Ethics: Issues in the Mental Health Profession

Michael W. Nettles, D.Min., M.Ed., LPC, LCPC, CCDP, MAC

DC Mental Health Counselors Association (DCMHCA)2014 Spring ConferenceUniversity of District of Columbia

Course DescriptionThis training is designed to allow participants to become familiar with issues and ethics in the helping professions.

Participants will be provided with a framework and a direction for working through ethical dilemmas

Participants will become familiar with ethics for helping professionals according to the AMHCA Code of Ethics

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Ethical Codes

Ethical codes are not intended to be blueprints for resolving every ethical dilemma; nor do they remove all need for judgment and ethical reasoning.

Formal ethical principles can never be substituted for an active, deliberative, and creative approach to meeting ethical responsibilities (Pope & Vasquez, 2007)

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Common Themes of Codes of Ethics (Koocher & Keith-Spiegel, 2008)

Promoting the welfare of consumers

Practicing within the scope of one’s Competence

Doing no harm

Protecting client’s confidentiality

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Common Themes of Codes of Ethics

Acting ethically and responsibly

Avoiding exploitation

Upholding the integrity of the profession by striving for aspirational practice

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Limitations of Codes of Ethics(Herlihy & Corey, 2006a; Pope & Vasquez, 2007; Herlihy & Remley, 1995)

Simply learning the ethics codes and practiceguidelines will not necessarily make for ethicalPractice

Practitioners who belong to multipleprofessional associations, licensed by theirstate and hold national certifications, may beresponsible to practice within the framework ofnumerous codes of ethics, yet these codes maynot be uniform 6

Limitations of Codes of Ethics

A practitioner’s personal values mayconflict with a specific standard within anethics code

Codes may conflict with institutionalpolicies and practices

Codes may not align with state laws orregulations regarding reporting requirements 7

The AMHCA Code of Ethics

AMHCA’s Code of Ethics is intended to be a guide to dothe following: Assist members to make sound ethical decisions To define ethical behaviors and best practices for

association members

To support the mission of the association

To educate members, students and the public atlarge regarding the ethical standards of mental healthcounselors

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The AMCHA Code of Ethics

Seven Main Sections

I.Commitments to ClientsII.Commitments to Other ProfessionalsIII.Commitments to Students, Supervisees and EmployeesIV.RelationshipsV.Commitments to ProfessionVI.Commitments to PublicVII.Resolution of Problems

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Ethics Codes and the Law

All of the codes of ethics state that practitioners are obligated to act in accordance with relevant federal and state statutes and government regulations

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Ethics and Law I. A. 2. c. Confidentiality The release of information without consent of the

client may only take place under the most extremecircumstances: the protection of life (suicidality or homicidality)child abuse, and/ or abuse of incompetent personselder abuse.

Above all, mental health counselors are required to comply with state and federal statutes concerning mandatedreporting.

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Ethics and Law

I. A. 2. d. ConfidentialityMental health counselors make every attemptto release only information necessary to complywith the request or valid court order.

Mental health counselors are advised to seek legal advice upon receiving a subpoena in order torespond appropriately.

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UnethicalWhen the word unethical is used, people think of

extreme violations of established codes. In reality, most violations of ethics happen quite inadvertently in clinical practice.

The best method of practice is to ask yourself, “Is what I am doing in the best interest of my client?” “Would my professional organization agree?”

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Transference

The process whereby clients project onto their therapists past feelings or attitudes they had toward significant people in their lives.

If therapist are unaware of their own dynamics, they may miss important therapeutic issues when they should be helping their clients to understand and resolve the feelings they are bringing into the present from their past.

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Counter-Transference

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Counter-TransferenceCounter-transference is a situation in which a therapist,

during the course of therapy, develops positive or negative feelings toward the patient.

These feelings may be the therapist's unconscious feelings that are stirred up during therapy and directed toward the patient..

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Counter-Transference IssuesBeing overprotective with a client

Treating clients in kind ways that goes beyond the norm

Rejecting a client

Seeing yourself in your clients

Developing sexual or romantic feelings

Developing a social relationship with clients 17

Exploitive RelationshipsI. A. 4. a., b.

a) Romantic or sexual relationships with clients are strictly prohibited. Mental health counselors do not counsel persons with whom they have had a previous sexual relationship.

b) Mental health counselors are strongly discouraged from engaging in romantic or sexual relationships with former clients. Counselors may not enter into an intimate relationship until five years post termination or longer as specified by state regulations. Documentation of supervision or consultation for exploring the risk of exploitation is strongly encouraged.

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Exploitive Relationships (cont’d)

1A. 4.d. Personal Values

Mental health counselors are aware of their own values,attitudes, beliefs and behaviors, as well as how these apply in a society with clients from diverse ethnic, social, cultural, religious, and economic backgrounds.

Value imposition refers to counselors directly attempting to influence a client to adopt their counselor’s values, attitudes, and beliefs, and behaviors.

It is possible for mental health practitioners to do this either actively or passively. 19

Value Sharing? “Is it possible for you to disagree with a client's values and still

accept him or her as a person?”

“Is the purpose of counseling to teach values to clients or to teach clients how to discover their own values?”

“What is the difference between exposing or imposing your

values on clients?”

“Is it ever justifiable for you to impose your values on clients? What about those situations in which you are convince that the client's values will result in self-destructive behavior?”

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Role of Spiritual and Religious Values

A counselors role is not to prescribe a particular pathway to clients in fulfilling their spiritual needs, but to help clients clarify their own pathway.

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Addressing Sexual Orientation

1973 the American Psychiatric Association stopped labeling homosexuality, a sexual orientation in which people seek emotional and sexual relationships with same-gendered individuals, as a form of mental illness

1975, the American Psychological Association endorsed this move by recommending that psychologists actively work to remove the stigma that had been attached to homosexuality

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Addressing Sexual OrientationCounselors understand that attempting to change the

sexual orientation or gender identity of LBGT clients may be detrimental, and further, such a practice is not supported by research and therefore should not be undertaken

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Confidentiality

Confidentiality I. A. 2. a. Confidentiality is the heartbeat of relationship

building and client confidence in the counseling process

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ConfidentialityConfidentiality, which is rooted in a client’s right to privacy, is at the core of effective therapy.

“It is the counselor’s ethical duty to protect private client communication” (Wheeler & Bertram, 2008, p.65)

Obtain and document your client’s consent before disclosing.

Respond ethically to legal requests for disclosure25

Duty to Warn and to Protect

Mental health professionals driven by the courts, have come to realize that they have a dual professional responsibility:

1. Identify those clients who are likely to do physical harm to third parties

2. Protect third parties from those clients judged potentially dangerous.

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Duty to Warn Duty to warn applies to those circumstances where case

law or statute requires the mental health professional to make a reasonable effort to contact the identified victim of a client’s serious threats of harm, or to notify law enforcement of the threat.

Tarasoff

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Duty to ProtectDuty to protect applies to situations where the

mental health professional has a legal obligation to protect an identified third party who is being threatened.

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HIV/AIDS Related IssuesThe HIV+ duty to protect decision is one of the more controversial and emotion-laden issues practitioners might encounter.

For practitioners who work with persons who are HIV+, the choice is often between protecting the client-therapist relationship and breaching confidentiality to protect persons at risk of infection.

This situation can put practitioners in a moral, ethical, legal, and professional bind.

State laws differ regarding HIV and the limits of confidentiality and the law is often different for medical professionals than for licensed psychotherapists. 29

HIV/AIDS Related Issues

Some states forbid any disclosure of HIV status to third parties.

Some states allow some disclosure to at-risk third parties by physicians and psychiatrists, but not by other mental health professionals.

Some states prohibit psychotherapists from warning identifiable victims of persons who are HIV-positive.

Other states have yet to address this issue by statute 30

HIV/AIDS Related Issues

Therapists need to keep current with regard to relevant medical information related to the transmission of HIV, know which sexual practices are safer and which are not, and encourage their clients to practice safer sex

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Confidentiality and HIV/AIDS Related IssuesI.A.2.n. Contagious, Life-Threatening Diseases

Mental health counselors may justify disclosing information to identifiable third parties if clients disclose that they have a communicable or life threatening illness.

However, prior to disclosing such information, mental health counselors must confirm the diagnosis with a medical provider.

The intent of clients to inform a third party about their illness, and to engage in possible behaviors that could be harmful to an identifiable third party, must be assessed as part of the process of determining whether a disclosure should be made to identifiable third parties.

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Tarasoff Decision

California Supreme Court “1976”A failure to warn an intended victim was professionally irresponsible

When a therapists determines “that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger”

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Bartering

Bartering - Exchanging goods or services in lieu of a fee

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BarteringI.E. 2.b. BarteringAccepting goods or services for professional services can open the door to misunderstandings, perceived or actual exploitation, boundary violations, and reduced effectiveness as a clinician.

Although bartering is not prohibited by ethics or law, most legal experts frown on the practice.

Mental health counselors usually refrain from accepting goods or services from clients in return for counseling services because such arrangements may create the potential for conflicts, exploitation and distortion of the professional relationship.

However, bartering may occur if the client requests it, there is no exploitation, and the cultural implications and other concerns of such practice are discussed with the client and agreed upon in writing. 35

Gift Giving

When determining whether or not to accept a gift from clients, counselors take into account the following:

The therapeutic relationship

The monetary value of a gift

The client’s motivation for the gift

The counselor’s motivation for wanting or declining the gift

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Steps In Making Ethical Decision Making

Identify the problem or dilemmaIdentify the potential issues involvedReview the relevant ethics codesKnow the applicable laws and regulationsObtain consultationConsider possible and probable courses of actionItemize the consequences of various decisionsChoose what appears to be the best course of action

(Barnett & Johnson, 2010)37

•Vignettes

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Counselor Responsibility and Integrity1.C.1. a-nCompetence is both an ethical and a legal concept. From an ethical perspective, competence is required of

practitioners if they are to protect and serve their clients.

From a legal standpoint, incompetent practitioners are vulnerable to malpractice suits and can be held legally responsible in a court of law

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Competence - 1.C.1.a-n

Even though mental health professionals may not intend to harm client, lack of competence often is a major contributing factor in causing harm.

Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.

Provide only those services and use only techniques for which they are qualified by education, training, or expertise.

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SummaryProfessionals are required to engage inongoing study, education, training, and consultation in their areas of practice.

A practitioner’s level of competence can diminish over time, which is a rationale for continuing education.

Failure to maintain one’s competence is considered “practitioner decay”

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References American Mental Health Counselors Association,

2010 American Counselors Association, 2014 NAADAC Code of Ethics, 2011

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AMCHAAmerican Mental Health Counselors Association 801 N. Fairfax Street, Ste. 304 Alexandria, VA 22314 V: 800-326-2642 F: 703-548-4775 www.amhca.org

Note: AMHCA revises its Code of Ethics every fewyears, but it does not follow a predetermined schedule. The current 2010 version will be revised within the nextseveral years.

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ACAAmerican Counseling Association5999 Stevenson AvenueAlexandria, VA 22304counseling.org • 800-422-2648 x222

Note: The 2014 ACA Code of Ethics was approved bythe Governing Council at its meeting at the ACAconference held in Honolulu, Hawaii.

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NAADACThe Association for Addiction Professionals1001 N. Fairfax Street, Suite 201Alexandria, Virginia 22314800.548.0497 • 703.741.7686Fax 800.377.1136 • 703.741.7698naadac.org.

Note: Revised March 28, 2011

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Thank you..

Michael W. Nettles D.Min., M.Ed., LPC, LCPC, CCDP, MAC Community Outreach Services, Inc.6215 Greenbelt Road, Suite 206College Park, MD 20740mwnettles@yahoo.com

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