Chuck Holt, Ph.D., MFT, LCADC
Jennifer Dustin, M.A., NCC, MFT
Intern, CADC Intern
“[Ethics] grades from a consciousness of a duty
nearly as strong as positive law, to a feeling that the
matter is all but a question of personal choice. . . .
[It] is the domain of obedience to the
unenforceable. That obedience is the obedience of
a man to that which he cannot be forced to obey.
He is the enforcer of the law upon himself.”
-John Fletcher Moulton, 1924
 NAC 641C (for CADC/ LADC/LCADC):
 NAC 641A (for MFT/ CPC):
 NAC 641B (for MSW):
What if the
ethical codes
and statutes
-- Does law trump ethics?
--The safest bet is to go with
whichever is more stringent.
 Bruff v. North Mississippi Health Services, Inc. (2001)
Bruff made clear to her employer (an EAP) that she was unwilling to provide
counseling to clients in any area which conflicted with her religious beliefs.
Bruff was ultimately terminated after having been provided due process by
the EAP; she filed a federal suit on the grounds of discrimination.
The court determined that an employer is not mandated to adapt to such
rigidity, and took a stance on the potential harm to clients.
 Ward v. Eastern Michigan University (2010)
Grad student dismissed from program due to refusing to treat a same-sex
couple, citing a religious conflict.
The court sided with EMU due to the clarity of university policy against
discrimination, and the programs stated incorporation of ACA / CACREP
 Keeton v. Augusta State University (2010)
Grad student made anti-gay statements in class.
Refused remediation plan, which intended to increase her clinical ability to
treat clients without imposing personal values (NOT to change her mind…)
• Ethical code violations occur in each case, and the judgments
have been in favor of the institutions’ obligation to those codes.
• ACA (2005) asserts that counselors must do no harm (A.4.a.) and take
steps to avoid imposing their own values on clients (A.4.b.).
• Additionally, “Counselors do not condone or engage in discrimination
based on age, culture, disability, ethnicity, race, religion/spirituality,
gender, gender identity, sexual orientation, marital status/partnership,
language preference, socioeconomic status, or any basis proscribedby
law” (C.5., p.10).
• These cases all referred to ACA, however other codes reflect
similar philosophies.
• NAADAC principles: 1 (nondiscrimination), 8 (preventing harm), and 9
(duties of care)
• AAMFT principles: 1.1 (nondiscrimination), 1.8 (respect clients’ rights to
make life decisions)
• NASW sections: 1.01 (commitment to clients),1.05 (cultural competence
and social diversity)
Traditional ideas of a
A line to be crossed… one
side is acceptable, and the
other is…??
Crossing vs. Violating
What’s the difference?
Motives, behaviors,
therapeutic considerations
THE HIGHWAY METAPHOR – Rules of the road
THE BRIDGE METAPHOR – Two sides finding a
way to connect
agreed upon meeting space
* Austin, W., Bergum, V., Nuttgens, S., & Peternelj-Taylor, C. (2006). A re-visioning of boundaries in
helping relationships: Exploring other metaphors. Ethics & Behavior, 16(2), 77-94.
 Typically refers to any relationship occurring outside of the
therapeutic context
 What do the codes say?
AAMFT – Avoid dual relationships when possible; take precautions if you
NAADAC – Attend to the power differential; avoid dual relationships
which pose any threat of harm to clients and others; do not accept
“substantial” gifts.
NASW – Avoid dual relationships when possible; take precautions if you
 They all agree: NO SEX!! Romantic relationships are
prohibited… Time lines? Ex-clients?
Personnel in a
• Things to consider:
• Security (e.g. encryption software, virus protection, HIPAA)
• Legal ramifications of practicing across state lines
• Contact licensing board in your state, client’s state, and get legal counsel.
• Confirm coverage with your malpractice insurance
• Informed consent
• Must address security issues, risks, benefits, etc.
• Face-to-face first session for assessment and review of consent docs
• Back-up plan for emergency contact, and if technology is not working
• Resources for practitioners
• Online Therapy Institute ( offers
resources and information for online practitioners.
• American Distance Counseling Association:
• Distance credential & ethics:
Reeves, A. (2011, Sept/Oct). Therapy and Skype. Family Therapy Magazine, 10(5), 48-49.
Shallcross, L. (2011, Oct). Finding technology’s role in the counseling relationship. Counseling Today, 54(4), 26-35.
 Carefully consider the risks and benefits of being “friends” with
current or former clients, and family/friends of clients.
 Apply privacy settings – even allowing “friends of friends” to
view your page puts you at risk.
 Avoid accepting friend requests from unknown sources.
 Do not include personal information on your page such as birth
date, physical address, phone number, etc.
 Address boundaries about Facebook communication as part of
the informed consent process.
 Carefully screen which photos you post.
 Be judicious about which clubs or fan pages you join – others on
these pages can access your info.
 Do not engage in work-related discussion in an online forum.
* Parrish, K. & Friedman, J. C. (2011). Counselors, clients, and Facebook: To friend or not to friend? Counselor, 12(1), 10-13.
A – attitudes the support or facilitate violence;
antisocial tendencies
C – capacity to act (mental, physical)
T – thresholds crossed (pathway to violence)
I – intent (specific plan, means, commitment)
O – others’ reactions (is the client justified?
N – noncompliance with risk reduction
Borum, R. & Reddy, M. (2001). Assessing risk in Tarasoff situations: ACTION.
Behavioral Science Law, 19, 375-385.