Counselor Ethics and Responsibilities

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Grand Canyon University *

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Apr 3, 2024

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1 Counselor Ethics and Responsibilities Stephanie A. Flores College of Humanities and Social Sciences, Grand Canyon University CNL-505: Professional Counseling, Ethics, and Legal Considerations Afiya Burson March 15th, 2023

2 Counselors have an ethical and professional responsibility to advocate for and protect the rights of their clients. The purpose of this essay is to discuss, in detail, how this would be exemplified by a counselor in the field. The essay will also cover topics such as how the five principles outlined by the American Counseling Association apply to and are incorporated in clients rights, the informed consent process, how counselors use self-care to ensure best practices, advocacy for client populations, and how counselor values affect decision making when facing a tough decision with a client. Counselors Responsibility to Protect Clients’ Rights The American Counseling Association (ACA) provides a guide for practitioners facing ethical dilemmas or needing guidance on ethical decision making. There are five basic principles to be applied when making a decision for the benefit of a client. Forester Miller and Davis (2016) found that autonomy pays special focus to two considerations: how a client's decisions and values may be received in society and affect others, and secondly, a client’s ability to make sound and rational decisions. The way a counselor can incorporate this into practice to maintain client rights is by allowing their client “the freedom to choose their own course of action and act in ways consistent with their own needs, as long as the choice does not interfere with the lives of others.” (Van Hoose, 1986) The second principle of justice is a counselors duty to the client to recognize unique needs and adjust their treatment to fit those needs in that regard. In this way they are advocating for and respecting the dignity of their client. Beneficence when discussing protection of clients rights, is a counselor's responsibility to prevent harm to and work for the welfare of their client. Any and all decision making should be done so by the counselor with this in mind, especially when discussing treatment options with the client to promote justice for the

3 client within the helping relationship. The fourth principle for counselors to incorporate in client care is nonmaleficence. Essentially, nonmaleficence is a counselor's ability to ensure they are not intentionally causing harm to their client and also not risking harm to others. An example of this could be a counselor protecting the clients confidentiality and adhering to the ACA Code of Ethics with any request to release information and only releasing minimal and essential information when legally required. Additionally, counselors must take special care to note that they are ultimately, legally responsible for protecting their client from harm and harm to others (Van Hoosen, 1986) and be proactive in providing services, specific to the needs of their clients, that promote positive outcomes. The last of the five basic principles a counselor is to incorporate into client care is fidelity. This final principle is concerning the counselor-client relationship and a counselor's professional responsibility to their client to build a genuine trust and loyalty to their client and foster a relationship that encourages the growth of their client. One way a counselor can fulfill this is by ensuring that they do not leave obligations unfulfilled (Forester-Miller & Davis, 2016), if they make plans or commitments to a client they must follow through. Client’s Rights to Informed Consent Informed consent can arguably be considered one of the most important parts of the client care process. Sood and Gupta (2018) explain that informed consent is the legal permission for treatment after the client has a clear understanding of treatment and all it entails. Additionally, they outline three specific components of valid consent: a client’s capacity to process information and make informed decisions, information about all possible risks with treatment, and free will without pressure from the counselor or outside sources. Clients are protected under informed consent with clear and detailed understandings of all billing processes and procedures, any fees associated with late or nonpayment, and advanced notice of changes to billing. (ACA,

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4 2014) Counselors have a duty to ensure their clients are aware of their rights to privacy and confidentiality especially with regard to release of their medical documentation and records (HIPAA). Through explanation of informed consent, clients are aware of the limitations to their privacy including any and all exceptions to this right under state law. Some of these conditions under WA State Legislature include if a counselor is subpoenaed by a court of law and under RCW 18.19.180 would only be legally obligated to produce documentation directly related to a complaint (WA State Legislature, n.d.). Credentialing boards require that practitioners are protecting the rights of clients under informed consent and counselors abiding by the ACA Code of Ethics also ensure to protect this right when rendering services to their client. Additionally, while informed consent must be discussed prior to entering into a professional counselor-client relationship, once the relationship is established informed consent should be re-discussed periodically as necessary. Counselors Duty to Warn and Protect One factor to be considered in order to determine “duty to warn” and “duty to protect” responsibilities as a counselor is the duty of the counselor to control the conduct of their client. Secondly, a determination of a need for a client to be controlled was required. One final factor to consider is the requirement that there is a foreseeable victim. Costa and Altekruse (1994) stated that the case of Tarasoff v. University of California at Berkeley created these three conditions for healthcare professionals to consider under “duty to warn” responsibilities. When a counselor takes all three of these into consideration this can aid in the decision to warn or protect potential victims from harm. In Washington State, whether inpatient or outpatient settings, the duty to warn or protect was amended in 2016 to alter the scope of persons to warn or protect to include “foreseeable” victims. (Washington State Medical Association, n.d.) This allows healthcare

5 professionals subject to this standard to warn and/or protect potential victims even if they have not explicitly been named. Client Record-Keeping Client record keeping protects not only the rights of the client, but also the rights of the counselor as well. Counselors have a professional, legal, and ethical responsibility to maintain appropriate records as expected under professional standards of care. Accurate and detailed record keeping is essential when a counselor is entering into and rendering services for a potential or current client. One important aspect of detailed and accurate record-keeping is for referral or transfer of services. The records reflect progress, treatment and services provided and any amendments to services as well. Case notes for each session should note counselor goals, evaluations of goal attainment, any problem areas within treatment that may have been observed through the clients behavior, and a plan of action for the next session (Piazza & Baruth, 1990). In the event of a counselor facing a malpractice suit, the detailed records can aid in providing legal documentation proving any and all services provided. Within client record keeping, counselors should keep signed documentation that clients have been notified of their rights within the counseling relationship. Any electronic documentation should be safeguarded. Counselors Responsibilities to Self-Care The ACA Code of Ethics (2014) considers self-care a counselor's professional responsibility to practice in order to promote their emotional, mental, physical, and spiritual health. I believe that it is incredibly important for a counselor to practice self-care to avoid burnout and assure they are providing care to each client to the best of their abilities. In my bachelor’s as well as my master’s programs at GCU I have learned more in depth about the importance and necessity of self-care and self-compassion. Self-compassion, as defined by

6 Nelson, et al., (2018) is the ability for us to acknowledge our needs, our failings as part of the human experience, and our awareness of our feelings without avoiding them. This allows for counselors to be aware of areas in their personal lives that may require more care and nuturing. Currently I work in a fast-paced and high-tension office where it is essential for my mental health to find a balance between work-life, school-life, and personal-life. I practice self- compassion and self-care in my current daily life by assessing my needs periodically so I am aware of areas within my life where I may need to be more kind to myself and give myself breaks as needed, in this way I am maintaining balance in my life and creating habits I can use when working to balance my professional and personal life as a counselor. An example of a self care activity I have engaged in recently is journaling. Journaling has been a way for me to organize my thoughts on current events and situations in my life and release any thoughts without worry of judgment or fear of hurting others. It has been incredibly helpful for self- reflection as well. A healthy self-care activity I have considered but not yet implemented is daily meditation. Some red flags I recognize in myself that suggest to me I need to address personal issues to avoid personal impairment are when I find myself feeling restless or impatient. When I am overwhelmed with personal issues, I can be a lot less patient when dealing with others and in those moments it’s a signal to myself that I need to step back and address whatever issues are causing my stress so that I don’t allow my impatience to seep into my interactions with others. I support and encourage counselors receiving personal counseling. I believe there are multiple benefits to counseling for all people and it can be an essential tool for counselors who need additional mental health support. Washington State has counseling resources within King County and offers affordable programs for those who need it. One example is Open Path Collective

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7 Therapy, through their counseling services, providers offer sessions as low as $30-$60 per visit (Public Health Seattle & King County, n.d.). Counselor Advocacy One way the ACA encourages advocacy for counselors at a government level is through their Take Action page. This page on their website provides links and information for members of the ACA and non-members to advocate for and be proactive in supporting laws and policies that benefit counselors. Currently, the ACA is supporting the JOBS Act. This Act provides students the opportunity to use federal Pell Grants toward high-quality, short term job training programs (ACA, 2023). A population that I am passionate about is low income individuals within my area. I have experienced the hardships and the difficulties families face living in low- income and poverty stricken areas and how the struggle can easily be generational. One way I can get involved in this is by researching local organizations who advocate for and support low- income individuals in my area and speak directly with the organization on ways that I can help. The ACA Code of Ethics under Section A.7.a encourages counselors (when appropriate) to advocate at multiple levels (i.e. individual or societal) to address obstacles to the growth and development of clients. (ACA, 2014) Counselor Values For the purpose of this essay, the issue I have chosen to address and feel strongly about is the case of 87-year-old Eleanor with terminal cancer. In this case, Eleanor has decided she wants to end her life through assisted medical suicide but is unsure how to discuss this with her family or if she should at all. She is adamant in her decision to end her life. My personal values and attitudes are rooted in my personal experiences and beliefs with this difficult topic. I empathize with Eleanors situation and understand that she would like to end her life, and I am under the

8 firm belief that terminally-ill adults who fully understand their prognosis, and are deemed legally able to make their own medical decisions should have the option to medically end their life with help from their physician. In the State of Washington, we have the Death with Dignity Act which allows terminally-ill adults to request lethal doses of medication from their physician to end their life. The act only applies to residents of Washington State who have a life expectancy of less than six months. (WA State Department of Health, n.d.) I would advocate for the client by ensuring that it is well documented that she is aware of her prognosis and has discussed in depth her decision with her physician. I would also be thorough in assessing my client to confirm that she is mentally sound and nothing is impairing or influencing her decision to end her life. It would be imperative that I explain to her that while I understand and support her decision, I need to make sure to fully assess her capability to make a decision so that further consultation can be had with her physician on the decision. “The order for medication may not be filled until the counselor determines that the individual is not suffering from depression or any other psychological disturbance that could impair the individual's decision-making skills” (Kiser, 1996). Conflicting Values in Advocacy Counselors are going to be faced with clients whose values conflict with their own when working with various individuals from diverse populations. There is most likely going to be a moment when a client does not agree with a group that I advocate for. In these instances it is incredibly important for counselors to maintain respect for their client’s rights to maintain their values, beliefs, and attitudes. The ACA Code of Ethics (2014) states in Section A.4.a. and A.4.b., that part of a counselors professional responsibility to the counseling relationship is to avoid harm to a client and avoid imposing personal values. If a counselor is at risk of imposing their

9 values (especially those that differ from their client) they should be proactive in seeking training in these areas so they can obtain the ability to be consistent with and align with client goals. Conclusion In conclusion, a counselor holds a lot of responsibility in entering into a professional relationship with a client or maintaining a counseling relationship with a current client. It is up to the counselor as the professional to respect, advocate for, and promote services that protect the rights of the clients. Counselors are provided guidelines such as the ACA Code of Ethics and the Practitioner’s Guide to Ethical Decision Making to make informed ethical decisions with the client. First and foremost, counselor’s have a professional and ethical obligation to always put the welfare of their client at the forefront of their care.

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10 References American Counseling Association. (2014). ACA 2014 Code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf American Counseling Association. (2023). Take Action. Retrieved from https://www.counseling.org/government-affairs/actioncenter Costa, L., & Altekruse, M. (1994). Duty-to-warn guidelines for mental health counselors. Journal of Counseling and Development : JCD, 72(4), 346–350. https://doi- org.lopes.idm.oclc.org/10.1002/j.1556-6676.1994.tb00947.x Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev. ed.). Retrieved from http://www.counseling.org/docs/default-source/ethics/practioner’s- guide-toethical-decision-making.pdf Kiser, J. D. (1996). Counselors and the legalization of physician-assisted suicide. Counseling and Values, 40(2), 127–131. https://doi-org.lopes.idm.oclc.org/10.1002/j.2161- 007X.1996.tb00845.x Nelson, J. R., Hall, B. S., Anderson, J. L., Birtles, C., & Hemming, L. (2018). Self-compassion as self-care: A simple and effective tool for counselor educators and counseling students. Journal of Creativity in Mental Health, 13(1), 121–133. Piazza, N. J., & Baruth, N. E. (1990). Client record guidelines. Journal of Counseling & Development, 68(3), 313. https://doi-org.lopes.idm.oclc.org/10.1002/j.1556- 6676.1990.tb01380.x Public Health Seattle and King County. (n.d.) Community Mental Health Resources. Retrieved from https://kingcounty.gov/depts/health/covid-19/~/media/depts/health/communicable-

11 diseases/documents/C19/community-mental-health-resource- guide.ashx#:~:text=Washington%20211%3A%20Provides%20information %20on,win211.org%20for%20more%20information.&text=%2DWARM %20(9276)%20TTY%3A,loved%20one%20can%20feel%20challenging . Sood, A., & Gupta, J. (2018). Patient counselling and consent. Best Practice & Research. Clinical Obstetrics & Gynaecology, 46, 43–47. https://doi-org.lopes.idm.oclc.org/10.1016/j.bpobgyn.2017.10.002 Van Hoose, W. H. (1986). Ethical principles in counseling. Journal of Counseling & Development, 65(3), 168. https://doi-org.lopes.idm.oclc.org/10.1002/j.1556- 6676.1986.tb01268.x Washington State Department of Health. (n.d.). Frequently asked questions about Death with Dignity. Retrieved from https://doh.wa.gov/you-and-your-family/illness-and-disease-z/death-dignity-act/ frequently-asked-questions-about-death-dignity#:~:text=The%20Death%20with %20Dignity%20Act%20allows%20terminally%20ill%20adults%20seeking,than%20six %20months%20to%20live . Washington State Legislature. (n.d.) Confidential communications. Retrieved from https://app.leg.wa.gov/RCW/default.aspx?cite=18.19.180 Washington State Medical Association. (n.d.) Guidance on new duty to warn or protect standard. Retrieved from https://www.wsha.org/wp-content/uploads/Volk-recs- FINAL.pdf

Counselor Ethics and Responsibilities

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