
related to Iris’s rights as a client (A2) to raise relevant topics within the safety
of the counselling relationship and, given her family’s cultural and religious
background, that it would important to be responsive to diversity (A12),
respecting inclusivity, diversity, difference, and intersectionality (B9); Rose
also noted that E6 addressed the supervisor’s ethical responsibility to respond to diversity, and that for both Rose and the supervisor, Iris (the client)’s welfare needed to be prioritized (B1; E4). Through this discussion, the
supervisor recognized that her own discomfort with discussing anything to
do with religion or spirituality was limiting Rose’s ability to take a holistic
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approach to working with Iris; providing space for topics important to the
client and her presenting issues, with a clear indication of the boundaries of
Rose’s competency (i.e., to provide counselling related to mental and emotional wellbeing rather than spiritual direction) would be an appropriate
approach.
Publicity: Rose and her supervisor would be comfortable having the
decision publicized that Rose had worked with the supervisor to find a diversity-responsive approach to meet Iris’s needs. Treating mental health issues, not unlike treating physical issues, involves understanding underlying problems. Rose has a professional obligation to explore the context of
Iris’s issues and the factors contributing to them. If it was publicised that
Rose asked about the underlying triggers in a culturally sensitive non-judgemental way, this should only illustrate a desire to provide a safe space for
Iris, the client, and ultimate care for her mental health.
Universality: The code is clear that, in all cases, counsellors are to offer
counselling to address evident needs of the client. In this case, it took courage to initiate a meeting with the supervisor, and to advocate on behalf of
the client. The act of asking about triggers loses merit unless the same actions would be taken on the part of the counsellor regardless of culture, race,
religion, gender, gender expression, or caste of the client. Counsellors ought
to be willing to discuss in a non-judgemental way what a client’s triggers and
supports are, regardless of what the answer may be.
Could things be better if every counsellor acted in the same manner?
Understanding our clients’ main triggers and supports offer two key indicators for counsellors to work with to assist their clients towards their goals.
Justice: In this case the client, Iris, was from Southeast Asia; she presented a different cultural perspective and had a right to have her needs met.
Regardless of where the client was from, what religion was indicated, what
gender, gender expression, or class they came from, leaving space for a client
to discuss triggers or supports, even if they point to the spiritual or religious,
even if it makes the counsellor uneasy, positively reinforces that this is the
client’s space (i.e., even if someone has a religious practice, it does not mean
that this is a current source of strength or support for them).
Conclusion: If it’s important to the client, it should be important to us.
It is appropriate to refer out if spiritual guidance is the main presenting issue
but any counsellor should be competent enough to hold space for a client
to discuss their spirituality and supervisors require the basic competence to
support their supervisee’s when issues related to spirituality or religion arise.
The ethical decision-making model backs this up.
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Work Through B: Virtue-Based
This case concerns a depressed and anxious client who feels that her
symptoms are getting worse because of her family’s choice of religion. She is
feeling rejected by her family and contacts within her place of worship. Her
counsellor, Rose, has been told by her supervisor to stay away from religious
topics.
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What are the emotions expressed by each party and how do they
impact suggestions for solving the discomfort?
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Iris (client) reports that she feels rejection and a lack of trust with her
family and others as well as anger with God and is unable to express her
feelings to her family.
Rose, Iris’ counsellor, feels frustrated by the notion that her supervisor
has told her to stay away from religious topics with clients. Rose feels restricted in what she can offer the client because the client’s issues with family
are intertwined with spirituality and her faith.
I am aware that the supervisor has power over the counsellor. However,
the supervisor needs to communicate with the counsellor to discuss the client’s treatment. Also, the counsellor hopes to create trust and support with
the client by listening (and exploring with empathic responses) to her story,
which is in itself healing.
I think the counsellor and supervisor need to communicate and identify
the needs of the client (i.e., to express herself) and how depression and anxiety are affecting the client. They also need to discuss the process of counselling: What helps? What hinders? How can Rose best support the client?
How can my values best show care for the client’s wellbeing?
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Two of the key ethical principles involved are: Beneficence (i.e., being
proactive in promoting the best interests of the client) and Autonomy (i.e.,
respecting the rights of clients to agency and self-determination).
Listening is key no matter what the issue is. In order to build a trusting
relationship with Iris, the client, she needs to be heard and valued. Perhaps
when Iris feels less vulnerable, a family session with another counsellor may
be of value. Or, Iris may gain self-confidence from Rose using a client-centred approach (e.g., empathy, unconditional positive regard, and genuineness) thus reducing her anger, loneliness, and lack of trust which will reduce
her anxiety. I would also include some communication skills (e.g., role-play,
cognitive behavioural techniques, relaxation exercises) to enhance the client’s confidence. Clear and respectful communication also needs to be prac-
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ticed between the supervisor and Rose.
Effect of decisions on relevant individuals.
All of the individuals need to listen with respect, not just with the client,
but also with each other (i.e., supervisor/counsellor). Better communication and understanding will strengthen all relationships.
What decision would best reflect my values?
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As counsellors, we cannot be experts on every topic and I think a client
needs to be able to explore their experiences without judgement. As counsellors, we also need to respect each other and learn from each other. Genuineness and unconditional regard for all individuals are the basis for strong
relationships. It is also important to communicate with other counsellors
and to consult and talk through situations with colleagues and supervisors
in a respectful manner. They do not need to agree on everything, but they
do need to LISTEN.
Work Through C: Principle-Based
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Step One – What are the key issues in this situation?
• Iris’ depression and anger related to her circumstances.
• Rose’s conflict between listening to her supervisor and avoiding religious/spiritual topics or attending to a core issue that the client is
bringing.
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Step Two – What ethical articles from the CCPA Code of Ethics are relevant to this situation? – Are there policies, case law, statutes, regulations,
bylaws or other related articles that are relevant to this situation?
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A3 – Boundaries of Competence – Rose does not have experience in
this area.
A4 – Supervision and Consultation – conflict between what the client
wants and what the supervisor is telling Rose.
A12 – Diversity Responsiveness – identity of Rose as a non-religious
person vs. identity of Iris as a person of faith.
E4 – Welfare of Clients and Protection of the Public – client welfare is
the primary consideration in all decisions and actions of supervisees and clinical supervisors.
Step Three – Which of the six ethical principles are of major importance
in this situation? (This step also involves securing additional information,
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consulting with knowledgeable colleagues or the CCPA Ethics Committee,
and examining the probable outcomes of various courses of action.)
• Beneficence – Rose must attend to what is in the best interest of her
client.
• Nonmaleficence – avoiding the main issue to preserve therapist
comfort level versus the clients’ healing; Rose must think about
what course of action would not hurt the client.
• Rose should consider consultation with counsellors who work with
faith-related issues and consultation with the Spirituality in Counselling chapter of the CCPA could be helpful.
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Step Four – How can the relevant ethical articles be applied in this
circumstance? – How might any conflict between ethical principles be resolved? – What are the potential risks and benefits of this application and
resolution?
• Based on Rose’s level of competence with faith-related issues and
her supervisor’s reluctance to attend to these issues in counselling,
Rose should consider providing a referral for Iris to work with a
counsellor who is more knowledgeable and comfortable in this area.
• In some cases, referral is not possible, in which case Rose should
discuss with her supervisor how to approach the situation or find a
different supervisor who will be able to help in this area.
• Ignoring the struggles with spirituality that Iris is bringing to counselling would cause harm to Iris and would potentially be a waste
of her time (and money) if she is not able to work through her core
issues.
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Step Five – What do my feelings and intuitions tell me to do in this situation? (See also Virtue-Based Ethical Decision-Making.)
To support the client in whatever concerns they are bringing and to
receive appropriate supervision to be able to help the client with their concern which is outside of my boundary of competence or to refer the client to
someone who has more experience with these issues.
Step Six – What plan of action will be most helpful in this situation? –
Follow up to evaluate the appropriateness, adequacy, and effectiveness of
the course of action taken. Identify any adjustments necessary to optimize
the outcome.
• Receive supervision from an external supervisor who specializes in
faith-based discussions.
• Be open with the client that this is something Rose is less familiar
with.
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Case 4.4
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A new employee at a well-established and long-standing adoption agency in a large Canadian city became aware
that the CEO of the agency had used this new employee’s
social work registration number to submit an insurance
claim for services for a child and their adoptive parents. The
CEO had been with the agency for about 10 years. The new
employee approached the CEO about this issue and the
CEO said she has been doing this for years, using the registration numbers of her staff who have master’s degrees,
as she only has a bachelor’s degree, to perform adoptions
business when clinical staff are busy. The CEO said that she
had checked with the agency lawyer and that it was legitimate and okay for her to do this.
Work Through A: Principle-Based
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Before making a decision, there would be several questions that would
be helpful to consider/explore:
• What are the agency’s procedures with regard to conducting adoption “business”?
• What are the agency’s policies regarding reporting ethical issues
and/or reporting someone for potential ethical violations?
• Are other professionals aware of the practice that the CEO did? And
what are their reactions? How do they feel about the lawyer’s opinion?
• Are clinical supervisors available for consultation (ad hoc for irregular circumstances)?
• How are the services marketed to clients? Does it include representation about the credentials of people working on the adoption
process?
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Key Issues:
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The counsellor/social worker has discovered that another professional
(i.e., the CEO) in the same agency has been using other social workers/
counsellors’ professional designations while carrying out professional work.
There is a power imbalance between the CEO and the new employee,
despite the CEO having a baccalaureate degree and the counsellor having
a master’s degree. The CEO signs pay cheques, does employee evaluations,
and hires and fires staff.
The CEO has indicated that this practice has been checked out by a
lawyer and it is okay.
Relevant Ethical Articles from CCPA Code of Ethics:
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The CEO has potentially violated several CCPA articles; however, she
may or may not actually belong to this association, or any other. It would be
important to confirm if she does belong to a professional association/organization. If so, then several of the articles could be used to report potential
violations, including:
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A5. Representation of Professional Qualifications:
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“Counsellor/therapists claim or imply only those professional
qualifications that they possess and are responsible for correcting any known misrepresentations of their qualifications by
others” (CCPA, 2020, p.6).
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A3. Boundaries of Competence:
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Counsellors/therapists limit their counselling/therapy services
and practices to those which are within their professional competence by virtue of their education and professional experience, and consistent with any requirements for provincial/territorial and national credentials. They seek supervision, consult
with and/or refer to other professionals when the counselling
needs of clients exceed their level of competence. (CCPA, 2020,
p. 6)
There is an uncertainty about whether or not the CEO has competence
to do the work she is doing, as she certainly does not have the credentials.
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A7. Responsibility to Counsellors/Therapists and Other Professionals:
“Counsellors/therapists demonstrate ethical conduct, integrity,
and professionalism in interactions with counsellor/therapist
colleagues and with members of other professional disciplines”
(CCPA, 2020, p. 7). The CEO is behaving deceptively which is
counter to working with integrity.
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B1. Primary Responsibility:
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Counsellors/therapists respect the integrity and promote the
welfare of their clients. They work collaboratively with clients
to devise counselling/therapy plans consistent with the needs,
abilities, circumstances, values, cultural, or contextual background of clients. (p. 9)
The CEO’s competence for the roles she is performing is unclear without supporting credentials and education.
The new employee needs to act according to:
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A8. Responsibility to Address Concerns about the Ethical Conduct of Another Professional:
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Counsellors-therapists have an obligation when they have
serious doubts as to the ethical behaviours of another helping
professional, whether that individual is a CCPA member or a
member of another professional body, to respectfully address
the concern and seek an informal resolution when feasible and
appropriate. When an informal resolution is not appropriate,
legal or feasible, or it is unsuccessful, the counsellor/therapist
reports their concerns to the relevant professional body. Counsellor/therapists consider whether there are any legally mandatory reporting obligations regarding the conduct of the helping
professional to take appropriate action. (CCPA, 2020, p. 7)
In this case, the CEO was approached and the issue of using other professionals’ credentials was raised.
Ethical principles of major importance:
•
•
•
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Beneficence – being pro-active in promoting the interests of clients.
Nonmaleficence – refraining from actions that risk harm and not
willfully harming clients.
Justice – Respecting the dignity of all persons and honouring their
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right to just treatment. If the reports, or recommendations are safeguarded by having registered master’s degree level professional sign
them, then a person who is not registered should not be assuming
this role.
• Fidelity – Honouring commitments to clients and maintaining integrity in counselling relationships. Especially if the description of
services and counsellor credentials show that the counsellors are
Masters-level.
The CEO pushed back stating that she had authorization by the agency’s legal advisor. The counsellor is advised to document all interaction and
discussions with dates, who was present, issues, and outcomes. The next
step could be one more attempt to rectify the issue, where the counsellor/
therapist can cite A8 from the Code of Ethics and, if possible, take a colleague or HR person with her.
And finally, if this is unsuccessful, call CCPA to request a consultation
before reporting the matter to the Board of Directors for the agency or the
appropriate regulatory body.
Instinctively it feels pretty clear that this behaviour is wrong; however,
the risk to employment or fear of “rocking the boat” may lead to a decision
to ignore the practice as others have reportedly been going along with it for
some time.
The solution requires not only a change in behaviour by the CEO but
more systemic changes with regard to oversight, policies and procedures,
and best practices. It is a challenging matter for a new employee as the
CEO’s behaviour is sanctionable and may lead to loss of employment.
I would also want to seek support from a qualified external supervisor
(CCC-S) as this kind of situation may cause discord within the workplace
and may also take some time to resolve.
Work Through B: Quick Check
If the decision in this case by the counsellor was to continue working
at this agency, allowing the CEO to continue using their credentials unopposed, then the quick check model review would be as follows:
Publicity: Would I want this ethical decision announced on the
front page of a major newspaper?
No. This action would cause serious repercussions for this agency and
the counsellor.
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Universality: Would I make the same decision for everyone?
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No, if the decision (as presented above) was to allow the CEO to continue with misinformation. Yes, if the decision was to not falsify identification
in agency business.
• If every counsellor/therapist made this decision, would it be a good
thing?
No. It would be unethical for anyone to falsify insurance claims in this
manner.
Justice: Is everyone being treated fairly by my decision?
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Not if you follow the CEO’s decision, but yes, if you follow a decision-making process and make the decision to not allow the CEO to use the
registration number. The CEO, with a bachelor’s degree, can perform adoption business if her degree is in social work, psychology, healthcare, youth
and childcare, as examples. I don’t believe that the agency lawyer would
approve falsifying an insurance claim. It is appropriate to wait for staff to
process the claim.
Everyone in this situation is not being treated fairly because the new
staff member has been used by the CEO without permission or consent.
This action sets a bad precedent and is a breach of ethics. In terms of ethical
principles, this action doesn’t respect the dignity of all persons or honour
their right to just treatment. In terms of societal interest, the CEO is not upholding responsibility to act in the best interest of society. Finally, this CEO
has taken actions that risk harm to the clients (nonmaleficance) and under
Articles A8 and A7 the person has “the responsibility to address concerns
about the ethical conduct of another professional” (CCPA, 2020, p. 7) and
“demonstrates ethical conduct, integrity, and professionalism in interactions with other counsellor/therapist colleagues and with members of other
professional disciplines” (CCPA, 2020, p. 7).
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CHAPTER 5
Case 5.1
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Sam is a counsellor who has been in private practice
for 1 year. Sam has facilitated support groups for years—
always for free and in service of her community. Recently,
Sam noticed that many of her clients were feeling increasingly isolated, so she decided to start a free support group
facilitated via Zoom. She invited a combination of her close
friends and clients, as she knew that all of these individuals had been seeking connection and community. Sam’s
friends became friends with her clients, and towards the
end of the 8-week group, Sam created a WhatsApp group
with all members (with their consent) so that they could
stay connected.
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Work Through A: Principle-Based
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Define the situation clearly, key issues: Sam is a counsellor who had
organized a support group for both friends and clients to support individuals in need of connection and community. The concerns would be related
to B8 Multiple Relationships, B13 Multiple Clients, and B11 Relationships
with Former Clients.
Determine who will be affected: In the group being facilitated by Sam
are both current clients as well as friends. The current clients might decide
to end therapy and continue in the group; therefore, they will then be former clients, still connected to the therapist and her friends. Another concern
is that Sam, as facilitator of the support group with clients and close friends,
is still in a professional counsellor/therapist role. The result of this decision
making needs to take into consideration the rights, professional obligations,
and potential impacts both of harm as well as benefits for the therapist, her
friends, and current as well as potential former clients.
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Underlying ethical principles: (a) Autonomy – all participants need
to be informed and therefore to make their own informed decisions and to
plan their own actions; (b) determine if there might be any harm to any of
the friends, clients, or herself as the therapist (Nonmaleficence) (c) upholding the clients’ trust (Fidelity).
Refer to professional guidelines: B8 – Counsellors make every effort
to avoid multiple relationships with clients that could impair professional judgement. Multiple relationships need to be managed and, as such, the
therapist needs to take appropriate professional precautions such as role
clarification, informed consent, consultation, and documentation. B13 –
When counsellors agree to provide counselling to multiple clients, counsellors need to clarify at the outset which persons are clients and the nature
of the relationships they will have with each person. If there are conflicting
roles that emerge, counsellors must clarify, adjust, or withdraw. B11 – Counsellors remain accountable for any relationships established with former clients, exercising caution to determine if any issues or relational dynamics
present during the counselling have been fully resolved.
Reflect honestly on personal competence: Is it ethical to combine the
group of both friends and clients? Should I put myself in a professional role
with my friends? Do I have the level of competence needed to manage the
situation?
Consult with trusted colleagues: Debrief with a trusted colleague in
order to consult about key facts, issues, ethical considerations, and potential
actions.
Formulate alternative courses of action: Are there different ways in
which this could be handled? Perhaps breaking the groups up into different
categories so that clients and colleagues are separate would be possible; the
counsellor would, therefore, not facilitate a professional support group with
friends, but would only offer that for clients.
Consider possible outcomes for all parties involved: Could there be
any harm done?
Make a decision and monitor the outcome: A decision was made to
proceed with the 8-week group for current and past clients (not friends) and
the group continued beyond the end date of the group so that they could
stay professionally connected.
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Work Through B: Quick Check
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In consideration of this dilemma, I will apply the quick check.
Publicity: Facilitating connections between your active clients and close
friends seems problematic on the surface. Although the support group and
corresponding WhatsApp group are seemingly separate from Sam’s for-fee
counselling services, if this group was publicized, it would likely draw criticism in relation to (B8) Multiple Relationships. More importantly, whether
paid or not, the relationship formed by the support group is professional in
nature, and therapists are not to take on friends as clients.
Perhaps this concern was addressed within the consent process or this
particular group was structured to run more independently from Sam (i.e.,
her as a participant); however, from the information available, that doesn’t
seem to be the case. Sam did organize the group, and therefore is in the position of responsibility as well as in the role of professional therapist.
Universality: If every counsellor created support groups and WhatsApp
groups as Sam did, this could be potentially problematic. Beyond concerns
with multiple relationships, Sam’s close friends would be able to easily infer
that the other members of the support group are indeed Sam’s clients. This
could be interpreted as a violation of Confidentiality (B2). More would need
to be known about the specific rules of conduct from within the group and
the corresponding WhatsApp group to know if such issues may have been
addressed. However, even with clear rules, the blurring of lines between
personal and professional is problematic.
Justice: With the information available, Sam seems to have had the best
of intentions with this group. However, by mixing her close friends in with
clients, she seems to be blurring the boundaries between her personal and
professional settings. Even though she may not see herself as in the role
of “counsellor” within these groups, there still exists a power differential
between herself and her clients, and, ultimately, even if unpaid, she is in
her professional role as a therapist in this circumstance; the same power
differential doesn’t exist with her close personal friends. It’s unclear how
this power dynamic would influence the discussions and interactions within
the groups, and for this reason, this mix of clients and friends is not recommended.
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Case 5.2
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A Grade 4 foster boy tells his foster mother that the
principal at his new school touched him in his privates
while the class was watching a movie together. The mother
called the school counsellor, and together they approached
the principal. The principal reassured the mother, saying
that the boy was troubled. When the counsellor spoke with
the principal after the mother left the meeting, concerned
that she must report the incident to child protection, the
principal insisted that he was to be notified of everything
that happens in the school and must approve any persons
coming into the school.
Key Issues:
A vulnerable Grade 4 foster child has disclosed sexual touching.
This is a reportable offense.
A principal at the school is identified by the child as the one who
touched him.
The principal has said that he must approve of anyone coming into
the school.
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Work Through A: Principle-Based
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Ethical Principles of Major Importance:
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Beneficence – Being proactive in promoting the best interests of
clients.
Fidelity – Honouring commitments to clients and maintaining integrity in counselling relationships.
Societal Interest – Upholding responsibility to act in the best interests of society.
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Justice – Respecting the dignity of all persons and honouring their
right to just treatment.
Nonmaleficence – Refraining from actions that risk harm and not
willfully harming clients.
CCPA Relevant Ethical Codes:
B1. Primary Responsibility – Counsellors/therapists respect the integrity and promote the welfare of their clients.
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B2. Confidentiality – Exceptions to confidentiality – “(iii) when a child
is in need of protection.”
B3. Duty to Warn – Take appropriate steps to inform authorities to take
action.
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A10. Third Party Reporting – When counsellors/therapists are required
or expected to share counselling/therapy information with third
parties, they ensure that details are discussed and documented with
clients as part of the initial and ongoing informed consent, including the nature of information to be shared, with whom it will be
shared, and when. Counsellors/ therapists determine whether a formal, signed consent for release of information form is warranted.
The counsellor may speak with the foster mother of the child to inform
her that the situation will be reported to Child Protection Authorities, so
that she is not surprised when they contact her. Alternatively, the counsellor
and the mother could make the report together.
In this circumstance, the counsellor/therapist is required to report to
child protective services. The School Act does not supersede the Child Protection Act and the principal’s permission is not required.
Regarding feelings and intuition – it is not my responsibility – legally or
professionally – to investigate this matter. Always believe and reassure the
child and let them know they are safe now.
To evaluate effectiveness – seek clinical supervision for support in this
serious matter that shatters assumptions about who is safe and what a potential pedophile looks like.
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Work Through B: Wise Practice
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The ethical dilemma here appears to be whether to report the disclosure
about sexual touching of a child, despite the principal’s assurances that it
didn’t happen and the principal, in essence, saying that he is in charge of
decisions like that in the school and doesn’t support the counsellor in filing
a report.
Applying the Wise Practices Lens to this scenario requires two-eyed
seeing – examining the situation from the Western perspective by considering CCPA’s (2020) Code of Ethics and Standards of Practice (CCPA, 2021)
and also considering the Indigenous perspective through applying the seven
sacred values: courage, honesty, humility, respect, truth, love, and wisdom.
There are several Principles and Articles in the Code of Ethics that are
relevant to this scenario:
• Beneficence – protecting the best interests of clients (the student in
this story is the most vulnerable).
• Justice – respecting the dignity of all, and honouring their right to
just treatment.
• Societal Interest – doing what’s best for the community; protecting
others.
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A2 – Respect for Rights – safeguarding the dignity and rights of clients.
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A4 – Supervision and Consultation – as the counsellor’s boss (the principal) is the person accused of sexually touching the child, it would
be helpful for the counsellor to seek external supervision or consultation as additional support during what is likely to become a
challenging and conflict-filled time after the principal is reported.
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A8 – Responsibility to Address Concerns About the Ethical Conduct
of Another Professional – although the counsellor addressed the
concern with the principal (the individual who has been accused),
which is an appropriate first step, the principal has, in essence, denied the concern and silenced the counsellor, leaving the counsellor
with the ethical responsibility to fulfill the “legally mandated reporting obligations (CCPA, 2020, p. 7).
A10 – Third-Party Reporting – It will be important to inform the foster
mother of the need to file a report; if the foster mother is willing, the
report could be filed together.
B1 – Primary Responsibility – The Grade 4 student is the most vulnerable in this case.
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B2 – Confidentiality - Exceptions include, as in this case, when a child
is in need of protection.
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B10 – Consulting with Other Professionals – In this case, the counsellor
can not likely consult locally without unintentionally revealing the
identity of individuals involved; it may, therefore, be helpful to consult with someone from the counsellor’s professional association,
to guide decision-making and documentation and to offer support
during what is likely to be a contentious situation at work.
The principles and relevant articles, combined, seem to make it very
clear that the counsellor will need to report the child’s revelation to the appropriate authorities. Next, applying the seven sacred values, can help to
view this scenario from an Indigenous perspective.
Courage: It took courage for the Grade 4 student to tell his foster mother what happened at school, especially since the person he was accusing,
the Principal, has the ultimate power and authority in the school. It will
also take courage for the counsellor to file a report that will put the leader of
the school under suspicion, especially when the counsellor knows that the
principal is a highly respected member of the community. The counsellor,
quite understandably, may fear being fired for not following the principal’s
policies.
Honesty: In reporting, the counsellor is not responsible to investigate
or determine guilt but, rather, to pass on, in a clear, honest, and transparent
way, the information that the student and his foster mother shared.
Humility: The counsellor is well aware that there can be many sides to
a story and, in this case, with humility, acknowledges not being in a position to judge. That said, the student is a vulnerable child and needs to be
supported. Filing a report will inform those in a position to investigate, who
may have previous information about similar accusations.
Respect: The counsellor, up until the foster mother came in to report
what her foster son had said, had fully respected the Principal. Now, that respect is in question, leaving the counsellor feeling unsure, perhaps deceived,
and on very shaky ground. The counsellor also respects the child and his
foster mother; for now, supporting them through the challenging process of
reporting and a likely subsequent investigation is the top priority.
Truth: Clearly, there are untruths in this scenario and, over time, the
whole story will surface. For now, the counsellor supports the child and his
foster mother for their courage and honesty in bringing the inappropriate
sexual touching to the counsellor’s attention and for their faith in the counsellor to believe that truth and act on it.
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Love: Moving forward with caring for the vulnerable child (and perhaps other vulnerable children who have been, or could be in the future,
harmed through inappropriate sexual touch) and offering support to the
foster mother, demonstrates the value of love and compassion.
Wisdom: Based on review of the Code of Ethics (CCPA, 2020), consultation, and the counsellor’s own inner sense of right and wrong, the counsellor displayed wisdom and discernment in recognizing the need to report
despite the Prinicipal’s denial and attempt to block the report.
From both perspectives, the seven sacred values and the Code of Ethics, the
decision to report is upheld.
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Case 5.3
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A counsellor is working with a 17-year-old teen who
identifies with the LGBTQIA’s+ community. The parents of
the teen are strict Christian and the teen does not feel accepted by their family or their community, however, they
continue to live at home. The teen is suicidal and safety
planning must be done. The teen is begging the counsellor
to not involve parents – as this would worsen the situation
that is the main issue for the teen.
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Work Through A: Quick Check
The ethical dilemma here seems to be whether or not to involve the parents – that is, can the teen be considered as a “mature minor” and, therefore,
be able to give informed consent without involving parents. As the teen is
still living at home, however, the parents could also be considered important supports in safety planning regarding the teen’s suicidal ideation.
From CCPA’s (2020) Code of Ethics, I have identified several principles
and articles as important to consider: Beneficence, Nonmaleficence, Autonomy, and Justice; Respect for Rights (A2), Diversity Responsiveness (A12),
Primary Responsibility (B1), Confidentiality (B2), Client’s Rights and Informed Consent (B4), Children and Person’s With Diminished Capacity
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(B5), Respecting Inclusivity, Diversity, Difference, and Intersectionality
(B9), and Referral (B16).
From a Quick Check perspective, the first consideration is what would I
be comfortable reading as headline news. The teen’s suicidality is a primary
consideration here – I would not want to read that my client had died by
suicide. Therefore, my decision-making is concerned primarily with safety
planning – how we, collaboratively, can best avoid that headline news story.
At the moment, despite the teen living at home, the parents do not seem
to be considered by the teen as supportive – the teen is begging me not to
involve them. Although I believe that, in the long term, building a strong relationship between the parents and teen would be helpful, in the short term
I would assess the teen’s cognitive and emotional ability to give informed
consent to counselling – based on the teen’s age and apparent differentiation from the parents’ beliefs, it is likely that “mature minor” status would
apply in this case. With informed consent from the teen in place, my next
priority will be to assess the level of suicide risk and, if it seems safe to allow
the teen to leave my office, to collaborate on developing a safety plan, with
clearly identified supportive people and resources that the teen can turn to.
I would be comfortable reading in headline news that the teen had found
life-enhancing support from a group supporting LGBTQIA+ youth, even if
I knew that might be upsetting to the parents.
Next, in the Quick Check model, I have to ask myself about Universality – would I make the same decision for everyone and if every counsellor/
therapist made this decision would it be a good thing? The challenge with
Universality is that no individuals are exactly the same, nor are the situations they find themselves in. However, yes, in the case of a mature minor,
expressing suicidal ideation, and begging me not to involve their parents, I
would make the same decision – to prioritize the teen’s immediate safety by
collaborating on a safety plan that involved other individuals the teen could
(and would) turn to for support.
The third component in the Quick Check model focusses on Justice – I
need to question whether everyone is being treated fairly by this decision.
This is where I need to face my own biases – as a parent myself, I am deeply
concerned about my children’s safety and wellbeing; I would not want to be
excluded from information about them as serious as suicidal ideation. That
said, I also recognize that sometimes I was not considered the best support
by my children as they grew into adulthood and differentiated their beliefs
and values from their parents’ and from how they were raised. Although
that’s a painful experience (on both sides), my priority as a parent remained
to keep my children alive and to help them to thrive. As a counsellor/therapist, my hope is that this teen’s parents will eventually see this decision in
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Work Through B: Principle-Based
Key Issues:
Teen identifies as LGBTQIA+
Teen is begging the counsellor to not involve the parents.
Teen is suicidal – safety planning necessary.
Relevant Sections and Codes:
Professional Responsibility
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a similar way – I am not trying to distance the teen and parents from each
other but, rather, trying to ensure the teen’s immediate safety with the hopes
of building a strong, healthy relationship with the parents going forward,
one in which the teen’s identity will be understood and respected by the
parents and the teen will, once again, feel comfortable in turning to those
parents for support.
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A2. Respect for Rights: It will be important to keep in mind the client’s
right to withhold information that could be detrimental to them
and their safety.
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A12. Diversity Responsiveness: It will be important to keep in mind the
client’s diversity and practice respect and understanding connected
to this diversity. This needs to also include working with the client
to locate resources and support.
Counselling / Therapy Responsibilities
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B1. Primary Responsibility: The counsellor must first remember their
position and obligation to work collaboratively to help the client.
B2. Confidentiality: To respect and retain the right of the client to keep
information confidential unless they are in imminent danger. Parents should only be informed if they need to know. Know the age
of informed consent in that province or territory. Be aware and understand the client’s wishes in regards to sharing information with
parents. Explain to parents the rights of the child’s desired privacy.
Conduct a joint meeting with parents and child.
B3. Duty to Warn: Take protective action when clients may be a danger
to themselves. Empower clients to take steps to minimize risk of
harm. Use the least intrusive interventions to prevent harm. Seek
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collegial consultation or legal support. Set up a safety plan with client, possibly voluntary or involuntary hospitalization.
B4. Client’s Rights and Informed Consent: Client must be able to give
consent voluntarily, knowingly, and intelligently.
B7. Access to Records: Parents or legal guardians have rights to access
their minor child’s records with a formal request, though these records are on a need-to-know basis only, so should be shared only if
in the best interest of the child.
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B9. Respecting Inclusivity, Diversity, Difference, and Intersectionality:
It will be important for the counsellor to understand the ways in
which the client’s life experiences, values, beliefs, and prejudicial
attitudes are alike or different from their own. Keeping in mind the
client’s perspective will help to gain understanding and aid in the
client’s personal development.
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B10. Consulting with Other Professionals: When sharing information
about a client it will be important not to divulge the client’s identity
unless such sharing has been approved with written consent from
the client. When in discussion with other professionals, counsellors
must remain accountable for the final decisions made.
Beneficence
Fidelity
Nonmaleficence
Autonomy
Justice
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Important Ethical Principles:
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Apply the Articles:
When working with the teen the counsellor will understand that there
may be information not shared, because of its sensitive nature and the
values held by the family (A2). As a result of the parents’ religious beliefs
and how the teen views themselves in the eyes of others, they will need the
opportunity to feel heard (A12, B9). The counsellor recognizes that they
have an obligation to protect the teen’s privacy and their trust, though precautionary resources are within their power to supply as a tool (B1, A12).
Although there is a risk of suicide, because the teen is 17 and has requested that information not be shared with their parents, the counsellor must
respect that right if the teen can be determined to be a mature minor and
capable of giving informed consent (B2, B4). The counsellor would not be
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overstepping boundaries to offer a group meeting with the teen’s parents
(B2). Recognizing that there is a chance the teen could harm themselves,
providing a safety plan and setting up a support system will give the teen
tools to help themselves (B3). The teen is still considered a minor as they are
under 19. However, if deemed to be a mature minor, as the teen has requested that information be held in confidence, the counsellor cannot share information with the parents (B7). Consulting with other professionals would
help clarify that the counsellor didn’t miss important options to support
their client (B10).
The conflict which presents itself is, whether the 17-year-old teen should
be considered a minor or be given the freedom to make the choice of what
is in their best interest and not tell their parents of the potential suicide risk.
Clarification on this discrepancy could be further explored by reaching out
to another professional. As an added avenue, the counsellor could make a
connection with a suicide specialist as a resource for the teen. However, not
telling the parents could result in legal action taken against the counsellor
in the future given that the child is still legally under the parents’ care and
protection.
My feelings tell me that the teen needs to have someone that they feel
safe with, someone who is accepting of them unconditionally. Holding this
trust will be an important step in the teen’s recovery. However, it could be
important to have the opportunity to meet as a group with the teen’s parents
to work on building communication within the family unit.
As a resolution to this dilemma, it would be important to reach out to
other professionals to confirm the best way forward in helping the teen. It
will also be beneficial to find contacts and professionally trained individuals
for the teen to speak with outside of counselling hours. The teen needs to be
made aware again of their right to confidentiality but given the opportunity
to be supported in communicating with their parents. Most importantly,
giving the client choice and the tools to move forward will be in their best
interest.
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Case 5.4
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The courts ordered a specific parenting course for the
parents of an 18-month-old child who was removed from
the parents for emergency life-saving surgery. The parents
are members of a religious sect that does not believe in
blood transfusions. The mother is a practicing doctor and
the father a well-educated professional. The parents are
currently suing almost everyone involved – the social workers (front line and supervisor), the lawyer who represents
Child Protection, other counsellors who have worked with
these parents as well as a psychologist who consulted on
the case. Despite the many difficulties in the case, the goal
is to return the child to the parents’ care. The courts would
like some assurance that these parents will cooperate with
the providers of the parenting course.
Work Through A: Quick Check
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Taking the case is in the best interest of the child, provided that the child
is not expected to suffer from an ongoing potentially life-threatening medical condition that will require ongoing urgent medical care. The parents
are mandated clients, and it would be best to establish a therapeutic alliance
by focusing on their goal to have the child returned to their care. I would
be careful to explain to the parents, at the onset of therapy and throughout,
what information from their treatment will be shared with other professionals and the courts and inform them of consequences of their non-participation in the therapy.
The Codes that come into play for this case are:
A2. Respect for Rights: “Counsellors/therapists participate in only those
practices that are respectful of the legal, civic, moral, and human
rights of themselves and others, and act to safeguard the dignity
and rights of their clients” (CCPA, 2020, p. 6). This case is very
complicated from a Human Rights perspective. CCPA’s Standards
of Practice states that, “Counsellors/therapists practice in a manner
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congruent with the overarching principles of the Universal Declaration of Human Rights, the UN Convention on the Rights of the
Child and the UN Declaration on the Rights of Indigenous Peoples to which Canada is a signatory” (2021, p. 2). These should be
checked to make sure that the request falls within the parameters of
the principles.
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A3 Boundaries of Competence: “Counsellors/therapists limit their counselling/therapy services and practices to those which are within their
professional competence by virtue of their education and professional experience, and consistent with any requirements for provincial/territorial and national credentials” (CCPA, 2020, p. 6). If this
course falls under the definition of counselling, whether the counsellor has competencies in parenting and parent-child relationships
would have to be considered.
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B1. Primary Responsibility: “Counsellors/therapists respect the integrity
and promote the welfare of their clients. They work collaboratively
with clients to devise counselling/therapy plans consistent with the
needs, abilities, circumstances, values, cultural, or contextual background of clients” (CCPA, 2020, p. 9).
From the Standards of Practice (CCPA, 2021):
The fact that this ethical article is first in this “counselling relationships”
section underscores the need for counsellors/therapists to be mindful of
their primarily obligation to help clients. Counsellors/therapists enter into
a collaborative dialogue with their clients to ensure understanding of counselling/therapy plans intended to address goals that are part of their therapeutic alliance. Counsellors/therapists inform their clients of the purpose
and the nature of any counselling/therapy, evaluation, training or education
service so that clients can exercise informed choice with respect to participation.
Counselling/therapy plans and progress are reviewed with clients to
determine their continued appropriateness and efficacy. The counsellors/
therapists’ primary responsibility incorporates most aspects of CCPA’s six
ethical principles:
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Beneficence
Fidelity
Autonomy
Nonmaleficence
Justice
Societal Interest
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A counsellor should take all of the aforementioned points into consideration before accepting this case. If the course is designed to help the parents
explore making decisions about their children or even feel comfortable with
a decision to allow blood transfusions in future and they agree to it willingly
without coercion, then the guidelines for this Code can be applied.
B4. Client’s Rights and Informed Consent:
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When counselling/therapy is initiated, and throughout the
counselling/therapy process as necessary, counsellors/therapists inform clients of the purposes, goals, techniques, procedures, limitations, potential risks and benefits of services to be
performed, and other such pertinent information that supports
the informed decision-making process. Counsellors/therapists
make sure that clients understand the implications of diagnosis,
fees and fee collection arrangements, record-keeping, and limits
of confidentiality. Clients have the right to collaborate in the
development and evolution of the counselling/therapy plan.
Clients have the right to seek a second opinion or consultation,
to refuse any recommended services, and to be advised of the
consequences of such refusal. (CCPA, 2020, p. 9)
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This leads back to the first comment made before: Is the course considered to be counselling or a stand-alone course? Will therapy be involved? If
so, informed consent must be adhered to.
From the Standards of Practice (CCPA, 2021):
Knowingly means that counsellors/therapists fully disclose
relevant information to clients so that they are briefed as to
what it is they are being asked to give their consent. This includes disclosing the type of information which may have to be
reported to a third party and the limits to confidentiality (e.g.,
requirements of public health laws, warrants, and subpoenas)
and checking the client’s understanding through discussion,
clarification, and opportunities to ask questions. Information
must be given to clients in a manner which is sensitive to their
cultural and linguistic needs. (p. 19)
B9. Respecting Inclusivity, Diversity, Difference and Intersectionality:
Counsellors/therapists actively invest in the continued development and refinement of their awareness, sensitivity, and competence with respect to diversity (between groups) and difference
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(within groups). They seek awareness and understanding of client identities, identification, and historical and current contexts.
Counsellors/therapists demonstrate respect for client diversity
and difference and do not condone or engage in discrimination.
(CCPA, 2020, p. 11)
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From the Standards of Practice (CCPA, 2021):
Counsellors/therapists engage in education, training, and other
learning experiences that will augment their competencies in
working with clients of diverse backgrounds. As they actively
seek to broaden their diversity perspectives and to consider
other worldviews, they also aim to refrain from imposing their
own values. Counsellors/therapists consider how clients’ diversity contexts shape their concerns and inform potential interventions. (p. 28 – 29)
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Counsellors/therapists are sensitive to and acknowledge their clients’
religious and spiritual beliefs and they incorporate such beliefs into their
counselling/therapy discourse with clients. This appears to be an important
consideration in this case and the counsellor is advised to consider whether
taking this case within the parameters of delivering a specific course would
enable them to work within this article of the code.
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C7. Reporting Assessment and Evaluation Results to Clients:
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Counsellors/therapists clearly specify with whom, when, and
how results of assessment and evaluation will be shared as
part of the informed consent process. Results are presented to
clients in a timely manner, in language appropriate to clients’
developmental, cognitive, intellectual, and linguistic abilities.
Counsellors/therapists provide clients with the opportunity to
pose questions and seek clarification. (CCPA, 2020, p. 15)
If any reports are to be written about the parents’ participation in the
course, Codes C7 and C8 should be understood and followed.
C8. Reporting Assessment and Evaluation Results to Third Parties:
The nature and extent of information to be shared with third
parties is determined on a need-to-know basis that has prior
informed consent and maintains client best interests as the
priority. Reports summarize the referral issue(s), nature and purpose of assessment undertaken, procedures followed, measures
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implemented and the rationale for their selection, and results
and findings. Report conclusions and recommendations clearly arise from the assessment results and findings. Reports are
written in an objective and professional tone, avoiding the use
of professional jargon in favour of language that can be understood by a wide reading audience. (CCPA, 2020, p. 15)
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Publicity: I have some hesitation about accepting the parents as clients
because of their tendency to sue everyone or to take issues to the press.
However, I need to make the clients (the parents in this case) my primary
concern - not protecting myself. The front-page news story that I’d hope to
see would be the parents speaking positively about the parenting course and
how it had been respectful and practical, and helped them better understand how to care for their child within the various child protection systems.
Universality: Yes, agreeing to take on the parents as clients, to build a
therapeutic relationship with them, and within that relationship to explore
their concerns about the parenting course and the potential benefits that
could come from it, is a decision that I would make in other similar cases.
Justice: The case must be considered from a long-term perspective. The
child needs specialized care and the mother is a doctor. The parents have
the means to support the child’s ongoing medical care. The child loves the
foster mother and is settled in care; however, if the course and the therapy is
effective and the parents become less angry, the child living with her parents
is optimal. Forming a therapeutic alliance with the parents to explore their
concerns about the course seems respectful and just. Helping the parents to
understand the potential benefits of the course, not the least of which is the
potential to regain custody of their child, is most likely to happen within
such a therapeutic alliance. Justice for the child is, of course, of paramount
importance; ideally, within a safe therapeutic setting, the parents could
begin to see the other perspective and their duty to protect the child’s life
should a similar need arise in the future. Justice for the instructors and other
participants of the parenting course is another consideration. If, through
counselling, the parents see the value of attending the course and participate willingly and without causing a disruption or distraction, that would
contribute to justice for all involved in the course.
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Work Through B: Virtue-Based
What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
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My first instinctive emotion is horror. I, personally, can’t imagine letting
an 18-month-old child die when they could likely be saved by allowing a
blood transfusion. So clearly, there is some pre-existing bias I am bringing to
the situation! (Refer to CCPA, 2020, Articles A2: Respect for Rights and A12:
Diversity Responsiveness). I would need to do some serious soul searching
to determine if I could subordinate my initial judgement, and feelings on
this issue. That said, I also inherently believe that the vast majority of people
have reasons for making the decisions they do, acting the way they do, or
believing what they do. I also believe that most people actually try to make
the best decision for themselves in any given situation. To be clear, I may not
agree with what they think, or the decision they make – but I do think that
there is always a reason behind it. In order for me to get to the point of being
willing or able to help in this situation, I would need to be curious. I would
need to want to understand (again, not agree, but understand) where they
are coming from (Refer to Articles B1: Primary Responsibility, B4: Client’s
Rights and Informed Consent, B9: Inclusivity, Diversity, Difference and
Intersectionality). Given that this appears to be court-ordered counselling,
then B18: Mandated Clients and Systems Approaches is also relevant.
How can my values best show care for the client’s wellbeing?
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My values tell me I should try to help in terrible situations – that bad
things happen when good people do nothing. I like understanding people,
discovering new perspectives, and solving tricky situations. I also like helping the client navigate a system that they feel is entirely stacked against them,
or with people who they feel are judging them. I have a great deal of experience in this particular niche, so I potentially could be better at it than others.
On the other hand, I also value honesty and transparency, and I doubt that
I would be able to hide what I am thinking or feeling on this topic (even if
I did want to). If I would say what I really thought, I believe that would further alienate the parents. If I was completely honest with them, there may be
a very small chance that they agree to talk with me – just because I am being
honest about where I stand on the issue, but that is likely not going to be the
case. In weighing values, I tend to default to honesty, because then people
know where I stand, and make their own decisions around that. Referring
to the CCPA (2020) Code of Ethics, reminding myself that my priority is the
client (B1), being really clear about the information provided in securing
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informed consent (B4), and upholding the principles of Nonmaleficence,
Autonomy, Fidelity, and Justice will be crucial.
How will my decision affect other relevant individuals in this
ethical dilemma?
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If I decide to help, and I am not able to subjugate my judgement, the clients will pick up on it, and could feel even more misunderstood and angry
(perhaps with a little betrayal mixed in). This would breach the principles of
Fidelity, Autonomy, and Nonmaleficence. If I decide to not take the client,
then someone who is just as judge-y as I am could take the case, and they
may not be as good as I am at getting unwilling / mandated clients onboard
(B19). In my view, my first consideration and primary responsibility (in this
situation) would be to the infant, rather than to the courts, the parents, or
the providers of the parenting course. By looking at it from that perspective,
I would consider taking the client, but the next step is to determine if I think
my involvement would be actually beneficial, and I doubt that (Beneficence,
Nonmaleficence).
What decision would I feel best about publicizing?
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I’d probably feel safer publicizing that I chose not to assist the child
going back to the parents. The child doesn’t have a voice, and I would feel
genuinely terrible to facilitate the child going back to the parents only to
have another incident occur. That said, I would also have to consider a potential headline that read that the 18-month-old was abused or died while
in the care of Child Protection. I think the “publicizing” question isn’t as
important as making a decision for the right reasons (both for oneself and
the interested parties), and a decision that I can live with in the long run.
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What decision would best reflect who I am as a person and practitioner within cultural/intercultural contexts?
I suspect that while I may be interested and curious about why these
parents think and feel the way they do, I don’t think that is sufficient to take
the client (regardless of cultural contexts). I believe the risks of my taking
the client outweigh the potential benefits, given how strongly my initial reaction to the scenario was. I would try my best to suggest a suitable referral
for this case (B16).
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Case 5.5
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A private practice counsellor is approached by a
mother distressed that her child has been abused by her
husband. The mother and father are in the early throes of
separation. The mother brings her child, age 7, to the therapist for consult. The counsellor is empathetic to the intense
situation and agrees to see the child because the mother is
in distress. According to the mother, there is a police investigation in process. The mother has stopped access to the
father because of her concerns.
After seeing the child for a few sessions, the therapist
receives a notice from the father advising her that he has
the right to be consulted about the care provided to his
child.
The therapist does not respond because she has a
signed consent to see the child by the mother, and since
there is no separation paperwork believes that it is within
her right and best practice to continue to see the child.
Work Through A: Virtue-Based
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Phase One: As I consider the dilemma, I am feeling confused as to why
the father is persistent in contacting me when I have consent from the mother and he is standing accused. I think most fathers, in the early process of
a separation, would want the courtesy of knowing their child is attending
counselling, the reason for counselling, and the child’s progress. The mother states that the father is accused and there is a police investigation underway. Without concrete evidence of this, or the presence of formal charges
against the father, the counsellor must maintain objectivity in this situation
and be aware that the mother may have an agenda (e.g., prepare for a custody battle by having the father appear to be an abuser). I would need to
determine the legal requirements of whether both parents in a case like this
need to consent for the child’s counselling (B5); I understand that this is
different across jurisdictions.
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Based on that statement that there is a police investigation underway,
the counsellor would want to determine a) if there was indeed a formal police investigation underway and b) if counselling with the child at this time
may interfere in any investigation (i.e., if the child has not yet been formally
interviewed regarding the alleged abuse). If the mother does not provide
consent for the counsellor to confirm this information (CCPA, 2020, A10:
Release of Information), then the counsellor should only offer supportive,
objective counselling for the child, focused on things such as coping with
family change or managing specific symptoms, rather than initially treating
the child as a child who has been abused (B14: Multiple Helpers, in the case
that police interviewers may also become involved).
My emotions are influencing me in the way that I am afraid for the
child in the fact that nobody knows the seriousness of what has happened.
The father has been excluded and in a way is being condemned, so should
I not be playing a role in keeping the child safe from him? I feel a level of
responsibility to make sure that my client has the right to be in session safe
from the father having knowledge of the counselling because the mother has
given her consent and the parents are now separated. If counselling focuses
on abuse and the effects of having an abusive father, but the father, in fact,
was not abusive, then the child could suffer psychological harm, cognitive
dissonance, and attachment impairment. The child could also be influenced
by the tone of therapy and provide false information in any police investigations.
My emotions are telling me that it is important for best practice for
continuity of seeing the child (B1: Primary Responsibility). My emotions
are also telling me that refusing to reach out to the father will escalate the
conflict and my fear would be that non-communication would be viewed by
the father as siding with the mother. I feel right in the fact that I have consent from the mother in a separation situation and as such the father has no
right to know what is happening in therapy because the charges the mother
has brought forward scares me.
I want to be fair and equitable in this circumstance to all parties that I
am in contact with (CCPA, 2020, Principles: Justice, Fidelity). It is not really
being fair to the father if we don’t know his side of the story and whether
the abuse allegations are founded. Although in some provinces, only one
parent’s consent is required for counselling, it would be in the best interest
of the child if, now that the father is seeking information, that his request
be considered. This could look like the counsellor informing the mother of
the request and suggesting that the process be a) the counsellor reach out
to the father and set out boundaries regarding possible shared information
(e.g., attendance and progress); b) the counsellor discuss with the child her
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feelings about what information could be shared with the father that she
would be comfortable with (i.e., attending therapy and doing well, focus on
lowering anxiety regarding family changes).
Phase Two: I value most my high standards of professional competence
(A1: General Responsibility and A3: Boundaries of Competence) and ethical behaviour and respecting the equal treatment of all persons (Justice). My
values can best show caring for my client in this situation by finding out as
much information as possible from all parties to make the best, informed
decision possible as to how to proceed with this case.
I will consult with a supervisor (A3: Boundaries of Competence; A4:
Supervision and Consultation) to help me sort through this issue and to
gain guidance and additional insights. I may also consult anonymously with
child protection authorities to obtain more information using this case as a
hypothetical scenario.
I feel that it is important for me to find out in the safest way possible
my responsibility. If I am afraid of speaking to the father, what are my other
options? Perhaps speak to the lawyer (B10: Consulting With Other Professionals) and the father together? I need to be able to put in place what I need
to be able to speak to the father, in order to make sure that I am not biased
in my view of the situation.
Phase Three: My decision to not communicate with the father will affect the father in the way that he will continue to be afraid of the counselling and that he might escalate the conflict because of his growing fear that
parental alienation will occur without his ability to do anything. I am also
afraid that the mother will feel that I am not on her side and will not continue to do her bidding, and if she fears that she will withdraw the child from
therapy with me. I am also afraid that continuing to see the daughter without consent and added information from the father will continue to support
bias in my mind and transfer that bias to the client.
The alternative is that the father’s hostility regarding being ignored/excluded could: a) impact the counsellor (e.g., worry about retribution from
the father) and thus impact the counselling relationship with the child; b)
result in the counsellor only hearing the mother’s side of the story and thus
endorsing her story, consciously or unconsciously, in the therapy with the
child.
I also worry that because I do not have all of the information I need to
make an informed decision as to why not to contact the father, I might be
putting myself in harm’s way. Perhaps I should reach out to another (e.g.,
ethics committee member, supervisor, colleague; A4: Supervision and Consultation, B10: Consulting With Other Professionals) in order to review
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this case to have the added information that I truly need for best practice.
I might also contact the father’s lawyer in order to gain clarity about the
father’s rights and responsibilities as they stand currently in order to better
inform my own decision making. Reaching out for supervision or consultation on this matter is a great idea. This is a complex case with potential for
negative impact on the child client, the parents, and the counsellor.
The counsellor could contact the father, explaining the consent piece
given the current joint custody. If the father is not happy with this explanation, the counsellor could suggest that the father have his lawyer contact
her and outline his current rights. Contacting the lawyer without the father’s consent may only create further hostility in this situation, regardless
of whether the lawyer provides any information.
By looking at this case through the lens of the current status of joint custody as there has been no court order to state anything different, I have the
responsibility to follow the current consent requirement of joint custody,
and I should make sure that is the case in order to follow best practice and
support my decision one way or the other. Although the counsellor can see
the child with only the consent of one parent, she should set firm boundaries regarding the current focus of therapy and the father’s right to any
information about the following sessions (which he still may have via joint
custody). The therapist needs to determine if the child will be harmed (e.g.,
increase in anxiety) by the sharing of any information, even generic, with
the father. If there is no evidence that harm can come to the child by this
information sharing, and the counsellor does not share the information,
then the counsellor may risk being accused of supporting parental alienation practices of the mother.
Phase Four: To best plan and take action by maintaining my own attitude of self-reflection, addressing balance and collaboration between all
parties involved in the case. Self-reflecting on why I feel the need to keep
the child safe from obtaining informed consent from the father. Am I afraid
of the mother? Losing the client if I don’t do what the mother asks? Why
am I afraid of finding out further information from the lawyer? Do I want
to keep things simple because I don’t know how to handle the complexity of
this case? Do I need to refer or obtain supervision or have added education
in high conflict situations in families?
If publicized, the best decision would be to: obtain supervision/expert
consultation, consider the facts of the situation, ensure beforehand that all
parental rights are confirmed, have a set plan to address any information
sharing related to counselling, and ensure that the child is not at risk for
harm if this plan is executed.
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Work Through B: Principle-Based
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B2. Confidentiality
B3. Duty to Warn
B5. Children and Persons with Diminished Capacity
B7. Access to Records
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To better understand this dilemma, I will apply the Principle-Based
Ethical Decision-Making Model. The 6 steps are summarized below.
Step One: There seem to be two key ethical issues relevant in this situation: (1) does the counsellor have consent to provide services and (2) how
to appropriately balance the well-being/safety of the client (i.e., child) with
the rights of the father.
Step Two: The following articles from CCPA Code of Ethics may be
relevant in this circumstance:
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At this stage, the allegations of abuse against the father are just that,
allegations. Therefore, it would be important to determine the status of the
police investigation and the separation proceedings – i.e., is there an emergency custody agreement and/or a no-contact, restraining, or protective order in place? This would influence what the counsellor could or could not
do in relation to communicating or consulting with the father. In addition,
what was the nature of the “notice” received from the father – e.g., was it an
email or a formal letter from lawyer?
Step Three: Given there is an active investigation, it’s reasonable for the
counsellor to assume there is some credibility to those allegations. As such,
the key ethical principle in this circumstance seems to be Nonmaleficence
– refraining from taking actions that risk harm to the client (i.e., the child).
Allowing the alleged abuser into the client-counselling relationship might
indeed harm the client and compromise safety.
Step Four: In relation to providing services to children, Children and
Persons with Diminished Capacity (B5) describes the need for informed
consent from both the child and those who are legally entitled to offer consent (e.g., parents). It doesn’t state that both parents/guardians need to consent. As the mother has provided consent on behalf of the child and without
legal paperwork indicating otherwise, this should be sufficient to continue
the counselling relationship. If there are any additional legal restrictions to
the father’s parental rights (whether temporary or permanent), this would
strengthen the counsellor’s decision to continue without the father’s consent. Regardless, it would be important to also ensure the child’s ongoing
assent as well.
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By not responding to the father and continuing to offer counselling services, the counsellor might risk deepening the divide between child and parent. However, given the ongoing investigation and the credibility/severity of
the allegations, this seems like a reasonable path forward. By responding to
the father, this might be viewed as compromising the client’s Confidentiality
(B2) – e.g., how does he know the child is seeing the counsellor if he doesn’t
have access to the child? It may be viable to ask the mother about the status
of the custody of the child.
Given the mother has indicated that she is restricting access to the alleged abuser, the child doesn’t seem in immediate danger so consequently
there isn’t an immediate Duty to Warn (B3); This, however, would likely
need to stay top of mind along with the possibility of the client’s records being subpoenaed – i.e., Access to Records (B7). It would be reasonable at this
point to review with the mother the counsellor’s ethical obligations in these
areas (even if this was noted within the informed consent documentation).
Step Five: Although the allegations haven’t yet been proven (and assuming the child hasn’t disclosed anything in therapy yet), given the police
investigation is moving forward, my intuition would tell me that the allegations are credible. Although, I’m sad to see the family unit break, that
unit seems to be ineffective in providing a safe environment for the child. I
would feel protective of the child who is caught up in a potentially dangerous situation. However, given the proactive actions of the mother and the
support of the police, I’d be hopeful that early intervention/supports will
lead to more positive outcomes for the child. I might worry about the longterm implications of this kind of trauma and the possibility about being
subpoenaed in the court battle between parents, whether or not the allegations are substantiated. My intuition would tell me at this point to ensure the
mother understands my ethical obligations in these circumstances to she’s
not caught off guard should something change. Step Six: Assuming no external legal requirements exist otherwise (e.g.,
documents from the court from the mother and/or father), in this situation,
it would be most helpful to continue to provide services to the child. The
need for ongoing consent from the mother and the child would be essential
in this circumstance as the situation might be fluid. This includes ensuring
understanding of the counsellor’s ethical obligations.
In addition, the counsellor might want to consult with another professional who has had more experience working with cases such as this (Consulting With Other Professionals – B10). They might have some additional
tips, strategies, or cautions that could assist in moving forward ethically.
Step Seven: As part of the follow-up and evaluation process, I would
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recommend staying in contact with the mother and any professional that
has been consulted. Given how dynamic these situations can be, there is a
possibility that the situation might warrant different actions if more information is obtained.
In addition, there would likely be an opportunity to construct a specific,
customized informed consent with additional information about situations
where family members, parents, or guardians might disagree with the treatment/care plan for their children.
There might also be an opportunity to craft a more generic response,
perhaps approved by a lawyer representing the counsellor, to respond to
inquiries like that sent by the father – whether it be an information email,
phone message, or a formal letter.
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CHAPTER 6
Case 6.1
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A 17-year-old transgender male on the autism spectrum comes to counselling and decides they want gender affirming healthcare. Current guidelines suggest, “The
adolescent has demonstrated a long-lasting and intense
pattern of gender nonconformity or gender dysphoria
(whether suppressed or expressed).” The dilemma is, “What
is the definition of long-lasting and intense?” The client has
stated they felt this way for the past 5 months and before
they identified as trans, they were non-binary, and before
that they were gender variant. The client has done extensive research and answers all the standard questions about
Hormone Replacement Therapy (HRT) very well. But when
asked non-standard questions about HRT they are lost. The
client knows a doctor that will prescribe HRT without a
formal assessment. The client has unrealistic expectations
about HRT and wants top surgery as soon as they can at 18.
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Work Through A: Virtue-Based
The Codes that would come into play for this case, if it is legal for the
counsellor to proceed are:
A2. Respect for Rights:
“Counsellors/therapists participate in only those practices that are
respectful of the legal, civic, moral, and human rights of themselves and
others, and act to safeguard the dignity and rights of their clients” (CCPA,
2020, p. 6). This case is very complicated from a Human Rights perspective.
CCPA’s (2021) Standards of Practice states that:
Counsellors/therapists practice in a manner congruent with the
overarching principles of the Universal Declaration of Human
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Rights, the UN Convention on the Rights of the Child and the UN
Declaration on the Rights of Indigenous Peoples to which Canada
is a signatory. (p. 2)
The counsellor should ensure that any therapy would be within the parameters of these principles.
A3. Boundaries of Competence:
B1. Primary Responsibility:
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“Counsellors/therapists limit their counselling/therapy services and
practices to those which are within their professional competence by virtue of their education and professional experience, and consistent with any
requirements for provincial/territorial and national credentials” (CCPA,
2020, p. 6). Counsellors who do not have specific training/competencies in
the area of supporting clients who wish to participate in gender transitioning medical procedures should offer referrals for counsellors who do have
these competencies.
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“Counsellors/therapists respect the integrity and promote the
welfare of their clients. They work collaboratively with clients
to devise counselling/therapy plans consistent with the needs,
abilities, circumstances, values, cultural, or contextual background of clients” (CCPA, 2020, p. 9).
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From the Standards of Practice (CCPA, 2021):
The fact that this ethical article is first in this “Counselling Relationships” section underscores the need for counsellors/therapists to be mindful of their primarily obligation to help clients. Counsellors/therapists enter
into a collaborative dialogue with their clients to ensure understanding of
counselling/therapy plans intended to address goals that are part of their
therapeutic alliance. Counsellors/therapists inform their clients of the purpose and the nature of any counselling/therapy, evaluation, training, or education service so that clients can exercise informed choice with respect to
participation.
Counselling/therapy plans and progress are reviewed with clients to
determine their continued appropriateness and efficacy. The counsellors’/
therapists’ primary responsibility incorporates most aspects of CCPA’s six
ethical principles:
Beneficence
Fidelity
Autonomy
Nonmaleficence
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Justice
Societal Interest
(p. 14)
If the counsellor proceeds with this case, they should work with the
client to carefully identify counselling goals.
B4. Client’s Rights and Informed Consent:
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When counselling/therapy is initiated, and throughout the
counselling/therapy process as necessary, counsellors/therapists inform clients of the purposes, goals, techniques, procedures, limitations, potential risks and benefits of services to be
performed, and other such pertinent information that supports
the informed decision-making process.
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Counsellors/therapists make sure that clients understand the
implications of diagnosis. Clients have the right to collaborate
in the development and evolution of the counselling/therapy
plan. Clients have the right to seek a second opinion or consultation, to refuse any recommended services, and to be advised
of the consequences of such refusal. (CCPA, 2020, p. 9)
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The counsellor must also have the competency to work with clients who
have autism spectrum disorder (ASD) and be able to explain informed consent in a clear manner to people with learning differences (note: the case
description does not include information about the degree of autism on the
spectrum).
B9. Respecting Inclusivity, Diversity, Difference and Intersectionality:
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Counsellors/therapists actively invest in the continued development and refinement of their awareness, sensitivity, and competence with respect to diversity (between groups) and difference
(within groups). They seek awareness and understanding of client identities, identification, and historical and current contexts.
Counsellors/therapists demonstrate respect for client diversity
and difference and do not condone or engage in discrimination.
(CCPA, 2020, p. 11)
This would also apply to differences in clients with diverse gender identification but also has implications for clients with ASD, and their understanding of information and concerns, particularly around HRT and their
expectations around it. The Standards of Practice (CCPA, 2021) for this
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code also cautions counsellors to refrain from imposing their own values
and to “consider how clients’ diversity contexts shape their concerns and
inform potential interventions” (p. 28 – 29).
I would recommend using the few months before the 18th birthday to
provide care related to past experience, discovery pathway, expectations,
changes in labels and meanings of labels, interpersonal relationships, and
personal supports.
Analysis of the situation:
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1. Examine the situation through personal awareness: I feel a sense of
compassion for those involved in this ethical dilemma as I do believe
that individuals need to have a sense of their own autonomy and in a
client-centred approach it is important that the client is taken seriously
in their own rights to determine their future and that they know themselves the best. I want to be sensitive and respect the client and their
wishes in a non-judgmental stance.
2. Examine the situation through a social/cognitive/emotive process:
It makes sense to me that the client does appear to be more lost in
non-standard questions as they have ASD and that as such they may
flounder more with non-standard questions. It makes sense to me with
the description that they may have felt this way for the past 5 months;
however, it also sounds that they have been gender non-conforming for
a much longer period of their life. I would want to know more from
other sources such as from a colleague, and since they are 17 years old,
more information from/about their support system such as guardians/
parents and other health care providers such as the family doctor.
3. Examine competing values: I would not want to be the person to block
the client’s wishes. I would want to explore more together to determine
more information about their expectations of HRT and beyond, because that seems to be a concern of the therapist. Because of the age being close to the age of majority but not quite I would wonder more about
consent being given and understood by my client and if that question
would put me at risk at all going ahead if I had the question of whether
this client’s story qualifies as long-lasting and intense.
4. Plan and take action: I would want to maintain an attitude of reflection
and I would want to understand the issues and values of others involved
in the situation. I would also want to be aware of the community implications of this client wanting gender affirming healthcare as I would
want to make sure that my attitudes are in the best interest of the client
and that by my process of collaboration that I am not putting the client
at any risk.
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Work Through B: Principle-Based
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There are several issues that I must consider before I support HRT for
a transgender client, understanding that counsellors do not diagnose, and
therefore only can work to support the client. In considering a client’s transition, it is important to consider the wide variety of factors impacting their
psychological, emotional, mental, and social lives. Before proceeding, it is
important to consider both the health and legal aspects too. I have therefore
decided to use the Principle-Based Ethical Decision-Making Model, which
offers a structured approach that facilitates a thorough ethical analysis.
Step One – What are the key issues in this situation?
Client’s Age, Jurisdiction & Consent to Treatment Legislation: Since
my client is a 17-year-old individual, considered a minor in most provinces
in Canada, the first thing to consider is their age and how that age impacts
the autonomy they have over their health decisions. In BC a minor is any
person under 19 years old, although in other provinces and territories it is
different (e.g., in Newfoundland a minor is a person under 16; Government
of Canada, 2023). In terms of children’s consent to treatment, approach also
varies depending on jurisdictions. On the other hand, the term “mature minor” needs to be included too. Each jurisdiction has different considerations
on who can be considered as such.
Since I practice in BC, I must be clear on what age to consent to medical
treatment is considered appropriate in my province. The Infants Act states:
Children may consent to a medical treatment on their own as
long as the health care provider is sure that the treatment is
in the child’s best interest, and that the child understands the
details of the treatment, including risks and benefits. It is up to
the health care provider to assess and ensure the child’s understanding of the treatment... A child under the age of 19 is called
a “minor.” “Mature minor consent” is the consent a child gives to
receive or refuse health care after the child has been assessed
by a health care provider as having the necessary understanding to give the consent. A child who is assessed by a health care
provider as being capable to give consent is called a “mature
minor” (…) A child who is a mature minor may make their own
health care decisions independent of their parents’ or guardians’ wishes. In B.C. there is no set age when a child is considered capable to give consent. (HealthLink BC, 2022, 119)
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In this case, because my client is not only a 17-year-old individual but
also autistic, I would have to assess the age and evaluate if my client would
be considered a “mature minor” in the province and have the ability to fully understand the treatment and give consent to counselling (CCPA, 2020,
B1. Primary Responsibility, p. 9; B4. Client’s Rights and Informed Consent,
p. 9). A 17-year-old youth with ASD could be fully capable of making the
decision and being considered a “mature minor.” However, for each case
it would be relevant to assess considering the nuances and unique circumstances in each client.
Client’s capacity to consent to treatment: Once the individual’s age is
considered, I must determine my client’s capacity to consent to counselling
treatment. According to the Canadian Paediatric Society, capacity is “the patient’s ability to understand information relevant to a treatment decision and
to appreciate the reasonably foreseeable consequences of a decision or lack of
decision” (Coughlin, 2018). Knowing that my client is on the autism spectrum, I am aware of their cognitive and emotional challenges. Therefore, I
must determine their autism level and how much support they require to
make decisions on their own in order to help them in the best possible way
on this desired transition. Additionally, I will also follow the World Professional Association of Transgender Health’s (WPATH) Standards of Care
(2022), especially the criteria stated for hormone therapy for adolescents
and make sure my client, especially on the criteria related to my duty as
a counsellor which is to make sure my client “demonstrates the emotional
and cognitive maturity required to provide informed consent/assent for the
treatment” while addressing “mental health concerns that may interfere with
diagnostic clarity, capacity to consent” (see: criteria for hormone therapy for
adolescents).
As part of my ongoing duty to inform my client about the “purposes,
goals, techniques, procedures, limitations, potential risks and benefits of
services to be performed” (CCPA, 2020, B4. Client’s Rights and Informed
Consent, p. 9), I will make sure they are aware of the importance of assessing
their capacity to consent considering their personal challenges and barriers.
I will, at the same time, validate their goals and confirm my commitment to
keep those goals, as well as the client’s wellbeing, as my main priority.
Severity Level of ASD (Required Support): My client identifies themself as a transgender male with ASD. They are aware of the evolution they
have gone through (identifying first as gender variant and then as non-binary) and are clear about the challenges that their autism brings to their life.
They were diagnosed with autism as a child. The case does not clearly express the level of autism of the individual nor the required support. I would
have to confirm they are in Level 1, requiring support, and not Level 2,
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requiring substantial support, or Level 3 requiring very substantial support.
In this case, I and my client must reflect on their level of autism and each
of the challenges that impact their current desire to go through HRT and
soon move forward with top surgery. One of the challenges my client might
experience, which is common for autistic individuals, is time perception
and required support.
Time Experiencing Gender Nonconformity or Gender Dysphoria:
Considering the other factors and assuming that my client does have the
capacity to decide and has a level of ASD that allows them to move forward,
another factor that would have to be taken into account is the time they have
been experiencing Gender Nonconformity or Gender Dysphoria. DSM5-TR considers “gender dysphoria in children as a marked incongruence
between one’s experienced/expressed gender and assigned gender, lasting
at least 6 months” (National Library of Medicine, 2023). My client has identified as trans for less than 6 months, which would make me consider delaying for a short period of time (another 6 months) to allow my client to better prepare for this transition and work on the aspects of the non-standard
questions where they felt lost. The only reason that would make me question waiting for some months is if my client is experiencing severe depression and waiting for this could become harmful and deteriorate my client’s
mental health. Again, I am keeping in mind that I as the counsellor would
not be diagnosing these conditions, and may need assistance in referring if
diagnosis is required to support.
Readiness assessment: After considering all of the above, a key issue as
a counsellor would be to explore the unrealistic expectations my client has
about HRT as well as the reaction they had when being asked non-standard
HRT questions. They seemed lost and this would have to be addressed, understanding if the way in which questions were framed was too unstructured
and their inability to answer was related to their autism or their actual capacity. Additionally, I will need to work collaboratively with other professionals for proper diagnosis and to provide a holistic approach that considers my
client as a whole. According to Standards of Care for the Health of Transgender and Gender Diverse People (Coleman et al., 2022), health care we should
provide to our trans clients is greater than the sum of its parts, and should
involve holistic inter- and multidisciplinary care between endocrinology,
surgery, voice and communication, primary care, reproductive health, sexual health and mental (p. 57). Addressing with the client the level of stability
of their gender incongruence (e.g., how much time they have felt this way)
as well as their lived experience of “long-lasting and intense” dysphoria
would be extremely relevant.
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Step Two: What ethical articles from the CCPA Code of Ethics are relevant to this situation? – Are there policies, case law, statutes, regulations,
bylaws or other related articles that are relevant to this situation?
I would consider the following articles from the CCPA Code of Ethics as
the most relevant for me to consider before approving or disapproving an
HRT or top surgery for this client:
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A3. Boundaries of Competence, p. 6
A12. Diversity Responsiveness, p. 8
B1. Primary Responsibility, p. 9
B5. Children and Persons with Diminished Capacity, p. 10
B9. Respecting Inclusivity, Diversity, Difference and Intersectionality, p. 11
B10. Consulting with Other Professionals, p. 11
C1. General Orientation, p. 14
C2. Informed Consent for Assessment and Evaluation
C10. Sensitivity to Diversity when Assessing and Evaluating, p. 16
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Other documents that should be considered on this case are:
• American Psychiatric Association. (2023). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). American Psychiatric Publishing.
• Canadian Counselling and Psychotherapy Association (2021).
Standards of practice. https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Webfile.pdf
• Government of Canada (2023). Article 12 of the Convention on the
Rights of the Child and Children’s Participatory Rights in Canada.
https://www.justice.gc.ca/eng/rp-pr/other-autre/article12/p3a.
html
• World Professional Association of Transgender Health. (2022).
Standards of care for the health of transgender and gender diverse
people (Version 8). https://www.wpath.org/publications/soc
• World Health Organization. (2023). International classification of
diseases: ICD-11 for mortality and morbidity statistics. https://icd.
who.int/browse11/l-m/en
» See: HA60: Gender incongruence of adolescence or adulthood
and HA61: Gender incongruence of childhood
Step Three: Which of the six ethical principles are of major importance
in this situation? (This step also involves securing additional information,
consulting with knowledgeable colleagues or the CCPA Ethics Committee,
and examining the probable outcomes of various courses of action.)
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Beneficence – I will proactively prioritize my client’s best interest.
Any course of action should ensure this principle is being protected
and promoted.
• Nonmaleficence – I will avoid actions that could harm my client.
• Autonomy – Although my main task in this case is to provide useful
information for my client on their current capacity to move forward
with gender affirming healthcare, my main duty is still to respect
their rights to self-determine what life decisions support their wellbeing in the best possible way.
• Justice – My client, as any other client, deserves the right to search
for the resources and paths that allow them to live the life that they
want. Even though autism brings several barriers and there could
be some steps on the way that might look different than what they
envision, the approach that I will take will consider this as my main
goal.
Step Four: How can the relevant ethical articles be applied in this
circumstance? – How might any conflict between ethical principles be resolved? – What are the potential risks and benefits of this application and
resolution?
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B1. Primary Responsibility (CCPA, 2020, p. 1). It is my main duty to
protect and respect my client’s welfare. I have been asked to participate in a decision that will impact my client’s life. If, after assessing
their current situation it is considered that HRT or top surgery are
not ideal as of now due to factors such as time experiencing dysphoria (less than 6 months), diminished capacity, or ability to weigh
the implications of their decision, I will work with my client on alternative scenarios and solutions to make sure they are supported
towards their wellbeing and personal goals.
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B5. Children and Persons with Diminished Capacity (CCPA, 2020, p.
10). As my client has ASD, I need to consider the level of capacity
they have for different decisions. Every decision requires a different
assessment because not all decisions have the same implications.
For example, my client could be fully capable of deciding what type
of job they want to do, which doesn’t necessarily mean they have the
capacity to understand the implications of the decision they have
made. I need to be mindful of this and support them in developing
the ability to understand this important decision’s implications and
be able to consider the specific barriers (and sometimes changes)
that my client’s autism brings.
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B10. Consulting with Other Professionals (CCPA, 2020, p. 1). The Standards of Care for the Health of Transgender and Gender Diverse
People, Version 8, recommends health care for trans clients to be
holistic and multidisciplinary. This article is extremely relevant for
a case like this. My client requires a multidisciplinary approach to
consider all the angles that support their wellbeing and prevent as
many risks as possible.
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C1. General Orientation (CCPA, 2020, p. 14). If I am to support this
client, it means that I have received appropriate training and I am
working within the boundaries of competence (A3. Boundaries of
Competence, p. 6) as well as a culturally sensitive approach that
considers diversity and intersectionality (A12. Diversity Responsiveness, p. 8; B9. Respecting Inclusivity, Diversity, Difference and
Intersectionality, p. 11)
C2. Informed Consent for Assessment and Evaluation (CCPA, 2020, p.
14). I am being asked to evaluate if I consider appropriate for my
client to move forward with HRT and female-to-male (FTM) top
surgery. Therefore, I should proceed providing ongoing and sufficient detailed informed consent throughout.
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C10. Sensitivity to Diversity when Assessing and Evaluating (CCPA,
2020, p. 16) I should consider the diversity factors that are impacting my client’s current ability to decide regarding gender affirming
care. I should be aware of the biases that could be impacting my
perception and consider the complexity of their identities without
making assumptions.
Step Five: What do my feelings and intuitions tell me to do in this situation? (See also Virtue-Based Ethical Decision-Making)
I believe that my client has been seeking to feel good about themself
for a long period of time. The search for their identity has been ongoing for
quite some time. As someone who has also worked with autistic adults for
several years, I am aware of the challenges they face in finding a sense of belonging and being able to communicate who they are to others. Due to this,
I want to ensure that their “feeling lost” after the non-standard HRT questions has nothing to do with their inability to communicate and that their
gender incongruence is solid. According to my intuition, my client will be
able to manage the transition they seek. The fact that they have gotten so far
in their own life and made so many complex decisions on their own doesn’t
make me doubt their conviction. I recognize, however, that the feelings they
express today are recent (5 months) and over the course of our collaboration, I have observed how they can develop fixed ideas that, over time, alter.
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In this regard, I believe they would benefit from processing their decision
for a period of time. Additionally, I am aware that the anxiety associated
with a gender transition is high, and that my client is still developing coping
mechanisms to deal with life’s challenges, such as independence (e.g., they
still rely on their family for financial support). Typically, an autistic adult requires some level of support throughout their life, but this does not prevent
them from making adult decisions or enjoying a fulfilling existence. To create those layers of support, it may require them some additional time than
most in their same age group. Therefore, I would like my client to ensure
that they have all of the support networks they will need, as well as the skills
that will allow them to make a smooth transition.
Step Six: What plan of action will be most helpful in this situation? –
Follow up to evaluate the appropriateness, adequacy, and effectiveness of
the course of action taken. Identify any adjustments necessary to optimize
the outcome.
• Be clear about my role in this case. It is not for me to diagnose my
client, but to support them in making this life-changing decision.
• Understand laws in our jurisdiction (BC, in this case) regarding
HRT and child consent to treatment to ensure the recommendations are aligned to the law.
• Talk with the client about the ethical decision that is being analyzed
and the way in which I am proceeding, clarifying my priority to
proactively look for their best interest.
• Include the agreements and steps taken in the ongoing informed
consent.
• Evaluate the client’s capacity to consent to treatment understanding
benefits, risks, consequences, and life implications.
• Recommend a self-care plan to ensure the client’s wellbeing throughout the process, whether the decision to move ahead with the HRT
and top surgery is made now or later. The recommendation should
include considerations of time frames for next steps.
• Consider and reflect on alternative scenarios and their pros and
cons (e.g., waiting longer for the surgery) both individually and
with the client.
• Connect with other professionals involved (e.g., physician, nurse)
to exchange perspectives, expand understanding, and provide a holistic assessment of the client’s situation. Have the client’s consent
prior to do so.
• Make the final evidence-based recommendation for the client.
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REFERENCES
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Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C,
Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Hancock, A. B.,
Johnson, T. W., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey,
S. J., Nahata, L., Nieder, T. O., Reisner, S. L., Richards, C., Schechter,
L. S., . . . Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of
Transgender Health, 23(S1), S1-S259. https://doi.org/10.1080/268952
69.2022.2100644
Coughlin, K. W. (2018). Medical decision-making in paediatrics: Infancy
to adolescence. Paediatrics & Child Health, 23(2), 138-146. https://doi.
org/10.1093/pch/pxx127
Government of Canada (2023). Article 12 of the Convention on the Rights of
the Child and Children’s Participatory Rights in Canada. https://www.
justice.gc.ca/eng/rp-pr/other-autre/article12/p3a.html
HealthLink BC (2022). The Infants Act, Mature Minor Consent and Immunization. https://www.healthlinkbc.ca/healthlinkbc-files/infants-act-mature-minor-consent-and-immunization
National Library of Medicine (2023). Table 2. DSM-5 criteria for gender
dysphoria. https://www.ncbi.nlm.nih.gov/books/NBK577212/table/pediat_transgender.T.dsm5_criteria_for_g/
World Professional Association of Transgender Health. (2022). Standards of
care for the health of transgender and gender diverse people (Version
8). https://www.wpath.org/publications/soc
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Case 6.2
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Mr. Thomas works within a middle school supporting
students preparing to transition into high school. Over the
years, he’s worked closely with Adrian, a student who was
eligible for a special vocational school as he repeated Grade
8 and struggled within the regular classroom structure. Mr.
Thomas was confident the vocational school pathway was
a suitable option for Adrian as he demonstrated strong motivation and persistence over the years. Adrian and his caregiver were excited about this opportunity; however, Adrian had been pushing for an IQ test every time he saw Mr.
Thomas – during their appointments and in the hallways.
After months of requests, Mr. Thomas concedes this would
be advantageous to support his case for referral to the vocational school.
When Mr. Thomas reviews the results, he’s surprised to
see that they make Adrian a candidate for the school for
those who are developmentally delayed. Mr. Thomas worries that if Adrian does not go to the vocational school that
he will not complete school at all. Mr. Thomas is certain the
vocational school is the best path forward and he consults
with the school doctor regarding Adrian’s case. She agrees
to back Mr. Thomas’s decision.
Mr. Thomas proceeds with the referral to the vocational school for Adrian but recently received an email from the
school asking him to send over Adrian’s assessment results.
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Work Through A: Wise Practices
Key Issues:
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Mr. Thomas has worked with Adrian who has been struggling to
complete Grade 8.
Adrian appears to be a suitable candidate to attend vocational
school.
Adrian has been pushing to get an IQ test, which would be required
to support the referral.
After reviewing the IQ results, it is discovered that Adrian is a candidate for attending a school for the developmentally delayed (i.e.,
not a candidate for the preferred vocational school).
Mr. Thomas is concerned that if Adrian doesn’t go to the vocational
school that he won’t complete his studies.
Mr. Thomas and the school doctor both agree that the vocational
school is the right choice for Adrian.
Upon submission of the referral, the vocational school begins to request Adrian’s assessment and continues to do so into the fall.
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Relevant Section and Codes:
A - Professional Responsibility
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A1. General Responsibility: It is important for the counsellor to be familiar with the Canadian Charter of Rights and Freedoms as well as
their federal and provincial legislation.
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A2. Respect for Rights: It will be important to keep in mind the client’s
right to withhold information that could be detrimental to him.
A7. Responsibility to Counsellors/Therapists and Other Professionals:
The counsellor must remain professional when in conversation
with other professionals regarding a client, being diligent to act
with honesty, accuracy, and integrity.
A10. Third Party Reporting: The counsellor must come with the understanding of the nature of their role as well as the details and responsibility of that role, remaining professional when in contact with
all parties, and understanding the uses of the information acquired
and limits of confidentiality.
A12. Diversity Responsiveness: It will be important to keep in mind the
client’s diversity and practice respect and understanding connected
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to this diversity. This needs to also include working with the client
to locate resources and supports.
B - Counselling / Therapy Responsibility
B1. Primary Responsibility: The counsellor must foremost remember
his position and obligation to work collaboratively to help the client.
B2. Confidentiality: To respect and retain the rights of the client to keep
information confidential unless he is in imminent danger.
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B4. Client’s Rights and Informed Consent: The client must be able to
give consent voluntarily, knowingly, and intelligently.
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B5. Children and Persons with Diminished Capacity: The counsellor
must keep in mind that although the parent or guardian has legal
authority to give consent for a child with low cognitive ability, the
child will be asked to assent.
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B7. Access to Records: Parents or legal guardians, on behalf of the student with limited cognitive capacity, would have to agree to release
records to the vocational school before they could be shared with
the school.
C - Assessment and Evaluation
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C1. General Orientation: Counsellors administering assessments must
be adequately trained to use the tool, know the risks and benefits
associated with the assessment, and be sure to use the appropriate
tool to test the intended need. They would also ensure that the assessment is done in a fair and appropriate way to retain validity.
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C2. Informed Consent for Assessment and Evaluation: It is important to
provide clients with information surrounding why the assessment
is being given and how it will be of benefit to them, as well as the
risks in completing the assessment and having results on file. Having this conversation upfront allows for discussion of options, more
informed decision making, as well as introducing a framework with
which to put the results into perspective.
C3. Assessment and Evaluation Competence: The counsellor must retain relevant and up-to-date training on the assessments being used
to evaluate an individual. When utilizing an assessment, the counsellor must be sure to evaluate the validity, reliability, strengths, and
limitations to be sure it is appropriate for the individual.
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C4. Administrative Conditions and Procedures: When assessments are
being used, the counsellor must be sure to provide appropriate supervision that will consider possible harmful or invalid results.
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C5. Technology in Assessment and Evaluation: Counsellors need to retain ethical responsibility when using technology which scores, interprets, and evaluates a client. Risks associated with the assessment
must be shared with the client. The counsellor needs to consider
any factors that could impede the client’s ability to get accurate test
results.
C6. Appropriateness of Assessment and Evaluation: Counsellors must
first evaluate the assessment to be sure it is appropriate for the client
being assessed.
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C7. Reporting Assessment and Evaluation Results to Clients: The counsellor must be sure to accurately report the findings of the assessment in a meaningful way to the client. This involves providing a
justifiable interpretation of the results.
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C8. Reporting Assessment and Evaluation Results to Third Parties:
Counsellors must adhere to provincial and federal laws when releasing the results of an assessment and be sure company policies
are followed in sharing information. A release must be signed by the
client (or, in this case, his parents or guardians) prior to the release
of information. Counsellors must take into consideration whether
the release of the assessment will potentially harm the client, or if
the receiver is not qualified to interpret the information.
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C10. Sensitivity to Diversity When Assessing and Evaluating: Counsellors must be sure to assess the client’s readiness to take the assessment as well as the level of the client’s ability to be assessed.
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Important Ethical Principles:
• Beneficence
• Fidelity
• Nonmaleficence
• Autonomy
The Decision: Given the background in this case it will be necessary for
Mr. Thomas to share the result of the assessment with Adrian and his parents. In doing so, Mr. Thomas can let Adrian and his parents know what his
options are and where those choices will potentially lead. It will be important to spend the time exploring what the options would mean for Adrian;
because the IQ score was below the cut-off for the vocational school, Adrian
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Wise Practices Lens Review:
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would likely not be invited to attend the school if the results are released.
However, based on Mr. Thomas’ experience with Adrian’s motivation and
performance in school, his knowledge of other students who have been successful in the vocational school, and the doctor’s support for the vocational
school option, Mr. Thomas is quite confident that the vocational school is
the right choice for Adrian and will open up the most future possibilities
for him. Mr. Thomas decides to recommend that the parents not agree to
share the assessment results for now. In collaboration with Adrian and his
parents, they decide that Mr. Thomas will speak to the school administrators, asking them to temporarily admit Adrian based on recommendations
from the school and the medical doctor, with the option of conducting an
assessment after the first 3 months in the new school if it is deemed necessary at that point.
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Courage – Mr. Thomas, in advocating for Adrian to be admitted to the
vocational school without an IQ test meeting the admissions qualifications,
may be risking his professional credibility and trust with the vocational
school team. However, it feels like the right option under the circumstances.
Honesty – Honesty, in this case, involves more than simply reporting
the results of an assessment process. It involves recognizing the limitations
of assessment results, acknowledging that some students may not be appropriately represented in the norm group of a standardized assessment and,
therefore, may receive scores that do not adequately reflect their abilities or
motivation.
Humility – Mr. Thomas recognizes the limitations of standardized
assessment processes and admissions procedures. He consulted with the
medical doctor to verify his own beliefs that Adrian could succeed in the
vocational school.
Respect – Mr. Thomas has to balance his respect for the vocational
school to set admission criteria with his respect for Adrian and his belief
that he can build a better future life for himself if given the opportunity to
attend the vocational school rather than the school for people who are developmentally delayed.
Truth – The reality of Adrian’s capability to manage the vocational
school program will be revealed over time. Mr. Thomas wants to give Adrian an opportunity to succeed – to prove that Adrian’s motivation, energy,
and work ethic offer more “truth” about his potential to succeed than the
standardized IQ results seem to indicate.
Love – Mr. Thomas is coming from a place of support and understanding for the thoughts, concerns, and capabilities of Adrian and his family;
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Work Through B: Virtue-Based
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this compassion and caring can create opportunities for Adrian to thrive.
Wisdom – Mr. Thomas recognized that Adrian’s capacity is not adequately represented by his low score on the IQ test. Based on his experience
of working with Adrian and his family, his consultation with the doctor, and
his knowledge of other students who had successfully graduated from the
vocational school, Mr. Thomas decided to challenge the existing policies
and advocate for an opportunity to Adrian to prove that he had the capacity
to succeed.
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Mr. Thomas works within a middle school supporting students preparing to transition into high school. Over the years, he’s worked closely
with Adrian, a student who was eligible for a special vocational school as
he repeated Grade 8 and struggled within the regular classroom structure.
Thomas was confident the vocational school pathway was a suitable option
for Adrian as he demonstrated strong motivation and persistence over the
years. Adrian and his caregiver were excited about this opportunity; however, Adrian had been pushing for an IQ test every time he saw Mr. Thomas
– during their appointments and in the hallways. After months of requests,
Mr. Thomas concedes this would be advantageous to support his case for
referral to the vocational school.
When Mr. Thomas reviews the results, he’s surprised to see that they
make Adrian a candidate for the school for those who are developmentally
delayed. Mr. Thomas worries that if Adrian does not go to the vocational
school that he will not complete school at all. Mr. Thomas is certain the
vocational school is the best path forward and he consults with the school
doctor regarding Adrian’s case. She agrees to back Mr. Thomas’s decision.
Mr. Thomas proceeds with the referral to the vocational school for Adrian but recently received an email from the school asking him to send over
Adrian’s assessment results.
1. What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
Based on my experience in referring other students with the needed IQ
scores but low motivation, I feel confident that Adrian will be successful in
the program at the vocational school and torn regarding what to do. The
ethical principles centrally involved here are Beneficence and Nonmaleficence and Article B1. In withholding assessment results, I don’t feel honest
in my actions with the staff at the vocational school, whom I respect and
who trust my judgement and me as a professional (B6).
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2. How can my values best show care for the client’s wellbeing?
My values in terms of the wellbeing of Adrian would have him remain in
the vocational school. If he encounters difficulty, the other school can still
be considered. Otherwise, I will feel like I have betrayed the trust the Adrian has placed in me (B1, C8).
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3. How will my decision affect other relevant individuals in this
ethical dilemma?
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Attending the other school will lead to very different career and life futures for Adrian. In terms of the staff at the vocational school, they may
feel tricked or betrayed by me, and I may be challenged professionally for
ignoring a component of the admission criteria for the vocational school
(B1, C8).
4. What decision would I feel best about publicizing?
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I would feel best about publicizing that I had presented an argument to
the staff at the vocational school to keep Adrian in the school, based on his
performance in my school, his high energy level and motivation to succeed,
and the fact that his IQ scores could have been influenced by the abject poverty in which he lives. Given that he was accepted into the program without
the test results and I have been told that he is doing okay, I think I have a
good chance to be successful (F1, F3).
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5. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
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A decision to continue to advocate for Adrian attending the vocational
school would best reflect who I am as a person (B1). Article C8 in the Standards of Practice document (CCPA, 2021) indicates that for valid reasons a
counsellor/therapist may withhold test data, if there is potential harm to the
client. This helps me balance my feelings of guilt and my need to advocate
for the client.
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Case 6.3
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Collin was recently hired by a company that does vocational assessments to help with career decision-making
for youth and return-to-work planning for adults who are
returning to work after illness or injury. Collin, a recent
graduate from a Masters in counselling program was excited to put into practice all the learning from the assessment
course in the program; what had been most interesting in
that course was selecting assessment tools that were “fit for
purpose” - choosing a customized battery to fill in the gaps
from what the counsellor had picked up through the intake
and interview process. Collin was disappointed to discover
that the new agency seemed to have a “one-size-fits-all” approach; most concerning was that Collin was expected to
conduct aptitude and interest assessments, even for clients
who had a solid school performance history and seemed
very self-aware. Also, Collin had been taught that the aptitude and achievement tests being used were “C” level - although students had been introduced to them in class and
administered them to peers under the professor’s supervision, Collin’s understanding was that the Master’s program
only qualified them to use “B Level” tools independently.
Collin’s first assignment was to fly in to a remote First Nations community to assess two Grade 11 students to help
with career decision-making about what post-secondary
training to enroll in after Grade 12 (and to select appropriate Grade 12 courses to prepare for that). Collin was also
asked to assess another member of the community - someone who was in recovery from addiction, couldn’t read beyond recognizing his name and other short words by sight,
and had never worked for more than 2 weeks at a time for
pay.
Collin was expected to travel to the community alone,
arriving the night before the assessment was scheduled,
and was told to administer the standard battery of assessments to all three clients. Collin was expected to write up
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reports for each of the three clients the following day and
then, on the third day, before flying home, to provide the
assessment results in three 1.5-hour meetings (one for each
test-taker, to include the test-taker, family members, and at
least one elder from the community). Collin has never delivered assessment results to third parties before.
When raising concerns with the agency director, Collin
was told not to worry - they had been successfully using
this standard battery for years, mostly in the city but at least
twice before in this community, and the instructions in the
manual were really easy to follow.
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Work Through A: Principle-Based
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In applying the Principle-Based Ethical Decision-Making model:
Step One required Collin to identify the key issues in this situation.
As Collin is relatively new to this organization, with limited “real world”
experience outside of experiential activities in courses as well as closely supervised clinical and practicum placements, Collin’s competence is a concern. Collin is also struggling with the company’s one-size-fits-all approach,
which doesn’t seem to respect the diversity of these clients and their unique
situations. Further complicating things is that the community is both remote and Indigenous – both of these characteristics could bring into question the usefulness of standardized career assessment tools.
In Step Two of this model, the CCPA (2020) Code of Ethics is reviewed
for relevant articles. From concerns related to counselling in general (A2,
A2, A3, A5, A10) and diversity (A12) to considerations specific to assessment (all of Section C) and working with Indigenous people (I1, I6-I9),
there are many applicable articles to look at.
Step Three of this model considers which of the six ethical principles
are most important in this situation. Collin considered them all to be relevant but prioritized nonmaleficence (do no harm), justice (it didn’t seem
fair to take a one-size-fits-all approach given how different the older client’s
needs and capabilities were compared to the two youth), and societal inter-
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est (if the results from a flawed assessment process were being used to help
individuals choose career and education pathways, might those individuals
be misdirected in ways that could cause harm to others in their community
or beyond?). As this step encourages consultation, Collin reached out to
an elder at the Friendship Centre near the university and also to a previous
practicum supervisor who had experience conducting similar assessments
within Indigenous communities.
Step Four guided Collin through a process of applying the ethical articles. Although there were many articles to consider, Collin’s three biggest
concerns seemed insurmountable, given the boss’s insistence on not straying from one-size-fits-all test battery, Collin’s self-identified limited competency, and the overall lack of diversity responsiveness and attentiveness
to Indigenous culture and context in this situation. Collin couldn’t see any
possibility of ethically proceeding with the scheduled assessments without
close supervision and the option for a customized approach. The best option seemed to be to refuse to do the assessment. However, the risk felt very
real that Collin’s employment could be on the line – perhaps even being
fired “for cause” (i.e., for insubordination in not following the boss’s instructions), leaving Collin without access even to Employment Insurance (EI).
In Step Five, Collin reflected on feelings and intuitions related to the
dilemma. Although it was scary to potentially be unemployed again, Collin
felt relieved in reaching a decision that felt fair to the individuals and their
community. Collin had a peaceful sense that refusing to conduct the assessments under these circumstances was the right thing to do.
In Step Six, Collin set up a meeting with the agency director, sending
a detailed memo in advance that outlined Collin’s concerns and the relevant articles and principles from the code. Although surprised by Collin’s
refusal to conduct the assessments using the standard battery, the director
was interested in hearing more about Collin’s concerns and external consultation. The Director acknowledged a personal lack of training and experience in vocational assessment, admitting that the one-size-fits-all approach
had preceded her being hired last year. The assessment tools being used
were those written into the funding contract and that had been purchased
in advance to fulfill the contractual obligations. Now aware of the ethical
concerns, the Director was willing to go back to the funder and to revisit
the contract with the Indigenous community to build in more flexibility and
diversity responsiveness to better meet test-taker’s unique needs.
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Work Through B: Wise Practices
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Collin recognized the decision about whether or not to proceed with
the assessments as requested as an ethical dilemma – a dilemma that felt
quite overwhelming to sort through and scary because, given the employer’s
unwillingness to consider alternatives, it left Collin fearing being fired for
refusing to follow the boss’s instructions. Collin, a recent graduate, had large
student loans to pay back and it hadn’t been easy to find a job in the field.
The Wise Practices Lens (CCPA, 2020) seemed like a good approach
to use, given that it provided space to consider the dilemma from both Indigenous and Western perspectives. From the recently completed Masters
program (which, although it embraced the values of equity, diversity, and
inclusion, and was beginning a process of Indigenizing the curriculum, still
very much comprised training from a Western perspective), Collin understood that a solid working alliance is foundational to all aspects of counselling and that, within Indigenous communities, relationship is particularly
important (CCPA, 2020, Wise Practices Lens; I8). Therefore, upon reflection, Collin recognized that one of the key underlying areas of concern was
the expectation that the “tester” would fly in the night before, test the next
day, write up results without consultation, and then provide those results in
brief meetings that wouldn’t allow much time for questions or discussion. It
felt like testing was being done to rather than with the test-takers – and by a
complete stranger to the test-takers and the larger community.
From a Western perspective, consulting the CCPA (2020) Code of Ethics, the process also felt wrong – raising concerns related to Articles A1-5,
A10, A12, B1, B4, B9, C1-8, C10, I1, and I6-9, especially given Collin’s very
limited competency with these types of assessments (A3, C3) and the absence of any option to customize the approach (C10), despite the significant
differences between the test-takers and the purposes for assessment.
Collin also considered the principles described in CCPA’s (2020) Code
of Ethics. It seemed clear that working outside Collin’s competency with inadequate supervision, having no room to appropriately customize the assessment approach, and proceeding with the assessment process in the absence of a solid relational foundation, could result in the assessments doing
harm instead of good, could perpetuate injustice, and might not support
societal interest (in that decisions informed by inappropriate assessment results might be inappropriate).
As Collin also believed in the importance of consultation and supervision (A4) and felt quite vulnerable about arguing with a new employer,
reaching out to the assessment instructor from the counselling program also
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seemed like a good idea. Without revealing the name of Collin’s employer
or the community where the testing was scheduled, Collin described the
dilemma – and was relieved to find that the assessment instructor expressed
very similar concerns.
Collin then chose to look at the dilemma through the Indigenous lens
of the seven sacred values. Upon reflection, the one-size-fits-all approach
to assessment, especially in these circumstances, felt disrespectful and uncaring (i.e., it didn’t exemplify values of respect or love). Collin’s concern
was that the assessment reports would be interpreted as “truth” and used to
inform very important decisions. To present the assessment results that way
felt dishonest, especially when there was a good chance that they might not
be valid due to cultural differences, literacy levels, and norms that didn’t fit
for these particular clients. However, Collin also recognized a great need
for humility, being new to the organization and the community and not
fully understanding the expectations or past experiences with assessment.
Seeking wisdom from the assessment instructor, when Collin’s boss was unwilling to discuss options, helped to build Collin’s courage and confidence
in making the tough decision to say no to the assessment request. The decision, although scary, came from a place of caring and love and placed the
potential clients, the most vulnerable people in this scenario, as the priorities.
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Case 6.4
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Routine Outcome Monitoring (ROM) was recently added for practicum students at one agency in town but is
not commonly used at the other sites. Based on ROM, one
student is not making adequate progress with a particular
client. She only needs 3 more hours with the client to complete her required practicum hours. Her site supervisor says
it’s too late in the term to start a new client so recommends
that she just continue with this one for three more sessions
and then she can refer the client to someone else to continue counselling.
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Work Through A: Principle-Based
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Step One – What are the key issues in this situation?
The key issues in this situation are related to the rights of the client
to have their needs met, the need for information regarding the progress
of the client in addition to what has been provided by ROM, the need for
the student to understand what is not working well with the client, and the
responsibility of the supervisor to ensure that the student learns from her
experience with this client.
Step Two – What ethical articles from the CCPA Code of Ethics are relevant to this situation?
Relevant articles in the CCPA (2020) Code of Ethics include: B1 – Primary Responsibility “to respect the integrity and promote the needs of their
clients” (p. 9); E1 – General Responsibility for respecting the rights of supervisee’s clients; E10 – Due Process and Remediation if that is shown to
be needed; and G1 – General Responsibility and G3 – Ethical Processes to
ensure that they keep in mind the ethical obligation of ensuring that students are offering services to clients that meet expectations of competence.
Step Three – Which of the six ethical principles are of major importance in this situation?
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In the main, the ethical principles involved are beneficence, fidelity, and
nonmaleficence.
Step Four – How can the relevant ethical articles be applied in this circumstance?
The first activity would be for the student or both the student and the
supervisor to have a discussion with the client about the ROM results to
talk about needs of the client that could be better met. That would begin to
address Articles B1, E1, and G1, by providing information to the student
and the supervisor about any issues that can be addressed in the remaining three sessions, and to facilitate an appropriate referral. The benefits are
clear in terms of helping to promote counselling that would better meet the
needs of the client. There don’t seem to be risks here, unless the student
and supervisor have been misunderstanding the needs of the client and the
client requests a new counsellor immediately, in which case Article E10 becomes relevant in the development of a remediation plan for the student.
This might delay the completion of the student’s practicum requirements.
Step Five – What do my feelings and intuitions tell me to do in this
situation?
My feelings and intuition tell me to proceed in steps and not come to
an early decision regarding the meaning of the information from the ROM
questionnaire, or the competence of the student or the supervisor.
Step Six – What plan of action will be most helpful in this situation?
To proceed as outlined in Step Four and to be informed about how to
proceed as each step of the plan is completed.
Work Through B: Virtue-Based
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As the practicum student counsellor, reflecting on my emotions and intuition, I feel conflicted – and a little bit scared. My client’s wellbeing is my
priority and it’s frustrating that the ROM results are not revealing progress.
However, I’m also aware that no-one else in my practicum cohort is being
held to this standard., as my site is the only one using ROM. I wonder if
the other students are actually doing any better than I am – or if the ROM
results are singling my experience with this client out in a unique way. I feel
a bit punished in that I may not successfully complete my practicum – in
part because we are using this tool. That said, though, I’m in this program
to learn (A1) – and if I’m not helping this client achieve desired outcomes
(A3), I’m curious about what I could be doing differently, to get better results.
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My values place the client’s needs above my own (B1). I also value excellence and continuous learning (A1). In my practicum, co-counselling
hours can count towards my total hours. Rather than referring the client to
another counsellor right away, I wonder if it might work (with the client’s
permission [B4]) to bring my supervisor into the next sessions to see if we
can make progress together towards the client’s goals (A4; B16)?
If co-counselling is a viable option, this would take additional time from
my site supervisor (but, perhaps, no more time than out-of-session supervision trying to turn this situation around or the time it might take to bring
in a new client and then move that client to someone else’s caseload once
my practicum has been completed). It might be perceived as unfair by other
practicum students, however. I’m confident, though, that my client would
be getting good support, which is important to me.
I would not feel good about publicizing that my client’s sessions were
abruptly terminated, nor would I feel good about word getting out that we
had continued to bring a client in for counselling with me despite evidence
that no progress was being made. I’d feel comfortable publicizing that we
engage our clients in Routine Outcome Monitoring (ROM) and respond to
what we find, collaborating with our clients in creating solutions that help
them to move forward.
From a place of cultural humility, I’m acutely aware that I still have so
much to learn. I’m grateful to have a site supervisor who wants to help me
learn and is willing to invest the time to co-counsel with me to help me
better understand how my client and I got stuck and how we can effectively
move towards the client’s goals together.
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CHAPTER 7
Case 7.1
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Quincy recently submitted a journal article to a well-respected, peer-reviewed academic journal in his area of expertise. As part of his graduate studies, Quincy worked as a
research assistant exploring disordered eating in men and
has published before but was a fourth or fifth author. This
time, however, will be the first time he’s the primary author.
He’s excited to extend the knowledge base with a novel
approach to addressing the challenges of men struggling
with disordered eating.
Quincy was excited to receive feedback from the reviewers but was surprised to find that some of the feedback
was unclear and contradictory. It’s a blind review, so he
doesn’t know who provided the feedback but one of the reviewers seems to be privileging one specific researcher and
approach, one that hasn’t been as inclusive to the specific
challenges of men. Although Quincy is familiar with this research and approach, he isn’t quite sure how to integrate
the feedback. His study specifically sought to take an alternative approach which one reviewer seems to be supportive of; the other was critical.
Work Through A: Principle-Based
Step One: What are the key issues in this situation?
Ethical principles: Justice and Societal Interest. Quincy is trying to broaden
the inclusivity of working with people who have eating disorders, ensuring
that male patients with disordered eating get competent care for their needs.
The restrictive prototype for this medical issue is the female and gay male
patient.
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Step Two: What ethical principles from the CCPA Code of Ethics are
relevant to this situation? Other policy, laws, regulations, and consultative
guidance:
• Policy, regulatory and guidance: Research Ethics board in the University, Graduate Supervisor, Peers, and CCPA Ethics Committee.
• D1 Researcher Responsibility (Parts of the Code of Ethics and Standards of Practice) might come into play.
• D8: Review of Scholarly Submissions: Counsellors/therapists who
review applications or manuscripts submitted for research, publication, or other scholarly purposes respect the confidentiality and
proprietary rights of those who submitted the materials (See also
A2, B2, I7).
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Step Three: Which of the six ethical principles are of major importance
in this situation?
Justice and Societal Interest
Step Four: How can the relevant ethical articles be applied in this circumstance?
Research builds and advances knowledge. Expanding therapeutic perspective and modalities can help all people (i.e., clinicians, the general population, and people living with disordered eating) by reducing injustice,
increasing knowledge translation, and updating clinical practice.
Step Five: For this situation, my feelings and intuition tell me that it is
important to learn (generally and in different ways) and conduct research
(one specific form of knowledge), to update best practice and professional
practice over time. So, staying true to the alternative results and responding
to the review in general would be most in alignment with my intuitions.
Step Six: What plan of action will be most helpful in this situation?
Follow up for consultation with the graduate supervisor, peers, and
CCPA ethics codes and committee(s) first to get feedback and guidance for
Quincy to reflect on. Then consider how to respond to the review (and to
the editor) in order to stay true to the results of the research and speak to
the concerns of the reviewer. It may mean having to not get published in this
journal and seeking publication in another.
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Work Through B: Quick Check
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Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
As the researcher, I would not want it published that I used a research
design/approach which is not inclusive to the specific challenges of the population I am researching (i.e., men) as this might show that I am not current
in my field. I would also not want to publish something that I don’t believe
in (i.e., a research approach that I don’t believe is most appropriate).
The decision that I would feel comfortable with is to provide a rationale
to the reviewer about why I chose this specific approach. This might mean
some adjustments to my manuscript to clarify how I chose my specific approach, outlining the pros and cons of alternatives. Further, a critique of
the reviewer’s suggested approach related to its inclusivity to men (i.e., by
providing evidence from other research that shows why it has not been inclusive) would be a good place to provide additional empirical evidence to
support my decision to take the alternate approach.
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Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
Considering that I am an expert in the field, and I am confident that I’ve
kept up to date with the emerging literature, I would make this decision in
every case – no matter who the reviewer is and whether or not it was a blind
review. I would respectfully explain my rationale to the reviewer who was
critical of my approach, providing evidence and editing the manuscript to
clarify the rationale for my selected approach over other alternatives.
This decision may not be obvious for other researchers to make. For example, if someone is less knowledgeable about the field of disordered eating
in men, they may need to do some more research on the literature to figure
out the best solution for them. It is also possible that in a few years, the literature will show that there is an even better approach to use and that this
current one is outdated. In research, we always use the best approach that
we can, given the current knowledge we have and the state of the literature
at that time. It is common in research that people have different opinions
on the best approach or theory and that there is disagreement among researchers and reviewers. The best we can do is provide a strong rationale
for our choices. It might be advantageous to consult with other more senior
researchers to see how they’ve approached this kind of feedback from article
reviewers.
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Justice: Is everyone being treated fairly by my decision?
Yes, everyone is being treated fairly in this decision. The reviewer’s
opinions are being respected and the rationale for the approach used has
been strengthened. I am also treating myself fairly in this decision by trusting the knowledge and expertise that I have and perhaps also opening the
eyes of the reviewer to emerging literature.
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Case 7.2
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June is a counsellor working independently within
private practice with children of diminished capacity. It’s
been years since she conducted any research; however,
she’s developed a new approach for her work and wants
to provide evidence of the positive impact it’s had with her
clients. She believes a qualitative approach would be best
and she wants to add a brief exit interview to her final appointment. The information would support refinement of
her approach.
As an independent practitioner, she doesn’t have access to a formal ethics review board at a university. Given
the nature of her clients, she sees this as an important step.
June is aware of independent ethics review boards; however, when she looks into the process, it’s very intensive
and expensive – more than she thought. June reconsiders
whether an ethics review is necessary at all.
Work Through A: Quick Check
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Publicity: Safety of participants, research and knowledge translation
standards, professional and best practices are key for this case study. June
needs to consult with her professional association’s ethics board for guidance, especially due to the diminished capacity of her clients. It’s one thing
to do an exit interview that you get consent for and involve the children
and their parents in; but research is a formal process with specific steps and
approval processes. An ethics consultation is the bare minimum. I would be
more comfortable with publicity if an ethics review had also been conducted, approving the research.
Universality: If every counsellor decided to participate in research
without meeting research and ethical standards, our field wouldn’t have research-informed best practices, thus seriously undermining the profession.
June needs a sponsor or mentor of sorts to help shepherd this project for-
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ward if it is to be “research.” Otherwise, it is more of an evaluation, which
would still be benefitted by an ethics consultation to ensure principles like
beneficence and nonmaleficence are considered. Even evaluations need to
consider the ethical components to remain supported.
Justice: June’s clients have diminished capacity so informed consent
would likely involve both clients and parents. Further, if some of her clients
need a different approach, a hope would be that June would provide that or
refer her clients to someone who can provide the necessary care. The welfare of her clients supersede her desire to gather data.
The virtue-based ethical decision-making model can help to better understand this dilemma.
1. What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
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From June’s perspective, I’d feel inspired by the positive impact this
approach has had on my clients. My intuition would tell me others could
benefit from the approach and I’d be motivated to share with other professionals. I’d be worried that “academics” or “researchers” might not see the
value and concerned that an independent ethics review board (ERB) would
add unnecessary costs and prohibit me from engaging in the research at all.
2. How can my values best show care for the client’s wellbeing?
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By engaging in research, I would be able to validate my approach and
extend the body of literature. This would support my clients by providing an
approach supported by research – although I believe my approach is helpful, without specific evidence, I don’t know that for certain.
Although I haven’t planned any deception, coercion, or undue risk
within the study, I am working with a vulnerable population so need to ensure they feel informed and comfortable with the study. I would show I care
about my client’s well-being by making the research process as accessible,
enjoyable, and seamless as possible – a process which doesn’t infringe on
my clients’ rights or impede our work together. It could be helpful to have an
external body offer verification of that, especially as I’m working as a private
practitioner. Whether or not I have access to an ERB, I will be sure to follow the Tri-Council Policy Statement: Ethical Conduct for Research Involving
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Humans (TCPS 2 – 2022); there is an online course with a quiz to confirm
that the policy is understood by researchers.
3. How will my decision affect other relevant individuals in this
ethical dilemma?
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If I don’t engage in the ERB, participants might feel awkward or uneasy
about participating in the research and perhaps even seek to discontinue
working with me all together. I might encounter barriers disseminating results and ultimately publishing – something that will undercut the motivations behind the study. I would, however, have more control over the study
and move forward with data collection more quickly. To alleviate concerns,
within my Informed Consent document for participants I would link to the
Tri-Council Policy Statement previously mentioned, emphasizing that the
research follows the guidelines described in that policy.
As a relatively new “researcher,” engaging in the ERB would demonstrate
my commitment to the ethical principles related to research and provide an
external layer of protection for participants – something they wouldn’t have
otherwise.
If I hold off my study and instead choose to take some professional development surrounding research methodology and/or research ethics, this
might serve as a good demonstration of my commitment without the ERB.
This, however, would delay the start of the study and could also still result
in the clients feeling discomfort.
4. What decision would I feel best about publicizing?
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As the costs aren’t so prohibitive that I wouldn’t be able to proceed with
the study, it seems unreasonable to use that as a reason not to engage with
an ERB. I’d feel best publicizing my commitment to ethical research practices through engaging in the ERB as I don’t have an established history of
research and I work independently.
5. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
I need to consider the vulnerable nature of my clients and offer them as
many layers of protection as possible. The ERB offers that additional layer
which can provide validation and does include considerations for diversity
such as those with diminished capacity.
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REFERENCES
Government of Canada (2022). Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. https://ethics.gc.ca/eng/documents/tcps2-2022-en.pdf
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Case 7.3
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Hassan works with military members dealing with
PTSD and would like to conduct a study examining their
experiences. Although he continues to get regular referrals
from the base, has a good rapport with his contacts within
the military, and everyone seems to agree, at least off the
record, that the potential outcome of the study would lead
to service improvements, he’s finding it challenging to get
formal approval to proceed. He’s getting a lot of hesitation
and has been advised that the research would need to be
vetted at every step, including the analysis and dissemination of results.
Hassan would like to have the military’s support, but
he’s worried that inviting them into the process would
compromise the integrity of the research, especially if participants had negative things to say about the military. He
doesn’t want to be restricted about what he can release and
doesn’t want to relinquish control over how the research is
conducted. However, he’s adamant that this research would
be important and fill a real gap for this vulnerable group.
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Work Through A: Quick Check
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Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
No. He needs to ensure that the military are not sponsoring the research
so that it is independent of outside influence and bias, and he needs to maintain integrity in this process.
Questions:
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Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
Yes, I would make the same decision for everyone. Yes, it would be a
good thing. He can’t agree to be “off the record” because he needs participants to sign the consent form.
Justice: Is everyone being treated fairly by my decision?
He needs to guarantee anonymity for participants, and he needs to
guarantee that the participants will not be identified by a third party. No,
not everyone is being treated fairly if he decides to gain support from the
military and if he doesn’t provide confidentiality. Additionally, if he holds a
dual role/conflict of interest as a counsellor and researcher, it is not a fair
process.
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Does he have an independent practice or does he work for the military
(i.e., as the employer)? My responses are based on this counsellor being in
private practice.
Decisions:
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1. He doesn’t require military approval for this research; he only needs
individual participant approval.
2. He has to uphold participant anonymity and privacy through a consent process and maintain their confidentiality (D5 - right to confidentiality; CCPA, 2020, p. 18).
3. Does he have a conflict of interest as a researcher and counsellor?
Multiple relationships are to be avoided (B8). As per Article D1, he
will need to gain approval for the research: “A person must seek independent ethical review and approval” (CCPA, 2020, p. 17).
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Work Through B: Principle-Based
D3 (voluntary participation)
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Step One: What are the key issues in this situation?
The key issue in this case is potential conflict of interest if the military is
involved in each step of the research.
Step Two: What ethical articles from the CCPA Code of Ethics are relevant to this situation? – Are there policies, case law, statutes, regulations,
bylaws or other related articles that are relevant to this situation?
D4 (informed consent of research participants)
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D7 (research sponsors) – this article is key in this case, if Hassan works
with the support of the military, he would need to acknowledge this
and it may affect the interpretation of his results.
Step Three: Which of the six ethical principles are of major importance
in this situation? (This step also involves securing additional information,
consulting with knowledgeable colleagues or the CCPA Ethics Committee,
and examining the probable outcomes of various courses of action.)
• Beneficence – Attending to the best interests of my research participants.
• Societal interest – In this case, what is in the best interest of society
is to be able to do research that might uncover the “truth”, this may
not be possible if the agenda of the military is to present the military
in a positive light and if the research might uncover some difficult
truths about PTSD in the military.
Step Four: How can the relevant ethical articles be applied in this
circumstance? – How might any conflict between ethical principles be resolved? – What are the potential risks and benefits of this application and
resolution?
In this case the ethical articles and the principles all align and point
to the same conclusion – to not partner with the military to conduct this
research.
The benefit of this is that it will be easier to protect participant’s identities so that they can share their true experiences without worrying about
repercussions with the military and this will lead to richer data/results.
The risk of this is that Hassan may be negatively impacting his relationship with the military.
Step Five: What do my feelings and intuitions tell me to do in this situation? (See also Virtue-Based Ethical Decision-Making.)
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My intuition tells me that getting formal support from the military
would affect the quality of data that I am collecting and the validity of the
study results, and I would worry that the military’s agenda would impact
my study.
My intuition also tells me that I need to take extra care to protect the
identities and confidentiality of my research participants so that they feel
safe sharing their experiences without worrying about repercussions. If I
work with the military, this may be more difficult to do.
Step Six: What plan of action will be most helpful in this situation? –
Follow up to evaluate the appropriateness, adequacy, and effectiveness of
the course of action taken. Identify any adjustments necessary to optimize
the outcome.
The best plan of action in this case is to continue the study without formal military approval, as long as Hassan still gets research ethics approval
in another way.
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CHAPTER 8
Case 8.1
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John is an intern preparing for his review with his
professor and site supervisor; the call is expected to go
smoothly in light of the recent written review John received.
However, the site supervisor arrives to the call angry and
fairly incoherent about her business and liability insurance
troubles. Neither John nor the professor totally understand
what the main issue is, and the professor proceeds to try to
get the meeting back on track to discuss performance. The
site supervisor again confirms that John’s performance as
an intern has been solid, identifying no problems with performance. However, the site supervisor states that the centre cannot support interns anymore. When the call ends,
John immediately writes a note to the site supervisor asking when he can transfer clients since he has 21 people in
his active caseload. John doesn’t receive any response from
the site supervisor that day or all weekend. John attempts
to log in to see his schedule for the week so that he can
at least start letting people know, but his credentials don’t
work and he cannot log in. However, he does still have clinic
email access; checking it, there is still no response from the
site supervisor. John wonders if it would be ethical to reach
out to his clients by email to explain that he is no longer
able to work with them.
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Work Through A: Principle-Based
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Step One: Intern cannot reach site supervisor and needs to act quickly
to provide resource and appropriate notice to clients, so they are not abandoned. Another ethical issue is the supervisor’s abandonment of the supervisee (E5).
Step Two: A7, A8, A9, B16, B17, E1, E3, E4, E5, E6, F2, F3, H2, and H3.
Step Three: Fidelity and Beneficence – In the absence of support, the
intern put client interests ahead of their own ensuring that the correspondence was “client-focused” not self-focused, complete with multiple options
for referral and additional resources starting with the clinic. Intern carried
out their obligation in the absence of support on the part of the site supervisor and with time running out. Nonmaleficence comes into play when considering that John may inadvertently do more harm to a client if he reaches
out via email and there is no prior client consent to do so, ensuring that he
has client’s permission to connect through email would be important.
Step Four: Acting promptly and with the client first in mind, the intern
honored client confidentiality, adhered to technology safety assuming he
had permission to email directly, and provided resources for clients to pursue. However, clients also may experience distress or discomfort to hear of
their current counselling relationship being terminated without knowing
immediately who they can follow-up with for continued support. John will
not have this information when he emails the clients. It might be more in the
best interest of the clients for John to have the university support the reaching out to the centre site and arranging some form of appropriate closure or
rereferral process.
Step Five: Feelings involved in the situation could make it difficult not
to be more “first person” in the goodbye letter making it about counsellor
and a difficult goodbye. Counsellor feelings are focused on the client, however, his plan of action may put the client in a position of feeling conflicted
about why they are receiving a surprise email from him and not some type
of joint statement from him and the centre. I feel that this may cause potential harm to the client in that they may not reach out to the centre for
follow-up counselling or lose their trust in systems.
Step Six: In this circumstance, it would be prudent for John to first
consult with his practicum professor and the degree-granting institution to
determine if there is a policy or process already in place for situations in
which a supervisee suddenly loses access to a practicum supervisor/site and
lacks ability to engage in ethical closure/referral of clients. For instance, the
professor may be aware of another way to contact the site supervisor and
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discuss John’s need to quickly inform clients of the changes, or to ensure
that the centre has an immediate process for informing clients of the changes and connecting them to new counsellors/resources.
Work Through B: Wise Practices
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In this situation, John is torn between his ethical responsibility to inform his clients about the closure of therapy (CCPA Code of Ethics, B17.
Closure of Counselling and Therapy, p. 12) and his obligation to follow his
supervisor’s lead. While he does not wish to harm the clinic’s reputation
or overrule his supervisor, he is extremely respectful of the trust his clients
have placed in him and recognizes that leaving abruptly and without notice
could have detrimental effects. Having not received a response from the supervisor, he decides to follow the Wise Practice Decision-Making Model.
Working with Indigenous clients, he has found great and profound answers,
particularly the emphasis given by Wagamese (2016) to relationship-based
decision-making, which resonates with his beliefs. As a basis for making
a decision, he has decided to consider the seven sacred values of courage,
honesty, humility, respect, truth, love, and wisdom (Baskin, 2007).
Courage, honesty, and humility: The concern that John expresses
comes from a place of humility. Despite the fact that he recognizes his role
as an intern and wants to respect the supervisor’s decision, he nonetheless
believes he is responsible for making contact with his clients and supporting them for a smooth transition to a new counsellor (CCPA, 2020, B17.
Closure of Counselling / Therapy, p. 12). While feeling confused, he insists courageously to present his concern to the supervisor through multiple
channels of communication. Furthermore, he does not wish to send those
emails behind his supervisor’s back without consulting him first. His value for honesty leads him to prefer to wait and consult with the professor
(CCPA, 2020, B10. Consulting with Other Professionals, p. 11) to determine whether there is another approach that can be taken.
Respect: In spite of his clear intention not to send the emails without
the supervisor’s approval, John feels conflicted. The counsellor has a great
deal of respect for his clients, and he recognizes that the news of the termination of counselling will come as a “shock” to some of them. Some of them
had a hard time trusting him at the beginning, but he has built a great therapeutic alliance with them. In this situation, John wonders what will happen
if his supervisor finally asks him not to contact them, even if it is the ethical
thing to do (CCPA, 2020, B1. Primary Responsibility, p. 9). It is his primary
responsibility to protect the welfare of his clients and, in some cases, it may
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be harmful not to provide them with notice.
Truth: John has no difficulty accepting reality. He is aware of his role in
this situation and is able to handle the complexity of the situation. In addition, he is aware of their ethical responsibilities to clients (both the supervisor and him) and the implications of leaving them without notice. As an
intern, John is also aware of the consequences of sending those emails without approval, as his supervisor holds a position of authority in this situation,
and he is the one that validates his hours. Even if he waits for an answer,
John asks himself what he will do in the event of a negative response. Upon
speaking with his professor, he realizes that whatever decision he makes
will have consequences, and he asks him to weigh the pros and cons of each
choice.   Love: The deep care John has for his clients explains his desire to contact them. As his professor pointed out, he has done his best to perform his
duties as an intern in the best manner possible, considering each client’s
unique needs (CCPA 2020, I7. Relevant Cross-Cultural Practice, p. 31). As
a result of his deep commitment to the counselling profession, he wants to
ensure that any people he cares about do not feel abandoned or confused if
the termination of counselling is not handled with the utmost respect.
Wisdom: John is also intuitive and creative and has thought of an alternative solution to the dilemma. Should the supervisor decide not to allow him to contact clients directly, he may ask the supervisor to conduct a
last co-counselling session with the clients who require closure, with the
supervisor leading the session and him as a co-counsellor. Respecting his
supervisor’s experience, he understands that he may be the best person to
handle the closure in a manner that addresses both the client’s needs and the
agency’s insurance concerns.   By analyzing the dilemma through the seven sacred values, he has been
able to determine the best course of action without feeling resentment towards the supervisor. Throughout the process, he has taken into account
the many aspects that need to be taken into consideration when managing
an agency, while at the same time not neglecting his main duty to protect
and look after the welfare of his clients. By viewing the situation from two
perspectives, he was able to gain a better understanding of how to proceed
(Marshall, 2004).
Notes and CCPA Code of Ethics relevant articles
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CCPA Code of Ethics, E1. General Responsibility, p. 20
CCPA Code of Ethics, B17. Closure of Counselling / Therapy, p. 12
CCPA Code of Ethics, I7. Relevant Cross-Cultural Practice, p. 31
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CCPA Standards of Practice, B19.Termination of Counselling, p. 38
CCPA Code of Ethics, p. 5:
“The “wise practices lens” model of decision-making (Wesley-Esquimaux & Snowball, 2010, p. 230) is a decision-making strategy
that practitioners may find helpful. The model uses teachings
from the seven sacred values that include courage, honesty,
humility, respect, truth, love, and wisdom (Baskin, 2007).”
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REFERENCES
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Marshall, A. (2004). Two-eyed seeing. http://www.integrativescience. ca/
Principles/TwoEyedSeeing/
Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, mental
illness and addiction through a Wise Practices Lens. International Journal of Mental Health and Addiction, 8(2), 390-407. 10.1007/s11469009-9265-6
WORKING THROUGH ETHICAL DILEMMAS
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Case 8.2
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During clinical supervision of a CCPA counsellor in a remote northern community in BC, the counsellor disclosed
that she had knowledge of a client having an affair with the
husband of another client. The husband was the only RCMP
in the small town and the counsellor was concerned that
the town would lose him.
Work Through A: Virtue-Based
1. Emotions and intuition:
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The counsellor has a professional obligation to raise their emotions and
intuition in supervision (A4 and B10) and the supervisor has an obligation
to help the supervisee move forward with treatment in light of what they
think they know (E5). If the counsellor feels that their own feelings interfere
with the ability to serve the client, then a referral may be necessary to align
with professional obligations.
2. Values:
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Showing care for the client’s well-being begins by acting as a counsellor
to address the issues the client brings to session. Divulging a supposed affair
between the two parties does not align with any professional duty to warn
clause (B3) and may in fact cause harm (A1). It would become more complicated if treating both (B13), possibly resulting in referral.
3. How does my decision impact other relevant individuals:
Sorting through their own thoughts, feelings, and reactions to the situation, and keeping the counselling space for the client illustrates proper
professional boundaries and purpose. Further to maintaining professional
boundaries the counsellor stays within their duty to protect the public (Societal Interest) and stays within their professional purpose.
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4. What decision would I feel bad about publicizing:
Telling a client about a potentially hurtful affair which may or may not
be true and may or may not be an issue to anyone but the counsellor could
result in diminished client confidence, termination of treatment (the main
purpose of the relationship), and defamation of another member of the
community which could be a legal offence depending on the jurisdiction
and further threaten the unity of a small community.
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5. Does the decision reflect who I am as a person:
Yes. As a counsellor, the client is there to work on a presenting issue and
the counsellor’s time would be best served focusing there.
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Work Through B: Wise Practices
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Due to the complexity of relationships and counselling in small communities, the clinical supervisor has chosen to consider the Wise Practices
Lens, applying Etuaptmumk (i.e., two-eyed seeing) and examining the seven sacred values (i.e., courage, honesty, humility, respect, truth, love, and
wisdom).
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The clinical supervisor might start by discussing how the case related to
Western ethical principles. For example, the core of this issue is maintaining
a client’s Confidentiality (B2) – i.e., the client who is having the affair has
the right for that disclosure to stay with the counsellor. This is something
embedded into the informed consent process and is a foundation of the
practice. The supervisor might point to one notable exception for confidentiality, Duty to Warn (B3) if the client was in immediate danger. This could
potentially be something to watch for; however, this case didn’t make note
of any suicidal ideation or threats of violence so this is likely not relevant.
The supervisor might reinforce for the counsellor that not sharing the disclosure isn’t an endorsement of the behaviour but rather a demonstration
of Primary Responsibility (B1) to the client. If the counsellor feels that they
aren’t able to maintain confidentiality, the supervisor would want to discuss
strategies for how to handle questions or concerns, perhaps engaging in role
play to practice those situations. If that didn’t feel like a satisfactory plan for
the counsellor, the supervisor might discuss appropriate referrals based on
a conflict of interest because of the Multiple Relationships (B8).
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The supervisor would then want to explore the notion of two-eyed
seeing which seeks to incorporate Indigenous and Western knowledge and
ways of knowing. Part of this process requires challenging assumptions. In
this case, that might include the counsellor’s fear that the community will
lose the RCMP officer. This fear could be rooted in the assumption that
the community needs that officer (and perhaps the RCMP more broadly)
to make it a safe community. There might be other layers of security and
protection available to the community that exceed what is currently being
offered.
In considering the seven sacred values, the supervisor might invite the
counsellor to reflect first on Honesty and Truth as that seems to be the primary issue. Although one might focus on the dishonesty of the affair, the
supervisor may need to point out that the client who is having the affair has
told the truth to the counsellor entrusting the counsellor with that secret.
Disclosing the revelation would breach that trust. While not condoning the
affair, the counsellor can still support the client to consider her next steps
and deal with the consequences of being truthful/honest. The counsellor
would also, presumably, be available to the wife (the other client) to support the emotional response of finding out the truth and deciding on a path
forward. Further, there may need to be some space to explore how the community sees situations such as these (i.e., affairs) as it pertains to Respecting
Inclusivity, Diversity, Difference and Intersectionality (B9) and Respectful
Awareness of Traditional Practices (I4).
The supervisor might want to point out the Courage and Humility it
took for the client to disclose infidelity. There can be a lot of shame and guilt
involved. If it’s the desire of the client to come clean about the affair to the
wife, that too will take courage and humility. Perhaps the client is seeking
to end the affair – that too takes courage. If the client is not looking to end
the affair, the counsellor might need courage to challenge the client to reconsider the consequences of living with this kind of secret. The counsellor
might need courage to withhold the secret when in session with the wife or
perhaps the humility to admit that they can’t keep that secret and should
reconsider continuing as the wife’s counsellor (i.e., a conflict of interest).
The supervisor may need to reinforce that, by keeping the affair secret,
the counsellor is showing Respect for the client’s autonomy and desires.
From the case, we don’t know why the disclosure occurred at this point
in time (e.g., is the client only now being honest and truthful with herself
about what has occurred? Is the client wanting to be honest and truthful
with the spouse? Has the client been coerced into the affair?). The supervisor might want to invite the counsellor to engage in conversations surrounding the seven sacred values, including respect, as a path to support the client
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to see the importance of respect towards all parties – herself, the husband,
and the wife.
Respecting the wife includes supporting her in her counselling goals
(e.g., is she happy in her marriage? Is she planning on building a family?
Does she know about this infidelity already? Does she suspect infidelity?).
There is also a respect for the boundaries of counselling – it’s not a counsellor’s role to be a “truth teller” at all costs.
The supervisor might recognize the counsellor’s Love for their community in the fear about losing the police officer; however, the supervisor
might call on the counsellor’s Wisdom to balance a complex set of conflicting demands. Perhaps the supervisor has case examples they might be able
to share with the counsellor – i.e., sharing their wisdom with the counsellor.
Circling back to Truth and Honesty, the supervisor should invite the
counsellor to engage in an ethical decision-making process themselves including a reflection about the assumptions they are making in this case and
their capacity to maintain confidentiality. If the counsellor is being honest
with themselves and is unable to effectively manage this Multiple Relationships (B8), the need for Referral (B16) should be considered. The supervisor should also Respect the decision the counsellor makes as a professional
as well.
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CHAPTER 9
Case 9.1
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A counsellor/psychotherapist is in private practice, and
has been for 6 years, specializing in their work with families
and couples. They are asked by a social services organization to consult the organization regarding their work with
families in order to provide a better approach and system
for their clients.
Work Through A: Virtue-Based
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When counsellors provide consulting services to organizations that
serve the same clients, they face a conflict-of-interest dilemma. By improving the agency’s services, the counsellor might put their own business at
risk, as they may lose clients from their business to the agency they are consulting for. Conversely, the counsellor may encourage the organization to
refer families to their own private practice, creating yet another conflict of
interest.
Considering this dilemma, and assuming that the counsellor has the
best interest of pursuing just outcomes, the counsellor could use the Virtue-Based Ethical Decision-Making Model.
As part of the Virtue-Based Model, counsellors are guided by questions
that help them analyze the dilemmas they are facing. In this case, the counsellor reflects on the following questions:
1. What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
I have had difficulty growing my own business over the past 6 years. As
a self-employed counsellor, it has been extremely difficult to stabilize my finances. It is an honour for me to be considered by this association to provide
my expertise and help improve their services to better support their clients.
However, I am conflicted since I know the clients they serve are the same
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clients I support through my private practice. I am aware of the conflict
of interest that accepting this offer would entail. Ideally, I would like to be
able to accept the offer and support them without this becoming a conflict
of interest. My intuition tells me that I could establish solid boundaries to
prevent this from happening, but my feelings tell me that it would not work,
and I would not be able to provide the best consultation services if this is on
my mind. I may be biased in my interventions, and the strategies I employ
may unintentionally be aimed at attracting clients to my company. It would
therefore be best to refer them to some other colleague who is not currently
engaged in private practice.
2. How can my values best show care for the client’s wellbeing?
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In this instance, the primary clients I serve are the individuals in my
private practice. It is still necessary for me to be mindful of potential clients, including the social services association which is contacting me as a
potential client. Whatever the case, I am committed to conducting myself in
an honest and transparent manner. Furthermore, I believe that my actions
affect my clients directly (current and future). I also value professionalism
and taking this offer would dilute my attention in a way that could adversely
affect my ability to provide customized and detailed attention to my clients.
When making ethical decisions, I also adhere to the ethical principles
outlined in the CCPA Code of Ethics (2020, p. 2). When making ethical
decisions, I also strive to provide fair treatment to my clients by prioritizing
their best interests and preventing potential harm. There is a serious commitment to my private practice, and I want to maintain integrity in all my
counselling relationships.
3. How will my decision affect other relevant individuals in this
ethical dilemma?
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According to the Code of Ethics, we should avoid engaging in dual relationships as much as possible (CCPA, 2020, F4. Conflict of Interest, p. 24).
The current invitation to support the social services organization is already
an invitation to participate in a multiple relationship in which a conflict of
interest cannot be avoided. Additionally, I consider Articles C4, C7, and
C8 of the CCPA Standards of Practice (C4. Consultative Relationships, C.7
Conflict of Interest, and C.8 Sponsorship and Recruitment) which discuss
the potential conflicts of interest and the responsibilities involved in engaging in consultation roles. The document also offers several alternatives to
avoid such problems, including “clear explanations of the objectives, informed consent, confidentiality limitations, and uses of information” (p.
44). In the event I accepted this invitation, I would be required to “refrain
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from recruiting or accepting as clients individuals whose obligations may
be a part of their current employment” (CCPA Standards of Practice, C.7,
p. 44).
4. What decision would I feel best about publicizing?
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As I am primarily focused on growing my private practice, I would be
more comfortable if I were publicly recognized for this goal. As a professional, I would not want my clients to see me changing my focus or feel confused
about the services I provide. I would feel differently if my company provided
a variety of services (including consultation services) and I had a team of
people dedicated to that area of work. I would, however, be more comfortable focusing my attention at this time on growing my private practice, and
later considering other ways in which I might be able to support associations (perhaps by writing a book or developing resources).
5. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
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Having worked as a Canadian counsellor, I understand the importance
of clearly defining roles and establishing boundaries in the workplace. I have
learned from some friends from Latin America that there, these dilemmas
are managed differently. Counsellors who work in private practice in Mexico, for example, are expected to provide support to their communities by
sharing their knowledge with other organizations. In small towns, it is not
uncommon for a professional to cover multiple roles and manage multiple
relationships. It may even be offensive to reject such an offer. In the context
I live in, it would be best to provide references from colleagues who are capable of performing the work in a more effective manner without conflict
of interest.
Work Through B: Wise Practices
Key Issues:
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Counsellor/psychotherapist who specializes in families and couples
is asked to consult for an organization.
Will advise on better approaches and systems.
Relevant Section and Codes:
A - Professional Responsibility
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A2. Respect for Rights: It will be important to keep in mind clients’ right
to withhold information that could be detrimental to them and their
safety (in this case, the client is an organization, so informed consent should discuss the pros and cons of being forthright and also
could include the consultant signing a non-disclosure agreement).
F - Consultation Services
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A7. Responsibility to Counsellors/Therapists and Other Professionals:
The consultant must remain professional when in conversation
with other professionals, being diligent to act with honesty, accuracy, and integrity.
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F1. General Responsibility: Counsellors must only provide the level of
service that they are knowledgeable about and have been supervised in. They should also maintain an understanding with their
client, whether they be paying or not, that all discussions remain
confidential. Consultants must remain unbiased and not discriminate in any fashion. All records are to be kept in a secure location
and are handled as the policies outline.
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F3. Consultative Relationships: Counsellors in a consultation relationship must provide clearly documented informed consent that
outlines the boundaries of the relationship, the limitations of the
counsellor’s competence, as well as limits of liability and any fees
associated with the services. There needs to be discussion around
how any suggestions or recommendations that are put into action
are the legal responsibility of the receiving party.
F4. Conflict of Interest: Counsellors must be aware of any underlying
concerns which may present opportunities (or the appearance of
opportunities) for personal advancement from the consultation.
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Important Ethical Principles:
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Beneficence
Nonmaleficence
Justice
The Decision: Before a counsellor can provide consulting support to
another company there would need to be a signed informed consent from
the social services organization (i.e., the client). After consent is given, the
client must be given an explanation of how consulting services differ from
counselling. The consultant will keep in mind that it is within the client’s
right not to divulge information that may harm them in any way. It is under-
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stood by the consultant that they will be working with honesty and integrity
with the client. The consultant will only provide services they are explicitly
trained to deliver and, regardless of the advice given, that it will be the receiving organization’s choice to act on and put into action any suggestions.
Wise Practice Lens Review:
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Courage – It will take courage to provide a critical review of existing
policies and practices within an organization.
Honesty – Being authentic with the client and standing separate from
possible biases will be the only way to effectively evaluate and make recommendations to the organization seeking assistance.
Humility – It will be important to acknowledge the limited time and information available to the consultant, so there will be much that the consultant simply doesn’t know. Presenting findings with humility and in a spirit
of openness and curiosity, will open the possibility for deeper reflection and
building a shared understanding of what may (and may not) work in this
organization’s context.
Respect – Building on a foundation of mutual respect, the consultant
and members of the client organization can create a collaborative space for
sharing knowledge and insights, presenting ideas tentatively for consideration.
Truth – The consultant will need to speak truth from a spirit of kindness, compassion, and wanting the best for the organization and their clients; hiding uncomfortable findings or “sugar-coating” results will not fulfill
the consultant’s contractual responsibilities.
Love – Keeping the end goal in mind (i.e., creating better systems and
processes to serve the organization’s clients (families and children), it will
be important for the consultant to remain open and unbiased, avoiding any
potential or perceived conflict of interest.
Wisdom – As a consultant, the counsellor can draw on years of relevant
experience but also recognize the boundaries of competency due to limited contexts and client groups, opening space for members of the organization to contribute their wisdom and experience as well. Together, they can
co-create new policies and systems that will enhance the organization’s work
with future clients.
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Case 9.2
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Jazpreet is a counsellor/psychotherapist for the last 10
years, who is in her 5th year of recovery from her treatment
for breast cancer. She is asked to consult by the local cancer
agency regarding clients who experience cancer treatment.
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Work Through A: Principle-Based
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Step One: What are the key issues in this situation?
• Disclosing breast cancer to clients, if this is something Jazpreet feels
would be uncomfortable or potentially triggering.
• Boundaries of competence – Jazpreet may have lived experience,
but does this translate to experience with clients who have breast
cancer? Has she ever worked with this population?
• Conflict of interest – should Jazpreet be consulting with a cancer
agency that may have been the one that treated her?
Step Two: What ethical articles from the CCPA Code of Ethics are relevant to this situation? – Are there policies, case law, statutes, regulations,
bylaws or other related articles that are relevant to this situation?
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F3. Consultative Relationships
F4. Conflict of Interest
F5. Sponsorship and Recruitment
A3. Boundaries of Competence
Step Three: Which of the six ethical principles are of major importance
in this situation? (This step also involves securing additional information,
consulting with knowledgeable colleagues or the CCPA Ethics Committee,
and examining the probable outcomes of various courses of action.)
• Beneficence – how can consulting in this way benefit clients?
• Nonmaleficence – will consulting cause harm to clients in any way?
• Societal Interest – will consulting uphold the best interests of society?
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Step Four: How can the relevant ethical articles be applied in this
circumstance? – How might any conflict between ethical principles be resolved? – What are the potential risks and benefits of this application and
resolution? Jazpreet should consider if there is any conflict of interest in this situation as well identify her boundaries of competence. Just because Jazpreet has
gone through cancer treatment does not make her an expert on counselling/
psychotherapy for clients who have undergone cancer treatment.
Step Five: What do my feelings and intuitions tell me to do in this situation? (See also Virtue-Based Ethical Decision-Making.)
• Jazpreet should do what she feels most comfortable with and identify any biases or personal feelings she may bring to her role.
• Jazpreet should seek consultation/supervision around her level of
knowledge and ability to consult as an expert in this field.
• Jazpreet should also consider how this role may affect her personally and consider ways to prioritize her professional self-care if this
role would be emotionally draining for her.
Step Six: What plan of action will be most helpful in this situation? –
Follow up to evaluate the appropriateness, adequacy, and effectiveness of
choosing to be a consultant. As she would be a consultant for therapists
working with clients, unless Jazpreet has the requisite training and education in this area of counselling, she should defer the offer until such time as
she has gained it, or seek supervision to support her in this new role.
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Work Through B: Quick Check
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Publicity: I find this criterion question interesting, because, as a counsellor, if the ethical dilemma is conflict of interest, and I believed it was not
a good idea for me to consult with the cancer agency (e.g., because it could
be triggering, or if I would be unable to be critical of an individual or agency that helped to save my life), then I would not mind that decision being
announced on the front page of a major newspaper. Similarly, if I believed
it was a good idea for me to consult (e.g., having a greater understanding of
the process, more empathy/understanding about how clients may be feeling) then I also would be fine with that decision being on the front page
of a newspaper. So, I believe that caution should be used when using this
question as a guide for ethical decision making. That said, if the ethical dilemma is a matter of competency (e.g., her expertise is in talk therapy, not
in consultation, and not related to terminal illness at all), I would have to
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consider a possible headline of “Cancer agency spends X dollars hiring a
consultant with no previous experience to conduct a comprehensive review
based solely on her experience as a patient.” In that case, it readily becomes
crystal clear that the optics would not be great.
Universality: I tend not to like absolutes on the best of days. In this
case, as with others, I do not think that there should be a “blanket” answer.
As with most things, there are pros and cons. I think the key to answering
this question lies in how self-aware that counsellor is – not only in acknowledging potential limitations or conflicts prior to accepting a contract, but
being able to identify them in the moment that something is going sideways
(e.g., being triggered or being out of her depth with lack of expertise). In
this case, I think it would be a good idea for Jazpreet to disclose to the cancer
agency that is requesting the consult, her exact level of experience with the
particular subject matter (e.g., personal and professional), as well as any potential biases/difficulties she would be bringing to the table. Perhaps a more
personal “inside view” is what they were seeking? Or, perhaps they were
preferring an unbiased view? I’d wonder how the cancer agency would feel
about a headline being on the front page of a major newspaper.
Justice, in this scenario, is a fascinating concept. Is it about things being equal? Is it about things being equitable? What is justice? It would not
seem to be “fair” if the counsellor who had cancer and underwent treatment
didn’t get the job just because she could be perceived to have bias. Similarly, it doesn’t seem “fair” that someone would not get the job, just because
they didn’t have cancer personally. The Cancer agency could justify hiring
or not hiring either counsellor to consult for the “right reasons.” On the
other hand, it would certainly be understandable to not hire someone that
doesn’t have the appropriate expertise or competency. Is that fair? I believe
most people would probably agree that an individual with no experience
or competency should not be hired to consult on something they do not
know anything about. In theory, “justice” to get (potentially) two different
perspectives might be to hire two experienced, competent people to consult
– one having gone through the experience of being treated for cancer, and
one not. It would then be the cancer agency’s decision as to which they find
more relevant or if they decide to incorporate both responses.
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Case 9.3
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A counsellor/psychotherapist named Alex, who has
just completed a graduate training in counselling and has
become recently certified to practice, presented their thesis
results that focused on eating disorders at their university’s
research presentation conference to the public. Following
their presentation, an attendee asks Alex whether they
would be willing to work with their daughter who they believe has an eating disorder.
Work Through A: Quick Check
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According to the CCPA Code of Ethics (F5. Sponsorship and Recruitment, p. 4), counsellors and therapists are not permitted to recruit clients
through consultation services. In this instance, Alex is not directly providing
consulting services; however, they are aware that it is not the appropriate
place to recruit new clients and/or market their services.
Considering the dilemma the attendee presents, Alex would prefer to
consult with their supervisor; however, the context in which the situation
occurs (i.e., a presentation) dictates that they make a quick ethical decision.
They are aware that other attendees and members of the academic community are present, which makes them feel vulnerable. They also recognize it
is their duty as the presenter to answer questions from attendees. Alex asks
the attendee to wait for a few minutes before answering. Due to their inexperience and not being able to reach out to their supervisor, they decide to
contact their mentor, with whom they discuss some of the key ethical issues
involved in this situation.
After making notes, Alex decides to examine the dilemma through the
guiding questions that the Quick Check Ethical Decision-Making Model
provides.
Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
In Canada, a counsellor/psychotherapist is not qualified to provide diagnosis, including eating disorders (CCPA, 2020, A3. Boundaries of Competence, p. 6; F1. General Responsibility, p. 24); eating disorders are diag-
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nosed by medical professionals such as physicians, nurse practitioners, or
psychologists (National Eating Disorders Information Center, 2023). As a
result of discussing this key issue with their mentor (CCPA, 2020, B10. Consulting with Other Professionals, p. 11), Alex determines they are not the
appropriate person to provide service to the attendee’s daughter.
Alex needs to approach the attendee in a way that represents their professional qualifications properly (CCPA, 2020, A5. Representation of Professional Qualifications, p. 6) while providing some guidance that does not
go beyond their current experience and training (CCPA, 2020, A3. Boundaries of Competence, p. 6; F1. General Responsibility, p. 24) or that it could
be considered as an opportunity to recruit clients (F5. Sponsorship and Recruitment, p. 4).
Alex decided to suggest that the attendee discuss with the daughter the
possibility of consulting a psychologist who has the necessary experience
to conduct a proper assessment (B16. Referral). They feel good about this
answer and aware of feeling proud to have acted professionally (A1. General
Responsibility) and within their limits of competence (A3. Boundaries of
Competency, p. 6). Meanwhile, Alex is cognizant that the attendee has trusted them after hearing the thesis presentation and that he deserves to receive
an answer that addresses his concerns. If this decision was to be announced
publicly, Alex feels calm and confident knowing they would be representing
the counselling/therapy profession in an ethical manner.
Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
It is the primary responsibility of counsellors/psychotherapists to ensure the client’s welfare is promoted in all professional contexts (CCPA,
2020, B1. Primary Responsibility Counsellors/therapists, p. 9), while maintaining awareness of the unique and diverse circumstances for everyone
they interact with professionally (CCPA, 2020, B9. Respecting Inclusivity,
Diversity, Difference and Intersectionality, p. 11). Although the attendee is
not a counselling client, Alex is approaching him as a potential client who
trusts Alex as a professional. Alex understands that the information provided to the attendee should be accurate, ethical, and culturally sensitive – as
it would for any other client or professional. Although Alex is unaware of
any other information about the client, the ethical principles of beneficence,
nonmaleficence, and justice serve as a guide. It is necessary for the counsellor/psychotherapist to obtain ongoing parental/guardian informed consent
as well as the client’s assent during counselling and throughout other professional activities. In this case, the attendee is speaking about someone else.
As such, the counsellor should be aware of the potential dual relationship
in this interaction (CCPA, 2020 B5. Children and Persons with Diminished
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Capacity, p. 10). The same decision, if applied to any other client or potential client, would be a positive one.
Justice: Is everyone being treated fairly by my decision?
As Alex wishes to ensure the attendee understands the importance of
respecting autonomy (CCPA, 2020, p. 2), they explain to the attendee that
if his daughter is an adult or mature minor, she should be able to choose
whether or not to consult with a professional and with whom to consult. In
addition, Alex offers some guidance proportionate to the professional context in which the attendee’s concern appears (i.e., an academic context) and
recommends which types of professionals the attendee should contact for
help to support the daughter (CCPA, B16. Referral, p. 12). It is Alex’s intention to be fair to both the attendee and the daughter, even though she is not
present. Alex avoids making assumptions about her situation and doesn’t
make any therapeutic recommendations.
Work Through B: Principle-Based
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Step One: Key issues for consideration are:
• Competence of the new graduate.
• Does the daughter actually have an eating disorder?
• What is Alex’s experience with eating disorders? Personal? Member
of the family? General area of interest?
• Why are the parents approaching Alex, specifically? “Cutting edge”
research? Type of eating disorder specialization? Prohibitive costs
of other counsellors?
Step Two: The specific articles would depend on the answers to the
questions posed in Step 1. The most relevant articles in general would be:
A1. General Responsibility
A2. Respect for Rights
A3. Boundaries of Competence
A4. Supervision and Consultation
A5. Representation of Professional Qualifications
A10. Third Party Reporting
B1. Primary Responsibility
B5. Children and Persons with Diminished Capacity
C3. Assessment and Evaluation Competence
C8. Reporting Assessment and Evaluation Results to Third Parties
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Step Three: Obviously, all six ethical principles are important. In this
scenario, if I am required to identify the most primary, they would be: nonmaleficence, beneficence, fidelity, and autonomy.
Step Four: In this case, to address the most obvious issue (degree of
competence), Alex would just have to make it clear that they are newly certified, and though eating disorders may be the subject of their thesis, they
(may) have limited practical experience counselling for that issue. Alex may
also want to disclose if they personally had an eating disorder – and be
forthcoming about any efforts that will be made to negate bias, triggering,
self-care, getting supervision, etc. Regarding the fact that the daughter is a
teenager, Alex would want to be very clear with ALL parties about responsibilities when reporting any assessment results and limits to confidentiality,
as well as respecting the teen’s autonomy. The potential risks of this could
be that the parents might want to choose that their daughter see someone
more experienced; however, a potential benefit would be gaining rapport/
trust for being so candid, truthful, and upfront.
Step Five: In this situation, assuming that Alex is self-aware, and believes that they are competent to provide assistance to the client, then I
think it would be okay for them to proceed. Even newly certified people
need to get experience. Ideally, however, this would still be under supervision / consultation with other counsellors/therapists, given Alex’s newness
– and especially if they have personal triggers related to the subject matter.
Step Six: I think it would be most beneficial to have the first meeting
with all parties (the teen and the parents together), to set expectations regarding reporting, autonomy, and confidentiality, and to confirm “goals.”
Then, if they decide to proceed, to do occasional check-ins every couple
of sessions to confirm that all parties are still getting benefit from therapy
would be helpful. If it is not working, a referral should be made.
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CHAPTER 10
Case 10.1
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David is a recent graduate who has made an ethical
decision based on what he was taught within his training
program. His supervisor has challenged that decision and
David now must justify his decision.
David is working with a child of divorced parents, one
parent who supports conversion therapy and the other
who doesn’t. David shows his supervisor evidence of working through an ethical decision-making model and has provided articles to support his decision. In David’s opinion it’s
in the “best interest” of the child not to alienate the relationship with either parent. David provides evidence that conversion therapy may be a valid approach when considering
religious freedoms.
His supervisor contends that because the laws for
considering the “best interests” of the child when working
with children of divorced parents has changed, specifically
within their jurisdiction in BC, that David’s decision is out
of date. He adds that the research supporting conversion
therapy is now greatly outweighed by that condemning it.
An internet search for current laws on Conversion Therapy
suggest that it is not legal in Canada, including BC.
Although David isn’t a supporter of conversion therapy, he feels ill equipped to discuss the matter given the one
parent’s outspoken and strong opinion on the matter. He
worries that the one parent will pull the child out of therapy
and great harm will come from this.
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Work Through A: Wise Practices
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When considering ethical aspects of a case, I examine the actual Codes
of Ethics (and the accompanying Standards of Practice), using the decision-making processes to support decision-making regarding the application of the Codes and Standards. The case, as presented, did not mention
our Code of Ethics.
In CCPA’s (2020) Code of Ethics and Standards of Practice (CCPA,
2021), Articles B4 and B5 outline the counsellor’s responsibilities regarding
consent for working with minor children (note: we are not provided with
the age of the child, but for these purposes it is assumed that child refers to
a minor.)
The counsellor should discuss the goals for counselling (within legal
parameters) with BOTH parents, (unless one has the legal parental decision-making rights). As a CCC with CCPA, David must take responsibility
for understanding the legal and ethical considerations around the use of
Conversion Therapy and consider seeking further consultation, in addition
to his current supervisor.
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B4. Client’s Rights and Informed Consent
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From the Code of Ethics: “When counselling/therapy is initiated,
and throughout the counselling/therapy process as necessary,
counsellors/therapists inform clients of the purposes, goals,
techniques, procedures, limitations, potential risks and benefits
of services to be performed, and other such pertinent information” (CCPA, 2020, p. 9).
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The Standards of Practice discusses informed consent:
Informed consent is essential to counsellors/therapists’ respect
for the clients’ rights to self-determination. Consent must be
given voluntarily, knowingly, and intelligently. Counsellors/therapists must provide clients a rationale for potential treatments
and procedures in easily understood terms. Any intervention
offered to a client should be grounded in an established theory
or have a supporting research base. (CCPA, 2021, pp. 18-19)
B5. Children and Persons with Diminished Capacity
Counsellors conduct the informed consent process with those legally
appropriate to give consent when counselling, assessing, and having as research subjects, children and/or persons with diminished capacity. These
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clients also give consent to such services or involvement commensurate
with their capacity to do so. Counsellors understand that the parental or
guardian right to consent on behalf of children diminishes commensurate
with the child’s growing capacity to provide informed consent.
Some other Articles that would come into play for this case, if it is legal
for the counsellor to proceed, are:
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A2. Respect for Rights: “Counsellors/therapists participate in only those
practices that are respectful of the legal, civic, moral, and human
rights of themselves and others, and act to safeguard the dignity
and rights of their clients” (CCPA, 2020, p. 6). This case is very
complicated from a Human Rights perspective. CCPA’s Standards
of Practice states that, “Counsellors/therapists practice in a manner
congruent with the overarching principles of the Universal Declaration of Human Rights, the UN Convention on the Rights of the
Child and the UN Declaration on the Rights of Indigenous Peoples to which Canada is a signatory” (2021, p. 2). The counsellor
should ensure that any therapy would be within the parameters of
the above principles.
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Other Codes that should be taken into consideration for this case would
include:
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A3 Boundaries of Competence: “Counsellors/therapists limit their
counselling/therapy services and practices to those which are within their professional competence by virtue of their education and
professional experience, and consistent with any requirements for
provincial/territorial and national credentials” (CCPA, 2020, p. 6).
Counsellors who do not have specific training/competencies in the
area of supporting children whose parents are divorced and who
are in disagreement or conflict about contentious issues in regard
to their child should consider referring this type of case to another counsellor who does have these competencies and seek supervision/consultation IF he does enter a counselling relationship with
this client and their parents.
B1. Primary Responsibility: “Counsellors/therapists respect the integrity
and promote the welfare of their clients. They work collaboratively
with clients to devise counselling/therapy plans consistent with the
needs, abilities, circumstances, values, cultural, or contextual background of clients” (CCPA, 2020, p. 9).
From the Standards of Practice:
The fact that this ethical article is first in this “counselling rela-
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tionships” section underscores the need for counsellors/therapists to be mindful of their primarily obligation to help clients
(within legal and ethical parameters). Counsellors/therapists enter into a collaborative dialogue with their clients to ensure understanding of counselling/therapy plans intended to address
goals that are part of their therapeutic alliance. Counsellors/
therapists inform their clients of the purpose and the nature
of any counselling/therapy, evaluation, training or education
service so that clients can exercise informed choice with respect
to participation. (CCPA, 2021, p. 14)
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B9. Respecting Inclusivity, Diversity, Difference and Intersectionality:
Counsellors/therapists actively invest in the continued development and refinement of their awareness, sensitivity, and competence with respect to diversity (between groups) and difference
(within groups). They seek awareness and understanding of client identities, identification, and historical and current contexts.
Counsellors/therapists demonstrate respect for client diversity
and difference and do not condone or engage in discrimination.
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This would also apply to differences in clients with diverse gender identification. The Standards of Practice for this article also cautions counsellors
to refrain from imposing their own values and to consider how clients’
diversity contexts shape their concerns and inform potential interventions.
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Wise Practice Lens Review
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Courage – It can be hard when your supervisor disagrees with you,
and you are asked to justify your decision. It can be stressful working with
families where the parents have different strongly held beliefs and values, especially when the parents are divorced. It also takes courage, as a therapist,
to review current literature and potentially revise your own beliefs.
Honesty – Advise parents that based on new research, you have updated your legal and ethical approach to working with their child. Furthermore, you would be explicitly respectful of both the parents’ beliefs, and
place value on the importance of the child’s relationship with both parents.
You can give names of other registered/certified counsellors that could work
with them if they decide to not proceed with you.
Humility – Offer that you respect their beliefs and rights as this child’s
parents; advise of your treatment plan; what you will work with the child on
(and not work on); how you would work with the child (e.g., if the child is
having difficulty with coping or acting out). If they don’t want to work with
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you, provide the names of other certified or registered clinicians. Consult
with peers and clinical supervisor.
Respect – Respect the parents’ beliefs and rights to choose their beliefs
and parenting styles. Confirm that you know they only want the best for
their child, and focus on identification of other goals to support the child’s
overall emotional needs for therapy.
Truth – Tell the parents what you can and can’t work on, how you can
work with their child. Come back to why the parents brought the child into
counselling.
Creating Love – Supporting the child’s connection with both parents
and the counsellor is important; good support for the child helps them to
navigate their world.
Wisdom – Learn from the child as well, based on their behaviour and
coping, to see if current counselling is effective.
Work Through B: Quick Check
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Based on his supervisor’s feedback (e.g., about conversion therapy now
being illegal in his jurisdiction and that the laws support putting the best
interest of the child first in working with children of divorced parents), David was grateful for the opportunity to reconsider his decision. Although
he still stands by his original statement that “it’s in the ‘best interest’ of the
child not to alienate the relationship with either parent,” he recognizes that
supporting any decision to pursue conversion therapy would not be ethical
according to the law or to the CCPA (2020) Code of Ethics and would not be
supported by the principles of autonomy, justice, or nonmaleficence.
Also supporting his new decision are Articles A1 (General Responsibility – in particular, recognizing the need for continuing professional development given that what counsellors have been taught in their programs
may have recently changed), A2 (Respect for Rights – given that conversion
therapy is now illegal and wouldn’t support the legal rights of his client),
A3 and A4 (Boundaries of Competence / Supervision and Consultation –
seeking supervision was helpful in offering new information), B1 (Primary
Responsibility – re-enforcing that his primary concern is to do what’s right
for his client rather than trying to please two parents with vastly different
beliefs), B9 (Respecting Inclusivity, Diversity, Difference, and Intersectionality – recognizing different perspectives within the family and also the
child’s identity that is likely the foundation for discussions about conversion
therapy). It’s also possible that David may be able to work with the child as
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a “mature minor” although that isn’t clear from the case description. David
also needs to clarify whether he is working with multiple clients (B13) and,
therefore, engaging in family therapy or if the child is his primary client,
in which cases the best interests of the child will be prioritized. David recognizes his boundaries of competence in this and will also offer a referral
(B16) to a program supporting youth who are questioning their sexual orientation and/or gender identity.
1. Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
• What I would feel most comfortable announcing is engaging in a
discussion with the child on what they feel is best for them and
what they want. With the information provided, it’s unclear what
the preferences of the child are.
• I would also feel comfortable publicizing that I am looking further
into the laws surrounding consent with minors and try to give the
child as much autonomy as possible (e.g., could they be considered
a mature minor, B5). Additionally, this would include advocating
for the child and their needs and preferences, regardless of whether
the parent agrees. While doing this, I would try to see if there is a
way for the parents to see eye-to-eye with each other and with the
child to build connection amongst the parties impacted. I would
include the parents in conversations about conversion therapy and
the most recent research about it – it’s possible they aren’t aware of
the dangers.
2. Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
• As every counsellor should be making decisions based on available
research and laws, yes, if every counsellor made this decision, it
would be a good thing.
• I would also choose to support the child in their interests and advocate for them regardless of whether their parents agreed with the
child or with each other. I feel this would be important for all counsellors to do as part of ethical practice.
3. Justice: Is everyone being treated fairly by my decision?
• In this case, the supervisor is being treated fairly by my decision to
incorporate his feedback and recommendations.
• The child is being treated fairly by being listened to and respected
and by being given agency over their own treatment.
• Both parents will be treated with the same respect as everyone else
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and given an opportunity to engage in the conversation and share
their opinions while also hearing the opinions of others; hopefully
they will feel that this is fair.
Case 10.2
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Dr. Janson is a faculty member at a university with a
Masters of Counselling program and also runs a research
lab employing several students. Mimi worked in the research lab throughout the first year of her graduate studies
and has recently taken on a small part-time contract with
Dr. Janson’s private practice and consulting business.
Dr. Janson is the only instructor scheduled to teach
the mandatory courses within Mimi’s second year; however, university policy states that Dr. Janson isn’t permitted to
instruct Mimi while she is also employing her. This means
that Mimi will need to delay her course enrollment, practicum position, and ultimately her graduation. Mimi insists
that this is “no big deal” but recently overheard the other
research lab students discussing how unfair the situation is
and that Mimi is making a huge mistake.
Work Through A: Virtue-Based
1. What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
The ethical issues here revolve around the dual relationships between
Mimi and Dr. Janson (B8). Mimi is a student and employee in Dr. Janson’s
lab and now in her private practice, and Dr. Janson is an instructor and an
employer in her lab and private practice. The challenge is how to manage
these multiple relationships.
There are processes within the university to manage the dual relation-
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ship regarding the lab. It seems unreasonable that similar processes and safeguards couldn’t be put in place regarding private practice as well. Therefore,
regarding the work in Dr. Janson’s private practice, there may be two ways
to proceed. One involves checking with Mimi to see if she is really okay with
the delay in her program, and perhaps assisting her in taking a leave from
the program for the period she will be working, if that is possible. Second,
the possibility of having another professor grade Mimi’s assignments could
be explored so that Mimi could complete the course with her cohort and not
delay her program.
2. How can my values best show care for the client’s wellbeing?
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I would meet with Mimi to discuss her options and look at the costs and
benefits of her decision to take a year off to work for Dr. Janson. I would also
talk with both Dr. Janson and Mimi regarding the possibility of her attending Dr. Janson’s class with someone else grading her assignments. I would
also discuss processes for them both to consider if challenges arose in the
class, the lab, or the private practice employment situation.
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3. How will my decision affect other relevant individuals in this
ethical dilemma?
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Dr. Janson, Mimi, and the other person who may be asked to grade
Mimi’s work would all be affected. Also, it will be important to be transparent in communicating the process to department faculty and students so
that gossip about it may be reduced.
CCPA’s Articles G4. Clarification of Roles and Responsibilities and G6 on
Relational Boundaries apply here.
4. What decision would I feel best about publicizing?
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That the issues arising regarding the dual relationships had been discussed and a resolution had been found (CCPA Code of Ethics Article B8,
Multiple Relationships).
5. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
The above decisions reflect my views on social justice, fair practices, relational and professional boundaries, and issues of power in mentor/student
relationships.
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Work Through B: Principle-Based
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Step 1: Key Issues
Mimi’s graduation will be delayed due to the work she has taken on as
a student. If she were to work with another faculty member or in another
counsellor’s private practice, she could do identical work with no penalty.
However, because her employer is also teaching a course that Mimi needs to
complete for graduation, an ethical dilemma has arisen. Although “university policy states that Dr. Janson isn’t permitted to instruct Mimi while she is
also employing her,” there are many precedents of students working for faculty in their research labs or being employed by faculty in other roles in the
university, so it seems to be the private practice that is the primary concern.
A key component of graduate level education is to prepare students for
work post-graduation. Mimi is getting relevant work experience with Dr.
Janson, work that will enhance her future employability. Delaying her graduation, instead of finding a way to effectively manage the dual relationships,
seems unjust (Justice), to be doing harm to Mimi (Nonmaleficence, Beneficence), taking away her choice of where to work (Autonomy), and not in
the best interests of society (Societal Interest) as qualified counsellors are in
high demand.
Step 2: Ethical Articles
As this is a dual relationship with an educator, I’ll first turn to Section G:
Counsellor/Therapist Education and Training. Although concerns around
protecting students generally relate to ensuring they aren’t exploited, there
is no reason to automatically assume that’s the case in Dr. Janson’s private
practice and consulting business. An alternate explanation could be that
she’s providing the most relevant work experience for Mimi’s professional
development as a counsellor. Just as supervisors are encouraged to seek supervision of their supervision, it would be helpful for Dr. Janson’s supervisor (perhaps the Department Head or program coordinator) to consult with
both Dr. Janson and Mimi to ensure that Mimi’s best interests are protected
(as a student, Mimi is the most vulnerable in this scenario) and that Dr.
Janson is fulling her ethical responsibilities for General Responsibility (G1)
and Ethical Orientation (G3). It would be helpful to draw up an informed
consent document or to amend the work contracts to ensure Clarification
of Roles and Responsibilities (G4). A commitment by Dr. Janson to ongoing supervision could address and monitor the Relational Boundaries (G6),
fulfilling the ethical obligation that dual/multiple relationships are “entered
into by the parties involved only after assessment of the rationale, risks, benefits, and alternative options” (CCPA, 2020, p. 26). It will also be important
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to ensure that Mimi is appropriately credited for any of her contributions to
Dr. Janson’s scholarly activities (G13).
There are other relevant articles throughout CCPA’s (2020) Code of Ethics: Respect for Rights (A2), Supervision and Consultation (A4), Responsibility to Counsellors/Therapists and Other Professionals (A7), Multiple
Relationships (B8), Acknowledging the Contributions of Others (D10), and
Conflict of Interest (F4). Taking all of these articles into account, assuming
that the multiple relationships benefit, rather than harm the vulnerable student, and are carefully managed with integrity, they are likely to result in a
positive outcome for the student.
Step 3: Principles
Most of the principles seem relevant – Beneficence (being proactive in
promoting Mimi’s best interests as a student), Nonmaleficence (refraining
from delaying Mimi’s graduation or forcing her to give up a professionally relevant job that fits with her school schedule), Autonomy (respecting
Mimi’s right to agency in choosing the work and school options that feel
like the best fit), Justice (honouring Mimi’s right to just treatment and not
punishing her for choosing work that is relevant to her career goals), and
even Societal Interest (by not delaying Mimi’s graduation when there are
long waitlists for qualified counsellors).
Step 4: Applying the Articles
I’d encourage Mimi and Dr. Janson to meet with a supervisor at the
university (e.g., the Program Coordinator, Department Head, or Dean, depending on the reporting structure), with a clear plan in place for how they
could make it work for Mimi to take Dr. Janson’s course and graduate on
schedule. The plan would involve strategies for how to handle any conflicts
at work or in the class, protecting Mimi as the most vulnerable person in
this scenario. Options could include reporting to someone else within Dr.
Janson’s private practice or having a faculty supervisor in place for Mimi
to consult with should any issues come up in the university research lab or
the classroom. Arrangements could be made for another faculty member
to grade Mimi’s assignments or for Dr. Janson to grade the assignments but
with an option available for another instructor to regrade the assignments
in the case of an appeal. All of this would serve to clarify roles and responsibilities and to set clear relational boundaries due to the multiple relationships (G4, G6). There would also need to be clarity about how to discuss the
multiple relationships with other faculty and students, ensuring that Mimi
wasn’t perceived as being privileged in some way.
Step 5: Feelings and Intuitions
My feelings and intuitions tell me that this is a workable plan. Based on
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assumptions that both Mimi and Dr. Janson are fully committed to ethical
practice (i.e., grounded in a mindset of “believing the best”), I think it is
doable to consult transparently, put reasonable supervision and appeal procedures in place, and proceed with Mimi taking Dr. Janson’s class (which is
required for her program), without terminating her employment with Dr.
Janson.
Step 6: Plan of Action
First, Mimi will talk with Dr. Janson about the feasability of her taking the course without the need to terminate her employment. Next, Mimi
and Dr. Janson, will speak to a supervisor at the university to discuss and
co-develop a plan that follows the ethical principles and articles described
above. After the course has been successfully completed, perhaps it would
be helpful for Dr. Janson and Mimi to document their process and how it
worked out, providing a precedent to advocate for university policy change
in the future.
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Case 10.3
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Dr. Rolland instructs an online course within the Masters
of Counselling Psychology program. As it’s one of the first
courses students take in the program, many of the students
struggle to meet the grading expectations and end up having
to retake the course or withdrawing from the program entirely. Due to its high enrollment, the marking load is similarly
high. With the majority of the assignments due near the end
of the course, Dr. Rolland struggles to provide feedback and
grades for one assignment before the next is due.
Recently, one of Dr. Rolland’s students expressed her
frustration over the assignment expectations and schedule.
She questioned how anyone can be successful in the course
and accused Dr. Rolland of intentionally withholding feedback to support her reputation as a program gatekeeper. Dr.
Rolland feels she’s communicated the course expectations
and flow early on in the course adequately to students. She’s
appalled to find an influx of poor evaluations by students at
the end of the course.
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Work Through A: Virtue-Based
What are the emotions expressed by each party and how do they
impact suggestions for solving the discomfort?
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The student is frustrated by, and feels helpless about, the lack of feedback on assignments and expectations during the course. She also feels disempowered, accusing the instructor of intentionally withholding feedback.
The instructor is also frustrated – by the student’s complaint and also
by what seems like an overwhelming workload. Upon receiving poor course
evaluations, she’s “appalled” – likely feeling anger, embarrassment, and a
lack of respect – perhaps mingled with some guilt and shame. She feels misunderstood and unsupported, and disappointed that her work throughout
the course wasn’t well received.
These underlying emotions suggest that the students’ (including the
others in the class who submitted poor evaluations) concerns need to be
heard and validated. However, they also suggest that some earlier intervention with the instructor might have been helpful. Dr. Rolland has a reputation as a “program gatekeeper” suggesting that this isn’t a new issue, which
raises the question, “Why now?” Had her previous evaluations been good
and suddenly this one wasn’t? Is there something unique about this cohort
of students? Is there something else going on for Dr. Rolland this term that
has created an unusually high backlog of marking? Or, is this a known and
ongoing pattern and is Dr. Rolland, at the program’s request, serving as the
gatekeeper? If so, are the course expectations clearly explained and is a grading rubric provided? Could the program support Dr. Rolland in re-aligning
assignments so that the first can be graded before the second is submitted,
and so on? Could Dr. Rolland be assigned a teaching assistant to help with
timely return of graded assignments? How can my values best show care for the [student/instructor]’s
wellbeing?
I value respect, fairness, and, in my role as a counsellor educator, protecting the public. I also value transparency, a mastery learning approach to
teaching, timely feedback to students, and clear and open communication.
I am student-centred and value creating a culture of kindness. I also value a
safe and nurturing work environment with supports and accommodations
as needed. I value a holistic approach to life and work, recognizing that “life
happens” and can, at times, become overwhelming for both students and
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How will my decision affect other relevant individuals in this
ethical dilemma?
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First, I need to unpack the dilemma. From the students’ perspective, it
seems that there’s a fairly consistent experience of unclear learning objectives and grading criteria, combined with a lack of timely feedback – they
are feeling set up for failure and some are perceiving that as intentional on
the instructor’s and program’s part.
From the instructor’s perspective, the workload feels unmanageable and
the program’s lack of support and high expectations have resulted in her
having a reputation with students as the “program gatekeeper.” As a result,
she’s exhausted and hurt.
Assuming that the course is over now (as evaluations have been submitted) and the student is appealing her grade, I would need to consult with
my supervisor about what options (and what supports) are available to me.
Aligned with my values, I actually do want students to succeed – and, more
than 60% of the students in this cohort did successfully complete the course.
I’m concerned that if I allow this student to resubmit her assignment, I will
receive many more similar requests – I’m already feeling exhausted and
overloaded and I don’t know how I can handle additional grading just as my
next courses are set to begin.
I do appreciate that this student has raised specific concerns about the
course – I’d been feeling for some time that changes were needed but, as it’s
an online course, making significant changes is a complex and time-consuming process and beyond my capacity to do on my own. Where I do feel
some capacity to influence change is in bringing up the students’ concerns at
the next faculty meeting and requesting a teaching assistant and/or instructional designer to work with me to revise the course. Ka
What decision would I feel best about publicizing?
I would be uncomfortable with it becoming widely known that students
who complain about their grades after a course is complete get the opportunity to revise and resubmit their assignments. In an early course in the
program that is, to a certain extent, designed to screen for student suitability
to successfully complete the rest of the program, having a wide-open appeal
process could result in endless re-grading and students getting through who
really don’t have the requisite competencies to succeed in grad school.
I would also be uncomfortable, however, in it being publicized that I
don’t invite or act upon students’ feedback.
I would feel best about suggesting and supporting a course revision that
spaces out the assignments more appropriately, so that students receive clear
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feedback on each assignment before submitting the next. I would like to be
known publicly as the instructor who supports student learning through a
mastery approach (rather than as the program gatekeeper), ensuring that
students who successfully complete my course are well-prepared for the rest
of the program. To avoid unexpected course evaluations at the end, I would
also build into the course design an opportunity for a midterm evaluation
of the course and my teaching and would set regular weekly office hours via
Zoom to invite students to ask questions and offer feedback throughout the
course. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
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I respect the complex lives of my students, who are all adult learners and
who come from diverse cultural backgrounds with varying levels of experience in a Canadian university. I want to offer what I am able to, to be supportive, but I also need to recognize the limits to my own capacity and my
need to align to program policies and expectations. Deciding to advocate
for support to revise the course to better meet the needs of future students
recognizes my current limitations and program policies, but also respects
and honours the perspectives of students who struggled in the current version of the course and have requested changes.
Work Through B: Quick Check
Ka
ro
The ethical dilemma here seems to revolve around unreasonable workloads – both for the students in a required course and for their instructor.
The course design, with all assignments scheduled towards the end of the
course, precludes the instructor getting timely feedback to students (i.e., the
students are generally not receiving feedback on one assignment before the
next one is due and must be submitted; therefore, they are not benefitting
from the feedback to improve their subsequent submission). On the surface,
it doesn’t seem that the instructor is fulfilling all of the obligations of the
teaching contract. However, it’s unclear whether the expectations are reasonable. Given the disappointing final evaluations from students, the complaints from students, and the instructor’s experience of feeling overworked
and overwhelmed while teaching the course, the ethical decision seems to
be to advocate for a revision of the course.
This decision could be supported by the ethical principles of Beneficence
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(promoting the best interests of student and also the instructor), Fidelity
(ensuring that the course syllabus, a contract with the students, leads to a
reasonable expectation of successful completion of the course), Nonmaleficence (removing the harm currently being done through untimely feedback), and Justice (honouring the students’ rights to a reasonable chance
of passing this required course by successfully demonstrating the learning
outcomes). There are also many relevant articles in CCPA’s (2020) Code of
Ethics, including:
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A1 (General Responsibility), especially related to personal care, as the
current workload seems untenable
A4 (Supervision and Consultation) - the instructor may need to get faculty support to significantly revise the online course
Bo
C7 (Reporting Assessment and Evaluation Results) - an emphasis in
this article is on timeliness
G1 (General Responsibility) - professional conduct and ethical approach to teaching
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G4 (Clarification of Roles and Responsibilities) - “Counsellor/therapist
educators also acknowledge the inherent power and privilege they
hold and convey their commitment to using these advantages to enhance the experience of supervisees/trainees” (CCPA, 2020, p. 25)
Ka
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It’s interesting that there seems to be nothing in the Code of Ethics or
Standards of Practice related to course design or curriculum issues – perhaps that could be a consideration in future revisions?
Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
I’d be happy to see front-page headlines that the university, in response
to student and instructor feedback, is investing in redesigning online courses to make them more effective, enhancing student success without compromising learning outcomes.
Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
Yes – even courses that are intended to be “gatekeeper” courses need
to have clear syllabi and scheduling of assignments and activities that facilitates a reasonable chance of success for competent students. Instructors
need sufficient time between assignments to provide adequate feedback that
can inform and shape the students’ subsequent assignment submissions. An
ethical approach to counsellor education would set students up for success,
rather than failure, as long as that success was aligned with learning out-
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comes designed to develop students to become competent counsellors.
Justice: Is everyone being treated fairly by my decision?
Although the current student who is complaining to Dr. Janson might
not get a better grade, the student will have been respectfully heard, the
complaints documented, and there will be a tangible result from those complaints in the form of a redesigned course. This is also fair to the many students who did closely follow the grading criteria and successfully completed
the existing course, in that the goalposts weren’t moved for a student from
their class who chose to complain after the course had ended. Revising the
course will also be fair to Dr. Janson and future instructors, creating a course
that is more manageable to teach and grade.
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Case 10.4
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A student approaches you about a problematic practicum site location and supervisor. The student reported
that the practicum supervisor berated her in front of the
other staff about her inability to connect with clients. As
a sessional faculty member, you don’t have a history with
this practicum site, but you are aware that they’ve been a
long-standing supporter of students providing multiple
placements each semester.
You know that this student had been at risk of getting
expelled from the program before and aren’t sure how to
proceed. You ask around and none of the other faculty indicated issues with the site location.
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Work Through A: Quick Check
Ka
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In applying this model, I’m assuming that I’m the practicum course instructor for this student and the decision I’m facing is whether to approach
the practicum site supervisor about the student’s concerns, pull the student
from the site (considering the site unsafe for the student’s learning), or take
the opportunity to share with the student my similar concerns about her
inability to connect with others. As a sessional faculty member, there will be
a course coordinator or other individual in a leadership role with whom I
can consult for guidance (CCPA, 2020, B10: Consulting With Other Professionals). There may also be a practicum coordinator. Assuming that I have
consulted with those individuals and that they confirm that the site (and the
specific supervisor) have offered good practicum placements in the past, I
would request a meeting with the site supervisor (as aligned to my job description, and meeting the ethical requirement of raising ethical concerns
about colleagues directly first; A8). Without revealing the student’s specific
concerns, I would ask for the supervisor’s preliminary review of the student’s progress. Should the same story surface about an “inability to relate
to clients,” I would ask if the supervisor had shared that feedback with the
student and, if so, how. I’m assuming that the “berating . . . in front of other staff” referred to a weekly case conference session, a regular process in
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which students and other counsellors on staff share video segments of their
sessions and offer observations and feedback. I would ask the supervisor
if she believed that the student could successfully complete her practicum.
Hearing, “No,” I’d recommend that the student be pulled from the practicum
site and a remediation plan developed to address her “inability to connect
with clients.” If that goal was successfully achieved, the remediation plan
would also include finding a new practicum placement with a skilled and
supportive supervisor next term (E4: Welfare of Clients and Protection of
the Public; E5: Welfare of Supervisees; E10: Due Process and Remediation).
Publicity – This criterion asks me to reflect on whether I’d want to read
my decision as front-page news. I imagine the student might be angry with
me, but I’m having a hard time picturing a front-page news story from it
that would have any credibility. However, I would definitely want to avoid
front-page news that read, “Young mother died by suicide after incompetent
counselling at XYZ agency” if I knew that my student had been that counsellor. Universality – As this decision followed an ethical process and policies
within the program, it would apply to other students in a similar situation.
Promoting the wellbeing, respect, and safety of clients, colleagues, students,
and supervisors is a core value of all counselling activities. Consultation,
accepting feedback from supervisors, and following through with that feedback is expected in all clinical settings.
Justice – In this case, clear communication is key to everyone being
treated fairly. Not listening exclusively to, nor discounting, any single perspective is important. As the course instructor, I treated the student fairly by investigating her concern, I treated the program fairly by consulting
with others who had more experience than me, and I treated the practicum
site and supervisor fairly by providing an opportunity for the supervisor to
share concerns and describe the process of giving feedback. Working with
practicum students, I also have a responsibility to protect the public – in
this case, the public was treated fairly by removing the risk of future clients
not being able to connect with their counsellor, as the therapeutic alliance
is fundamental to counselling success (Principles of Nonmaleficence, Justice, Societal Interest; E1: General Responsibility, E4: Welfare of Clients and
Protection of the Public). WORKING THROUGH ETHICAL DILEMMAS
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Work Through B: Virtue-Based
1. What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
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First, I feel torn in wanting to support the student (E5: Welfare of Supervisees) and in needing to support the site if the student is having difficulties (E4: Welfare of Clients and Protection of the Public). I am presuming
that the site been approved so they meet all of the standards of supervision required by the program. I also feel hampered by a lack of information
from everyone involved. My intuition tells me that when I contact the site a
more complete picture might emerge. My first priority will be to contact the
course supervisor to check on program protocols for contacting sites in such
situations (A4: Supervision and Consultation).
2. How can my values best show care for the client’s wellbeing?
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My values can show best by being even-handed in the situation, focusing both on making sure the student is heard and respected and not avoiding gate-keeping processes if they are needed (E5: Welfare of Supervisees;
E10: Due Process and Remediation; Principles: Justice, Societal Interest).
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3. How will my decision affect other relevant individuals in this
ethical dilemma?
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The decision taken jointly by the course supervisor, the practicum site
and me will determine the student’s future in the program and/or the view
of the site by the program.
4. What decision would I feel best about publicizing?
Ka
That the decision supported the student and the practicum site, whatever decision was taken.
5. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
A decision to collaborate with all parties involved and to support a just
outcome by checking in with the student, practicum course supervisor, and
practicum site.
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CHAPTER 11
Case 11.1
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Suzie has been a counsellor for 25 years. They have
been working at the same agency for their entire career,
and recently a new executive director has come on board.
The agency is looking to make changes and digitize business processes. The executive director seems excited about
this switch as it will produce more clients locally and across
provinces as well as improve efficiencies in the administrative, bookkeeping and client record processes. The executive director seems focused on increasing client volume, has
no background in ethical health management, and is focusing on the financial aspect of the organization. Additionally, the executive director wants to expand service provision
across provinces and internationally to gain more financial
resources for the agency. The executive director wants to
have a conversation with the counsellors in the agency to
understand the impact that these changes may have on
the counsellors, and to find ways to support them so they
may go through the changes rapidly and effectively. Suzie is grateful for the upcoming meeting. However, Suzie is
unsure about the changes, feeling uncomfortable with being responsible for client booking, communications, record
keeping, and invoicing digitally since they were previously
only responsible for these processes in paper form. Suzie is
also unfamiliar with all the platforms associated with this
switch, such as social media pages, websites, and management systems. They are nervous about talking to their
employer about their discomfort and they don’t know their
responsibilities or how to approach the topic. Suzie is also
concerned about the timelines as these changes will occur
rather quickly. Suzie is aware that they are not the only one
concerned about these changes; other counsellors in the
agency have expressed concerns too. Suzie is afraid of losing their job and feels entirely out of their depth.
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Work Through A: Virtue-Based
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The central concerns of the virtue-based ethical decision-making model
is to approach the situation with the belief that the counsellor is a virtuous
person concerned with how their decisions may impact others and themselves, with overall justice and fairness for all parties involved. A virtuous
person also recognizes that these ethical situations are nuanced and complex, and feels a duty towards natural justice. In the case of Suzie, it is clear
that Suzie feels out of their depth with regards to the technology change.
Not only are they out of their depth, but there are several other colleagues
within the agency who have identified similar concerns with the digitization
of their practice. It would be imperative for Suzie to discuss further with
their colleagues and address these concerns with the executive director and
identify clearly where the largest concerns are. It is possible that amendments to the process could be made where both parties have room to adapt
to new processes without altering the business strategy of the executive director while maintaining a sense of safety for the counsellors as they learn
these new systems. Suzie ought to reflect on how this situation, if left unaddressed, may impact their ability to care for their clients. Would the stress
at work mitigate their ability to be present in session? Would their lack of
technological literacy get in the way of maintaining client privacy? Would
their lack of confidence impact their relationships at work with their colleagues and the executive director? Could these challenges have cascading
impacts over time, such as if mistakes were made and word spread of the
error, how would that impact Suzie or the agency as a whole? If Suzie was
in the client’s shoes, would they want Suzie to address these concerns with
the agency? The answers to these questions are unique to each practitioner
but would highlight the emotions and intuitions Suzie may have about this
situation overall, and hopefully, compel them to act. These actions may also
not bring about ideal or clear outcomes. Suzie may not get the response
they were hoping for from their executive director, but their duty to assess
a situation that makes them uncomfortable, and act to address it, is a part
of ethical decision making. Hopefully, if Suzie has good relationships with
their colleagues and executive director, some compromise could be made
among all parties to identify some creative workarounds to this situation
and promote better communication at the agency to prevent future concerns like this from occurring.
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Work Through B: Wise Practices
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As much as Suzie desires to continue at their current job and learn new
skills, adding a technology-based service is not within their current competency. In addition, Suzie has a large number of Indigenous clients, which
adds to their concern about being able work with the new systems in place.
They fear that the new way of doing things will not be compatible with their
clients’ needs and realities.
In order to address this issue, they contact their supervisor, who has
more experience working with telehealth. It is important for them to navigate this dilemma while ensuring that their practice is sensitive to the needs
of their clients and at the same time adapting to the changes at the agency.
Suzie’s supervisor refers to the Code of Ethics (CCPA, 2020), especially
attending to Section H: The Use of Electronic and Other Technologies that
was recently added (p. 28). Suzie, however, points to Section I: Indigenous
Peoples, Communities and Contexts and refers to new Wise Practices Lens
ethical decision-making model, embracing the concept of two-eyed seeing,
as well as the inclusion of the seven sacred values: courage, honesty, humility, respect, truth, love, and wisdom. In Suzie’s counselling practice, they
have been using this approach for the past few years under the guidance of
an Elder who has taught them how to incorporate it. In order to navigate
Suzie’s challenge, they both bring their perspectives to the table.
Courage, honesty, and humility: In reaching out to the supervisor, Suzie clearly shows these values. It was a humbling experience to acknowledge
the limits of their competence (CCPA, 2020, A3. Boundaries of Competence, p. 5) in this case and it took courage to admit their lack of competence to the supervisor (CCPA, 2020, A4. Supervision and Consultation, p.
5) who was known for expertise in this area. Suzie recognizes that the world
is changing and while they have a vast experience in counselling skills, they
lack the skills to adjust properly to the new ways in the agency. Suzie is unsure whether they will be ready by when these skills will be required. They
also want to be honest with their employer but fear losing their job.
Respect: After working as a counsellor for 25 years, Suzie has a great
deal of respect for the profession, their agency and their clients. With the
assistance of their family members, they have acquired some digital competencies for personal use. However, they realize that the decision being made
seems disrespectful to the counsellors, who have not had an opportunity
to develop digital literacy, as well as to the clients, who might feel uncomfortable with the changes taking place at the agency. Despite their desire to
adapt, they are unsure whether they will be able to do so or if they will fall
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behind their colleagues and be fired shortly thereafter. They are concerned
that if they do not receive proper training, it may affect their focus and ability to provide effective support to their clients (CCPA, 2020, H4. Technology-based Service Delivery, p. 28).
Truth: Suzie is also concerned about the new focus the agency has
placed on working across provinces and going against the law without being
aware of it. It is their understanding that the CCPA Code of Ethics states
that “counsellors/therapists ensure their clients are aware of the relevant
legal rights and limitations governing the practice of counselling/supervision across provincial/territorial lines or international boundaries” (CCPA,
2020, H7. Jurisdictional Issues, p. 29).
Love: Despite Suzie’s love for their profession, they feel vulnerable due
to the rapid advancements of technology, which may force them to leave
the agency. They care about their clients and are aware that they don’t want
to leave them in the middle of their process. Suzie’s supervisor discusses
with them the possibility of staying in their current position while gradually
learning the new system.
Wisdom: Suzie is a valuable asset to the agency and its clients. It is extremely valuable that they have 25 years of experience, especially their ability to understand vulnerable populations and Indigenous clients. Therefore,
their supervisor advises them to refrain from jumping to conclusions too
quickly and suggests that the two-eye-seeing perspective be brought up at
the meeting, so the agency leaders are aware of both the challenges and
the benefits these changes provide. They came to the following conclusions
through the two-eyed-seeing perspective:
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Western Perspective - Indigenous communities and vulnerable populations have historically been affected by colonizing
practices, forcing them to adapt to
Western views. Over time, many of
these changes have exacerbated the
multibarrier realities they already
experience. The changes taking
place at the agency will require
cultural sensitivity and sensitivity
towards vulnerable groups, including counsellors who are not computer literate. (CCPA, 2020, I1.
Awareness of Historical and Contemporary Contexts, p. 30).
- There is a need for mental health
services to adapt to the current
trends and needs. Companies and
agencies were forced to respond to
the post-pandemic world by providing remote services and adjusting to
technological advancements.
- The proposed changes should
be compatible with the practices
and approaches applicable to Indigenous communities with which
“they are involved” (CCPA, 2020,
I4 Respectful Awareness of Traditional Practices, p. 3; B9. Respecting Inclusivity, Diversity, Difference and Intersectionality, p. 11).
- Any profession requires continuing
education, and counsellors are no
exception (CCPA, 2020, A1: General Responsibility, p. 6). As part of
the agency’s expectations, counsellors should be open to learning new
technologies and approaches that
will enable them to continue to provide relevant services to clients.
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Indigenous & Traditional
Perspective ro
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- The use of technological services
allows the agency to serve more
people and provide mental health
support remotely, benefiting clients
in remote areas and clients with disabilities who are unable to travel.
Ka
Following the two-eyed seeing perspective, Suzie felt more confident
and prepared to advocate for the needs she addressed in supervision. It is
important for them to adapt to the changes occurring at the agency, but they
will request that they be provided with adequate training and a gradual adjustment that will enable their clients (and other counsellors experiencing
the same concerns) to suffer as little impact as possible (Nonmaleficence).
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Case 11.2
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Violet is a private practitioner who has chosen a cloud
provider for her client records. The servers sit within the
country of Canada and the company she has chosen to use
is reputable and even used by her supervisor. This software
is probably even more robust than what she needs for her
practice, but she wanted to enhance client experience and
keep all her records (e.g., Customer Relationship Management [CRM], invoicing, client’s progress notes) in one place.
Violet gets a cyber-attack and it comes with a threat.
They want money for the release of all her client records
back to her. She doesn’t have that kind of money and the
threat of her clients’ confidential records making it onto the
web has her panicked.
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Work Through A: Principle-Based
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Step One: Key Issues – Technological competence as counsellor if they
are using technology (H5), duty to do no harm (A1), ensuring confidentiality (B2)
Step Two: Ethical Articles:
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B6. Maintenance of Records:
Counsellors/therapists maintain records with sufficient detail
and clarity to track the nature and sequence of professional
services rendered. They ensure that the content and style are
consistent with any legal, regulatory, agency, or institutional
requirements. Counsellors/therapists secure the safety of such
records and create, maintain, transfer, and dispose of them in a
manner compliant with the requirements of confidentiality and
the other articles of this Code of Ethics. (See also B2, B18, H1, H2;
CCPA, 2020, p. 10)
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B7. Access to Records:
Counsellors/therapists understand that clients have a right of
access to their counselling/therapy records, and that disclosure
to others of information from these records only occurs with the
written consent of the client and/or when required by law. (See
also B4, H1; CCPA, 2020, p. 10)
C5. Technology in Assessment and Evaluation:
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Counsellors/therapists recognize that their ethical responsibilities are not altered, nor in any way diminished, by the use
of technology for the administration, scoring, and interpretation of assessment and evaluation instruments. Counsellors/
therapists retain their responsibility for the maintenance of the
ethical principles of privacy, confidentiality, and responsibility
for decisions regardless of the technology used. (See also B2, E8,
Section H; CCPA, 2020, p. 15)
H1. Technology-Based Administrative Functions:
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As part of the informed consent process, counsellors/therapists indicate to clients at the outset of services whether digital
records will be kept. If electronic record-keeping is to be implemented, counsellors/therapists ensure that digital security
measures necessary to protect client confidentiality and privacy
are in place (e.g., encryption, firewall software). (See also B2, B4,
B6, B7, E2; CCPA, 2020, p. 28)
H2. Permission for Technology Use:
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Counsellors/therapists seek client informed consent prior
to using Internet-based communication with clients (e.g.,
email, texting, and related forms of digital communication).
Counsellors/therapists take necessary precautions to avoid
accidental breaches of privacy or confidentiality when using
Internet-based communication devices and apprise clients of
associated risks. (See also B4, B6, E2; CCPA, 2020, p. 28)
H3. Purpose of Technology Use:
Counsellors/therapists clarify under which circumstances and
for which purposes technology-based communication will be
used (e.g., setting up appointments, counselling/therapy sessions, record-keeping, billing, assessment, third-party reporting)
WORKING THROUGH ETHICAL DILEMMAS
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and they review their related policy as part of the informed
consent process with clients. (See also B4; CCPA, 2020, p. 28)
H4. Technology-based Service Delivery:
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When technology-based applications are incorporated as a
component of counselling/ therapy programs and services,
counsellors/therapists ensure that (a) they have demonstrated and documented competence through appropriate and
adequate education, training, and supervised experience; (b)
necessary digital security measures are in place to protect client
privacy and confidentiality; (c) technology applications are
tailored or matched to unique client concerns and contexts; (d)
research evidence supports the efficacy of the technology for
the particular purpose identified; (e) decisions to implement
new and emerging technologies that are not yet accompanied
by a solid research foundation are based on sound clinical
judgement and the rationale for their selection is documented;
(f ) client preparedness to use the specific technology-based
application is assessed and education and training are offered
as warranted; and (g) informed consent is tailored to the unique
features of the technology-based application being used.
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In all cases, technology-based applications do not diminish the
responsibility of the counsellor/therapist to act in accordance
with the CCPA Code of Ethics and Standards of Practice, and, in
particular, to ensure adherence to the principles of confidentiality, informed consent, and safeguarding against harmful effects.
(See also A3, B2, B4, C1, C5; CCPA, 2020, pp. 28-29)
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H5. Technology-based Counselling/Therapy Education:
“Counsellor/therapist educators who use technology to provide
or enhance instruction in fully online or blended counselling/
therapy programs have demonstrated competency in this mode
of delivery through their education, training, and/or experience”
(CCPA, 2020, p. 29).
H6. Personal Use of Technology:
In their use of social media and related technology in their
personal lives, counsellors/ therapists monitor the style and
content of their communication for ethical congruity and professionalism. They attend to privacy/security features, continue
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to honour client confidentiality, demonstrate respect for and
valuing of all individuals, and represent themselves with integrity. (See also B2, G2; CCPA, 2020, p. 29)
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Step Three: Ethical principles:
Beneficence: Taking proper (i.e., SOAP – Subjective, Objective, Assessment, Plan) progress notes as if they may be exposed at any time, not
divulging every last detail which reduces harm if progress notes were to be
exposed, and staying trained on the industry standards for use and protection of client data.
Nonmaleficence: Taking every available precaution electronically (e.g.,
VPNs, dual authentication, encrypted email) to reasonably secure the clinical relationship with the client.
Justice: Taking necessary measures to deidentify personal information
on the web of these clients related to the timeframe of treatment.
Societal Interest: Taking measures to educate and eradicate such
threats across the field.
Step Four: (Please see Step Three) Also, contact the cloud service provider, seek legal advice, and alert clients of possible breach.
Step Five: What feelings say – Stay away from emotionally charged
public statements and focus on resolution for the sake of the clients.
Step Six: Plan of action most helpful – Consult with legal representative, contact cloud service provider, and advise clients of the potential
breach, while also advising of the actions that have been taken in order to
protect their information further. Focusing on preventative measures, shore
up well-defined and clearly stated consent statements before engaging in
therapy and stay current on associated training to improve protocols where
necessary to reflect contemporary standards.
Work Through B: Quick Check
Key Issues:
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The cyber-attacker is wanting money for the release and return of
her client records.
» Do they actually have the records?
» How will releasing the records benefit them?
The counsellor doesn’t have that kind of money.
Her client’s confidential records making it onto the web has her
panicked.
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Relevant Section and Codes:
B. Counselling / Therapy Responsibilities
B2. Confidentiality: There is a responsibility to respect and protect the
disclosure of client information.
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B6. Maintenance of Records: Records can be kept with unity, confidentiality, and securely to protect the client.
H. Use of Electronic and Other Technologies
H1. Technology-Based Administrative Functions: The clients would
have previously been informed of the risks associated with the use
of technology.
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H3. Purpose of Technology Use: Clients should be made aware of the
types of technology being used and the risks associated with technology. This would take place in the beginning of the counsellor
/ client relationship by way of informed consent and reinstated if
there are changes.
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H4. Technology-based Service Delivery: The counsellor must learn to
adjust to adapt to the new technology as it grows into our daily lives.
Counsellors need to consider the client’s comfort level when working with technology.
Beneficence
Fidelity
Nonmaleficence
Autonomy
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Important Ethical Principles:
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Analysis: Concerns surrounding this case centre around confidentiality
and protection of the client’s information (B2). As it is very important to
protect both the identity and the disclosed information of an individual,
care is needed to protect these critical aspects of the professional relationship (B6). When working with technology in an administrative capacity
there would need to have been a conversation between the counsellor and
their clients, outlining the risks with technology (H1, H3). Although the
technology being used has been secure in the past, there are always new
risks that can present themselves, that need to be addressed (H4).
Decision: Making a decision in this instance is difficult – there is no
proof that the individual blackmailing Violet actually has the files. Because
there is a danger of client information being leaked to the public it will be
necessary for Violet to contact her clients and inform them of what has
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transpired. It will also be important to report the criminal activity to the
proper authorities for further investigation. As an added measure, Violet
will need to find an alternative secure location to hold her private files to
avoid any other possible incidence.
Publicity: If this case and decision were to be released publicly, I believe it takes into consideration the codes that cover the protection of client’s
confidentiality while also making an effort to rectify the possible leak of
information.
Universality: If the same decision were being made by other counsellors, then we would see changes in the way important files were being stored
and secured. As there are multiple clients involved in this case, I would say
that I would make the same choice for each of them. Informing the clients
will show honesty and present an opportunity to once again establish open
discussion around how files are protected and changes that need to happen.
Justice: In this decision everyone has been treated fairly. All of the clients are at an equal risk level.
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CHAPTER 12
Case 12.1
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Mr. Xi is a school counsellor who is currently supporting an Indigenous 10-year-old boy who is in foster care. Mr.
Xi has met the foster mom, Naomi (35-year-old Black women; non-Indigenous) and was happy to see she was invested
in supporting the student. The student tends to run away
from school whenever he is challenged and this behaviour
is becoming more frequent. As the school is centrally located in a busy city, it’s particularly dangerous for the student
when he does run away. Sometimes he hides out in alleyways; sometimes he gets an older friend from a previous
foster placement to pick him up.
Mr. Xi is debriefing a recent incident with Naomi. The
student ran away from school and was found by Naomi
downtown at a bus loop. Because the student informed the
bus driver that Naomi had kidnapped him, they were hesitant to turn him over, the police were called, and Naomi
was handcuffed before the case worker was able to intervene. Naomi is furious with the school, the police, and the
student. She shares with Mr. Xi that she doesn’t need the
aggravation. Mr. Xi worries about the fit of the foster care
placement but knows that the student has been through
multiple homes just within the last few months.
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Work Through A: Virtue-Based
In applying the virtue-based ethical decision-making process, the following questions help to conceptualize the dilemma and ethical next steps.
The responses will be written from the perspective of Mr. Xi, the school
counsellor.
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1. What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
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I’m worried that Naomi isn’t the best fit for this student, given her response. I’m surprised by her level of anger at the school (i.e., she was aware
the student frequently runs away from the school and we co-developed and
implemented the protocol for this situation). Given the historically tenuous
relationship between the police and Black communities, my intuition tells
me she was triggered by the police response and I worry that her disappointment with the school will impair her ability to collaborate with me to
support the student.
My intuition tells me that Naomi is not abusive, but I fear if I don’t address the police response, she’ll walk away from the student. I feel pressured
to make this placement work as this student hasn’t had stability in his life
and I believe that he craves this.
2. How can my values best show care for the client’s wellbeing?
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First and foremost, my duty is to my client – the student. To ensure
the student’s wellbeing, I need to assess whether the placement with Naomi is indeed suitable and safe. I need to determine if there are any other
factors impacting the student which might be leading to this escalation in
behaviour. I’d need to offer empathy and understanding instead of discipline
or threats of punishment. It will be important to assess the student’s cultural
ties with the Indigenous community. I recognize my own limited experience in working with Indigenous students, so I’d like to consult with the
Elder-in-Residence at our school for support and guidance.
I also need to assess if Naomi’s feelings of frustration represent a true
incompatible placement or just a need for additional supports. I am not
aware of whether Naomi has had a foster placement before. I need to support Naomi to ensure we can collaborate on solutions.
Lastly, I need to find a way to deal with the inappropriate response by
the police. Ignoring it feels like being complicit and may serve to impair a
working, collaborative relationship between the student, the school, and
Naomi.
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3. How will my decision affect other relevant individuals in this
ethical dilemma?
There seem to be three interconnected decisions to be made:
Whether or not to continue to support Naomi as a suitable foster
parent for the student;
• What to do about the social injustice Naomi experienced at the
hands of the police which resulted from the student’s accusation;
and
• How to use my training and influence to combat racism (related
to the police response) and, if the student is interested, to provide
culturally appropriate supports at school.
First, if I continue to support the foster placement and it is indeed suitable, I will facilitate stability for the student, bridge the divide between Naomi and her foster son, and strengthen their relationship. However, if Naomi
isn’t a good fit, the student will be at risk for further harm (e.g., the student
will be displaced yet again). Although it’s possible that the next placement
would be better, it could be worse. At minimum, the student would be working through the transition process again which seems to be associated with
an escalation of his behaviour. Further, Naomi may withdraw her support
from future foster placements leading to even less homes being available to
children in need.
Second, if I choose to ignore the police response, I may deepen Naomi’s
frustration with the school and I may disappoint/anger my colleagues/community through my inaction. Further, I may be signaling to the student that
such behaviour is acceptable. If I advocate for change with the police, I may
risk the student (and Naomi’s) confidentiality and add more chaos to the
transition process they are going through. Third, offering my training to the teachers and administrators could extend the school team’s ability to take a trauma-informed approach to working with students. Consulting with our Elder-in-Residence could promote
more culturally appropriate strategies and supports throughout the school.
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4. What decision would I feel best about publicizing?
Without any evidence of neglect or abuse, continuing to support Naomi seems like the best decision provided we can mend the relationships
between her, her foster son, and the school and move forward together. Assuming this is her first foster placement, the fear and anxiety she felt trying
to track down the student was only amplified by the police response and we
do need to attend to that. This might include adjusting our response plans,
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reviewing additional supports, and discussing the police response and potential avenues for action moving forward. I would also feel good about
involving our Elder-in-Residence in planning additional supports for our
student and in offering parenting strategies and community connections to
Naomi.
5. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
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As a member of a visible minority group myself, and a previous target
of racism, I understand the shame and anger Naomi feels about the police
response and how hurt she must feel that the child she is trying to help
facilitated that situation. My intuition tells me the student didn’t anticipate
that level of response. I believe it would be helpful to support Naomi and
her foster son to work together, to work with the teachers and administrators at the school to develop an improved safety plan for our student, and
to advocate to the administration team at our school to contact the police
liaison to express our concern at how Naomi was treated and to collaborate
on putting a plan in place to ensure that nothing similar occurs again. As
a counsellor trained in trauma-informed practices, I’d be happy to offer to
facilitate a workshop for the teachers and administrators at our school and
also for the police to better equip both groups to provide trauma-informed
care and to combat racism.
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Work Through B: Principle-Based
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Step One – What are the key issues in this situation?
• The student’s behaviour of running away is concerning, especially
as it is becoming more frequent. Since it seems that this behaviour
comes up when the student is challenged, I would be curious to
know what “challenges” the student is facing at school and why it is
that he is being challenged more frequently now.
• The student is also putting himself in danger by running away from
the school in a busy city.
• The student is potentially putting Naomi in danger by having uncomfortable interactions with the police.
• The fit of the foster care placement for the student is in question and
the foster parent is very upset. I would also be curious to know why
the child said that the foster mom kidnapped him.
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•
The student has been going through multiple homes and it is unclear
at this time why this is.
• It is important to remember who the client is (i.e., the student) and
that his needs and best interests should remain central.
Step Two – What ethical articles from the CCPA Code of Ethics are relevant to this situation? Are there policies, case law, statutes, regulations, bylaws, or other related articles that are relevant to this situation?
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A2 Respect for Rights – it is important in this case to respect the client
and his wishes primarily, as the client, but also to respect Naomi.
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A12 Diversity Responsiveness – it is important to be aware of the cultural contexts and identities that are at play here. For example, knowing the history of the Black community with police can help us to
understand why Naomi may have been so upset and angry about
her interaction with the police and being handcuffed. Knowing
about the overrepresentation of Indigenous children in foster care
and the history of Indigenous children being removed from their
homes can also help us to see the client from that lens and to try to
understand his behaviour with this in mind.
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B5 Children and Persons with Diminished Capacity – since the client
is a 10-year-old student, it is important to understand if he can give
consent in counselling (i.e., is he considered a mature minor) and
to know to what degree his foster parent is still responsible for consenting on his behalf.
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B9 Respecting Inclusivity, Diversity, Difference, and Intersectionality –
this includes a continued sensitivity to the identities of both Naomi
and the student and how their identities may have similarities and
differences and how this might play out in their relationship with
each other as well their relationships with institutions such as the
foster care system, the police, and the school system.
I1 Awareness of Historical and Contemporary Contexts – it is important to understand how counselling, schools, and the foster care system have contributed to the harms endured by Indigenous peoples
and how this can be affecting the client’s willingness and comfort in
counselling.
I7 Relevant Cross-Cultural Practice – it is important to remember that
any interventions used with the student be culturally appropriate
and to recognize the limitations of each approach used.
I9 Culturally Embedded Relationships – this includes seeking consultation from Elders and leaders in the student’s Indigenous community
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on how to best support the student in an ethical way to ensure culturally appropriate solutions for the student.
Step Three – Which of the six ethical principles are of major importance in this situation? (This step also involves securing additional information, consulting with knowledgeable colleagues or the CCPA Ethics Committee, and examining the probable outcomes of various courses of action.)
• Beneficence: it is important to promote the best interest of the client (i.e., the child), whether that be staying at the current foster
home or not.
• Fidelity: honouring the commitment to the client and remembering who the client is in this case (the student).
• Consulting with colleagues who may know more about the foster
care system and the counsellor’s role in this would also be important at this point. For example, if it is determined that the placement
is not a good fit, what can a counsellor actually do in this situation
and does this mean referring to a different type of professional?
• Consulting with an Elder from the Indigenous community to learn
more about what supports and/or training might be available for the
child at school, for the foster mother, and for me as a counsellor.
Step Four – How can the relevant ethical articles be applied in this circumstance? How might any conflict between ethical principles be resolved?
What are the potential risks and benefits of this application and resolution?
• The ethical articles can be applied in this case by understanding the
cultural context of Naomi and the student as well as respecting the
rights of the student.
• There may be a conflict between ethical principles of beneficence
and societal interest in that if it is determined that the foster placement is not a good fit for the student, honouring beneficence would
mean supporting the student in finding a better placement but this
may not be in the best interest of society in that finding a new placement for the child will likely take up time and resources.
• In this case, the beneficence of the client should be prioritized. The
benefit of this is that the child and Naomi may feel better about their
situation, but the risk is that a better fit may not be found and that
the child will be moving to another home after having moved many
times in the last few months.
• In this case, it is not yet clear if the foster placement is a good fit
and this should be determined first as well as ways to minimize the
client’s behaviour of running away.
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•
It will be important to explore the child’s connections with the Indigenous community and any family members.
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Step Five – What do my feelings and intuitions tell me to do in this situation? (See also Virtue-Based Ethical Decision-Making.)
• My feelings and intuition tell me that there should be some conflict
resolution work done between the child and the foster parent which
may include a referral to family counselling.
• My intuition also tells me that there is a reason why the child is
behaving this way that can be uncovered and that the child can be
supported to adjust his behaviour in the face of challenges and that
this could be a good topic to explore in counselling with the child
(i.e., finding more positive coping mechanisms that would not be
dangerous to both the child and the foster parent when the child is
feeling challenged).
• Additionally, my intuition tells me that the foster mom might need
some additional support and counselling to adjust to the role of being a foster parent and also to work with an Indigenous child, since
this is a challenging situation for her, and I would consider referring
her to an external counsellor.
• Lastly, I am noticing that the child often asks a friend from a previous foster placement to pick him up and I am curious about the
relationship that the student has with the other child and whether
this other student could be a support for the client.
Step Six – What plan of action will be most helpful in this situation?
Follow up to evaluate the appropriateness, adequacy, and effectiveness of
the course of action taken. Identify any adjustments necessary to optimize
the outcome.
• The plan of action that would be most helpful in this situation would
be to talk to the child about his experiences in the foster placement
to understand more about why he may be behaving in this way and
to refer the child and Naomi to family counselling to hopefully make
it a better experience and fit for both.
• Another plan of action would be to continue to explore with the student why he is exhibiting these behaviours (i.e., running away from
school; accusing his foster mother of kidnapping him) and to come
up with some coping strategies together.
• It would also be helpful to consult with the child’s teacher, the school
administrators, and Elders or other leaders within the local Indige-
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nous community to gain more knowledge about how to effectively
support this child and others similar to him as this is an area in
which I have limited experience.
Work Through C: Wise Practices Lens
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The Wise Practices Lens provides an ethical decision-making approach
that facilitates looking at ethical dilemmas through “two-eyed seeing”
(CCPA, 2020, p. 5) - drawing from both Indigenous and Western knowledges and perspectives. Applying this to the dilemma Mr. Xi has encountered
with Naomi and her foster child, I’ll first identify relevant principles and
articles from the Code of Ethics and then will examine the dilemma through
the seven sacred values: courage, honesty, humility, respect, truth, love, and
wisdom. The two perspectives, combined, will help to identify an ethical
way forward for all involved.
Principles: Beneficence, nonmaleficence, justice, societal interest
Articles: A1 (General Responsibility), A2 (Respect for Rights), A12
(Diversity Responsiveness), B1 (Primary Responsibility), B4 (Client’s
Rights and Informed Consent), B5 (Children and Persons with Diminished
Capacity), B9 (Respecting Inclusivity, Diversity, Difference, and Intersectionality), B10 (Consulting with Other Professionals), I1 (Awareness of Historical and Contemporary Contexts), I2 (Reflection on Self and Personal
Cultural Identities), I6 (Strengths-Based Community Development), and
I8 (Relationships).
Combined, these articles and principles remind me to approach this
situation with cultural humility and to prioritize the needs of the student /
foster child (the most vulnerable person in this case) but also holding space
for the foster mother, Naomi, who has been traumatized and humiliated in
this situation. I recognize the unique considerations due to the different cultures/ethnicities involved and am grateful to have access to Elders from the
First Nations community to consult with about potential solutions.
Seven Sacred Values:
Courage— “to speak, to reveal, to reach out, to be open, to be
introspective” (Wesley-Esquimaux & Snowball, 2010, p. 396).
•
•
It will take courage to explore the fit of the foster care placement
from both perspectives including the courage to speak to both Naomi and the student about their experiences with each other.
Courage can be demonstrated by acting in the best interest of the
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This value can be enacted by facilitating the opportunity for Naomi and the student to speak openly and honestly with one another
within the safe confines of a counselling room, holding the counsellor (as a representative of the school) accountable for honest answers as well.
Within counselling, Naomi might also be supported to honestly examine her own biases and assumptions and to examine the impact
of the traumatic incident with the bus driver and the police.
Humility— “we are all in this together and all have inherent value, no one person is greater than any other in spirit, we are all
ordinary and extraordinary beings, our greatest task is to learn
to be of service” (Wesley-Esquimaux & Snowball, 2010, p. 396).
With humility, the counsellor can create space to learn from Naomi
and the student about how they feel in the situation and to honour
each of their experiences/emotions.
It will take humility within the counsellor to acknowledge the
school’s failures in keeping their student safely onsite.
Naomi can be supported to examine the limits to her competence
and, with humility., to ask for the support that she needs to be successful with her foster son.
Respect— “coming together and honouring each other’s place
and space, knowing that this is something you must give to get,
honouring the smallest to the oldest, walking in beauty” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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student whether the fit of the placement is determined to be good
or not good.
The counsellor, representing the school, will also need to be courageous in acknowledging their inconsistency in keeping the child
at the school and in advocating for better procedures to ensure his
safety.
Honesty— “to know yourself and your own values, biases and
beliefs, to speak from the heart and soul, to allow yourself to
truly be seen, know and be known” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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This value can be enacted by demonstrating respect for both Naomi
and her foster son, deeply listening to each of them.
Respect for “place and space” also entails honouring the fact that
both Naomi and her foster son deserve to be in a situation that feels
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good for them – their home needs to feel like a safe and respectful
place for them both.
Respect for the child can be demonstrated by considering what
might need to change at school to make it feel like a safe space to
learn.
Truth— “our truth is not the only truth, there are many paths
to home, we are created equal, no matter how much we learn,
there is much we do not know” (Wesley-Esquimaux & Snowball,
2010, p. 396).
Enacting this value requires remembering that the truth of the situation may be different for everyone involved (e.g., Naomi, her foster
son, the school counsellor, the bus driver, the police) and that no
one’s truth is the only truth. This also means being open to hearing
other people’s truths that may be different from your own – and to
speaking truths, even when they may be uncomfortable and difficult for others to hear.
Love— “unconditional acceptance of self and other; accepting
and embracing difference; allowing; and gracefully giving of everything we are” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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To enact this, the counsellor could support both Naomi and her
foster child to fully accept themselves and each other, accepting and
celebrating their differences, and facilitating opportunities for each
to contribute their strengths. The counsellor could consider involving other stakeholders at the school (e.g., teachers, administrators,
student peer leaders) to examine how they could create a more welcoming and inclusive environment for the child, embracing his differences, and meeting his needs in a spirit of love.
Wisdom— “providing an expansive and inclusive view of the
world” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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•
•
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In this context, the counsellor might work towards helping Naomi
and her foster child to better understand each other’s worlds and
realities and the options available to each of them.
The counsellor might also meet with the teachers and administrators to enhance their cultural competency in meeting the needs of
the student so that he is less likely to be triggered to run away.
This could include allowing all involved to share their own lived
experiences and worldviews with each other and to share in each
other’s wisdom. This could also include providing opportunities
to share cultural wisdom and lessons with the others in order to
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build empathy and a shared understanding (e.g., Naomi and her
foster child learning from each other about their cultural histories
and histories of oppression so they can each begin to understand
the others’ perspective; enhancing a trauma-informed approach to
working with Indigenous students and others at the school).
Applying these values from the Wise Practices Lens and the relevant
principles and articles from the Code of Ethics (CCPA, 2020), the counsellor could help Naomi and her foster child to decide whether or not to
continue with this placement and, if they choose to continue, how to work
together more effectively. It could also better equip the school to meet the
needs of this student and other children who may not be feeling safe when
challenged at school.
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REFERENCES lin
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Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, mental
illness and addiction through a Wise Practices Lens. International Journal of Mental Health and Addiction, 8(2), 390-407. 10.1007/s11469009-9265-6
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Case 12.2
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After being removed from his Indigenous biological
parents at 3 years old, James, who is now in his 40s, spent
several years in foster homes before being adopted at 7
years old into a White family. He was grateful to his adoptive parents but always felt a bit like a “fish out of water”
compared to the other two older biological children. James
really struggled to find his way through school and, in comparison to his siblings, he hasn’t established a “good” career
in the eyes of his father.
Now, as an adult, James is seeking to reconnect with
his Indigenous roots and has found his biological father
who lives in the nearby First Nations community. When he
brought this up to his adoptive parents, his mother seemed
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Work Through A: Wise Practice
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supportive, but his father was angry. His father regularly
scoffs at James, saying he’s just using his Indigeneity as a
crutch to explain why he isn’t as successful as his siblings.
To make matters worse, James’ father is now sending him
Facebook memes about how Indigenous groups just complain.
James comes to Georgina to try to work through this
family dynamic conflict. However, Georgina has very limited experience working with Indigenous clients in situations
like this.
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Georgina perceives her lack of previous experience with situations
like this as a competency concern, leaving her with the ethical dilemma of
whether or not to proceed with James or to refer him to someone else. This
ethical situation requires consideration of A3 (Boundaries of Competence),
I3 (Recognition of Indigenous Diversity), and I7 (Relevant Cross-Cultural
Practice). As Georgina is not confident about her competence in this area,
certainly seeking supervision is in alignment with the development of new
skills and competencies.
In a recent professional development workshop, she learned about the
concept of two-eyed seeing (i.e., considering issues from both Indigenous
and Western perspectives). In reading about the Wise Practices Lens in
CCPA’s (2020) Code of Ethics, a quote from Wagamese (2016) really jumped
out at her: “Relationships never end; they just change. In believing that lies
the freedom to carry compassion, empathy, love, kindness and respect into
and through whatever changes. We are made more by that practice.” (p. 5).
She also read about the seven sacred values in the Wise Practices Lens: courage, honesty, humility, respect, truth, love, and wisdom. Georgina’s dilemma
with this case relates to her level of competence in supporting James through
his conflict with his father, understanding that her limited knowledge in Indigenous ways of knowing and being may preclude her from being the best
fit for her client. The decision is to consult with her supervisor and explore
her capacity to work with James before moving forward with this client.
Courage, honesty, and humility: In reaching out to her supervisor,
Georgina demonstrated all three of these values. It was a humbling experience to acknowledge the limits of her competence in this case and it took
courage to admit her lack of competence to her supervisor, who was known
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for expertise in this area. Georgina was concerned that she may have exaggerated her qualifications when she applied for the job, knowing that experience with Indigenous clients was important in her role (CCPA, 2020,
I.10 Appropriate Use, p. 32). She values honesty – and tried to be honest
throughout the interview – but realizes that she may have allowed the interviewers to make assumptions about her experience that weren’t completely
true. She is committed to being completely honest with her supervisor now,
asking for the help she needs and for a candid opinion about whether or not
she should refer James to someone else.
Respect: Georgina has a great deal of respect for her supervisor, as well
as for James, her client, as he strives to better understand his Indigenous
roots. She mentions to her supervisor that she is an adopted child herself,
so has empathy for James and his search for his biological family, and also
a great deal of respect for James’ adoptive parents, who she recognizes have
worked hard to provide a home for him. Georgina is very uncomfortable,
however, with James’ father’s scoffing and derogatory Facebook memes –
she acknowledges to her supervisor that this is making it challenging to fully
respect the father and his point of view, and that she would remain aware of
the possibility of becoming biased. Georgina and her supervisor agree that
this would be an area to work with her supervisor on if she decides to move
forward with James.
Truth: Georgina’s supervisor will hopefully be able to offer some historical context about the challenges associated with Indigenous children
being removed from their communities and adopted by White families who
have raised them outside of their Indigenous cultures and extended families
(CCPA, 2020, I1. Awareness of Historical and Contemporary Contexts, p.
30). As a White person, adopted into a White family, this wasn’t part of
Georgina’s own adoption story. She would need to pause to reflect on the
truth presented by her supervisor, and what it means from different perspectives.
Love: Georgina cares deeply about all of her clients and knows that her
tendency is to jump in to help, even at times when she may be underprepared or ill-equipped. Consulting with her supervisor will help her see that
sometimes the most loving response is to ensure that her clients get the best
support available, even if it isn’t from her.
Wisdom: What Georgina can bring to this case is extensive experience
in family counselling, along with personal and professional experience
working with adults who have been adopted. What her supervisor can bring
is extensive experience with Indigenous clients, including those who are
seeking to reconnect with their Indigenous roots. Therefore, the decision to
work with James with close supervision or even in a co-counselling experi-
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ence might provide a rich learning experience for Georgina and offer James
the support that he needs in the midst of the family conflict he is experiencing, that upholds the ethical approach to build competence, maintaining
beneficence and nonmaleficence.
Work Through B: Virtue-Based
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As I consider the virtue-based ethical decision-making process, the following questions help me to conceptualize the dilemma and the best path
forward.
1. What emotions and intuition am I aware of as I consider this
ethical dilemma and what are they telling me to do?
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Although I’m happy to hear of James’ desire to reconnect with his biological father and Indigenous roots, I’m saddened, annoyed, and angered
by his adoptive father’s response. I’m curious if James’ father has ever expressed these kinds of feelings before or if these have resulted from James’
newly expressed desire to reconnect with his biological father.
My intuition tells me that if James challenges his father’s behaviour, he
will risk damaging that relationship. My intuition also tells me it’s important
for James to maintain that relationship with his adoptive parents as a source
of support in his life.
2. How can my values best show care for the client’s wellbeing?
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I value the reunification of families and exploring one’s cultural identities so it’s important to support the client’s expressed desire to reconnect
with his biological parents. This value also pressures me to ensure the client
maintains a relationship with his adoptive parents.
Supporting James means supporting him to manage his relationship
with his adoptive father which may include challenging him.
3. How will my decision affect other relevant individuals in this
ethical dilemma?
My decision will impact James, his adoptive parents, his biological father, and the Indigenous community.
If I help James to move forward without the support of his adoptive father, I would facilitate the connection with his biological father and the First
Nation’s community – something the client has expressed that he desires.
This could be quite healing for him and the community. I might, however, alienate James from his adoptive father, causing James further distress.
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I could also risk escalating the adoptive father’s feelings about Indigenous
peoples and perhaps even the father’s public social media behaviour. It’s also
possible, however, that James’ adoptive father will, in time, see the benefit of
this revived relationship with James’ biological father and Indigenous community.
Instead, if I’m successful supporting James to work through this conflict
with his adoptive father, James may emerge with strengthened relationships
with his adoptive parents, his biological father, and the Indigenous community. This would be the best-case scenario. Alternatively, the adoptive father
could respond poorly – e.g., cutting off his relationship with James, continuing to share those problematic social media posts.
4. What decision would I feel best about publicizing?
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Should this become a front-page news story, I would feel best that it portrayed me discussing the potential outcomes, as summarized above, with
James and helping him decide what the best path forward is. This might
mean bringing together all parties – the adoptive parents, biological father,
and leaders from the Indigenous community.
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5. What decision would best reflect who I am as a person and
practitioner within cultural/intercultural contexts?
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I think it’s important to ensure that James’ connection to the Indigenous
community is also considered in the context of this case. It’s not just James’
relationship to the adoptive and biological father that should be considered,
but the potential for James to rebuild a sense of community and connect to
his Indigeneity.
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Case 12.3
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Levi is a therapist working within a community organization. His client, Sonia, is an Indigenous mother of one
young girl. Sonia is working through finding out a friend
of hers died by suicide after being trapped in an abusive
relationship. Sonia, herself, is a survivor of intimate partner
violence. Because Sonia’s child is so young, she often brings
her to her appointments and she’s able to play in the children’s corner within the office.
Levi is noticing more and more that Sonia’s child is
coming in clothes that look unclean and is concerned about
Sonia’s ability to care for her.
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Work Through A: Wise Practices Lens
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The Wise Practices Lens (CCPA, 2020) applies a “two-eyed seeing”
(p. 5) approach, integrating both Western and Indigenous perspectives in
examining ethical dilemmas and reaching decisions. In this case, Levi has
become increasingly concerned that the young child of one of his clients is
potentially being neglected by her mother (Sonia, his client). As the mother
and child are Indigenous, Levi thinks that combining both Western and Indigenous ways of knowing might be particularly relevant in examining this
case. He begins by identifying principles and values from the Code of Ethics
(CCPA, 2020) and then applies the “seven sacred values” (CCPA, 2020, p.
5) to more fully explore the case.
Principles
Beneficence, Fidelity, Nonmaleficence, Autonomy, Justice, Societal Interest (all of them!). Of particular concern here is not hurting the client and
upholding the trust she has in the counsellor, without putting the client’s
child at risk.
Articles
A2 (Respect for Rights), A10 (Third Party Reporting), A12 (Diversity
Responsiveness), B1 (Primary Responsibility), B2 (Confidentiality – and,
in this case, informing the client about exceptions such as “when a child is
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in need of protection”; p. 9), B4 (Client’s Rights and Informed Consent),
B9 (Respecting Inclusivity, Diversity, Difference, and Intersectionality), I1
(Awareness of Historical and Contemporary Contexts), I2 (Reflection on
Self and Personal Cultural Identities), I8 (Relationships).
Seven Sacred Values
Courage— “to speak, to reveal, to reach out, to be open, to be
introspective” (Wesley-Esquimaux & Snowball, 2010, p. 396).
This includes the courage to ask questions and explore the situation
without making any assumptions or jumping to any conclusions.
The course of action would be to explore with Sonia in a way that is
culturally sensitive, trauma-informed (especially regarding her history of experiencing intimate partner violence), and client-centred.
Honesty— “to know yourself and your own values, biases and
beliefs, to speak from the heart and soul, to allow yourself to
truly be seen, know and be known” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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It is important that Levi recognizes his own biases and is honest
with himself. For example, he could reflect on why he is concerned
and what assumptions are being made here about how the child
“should” be presenting.
Humility— “we are all in this together and all have inherent value, no one person is greater than any other in spirit, we are all
ordinary and extraordinary beings, our greatest task is to learn
to be of service” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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Levi recognizes that his knowledge is limited about the history of
Indigenous children being taken from their families. He humbly acknowledges that he does not know the full story in this case and that
some key facts may be missing.
Levi acknowledges, with humility, that he cannot understand what
it might be like for an Indigenous mother living with this history.
Levi humbly reflects on Sonia’s complex history and how she is able
to show up as a mother.
Levi should also reflect on other possible explanations for Sonia’s
child, for example, that she loves to play in the dirt and so her
clothes get dirty frequently or that she has a favourite dress that she
pulls out of the laundry, even if it’s dirty, because she wants to dress
up for counselling.
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Respect— “coming together and honouring each other’s place
and space, knowing that this is something you must give to get,
honouring the smallest to the oldest, walking in beauty” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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Levi recognizes that there may be a lot he does not know about their
family life (e.g., current stressors for the child/Sonia, reasons the
child may be showing up like this, how common/normal this is for
this child or other children in general).
“If truth is about the future, it is also about the First Nation, Métis
and Inuit youth that are growing up in circumstances that continue
to reflect colonial impacts and despair, as well as growing potential
for self-actualization and pride” (Wesley-Esquimaux & Snowball,
2010, p. 402). Levi ponders: What other things may the child be
experiencing? How are the child and mother experiencing colonial
impact and how might this affect the presentation of the child?
Love— “unconditional acceptance of self and other, accepting
and embracing difference, allowing, and gracefully giving of everything we are” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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Levi respects Sonia as a mother, knowing that how she does things
may not be how he would choose to do them but that this does not
make them wrong. He refrains from judging the mother until he
learns more of her story.
Respect also means respecting her child as deserving proper care.
When thinking about equality and fairness, Levi asks: Would I
think the same thing if this were a child and parent of a different
race?
Truth— “our truth is not the only truth, there are many paths
to home, we are created equal, no matter how much we learn,
there is much we do not know” (Wesley-Esquimaux & Snowball,
2010, p. 396).
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This includes unconditional acceptance of Sonia and her child, regardless of whether or not there is neglect.
“Establishing a sense of trust and unity in interpersonal relationships and paying attention to the young people that require positive reinforcement” (Wesley-Esquimaux & Snowball, 2010, p. 403)
– This means establishing a relationship of trust with Sonia and her
child to explore the possibility of neglect.
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Wisdom— “providing an expansive and inclusive view of the
world” (Wesley-Esquimaux & Snowball, 2010, p. 396).
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Wisdom to know that there are different conventions of “personal
presentation” / hygiene. This means having an inclusive view that
there may be lots of “right” ways to present.
Accept diverse ways of knowing and being.
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Having applied two-eyed seeing, through using the principles and articles from the Code of Ethics and also the seven sacred values as presented
in the Wise Practices Lens ethical decision-making model, Levi decides to
continue to monitor his concerns but, as the child seems alert and well-fed,
and is clearly attached to her mother, to not jump to conclusions about neglect at this point. Instead, he will gently speak with Sonia about how she’s
doing and if she feels she may need any additional support in caring for her
child. Based on that conversation, and his ongoing observations, Levi will
remain open about how to proceed. However, for now, he does not consider
the child to be in an unsafe situation that would necessitate a report to any
authorities for further investigation.
REFERENCES
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Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, mental
illness and addiction through a Wise Practices Lens. International Journal of Mental Health and Addiction, 8(2), 390-407. 10.1007/s11469009-9265-6
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Work Through B: Quick Check
Key issues:
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The most vulnerable individual in this situation is the child, even
though the child isn’t Levi’s client. If Levi perceives that the child
is in need of protection (CCPA, 2020, B2 iii), he will have a duty to
report that, even if that means breaching confidentiality.
Although it is the counsellor’s primary duty to focus on the client’s
welfare (B1), having the client’s child in the sessions creates a conflict of interest and becomes implicitly a Multiple Relationship Issue
(B8). In the context of Multiple Relationships, now the counsellor
can’t ignore the presence of the child, so he cannot concentrate solely on Sonia, the client.
A counsellor would not be exposed to the client’s child if the child
were not accompanying the mother to sessions. With the client’s
child present, extra information may emerge that the client is not
revealing, creating a dilemma of addressing the potential neglect
and moving away from the main responsibility, which is meeting
the client’s needs. Although it is not the child who is the client here,
but her mother, the counsellor may be torn between addressing the
potential risks for a child both hearing information that could affect her and being exposed to her mother’s private conversations
during the session. Furthermore, the counsellor may be sensing information that could indicate a potential risk that he cannot avoid
assessing.
Levi’s main responsibility as the counsellor is to support Sonia (the
client) in her current emotional state; however, this is superseded by the need to protect vulnerable children. It wouldn’t be as
challenging if Sonia attended sessions alone. This would mean the
counsellor wouldn’t even be aware of the care Sonia’s child is receiving and there would be no dilemma in addressing this issue if this
were the case.
In bringing her child to sessions, Sonia shows that she lacks the
support she needs to take care of her personal needs (i.e., someone
to look after her child while she attends sessions) and that she cares
enough not to leave her child alone. The counsellor can use this information to learn about the client’s current situation and to ensure
that a safe space becomes a support for them.
The counsellor’s main dilemma may be whether or not to express
concern about Sonia’s child. The client might feel judged and unsafe
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if he addresses it at an early stage of the therapeutic alliance. However, the counsellor would potentially be committing an act of neglect
if he didn’t. Counsellors must attend to intuitions, as well as signs
of neglect of vulnerable populations. It is possible, however, that
multiple biases are contributing to his concerns, including the way a
child should dress in order to appear to be taken care of. Depending
on the social context, caring adults can mean different things. The
way one looks and the style of one’s hair is not considered a priority
in certain cultures, while in others they are seen as signs of health
and care. In assessing whether his perception may be biased and
rushed, the counsellor could take into account the client’s vulnerability and the difficult emotions she is dealing with. The counsellor
should also take into account their own identities and unexamined
privilege (I2).
• How the counsellor resolves this ethical conflict without breaking
the therapeutic alliance will be the main ethical conflict he faces.
1. Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
Levi could imagine different scenarios to answer this question.
First scenario: Addressing his desire to know more about Sonia’s child
wellbeing.
A public disclosure that Levi cares about his client’s child’s wellbeing as
much as his client’s, in a culturally sensitive and non-judgmental manner,
should only demonstrate a genuine desire to care for both the client and
her child. As part of providing support to a client, it’s important to consider
their context, their roles, and the larger system they are part of, including
the historical context of their Indigeneity (I1). Sonia is showing that her
child is a significant part of her world by bringing her to the sessions. The
counsellor could join this reality and address his honest concern for Sonia’s
child by recognizing the value that she has for her.
If this issue was handled in an insensitive way (e.g., asking Sonia why
her child is disheveled), it could re-traumatize her and trigger shame and
feelings of being judged. Levi would certainly be regarded as an unethical
counsellor if this were publicized, as he would have violated the principles
of beneficence, nonmaleficence, autonomy (as the mother of the child, she
has the right to care for her in her own way), and fidelity (being loyal to the
client).
Second Scenario: Not addressing his concern about Sonia’s child and
waiting for the therapeutic process to show what is really going on.
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Grieving (losing her friend) and possibly re-traumatization (as a domestic violence survivor) are two issues the client is experiencing. It is most
important that she finds a safe space to process both because she may be
feeling that “it could have been her.” The counsellor’s commitment to his primary responsibility and the fidelity to honor the client’s wellbeing, if made
public, would only demonstrate his fidelity to honour the client’s wellbeing.
If the counsellor later discovers that his intuition (but also potential
bias) about the child being neglected is true, he could feel guilty about not
addressing it earlier. Though this is possible, the counsellor’s feelings do
not take precedence over the client’s. Furthermore, the counsellor does not
have enough information to know that the child is in danger (B3) from the
current information he has (a disheveled child).
However, if the child is indeed in need of protection (B2 iii), and Levi
did not report his concerns, he would have breached his Code of Ethics and
also neglected his responsibilities as a citizen – he wouldn’t want that to be
the front-page news story!
2. Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
First Scenario: As part of the therapeutic process, authenticity implies
addressing issues that arise in a sensitive and honest manner. The process
of sharing concerns throughout the process, and incorporating them into
an ongoing informed consent, would be done regardless of the client or
their context. In this case, the first scenario would allow the counsellor to
maintain an authentic level of interaction without feeling intimidated by the
client’s specific situation. If this is how the counsellor usually proceeds, it
would be ethical to be consistent in his standards of practice.
Second Scenario: An understanding of the level of crisis a client comes
into a therapeutic relationship with, as well as the gradual construction of
trust, is essential for a successful therapeutic relationship. Clients should be
respected and given the chance to address the issues that matter to them.
Listening, understanding, and getting to know your clients, as well as building trust, is always a good/ethical decision. The counsellor could find out
if his concern about Sonia’s child is biased or if there is a real neglect he
should address later by taking the time to investigate. Every client deserves
that the counsellor transcends his biases and does not let them guide his
decisions, instead taking the time to create a safe and trusting environment
before jumping to conclusions. In building this environment, the counsellor
should also attend to the limitations of the interventions and practices used
and use culturally appropriate practices (I7).
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3. Justice: Is everyone being treated fairly by my decision?
First Scenario: Making assumptions before knowing a client is never
fair. The counsellor needs to hear Sonia’s story and get to know her better,
including her role as a mother and how she cares for her child. In contrast,
the child, being present in the therapeutic space, also deserves to be seen
and taken into account, which partly causes the dilemma. In order to follow the justice principle, the counsellor should consider both Sonia and her
child and what a fair treatment would be for both. In the event that a child
exhibits obvious signs of abuse, the counsellor could address it accordingly
(B2 iii).
Second Scenario: The CCPA Code of Ethics defines justice as “respecting the dignity of every individual and honouring their right to just treatment.” The second scenario involves allowing space to understand the client
better in order to address whatever issues may be present, which is respectful and honours the client’s rights (including her daughter’s). Among the different areas that concern the client, her daughter’s wellbeing may be one of
them, but it is up to the client to bring this up, and it is up to the counsellor
to have enough evidence that shows potential harm to focus on it.
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APPENDIX - A
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Code of Ethics ( Excerpt)
APPENDIX - A
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Code of Ethics (Excerpt)
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The terms therapy/therapist have been used throughout this document as
generic activities/titles that encompasses a variety of professional activities
and titles used by practitioners engaged in counselling and psychotherapy
in Canada.
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The articles (e.g., A1, C5, G2) contained within the Code of Ethics are
designed to function as an integrated set of principles. Cross-referencing
has been included in the document to assist readers in locating the most
commonly occurring combinations of articles to support informed ethical
practice. The Standards of Practice are also cross-referenced to the Code
of Ethics.
Words followed by the superscript symbol ǂ are defined in the Glossary of
Terms at the conclusion of the Code of Ethics.
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Preamble
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The Code of Ethics for the Canadian Counselling and Psychotherapy Association is a living document. Between revisions to the Code, feedback from
members is accepted and compiled in preparation for reviews, updates,
additions, and amendments.
The Revision Process
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Approximately every five years, the Canadian Counselling and Psychotherapy Association publishes a call for Task Group members to undertake
a data-informed review and revision of the existing Code of Ethics and
Standards of Practice. The membership of the Task Group is strategically
diverse, including scholars, practitioners, educators, ethics experts, and
representatives of special interest groups, among others.
Context
The Task Group determined that one of the most important adjustments to
the Code
of Ethics in 2020 would be to include several new sections, one of which
was a section to draw attention to important concepts and contexts addressed by the Truth and Reconciliation Commission. The Group wished
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APPENDIX A
to begin a process of development that could ensure that CCPA members
understood the ethical imperative to seek knowledge and understanding
and commit to self-reflection before engaging with Indigenous clients and
communities. The criticality of cultural humility and recognition of cultural blindness were focal points in locating relevant research by Indigenous
scholars and experts to assist with the process. Consultation with Elders
and knowledge-keepers was prominent in the preferred update and review
process.
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Within the mandate of development and revision, the Task Group chose to
strengthen existing and incorporate new articles of ethics that more clearly
addressed concerns related to:
Working with Indigenous clients and communities;
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Working with persons who identify (for a variety of reasons) as
marginalized, vulnerable, or disadvantaged;
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Working with clients using new technologies;
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Working with or as a supervisor or consultant.
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Since the last revision of the CCPA Code of Ethics, there have been
major shifts in the use of technology in the counselling and psychotherapy profession as well as changes in Canadian demographics and social, political, economic, and cultural awareness. There
is therefore a renewed focus on these elements in the revised Code
and those related to social justice, self-reflection, and diversityǂ.
Phases of Revision
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The first step in the revision process involves the dissemination and review of existing codes of ethics in counselling and psychotherapy related
professions from around the world. Scholarly articles and other research
focused on ethics and consultations with known experts or persons with
lived experience are sought out by individual Task Group members and are
considered by the full Task Group.
The second step in the revision process involves members of the Task
Group assembling in small groups to make recommendations pertaining to
additions, deletions, and adjustments to the Code of Ethics. The proposed
revisions are then distributed to the full Task Group.
APPENDIX - A
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The third step in the revision process is a full group review of the work of
the sub-groups. The proposed revisions are reviewed with respect to style
and content. Style refers to semantic clarity and grammatical and syntactical accuracy. Content review focuses on completeness and correctness
of concepts presented; analysis of potential omissions and overlap; and
alignment with CCPA bylaws and Canadian statutes.
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Once the Task Group believes a first draft is ready for internal review by
CCPA Chapter Presidents, Chairs of CCPA-associated committees, and
National Office personnel,
the first phase of review is undertaken. The preliminary draft of the revised
Code is transmitted for feedback.
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The feedback from the first phase of review is considered line by line by
the Task Group. Additions, deletions, amendments, and further research are
undertaken to address the needs identified in the first phase of feedback.
Once revisions have been approved by the Task Group and incorporated,
the next phase of review is undertaken.
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The second phase of review is extended to a broader group of reviewers associated with the counselling and psychotherapy profession. The feedback
from the second phase
of review is considered by the Task Group using the same processes as the
first phase. Revisions are approved and made by the Task Group, leading to
the third and final phase of review.
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In the third phase of review, the proposed Code of Ethics is presented to the
CCPA Board of Directors for its approval.
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Upon confirmation of final approval of the revisions to the Code of Ethics,
the Task Group draws upon the revised document to guide revisions to
CCPA’s Standards of Practice. A similar process of multi-phase review and
feedback is undertaken.
Commitment to a Living, Cross-Referenced Document
CCPA is committed to the concept of living documents with respect to
the Code of Ethics and Standards of Practice. This commitment includes
ongoing cross-referencing within the Code of Ethics and between the Code
of Ethics and Standards of Practice to ensure currency and consistency. A
glossary of terms has been included in the revised Code of Ethics to clarify
commonly used terminology.
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APPENDIX A
CCPA is also committed to the use of technology to enhance and further
develop the Code of Ethics and Standards of Practice. Electronic versions
of the documents contain hyperlinks to allow readers quick access to
cross-referenced components.
Introduction
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This Code of Ethics expresses the ethical principles and values of the
Canadian Counselling and Psychotherapy Association and serves as a
guide to the professional conduct of all its members. It also informs the
public, which they serve, of the standards of ethical conduct that members
are responsible to uphold and for which they are held accountable. The
Code reflects such values as integrity, competence and responsibility with
an understanding of and respect for the cultural diversity, systemic issues,
and the social contexts in Canada. It is part of a social contract, based on
attitudes of mutual respect and trust, by which society supports the autonomy of the profession in return for the commitment of its members to act
ethically in the provision of professional services. The Code of Ethics is
designed to be used in combination with the Standards of Practice as well
as other sources of information such as recent literature and research, legal
statutes, cultural knowledge keepers, and other practice guidelines.
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Members of CCPA have a responsibility to ensure that they are familiar
with this Code
of Ethics, to understand its application to their professional conduct, and to
strive to adhere to its principles and values. Counsellors/therapists should
also use the CCPA Professional Standards of Practice, as well as other
sources of information to assist them in making informed professional
decisions. These sources of information include the laws, regulations, and
policies, that are professionally relevant to their working environment.
Members are accountable to both the public and their professional peers
and are therefore subject to the complaints and disciplinary procedures
of the Canadian Counselling and Psychotherapy Association. Violations
of this Code, however, do not automatically imply legal liability. Such a
determination can only be made by legal and judicial proceedings. This
peer review process is intended to enable the Association to advise and to
discipline its members in response to substantiated complaints originating
either with professional peers or the public.
Although a code of ethics is essential to the maintenance of ethical integrity
and accountability, it cannot be a substitute for the active process of ethical
APPENDIX - A
409
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decision- making. Members increasingly confront challenging ethical demands and dilemmas in
a complex and dynamic society to which a simple and direct application of
this code may not be possible. Also, reasonable differences of opinion can
and do exist among members with respect to how ethical principles and
values should be rank ordered when they are in conflict. Therefore, members must develop the ability and the courage to exercise a high level of
ethical judgment. For these reasons, the Code includes a section on ethical
decision-making.
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This Code is not a static document but will need revisions over time because of the continuing development of ethical knowledge and the emergence of consensus on challenging ethical issues. Therefore, members and
others, including members of the public, are invited to submit comments
and suggestions at any time to CCPA by contacting the National Office at
https://www.ccpa-accp.ca/contact-us/.
Ethical Principles
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b) Fidelity
- Being proactive in promoting the best interests of
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a) Beneficence
clients.
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The expectations for ethical conduct as expressed in this Code are based on
the following fundamental principles:
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c) Nonmaleficence
- Honouring commitments to clients and
maintaining integrity in counselling relationships.
- Refraining from actions that risk harm
and not willfully harming clients.
d) Autonomy
and self-determination.
- Respecting the rights of clients to agency
e) Justice
- Respecting the dignity of all persons and
honouring their right to just treatment.
f) Societal Interest best interests of society.
- Upholding responsibility to act in the
The CCPA Process of Ethical Decision-Making
This brief overview of approaches to the process of ethical decision-mak-
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APPENDIX A
ing is provided to offer direction to counsellors/therapists when faced with
making ethical decisions and resolving ethical dilemmas.
1. Principle-Based Ethical Decision-Making
Step One
– What are the key issues in this situation?
Step Two
– What ethical articles from the CCPA Code of
Ethics are relevant to this situation?
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– Are there policies, case law, statutes, regulations,
bylaws or other related articles that are relevant to
this situation?
– Which of the six ethical principles are of major importance in this situation? (This step also
involves securing additional information, consulting with knowledgeable colleagues or the CCPA
Ethics Committee, and examining the probable
outcomes of various courses of action.)
Step Four in this circumstance?
– How can the relevant ethical articles be applied
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Step Three
– How might any conflict between ethical principles be resolved?
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– What are the potential risks and benefits of this
application and resolution?
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Step Five
Step Six situation?
– What do my feelings and intuitions tell me to do
in this situation? (See also Virtue-Based Ethical
Decision-Making.)
– What plan of action will be most helpful in this
– Follow up to evaluate the appropriateness, adequacy, and effectiveness of the course of action
taken. Identify any adjustments necessary to optimize the outcome.
2. Virtue-Based Ethical Decision-Making
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411
A virtue ethics approach is based on a belief that counsellors/therapists as
virtuous persons have the ability to make ethical decisions that are informed
by their understanding of the interests of others, a capacity to subordinate
self-interest in the pursuit of just outcomes, an acceptance of complexity,
and a commitment to natural justice. Although there is no step-by-step
methodology for this approach, the following questions may help with the
process of context-specific, virtue-based ethical decision making:
2.
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What emotions and intuition am I aware of as I consider this ethical dilemma and what are they telling me to do?
How can my values best show care for the client’s wellbeing?
4.
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3.
How will my decision affect other relevant individuals in this ethical dilemma?
What decision would I feel best about publicizing?
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3. Quick Check
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What decision would best reflect who I am as a person and practitioner within cultural/intercultural contexts?
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1. Publicity
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2. Universality
3. Justice decision?
Would I want this ethical decision announced on the front page of a major
newspaper?
Would I make the same decision for everyone? If every counsellor/therapist made
this decision, would it be a good thing?
Is everyone being treated fairly by my
4. Wise Practices Lens
Counsellors/therapists are encouraged to approach all ways of knowing
when engaging in decision-making. Using Etuaptmumk1 (two-eyed seeing) is of immense assistance. This way of perceiving situations refers to
“learning to see from one eye with the strengths of Indigenous knowledges
and ways of knowing and from the other eye with the strength of Western
knowledges and ways of knowing...and learning to use both eyes together
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Pronounciation: ad oo apt mumk
APPENDIX A
for the benefit of all.” (Marshall, A., 2004, http://www.integrativescience.
ca/Principles/TwoEyedSeeing/).
Richard Wagamese, of the Ojibway Nation, reminds readers of the importance of relationship in decision-making:
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We are born into a state of relationship, and our ceremonies and
rituals are
guides to lead us deeper into that relationship with all things. The
big lesson? Relationships never end; they just change. In believing
that lies the freedom to carry compassion, empathy, love, kindness
and respect into and through whatever changes. We are made more
by that practice. (Wagamese, R., 2016, p. 44).
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The “wise practices lens” model of decision-making (Wesley-Esquimaux
& Snowball, 2010, p. 230) is a decision-making strategy that practitioners
may find helpful. The model uses teachings from the seven sacred values
that include courage, honesty, humility, respect, truth, love, and wisdom
(Baskin, 2007).
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For a more comprehensive treatment of ethical decision-making, members
are directed to the CCPA publication, Counselling Ethics: Issues and Cases, available from the CCPA National Office.
A. Professional Responsibility
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Counsellors/therapists are expected to conduct themselves with integrity,
professionalism, and ethical care in all aspects of their work with clients,
clients’ families, colleagues, communities, and the public. This responsibility includes engaging in appropriate, contextualized professional development and self-care practices to maintain optimum capacity.
A1. General Responsibility
Counsellors/therapists maintain high standards of professional competence
and ethical behaviour and recognize the need for continuing education and
personal care in order to meet this responsibility. (See also C1, E1, E11, F1,
G2, Section I)
A2. Respect for Rights
Counsellors/therapists participate in only those practices that are respectful
of the legal, civic, moral, and human rights of themselves and others, and
act to safeguard the dignity and rights of their clients, students, supervisees,
APPENDIX - A
413
and research participants. (See also D1, D9, E1, Section I)
A3. Boundaries of Competence
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Counsellors/therapists limit their counselling/therapy services and practices
to those which are within their professional competence by virtue of their
education and professional experience, and consistent with any requirements for provincial/territorial and national credentials. They seek supervisionǂ, consult with and/or refer to other professionals when the counselling
needs of clients exceed their level of competence. (See also C3, C4, D1,
E4, E6, F1, F2, G2, G14, H4, Section I)
A4. Supervision and Consultation
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Counsellors/therapists seek supervisionǂ and consultationǂ across the career
span
to support and enrich their ongoing professional development. Supervisionǂ
and consultationǂ are warranted especially when counsellors/therapists are
confronted with dilemmas or uncertainties, and when they are developing a
new practice area or updating knowledge and skills related to a former area
of practice. (See also B10, C4, C7, Section E, Section F, I5, I9, I10)
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A5. Representation of Professional Qualifications
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Counsellors/therapists claim or imply only those professional qualifications
that
they possess and are responsible for correcting any known misrepresentation of their qualifications by others. Counsellors/therapists working in
a province or territory with professional statutory regulation ensure they
adhere to the specific representation of professional qualifications requirements that have been mandated by statute and/or Regulatory College
bylaw. (See also H7, I5)
A6. Professionalism in Advertising
Counsellors/therapists when advertising and representing themselves publicly, do so
in a manner that accurately and clearly informs the public of their services
and areas of expertise. Counsellors/therapists belonging to a statutory
regulatory college additionally adhere to the specific advertisement requirements as mandated by statute and/or Regulatory College bylaw.
A7. Responsibility to Counsellors/Therapists and Other Professionals
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APPENDIX A
Counsellors/therapists demonstrate ethical conduct, integrity, and professionalism in interactions with counsellor/therapist colleagues and with
members of other professional disciplines. (See also Section I)
A8. Responsibility to Address Concerns About the Ethical Conduct of
Another Professional
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Counsellors/therapists have an obligation when they have serious doubts
as to the ethical behaviour of another helping professional, whether that
individual is a CCPA member or a member of another professional body,
to respectfully address the concern and seek an informal resolution with
the counsellor/therapist, when feasible and appropriate. When an informal
resolution is not appropriate, legal, or feasible, or is unsuccessful, counsellors/therapists report their concerns to the relevant professional body.
Counsellors/therapists consider whether there are any legally mandatory
reporting obligations regarding the conduct of the helping professional to
take appropriate action. (See also E4, E5)
A9. Supporting Clients When Ethical Concerns Arise
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When counsellors/therapists have reasonable grounds to believe that a client has an ethical concern or complaint about the conduct of a CCPA member (including oneself) or members of another professional body, counsellors/therapists inform the client of their rights and options with respect to
addressing the concerns. When the concern regards a CCPA member, the
counsellor/therapist informs the client of the CCPA Procedures for Processing Complaints of Ethical Violations and how to access these procedures.
A10. Third Party Reporting
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When counsellors/therapists are required or expected to share counselling/
therapy information with third parties, they ensure that details are discussed
and documented with clients as part of the initial and ongoing informed
consent, including the nature of information to be shared, with whom it will
be shared, and when. Counsellors/ therapists determine whether a formal,
signed consent for release of information form is warranted. (See also B18,
C8, D5, E2)
A11. Sexual Harassment
Counsellors/therapists do not condone or engage in sexual harassment in
the workplace, with colleagues, students, supervisees, clients, or others.
These encounters may be verbal, pictorial, written comments (including but
APPENDIX - A
415
not exclusive of texting, messaging, taking photos, making posts and comments on websites, Twitter, or other platforms), gestures, unwanted sexual
images, or physical contacts of a sexual nature. (See also G11, G12)
A12. Diversity Responsiveness
A13. Extension of Ethical Responsibilities
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Counsellors/therapists continually seek to enhance their diversityǂ awareness, sensitivity, responsiveness, and competence with respect to their own
self-identities and those of their clients. They are attuned to various effects
related to diversityǂ and how they may influence interactions with clients.
(See also B9, C10, D9, E7, E12, Section I)
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Counselling/therapy services and products provided by counsellors/therapists through classroom instruction, public lectures, demonstrations,
publications, radio and television broadcasts, computer technology, and
other media must meet the appropriate ethical standards consistent with this
Code of Ethics. (See also I5, I10)
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A14. Professional Will and Client File Directive
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Counsellors/therapists undertake to establish a formal stand-alone agreement with a qualified practitioner to serve as executor whose sole responsibility will be to fulfil any ethical obligations including the management of
client records should their practice end due to death, or incapacitation such
that they are unable to do so.
B. Counselling / Therapy Responsibilities
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The specific responsibilities of counsellors/therapists vary across time
and multiple geographic, environmental, social, cultural, economic, and
political contexts. Despite the variety of situations in which counsellors/
therapists may find themselves, their responsibility for safeguarding the
welfare of clients, maintaining their trust, and protecting their personal data
is constant across time and consistent across contexts.
B1. Primary Responsibility
Counsellors/therapists respect the integrity and promote the welfare of their
clients. They work collaboratively with clients to devise counselling/therapy plans consistent with the needs, abilities, circumstances, values, cultural,
or contextual background of clients. (See also C1, D2, E1, E4, Section I)
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APPENDIX A
B2. Confidentiality
Counselling/therapeutic relationships and information resulting therefrom
are kept confidential. However, there are the following exceptions to confidentiality: (i) when disclosure is required to prevent clear and imminent
danger to the client or others; (ii) when levels of jurisprudence demand that
confidential material be revealed;
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(iii) when a child is in need of protection; (iv) persons with diminished
capacity, and as otherwise mandated by municipal, provincial/territorial,
and federal law. (See also B4, B6, B13, B18, C5, D5, D8, E10, G7, H1, H4,
H6)
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B3. Duty to Warn
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When counsellors/therapists become aware of the intention or potential of
clients to place others in clear and imminent danger, they use reasonable
care to give threatened persons such warnings as are essential to avert
foreseeable dangers. In cases in which it may not be appropriate or safe for
counsellors/therapists to intervene directly to give warnings to threatened
persons, they take appropriate steps to inform authorities to take action.
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B4. Client’s Rights and Informed Consent
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When counselling/therapy is initiated, and throughout the counselling/therapy process
as necessary, counsellors/therapists inform clients of the purposes, goals,
techniques, procedures, limitations, potential risks and benefits of services
to be performed, and other such pertinent information that supports the
informed decision-making process.
Counsellors/therapists make sure that clients understand the implications of
diagnosis, fees and fee collection arrangements, record-keeping, and limits
of confidentiality.
Clients have the right to collaborate in the development and evolution of
the counselling/ therapy plan. Clients have the right to seek a second opinion or consultation, to refuse any recommended services, and to be advised
of the consequences of such refusal. (See also B2, B5, B8, B15, B18, C2,
D3, D4, E2, G10, H1, H2, H3, H4)
B5. Children and Persons with Diminished Capacity
When working with children and/or persons with diminished capacity,
APPENDIX - A
417
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counsellors/ therapists conduct the informed consent process with those
who are legally entitled
to offer consent on the client’s behalf, typically parents or others appointed
as legal guardians. Counsellors/therapists also seek the client’s assent to the
proposed services or involvement, proportionate with the client’s capacity
to do so. Counsellors/therapists understand that the parental or guardian
right to consent on behalf of children diminishes commensurate with the
child’s growing capacity to provide informed consent. These dual processes
of obtaining parental/guardian informed consent and client assent apply to
assessment, counselling/therapy, research participation, and other professional activities. (See also B4, D4)
B6. Maintenance of Records
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Counsellors/therapists maintain records with sufficient detail and clarity
to track the nature and sequence of professional services rendered. They
ensure that the content
and style are consistent with any legal, regulatory, agency, or institutional
requirements. Counsellors/therapists secure the safety of such records and
create, maintain, transfer, and dispose of them in a manner compliant with
the requirements of confidentiality and the other articles of this Code of
Ethics. (See also B2, B18, H1, H2)
B7. Access to Records
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Counsellors/therapists understand that clients have a right of access to their
counselling/therapy records, and that disclosure to others of information
from these records only occurs with the written consent of the client and/or
when required by law. (See also B4, H1)
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B8. Multiple Relationships
Multiple relationships are avoided unless justified by the nature of the
activity, limited by time and context, and entered into with the informed
consent of the parties involved after assessment of the rationale, risks, benefits, and alternative options.
Counsellors/therapists make every effort to avoid or address and carefully
manage multiple relationships with clients that could impair objectivity and
professional judgment and increase the risk of exploitation or harm. When
multiple relationships cannot be avoided, counsellors/therapists take appropriate professional precautions such as role clarification, ongoing informed
consent, consultationǂ and/or supervisionǂ, and thorough documentation.
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APPENDIX A
(See also B4, E7, F5, G4, G6, I5, I8, I9)
B9. Respecting Inclusivity, Diversity, Difference and Intersectionality
B10. Consulting with Other Professionals
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Counsellors/therapists actively invest in the continued development and
refinement of their awareness, sensitivity, and competence with respect
to diversityǂ (between groups) and difference (within groups). They seek
awareness and understanding of client identities, identification, and historical and current contexts. Counsellors/therapists demonstrate respect for
client diversityǂ and difference and do not condone or engage in discrimination. (See also C10, E6, E12, Section I)
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Counsellors/therapists may consult with other professionals about their
work with clients. Consultationǂ is to be undertaken in a de-identified
manner unless clients have offered consent in writing to have their identity revealed. Counsellors/therapists exercise care in choosing professional
consultants to avoid any conflict of interest. (See also A4, E2, Section F,
Section I)
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B11. Relationships with Former Clients
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Counsellors/therapists remain accountable for any relationships established
with former clients. Relationships could include, but are not limited to,
those of a social, financial, business, or supervisory nature. Counsellors/
therapists are thoughtful and thorough in their consideration of potential
post-counselling/therapy relationships. Counsellors/ therapists seek consultationǂ and/or supervisionǂ on such decisions. Relational accountability also
applies to electronic interactions and relationships. (See also B12)
B12. Sexual Contact
Counsellors/therapists avoid any type of sexual contact with clients and
they do not counsel persons with whom they have or have had a sexual or
intimate relationship. Counsellors/therapists do not engage in sexual contact with former clients within a minimum of three years after terminating
the counselling/therapeutic relationship.
If the client is clearly vulnerable, by reason of emotional or cognitive disorder, to exploitative influence by the counsellor/therapist, this prohibition is
not limited to
the three-year period but extends indefinitely. Counsellors/therapists, in all
APPENDIX - A
419
such circumstances, clearly bear the burden to ensure that no such exploitative influence
has occurred and seek documented consultationǂ for an objective determination of the client’s ability to freely enter a relationship or have sexual
contact without impediment. The consultationǂ must be with a professional
with no conflict of interest with the client or the counsellor/therapist. This
prohibition also applies to electronic interactions and relationships. (See
also A11, B12, G11, G12)
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B13. Multiple Clients
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When counsellors/therapists agree to provide counselling/therapy to two
or more persons who have a relationship (such as spouses/life partners, or
parents and children), counsellors/therapists clarify at the outset who the
client is and the nature of the relationship with each of the other parties.
This clarification includes confidentiality limits, risks and benefits, and
what information will be shared, when, how, and with whom. (See also B2,
F5, I8, I9)
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B14. Multiple Helpers
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Counsellors/therapists who, after entering a counselling/therapy relationship, discover that the client is already engaged in another counselling/
therapeutic relationship, are responsible for discussing with the client
issues related to continuing or terminating counselling/therapy. It may be
necessary, with client consent, to discuss these issues with the other helping
professional. (See also I9)
B15. Group Counselling / Therapy
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Counsellors/therapists have the responsibility to screen prospective group
members and to engage them in an informed consent process prior to the
first group session. This responsibility is especially important when group
goals focus on self-understanding and growth through self-disclosure.
Counsellors/therapists inform clients of group member rights, issues of
confidentiality, and group techniques typically used. They
take reasonable precautions to address potential physical and/or psychological harm resulting from interaction within the group, both during and
following the group experience. (See also B4)
B16. Referral
Counsellors/therapists determine their ability to be of professional assis-
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APPENDIX A
tance to clients. They avoid initiating a counselling/therapy relationship or
refer an existing client for whom the counselling/therapy relationship does
not productively pursue the client’s goals. Counsellors/therapists suggest
appropriate alternatives, including making a referral, co-therapy, consultationǂ, supervisionǂ, or additional resources. Should clients decline the
suggested referral, counsellors/therapists are not obligated to continue the
relationship. (See also G14)
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B17. Closure of Counselling / Therapy
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Counsellors/therapists begin closure of counselling/therapy relationships,
with client agreement whenever possible, when (a) the goals of counselling/therapy have been met; (b) the client is no longer benefiting from
counselling/therapy; (c) the client has not paid the counselling fees formerly discussed, agreed to, and charged; (d) client insurance will not cover
further reimbursement and the client is unable or unwilling to commit to
out-of-pocket payment for service; (e) previously disclosed agency or institutional limits do not allow for the provision of further counselling/therapy services; or (f) the client or another person with whom the client has
a relationship threatens or otherwise endangers the wellbeing of the counsellor/therapist. Counsellors/therapists make reasonable efforts to facilitate
appropriate access to alternative counselling/therapy services when client
need is ongoing and service provision has ended.
B18. Mandated Clients and Systems Approaches
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Counsellors/therapists recognize that there is a heightened fiduciary dutyǂ
when undertaking services with mandated clientsǂ and in systems of care
contexts. Counsellors/therapists understand the highly probable likelihood
that counselling/ therapy notes may be shared with third parties and seek
to proactively identify systemic expectations surrounding such information
sharing with third parties. Clients are fully informed and educated throughout counselling/therapy processes of this potential eventuality and the
consequences thereof. (See also A10, B2, B4, B6, B7, C8)
C. Assessment and Evaluation
Assessment and evaluation are foundational components of counselling/
therapy.
These may be undertaken formally and informally, and in structured and
unstructured formats. Ethically congruent assessment and evaluation
require counsellors/therapists to be particularly attentive to informed
APPENDIX - A
421
consent processes, confidentiality and third-party sharing of information,
boundaries of competence, and diversityǂ. When employing standardized
measures in formal assessment and evaluation, counsellors/therapists must
ensure that they are adequately trained to select and administer appropriate
measures, to interpret and report on the results, and to seek consultationǂ or
supervisionǂ
when unsure.
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C1. General Orientation
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Counsellors/therapists ensure that they have received adequate and appropriate education and training to regarding the nature and purpose of assessment and evaluation. They are committed to employing assessment and
evaluation measures and strategies that will best serve the needs of individual clients and their contexts. (See also A1, B1, E1, H4)
C2. Informed Consent for Assessment and Evaluation
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Counsellors/therapists inform clients about the purpose of assessment and
evaluation in counselling/therapy and the rationale for proposing specific
approaches and measures. Counsellors/therapists provide sufficient detail
to permit informed consent, including discussion of (a) any formal measures to be employed, (b) assessment timeline and processes, (c) risks and
benefits, (d) alternatives, (e) financial costs (when applicable) and (f) when,
how, and with whom the findings will be shared. (See also B4, E2)
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C3. Assessment and Evaluation Competence
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Counsellors/therapists practice within the boundaries of their competence
and employ only those assessment and evaluation approaches and measures
for which they have verifiable (i.e., documented and demonstrable) competence and meet established professional prerequisites and standards. (See
also A3, E6)
C4. Administrative Conditions and Procedures
Counsellors/therapists ensure that assessment and evaluation instruments
and procedures are administered and supervised under established conditions consistent with professional standards. They note any departures
from standardized conditions and any unusual behaviour or irregularities
which may affect the interpretation of results. Prior to engaging in formal
and informal assessment processes, counsellors/therapists are attentive and
sensitive to the client’s contexts including familial, communal and cultural
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APPENDIX A
identity and/or membership, to ensure fair and valid assessment practice.
(See also A3, A4, D10, E5, E8)
C5. Technology in Assessment and Evaluation
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Counsellors/therapists recognize that their ethical responsibilities are not
altered, nor in any way diminished, by the use of technology for the administration, scoring, and interpretation of assessment and evaluation instruments. Counsellors/therapists retain their responsibility for the maintenance
of the ethical principles of privacy, confidentiality, and responsibility for
decisions regardless of the technology used. (See also B2, E8, Section H)
C6. Appropriateness of Assessment and Evaluation
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Counsellors/therapists ensure that assessment and evaluation instruments
and procedures are valid, reliable, and appropriate to both the unique needs
of the client and the intended purposes. Counsellors/therapists consider all
factors (e.g., social, cultural, identity, ability, language fluency, etc.) which
may influence the assessment/evaluation process when determining its use.
(See B9, D9, E8, Section I)
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C7. Reporting Assessment and Evaluation Results to Clients
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Counsellors/therapists clearly specify with whom, when, and how results
of assessment and evaluation will be shared as part of the informed consent
process. Results are presented to clients in a timely manner, in language
appropriate to clients’ developmental, cognitive, intellectual, and linguistic
abilities. Counsellors/therapists provide clients with the opportunity to pose
questions and seek clarification. (See also B4, B5, E8)
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C8. Reporting Assessment and Evaluation Results to Third Parties
The nature and extent of information to be shared with third parties is
determined
on a need-to-know basis that has prior informed consent and maintains
client best interests as the priority. Reports summarize the referral issue(s),
nature and purpose of assessment undertaken, procedures followed, measures implemented and the rationale for their selection, and results and
findings. Report conclusions and recommendations clearly arise from the
assessment results and findings. Reports are written in an objective and
professional tone, avoiding the use of professional jargon in favour of language that can be understood by a wide reading audience. (See also A10,
B18, E10)
APPENDIX - A
423
C9. Integrity of Instruments and Procedures
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Counsellors/therapists attend to the integrity and security of assessment
manuals, protocols, and reports, consistent with any legal and contractual
obligations, and with particular attention to the appropriate use and storage
of instruments. They refrain from appropriating, reproducing, or modifying established content and procedures without the express permission and
adequate recognition of the original author, publisher, and copyright holder.
When the reliability, validity, usefulness, and value of a measure depend
on its novelty2 to clients, counsellors/therapists appropriately limit client
exposure to the instrument according to the timeline and manner specified
in the test manual.
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Counsellors/therapists ensure that they have provided for the security and
maintenance of evaluation and assessment results in their professional will
and client file directive.
C10. Sensitivity to Diversity when Assessing and Evaluating
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Counsellors/therapists consider the potential influence of diversityǂ factors
on client performance and determine whether appropriate accommodations
can be made to administration and interpretation or whether alternative
assessment measures and approaches are warranted. Counsellors/therapists
proceed with particular care and caution in the selection, administration,
and interpretation of assessment measures and procedures when clients are
members of groups not represented in standardization processes for formal
instruments and procedures. (See also A12, B9, E12, Section I)
D. Professional Research and Knowledge Translation3
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Critical to the expansion of the evidence-informed foundation for the
practice of counselling/therapy is the undertaking of scholarly research
and knowledge translation. Counsellors/therapists adhere to the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans,
2
In the context of assessment and evaluation, novelty refers to unfamiliarity with
test content and procedures in order to ensure the reliability, validity, usefulness, and value
of a measure. Because repeated exposure to a test may artificially inflate scores, yielding
assessment outcomes that are inaccurate and unfair (e.g., due to practice effects), minimum
test-retest intervals are specified for some measures.
3
Knowledge Translation in this document refers to the dissemination of research
findings through a variety of communication modalities such as oral traditions, media, print,
presentation, practical use, among others.
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APPENDIX A
using Ownership, Control, Access, and Possession (OCAP) principles for
Indigenous Peoples, and demonstrate ethical congruence as they engage
in research and share research findings in oral, written and visual formats.
(See also Section I)
D1. Researcher Responsibility
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Counsellors/therapists plan, conduct, and report on research in a manner
consistent with relevant ethical principles, professional standards of practice, federal and provincial laws, institutional regulations, cultural norms,
and, when applicable, standards governing research with human participants. These ethical obligations are shared by all members of the research
team, each of whom assumes full responsibility for their own decisions and
actions. Before engaging in any study involving human participants, the
principal researcher seeks independent ethical review and approval. (See
also A2, A3, I3, I6, I8, I9, I10)
D2. Welfare of Research Participants
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Counsellors/therapists are responsible for protecting the welfare of participants throughout research activities. They acknowledge and address
the inherent risks involved in working with human participants and take
reasonable precautions to
avoid causing harm. Plans for addressing and mitigating inherent risks are
included
in protective actions. Counsellors/therapists recommend referrals to other
helping professionals or resources when warranted and do not engage in
providing counselling/ therapy to those with whom they are engaged in
research activities. (See also B1, I8)
Ka
D3. Voluntary Participation
Counsellors/therapists who are conducting research give priority to informed and voluntary participation. Researchers may proceed without
obtaining the informed consent of participants if approved or exempted by
an independent ethics review. (See also B4)
D4. Informed Consent of Research Participants
Counsellors/therapists inform all research participants of the purpose(s) of
the research being undertaken. In addition, participants are made aware of
any experimental procedures, possible risks, disclosures and limitations
on confidentiality. Participants are also informed that they are free to ask
APPENDIX - A
425
questions and to discontinue at anytime. (See also B4, B5, E3)
D5. Research Participant Right to Confidentiality
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Counsellors/therapists maintain the confidentiality of the identity of research participants. They do not disclose in publications, presentations, or
public media,
any personally identifiable information about research participants, unless
otherwise authorized by the participants, consistent with informed consent
procedures. (See also A10, B2, D6)
D6. Research Data Retention
D7. Research Sponsors
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Counsellors/therapists who conduct research are obligated to retain their
research
data and to make it available in a de-identified format in response to
appropriate requests from qualified fellow researchers for the purposes of
replication or verification. Counsellors/therapists are obligated to follow
the data destruction schedules of the agency or institutional ethics review
board. (See also D4, D5)
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When counsellors/therapists are the recipients of funding or other resources
to support their research, they clearly acknowledge sponsors and the nature
of the support in their application for ethics review and in any publications
arising from the research. They also complete and submit in a timely manner any research-related reports requested by sponsors.
D8. Review of Scholarly Submissions
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Counsellors/therapists who review applications or manuscripts submitted
for research, publication, or other scholarly purposes respect the confidentiality and proprietary rights of those who submitted the materials. (See also
A2, B2, I7)
D9. Reporting Research Results
When reporting the results of their research, counsellors/therapists document any variables and conditions that might affect the outcome of the
investigation or the interpretation of the results. They provide sufficient
detail for others who might wish to replicate the research. (See also A12,
C4, C6, E6, I2)
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APPENDIX A
D10. Acknowledging the Contributions of Others
D11. Submission for Publication
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Counsellors/therapists appropriately acknowledge the contributions of others to research investigations and/or scholarly publications. When the contributions are substantial in nature, counsellors/therapists identify contributors as co-investigators or co-authors. They also give due credit by offering
oral and written acknowledgment of contributions. Counsellors/therapists
also acknowledge the historical contributions of those whose prior research
and publication significantly influenced the current study or publication.
When a publication is based primarily on a student thesis or dissertation,
the student is listed as principal investigator and author. (See also G13, I8)
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Counsellors/therapists do not simultaneously submit copies of the same
creative work, or manuscripts that are highly similar in content, for consideration by two or more publishers. In addition, manuscripts or other creative material already published in whole or in substantial part should not
be submitted for publication without the express permission of the original
publisher.
E. Clinical Supervision Services
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There are a number of contexts in which counsellors/therapists may offer
clinical supervisionǂ. They may undertake a clinical supervisory role with
pre-service counsellors/therapists who are completing practica or internships. They also may enter into clinical supervisionǂ relationships with
in-service counsellors/therapists who are (a) pursuing certification, licensure, or registration; (b) required to engage in clinical supervisionǂ as part
of an employment contract; (c) seeking to update competencies or to develop new competencies in a particular area of counselling/therapy practice;
(d) fulfilling sanctions imposed by an ethical or other professional body;
or (e) choosing to participate in clinical supervisionǂ and consultationǂ as a
valued and valuable practice across the career span.
E1. General Responsibility
Clinical supervisors demonstrate professionalism, integrity, and respect for
the rights of others, with priority accorded to the welfare of supervisees’
clients and, more generally, to protection of the public. Counsellors/therapists who enter into this professional role exhibit ethical attunement and
commitment to conducting themselves in a manner that is consistent with
the CCPA Code of Ethics and Standards of Practice. (See also A1, A2, B1,
APPENDIX - A
427
C1, F1, G1, I8)
E2. Informed Consent
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Clinical supervisors embark on an informed consent process with supervisees that begins with the first contact and continues throughout the period
of supervisionǂ. The notions of participating voluntarily, knowingly, and
intelligently apply to clinical supervisionǂ. Informed consent involves
identifying, discussing, and verifying understanding and acceptance of, the
roles, rights, responsibilities, and requirements of clinical supervisors and
supervisees.
Bo
Supervisors make supervisees aware of all expectations and requirements
(e.g., furnishing recordings of counselling/therapy sessions and copies of
counselling/ therapy documentation for review) prior to, or no later than,
the outset of supervisionǂ.
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In clinical supervisionǂ, informed consent also applies to clients. Clients
must be made aware when counsellors/therapists are concurrently participating in clinical supervisionǂ and should be provided with details about the
identity of and contact information for the clinical supervisor, the nature
and purpose of the clinical supervisionǂ, and the degree to which their
counselling/therapy information will be shared with the clinical supervisor
and any other individuals (e.g., other students in a practicum class, other
supervisees in group supervisionǂ). Supervisors ensure that clients have offered specific informed consent for audio or video recording and review of
their counselling/therapy sessions, as well as review of documents in their
counselling/therapy files (unless carefully deidentified). Clinical supervisors enter into clinical supervisionǂ relationships and processes voluntarily,
knowingly, and intelligently. They confirm and communicate awareness
and acceptance of the roles, rights, responsibilities, and requirements that
accompany their agreement to serve as clinical supervisor. (See also A10,
B4, B10, C2, G14, H1, H2)
E3. Ethical Commitment
Clinical supervisors are conversant with ethical, legal, and regulatory issues
relevant to the practices of counselling/therapy and clinical supervisionǂ.
Clinical supervisors model and underscore the importance of ethical commitment and accountability by involving supervisees in review and discussion of the CCPA Code of Ethics and Standards of Practice (and any other
professionally relevant codes and standards). Clinical supervisors discuss
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APPENDIX A
direct and vicarious liability with supervisees and employ risk management
strategies. (See also D4, F2, G1, G3, I8)
E4. Welfare of Clients and Protection of the Public
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Client welfare and protection of the public are the primary considerations
in all decisions and actions of supervisees and clinical supervisors. Responsibility for safeguarding extends beyond the immediate clients of supervisees to protection of other members of the public who might be affected by
supervisees’ comportment and competence.
E5. Welfare of Supervisees
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Clinical supervisors are particularly mindful of the CCPA ethical principle
of societal interest and its call for responsibility to society. The professional
mandate to accord primacy to the wellbeing of clients of supervisees and
protection of the public aligns with the crucial gatekeeping role that clinical
supervisors fulfill. Clinical supervisors educate and redirect supervisees,
override supervisee decisions or actions, and/or intervene to prevent or
mitigate harm to clients or members of the public. (See also A3, A8, B1)
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Clinical supervisionǂ gives priority to supervisee wellbeing and providing
opportunity to experience success. Clinical supervisors are committed to
promoting the professional growth and development of their supervisees
in a supervisory culture and climate that foster a reciprocal sense of safety,
trust, and predictability.
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Clinical supervisors monitor supervisee performance and progress, striving
for
an appropriate balance of challenge and support. At all times, clinical
supervisor interactions with supervisees are characterized by professionalism, integrity, acceptance, valuing, and respect. If difficulties emerge in the
supervisory relationship and/or process, it is incumbent on clinical supervisors to discuss concerns with supervisees and to identify potential routes
for amelioration. Attending to supervisee welfare may necessitate any of
the following: revisiting and potentially revising the supervisionǂ contract/
plan/agreement, offering increased supervisionǂ, developing and implementing a remedial plan, recommending personal counselling, engaging
an impartial third party to mediate disagreements, proposing a medical or
mental health hiatus, or assigning a new clinical supervisor, among other
activities. (See also A4, A8, C4, G7, I8)
E6. Boundaries of Competence
APPENDIX - A
429
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Counsellors/therapists who conduct clinical supervisionǂ appraise their theoretical, conceptual, clinical/technical, diversityǂ, and ethical competencies
in both counselling/ therapy and clinical supervisionǂ from the standpoint of
suitability and sufficiency
for the counselling context of supervisees. They limit their involvement as
clinical supervisors to their verifiable (i.e., documented and demonstrable)
competencies and seek supervision of supervisionǂ or refer supervisees to
other appropriately qualified clinical supervisors when another area and/or
higher level of expertise is warranted. (See also A3, B9, C3, G2, I4)
E7. Relational Boundaries
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Counsellors/therapists who offer clinical supervisionǂ invest in the establishment, maintenance, and clarification of appropriate relational boundaries with their supervisees. They acknowledge the inherent power and
privilege associated with the role of clinical supervisor regardless of supervisees’ developmental status (e.g., pre-service vs in-service). Counsellors/
therapists underscore the professional nature of the relationship and convey
their commitment to establishing a supervisory climate and culture of safety, trust, honesty, respect, and valuing. Dual or multiple relationships with
supervisees are explicitly identified as such and are navigated with care
and caution so as to guard against any potential for impaired objectivity or
exploitation. (See also A11, B8, G4, G6, G11, G12, Section I)
E8. Program Orientation
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Counsellors/therapists responsible for clinical supervisionǂ take responsibility for the orientation of supervisees and relevant professional partners to
all core elements of such programs and activities, including clear policies
pertaining to assessment and evaluation tools, record keeping and reporting, appeals, and fees with respect to all supervised practice components,
both simulated and real. (See also C4, C5, C6, C7, G3, G5, G7, I8)
E9. Fees
Clinical supervisionǂ is a specialty area of professional practice with a
substantial corpus of requisite knowledge and skills. Clinical supervisionǂ
competencies are distinct from and complementary to those associated with
the practise of counselling/therapy. When clinical supervisors offer their
services outside of assigned duties in a paid position/ employment contract,
it is ethically congruent to charge a fee for these services. Details about fees
are included in the supervisionǂ plan/agreement/contract and are discussed
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APPENDIX A
as part of the informed consent process. Supervisees are apprised of the
rates, payment schedule, method of payment, and collection processes (if
applicable).
E10. Due Process and Remediation
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Counsellors/therapists responsible for clinical supervisionǂ and their supervisees recognize when such activities evoke significant personal issues
and refer to other sources when necessary to avoid counselling/providing
therapy to those for whom they hold administrative, evaluative, and/or
subordinate responsibilities. Counsellors/therapists responsible for clinical
supervisionǂ and their supervisees ensure that any professional experiences
which require self-disclosure and engagement in self-growth activities are
managed in a manner consistent with the principles
of informed consent, confidentiality, and safeguarding against any harmful
effects. Counsellors/therapists remain cognizant of their power and privilege throughout the supervisionǂ process. (See also B2, C8, G9, G10)
E11. Self-Care
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Counsellors/therapists responsible for clinical supervisionǂ encourage and
facilitate the self-development and self-awareness of supervisees. They do
so to support integration of supervisees’ professional practice and personal
insight with the delivery of counselling/ therapy skills in an ethical, legal,
and competent manner and with sensitivity to the culturally diverse context
in which they work. (See also A1, G8)
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E12. Diversity Responsiveness
Ka
Counsellors/therapists responsible for clinical supervisionǂ display sensitivity and responsiveness to individual differences that reciprocally shape
the supervisory relationship, such as personal and professional beliefs and
values, cultural factors, and developmental stage.
Counsellors/therapists who conduct clinical supervisionǂ continually seek
to enhance their diversityǂ awareness, sensitivity, responsiveness, and
competence. They promote awareness and understanding of the self-identities of clients, supervisees, and clinical supervisors and explore with their
supervisees the potential influence on counselling and clinical supervisionǂ
of the various aspects of difference and diversityǂ. (See also A12, B9, C10,
Section I)
F. Consultation Services
APPENDIX - A
431
There are a number of contexts in which counsellors/therapists may offer
consultationǂ services. They may undertake a consultative role a) informally with colleagues or peers, b) formally with agencies or institutions, c) as a
private practice service, and d) informally or formally on an ad hoc and/or
pro bono basis. In all cases, despite counsellors/therapists are not engaging
in counselling/therapy in the consultative role, they are nonetheless responsible for adhering to the professional Code of Ethics for counsellors/therapists in the consultative role.
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F1. General Responsibility
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Counsellors/therapists provide consultative practices and services only in
those areas in which they have demonstrated competency by virtue of their
education and experience. (See also A1, A3, E1, I5)
F2. Undiminished Responsibility and Liability
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Counsellors/therapists who work in agencies or private practice, whether
incorporated or not, must ensure that there is no diminishing of their individual professional responsibility to act in accordance with the CCPA Code
of Ethics, or in their liability for any failure to do so. (See also A3, E3)
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F3. Consultative Relationships
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Counsellors/therapists ensure that consultationǂ occurs within a voluntary
relationship between a counsellor/therapist and a help-seeking individual, group, or organization, and that the goals are understood by all parties
concerned. Consultationǂ requires that informed consent (including limits to
liability) be incorporated as an integral and ongoing process. (See B10)
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F4. Conflict of Interest
Counsellors/therapists who engage in consultationǂ avoid circumstances
where the duality or multiplicity of relationships or the prior possession of
information could lead to a conflict of interest.
F5. Sponsorship and Recruitment
Counsellors/therapists providing consultationǂ services present any of
their organizational affiliations or memberships in such a way as to clarify
any related sponsorships or certifications to address potential conflicts of
interest. Counsellors/ therapists do not recruit clients to their counselling/
therapy practice as a consequence of their consultationǂ services. (See also
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APPENDIX A
B8, B13)
G. Counsellor / Therapist Education and Training
G1. General Responsibility
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Practitioners who undertake the responsibility of counsellor/therapist education
and training are tasked with roles that include mentorship, teaching,
supervisionǂ, assessment, feedback, evaluation, reporting, and fiduciary
dutiesǂ. They engage aspiring counsellors/therapists in comprehensive, evidence-supported education and training that fosters the development of theoretical, conceptual, clinical, relational, ethical, and diversityǂ knowledge
and skills. The primary goal of counsellor/therapist education and training
is to ensure that graduates are well-prepared to embark on counselling/therapy career paths as caring, confident, and competent professionals.
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Counsellor/therapist educators conduct themselves in a manner consistent
with the CCPA Code of Ethics and Standards of Practice. They adhere to
current CCPA guidelines and standards with respect to education and training of aspiring counsellors/therapists. (See also E1, E3, G3, I4)
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G2. Boundaries of Competence
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Counsellor/therapist educators are aware of and operate within their boundaries of verifiable competence with respect to teaching content, methods,
and mode of delivery (e.g., traditional, online, blended). Counsellor/therapist educators are required to acquire any necessary skills and knowledge
prior to undertaking teaching students to ensure that competence can be
demonstrated. (See also A1, A3, E6, H6, I4, I5)
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G3. Ethical Orientation
Counsellor/therapist educators ensure that students and trainees become
familiar
with the CCPA Code of Ethics, Standards of Practice, regulatory college
acts and
policies (if applicable), and relevant case law and legal statutes. They clarify respective expectations of counsellor/therapist educators and students/
trainees/supervisees to uphold these ethical and legal responsibilities.
Counsellor/therapist educators’ model and promote safe, ethical conduct,
professional attitudes and values and ensure adequate knowledge of regulatory features of the profession. (See also E3, E8)
APPENDIX - A
433
G4. Clarification of Roles and Responsibilities
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Counsellor/therapist educators who occupy multiple roles in the education
and
training of students/trainees undertake at the outset to clarify the respective
roles and accompanying responsibilities. Counsellor/therapist educators
also acknowledge the inherent power and privilege they hold and convey
their commitment to using these advantages to enhance the experience of
supervisees/trainees. (See also B8, E7, G9, G13)
G5. Program Orientation
G6. Relational Boundaries
Bo
Counsellor/therapist educators orient students/trainees/supervisees to the
content, sequencing, and requirements, and expectations of the program, including all supervised practice components (both simulated and real). Any
requirements or expectations related to self-disclosure and personal counselling are communicated prior to admission to the program. (See also E8)
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Counsellor/therapist educators acknowledge the inherent power and privilege imbalances associated with their positions and the influence that these
exert on their relationships with students/ trainees/supervisees. Counsellor/
therapist educators therefore exercise care and caution in establishing such
relationships and ensure that appropriate relational boundaries are clarified
and maintained. Dual and multiple relationships are avoided unless justified
by the nature of the activity, limited by time and context, and entered into
by the parties involved only after assessment of the rationale, risks, benefits, and alternative options. (See also B8, E7, I2)
Ka
G7. Confidentiality
Counsellor/therapist educators honour the confidentiality of information
obtained about students/trainees/supervisees, subject to any safety-related
exclusions and mandatory reporting requirements discussed during the
orientation and/or informed consent process. Students/trainees/supervisees
are apprised in advance of any limits to confidentiality related to policies
for assessment, feedback, evaluation, and performance reporting. (See also
B2, E5, E8, I7)
G8. Self-Development and Self-Awareness
Counsellor/therapist educators encourage and facilitate the self-develop-
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APPENDIX A
ment and self-awareness of students and trainees to help promote ongoing
integration of personal insight with professional practice. (See also E11, I3,
I8)
G9. Dealing with Personal Issues
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Counsellor/therapist educators are attentive to any indicators that learning
activities have evoked significant psychological and emotional distress for
students/trainees/ supervisees. They recommend referrals to other helping
professionals or resources when warranted and do not engage in providing counselling to those for whom they hold administrative or evaluative
responsibility. (See E10, G4)
G10. Self-Growth Activities
Bo
Counsellor/therapist educators, trainers, and supervisors ensure that any
learning experiences requiring self-disclosure and participation in selfgrowth activities are managed in a manner consistent with the principles of
informed consent, confidentiality, and safeguarding against harmful effects.
(See B4, E10)
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G11. Sexual Contact with Students and Trainees
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Counsellor/therapist educators do not engage in intimate contact of a
romantic and/ or sexual nature with current students/trainees/supervisees.
They embark on such relationships with former students/trainees/supervisees only after thoughtful and thorough consideration of the potential
influence of power and privilege imbalances and the potential for perceived
or actual pressure or coercion, lack of objectivity, exploitation, and harm.
(See A10, A11, B12, E7)
G12. Sexual Intimidation or Harassment
Counsellor/therapist educators are attentive to any potential for sexual
intimidation
or harassment of students/trainees/supervisees, including unnecessary
queries related to gender identity, sexual orientation, and sexual behaviour.
They do not engage in
nor ignore sexual intimidation or harassment, which may be evidenced
directly or indirectly, in person or using technology (including, but not restricted to, social media, text messaging, email transmission, and telecommunication). Counsellor/therapist educators promote prevention through
education and expressed expectations and take an active role in interven-
APPENDIX - A
435
tion when concerns arise. (See also A11, B12, E7)
G13. Scholarship
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Counsellor/therapist educators promote and support engagement in scholarly activities such as research, writing, publishing, and presenting. When
collaborating with students/ trainees/supervisees on such activities, counsellor/therapist educators only take credit for their own work and give credit to students/trainees/supervisees commensurate with their contributions.
(See also D10, G4)
G14. Establishing Parameters of Counselling/Therapy Practice
Bo
Counsellor/therapist educators confirm that students/trainees/supervisees
inform clients of their status as students/trainees/supervisees and take steps
to ensure that boundaries of competence and appropriate parameters of
practice are honoured. (See also A3, B16)
H. Use of Electronic and Other Technologies
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Recent decades have witnessed global growth in technology-based, electronic, and online communication. This expansion of technology in both
personal and professional domains has been accompanied by developments in the counselling/therapy profession. Programs and services may be
assisted, supported, or delivered by technology. For example, counselling/
therapy may involve synchronous approaches such as phone conversations
or online meetings, and asynchronous approaches such as text and email
correspondence, any of which may take place across vast distances.
Ka
Foundational ethics for the counselling/therapy profession remain at the
cornerstone of all actions; however, counsellors/therapists face additional
considerations when utilizing technology for administrative and/or therapeutic purposes, including public health and privacy acts.
H1. Technology-based Administrative Functions
As part of the informed consent process, counsellors/therapists indicate to
clients at the outset of services whether digital records will be kept. If electronic record-keeping is to be implemented, counsellors/therapists ensure
that digital security measures necessary to protect client confidentiality and
privacy are in place (e.g., encryption, firewall software). (See also B2, B4,
B6, B7, E2)
436
APPENDIX A
H2. Permission for Technology Use
H3. Purpose of Technology Use
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Counsellors/therapists seek client informed consent prior to using Internetbased communication with clients (e.g., email, texting, and related forms of
digital communication). Counsellors/therapists take necessary precautions
to avoid accidental breaches of privacy or confidentiality when using Internet-based- communication devices and apprise clients of associated risks.
(See also B4, B6, E2)
Bo
Counsellors/therapists clarify under which circumstances and for which
purposes technology-based-communication will be used (e.g., setting up
appointments, counselling/therapy sessions, record-keeping, billing, assessment, third-party reporting) and they review their related policy as part of
the informed consent process with clients. (See also B4)
H4. Technology-based Service Delivery
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When technology-based applications are incorporated as a component of
counselling/ therapy programs and services, counsellors/therapists ensure
that (a) they have demonstrated and documented competence through
appropriate and adequate education, training, and supervised experience;
(b) necessary digital security measures are in place to protect client privacy
and confidentiality; (c) technology applications are tailored or matched to
unique client concerns and contexts; (d) research evidence supports the efficacy of the technology for the particular purpose identified; (e) decisions
to implement new and emerging technologies that are not yet accompanied
by a solid research foundation are based on sound clinical judgment
and the rationale for their selection is documented; (f) client preparedness
to use
the specific technology-based application is assessed and education and
training are offered as warranted; and (g) informed consent is tailored to
the unique features of the technology-based application being used.
In all cases, technology-based applications do not diminish the responsibility of the counsellor/therapist to act in accordance with the CCPA Code of
Ethics and Standards
of Practice, and, in particular, to ensure adherence to the principles of
confidentiality, informed consent, and safeguarding against harmful effects.
(See also A3, B2, B4, C1, C5)
H5. Technology-based Counselling/Therapy Education
APPENDIX - A
437
Counsellor/therapist educators who use technology to provide or enhance
instruction in fully online or blended counselling/therapy programs have
demonstrated competency in this mode of delivery through their education,
training, and/or experience.
H6. Personal Use of Technology
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In their use of social media and related technology in their personal lives,
counsellors/ therapists monitor the style and content of their communication for ethical congruity and professionalism. They attend to privacy/security features, continue to honour client confidentiality, demonstrate respect
for and valuing of all individuals, and represent themselves with integrity.
(See also B2, G2)
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H7. Jurisdictional Issues
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Counsellors/therapists who engage in the use of distance counselling/supervisionǂ, technology, and social media within their therapeutic practice understand that they may be subject to laws and regulations of both the counsellors’/therapists’ practicing location and the client’s place of residence.
Counsellors/therapists ensure that clients are aware of pertinent legal rights
and limitations governing the practice of counselling/supervisionǂ across
provincial/territorial lines or international boundaries. (See also A5)
I. Indigenous Peoples, Communities and Contexts
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This section is designed to focus on ethical constructs related to counsellors/therapists working with Indigenous Peoples, communities and
contexts. It is based on the premise that counsellors/therapists approach Indigenous Peoples, communities and contexts from a place of humility and
not-knowing. It is based on being respectful of the unique history of the
land now known as Canada. It is designed as CCPA’s initial response to the
Truth and Reconciliation Commission’s Calls to Action in relation to ethics
and standards of practice. CCPA recognizes that this section is a first step
in the journey of a shared understanding that requires the involvement of a
grassroots, Indigenous community-driven exploration of Indigenous-based
ethics in order to inform the ongoing development of a national Codes of
Ethic and Standards of Practice for the Association.
There are multiple situations in which counsellors/therapists may be
involved with Indigenous Peoples, their communities and contexts. The
importance of recognizing and acknowledging the unique history, present-day echoes of that history, and ongoing experiences of Indigenous
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APPENDIX A
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Peoples is critical to respectful and supportive work. Also of importance is
the mindfulness of counsellors/therapists in acknowledging the diversityǂ
of Indigenous Peoples, communities and contexts in Canada and the degree
to which clients may or may not have lived experience of their culture and
language. Counsellors/ therapists must also be attentive to clients who may
identify as Indigenous but are not from lands now known as Canada. All
counsellors/therapists acknowledge the unique historical trauma as well as
the resiliency and persistent cultural vibrancy of Indigenous Peoples and
communities. (See also A12, B9, B10, C6, Section D, E12)
I1. Awareness of Historical and Contemporary Contexts
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Counsellors/therapists understand the impacts of the helping profession in
contributing to the historical, political, and socio-cultural harms endured
by Indigenous Peoples in Canada. Counsellors/therapists seek knowledge
to understand and articulate the effects that colonization has on Indigenous
Peoples. (See also A1, A2, A7, A12, B1, B9, E12, F4, I3)
I2. Reflection on Self and Personal Cultural Identities
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Counsellors/therapists reflect on and understand their own identity (social/
self-location) as it relates to the shared Canadian history of colonialism and
the impacts therein. They explore issues of internalized racism, unexamined privilege, questioning assumptions and previous learning. (See also
A12, B1, B9, C10, E12, G6)
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I3. Recognition of Indigenous Diversity
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Counsellors/therapists recognize that although Indigenous Peoples within
Canada may share values and beliefs and exhibit similarities in cultural
practices, it is crucial to acknowledge Indigenous diversityǂ at individual,
community, and Nation levels. This diversityǂ precludes pan-Indigenous
assumptions about cultural teachings, identities, and practices. The onus
is on counsellors/therapists to proceed from a stance of not knowing and
openness to exploring. (See also A2, A3, A12, B1, B9, C6, C10, D1, E12,
G8, I1)
I4. Respectful Awareness of Traditional Practices
Counsellors/therapists seek to become familiar with shareable traditional
teachings, values, beliefs, approaches, protocols and practices relevant to
Indigenous communities with which they are involved. (See also A1, A3,
A7, A12, B1, B9, E6, E12, G1, G2)
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I5. Appropriate Participation in Traditional Practices
I6. Strengths-Based Community Development
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Counsellors/therapists seek clarity and confirmation through the use of cultural guides to determine when it is appropriate for them as to participate in
or otherwise engage with traditional Indigenous approaches and practices.
They proceed only with the express agreement of recognized traditional
teachers, Indigenous Elders, and healers (where appropriate) and with attention to the ethical consideration of both clinical and cultural boundaries
of competence. (See also A3, A4, A7, A12, A13, B1, B8, B9, E12, F1, G2)
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Counsellors/therapists seek to understand and acknowledge the strengths,
resilience, and resources within Indigenous communities. They support and
contribute to programs and services that promote community development.
(See also A12, B1, B9, D1)
I7. Relevant Cross-Cultural Practice
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Counsellors/therapists recognize that relevant cross-cultural practices have
limitations. Prior to use, they consider the advantages and disadvantages of
using such practices. Counsellors/therapists seek culturally appropriate education and training, consider the potential results of using such practices,
and collaborate with clients in determining use or applicability. (See also
A3, A7, A12, Section B, Section C, Section D, G2)
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I8. Relationships
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Counsellors/therapists seek to build relationships with Indigenous Communities that are based on mutual benefit, respect, and cultural humility. (See
also A7, A12, B1, B8, B9, B13, B14, C10, D1, D2, D10, E1, E3, E5, E8,
E12, G8)
I9. Culturally Embedded Relationships
Counsellors/therapists understand the distinct cultural and ethical differences of dual relationships, multiple relationships, gifting, and Traditional
Knowledge keeping. Cross- cultural contexts take priority over rule-based
contexts in these cases. Counsellors/ therapists thoughtfully consider
cross-cultural contexts when engaging in ethical decision-making and seek
consultationǂ and supervisionǂ as warranted to ensure culturally appropriate
outcomes. (See also A2, A4, A7, A12, B1, B8, B9, B10, B14, D1, E7, E12)
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I10. Appropriate Use
I11. Honouring Client Self-Identification
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Counsellors/therapists acknowledge and honour the understanding that
when working with members of Indigenous communities, the adoption or
incorporation of Indigenous perspectives, knowledge, artifacts, story making, research, and historical discoveries, must first serve and be approved
by the Indigenous community(ies) from which such ideas originate. (See
also A2, A3, A4, A7, A12, A13, Section D)
Glossary of Terms
Clinical supervision
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Counsellors/therapists consider Indigenous peoples within the context of
their culture and history, dependent upon the client’s wishes to identify
with and participate in their own cultural practices. Counsellors/therapists
encourage the client to direct the level of cultural involvement or talk within the therapeutic session. (See also A2, A12, B1, B9)
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Clinical supervision refers to a formal arrangement between a clinical
supervisor and supervisee to embark on a supervisory relationship and
process. Reciprocal informed consent commences with the development
of a supervisory plan/agreement/contract and includes discussion of the
proposed supervision schedule (e.g., anticipated dates, session duration,
supervision period); fees (if applicable, including payment and collection
processes); learning goals and objectives; roles, rights, responsibilities,
and requirements of each party; assessment, formative and summative
feedback, evaluation, and reporting processes; procedures to follow in the
event of a client emergency (including alternate contact if the supervisor is
not available); avenues for resolving any conflict between the supervisor
and supervisee; remedial processes; and plans for transfer of supervision
records in the event of supervisor relocation, retirement, incapacitation, or
death.
Consultation
Consultation is an arrangement between professionals in which the consultant provides
a service, such as sharing of skills, providing opinion on a case, problem
solving, and brainstorming but the professional receiving the consultation
has the right to accept or reject the opinion of the consultant. A consultant
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does not take on the legal responsibility or liability for decisions made by
the therapist. Consultation also may be undertaken as a formal arrangement
with fee requirements.
Diversity
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Diversity refers to various differences which include but are not restricted
to: age and generation, sex, gender, biological heritage/genetic history,
ethnicity (includes culture; individual may identify multiple ethnic affiliations), cultural background (shared beliefs, practices, traditions), geographic history, linguistic background, relational affiliation/ orientation, religion/
spirituality, educational status, occupational status, socioeconomic status,
mental health, physical health, physical (dis)ability, sensory impairment
and/or (dis)ability, learning differences and/or (dis)ability, intellectual (dis)
ability, historical issues of prejudice, discrimination, oppression, collective
trauma, etc., current issues of prejudice, discrimination, oppression, collective trauma.
Fiduciary Duty
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A duty to act for someone else’s benefit, while subordinating one’s personal interests to that of the other person.” (Black’s Law Dictionary, https://
thelawdictionary.org)
Mandated Client
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Involuntary clients, or mandated clients are those who come to treatment
under the coercion of a legal body or pressure from significant others,
family members and institutions such as child protective services (Rooney,
2009; Regehr & Antle, 1997; Pope & Kang, 2011; Trotter, 2006).
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