_____________________________________________________________ Managing Professional Boundaries
ethical codes or for the particular situation to be only vaguely addressed by law, ethics code, or both. The APA Code (2017) states that “If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psy- chologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code” (Standard 1.01). The NASW Code (2021) states that “Social workers’ ethical obligations may conflict with agency policies or relevant laws or regulations. When such conflicts occur, social workers must make a reasonable effort to resolve the conflict in a manner that is consistent with the values, principles, and standards expressed in this code.” (Introduction). The ACA Code (2014) adds that “If the conflict cannot be resolved… counselors, acting in the best interest of the client, may adhere to the requirements of the law, regulations, and/or other governing legal authority” (Standard 1.1.c). An understanding of the ethical standards for one’s profession, coupled with the laws and regulations governing that profession, provides sound guidance when faced with ethical situations. While each profession has developed their own set of ethical standards, the underlying values which are central to those professions are remarkably similar. Principles of beneficence, nonmaleficence, integrity/fidelity, and autonomy/justice span the ethics codes of the professions and are meant to describe the ideals all professionals should aspire to. BENEFICENCE At its core, beneficence is the responsibility and duty of the cli- nician to help their client overcome life’s challenges to achieve a state of well-being. Through respectful, carefully thought-out interventions, healthcare providers work toward helping the client achieve the best possible outcome while minimizing harm. Beneficence is the duty of the clinician to act in ways that improve the well-being of the client. This principle is addressed in professional ethics codes by the following: • APA (2017)—Psychologists strive to help their client achieve a state of emotional well-being (Principle A). • NASW (2021)—Social workers understand that relationships between and among people are a vehicle to change, and they seek to strengthen relationships in an effort to promote, restore, maintain, and enhance the well-being of individuals, social groups, and communities (Value: Importance of Human Relationships). • ACA (2014)—Counselors work for the good of the individual and society by promoting mental health and well-being, enhancing development throughout the life span. They work to help the client foster control over the direction of their life (Introduction).
• AAMFT (2015)—Marriage and family therapists participate in activities which contribute to a better community and society (Preamble). Clinical Consideration : A client with a diagnosis of adjustment-related depression has been seen for eight sessions of cognitive behavioral therapy and has shown little to no improvement in mood and behavior. Recom- mending another form of treatment since this method is not working is a form of beneficence. • NBCC (2023)—Counselors strive to enhance the social and mental well-being of their clients while supporting the overall wphysical health of each client (Core Values). NONMALEFICENCE Nonmaleficence is the principle by which the clinician strives to do no harm. The clinician will not cause intentional harm to clients, and they will avoid behaviors that may place their clients at risk of harm. Harm is broadly defined and can include emotional, physical, and/or psychological harm. It requires the healthcare provider to carefully consider risks and benefits when making decisions that affect the care of the client. • APA (2017)—Psychologists strive to do no harm and attempt to resolve conflicts in a way that minimizes harm (Principle A). • NASW (2021)—Social workers use their knowledge, values, and skills to help people in need, and they elevate service to others above their own self- interest. They continually work to increase their professional knowledge and skills and apply them in practice (Value: Service, Competence). • ACA (2014)—Counselors act to avoid harming their clients (Client Welfare). • AAMFT (2015)—Competence is essential to the well-being of clients and their communities (Professional Competence & Integrity). • NBCC (2023)—Counselors seek to minimize undue harm and take particular care of those who are vulnerable or in anguish (Core Values). INTEGRITY/FIDELITY Clinical Consideration : The concept of “do no harm” may seem straightforward, for example yelling at or hitting a cli- ent is clearly unacceptable. However, there may be situations where acts of potential harm must be weighed against what is best for the client. Consider, as an example, the client who you feel would benefit from a psychotropic medication evaluation. Does the potential for harm from side effects of a medication outweigh the potential benefit of the medica- tion to the client’s mental health?
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