Ethical Issues In Counseling With Children And Adults
Ethical issues in counseling generally fall on the therapist, and navigating situations that may cause marriage cognitive dissonance can be particularly challenging in maintaining professional standards. This means that it is the therapist’s responsibility to avoid unethical interactions with clients.
Common ethical issues in counseling
This article will take a closer look at what the therapist’s ethical responsibilities entail and examine some common ethical problems faced by mental health professionals.
Maintaining boundaries
The most common ethical issue faced by mental health professionals is maintaining boundaries. At times it can be difficult to ensure that you are not developing a personal relationship with a client. Sometimes clients may blur or attempt to blur the lines because of how the therapist-client relationship develops. For example, a client might form a strong attachment to their therapist who appears to be more than professional. It is important for the therapist to maintain and re-establish boundaries as needed.
Therapists also should not counsel someone who they know personally or are personally connected to, even if the connection is removed, such as the parent of one of their child’s friends.
Professional ability
Therapists are generally best trained in certain areas of therapy. A specific therapist may be skilled in working with children, helping people with marriage problems, or using specific types of treatment such as cognitive-behavioral therapy. It is essential that a therapist only provide the therapy that they have been trained to provide. For example, according to the American Psychological Association’s “Ethical Principles of Psychologists and Code of Conduct”, psychologists are to provide mental health care “only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience”. If a client needs a different type of therapy, it is the therapist’s ethical responsibility to help the client find someone else, or at least let the client know that they need to find someone else.
Personal problems
Therapists are responsible for maintaining a standard of professionalism. They must keep their personal and professional lives as separate as possible. This can be difficult in some instances, and mental health professionals are only human. This means that things will happen in their lives that may affect their ability to be an effective counselor for their clients. When these things happen, the therapist must find a way to work through the issue at hand.
If a therapist can separate their personal problems from their professional life and carry on with their work, they can do so ethically. If they are unable to do so, then they must take a leave or otherwise remove themselves from situations where they are responsible for counseling others. A therapist in the middle of a contentious divorce, who has recently lost a loved one, or who is experiencing addiction should seek out professional help for themselves. They should take a break from counseling clients if their ability to counsel effectively is impaired.
Respecting client differences
Clients come from different backgrounds, walks of life, and cultures. A mental health professional is required to respect all differences and to maintain a level of professionalism and courtesy with those who have different backgrounds, thoughts, beliefs, and feelings from their own. If the therapist is unable do this for any reason, they should seek out professional training until they are able to do so.
Getting the authorities involved
In certain situations, however, a therapist is required to get the authorities involved. Depending on the state in which a therapist practices, this may include when a client presents an immediate risk to themselves or others. In rare events, they may even have to warn another party if they have reason to believe their client is going to harm that person. For example, according to the American Psychological Association, psychologists can information to “safeguard the client/patient, psychologist, or others from harm”.
Therapists are also required to report suspected child and elder abuse and neglect. Laws vary by state, so if you have specific questions, you can check with your state’s licensure board for mental health professions or talk to your own therapist.
If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.
Maintaining their role according to APA’s code of ethics
A therapist is intended to help an individual (or sometimes a group or couple) reach healthy decisions on their own. Mental health professionals are to facilitate the decision-making process for the participant and ensure there is informed consent before they work with clients. The American Counseling Association’s Code of Ethics provides the following ethical guidelines regarding informed consent: “Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor”.
Maintaining therapy
Once therapy begins, the therapist is required to continue working with that client as long as the client is benefiting from treatment and wishes to continue. If the therapist discontinues services, it could be considered abandonment.
This does not mean, however, that the client dictates all aspects of the therapeutic relationship. The therapist could need to change hours, move, or have a host of reasons that would make it too difficult to continue therapy with the client. When this is the case, the therapist needs to give the client notice and provide the client with appropriate referrals so treatment is not disrupted.
Provide proper testimony
In some situations, a therapist may be called on to give expert testimony in a court case or a custody battle. In these situations, it is important that the therapist provide accurate and complete testimony about what they have found and report only the facts. Staying focused on specific clinical information and assessments is imperative. The therapist should never have a vested interest in any particular outcome from this type of testimony.
Ethical dilemmas in managing a team of therapists
If the therapist in question is responsible for an entire office or a group of therapists, they must monitor what those other therapists are doing. They need to pay attention to whether the other therapists in their facility are also maintaining the ethical guidelines discussed in this article. If they’re not, the therapist in charge would be responsible for issuing reprimands, requiring additional training, or removing specific therapists from their positions. If they don’t, this could be considered an ethical violation.
Proper billing procedures
What does billing have to do with ethics? In fact, there is an important connection. Therapists, just like anyone else who bills for an office call or hourly appointment, are responsible for proper billing. Whether they are billing a client directly or an insurance company, they must make sure that they bill only for the services that are provided and accurately account for the time that is spent on a visit. These types of billing responsibilities help maintain ethical standards. For example, the American Psychological Association has guidelines for ethical dilemmas regarding billing that include how fees should be represented, records maintained, and compensation agreed upon.
Working with a mental health professional
When working with a therapist, keep in mind the above ethical standards that your therapist must maintain. Whether you meet with an in-person or online therapist, the ethical standards remain the same. Asking your therapist about their licensure, how many hours of experience they have, their billing process, or anything else that pertains to your treatment should be accepted and answered by your therapist. If your therapist seems less than forthcoming, it might be time to consider seeking a new therapist who is more open.
BetterHelp provides therapy
You may ask, "Are there child counselors near me?" If you are seeking online professional counseling and aren’t sure where to turn, you can log on to BetterHelp. You’ll be able to find a mental health professional who can talk to you about anything you’re experiencing at a time convenient for you. You can also do it from the comfort of your own home. The counselors are licensed, and all possess at least three years and 2,000 hours of hands-on experience.
Takeaway
What are the most common ethical issues in counseling?
Statistics reporting the most common ethical violations in counseling are limited. They often vary by region and with time, so it's difficult to determine which is the most frequent at any given time. One study published in 2019 reported that from 2010-2014, the most frequent types of counseling ethical issues across state licensing boards included "failure to acquire the appropriate amount of continuing education, dual relationships (sexual and nonsexual), and misrepresentation of credentials."
Other ethical and legal violations include:
- Breach of information
- Billing fraud
- Misrepresentation of credentials
- Failure to comply with licensing requirements
- Boundary crossing
What is the APA code of ethics regarding a therapist treating family members?
It is widely considered unethical for a therapist to treat their family members or close friends. This is typically called a dual relationship and violates the American Psychological Association's (APA) code of conduct.
What is non-maleficence in a therapy?
Non-maleficence in counseling refers to the obligation of a counselor to do no harm to their client, their family, or other third parties. Examples of maleficence in counseling include:
- Using a specific therapeutic intervention, even though it might harm the patient
- Abusing client information by threatening to reveal potentially damaging personal details as a form of blackmail
- Taking sexual advantage of an emotionally vulnerable client
- Demeaning a client during a session
How do mental health professionals deal with resistant clients?
How a therapist may choose to work with a resistant client often depends on the type of resistance they're presenting and what the therapist deems is in their best interest. However, there are some core strategies that therapists can practice when confronted with a resistant client:
Remain calm
Instead of becoming reactive, many therapists practice mindfulness to become grounded in the moment and create space to think before they respond. This might include paying attention to the emotional and physical sensations they're experiencing, such as the release of adrenaline, heart palpitations, confusion, fear, or anger. Practicing breathing techniques like box breathing can also help calm the fight-or-flight reaction in the moment.
Practice empathy
Validating a client's feelings and seeking clarification in their own words can help counselors diffuse challenging encounters in therapy. They might use phrases like: "If I understand correctly, you're feeling ____. Is that right?" It might also be helpful for the therapist to tell the client they're sorry that something they said or did has made them angry, they don't believe that therapy is helpful, they don't perceive that the therapist is competent, etc.
Establish boundaries
While a therapist may express empathy and acknowledge the client's feelings, they must also draw boundaries about what is and is not acceptable—for example, shouting, swearing, or making threats. Some difficult clients might skip sessions or refuse to pay for them. In all cases, establishing clear boundaries can help a counselor manage a resistant client.
Explore the resistance
Counselors can use difficult or resistant behavior as a means for better understanding their clients. For example, if a client is rude and insults their counselor, the counselor might ask them to talk more about what they are thinking or feeling that lead to their actions. For clients who fight treatment or refuse to participate, a therapist might first remark on their tenacity and resolve and then ask where they think those strong traits originated.
Maintain perspective
When faced with a resistant client, it can be easy to become fixated on the client's behavior. Instead, some therapists consider how to use that behavior to their advantage. For example, it might help remind them why they became a counselor in the first place or learn how the experience can help them grow as a counselor and develop strengths they might use in their personal life.
Seek support from peers
Sometimes, sharing stories about demanding clients (without revealing information that might present ethical and legal issues) can help counselors feel validated and know that they aren't alone in those types of experiences.
Is it okay for a therapist to hug a client?
It is only okay for a therapist to hug a client if the client initiates the hug or asks for one. However, in most cases, therapists will avoid hugging a client altogether.
What are the most common boundary violations in counseling?
The Society for Psychotherapy defines boundary violation as "a departure from accepted practice that places the client or the therapeutic process at serious risk." Common boundary violations include having an inappropriate relationship with a client, revealing delicate information to the client for any purpose other than assisting the therapeutic process, accepting gifts from clients, or engaging in social contact outside of appointments.
Why are boundaries important in counseling?
Boundaries are an essential part of ethics in counseling. Counselors are responsible for maintaining professional boundaries to ensure they act in their client's best interests. Boundaries are also important because they:
- Provide a sense of safety for both the client and the counselor.
- Help maintain a professional relationship, ensuring the focus remains on the client's needs and goals.
- Build trust between the counselor and client.
- Help maintain the secrecy of the counseling relationship.
What are therapists not allowed to share?
Therapists are never allowed to share information about their clients' identities, details about treatment, or things that clients share in sessions. There are a few exceptions to this rule:
- If the client is a danger to themselves or others
- If the therapist suspects the client is committing abuse towards a child, elder, or other individuals who may be dependent on them for care
- If they are served with a court order
Therapists aren't allowed to share details about their own personal lives with a patient unless it's necessary, relevant, or beneficial for treatment. They aren't allowed to share anecdotal information about a client with another client.
What are ethical dilemmas counseling?
According to the APA's code of ethics, unethical counseling refers to behavior that violates one or more of the ethical principles. Ethical considerations listed in the code include:
- Beneficence and non-maleficence: Counselors strive to benefit their clients and take care to do no harm. They aim to promote client well-being and minimize any potential harm resulting from their actions.
- Fidelity and responsibility: Counselors strive to establish and maintain trust in their professional relationships by upholding professional standards of conduct. They are responsible for their decisions and actions and must act with integrity and honesty in all aspects of their work.
- Integrity: Counselors strive to be honest, truthful, and accurate when treating clients. Counselors are forbidden to steal, cheat, engage in fraud or deception, or intentionally misrepresent themselves or their work.
- Justice: Counselors strive to treat all individuals equally and fairly, remaining aware of their own biases. They must understand their capabilities' boundaries and honestly examine their expertise's limits.
- Respect for people's rights and dignity: Counselors must respect all individuals' dignity, autonomy, and rights. They strive to safeguard and promote the rights and well-being of their clients to ensure all individuals are treated with respect, sensitivity, and compassion. Counselors should remain aware of and consider their clients' diverse backgrounds, needs, and characteristics and strive to provide inclusive, available services to all.
What are some therapist red flags?
Although therapists are bound to the ethical principles established by the APA, not every therapist adheres to them and provides the best care possible. Some red flags your therapist might not be ethical or competent include:
- They don't make their credentials available to clients, or you can't find them when you search your state's licensing board websites
- They behave unprofessionally. For example, they're consistently late to appointments, overshare details of their own lives in sessions, or treat you with disrespect in any way
- They have a lack of boundaries and push you to extend your relationship beyond counselor/client roles, share information you aren't comfortable talking about, or giving gifts to their clients to form a personal relationship outside of treatment
- They violate your boundaries or that of other patients. They don't provide you with Health Insurance Portability and Accountability Act documents detailing informed consent for treatment.
- They behave in exploitive or abusive ways, such as making threats, using inappropriate language, shouting or speaking in a hurtful way, or otherwise demeaning you.
- They overcharge or charge you for services they didn't deliver. Unethical billing practices might also include double-charging you or misrepresenting your medication prescriptions.
- They have limited or outdated knowledge in relevant areas.
They try to dominate or control you. This may take the form of bullying, intimidation, dismissing or invalidating your feelings and experiences, or manipulation.
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