Counseling Today, Ethics Update

New mandates for selecting interventions

David Kaplan June 2, 2006

American Counseling Association members received the 2005 ACA Code of Ethics bundled with the December 2005 issue of Counseling Today. Completed over a three-year period, this revision of the ethical code is the first in a decade and includes major updates in areas such as confidentiality, dual relationships, the use of technology in counseling, selecting interventions, record keeping, end-of-life issues and cultural sensitivity. 

All ACA members are required to abide by the ACA Code of Ethics, and 21 state licensing boards use it as the basis for adjudicating complaints of ethical violations. As a service to members, Counseling Today is publishing a monthly column focusing on new aspects of the 2005 ACA Code of Ethics (the ethics code is also available online at www.counseling.org/ethics).

ACA Chief Professional Officer David Kaplan conducted the following interview with Barbara Herlihy and Judy Miranti, two members of the ACA Ethical Code Revision Task Force.

Standard 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 Standards A.4.a., E.5.c., E.5.d.)

David Kaplan: A new standard in the ACA Code of Ethics (C.6.e., see above) states that counselors now need to use interventions and approaches that are grounded in theory and/or have an empirical or scientific foundation. If there is no theoretical or empirical support for a particular technique or procedure, the counselor must inform the client that the technique or procedure is “unproven” or “developing” and discuss potential risks and other ethical considerations. Why did the Ethical Code Revision Task Force add this new standard?

Barbara Herlihy: There was concern that some counselors implement techniques that grow out of their own bias, are faddish or clearly unproven in a scientific way. The task force felt that counselors need to have a rationale for treatments and procedures that are grounded in an established theory or have a supporting research base. 

Judy Miranti: Much of the discussion about the need to have theoretical or empirical grounding focused on sexual orientation issues in counseling — specifically around reparative/conversion therapy.

DK: Let’s come back to the reparative/conversion therapy issue in just a moment.

First, I do think we need to acknowledge that the new “Scientific Bases for Treatment Modalities” standard advances the profession.

JM: It moves the profession forward by telling counselors that while eclecticism or the application of several techniques could be therapeutic, the treatment modalities selected need to be research-based.

BH: The new standard on scientific bases for treatment modalities reminds us that the counseling profession has developed quite a body of literature both in theory and research which guides us toward effective practice. As such, our work needs to remain grounded in this carefully developed research base.

DK: You mentioned that one of the discussion points around this section was conversion/

reparative therapy — an approach that purports to “convert” homosexuals to heterosexuality.

JM: Both the Ethical Code Revision Task Force and the ACA Executive Committee felt that it was important to look at the biases and prejudices involved in conversion/reparative therapy and the possible harm that this approach can cause.

DK: Since the 2005 ACA Code of Ethics has been published, the Ethics Committee has formally ruled that conversion/reparative therapy does fall under C.6.e. and that any counselor using this approach must tell clients that conversion/reparative therapy is developing or unproven.

BH: Although conversion/reparative therapy may have been the first specific technique, procedure or modality that has been identified as needing to be labeled as “developing” or “unproven,” it is important to note that Standard C.6.e., “Scientific Bases for Treatment Modalities,” wasn’t aimed exclusively at that approach. This new standard was designed to focus broadly on any technique, procedure or modality that might be controversial and whose effectiveness or appropriateness is unfounded or not grounded in research.

DK: Why didn’t the Ethical Code Revision Task Force decide to specifically state in the ethical code that conversion/reparative therapy is banned?

JM: This did come up, and some task force members felt that we should be specific and list approaches that are unethical.

BH: But in the end, we decided that this would set a precedent — the ACA Code of Ethics has never listed specific interventions or approaches that are unethical — and that it was not in the best interest of the counseling profession to start now.

JM: We would not have been able to be all-inclusive and be assured that we had listed every intervention that should be banned. Therefore, a laundry list of forbidden interventions would lead counselors to assume that any intervention not on the list was fully approved by ACA.

DK: And you would worry about harmful techniques, procedures and modalities that were left off the list or were developed after the list was published.

JM: Exactly!

DK: How does a professional counselor know whether a technique, procedure or modality needs to be labeled as unproven or developing? In other words, how does a counselor determine whether Standard C.6.e., “Scientific Bases for Treatment Modalities,” applies to the intervention or approach they are using with a client?

BH: When in doubt about the scientific base of a technique, procedure or modality, use the standard “consult, consult, consult.” Call a former professor. Call an expert. Talk to some colleagues. But by all means, consult.

JM: Utilize resources on the ACA website and other websites. Keep current with the research by going to workshops and reading professional books and journals, and stay in contact with other practitioners who can serve as consultants.

DK: This is a good time to remind readers that ACA’s manager for Ethics and Professional Standards, Larry Freeman (800.347.6647 ext. 314 or lfreeman@counseling.org), provides free ethics consultation to ACA members and that our best-selling book, the ACA Ethical Standards Casebook by Barbara Herlihy and Gerald Corey, was just revised to include the 2005 ACA ethical standards. (Note: For more on the ACA Ethical Standards Casebook, turn to “Behind the Book” on page 30.) The casebook can be ordered at 800.347.6647 ext. 222 or www.counseling.org/publications. Free ethics resources are also available to ACA members at www.counseling.org/ethics.

So far we have been talking about Standard C.6.e., “Scientific Bases for Treatment Modalities,” in terms of the techniques, procedures and modalities that counselors use with their clients. Does it also apply when the counselor is asked for a referral?

BH: If a client requested an approach that was not grounded in theory or an empirical/

scientific foundation, it would be my responsibility to thoroughly discuss the unproven or developing nature of the approach, the limitations of that approach and alternative approaches. If the client proceeded to choose that intervention after this thorough discussion, it would be my responsibility to facilitate that process and provide a referral.

DK: The ACA Ethics Committee has just completed an extensive paper on the subject of referrals for conversion/

reparative therapy and other interventions that do not have a scientific base that very much supports your statement. An abridged version was published on pages 14-15 of the July 2006 edition of Counseling Today, and the complete document is available at www.counseling.org/ethics.

Switching gears, what do you think ACA needs to do to assist professional counselors with the new standard “Scientific Bases for Treatment Modalities”?

JM: We should consider developing a website section for practitioners fashioned around this standard that provides information on proven treatment modalities. We also need to help professional counselors define the potential risks and ethical considerations of specific approaches. Students and counselor educators have access to the most recent literature, but practitioners in the field may not.

DK: Please convey thanks to the entire Ethical Code Revision Task Force for yet another new standard that advances the profession. Any final thoughts?

BH: Professional counselors need to understand that Standard C.6.e. was not meant to be rigid and imply that only techniques, procedures or modalities that have been supported by experimental studies with random selection can be utilized. If that were the case, we would only use cognitive behavior therapy because it is the easiest to study under experimental (or at least quasi-experimental) conditions. We have to think more broadly and inclusively than that and include qualitative and other approaches. The point is that we don’t want counselors using biased approaches that are not thought through and have no evidence of validity.

Next month: New requirement to have a transfer plan

Letters to the editor: ct@counseling.org

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