Any person working in a helping profession has the potential to encounter ethical issues. Mental health counsellors, depending on what type of therapeutic services they are offering, face specific challenges and ethical dilemmas. By understanding what those ethical issues may be and how to handle them if they arise in the workplace, a counsellor will be better equipped to continue helping their clients and remain professional.
Mental health counsellors have to uphold confidentiality on a daily basis. The American Mental Health Counselor's Association (AMHCA) has a strict code of ethics that covers issues concerning protecting client's privacy and records.
Confidentiality, the ethical requirement to keep a client's information private, applies to clinical practice, teaching and research. In order to give information either written or spoken, the client (or guardian if the client is under the age of 18) must give written consent.
The AMHCA provides specific guidelines for exceptions to this rule. The first is when a person's life is in foreseeable danger through homicidal or suicidal ideation (serious thoughts about committing suicide or homicide). Mental Health Counselors are trained to assess whether there is "serious and foreseeable harm" as defined by the American Counseling Association. If as a counsellor you are unsure of what designates serious and foreseeable harm, the best course of action is to consult your supervisor.
The second exception with confidentiality involves suspected abuse or neglect of a child, elderly person or person who is unable to care for themselves. This includes physical and sexual abuse. Mental-health counsellors are trained in their individual states as mandated reporters, meaning it is required of them by law to report any suspected abuse.
The final exception is when records are required under a valid court order. However, even under these circumstances, the counsellor must inform the client of the court order. From here, the client can still refuse the release of their records, which will be further handled by the client's attorney.
Some common scenarios that a counsellor might be presented with are informing a partner or spouse of STDs and domestic violence. While informing a person about this information might seem the right thing to do, it is not an acceptable breach of confidentiality and can result in legal action.
Another question or issue that may come up is how to handle feelings towards a client that fall outside the realm of a helping relationship.
The AMHCA provides strict guidelines that mental health counsellors must follow. Starting with what is labelled a "dual relationship," this basically involves any person you may know in another capacity outside the clinical office.
The counsellor is to make every effort to avoid dual relationships. However, If the owner of the bakery you get your morning coffee at walks through your door, the AMHCA does not prohibit you from taking that person on as a client. The most important step to take in this situation is to acknowledge the dual relationship and have an open dialogue about how it might affect the work accomplished in the counselling session.
Sexual Relationships with Clients
Differing from dual relationships, the AMHCA specifies that a counsellor is not to under any circumstances engage in sexual relationships with current clients. If a former sexual partner enters your clinical office, the correct action to take is to refer that person elsewhere.
If a counsellor begins to have sexual feelings towards a current client, seek out a supervisor to assess whether terminating treatment is the best course of action. If as a counsellor you are licensed and no longer require supervision, the importance of professional consulting is as an option. When consulting a colleague, however, keep in mind the bounds of confidentiality.
Finally, what about former clients? The AMHCA states a counsellor must wait at least two years after a person has stopped seeing them for counselling to engage in any type of sexual relationship. However, it is generally advisable to avoid engaging in a sexual relationship with a former client.
Group, Family, and Couples Counseling
Providing counselling services to a group of people has its own challenges. Whether that group is a selected number of individuals, a family or a couple, the counsellor must define a role and relationship for each person in that room.
When providing group therapy, defining the rules of confidentiality and socialising outside the group is important. Having group members sign confidentiality agreements is one way to help protect the privacy of other members.
The American Counseling Association (ACA) also provides specific guidelines for ethical concerns in couples, family and group counselling.
One of the most significant issues that may present itself is splitting; this occurs when one or more person in a counselling session seeks to align themselves with the facilitator (the counsellor) at the expense of others. Allowing this to happen can create a number of problems including damaging the trust of the group and possibly the therapeutic relationship.
Relationships with Coworkers, Employees, and Supervisees
If a counsellor is not in private practice, meaning that person works for an agency, how a person interacts with other employees is equally as important and how one interacts with clients.
Coworkers in this environment can have varying roles. If a counsellor is charged with the responsibility of clinical supervision for other counsellors, there are specific guidelines provided by the AMHCA and ACA for how clinical supervision should be conducted.
A supervisor may encounter several ethical issues when providing supervision. Since this is the opportunity for an employee to discuss case material and therapeutic approaches and techniques, it is the responsibility of the supervisor to ensure that employee is following best practice guidelines.
Supervision, if not done correctly, can turn in to more of a counselling session than supervision. The role of a supervisor is not to provide therapeutic services; this is a common ethical issue. The best measure in this situation to keep the supervision hour focused on work and to provide a referral to the agency's employee-assistance program (a program offered by some agencies that provides a limited number of free clinical sessions at an outside clinic).
The rule of dual relationships also applies here; while coworkers may become friends, the role of a supervisor is different and, therefore, dual relationships should be avoided.
Another issue that may come up is when sensitive issues are discussed in clinical supervision; the same confidentiality laws apply, meaning a supervisor cannot disclose information about a case discussed in supervision unless it meets criteria for the four exceptions.
Finally, looking at it from the perspective of the person being supervised, it is imperative that during the informed-consent process with a client (the explanation of confidentiality), it is openly discussed that the counsellor is supervised and to provide the contact information for the supervisor.
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