Mental health counselors will likely deal with multiple ethical dilemmas during the course of their careers. When these situations occur, the onus generally falls on the counselor to see the situation through properly. As a result, therapists need to be very well versed in the potential ethical issues they might face, as well as what actions to take when they arise. Some issues are black and white, but others live in shades of gray — so we turned to the American Counseling Association (ACA) for guidance to help therapists determine how to identify ethical issues and what to do once they’ve spotted one.
What Is Considered an Ethical Issue in Counseling?
According to the American Psychological Association (APA), “an ethical dilemma arises when two or more of the values found in the ethical principles conflict.” A dilemma becomes ethical when the resolution of the dilemma appeals to a professional’s values, requiring more than just technical expertise to resolve. The APA iterates that “resolving an ethical dilemma requires identifying the relevant values and weighing those competing values against one another to determine which receives priority.”
The ACA’s Code of Ethics notes that counselors “are expected to engage in a carefully considered ethical decision - making process, consulting available resources as needed.” The ACA outlines that resolving ethical issues is a process and that counselors must engage in a pattern of ethical reasoning, which “includes consideration of professional values, professional ethical principles, and ethical standards.” There are a wide range of ethical issues that may arise for professional counselors.
5 Examples of Ethical Issues in Mental Health Counseling
There are a myriad of ethical issues in counseling examples, but some of the most common have been highlighted by the ACA. These include:
- Relationships with clients: The ACA’s Code of Ethics prohibits sexual and/or romantic interactions with clients, the romantic partners of clients, or the family members of clients. This rule applies when a therapist has had a relationship with a client in the past – should the client come to them in a professional capacity after the relationship has ended, the therapist should refuse services based on the ACA’s Code of Ethics. Therapists are also prohibited from engaging in a romantic relationship with a former client, their romantic partners, or their family members for a “period of 5 years following the last professional contact.” And as for non - romantic relationships, the ACA advises that counselors should still avoid entering into a sexual and/or romantic relationship with a current or former client, or their romantic partners or family members, “when the interaction is potentially harmful to the client.”
- Counseling friends & family members: Therapists are generally prohibited from entering a professional counseling relationship with friends or family members “with whom they have an inability to be objective.” An ethical issue arises when a therapist cannot remain neutral in their counseling session with any client. If a counselor has any reason to believe they would not be able to remain neutral during counseling an individual, they should not take on the patient as a client.
- Befriending clients on social media: The ACA prohibits “personal virtual relationships with clients” or, in other words, being connected with a current client on a social media platform. Even if a client reaches out first, the best practice is to deny the request to connect online. Accepting a “friend request” from a current or former client may present an ethical issue and blur the line between a professional and personal relationship. While a therapist might really enjoy a client as a person, building a personal relationship outside of their professional relationship is never a good idea when the goal is to remain neutral during counseling.
- Maintenance of confidentiality: Mental health counselors should be proactive to ensure an ethical issue does not arise as a result of loose security systems, whether physical or technical. This extends beyond the building exterior to the digital sphere, as well. Therapists should also train any employees as part of their practice, including interns, assistants, and receptionists, on privacy and confidentiality best practices.
- Required disclosures: While confidentiality is of the utmost importance, sometimes disclosure of a client issue is required by law. According to the ACA, the general requirement that therapists must maintain client confidentiality is waived when “disclosure is required to protect clients or identified others from serious and foreseeable harm,” or when otherwise required by law, for example, when a patient makes a serious threat of harm toward themselves or another individual. Even then, psychologists should seek to minimize the amount of information shared in order to maintain the integrity and privacy of their clients. For this reason, only essential information should be revealed, and therapists should attempt to obtain client consent before proceeding.
What Happens if a Complaint Is Filed Against a Mental Health Counselor?
Facing an ethics violation complaint can be nerve racking for any professional, but knowing the process involved can provide some predictability and relief. The basic timeline for a complaint filed against a mental health counselor is as follows, according to the ACA:
Step 1: Filing
Any current member of the ACA can have an ethics complaint filed against them, and so can any former professional who was an ACA member during the time of the alleged violation. Anyone can file a complaint if they “have reason to believe that an ACA member” has violated the ethics code, and the complaint can be considered if it is received “less than five years after the alleged conduct either occurred or was discovered by the complainant.”
Step 2: Ethics Committee Review
The Ethics Committee of the ACA, comprised of nine appointed members, handles the complaint. If the Committee determines they have jurisdiction over the complaint, the complainant will be sent a formal ethics complaint form to fill out. The complainant will be assigned an ACA staff liaison to help complete the form.
Step 3: Ethics Committee Acceptance
The Committee conducts an initial review of the complaint and decides whether sufficient information exists to determine whether a violation may have occurred. If so, the complaint is deemed “accepted.”
Step 4: Charged Member Response
The accused ACA member will be sent a copy of the accepted complaint, as well as supporting evidence and documents submitted by the complainant. The charged ACA member then has 30 business days to respond. It’s important to remember that the complainant bears the burden of proof during this process.
Step 5: Hearing
The Committee will hold a hearing to determine whether a violation of the ethics code occurred and, if so, what disciplinary action should be imposed. Each party has the right to call witnesses to testify on their behalf. The Ethics Committee will make its final decision. The charged ACA members have 30 business days in which to file notice of appeal.
Court Cases Involving Counselor Ethics Violations
While there are unfortunately existing cases of ethical violations in counseling, the silver lining is that therapists do not get sued often. What’s more, therapists have the ability to learn from past professionals’ mistakes. Some recent notable cases include the following:
- Copas v. Lee: A prospective counseling client, who was gay, sued the State of Tennessee asserting that state laws that allowed therapists to deny care to LGBTQ+ individuals based on values conflicts violated the Constitution. Ultimately, the client’s claim was dismissed for procedural reasons; however, the case raises an interesting discussion about the importance of maintaining neutrality as a therapist.
- In re Jakubaitis: In this federal bankruptcy case, a debtor sought an order from the court preventing questioning related to his mental health. The court found that questions about the duration of his prescription and his medication’s side effects did not require him to “divulge communications between him and psychotherapist,” and were therefore not privileged. Therapists can take away the key point that in a legal situation, clients may have to testify regarding their prescribed medications.
- Marshall v. Compton: In this Kentucky public school case, a student reported bullying to a school counselor before becoming involved in a serious altercation with other students. The court found that the school counselor had no duty under the negligence statute to prevent the fight, and that it was unforeseeable. Therapists can gather that some jurisdictions may grant more leniency than other jurisdictions in terms of the standards involved in professional negligence.
What to Do if You Face an Ethical Issue in Counseling a Patient
As a professional, facing an ethical dilemma at some point in your career is inevitable. How you respond to the situation is what matters.
Step 1: Document the dilemma. Keeping detailed records will help you down the road in the event that an ethical dilemma devolves into a legal situation.
Step 2: Reach out to the ACA. Always seek the advice of the ACA, trusted professionals, and the ACA Ethics Committee when faced with a troubling occurrence. Keep records of your communications with the ACA, as well as the ACA’s responses.
Step 3: Consider ending the relationship with the client involved in the ethical dilemma. When deciding whether to end the counseling relationship with the client, it may be helpful to reference the Society for the Advancement of Psychology’s guide to the ethical termination of therapy. It’s also important for therapists to carry comprehensive malpractice and liability insurance in an unfortunate situation that plays out on their own watch.
Final Thoughts
If you’re a mental health counselor facing an ethical dilemma, know you’re not alone. Reaching out to other trusted therapists, the ACA, professors, or other professional organizations can help guide you on the right steps to take to avoid malpractice or improper treatment of a patient. Remember that while facing an ethical dilemma may be out of your control, you always have control over how you respond.
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