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Professional Counselor Continuing Education
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What’s Inside
Chapter 1: Code of Ethics for Counselors and Marriage and Family Therapists [6 CE Hours] 1 This course will fulfill the requirements for continuing education/certification for counselors on the topic of ethical practice. It aligns with the standards and Code of Ethics of the NBCC, ACA, and AAMFT. Additionally, this course will include best practice strategies to address common areas of ethical concerns in counseling including currents topics such as the use of long-distance counseling through technology. Chapter 2: Keeping Clients Safe: Error and Safety in Behavioral Health Settings [3 CE Hours] 47 This course focuses on five major components of the problem of medical error for behavioral health professionals. The first section describes the severity of the problem of medical error in the U.S. and outlines the evolution of the patient safety movement. The second section introduces concepts from human factors research that are essential to understanding the complexity of patient safety, and also outlines the importance of a culture of safety. The third section presents three basic strategies to reduce harm: Safety briefings, root cause analysis, and full disclosure. A fourth section addresses three error-prone situations that are common in behavioral health settings: Inadequate assessment of suicide risk, failure to comply with mandatory reporting laws, and failure to detect medical conditions that have psychological symptoms. The final section describes the psychosocial needs of survivors of medical error and their families. This course is intended for social workers, mental health counselors, marriage and family therapists, psychologists, and advanced practice and psychiatric nurses. Chapter 3: Telemental Health: An Alternative to Traditional Psychotherapy, 2nd Edition [3 CE Hours] 68 Telemental health (TMH) is a broad term that refers to the provision of behavioral and mental health services using telecommunications or videoconferencing technology. Because technological advances in TMH are developing so rapidly, many practitioners may not have learned about how these advances can be integrated into clinical practice. Research has shown no evidence that TMH delivery of evidence-based mental health treatment is less effective than in-person delivery, even in the treatment of complex disorders like PTSD. This intermediate-level course provides a framework for understanding issues relating to TMH and offers information for developing TMH clinical practices. Chapter 4: Understanding, Recognizing, and Mitigating Implicit Biases in Healthcare [3 CE Hours] 92 Researchers have identified that unconscious biases affect clinicians’ perceptions of others, influencing decisions and actively contributing to health inequalities. Typically, implicit biases are negative and unintentionally lead to disparities in patient–provider interactions, treatment decisions, and overall access to care. The purpose of implementing implicit bias training is to emphasize to healthcare providers a modifiable risk known to play a role in the causation of health disparities. This interactive course incorporates several features to engage learners and promote active participation. Final Examination Answer Sheet 118
©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
ii
COUNSELOR CONTINUING EDUCATION
Book Code: PCUS1525
What are the requirements for license renewal? License Expires Frequently Asked Questions
Contact Hours and Mandatory Subjects
Varies depending on state.
See state requirement chart on the following pages.
How much will it cost?
CONTACT HOURS PRICE
COURSE CODE
COURSE TITLE
Chapter 1: Code of Ethics for Counselors and Marriage and Family Therapists
6
$44.95 PCUS06CE
Chapter 2: Keeping Clients Safe: Error and Safety in Behavioral Health Settings
3
$29.95 PCUS03KC
Telemental Health: An Alternative to Traditional Psychotherapy, 2nd Edition Understanding, Recognizing, and Mitigating Implicit Biases in Healthcare
Chapter 3:
3
$29.95 PCUS03TH
Chapter 4:
3
$29.95 PCUS03IB
Best Value - Save $24.80 - All 15 Hours
15
$110.00 PCUS1525
How do I complete this course and receive my certificate of completion? See the following page for step-by-step instructions to complete and receive your certificate. How do I know the board will accept your course? Colibri Healthcare, LLC has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6341. Programs that do not qualify for NBCC credit are clearly identified. Colibri Healthcare, LLC is solely responsible for all aspects of the programs. Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling (Provider #50-4007). Colibri Healthcare, LLC is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved Provider of continuing education for Licensed Mental Health Counselors #MHC-0040. What information do I need to provide for course completion and certificate issuance? In order to receive course credit, you may be asked to provide your license number and additional information such as date of birth and/or last 4 numbers of your Social Security number. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Counselors you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-866-653-2119, Monday - Friday 9:00 am - 6:00 pm, Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home- study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.
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Book Code: PCUS1525
COUNSELOR CONTINUING EDUCATION
How Many Continuing Education Hours do I Need? NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
HOURS ALLOWED BY HOME- STUDY
HOURS REQUIRED
STATE
MANDATORY
Alabama - LPC Alabama - ALC
40
10
6 hours of ethics.
10
2.5
2 hours of ethics.
Alaska
40
20
3 hours of professional ethics, 3 hours of suicidality, 3 hours of cultural competency.
Arizona
30
30
3 hours in behavioral health ethics or mental health law; 3 hours in cultural competency and diversity.
Arkansas California
24 36
24 36
3 hours of ethics.
6 hours of laws and ethics each renewal; 7 hours of HIV/AIDS (required first renewal only). As a one-time requirement, a licensee before the time of their first renewal after July 1, 2023, or an applicant for reactivation or reinstatement to an active license status on or after July 1, 2023, shall have completed a minimum of three hours of training or coursework in the provision of mental health services via telehealth, which shall include law and ethics related to telehealth.
Colorado
40 15
20 15
None.
Connecticut
3 hours of ethics (LPC only), 1 hour of cultural competency, 2 hours of mental health conditions common to veterans and family members of veterans (once every 6 years).
Delaware District of Columbia
40 40
20 40
None.
6 hours of ethics; 4 hours of trauma counseling; 2 hours of cultural competence and appropriate clinical treatment specifically for individuals who are lesbian, gay, bisexual, transgender, gender non-conforming, queer, or questioning their sexual orientation or gender identity and expression. In addition, 10% of the total hours must be on topics designated by the Director of DOH as a public health concern. 2 hours Preventing Medical Errors in Behavioral Health (each renewal); 3 hours Ethics & Boundaries in Psychotherapy - or - 3 hours Teletherapy (each renewal); 2 hours Domestic Violence (required every third renewal); 3 hours Florida Laws and Rules (required every third renewal); Supervisors: 4 hours Qualified Supervision Training (every third renewal). 5 hours of ethics relating to professional counseling, social work, marriage or family therapy (must be obtained through synchronous activities); 15 hours have to relate to specialty/profession.
Florida
30
30
Georgia
35
10 (Maximum of 10 hours may be obtained asynchronously.)
Idaho Illinois
20 30
20 30
3 hours of ethics.
All clinical professional counselors are required to complete 18 hours in clinical supervision training ( one-time (lifetime) requirement) 1 hour of implicit bias awareness, 1 hour in the diagnosis, treatment, and care of individuals with Alzheimer disease and other dementias, 1 hour in sexual harassment training, and 1 hour of mandated reporter training.
Indiana
40
40
At least 20 hours of Category I Continuing Education and 2 hours of Category I Ethics Continuing Education.
Iowa
40 30 10
40 30 10
3 hours in ethics.
Kansas
3 hours in ethics; 6 hours related to the diagnosis and treatment of mental disorders. 3 hours in domestic violence (within first 3 years of licensure); 3 hours in law, 6 hours in suicide assessment, treatment, and management (within first year of licensure and every 6 years thereafter). 3 hours of ethics; 6 hours of diagnosis (assessment, diagnosis, and treatment under Diagnostic and Statistical Manual of Mental Disorders 5); 3 hours of supervision for those approved by board to supervise.
Kentucky
Louisiana - LPC
40
10
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COUNSELOR CONTINUING EDUCATION
Book Code: PCUS1525
HOURS ALLOWED BY HOME- STUDY
HOURS REQUIRED
STATE
MANDATORY
Maine
55
55
An applicant for renewal as a clinical professional counselor in Maine shall demonstrate a minimum of 12 hours of coursework in family or intimate partner violence; 4 hrs in ethics. At least 30 CEUs shall be in Category A activities and not more than 10 CEUs may be in Category B activities.
Maryland
40
10
Massachusetts
30 40 24
15 40 24
None.
Minnesota Mississippi
4 hours of cultural competence.
6 hours of professional ethics or legal issues in the delivery of counseling services; 2 hours in Telemental Health Counseling if a Distance Professional Services provider; 1 hour in supervision per year; a minimum of 2 hours per renewal period. 2 hours in suicide assessment, referral, treatment, and management training.
Missouri Montana Nebraska
40 20 32
40 20 32
2 hours related to suicide prevention.
4 hours in ethics, 6 hours relating to diagnosis and treatment of major mental disorders (LIMHP only). 6 hours of ethics specifically pertaining to the field of practice of marriage and family therapy, or professional counseling; 4 hours must specifically pertain to suicide prevention; 6 hours of cultural competency and diversity, equity, and inclusion; approved supervisor needs 2 hours of training pertaining to supervision.
Nevada
40
20
New Hampshire
40 40 40 36 40
20 40 40 12 40
6 hours of ethics; 3 hours in suicide prevention
New Jersey New Mexico
5 hours of ethics; 3 hours of social and cultural competence.
12 hours of ethics; 9 hours in supervision for all licensees who are supervisors.
New York
3 hours in appropriate professional boundaries.
North Carolina
3 hours or ethics; Required Jurisprudence Exam offers 5 hours in ethics; LCMHC supervisors require an additional 10 hours of training related to knowledge and competency in the field of counseling supervision. 3 hours of ethics; LPCCs require an additional 10 clinical hours. 3 hour of ethics; 3 hours of supervision training for supervising professional counselors. 6 hours in ethics, 4 in cultural competency, 3 supervision-related training (supervisors only), and 2 hours in suicide risk. 3 hours of ethics; 2 hours of state approved child abuse recognition and reporting (3 hours at initial licensure); 1 hour in suicide prevention.
North Dakota
30 30
15 30
Ohio
Oregon
40
40
Pennsylvania
30
30
Rhode Island South Carolina
40 40
40 40
None.
6 hours of ethics; supervisor must complete 10 hours of supervision oriented continuing education during every two-year licensure period. Supervisor must complete 4 hours of supervision oriented continuing education during every two-year licensure period; 4 hours of ethics. 3 hours of ethics; at least 2 hours of suicide prevention training once every 4 years. 6 hours of ethics (completion of Texas jurisprudence exam will count as 1 hour of continuing education in counselor ethics); 1 hour of human trafficking prevention; 3 hours in cultural diversity and competency; 6 hours of supervision if licensee has supervisor status.
South Dakota
40
40
Tennessee
20 24
10 24
Texas
Utah
40 40
10 28
6 hours of ethics.
Vermont
4 hours of ethics. Remaining 36 hours must be in the theory and practice of clinical mental health counseling. 2 hours of ethics, standard of practice, or laws governing the profession in Virginia. 6 hours of professional ethics; 6 hours of training in suicide assessment, treatment and management. The training must be repeated once every six years. 3 hours of ethics and 2 hours must be specific to veterans and family members of veterans; 3 hours of supervision of clinical counseling if have supervisor status.
Virginia
20 36
20 26
Washington
West Virginia
35
20
Wisconsin Wyoming
30 45
30 45
4 hours of ethics and professional boundaries.
3 hours of ethics; 3 hours of suicide assessment or intervention.
NOTE: CE Rules can change. Always check your state board for the most up-to-date information. Book Code: PCUS1525 COUNSELOR CONTINUING EDUCATION v
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ALL 15 HOURS IN THIS CORRESPONDENCE BOOK PCUS1525 If you are only completing individual courses in this book, enter the code that corresponds to the course below online. 15 $110.00
Code of Ethics for Counselors and Marriage and Family Therapists Keeping Clients Safe: Error and Safety in Behavioral Health Settings Telemental Health: An Alternative to Traditional Psychotherapy, 2nd Edition Understanding, Recognizing, and Mitigating Implicit Biases in Healthcare
6
$44.95
PCUS06CE
3
$29.95
PCUS03KC
3
$29.95
PCUS03TH
3
$29.95
PCUS03IB
vi
COUNSELOR CONTINUING EDUCATION
Book Code: PCUS1525
Chapter 1: Code of Ethics for Counselors and Marriage and Family Therapists 6 CE Hours
Release Date: January 8, 2024
Expire Date: January 8, 2028
Author Deborah Converse, MA holds an M.A. in Education for Emotionally Disabled Students from the University of Central Florida, a B.A. and M.A. in Psychology, and was awarded National Board Certification in 2000 as an Exceptional Needs Specialist, Birth-21+ endorsement. She has dedicated her career to building knowledge and acceptance of individuals with special needs within their families, schools and communities, and has addressed How to receive credit ● Read the entire course online or in print. ● Answer the final examination questions at the end of the course. ○ A passing grade of 75% is required. Test questions link content to learning objectives as a method Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider Disclosures Resolution of conflict of interest
education and employment issues for students facing challenges that include developmental, emotional and behavioral challenges, mental illness, mobility and chemical dependency within the public school system setting. She has authored numerous instructional programs and presented them at state, national, and international conferences on education and mental health. Deborah has written for Elite/Colibri for 13 years. to enhance individualized learning and material retention. ● Provide required personal information and payment information.
● Complete the Course Evaluation. ● Print your Certificate of Completion.
Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
relative to diagnostic and treatment options of a specific patient’s medical condition.
©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Learning outcomes After completing this course, the learner will be able to:
Discuss components of ethical decision making in therapy and counseling. List ethical standards specific to minor clients and incapacitated or incompetent individuals. Explain standards that guide long distance counseling or therapy using technology and social media from the NBCC, ACA, AAMFT codes of ethics and AMFTRB guidelines. Discuss the NBCC, ACA, and AAMFT directives opposing conversion-reparative therapy and counseling. Identify standards for advocacy from the ACA and AAMFT codes of ethics. List the complaint process and sanctions for ethics violations.
Identify and define the standards of the NBCC, ACA, and AAMFT codes of ethics for professional competence, informed consent, confidentiality, dual relationships, and duty to warn. Discuss fundamental principles of the ACA Code of Ethics. Explain the requirements for client records in the NBCC, ACA, and AAMFT codes of ethics. Identify exceptions that allow disclosure of confidential information. Discuss assessment guidelines in the NBCC Code of Ethics. List and define competencies for multicultural diversity sensitivity from the ACA and AAMFT codes of ethics. Explain the term “foreseeable harm” related to confidentiality of client disclosures.
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Book Code: PCUS1525
EliteLearning.com/Counselor
Implicit bias in healthcare Implicit bias significantly affects how healthcare
health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact
INTRODUCTION
Mental health professionals today face complex ethical considerations related to a host of factors. Increasing client diversity, changing family dynamics, and new methods of providing counseling and therapy through digital technology and social media bring new ethical challenges. Ethical practice requires counselors and therapists to reconsider issues of confidentiality, informed consent, multiple relationships, patient privacy, and records security. The practitioner must keep pace with revised ethical standards of practice and the needs of an increasingly diverse population. A working knowledge and daily application of revised ethical guidelines are required of all mental health counselors, therapists, and staff to provide the highest level of service to their clients. ● “Ethics” refers to the beliefs that individuals hold about what is right and what is wrong. ● “Morals” are similar and have been described as a person’s individual values that guide their behavior based on their beliefs of right and wrong. ● “Ethical conduct” refers to the behaviors exhibited by the counselor and the therapist. Good ethical conduct in counseling and therapy is grounded in moral principles, professional standards, decision making skills, understanding ethical codes, and a commitment to client welfare. Both laws and ethical codes regulate the practice of therapists and counselors. Professional organizations do not enforce laws; rather, they develop standards and guidelines to assist the practitioner in delivering services based on ethical principles. Laws are defined and enforced by governmental definitions of the minimum standards of conduct that are acceptable to society. Common types of ethical violations that occur in the counseling profession include errors in informed consent, breach of confidentiality, inappropriate relationships with clients, false or misrepresented statements, fraudulent billing practices, and boundary violations. Historical Perspectives Standards of practice and the idea of accountability can be traced back to ancient Egypt. The code of Hammurabi was established as far back as 2000 B.C.E. It contained a description of physicians’ responsibilities and the consequences and punishments if a patient's health did not improve. The Hippocratic Oath, written in 400 B.C.E., can be viewed as an early example of a code of ethics to guide the practice of medical professionals and define obligations to their profession, practice, and patients. This ancient oath is the foundation for the values and ethical principles in our current codes of ethics.
In order to educate and guide counselors and therapists, professional associations have developed codes of ethics as resources, as well as processes to review ethics complaints to protect clients. Recent revisions to these codes will be discussed, with policies and procedures to address ethical complaints if a violation is alleged. The “Standards for Privacy of Individually Identifiable Health Information,” or the Privacy Rule, establishes a set of national standards to protect health information. The U.S. Department of Health and Human Services (HHS) issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Privacy Rule addresses the use and disclosure of individuals’ health information by professionals subject to the Privacy Rule (HIPAA, 1996). The major goal of the Privacy Rule is to ensure that health information is properly protected while allowing the flow of information to promote quality healthcare and protect the public’s health. The HIPAA Privacy Rule and the codes of ethics for mental health practitioners complement each other and were developed to ensure privacy, confidentiality, and the well-being of individuals and society. This course reviews the codes of ethics and guidelines from several different organizations, including: ● The National Board for Certified Counselors (NBCC) ● The American Counselors Association (ACA) ● The American Association of Marriage and Family Therapy (AAMFT) ● The Association of Marital Therapy Regulatory Board (AMFTRB) The codes and guidelines for each of these associations will be summarized. Some codes have been recently revised, and all should be reviewed in their entirety on their respective websites included in the resource section at the end of this course. The writings of Aristotle concluded that ethics provided guidelines for virtuous and moral action. In his rule, the “Gold Mean,” Aristotle defined an ethical choice as one that falls in the middle of two extremes, one of excess and the other of deficiency (Elgridge, 2023). After World War II, the American Psychological Association (APA) saw the need to develop a code of ethics due to a change in the type of professional activity requested of its members. Psychologists were called to address the mental health needs of soldiers returning home from the war and were responsible for developing psychological assessments to determine eligibility for the draft.
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Book Code: PCUS1525
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A committee was formed to identify ethical issues to effectively guide psychologists’ practice. It covered concepts that included the psychologists’ responsibilities when treating clients, training students, and consulting colleagues as well as ethical research practices (Hobbs, 1948). Throughout the years, other mental health organizations developed codes of ethics and enacted subsequent revisions to address the continuing changes in society and the needs of their clients. The ACA can trace its roots to 1952 when independent member associations held a joint convention. These associations included the National Vocational Guidance Association (NVGA); the National Association of Guidance and Counselor Trainers (NAGCT); the Student Personnel Association for Teacher Education (SPATE); and the American College Personnel Association. They established the American Personnel and Guidance Association (APGA) to form a professional group that united all counselors. A Code of Ethics was first developed and adopted in 1963. In 1983, the association adopted the name American Association of Counseling and Development. It was changed again on July 1, 1992, to the American Counseling Association (ACA). This new membership association unified the various counseling professions into one entity that reflected shared goals, purpose, and commitment to ethical practice. The ACA developed a professional Code of Ethics that has been adopted by licensing boards who use the code as the basis in counseling decision-making on ethical issues. The ACA Code has been revised every 7 to 10 years: The recent revision adopted in 2014 replaces the 2005 edition. The American Counseling Association now services professional counselors in the United States and in 50 other countries in Europe and Latin America, as well as the
Philippines and the Virgin Islands. In addition, the ACA is associated with a comprehensive network of 19 divisions and 56 branches (ACA, 2023). The American Association for Marriage and Family Therapy (AAMFT) was founded in 1942 to address the needs and changing demands of couples and family relationships. This membership association supports research and provides education, tools, and resources to provide effective services in the field of marriage and family therapy. The AAMFT’s goal is to ensure that trained, ethical professionals meet the needs of clients and society. This association is now the professional membership association for the field of marriage and family therapy, with more than 50,000 marriage and family therapists throughout the United States, Canada, and around the world. The National Board for Certified Counselors, Inc. and Affiliates (NBCC) is a not-for-profit, independent certification organization that was established in 1982 (NBCC, 2023a). The organization was founded to create a voluntary national certification system and to identify certified counselors by maintaining a registry of membership. Since then, NBCC divisions and affiliates have expanded their commitment to include advancement of the profession with the goal of improving mental health around the world. Today, there are more than 69,000 National Certified Counselors (NCCs) in more than 40 countries. These counselors volunteer to obtain certification through a rigorous program to achieve national standards, set by the profession, based on research, written dissertations, and examinations. Certified NCCs are encouraged to mentor other counselors to improve their practice and obtain certification as an NCC. NCCs may be members of associations such as ACA and AAMFT, depending on their area of expertise.
FOUNDATIONS AND SHARED BELIEFS
Trust appears to be the common thread throughout ethical counseling and marriage and family therapy practice. Therapists, patients, and students view trust as fundamental to psychotherapy (Allen, 2021). One shared belief among therapists and counselors is that professionals must do the right thing and make ethical decisions that are in the best interest of the client. The counselor–client relationship impacts ethical decision making and must consider the cultural context of the professional relationship along with ethical principles. The structure of common therapeutic relationship factors includes confidence in the therapist and confidence in the treatment plan, which is built on trust (Finsrud et al., 2022). Confidentiality is essential in developing an effective relationship between mental health practitioners and their clients. Research supports the ethical principle in counseling and therapy that asserts effective practice is based on trust and confidentiality between the practitioner and client. The client may approach a counselor or therapist feeling vulnerable and seeking assistance in times of crisis. The client may be fearful, ashamed, or unwilling to share feelings at first. If the client believes that the information shared will be kept confidential, there is a greater possibility of developing an effective collaborative relationship with the therapist and a positive outcome for the client.
Over the last decade, ethical issues faced by counselors have received increased attention in counseling literature, and no area of study is more important in the practice of counseling (Cottone et al.,2021). Counselors are often confronted with situations that require sound ethical decision-making. Determining the appropriate course of action when faced with difficult ethical conflicts can be challenging and should never be done in isolation. Codes of conduct are designed to protect clients and society. Counselors and therapists encounter ethical issues and challenges that require complex decisions, and they must be familiar with the ethical codes for their association. They must know what areas and issues are problematic to avoid potential risks of ethical violations that may harm clients and families. Ethics in counseling and therapy focuses on ideals rather than obligatory rules. It emphasizes professionals’ character and their relationships with their clients. The study of ethics is more than solving a specific ethical or legal dilemma. Although ethics codes speak to many issues, the counselor must recognize that codes are broad and do not cover every ethical issue faced by counselors and therapists. The professional’s ethical awareness, behavior, and problem- solving skills will determine how they translate and apply these general guidelines to professional practice. Ethics codes do not provide explicit instructions for every possible situation.
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Book Code: PCUS1525
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Client Focus Counselors and therapists must be aware that their focus on their clients’ welfare takes precedence over their own. Practitioners must understand their own needs, as well as their potential for imposing personal values and biases Right of Informed Consent Informed consent is an ethical and legal requirement and an integral part of any counseling plan and therapeutic process. Providing clients with information they need to make informed choices promotes the active participation of clients and families in the counseling plan and is critical to achieve a positive outcome. Informed consent educates clients about their rights and responsibilities and builds Confidentiality Confidentiality is a standard of conduct that prevents the professional from disclosing information concerning clients. State and federal statutes, administrative codes, regulations, and case law interpret rulings by the court and include components of confidentiality. Confidentiality is fundamental to the counseling and therapeutic relationship, and professionals must not disclose client information without prior consent. The ethics codes, as well as state and federal laws, provide some exceptions to confidentiality standards that will be discussed. Confidentiality is based on our society’s belief that individuals have a right to privacy and to decide what information they will share and with whom. Confidentiality is an ethical principle that holds the practitioner responsible for respecting the client’s privacy and protecting information disclosed during therapy. Both the Code of Ethics and the Confidentiality in Group Counseling Providing services to a family or group presents ethical challenges when the practitioner works with multiple clients at the same time. The counselor or therapist must inform all members of the group of their rights to confidentiality at the onset of services and include a statement that the practitioner will not disclose any information that one family member offered in a private discussion. Some practitioners decide to address this situation by meeting only in a group setting with the family and never with one member individually. The practitioner working with a family or a group may need to assess progress frequently as new issues may emerge that must be addressed and added to the written services agreement. Interventions that were planned for one member of the family may not be appropriate for others or may have a negative effect on some members. The practitioner must always maintain their view of the family as a unit and not appear to focus on one member of the group. The practitioner must also keep everyone informed of their obligation to maintain confidentiality. Informed consent is an ongoing process as the treatment plan or service agreement evolves. In most cases, the initial contact to the therapist or counselor’s office for assistance is made by one of the group members. The other members may not share this desire or commitment to participate in the treatment plan. Informed consent by all group members is particularly important in these situations, especially with minors who cannot legally provide consent. The reluctance on the part of some members may complicate the delivery of effective services, including maintaining confidentiality. The therapist or counselor must avoid being viewed as biased toward one member over another and must work to establish the trust of all members. Establishing trust is important to encourage sharing, communication, and participation among members,
that may impact service to clients. Professionals have a responsibility to continually expand self-awareness and recognize areas of biases, prejudices, and vulnerabilities.
empowerment for a trusting, collaborative relationship with the therapist or counselor. Informed consent is not a single form or procedure and must be revisited throughout the counseling/therapeutic process whenever changes or new components are introduced. HIPAA Privacy Rule provide explicit, detailed provisions that cover client consent for disclosure of information and which entities can receive information. Privileged communication, resulting from a therapy or counseling session, is a legal concept that protects the client from having confidential information disclosed without their consent. Confidentiality in the professional–client relationship is consistent with the obligation to serve as an advocate for the client and for the greater society. Confidentiality, as addressed in ethics codes and case study examples of violations, will be presented in this course. The Tarasoff v. University of California (1976) case and its resulting legal actions led to revisions to the codes of ethics. This precedent-setting case has led to changes in many state laws concerning the release of confidential information, duty to warn, and protection from harm. and respect for confidentiality rules. The therapist or counselor should avoid contact with any members outside of the professional setting to avoid any appearance of favoritism and potential ethical boundary violations. When counseling groups or families, confidentiality may be difficult to accomplish. Each client has different behaviors, levels of maturity, affiliations, loyalties, and attitudes toward the counseling or therapy. There are also levels of varying commitments to keep information from the group sessions private. In all codes of ethics, there are statements that guide the counselor to build commitment to confidentiality: ● Inform all clients in the group of the rules of confidentiality. ● Define ground rules and parameters for the group to support positive, productive discussions among members. ● Identify who the client is in the counseling setting. ● Discuss how confidentiality matters will be addressed. ● Determine how information by one member may be disclosed to other members by the counselor. ● Discuss how to disclose information that was previously held as secret in the group counseling session. ● Provide rules for communication, fairness, and respect in the group. ● Explain that confidentiality cannot be guaranteed in the group setting. ● Identify and discuss the impact of distance counseling regarding confidentiality. The ACA suggests that counselors clearly explain the importance and parameters of confidentiality as it applies to members of the group (ACA, 2014). Additionally, the AAMFT notes, as with other information shared in a counseling setting, that marriage and family therapists:
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Book Code: PCUS1525
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● Do not disclose client confidences except by written authorization, waiver, or when mandated by law. ● Do not take verbal authorization except when permitted in an emergency situation or when ordered by law. ● Do not disclose information outside the treatment context without a written authorization from each individual competent to execute the waiver. ● Disclose the nature of confidentiality to clients, as well as the possible limitations of the clients’ right to confidentiality. ● Review with clients the circumstances where confidential information may be requested and when it can be disclosed. ● Understand the circumstances that may necessitate repeated disclosures.
● Do not reveal any individual’s confidences to others in the client group without the prior written permission of that individual (AAMTF, 2015). The foregoing information serves as a guideline only and it is recommended that the entire AAMFT Code of Ethics be reviewed to understand the complex nature of confidentiality in group therapy. The NBCC 2023 Standards include the following directives: ● Counselors shall clearly identify in writing the primary client in the record. ● Counselors will also identify in the record those individuals who are receiving related professional services in connection with such client relationship. ● In the context of couple, family, or group counseling,
the counselor shall not reveal any individual client’s confidences to others without the prior written permission of that individual.
Confidentiality Laws with Minors or Incapacitated Clients Federal and state laws mandate the reporting of suspected child abuse or neglect. Additionally, statutes require the protection of others who may not have the ability to protect themselves, such as elderly individuals or those who are residing in institutions. Counselors and therapists who work with these clients are mandated reporters and must study applicable state laws that detail procedures for reporting abuse, including the required time limits, representatives to contact and their phone numbers.
giving informed consent. As appropriate, the counselor shall collaborate with the parent(s) or legal guardian, discussing the role of counseling, the confidential nature of the counseling relationship, and the autonomy of the client as required by the NBCC Code of Ethics, State and Federal law, and other applicable ethical standards. When working with minors or incapacitated adults who are legally incapable of giving informed consent, the counselor shall consider the custody agreement, power of attorney document, or legal agreement that may impact the rights of a parent or legal guardian.
Counselors and therapists must provide informed consent to minor or incapacitated clients as well. They must also take care to discuss the rules of confidentiality at their clients’ developmental or cognitive levels. The language used must be appropriate so that clients will understand that there are times when parents, guardians, or other officials must be notified concerning the information that they share. The NBCC 2023 Code of Ethics contains the following standards in this area: ● Counselors working with minors, incapacitated adults, or other persons unable to give legal consent to release confidential and privileged information, shall protect the confidentiality of information received in the counseling relationship as specified by Federal and State laws, written policies, and applicable ethical standards. In all cases, the counselor shall discuss with the client and their legal representative the limits of confidentiality and the rules concerning the release of any information. ● Counselors respect and honor the inherent and legal rights of the parents and legal guardians of minors and incapacitated adults who are legally incapable of Duty to Warn The confidentiality requirement of nondisclosure does not apply when imminent danger to the client or others exists. This duty to warn was a result of the Tarasoff case in California and has been added to many states’’ laws across the nation. The laws may vary across the states concerning the therapist’s obligation to warn and include such terms as: ● Whether the practitioner “must” warn of imminent danger or “may” warn of imminent danger. ● What constitutes a serious, foreseeable, and imminent danger? ● Which individuals must be given a warning of imminent danger and when? ● What circumstances warrant the therapist’s obligation to warn of imminent danger? ● Must the practitioner need to have firsthand information of the danger, or can a credible source inform them?
The practitioner should have expertise in working with these clients and should be competent in communication with them. A statement should be included in the plan of service that indicates (1) what was told to the client, and (2) that the practitioner took steps to inform them of disclosure in the following situations: ● If they report they are being abused; ● If they say they plan to hurt themselves; and ● If they say they plan to hurt others. If the practitioner believes any of the three indicators of harm are credible, the practitioner must follow the appropriate steps to report abuse or neglect and to warn others if the threat is deemed a serious one. The rules that govern the actions to take in these cases vary from state to state; therefore, the practitioners must follow the mandates within their jurisdictions of practice and licensure, as well as the code of ethics. Case studies and additional considerations will be covered in subsequent sections. ● Who is a credible source? ● What is the practitioner’s assessment of danger conflicts with opinions from medical or law enforcement personnel? ● Is the practitioner legally accountable if they issue a warning and danger was not imminent? It is imperative that any counselor or therapist confronted with a potential duty to warn situation seeks legal consultation for the best course of action. The ACA’s general requirement that counselors keep information confidential does not apply when: ● Disclosure is required to protect clients or identified individuals from serious and foreseeable harm; ● Legal requirements demand that confidential information must be revealed;
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● The counselor is in doubt as to the validity of the exception and must consult with other professionals; and when ● Additional considerations apply to address end-of-life and child welfare issues (ACA, 2014). The foregoing statements are addressed in detail in the ACA Code of Ethics, which must be studied in its entirety to understand the complexities of confidentiality between the client and the counselor. The NBCC 2023 Code of Ethics provides the following standards: ● Counselors shall take proactive measures to avoid harming their clients and avoid imposing personal values on those who receive their professional services. Counselors will seek to minimize unavoidable or unanticipated harm, and where possible seek to address unintentional harm. ● Counselors shall not share client information that is obtained through the counseling process without specific written consent by the client or legal guardian except when necessary to prevent serious and foreseeable harm to the client or others, or when otherwise mandated by federal or state law or regulation. Multicultural Issues A major focus of the ACA Code of Ethics’ expanded revision in 2014 was multicultural diversity competency. Multicultural diversity is a major component of the NBCC and AAMFT ethics codes as well. As the population increases and becomes more diverse, increased proficiency in multicultural diversity must be considered, and therapists and counselors must consider their personal values and biases. Cultural influences must be recognized and appreciated in order to build trust and collaboration for effective counseling and therapeutic relationships. These influences are complex, and counseling and therapy methods must be individualized and specific to the diverse needs of the client. Counselors and marriage and family therapists may work with client groups that represent multiple sexual orientations, genders, cultures, ethnic, racial, generational, and religious groups; therefore, multicultural diversity awareness and acceptance is central to effective therapy. Ethical challenges in multicultural diversity may begin with the validity of assessments because appropriate evaluation tools must be used. It is crucial to locate a culture fair or a culture-free method of assessment. The APA (2023a) defines a culture-fair test and cross-cultural testing as follows: ● A test based on common human experience and considered to be relatively unbiased with respect to special background influences. Unlike some standardized intelligence assessments, which may reflect predominantly middle-class experience, a culture-fair test is designed to apply across social lines and to permit equitable comparisons among people from different backgrounds. ● Cross-cultural testing is the assessment of individuals from different cultural backgrounds. The use of instruments that are free of bias is essential to valid cross-cultural testing, as it provides for the measurement equivalency necessary to ensure that outcomes have the same meaning across diverse populations of interest. For example, scores on a coping questionnaire that possesses bias may be a legitimate measure of coping if they are compared within a single cultural group, whereas cross-cultural differences identified on the basis of this questionnaire may be influenced by other factors,
● Counselors who provide clinical supervision services shall keep accurate records of supervision goals and the supervisee’s progress. All supervision-related information shall be treated as confidential, except to prevent serious and foreseeable harm to a client or others, or when legally required to do so by a court or government agency order. The AAMFT Code of Ethics includes the following standards: ● Marriage and family therapists disclose to clients and other interested parties at the outset of services the nature of confidentiality and possible limitations of the client’s right to confidentiality. ● Therapists review with clients the circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. Circumstances may necessitate repeated disclosures. ● Marriage and family therapists do not disclose client confidences, except by written authorization or waiver or where mandated or permitted by law. ● Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. such as translation issues, item inappropriateness, or differential response styles. Therapists should strive to be culturally aware and learn about the cultural identities they serve. The client’s cultural identity impacts assessment, communication, client goals, and methods of service, and counselors must expand their strategies and skills to be effective in a variety of cultural contexts. Problems may also arise when making a diagnosis in a multicultural context when using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition–Text Revision (DSM-5-TR). There are many cultural beliefs and experiences that influence diagnosis, and the DSM-5-TR revision in 2022 incorporated greater cultural sensitivity and understanding in the diagnostic process (APA, 2022): Some changes implemented in DSM-5-TR include language that challenges the view that races are discrete and natural entities: ● The term “racialized” is used instead of “race/racial” to highlight the socially constructed nature of race. ● The term “ethnoracial” is used in the text to denote the U.S. Census categories, such as Hispanic, White, or African American, that combine ethnic and racialized identifiers. ● The terms “minority” and “non-White” are avoided because they describe social groups in relation to a racialized “majority,” a practice that tends to perpetuate social hierarchies. ● The emerging term “Latinx” is used in place of Latino/ Latina to promote gender-inclusive terminology. ● The term “Caucasian” is not used because it is based on obsolete and erroneous views about the geographic origin of a prototypical pan-European ethnicity. ● Prevalence data on specific ethnoracial groups were included when existing research documented reliable estimates based on representative samples. In addition, information is provided on variations in symptom expression, attributions for disorder causes or precipitants, and factors associated with differential prevalence across demographic groups. Cultural norms that may affect the level of perceived pathology are also reported.
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Book Code: PCUS1525
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