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Ethics: Issues in the Mental Health Profession


Confidentiality Mental health counselors make every attempt to release only information necessary to ... develops positive or negative feelings toward the patient. – PowerPoint PPT presentation

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Title: Ethics: Issues in the Mental Health Profession

Ethics Issues in the Mental Health Profession
  • Michael W. Nettles, D.Min., M.Ed., LPC, LCPC,

DC Mental Health Counselors Association
(DCMHCA) 2014 Spring Conference University of
District of Columbia
Course Description
  • This training is designed to allow participants
    to become familiar with issues and ethics in the
    helping professions.
  • Participants will be provided with a framework
    and a direction for working through ethical
  • Participants will become familiar with ethics for
    helping professionals according to the AMHCA Code
    of Ethics

Ethical Codes
  • Ethical codes are not intended to be blueprints
    for resolving every ethical dilemma nor do they
    remove all need for judgment and ethical
  • Formal ethical principles can never be
    substituted for an active, deliberative, and
    creative approach to meeting ethical
    responsibilities (Pope Vasquez, 2007)

Common Themes of Codes of Ethics (Koocher
Keith-Spiegel, 2008)
  • Promoting the welfare of consumers
  • Practicing within the scope of ones Competence
  • Doing no harm
  • Protecting clients confidentiality

Common Themes of Codes of Ethics
  • Acting ethically and responsibly
  • Avoiding exploitation
  • Upholding the integrity of the profession by
    striving for aspirational practice

Limitations of Codes of Ethics(Herlihy Corey,
2006a Pope Vasquez, 2007 Herlihy Remley,
  • Simply learning the ethics codes and practice
  • guidelines will not necessarily make for ethical
  • Practice
  • Practitioners who belong to multiple
  • professional associations, licensed by their
  • state and hold national certifications, may be
  • responsible to practice within the framework of
  • numerous codes of ethics, yet these codes may
  • not be uniform

Limitations of Codes of Ethics
  • A practitioners personal values may
  • conflict with a specific standard within an
  • ethics code
  • Codes may conflict with institutional
  • policies and practices
  • Codes may not align with state laws or
  • regulations regarding reporting requirements

The AMHCA Code of Ethics
  • AMHCAs Code of Ethics is intended to be a guide
    to do
  • the following
  • Assist members to make sound ethical decisions
  • To define ethical behaviors and best practices
  • association members
  • To support the mission of the association
  • To educate members, students and the public at
  • large regarding the ethical standards of mental
  • counselors

The AMCHA Code of Ethics
  • Seven Main Sections
  • Commitments to Clients
  • Commitments to Other Professionals
  • Commitments to Students, Supervisees and
  • Relationships
  • Commitments to Profession
  • Commitments to Public
  • Resolution of Problems

Ethics Codes and the Law
  • All of the codes of ethics state that
    practitioners are obligated to act in accordance
    with relevant federal and state statutes and
    government regulations

Ethics and Law
  •  I. A. 2. c. Confidentiality
  • The release of information without consent of
  • client may only take place under the most
  • circumstances
  • the protection of life (suicidality or
  • child abuse, and/ or abuse of incompetent
  • elder abuse.
  • Above all, mental health counselors are required
    to comply with state and federal statutes
    concerning mandated
  • reporting.

Ethics and Law
  • I. A. 2. d. Confidentiality
  • Mental health counselors make every attempt
  • to release only information necessary to comply
  • with the request or valid court order.
  • Mental health counselors are advised to seek
  • advice upon receiving a subpoena in order to
  • respond appropriately.

  • When the word unethical is used, people think of
    extreme violations of established codes. In
    reality, most violations of ethics happen quite
    inadvertently in clinical practice.
  • The best method of practice is to ask yourself,
  • Is what I am doing in the best interest of my
  • Would my professional organization agree?

  • The process whereby clients project onto their
    therapists past feelings or attitudes they had
    toward significant people in their lives.
  • If therapist are unaware of their own dynamics,
    they may miss important therapeutic issues when
    they should be helping their clients to
    understand and resolve the feelings they are
    bringing into the present from their past.

  • Counter-transference is a situation in which a
    therapist, during the course of therapy, develops
    positive or negative feelings toward the patient.
  • These feelings may be the therapist's unconscious
    feelings that are stirred up during therapy and
    directed toward the patient..

Counter-Transference Issues
  • Being overprotective with a client
  • Treating clients in kind ways that goes beyond
    the norm
  • Rejecting a client
  • Seeing yourself in your clients
  • Developing sexual or romantic feelings
  • Developing a social relationship with clients

Exploitive Relationships
  • A. 4. a., b.
  • Romantic or sexual relationships with clients are
    strictly prohibited. Mental health counselors do
    not counsel persons with whom they have had a
    previous sexual relationship.
  • Mental health counselors are strongly discouraged
    from engaging in romantic or sexual relationships
    with former clients. Counselors may not enter
    into an intimate relationship until five years
    post termination or longer as specified by state
    regulations. Documentation of supervision or
    consultation for exploring the risk of
    exploitation is strongly encouraged.

Exploitive Relationships (contd)
  • 1A. 4.d. Personal Values
  • Mental health counselors are aware of their own
  • attitudes, beliefs and behaviors, as well as how
    these apply in a society with clients from
    diverse ethnic, social, cultural, religious, and
    economic backgrounds.
  • Value imposition refers to counselors directly
    attempting to influence a client to adopt their
    counselors values, attitudes, and beliefs, and
  • It is possible for mental health practitioners to
    do this either actively or passively.

Value Sharing?
  • Is it possible for you to disagree with a
    client's values and still accept him or her as a
  • Is the purpose of counseling to teach values to
    clients or to teach clients how to discover their
    own values?
  • What is the difference between exposing or
    imposing your values on clients?
  • Is it ever justifiable for you to impose your
    values on clients? What about those situations in
    which you are convince that the client's values
    will result in self-destructive behavior?

Role of Spiritual and Religious Values
  • A counselors role is not to prescribe a
    particular pathway to clients in fulfilling their
    spiritual needs, but to help clients clarify
    their own pathway.

Addressing Sexual Orientation
  • 1973 the American Psychiatric Association stopped
    labeling homosexuality, a sexual orientation in
    which people seek emotional and sexual
    relationships with same-gendered individuals, as
    a form of mental illness
  • 1975, the American Psychological Association
    endorsed this move by recommending that
    psychologists actively work to remove the stigma
    that had been attached to homosexuality

Addressing Sexual Orientation
  • Counselors understand that attempting to change
    the sexual orientation or gender identity of LBGT
    clients may be detrimental, and further, such a
    practice is not supported by research and
    therefore should not be undertaken

  • Confidentiality I. A. 2. a.
  • Confidentiality is the heartbeat of relationship
    building and client confidence in the counseling

  • Confidentiality, which is rooted in a
  • clients right to privacy, is at the core of
  • effective therapy.
  • It is the counselors ethical duty to protect
    private client communication (Wheeler Bertram,
    2008, p.65)
  • Obtain and document your clients consent before
  • Respond ethically to legal requests for

Duty to Warn and to Protect
  • Mental health professionals driven by the courts,
    have come to realize that they have a dual
    professional responsibility
  • Identify those clients who are likely to do
    physical harm to third parties
  • Protect third parties from those clients judged
    potentially dangerous.

Duty to Warn
  • Duty to warn applies to those circumstances where
    case law or statute requires the mental health
    professional to make a reasonable effort to
    contact the identified victim of a clients
    serious threats of harm, or to notify law
    enforcement of the threat.
  • Tarasoff

Duty to Protect
  • Duty to protect applies to situations where the
    mental health professional has a legal obligation
    to protect an identified third party who is being

HIV/AIDS Related Issues
  • The HIV duty to protect decision is one of the
    more controversial and emotion-laden issues
    practitioners might encounter.
  • For practitioners who work with persons who are
    HIV, the choice is often between protecting the
    client-therapist relationship and breaching
    confidentiality to protect persons at risk of
  • This situation can put practitioners in a moral,
    ethical, legal, and professional bind.
  • State laws differ regarding HIV and the limits of
    confidentiality and the law is often different
    for medical professionals than for licensed

HIV/AIDS Related Issues
  • Some states forbid any disclosure of HIV status
    to third parties.
  • Some states allow some disclosure to at-risk
    third parties by physicians and psychiatrists,
    but not by other mental health professionals.
  • Some states prohibit psychotherapists from
    warning identifiable victims of persons who are
  • Other states have yet to address this issue by

HIV/AIDS Related Issues
  • Therapists need to keep current with regard to
    relevant medical information related to the
    transmission of HIV, know which sexual practices
    are safer and which are not, and encourage their
    clients to practice safer sex

Confidentiality and HIV/AIDS Related Issues
  • I.A.2.n. Contagious, Life-Threatening Diseases
  • Mental health counselors may justify disclosing
    information to identifiable third parties if
    clients disclose that they have a communicable or
    life threatening illness.
  • However, prior to disclosing such information,
    mental health counselors must confirm the
    diagnosis with a medical provider.
  • The intent of clients to inform a third party
    about their illness, and to engage in possible
    behaviors that could be harmful to an
    identifiable third party, must be assessed as
    part of the process of determining whether a
    disclosure should be made to identifiable third

Tarasoff Decision
  • California Supreme Court 1976
  • A failure to warn an intended victim was
    professionally irresponsible
  • When a therapists determines that his patient
    presents a serious danger of violence to another,
    he incurs an obligation to use reasonable care to
    protect the intended victim against such danger

  • Bartering - Exchanging goods or services in lieu
    of a fee

  • I.E. 2.b. Bartering
  • Accepting goods or services for professional
    services can open the door to misunderstandings,
    perceived or actual exploitation, boundary
    violations, and reduced effectiveness as a
  • Although bartering is not prohibited by ethics or
    law, most legal experts frown on the practice.
  • Mental health counselors usually refrain from
    accepting goods or services from clients in
    return for counseling services because such
    arrangements may create the potential for
    conflicts, exploitation and distortion of the
    professional relationship.
  • However, bartering may occur if the client
    requests it, there is no exploitation, and the
    cultural implications and other concerns of such
    practice are discussed with the client and agreed
    upon in writing.

Gift Giving
  • When determining whether or not to accept a gift
    from clients, counselors take into account the
  • The therapeutic relationship
  • The monetary value of a gift
  • The clients motivation for the gift
  • The counselors motivation for wanting or
    declining the gift

Steps In Making Ethical Decision Making
  • Identify the problem or dilemma
  • Identify the potential issues involved
  • Review the relevant ethics codes
  • Know the applicable laws and regulations
  • Obtain consultation
  • Consider possible and probable courses of action
  • Itemize the consequences of various decisions
  • Choose what appears to be the best course of
    action (Barnett Johnson, 2010)

  • Vignettes

Counselor Responsibility and Integrity1.C.1. a-n
  • Competence is both an ethical and a legal
  • From an ethical perspective, competence is
    required of practitioners if they are to protect
    and serve their clients.
  • From a legal standpoint, incompetent
    practitioners are vulnerable to malpractice suits
    and can be held legally responsible in a court of

Competence - 1.C.1.a-n
  • Even though mental health professionals may not
    intend to harm client, lack of competence often
    is a major contributing factor in causing harm.
  • Counselors practice only within the boundaries of
    their competence, based on their education,
    training, supervised experience, state and
    national professional credentials, and
    appropriate professional experience.
  • Provide only those services and use only
    techniques for which they are qualified by
    education, training, or expertise.

  • Professionals are required to engage in
  • ongoing study, education, training, and
  • consultation in their areas of practice.
  • A practitioners level of competence can diminish
    over time, which is a rationale for continuing
  • Failure to maintain ones competence is
    considered practitioner decay

  • American Mental Health Counselors Association,
  • American Counselors Association, 2014
  • NAADAC Code of Ethics, 2011

  • American Mental Health Counselors Association
  • 801 N. Fairfax Street, Ste. 304
  • Alexandria, VA 22314
  • V 800-326-2642 F 703-548-4775
  • Note AMHCA revises its Code of Ethics every few
  • years, but it does not follow a predetermined
  • The current 2010 version will be revised within
    the next
  • several years.

  • American Counseling Association
  • 5999 Stevenson Avenue
  • Alexandria, VA 22304
  • 800-422-2648 x222
  • Note The 2014 ACA Code of Ethics was approved by
  • the Governing Council at its meeting at the ACA
  • conference held in Honolulu, Hawaii.

  • The Association for Addiction Professionals
  • 1001 N. Fairfax Street, Suite 201
  • Alexandria, Virginia 22314
  • 800.548.0497 703.741.7686
  • Fax 800.377.1136 703.741.7698
  • Note Revised March 28, 2011

Thank you..
  • Michael W. Nettles
  • D.Min., M.Ed., LPC, LCPC, CCDP, MAC
  • Community Outreach Services, Inc.
  • 6215 Greenbelt Road, Suite 206
  • College Park, MD 20740