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CODE OF ETHICS FOR COUNSELORS AND MARRIAGE AND FAMILY THERAPISTS [6 CE hours] 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. The 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.
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BEHAVIORAL ADDICTIONS 58 [6 CE hours] This course will provide clinicians with the latest clinical and empirical evidence that addresses behavioral addictions, including phenomenology, epidemiology, comorbidity, neurobiologic mechanisms, genetic contributions, treatment response, and prevention. The distinction between impulse control disorders and behavioral addictions is discussed. For each behavioral disorder proposed for inclusion as a behavioral addiction, current evidence is presented that supports or refutes this designation.
CULTURAL HUMILITY IN HEALTHCARE
107
[2 CE hours] The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists and other behavioral healthcare professionals to use when working with patients from diverse backgrounds in a culturally humble manner.
FINAL EXAM ANSWER SHEET
130
©2026: 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.
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COUNSELOR CONTINUING EDUCATION
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COUNSELOR CONTINUING EDUCATION
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COUNSELOR CONTINUING EDUCATION
PCUS06CE — 6 CE CREDITS
R elease D ate : 1/08/2024
E xpiration D ate : 1/08/2028
Codes of Ethics for Counselors and Marriage and Family Therapists
Audience This course is designed for counselors and therapists in all
10. Explain standards that guide long-distance counseling or therapy using technology and social media from the NBCC, ACA, AAMFT, Code of Ethics, and AMFTRB guidelines. 11. Discuss the NBCC, ACA, and AAMFT directives opposing conversion-reparative therapy and counseling. 12. Identify standards for advocacy from the ACA and AAMFT codes of ethics. 13. List the complaint process and sanctions for ethics violations. Faculty Deborah Converse, MA, NBCT, holds an MA in Education for Emotionally Disabled Students from the University of Central Florida, a BA and MA 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 commu- nities, and has addressed education and employment issues for students facing challenges that include developmental, emotional and behavioral challenges, mental illness, mobil- ity and chemical dependency within the public school system setting. She has authored numerous instructional programs and presented them at state, national, and international con- ferences on education and mental health. Faculty Disclosure Contributing faculty, Deborah Converse, MA, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. Division Planner Scott Deatherage, PhD Senior Director of Development and Academic Affairs Sarah Campbell
practice settings. Course Objective
The purpose of this course is to provide counselors and thera- pists with a comprehensive understanding of ethical standards and professional responsibilities outlined by NBCC, ACA, and AAMFT, including competence, confidentiality, informed consent, multicultural considerations, and ethical decision- making across diverse practice settings. Learning Objectives Upon completion of this course, you should be able to: 1. 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. 2. Discuss fundamental principles of the ACA Code of Ethics. 3. Explain the requirements for client records in the NBCC, ACA, and AAMFT codes of ethics. 4. Identify exceptions that allow disclosure of confidential information. 5. Discuss assessment guidelines in the NBCC Code of Ethics. 6. List and define competencies for multicultural diversity sensitivity from the ACA and AAMFT codes of ethics. 7. Explain the term “foreseeable harm” related to confidentiality of client disclosures. 8. Discuss components of ethical decision making in therapy and counseling. 9. List ethical standards specific to minor clients and incapacitated or incompetent individuals.
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___________________________________ Code of Ethics for Counselors and Marriage and Family Therapists
Director Disclosure The division planner and director have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. Accreditations & Approvals NetCE has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6361. Pro- grams that do not qualify for NBCC credit are clearly identified. NetCE is solely responsible for all aspects of the programs. This course has been approved by NetCE, as a NAADAC Approved Education Provider, for educational credits, NAA- DAC Provider #97847. NetCE is responsible for all aspects of their programming. Designations of Credit NetCE designates this continuing education activity for 6 NBCC clock hours. About the Sponsor The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare. Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice. Disclosure Statement It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distrib- uting or providing access to this activity to learners. HOW TO RECEIVE CREDIT • Read the entire course online or in print. • Complete a mandatory test (a passing score of 75 percent is required). Test questions link content to learning objectives as a method to enhance individualized learning and material retention. Provide required personal information and payment information. • Complete the mandatory Course Evaluation.
INTRODUCTION Mental health professionals today face complex ethical consid- erations 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 confidential- ity, 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 popula- tion. 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 prac- titioner 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 counsel- ing profession include errors in informed consent, breach of confidentiality, inappropriate relationships with clients, false or misrepresented statements, fraudulent billing practices, and boundary violations. In order to educate and guide counselors and therapists, profes- sional 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 Porta- bility 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 [1].
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Code of Ethics for Counselors and Marriage and Family Therapists __________________________________
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. 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 descrip- tion 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 profes- sion, practice, and patients. This ancient oath is the founda- tion for the values and ethical principles in our current codes of ethics. 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 [2]. 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. 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 [3].
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 associa- tions included the National Vocational Guidance Association (NVGA); the National Association of Guidance and Coun- selor Trainers (NAGCT); the Student Personnel Association for Teacher Education (SPATE); and the American College Personnel Association. They established the American Personnel and Guidance Asso- ciation (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 [4]. 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 educa- tion, 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 [5]. 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.
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Today, there are more than 69,000 National Certified Coun- selors (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, depend- ing 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. Thera- pists, patients, and students view trust as fundamental to psychotherapy [6]. One shared belief among therapists and counselors is that professionals must do the right thing and make ethical deci- sions 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 profes- sional relationship along with ethical principles. The structure of common therapeutic relationship factors includes confi- dence in the therapist and confidence in the treatment plan, which is built on trust [7]. Confidentiality is essential in developing an effective relation- ship 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 collab- orative 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 [8]. Counselors are often confronted with situations that require sound ethical decision-making. Determining the appropriate course of action when faced with difficult ethi- cal conflicts can be challenging and should never be done in isolation. Codes of conduct are designed to protect clients and soci- ety. 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 aware- ness, 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. CLIENT FOCUS Counselors and therapists must be aware that their focus on their clients’ welfare takes precedence over their own. Prac- titioners must understand their own needs, as well as their potential for imposing personal values and biases that may impact service to clients. Professionals have a responsibility to continually expand self-awareness and recognize areas of biases, prejudices, and vulnerabilities. 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 fami- lies in the counseling plan and is critical to achieve a positive outcome. Informed consent educates clients about their rights and responsibilities and builds 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. 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 com- ponents 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 prin- ciple that holds the practitioner responsible for respecting the client’s privacy and protecting information disclosed during therapy. Both the Code of Ethics and the 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.
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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 case and its resulting legal actions led to revisions to the codes of ethics [9]. This precedent-setting case has led to changes in many state laws concerning the release of confidential informa- tion, duty to warn, and protection from harm. Confidentiality in Group Counseling Providing services to a family or group presents ethical chal- lenges 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 agree- ment. 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 confi- dentiality. 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 impor- tant to encourage sharing, communication, and participation among members, 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 impor- tance and parameters of confidentiality as it applies to mem- bers of the group [10]. Additionally, the AAMFT notes, as with other information shared in a counseling setting, that marriage and family therapists [11]: • 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. 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.
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• 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.
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 jurisdic- tions of practice and licensure, as well as the code of ethics. Case studies and additional considerations will be covered in subsequent sections. 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? • 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 informa- tion confidential does not apply when [10]: • Disclosure is required to protect clients or identified individuals from serious and foreseeable harm;
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 resid- ing 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. 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 stan- dards 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 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.
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Code of Ethics for Counselors and Marriage and Family Therapists __________________________________
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 con- sider 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 defines a culture-fair test and cross-cultural testing as follows [13]: • 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
• Legal requirements demand that confidential information must be revealed; • 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. 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 [12]: • 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. • 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 [11]: • 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.
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, 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 mul- ticultural context when using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5-TR).
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___________________________________ Code of Ethics for Counselors and Marriage and Family Therapists
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 [14]. 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. Attention was paid to the risk of misdiagnosis when evaluating individuals from socially oppressed ethnoracial groups. Clearly, it is impossible to be an expert in working with all cultures. Many researchers in this field report that it is impor- tant to look at the universal principles and standards that are at the core of therapy and counseling. These are basic human rights, and promoting an individual’s mental health to reach full potential is fundamental. A counselor should work beyond their cultural beliefs and social systems and strive to understand clients from their viewpoints. A counselor must be aware of a client’s external influences that may impact the development of service plans. There are many training and educational programs to help build competence in multicultural diversity and to help the practitioner appreciate the social and cultural influences that shape a client’s view of the world. Practitioners who do not consider these influences may incorrectly evaluate, or label, the client. They risk diagnosing behavior as pathological or impaired, although it may be an accepted and normal practice in the client’s culture.
Multicultural awareness in counseling and therapy is critical for the counselor or therapist to communicate effectively in a way that is culturally sensitive. The practitioner must consider the effects of the client’s culture in all phases of the service plan to deliver effective, individualized service. In addition to training and educational programs, practitioners should increase their own multicultural competencies through hands-on experiences with local cultures in their communi- ties of practice. This could include attending special events; volunteering; consulting professionals in the community; and participating in workshops, advocacy programs, and discussion groups along with consulting supervisors or other colleagues who have experience with the community. These activities, combined with guidelines from the code of ethics, may help practitioners develop competencies to further serve clients from diverse cultures. Practitioners must identify and understand their own cultural perspective as it impacts their practice with diverse popula- tions. While there may be situations that show blatant discrimination toward others or ignorance of other cultures, many cultural insensitivities or negative behaviors have been termed “micro- aggressions,” which are defined as, “A comment or action that subtly and often unconsciously or unintentionally expresses a prejudice” [15]. Well-meaning therapists who believe that they are culturally sensitive and open minded may offend members of another culture without being aware that they are doing so. Micro-aggressions are linked to implicit bias (see glossary) that may be subtle, unconscious, and unintentional as well. According to the APA, [16]: • Implicit bias is thought to be shaped by experience and based on learned associations between particular qualities and social categories, including race and/ or gender. • Individuals’ perceptions and behaviors can be influenced by the implicit biases they hold, even if they are unaware they hold such biases. • Implicit bias is an aspect of implicit social cognition: the phenomenon that perceptions, attitudes, and stereotypes can operate prior to conscious intention or endorsement. Therapists and counselors must be careful to identify their potential for bias and stereotyping clients from other cultural backgrounds and should complete implicit bias training as part of their professional preparation for practice. Nontraditional Family Groups Today’s professional will encounter a variety of nontraditional families and groups. Same-sex or transgender parents; same-sex family members; and biological, surrogate, and stepparents and -children are all within these nontraditional family groups.
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Code of Ethics for Counselors and Marriage and Family Therapists __________________________________
TECHNOLOGY-ASSISTED SERVICES The computer age has presented new areas of ethical concerns that have affected every mental health organization today. Com- puters and other forms of technology are now the standard methods for recording, storing, retrieving, and transmitting patient information, clinical records, session notes, insurance information, evaluation results, and all other data involved in a client’s case. Massive amounts of information can now be stored on increas- ingly smaller, faster, and more portable electronic devices. Audio and visual records of every part of the therapeutic and counseling service can now be easily recorded and accessed. The convenience, ease of use, and portability of these systems can unfortunately lead to confidential information being sto- len, lost, or transmitted accidentally. The constant upgrades and expansions among these systems lead to increasing pos- sibilities of privacy violations and other ethical concerns for confidentiality maintenance in cyberspace. Email interception by unauthorized parties is a widespread problem and is a violation of a client’s privacy. Some compa- nies and agencies feel justified in monitoring worksite email accounts and Internet usage because they view these employee email accounts as the company’s property and a part of the company’s technological infrastructure. Another justification is that they claim to determine whether personal business is being conducted on work time or if inappropriate Internet sites have been accessed. An example of this is within school systems where specific words and content are regularly flagged to monitor student and faculty use. If a school counselor or therapist reports that a child threatened to kill themself, the word “kill” may be red flagged in email correspondence by a county technology official who is monitoring the account in an office in another city and may trigger an investigation by individuals outside of the counseling relationship. This type of monitoring is a common practice in many public-school systems for all students and staff. Technology has taken therapy and counseling out of the office and moved it across geographic borders. It allows a practitioner to work with clients from any location any time of day or night. This may be convenient for both parties; however, it opens many opportunities for confidentiality breaches and privacy right violations that will be covered in detail in subsequent sections. In addition to crossing geographic boundaries, technology leads to boundary issues that cross the line from professional to personal with clients. Counselors and therapists may have websites and social media pages that are professional, in addition to personal online pages. These two types of social media must be kept separate at all times to maintain appro- priate boundaries with clients. An example of this might be a Facebook page that can be used for professional purposes; however, the profile can also include personal information that may include interactions with friends.
There is no “typical” family group, and each person in the family may face issues related to their unique family composi- tion. These issues may include discrimination, bullying, loss of employment, child custody issues, antigay prejudices or violence, feeling ostracized or isolated in the community, and feeling devalued by society. The family or group counselor or therapist should acquire specialized skills and experiences to understand the complexi- ties of nontraditional family groups in order to practice in a nonjudgmental, supportive manner. The following issues may present: • Sexual or gender orientation within the family group may lead to prejudice, discrimination, or bias in the community. • Minority sexual orientation or gender issues may be the focus in custody issues the family is facing. • Co-parenting and blended families may present added stress to all family members. • Children may face issues at school or within the community due to their family composition. • Same-sex or transgender couples may experience discrimination related to adoption or conceiving a child through the use of a surrogate. • There may be conflicts between the biological parent and a stepparent who now has custody of the child. • Extended families may not accept the nontraditional family members. • Parents may need support to help their children feel confident and comfortable with a lifestyle that contradicts what they see and experience outside of their homes. The parents may require strategies to help their children face discrimination, isolation, and any negative stereotypes that they may encounter. • Teens and children may face challenges due to their sexual or gender identity. • It may take additional time to build trusting, collaborative relationships with members of the group to overcome their reluctance to share their feelings due to negative, judgmental experiences that they may have had in the past. • A member of the family may be questioning sexual orientation or gender or may be in transition and need support through the process. The family may need services to help them adjust to the changes within the family. Microaggressions that are related to gender expression and sexual identity can occur when working with members of the LBGTQ community. For example, the counselor or therapist should ask in their first session which gender pronoun the client prefers.
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