9. The counselor must clearly communicate their role and the client’s role in the counseling process, to establish and clarify client expectations and desired outcomes. The client should understand they will be an active participant and involved in all stages of the counseling process including decision making and planning as the counseling sessions progress with the focus on a client centered practice. Any special concerns, sensitivities, legal requirements, security issues, triggers, or additional information, to enhance the counseling process and encourage client participation, should be included in planning, and reflected in consent documents. 10. Appropriate documentation of information is critical for a permanent record of the topics being discussed. Consent forms and therapy contracts will vary but should reflect the topics listed above as well as any information specific to the client and practice. 11. Informed consent is an ongoing process and will need to be revisited if any changes are made during the process of Discussion Informed consent is a requirement for ethical practice and a legal regulation in Texas law and receives considerable attention in all association codes of ethics. For some clients and minors, it may be difficult if not impossible to achieve due to age, cognitive ability level, sensory or processing impairment, or competency issues. Informed consent requires client engagement and understanding of the basic concepts of confidentiality and the role of the client and counselor in the counseling process. To give informed consent, the client must comprehend the goals, expected outcomes, confidentiality guidelines and Case Study 2: Informed Consent Counselor S. worked for a large company that offered counseling services to employees as a benefit through their insurance plan. Employee J. feared she was developing a dependency on alcohol that was affecting her marriage and performance at work. She decided to take advantage of the counseling service that was suggested by her supervisor who observed J.’s reluctance to take on new projects, which was a change in her work performance. Counselor S. was contacted by the supervisor, who asked the counselor to report back to her after meeting with Employee J. The counselor agreed to make the report because he believed Employee J. had confided in the supervisor about her concerns over her possible alcohol dependency affecting her work. Employee J. believed that all information shared in counseling was confidential as she had signed the counselor’s consent form that included information on client/counselor confidentiality and HIPAA PHI disclosure. Employee J. discussed concerns over her alcohol use with the counselor and, after some assessment and working through a shared decision-making process, Counselors S. and J. agreed that she needed assistance for her dependency on alcohol. Since substance abuse counseling falls outside of the counselor’s area of competency, the counselor made a referral to a local treatment center, and J. agreed to attend treatment. Upon receiving the report from Counselor S., the supervisor called Employee J. into the office. The supervisor, trying to
counseling. The therapy contract and consent forms may be amended to reflect changes. Items that could require revised consent documents may include altered frequency and duration of sessions, new techniques, goals, desired outcomes, expectations, directives, or assigned tasks between sessions. Changes in counseling staff or participants should be added along with their roles in the counseling process. 12. Each client/counselor relationship is unique so the consent process will need to be tailored to meet client needs. 13. Any specific legal and agency rules, organizational requirements, and HIPAA regulations apply and must be included in the informed consent process. Technology assisted modalities involve a different set of consent requirements and will be reviewed in a separate section of the course. exceptions, boundaries/rules, their role in decision-making, and the plans, methods, and fees to be followed. If technology- assisted counseling methods are used, there are additional consent issues to consider that will be reviewed. Informed consent should reflect client values, needs, preferences, and desired outcomes that are incorporated in the plan being considered for consent. Remember informed consent is a dynamic process, not simply an initial intake form to sign, and may need to be revisited throughout the counseling process. help J. by making her job less stressful, assigned J. a new role as an assistant with less responsibility until she completed the alcohol treatment program. J. accepted the new position but felt embarrassed and angered that her privacy was violated by the counselor. Discussion What ethical issues are involved here and what mistakes did the counselor make? Counselor S. violated J.’s right to confidentiality under HIPAA PHI and the TAC laws for disclosure because there was no duty to warn anyone, as she was not in imminent danger to self or others, and there was no billing or payment involved that required disclosure of information to a third party. Employee J. did not give consent to share any information with the supervisor, so the informed consent process, included HIPAA rules, was violated. The counselor should never have agreed to give a report to the supervisor, especially without consent by Employee J. Had Employee J. known the information would be shared with the supervisor, she could have decided not to enter counseling, but she was not duly informed to make that decision. J. reported the counselor to the State Board, and he was found in violation of the TAC, NBCC directives, and the HIPAA Privacy Act disclosure of PHI to the supervisor.
BOUNDARY ISSUES
Another common area of ethical concern in counseling involves setting and maintaining appropriate boundaries for relationships with clients. Detailed guidelines on maintaining boundaries are provided in the TAC and the ethics codes provided by national counseling associations and are fundamental components of ethical practice. Boundary guidelines may seem straightforward,
but when applied to actual situations with clients they may be more complex. The process of counseling is inherently personal and based on the primary goal of ensuring the welfare of the client. This involves encouraging open communication and building trust with the client while maintaining professional boundaries.
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Book Code: PCTX1324
EliteLearning.com/Counselor
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