Diploma in Counseling-Ethics

Diploma in Counseling
2020
CO-IHP-101:Issues and Ethics in the
Helping Professions
• Introduction
• Professional ethics
• The counselor as a Person and as a Professional
• The values and the helping relationship
• Multicultural perspectives and diversity issues
• Client rights and counselor responsibilities
• Confidentiality, ethical and legal issues
• Managing boundaries and multiple relationships
• Professional competence and training
• Issues in supervision and consultation
• Issues in theory and practice
• Ethical issues in couples and family therapy
• Ethical issues in group work
• Ethical issues in community work
Introduction
Concept of Boundaries
• A sense of personal identity and self definition that
has consistency and cohesion over time.
• This remains constant regardless of emotional ups
and downs or external pressures.
• The framework within which the worker-client
relationship occurs.
• Provides a system of limit setting
• The line between the self of client and self of worker
Why Talk About Boundaries?
• Reduces risk of client exploitation
• Reduces client anxiety as rules and roles are
clear
• Increases well-being of the worker
• Provides role model for clients
Who Negotiates Boundaries?
• Duty of the worker to act in the best interest
of the client
• The worker is ultimately responsible for
managing boundary issues
Why the Worker?
• Worker is the professional!
• Clients may not be aware of the need for
boundaries or able to defend themselves
against boundary violations
• There is an inherent power imbalance
between worker and client- worker is
perceived as having power and control
What are Some Examples of Boundaries?
Clear Boundary Areas:
• Planning social activities with clients
• Having sex with clients
• Having family members or friends as clients
A Client Should Not Be Your:
• Lover
• Relative
• Employee or Employer
• Instructor
• Business Partner
• Friend
Strictly prohibited by the Social Work Code of Ethics

Areas Where Boundaries May Blur:
• Self disclosure
• Giving or receiving significant gifts
• Dual or overlapping relationships
• Becoming friends
• Physical contact
What are some other areas where
boundaries may be blurred?
Danger Zones
• Over-identification with client’s issues
• Strong attraction to client’s personality
• Strong physical attraction to client
• Clients who can potentially reward you with
their influence
• Transference and counter transference
Questions to ask in Examining Potential
Boundary Issues:
• Is this in my client’s best interest?
• Whose needs are being served?
• How would I feel telling a colleague about this?
• How would this be viewed by the client’s family or
significant other?
• Does the client mean something ‘special’ to me?
• Am I taking advantage of the client?
• Does this action benefit me rather than the client?
Appropriate Boundaries
Reduce
Risk of Client Exploitation
Exploitation
• Use of professional relationship to promote or
advance our emotional, financial, sexual,
religious, or personal needs
• Stems from the inherent power differential
and the ability we have to exert influence on
the client
A Closer Look at Exploitation:
• Client may actually initiate and be gratified by the
exploitation- they may enjoy feeling ‘special’ or being
‘helpful’
• Can be subtle and vary from promoting excessive
dependency to avoiding confrontation because we
enjoy the adoration of our clients
• Using information learned professionally from the
client for personal gain
Increases in
“Dual Relationship”
Situations
Dual Relationships
• When you have more than one role with a
client
• Such relationships can blur boundaries
• This ‘blurring of boundaries’ increases the risk
of exploitation as roles can become confused
Important Note:
Most cases of sexual exploitation or other

ethical violations began with a step into a
seemingly innocent dual relationship*
*Taylor Aultman
Not All Client Interactions are Dual
Relationships:
• Running into a client at a social event
• Your client is your waiter at a restaurant
• How you participate in the interaction will

determine the outcome
Some Dual Relationships are Unavoidable
• You and a client belong to the same church

• A client lives in your neighborhood
• Your agency hires clients as staff or utilizes
clients as volunteers
Dealing with Unavoidable
Dual Relationships
• Open and honest discussion with client on the
nature of your relationships
• Separate functions by locations- work, home,
etc.
• Be aware of threats to confidentiality
• Understand your role as professional
Group Exercise
A client, who is a mother of three latency age
children, is facing the breakup of her marriage. She is
very concerned about how her children will respond,
what steps she can take to minimize the disruption to
their lives, and how she will manage financially with
the reduced income. The social worker relates her
own experience of divorce and the parenting issues
which followed.
A social worker and client both agree to
terminate services. After several years the
worker sees the client at a shopping mall. The
client offers to take the worker to the food court
for lunch to show appreciation for all the help
provided during their treatment sessions.
You have a client who recently started his own
small tax accounting business. He has shared
with you that the business is struggling and he
does not know what he will do if the business
fails. The client asks to prepare your taxes this
year.
You have a client who is an independent artist
and he brings you a gift of his artwork. The
client gathers the materials for his art from
salvage around town.
You and your family are attending a home game.
As you are walking to the stadium a client
recognizes you and offers for you to join her
tailgate party. The client also notices that your
tickets are in the same area of the stadium as
hers.
You work in a large outpatient setting that
employs several social workers. You are
interested in a client waiting to see a
colleague.
You are a social worker in private practice
whose client has just been diagnosed with
a terminal illness. The client is frightened,
crying, and hunched over.
A year after termination, a client calls and
invites you to lunch to catch up on events
that have transpired since the ending of
therapy.
You and a client have similar tastes and
interests. After a year of therapy, you and the
client terminate the professional relationship.
The client expresses gratitude at her progress,
sadness at the ending of the relationship, and
hope that the two of you can become friends
now that therapy has ended.
Minimizing Risk of Exploitation and
Boundary Crossing:
• Be alert to potential or actual conflicts of
interest
Boundary Crossing:
interest
• Maintain supervision or consultation
relationships
Boundary Crossing:
interest
relationships
• Be aware that isolation is often a major factor
in ethical violations
Boundary Crossing:
interest
relationships
• Meet your personal needs in other areas of
your life
Boundary Crossing:
• Be alert to potential or actual conflicts of interest
• Maintain supervision or consultation relationships
• Be aware that isolation is often a major factor in
ethical violations
• Meet your personal needs in other areas of your life
• Relationship should focus on client at all times
Boundary Crossing:
ethical violations
• A clear understanding of ethics and attention to
professional boundaries
Professional ethics
PROFESSIONALISM AND
ETHICS
Professional Codes
Kultgen – Chapter 10
Meaning: Professional Ethics
1. Norms required by the moral point of view for
the kind of work (a rational ethic)
2. Common norms actually followed by most
professionals
3. Common elements of codes of professional
associations
4. Prospective compact between the professions
and society (represents convergence of the first
three)
Evaluating Codes of Conduct
• Social functions – Actual consequences that explain
the existence of rules, practices, and institutions
• Human functions – Consequences of possible rules,
practices, and institutions for human welfare that
would warrant their observance or support from the
moral( IS THE PRINCIPLE OF RIGHT AND WRONG
BEHAVIOURS) point of view
Social Functions of Professional Codes
• The social functions of codes are

ideological – promote the profession and
impute loyalty to the institution
• Codes are instruments of persuasion – to
both the profession and the public they
serve
• Ethical codes are notably missing in
business professions, other than
accounting
Social Function
• Common values are enhanced

• Codes may be used among members for
disciplinary reasons
• The disciplinary utility of codes is limited because
enforcement mechanisms are weak
• Professions use codes to instill trust in the public
(we must be ethical, just look at our code)
Social Function
• Codes are often used to persuade society that
the profession deserves status and autonomy
Human Functions
• To guide practitioners who have not thought
through moral issues, but are not desired to
eliminate the need for personal judgment
• An ideal code is consensual, rationally valid,
and accepted by both the members and public
Food for thought
• Can a code be an effective tool of
morality(morality is the standard of society
used to decide what is right or wrong
behavior) and a good public relations tool at
the same time?
Semantics of a Code
• Codes are texts that communicate ideas,
express attitudes, and direct behavior
• They should be clear, precise, unequivocal
• They should be internally consistent (one
can tell which provisions take priority)
• Do most codes meet these criteria?
Criticisms of Codes
• Promote superiority of the male
• Vague
• Do not provide explicit definitions
• Do not address whether the primary purpose is to serve
the individual or society
• Address “confidentiality”, but do not explain what that
covers
• Do not have a tight “logical structure”
• Often assign priority to legalities over client interest, but
only hint at ethical principles
Should a rational code of professional ethics
be supplemented with a legal code?
Do we really want professional conduct to be
legally regulated beyond the statutes
already in place for negligence, fraud,
breaches of contract, etc.
Questions?
Should a rational code of professional ethics

be supplemented with a legal code?
Do we really want professional conduct to be
legally regulated beyond the statutes
already in place for negligence, fraud,
breaches of contract, etc?
Characteristics of an Effective TRS
THERAPEUTIC RELIALISATION SCALE
• Self-awareness
– Must know themselves, their values & needs
– Must know own strengths & growth areas
• Ability to communicate
– Verbally
– In writing
Characteristics of an Effective TRS
• Knowledge base (TRS)(Therapeutic realization
scale)
• Strong belief in recreation & leisure
• High ethics
• Commitment to civil rights
Characteristics of an Effective
Therapeutic Realization Scale
• Self-confident vs. timid
• Timely vs. tardy ( DELAYING BEYOND THE EXPECTED TIME)
• Pro-active vs. procrastinator( Is a person who habitually
puts off doing things)
• Courteous vs. insensitive
• Respectful vs. disrespectful
• Professional vs. unprofessional
• Integrity vs. unreliability or dishonesty
• Personal responsibility vs. blames others
Characteristics of an Effective
Therapeutic Realisation Scale
• Positive regard(concerning/protective
interest) for client
• Empathetic
• Flexible
• Others..
– Depends on author
How professional are you now?
• Strengths
• Growth areas
What are ethics?
• Statements of what is right or wrong, which
usually are presented as systems of valued
behaviors & beliefs
• Serve the purpose of governing conduct
– Jacobson & James, 2001
What are ethics?
• Involves study of what is morally good & bad,
right & wrong regarding human behavior
– Sylvester, Voelkl, & Ellis, 2001
• Standards of behavior
• Govern conduct
• How you should act or behave
Clinical Ethics
Clinical ethics is defined as the systematic
identification, analysis, and resolution of
ethical problems associated with the care of
particular patients.
• The concern is with moral dilemmas that
confront all health care professionals. (ATRA,
1998)
Code of Ethics
• Written list of values & standards of conduct
of a group
• Framework for decision-making
• Are normally general statements
• Do not give specific answers to every possible
dilemma that might arise
Professional Ethics
• System of conduct to guide the practice of a
specific discipline
• Applied ethics
• Professional & societal expectations that
those who practice TR have a duty to practice,
behave & act in an ethical manner
Personal Ethics Influenced By…
• Faculty/mentors
• Internship supervisors
• Professional codes of ethics
• Textbooks & professional materials
• Colleagues
• Family & friends
• Religious & moral influences
Therapeutic Realization & Ethics
• Most professions have 1 code of ethics
• Therapeutic Realization has how many?
– ATRA
– NTRS (previously)
– ITRS (perhaps other state organizations)
– NCTRC
TR & Ethics
• ATRA code does not have enforcement
procedures
• CTRS’ violation of professional ethics can be
sanctioned by NCTRC
– Misconduct standard
– Gross or repeated violations
– Suspension
– Revocation of certification
ATRA Code of Ethics (2009)
• Principle 1 & 2 both deal with protecting from harm
• Principle 1:Beneficence
– Practitioners maximize benefits to the client and minimize possible
harm.
– Taking action to remove the patient/client from harm
• Principle 2: Non-Maleficience
– Use knowledge, skills, abilities & judgments to help persons while
respecting their decisions & protecting them from harm
– Not inflicting harm
• Principle 3:Autonomy
– Respect the individual's right of CHOICE.
– Respect the decisions of legally appointed
guardians / advocates if client is incapacitated
• Principle 4:Justice
– Access to services must be available to all. There must be fairness in
distribution of service based on individual need.
– Consider race, creed, orientation, gender, etc.
• Principle 5:Fidelity
– Tell the truth, the whole truth and nothing but the truth. Do what you
say you are going to do.
– Meet commitments
– Secondary obligation is to colleagues, agency, & professions
• Principle 6: Veracity
– Should be truthful and honest
– Deception, by being dishonest or omitting what is
true should be avoided
• Principle 7: Informed Consent
– Services should be based on mutual respect and shared decision
making
– Provide information about service, benefits, outcomes, length of
treatment, expected activities, & limitations
– Provide information about professional’s training & credentials
– Information provides so person can decide to accept treatment
• Principle 8:Confidentiality and Privacy
– Always respect people's privacy and always be confidential with regard
to patient care.
• Principle 9:Competence
– Continually take steps to attain, maintain, and expand your
competence in Therapeutic Recreation practice.
– Demonstrate current competence
– Maintain credential
• Principle 10:Compliance with Laws and
Regulations
– Know the laws governing the profession and the
population served.
• E.g. The Rehabilitation Act of 1973
• ADA
• IDEA
• OSHA
• Patient Bill of Rights (by end of 1999)
Ethics & Confidentiality
• Assume all information is confidential & may
not be shared
• Unless
– Specific permission is obtained
• Or
– Clients pose danger to selves
– Clients request release of information to 3rd party
– Court orders
Ethics & Confidentiality
• Don’t make promises
you can’t keep
• Tell clients about times
& conditions when
information will be
shared
• Impact on professional
relationship
Decision-Making Model for Ethical
Situations
• Step One: Identify the Behavior
– What is the behavior, action, or decision at question?
• Step Two: Determine Professional Relevance

– Does this pertain to the Therapeutic Realization Scale professional
role?
• Step Three: Differentiate Personal and/or

Professional Ideals and Values
– How are my personal values influencing my professional judgment?
Decision-Making Model for Ethical Situations
• Step Four: Consider Legal Duties

– Is there any law or judicial violation involved in this dilemma?
• Step Five: Assess Ethical Obligations

– Is there a behavior in this dilemma that violates an ATRA Code of
Ethics Principle?
• Step Six: Define Action

– What do I do next?
What should we do?
• Include code of ethics in each
staff’s/volunteer’s/intern’s orientation & in-
service training
• Document code of ethics in written plans of
operation
• Discuss ethical situations in staff meetings
• Attend conference sessions on ethics
The counselor as a Person and as
a Professional
SECTION I:
PROFESSIONAL ORIENTATION
 Chapter 1: The Counselor's Identity: What,

Who, and How?
 Chapter 2: The Counseling Profession’s Past,

Present, and Future
 Chapter 3: Standards in the Profession: Ethics,

Accreditation, Credentialing and
Multicultural/Social Justice Competencies
79
Chapter 1
The Counselor's Identity:

What, Who, and How?
80
Defining Guidance
• Guidance, Counseling and Psychotherapy:

Variations on Same Theme?
• Definitions
– Guidance
– Counseling
– Psychotherapy
• See Figure 1.1, p. 4
81
Comparison of Mental Health Professionals
• The following PowerPoint slides lists a number of

professionals in the field. For each, see if you can
identify the following:
– Major professional organization(s)
– Major roles and functions
– Names and types of credentials
– Names of accrediting body associated with it
82
• Counselors
– School Counselors
– Clinical Mental Health Counselors (Agency Counselors)
– Marriage, Couple, and Family Counselors
– Student Affairs and College Counselors
– Addiction Counselors
– Rehabilitation Counselors
– Pastoral Counselors
83
 Social Workers  Psychoanalysts
 Psychiatric-Mental Health
 Psychologists
Nurses
 Clinical Psychologists
 Counseling Psychologists  Expressive Therapists
 School Psychologists
 Human Service Practitioners
 Psychiatrists
 Psychotherapists
84
Professional Associations in Social Services
• Benefits of:
– National and regional conferences
– Access to malpractice insurance
– Lobbyists
– Newsletters and journals
– Mentoring and networking
– Information on cutting-edge issues in the field
– Codes of ethics and standards for practice
– Job banks
85
• ACA American Counseling Association

– 19 Divisions of ACA (see pp. 12-13)
– Associations Related to ACA
• ACAIT: ACA Insurance Trust
• ACAF: American Counseling Association Foundation
CACREP: Council for the Accreditation of Counseling
and Related Educational Programs
• CORE: Council on Rehabilitation Education
• NBCC: National Board for Certified Counselors
• CSI: Chi Sigma Iota
86
• ACA American Counseling Association (Cont’d)

– Branches of ACA
• 56 Branches
– 50 state branches
– Puerto Rico and Washington D. C.
– Associations in Latin America
– Four Regional Associations in U. S.
– Membership Benefits of ACA (see Bottom of p. 14)
87
• AATA: American Art Therapy Association
• AAMFT: American Association of Marriage & Family Therapists
• APA: American Psychiatric Association
• APNA: American Psychiatric Nurses Association
• APA: American Psychological Association
• NASW: National Association of Social Workers
• NOHS: National Organization for Human Services
88
Characteristics of the Effective Helper
• 9 Common Factors
– 6 “Working Alliance” Empathy
– 3 “other: Cognitive
Complexity
Acceptance
Competence Genuineness
Embracing a Wellness
Compatability with Perspective
and Belief in Theory
Cultural
The "It" Factor Competence
89
The Nine Characteristics
• Empathy
– More than any other component, most related to positive
client outcomes
– See Rogers’ definition, p. 18
– A personal characteristic to embrace
– A skill to learn (Chapter 5 will address this)
90
• Acceptance
– Sometimes called “Positive Regard”
– Foundation for a therapeutic alliance
– An attitude that regardless of what the client says, he or
she will be respected
– Suspension of judgment
– In some manner, almost all counseling approaches stress
acceptance of client and client acceptance of self
91
• Genuineness
• Refers to willingness of the therapist to be authentic,
open, and honest within the helping relationship
• Gelso and Carter: All counseling relationships have to deal
with the “real relationship” between the counselor and
client
• Research on genuineness shows that it may be important
in client outcomes
• May be related to emotional intelligence (ability to
monitor one’s emotions)
92
• Embracing a wellness perspective

– Counselors can easily become stressed, burnt out, have
compassion fatigue, and experience vicarious traumatization
– All of above can lead to countertransference
– Myers and Sweeney suggest attending to:
• Creative Self; Coping Self; Social Self; Essential Self; Physical
Self
• See table 1.1 page 21
– Personal Therapy? (85% of helpers have done it!)
– Other ways?
93
• Cultural Competence
– Clients from nondominant groups are sometimes
distrustful of counselors.
– They are often misunderstood, misdiagnosed, find
counseling unhelpful, attend counseling less frequently,
and drop out more quickly.
– Since culture influences ALL relationships, throughout this
text, and especially in chapters 14 and 15, cultural
competence will be discussed
94
• Cultural Competence (Cont’d)

– For now, consider D’Andrea and Daniel’s RESPECTFUL model:
 R – Religious/spiritual identity
 E – Economic class background
 S – Sexual identity
 P – Psychological development
 E – Ethnic/racial identity
 C – Chronological disposition
 T – Trauma and other threats to their personal well-being
 F – Family history
 U – Unique physical characteristics
 L – Language and location of residence
95
• The “It” Factor

– The unique way that each therapist has of working with
clients.
– Using your unique personality to connect with the client
and build a working relatinoship.
– What is your “it” factor?
96
• Compatibility with and Belief in a Theory

– As counselors, we have to find a theory that “fits” our
personality style
– Helpers are usually attracted to theories that they find
comfortable.
– The more you feel comfortable, like, and understand your
theory, the more you will believe in it.
– Strong belief in a theory helps clients believe in the
helper’s approach and yields better client outcomes
97
• Competence
– Counselor expertise (mastery) has been shown to be a
crucial element for client success in counseling
– Perceived incompetence is often sensed by clients
– Demonstrated through helper’s desire to:
• Join professional associations
• Mentoring and supervising
• Reading professional journals
• Continuing education
• More!
98
• Competence (Cont’d)
 Shown throughout ACA’s ethical code:
1. practicing within one’s boundary of competence
2. practicing only in one’s specialty areas
3. accepting employment only for qualified positions
4. monitoring one’s effectiveness
5. knowing when to consult with others
6. keep current by attending continuing education activities
7. don’t offer services if physically or emotionally impaired
8. assure proper transfer of cases when incapacitated or leaves a
practice (ACA, 2005, Standard C.2)
99
 Cognitive Complexity
 Cognitive complexity means you are a:
▪ Helper who believes in your theory but able to question it
▪ Critical thinker
▪ Helper who views the world from multiple perspectives
▪ Likely more empathic, open, and self-aware
▪ Better able to cure “ruptures” in the counseling relationship
▪ Person who is not seeking “truth”
▪ A person who does seek the best way to help your client
 Hopefully, your program will support you and challenge you to
view situations in new and complex ways.
100
Multicultural/Social Justice Focus
• Inclusion of Multiculturalism in the Profession

– Small number of person from culturally diverse groups
entering counseling profession
– We all need to make the helping professions attractive for
people of color
– To become culturally competent, all counselors must:
1.Learn counseling strategies that work for all clients
2.Work with client s from diverse backgrounds
3.Gain a deep appreciation for diversity
4.Acquire an identity as a counselor that includes a
multicultural perspective
101
Ethical, Professional, and Legal Issues
• Knowing Who We Are and Our Relationship To Other Professionals

– Professional identity gives us a sense of who we are, and who we are not.
• Helps us know:
– how to practice only within our areas of competence
– when to consult with other, related mental health
professionals
– when to refer clients because of our lack of expertise
– when to refer clients due to lack of cross-cultural
knowledge and skills with some clients
102
Ethical, Professional, and Legal Issues
• Impaired Mental Health Professionals

– We have a responsibility to know when an impairment will
negatively affect our clients
– Know to seek help for our problems
– Know when to “limit, suspend, or terminate” work if our
impairment negatively affects others
– Impairment can lead to incompetence
• Incompetence is unethical and can be illegal and lead to
malpractice suitsAa21`a
103
The Counselor in Process
• Personal Therapy and Related Growth Experiences

– Can you understand your client if you have never sat in his
shoes (been in counseling)?
– Counseling prevents countertransference
– Counseling helps you develop as a counselor
– Other ways of growing: prayer, meditation, relaxation
exercises, exercise, reading, other???
– We can grow personally and professionally throughout our
lives
104
The Counselor as a Person & a
Professional
Lecture 2
Steve Zanskas, Ph.D., CRC
Week in Review…
• Understand the difference between law and ethics
• Differentiate between aspirational and mandatory ethics
• Begin to learn about the role of ethics codes in making ethical
decisions
• Introduced to the six moral principles
• Reviewed one model of working through an ethical dilemma
• Involving the client in the ethical decision making process
Informal Survey of Principles
(n=20)
1 2 3 4 5 6
Autonomy 20% 25% 15% 5% 20% 15%
Beneficenc 15% 10% 15% 10% 30% 20%

e
Fidelity 5% 10% 15% 35% 20% 10%
Justice 0% 15% 15% 15% 15% 40%
Non- 40% 10% 25% 15% 10% 0%

Maleficence
Veracity 30% 20% 15% 20% 5% 15%
Case of Kevin
• Kevin informs his counselor that he lost his job
and he will not be able to continue counseling
because of his inability to pay for the sessions.
– Four counselor responses in the text
Models of Ethical Decision Making
• Feminist Model (Hill, Glaser, & Harden, 1995)
– Power should be equalized
– Maximizes client involvement
• Social Constructionist Model (Cottone, 2001)
– Emphasizes the social aspects of decision making in
counseling
– Interactive, consensus driven, negotiation model
Models Continued…
• Transcultural Integrative Model
– Includes cultural factors when resolving dilemmas
– Considers universal principles
• (Garcia, Cartwright, Winston, & Borzuchowska, 2003)

• (Frame & Williams, 2005)
Corey, Corey, & Callanan’s Model
(2007)
• Identify the problem or dilemma
• Identify the potential issues involved
• Review your relevant ethical code
• Know the applicable laws & regulations
• Consult
• Consider the possible and probable courses of action
• List the consequences of the potential decisions
• Decide on what appears to be the best course of action
• Time for a break…
How many agree with these statements?
• “Counselor know thyself…”
• “Counselor heal thyself…”
• It is difficult to distinguish between what is

personal and what is professional.
What are my Motivations for
Becoming a Counselor
• Two critical questions:

– “What are my motivations for becoming a
counselor?”
– “What are my rewards for counseling others?”
Personal Problems & Conflicts
• Should we be aware of our own biases, areas
of denial, unresolved problems or conflicts?
• The critical consideration is not whether you
are struggling with personal issues, but how
you address them.
Professional Therapy
• Do you feel professional therapy should be
required for all counselors?
• Under what circumstances?
– Pre-service
– Post graduate
Professional Therapy for Counselors
A means of increasing your availability to your
clients.
Formal Methods:
– Individual therapy
– Group counseling
– Consultation with colleagues
– Continuing education
– Reading
Professional Therapy for Counselors
continued
• Informal methods include:
– Reflection
– Evaluating the meaning of your work and life
– Remaining open to the reactions of significant others
– Travel
– Meditation
– Spiritual activities
– Exercise
– Time with friends and family
Experiential Learning
• Experiential Learning: a basic component of
many counseling programs that provides
students with the opportunity to share their
values, life expectations, and personal
concerns in a peer group.
– This is not necessarily the same as group therapy.
Experiential Learning continued
• Instructors and/or supervisors need to clarify the line
between training and therapy.
• Students should be informed at the outset of the
program of any requirement for personal exploration
and self-disclosure.
• This informed consent is especially important in
cases where the instructor also functions as the
facilitator of the group experience.
Personal Therapy During Training
• Coster & Schwebel (1997) found that
psychologists favored recommending personal
therapy to all students but not requiring it
unless it appeared to be professionally
necessary.
• Students are more likely to seek personal
therapy when faculty are supportive of such
experience.
Personal Therapy continued
• Few empirical studies in the literature focus

on the benefits or liabilities of personal
therapy.
• The average length of treatment for those
receiving therapy was 1.5 years.
Personal Therapy continued
• The majority of students entered treatment
voluntarily.
• It is both practical and ethical to refer professionals
external to a program for student therapy.
• 8 in 10 clinicians in Newhouse-Session’s study
thought that personal counseling should be
mandated for any person in the counseling
profession.
Reasons for Participating in Personal
Psychotherapy
• The experience of being a client.

• Personal awareness:
– the areas in your life that are not developed
– areas limit your effectiveness
– how these areas affect your professional work
Common Issues that Surface in a Practicum or
Internship
• A tendency to tell people what to do
• A desire to alleviate clients’ pain
• A need for quick solutions
• A fear of making mistakes
• A desire to be recognized and appreciated
• A tendency to assume too much responsibility for client
change
• A fear of doing harm, however inadvertently
• A tendency to deny or not recognize client issues that may
relate to their own issues
Psychotherapy for Remediation
Purposes
• One study found that although personal
psychotherapy was often endorsed as a
remediation, the efficacy of this approach has
not been empirically established.
• Mandated psychotherapy is not always viewed
as an effective intervention.
Ethical Issues in Requiring Personal
Therapy
• The APA (2002) has the following standard on

mandatory individual or group therapy:
– If therapy is a program or course requirement, students
are allowed the option of choosing therapy from outside
professionals.
– The faculty responsible for grading the students do NOT
provide this therapy for the students.
Personal Questions about Therapy
• What kind of self-exploration have I engaged in prior
to or during my training?
• How open am I to examining my own personal
characteristics that could be either strengths or
limitations in my role as a counselor?
• At this time, what am I doing to work through
personal problems?
Ongoing Therapy for Practitioners
• The problem areas most often addressed in personal
therapy:
– Depression or general unhappiness
– Marriage or divorce
– Relationship concerns
– Self-esteem and self-confidence
– Anxiety
– Career
– Academics
– Family-of-origin issues
• According to Mahrer (2000), “It seems sensible that
if therapists truly have faith in some of the methods
they use in their professional work, they would use
these methods on and for themselves in their
personal lives.”
Transference
• Transference is the process whereby clients project onto their
therapists past feelings or attitudes they had toward
significant people in their lives
• Transference: the “unreal” relationship of therapy
– Counselors need to be aware of their personal reactions to
a client’s transference
– All reactions of clients to a therapist are not to be
considered as transference
– Ethical issue is dealing appropriately with transference
Issues and Ethics - Chapter 2 (2)

Countertransference: Clinical
Implications
• Countertransference: any projections by
therapists that distort the way they perceive
and react to a client.
• Can be a constructive or destructive element
in the therapeutic relationship.
• Whether the clients stimulated the
countertransference or not, what matters is
how the therapist responds.
Countertransference
• Indicators of countertransference:
– being overprotective with a client
– treating clients in benign ways
– rejecting a client
– needing constant reinforcement and approval
– seeing yourself in your clients
– developing sexual or romantic feelings for a client
– giving advice compulsively
– desiring a social relationship with clients

Stress in the Counseling Profession
• Counseling can be a hazardous profession
• Some sources of stress for counselors are:
– Feeling they are not helping their clients
– The tendency to accept full responsibility for clients’
progress
– Feeling a pressure to quickly solve the problems of clients
– Having extremely high personal goals and perfectionistic
strivings

Counselor Impairment
• Impaired counselors have lost the ability to resolve stressful events and
are not able to function professionally
• Shared characteristics of impaired counselors:
– fragile self-esteem
– difficulty establishing intimacy in one’s personal life
– professional isolation
– a need to rescue clients
– a need for reassurance about one’s attractiveness
– substance abuse

• Ethically, what would you do if you felt a
colleague is impaired?
ACA Code: C.2.g. Impairment
• Counselors are alert to the signs of impairment from their own physical,
mental, or emotional problems and refrain from offering or providing
professional services when such impairment is likely to harm a client or
others. They seek assistance for problems that reach the level of
professional impairment, and, if necessary, they limit, suspend, or
terminate their professional responsibilities until such time it is
determined that they may safely resume their work. Counselors assist
colleagues or supervisors in recognizing their own professional
impairment…
ACA Code & Self Care
• Section C Professional Responsibility: Intro
• Counselors have a responsibility to
the public to engage in counseling
practices that are based on rigorous
research methodologies. In addition,
counselors engage in self-care activities
to maintain and promote their
emotional, physical, mental, and spiritual
well-being to best meet their professional
responsibilities.
Maintaining Vitality as a Counselor
• Counselors are often not prepared to maintain their vitality
• Sustaining the personal self is an ethical obligation
• Personal vitality is a prerequisite to functioning in a
professional role
• Main challenge is to create a balanced life:
– Spirituality - Self-direction
– Work and leisure - Friendship
– Love

The values and the helping
relationship
Introduction To Helping Relationships
PowerPoint produced by Melinda Haley, M.S., New Mexico State University.
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Helping Relationships
Dimensions of the Helping Relationship
Within the relationship the helpee may feel:
Trusted Confronted
Safe Not judged
Important Listened to
Respected Valued
Understood Accepted

What can the helper do to enhance the relationship
– Be warm and encouraging

– Show strength and confidence
– Be consistent and dependable
– Model honesty and integrity
– Restrain your own personal needs
– Resonate with what you sense is going on
– Be open to change within the relationship
– Stay flexile
– Respond therapeutically
– Show caring and understanding

Stages in Helping
Building the Working Alliance
– Who is to be included? Is this family therapy? Will someone other than

the helpee be there?
– Have a distraction free environment. Have a quiet place that facilitates

openness and discussion where there is enough space to sit facing
each other.
– Give your undivided attention. With body posture, eye contact, facial
expressions etc., let the helpee know you are fully present.

Stages in Helping
Building the Working Alliance (continued)
– Focus your concentration. Do not disassociate and start thinking

thoughts unrelated to the helpee or the helping process.
– Show warmth and caring. Be real, don’t play the “role” of the helper.
– Listen and not just with your ears but with your senses and your whole
being.

Stages in Helping
– Find out expectations and desires. What does the helpee expect you
can do for him or her? What does he or she expect from the helping
process?
– Discuss ground rules. What are the parameters of the relationship?

Have these been make clear? What are the goals to be worked on?
How much time will it take?
– Learn about the person. Get to know him or her from his or her point of
reference.

Stages in Helping
– Don’t ask too many questions. Listen more than you talk. Ask open
ended questions (e.g. questions the helpee can’t answer with a yes or
a no).
– Reflect back what you understand. Try to re-state in your own words
what the helpee has expressed in both content and feeling.
– Your job is not to fix the problem. Your role is to build a relationship in
which the helpee feels safe enough to explore his or her issues and
then with your guidance and help, come up with his or her own answers.
Stages in Helping
– Ask the helpee how the helping process is going for them. Do they feel
it is helping? What is helping most?
– Assess the level of resistance. Is the helpee reluctant?
– Get a commitment to continue. Help the helpee accept responsibility for

the process and outcomes, commit to working on the problem or issue
between sessions and commit to returning to see you.

Stages in Helping
Facilitating Positive Action
– What changes are needed? What needs to be changed and what

interventions are appropriate to facilitate the helpee’s goals?
– Is there a working diagnosis? Do you have a road map of where the

helpee needs to be heading that will help with intervention planning?
– Have the pertinent issues been explored thoroughly? Has enough

information been collected?

Stages in Helping
Facilitating Positive Action (continued)
– Has transference or countertransference been identified and

addressed? Help the helpee identity and work through these feelings
and work through your own.
– Is confrontation needed? If so, is there enough trust in the relationship

to sustain it?
– Have goals been set? Are these realistic and obtainable? Have they
been prioritized?

Stages in Helping
– What needs to be clarified? What are the helpee’s feelings? Issues?

What skills or resources does the helpee have to deal with these?
– Is there a plan of action? What are the steps that need to be taken to
reach the helpee’s goals?
– How does the “treatment plan” fit with the helpee’s cultural values? Are
you imposing your values or is the plan respectful of the helpee’s culture
and worldview?

Stages in Helping
– How do you terminate the session or helping relationship? Summarize

accomplishments and evaluate progress. Make sure to process
thoughts or feeling regarding the end (of the session or the helping
relationship.)

Uses of the Helping Relationship
Diagnostic Aid:
• The helpee probably acts with you much in the same way he or she
acts with others.
• What are the helpee’s coping and interpersonal styles?
• Is the helpee passive, withdrawn or dependent? Or is the helpee

controlling, obnoxious, or dominant?
• Use the relationship to aid the helpee in identifying patterns that

might not be working as well as they could.

Unfinished Business or Transference
• You will remind the helpee of other people in his or her life and he or
she may transfer unfinished feelings onto you.
• Use this opportunity to help the helpee work through this residual
feelings.

Problem Solving Collaboration
• Model ways of problem-solving.
• Aid the helpee in generating new options for himself or herself.

Brainstorm!
• Help the helpee identify opportunity.

Novel Interaction Experiences
• Aid the helpee in discovering new ways of relating to people.
• Help them be accountable for their behavior.
• Create the opportunity for honesty, openness and caring. The

helpee might not have experienced those things within a
relationship.

Customized Relationships
– The relationship with the helpee will change over the course of the
relationship. The relationship is dynamic.
– Each relationship is dependent upon a multitude of variables that will be

different for each helping experience (e.g. issues, gender, culture,
preferences and needs.)
– As the stages of helping occur the dimensions of the relationship will

reflect that (e.g. trust building, goal setting, limit setting).

How to Resolve Conflicts in the Helping Relationship
– Identify the triggers (What gets you angry or upset).
– Explore the origins of the conflict (When did it start? What is it

about?)
– Examine the issues (Why do you lose control?)
– What can be learned? (How does this reflect other aspects of your
life?)

How to Resolve Conflicts in the Helping Relationship (continued)
– Resist blaming. It takes two to participate in any conflict.
– Commit yourself to change. Do whatever is in your power to do.
– Experiment. Do things differently. Try something new.
– Use a mediator. If you can’t solve it yourself, ask for help.

Introduction to Helping Relationships
Presentation Resources
Brammer, L. M. & MacDonald, G. (1999). The helping relationship: Process and

skills, 7th ed. Needham Heights, MA.: Allyn & Bacon.
Kottler, J. A. (2000). Nuts and bolts of helping, 1st ed. Needham Heights, MA:
Allyn & Bacon.

Becoming A Helper
4th Edition
by Marianne Schneider Corey & Gerald Corey
Wadsworth Group
A division of
Thomson Learning, Inc.
What Are Your Needs as a Helper?
• To what degree do you have the need to

– make an impact – make money
– return a favor – gain prestige and status
– care for others – provide answers
– work on your personal – gain and maintain control
issues (self-help) – variety and flexibility
– be needed
Becoming A Helper - Chapter 1 (1)

Portrait of the Ideal Helper
• Some of the characteristics of a helper who is
making a significant difference are:
– being committed to assessing your strengths and weaknesses
– doing in your own life what you expect your clients to do
– having good interpersonal skills
– recognizing that it takes hard work to bring about change
– welcoming and understanding diversity

Portrait of the Ideal Helper
• Some of the characteristics of a helper who is
making a significant difference (continued):
– being aware of your own problems and monitoring how they influence
your work with clients
– taking care of yourself
– questioning life and engaging in self-examination
– having meaningful relationships in your life
– having a healthy sense of self-love

Factors in Choosing a Career Path
• Recognize that choosing a career path is an
ongoing process rather than a one-time event
• In choosing a career, it is well to consider the
following factors:
– self-concept
– motivation and achievement
– interests
– abilities
– values
Factors in Choosing a Career Path
• Some work values for you to explore include:
– income – family relationships
– power – interests
– prestige – serving people
– job security – adventure
– variety – creativity
– achievement – inner harmony
– responsibility – teamwork
– independence – intellectual challenge
– competition

How to Get The Most from
Your Fieldwork Experience
• There are concrete steps you can take to ensure getting the maximum
benefit from your fieldwork and supervision experiences
• Assume an open stance in learning from your supervisions This can best
be done by:
– being able to ask for what you need
– saying "I don't know" at times
– expressing your reactions
– dealing with yourself and your client in supervision
– being willing to learn from supervisors, without copying their styles
– accepting different styles of supervision
– being assertive without becoming aggressive

Know Thyself, Then Help Others
• The value of self-exploration
– Knowing yourself is a basic requisite to helping
others
– Using individual and group counseling for self-
exploration

Know Thyself, Then Help Others
• Essential that you understand your family-of-origin issues
– Identify issues in your family
– Identify family rules
of origin -- how your experiences
in your family have current – Ways you coped with conflicts in
influences your family
– Become aware of how your – Messages you received from your
issues with your family might family
help or hinder you in working – Significant developments in your
with families family
– Identify your role in your family – Identify areas for further self-
– Review ways you related to exploration
siblings and parents

Life Transitions
• Overview of the nine stages of development
from infancy to old age
– 1. INFANCY: (Birth to age 1) Task is to develop a sense of trust in self,
others, and the environment
– 2. EARLY CHILDHOOD: (Ages 1 to 3) Task is to begin the journey toward
autonomy
– 3. PRESCHOOL AGE: (Ages 3 to 6) Task is to find out who we are and
what we are able to do
– 4. MIDDLE CHILDHOOD: (Ages 6 to 12) Task is to achieve a sense of
industry

Life Transitions
• Overview of the nine stages of development
from infancy to old age
– 5. ADOLESCENCE: (Ages 12 to 20) Task is to search for an identify and
find one’s voice
– 6. EARLY ADULTHOOD: (Ages 20 to 35) Task is to form intimate
relationship
– 7. MIDDLE ADULTHOOD: (Ages 35 to 55) Task is to learn how to live
creatively with ourselves and others
– 8. LATE MIDDLE AGE: (Ages 55 to 70) Task is to decide what we want
to do with the rest of our lives
– 9. LATE ADULTHOOD: (Age 70 onward) Task is to complete a life
review and put life into perspective
Some Key Questions
for Self-Reflection
• What are some major turning points in your
development?
• How have your earlier experiences impacted
your present way of thinking, feeling, and
behaving?
• Are there any ways that you’ve converted your
problems into sources of strength?

The Five Stages of
the Helping Process
• Stage 1: Establishing a working relationship
– Create a relationship that allows client to tell their story
– Create a climate for change
– Establish a working relationship -- make us of basic listening and
attending skills and establish rapport
– Educate clients and obtain informed consent
• Stage 2: Identifying clients’ problems
– Create a therapeutic climate so clients can identify and clarify their
problems
– Strive to understand the social and cultural context of the client's
problem -- and avoid "blaming the victim"
– Conduct an initial assessment
– Identify exceptions to one’s problems

The Five Stages of
the Helping Process
• Stage 3: Helping clients create goals
– Help clients gain a focus -- narrow down the task
– Assist clients to identify specific goals
– Establish and refine goals collaboratively
• Stage 4: Encouraging clients exploration and taking action
– Confront clients with care and respect -- challenging clients is a way of
demonstrating your involvement
– Make use of appropriate, timely, and relevant self-disclosure
– Identify ways to accomplish goals
– Develop and assess action strategies
– Carry out an action program

The Five Stages of
the Helping Process
• Stage 5: Termination
– Help clients bring closure to their work and consolidate their learnings
– Assist clients in developing a plan for continuing the change process on
their own

Understanding Transference
• The following are some common ways that
clients may respond to you:
– Clients who make you into something you are not
– Clients who see you as a super person
– Clients who make unrealistic demands on you
– Clients who are not able to accept boundaries
– Clients who displace anger onto you
– Clients who easily fall in love with you

Dealing with Transference
• Some pointers in effectively dealing with
transference or client reactions to you:
– Be willing to examine your own reactions
– Monitor your own countertransference
– Seek supervision or consultation with difficult
cases
– Avoid blaming or judging the client
– Avoid labeling clients
– Demonstrate understanding and respect

Difficult Clients
or Difficult Helpers?
• Some common problematic behaviors
displayed by clients at times:
– Clients who are sent to you -- involuntary clients
– Clients who are typically silent and withdrawn
– Clients who talk excessively
– Clients who overwhelm themselves
– Clients who often say “Yes, but . . .”
– Clients who blame others
– Clients who deny needing help
– Clients who are overly dependent on you
Difficult Clients
or Difficult Helpers?
• Some more common problematic behaviors
displayed by clients at times:
– Clients who manifest passive-aggressive behavior
– Clients who rely primarily on their intellect
– Clients who use emotions as a defense
• Two things to keep in mind when you are dealing
with difficult behavior manifested by clients are:
– Avoid getting defensive and reacting with sarcasm
– Let clients know how their behavior is affecting you

Values in the Helping Process
• Values are a basic part of any helping relationship
• Examples of basic values that constitute the
foundation of the helping relationship
– assuming responsibility for one’s actions
– developing the ability to give and receive affection
– being sensitive to the feelings of others
– practicing self-control
– finding a sense of purpose and meaning in life
– being open, honest, and genuine
– developing successful interpersonal relationships
Values in the Helping Process
• Some key questions to reflect on
– What is the difference between exposing versus
imposing my values?
– What are the basic values I hold pertaining to the
helping process?
– It is acceptable that my values are showing?
– How can I determine when and how to share my
values with clients?
– What are some areas where I am most likely to
encounter value conflicts with clients?
– How can I best deal with value conflicts?
Potential for
Conflict of Values
• Lesbian, Gay and Bisexual Issues
• Family Issues
• Gender-Role Identity
• Religious and Spiritual Values
• Abortion
• Sexuality
• End-of-Life Decisions

Cultural Diversity
• A multicultural perspective on helping
– Ethical practice implies incorporating a multicultural
perspective in all helping relationships
– The professional codes call for a diversity perspective
– It is essential that helpers become aware of their own
biases, cultural values, and basic attitudes toward
diversity
– Helpers are challenged to identify and overcome
cultural tunnel vision

Cultural Diversity
• Recognize and challenge your cultural
assumptions
– What are your assumptions about:
• self-disclosure?
• family values?
• nonverbal behavior?
• trusting relationships?
• self-actualization?
• directness and assertiveness?

Multicultural Competencies
• Some beliefs and attitudes of culturally skilled
helpers
– Familiarity with your own culture
– Ability to identify your basic assumptions
– Not allowing your bias, values, or problems
interfere with working with culturally different
clients
– Welcoming diverse value orientations
– Monitoring your functioning through consultation
and supervision
• Some areas of knowledge of culturally skilled
helpers
– Understand worldview of clients with different
cultural backgrounds
– Possess specific knowledge of particular individuals
with whom you are working
– Acknowledge your own racist attitudes, beliefs, and
feelings
– View diversity in a positive light
– Know how to help clients make use of indigenous
support systems
• Some skills and intervention strategies of
culturally skilled helpers
– Seek out consultation to help develop necessary
skills
– Use methods and define goals consistent with the
life experiences of culturally diverse client
populations
– Be willing to go outside of the office
– Educate clients about the helping process
Ethical Practice
• Ethical practice requires that you:
– base your actions on informed, sound, and
responsible judgment
– consult with colleagues or seek supervision
– keep your knowledge and skills current
– engage in a continual process of self-examination
– remain open

Role of Professional Codes
• Professional codes :
– educate us about responsibilities
– are a basis of accountability
– protect rights and welfare of clients
– are a basis for improving professional practice

Ethical Decision Making
• Ethical decision-making model:
1. Identify the problem or dilemma
2. Identify the potential issues involved
3. Apply the ethics codes
4. Know the applicable laws and regulations
5. Obtain consultation
6. Consider possible and probable courses of action
7. Explore the consequences of various decisions
8. Decide on the course of action
Informed Consent
• Clients need enough information about the
helping process to be able to make informed
choices
– The informed consent process begins with the
intake interview and continues for the duration of
the helping relationship
• The aim is to involve clients in a collaborative
partnership

Confidentiality
• Confidentiality is a central concept in the client-
helper relationship
– Confidentiality needs to be discussed with clients from
the onset of the relationship
– Confidentiality is essential but is not absolute
– Some exceptions to confidentiality:
• Client poses a danger to self or others
• Client under age of 16 is the victim of abuse
• Client needs to be hospitalized
• Information is made an issue in a court action
• Client requests a release of record
Client Autonomy
• Respecting the client’s autonomy is basic
– Helpers do not make decisions for clients, nor do
they foster dependent attitudes and behavior
– As helpers, your main job is to put yourself out of
business

Ethical Issues in Managed Care
• Five major ethical issues regarding practices of
managed care
– Informed Consent
– Confidentiality
– Abandonment
– Utilization Review
– Competence

Grounds for Malpractice
• Abandoning a client
• Sexual misconduct
• Breaking confidentiality inappropriately
• Failing to respect a client's privacy
• Failing to protect others from a dangerous client
• Practicing beyond one's competence
• Failing to honor a contract with a client
• Failing to provide for informed consent
Ways to Prevent Malpractice Actions
• Make use of informed consent procedures

• Define clear contracts with clients
• Do not practice outside of your competence
• Take steps to maintain your competence
• Document carefully
• Know and follow state and local laws
• Know and follow the codes of ethics
• Respect confidentiality
• Report any cases of suspected child abuse
• Carefully consider bartering arrangements

Ways to Prevent Malpractice Actions
• Keep relationships with clients professional
• Avoid engaging in sexual relationships with clients
• Treat your clients with respect
• Obtain parental consent when working with minors
• Make use of assessment procedures
• Make it a practice to consult with colleagues
• Keep current client records
• Avoid promising clients anything you cannot deliver
• Anchor your practice to a theory
• Abide by the policies of the institution that employs you

Codes on Multiple Relationships
• Codes caution against forming dual or
multiple relationships with clients
• Dual or multiple relationships
– Can be sexual or nonsexual
– Sexual dual relationships, by their nature, are unethical
– Nonsexual dual or multiple relationships tend to be complex
– Maintaining appropriate boundaries is what is essential
– Some dual relationships can be avoided
– Not all dual relationships can be avoided
– Dual or multiple relationships are not necessarily harmful or unethical

When Operating in
More Than One Role
• Avoid combining professional and personal
relationships
• Set healthy boundaries from the outset
• Secure informed consent of clients
• Involve the client in setting the boundaries of
the relationship
• Discuss the potential benefits and risks with the
client
• Seek consultation
• Work under supervision when needed
• Document and monitor their practices
• Refer when necessary
Socializing with Former Clients
• Socializing with former clients is probably
unwise
• Imbalance of power likely never changes
• Helpers need to be aware of their motivations
• Former clients may need helper at a later time
• Helpers need to establish their own
boundaries

Guidelines for Bartering
• Think carefully before engaging in bartering
• Involve the client in the decision making process
• Determine the value of goods or services in a
collaborative fashion
• Consider the cultural context
• Establish specific conditions
• Document the arrangement
• Consult with experienced colleagues or
supervisors
Accepting Gifts
• Questions to consider in making a decision of
whether or not to accept gifts from the client
– What is the monetary value of the gift?
– What are the clinical implications of accepting or
rejecting the gift?
– When in the helping process is the offering of a gift
occurring?
– What are the helper’s motivations for accepting or
rejecting a client’s gift?
– What are the cultural implications of accepting or
rejecting the gift?
Sexual Attractions
• How helpers can deal with sexual attractions
to clients
– Acknowledge the feelings to oneself
– Explore the reasons for the attraction
– Never act on these feelings
– Talk with a colleague or a supervisor
– Seek personal counseling if necessary
– Monitor boundaries by setting clear limits

Working in the Community
• The community approach involves four facets
1. Direct Client Services -- Outreach approach
2. Indirect Client Services -- Client advocacy
3. Direct Community Services – Preventive
education
4. Indirect Community Services – Changing the
social environment

Multiple Roles of
Community Workers
• Helpers need to be able to assume
nontraditional roles if they hope to make an
impact on social systems. These roles include:
– Advocate
– Change agent
– Consultant
– Adviser
– Facilitator of indigenous support systems
– Facilitator of indigenous healing systems
Skills in Mobilizing
Community Resources
• Achieve credibility within the community
• Build on the strengths of the community
• Establish and maintain a personal network
• Assist the community to identify its needs
• Assume responsibility for instigating change
• Address ethical issues in the delivery of
services

Special Populations
• How to work with special populations
– Be aware of your own assumptions, beliefs, and
stereotypes
– Challenge ways society might stigmatize special
groups
– Identify specific populations most in need of help
– Reach out to a target population
– Direct educational efforts toward action programs

Working with Groups
• Group work as a treatment of choice
– Some of the advantages of using groups are
• Groups fit well into the managed care model
• Groups can be brief and cost-effective
• Groups provide a sense of community
• Groups foster interpersonal learning
• Groups have unique healing qualities
• Groups provide a natural place to experiment with change
• Groups provide members with feedback
• Groups allow people to learn from one another
• Groups offer both support and challenge

Working with Families
• Some assumptions of a family systems
approach:
– Client's problematic behavior may serve a function for family
– Dysfunctional patterns may be passed across generations
– Actions by any family member will influence other members
– An individual may carry symptoms for the entire family
– Individuals are best understood within the context of a family system
– Accurate assessment of an individual's problems requires observation
of other family members
– Focusing on individual dynamics without considering dynamics within
a system gives an incomplete picture

Stress for Helpers
• Common individual stressors
– Striving for perfection
– Excessive need for approval
– Self-doubt
– Physical and emotional exhaustion
– Assuming too much responsibility for clients
– Ruminating about cases
• Stresses association with working in
organizations
– Excessive demands of agencies
– Constant paperwork
– Dehumanization and erosion of ideals

Stress and Burnout
• How stress paves the way to burnout
– Stress at work tends to impact your personal life
– Working intensely with people opens you up to your own wounds -- it
reactivates earlier conflicts and pain
– Constant stress that is not managed results in physical and
psychological exhaustion
• Burnout
– There are internal and external causes of burnout
– Chronic burnout can lead to becoming impaired
– You are challenged with recognizing signs of burnout before you
become an impaired practitioner

Take Care of Yourself
• The challenge of self-care for helpers
– There are no easy answers
– Important for you to discover your own path to
keeping alive
– Develop a personal strategy for coping with stress
and dealing with burnout

Cognitive Approaches to Self-Care
• Learn to identify constructive and
nonconstructive beliefs
• Recognize the ways your thinking influences
your behavior
• Challenge distorted beliefs
• Acquire ways to change self-defeating thinking

You Have Control Over Yourself
– Assess your current behavior to see if it is working
– Strive to develop realistic expectations
– Learn practical strategies for managing stress
– Realize you are one person
– Avoid taking on too many projects at once
– Learn time management techniques
– Practice time management strategies
– Find other sources of meaning besides work

You Have Control Over Yourself
– Learn and respect your own limits
– Strive for variety within your job
– Build linkages with colleagues and friends
– Watch for subtle signs of burnout
– Make taking care of yourself a priority
– Treat yourself as you want others to treat you
– Recognize that you can be an active agent in
your life

Multicultural perspectives and
diversity issues
Multicultural Perspectives and
Diversity Issues
Chapter Four
How do you define multicultural?
The Need for a Multicultural Emphasis
• Traditional therapy-western development.
• We are working in an increasingly diverse society.
• All counseling can be thought of as multicultural if
culture is broadly defined to include not only race,
ethnicity, and nationality, but also gender, age, social
class, sexual orientation, and disability (Das, 1995).
Multicultural Terminology
• Multiculturalism • Cultural Empathy
• Cultural Diversity • Stereotypes
• Multicultural Counseling
• Racism
• Diversity
• Diversity-Sensitive
• Unintentional Racism
Counseling • Cultural Racism
• Culture-Centered • Cultural Tunnel Vision
Counseling
• Culturally Encapsulated
• Ethnicity
• Ethnic Minority Group
Multicultural Terminology
• Ethnicity: a sense of identity that stems from
common ancestry, history, nationality, religion,
and race.
• Ethnic Minority Group: a group of people
who have been singled out for differential and
unequal treatment and who regard
themselves as objects of collective
discrimination.
Multicultural Terminology continued
• Multiculturalism: a generic term that

indicates any relationship between and within
two or more diverse groups.
• Cultural diversity: the spectrum of
differences that exists among groups of
people with definable and unique cultural
backgrounds.
• Multicultural counseling: a helping role and process
that uses approaches and defines goals consistent
with the life experiences and cultural values of
clients, balancing the importance of individualism
versus collectivism in assessment, diagnosis, and
treatment.
• Diversity: individual differences such as age, gender,
sexual orientation, religion, and physical ability or
disability.
• Diversity-sensitive counseling: a concept that
includes age, culture, disability, education level,
ethnicity, gender, language, physique, race, religion,
residential location, sexual orientation,
socioeconomic situation, and trauma.
• Cultural empathy: therapists’ awareness of clients’
worldviews, which are acknowledged in relation to
therapists’ awareness of their own personal biases.
• Culture-centered counseling: a three-stage
developmental sequence, from multicultural
awareness to knowledge and comprehension
to skills and applications.
• Stereotypes: oversimplified and uncritical
generalizations about individuals who are
identified as belonging to a specific group.
• Racism: any pattern of behavior that, solely because

of race or culture, denies access to opportunities or
privileges to members of one racial or cultural group
while perpetuating access to opportunities and
privileges to members of another racial or cultural
group.
• Unintentional racism: racism that is subtle, indirect,
and outside our conscious awareness.
• Cultural racism: the belief that one group’s

history, way of life, religion, values, and
traditions are superior to others.
The Problem of Cultural Tunnel Vision
• Many new students in training ONLY know
their own culture.
• Cultural tunnel vision: a perception of reality
based on a very limited set of cultural
experiences.
• Students may misinterpret a healthy response
by the client to the helper’s
cultural/theoretical bias as “resistance.”
Characteristics of the “Culturally
Encapsulated” Counselor
• Defines reality according to one set of cultural
assumptions.
• Shows insensitivity to cultural variations.
• Accepts assumptions without proof for fear of
disproving his/her own assumptions.
• Fails to evaluate other viewpoints and makes little
attempt to accommodate others’ behavior.
• Is trapped in one way of thinking that resists
adaptation and rejects alternatives.
– (Wrenn, 1962 & 1985)
Learning to Address “Cultural
Pluralism”
• Cultural pluralism: a perspective that recognizes the
complexity of cultures and values the diversity of
beliefs and values.
– Learning about your own culture helps you acquire
multicultural competence.
– Self-exploration makes learning about race, cultures, and
experiences of clients a manageable process.
– “Pluralistic” is cited twice in Tennessee Chapter 450 under
Rule 450-1-.01(29) & 450-1-.02(2d) relating to the practice
of a professional counselor or professional counselor as a
mental health service provider
Reaching Diverse Client Populations
• Identify resources in the client’s family and the larger
community and use them in delivering culturally
sensitive services.
• Due to psychology being based on Western
assumptions, the influence and impact of racial and
cultural socialization has not always been
considered.
• Minority clients are underrepresented in mental
health, and many stop coming after 1 or 2 sessions.
Reaching Diverse Client Populations
cont.
• The medical model of clinical counseling.

• Culturally encapsulated counselors may
assume that a lack of assertiveness is a sign of
dysfunctional behavior that should be
changed.
Ethics Codes from a Diversity
Perspective
• Therapists should try to uncover and respect
cultural and experiential differences.
• Counselors are expected to become aware of
their own attitudes and biases that can
interfere with cultural competence.
• Counselors are prohibited from discriminating.
Cultural Values & Assumptions in
Therapy
• Sue & Sue (2003) feel counselors need to include
support systems such as family, friends, community,
self-help programs, and occupational networks in
their perception of mental health practices.
• The diversity-sensitive counseling movement focuses
attention on the problems of discrimination,
oppression, and racism.
– Some believe this movement lacks moderation and tries to
force its agenda on counseling practice.
Western vs. Eastern Values
• Contemporary theories of therapy are grounded in
Western assumptions, yet most view the world
differently.
• Has there been too great of a focus on individualism
and not enough on broader social contexts?
• There is a growing belief that religion and spirituality
need to be included in counseling practice.
Non-Western Values
• Confucian: • Tao-the path or way:
• The middle way • Harmony of opposites &
– Balance
relativity
• An ideal relationship
between human beings • Simplicity
• Reciprocity • Reversal & Cyclicity
– The other person’s reaction • Nonaction
• Sincerity-congruent with – being natural
one’s actions
Non-Western Values
• Hindu-Character of the • Islamic-5 Major Classes of
person over action: Ethics or Acts:
• Dharma- • Forbidden
– Restraint of anger • Undesirable
– Truthfulness of speech – Can be avoided
– An agreeable nature • Neutral
– Forgiveness
– Purity of conduct
• Desirable-not obligatory
– Avoidance of conflict • Good or desirable
• Ahimsa- – Justice
– Benefit
– Noninjury & nonviolent action
– Truthfulness
– Willing good (intentions)
Challenging Professionals’
Stereotypical Beliefs
• “Lack of motivation”
• “Talk therapy”
• Practitioners who counsel clients without an
awareness of their own stereotypical beliefs
can easily cause harm to their clients.
Assumptions about Self-Disclosure
• “Self-disclosure is essential for the therapeutic
process to work”.
– Sharing personal problems in some cultures reflects poorly
on one’s family.
• In many cultures dance, circumlocutions, and rituals
may precede intimate disclosures.
• If your techniques are not working with a client, you
must learn other ways of connecting with this client.
Assumptions about Assertiveness
• It is better to be assertive than to be

nonassertive.
• Asian Americans are often viewed as
nonassertive and passive, but this assumption
has not been supported by research according
to Sue & Sue (1985).
Assumptions: Self-Actualization &
Trusting Relationships
• Many assume that it is important for the client to
become a fully functioning person.
– Counselors may focus on what they feel is best for the
client and forget to think about how this might impact
others in the life of the client.
• Many middle class Americans readily talk about their
personal lives.
• Many Asian Americans, Hispanics, and Native
Americans have been brought up not to speak until
spoken to, especially elders or authority figures.
Assumptions about Nonverbal
Behavior
• Americans tend to feel uncomfortable with silence
and tend to talk to ease their tension.
• Silence may be a sign of respect and politeness in
some cultures.
• Direct eye contact, physical gestures, and probing
personal questions may be seen as offensively
intrusive by clients from another culture.
– Among some Native American and Hispanic groups, eye
contact by the young is a sign of disrespect.
Assumptions about Directness &
Respect
• Western approaches tend to stress directness
– Other cultures directness is perceived as a sign of
rudeness.
• Some cultures prefer to deal with problems
indirectly.
• Deference as a sign of respect in other
cultures outside America.
Addressing Sexual Orientation
• In 1973, the American Psychiatric Association
stopped labeling homosexuality as a form of mental
illness.
• In 1975, the mental health system began to treat the
problems of people who are GLBT rather than
treating them as a problem.
• Mental health professionals who have negative
reactions to homosexuality are likely to impose their
own values and attitudes, or convey disapproval.
Addressing Sexual Orientation
continued
• Serious damage to a client can occur when a
client discloses their sexual orientation well
into an established therapeutic relationship.
• The APA developed a committee on lesbian,
gay, and bisexual concerns and they
developed guidelines for psychotherapy (pp.
128-9).
– The guidelines are relevant to all mental health
professionals, not just to psychologists.
Value Issues of Gay and Lesbian Clients
• Concealing sexual orientation or “coming out.”
• Loss of friends.
• Clinicians who work with gay men need to be
able to talk with their clients about “safe-sex”
practices.
Educating Counselors about the Concerns
of Clients
• Before therapists provide mental health
services to people who are GLBT or their
children, they should complete formal,
systematic training on sexual diversity.
• A study to assess psychologists’ attitudes
toward parenting found that they held
affirming attitudes toward parents who are
gay or lesbian.
Educating Counselors about Concerns of
Clients continued…
• Practitioners post-graduate training topics:

– Coming out
– Family estrangement
– Support system development
– Internalized homophobia
Court Case about a Therapist’s Refusal
to Counsel Gay Clients
• Ms. Bruff was fired by her employer for her refusal to
“counsel anyone on any subject that went against
her religion”.
• She was offered several other job opportunities
within the agency and she turned them down.
• The courts eventually found that she was not
improperly dismissed and that the company made
reasonable attempts to accommodate her religious
beliefs.
The “Bruff” Case continued
• In a counseling relationship, it is not the

client’s place to adjust to the therapist’s
values.
The “Bruff” Case continued
• What is your position?
• Our authors felt that Bruff should have
informed her potential clients in writing about
her religious convictions and moral opposition
pertaining to homosexuality.
– They also question whether she should have had a
position in a public counseling agency given her
inexperience and ineffectiveness working with
diverse client populations.
Matching Client & Counselor
• C.H. Patterson (1996) states that ALL
counseling is multicultural.
– According to him, all clients belong to multiple
groups that influence their perceptions, belief,
attitudes, and behavior.
– This belief allows room for clinicians to effectively
work with clients who differ from themselves in a
number of significant ways.
continued
• Counselors become too analytical about what
they say and do when they are overly self-
conscious about their ability to work with
diverse client populations.
• The more differences between the client and
the therapist, the stronger the need to
collaboratively find meaning and
understanding.
continued
• If there are differences between the client and
the therapist, should the clinician or the client
address this?
– Most clients will not initiate this conversation due
to the power differential between them and the
therapist.
– Therefore, the therapist should directly address
these differences.
continued
• Corey, et. al., (2007) express that the counseling
process is ever-changing, that clinicians must stay
with the client and be led by the client into the most
important areas for him or her.
• Monitor your internal dialogue and use it as part of
the therapy process rather than to strive to discover
the ideal match.
• The most important aspects of culture-centered
counseling can be learned, but not necessarily
taught.
continued
• Pay attention to the voices within you and
within your clients.
• You only hear the spoken content if your
approach is rigid and concrete.
• Unintentional racism can be more dangerous
than those who are more open with their
prejudices.
Signs of a culturally ineffective
counselor
• Being afraid to face the differences between
you and your clients.
• Refusing to accept the reality of these
differences.
• Perceiving the differences as problematic.
• Feeling uncomfortable working out these
differences.
How to Learn to Work with Clients that
Differ from Us
• Be trained in multicultural perspectives, both
academic and experiential.
• Agree with the client to develop a working
therapeutic relationship.
• Be flexible in applying theories and techniques to
specific situations.
• Be open to being challenged and tested.
• Be aware of your own value systems, of potential
stereotyping and any traces of prejudice, and of your
cultural countertransference.
Multicultural Training for Mental
Health Workers
• Referral should not be viewed as a solution to
the problem of inadequately trained helpers.
• You may not have the luxury of referral.
• CACREP standards call for supervised
practicum experiences that include people
from the environments in which the trainee is
preparing to work.
Characteristics of the Culturally Skilled
Counselor
• Understands their attitudes and beliefs about
race, culture, ethnicity, gender, and sexual
orientation.
• Understands his or her own worldview.
• Develops skills, intervention techniques, and
strategies necessary to serve diverse client
groups.
Characteristics of the Culturally Skilled
Counselor continued
• La Roche & Maxie (2003) believe that acquiring
cultural competence is an active and lifelong learning
process, rather than a fixed state that is arrived at.
• Multicultural competencies: a set of knowledge and
skills that are essential to the culturally skilled
practitioner.
• You can find the essential attributes of culturally
competent counselors on pp. 143-144 in our text.
Hermeneutic (Interpretation) Model of
EDM
• An ethical dilemma
• The counselor’s, supervisor’s, & client’s
– values, race, ethnicity, gender, personal history, etc.
• Agency policies
• Geographic region & culture
• Local, state, & federal laws
• Professional codes of ethics
• Professional knowledge
• Ethical theories
– (Houser, Wilcezenski, & Ham, 2006)
Client rights and counselor
responsibilities
Chapter 5
Client Rights and Counselor

Responsibilities
“Nothing can spare us the torment of ethical
decision”(p. 330).
(Jung, 1963)
Questions….
• Which of the moral principles are promoted by
consent?
• What does the kind of consent process say about the
nature of the relationship between the counselor
and client?
• Does obtaining consent promote certain values but
endanger others?
• Can consent damage, if not destroy the value of
certain forms of therapy?
Frequency of Citation in the ACA Code
of Ethics…
• Client Rights
– 5 references
– 2 are in the index
• Counselor Rights or Responsibilities
– No specific citation
ACA Code of Ethics (2005)
• Section B: Confidentiality, Privileged Communication,
& Privacy
• Introduction
– Trust
• Working Alliance
– Ongoing Partnerships
– Establishing & Upholding Boundaries
– Confidentiality
• Communicated in a culturally competent manner
B.1. Respecting Client Rights
• B.1.a. Multicultural/Diversity Considerations
• B.1.b. Respect for Privacy
– When do you solicit private information from clients?
• B.1.c. Respect for Confidentiality
– When do you share client information?
• B.1.d. Explanation of Limitations
– When do you explain?
B.2. Exceptions
• B.2.a. Danger & Legal Requirements
• B.2.b. Contagious, Life Threatening Diseases
• B.2.c. Court Ordered Disclosure
• B.2.d. Minimal Disclosure
Other ACA Code References
• F.1.c. Supervisors make supervisees aware of client rights
including the protection of client privacy and confidentiality in
the counseling relationship. Supervisees provide clients with
professional disclosure information & inform them how the
supervision process influences the limits of confidentiality.
Supervisor make clients aware of who will have access to
records of the counseling session and how these records will
be used.
Case Example
• A voluntary inpatient client on a unit for persons with dual
diagnosis requests discharge. The therapist, does not feel he
is ready for discharge. The therapist talks with his client for
nearly two hours, trying to convince him that he needs further
treatment before he will be able to face the world without
resuming his substance abuse behavior. Finally, the client
relents and agrees to stay.
• Did the therapist act appropriately?
TCA Title 63
Professions of the Healing Arts

TCA
• 63-22-114 Confidentiality:
• The confidential relations and communications between licensed marital
and family therapists, licensed professional counselors or certified clinical
pastoral therapists and clients are placed upon the same basis as those
provided by law between attorney and client, and nothing in this part shall
be construed to require any such privileged communication to be
disclosed. However, nothing contained within this section shall be
construed to prevent disclosures of confidential communications in
proceedings arising under title 37, chapter 1, part 4 concerning mandatory
child abuse reports.
37-1-403. Reporting of brutality, abuse, neglect or child sexual abuse.
(a) (1) Any person who has knowledge of or is called upon to

render aid to any child who is suffering from or has sustained
any wound, injury, disability, or physical or mental condition
shall report such harm immediately if the harm is of such a
nature as to reasonably indicate that it has been caused by
brutality, abuse or neglect or that, on the basis of available
information, reasonably appears to have been caused by
brutality, abuse or neglect.
Signs of Child Abuse
• Wary of physical contact with adults

• Apparent fear of parents or going home
• Inappropriate reaction to injury
• Lack of reaction to frightening events
• Apprehensive when other children cry
• Acting-out behavior to get attention
• Fearful, withdrawal behavior
• Short attention span or learning difficulties
• Regression into earlier stages of development
• Sudden change in behavior
• Fearful reaction to questions about injury
(2) Reporting Requirements by telephone or
otherwise…
(A) Judge having juvenile jurisdiction over the child;
(B) Department, in a manner specified by the department,
either by contacting a local representative of the department
or by utilizing the department's centralized intake procedure,
where applicable;
(C) Sheriff of the county where the child resides; or
(D) Chief law enforcement official of the municipality where
the child resides.
Informed Consent
• Need to be considered within the context of the
therapist’s values, orientation & work setting
(Somberg, Stone, & Claiborn, 1993).
• Therapist’s role in teaching clients.
• What would you include in an informed consent
statement?
– Verbal
– Written
Case of Dottie
• What are the ethical and legal implications of
Dottie’s practice?
• If you were Dottie, what would you have
done?
• Would you have followed up with the client
after he had cancelled?
Checklist for Informed Consent
• Voluntary participation
• Client involvement
• Counselor involvement
• No guarantees
• Risks associated with counseling
• Confidentiality and privilege
• Exceptions to confidentiality and privilege
• Counseling approach or theory
• Counseling and financial records
• Ethical guidelines

Checklist for Informed Consent
• Licensing regulations
• Credentials
• Fees and charges
• Insurance reimbursement
• Responsibility for payment
• Disputes and complaints
• Cancellation policy
• Affiliation membership
• Supervisory relationship
• Colleague consultation

Content of Informed Consent
• The therapeutic process
• Background of therapist
• Costs involved in therapy
• The length of therapy and termination
• Consultation with colleagues
• Interruptions in therapy
• Clients’ right of access to their files
• Rights pertaining to diagnostic labeling
• The nature and purpose of confidentiality
• Benefits and risks of treatment
• Alternatives to traditional therapy*
• Tape-recording or videotaping sessions

What would you put in a professional disclosure
statement?
Contracts?
• Therapeutic, Business, or Both?
• Are contracts necessary to clarify the
therapeutic relationship?
• Verbal?
• Written?
– Detail?
– Emphasis?
Questions about contracts…
• Should the contract specify all techniques?
• What if you as a therapist have personal or moral
problems with the client’s goal?
• How should a therapist respond to a client who does
not want a contract?
– (Hare-Mustin, Marecek, Kaplan, & Liss-Levinson, 1979)
– (Widiger & Rorer, 1984)
– (Bersoff, 2003)
Record Keeping
• What are your feelings about the paperwork involved
with our work?
• Progress Notes
– Required
– Behavioral Language
– Describe Specific Concrete Behavior
• Process Notes
• “If you did not document it, then it did not happen.”
0450-1-.18 MANDATORY RELEASE OF CLIENT
RECORDS.
• (1) Upon request from a client or the client’s
authorized representative, an individual registered
with this board shall provide a complete copy of the
client’s records or summary of such records which
were maintained by the provider.
• (2) It shall be the providers option as to whether
copies of the records or a summary will be given to
the client.
Mandatory record release
• (3) Requests for records shall be honored by the
provider in a timely manner.
• (4) The individual requesting the records shall be
responsible for payment of a reasonable fee to the
provider for copying and mailing of the records.
• Authority: T.C.A. 4-5-202, 63-2-101 and 63-2-102.
TCA 33-3-619. Commitment to involuntary care —
Disclosure of information.
If a commitment to involuntary care and treatment is

entered, the certifying professionals shall disclose to
the hospital, treatment resource, or developmental
center that admits the person on its request
information they have about the person, including
diagnosis, past treatment, and anything else relating
to the person's condition that may aid the facility in
providing appropriate care and treatment.
• [Acts 1983, ch. 323, § 9; T.C.A., § 33-378; Acts 1984, ch. 922, §§ 16, 19; 2000, ch. 947, § 1.]
Special Cases…
• Involuntary Commitment
• Managed Care
• School Counselors
– Administrative v Clinical
• Records Retention
– How Long?
– Retirement
– Death
33-6-401. Emergency detention. —
IF AND ONLY IF:
(1) a person has a mental illness or serious emotional
disturbance, AND
(2) the person poses an immediate substantial likelihood of
serious harm under § 33-6-501 because of the mental illness
or serious emotional disturbance,THEN
(3) the person may be detained under § 33-6-402 to obtain
examination for certification of need for care and treatment.
• [Acts 2000, ch. 947, § 1.]
33-6-403. Admission to treatment facility. —
Involuntary Commitment
(3) the person needs care, training, or treatment because of
the mental illness or serious emotional disturbance, &
(4) all available less drastic alternatives to placement in a
hospital or treatment resource are unsuitable to meet the
needs of the person,THEN
(5) the person may be admitted and detained by a hospital or
treatment resource for emergency diagnosis, evaluation, and
treatment under this part.
– [Acts 2000, ch. 947, § 1.]
ACA Code-A.12. Technology Applications
• A.12.a. Benefits and Limitations
• A.12.b Technology-Assisted Services
– Appropriateness
• A.12.c. Inappropriate Services
– Face to Face
• A.12.d. Access
– Provide Reasonable Access
• A.12.e. Laws & Statutes
– Use does not violate laws
• A.12.f. Assistance
– State & National Lines
• A.12.g. Technology & Informed Consent
– Difficulty in ensuring…
Clinical Example
• A counselor offering online services receives an inquiry from a
man about providing counseling for his 10 year old son, who is
having increasing problems abiding by the rules set for his
behavior at school & at home. The counselor says that he has
no problems with this arrangement provided the parents fax
him their consent for him to treat their son and the boy is
agreeable.
• Are there ethical considerations that the counselor is
overlooking?
• (Ford, 2000)
Ethical Issues in Online Counseling
• It is the counselor’s responsibility to examine the ethical, legal, and
clinical issues related to online counseling
• Providing counseling services online is controversial
• There are potential legal issues that must be addressed, a few of which
include:
– Competence of practitioner in providing online counseling
– Informing client of limits and expectations of the relationship
– Developing a plan for how emergencies can be addressed

Some Advantages of
Online Counseling
• Reaching clients who may not participate in face-to-face
therapy
• Improving client access in rural areas
• Increasing flexibility in scheduling
• Facilitating assigning and completing of client homework
• Augmenting a problem-solving approach
• Improving an orientation to the counseling process
• Enhancing the provision of referral services

Some Disadvantages of
Online Counseling
• Danger of making an inaccurate diagnosis

• Compromise confidentiality and privacy
• Problems involved in being able to protect suicidal clients
• Difficulties in attending to clients who are in crisis situations
• Absence of traditional client-therapist relationship
• Inability to address a range of more complex
psychological problems
• Inability to deal with interpersonal concerns in the
therapy process

Computer-Assisted Therapy
• Access
• Secure (encrypted websites)
• Confidentiality and network computers
• Degree of privacy
– (Barak, 1999)
– (Ford, 2000)
Another Case Example…
• A web site advertises individual and group
therapy services via the Internet, provided by
a “master’s-level counseling student” with
both individual and group counseling
experience.
• What are the potentially misleading and
unethical elements of this announcement?
• (Ford, 2000)
Malpractice
• Defined: “Bad practice”
– Failure to render professional services or the
degree of skill that is ordinarily expected of other
professionals in a similar situation.
– A legal concept related to negligence.
Negligence
• Unjustified departure from usual practice or failure
to exercise due care in fulfilling your responsibilities.
• “Standards of Care”
• Duty
• Breach of Duty
– Reasonable care
– Applying knowledge & skill
– Good judgment
Negligence continued…
• Injury
• Causation
– Burden of proof is on the client
– The professional’s breach of duty was the
proximate cause of the injury
Reasons for Malpractice Suits
• Failure to obtain or document informed consent
• Client abandonment
• Marked departures from established therapeutic practices
• Practicing beyond the scope of competency
• Misdiagnosis
• Crisis intervention
• Repressed or false memory
• Unhealthy transference relationships
• Sexual abuse of client
• Failure to control a dangerous client
• Managed care and malpractice

Risk Management
• Four-step process:
– Identify potential risks.
– Evaluate whether the risk warrants further action.
– Use preventive or risk control strategies.
– Review treatment periodically.
• (Calfee, 1997).
Confidentiality, ethical and legal
issues
Ethics in Counselling Practise
Professor Craig A. Jackson

Head of Division of Psychology
Craig.Jackson@bcu.ac.uk
Ethics Morality & Laws
Ethics refers to the beliefs that individuals hold about “what is right”
Ethical Conduct: the behaviours exhibited by the counsellor
Good ethical conduct grounded in sound moral principles,

understanding the ethical codes, and having the desire to do “what is
right”
Laws and Ethical Codes regulate the work of counsellors
Laws enforced by government of society standards
Morality refers to proper ethical conduct and involves an evaluation of

conduct based on standard expectations often influenced by cultural,
religion, etc.
Components of Ethical Counselling
The components of good ethical behaviour include:
Understanding & implementing ethical codes.

Doing what is best for the client
Practicing the four core virtues:

prudence, integrity, respectfulness, & benevolence
(Meara, Schmidt & Day, 1996)
Realising importance of intuition, integrity, & honest self-evaluation

in ethical decisions
Placing client welfare as paramount

Virtue Ethics don't cover Everything
Although ethics codes speak to various issues, counselor must
recognise that these codes tend to be broad, & thus they do not
cover all ethical issues faced by counsellors
Ethics codes offered by most professional codes are broad & general
not precise & specific
Own ethical awareness & problem-solving skills will determine how to

translate these general guidelines into professional day-to-day
behaviour
Ethical codes are necessary, but not sufficient, to exercise ethical

responsibility - be aware of code limits
Client's needs before Counsellor's
Ethically, counsellors need to be aware of their – own needs,

areas of unfinished business,
potential personal conflicts and defences
how this may effect the clients
Responsibilities to work actively toward expanding own self-

awareness and recognise areas of prejudice & vulnerability
Personal power is an effective quality of the therapist
Counsellor's need to nurture

Multicultural Issues
Biases are reflected when:
Neglect social and community factors to focus

unduly on individualism
Assess clients with instruments that have not

been normed on the population they represent
Judge as psychopathological those behaviours,

beliefs, or experiences that are normal for the
client’s culture
Sexuality Issues
LGBT issues
Sexuality / Gender matching of

counsellors
Dual Relationships: Some Pointers
Will my dual relationship keep me from confronting and challenging

the client?
Will my needs for the relationship become more important than

therapeutic activities?
Can my client manage the dual relationship?
Whose needs are being met: my client’s or my own?
Can I recognise and manage professionally my attraction to my

client?
Ethical Issues and Practice
Why are ethical standards needed?
What ethical standards guide the work of

counselling psychologists?
What areas of ethical difficulty are faced by

professionals in the field?
How do counsellors make ethical decisions?

Ethical Standards are Needed
Ensure competent professional behaviour
Responsibility to public trust
Professionals monitor their own & other members’ behaviour
Controversies over the development of ethical codes
Ethical dilemmas
Character and virtue
BPS Ethics code

Principles of Ethical Practice
Autonomy:
independence and self- determination
Nonmaleficence:
do no harm
Beneficence:
promote good or wellness
Justice:
commitment of fairness
Fidelity:
make honest promises / don't deceive / exploit clients
Common Ethical Dilemmas in Practice
Multiple-Role Relationships
Informed Consent
Confidentiality
Privileged Communication
Legal cases
Expert testimony
Multiple Roles Relationships Conflict
Problems with multiple role relationships

(Pope, 1991):
Erosion/distortion of therapy
Conflicts of interest
Adverse effects on client rights & cog process

Multiple Roles Relationships Conflict
Guidelines (Herlihy & Corey, 1997)
Set healthy boundaries early
Consult with fellow professionals
Work under supervision
Use self-monitoring
Informed Consent
Two central aspects:
Disclosure & Free consent
Origins of informed consent
Informed consent requires a consent that is competent, knowing,

and voluntary
The process of informed consent:

Ongoing
Includes a discussion of the limits of confidentiality
Some Aspects of Informed Consent
General goals of counselling,

Responsibilities of counsellor toward client,
Responsibilities of clients,
Limitations of & exceptions to confidentiality,
Legal & ethical parameters that define relationship,
Qualifications & background of practitioner,
Fees involved,
Services client can expect,
Approximate length of therapeutic process
Confidentiality
Not disclosing client information

without her/his prior consent
Secrets and trust in friendship vs.

the counselling relationship
Caveats to Confidentiality
• Client request for release of information
• Court orders for confidential information
• Child abuse or abuse of a vulnerable adult
• Danger to oneself
• Danger to others
Confidentiality Case Study
Recent Trends
• Duty to Warn
• Reporting Child Abuse
• Technology Usage
• Relationships with Former Clients
• Managed Care
• Confronting Counsellor Impairment

How Counsellors Make Ethical Choices
Identify the ethical dilemma: ethical, legal, moral?
Identify potential issues: evaluate the rights and responsibilities of all parties
Look at the relevant ethics code for guidance
Consider applicable laws
Consult
Brainstorm various courses of action
Identify the consequences of each action
Decide on the best possible course of action
Corey 2005
Risk Management
Competence
Quantify hazards
Communication
Attention to the therapeutic relationship
Supervision and consultation
Record keeping
Insurance
Knowledge of ethics and relevant law
Practice self-care
Ethical and Legal Issues
in Counseling Practice
COUN 540: Foundations

Spring 2009
Tonight’s Goals
Discuss how ethics and law guide and govern our professional
behavior– similarities and differences
Introduce ethical codes - ACA Code of Ethics
Major ethical/legal issues we encounter in practice
informed consent confidentiality duty to warn
To introduce the concept of the Ethical Decision Making Model

and explore its use
Ethics and Law
Governing our Professional Practice
Law Ethics
Created by legislature and Rooted in philosophy,

courts created by professional
associations
Govern citizens (federal, Govern members of

county, state) profession – guide practice
Represent minimal Represent ideal standards

standards
Penalty  fines, jail Penalty  loss of license,

professional sanctions
Criminal vs Civil Law
Criminal  Go to Jail, associated professional sanctions
Example: Sexual contact with client is a
Felony 4th Degree
Civil  Monetary consequences, associated professional

sanctions
Malpractice door opens when it can be proven that the

counselor had:
1) A duty
2) That duty was breeched
3) The client experienced damage
4) It was the breech of duty that
caused the damage
When Questions of Law Arise
Consider it to be a legal issue if…
*lawyers are involved
*the matter has come to court,
*the counselor may be in danger of being
accused of misconduct
Avoid being impulsive take time to think before reacting

(e.g. receipt of subpoena)
Talk to a lawyer (American Counseling Association) when it is, or

might be a legal issue to determine your next
appropriate action
When Ethics and Law Collide
H.1.b. Conflicts Between Ethics and Laws
If ethical responsibilities conflict with law,
regulations, or other governing legal authority,
counselors make known their commitment to
the ACA Code of Ethics and take steps to
resolve the conflict.
If the conflict cannot be resolved by such means,
counselors may adhere to the requirements of
law, regulations, or other governing legal
authority.
ACA Code of Ethics (2005)
ACA Code of Ethics
Revised in 2005
Section A: The Counseling Relationship
Section B: Confidentiality, Privileged
Communication, Privacy
Section C: Professional Responsibility
Section D: Relationship with Other Professionals
Section E: Evaluation, Assessment and
Interpretation
Section F: Supervision, Training and Teaching
Section G: Research and Publication
Section H: Resolving Ethical Issues
Functions of Ethical Code
First and most important – to safeguard welfare of client
and society
Define ethical conduct in a profession – to inform and

educate members
Define Standards of Practice – important in legal actions
Create a means by which members are held accountable

for actions – protecting public
Offer a way to promote professional growth, best practice

Commonalities in
Mental Health Ethical Codes
*Priority placed on welfare of clients & society
*Competency
*Personal awareness of own values, biases
*Prohibition on sexual involvement with clients
*Research criteria to protect subject/client rights
*Responsibility to protect confidentiality
*Helping clients reach self-determined goals
*Ongoing professional development
*Obligation to confront colleagues demonstrating unethical,
illegal, incompetent practice
*High personal standards of integrity
Kotter & Brown (1992)
Limitations of Ethical Codes
Broad - The mental health field is so diverse, with counselors and client
populations varying broadly in terms of role played…this leads to creations
of codes that must be broad in scope to accommodate application in many
different situations
Changeable - Codes must adapt and change as new issues arise

(e.g. HIV; technology)
Clarity of Guidance - Guidelines provided by codes are not always

clear and call for a systematic manner of decision making – they are
not “cookbooks” for perfect decisions in every situation
Conflicts between Codes - in some cases, conflicts between professional

associations
Ethical and Legal Concerns:
Major Areas of Focus
Informed Consent
Confidentiality
Duty to Warn/Duty to Protect
Record Keeping
Technology
Managed Care
Informed Consent
An opportunity for building foundations for a truly
collaborative and effective counseling relationship -
defines the relationship
Promotes idea of clients as informed partners in the

counseling process – they know the rules and
participate willingly
As important with children as with adults
Beginning and throughout the relationship –

written and discussed
Confidentiality/Privacy
The trusting foundation on which the counseling
relationship is build
Confidentiality versus Privilege
Duty to protect private communication in the

therapeutic relationship
HIPPA rules have important impact
Place where law and ethics may collide (e.g. mandatory

reporting of child abuse)
Challenges in Confidentiality
Subpoenas
Counseling Minors
Substance abuse
Group/Family Counseling
Offenders
After Death of Client
Technology
Duty to Warn
Societal interest in protection may over-ride confidentiality duty
to client
Concept of vulnerable population
Domestic violence laws vary from state to state re mandatory

reporting – but when child/elder involved – line is crossed
Past crimes usually not a duty though a client’s risk to others

may trigger duty to warn
AIDS/HIV ACA Code B.2.b.

Duty to Protect
Threat of harm to self and threat of suicide
raise affirmative duty
Risk Assessment essential
Children especially concerning. Case of Nicole Eisel brings duty

to school setting - minor
Other threats of self harm (e.g. cutting)
End of life issues

Record Keeping
Good record keeping part of Standard of Practice
…know law and regulations inc.
Health Information Protection and Portability Act

(HIPPA)
Wheeler and Bertrham (2008) identify four Purposes of

Client Records
*Clinical management
*Legal implications for client
*Protection of health info
*Risk management
Technology
Technological advances are changing how we
define and go about the business of
counseling…and introduce a new plate of
potential challenges
e.g. on-line counseling services
electronic media
Managed Care
Presents a number of issues relating to
counseling practice which relate to potential
for ethical challenges…
*diagnosis dependent
*session numbers limited
*confidentiality concerns
Ethical Decision Making
Counselors must have a systematic model
which can be utilized to reach decisions
Not just following the rules…real ethical

decision making takes…
Reflection & evaluation
Consultation with colleagues
Courage
Best when client can be involved in the process

The Ethical Decision Making Model
Seven Steps
1. Identify and describe the problem (legal, ethical, and
professional) and potential issues involved
2. Refer to the ACA Code of Ethics – is there a fit? Consider law
and regulation that may apply
3. Determine the nature and dimensions of the dilemma –
consult with colleagues, literature review4. Identify possible
courses of action
5. Consider potential consequences of each
course of action and choose the best one
6. Evaluate the selected course of action
7. Implement the course of action
Ethics vs Morality
Morality is associated with a “personal belief system” – the
basis by which we decide what is right and what is wrong
Grounded in culture - arising from a social context, from the

values we learn, the beliefs we have about living
Differences within and between a reality – look out for
those broad brushes
Historical forces influence the moral judgments of the time

e.g. perception of children and discipline
Ethical Reasoning
The Five Moral Principles
The Five Moral Principles…function as a true cornerstone
of ethical reasoning and serve as guides when counselors face
difficult questions regarding a course of action:
Autonomy
Nonmaleficence
Beneficence
Justice
Fidelity
Used to evaluate the course of action we should take – note not

unusual for there to be conflict between moral principles
Autonomy
Respecting Clients’ Right to Independence
Client’s right to drive her/his own bus…make own decisions
Client’s independence, freedom to choose & direct one’s own

actions – we avoid fostering dependency in counseling
relationships
Centered in respect for client’s values and culture
Considerations of competence - decisions that are rational and

solid –safe for self/others, throws a wrench
Decision making involves consideration of impact of actions on

others
Nonmaleficence
To Cause No Harm
A major concern in ethical decision making and a

long held belief as the most important of the ethical
principles – thank you Hippocrates
Nonmaleficence = not causing harm to others.

Avoid practices that have potential to harm
Includes the concept of not harming self or acting

in ways that would cause harm to others
Beneficence
To Do Good
Counselor's responsibility – duty - to promote and to

contribute to the welfare of the client.
Means to do good, to be proactive and also to

prevent harm when possible (Forester-Miller &
Rubenstein, 1992).
First priority, do no harm, second priority is to do

good – client should be better at end of relationship
than at the beginning
Justice
Fair and Nondiscriminatory
Fair is not synonymous with the same…
Quality of services; matters of access to service; fees; time

allocation
Involves examining the interests and needs of both the

client and those involved and impacted by her/his actions
Client needs considered in context to those of others
The presence of stereotypes suggests absence of justice

Fidelity
Loyalty & Honor to Commitments Made
Creating a therapeutic climate in which trust

can flourish makes client growth and
progress possible
Promises made in good faith and kept
Obligations met
Managing boundaries and multiple
relationships
Managing Boundaries and Multiple
Relationships
March 18, 2008
COUN 7885/8885
• Are all dual or multiple relationships
unethical?
• What do you see as the primary concern
regarding dual or multiple relationships?
Introduction
• Ethics codes of most professional organizations stress
thinking of the best interests of clients when
considering boundary issues.
• According to the APA (2002), a multiple relationship
exists when a practitioner is in a professional role
with a person in addition to another role with that
same individual, or with another person who is close
to that individual.
– Dual or multiple relationships can also occur when
professionals assume two or more roles at the same time
or sequentially with a client.
What are some examples of dual
relationships?
– Assuming more than one professional role or blending a

professional and nonprofessional relationship;
– Providing therapy to a relative or a friend’s relative;
– Socializing with clients;
– Becoming emotionally or sexually involved with a client or
former client;
– Combining the roles of supervisor and therapist;
– Having a business relationship with a client;
– Borrowing money from a client; or
– Loaning money to a client.
Dual and Multiple Relationships
• Codes of ethics caution professionals against
any involvement with clients that might impair
their judgment and objectivity, affect their
ability to render effective services, or result in
harm or exploitation to clients.
• Generally laws do not specifically address dual
relationships with one exception…
Sexual attraction
QuickTime™ and a
Sorenson Video decompressor
are needed to see this picture.
Differing Perspectives
• Pope & Vasquez (1998) contend that dual

relationships impair a therapist’s judgment,
increasing the potential for conflicts of interest,
exploitation of the client, and blurred boundaries
that distort the professional nature of the
• Tomm (1993) believes that simply avoiding dual
relationships does not prevent exploitation.
Differing Perspectives continued
• Moleski & Kiselica (2005) counselors are

rethinking their traditional approach to the
therapeutic process &entering into more
secondary relationships.
• Are some dual relationships unavoidable?
Differing Perspectives cont’d…
• Can you identify a nonsexual dual relationship that
may be considered helpful?
• Castro, Caldwell, & Salazar (2005) believe that the
mentoring relationship is a personal one, in which
both mentor and mentee may benefit from knowing
the other personally and professionally.
– According to Warren (2005), ethical problems are likely to
arise if the mentor’s role becomes blurred, so that he or
she is more of a friend than a mentor.
Factors to Consider Before Entering into a
Multiple Relationship
• Young & Gottlieb (2004) recommend that practitioners

address several questions to make sound decisions about
multiple relationships (p.267):
– Necessary or avoidable?
– Potential for harm to the client?
– Potential to be beneficial?
– Can I evaluate this objectively?
• How would you proceed if the dual relationship is judged to
be appropriate and acceptable?
Boundary Issues
• Gutheil & Gabbard (1993) distinguish between
boundary crossings & boundary violations.
• How would distinguish between the two concepts?
– A boundary crossing is a departure from commonly
accepted practices that could potentially benefits clients
(changes in role).
– A boundary violation is a serious breach that results in
harm to clients (exploitation of the client at some level.
Establishing and Maintaining
• According to Borys (1994), many clients require the

structure provided by clear and consistent
boundaries.
• How many of you agree with Strasburger, Jorgenson,
& Sutherland (1992)?
– Are therapists who push nonsexual boundaries are more
likely to become sexually involved with clients?
Role Blending
• What does the phrase role blending mean?
• Role blending simply means combining roles and
responsibilities.
• Some roles involve inherent duality such as counselor
educators that serve as instructors, but also act a therapeutic
agents.
• According to Herlihy & Corey (2006b), there are ten key
themes surrounding multiple roles in counseling.
– For a review of these items, please see pp. 269-270 in our
text for this list.
Banning Nonsexual Dual Relationships
• Trend during the last 10 years in state licensure:
– Prohibit dual relationships, including nonsexual dual
relationships.
• Dual relationships are often unavoidable, especially
in smaller or rural communities.
• Our authors state that prohibiting all forms of
multiple relationships does not seem to be the best
answer to the problem of exploitation of clients and
that you are likely to find that occasionally role
blending is inevitable.
Controversies on Boundary Issues
• Arnold Lazarus (1994, 1998, 2001) dislikes this
debate being defined by rules and calls for a process
of negotiation in many areas of nonsexual multiple
relationships that some would contend are in the
forbidden zone.
• Lazarus states that the major difference between his
views and those of others is that they dwell mainly
on the potential costs and risks, whereas he focuses
mainly on the potential advantages when certain
boundaries are transcended.
Controversies on Boundary Issues
continued
• Do you agree or
disagree with Lazarus’
opinion that QuickTime™ and a
professionals who Sorenson Video decompressor
hide behind rigid

boundaries often fail
to be of genuine help
to their clients?
Advantages of Boundary Crossings
• Boundary crossings can be helpful

• Boundary violations are usually harmful.
• Many therapists confuse these two different
issues.
Commentary on Boundary Crossing
Cases (pp.274-275)
• There seems to be an assumption that without
ethical rules and regulations all practitioners would
be violating the rights of clients.
– Our authors agree with Lazarus that this focus on the
negative, emphasizing what the practitioner cannot do,
can also be detrimental to the client.
• Attending a student’s school play, etc. can do a lot to
help the counselor build a relationship with a
student.
• The therapist’s character and values have more
influence than training and orientation.
Managing Multiple Relationships in
Small Communities
• Practitioners who work in small communities often have to
blend several professional roles and functions.
• Some communities operate substantially on bartering rather
than on a cash economy.
• Campbell & Gordon (2003) The APA ethics code offer 3 criteria
for making decisions about entering into multiple
relationships:
– risk of exploitation
– loss of therapist objectivity
– harm to the professional relationship.
Bartering for Professional Services
• Bartering involves
exchanging services in
lieu of paying a fee.
• Such bartering can QuickTime™ and a
often lead to hurt
feelings due to one
party feeling that the
exchange was or is
inequitable.
Ethical Standards on Bartering
• Our authors agree with the general tone of how most ethics
codes address the complexities of bartering.
• However, they feel bartering should be evaluated within a
cultural context.
• Thomas (2002) maintains that bartering should not be ruled
out simply because of the slight chance that a client might
initiate a lawsuit against the therapist.
– Thomas recommends a written contract that spells out the
nature of the agreement between the therapist and client,
which should be reviewed regularly.
Deciding About Bartering…
• Bartering is not prohibited by ethics or law, but most
legal experts frown on the practice.
• If you decide to barter with a client, you would need
to report the bartered services or goods as income to
the Internal Revenue Service.
• Our authors agree with Thomas (2002), who
recommends creating a written contract that
specifies hours spent by each party and all
particulars of the agreement.
Giving or Receiving Gifts?
QuickTime™ and a
Giving or Receiving Gifts
• Few professional codes of ethics specifically address
the topic of giving or receiving gifts in the
• Our authors prefer to evaluate each situation on a
case-by-case basis rather than establishing a hard
and fast rule.
• It is more problematic to accept a gift at an early
stage of a counseling relationship because doing so
may be a forerunner to creating lax boundaries.
• Social relationships
with clients?
QuickTime™ and a
Social Relationships with Clients
• Reasons for discouraging the practice of accepting

friends as clients or of becoming socially involved
with clients:
– Therapists may not be as challenging as they need to be
with clients they know socially.
– Counselors’ own needs to be liked and accepted may lead
them to be less challenging, lest the friendship or social
relationship be jeopardized.
– Counselors’ own needs may be enmeshed with those of
their clients to the point that objectivity is lost.
Social Relationships with Clients
continued
• Reasons for discouraging the practice of

accepting friends as clients or of becoming
socially involved with clients, continued:
– Counselors are at greater risk of exploiting clients
because of the power differential in the
• Few professional ethics codes specifically
mention social relationships with clients.
Cultural Considerations
• What do you think?
• Parham & Caldwell (2006) believe that Western
ethical standards that discourage dual and multiple
relationships can prove to be an obstacle or
hindrance in counseling African American clients.
• In some Asian cultures it is believed that personal
matters are best discussed with a relative or a friend.
• Clients from many cultural groups prefer to receive
advice and suggestions from an expert.
Forming Relationships with Former
Clients
• According to Grosso (2002), mental health
professionals are not legally or ethically
prohibited from entering into a nonsexual
relationship with a client after the termination
of therapy.
• Although forming friendships with former
clients may not be unethical or illegal, the
practice could be unwise. Why?
Forming Relationships with Former
Clients continued
• In the long run, former clients may need you

more as a therapist at some future time than
as a friend.
• Our authors question helpers who rely on
their professional position as a way to meet
their social needs.
Your Position on Socializing with
Current or Former Clients
• Factors to be considered include whether the social
involvement was initiated by a client or the therapist,
whether the social contact is ongoing or occasional,
and the degree of intimacy.
• If you are psychoanalytically oriented, you are likely
to adopt stricter boundaries.
• If you are a behavior therapist helping a client to stop
smoking, it may be possible to have social contact at
some point.
Sexual Attractions in the Client-
Therapist Relationship
• There has been a lack of systematic research into the

sexual attraction of therapists to their clients.
• Pope and his colleagues (1986) found that only about
13% of their respondents said they had never been
attracted to any client.
– They found that 82% reported that they had never
seriously considered actual sexual involvement with a
client and that 93.5% reported never having had sexual
relations with their clients.
Sexual Attractions in the Client-
Therapist Relationship continued
• According to Pope, Sonne, & Holroyd (1993),
the tendency to treat sexual feelings as if they
are taboo has made it difficult for therapists to
acknowledge and accept attractions to clients.
• There is a distinction between finding a client
sexually attractive and being preoccupied with
this attraction.
Educating Counselor Trainees
• Generally it has been suggested that training

programs spend too little time addressing how to
deal with sexual attraction to clients.
• Little attention has been given to the ethical aspects
of nonerotic physical contact.
• Pope & colleagues (1986) found that 57% of the
psychologists in their study sought consultation or
supervision when attracted to a client.
continued
• Pope, Sonne, & Holroyd (1993) maintain that
practice, internships, and peer supervision groups
are ideal places to talk about this issue but that it is
topic rarely discussed.
• Practitioners who have difficulty setting and keeping
appropriate boundaries in their personal life are
more likely to encounter problems in establishing
appropriate boundaries with their clients.
continued
• Housman & Stake (1999) surveyed sexual ethics
training and student understanding of sexual ethics
in clinical psychology doctoral programs and found
that 94% of the students had received sexual ethics
training.
– Programs provided an average of 6 hours of training.
– It was concluded that most students in training do not
understand that sexual attractions for clients are normal.
– Their findings suggest that only half the students who are
attracted will seek supervision.
Suggestions for Dealing with Sexual
Attractions
• Jackson & Nuttall (2001) provide several
recommendations to minimize the likelihood
of sexual transgressions by clinicians on pp.
293-294 of our text including:
– Know the difference between sexual attraction to
clients and acting on the attraction.
– Terminate the therapeutic relationship when
sexual feelings obscure objectivity.
Sexual Relationships in Therapy:
Ethical and Legal Issues
• The issue of erotic contact in therapy is not simply a
matter of whether or not to have sexual intercourse
with a client.
• Therapists may:
– Have sexual fantasies about their clients.
– Behave seductively with their clients.
– Influence clients to focus on sexual feelings toward them.
– Engage in physical contact that is primarily intended to
satisfy their sexual desires.
Ethical Standards on Sexual Contact
with Clients
• Sexual relationships between therapists and clients

continue to receive considerable attention in the
professional literature.
• Most states have declared such relationships to be a
violation of the law.
• Existing ethics codes do not, and maybe cannot,
define some of the more subtle ways that sexuality
may be a part of professional relationships.
The Scope of the Problem
• Sexual misconduct played a role in 53% of the
complaints opened by the APA in 2002, and all of
these sexual dual relationships involved male-
psychologist-female client complaints.
• Lamb, Catanzaro, & Moorman (2003) found that the
majority of the sexual boundary violations occurred
after the professional relationship had ended (50%
after therapy, 100% after supervision, and 54% after
teaching).
At-Risk Therapists
• In Lamb, Catanzaro, & Moorman’s 2003 study

of professionals who engaged in sexual
boundary violations, respondents cited
concurrent dissatisfaction in their own lives as
a risk factor leading to sexual misconduct.
At-Risk Therapists continued
• Jackson & Nuttall (2001) urge high-risk clinicians to:

– Avoid the isolation of private practice
– Closely monitor their boundaries with clients
– Obtain ongoing professional supervision
– Seek their own therapy to address any remaining abuse-
related issues.
Harmful Effects of Sexual Contact with
Clients
• Studies continue to demonstrate that clients

who are the victims of sexual misconduct
suffer dire consequences.
• Sexual contact is especially disruptive if it
begins early in the relationship and if it is
initiated by the therapist.
Harmful Effects of Sexual Contact with
Clients continued
• According to Olarte (1997), the harmful

effects of sexual boundary violations include:
distrust of the opposite sex, distrust for
therapists and the therapeutic process, guilt,
depression, anger, feeling of rejection, suicidal
ideation, and low self-esteem.
Legal Sanctions Against Sexual
Violators
• Consequences include:
– Felony conviction
– License revoked or suspended
– Expulsion from professional organizations
– Loss of insurance coverage
– Job loss
• States that have enacted legal sanctions in cases of sexual
misconduct in the therapeutic relationship, making it a
criminal offense.
– California, Colorado, Florida, Georgia, Idaho, Maine, Michigan,
Minnesota, Missouri, New Hampshire, New Mexico, North Dakota,
Rhode Island, Texas, Washington, and Wisconsin.
Legal Sanctions Against Sexual
Violators continued
• Professionals cannot argue that their clients

seduced them.
• Criminal liability is rarely associated with the
practice of mental health professionals.
• The two major causes of criminal liability are
sex with clients (and former clients) and
fraudulent billing practices.
Assisting Victims in the Complaint
Process
• Although the number of complaints of sexual

misconduct against therapists has increased,
individuals are still reluctant to file complaints for
disciplinary action against their therapists, educators,
or supervisors.
• Clients can file an ethical complaint with a
professional association or with the therapist’s
licensing board.
Assisting Victims in the Complaint
Process continued
• Administrative action begins with the client

filing a complaint with the therapist’s licensing
board, which has the power to discipline a
therapist using the administrative process.
• Legal alternatives include civil suits or criminal
actions.
Sexual Relationships with Former
Clients
• Most professional organizations prohibit their

members from engaging in sexual
relationships with former clients because of
the potential for harm.
• The burden of demonstrating that there has
not been exploitation rests with the therapist.
Sexual Relationships with Former
Clients continued
• One question that is always unclear is when

the professional relationship actually ended.
• Is there a major difference between an
intense, long-term therapy relationship and a
less intimate, brief-term one?
Corey, Corey, & Callanan on Sexual
Relationships with Former Clients
• Our authors believe the statement “Once a client,

always a client” is a dogmatic pronouncement that
should be subject to discussion.
• What is your position?
• Does an absolute ban on all sexual relationships with
former clients imply that diagnosis and treatment are
not relevant?
Nonerotic Physical Contact with Clients
• Can nonerotic physical contact be appropriate
and can have significant therapeutic value?
• Do you feel it is worth the risk of touching
clients?
continued
• A therapist’s touch can be…
– A genuine expression of caring.
– Can be done primarily to gratify the therapist’s
own needs.
• The power differential between therapist and
client should be considered…
• Does touching elicits different feelings in men
than it does in women?
continued
• According to Rabinowitz (1991), it may be safer for a
hug to occur in group therapy rather than in
individual counseling because there are witnesses to
the context of the touching, leaving less room for
misinterpretation.
• According to our authors, it is critical to determine
whose needs are being met when it comes to
touching.
continued
• If touching occurs, it should be a spontaneous

and honest expression of the therapist’s
feelings.
• Practitioners need to formulate clear
guidelines and consider appropriate
boundaries, but touch can be a therapeutic
means to healing.
In closing…
• Dual or Multiple Relationships…
• The issue is exploitation…
• Ask yourself:
– Does the dual role will involve a power differential?
– Reflect upon what you are doing.
– Whose needs are primarily being met?
– Would you be engaging in this relationship if your
colleagues were watching you?
PROFESSIONAL ETHICS:
Boundaries in Helping Relationships
_________________
Jan Vick, LCSW-BACS, ACSW

Joel A. Vanderlick, LCSW
Trinell Merricks, GSW
Professional competence and
training
Professional Competence
September 12, 2013
Quiz
• What is one aspect of therapist competence?
Competence Defined
• Second most often reported area of ethical

complaint (Neukrug, Millikin, & Walden, 2001)
• Ethical and legal concept
– Ethically, competence is required if we are to
avoid doing harm to our clients (see ethical
codes)
– Legally, incompetent practitioners are vulnerable
to malpractice suits and can be held legally
responsible in a court of law
Competence Defined
• Definition: the extent to which a therapist has the
knowledge and skill required to deliver a treatment
to the standard needed for it to achieve its expected
effects (Fairburn & Cooper, 2011)
• Provides services that are consistent with licensure &
training (academic & supervised experience)
• Accurately represents credentials and qualifications
• Engages in continuing education in field, especially in
specialty areas
Licensing & Competence
• License does not:
– specify the type of clients, issues, or interventions
he or she may address, instead, the practitioner is
ethically obligated to restrict practice to areas of
qualification based on training and experience
– guarantee competence to conduct psychological
services
• Practitioner is ethically obligated to restrict
practice to areas based on training and
experience
Impact on Therapy
• Strunk (2010): competence (skills,
interpersonal relationships, etc) key to
effective outcomes in specific syndromes: high
anxiety and early-onset depression
Malpractice
• Occurs when a counselor fails to provide reasonable care
that is generally provided by other professionals and it
results in injury to the client.
• Four conditions must exist:
– The counselor had a duty to the client
– The duty of care was not met
– The client was injured in the process
– There was a close causal relationship between the
counselor’s failure to provide reasonable care and the
client’s injury
Case 1-7: A 35 year-old woman with a diagnosis of psychomotor epilepsy and
multiple personality disorder filed a complaint with the APA Ethics Committee
against her psychologist of four years for practicing outside her areas of
competence. Client claimed that she discovered that her psychologist did not
have prior training or supervised experience in her multiplicity of issues; client’s
condition worsened during treatment leading to hospitalization. Psychologist
informed the Ethics Committee that she began treatment as an employee of a
community mental health center and was under supervision of two clinic
consultants: a neurologist who controlled client’s medication and a psychiatrist
experienced in multiple personality disorders. Psychologist started a private
practice during the third year of therapy with client and was advised by
psychiatrist to allow client to remain with the clinic while the clinic administrator,
who was not a psychologist, recommended psychologist to work with client in
private practice to avoid disruption of treatment. Psychologist continued therapy
with client in private practice and kept the same psychiatrist for consultation as
needed.
After six months of therapy proceeding well, client began
decompensating. Client called psychologist late one night threatening
suicide because she felt hopeless and she blamed psychologist for not
being more helpful. Psychologist called the police who took client to
the county psychiatric hospital emergency room where psychologist
met her and stayed with her until she was admitted. Psychologist
continued therapy with client at the hospital until client refused to
see psychologist. Client ultimately returned to the community mental
health center for therapy with a different practitioner.
• Psychologist informed the APA Ethics Committee that she acted
professionally and responsibly as evidenced by her consultations with
the psychiatrist and that the clinic administrator recommended she
take client into her private practice.
Adjudication:
The APA Ethics Committee found psychologist in violation of the
principles of competence and responsibility. She tried to operate
beyond the limits of her competence and used mistaken
judgment in seeing the client in private practice as opposed to
allowing client to continue in the more structured environment of
the clinic where trained staff to deal with this issue was extant –
as the psychiatrist had advised. Further, she did not take full
responsibility for the consequences of her actions by transferring
responsibility for her decisions to other parties – who were not
psychologists. Psychologist was censured with stipulation to take
two advanced courses: organic disturbances and diagnosis and
treatment of borderline personality and multiple personality
disorders. Psychologist accepted the censure and stipulations
(APA, 1987).
Assessment of Competence
• Must involve knowledge + application of knowledge

• Direct measures of knowledge
– Exam: Treatment strategies, indications,
contraindications, implementation practices, therapeutic
response, adverse effects, evaluation of effect
• Patient outcomes: confounded by patient variables
• Evaluation of treatment sessions: difficult to define
& operationalize therapist-related behaviors
Continuing Education and
Demonstration of Competence
• Relicensure as a marriage and family therapist, CA
requires specific courses and a minimum number of
hours of continuing education (CEU)
• Work with more experienced colleagues or professionals
• Attend conferences and conventions
• Take additional courses in areas you do not know well
and in theories that you are not necessarily drawn to.
• Participate in workshops that combine didactic work with
supervised practice
Ethical Issues in Training Therapists
• Leverett-Main (2004) found that program
directors rated standard screening measures
such as GRE scores and letters of
recommendation as ineffective.
– Practicum and internship performances were
considered to be the most effective measures of
graduate student success.
Ethical Issues in Training Therapists
continued
• According to Johnson & Campbell (2004), “There is
currently no consistent approach to screening for
character and fitness during graduate school
admission; similarly, there is no consistent approach
to effectively addressing problems with character
and fitness once they are revealed.”
• Candidates should be given information about what
will be expected of them if they enroll in the
program.
Content of a Program
• Some programs are structured around a specific
theoretical orientation.
• Other programs have a broader content base and are
aimed at training generalists.
• Counselor educators and trainers are expected to
present varied theoretical positions.
• Our authors suggest that students be exposed to the
major contemporary counseling theories and that
they be taught to formulate a rationale for the
therapeutic techniques they employ.
How can we best train?
• According to Lazarus, formal education and training
in psychological diagnosis and treatment often
undermine the natural talents and skills of trainees.
• Our authors agree with Lazurus (2001), in calling for
training programs “to avoid instilling a fear of
lawsuits in students and terrorizing them about the
dangers of running afoul of licensing agencies.”
Evaluation Criteria & Procedures
• Every school has an ethical responsibility to

screen candidates in order to protect the
public from incompetent practitioners.
• However, 54% of surveyed professional
psychology programs do not have written
guidelines for intervening with problematic
students.
Review, Consultation, and Supervision
by Peers
• Peer review is an organized system by which
practitioners within a profession assess one
another’s services.
• Peer supervision groups are useful for counselors at
all levels of experience.
• Peer-consultation groups can also function as an
informal and voluntary form of review in which
individual cases and ethical and professional issues
are examined.
Making Referrals
• You should be able to determine whether you are
competent to treat a given client by the end of the
initial interview, except in rare cases
• Clients can be negatively affected when you refer
them too quickly
• If you make frequent referrals, then you may need to
examine your perception of your level of
competence
• Ethical Codes
Multicultural Competency
• Survey
Scope of Competence v. Practice
• Group activity
Comprehensive Exam Review
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Professional
Orientation
Part 2
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Ethical Standards
Counselors must act within legal and ethical
parameters. These parameters are defined by
laws, litigation precedents, official policies,
and ethical standards of practice.
Counseling essentially is a self-regulating

profession because most practices are not
governed by laws. Counselors use ethical
codes to guide their conduct and practice.
Most counselors adhere to the American
Counseling Association Code of Ethics and
Standards of Practice. Ethical codes are
voluntarily self-imposed behavioral
guidelines to which members subscribe.
Violations of ACA ethical codes can result in

expulsion from membership in ACA. Many
states have adopted the ACA Code of Ethics
for licensed counselors, meaning that viola-
tions of the code can be violations of the law.
Important Legal and Ethical Concepts and
Responsibilities:
Autonomy - clients have the right to make their

own decisions.
Beneficence - counselors should work for the

good of the clients.
Nonmaleficence - counselors should do no harm.
Justice - clients have the right to be treated fairly.

Scope of Practice - Counselors limit their practice
to those techniques, clients, and concerns for
which they have been adequately trained and are
qualified to perform. Many licensure laws require
counselors to disclose their scope of practice to
potential clients.
Confidentiality - Clients have the right to

expect that what they share in counseling will
not be shared with others.
Informed Consent - Clients voluntarily agree
to counseling only after being informed about
the services counselors offer. It includes
coverage of benefits, possible harm, and
limitations. If clients are minors, then
parents or legal guardians must consent.
Duty to Warn - If a client presents imminent

danger to herself or himself or others, the
counselor must contact responsible parties to
prevent harm.
Dual Relationship - A dual relationship exists
when the counselor simultaneously tries to
maintain with a client a counseling relationship
and another type of relationship, such as spouse,
relative, business partner, teacher or supervisor,
or sexual partner. Dual relationships are
potentially harmful to clients because the
counselor cannot remain objective and the client
does not have autonomy.
Malpractice - The techniques the counselor

uses causes real harm to the client.
Privileged Communications - Many state laws
state that counselors cannot disclose what is said
in counseling without prior permission of the
client. There are exceptions in the case of child
abuse, court orders, or suspected harm to the
client or others.
Abandonment - This situation exists when a

counselor ceases to provide necessary counseling
services to a client and fails to provide for
alternative services through a referral.
Defamation - A counselor who divulges
information that causes damage to someone's
reputation might be sued for defamation. If
the defamatory statements are written, it is
libel; if spoken, they are slander.
Bartering - This is the act of trading goods or

services, rather than money, for provision of
counseling services. Bartering is strongly
discouraged as a method of payment for
counseling services rendered.
ACA (then APGA) first adopted its own ethical
standards in 1959. Prior to that, members
subscribed to ethical standards of other asso-
ciations, primarily the American Psychological
Association (APA).
The current ACA Code of Ethics and Standards

of Practice were adopted in April, 1995. There
are two components: the Code of Ethics and the
Standards of Practice.
The ACA Standards of Practice contain
general principles for the effective and
ethical practice of various aspects of the
counseling profession.
The ACA Code of Ethics contains specific

points of attention for ethical counseling
practice.
Both the Standards of Practice and the Code
of Ethics are divided into the following
sections:
A. The Counseling Relationship

B. Confidentiality
C. Professional Responsibility
D. Relationships with Other Professionals
E. Evaluation, Assessments, and Interpretation
F. Teaching, Training, and Supervision
G. Research and Publication
H. Resolving Ethical Issues
It is important to remember that the ACA
Standards of Practice are ideals to which each
counselor should aspire.
Evaluation of actual counselor behaviors rela-
tive to the Standards of Practice are often made
in reference to specific ethical standards.
Because the Standards of Practice represent

the “best thinking” in the counseling
profession about how counselors are to
conduct their counseling-related activities,
they are presented here in their entirety.
American Counseling Association
Standards of Practice
Section A: The Counseling Relationship
SP-1 Nondiscrimination - Counselors respect

diversity and must not discriminate against
clients because of age, color, culture, disability,
ethnic group, gender, race, religion, sexual
orientation, marital status, or socioeconomic
status.
SP-2 Disclosure to Clients - Counselors must
adequately inform clients, preferably in
writing, regarding the counseling process and
counseling relationship at or before the time it
begins and throughout the relationship.
SP-3 Dual Relationships - Counselors must make

every effort to avoid dual relationships with
clients that could impair their professional
judgment or increase the risk of harm to clients.
When a dual relationship cannot be avoided,
counselors must take appropriate steps to ensure
that judgment is not impaired and that no
exploitation occurs.
SP-4 Sexual Intimacies with Clients - Counselors
must not engage in any type of sexual intimacies
with current clients and must not engage in sex-
ual intimacies with former clients within a min-
imum of two years after terminating the coun-
seling relationship. Counselors who engage in
such relationship after two years following
termination have the responsibility to thoroughly
examine and document that such relations did not
have an exploitative nature.
SP-5 Protecting Clients During Group Work -
Counselors must take steps to protect clients
from physical or psychological trauma
resulting from interactions during group
work.
SP-6 Advance Understanding of Fees -

Counselors must explain to clients, prior to
their entering the counseling relationship,
financial arrangements related to professional
services.
SP-7 Termination - Counselors must assist in
making appropriate arrangements for the
continuation of treatment of clients, when
necessary, following termination of counseling
relationships.
SP-8 Inability to Assist Clients - Counselors

must avoid entering or immediately terminating
a counseling relationship if it is determined that
they are unable to be of professional assistance
to a client. The counselor may assist in making
an appropriate referral for the client.
Section B: Confidentiality
SP-9 Confidentiality Requirement - Counselors

must keep information related to counseling
services confidential unless disclosure is in the best
interest of clients, is required for the welfare of
others, or is required by law. When disclosure is
required, only information that is essential is
revealed and the client is informed of such
disclosure.
SP-10 Confidentiality Requirements for
Subordinates - Counselors must take measures
to ensure that privacy and confidentiality of
clients are maintained by subordinates.
SP-11 Confidentiality in Group Work -
Counselors must clearly communicate to group
members that confidentiality cannot be
guaranteed in group work.
SP-12 Confidentiality in Family Counseling -

Counselors must not disclose information about
one family member in counseling to another
family member without prior consent.
SP-13 Confidentiality of Records - Counselors
must maintain appropriate confidentiality in
creating, storing, accessing, transferring, and
disposing of counseling records.
SP-14 Permission to Record or Observe -

Counselors must obtain prior consent from
clients in order to electronically record or
observe sessions.
SP-15 Disclosure or Transfer of Records -
Counselors must obtain client consent to
disclose or transfer records to third parties,
unless exceptions listed in SP-9 exist.
SP-16 Data Disguise Required - Counselors

must disguise the identity of the client when
using data for training, research, or
publication.
Section C: Professional Responsibility
SP-17 Boundaries of Competence -

Counselors must practice only within the
boundaries of their competence.
SP-18 Continuing Education - Counselors

must engage in continuing education to
maintain their professional competence.
SP-19 Impairment of Professionals -
Counselors must refrain from offering
professional services when their personal
problems or conflicts may cause harm to a
client or others.
SP-20 Accurate Advertising - Counselors

must accurately represent their credentials
and services when advertising.
SP-21 Recruiting Through Employment -
Counselors must not use their place of
employment or institutional affiliation to recruit
clients for their private practices.
SP-22 Credentials Claimed - Counselors must

claim or imply only professional credentials
possessed and must correct any known
misrepresentations of their credentials by
others.
SP-23 Sexual Harassment - Counselors
must not engage in sexual harassment.
SP-24 Unjustified Gains - Counselors must

not use their professional positions to seek or
receive unjustified personal gains, sexual
favors, unfair advantage, or unearned goods
or services.
SP-25 Clients Served by Others - With the consent
of the client, counselors must inform other mental
health professionals serving the same client that a
counseling relationship between the counselor and
client exists.
SP-26 Negative Employment Conditions -

Counselors must alert their employers to
institutional policy or conditions that may be
potentially disruptive or damaging to the
counselor's professional responsibilities, or
that may limit their effectiveness or deny
clients' rights.
SP-27 Personnel Selection and Assignment -
Counselors must select competent staff and
must assign responsibilities compatible with
staff skills and experiences.
SP-28 Exploitive Relationships with

Subordinates - Counselors must not engage in
exploitive relationships with individuals over
whom they have supervisory, evaluative, or
instructional control or authority.
Section D: Relationship With Other Professionals
SP-29 Accepting Fees from Agency Clients -

Counselors must not accept fees or other
remuneration for consultation with persons
entitled to such services through the counselor's
employing agency or institution.
SP-30 Referral Fees - Counselors must not

accept referral fees.
Section E: Evaluation, Assessment, and
Interpretation
SP-31 Limits of Competence - Counselors must

perform only testing and assessment services for
which they are competent. Counselors must not
allow the use of psychological assessment
techniques by unqualified persons under their
supervision.
SP-32 Appropriate Use of Assessment

Instruments - Counselors must use assessment
instruments in the manner for which they were
intended.
SP-33 Assessment Explanations to Clients -
Counselors must provide explanations to
clients prior to assessment about the nature
and purposes of assessment and the specific
uses of results.
SP-34 Recipients of Test Results - Counselors

must ensure that accurate and appropriate
interpretations accompany any release of
testing and assessment information.
SP-35 Obsolete Tests and Outdated Test Results
- Counselors must not base their assessment or
intervention decisions or recommendations
solely on outdated data or test results.
Section F: Teaching, Training, and
Supervision
SP-36 Sexual Relationships with Students or

Supervisees - Counselors must not engage in
sexual relationships with their students and
supervisees.
SP-37 Credit for Contributions to Research -

Counselors must give credit to students or
supervisees for their contributions to research
and scholarly projects.
SP-38 Supervision Preparation - Counselors
who offer clinical supervision services must be
trained and prepared in supervision methods
and techniques.
SP-39 Evaluation Information - Counselors

must clearly state to students and supervisees, in
advance of training, the levels of competency
expected, appraisal methods, and timing of
evaluations. Counselors must provide students
and supervisees with periodic performance
appraisal and evaluation feedback throughout
the training program.
SP-40 Peer Relationships in Training - Counselors
must make every effort to ensure that the rights of
peers are not violated when students and
supervisees are assigned to lead counseling groups
or provide clinical supervision.
SP-41 Limitations of Students and Supervisees -

Counselors must assist students and supervisees
in securing remedial assistance, when needed, and
must dismiss from the training program students
and supervisees who are unable to provide
competent service due to academic or personal
limitations.
SP-42 Self-Growth Experiences - Counselors
who conduct experiences for students or
supervisees that include self-growth or self
disclosure must inform participants of
counselors' ethical obligations to the profession
and must not grade participants based on their
nonacademic performance.
SP-43 Standards for Students and Supervisees -

Students and supervisees preparing to become
counselors must adhere to the Code of Ethics
and the Standards of Practice of counselors.
Section G: Research and Publication
SP-44 Precautions to Avoid Injury in Research

- Counselors must avoid causing physical,
social, or psychological harm or injury to
subjects in research.
SP-45 Confidentiality of Research Information -

Counselors must keep confidential information
obtained about research participants.
SP-46 Information Affecting Research
Outcome - Counselors must report all
variables and conditions known to the
investigator that may have affected research
data or outcomes.
SP-47 Accurate Research Results - Counselors

must not distort or misrepresent research
data, nor fabricate or intentionally bias
research results.
SP-48 Publication Contributors - Counselors
must give appropriate credit to those who have
contributed to research.
Section II: Resolving Ethical Issues
SP-49 Ethical Behavior Expected - Counselors

must take appropriate action when they possess
reasonable cause that raises doubts as to
whether other counselors or mental health
professionals are acting in an ethical manner.
SP-50 Unwarranted Complaints - Counselors
must not mitigate, participate in, or encourage
the filing of ethics complaints that are
unwarranted or intended to harm a mental
health professional other than to protect clients
or the public.
SP-51 Cooperation with Ethics Committees -

Counselors must cooperate with investigations,
proceedings, and requirements of the ACA
Ethics Committee or ethics committees of other
duly constituted associations or boards having
jurisdiction over those charged with a violation.
Codes of ethics and standards of practice are
necessary, but not sufficient to answer all ethical
questions and prescribe ethical behavior.
Counselors are confronted with situations in

which several legal or ethical standards might
apply or even conflict with each other.
When deciding on a course of action, often they

must be knowledgeable of both applicable laws
and broad ethical principles.
Professional Preparation
Standards
State and national organizations (e.g., NBCC)
and agencies establish minimum training and
experiential standards for individuals seeking
licensure or certification.
In addition, some organizations, such as the

Council for the Accreditation of Counseling and
Related Educational Programs (CACREP), set
standards for programs that prepare and train
counselors.
The Association for Counselor Education and
Supervision (ACES) adopted voluntary prepa-
ration guidelines for master's-level programs in
1963.
The American School Counselor Association

adopted guidelines for training school
counselors in 1967, and the American College
Personnel Association (formerly a division of
ACA) adopted guidelines for training student
personnel workers in 1968.
In 1971, ACES formed the Commission on
Standards and Accreditation, which developed
the Standards for Preparation of Counselors
and Other Personnel Services Specialists in
1973.
In 1977, ACES adopted Guidelines for

Doctoral the Preparation in Counselor
Education.
These guidelines were revised in 1979 and
adopted by ACA in 1980.
In 1981, the Council for the Accreditation of

Counseling and Related Educational
Programs (CACREP) was formed as a non-
profit accrediting body.
Historically, professional preparation and
training of counselors has focused on identifying
characteristics of effective counselors and
specific skills training.
Today, preparation programs recognize the

importance of both.
Counselors are trained at the master's or doctoral
level. Counselor preparation programs select
applicants based upon both academic and
personal suitability.
Typically, master's-level programs require

applicants to hold a bachelor's degree with a
minimum grade point average and submit letters
of recommendation attesting to the applicant's
good character. Many programs interview
applicants to ascertain their interpersonal skills.
Most master's programs require a minimum of
36 semester hours of coursework.
There are several other organizations that offer
accreditation to programs that prepare other
types of counselors, such as the American
Association of Marriage and Family Therapists
(AAMFT) and the Council on Rehabilitation
Education (CORE).
In addition, some divisions of the American

Counseling Association (ACA) have adopted
voluntary training standards for counselors for
their respective specialty areas.
Programs accredited by the Council for the
Accreditation of Counseling and Related
Educational Programs (CACREP) require a
minimum of 48 semester hours (72 quarter hours)
for master's degrees in counseling, although some
specialties require 60 semester hours.
Often, applicants are required to submit a

Graduate Record Examination score and letters
of recommendation. Some programs require
that applicants have a year or more of work
experience as a counselor, and most doctoral
programs interview candidates prior to
acceptance.
CACREP requires curricular experiences
in each of the following eight “common
core” areas:
Human Growth and Development

Social and Cultural Foundations
Group Work
Career and Lifestyle Development
Appraisal
Research and Program Evaluation
Professional Orientation
CACREP program accreditation also requires a
minimum of 100 clock hours of supervised
counseling practicum and 600 clock hours of
supervised internship at the master's level.
Some specialty areas require more hours of
supervised practice.
In addition, CACREP specifies standards for

the institution, program objectives, faculty and
staff, organization and administration, and
program evaluations.
Doctoral-level counselor preparation
programs typically require a master's degree
in counseling.
Doctoral programs prepare counselors for

counseling and supervision in agencies,
institutions, or private practice, and they
prepare counselor educators and supervisors to
work as faculty in colleges and universities.
Doctoral training typically takes 2 to 3 years of
full-time study(4 - 6 part time) and includes
advanced coursework, advanced practica and
internship, and preparation and defense of a
dissertation.
CACREP accredited doctoral programs require

advanced coursework in specified areas,
including counseling, group work, consultation,
research methodology, appraisal, diversity,
counselor education, supervision, and ethical
and legal issues.
Professional Credentialing
The main purpose of professional
credentialing is to protect the public and
assure that professionals are properly trained
and qualified.
Professions are regulated by registration,

certification, licensure, and accreditation.
A Registry is a voluntary listing of individuals
using a professional title.
Requirements for registration include a

minimal level of education and experience
and payment of a fee. It does not restrict the
use of the title. Registration without
certification or licensure affords little
protection to the public. In some countries,
registration is similar to licensure.
Certification sets minimum levels of education
and experience, but also restricts use of the title.
It does not restrict the practice of counseling so

that unqualified persons could claim to perform
counseling but call themselves certified
counselors.
School counselor certification does restrict use
of the title and of the practice of school
counseling. All states and the District of
Columbia have certification standards for
school counselors.
The most widely recognized national certification
body for counselors in the U.S. is the National
Board for Certified Counselors (NBCC).
National Certified Counselors (NCCs) must

hold a graduate degree that includes specified
coursework in counseling, have completed
supervised experience in counseling, and pass
either the National Counselor Examination for
Licensure and Certification (NCE), or the
National Clinical Mental Health Counseling
Examination (NCMHCE).
NBCC also offers the following specialty
certifications:
Certified Clinical Mental Health

Counselor (CCMHC)
National Certified School Counselor
(NCSC)
Master Addictions Counselor (MAC)
NCCs must complete 100 contact clock
hours of approved continuing education
every five years to be recertified.
Licensure is established by state law and

restricts the use of the title.
Similar to certification, licensure requires

minimum levels of education and experience,
and in some states, restricts aspects of the
practice of counseling.
Nearly all states have counselor licensure.
Licensed professional counselors (LPCs)

typically must hold at least a master's degree,
have supervised experience, and pass an
examination such as the NCE.
LPCs must submit evidence of continuing

education units (CEUs) in order to renew their
license.
Accreditation sets educational preparation
standards for a profession.
The Council for the Accreditation of

Counseling and Related Educational Programs
(CACREP) has standards covering the
training institution, program objectives and
curriculum, clinical instruction, faculty and
staff, and organization and administration.
To receive accreditation, a counselor
preparation program submits a self-study
documenting how it meets each of the specific
CACREP standards.
A team of trained reviewers visits the program

for 3 - 4 days and submits a report to the
CACREP board, which issues the accreditation
decision.
CACREP accredits the following entry-level
(master's) programs:
Community Counseling (with possible

specializations in Career Counseling or
Gerontological Counseling)
Marriage and Family Counseling
Mental Health Counseling
School Counseling
Student Affairs Practice in Higher Education
(with possible specializations in College
Counseling or Professional Practice)
In addition, CACREP accredits doctoral-level
programs in Counselor Education and
Supervision.
The emergence of certification, licensure, and

accreditation for counselors has been vital in
establishing counseling as a profession and
distinguishing it from other helping professions.
Public Policy Issues
Older professions, such as social work and
psychology, are widely recognized by the
public and have earned the right to provide
services and receive reimbursement by
government agencies and insurance
companies.
In order to compete with these professions,

counselors must earn these rights through
licensure, the inclusion of counselors and
counseling services in government policies, and
by educating insurance companies of their
ability to provide cost-effective services.
The helping professions are highly competitive.
Psychiatrists, psychologists, family therapists,

and social workers all compete with counselors
for clients, legal recognition, and reimburse-
ment from insurance companies. School
counselors also compete with school social
workers and others to provide services.
Counselors can advocate on behalf of their
profession and their clientele by:
Becoming certified and licensed
Obeying professional standards of

ethical conduct
Practicing within their boundary of

training and expertise
Becoming active members of national,

state, and local counseling
associations
Promoting mental health and counseling
to the public
Educating the public about counseling

qualifications and services
Educating insurance companies and

health maintenance organizations
Organizing other counselors in lobbying

efforts
Lobbying government representatives
on issues affecting mental health
and counseling
Encouraging fellow counselors to join

professional organizations and
to obtain appropriate profes-
sional credentials
This concludes Part 2 of the
presentation on
PROFESSIONAL
ORIENTATION
Issues in supervision and
consultation
PROFESSIONAL ETHICS:
Boundaries in Helping Relationships
_________________
Jan Vick, LCSW-BACS, ACSW

Joel A. Vanderlick, LCSW
Trinell Merricks, GSW
Concept of Boundaries
• A sense of personal identity and self definition that
has consistency and cohesion over time.
• This remains constant regardless of emotional ups
and downs or external pressures.
• The framework within which the worker-client
relationship occurs.
• Provides a system of limit setting
• The line between the self of client and self of worker
Why Talk About Boundaries?
• Reduces risk of client exploitation
• Reduces client anxiety as rules and roles are
clear
• Increases well-being of the worker
• Provides role model for clients
Who Negotiates Boundaries?
• Duty of the worker to act in the best interest
of the client
• The worker is ultimately responsible for
managing boundary issues
Why the Worker?
• Worker is the professional!
• Clients may not be aware of the need for
boundaries or able to defend themselves
against boundary violations
• There is an inherent power imbalance
between worker and client- worker is
perceived as having power and control
What are Some Examples of Boundaries?
Clear Boundary Areas:
• Planning social activities with clients
• Having sex with clients
• Having family members or friends as clients
A Client Should Not Be Your:
• Lover
• Relative
• Employee or Employer
• Instructor
• Business Partner
• Friend
Strictly prohibited by the Social Work Code of Ethics

Areas Where Boundaries May Blur:
• Self disclosure
• Giving or receiving significant gifts
• Dual or overlapping relationships
• Becoming friends
• Physical contact
What Are Some Other Areas Where
Boundaries May Be Blurred?
Danger Zones
• Over-identification with client’s issues
• Strong attraction to client’s personality
• Strong physical attraction to client
• Clients who can potentially reward you with
their influence
• Transference and counter transference
Questions to Ask in Examining Potential
Boundary Issues:
• Is this in my client’s best interest?
• Whose needs are being served?
• How would I feel telling a colleague about this?
• How would this be viewed by the client’s family or
significant other?
• Does the client mean something ‘special’ to me?
• Am I taking advantage of the client?
• Does this action benefit me rather than the client?
Reduce
Exploitation
• Use of professional relationship to promote or
advance our emotional, financial, sexual,
religious, or personal needs
• Stems from the inherent power differential
and the ability we have to exert influence on
the client
A Closer Look at Exploitation:
• Client may actually initiate and be gratified by the
exploitation- they may enjoy feeling ‘special’ or being
‘helpful’
• Can be subtle and vary from promoting excessive
dependency to avoiding confrontation because we
enjoy the adoration of our clients
• Using information learned professionally from the
client for personal gain
Increases in
“Dual Relationship”
Situations
Dual Relationships
• When you have more than one role with a
client
• Such relationships can blur boundaries
• This ‘blurring of boundaries’ increases the risk
of exploitation as roles can become confused
Important Note:
Most cases of sexual exploitation or other

ethical violations began with a step into a
seemingly innocent dual relationship*
*Taylor Aultman
Not All Client Interactions are Dual
Relationships:
• Running into a client at a social event
• Your client is your waiter at a restaurant
• How you participate in the interaction will

determine the outcome
Some Dual Relationships are Unavoidable
• You and a client belong to the same church

• A client lives in your neighborhood
• Your agency hires clients as staff or utilizes
clients as volunteers
Dealing with Unavoidable
Dual Relationships
• Open and honest discussion with client on the
nature of your relationships
• Separate functions by locations- work, home,
etc.
• Be aware of threats to confidentiality
• Understand your role as professional
Group Exercise
A client, who is a mother of three latency age
children, is facing the breakup of her marriage. She is
very concerned about how her children will respond,
what steps she can take to minimize the disruption to
their lives, and how she will manage financially with
the reduced income. The social worker relates her
own experience of divorce and the parenting issues
which followed.
A social worker and client both agree to
terminate services. After several years the
worker sees the client at a shopping mall. The
client offers to take the worker to the food court
for lunch to show appreciation for all the help
provided during their treatment sessions.
You have a client who recently started his own
small tax accounting business. He has shared
with you that the business is struggling and he
does not know what he will do if the business
fails. The client asks to prepare your taxes this
year.
You have a client who is an independent artist
and he brings you a gift of his artwork. The
client gathers the materials for his art from
salvage around town.
You and your family are attending a home game.
As you are walking to the stadium a client
recognizes you and offers for you to join her
tailgate party. The client also notices that your
tickets are in the same area of the stadium as
hers.
You work in a large outpatient setting that
employs several social workers. You are
interested in a client waiting to see a
colleague.
You are a social worker in private practice
whose client has just been diagnosed with
a terminal illness. The client is frightened,
crying, and hunched over.
A year after termination, a client calls and
invites you to lunch to catch up on events
that have transpired since the ending of
therapy.
You and a client have similar tastes and
interests. After a year of therapy, you and the
client terminate the professional relationship.
The client expresses gratitude at her progress,
sadness at the ending of the relationship, and
hope that the two of you can become friends
now that therapy has ended.
Boundary Crossing:
interest
Boundary Crossing:
interest
relationships
Boundary Crossing:
interest
relationships
Boundary Crossing:
interest
relationships
• Meet your personal needs in other areas of
your life
Boundary Crossing:
ethical violations
Boundary Crossing:
ethical violations
• A clear understanding of ethics and attention to
professional boundaries
Issues in theory and practice
Theory and Practice of
Counseling and Psychotherapy
Family System Therapy

The Family Systems Perspective
• Individuals – are best understood through assessing
the interactions within an entire family
• Symptoms – are viewed as an expression of a
dysfunction within a family
• Problematic behaviors –
– Serve a purpose for the family
– Are a function of the family’s inability to operate
productively
– Are symptomatic patterns handed down across
generations
• A family – is an inter-actional unit and a change in
one member effects all members
Adlerian Family Therapy
• Alfred Adler
• Adlerians use an educational model to counsel
families
• Emphasis is on family atmosphere, birth order, and
family constellation
• Therapists function as collaborators who seek to join
the family
• Understand the purposes of underlying children’s
misbehavior
Adlerian Family Therapy Therapy Goals
• Unlock mistaken goals and interactional patterns
• Engage parents in a learning experience and a
collaborative assessment
• Emphasis is on the family’s motivational patterns

(e.g., a desire to belong)
• Main aim is to initiate a reorientation of the

family
Multigenerational Family Therapy
• Murray Bowen
• The application of rational thinking to emotionally
saturated systems
– A well-articulated theory is considered to be essential
• With the proper knowledge the individual can change
– Change occurs only with other family members
• Triangulation
– A pattern of interaction with two-against-one experience
– A third party is recruited to reduce anxiety and stabilize a
couples’ relationship
• Make the most use of genograms
• Differentiation of the self
– A psychological separation from others
– Involve (1) psychological separation of intellect and
emotions and (2) of independence of the self from others.
– The greater one’s differentiation, the better one’s ability to
keep from being drawn into dysfunctional patterns with
other family members.
• To change the Therapy Goals
individuals within the context of
the system
• To end generation-to-generation transmission
of problems by resolving emotional
attachments
• To lessen anxiety and relieve symptoms
• To increase the individual member’s level
of differentiation
Human Validation Process Model
Virginia Satir
• Open communications
– Individuals are allowed to honestly report their
perceptions
• Enhancement of self-esteem
– Family decisions are based on individual needs
• Encouragement of growth
– Differences are acknowledged and seen as
opportunities for growth
• Transform extreme rules into useful and
functional rules
– Families have many spoken and unspoken rules
Experiential Family Therapy
Therapy Goals (Carl Whitaker)
• Application of existential therapy to family systems
• Help individuals achieve more intimacy by increasing their
awareness of their inner potential and opening channels
for family interaction
• An interactive process between a therapist and a family
• Encourage members to be themselves by freely expressing
what they are thinking and feeling
• Techniques grow out of the therapist’s intuitive and
spontaneous reactions (Therapist use of self) to the
present situation in therapy
Structural Family Therapy
• Salvador Minuchin
• Focus is on family interactions to understand the
structure, or organization of the family
• Symptoms: are a by-product of structural failings
• Structural changes must occur in a family before an
individual’s symptoms can be reduced
•
Structural Family Therapy
• Therapy Goals
– Reduce symptoms of dysfunction
– Bring about structural change by modifying
the family’s transactional rules and
developing more appropriate boundaries
Strategic Family Therapy
• Jay Haley
• Focuses on solving problems in the present
• Presenting problems are accepted as “real” and not a
symptom of system dysfunction
• Therapy is brief, process-focused, and solution-
oriented
• The therapist designs strategies for change
• Change results when the family follows the
therapist’s directions & change transactions
Strategic Family Therapy
• Therapy
Resolve presenting Goals
problems by focusing on
behavioral sequences
• Get people to behave differently
• Shift the family organization so that the presenting
problem is no longer functional
• Move the family toward the appropriate stage of
family development
– Problems often arise during the transition from one
developmental stage to the next
Family therapy as a whole
• Basic assumption
– An individual’s problematic behavior grows out of the
interactional unit of the family, community, and societal
systems
• Focus of family therapy
– Short term, solution-focused, action-oriented, and here-
and-now interaction.
– Focus on how current family relationships contribute to
the development and maintenance of symptoms.
• Role of goals and values
– Specific goals are determined by family and
therapist
– Global goal is to reduce family’s distress
• How family change
– Cognitive, emotional, or behavioral changes
– Change needs to happen in relationships, not just
within the individual
• Techniques of family therapy
– Techniques are tools for achieving therapeutic
goals
– Personal characteristics (respect, empathy,
sensitivity) are even more important
– Always consider what is in the best interests of the
family.
From a multicultural perspective
• Contributions
– Many ethnic and cultural groups place great value
on the extended family
– Approach each family as unique culture
• Limitations
– Few limitations for multicultural counseling
Summary and Evaluation
• Contributions
– Inclusion of all parts of the system rather than being
limited to the “identified patient”
– Rather than blaming either “identified patient” or the
family, the entire family has an opportunity (1) to examine
the multiple perspectives and interactional patterns that
characterize the unit and (2) participate in finding
solutions.
• Limitations
– lose sight of the individual by focusing on the broader
system
Chapter Two
Group Leadership
576
Group Leader as a Person
• The most important instrument you have is YOU
 Your living example, of who you are and how you
struggle to live up to your potential, is the best way to
model for members
• Strive to live a growth-oriented life

 Live the way you encourage group members to live
577
Theory and Practice of Group Counseling—Chapter 2 (1)
Key Characteristics of Effective
Group Leaders
 Personality and character  Sincerity and authenticity
 Presence  Sense of identity
 Personal power  Belief in the group process and

enthusiasm
 Courage
 Inventiveness and creativity
 Willingness to confront
oneself
Theory and Practice of Group Counseling– Chapter 2 (2) 578

Issues For Beginning
Group Leaders
• Initial anxiety
– Realistic versus unrealistic anxiety
• Self-disclosure
– How much or how little to disclose
– Appropriate and facilitative self-disclosure
 Challenges of dealing with a system

– Retaining one’s dignity and integrity in a system aimed at
cost-cutting
– Being one’s own advocate
Theory and Practice of Group Counseling—Chapter 2 (3) 579

Group Leadership Skills
• Active listening • Confronting
• Restating • Reflecting Feelings
• Clarifying • Supporting
• Summarizing • Empathizing
• Questioning • Facilitating
• Interpreting
580
Theory and Practice of Group Counseling—Chapter 2
Group Leadership Skills
• Initiating • Disclosing oneself
• Setting goals • Modeling
• Evaluating • Linking
• Giving feedback • Blocking
• Suggesting • Terminating
• Protecting
Theory and Practice of Group Counseling—Chapter 2 581

Skills for Opening
Group Sessions
• Ask members to briefly check in and comment on what
they want to explore
• Be attentive to unresolved issues from prior sessions
• Ask members to report their progress or difficulties during

the week
582
Skills for Opening
Group Sessions
• With members, create an agenda for each session
• Consider using structured exercises to open sessions

583
Skills for Closing
Group Sessions
• Allow time for closure
• Encourage members to evaluate their own progress
• Close a session without closing the issues raised during

the session
• Ask clients if there are topics they’d like to discuss next
week
• Make summary comments
584
Skills for Closing
Group Sessions
• Teach members how to integrate what they have learned
for themselves
• Encourage members to offer feedback to each other
• Discuss homework assignments

Tips for Increasing Diversity
Competence
• Become aware of your biases and values
• Try to understand the world from the member’s vantage

point
• Gain a knowledge of the dynamics of oppression,

racism, discrimination, and stereotyping
• Study the traditions and values of the members of your

group
586
Tips for Increasing Diversity
Competence
• Learn general knowledge, but avoid stereotyping
• Be open to learning from your members
• Recognize that diversity can enhance the group process

Ethical issues in couples and
family therapy
Ethical Issues in Couples and Family
Therapy
April 8, 2008
COUN 7885/8885
Steve Zanskas, Ph.D., CRC
Introduction
• A paradigm shift…
• Systems theory views psychological problems
as arising from within the individual’s present
environment and the intergenerational family
system.
Introduction continued
• The family systems perspective is grounded on the

assumptions that a client’s problematic behavior
may:
– Serve a function or purpose for the family
– Be a function of the family's inability to operate
productively
– Be a symptom of dysfunctional patterns handed down
across generations.
Introduction continued
• The family as a functioning entity that is more than
the sum of its members.
• Training programs include:
– the study of systems theory
– examination of family of origin
– use of live supervision
– an emphasis on ethical and professional issues specific to
working with couples and families.
Ethical Standards in Couples and Family
Therapy (AAMFT)
• “Marriage and family therapists advance the

welfare of families and individuals.”
– The assumption…by agreeing to become involved in family
therapy, the members can generally be expected to place a
higher priority on the goals of the family as a unit than on
their own personal goals.
Therapy (AAMFT) cont.
• “Therapists respect and guard confidences of each
individual client.”
• How?
– Treat all information received from a family member as if the person
were in individual therapy.
– Refuse to see any member of the family separately, claiming that
doing so fosters unproductive alliances and promotes the keeping of
secrets.
• Principle of professional competence and integrity
implies:
– Clinicians keep abreast of developments in the field
through continuing education and clinical experiences.
• The code concerning “responsibility to students and
supervisees” cautions practitioners to avoid multiple
relationships, which are likely to impair clinical
judgment.
Ethical Standards in Couples and Family Therapy
(AAMFT) cont.
• Researchers must use informed consent procedures
& explain to participants what is involved in any
research project.
• Ethical practice requires measures of accountability
that meet professional standards.
– Includes contributing time for the betterment of society
– donating services
• Financial arrangements:
– Couples and family therapists do not accept payment for
making referrals and do not exploit clients financially for
services.
– They are truthful in representing facts to clients and to
third parties regarding any services rendered.
– Ethical practice dictates a disclosure of fee policies at the
onset of therapy.
• Advertising:
– Ethical practice dictates that practitioners
accurately represent their
• Competence
• Education & training
• Experience in couples and family therapy.
Special Considerations in Working with
Couples/Families
• The most commonly reported reasons for seeking couples
therapy were problematic communication and lack of
emotional affection.
• Therapists need to consider that the status of one partner or
family member does not improve at the expense of the other
partner or another family member.
• Therapists who function as an advocate of the system avoid
becoming an agent of any one partner or family member.
What would you do?
• The Divorce…
QuickTime™ and a
Personal Characteristics of the Family
Therapist
• Self-knowledge is critical for family therapists
– Especially with regard to family-of-origin issues.
• Assumed that trainees can benefit from an
exploration of the dynamics of their own family of
origin.
• Clinical evidence supports a family-of-origin
approach to supervision is a necessary dimension of
training for therapists.
Educational Requirements for Family
Therapy
• Family therapy programs use three primary methods
of training:
– Didactic course work
– Master therapist videotapes & trainee tapes for
postsession viewing by the trainees and supervisors
– Regular supervision by an experienced family supervisor
who, together with trainees, may watch the session behind
a one-way mirror or on videotape.
Educational Requirements for Family
Therapy continued
• Some of these include:

– Gender awareness
– Cultural sensitivity
– An understanding of the impact of larger systems
on family functioning
Experiential Qualifications for Family
Therapy
• Trainees develop their own styles of interacting with families
through direct clinical contact with families & close
supervision.
• Supervisory methods include:
– Audiotapes
– Videotapes
– Written process notes
– Co-therapy
– Corrective feedback by telephone
– Live supervision including calling the trainee out of the family session
for consultation
Therapy continued
• Most graduate programs employ both didactic and
experiential methods and supervised practice.
– Didactic methods include lectures, group
discussion, demonstrations, instructional
videotapes of family therapy sessions, role
playing, and assigned readings.
– Experiential methods include both personal
therapy and working with issues of one’s own
family of origin.
Therapy continued
• Family therapy trainees can also profit from

the practice of co-therapy.
Values in Couples and Family Therapy
• Values pertaining to marriage can influence
therapists’ interventions.
• The therapist’s value system influences
– the formulation and definition of the problems
– the goals and plans for therapy
– the direction the therapy takes
continued
• According to Gladding et al. (2001):

– the content of values is important, but they
emphasize the process of valuing, which includes
their values, beliefs, & actions
• It is not the function of any therapist to make
decisions for clients.
continued
• The role of the therapist is to help family members:

– See more clearly what they are doing,
– Make an honest evaluation of how well their present
patterns are working for them, and
– Encourage them to make necessary changes.
Gender-Sensitive Couples and Family
Therapy
• Try to help women and men move beyond
stereotyped gender roles.
• Our perception of gender is related to our cultural
background.
• Ethical practice is enhanced if therapists are aware of
the history and impact of gender stereotyping as it is
reflected in the socialization process in families.
Feminist Perspective on Family
Therapy
• Feminist therapists contend

– clinical practice of family therapy has been filled with
outdated patriarchal assumptions
– grounded on a male-biased perspective of gender roles
and gender-defined functions within the family
• Feminist view focuse on gender and power in
relationships and encourage a personal commitment
to challenge gender inequity.
Feminist Perspective on Family
Therapy
• Feminist therapists challenge traditional gender roles and the

impact this socialization has on a relationship and a family.
• Feminist therapists advocate for definite change:
– social structure
– equality
– power in relationships
– the right to self-determination
– freedom to pursue a career outside the home
– the right to an education
A Nonsexist Perspective on Family
Therapy
• It is critical that family therapists take

whatever steps are necessary to account for
gender issues in their practice and to become
nonsexist family therapists.
A Nonsexist Perspective on Family
Therapy continued
• According to Margolin (1982), family therapists are
particularly vulnerable to the following biases:
– assuming that remaining married would be the best choice for a
woman
– demonstrating less interest in a woman’s career than in a man’s career
– encouraging couples to accept the belief that child rearing is solely the
responsibility of the mother
– showing a different reaction to a a wife’s affair than to a husband’s
– giving more importance to satisfying the husband’s needs than to
satisfying the wife’s needs
Responsibilities of Couples and Family
Therapists
• Legal obligations may require therapists to put the
welfare of an individual over that of a relationship.
– The law requires family therapists to inform authorities if
they suspect child neglect or abuse or become aware of it
during the course of therapy.
• In cases of domestic violence:
– Clinicians agree conducting couples therapy while there is
ongoing domestic violence presents a potential danger to
the abused & is unethical.
Confidentiality in Couples and Family
Therapy
• If therapists use any material from their practice in
teaching, lecturing, and writing, they need to take
care to preserve the anonymity of their clients.
• When working with families, any release of
information must be agreed to by all parties.
– Exceptions to this policy:
• when a therapist is concerned that a family member will harm
him- or herself, or will do harm to another person.
• when the law mandates a report.
Confidentiality in Couples & Family Therapy
continued
• Couples need to be frequently reminded of the “no
secrets” policy.
• ACA’s (2005) standard dealing with couples and
family counseling states:
– “Counselors seek agreement and document in writing such
agreement among all involved parties having capacity to
give consent concerning each individual’s right to
confidentiality and any obligation to preserve the
confidentiality of information known.”
Differing Views: Confidentiality & Family
Therapy
• Therapists should not divulge in a family session any
information given to them by individuals in private sessions.
• Reserve the right to bring up certain issues in a joint session.
• Est. a policy of refusing to keep information secret that was
shared individually.
• Inform their clients that any information given to them during
private sessions will be divulged as they see fit in accordance
with the greatest benefit for the couple or the family.
Informed Consent in Couples & Family
Therapy
• Before each person agrees to participate in family therapy, it
is essential that the counselor provide information about:
– the purpose of therapy
– typical procedures
– risks of negative outcomes
– possible benefits
– fee structure
– limits of confidentiality
– rights and responsibilities of clients
– the option that a family member can withdraw at any time
– what can be expected from the therapist
Therapy continued
• Taking the time to obtain informed consent from
everyone conveys the message that no one member
is identified as the source of all the family’s
problems.
• In informed consent documents, it is essential that
the therapist’s policy spell out conditions for family
therapy to begin.
Therapy continued
• There is no professional agreement on whether it is necessary

to see all the family for therapy to take place.
• Corey, Corey, & Callanan (2007) believe it is particularly
important when it comes to therapy with children.
• Including the whole family in therapy
– provides more protection for the child
– as the family system corrects itself, the family can become a source of
support for the child.
Ethical issues in group work
Ethics and Group Counseling
Mary Saint, M.Ed., LPC

Screening of Members
• Select members whose needs and goals are compatible with group
• Who will not impede group process
• Whose well-being is not jeopardized by the group experience
• In working with minors, secure written permission of their custodial parents or
legal guardians, even if this is not required by state law.
Orientation and Providing Information
Prepare prospective or new group members by providing as much information
about the existing or proposed group as necessary.
 entrance/termination procedures, group participation
 expectations and the nature of the group
 professional disclosure statement
 informed consent
 goals of group
Confidentiality
Clearly define what confidentiality means, why it is important
and the difficulties involved in its enforcement.
• Emphasize importance of maintaining confidentiality

before the group begins and at various times in the group.
• Inform group members that confidentiality in group
therapy may not be protected under the state laws of
privileged communication
• Taped sessions are only done with prior consent
• When confidentiality must be violated, discuss it
with the group member and obtain written release
Leaving a Group
Provisions are made to assist a group member to terminate in
an effective way
• Legally mandated member is informed of
possible consequences
• Member leaving prematurely is discussed with
the group
• Counselor encourages members to discuss
reasons for wanting to leave the group
• Counselor intervenes if undue pressure is
placed on member to remain in the group
Coercion and Pressure
Protect against physical threats,
intimidation, coercion, and undue peer
pressure insofar as is reasonably possible
• Therapeutic pressure v/s undue pressure

for change
• Others persuade against their will
• Physical or verbal aggression
Imposing Counselor Values
Develop an awareness of your own values and needs
and the potential impact they have on the interventions
likely to be made.
• Remain alert to ways in which your

personal reactions might inhibit the group
process
• Monitor your countertransference
• Avoid using the group as a place where you
work through your personal problems.
Equitable Treatment
• Maintain awareness of behavior toward
individual group members
• Ensure equal use of group time for all
members
• Recognize and respect differences
(culture, race, religion, age etc).
Dual Relationships
Avoid relationships that might impair objectivity and professional judgment
or compromise a group member’s ability to fully participate fully in group.
• Avoid mixing professional relationships with social ones.
• Do not barter or exchange services.
• Avoid admitting family members, relatives ore personal friends as members
of the group.
• Do not engage in sexual relationships with either current or former group
members.
Use of Techniques
Restrict your scope and practice to client populations for which you are prepared
by virtue of your education, training and experience.
Goal Development
• Group members should be assisted in developing personal goals
• Goals should be assessed throughout the course of a group and the counselor
should assist in revising goals when appropriate
Termination from the Group
It is the responsibility of the

group counselor to help
promote the independence of
members from the group in a
timely manner.
Evaluation and Follow-up
• On-going assessment and use of skills to assist members in evaluating their own
progress
• Follow-up may take the form of personal contact, telephone or written contact
 reach goals
 positive or negative effect on participants
 could members benefit from some type of referral
Professional Development
Recognize that professional development is a continuous, on-going, developmental
process throughout a career.
• Maintain and upgrade knowledge and skill competencies

• Keep abreast of research findings and new developments
* Always consult with colleagues or clinical supervisors whenever there is a potential
ethical or legal dilemma.
 Find sources of ongoing supervision.
• Be aware of your state laws and professional organization ethical guidelines that limit
your practice, as well as the policies of the agency for which you work.
• Courts may refer to group leader’s professional organization’s code of ethics to

determine liability.
References
Corey, G. (1995). Theory and Practice of Group Counseling (4th ed.). Ca.:
Pacific Grove.
Corey, G., Corey, M., & Callahan, P. (1998). Issues and Ethics In the Helping Professions
(5th ed.). California: Brooks/Cole Publishing Co.
Corey, G., Williams, G. T., & Moline, M. E. (1995). Ethical and Legal Issues
in Group Counseling. Ethics & Behavior, 5(2), 161-183.
Gladding, S. T. (1999). Group Work: A counseling specialty (3rd ed.). Columbus,
Oh: Merrill.
Rapin, L., & Keel, L. (1998, arch 29). Association for Specialists in Group Work Best
Practice Guidelines. Retrieved July 3, 2004, from
http://www.asgw.org/best.htm
Ethical issues in community work
Ethical Issues in Community
Practice
Do the ends ever justify the means?

Community organization differs from direct practice
in that:
•
• 1) Social transformation is the primary goal of the intervention.
• 2) “Clients” are primarily constituency group members, residents of target
communities, and members of marginalized populations. In many instances organizers do
not have direct contact will all members of the client group.
• 3) Both the social worker and program constituents must develop a critical consciousness about
social and economic conditions that contribute to the marginalization of oppressed groups.
• 4) Most interventions take place in partnership with constituency group members. In some
situations, the constituency group serves as the organizer’s employer.
• 5) Working with people to gain power often requires the use of confrontation tactics, targeting
powerful groups in society.
• 6) Ethical conduct is often viewed as situational, requiring that the organizer assess the
seriousness of the situation, accessibility of the decision-makers, and possible risks to targets
before deciding on the appropriate use of tactics
• 7) The organizer may be a member of the target community. In some situations, the
organization may prefer to hire a member of the geographic community or person who identifies
with the community served (for example, a person with a disability or a gay man or lesbian).
The NASW Code of Ethics guides social work practice, but may not be
sufficient to help community organizers or practitioners who incorporate
community skills into other forms of practice because:
• Much activity takes place outside the organization that employs the
worker.
• We help people fight for power and consequently encounter
opposition from powerful people.
• We have opponents or targets who may engage in unethical tactics.
• We often work in professional situations in which our colleagues and
opponents are not social workers.
• We often receive limited supervision in the development of strategies,
especially from other social workers.
• While community interventions may prove beneficial to individual
participants, our intention is not to change the behavior of
beneficiaries, but to change society.
Most discussions of ethics in community organization
is limited to Alinsky’s “Of means and ends”
• One’s concern with the ethics of means and ends varies inversely with one’s personal interest in the issue.
• The judgment of the ethics of means is dependent upon the political position of those sitting in judgment.
• In war, the end justifies almost any means.
• Judgment must be made in the context of the times in which the action occurred and not from any other
chronological vantage point.
• Concern with ethics increases with the number of means available and vice versa.
• The less important the end to be desired, the more one can afford to engage in ethical evaluations of the
means.
• Generally success or failure is a mighty determinant of ethics.
• The morality of means depends upon whether the means is being employed at a time of imminent defeat
or imminent victory.
• Any effective means is automatically judged by the opposition as being unethical.
• You do what you can with what you have and clothe it with moral garments.
• The goals must be phrased in general terms like “Liberty, Equality, Fraternity….. (Alinksy, 1971, pp. 24-47)
Alinksy often embarrassed or humiliated opponents.
The question for social workers is:
• Are such tactics consistent with the code of ethics?

• Are social workers comfortable with such tactics?
• Is the situation serious enough to justify such tactics?
• Do our participants/constituents wish to participate from or
benefit from these tactics?
• How important is it to produce a successful outcome? For
example, in community development, the process is more
important than the outcome. In politics, however, “winning is
everything.”
Codes of Ethics incorporate certain
values or principles that should guide
practice. Values are statements of an
ideal that we try to achieve, while ethics
offer us directives for action that are
derived from the desired values
Basic values associated with community practice
include
– Cultural diversity and understanding.
– Self-determination and empowerment.
– Development of a critical consciousness.
– Mutual learning and partnership with
constituents.
– A commitment to social justice and the equal
distribution of resources.
Ethical practices that differentiate community
organization from micro practice include:
• Personal boundary setting and sexual relations.

• Choosing tactics that can put people at risk.
• Value Conflict between the organizer and
beneficiaries/participants.
• Informed consent.
• Long-terms versus short-term gains.
• Reporting criminal activity
Often organizers face ethical dilemmas. According to Hardcastle et al.
(1997), ethical dilemmas occur when “two ethical dilemmas require
equal but opposite behavior and the ethical guidelines do not give clear
directions or indicate clearly which ethical imperative to follow” (p.22).
Often the organizer can use prevailing theories to sort out ethical
dilemmas and establish appropriate goals. Theories may be
deontological, involving “good” or “right” motives or teleological,
involving “good” or “right” outcomes achieved by the social change
effort in question (Rothman, 1998).
One tool for making ethical choices relies on the social work code of ethics:
Lowenberg & Dolgoff (1996) have developed an ethical rules screen based on
the principles in the NASW Code of Ethics.
• Principle #1 Protection of Life

• Principle #2 Equality and Inequality
• Principle #3 Autonomy and Freedom
• Principle #4 Least Harm
• Principle #5 Quality of Life
• Principle #6 Privacy and Confidentiality
• Principle #7 Truthfulness and Full
Disclosure (p. 63).
Reisch & Lowe (2000) have identified an appropriate problem-
solving model that social workers can use to address ethical
dilemmas:
• Identify the ethical principles that apply to the situation at hand.
• Collect additional information necessary to examine the ethical dilemma
in question.
• Identify the relevant ethical values and/or rules that apply to the ethical
problem.
• Identify any potential conflict of interest and the people who are likely to
benefit from such conflicts.
• Identify appropriate ethical rules and rank order them in terms of
importance.
• Determine the consequences of applying different ethical rules or ranking
these rules differently (p. 26).
Supervision & Consultation should also be used to resolve
ethical dilemmas. This can include a combination of the
following resources:
1) Constituency Group Members and Beneficiaries of

Social Change Processes.
2) Peers.
3) Agency Supervisory Staff.
4) Board Members.
• 5) Mentors.
• 6) Professional Organizations. For example, NASW,
Association for Community Organization and Social
Administration (ACOSA) and the (non- social work related)
National Organizer’s Alliance and COMM-ORG.
Discussion Questions
• What type of ethical dilemmas would you
expect to encounter in macro practice?
• What type of ethical dilemmas would you
expect to encounter using a multi-systems
approach?
• How would you personally resolve the “Hitler”
dilemma?
Exercise: Use the following tools to resolve one of the
ethical dilemmas in Chapter 2.
Ethical Rules Screen Problem-solving Approach

• Identify the ethical principles that apply to the
• Principle #1 Protection of Life situation at hand.
• Principle #2 Equality and • Collect additional information necessary to
examine the ethical dilemma in question.
Inequality • Identify the relevant ethical values and/or rules
• Principle #3 Autonomy and that apply to the ethical problem.
Freedom • Identify any potential conflict of interest and the
people who are likely to benefit from such
• Principle #4 Least Harm conflicts.
• Identify appropriate ethical rules and rank order
• Principle #5 Quality of Life them in terms of importance.
• Principle #6 Privacy and • Determine the consequences of applying
different ethical rules or ranking these rules
Confidentiality differently
• Principle #7 Truthfulness and
Full Disclosure
Values and Ethics
in Social Work
The Nature of Values
A value is a type of belief, centrally located in
one’s total belief system, about how one
ought, or ought not to behave, or about
some end-state of existence worth or not
worth attaining.
Instrumental Values: How we should or should
not behave
Provide the moral or ethical guidelines that
help determine how we conduct our lives,
and as social workers, how we perform our
work.
Terminal Values: Reflects the bottom line of
what we want to accomplish.
The Difficulty of Dealing with Values
Values are such a central part of our thought

processes that we often are not consciously
aware of them and therefore are unable to
identity their influence on our decisions.
A person may be forced to choose among

values that are in conflict with one another.
This is known as a value conflict.
Addressing values in the abstract may be quite

different from applying them in a real-life
situation.
Values are problematic because they change

over time.
The Place of Values in Social Work
Values clarification is an important aspect of
social work practice.
Social workers must be concerned with his or
her own values , and control for
inappropriate intrusion into practice
situations. This is known as value
suspension.
Values Held by Social Workers
Commitment to the primary importance of
the individual in society.
Commitment to social change to meet
socially recognized needs.
Commitment to social justice and the
economic, physical, and mental well-being of
all in society.
Respect and appreciation for individual and
group differences.
Commitment to developing clients’ ability to
help themselves.
Willingness to transmit knowledge and skills
to others.
Respect for confidentiality of relationship
with clients.
Willingness to keep personal feelings and
needs separate from professional
relationships.
Willingness to persist in efforts on behalf of
clients despite frustration.
Commitment to a high standard of personal
and professional conduct.
Areas of Practice Addressed by the NASW Code
of Ethics
Standards related to the social worker’s
ethical responsibility to clients.
The social worker’s ethical responsibility to
colleagues.
The social worker’s ethical responsibilities in
practice settings.
Areas of Practice Addressed by the NASW Code
of Ethics
The social worker’s ethical responsibilities as
a professional.
The social worker’s ethical responsibility to
the social work profession.
The social worker’s ethical responsibilities to
the broader society.
Competencies Required
For
Social Work
Practice
Competencies Related to
Interpersonal Helping
 Self-awareness and the ability to use self in facilitating
change.
 Knowledge of the psychology of giving and receiving help.
 Ability to establish professional helping relationships.
 Understanding differing ethnic and cultural patterns, as well
as the capacity to engage in ethnic-gender-, and age-
sensitive practice.
Knowledge and application of the Code of
Ethics as a guide to ethical practice.
General understanding of individual and
family behavior patterns.
Skill in client information gathering.
Ability to analyze client information and
identify both the strengths and problems
evident in a practice situation.
Capacity to counsel, problem solve, and/or
engage in conflict resolution with clients.
Possession of expertise in guiding the change
process.
Professional Development
Ability to be introspective and critically
evaluate one’s own practice.
Ability to make use of consultation.
Ability to consume and extend professional
knowledge.
Frequently Used Social Work Competencies
Case Planning and Maintenance

Individual and Family Treatment
Delivery System Knowledge Development
Staff Information Exchange
Risk Assessment and Transition Services
Staff Supervision
Case Planning and Maintenance
Expertise in service planning and monitoring
Ability to carry out the employing agency’s
programs and operating procedures
Knowledge of client’s background factors
Skills in interagency coordination
Ability to engage in case advocacy
Individual and Family Treatment
Sufficient knowledge of human development
to make in-depth psychosocial assessments.
In-depth knowledge of family functioning.
Skill in the selection and application of
individual and/or family treatment
modalities.
Delivery System Knowledge Development
Ability to maintain up-to-date knowledge of

a variety of human service programs.
Skills in building interagency coordination
and linkage.
Staff Information Exchange
Ability to prepare and consume written and
oral presentations regarding agency
programs.
Capacity to facilitate staff members’ ability to
make decisions and resolve problems.
Ability to facilitate interdisciplinary
collaboration.
Risk Assessment and Transition Services
Ability to apply general systems and/or

ecosystems theory when assessing factors
affecting a practice situation.
Skill in engaging clients in examining
problems in social functioning.
Skill in utilizing social work assessment
techniques.
Risk Assessment and Transition Services
Continued
Skill in the use of crisis intervention.
Ability to facilitate client transitions between
services and/or to terminate service.
Staff Supervision
Knowledge of the literature regarding the
supervisory process.
Capacity to facilitate the work of supervisees.
Ability to conduct worker evaluation and
professional development.
Prevention:
The
Future of
Social Work
Three Stages of Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention
Primary Prevention
Actions taken prior to the onset of a problem
to intercept its cause or to modify its course
before a person is involved.
It is the elimination of the noxious agent at its
source.
Secondary Prevention
Involves prompt efforts to curtail and stop the
disease in the affected persons and the
spreading of the disease to others.
Tertiary Prevention
Involves rehabilitative efforts to reduce the
residual effects of the illness, that is, reducing
the duration and disabling severity of the
disease.
Advocacy
The social worker advocate is one who is
his/her client’s supporter, advisor, champion,
and if need be, representative in his/her
dealings with the court, the police, the social
agency, and other organizations that affect
his/her well-being.
This is Individual advocacy.
Advocacy
 The social worker advocate is one who identifies with the
plight of the disadvantaged. He/she sees as his/her primary
responsibility the tough-minded and partisan representation
of their interests, and this supersedes his/her fealty to
others. This role inevitably requires that the practitioner
function as a political tactician.
 This is advocacy on behalf of a group or class of people.
Empowerment
Empowerment is a process whereby persons
who belong to a stigmatized social category
throughout their lives can be assisted to
develop and increase skills in the exercise of
interpersonal influence and the performance
of valued roles.
Network
Network is the process of developing multiple
interconnections and chain reactions among
support systems.
Personal networking
Networking for mutual aid and self-help
Human service organization networking
Networking with communities for
community empowerment
Class Action Social Work
A forensic social work/legal profession
collaborative litigation activity involving
social work concerns, with the goal of
obtaining a favorable court ruling that will
benefit the social welfare of a specific group
of persons.
Examples of Class Action Social Work
Serrano v. Priest: Argued that the quality of a

child’s education should not be dependent on
the wealth of a school district.
Examples of Class Action Social Work
Nicacio v. United States INS: Hispanic plaintiffs

who were exhibiting psychiatric symptoms,
allegedly caused by stressful interrogations
conducted by patrol officers of the United
States INS.
Reference
Morales, A.T. & Sheafor, B.W. (2004). Social work: A profession of many faces. Boston: Allyn and Bacon.

Diploma in Counseling-Ethics

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Diploma in Counseling

Strictly prohibited by the Social Work Code of Ethics

Most cases of sexual exploitation or other

• How you participate in the interaction will

• You and a client belong to the same church

• The social functions of codes are

• Common values are enhanced

Should a rational code of professional ethics

• Step Two: Determine Professional Relevance

• Step Three: Differentiate Personal and/or

• Step Four: Consider Legal Duties

• Step Five: Assess Ethical Obligations

• Step Six: Define Action

 Chapter 1: The Counselor's Identity: What,

 Chapter 2: The Counseling Profession’s Past,

 Chapter 3: Standards in the Profession: Ethics,

The Counselor's Identity:

• Guidance, Counseling and Psychotherapy:

• The following PowerPoint slides lists a number of

 Social Workers  Psychoanalysts

• ACA American Counseling Association

• ACA American Counseling Association (Cont’d)

• AATA: American Art Therapy Association

• AAMFT: American Association of Marriage & Family Therapists

• APA: American Psychiatric Association

• APNA: American Psychiatric Nurses Association

• APA: American Psychological Association

• NASW: National Association of Social Workers

• NOHS: National Organization for Human Services

• Embracing a wellness perspective

• Cultural Competence (Cont’d)

• The “It” Factor

• Compatibility with and Belief in a Theory

• Inclusion of Multiculturalism in the Profession

• Knowing Who We Are and Our Relationship To Other Professionals

• Impaired Mental Health Professionals

• Personal Therapy and Related Growth Experiences

Autonomy 20% 25% 15% 5% 20% 15%

Beneficenc 15% 10% 15% 10% 30% 20%

Fidelity 5% 10% 15% 35% 20% 10%

Justice 0% 15% 15% 15% 15% 40%

Non- 40% 10% 25% 15% 10% 0%

• (Garcia, Cartwright, Winston, & Borzuchowska, 2003)

• “Counselor know thyself…”

• “Counselor heal thyself…”

• It is difficult to distinguish between what is

• Two critical questions:

• Few empirical studies in the literature focus

• The experience of being a client.

• The APA (2002) has the following standard on

Issues and Ethics - Chapter 2 (2)

Issues and Ethics - Chapter 2 (3)

Issues and Ethics - Chapter 2 (4)

Issues and Ethics - Chapter 2 (5)

Issues and Ethics - Chapter 2 (6)

PowerPoint produced by Melinda Haley, M.S., New Mexico State University.

“Copyright © Allyn & Bacon 2004”

Dimensions of the Helping Relationship

Within the relationship the helpee may feel:

“Copyright © Allyn & Bacon 2004”

What can the helper do to enhance the relationship

– Be warm and encouraging