Counseling Today, Cover Stories

A living document of ethical guidance

By Laurie Meyers May 22, 2014

Branding-Box-EthicsAfter three years of work that included 40 conference calls, numerous face-to-face meetings, two meetings at American Counseling Association annual conferences, two town hall meetings and the evaluation of feedback received from more than 100 ACA members, the 2014 ACA Code of Ethics was approved and released at the end of March, replacing the prior ethics code that had been in place since 2005.

“The revised code makes it clear that we have completely made the transition as a profession from focusing on the needs of the counselor to the needs of the client — that our clients are more important than we are,” says David Kaplan, ACA’s chief professional officer and staff liaison to the ACA Ethics Revision Task Force. “The code now states the values of the counseling profession and the basic ethical principles that all counselors — not just ACA members — are expected to use to inform their practice, teaching, supervision and research.”

The 11 members of the ACA Ethics Revision Task Force, chosen for their backgrounds and expertise in ethics, started the process knowing that every area of the code would need scrutiny. Two areas in particular stood out, however — the sticky question of counselor personal values and the ethical use of technology and social media with counseling clients. These areas wound up influencing the ethics code in its entirety because task force members decided it was important to infuse the issues throughout the finalized ethics language.

“A code of ethics is a living document that is meant to change as the profession grows and develops over time,” says Ethics Revision Task Force Chair Perry Francis, a counseling professor in the Department of Leadership and Counseling at Eastern Michigan University (EMU).

The counseling profession has experienced a substantial amount of growth, development and change in the nine years since the release of the 2005 code, and the Ethics Revision Task Force thought it was important for the 2014 ACA Code of Ethics to address the current professional and societal climate. Therefore, task force members carefully considered feedback from practitioners in the field to ensure the revised ethics code would provide guidance for current practices and challenges in the profession, says Francis, who also coordinates EMU’s counseling training facility and sees clients on a limited basis.

“The major sections were, as expected, social media, technology and distance counseling; clarifying the concepts of boundaries in our connected world; [and] addressing the confusion on the difference between values and competence when working with or referring clients,” he says.

Professional values

The committee’s changes started with the ethics code’s preamble. For the first time, specific professional values are delineated at the very beginning of the document.

“We wanted to state the values of the profession,” says task force member Richard Watts, a professor and director of the Center for Research and Doctoral Studies in Counselor Education in the College of Education at Sam Houston State University in Huntsville, Texas. “We didn’t think previous versions had emphasized — to this degree — the values of the profession.”

Specifically, the preamble names these core professional values:

1) Enhancing human development throughout the life span

2) Honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential and uniqueness of people within their social and cultural contexts

3) Promoting social justice

4) Safeguarding the integrity of the counselor-client relationship

5) Practicing in a competent and ethical manner

“While the professional values of counseling have always been in our code of ethics, we clarified and highlighted them to ensure that there was no confusion on the expectation of professional counselors as they interacted with clients,” Francis says.

Task force members pointed to two legal cases that made it clear that not all counselors or counselors-in-training understood the overarching values and expectations of the profession. Ward v. Wilbanks involved an EMU student in the school counseling program, Julea Ward, who, during her practicum at the in-house clinic, refused to counsel a client who stated on the intake form that he wanted help with issues relating to a same-sex relationship. Ward wanted to refer the case to another counselor-in-training because her religious beliefs held that same-sex relationships were immoral. After being informed that referring a client based solely on personal beliefs was unethical, she was offered a remediation program to help her counsel such clients. Ward requested a formal hearing instead and was dismissed from EMU’s program for violating the ACA Code of Ethics. She later filed a lawsuit alleging infringement of her religious freedom.

The other case, Keeton v. Anderson-Wiley, was similar. Jennifer Keaton, a counseling student at Augusta State University in Georgia, declared her opposition to counseling members of the lesbian, gay, bisexual and transgender community and stated that she was a proponent of reparative therapy. After declining to enter remediation, she was removed from the university’s counseling program. She subsequently filed a lawsuit against the school.

“We kind of had this little ‘out’ in the old code,” says Ethics Revision Task Force member Linda Shaw, professor and head of the Department of Disability and Psychoeducational Studies at the University of Arizona. “The standard that allows you to refer when you feel you’re not going to be effective was stated very generally.”

In other words, a counselor who wanted to refer a client based solely on personal beliefs might sidestep the issue of discrimination by claiming he or she would not be effective counseling the client, Shaw explains. “We just didn’t have the clarity [in the 2005 ethics code] saying that there is a difference between a lack of knowledge and referring because of personal values,” she says.

Adds Watts, “There was a lot of discussion about making sure that we treat all clients inclusively — that clients are not discriminated against because of subjective values or class identity.”

“I think we made it more clear that client welfare is the paramount issue in every mental health code,” he continues. “Refusing to see clients because of sexual orientation or any other subjective reason is clearly discriminatory, and we were concerned that competence was functioning as a smoke screen.”

Online without being out of line

The other big change in the 2014 ACA Code of Ethics is the addition of an entire section on the ethical use of technology and social media with clients.

“I think the most glaring omission in the 2005 code was technology,” says Ethics Revision Task Force member Gary Goodnough, a professor and chair of the Counselor Education and School Psychology Department at Plymouth State University in New Hampshire. “We were not as detailed as we should have been. It really needed its own section.”

“I think as a group we were certainly conscious of the need of bringing the code into this decade in terms of addressing new technologies and questions counselors have about social media,” agrees Shaw.

The new section devoted to social media and technology addresses a growing need in the profession, Francis says. Given the transient and ever-evolving nature of technology, the task force tried to write the guidelines as broadly as possible so that the standards will remain relevant to future applications of technology — even those not dreamed of yet.

“A major goal was to make sure that technology was focused on not just in a new section but infused throughout, like multiculturalism was infused in the 2005 code,” says Michelle Wade, who was a private practitioner and a student representative to the task force until stepping down in July 2013 to join the ACA Ethics and Professional Standards Department as an ethics specialist.

“The profession is in growth,” Wade notes. “Some counselors are still very traditional and only conduct face-to-face sessions, but others are doing distance counseling, both by phone and online.”

This shift brings with it some significant concerns. “Sometimes, I think a lot of our profession thinks that Skype is all you need [to provide] distance counseling,” Wade says.

In reality, Skype is not compliant with the Health Insurance Portability and Accountability Act (HIPAA). But the ethical concerns don’t end there. Distance counselors need to understand that they may be subject to the rules and regulations of both their state and the state in which the client is located, emphasizes task force member Mary Hermann, an associate professor and department chair of counselor education at Virginia Commonwealth University in Richmond.

Counselors must be aware of these differences for every state in which they have a distance client. “Counselors have to make sure that they have a secure means of connecting and that their encryption standards are current,” Hermann says. “Different states may have different standards.”

“Informed consent and disclosure are important in this area,” adds Goodnough, who is also Plymouth State’s graduate program coordinator for school counseling. “What are the risks and benefits? What do we do if the technology fails or there is a client emergency?”

“Distance counseling definitely starts first and foremost with informed consent,” agrees Wade.

As it states in the new code: “In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology and/or social media, are addressed in the informed consent process:

  • distance counseling credentials, physical location of practice and contact information;
  • risks and benefits of engaging in the use of distance counseling, technology and/or social media;
  • possibility of technology failure and alternate methods of service delivery;
  • anticipated response time;
  • emergency procedures to follow when the counselor is not available;
  • time zone differences;
  • cultural and/or language differences that may affect delivery of services;
  • possible denial of insurance benefits; and
  • social media policy.”

But after counselors obtain informed consent and find a secure, HIPAA-compliant method of communication, Wade doesn’t think that distance counseling should differ significantly from face-to-face counseling. For example, she says, counselors should already have a crisis plan in place for their regular clients. Distance counseling just requires that counselors become aware of the resources available in the distance client’s location, she says.

Distance counseling is not for every client or counselor, but in some ways, it can be empowering, Wade says. Because the counselor is less available, the client is encouraged to learn what other resources are available and how to use them.

“For instance,” she says, “say I have a client I treat face to face during the summer who has to return to college in the fall. We can do distance counseling, but I would make her aware that the crisis center at her college is there as a backup resource.”

Social media scrutiny

Some counseling professionals have demonstrated resistance to new technology, but others have jumped right in, especially when it comes to social media, Wade says.

In fact, she notes, counselors have not always looked carefully before leaping into the social media pool, getting caught up in a technological and cultural movement that was not even in its infancy when the 2005 ACA Code of Ethics was released. “People were just doing things — participating in social media — and not thinking about it from an ethical perspective,” she says.

Social media guidance for today’s counselors is critical, says Goodnough, who notes that if counselors are going to be online, they need to present a professional image.

There are other issues that the revised code of ethics addresses as well. For instance: “We don’t follow our clients online. We don’t look at their Facebook,” Goodnough says emphatically. “These guidelines are helpful.”

Specifically, the code states that counselors respect the privacy of their clients’ presence on social media unless given consent to view such information.

Wade adds that although Googling a client online is tempting, especially if a counselor feels like the client is holding back, it is still regarded as an invasion of privacy.

When both the counselor and client are online, distinguishing boundaries can be tricky, Wade says. “I wanted to take a firm stand on ‘friending’ clients,” she says. “Counselors really need to distinguish between their personal online presence and their professional one.”

“You have a professional relationship with the client,” she continues, “and seeing you as a person, not just as a professional, could really change the balance of the relationship.”

As the new code makes clear, counselors who are on Facebook both personally and professionally need to set up distinct, separate profiles for each, Wade emphasizes. “Your personal profile should not have the same email or name as your professional profile,” she says.

“If you have a company name, use it for your professional page. Make the security settings on your personal Facebook page as high as possible so that you cannot be found accidentally,” Wade suggests.

For counselors who are new to social media or concerned about privacy on Facebook, Twitter may be a better option, says Wade. “It’s more anonymous than other social media,” she explains.

Twitter is a social media platform in which users “tweet” their thoughts — which may or may not include a link to an article, photo or video — in 140 characters or less. Signing up requires only a name, a username (such as @ACA_CTOnline) and an email address. Counselors can also sign up with their real names or the names of their practice if they wish to tweet about their areas of counseling expertise. For more personal tweeting, anyone who wishes to remain anonymous can sign up using a nom de plume, an anonymous email address and a Twitter name that doesn’t hint at his or her profession, location or true identity (think @Cyrano not @AdlerDC).

At the same time, counselors must remember client boundaries. For example, a counselor should not follow a client’s tweets without permission. Even if permission is granted, think ethically, advises Wade.

“Think carefully about how to handle the information your client may release,” she says. “What if a client posts something suicidal? You will have to deal with it.” Unless a counselor checks his or her social media networks every five to 10 minutes, many of the posts or tweets will not be read in real time, which makes timely crisis intervention unlikely, Wade points out.

If a client asks a counselor to follow him or her on social media, the counselor should sit down and discuss why the client wants to be followed, Wade says. In addition, the counselor should make sure the client understands that social media activity cannot serve as a mode of direct counselor-client communication, she says. If a counselor does decide to follow a client, it is probably best that the counselor and client review the client’s activity in a session so they can discuss the content and address any potential problems.

To respect their clients’ privacy, counselors should not routinely ask them about their social media activity, Wade says. If a client mentions specific activity or incidents on social media multiple times, the counselor might want to ask if there is something the client would like to discuss about his or her online activity.

Ethics Revision Task Force member Lynn Linde, a clinical assistant professor in the school counseling program at Loyola University Maryland, is well aware of the dark side of social media — particularly Instagram, a platform that allows users to upload photos and use a number of filters to change a photo’s appearance. The pictures are public, and people can “like” and post comments to them.

“Cyberbullying is an epidemic on Instagram,” says Linde, who is also a past president of ACA. “Kids don’t understand that once they take a picture and [post it or] send it to someone, it’s there forever. … Cyberbullying can happen anywhere, with anyone.”

For this reason alone, ethically, school counselors must have a basic understanding of social media so they are aware of the issues students may be facing, Linde emphasizes.

Counselors also need to know where the boundaries are. “I’ve gotten a lot of questions from school counselors about whether they can look at a client’s Facebook page,” she says. Linde’s response is that the school itself may have the legal right to access the student’s Facebook page, but, ethically, counselors should always respect their clients’ virtual privacy.

With all the new technologies available, Linde also thinks that counselors need to reconsider one technology that has become old hat — email. Because it is a method of communication that has become ubiquitous, counselors can get lazy about putting the proper safeguards in place. Particularly at schools, she says, everyone emails everyone else — counselors to teachers, counselors to parents, counselors to counselors and so on. “People forget that anything that is put in an email can go anywhere to anyone,” Linde says.

Other changes

The definition of relationship has expanded in the 2014 ACA Code of Ethics. Language has been added that prohibits counselors from having personal virtual relationships with clients, Goodnough notes. In addition, the prohibition on counselors having a relationship with a former client has been brought back after an inadvertent omission in the 2005 code, Hermann says.

Certain types of nonsexual, yet still problematic, counseling relationships are prohibited as well, such as counseling a family member or friend if the counselor will be unable to remain objective, Goodnough says.

Again, however, task force members assert that lack of objectivity should not be confused with the imposition of personal values.

The revised ethics code has also removed the end-of-life exception to the referral rule. Counselors may no longer refer a client because he or she is terminally ill and considering either physician-assisted or self-inflicted suicide. If the client wants to discuss the decision, counselors should check the laws in their state. If a counselor’s state has legalized physician-assisted suicide, then any discussion is legally covered. If the state does not allow physician-assisted suicide, counselors should consult an attorney to see if that ban includes discussing the issue, Kaplan says.

The 2014 code has also clarified “duty to inform.” If a client has revealed a diagnosis of a life-threatening disease and the counselor is concerned that a third party may be at risk, the counselor does not have to confirm his or her client’s diagnosis but should check state laws to see if it is legal to inform the third party, Kaplan explains.

Another area that has been clarified in the revised code is providing pro bono services. “The pro bono issue was one we kept coming back to, deciding what we meant by ‘pro bono,’” Shaw says. “Did pro bono mean reduced rate, or in some way addressing unmet needs?”

The task force also discussed whether it was fair to ask counselors who might be struggling financially to offer free or reduced rate counseling, Shaw says.

“We wanted to broaden the notion of what pro bono means,” Goodnough says. The revised code says that counselors should make a reasonable effort to engage in pro bono activity, but this can include public speaking, putting free professional information on their websites or volunteering counseling services in the wake of a disaster, Kaplan explains.

“The pro bono requirement is in many ways related to social justice,” Shaw says. “It is an attempt to do what you can as a counselor to improve access to services or information. It means sharing your knowledge and expertise in ways that benefit others, without posing an unreasonable burden on you.”

The revised ethics code also attempts to clarify counselors’ responsibilities with mandated clients. As Goodnough points out, these clients may be mandated, but they don’t really give up their autonomy. “Let them know what the reporting requirements are, the type of [information] we might be sharing, who we might be sharing it with and what the consequences are for not participating,” he says. “But they can still refuse counseling services.”

Another ethics issue the task force addressed was where client confidentiality starts and where it ends. Under the revised code, the responsibility to protect confidentiality begins even before a counselor takes on a client and continues after the client’s death.

“A good example comes from college counseling centers,” says Francis. “It is not uncommon on a college campus for a dean of students or a member of the faculty to refer a student for counseling services. In some cases, the referring agent may follow up to see if the student has sought services.”

“The ethics code now point out that a prospective client — someone who has an appointment but has not yet come in for services — is afforded the same privacy and confidentiality as a regular client,” he explains. “We do not release information without permission or sound ethical or legal justification.”

The 2014 ACA Code of Ethics also includes updated requirements for counselor educators. “The code now makes it their ethical obligation to teach classes within their areas of competency, provide current information and provide students with direct assistance with
field placements and career assistance,” Kaplan says.

Educators and researchers will find some significant changes in the area of ethical research as well. “The emphasis on anonymity of persons and case studies was strengthened,” Watts points out. “If you are going to use a case study, you should get permission. … The use of clients, students or research participants is appropriate only if the person has seen and agreed to it or details are obscured enough that they cannot be identified.”

Thinking and acting ethically

The 2014 ACA Code of Ethics requires counselors to use a problem-solving model when confronted with an ethical dilemma, Kaplan says.

“There are a number of models out there,” Shaw adds. “Which one [to use] is not as important as that we ensure that counselors are familiar with one, have working knowledge of it and use it to sort out some of the thornier issues.”

But the Ethics Revision Task Force members also hope the entirety of the code, including its tone throughout, will guide counselors when they are in doubt.

“I felt that we needed to work at making the code more than just specific guidance for specific situations,” Shaw says. “We needed to create a context for counselors’ ethical conduct by having a mindful, thoughtful approach to practicing ethically.”

“The whole code of ethics needs to be looked at in its entirety. It’s all connected,” adds Linde. “I hope the message comes across that we want people to be thoughtful.”

Concludes Shaw, “If you asked me what the most important change was — technology is going to keep changing, but I think the values issues questions … are really fundamental to who we are as counselors. To me, it is the most profound change in the code.”

 

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The five most common ethical concerns

American Counseling Association members receive free confidential ethics consultations as a benefit of their membership. Michelle Wade, an ethics specialist in the ACA Ethics and Professional Standards Department, handles many of these calls and emails. She provided Counseling Today with a list of the five ethical concerns that ACA members seek guidance on most frequently.

Although she here suggests applicable areas of the revised ACA Code of Ethics for each of the five concerns, she cautions that none of this should be taken as official ethical advice. To receive assistance with a specific ethical dilemma or question, contact the ACA Ethics Department at 800.347.6647 ext. 314 or ethics@counseling.org.

Subpoena questions/release of information

There are several ethical standards within the 2014 ACA Code of Ethics that need to be considered regarding the release of client information: A.1.a., A.2.a., A.4.a., B.1.c., B.1.d., B.2.d. and B.2.e.

Breaking confidentiality/mandated reporting

Note that the ACA Code of Ethics does not address mandated reporting directly because every state has its own regulations. Therefore, it is important to understand what your state’s regulations are regarding reporting. With regard to ethics, Wade refers counselors to standards B.2.a. and B.2.e. as well as A.2.a., B.1.b., B.1.c. and B.1.d.

Extending professional boundaries

Navigating the relationship between counselor and client can be difficult at times. The ethical standards that address this situation within the 2014 ACA Code of Ethics are found in A.6.

Distance counseling/social media/technology

There is a brand-new section within the 2014 ACA Code of Ethics that addresses distance counseling, technology and social media. That section (Section H) provides some guidance and considerations when working with technology and distance counseling as well as social media.

Personal values

“ACA celebrates that our members are all different and would never ask anyone to change who they are,” Wade says. “However, ACA would ask counselors to put themselves second to their clients. In the 2014 ACA Code of Ethics, A.4.b. was expanded to include the necessity of obtaining training and multicultural competency as a counselor. A.11.a. and A.11.b. were also added to suggest that referrals need to be based on competency, not values, and the reasoning for that was, again, the client comes first.”

 

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Getting familiar with the revised ACA Code of Ethics

In addition to the hard copy of the 2014 ACA Code of Ethics that was packaged with this issue of Counseling Today, ACA members can access the code online at counseling.org/ethics.

To familiarize themselves with the differences between the 2005 and 2014 ethics codes, counselors may also wish to listen to a podcast, “The NEW 2014 Code of Ethics: An Overview,” also available at counseling.org/ethics.

Additional resources, including a six-part webinar series (worth a total of six CEs), can be found at counseling.org/continuing-education/webinars.

Also, beginning next month with the July issue, Counseling Today will feature a new column series that highlights the most significant changes in the revised ethics code.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

 

Letters to the editor: ct@counseling.org

 

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1 Comment

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    Reply

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