Case Study Four: Unethical Statements Sue and Bob went to a counselor for marriage counseling, hoping to learn some skills for better communication and conflict resolution. The counselor assured them that they would see improvement in eight sessions if they implement the strategies she would “teach” in those areas. Bob and Sue agreed to pay $75.00 dollars per session, which would be covered by a managed care plan they both could assess. The counselor was called “Doc” around the office, so Bob and Sue assumed he had a PhD in some field of mental health counseling or therapy. They were given a blanket form for consent that contained a minimal explanation of HIPAA and release of information for insurance billing purposes. Doc, Sue, and Bob developed a friendly working relationship, but the strategies were focused on meditation, relaxation/ breathing exercises, and mindfulness, not communication or conflict resolution strategies. This continued into the fourth week and Sue and Bob, not wanting to complain, did not object. They did ask when they would “learn” the strategies they hope to accomplish. Doc answered by saying the skills they were developing were very beneficial, and in time they would move to communication and conflict resolution skills. By the eighth week, they had not worked on the preferred goals, and Bob and Sue were feeling disillusioned and somewhat betrayed. The counselor wanted them to continue, with a small increase in fee; they declined, and left feeling they wasted their time and were angry that their needs were not addressed. They would not have continued even if the fee had remained the same. Sue and Bob learned the counselor did not have a PhD, had no credentials for marriage counseling, and was trained as a school counselor. They considered filling a complaint with the state examiner board. Discussion What ethical issues can be identified in this case and what should have been done to address them? There are several violations apparent even with the minimal information given. The counselor is not practicing within his area of competence, which is outside of the marriage counseling that Bob and Sue The TBHEC Consolidated Rulebook for Professional Counselors (2023) refers to TAC Chapter 884, RULE §884.20, Disciplinary Guidelines and General Schedule of Sanctions that are administered in cases of violations of rules, regulations, and ethics codes (Tex.reg, 2022). The chapter outlines the types of violations, aggravating and mitigating factors, disciplinary sanctions, and additional conditions and restrictions necessary to educate or rehabilitate the licensee. Here are some excerpts from the chapter: (a) Purpose. These disciplinary sanction guidelines are designed to provide guidance in assessing sanctions for violations of the Occupations Code, Chapter 507, and the Council’s rules. The purpose of disciplinary sanctions is to protect the public, deter future violations, offer opportunities for rehabilitation if appropriate, punish violators, and deter others from violations. These guidelines are intended to promote consistent sanctions for similar violations, facilitate timely resolution of cases, and encourage settlements. (b) Standard Disciplinary Sanctions. The Council may impose the following disciplinary sanctions which are listed in descending order of severity: (1) Revocation. (2) Suspension for a definite period of time; (3) Suspension plus probation of any or all the suspension periods. (4) Probation of the license for a definite period of time; (5) Reprimand; and (6) Administrative penalty.
were seeking. This could be labeled as fraud and incompetency in practice outside the area of expertise. The methods he chose were totally ineffective to meet the clients’ needs, and the clients should have been referred to a qualified counselor in the field of marriage counseling. This is also a violation of Texas law Rule 681.41, which covers ethical practice. It includes misleading, deceptive, and/or exaggerated claims of qualifications, field of competency, effectiveness of service, fees, informed consent, purpose, goals, and techniques. It also requires the counselor to take immediate action if these violations occur. All these violations can be found in this case. The counselor allowed Bob and Sue to believe he had an advanced education credential by using the title of Doc, but he did not hold that degree. This is misleading or deceptive at best. The process of informed consent was not carried out effectively. The counselor and clients did not agree on the needs, goals, desired outcome, methods, risks, benefits, client rights, duration, fees, or any plan or process to be followed in writing. There was no informed consent since there was a total lack of understanding on the clients’ part. There was a lack of honest communication as the couple clearly stated their desired outcome but were ignored. They were misled when they were told that communication and conflict resolution skills would be covered initially and when they inquired at the fourth week. This indicates the counselor was aware that he was acting in his best interest, not that of the clients, as he proceeded to provide ineffective techniques. Finally, that counselor planned to raise the fee for additional sessions with this couple. Fees should be established, and agreed upon, at the beginning and maintained. Fraud, deception, and misrepresentation can go beyond statements or lack thereof. If the counselor practices in a manner contrary to any law, directive, or standard in the relevant code of ethics, they have committed an ethical violation and aresubject to sanctions. (d) Additional Conditions. The Council may impose additional conditions or restrictions upon a license deemed necessary to facilitate the rehabilitation and education of the licensee and to protect the public, including but not limited to: (1) Consultation with the licensee on matters of ethics rules, laws, and standards of practice by a licensed professional approved by the Council. (2) Restrictions on the licensee’s ability to provide certain types of services or to provide services to certain classes of patients; (3) Restrictions on the licensee’s supervision of others in a particular area of practice. (4) Completion of a specified number of continuing education hours on specified topics approved in advance by the Council in addition to any minimum number required of all licensees as a condition of licensure; (5) Taking and passing with the minimum required score of any examination required by the Council of a licensee; and (6) Undergoing a psychological or medical evaluation by a qualified professional approved in advance by the Council and undergoing any treatment recommended pursuant to the evaluation. The TBHEC has adopted a Consolidated Rulebook for Marriage and Family Therapists and refers to the same TAC Chapter 884, RULE §884.20, Disciplinary Guidelines and General Schedule of Sanctions administered in cases of violations of rules, regulations, and ethics codes (Tex.reg, 2022).
ETHICAL VIOLATIONS AND SANCTIONS Texas Behavioral Health Executive Council and Texas State Board of Examiners of Professional Counselors Rules
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Book Code: PCTX1324
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