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 The Texas Administrative Code: Boundary Rules The TAC addresses boundary issues in Rule §681.41 General Ethical Requirements (Tex.reg, 2021): (h) In accordance with §503.401(a)(4) of the Act, a licensee must not intentionally or knowingly offer to pay or agree to accept any remuneration directly or indirectly, overtly, or covertly, in cash or in kind, to or from any person, firm, association of persons, partnership, corporation, or entity for securing or soliciting clients or patronage. (j) A licensee must not engage in activities for the licensee’s personal gain at the expense of a client. (k) A licensee may promote the licensee’s personal or business activities to a client if such activities, services, or products are to facilitate the counseling process or help achieve the client’s counseling goals. Prior to engaging in any such activities, services or product sales with the client, the licensee must first inform the client of the licensee’s personal and/or business interest therein. A licensee must not exert undue influence in promoting such activities, services, or products. (l) A licensee must set and maintain professional boundaries. (m) (Except as provided by this subchapter, non-therapeutic relationships with clients are prohibited. (1) A non-therapeutic relationship is any non-counseling activity initiated by either the licensee or client that results in a relationship unrelated to therapy. (2) A licensee may not engage in a non-therapeutic relationship with a client if the relationship begins less than two (2) years after the end of the counseling relationship; the non-therapeutic relationship must be consensual, not the result of exploitation by the licensee, and is not detrimental to the client. (3) A licensee may not engage in sexual contact with a client if the contact begins less than five (5) years after the end of the counseling relationship; the non-therapeutic relationship must be consensual, not the result of exploitation by the licensee, and is not detrimental to the client. (4) For purposes of paragraphs (2) and (3) of this subsection, the licensee must be able to demonstrate there has been no exploitation and the non-therapeutic relationship is not detrimental to the
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. client in light of all relevant factors, including, but not limited to, the factors set forth in §681.42(b)(4)(A) - (G) of this title (relating to Sexual Misconduct). (5) The licensee must not provide counseling services to previous or current: (6) The licensee must not give or accept a gift from a client or a relative of a client valued at more than $50, borrow or lend money or items of value to clients or relatives of clients, or accept payment in the form of goods or services rendered by a client or relative of a client. * (7) The licensee must not enter a non-professional relationship with a client’s family member or any person having a personal or professional relationship with a client if the licensee knows or reasonably should have known such a relationship could be detrimental to the client. (n) The licensee must not knowingly offer or provide counseling to an individual concurrently receiving counseling treatment intervention from another mental health services provider except with that provider’s knowledge. If a licensee learns of such concurrent therapy, the licensee must request release from the client to inform the other professional and strive to establish positive and collaborative professional relationships. (o) A licensee may take reasonable action to inform medical or law enforcement personnel if the licensee determines there is a probability of imminent physical injury by the client to the client or others, or there is a probability of immediate mental or emotional injury to the client. (p) The licensee must take reasonable precautions to protect clients from physical or emotional harm resulting from interaction: (1) within a group; or (2) individual counseling. (A) family members. (B) personal friends. (C) educational associates; or (D) business associates. *The acceptable amount of the gift may vary within agencies and practices with some limits lower than the stated $50.
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Book Code: PCTX1326
EliteLearning.com/Counselor
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