Current Ethical Issues for Professional Counselors in the

Current Ethical Issues for Professional Counselors in the United States David Kaplan, Ph. D Chief Professional Officer American Counseling Association http: //www. counseling. org/kaplan/nihon. aspx October 2012

I have been counseling an adult woman with a presenting problem of difficulty in coping with the death of her mother. Her mother and grandmother (who is also deceased) suffered from progressive Alzheimer’s disease. My client revealed to me that she administered a lethal dose of sleeping pills to her grandmother during the final stages of the Alzheimer’s, and that she has also caused the death of her mother by withholding cardiac medication. It was then revealed that it is likely she will have to take care of a third relative with Alzheimer’s disease, an elderly Aunt. It is important to understand that my client is not a bad person and did what she did while under tremendous stress and pressure and with feelings of compassion for the deteriorating condition of her mother and grandmother. My question is in two parts: First, what are my ethical obligations upon hearing the manner in which my client’s mother and grandmother died? Second, am I responsible to do anything about the upcoming situation with the Aunt?

Dual Relationships have been replaced beneficial vs. harmful relationships

What about Sex? • Sexual or romantic interactions with clients continues to be prohibited. • The prohibition on sexual or romantic interactions with former clients has been increased from two to five years. • In addition, counselors are now explicitly prohibited from having sex or a romantic relationship with the partners or family members of clients for a 5 year period.

Now that we covered love, what about death… • There is a new section (A. 9. ) that covers end of life care for terminally ill clients. – Gives counselors permission to work with terminally ill clients who wish to explore their end of life options. – Gives permission to keep discussions with terminally ill clients who are considering hastening their own death confidential.

And a requirement to protect the confidentiality of a client who has died. B. 3. f. Deceased Clients Counselors protect the confidentiality of deceased clients, consistent with legal requirements and agency or setting policies.

A Focus on cultural Sensitivity

B. 1. a. Multicultural/Diversity Considerations Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality…

A. 2. c. Developmental and Cultural Sensitivity …When clients have difficulty understanding the language used by counselors, they provide necessary services (e. g. , arranging for a qualified interpreter or translator) to ensure comprehension by clients…

A new mandate about selecting interventions…. . C. 6. e. Scientific Bases for Treatment Modalities Counselors use techniques/ procedures/modalities that are grounded in theory and/or have an empirical or scientific foundation. Counselors who do not must define the techniques/procedures as “unproven” or “developing” and explain the potential risks and ethical considerations of using such techniques/procedures and take steps to protect clients from possible harm. (See A. 4. a. , E. 5. c. , E. 5. d. )

And now counselors must think about the end of their practice from the very beginning. . . C. 2. h. Counselor Incapacitation or Termination of Practice When counselors leave a practice, they follow a prepared plan for transfer of clients and files. Counselors prepare and disseminate to an identified colleague or “records custodian” a plan for the transfer of clients and files in the case of their incapacitation, death, or termination of practice.

Technology gets an entire new section (A. 12. Technology Applications) • Counselors must give thorough informed consent about the benefits and limitations of IT applications. • When providing distance counseling, counselors must determine that the application is appropriate for that particular client. • Counselors ensure that their use of technology does not violate any laws.

Counselors who maintain web sites must… • Regularly check that links work and are professionally appropriate. • Establish ways that the counselor can be contacted if the technology fails. • Provide links to relevant licensing boards and professional certification boards. • Establish a method for verifying client identity. • Strive to provide a site that is accessible to persons with disabilities.

New ethical mandates about the diagnosis of mental disorders E. 5. c. Historical and Social Prejudices in the Diagnosis of Pathology Counselors recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and the role of mental health professionals in perpetuating these prejudices through diagnosis and treatment E. 5. d. Refraining From Diagnosis Counselors may refrain from making and/or reporting a diagnosis if they believe it would cause harm to the client or others.

The ACA Code of Ethics is available at www. counseling. org/ethics

The legal case of Ward v. Wilbanks

The Basics

• A practicum student referred rather than counsel a homosexual client. • After due process, the student was dismissed from the counseling program. • The student sued the university counseling faculty and officials alleging violation of her right to practice her religious beliefs.

Ward vs. Wilbanks Outcome

The Judge ruled against the student and for the university counseling program ACA has posted the decision at: www. counseling. org/kaplan/EMU. pdf

EMU Judge’s Opinion • There is a “rational basis” to adopt the ACA Code of Ethics into a counselor preparation program.

The case is now being appealed to a higher court

EMU lawsuit issues • Is it permissible to deny counseling services to a homosexual on the basis of the counselor’s values? • Can referral be made at any time a professional counselor wishes to do so? • When is a client?

Is it permissible to deny counseling services to a homosexual on the basis of the counselor’s values?

ACA Code of Ethics C. 5. Nondiscrimination Counselors do not condone or engage in discrimination based on age, culture, disability, ethnicity, race, religion/spirituality, gender identity, sexual orientation, marital status/partnership, language preference, socioeconomic status, or any basis proscribed by law.

Judge’s opinion “The ACA Chief Professional Officer, Dr. Kaplan, explained in his expert report that plaintiff’s request to refer clients based on their protected status (sexual orientation) ‘was a clear and major violation of the ACA code of Ethics as it would have been if she had refused to counsel an assigned African American on the basis that her values would not allow her to provide services to people of color. ’ ”

Can referral be made at any time a professional counselor wishes to do so?

ACA Code of Ethics A. 11. c. Appropriate Termination Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling.

ACA Code of Ethics A. 11. a. Abandonment Prohibited Counselors do not abandon or neglect clients.

Judge’s opinion “Regarding referrals. . . ACA chief Professional Officer David Kaplan [states that] there is no statement in the ACA Code of Ethics that referral can be made on the basis of counselor values. ”

Judge’s opinion “Referrals are taught to be a last resort…EMU could not confer a counseling degree on a student who said she would categorically refer all clients who sought counseling on topics with which she had contrary moral convictions. ”

When is a client?

ACA Testimony The ACA published book The Counselor and the Law makes it clear that the definition of a client begins at the moment an individual requests assistance… This obligates professional counselors to respect the dignity and to promote the welfare of a client even if a session has not yet occurred. It is therefore clear that the individual assigned to Ms. Ward was her client.

Current Ethical Issues for Professional Counselors in the United States David Kaplan, Ph. D Chief Professional Officer American Counseling Association http: //www. counseling. org/kaplan/nihon. aspx October 2012