Tag Archives: Ethics & Legal Issues

Ethics & Legal Issues

Hey, Siri: Did you break confidentiality, or did I?

By Nicole M. Arcuri Sanders January 14, 2020

Did you know that your tech devices have the potential to break your clients’ confidentiality just by being in the counseling setting with you? Imagine that you have worked a full day seeing an array of clients for the various concerns they are facing. Then, at the end of the day, you snuggle up on the couch and scroll through your phone’s applications. You notice numerous ads and suggestions that relate to the topics clients have shared. For instance, imagine a client sharing about a traumatic event that happened in the Catskills, and now you have Airbnb suggestions for that area, along with resources for dealing with sexual abuse.

You may be wondering, “How did that happen? Was my phone listening to our session?” The answer might be yes.

In other cases, you might not be made aware that your phone was listening, but it is important to know that it has that capability. The reason for this is the voice assistant technology on your devices. While on, these devices are constantly listening. For instance, Apple iPhone is listening for the word “Siri”; anything said after that is considered a command. The same is true with Amazon’s voice assistant Alexa and with Google Assistant. Each of these devices is waiting for its name to be called so that it can follow up with whatever assistance the person using it desires.

However, it has been found that the devices sometimes mistake certain words and are activated unintentionally.

This past July, The Guardian newspaper shared shocking reports from an Apple contractor. This whistleblower reported that Apple contractors “regularly hear confidential medical information, drug deals, and recordings of couples having sex, as part of [Apple contractors’] job providing quality control.” These workers are tasked with listening to grade the responses of the company’s Siri voice assistant. For example, the workers will grade if the response from Siri was accidental or deliberate and if Siri’s response was appropriate.

But what does this mean for professional counselors? Just think invasion of privacy and breach of confidentiality concerns.

Voice assistant concerns in the counseling setting

This next section is going to present a hypothetical counseling office to address some of the confidentiality concerns that surround the counseling experience with technological voice assistants. Consider whether you address these concerns in your informed consent with clients. Would these occurrences align with Health Insurance Portability and Accountability Act (HIPAA) regulations?

Waiting room: Counselors strive to create a warm and inviting setting to foster a comfortable feeling for clients because they are in a vulnerable situation. Perhaps some relaxing music is playing in the waiting room. Consider Alexa being programed to shuffle through various playlists of calming songs throughout the day.

As clients await their sessions or end their sessions, they may need to discuss billing with the front-desk assistant or call their insurance companies. Clients may even take a call during this time for other purposes. Alexa hears all of these conversations throughout the day. Therefore, the potential is there for the entrance to this “safe place” for clients to instead become a place where personal information is leaked to Alexa and to those who monitor Alexa or have access to Alexa’s recordings.

Additionally, clients may not even realize that while they are in your office discussing billing, diagnosis, and plans moving forward, their smartphone’s voice assistant can be eavesdropping as well. The same goes for all of the other smartphones located in the waiting room, including those being used by personnel working the front desk.

In session: When clients and counselors meet in an office, safety is a concern. Therefore, counselors may choose to keep their phones in their pocket or nearby in case they need to call for help. Some sites may even have a policy requesting that counselors have their cellphones on them at all times. However, now these phones’ voice assistants can have access to the dialogue that occurs within the room. This also means that whoever is monitoring the voice assistants have access. What was intended to be a safe place for clients to navigate and process concerns is now compromised.

Can you imagine if you, as the counselor, were facilitating a group and each client had a smartphone with a voice assistant? Consider also if you take notes on an iPad that has voice assistant technology. As counselors, we understand there are some limits to confidentiality. However, these voice assistant technologies have the capability to leak what clients and counselors once believed to be confidential information.

 

Disconnect: Don’t be considered liable

A number of considerations need to be taken into account by both the counselor and the client regarding confidentiality of sessions when voice assistant technologies are present. First and foremost, this issue should be addressed. Now that you are aware of the implications for your practice, you are ethically responsible for addressing these possibilities with your clients.

According to the 2014 ACA Code of Ethics, clients have the right to confidentiality and an explanation of it limits (Standard A.2.b.). Understanding these limits, clients have the right to make an informed decision regarding whether they would like to participate in counseling services with you (Standard A.2.a.).

Therefore, if you choose to utilize voice assistant technologies, you need to inform clients of the benefits and risks prior to them beginning counseling services. This explanation is not limited only to the counselor using these technologies but also acknowledging whether the counseling site allows its staff or clients to use them. If your site chooses not to utilize voice assistant technologies, you will need to address what your protocol is concerning this matter. For instance, will all cellphones be turned off? How will this be regulated?

What if your site requires cellphones for safety concerns or if clients are not willing to turn their phones off? How can you still protect client confidentiality and be in alignment with HIPAA regulations? The simple answer is to turn off your voice assistant technologies. You might consider noting the confidentiality risks in your informed consent and then sharing some of the directions noted below for how to disable these technologies.

 

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For iPhones and iPads, to turn off Siri, complete the following directions:

1) Open your settings.

2) Click Siri and Search.

3) Toggle OFF, listen for “Hey Siri.”

4) Toggle OFF, Press Home (or side button) for Siri.

5) Toggle OFF, allow Siri when locked.

 

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To turn off “Hey/OK Google,” complete the following directions:

1) Open your settings.

2) Under Google Assistant, tap Settings again.

3) Under Devices, tap Phone.

4) Turn OFF Access with Voice Match/Assistant.

 

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To turn off Amazon Alexa, complete the following directions:

1) Open your settings.

2) Select Alexa Privacy.

3) Tap Manage How Your Data Improves Alexa.

4) Turn “Help Improve Amazon Services and Develop New Features” OFF by tapping the switch.

5) Confirm your decision.

 

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These steps can provide clients with a choice while also informing them of the risks of their choices. In group counseling, however, as a safeguard to clients’ confidentiality, I would recommend not allowing any client to keep their cellphones, iPads or any other voice assistant technologies on.

Because these devices may travel with us basically everywhere we go, our conversations are being monitored for product improvements, but in the process, our confidentiality is being breached. Currently, with some simple options for turning off these technologies, clients can continue to maintain the level of confidentiality to which they originally thought they were agreeing.

As counselors, we take many safeguards to protect our clients’ confidentiality. I encourage you to toggle off your voice assistant technology options to keep your devices from being the reason you are held liable for breaking confidentiality. Moving forward, as technologies continue to transform, we as counselors need to be ready to address implications in the counseling setting.

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Nicole M. Arcuri Sanders is a licensed professional counselor, national certified counselors, approved clinical supervisor, and core faculty at Capella University within the School of Counseling and Human Services. Contact her at Nicole.ArcuriSanders@capella.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Grieved: A firsthand account of enduring a client grievance as a counselor

By Jessica Smith January 7, 2020

I learned in graduate school that most counselors will experience three things in their careers: a client who dies by suicide, a client who overdoses, and a client who files a grievance. I remember hoping that I would be the exception to the rule. Throughout my career, I tried to do everything in my power to avoid that grad school prophecy. But fate had other plans: Last year, one of my clients filed a grievance against me.

Shame breeds in secrecy. In my experience, being the subject of a client grievance is one of the most shaming — and isolating — events a counselor can encounter. Those who choose to speak openly and honestly about the grievance process are often met with judgment and criticism. In an effort to help combat the silence and stigma, I’m sharing my story with the hope that it will provide guidance and support to other counselors who are going through this difficult and trying process. I want to remind others that they are not alone on this journey while also offering a road map for a way through. It will be OK.

One of the things that helped me get through the grievance process was conceptualizing it in terms of Elisabeth Kubler-Ross’ grief cycle. I tell my clients that the stages are the road map for grief. If I had a road map, then I had a direction to go, and I was not stuck or lost. I did not know when I would reach acceptance, but I knew that it was on the horizon if I just kept moving forward.

 

Denial and shock

Early last year, while checking my email in a Target parking lot, I saw a message from the Department of Regulatory Agencies (DORA) sitting in my inbox. In Colorado, DORA is the governing body that issues licenses to providers while also handling consumer grievances. My heart began beating quickly. I felt dizzy and nauseous. I walked into the store to return an item at the customer service counter, and I had to will my legs to move forward and my mouth to speak. I felt like everyone around me could see a massive letter “G” tattooed across my forehead. My hands began to shake as I drove home so that I could read the email at my desktop computer. As I read through the entire message from DORA, I started to cry.

A few weeks prior, I had taken on a new client at my practice. Interestingly, my intuition immediately suggested that this client would be challenging. The second session reinforced my sense that building a therapeutic relationship with this client was going to be a rough road. The third session didn’t happen — the client was a no-show, no-call. When I reached out to the client through a text message, she said that she did not want to schedule a future session with me, so I discharged her from therapy that afternoon. I had a feeling this would not be the last time that I heard from this client. My intuition was correct.

I received an email from the client that night, criticizing me for the way I had handled the interaction. She thanked me for helping her but asked me to explain my “side of the story.” Because I had already discharged her from therapy and felt that any potential future counselor-client relationship would be negatively impacted by the exchange, I told her that I no longer felt comfortable working with her. Again, I had a feeling this would not be the last time I heard from this particular client. My intuition was right again.

 

Bargaining

DORA was citing me for poor communication and abandonment. I immediately reached out to a friend and former colleague who had worked with an organization that completed assessments for DORA. I knew she had also been through the client grievance process a few years prior. As I prepared for our discussion, I looked up everything I could find on the internet about the grievance process, client abandonment, HIPAA, and mental health statutes. Nothing was clear, and most of the information seemed contradictory.

On the phone, I laid out the facts of the case before my friend. Like many others I would talk to along the way, she thought it likely the case would be dropped. Thankfully, the grievance was not based on a verbal exchange; resolving the case would not depend on pitting my word against the client’s. My friend advised me that I might need to seek legal counsel, and we discussed my official response to the complaint, which I typed up immediately and sat on over the weekend.

The following Monday, I gathered the client’s file and submitted it to DORA, along with my response to the grievance. I also reached out to my insurance carrier to let it know about the grievance. All the while, I was hoping the case would be dismissed so that this nightmare would end. Due to the benign nature of my case and the cost, I chose to hold off on hiring legal counsel at the beginning, but my insurance provider encouraged me to reach out to a lawyer if the case continued any further.

 

Depression

The grievance was all I could think about. It consumed me. I would fall asleep ruminating about it and wake up the next morning to a continuation of my thoughts from the night before. Or, just as often, I would wake up in the middle of the night, my anxiety quickly rising as I remembered that this was not a dream — it was really happening to me. I prayed for it all to go away. I wanted to return to a sense of normalcy. I began second-guessing myself and the image I was presenting to my clients at work. I felt on edge and afraid that something else would happen. I feared that this grievance process would not be the end of it.

I had been in the field for seven years and had never experienced an issue like this previously. I had provided services in challenging and demanding settings, including detoxes, residential treatment facilities, and jails, and I had never before had a client complain to a supervisor or another colleague about my work.

Because the personal is professional and the professional is personal in our work, it can be hard to separate the two. This makes it difficult to prevent internalization during the grievance process. I felt like a bad counselor and, thus, a bad person. At the same time, I felt confused because I had other clients telling me that I was an incredible therapist who had helped them change their lives for the better and become the best versions of themselves. I tried to hold space for all of these experiences and live in the gray, but it was tiresome and tough to do.

Fearing judgment and criticism, I was mindful of who I shared my troubles with. I was in a vulnerable place and was already attacking and beating myself up enough without someone else adding to the punishment and suffering. Like most therapists, I am attuned to nonverbal cues and underlying speech tones and was always looking for them when I told my story to fellow counselors. For the most part, I chose to keep the experience to myself and a few confidants, but I knew that wasn’t enough. I also needed the perspective and guidance of other professionals during this demanding time, so I shared with people in my therapist support groups. The majority of the people I told were empathetic, nonjudgmental and supportive, but there were a few whose faces dropped once I told them. There were still others who tried to use my story as their own personal case study, which was disappointing and disheartening.

I felt like I was in a dream, observing this entire experience happening to me from a distance. I believe that, at the time, this was a necessary coping strategy. I had to compartmentalize the experience so that I could go to work each day and meet with clients at my private practice. I likened it to being sued by your company and continuing to show up for work every day, knowing what is happening around you and within you.

I questioned myself constantly and considered what I could have done differently. I read through the mental health statutes and searched HIPAA forums, but nothing was transparent and straightforward. I tried to look up articles, podcasts and research on the grievance process but could find only one research article from the 1990s on the impact of the grievance experience on psychologists. It helped to know that my experience of the process was normal and valid, but it did not ease my fears.

 

Anger

I have two licenses in Colorado, which is advantageous in my work — except for when I going through the grievance process. My double licenses made it doubly difficult because my case had to go before both boards. The two licensing bodies can have differing opinions and sanctions, but I learned early on that once one board reaches a verdict, the other board often follows suit. I received an email informing me that the Colorado State Board of Licensed Professional Counselor Examiners would be the first to review my case, in May. I had submitted my paperwork in February, so it would be months before I would know the resolution of my case. I was learning that the grievance process is a prolonged waiting game.

Meanwhile, I was expanding my practice and interviewing contract therapists. Then, in April, I received an email from the Colorado State Board of Addiction Counselor Examiners informing me that my case had gone before its board first, without my knowledge. I was blindsided. I was in the middle of doing interviews but, thankfully, had a break, so I drove home. I made it about halfway before pulling over to the side of the road to read the rest of the email. My mind was blown. I felt like my sense of reality was crumbling.

The Board of Addiction Counselor Examiners had found me “guilty” of the allegations and was moving the case forward to Colorado’s Office of Expedited Settlement. I found a lawyer online and emailed him from the side of the road. I felt powerless and out of control and needed to find a way to regain my sense of self-agency. I knew that taking action was the way for me to do that. I didn’t want to have any regrets about what I could have or should have done, so I was finally ready to get legal assistance for this fight.

I met with the lawyers the following week and learned that they were receiving three to five grievance cases per day. In the past, they said, they had received only three to five grievance cases per month. After our meeting, I looked up the list of therapists involved in disciplinary actions through DORA’s website, and the numbers were staggering. There are approximately 26,000 counselors in Colorado, and more than 11,000 have received disciplinary action.

I was angry — with myself, with the system, with the profession, and with the client. I felt so much anger pulsating through me that I wanted to scream and to run away, both at the same time. I thought about walking away from it all — leaving the counseling profession, giving up my licenses, and moving on to a different, safer, easier path.

Mainly I thought, “Why me?” I felt myself moving into a victim mentality as I had done in the past when going through trying experiences. Because I have been victimized in my past, this is an easy role for me to assume when I am experiencing pain and suffering. I blame others and shut down.

Anger is an uncomfortable emotion, but I knew I was meant to have it in this moment because it would lead to motivation, change and movement. I could harness it or let it eat me alive. It was my choice alone.

 

Acceptance

Like many grieving people, I remained stuck for some time in the anger phase. Anger feels powerful and motivating, unlike sadness, which is exhausting and debilitating. However, I always go back to the saying that “anger is like taking a cyanide pill and hoping it will kill your enemy.” It only ends up hurting you in the end. My anger toward myself, the client, the system and the profession would not serve me. It would end up eating me alive if I allowed it to.

I was walking home from work one day when suddenly it began to rain. Completely unprepared, I had nothing to keep me dry. It was only a mild shower, however, so I said out loud, “If it keeps raining like this, then I’ll be OK.” It started raining harder. Undaunted, I said again, “If it keeps raining like this, then I’ll be OK.”

And then it began to pour. I was halfway home, caught in a storm without a raincoat. All I could do was surrender. I was broken open. The armor of anger I had been parading around in fell away as I began to cry. “I surrender,” I said aloud. “I get it. I’ll always be OK.” I started to smile as tears mingled with the raindrops running down my face. Nature has a way of asking us to let go of our resistance and surrender.

I released my anger in that moment, realizing that I’d been aiming most of it at myself. I began the slow process of forgiving myself and coming back home to the idea that we are all doing the best we can. I never meant to hurt the client, and I had no malicious intent in my actions. I had done the best I could in that moment and with the situation.

I moved into acceptance by making meaning of the experience and discovering that it was meant to realign me with my soul’s calling and purpose. I realized that I cannot veer far off my course in life before the universe pushes me back into my lane.

 

Lessons learned: Seek support, ask for help, find allies

It is difficult to share with others what it’s like to go through the grievance process, but it is also incredibly necessary. As is the case with any grief process, we need sources of support to call on to ground us and anchor us when we feel like we are floating away or losing sight of our true selves. As professional counselors, we may make mistakes, but that does not make us bad people. We need to be reminded of our goodness and wholeness.

It is essential to surround ourselves with genuine and unconditional love and to have a safe place to cry and yell without fear of judgment or criticism. When all we want is to lie on the ground and give up, our support systems can lift us up and keep us moving forward. And, finally, we need to be reminded that counseling is extremely difficult work.

My only regret about the whole process is that I did not seek legal counsel sooner. I wonder what might have happened if I had not been deterred by the nature of my case and the cost. Although I now realize that I needed to go through this process to realign my priorities and path both personally and professionally, I sometimes question whether things would have turned out differently if I had sought the assistance of a lawyer in formulating my response to the grievance originally.

Retaining attorneys earlier in the grievance process might not have helped me avoid the verdict of “guilty,” but it likely would have provided me more peace of mind. In fact, once I sought legal counsel and spoke with my lawyers, I felt a sense of ease and relief. As I mentioned, I was restless and waking up frequently during the nights, but after that initial afternoon meeting with my lawyers, I got my first full night’s sleep in two months. I am aware of how vital regaining the ability to rest was to enduring the trauma of the grievance process. Sleep heals.

Later on in the process, I connected with the Colorado Counseling Association (CCA). I remember saying to myself, “DORA protects the consumers, but who protects the counselors?” This was my answer. I went to an event sponsored by CCA and learned more about the advocacy work it does to support and help counselors. Specifically, it is fighting to change the vague and subjective language of the clause in the mental health statute of “best practices” that was cited in my case and many other cases as a catch-all category for disciplinary actions. Here were even more people on my side who were passionate about advocating for counselors and changing the system.

During the grievance process, someone had said to me that the tower I had built with all I had believed to be true was crumbling and falling, leaving behind a pile of rubble and debris. My beliefs about my career had been built on shaky and rocky ground to begin with, so it was inevitable that they would all come tumbling down eventually. Now that the collapse had ended, I had to decide what to do with the debris. I could choose to walk away from the bricks and stones in the rubble, or I could use them to build a new tower on stronger ground.

I am still in the process of rebuilding, and I know that it will be a slow and methodical project. I am fulfilling the stipulations from DORA and considering the future. I am not sure if I will ultimately want to maintain both of my licenses. For now, however, I have chosen to keep them. But I know that the choice is mine — no one else’s. I now have a solid foundation on which to build my tower.

With each placement of brick and stone, I feel stronger and more powerful than I was before this experience. My battles scars and wounds will influence how I build my tower, but they will not halt or control the construction. As Carl Jung said, “I am not what happened to me; I am what I choose to become.”

 

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Jessica Smith is a licensed professional counselor and licensed addiction counselor with a private practice, Radiance Counseling (radiancecounseling.com), in Colorado. Contact her at jsmith@radiancecounseling.com.

 

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ACA members: Facing a dilemma about ethics, business practices or risk management? Contact the ACA Ethics and Professional Standards Department at (800) 347 6647, ext. 321 or email: ethics@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Confidentiality – The core of ethics

By Gregory K. Moffatt September 17, 2019

As my colleague and I chatted casually in the copy room about life’s odds and ends, she mentioned a client I had referred to her some months earlier.

“Thomas [not the client’s real name] is doing so well,” she commented absentmindedly. “Thank you for the referral.”

Nobody was around to hear us, but I couldn’t believe my ears. My colleague had just used a client’s name. Even though I had referred the client to her and I knew she was seeing him, I was shocked she had identified him so casually.

When we study counseling ethics, we often use phrases such as “do no harm” or “what is in the best interest of the client” as general landmarks for ethical dilemmas. In the 2014 ACA Code of Ethics, nearly all of the ethical standards, from Section A through Section I, in some way or another relate back to protecting the client from harm.

Although I use these benchmarks myself and often mention them to my supervisees and interns, I would suggest that confidentiality comes in at a close second place for the core of our ethical conduct.

Our informed consent, release of information documents, and testimony in court are all centered around the importance of maintaining the confidentiality of our clients. We don’t leave client files lying about on our desks or open on our computer screens.

Current common practice in office construction is to have windows in all office doors. The attorney for the university where I teach loves this practice. But this approach creates an ethical problem for us as counselors. We cannot maintain the confidentiality of our clients’ identities if passersby can easily glance in the window and see them.

When the Health Insurance Portability and Accountability Act (HIPAA) was first introduced to us, I resented it as another governmental intrusion into my work, but I came to realize its power to protect the confidential information of our clients — the very thing I am advocating here. While I don’t necessarily “love” HIPAA, I value it highly and comply with all of its requirements. I pay heed to HIPAA not simply to keep from getting into trouble, but rather to protect my clients.

The very words in this article model my respect for client confidentiality. I have changed the name of the client and a few of the specifics regarding the interaction between my colleague and me. If either of them happened across this article, there is little chance that they would recognize themselves. The gist of the story is true, but some details were changed to protect both the client and my colleague.

I drill a high regard for confidentiality into the minds of my clinicians. I want to ensure that they are so sensitized to this part of our ethics that even the smallest breach will scream at them.

While I certainly appreciate a word of thanks from a colleague if I refer a client, I don’t want to hear, “Thanks for referring Thomas to me …” Even the simple use of a client’s first name in a private conversation between colleagues is a big deal. If we allow that, what other slips will we allow?

I couldn’t let the situation pass. According to Standard D.1.d. of the 2014 ACA Code of Ethics, it is my duty to address ethical lapses within the field. This provision says that if we perceive an ethical violation, we should first approach colleagues directly to resolve it.

As awkward as it was, I gently told my friend it made me uncomfortable that she had used the client’s name. I had scarcely finished the sentence before her mouth dropped open and she quickly covered it with her hand upon the realization of what she had done. She apologized and said she knew better. Somewhat to my surprise, she also thanked me for modeling ethical conduct and for respectfully calling this out to her. She won’t make that mistake again, and I’m glad I did the right thing.

Thomas will never know what happened. But this isn’t just about Thomas. It is about a way of behaving that protects all of our clients, regardless of whether they will ever find out.

Basketball legend John Wooden has been credited with saying, “Character is how you behave when no one is watching.” Ethical behavior, including confidentiality, is perhaps most clearly reflected when no one is watching.

 

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counselor self-disclosure: Encouragement or impediment to client growth?

Written and compiled by Bethany Bray January 29, 2019

W. Bryce Hagedorn once counseled a client who was wrestling with intense feelings of shame regarding things he had done during the Vietnam War. The client, a veteran of the U.S. Marine Corps, felt responsible for the soldiers he had lost during combat. He never expressed any details connected to these painful and complicated memories, however, until Hagedorn used a pivotal therapeutic tool: self-disclosure.

Hagedorn is also a Marine Corps veteran who has served in combat. The disclosure of his military service “opened the door to share things that the client had never shared before, even with going to the Department of Veterans Affairs [for treatment] for years. Before he was able to share, he wanted to know if I would be judging him,” says Hagedorn, a licensed mental health counselor and director of the counselor education program at the University of Central Florida.

When used sparingly, professionally and appropriately, counselor self-disclosure can build trust, foster empathy and strengthen the therapeutic alliance between counselor and client. However, counselor self-disclosure also holds the potential to derail progress and take focus off of the client. It is a tool that should be used with care — and in small doses, according to the ethics professionals working at the American Counseling Association (see sidebar below). Learning how, when or whether to use self-disclosure with clients is best achieved through training, experience and supervision.

Hagedorn notes that once a clinician self-discloses, the client may naturally be inclined to ask questions seeking additional personal information about the counselor. “If you’re going to self-disclose, know ahead of time where your bailout point is,” says Hagedorn, a member of ACA. “Once you open the self-disclosure door, where are you going to stop? When I worked with couples, they could see that I was wearing a wedding ring. I was often asked how long I had been married, if I had kids or if I ever struggled like [the clients were] struggling. Know where you’re going to stop answering questions.”

Hagedorn doesn’t believe that self-disclosure should be an automatic, out-of-the-gate technique for counselor practitioners. Rather, he advises, counselors should consider it a tool to keep in reserve, using it only when appropriate — and with clear intention.

“I’m in favor of less is more with self-disclosure,” Hagedorn says. “If you’re going to self-disclose, you have to do it with dignity and understand the reasons why a client is asking [for personal information from a counselor]. Explain to the client, ‘Even if I have walked down a similar path, it doesn’t mean I have walked down your path.”

 

The many aspects of self-disclosure

Counseling Today recently collected insights about counselor self-disclosure from American Counseling Association members of varied backgrounds and practice settings. Read their thoughts below.

We encourage readers to add their own thoughts to this discussion by posting comments at the bottom of this article.

 

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Kimberly Parrow is a doctoral student at the University of Montana. She is a licensed clinical professional counselor who specializes in working with clients to address grief and posttraumatic growth.

Client comments often spark the urge for self-disclosure. The feelings of connection in a professional counseling relationship tempt counselors to self-disclose, sometimes without warning. I think the consideration of providing personal details to clients occurs regularly [but] believe situations when such disclosures are appropriate are few. Appropriate self-disclosure is client-focused, validates the client’s experience and spurs further exploration. A constructive disclosure is brief, focused on meaning and light on story.

Professional counseling relationships require a harmony of the necessary theoretical and relational components. When the pull to disclose occurs, I take a moment and ask myself three things:

a) Is the disclosure grounded in theory?

b) Is there any other way to keep the locus of the experience within the client’s world?

c) How will the disclosure affect the therapeutic relationship?

For these reasons, I think it is important to keep in mind that the decision to disclose should not be made in the moment. An appropriate disclosure is the product of thoughtful planning.

I once had a young adult client recovering from a tragedy that killed several people and left him clinging to life. Our work began after several months of hospitalization and physical therapy. A number of sessions became focused on his feelings of dissociation regarding his own near-death experience. He would make statements such as, “I almost died, and it feels like I don’t care.” He explained the feeling was getting in the way of connecting with his family and friends. His support people couldn’t understand why he wasn’t more thankful to be alive, and neither could he. Feelings of isolation and confusion were becoming a sticking point in his recovery. He felt alone in a rare experience. However, he wasn’t and isn’t alone; I have had a near-death experience too.

My decision to disclose took several days. The disclosure would be tied to our treatment goals, but keeping the locus on the client was a challenge. A discussion of my experience might be too alluring and could pose a threat to our therapeutic relationship and focus. Eventually I decided on a very brief statement, [saying], “I almost died once too,” and waited for the subject to surface again. When it did, I shared my brief statement. It was simple and powerful. In that moment, he was able to trust that my validation of and explanation for his dissociation was real, because I had also lived it. As a result, our therapeutic bond deepened, and our trauma recovery work gained traction.

 

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Benjamin Hearn is a school-based counselor in Columbia, South Carolina.

Self-disclosure is something that we all do with our clients from the moment we begin interacting with them. Our clothes, offices and other nonverbal communications all disclose things about [us], either intentionally or unintentionally.

Our more common notion of self-disclosure, however, centers on information we share about ourselves verbally with our clients. One piece of information that I have found myself often considering whether to disclose is my identity as a gay male. I most often disclose this information when I have sufficient client rapport and a client voices an incorrect assumption about me, such as asking about my wife. At other times, I may use disclosure to model a healthy gay identity or to promote a sense of similarity between myself and a client.

This latter approach was particularly helpful with a teenage client who had recently come out as gay but did not know other gay people and conceptualized them using common stereotypes. In order to keep the focus on him while disclosing, I framed my disclosure with a question afterward, saying, “I’m not sure if you know this, but I’m also gay and wonder if you see me as fitting within these stereotypes?” This allowed my client to explore differences in gay identities, as well as modeling a secure identity. He noted that he was surprised at how casual I had been in my statement, after which I was able to assist him in exploring reasons that he was anxious about his own disclosure to others.

Regardless of the content being self-disclosed, counselors should consider the possible risks and benefits of disclosure prior to disclosure and how they will keep focus on the client afterward. This can be done by questioning how a client responds to the information or by ending the disclosure using an empathy statement such as, “I remember when my own child left for college. You feel like the house and your life is just emptier.” Though this statement contains a self-disclosure, it is framed in a way that acts as an empathy statement, which the client is then able to evaluate according to their own experience.

Overall, mindful and intentional self-disclosure can act as a powerful technique in the therapeutic relationship [that] can normalize client issues, model healthy behaviors and increase clients’ own self-exploration.

 

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John J. Murphy is a licensed psychologist and professor of psychology and counseling at the University of Central Arkansas. He is the author of the book Solution-Focused Counseling in Schools, published by ACA.

The decision to self-disclose, like any counseling decision, is based on my judgment of its potential to enhance clients’ goals. For me, self-disclosure is never planned but occurs spontaneously, just as it does in other relationships and conversations. Self-disclosure can help convey our humility, humanity and understanding. Research indicates that the most effective counselors are seen by clients as genuine, compassionate and accessible, and self-disclosure can help foster such perceptions.

The following examples of self-disclosure occurred in a psychoeducational group that I led for parents and guardians of children with behavioral difficulties:

  • We started the first meeting by stating that some parents describe parenting as one of the most joyful, gratifying and challenging experiences of their lives. I commented that parenting was much more draining and humbling than I ever expected, adding that “if I made as many mistakes on a job as I do as a parent, I’m pretty sure I’d be fired within a week.” They liked that metaphor and brought it up a few times in subsequent meetings.
  • I made the following comments in a meeting during which a parent stated how hard it was to change her parenting style: “Some of my parenting habits have been really hard to break. One that comes to mind is the use of those short ‘precision requests’ we discussed last week. Even though I teach it to parents, it’s hard for me to do it with my own kids. So, I have these times when I can almost see the words traveling from my mouth toward one of my kids, and I just want to reach out and pull them back before they get there. I’m not sure why I expect these words to work now when they haven’t worked the last 100 times. It’s frustrating and embarrassing.”

Both examples framed the experience of making and accepting mistakes — a valuable skill for any parent — as a shared, inevitable part of any major life journey, parenting or otherwise. While neither example was deeply personal or self-revealing, I hope that acknowledging my own parenting blunders and frustrations helped level the relationship and enhance my approachability.

Self-disclosure, like anything else we do as counselors, is only as useful as clients’ response to it. Obtaining regular client feedback on their experience of the alliance can also help detect a client’s response to self-disclosure and other aspects of our overall counseling style and approach.

 

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Catherine Beckett is an adjunct faculty member in the doctoral counseling program at Oregon State University. She also has a private practice in Portland, Oregon, specializing in grief counseling.

Like many other aspects of counseling, clients are going to have different experiences with different approaches. One question I always ask during the intake process is, “If you have had counseling in the past and it worked well, what was it about the therapist’s approach or style that was positive for you? Or, if it did not work well, were there aspects of the approach or style that contributed?”

Some clients say, “That therapist shared too much; I didn’t like it.” Whereas others may say, “That therapist wouldn’t even answer basic questions about him[self] or herself, and I found it hard to have a relationship with somebody I didn’t know at all.” So, within the bounds of what I believe is ethical and what I feel comfortable with, I will try to be respectful of a client’s preferences in the service of building a positive alliance.

The second principle I have found useful is the practice of requiring myself to have clarity about the purpose of a disclosure prior to making it. I suggest to clinicians whom I supervise that they be able to follow any disclosure with, “The reason I am sharing this is …” This serves two purposes. First, it holds counselors responsible for clarity around intention. Second, it makes the purpose or intention clear to the client, as opposed to — and guards against the possibility of — a disclosure coming across as chitchatty, or as the counselor making the session about him/her.

I also believe that counselors need to be very cautious about using disclosures to convince a client that we understand how she or he feels. Even if we have had an experience similar to what that client is going through, the reality is that we don’t know how she or he feels. We had our own experience, and the experience of our client may be quite different.

 

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John Sommers-Flanagan is a professor of counselor education at the University of Montana and the author of eight books, including Tough Kids, Cool Counseling, published by ACA.

My first thought about self-disclosure is that it’s a multidimensional, multipurpose and creative counselor response (or technique) that includes a fascinating dialectic. On one hand, self-disclosure should be intentional. If counselors aren’t aware that they’re using self-disclosure and why they’re using it, then they’re probably just chatting. On the other hand, self-disclosure should be a spontaneous interpersonal act.

Self-disclosure is an act that involves revealing oneself. As Carl Rogers would likely say, if your words aren’t honest and authentic, then your words aren’t therapeutic. From my perspective — which is mostly person-centered — the purest (but not only) purpose of self-disclosure is to deepen interpersonal connection. As multicultural experts have noted, self-disclosure can facilitate trust more effectively than a blank slate, because transparency helps clients know who you are and where you stand. What’s less often discussed is that it’s impossible to not self-disclose; we’re constantly disclosing who we are through our clothing, mannerisms, informed consent form, office accoutrements and questions.

I remember working with a 19-year-old white, cisgender, heterosexual male. He told me he was diagnosed as having reactive attachment disorder. After listening for 15 minutes, I was convinced that there was no possible way he could meet the diagnostic criteria for reactive attachment disorder. First, I used an Adlerian-inspired question/disclosure: “What if it turned out you didn’t really have reactive attachment disorder?”

You might not consider a question as self-disclosure, but every question you ask doesn’t simply inquire, it simultaneously reveals your interests.

Later, I disclosed directly, using immediacy: “As I sit and listen to all your positive relationships, it makes me think you don’t have reactive attachment disorder.” Despite my interpersonally clever use of an educational intervention embedded in a self-disclosure, my client didn’t budge, countering with, “That doesn’t make any sense, because I’m diagnosed with reactive attachment disorder.”

At that point, I wanted to use self-disclosure to share with him all the ways in which I was a smarter and better health care professional than whoever had originally misdiagnosed him. Fortunately, I experienced a flash of self-awareness. Instead of using disclosure to enhance my credibility, I spontaneously disclosed, “I’ve been talking way too much. I’m just going to put my hand over my mouth and listen to you for a while.”

As I put my hand over my mouth, my client smiled. The rest of the session was — in both our opinions — a rousing success.

 

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Zachary R. Taylor is a licensed professional counselor (LPC) and behavioral health director at a health center in Lexington, Virginia.

I specialize in working with patients who have chronic anxiety and panic, and I regularly disclose that I suffered from these disorders myself for more than 10 years.

The key is being specific about my experiences because many anxious patients feel no one understands what they are going through. Simply saying, “I too was anxious” often doesn’t connect. Instead, I choose specific stories about my many trips to the emergency room, my phobia of checking the mail, the clutching on to my Xanax and my sophisticated driving routes through town to avoid anxiety triggers.

When I share these things, it’s usually out of an effort to normalize their experience and get leverage because, if they know I’ve been there, they’re more likely to accept my help not only as a licensed counselor but also as a former anxiety sufferer who has used these same counseling principles to recover.

Second, I use self-disclosure to reinforce principles we are working on in counseling. For example, to this day, I still experience scary and sometimes tragic images that flash through my mind out of the blue. These used to send me into full-on anxiety spirals, during which I would go through all kinds of safety behaviors to reassure myself that I, and everyone I loved, was OK.

The only real difference between these images then and now is not that the images don’t come back anymore but that I learned how to do things many counselors know as cognitive defusion and psychological flexibility. This is the ability to recognize the imaginary quality of these images and learning how to have the courage to treat them as things I can safely ignore.

This example, in particular, is useful when patients believe every anxious thought, image or sensation and take them as something they need to either respond to or repress. It gives them a new vision that recovery doesn’t mean never having another anxious thought but learning to cope with them when they show up.

However, we must remember there’s a difference between showing patients our psychological scars versus our psychological wounds. There is a significantly greater risk in revealing hurts not yet healed. We must be judicious in self-disclosure, make it brief, always have a clear therapeutic purpose and have a reasonable expectation that the patient can manage the disclosure and that they never feel the need to care for us in the process.

 

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Richard S. Balkin is an LPC and the editor of the Journal of Counseling & Development. He is also a professor and doctoral program coordinator in the Department of Leadership and Counselor Education at the University of Mississippi.

In the second semester of my master’s program, my skills class was taught by a professor who followed a psychoanalytic orientation. She was clear that she would give feedback based on this orientation and that it was OK to reject her feedback as long as we supported any alternative with our understanding of theory. I do not recall any student rejecting her feedback. That being said, I do recall my first session with a client. When the client entered the room, I reached out to shake hands. When reviewing my initial session with the professor and class, I was asked [by the professor] why did I reach out to shake hands? When I indicated I thought that was the polite thing to do, I was told, “That’s about you, not the client.”

I remember being taken aback by this feedback, which seemed to me rather extreme. Not only did I listen to it at the time, but I was influenced by it for many years. Naturally, not shaking hands with the client easily extended to what I could possibly share with a client. If the initiation of a handshake was viewed as countertransference, I could only imagine what my professor would say if I were to self-disclose.

Of course, all of this was challenged in my first year working as a professional counselor, when I worked on a dual diagnosis unit with adolescents. Many members of the multidisciplinary treatment team were active in 12-step support programs, so self-disclosure as a means for teaching about addiction and working together was very natural. More importantly, the adolescents seemed to appreciate the candor and learn something from it.

No doubt, self-disclosure can be helpful, but it can also be self-serving for the counselor, contributing to an unhealthy dynamic in the counseling relationship. If the curative components of counseling truly are based on the counseling relationship, then counselors might do well to consider how self-disclosure will deepen the counseling relationship. In [the ACA-published book] Relationships in Counseling and the Counselor’s Life, my co-author, Jeffrey Kottler, and I mention ways that self-disclosure can be therapeutic, [including] communicating understanding and acceptance and promoting deeper reflection.

 

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Sidney Shaw is an LPC in Anchorage, Alaska, and a core faculty member in the School of Counseling at Walden University.

Researchers often describe two types of self-disclosure: immediate and nonimmediate self-disclosure. Immediate refers to process self-disclosures from the counselor about their own feelings or ways of experiencing the relationship with the client. Nonimmediate self-disclosure or counselor disclosure about their life, personal experiences or biographical information is often what counselors are referring to when they discuss self-disclosure. Immediate and nonimmediate self-disclosure both have potential to deepen the alliance and promote client wellness. That said, there can also be negative effects of indiscriminate self-disclosure. The litmus test of whether or not to engage in self-disclosure is to do so only when it will be therapeutic for the client.

In the spirit of self-disclosure, I’ll share an anecdote about nonimmediate self-disclosure from my own practice. Early in my counseling career, I worked with indigenous communities, and one of my first experiences was to co-facilitate groups on the topic of healthy families and communities. In preparing for the upcoming groups, my supervisor asked me, “Have you thought about what story you are going to share about yourself?” I replied that I had not considered it, and I could feel my anxiety rise as he mentioned it. As a recent counseling graduate, I was highly concerned about negative effects of self-disclosure — e.g., too much emphasis on me, communicating that how I dealt with a situation is how the client should deal with it, etc.

As my supervisor pointed out, and as supported by my subsequent experience and broader research findings on the topic, self-disclosure is frequently an important element of developing trust in working with indigenous clients. One of the groups that I co-facilitated was on the topic of male family relationships. With this in mind, I shared a brief story about my father, how we had been through a long period in which our relationship was conflictual and how we eventually worked to move toward a more harmonious relationship. Cultural context is an important factor to consider in terms of how and to what degree to engage in self-disclosure. Thoughtful and intentional self-disclosure can help counselors build alliances with individual clients and with communities outside of their own.

As counselors, we may initially intend to self-disclose in order to promote client well-being, but self-disclosure can subtly and unwittingly begin to creep toward serving our own needs. The question of whether or not our self-disclosure is therapeutic for the client is not one that counselors should answer in isolation. Ongoing consultation with skilled, wise and competent supervisors and peers is an essential element of helping counselors answer this question.

 

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Caitlyn M. Bennett is a licensed mental health counselor and an assistant professor at the University of North Texas.

One of my areas of clinical expertise is anxiety, especially in adolescents and young adults. Anxiety has a way of making people feel out of control, and oftentimes, clients have told me that they “feel crazy.” Because of this, I have found when processing and making sense of the physiological aspects of anxiety — i.e., racing heart, tightness of chest, etc. — with clients, it can be empowering and validating to self-disclose my personal physical expressions of anxiety.

Prior to this self-disclosure, I find that general psychoeducation about anxiety [and its effects on] the brain and body serves as a catalyst to making sense of anxiety as well as serving as a bit of a normalizing factor. This helps me to gauge whether clients feel connected and understand the physiological impacts of anxiety. For example, their experience of anxiety may not involve as much of the physical experiences. Thus, me expressing my personal physical experiences of anxiety would not be helpful for the client.

After exploring psychoeducation, I begin to encourage clients to share about their personal physical experience of anxiety. If clients have a hard time identifying where in their body they experience anxiety, this is where I introduce self-disclosure by sharing, “When I feel anxious, I may feel my anxiety in my chest or my shoulders tense up. What about for you?”

I have found that this softens and makes exploring anxiety safer and more relatable without taking away from the counseling space being for the client. It also creates an added layer of connectivity for the therapeutic relationship. I have found that some of the most powerful sessions have been when clients feel understood by me as their counselor and also realize that I am only human too.

In all aspects of self-disclosure, I reflect on rapport and encourage my students to do the same. For example, I don’t make it a point to self-disclose prior to establishing a working therapeutic relationship. Self-disclosing prior to creating this relationship may create misunderstanding of what counseling will or will not look like for the client.

It is also important for counselors to remember that self-disclosure can be such a powerful tool. In my personal process of integrating self-disclosure with a particular client, I reflect on the pros and cons of self-disclosure, the difference of impact in emotional (personal feelings) versus content (facts) self-disclosure, the development of the client and multicultural factors. When I have explored this with counselors-in-training, we often focus on using self-disclosure “for good and not for evil.” That is, will the self-disclosure I choose to use be helpful for my client and their process or only benefit myself?

 

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Carol ZA McGinnis is a licensed clinical mental health counselor and approved supervisor. She is a pastoral counselor and clinical director for the AWI Counseling Center at the Fairview United Methodist Church in Phoenix, Maryland, and an associate professor and clinical mental health track coordinator in the graduate counseling program at Messiah College.

As a person-centered [counselor], I rarely self-disclose and only after professional consultation and deep reflection on how that content may be of significant help to the client.

One client who had decided to drop out of high school and pursue her GED received a brief self-disclosure from me at our termination session. I considered the fact that I had dropped out of high school and earned my GED many years prior to completion of my Ph.D. sufficient to disclose. [In doing so, I] meant to encourage and challenge the client to stay the course.

Another client I can recall self-disclosing to was a Muslim adolescent whose parents had asked with concern about my religious orientation. After consultation with my site supervisor and fervent prayer, I decided to disclose my faith tradition along with reiteration of my work that would focus on the client’s beliefs and not my own. It was rewarding to receive a copy of the Koran at our termination session in appreciation from the client and his family.

I do, however, use emotional self-disclosure fairly frequently to validate and normalize client anger. Oftentimes, people who come to me for help with their anger feel shame, guilt or fear, and it has been helpful for them to hear that I am in alignment with them when they report an unfair or unjust event as the source of that emotional response. This disclosure does not include circumstances or stories from my life but instead remains strictly within the realm of emotion in the moment.

One client example of this type of disclosure involved a [client’s] vague memory of an unidentifiable doctor who had engaged in questionable behavior during a medical physical when she was a teenager. The client could not recall what had happened beyond [the doctor’s] request to have her strip naked and do jumping jacks, yet the anger she held toward him was fresh. When this client cursed through tears at this person in the counseling session, I disclosed my own feeling of anger toward this person because he had violated her trust and his professional mandate to act in an ethical manner. Efforts to report this professional were largely unsuccessful due to the client’s blocked memory, yet the client reported feeling affirmed and validated by our work that focused on mitigating that traumatic event.

 

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Practitioners who choose to self-disclose information about their personal lives in counseling sessions often walk a fine line between using it as a tool to connect with clients and diverting attention away from clients and on to themselves.

When used incorrectly, self-disclosure can take focus away from the therapeutic work and the needs of the client. When used appropriately, however, practitioner self-disclosure can build trust, strengthen the therapeutic relationship and help a counselor to express empathy.

So, how much self-disclosure is too much? Practitioners must always put the client first when using any intervention, including self-disclosure, says Joy Natwick, ethics specialist for the American Counseling Association. Counselors should carefully consider their client’s needs and presenting issues and whether the self-disclosure could trigger an issue with which the client struggles, such as excess worry or caretaking behavior, she says.

In addition, self-disclosure should never be used as a response to the counselor’s emotional needs or in situations in which self-disclosure would jeopardize the quality of care to the client, Natwick emphasizes.

Self-disclosure should be regarded as a tool to engage clients and help move them toward their treatment goals. If it would have any other outcome, it is unlikely to be the correct intervention to use, Natwick says.

For additional guidance, consult the following standards in the 2014 ACA Code of Ethics:

  • A.1.a. Primary responsibility
  • A.4.a. Avoiding harm
  • A.4.b. Personal values
  • A.6.b. Extending counseling boundaries
  • B.7. Case consultation
  • C.2.g. Impairment
  • C.6. Public responsibility
  • H.6. Social media
  • I.1.b. Ethical decision making

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Ethics, religion and diversity

By Gregory K. Moffatt February 5, 2018

Tears streamed down her face. Kaylah (not her real name) was a 21-year-old woman struggling with a romance in trouble. I’d seen it many times, even though I’d only been in the field for a few years at this point. My heart broke for Kaylah as I saw the same old story played out in the same old way — only the names and a few of the details were new.

Kaylah had been psychologically mistreated and her relationship was in serious trouble. Her partner demonstrated what social psychologists call the principle of least interest. This principle teaches that the person in any relationship — work, friendship, marriage — who has the least interest in maintaining it possesses the most power. My client’s partner treated her well on occasion but at other times humiliated her in front of others, exploded at her or ignored her for days on end. Kaylah tolerated these behaviors because she was desperate to maintain the relationship.

Kaylah’s partner’s emotions ran hot and cold. One day, they were talking about starting a family; the next, Kaylah’s partner threatened to leave, causing Kaylah to feel confused, hurt, angry and torn. Like most abused women, at times Kaylah felt surges of confidence that she should leave the relationship and never look back. Then, as if someone had flipped a switch, she was overwhelmed with love, hope and compassion for her relationship. In this phase, Kaylah made excuses for the pitiful way she was treated and assumed all the responsibility for their relationship troubles. It was classic battered woman syndrome.

What readers also need to know about Kaylah is that she was a lesbian. She was also a staff member at a church. Her lover, a member of the pastoral staff, was also Kaylah’s boss, which created a serious power issue (and a significant ethical issue too). For obvious reasons, the relationship was a carefully guarded secret. Kaylah had no one to talk to because her family wasn’t receptive to her lesbian lifestyle and she didn’t feel she could confide in her friends in the religious community. She also worried that if anyone found out, her partner would terminate the relationship — the thing Kaylah feared most in the world. Exposure might also mean that Kaylah could lose her job, her family and the few friends she had. She was totally isolated. What a mess.

One last thing that I need to tell readers: I am a person of religious faith, and until I met Kaylah, I hadn’t been forced to clarify the place for my religious beliefs in the counseling profession. That day, the decision I faced became crystal clear to me.

No room for debate

It was around the time that Kaylah entered my world that I taught my first college course overseas. As I was preparing to teach a marriage and family course in India, it dawned on me that our two cultures were very different. I worried that my knowledge would be so based in American culture that it wouldn’t translate well into Indian culture. But without denying our vast differences, my host reassured me. “Dr. Moffatt,” he said, “problems are problems.”

How right he was. Hurting relationships are the same regardless of culture, age, religion or sexual orientation.

In some ways, I can’t believe that equity for LGBTQ clients even remains a topic for debate. I remember when the AIDS epidemic first became public in the 1980s. Some people of religious faith actually stated that AIDS victims deserved the outcome as punishment for their lifestyle. I hope that even the most cold-hearted person today wouldn’t utter such nonsense. Even in those uncertain times when we didn’t know much about the disease, doctors served these men and women because it was their professional duty to do so, regardless of their personal opinions on homosexuality, drug use, multiple partners or other factors. Today, many nonprofit counseling agencies are run by faith-based agencies specifically for those who have HIV/AIDS. Thank goodness.

How, then, could there still be any possibility of debate in the 21st century over whether we should discriminate against our clients? Our concept of human rights as counselors is that all people deserve the same treatment, regardless of worldview, religion, gender, age or creed. Our modern view of equality has been evolving for decades, yet even counselors have not yet perfected it in practice. Just in the past decade or less, there have been several highly publicized court cases in which graduate students have refused to work with gay clients and suffered academic consequences because of their beliefs. These include Julea Ward in 2009 at Eastern Michigan University, Jennifer Keeton in 2010 at Augusta State University and Andrew Cash in 2014 at Missouri State University.

Supporters of these students lauded their bravery and commitment to their religion. Even though I am a person of faith, I cannot see why this type of irresponsibility to clients should be lauded. Interestingly, Christian tradition teaches that Jesus spent most of his time with the outcasts of his culture, not with the religious upper echelon, and he didn’t abandon people simply because they behaved in ways that were contrary to Jewish teachings. Gandhi and Mother Teresa also demonstrated a seeming lack of interest in religious pedigree. Instead, they helped the people who came to them.

Sadly, the three lawsuits from academia that I noted are just the ones that made the news. I suspect that many more therapists are practicing discrimination without the public becoming aware. “I’m not culturally competent to work with those issues” is a common argument that I hear among some in the profession to justify their referral of LGBTQ clients. In fact, the real reason is often a personal belief system rather than a question of competence. There is no way to tell how much of this type of referral or redirecting of client goals happens in our profession, but if my anecdotal experiences as a clinician, supervisor, professor and public figure in the field are any measure, the answer is a lot.

This clearly violates our ACA Code of Ethics. Under Standard A.4.b., we are clearly called to “seek training in areas in which [we] are at risk of imposing [our] values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.” Notice that it says seek training, not refer. In fact, Standard A.11.b. specifically prohibits referring solely on the basis of a conflict between the counselor’s values and the client’s values.

This culture war hit home for the American Counseling Association in 2016 when the Tennessee Legislature passed a bill that the state’s governor subsequently signed into law making it legal for counselors and therapists to discriminate against their clients if the client’s “goals, outcomes or behaviors … conflict with the sincerely held principles of the counselor or therapist.” This legislation clearly contradicted the ACA Code of Ethics. Consequently, ACA moved its planned 2017 annual conference from Nashville to San Francisco.

It should be noted that before we even get to the standards in the ACA Code of Ethics, our association’s mission statement directs that we exist to “promote respect for human dignity and diversity” through the profession. The key word here is not diversity but rather promote. We are actively to promote diversity, not actively run away from it.

A common base for truth

For any reader who thinks that I am not sensitive to the importance of religion, please bear with me. Religion does indeed matter, and many religions have clear teachings on a variety of subjects — sex, marriage, work, the roles of men and women — that are central to people’s faith and shouldn’t be ignored. But we must also recognize that many discriminatory traditions have their roots in religious teachings. Even in my short lifetime, I can remember a relative of mine excusing the discriminatory practices of his all-white church, saying, “God didn’t intend for the races to mix.” He then proceeded to use Bible verses to justify that belief. He made similar comments about mixed-race marriage, again justifying them weakly through religious teachings. Refusing to see clients based simply on sexual orientation is no different.

Some religious therapists have defended discriminatory practice by arguing that equating racism with clinical treatment of gay couples is comparing apples and oranges. The argument goes that if a counselor’s religious views teach that, for example, the heart of a couple’s problems is directly related to homosexuality — something the counselor’s religion teaches is inappropriate — then helping these clients maintain the very relationship that is causing their grief would be problematic if not unethical/immoral. I’ll address this argument momentarily. But, first, a brief tangent.

It would be disingenuous to say that counselors never force a worldview on a client. Of course we do. For example, one of the goals we almost always have for clients who are addicted is that they stop doing their drug of choice, even if they don’t want to stop. The difference between this worldview and that of the anti-gay worldview, however, is that this worldview is based on objective research, not moral code or religious teaching. Using methamphetamine destroys tooth enamel, leads to degenerative behaviors and can eventually kill the user. Alcohol abuse changes brain structure, destroys the liver and leads to degenerative lifestyle and potentially death, not to mention a host of other social ills.

As for a religious argument against homosexuality, there is no scientific evidence that being gay, transsexual, bisexual, etc., is clearly linked to any social or physical issue that is not also present among the heterosexual population. We must have a common base for “truth,” and that base is research, not religion.

Many years ago, a religious group, knowing I am a person of faith, asked me to do a seminar addressing why homosexuals would not be good parents. I refused because there is absolutely no evidence that one’s sexual orientation has anything to do with quality of parenting. It would be unethical to promote such a baseless argument. Academic integrity demands that as professional counselors, we pursue what we know. We must be driven by facts, not opinions and preferences.

Make a choice

Empathizing and working with a diverse population does not mean that a counselor must sacrifice her or his own position. We are free to think what we want, engage in our own religious practices and beliefs, and live our lives as we choose.

For many years, I’ve spent part of my year in the United States and part of the year in Chile, my second home. During this time, I have also traveled the world. Whether I’m in a clinic in India, the Philippines, Peru or Mexico, I still think like an American/Chilean. But when I’m in those varied cultures, I try to see the world through the eyes and culture of the people I encounter. I can easily do that without making any value statement about the culture itself, and even though I have personally adopted many customs and preferences from around the world, I have done so voluntarily. I would still be a competent counselor in those cultures if I hadn’t. My preferences are irrelevant when working in another country.

Our professional ethic simply means that we will not thrust our belief systems upon our clients any more than we would try to sell our clients a car, recruit them into a political party or manage their retirement accounts. What we cannot do is make choices that are at odds with wanting to work as a counselor, such as simultaneously wanting to function as a missionary who proselytizes clients into our personal belief system.

I occasionally work with individuals who have been mandated to treatment. Some of them have drug issues. I’ve heard all the arguments:

“Why is weed illegal? It’s a dumb law.”

“Who cares what I do in my own home?”

“Smoking weed doesn’t affect my job or my personal life, so why should I have to go to addiction counseling?”

My response is always the same. You can do anything you want — but all behaviors have consequences. If you want to smoke weed, go ahead. But if you don’t want to risk arrest, being fired from your job or kicked off your athletic team, don’t smoke weed. You can’t have it both ways.

To our profession, I make the same suggestion. If you are a pastor or priest, be a pastor or priest. Nobody is trying to stop you. But do not attempt to be a pastor while you are a counselor. If your religion teaches that you must proselytize in the workplace, then the counseling profession is not the best fit for you. There is nothing wrong with being a pastoral counselor in which your focus is pastoring, not counseling. But don’t pretend to be a counselor who is religious when, in fact, you want to function as a pastor who is also a counselor.

As counselors, our job is to help the hurting. We cannot — we must not — attempt to evaluate who we think is worthy of our help. Whether our clients are gay or lesbian, battered women or batterers, abused children or abusers, we don’t pick and choose who we help. Our ethical standards determine when we refer or step away, but our personal feelings — whether driven by religion, morals or anything else — have no role in our decision to help. Pain is pain. The pain of Kaylah’s relationship was no different than the pain from any other relationship. The fact that she was a lesbian was, in some ways, irrelevant.

Diversity includes people of faith

History hasn’t always been friendly toward people of faith. We hardly need to be reminded of the many wars and episodes of genocide that have been perpetrated against various religious groups throughout history. Even today in different places around the world, including the U.S., Christians, Jews, Muslims and others are persecuted for their faith. Television mogul Ted Turner brashly claimed in 1990 that Christianity was a “religion for losers.” These were thoughtless words from one who knew nothing of the religion. Jewish men, women and children are still isolated in many parts of the world. And I can’t imagine how difficult it must be to live as a Muslim in the U.S. Sadly, the words “Muslim” and “terrorist” are sometimes used interchangeably these days.

The field of psychology has not always been friendly to people of faith either. Sigmund Freud proposed that neurosis and religion were closely related and that religious people were weak and in need of a dominant father figure. In the 1950s, Alfred Kinsey despised religion, claiming it repressed “healthy sexual desires.” And as a graduate student, I was taught that we should never talk about religion in session, even if our clients brought it up, because it would only distract from more important issues. Really? Faith can be a central part of a person’s existence, influencing almost everything, from food, dress and marriage to job choice and child rearing. Yet I was taught that this was somehow unimportant and distracting.

About 20 years ago, I was presenting an ethics seminar for professional counselors. One of the case studies the seminar participants were supposed to discuss involved religion. The concise version of the question I posed was, “If your client was a person of religious faith, would it be acceptable to include that person’s religion in your therapeutic process?” Every single one of the 75 or so participants said no. Apparently, they had the same training I had.

I have personally witnessed bias within the counseling profession against people of faith. At professional conferences, I have heard comments in hallways and elevators openly disrespecting people of various religions. One clinician, wearing her conference name badge, rolled her eyes as the elevator door closed and said to another attendee, “Oh, God, this hotel is crawling with Christians. Heaven help us!” To which her friend snickered and nodded consent, as if Christians, Jews or Muslims were some sort of infestation.

At a past ACA annual conference, I attended a workshop on gay and lesbian issues. In the workshop, the leader subtly condescended to people of faith — something Derald Wing Sue calls microaggressions — and the audience openly jeered, laughed and mocked Christians in their public comments. No one said a word about the overtly biased, thoughtless and hurtful commentary. Although I certainly didn’t fear for my safety, I didn’t feel comfortable confronting this bigotry. And even though I agreed with the position presented by the session leader, I have never felt more discriminated against in my life.

The heckling I witnessed was the same thing that those in the LGBTQ community have rightly fought against in times past. It was the same behavior — only the target had changed. People of faith should be as welcome as members of any other group in a professional meeting.

I might also argue that people of religious faith can make outstanding counselors. Many religions teach the inherent value of all humans, creating a natural empathy among the religious for a hurting world. Although there are individuals who have used religion to pursue their own selfish agendas, there is no scientific evidence that people of faith are less intelligent, weaker or any less capable of working in the helping professions than are nonreligious individuals.

Conclusion

In a public presentation many years ago, Albert Ellis, a man known widely for his aggressive approach to his clients, littered his address with profanity. Visibly upset, several participants in the room eventually made an overtly public statement by storming out. The only remark Ellis made about it was this: “Counselors should never be upset with what people say.”

I have never forgotten those words. Whether or not Ellis was right, the message I took away was that, as counselors, we treat those who need help. In that regard, our clients’ words, sexual orientation, religion, age, gender, race, criminal history and socioeconomic status have no relevance. We help. That is what we do.

Many people in the counseling profession are also, in their personal lives, deeply committed to their faith. These counselors see clients daily without issue and function at the highest level of ethical conduct. But the few who feel they are called to change the profession, rather than to accept the profession as it is or to move on to another line of work, give us a black eye. Even worse, these counselors leave clients hurting — and perhaps discourage them from ever seeking help from another counselor again. It is always about the client.

Counselors using their religion as an excuse to refer clients or to force their ideas about sexuality upon their clients can deceive themselves into thinking they have ethical grounds for doing so. You don’t. Period. You must seek training to work through this issue (Standard A.4.b.) rather than perpetually referring LBGTQ clients.

As a footnote, I saw Kaylah in counseling off and on for a little over a year. During that time, her relationship went through various ups and downs. When we terminated, her daily functioning had improved significantly, but she was still nursing her seriously troubled relationship.

Months after termination, I happened across Kaylah in a shopping center. She was with her mother. Meeting clients on the street always makes me nervous, but when our eyes met from a distance, she beamed and ran toward me, towing her mother along by the hand.

Kaylah introduced me to her mother and, in turn, her mother’s face brightened. She stepped forward and hugged me tightly. When she stepped away, she had tears in her eyes. “I don’t know what all you did, but I know you saved my daughter,” she said. “Thank you for helping my baby.”

These were the most sincere and heartfelt words of gratitude I have ever received. I’m positive I did the right thing by my client, and I can’t imagine a world in which my religion would have allowed me to tell Kaylah to move along because I don’t work with clients who are gay.

 

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Gregory K. Moffatt is a professor of counseling and human services at Point University in Georgia. He is a licensed professional counselor and certified professional counselor supervisor. Contact him at Greg.Moffatt@point.edu.

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Other pieces written by Gregory K. Moffatt, from the Counseling Today archives:

 

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