essay on ethics in counselling

Counseling Ethics Code: 10 Common Ethical Issues & Studies

Despite their potentially serious consequences, ethical issues are common, and without preparation and reflection, many might be violated unwittingly and with good intentions.

In this article, you’ll learn how to identify and approach a variety of frequently encountered counseling ethical issues, and how a counseling ethics code can be your moral compass.

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This Article Contains:

Counseling & psychotherapy ethics code explained, 7 interesting case studies, 3 common ethical issues & how to resolve them, ethical considerations for group counseling, a take-home message.

Most of us live by a certain set of values that guide our behavior and mark the difference between right and wrong. These values almost certainly influence how you approach your work as a counselor .

Following these values might feel natural and even intuitive, and it might feel as though they don’t warrant closer examination. However, when practicing counseling or psychotherapy, working without a defined counseling code of ethics is a bit like sailing a ship without using a compass. You might trust your intuitive sense of direction, but more often than not, you’ll end up miles off course.

Fortunately, there are a variety of professional organizations that have published frameworks to help counselors navigate the challenging and disorienting landscape of ethics.

Members of these organizations are often recommended or required to adhere to a framework, so if you belong to one of them and you’re not familiar with their respective code of ethics, this should be your first port of call. However, these ethical frameworks are also often available online for anyone to read, and so you don’t need to join an organization to adhere to its principles.

Each organization takes a slightly different approach to their code of ethics, so you may find it useful to view several to find one that resonates best with your practice. As an example, the British Association of Counselling and Psychotherapy (2018) has a framework that emphasizes aspiring to a variety of different values and personal moral qualities.

Those values include protecting clients, improving the wellbeing and relationships of others, appreciating the diversity of perspectives, and honoring personal integrity. Personal moral qualities include courage, empathy , humility, and respect.

These values and qualities are not meant to be strict criteria, and there is no wholly objective way to interpret them. For example, two counselors might display the same legitimate values and qualities while arriving at different conclusions to an ethical problem. Instead, they reflect a general approach to how a counselor should think about ethics.

Nevertheless, this approach to ethics may be overly prescriptive for you, in which case a looser and more general framework may be better suited to the nature of your practice. Most professional organizations recognize this, and there is a set of foundational principles that feature widely across different frameworks and refine the collection of different values and qualities described above into simpler terms.

These principles are autonomy , beneficence, non-maleficence, fidelity, justice, veracity, and self-respect (American Counseling Association, 2014; British Association for Counselling and Psychotherapy, 2018). They are largely consistent across frameworks aside from some minor variations.

• Autonomy is the respect for a client’s free will.
• Beneficence and non-maleficence are the commitment to improve a client’s wellbeing and avoid harming them, respectively.
• Fidelity is honoring professional commitments.
• Veracity is a commitment to the truth.
• Justice is a professional commitment to fair and egalitarian treatment of clients.
• Self-respect is fostering a sense that the counselor is also entitled to self-care and respect.

Putting these principles into practice doesn’t require a detailed framework. Instead, as the British Association for Counselling and Psychotherapy (2018) recommends, you can simply ask yourself, “ Is this decision supported by these principles without contradiction? ” If so, the decision is ethically sound. If not, there may be a potential ethical issue that warrants closer examination.

Regardless of whether you navigate using values, qualities, or principles, it’s important to be prepared for how they might be challenged in practice. As explained above, these are not intended to be strict criteria, and it’s good to foster a healthy amount of flexibility and intuition when applying your ethical framework to real-life situations.

You might also interpret challenges to other principles. There is no correct or incorrect interpretation to any of these cases (Cottone & Tarvydas, 2016; Zur, 2008).

For each, consider where you think the problem lies and how you would respond.

A counselor has been seeing their client for several months to work through substance use issues. A good rapport has been formed, but the client has not complied with meeting goals set during therapy and has not reduced their substance use.

The counselor feels they may benefit from referring the client to a trusted colleague who specializes in helping individuals with substance use issues who are struggling to engage with therapy. The counselor contacts the colleague and arranges an appointment within their client’s schedule.

When the client is informed, the client is upset and does not wish to be seen by the colleague. The counselor replies that rescheduling is not possible, and they should consider the appointment a necessary part of therapy.

Beneficence

A counselor working as part of a university service is assigned a client expressing issues with their body image. The counselor lacks any knowledge in working with these issues, but feels as though they may help the client, given the extent of their experience with other issues.

On reflection, the counselor decides to contact a colleague outside the university service who specializes in body image issues and asks for supervision and advice.

Non-maleficence

A counselor developing a new exposure-based form of anxiety therapy is working with a client with severe post-traumatic stress. There is promising evidence suggesting the therapy is effective for reducing mild anxiety, but it is unknown whether the therapy is effective in more extreme cases.

As a result, the counselor recognizes that this client in particular would provide a particularly valuable case study for developing the therapy. The counselor recommends this therapy to the client.

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A client with a history of depression and suicidal ideation has been engaging successfully with therapy for the last year. However, recently they have experienced an unfortunate coincidence of extremely challenging life events because of their unstable living arrangement.

The counselor has noticed problematic behaviors and thought patterns emerging, and is seriously concerned about the client’s mental health given the history.

In order to have the client moved from their challenging living environment, they decide to recommend that the client be hospitalized for suicidal ideation, despite there being no actual sign of suicidal ideation and their client previously expressing the desire to avoid hospitalization.

A school counselor sees two students who are experiencing stress regarding their final exams. The first is a high-achieving and popular student who is likable, whereas the second is a student with a history of poor attendance and engagement with their education.

The counselor agrees that counseling is appropriate for the first student, but recommends the second student does not attend counseling, instead addressing the “transient” exam stress by directing their energy into “working harder.”

A counselor is assigned a teenage client after both the client and their family consent to therapy for issues with low mood. After the first session together, it is apparent that the client has been withholding information about their mental health from their family and is showing symptoms typical of clinical depression.

The counselor knows that their client is a high-performing student about to enter a prestigious school and that the client’s family has high hopes for the future. The counselor reassures the family that there is no cause for serious concern in order to protect them from facing the negative implications of the client’s condition.

Self-interest

A counselor is working with a client who is a professional massage therapist. The client offers a free massage therapy session to the counselor as a gesture of gratitude. The client explains that this is a completely platonic and professional gesture.

The counselor has issues with close contact and also feels as though the client’s gesture may not be entirely platonic. The counselor respectfully declines the offer and suggests they continue their relationship as usual. However, the client discontinues therapy abruptly in response.

Ethics in counseling

Ethical issues do not occur randomly in a vacuum, but in particular situations where various factors make them more likely. As a result, although ethical issues can be challenging to navigate, they are not necessarily difficult to anticipate.

Learning to recognize and foresee common ethical issues may help you remain vigilant and not be taken unaware when encountering them.

Informed consent

Issues of consent are common in therapeutic contexts. The right to informed consent – to know all the pertinent information about a decision before it is made – is a foundational element of the relationship between a counselor and their client  that allows the client to engage in their therapy with a sense of autonomy and trust.

In many ways, consent is not difficult at all. Ultimately, your client either does or does not consent. But informed consent can be deceptively difficult.

As a brief exercise, consider what “informed” means to you. What is the threshold for being informed? Is there a threshold? Is it more important to be informed about some aspects of a choice than others? These questions do not necessarily have a clearcut answer, but nevertheless it is important to consider them carefully. They may determine whether or not your client has given sufficient consent (West, 2002).

A related but distinct challenge to informed consent is that it is inherently subjective. For example, your client may have as much knowledge about a decision as you do and feel as though they fully understand what a decision entails. However, while you have both experience and knowledge of the decision, they only have knowledge.

That is to say, to some extent, it is not possible for your client to be informed about something they have not actually experienced, as their anticipated experience based on their knowledge may be wholly different from their actual experience.

The best resolution to these issues is to avoid treating informed consent like a checkbox that needs to be satisfied, where the client is required to ingest information and then give their consent.

Instead, encourage your client to appreciate the importance of their consent, reflect on their decision, and consider the limitations of their experience. In doing so, while they may not be able to become fully informed in an objective sense, they will achieve the nearest approximation.

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Termination of therapy

Another time of friction when ethical issues can surface is at the conclusion of therapy , when the counselor and client go their separate ways. When this termination is premature or happens without a successful resolution of the client’s goals, it is understandable why this time is difficult.

This can be a challenging transition even when therapy is concluded after a successful result. Like any relationship, the one between a counselor and client can become strained when the time comes for it to end.

Your client may feel uncertain about their ability to continue independently or may feel rejected when reminded of the ultimately professional and transactional nature of the relationship (Etherington & Bridges, 2011).

A basic preemptive action that can be taken to reduce the friction between you and your client during this time is ‘pre-termination counseling,’ in which the topic of termination is explicitly addressed and discussed.

This can be anything from a brief conversation during one of the concluding appointments, to a more formal exploration of termination as a concept. Regardless, this can give your client the opportunity to acclimatize and highlight any challenges related to termination that may be important to explore before the conclusion of therapy.

These challenges may involve features of your client’s background such as their attachment history, which may predispose them toward feelings of abandonment, or their experience of anxiety, which may influence their perceived ability to cope independently after therapy.

If you already have knowledge of these features of your client’s background, it may be worth considering these potential challenges well in advance of the termination of therapy.

Online counseling

Remote forms of therapy are becoming increasingly common. This has many obvious benefits for clients and counselors alike; counseling is more accessible than ever, and counselors can offer their services to a broad and diverse audience. However, online counseling is also fraught with commonly encountered ethical issues (Finn & Barak, 2010).

As remote practice frequently takes place outside the structured contexts more typical of traditional counseling, ethical issues commonly encountered in online counseling are rooted in this relative informality.

Online counseling lacks the type of dedicated ethical frameworks described above, which means e-counselors may have no choice but to operate using their own ethical compass or apply ethical frameworks used in traditional counseling that may be less appropriate for remote practice.

Research suggests that some online counselors may not consider the unique challenges of working online (Finn & Barak, 2010). For example, online counselors may feel as though they do not have the same responsibility for mandatory reporting, as their relationship with their clients may not be as directly involved as in traditional counseling.

For online counselors who are aware of their duty to report safeguarding concerns, the inherent anonymity of online clients may present a barrier. Anonymity certainly has the benefit of improved discretion, but it also means a counselor may be unable to identify their client if they feel they are threatened or otherwise endangered.

Online counselors may also be unclear regarding the limits of their jurisdiction, as qualifications or professional memberships attained in one region may not be applicable in others. It can often seem like borders do not exist online, and while to some extent this is true, it is important to respect that jurisdictions exist for a reason, and it may be unethical to take on a client who you are not licensed to work with.

If you work as an e-counselor, the best way to resolve or preemptively prepare for these issues is to acknowledge they exist and engage with them. A good place to start may be to develop a personal framework for your practice that has a plan for issues of anonymity and confidentiality, and includes an indication of how you will report safeguarding concerns.

In a group setting, clients may no longer feel estranged from society or alone in their challenges, and instead view themselves as part of a community of people with shared experiences.

Clients may benefit from insights generated by other group members, and for some individuals, group counseling may literally amplify the benefits of a one-to-one approach.

However, group settings can also bring unique ethical issues. Just as some groups can bring out the best in us, and a therapeutic context can foster shared insights, other groups can become toxic and create a space in which counter-therapeutic behaviors are enabled by the implicit or explicit encouragement of other group members.

Similarly, just as some group leaders can inspire others and foster a productive community, it is also all too easy for group leaders to become victims of their status.

This is true for any relationship in which there is an inherent imbalance of power, such as traditional one-to-one practice, but in a group context, the counselor is naturally invested with a greater magnitude of influence and responsibility. This can lead to the judgment of the counselor becoming warped and increase the risk of overstepping ethical boundaries (Mashinter, 2020).

As a group counselor, first and foremost, you should foster a diligent practice of self-reflection to ensure you are mindful of the actions you take and remain alert to any blind spots in your judgment.

If possible, it may also be useful to examine ethical issues related to your authority by referring to another authority, in the form of supervision with one of your colleagues.

Finally, to prevent counter-therapeutic dynamics from developing within your group of clients, it may be useful to develop a clear code of conduct that emphasizes a commitment to group beneficence through mutual respect (Marson & McKinney, 2019).

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Take a structured approach to preparing for and dealing with ethical issues, whether this is referring to a framework published by a professional organization or simply navigating by a set of core values.

Prepare for the most common types of ethical issues, while also keeping an open mind to the often complex nature of ethics in practice, as well as the specific ethical issues that may be unique to your practice. Case studies can be a useful tool for doing this.

If in doubt, refer to these five steps from Dhai and McQuiod-Mason (2010):

• Formulate the problem.
• Gather information.
• Consult authoritative sources.
• Consider the alternatives.
• Make an ethical assessment.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• American Counseling Association. (2014). Ethical & professional standards . Retrieved July 22, 2021, from https://www.counseling.org/knowledge-center/ethics
• British Association for Counselling and Psychotherapy. (2018). BACP ethical framework for the counselling professions . Retrieved from https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/
• Cottone, R., & Tarvydas, V. (2016). Ethics and decision making in counseling and psychotherapy . Springer.
• Dhai, A., & McQuoid-Mason, D. J. (2010). Bioethics, human rights and health law: Principles and practice . Juta and Company.
• Etherington, K., & Bridges, N. (2011). Narrative case study research: On endings and six session reviews. Counseling and Psychotherapy Research , 11 (1), 11–22. https://doi.org/10.1080/14733145.2011.546072
• Finn, J., & Barak, A. (2010). A descriptive study of e-counselor attitudes, ethics, and practice. Counseling and Psychotherapy Research , 10 (4), 268–277. https://doi.org/10.1080/14733140903380847
• Marson, S. M., & McKinney, R. E. (2019). The Routledge handbook of social work ethics and values . Routledge.
• Mashinter, P. (2020). Is group therapy effective? BU Journal of Graduate Studies in Education , 12 (2), 33–36.
• West, W. (2002). Some ethical dilemmas in counseling and counseling research. British Journal of Guidance & Counselling , 30 (3), 261–268. https://doi.org/10.1080/0306988021000002308
• Zur, O. (2008). Bartering in psychotherapy & counseling: Complexities, case studies and guidelines. New Therapist , 58 , 18–26.

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What our readers think.

I appreciated your insight on the autonomy of the client, and this article was a great help for me in my master’s program and things to consider as I choose the right path for practice.

I enjoyed the lessons

I was recently at a social gathering where a former chemical dependency group counselor also attended. I tried to be polite, however I felt stalked. I was speaking with another person at the event, and he was within earshot of the conversation and hijacked my intent and the conversation. I had to literally seek an escape route. Before the event was over, he knocked my food from my plate and then ran to take the seat intended for me. This person knew that I am a retired professional and had access to my mental and physical health files. To say I was triggered is an understatement. What else could I have done in the moment to protect my psyche from the collateral damage that his inappropriate behaviors caused me? Is there any recourse? Do I now have to avoid the venue for fear he may show up there again and harass me further? Thank you in advance for your prompt attention.

I’m truly sorry to hear about your distressing experience. No one should ever feel cornered or unsafe, especially in social settings. In the moment, prioritizing your safety and well-being is paramount. If you ever find yourself in a similar situation, consider:

– Seeking Support : Approach a trusted friend or event organizer to stay with you, making it less likely for the individual to approach. – Setting Boundaries : Politely yet firmly assert your boundaries if you feel safe to do so. Let the person know their behavior is unwelcome. – Seeking Professional Advice : Consider discussing the situation with a legal professional or counselor to understand potential recourse.

Remember, you have every right to attend venues without fear. If you’re concerned about future encounters, perhaps inform the venue’s management about your experience.

Warm regards, Julia | Community Manager

Thanks for the reminder that group counseling is also a whole different thing compared to a more typical counseling session. I’d like to look for professional counseling services soon because I might need help in processing my grief. After my dog died a month ago, it’s still difficult for me to get on with my life and get on with life normally.

https://www.barbarasabanlcsw.net/therapy-with-me

Thanks the topic is well explained have learnt alot from it

Very informative article. I particularly enjoyed the case studies on the ethical principles

Thanks a lot

Ngini Nairobi, Kenya

very useful article .thank u very much. from… Sri Lanka

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Following the counseling code of ethics.

Thoughtful and impactful counselors understand that it is critically important to develop a bond of trust and respect with their clients. It is this bond that frees clients to feel as though they can be open and vulnerable without fearing judgment or a betrayal of confidence.

To help professional counselors understand how to safeguard themselves and best serve their clients, the American Counseling Association (ACA) publishes a set of ethical guidelines that promote respect, dignity and just treatment within the context of the counselor and client relationship. This Code of Ethics can assist professionals who are faced with ethical dilemmas in counseling by offering a detailed set of protocols to help guide their course of action.

Keeping a Code of Ethics

The ACA Code of Ethics outlines various ethical scenarios for counselors and offers guidelines for navigating ethical dilemmas in counseling. 1 If you find yourself faced with a delicate situation in your work as a counselor, these guidelines can help you assess how to appropriately and effectively serve your clients and your profession.

The Counseling Relationship: Counselors must keep the welfare of the client in mind and establish boundaries that make the client-counselor relationship clear. This means that clients need to understand the counseling process and have clearly established counseling goals. Records should be safeguarded and recorded in an accurate and timely manner. Professional boundaries should always be maintained, and a romantic or sexual relationship should never occur between counselors and clients. Session fees should be affordable for the client, and they should be made clear from the start.

Confidentiality and Privacy: Counselors need to safeguard the individual rights and privacy of their clients. Trust is the cornerstone of the counseling relationship, and counselors are responsible for maintaining a trustworthy partnership. Clients should be made aware if information about them has to be shared with others outside the counseling relationship, and only essential information should ever be revealed to outside parties. Counselors are required to disclose client behaviors that indicate the potential for self-harm or harm to others. Lastly, if sessions are to be recorded or observed, counselors must first get the permission of their client.

Professional Responsibility: All counseling practices and treatments should be grounded in research and accepted practice. The ACA also encourages counselors to offer pro bono work as a part of their professional activity. In order to stay abreast of the practice, counselors must understand the need for continued education and maintain awareness of changing practices and procedures in the field.

Relationships With Other Professionals: How professional counselors interact with their peers will influence what services their clients have access to. Counselors must strive to provide clients with the most comprehensive clinical and support service available, which means that they should have a basic knowledge of which additional services are available locally. All positive working relationships with colleagues should be grounded in respect, even if professional approaches differ.

Evaluation, Assessment and Interpretation: Without an accurate assessment of a client’s presenting situation, the individual may not receive appropriate treatment. Professional counselors must understand the context of the client’s beliefs, behaviors and cultural background . In giving a diagnosis, counselors must carefully consider whether the associated treatment and potential outcomes will do more harm than good to the client.

Supervision, Training and Teaching: Whether you are a counseling student or instructor, boundaries within your professional relationships are also important to ethical counseling behavior. Supervisors must maintain a professional relationship with their students, whether sessions are electronic or face-to-face. Teachers and supervisors must aim to be fair, honest and accurate when assessing students or supervisees. Counselor educators and supervisors must apply pedagogically sound instructional models. In addition, counseling educators should actively work to recruit and retain a diverse body of students in support of a commitment to improve diversity in the counseling field.

Research and Publication: Benefits to clients will only be realized if important research advancements in the field of counseling are shared with practitioners. Professionals have an ethical obligation to contribute to that knowledge base whenever possible and to keep aware of its current advancements.

Distance Counseling, Technology and Social Media: Current trends in technology have changed the field, and today, face-to-face interaction isn’t always necessary. While distance counseling has removed roadblocks to counseling services for some, it also comes with new and evolving ethical considerations. Counselors have to understand new platforms and resources in order to determine whether they will better serve their clients. These new service delivery formats also bring increased concerns for confidentiality and privacy that professionals should be mindful of. And it may seem obvious, but confidential information should never be shared on social media.

Resolving Ethical Issues: Ethical dilemmas must never be ignored, for the good of the client, the counselor and, ultimately, the profession itself. Not only should professional counselors follow a strict personal code of ethics in their work, they should also hold peers accountable to high ethical standards. The best practice is always to be proactive and take action, and, if necessary, cooperate with any investigations into wrongdoing.

Facing an Ethical Dilemma

When challenges arise, the way forward may not immediately be clear. Start by separating facts from assumptions, bias, hypotheses or suspicions. Determine if the problem is an ethical, professional, clinical or legal problem (or a combination). Review the professional literature, especially the ACA Code of Ethics, to see if guidelines for addressing the problem are provided there. Consult with other professional counselors to get input on resolving the situation. Online resources are also available for contacting state and national professional associations.

Remember, your action or inaction in any situation involving ethics will impact all parties involved, so let the foundational principles of counseling guide your decisions:

• Autonomy: Counselors should encourage and enable clients to take control of the direction of their own lives wherever possible
• Nonmaleficence: Counselors’ chosen action or inaction should never intentionally cause harm
• Beneficence: Mental health and well-being should be a priority for the good of the individual and for society more broadly
• Justice: Counselors should treat all people fairly and equitably
• Fidelity: Counselors should honor all personal and professional commitments, promises and responsibilities

To help determine if your chosen course of action is the correct one, test it according to the principles of justice, publicity and universality, as outlined in the “Practitioner’s Guide to Ethical Decision Making” from the ACA. 2 First, would you treat another person in the same situation the same way? Secondly, would you want your behavior in resolving this situation reported to the press? And finally, would you recommend this solution to another counselor facing a similar ethical dilemma? When you’ve decided on a strategy, be sure and set an appointed time to follow up and evaluate whether your actions achieved their desired effects.

Create an Admirable, Ethical Counseling Career

Take a deep dive into the professional, ethical and legal matters you may encounter in counseling. Explore unique concentrations in School Counseling or Clinical Mental Health Counseling , with a specialization in Military and Veterans Counseling , in the Online Master of Education in Counseling program from William & Mary.

• Retrieved on October 24, 2018, from counseling.org/resources/aca-code-of-ethics.pdf2
• Retrieved on October 24, 2018, from counseling.org/docs/default-source/ethics/practioner-39-s-guide-to-ethical-decision-making.pdf?sfvrsn=f9e5482c_1

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Reflection on Professional Ethics of Counselors Essay

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Confidentiality

Relationships.

In the counseling profession, moral quandaries are unavoidable. The counselor must determine whether to disclose personal information in case the client confesses to having committed a crime in the past or that her spouse has abused her. An adviser could be conflicted about whether to support the client if he makes a choice that the counselor vehemently disagrees with.

In counseling, maintaining confidentiality is a crucial ethical concept since, without it, a client won’t be able to trust an expert to keep her secrets private. The ethical code directs everyone in this sphere in how to react when you learn something that you don’t believe should be kept a secret, such as that one of the clients plans to commit suicide. The criteria were updated in 2014 to state that ACA (American Counseling Association) members may violate confidentiality in order to avoid “severe and predictable damage” (Francis, 2020, p. 3). According to the rule, confidentiality is waived when someone is in obvious and impending danger.

It’s not always simple to keep the client-counselor connection professional. Counselors can find that they and the client both hang out with the same people or that they both find each other attractive. It all depends on the level of empathy for the client. Empathy is defined as “cognitive, affective, and behavioral interpersonal reactions to another person, including various forms of perspective taking, empathic concern, personal distress, and other congruent emotional and behavioral responses” (Lishner, 2017, p.1). It is more likely that you will abuse your authority since your patient is in a vulnerable situation, such as by taking advantage of them sexually. The code of ethics provides counselors with a yardstick, which is used to measure the quality of their personal interactions, such as the rule that you should not start a romantic or sexual connection with a client until the counseling relationship has come to an end.

Francis, P. C. (2020). Legal and ethical issues in college counseling. In D. A. Paladino, L. M. Gonzalez, & J. C. Watson (Eds.), College counseling and student development: Theory, practice, and campus collaboration (pp. 77–98). American Counseling Association.

Lishner, D. A., Stocks, E. L., & Steinert, S. W. (2017). Empathy. Encyclopedia of Personality and Individual Differences , 1–8. Web.

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10 Ethics in Counseling Psychology

Melba J. T. Vasquez Independent Practice Austin, Texas

Rosie Phillips Bingham Student Affairs University of Memphis Memphis, Tennessee

• Published: 18 September 2012
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This chapter focuses on the contributions that counseling psychology has made to the evolution of professional ethics. Kitchener’s moral principles and Meara, Schmidt, and Day’s (1996) virtue ethics are examples of contributors whose work has influenced the ethics discourse. Changes to the 2002 American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct are discussed, as are mechanisms for accountability and key areas of concern for psychologists. Counseling psychology’s unique contribution to social justice as an ethical imperative is addressed, and an ethical decision-making model is suggested. Finally, future directions in ethics, especially in regard to the social milieu, are described, including the direction of ethics training.

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Ethical issues and considerations in counseling

Mental health counselors give patients a safe space to confide private and sensitive information. These disclosures allow patients to receive proper treatment and improve their mental health. 1 However, counselors face serious ethical dilemmas when clients share information that could harm themselves or others. The boundaries between counselors and patients can also become blurred, leading to potential conflicts of interest. 2

Mental health professionals can navigate these challenges by adhering to strict counseling ethics. This article explores ethical guidelines for counselors, common ethical issues, and strategies for resolving ethical issues.

What are counseling ethics?

The American Counseling Association (ACA) defines counseling ethics as professional values that serve as “the foundation for ethical behavior and decision making.” 2 These values enable counselors to maintain professional relationships with clients and provide compassionate care for patients from all backgrounds.

The ACA’s Code of Ethics lists six essential professional values for counselors: 2

• Autonomy: Empower clients to take control of their own lives
• Nonmaleficence: Avoid actions that could harm clients and others and take steps to minimize unavoidable harm
• Beneficence: Positively affect clients and society by helping individuals improve their mental health
• Justice: Treat all clients with fairness and equality
• Fidelity: Keep commitments and promises made to clients.
• Veracity: Be honest when interacting with clients, colleagues, and others in professional settings

Examples of ethical issues in therapy

Mental health professionals frequently confront gray areas in ethical guidelines when interacting with clients and colleagues. Let’s explore two common areas where counselors face ethical dilemmas.

Breaking confidentiality in counseling

According to the ACA, mental health professionals have an ethical duty to maintain client confidentiality. Counselors can be compelled to break confidentiality when the client threatens harm to themselves or others. This is a fairly clear cut example and a counselor would cover this while outlining counseling services. However, counselors may face less clear-cut ethical issues when requests are made by outside agencies for patient records. 2

For example, law-enforcement officials may demand access to confidential patient information. Counselors should release records only if the police have a court order. Similarly, a parent might request information about a minor child’s counseling sessions. Counselors should ensure that the parent has custodial rights before revealing any information. 3

Dual relationships in counseling

A dual relationship occurs when the counselor has two or more roles in a client’s life. For instance, a counselor might be asked to provide treatment for a family member or a former romantic partner. 4

The National Board for Certified Counselors recommends that counselors avoid having multiple relationships with clients to avoid conflicts of interest. 4 They can refer these clients to another counselor or terminate their professional relationship if a dual relationship develops.

Ethical guidelines for counselors

Counselors may need to navigate ethical dilemmas that don’t have obvious solutions. Mental health professionals can use a variety of approaches, practices, and techniques to address nuanced ethical issues. Let’s explore examples of these in greater depth.

Informed consent in therapy

A standard when it comes to ethical guidelines, counselors can empower their clients to give informed consent by providing comprehensive information about the counseling process. For example, the counselor should discuss the potential risks and limitations of the treatment with the patient. They should also disclose their credentials, their fees, their confidentiality policies, and other relevant information. The client can decide whether to proceed with the therapy based on this information. 2

Informed consent helps mental health counselors avoid ethical issues by clearly defining the counselor-client relationship. It also ensures that clients are willing participants in their therapy and understand their rights. 2

Setting boundaries in therapy

Counselors can prevent unethical relationships from developing by setting and maintaining clear boundaries. The ACA prohibits counseling professionals from providing services to previous romantic partners, for example. Also, a counselor can’t enter a romantic relationship with a client until five years after their last session. 2

Furthermore, the ACA recommends that counselors exercise caution when extending their relationships with clients outside their practices. These precautions help counselors maintain professional client relationships and avoid violating ethical boundaries. 2

Ethical decision-making models

Ethical decision-making models enable counselors to solve intricate ethical challenges. The ACA’s decision-making model includes these steps: 5

• Gather all relevant information about the ethical issue
• Consult the ACA Code of Ethics for guidance
• Get feedback from colleagues, supervisors, and professional organizations
• Brainstorm possible solutions
• Weigh the consequences of each option
• Ensure that the chosen option is fair and universal
• Take action

Following a straightforward decision-making model makes it easier for counselors to think about ethical issues and explain their decisions to others.

Counselor competence

Mental health counselors practice ethical behavior by acting only within their areas of competence. They should provide services only if they have appropriate education and training. Also, counselors should continually educate themselves on new developments in their specialty to ensure they can provide the best care. This practice ensures that counselors don’t harm clients by maintaining ethical standards and providing only appropriate treatment. 2

Counselor supervision

Counselors and counselors-in-training receive clinical supervision from more experienced practitioners as a part of the path to counseling licensure . Supervisors provide guidance for ethical issues and help counselors develop treatment plans if they’re unsure about the best course of action. 4

Like regular counselors, supervisors must follow strict ethical guidelines. For example, they should intervene if they believe their supervisee may harm a client, and they should avoid having any dual relationships with supervisees. 4

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• Retrieved on August 21, 2023, from tandfonline.com/doi/abs/10.1080/10503307.2017.1417652
• Retrieved on August 21, 2023, from counseling.org/resources/aca-code-of-ethics.pdf
• Retrieved on August 21, 2023, from ct.counseling.org/2021/02/voice-of-experience-managing-requests-for-client-information
• Retrieved on August 21, 2023, from nbcc.org/assets/ethics/nbcccodeofethics.pdf
• Retrieved on August 21, 2023, from counseling.org/docs/default-source/ethics/practioner-39-s-guide-to-ethical-decision-making.pdf?sfvrsn=f9e5482c_12

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6 Reasons Why Ethical Frameworks Matter in Counselling

Counselling is a profession that requires a high level of trust, integrity, and discretion. As counsellors navigate sensitive personal matters, their actions can significantly impact the lives of their clients. Hence, following a defined ethical framework is not just crucial—it’s an absolute necessity. But what exactly is an ethical framework in counselling, and why is it so important? Let’s delve into these aspects.

What is an Ethical Framework in Counselling

An ethical framework in counselling is a backbone that ensures the profession operates with integrity, respect, and competence. Essentially, it’s a set of guidelines and principles outlining the professional conduct of counsellors.

This framework includes aspects like confidentiality, competence, integrity, and respect for the client’s autonomy, providing a standard for the responsibilities and duties of a counsellor. In adhering to these guidelines, counsellors can offer the best possible support to their clients, maintaining professionalism and ethical decorum.

At the heart of any ethical framework in counselling lie a few fundamental principles. These include autonomy, ensuring clients have the freedom to make their own decisions; beneficence, promoting the wellbeing of clients; non-maleficence, doing no harm; and justice, treating all clients fairly and equitably.

Establishing professional standards for ethical conduct is vital in ensuring that all counsellors uphold the principles of their profession. These standards provide clear expectations and serve as a reference point in the event of ethical dilemmas, ensuring consistent and ethical practice across the profession

Ensuring Client Safety and Welfare

The unwavering commitment to client safety and welfare is at the core of an ethical framework in counselling. Upholding confidentiality builds trust in the counselling relationship, as clients share deeply personal information expecting discretion and respect. Promoting informed consent and client autonomy empowers clients in their therapeutic journey, allowing them to make well-informed decisions about their treatment. The ethical guidelines also address potential conflicts of interest and dual relationships, ensuring that nothing compromises the professional relationship or biases the counsellor’s judgement. Additionally, the framework puts emphasis on safeguarding vulnerable populations and maintaining cultural sensitivity. This ensures that all clients receive empathetic, respectful, and inclusive support regardless of their background or personal circumstances.

Professional Integrity and Competence

Integral to an ethical framework in counselling is the emphasis on professional integrity and competence. This underscores the necessity for counsellors to pursue continuing education and training, thereby keeping their skills and knowledge up-to-date and relevant. A superb avenue for such professional development would be to gain a  Diploma  in Psychotherapeutic Counselling.

Beyond training, ethical considerations permeate all aspects of counselling practice, from the accuracy and fairness of assessment and diagnosis to the need for counsellors to stay mindful of their biases. This constant striving for objectivity and impartiality helps ensure that personal biases do not impact the therapeutic process.

Furthermore, the ethical framework highlights the importance of maintaining professional boundaries and using power judiciously, warding off potential misuse of the counsellor-client relationship. By adhering to these guidelines, counsellors not only uphold the integrity of their profession but also ensure the best possible support for their clients.

Ethical Guidelines for Confidentiality and Privacy

Confidentiality is a cornerstone of ethical guidelines in counselling. Its importance in building trust with clients cannot be overstated. Clients need to feel safe that their shared information will remain private, fostering an environment conducive to personal growth and healing. However, there are exceptions to confidentiality, such as when there’s a risk of harm to the client or others. Counsellors must be prepared to handle these situations delicately, balancing ethical obligations with legal and safety concerns. Moreover, with the rise of digital technologies in counselling practices, maintaining client privacy has extended into the digital sphere. It’s incumbent upon counsellors to utilise technology responsibly, ensuring client information remains secure and private in this digital age.

Ethical Decision-Making in Challenging Situations

Ethical dilemmas in counselling, be it conflicting interests or difficulties in maintaining confidentiality, can be complex. The ethical framework provides guidance, outlining various models for ethical decision-making. For instance, a step-by-step model might guide a counsellor through a situation where a client reveals intentions of self-harm. In such cases, the ethical decision-making process ensures the resolution prioritises client welfare despite the dilemma between client confidentiality and safety. These instances highlight the critical role of ethical considerations and resolution strategies in navigating challenging counselling scenarios.

Ethical Supervision and Self-Care

Supervision plays a crucial role in upholding ethical standards in counselling, offering a space for reflection and guidance. Furthermore, a counsellor’s personal well-being can significantly influence their ethical practice. Recognising this, the ethical framework encourages strategies for self-care and preventing burnout. By ensuring their mental and emotional health, counsellors can better serve their clients and adhere to ethical guidelines.

Legal and Regulatory Considerations

Alongside adherence to an ethical framework, counsellors are also required to navigate relevant laws, codes, and regulations within their practice. Comprehending the implications of these legal requirements on ethical practice is paramount. Undertaking a Therapeutic and Psychotherapy Counselling  degree  can provide essential knowledge in this area, ensuring counsellors are well-versed in legal and ethical requirements. Ethical compliance is about more than just maintaining professional standards—it plays a crucial role in forestalling legal complications. This fact underscores the equal importance of legal knowledge and ethical conduct in counselling. By aligning their practice with both these aspects, counsellors can better serve their clients, uphold their professional integrity, and prevent potential legal issues.

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Social, Legal & Ethical Issues in Counselling - A Reflection

The most important function of counselling is to provide a service to the client that promotes the client’s autonomy and development which must take priority in the relationship within an ethical framework. Having good intentions is not good enough as the counsellor’s awareness of the relationship into which the client and counsellor enter together and awareness of the impacts between the two people on each other is what facilitates the effectiveness and outcome (Bond, 2010). The counsellor themselves is an instrument and their willingness to be a real person in the relationship (Corey, 2001).

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• v.64(Suppl 1); 2022 Mar

Ethical and Legal Issues in Psychotherapy

Ajit avasthi.

Department of Psychiatry, Fortis Hospital, Mohali and CMC, Chandigarh, India

Sandeep Grover

1 Department of Psychiatry, Post Graduate Institute Medical Education and Research, Chandigarh, India

Anil Nischal

2 Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India E-mail: moc.oohay@2002gpeednasrd

INTRODUCTION

Psychotherapeutic interventions are part and parcel of the management of various psychiatric disorders. Pharmacotherapy for most psychiatric disorders is often combined with psychotherapy to improve the overall outcome. Over the years, different types (Psychoanalytic, Cognitive Behaviour, Family, Interpersonal, Supportive, Eclectic, and Brief therapies) and different schools of psychotherapy have emerged and the modality of carrying out psychotherapy has also changed from in person psychotherapy to e-therapy. E-therapies are being carried out by using synchronous and asynchronous methods. Despite all this, it is evident that there are certain common ingredients for all kinds of psychotherapies.[ 1 ]

The Government of India has recently issued Telemedicine Practice Guidelines[ 2 ] which formalize teleconsultations. These guidelines, however do not talk much about psychotherapeutic interventions. These changing methods of carrying out psychotherapy are going to bring in more and more ethical and legal issues. Hence, it is important to understand various ethical and legal issues pertinent to the practice of psychotherapy.

Multiple efforts have been made to define psychotherapy. However, till today the definition of psychotherapy given by Wolberg[ 1 ] is considered to be comprehensive, which defines it as “a treatment , by psychological means , of problems of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient with the objective of removing , modifying or retarding existing symptoms; mediating disturbed patterns of behavior and promoting positive personality growth and development.”

Indian Psychiatric Society (IPS) formulated the guidelines for various specific psychotherapies in the year 2010. However, the guidelines for ethical and legal issues in psychotherapy, which were published for the first time by the IPS was not updated. Accordingly, these guidelines are an update of the previous version of guidelines[ 3 ] for ethical and legal issues in psychotherapy. The basic aim of these guidelines is to establish minimum ethical standards for practice of psychotherapy by the psychiatrists. These guidelines provide a broad outline, which can be applied to the wide range of approaches used by individual psychiatrists in their clinical practice. These guidelines address the common ethical and legal issues arising out of common ingredients of psychotherapy.[ 1 ]

The three most important issues for the best ethical practice include positive ethics , risk management , and defensive practice .[ 4 ] Positive ethics basically focuses on the constant efforts made by the psychotherapist for achieving the best possible ethical standards. This is mainly guided by aspirational virtues of the therapist to do good and provide maximum benefit to the client (beneficence), avoid exploitation and harm to the clients and those associated with the client (non-maleficence), faithful to the explicit and implicit obligations that a therapist is expected to be with their client (fidelity), promoting independence, rather than dependence of the client on the therapist through own actions (autonomy), providing fair and equal treatment, and access to treatment, to all individuals (justice) and taking care of own physical and psychological wellbeing so that they are able to implement the required virtues effectively (self-care).[ 5 ] Risk management specifically focuses on reducing the risks for the therapist in the form of complaints to the ethics bodies or malpractice claims. Risk management basically addresses the issues of informed consent, effective documentation, and consultation.[ 5 , 6 ] Defensive practice focuses on the direct protection of the psychotherapist and involves decision-making based on reducing the possibility of adverse outcomes for the psychotherapist.[ 4 , 6 ] For example, restricting the type of clients taken up for the therapy and refusing to take up a certain type of clients, such as those with active suicidal ideation and suicidal behavior or those with severe personality disorders, in view of the increased risk.[ 5 , 7 ]

Based on these three principles, these guidelines cover the ethical and legal issues in psychotherapy under the broad headings of competence of therapist, responsibilities of therapists towards their clients, therapeutic contract, informed consent, confidentiality, privilege and psychotherapy supervision, documentation, self-disclosure, matters of business (advertising, fees, etc.), research, counter-transference, boundaries, professional negligence, termination, and post-termination issues.

However, it is important to remember that these guidelines provide a broad framework, and these are not a substitute for professional knowledge, clinical judgment, and formal legal advice. These guidelines cannot specifically address every situation or dilemma that a therapist may face.

BASIC TENETS OF A GOOD PSYCHOTHERAPIST

A good therapist is expected to be competent, responsible for the client and self, seek proper informed consent and assent (if required) [ Table 1 ].

Basic tenets of a good psychotherapist

COMPETENCE OF THERAPIST

Competence is defined as “the possession of required skill , knowledge , qualification or capacity.” [ 8 ] Accordingly, in terms of ethics, the psychotherapists are expected to be aware of their competence and limitations, i.e., the level of their knowledge, training, and supervised experience for particular kind of therapies. Another issue which is often considered while discussing competence includes “emotional competence,”[ 9 ] i.e., whether the therapist is aware of his emotional state while dealing with their clients. The therapists are expected to refrain from starting or continuing with a therapy, when they themselves are aware that there is a substantial chance that their personal problems will hinder in their performance as a therapist in a competent manner. The therapist is also expected to seek professional help, when they become aware that their personal problems might interfere in performing their role of a therapist adequately. For the ongoing therapies, the therapist can limit, suspend, or terminate the therapy.[ 10 ] For new therapies, they should refrain from starting any kind of therapy, till they themselves feel that they can perform their role as a therapist effectively. Seeking the opinion of other therapists/clinicians or their supervisors can be very useful in determining the same. Further, all the therapists, irrespective of their level of training are expected to seek supervision from their mentors or fellows colleagues, so as to be aware of their competence.

In India, many of the clinicians are not formally trained in specific kind of psychotherapies. In such a scenario, while offering a particular psychotherapy, the psychotherapists need to clearly mention the same to the prospective client during the initial interactions itself. The therapist can mention that they have not had any formal training in the module of psychotherapy; however, they have expertise in the practice and based on that they may be in position to help him/her.

RESPONSIBILITIES OF THERAPIST

From an ethical point of view, it is important that the therapists are aware of their responsibility towards their clients and self [ Table 2 ].[ 11 ] It is important to note that any irresponsible behavior on the part of the therapist may not only be in conflict with the ethical principles but might also give rise to situations, which can have legal implications.

Responsibilities of the therapist towards their clients and self

ASSESSMENT FOR PSYCHOTHERAPY

Assessment for psychotherapy has prime importance in practice of psychotherapy and clinical psychiatry. The success of any psychotherapy depends on offering the right therapy to the right patient. It is important to consider that all patients seeking help may not be suitable for psychotherapy, or they may be suitable for one kind of psychotherapy and not the other. Hence, assessment for psychotherapy is one of the most important aspects of psychotherapy. Besides suitability, another important aspect to consider while assessing for psychotherapy is the feasibility of psychotherapy, although, with the availability of the tele-psychiatry services, the feasibility issues related to distance have now been addressed to some extent. The basic components need to be considered while assessing for psychotherapy [ Table 3 ] and depending on the need, further detailed evaluation may be carried out. Ethically, it is important to convey to the patient that assessment is an ongoing process and it may not be feasible to complete the same in the initial 1–2 sessions. Hence, initially, the assessment and supportive psychotherapy sessions may go hand in hand, before switching to more intensive therapy, if the patient is found suitable for the same. The therapist needs to inform the client clearly that at the end of the assessment, it is also possible that patient may not be taken up for more intensive therapy, if they are not found suitable for the same. In that case, only supportive psychotherapy may be used. The payment related issues for the assessment phase need to be clearly mentioned right at the beginning, as at times, proper therapeutic contract is signed only when a reasonable level of assessment has been done.

Assessment for psychotherapy

CSA – Child sexual abuse; CBT – Cognitive behaviour therapy; OCD – Obsessive compulsive disorder; POP – Psychoanalytically oriented psychotherapy; OBS – Organic brain syndrome ; BT – Behaviour therapy

INFORMED CONSENT

Informed consent in an invaluable aspect of any kind of psychotherapy as it ensures that the client’s decision to take part in psychotherapy is informed, voluntary, and rational.[ 12 ] It is often presumed that if the client is seeking help for their problems, it implies consent, but it is important to remember that this does not amount to “informed consent.”

Informed consent needs to be seen as means of protecting the rights of clients as it gives the client an opportunity to make an informed decision about engaging in psychotherapy. It also emphasizes making treatment decisions and increasing a sense of ownership over the process on the part of the client.[ 12 ] A proper informed consent procedure [ Table 4 ] also facilitates the therapist and the client to establish a partnership with a common goal, decreases the likelihood that the client will put the therapist on a pedestal and become overly dependent on the therapist.[ 12 , 13 ] Last but not the least, a proper informed consent can reduce the client’s anxiety as it demystifies the therapeutic process.[ 12 ]

Basic tenets for drawing an informed consent form/seeking verbal informed consent[ 10 ]

Some of the components of the informed consent, as discussed, will also be covered under the heading of “therapeutic contract.” However, it is important to note that the therapeutic contract is made only after both client and the therapist have mutually discussed and have agreed on the issues to be included in the contract. It is also possible that some of the patients may not agree for the therapy if they are provided proper information about the various aspects of therapy, especially their role in the therapy. Hence, including various aspects of psychotherapy as part of the informed consent procedure is of utmost importance.

Whenever the psychiatrist plans to obtain an informed consent (either written or verbal), efforts must be made to take into consideration the cognitive impairments of the clients arising due to conditions such as intellectual disability, schizophrenia, or Alzheimer’s disease. Although in India, clinicians often depend on the family members or a legally appointed guardian for medical and mental health care decisions of the clients, psychiatrists must nevertheless provide patients with an appropriate explanation of services, consider the patient’s preferences and best interests, and seek the patient’s assent.[ 12 ] Further, it is important for the therapist to view consent capacity not as an all-or-none ability but as a continuum.[ 6 ] It is suggested that the therapist should aim to formulate a “goodness-of-fit model of the informed consent process” that fits to each client’s cognitive strengths, vulnerabilities, and decision-making capacities and styles.[ 14 , 15 ] Often clients from India can understand the reasons for and nature of therapy, but may not be able to take decision, because of lack of experience in making healthcare decisions on their own, or undue trust on their doctors. Keeping this in mind, the informed consent procedure need to be approached with the motive of educating the client about the procedure and things involved in the therapy. Any kind of discussion between the client and other family members need to be encouraged to make more informed decisions. However, it is also important that just on the basis of clinical diagnosis, the therapists should not assume that the patients cannot give consent. Data suggests marked within diagnosis heterogeneity, with the level of cognitive confusion or distortion, particularly verbal and executive functioning skills to be a more reliable predictor of consent capacity than diagnostic criteria.[ 16 , 17 ] Further, as per the MHCA, if a client does not possess competency at the beginning of the treatment, the consent should be obtained from the client whenever the client is competent to understand the procedure of the therapy. Further, as per the MHCA, if the therapy has been started when the client was a minor, and crosses the age of 18 years, the client should be treated as a major, and assent should be replace with the informed consent.

Ideally, first session should be utilized to obtain informed consent, but this is not always possible or clinically feasible because sometimes the clients presents with the crisis, which requires urgent attention. In such a scenario, consent needs to be obtained at the first possible opportunity once the crisis has resolved.

Further, it is also important to understand that informed consent to psychotherapy be conceptualized as an ongoing process designed around a client’s evolving treatment needs and the subsequent treatment plans to which they must consent.[ 18 ] While some parts of the informed consent process can reliably be covered at the beginning phase of the psychotherapy (e.g., confidentiality and disclosure procedures, fees and payment options, and cancellation policies), more substantive parts of the informed consent process may be covered in subsequent sessions. Issues like specific goals of the therapy, the techniques to be used, and the estimated duration of the therapy may not be clear during the initial meeting; in such cases, it is neither in the best interest of the client nor the therapist to establish such matters in haste.[ 12 , 19 ]

The therapist is obliged to provide full information about the nature of treatment and goals of therapy, and viable alternative treatment with the level of evidence for their effectiveness for the condition which the client is suffering, both to the client and the family members or the legal guardian.[ 13 ]

During the informed consent procedure, it is very important that the therapist informs the client about the appointment schedule, the duration of each session, homework assignments, anticipated duration of therapy with due importance given to various eventualities during the therapy and the general treatment objectives and therapeutic techniques which are going to be used.

The confidentiality issues need to be discussed at length, along with the exception clauses.

When a trainee is providing psychotherapy the therapist needs to inform the client that she/he is a trainee, that his supervisor is responsible for the therapy, and that the trainee meets regularly with the supervisor for guidance and advice.[ 12 ]

THERAPEUTIC CONTRACT

The therapeutic contract should be in the form of a written document, which needs to include information about the responsibilities of the therapist and the client(s) participating in a particular psychotherapy. A ”model therapeutic contract” is provided [ Table 5 ], which can be modified as per the need. If the client has any issues with the therapeutic contract, the option of legal opinion should be kept open.

Components of the therapeutic contract

ISSUES SPECIFIC TO ONLINE PSYCHOTHERAPY

At present, the Telemedicine Guidelines, as Issued by the Government of India, is silent about the online psychotherapeutic interventions. However, this should not be interpreted as psychotherapeutic interventions cannot be done by tele-mode. However, the clinicians, who are carrying out online psychotherapy intervention, should inform their clients about the same.

In case someone wants to carryout an online psychotherapy intervention, then the feasibility aspect should take into consideration the mode of communication (i.e., synchronous/asynchronous; voice call/video call; text chat; a mix of various modes). These facts need to be discussed in detail, and the client should be appraised about the same. American Counselling Association,[ 20 ] National Board for Certified Counsellors,[ 21 ] and International Society for Mental Health Online[ 22 ] were among the initial few organizations, which discussed the ethical and legal issues of online/e-therapies. Other organizations have also come up with some of the recommendations for the online therapy. Some of the issues, which are ethical obligations on the part of the therapist and may be of some legal protective value for the therapist, are listed in Table 6 . These issues need to be taken into consideration during the process of informed consent and making the therapeutic contract.

Specific issues related to online/e-therapies

CONFIDENTIALITY

Ensuring confidentiality of the information is the foundation of any kind of psychotherapy. Until and unless the clients are assured about the confidentiality of the information which is likely to be disclosed, the clients cannot be expected to share the embarrassing, and sometimes personally damaging information in the treatment setting.[ 23 ] As part of the medical profession, the therapists are expected to maintain the confidentiality of their clients. However, it is important to remember that the ethical requirement of confidentiality overlaps with the law; hence, answers to some of the situations can only be predicted by an understanding of both ethics and law. Hence, in situations where things are not clear, the therapist can seek legal consultation. Despite the complexity of confidentiality issues, one must remember that in a majority of tricky situations often the best way of resolving legal and ethical dilemmas is to obtain the client’s consent for disclosure.

It is also important to note that confidentiality is not absolute, and there are exceptions to the confidentiality of information. Accordingly, while drawing the therapeutic contract and seeking informed consent/assent, the client needs to be informed about the exceptions to the confidentiality [ Table 7 ]. Failure to do so can place both the therapy and the therapist at significant risk.[ 24 ] The exceptions to the confidentiality clause are disclosure of the confidential information without the consent of the client in different situations (example reporting abuse, protecting clients and their potential threatened victims, defending oneself from inappropriate, or threatening client behavior), disclosure of information as evidence in a legal proceeding and for protecting self, in case threatened or sued by the client.

Confidentiality and its exceptions during the therapy

Therapists should report child, elder, or dependent adult abuse to appropriate authority if it comes to their knowledge. It is an obligation to report child sexual abuse to police, directly or through an appropriate channel, under Section 21(1) of the Protection of Children against Sexual Offences.[ 25 ] Failure to do is punishable by imprisonment up to six months with/without fine.

Breach of confidentiality is permitted where an imminent danger to the client himself/herself or others exists. When a patient threatens to self-harm the therapist should explain the situation to his family and make an emergency referral to the nearest mental health care facility. In case a family member is not available, it would be prudent to inform the law enforcing agencies about the client’s intentions. When imminent danger to others is sensed appropriate action, including informing the police is justified. Therapists need to consider pros and cons of breeching confidentiality versus potential harm. Nonserious harm to self or damage to property are not a strong enough reasons to infringe on confidentiality. In case the therapist decides to breech confidentiality, information conveyed should be limited to that necessary in the context of the situation. Marital negotiations such as during reconciliation/separation may be privileged from disclosure.[ 26 ]

Ensuring the confidentiality of the information is the foundation of any kind of psychotherapy. Until and unless the clients are assured about the confidentiality of the information which is likely to be disclosed, the clients cannot be expected to share the embarrassing and sometimes personally damaging information in the treatment setting.[ 23 ] As part of the medical profession, the therapists are expected to maintain the confidentiality of their clients. However, it is important to remember that the ethical requirement of confidentiality overlaps with the law, hence, answers to some of the situations can only be predicted by an understanding of both ethics and law. Hence, in situations where things are not clear, the therapist can seek legal consultation.

However, it is also important to note that there are exceptions to confidentiality of information. Accordingly, while drawing the therapeutic contract and seeking informed consent/assent, the client needs to be informed about the exceptions to the confidentiality [ Table 7 ]. Failure to do so can place both the therapy and the therapist at significant risk.[ 24 ] The exceptions to the confidentiality clause are disclosure of the confidential information without the consent of the client in different situations (e.g., reporting abuse, protecting clients and their potential threatened victims, defending oneself from inappropriate or threatening client behavior), disclosure of information as evidence in a legal proceeding and for protecting self, in case threatened or sued by the client.

Besides the above, there are situations where the issues of confidentiality are not defined specifically for psychotherapy by the law enforcement agency the general laws related to confidentiality in medical practice will be applied. Some of the important situations where there are grey zones include confidentiality issues in case of minors, when the parents are having conflictual relationship or are undergoing the divorce proceedings; confidentiality in case the client is dead, and confidentiality issues in case of marital or family therapy. The therapist should anticipate these situations and discuss these issues while obtaining the informed consent and incorporate the same into the therapeutic contract. However, for things which are not clear, it is always advisable for the therapist and the client to seek the opinion of colleagues and lawyers before finalizing the contract.

BOUNDARY ISSUES DURING PSYCHOTHERAPY

The concept of boundaries emerges from ethical, cultural, moral, and jurisprudence underpinnings. When boundaries are not respected, therapists often start acting in their own interest rather than that of the client and this may lead to exploitation of the client. Terms such as, “Boundary crossings” and “Boundary violations,” have been mentioned in literature. Boundary crossings are essentially harmless and do not lead to harm or exploitation. However, Boundary violations are typically harmful and are usually exploit clients’ needs-erotic, affiliative, financial, dependency or authority.[ 26 , 27 , 28 ]

Boundary issues in psychiatry and psychotherapy per se , do not have black and white answers. Nonsexual boundary crossings as part of the therapy and treatment plan can strengthen the therapist–client working relationship.[ 22 ] Conversely, crossing the boundaries can also be detrimental to the psychotherapy, disrupt the therapeutic alliance, and can cause immediate or long-term harm to the client. Choice about whether to cross a boundary confront the therapists on day-to-day basis can be often subtle and complex, and at times have an influence on how therapy progresses, stalls, or ends.[ 25 ]

A large amount of data has accumulated over the years, mostly from the Western countries, in relation to the dual relationships, bartering, nonsexual touch, meeting therapy clients outside the office for social visits, and other nonsexual boundary issues.[ 29 ] People who consider the ethical boundaries to be inflexible mostly rely on the psychotherapeutic principles of Freud.[ 24 ] However, it is noted that Freud used to send postcards to his clients, gave gifts to his clients, lent them books, corrected them when they spoke in misinformed manner about his family members, provided financial support to his clients at the time of need, provided food to an analytic patient, conducted an analysis of a person while walking through the countryside during a vacation and shared meals with him, and analyzed his own daughter. Accordingly, some of the authors have tried to interpret the therapeutic alliance and boundary issues as followed by Freud as the relationship limited only to the analytic sessions, and other relationships are possible outside the therapy sessions. Some of the similar behaviors have also been noted for M. Klein and Winnicott.[ 24 ] It is claimed that latter on one occasion, held the hand of a client for hours together during the therapy, disclosed information about another client, and ended each session with coffee and biscuits. However, these historical descriptions don’t mean that these are acceptable behaviors, and it is suggested that in ideal situation the therapists should limit themselves to interpretation only.[ 27 ] However, a major conflict arises when one moves from the classical analytic interpretative psychotherapy to expressive-supportive psychotherapy, where interpretation is not the main ingredient of psychotherapy and the commonly used ingredients include suggestion, confrontation, advice, and praise. In fact, in supportive psychotherapy actually partial gratification of the patient’s transference needs may at times be therapeutic. Hence, there is an in-built confusion with regard to psychotherapeutic boundaries.

Considering all these, the issue of boundaries becomes more complicated when it comes to talking about boundaries of the clients, which are considered to be more flexible.[ 25 ] It is said that crossing boundaries “may at times be salutary, at times neutral, and at times harmful” and that the nature, clinical usefulness, and impact of a particular crossing “can only be assessed by a careful attention to the clinical context.”[ 23 ] Hence, the issue of boundary violations should be understood on case to case basis by taking into consideration the situations in which violation occurred, type of therapy, and possible harmfulness it has on the client.

Boundaries and boundary violations can be understood under the subheadings of role, time, place and space, money, gifts, services and related matters, clothing, language, self-disclosure and related matters, and physical contact.[ 27 ] In the subsequent section, these are discussed briefly mainly in the context of dynamic therapy. Role as a boundary should answer the question “Is this a therapist does or is expected to do.” Although the ideology of the therapist will have a significant impact on the answer to this question but is often a useful orienting device for avoiding pitfalls of role violations. Abiding by the time of the session is considered as an essential boundary, as it provides structure and containment to the clients, because some of the clients feel reassured by the fact that remembering and reliving of traumatic past will be for a set time only. Accordingly, beginning and ending the sessions beyond the schedule are susceptible to crossings of boundary. The time schedule for the therapy session is also equally important because knowingly or unknowingly scheduling/rescheduling psychotherapy at the end of the day’s work, or beyond the working time, rather than the usual working hours, may actually go against the therapist if they are alleged of sexual misconduct. This becomes much more important and calls for interpretation when the appointments are rescheduled. Essentially it is suggested that whenever possible, the psychotherapy should be scheduled in working, high movement/traffic hours when other people are around. The place of meeting of therapist and client should be limited to the psychotherapy sessions in the therapists working place, with exceptions being the client is admitted to emergency/intensive care unit after a suicide attempt. In terms of the therapist meeting, the client outside the office (attending the personal/family get-togethers of the client), this does not have one answer and should be interpreted and scrutinized in the light of type of therapy being conducted and the situation. Money or fee for the therapy is seen as a boundary for the therapist, as an indicator of work during the therapy, for which they are paid. However, this doesn’t mean that if the therapist decides to see a client free of cost at the beginning, he should not do so. However, if the therapist was charging earlier, but now ignores nonpayment of fees, or stops collecting fees, especially when there are no issues related to affordability, this needs to be scrutinized as a boundary violation. If the therapist decides to see a client free of cost, right from the beginning, this requires documentation in the therapeutic contract. Any kind of gift (including medication samples) from the therapist to the client, how small it may be, must be interpreted as a boundary violation. Similarly, seeking favor or services from the client for personal benefit by the therapist must be considered a boundary violation. However, some of the issues of social manners/obligations must not be out rightly interpreted as boundary violations. Dressing that is excessively revealing or frankly seductive, on the part of the therapist may represent a boundary violation as it can be potentially harmful to the client. Language as a boundary includes the words, tone of the speech (which can be seductive), and how the therapist addresses the client. In terms of dynamic therapy, self-disclosure (especially about their personal fantasies , dreams , social , sexual , financial , vacation ) is interpreted as a boundary violation. However, some of the issues like using examples from their own life or trying to explain the effect of a borderline client on the therapist may not always represent a boundary violation and should be looked in the context in which it occurred. It is suggested that when self-disclosure is to be done, it is important for the therapist to answer to themselves – is it consistent with the client’s clinical needs and the therapy goals? Is it consistent with the kind of therapy being provided and the theoretical orientation?, does it mainly reflect or express your own personal needs (to talk about yourself, to bring the focus to yourself?), what is your purpose in self-disclosing at this particular time?, what is therapists own assessment of the possible risks, costs, or downsides, if any, of self-disclosure with this client in this situation at this time?, does self-disclosure or disclosing this particular content or level of detail represent a significant departure from your usual practice? If so, why the change?, will you as a therapist hesitate to discuss this disclosure with your supervisor or consultant or document it in the client’s record? If you would hesitate, what are the reasons?). Answers to these questions can often guide the therapist about self-disclosure. As far as physical contact is concerned, anything beyond hand shake needs to come under the scrutiny.[ 27 ]

Some of the authors suggest that rather than making decisions about boundary violation in the context in which it occurred, it is important to assess the boundary violation in the context of general approach to ethics.[ 29 ] Nine steps have been described [ Table 8 ],[ 29 ] which could be helpful in considering whether a specific boundary crossing is likely to be helpful or harmful, supportive of the client and the therapy or disruptive, and in using due care when crossing boundaries. These steps can be followed by the therapist and others who may have to evaluate the conduct of a therapist when there is a complaint about boundary violation.

Steps in interpreting boundary violations

Besides, these other important factors which can influence the boundaries include the socio-cultural background of the therapist or the client. For example, in contrast, to the West, a therapist accepting a gift (box of sweet on a festival) from his client in India (even if that has been mentioned in the therapeutic contract), where refusing a gift is considered as an insult, cannot be interpreted as a boundary violation in true sense.

Often therapist feel troubled in some way or the other about the path they took across a boundary, but that they had failed to take it seriously, had shrugged it off, or pushed it out of awareness for any number of reasons such as fatigue, stress, being in a hurry, not wanting to disappoint a client who wanted to cross that boundary, or failing to appreciate the potential of boundary on the clients and the therapy may lead to a variety of issues. Hence, it is advisable to seek supervision while conducting a therapy.

It is said that the therapists may have certain common cognitive errors about boundary violations [ Table 9 ],[ 29 ] and certain steps have been suggested, which could be helpful to identify and avoid continuation of boundary violations.[ 29 ]

Cognitive errors with regard to boundary violations and steps[ 29 ]

PROFESSIONAL NEGLIGENCE

Simply stated negligence means deficiency in the level of care. Professional negligence refers to the situation when any professional fails to uphold his professional duty to a required standard or breaches a duty of care that causes to harm to someone. All professional workers are considered to profess some special skill to a specific level of learning and are expected exercise it with a reasonable degree of care/caution. To allege professional negligence, the following must be established: (a) A duty of care exists, i.e., the therapist agreed to provide care/treatment. (b) A breach of duty occurred, i.e., the therapist failed to provide care of reasonable degree/standard accepted/established by the profession, and (c) The breach harmed the client or someone else, i.e., directly led to a physical, material, or emotional injury/damage.

Various acts which fall within the ambit of medical negligence include recklessness in undertaking/carrying out a treatment, indifference in handling the case, failure to act diligently and alertly at the appropriate time, wrong diagnosis or treatment which under no norms of practice can be justified, evident negligence like administering a prohibited or known counterproductive treatment and misrepresenting that one possesses the skill or expertise which he/she does not possess.

Hence, all practitioners must bear in mind that they should bring in a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Failure to exercise a reasonable degree of skill in diagnosis and providing care can constitute professional negligence.[ 26 ]

As therapist, it is important to understand the Bolam test and the Bolitho test of liability in the context of negligence. The Bolam Test states that to prove liability, one needs to prove that the therapist was negligent and acted in a manner that no other therapist would have. Hence, “A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.” The Bolitho test further qualifies “the Bolam test” with logical basis, i.e., the court has to be satisfied that the expert opinion had a logical basis. In India, clients may approach Consumer Protection Forum, a quasi-judicial body at district, state, and national levels.[ 26 , 30 ]

ETHICS IN PSYCHOTHERAPY TERMINATION

The formal termination of psychotherapy is understood as an intentional process that occurs over time when a client has achieved most of the treatment goals and/or when psychotherapy has to be terminated due to other reasons.[ 24 ] As formal termination involves, ending of a process (whether successful or unsuccessful), it has important ethical issues [ Table 10 ]. First and most important issue is ending the therapy in a planned way, rather than abandoning the client. Unplanned termination of the therapy from the therapist side may convey betrayal and abuse of power. While deciding a planned termination, it is important to note that “termination of psychotherapy” is not a point but is a process; hence, the termination of psychotherapy should be discussed with the patient, from time to time in the therapy (i.e., someday patient will be able to manage his/her affair without the help of the therapist, by the gains made in the therapy), so that it does not come as a shock to the client. Hence, the therapist, from time to time, should ask the patient to review what all she/he is able to manage outside the psychotherapy sessions, what all they consider as gains in terms of their ability to handle the previously unmanageable situations and how they see themselves in relation to the original goals of the therapy. The therapist can also give their feedback in terms of improvement/gains which they perceive in the client to validate or contradict the patient’s self-assessment of psychological growth, resilience, and strengths. Further, while discussing the termination of therapy, the therapist can also convey to the patients as to when to return back for psychotherapy in future. This will help the patient understand that talking about termination of psychotherapy does not mean end of the therapeutic contact forever. Another way to proceed towards termination is by asking the client to imagine how they are going to handle the situations of life in the absence of the therapist.[ 31 ]

Basics principles of the termination of psychotherapy

Sometimes premature termination of psychotherapy may be considered, either by the therapist, client or due to other external factors. One of the issues which may lead to premature termination of therapy by the therapist can be default on the part of the client to pay the fees due to various reasons. In such a situation, it is not ethical to communicate to the client that “we are not going to meet again,” because of the payment-related issues. Rather, the therapist should anticipate the same and alternatives be discussed during the informed consent procedure and this must be mentioned in the therapeutic contract. In general, it is advisable that termination of therapy in such a scenario be considered as the last option when all other options have been exhausted. In such a scenario too, there should be ample time for the therapist and client to end the therapy in a congenial environment.

As far as therapist is concerned “psychotherapy should be terminated from the therapist side, when it is evident that client no longer needs psychotherapy, is not likely to benefit or is being more harmed than benefitting from continuing psychotherapy.” Such a decision can be reached by continuously reviewing the progress in the psychotherapy from time to time and the goals (original or adjusted from time to time in therapy) of psychotherapy at the beginning. If review of the evidence suggests that the client’s mental state is gradually deteriorating, then it is advisable to consider termination of psychotherapy. However, in such situations, if the therapist is in dilemma, proper supervision or a referral to another therapist can be very beneficial for the therapist to validate/contradict his decision. Other important issue which might lead to termination of psychotherapy from the side of the therapist is continued unmanageable counter-transference and distress to self while continuing with the therapy. Psychotherapy may also be terminated, if the client files a case (starts legal proceedings) against the therapist. Besides these, other reasons of termination of therapy from therapist’s side may include shifting of work place of therapist, therapist falling sick or superannuating from their job. However, it is important to note that some of these situations can be anticipated before the initiation of psychotherapy, like end of tenure/training date and retirement date. Accordingly, it is advisable to include the same in the therapeutic contract. Similarly, the name of a colleague can be incorporated in the therapeutic contract, as an alternative therapist, in any unforeseen eventuality.[ 25 ]

In situations which warrant termination of psychotherapy from the therapist’s side, the therapist should make all possible attempts to have a pretermination session before ending a therapeutic relationship. The pretermination session needs to be seen as an opportunity of providing advance notice to the client or an opportunity to negotiate an end date, discussing the gains made during the therapy and the deficits which are still persisting, planning for relapses and future stressors, and providing details of an alternative therapist’s for future treatment needs.

In case the termination is initiated by the client, then too the therapist should follow the ethical obligations to their clients. Usually, when the therapy is terminated by the client, they either stop coming or stop responding to the phone calls due to various reasons. In such a scenario, it is ethical to let the client know (possibly by writing a letter, with the appointment date and time) that therapist is willing to continue treatment or meet for one/few sessions to sum up and end the therapy, willingness of the therapist to resume therapy in future if the client desires so, and if the patient wishes, then the therapist can refer them to another therapist.[ 31 ] The issue of termination of therapy can be discussed in the therapeutic contract, as this makes it easier for the client to convey discontinuation of the therapy to the therapist rather than making the therapist feel abandoned.

ETHICAL ISSUES DURING THE POSTTERMINATION PHASE

The relationships between therapist and the client after the termination of psychotherapy have always being debated. Although no law bar the physician to have a sexual relationship with their ex-patients, it is an accepted norm that it is unethical to terminate the psychotherapy for having a sexual relationship with the client. Regarding the sexual relationship, after the termination of psychotherapy, there are different views. Some of the therapists consider that the client may agree for such a relationship because of unresolved transference and hence such a relationship is unethical. Others therapists consider that if a proper termination of therapy has been done, transference should be considered as resolved, and hence having a sexual relationship after proper termination is not unethical. However, the issue of sexual relationship with a client, who was receiving the therapy (therapies other than dynamic), that does not encourage transference, becomes very much complicated. Hence, there is no clear consensus on the issue on sexual relationship with an ex-client. Accordingly, the sanctity of the same will depend on case to case basis. When faced with such a situation, therapist should seek supervision.

DOCUMENTATION IN PSYCHOTHERAPY

Documentation in psychiatry is considered to be of paramount importance. The psychiatric records should be regarded as a medical and legal record of assessment, diagnosis, investigations, decision-making, pharmacological and nonpharmacological management done in the specific case. From the medicolegal point of view, psychiatrists are expected to maintain factual, legible and accurate records because it serves as a guide to the clinician to provide and plan care for the patient. Treatment records also serve as a guide for the care of the patient in case of a change of clinician.[ 32 ] Another important usage of medical record is in the court of law in cases of litigations due to various reasons involving the patient or the clinician.[ 23 ] A proper documentation of what has transpired between the patient and clinician can at times come to the rescue of the psychiatrist in the court of law or when such an evaluation is done by Medical Council of India in cases of complaints against the clinicians.

However, the other side of the coin is that psychotherapy involves the disclosure of sensitive, personal information about the patient and other people in the patient’s life. The patient reveals this information to the psychiatrist with the faith and trust that this will help in progress of the treatment and that no information will be revealed to any other person without informed consent for disclosure. However, despite ethical issue of confidentiality of the doctor–patient relationship, medical records are open to disclosure in unanticipated ways that are beyond the control of the patient or the clinician, as in the cases where such a demand is made by the court of law. In the United States, there are provisions in the law, where the therapist has the discretion as to what to disclose and what not to disclose in relation to information obtained during psychotherapy, but such is not the case in India. Another important aspect, which can lead to breach of confidentiality, is the use of computers and servers to store the data and clients treatment records. Such information can be assessed by or transmitted to unauthorized persons, inspite of use of all possible security systems.[ 32 ]

Thus weighing the pros and cons about documenting everything that transpired in the therapy or not documenting anything is often a big dilemma. From medicolegal aspects, not documenting anything can put the therapist at a bigger risk. However, documenting everything can lead to lot of damage to the client if these documents are disclosed or assessed by someone. From ethical point of view too, not documenting anything is unacceptable. Hence, the extent of documentation may vary rom session to session and will be heavily influenced by the kind and intensity of psychotherapy. Furthermore, the documentation must be based on the probability of records being assessed by others. Hence, the clinicians should use their clinical judgment to maintain concise, factual documentation of psychotherapy while respecting the privacy of the patient. However, documentation must include notable events in the treatment setting or the patient’s life, clinical observations of the patient’s mental and physical state, psychiatrist’s efforts to obtain relevant information from other sources, investigation findings including psychological test findings, information provided to the client in relation to medications if any, suicidal ideation with intention to act, child abuse, threats of harm to others, consultation with other clinicians if any, and basic information required to maintain continuity of care in any eventuality. Documentation of information with regard to intimate personal relationships, fantasies and dreams, and sensitive information about other individuals in the patient’s life must be based on the clinical judgment. However, documentation of any hypotheses or speculations must be avoided [ Table 11 ].[ 26 , 32 , 33 , 34 ] The therapist can maintain a personal note which can be kept separately from the medical records, which can contain details of the intimate issues of the client, issues related to other people in the patient’s life, therapists own observations, hypotheses, etc. These can act as a guide to future psychotherapeutic work. However, an important aspect of it is that it should not have any information which can disclose the identity of the clients to others. Further, informed consent must be obtained from the client in case the therapist wants to use such records for teaching purposes without the client being identified. Further, the notes should be destroyed as soon as these have served the purpose for which they were maintained. It is also important to note that the content of such notes may not be useful for the therapist in case of legal proceedings.[ 32 ]

Basic principles of documentation of psychotherapy records

SPECIFIC LEGAL ISSUES

Some of the other issues which are related to psychotherapy and can have legal issue include duration of maintenance of records and appearing in the court of law to testify.

Sharing records

It may be noted that, as per the Medical Council of India guidelines,[ 35 ] treatment records need to be maintained for at least 3 years. Any request for medical records from a client or his/her authorized representative or legal authorities should be duly acknowledged, and copy of records should be provided within a 72 h period. However, records of medicolegal cases should not be handed over to anyone without a valid legal order from the court of law.

When a client’s psychotherapy records are summoned by a court of law the client should be informed and his consent sought before submitting their records to the court of law. If the client does not agree, the same should be mentioned to the court, and the records need to be shared when the concerned court withdraws the privilege provided on account of confidentiality. At this point, the therapist must abide by the order of the court; otherwise, a contempt-of-court order may be issued. When the court mandates so, a summary of psychotherapy records is usually submitted. The proper procedure is that the summoned records should be submitted to the court under sealed cover and marked “Confidential.” Tampering with or destroying records to avoid disclosing the information is unethical as well as illegal.[ 26 , 36 , 37 ]

When a therapist is asked to present evidence in a Court of Law, he or she must be aware regarding the basic requirements of presenting evidence. A witness report should be of adequate clarity and should help in resolving the case.

False memories versus true memories

A particular debate which arises during psychotherapy is the theme of “false memories,” especially those concerning sexual abuse and can lead to psychotherapist being challenged in the court of law. The concept of false memory is at times abused as a defense by real perpetrators of crime which may divert attention from redressing the crime and can further lead to mental health issues in the client.

It is important that every therapist should take diligent precautions to avoid encouragement of false memories in a client during the course of the psychotherapy. Some of the common tributes found in allegations of false memories have characteristics of these memories involving sexual abuse are discontinuous, memories of abuse in childhood are recovered in a therapeutic setting, there is an absence of corroborative evidence, the reclamation of such memories is followed by a confrontation with the alleged accusers who deny these claims and the false memories are often very traumatic in nature and are based in high ritualistic settings.

Understanding the dynamics of the potential roles that a therapist can play in such legal proceedings can be made easier with the help of a model known as the Drama triangle. This model is based on the perceptions that other parties have about the therapist taking on the potential role of “rescuer,” “persecutor,” or “victim,” even though this is not the therapist’s intention. One of the inferences which can be drawn from the debate on false memories is that the therapist should understand the boundaries of responsible practice and also understand the limitations of retrieved memories and the role suggestion can play in shaping these memories. One should be aware of the implications of instantaneously assuming that the abuse has occurred without examining all aspects. In order to avoid future conflicts, it is important that therapist may record such sessions or can make simultaneous notes and avoid therapeutic techniques which can encourage false memories.[ 38 ]

EXPERT OPINION

At times a psychiatrist may be called by the court of law as an expert witness in a case and may be required to provide their opinion or report. Courts, in general, want an honest, impartial, and learned opinion from the expert. In such a situation, it is important to understand what is being asked and response need to be precise to the question asked [ Table 12 ].

Basic principles of writing an expert report

In contrast to routine clinical practice, psychotherapy is a special situation, especially in Indian setting where there is no much distinction between psychotherapists per se and the psychiatrist. Whenever a client approaches a psychiatrist and if he thinks that psychotherapy could be an appropriate treatment modality, or if the client requests for psychotherapy in the light of his competence, the therapist should obtain informed consent. This should include providing information to the client as to what is psychotherapy, what is expected from the patient, what is expected from the therapist, what are the limitations of the therapy and therapist, fees involved, alternative modalities of treatment along with efficacy of each of the alternative treatments in the condition which the client is suffering from. After an informed consent is obtained, the therapist along the client should draw a therapeutic contract, with do’s and don’t for either of them. Throughout the therapy and during drawing the therapeutic contract, the therapist should be aware of the confidentiality issues and also make the client aware about the exceptions to the confidentiality issues. Similarly, awareness of the boundaries and boundary violations is important, to work in the limits of the boundaries. However, if boundary violations occur, steps must be taken to minimize the harm. Whenever therapy ends, it needs to end in a congenial environment, with the scope for the client to seek treatment again if he desires so, or an opportunity to be referred to someone else.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

123 – Ethical Frameworks in Counselling

123 – Why Is There a Need for Ethical Frameworks in Counselling

Dual relationships in counselling training – when a client disagrees with us.

In episode 123 of the Counselling Tutor Podcast, Ken Kelly and Rory Lees-Oakes discuss the need for ethical frameworks in counselling. Our new regular segment, ‘Check-In with CPCAB’, then looks at dual relationships in counselling training. Finally, the presenters discuss what to do when a client disagrees with you.

Why Do We Need Ethical Frameworks in Counselling? (starts at 1.15 mins)

The concept of ethical frameworks derives from the theory of utilitarianism, which promotes actions that maximise wellbeing for the majority of a population.

Philosopher Jeremy Bentham founded this concept, based on the idea of the best action being the one that brings about  ‘ the greatest happiness of the greatest number ’.

Professional bodies in most areas of work have ethical frameworks that they expect their members to abide by; these are sometimes also called ‘codes of practice’.

This is all an inherent part of being a professional – a word based on the concept of ‘ professing ’ (i.e. making a public declaration of allegiance to a set of beliefs).

In counselling, for example, there are a number of professional bodies, each with its own ethical framework. One example is the BACP’s Ethical Framework for the Counselling Professions .

Ethical frameworks in counselling give us a set of standards to work to , helping to ensure consistency in provision across the profession – and thus also a benchmark for accountability (so supporting the investigation of any complaints from clients).

They are living documents that are updated periodically in light of new research evidence, learning from complaints, and societal changes.

For example, the BACP’s Ethical Framework was updated in 2018. In Counselling Tutor Podcast episode 83 , Rory interviewed Professor Tim Bond, consultant to the BACP and author of  Standards and Ethics for Counselling in Action  (4th edition) (Sage, 2015).

The ethical framework to which we are working is important in clinical supervision; those counsellors who are BACP members are required to revisit this explicitly at least once a year.

It’s also good to draw clients’ attention to its existence, for example referring to it in contracting and even offering them a copy.

Rory has also written a handout on ethical frameworks in counselling and how to work with these. You can download this free of charge here; it is also available through the Handouts Vault and Counselling Study Resource (CSR).

Check-In with CPCAB: Dual Relationships in Counselling Training (starts at 13.30 mins)

Rory speaks to Heather Price (Senior Counselling Professional) at CPCAB (Counselling & Psychotherapy Central Awarding Body) about dual relationships in counselling training.

Heather explains that this situation occurs when two people who already know each other well outside the classroom (e.g. through being relatives or colleagues) attend the same course.

When Rory worked as a course tutor, he always tried hard to prevent dual relationships in counselling training from occurring.

If it does happen, it can create challenges and difficulties for the two people themselves, their peers and the tutor (whose responsibility it is to hold the boundaries for the whole group). This can have implications for professional ethics and confidentiality.

The ideal situation in counselling training is that there is a ‘ level playing-field ’ for all, with no two people having intimate knowledge of each other’s experiences prior to the course starting.

It can therefore be better if two relatives or colleagues who both want to study counselling either go to different centres or else stagger their studies over time so they are not in the same group together.

For more information, please see CPCAB’s website . CPCAB is the UK’s only awarding body run by counsellors for counsellors.

When a Client Disagrees with Us (starts at 25.00 mins)

This situation could occur for various reasons, such as:

• the client being in denial, i.e. being unable (yet) to accept a situation
• the counsellor having misheard the client
• the counsellor having unconsciously been pulled into their own frame of reference.

Ken and Rory share various tips on what to do when a client disagrees with you:

• Don’t argue back.
• Instead, try to explore their disagreement.
• Be willing to own up to being wrong yourself if that is so.
• Watch the client’s body language carefully, being alert to any mismatches between this and their words.
• Thank the client for having the courage and honesty to point out that they feel you’ve got it wrong.

In short, be curious but gentle, and allow the client their autonomy.

Free Handout Download

Ethical Bodies

Links and Resources

Counselling Tutor Facebook group

Counselling Tutor Facebook page

Counselling Tutor website

Counselling Study Resource

Counselling Tutor Handouts Vault

Basic Counselling Skills: A Student Guide

Counselling Theory in Practice: A Student Guide

Spotted out-of-date info or broken links? Kindly let us know the page where you found them. Email: [email protected]

Ethical Framework for the Counselling Professions Formally adopted 1 July 2018

This is the full text of the  Ethical Framework . Follow the link in each section for additional information, FAQs and resources.

All BACP members must work in accordance with the Ethical Framework. You commit to complying with the Framework when you join or renew your membership and it is the main point of reference for decisions in professional conduct hearings.

You should read it, and understand its main principles and points, before working with clients. It’s much better to build the Ethical Framework into your practice to help you face challenges and issues rather than just turning to it if something goes wrong.

It has three main sections:

• Our commitment to clients provides a summary of working to professional standards and building an ethical relationship
• Ethics specifies the values, principles and personal moral qualities that inform our work and underpin supervision
• Good practice considers the application of our commitments to clients and ethics to our practice

Our commitment to clients

Clients need to be able to participate freely as they work with practitioners of the counselling professions towards their desired goals. This requires clients to be able to trust their practitioner with their wellbeing and sensitive personal information. Therefore, as members or registrants of BACP, we take being trustworthy as a serious ethical commitment. We have agreed that we will:

1. Put clients first by: a . making clients our primary concern while we are working with them b . providing an appropriate standard of service to our clients

2. Work to professional standards by: a . working within our competence b . keeping our skills and knowledge up to date c . collaborating with colleagues to improve the quality of what is being offered to clients d . ensuring that our wellbeing is sufficient to sustain the quality of the work e . keeping accurate and appropriate records

3. Show respect by: a . valuing each client as a unique person b . protecting client confidentiality and privacy c . agreeing with clients on how we will work together d . working in partnership with clients

4. Build an appropriate relationship with clients by: a . communicating clearly what clients have a right to expect from us b . communicating any benefits, costs and commitments that clients may reasonably expect c . respecting the boundaries between our work with clients and what lies outside that work d . not exploiting or abusing clients e . listening out for how clients experience our working together

5. Maintain integrity by: a . being honest about the work b . communicating our qualifications, experience and working methods accurately c . working ethically and with careful consideration of how we fulfil our legal obligations

6. Demonstrate accountability and candour by: a . being willing to discuss with clients openly and honestly any known risks involved in the work and how best to work towards our clients’ desired outcomes by communicating any benefits, costs and commitments that clients may reasonably expect b . ensuring that clients are promptly informed about anything that has occurred which places the client at risk of harm or causes harm in our work together, whether or not clients are aware of it, and quickly taking action to limit or repair any harm as far as possible c . reviewing our work with clients in supervision d . monitoring how clients experience our work together and the effects of our work with them.

1 . Our ethics are based on values, principles and personal moral qualities that underpin and inform the interpretation and application of Our commitment to clients and Good practice .

2 . Values are a useful way of expressing general ethical commitments that underpin the purpose and goals of our actions.

3 . Our fundamental values include a commitment to:

• respecting human rights and dignity
• alleviating symptoms of personal distress and suffering
• enhancing people’s wellbeing and capabilities
• improving the quality of relationships between people
• increasing personal resilience and effectiveness
• facilitating a sense of self that is meaningful to the person(s) concerned within their personal and cultural context
• appreciating the variety of human experience and culture
• protecting the safety of clients
• ensuring the integrity of practitioner-client relationships
• enhancing the quality of professional knowledge and its application
• striving for the fair and adequate provision of services

4 . Values inform principles. They become more precisely defined and action-orientated when expressed as a principle.

5 . Principles direct attention to important ethical responsibilities. Our core principles are:

• Being trustworthy:  honouring the trust placed in the practitioner
• Autonomy:  respect for the client’s right to be self-governing
• Beneficence:  a commitment to promoting the client’s wellbeing
• Non-maleficence:  a commitment to avoiding harm to the client
• Justice:  the fair and impartial treatment of all clients and the provision of adequate services
• Self-respect:  fostering the practitioner’s self-knowledge, integrity and care for self

6 . Ethical decisions that are strongly supported by one or more of these principles without any contradiction with the others may be regarded as well-founded.

7 . However, practitioners may encounter circumstances in which it is impossible to reconcile all the applicable principles. This may require choosing which principles to prioritise. A decision or course of action does not necessarily become unethical merely because it is controversial or because other practitioners would have reached different conclusions in similar circumstances. A practitioner’s obligation is to consider all the relevant circumstances with as much care as possible and to be appropriately accountable for decisions made.

Personal moral qualities

8 . Personal moral qualities are internalised values that shape how we relate to others and our environment. They represent a moral energy or drive that may operate unconsciously and unexamined. This moral energy or drive is ethically more beneficial when consciously examined from time to time and used to motivate our ethical development or shape how we work towards a good society.

9 . ‘Personal moral qualities’ are a contemporary application of ‘virtues’ from moral philosophy.

10 . The practitioner’s personal and relational moral qualities are of the utmost importance. Their perceived presence or absence will have a strong influence on how relationships with clients and colleagues develop and whether they are of sufficient quality and resilience to support the work.

11 . High levels of compatibility between personal and professional moral qualities will usually enhance the integrity and resilience of any relationship.

12 . Key personal qualities to which members and registrants are strongly encouraged to aspire include:

• Candour:  openness with clients about anything that places them at risk of harm or causes actual harm
• Care:  benevolent, responsible and competent attentiveness to someone’s needs, wellbeing and personal agency
• Courage: the capacity to act in spite of known fears, risks and uncertainty 
• Diligence:  the conscientious deployment of the skills and knowledge needed to achieve a beneficial outcome
• Empathy:  the ability to communicate understanding of another person’s experience from that person’s perspective
• Fairness:  impartial and principled in decisions and actions concerning others in ways that promote equality of opportunity and maximise the capability of the people concerned 
• Humility:  the ability to assess accurately and acknowledge one’s own strengths and weaknesses 
• Identity:  sense of self in relationship to others that forms the basis of responsibility, resilience and motivation 
• Integrity:  commitment to being moral in dealings with others, including personal straightforwardness, honesty and coherence 
• Resilience:  the capacity to work with the client’s concerns without being personally diminished 
• Respect:  showing appropriate esteem for people and their understanding of themselves 
• Sincerity:  a personal commitment to consistency between what is professed and what is done 
• Wisdom:  possession of sound judgement that informs practice

13 . The challenge of working ethically means that practitioners will inevitably encounter situations that require responses to unexpected issues, resolution of dilemmas, and solutions to problems. A good understanding of the ethics that underpin our work is a valuable resource which is helpful in making significant decisions. The use of an ethical problem-solving model and discussion about ethics are essential to good practice. This Ethical Framework is intended to assist practitioners by directing attention to the variety of ethical factors that may need to be taken into consideration and to identify alternative ways of approaching ethics that may prove more useful.

14 . No statement of ethics can eliminate the difficulty of making professional judgements in circumstances that may be constantly changing and full of uncertainties. By accepting this statement of ethics, members and registrants of the British Association for Counselling and Psychotherapy are committing themselves to engaging with the challenge of striving to be ethical, even when doing so involves making difficult decisions or acting courageously.

Good practice

1 . As members of the British Association for Counselling and Psychotherapy (BACP) we are committed to sustaining and advancing good practice.

2 . This section of the Ethical Framework looks behind Our commitment to clients and Ethics  to consider their implications for good practice in more detail.

3 . It sets out what can be expected of all members and registrants of BACP as practitioners providing therapeutically-informed services, particularly coaching, counselling, pastoral care, psychotherapy and using counselling skills. This includes being a supervisor, trainer, educator of practitioners, or researcher of any aspect of the counselling professions. Trainees will fulfil all the commitments to clients within the  Ethical Framework when working with members of the public as their clients. Good practice point 81 sets out the commitments for working with other trainees to learn new knowledge and skills.

4 . As members and registrants of BACP, we have committed ourselves to the principles and values set out in this Ethical Framework and recognise that our membership or registration may be at risk if we fail to fulfil our commitments.

5 . Our responsibilities are set out as full or qualified obligations. We are fully and unconditionally committed to fulfilling a specific requirement of Good practice where we state ‘we will…’ or ‘we must…’. Where we consider a requirement may need to be varied for good ethical reasons, we state that ‘we will usually…’.

6 . We are committing ourselves to being openly accountable and willing to explain how we have implemented any of these obligations to people with a valid interest in our work.

Putting clients first

7 . We will make each client the primary focus of our attention and our work during our sessions together.

8 . Any professional or personal interests that conflict with putting a client’s interests first will be carefully considered in consultation with a supervisor, an independent experienced colleague or, when appropriate, discussed with the client affected before services are offered.

9 . We will give careful consideration to how we manage situations when protecting clients or others from serious harm or when compliance with the law may require overriding a client’s explicit wishes or breaching their confidentiality – see also 10 , 55  and 64 .

10 . In exceptional circumstances, the need to safeguard our clients or others from serious harm may require us to override our commitment to making our client’s wishes and confidentiality our primary concern. We may need to act in ways that will support any investigations or actions necessary to prevent serious harm to our clients or others. In such circumstances, we will do our best to respect the parts of our client’s wishes or confidences that do not need to be overridden in order to prevent serious harm.

11 . We share a responsibility with all other members of our professions for the safety and wellbeing of all clients and their protection from exploitation or unsafe practice. We will take action to prevent harm caused by practitioners to any client – see also 24 .

12 . We will do everything we can to develop and protect our clients’ trust.

Working to professional standards

13 . We must be competent to deliver the services being offered to at least fundamental professional standards or better. When we consider satisfying professional standards requires consulting others with relevant expertise, seeking second opinions, or making referrals, we will do so in ways that meet our commitments and obligations for client confidentiality and data protection.

14 . We will keep skills and knowledge up to date by: a . reading professional journals, books and/or reliable electronic resources b . keeping ourselves informed of any relevant research and evidence-based guidance c . discussions with colleagues working with similar issues d . reviewing our knowledge and skills in supervision or discussion with experienced practitioners e . regular continuing professional development to update knowledge and skills f . keeping up to date with the law, regulations and any other requirements, including guidance from this Association, relevant to our work

15 . We will keep accurate records that:

• are adequate, relevant and limited to what is necessary for the type of service being provided
• comply with the applicable data protection requirements – see Information Commissioner's Office website  (www.ico.org.uk).

16 . We will collaborate with colleagues over our work with specific clients where this is consistent with client consent and will enhance services to the client.

17 . We will work collaboratively with colleagues to improve services and offer mutual support – see 56–59 Working with colleagues and in teams .

18 . We will maintain our own physical and psychological health at a level that enables us to work effectively with our clients – see 91 Care of self as a practitioner .

19 . We will be covered by adequate insurance when providing services directly or indirectly to the public.

20 . We will fulfil the ethical principles and values set out in this Ethical Framework  regardless of whether working online, face-to-face or using any other methods of communication. The technical and practical knowledge may vary according to how services are delivered but all our services will be delivered to at least fundamental professional standards or better.

21 . We will respect our clients’ privacy and dignity.

22 . We will respect our clients as people by providing services that: a . endeavour to demonstrate equality, value diversity and ensure inclusion for all clients b. avoid unfairly discriminating against clients or colleagues c . accept we are all vulnerable to prejudice and recognise the importance of self-inquiry, personal feedback and professional development d . work with issues of identity in open-minded ways that respect the client’s autonomy and be sensitive to whether this is viewed as individual or relational autonomy e . challenge assumptions that any sexual orientation or gender identity is inherently preferable to any other and will not attempt to bring about a change of sexual orientation or gender identity or seek to suppress an individual’s expression of sexual orientation or gender identity f . make adjustments to overcome barriers to accessibility, so far as is reasonably possible, for clients of any ability wishing to engage with a service g . recognise when our knowledge of key aspects of our client’s background, identity or lifestyle is inadequate and take steps to inform ourselves from other sources where available and appropriate, rather than expecting the client to teach us h . are open-minded with clients who appear similar to ourselves or possess familiar characteristics so that we do not suppress or neglect what is distinctive in their lives.

23 . We will take the law concerning equality, diversity and inclusion into careful consideration and strive for a higher standard than the legal minimum.

24 . We will challenge colleagues or others involved in delivering related services whose views appear to be unfairly discriminatory and take action to protect clients, if necessary – see 11 .

25 . We will do all that we reasonably can to ensure that our clients are participating on a voluntary basis. Hesitant clients or clients who feel under pressure from other people or agencies to work with us will have their reservations acknowledged and taken into account in how services are offered.

26 . We will work with our clients on the basis of their informed consent and agreement. We recognise that exceptional situations may arise where we may need to prioritise the safety of the client or others over our client’s wishes and confidentiality – see 10 .

27 . Careful consideration will be given to working with children and young people that: a . takes account of their capacity to give informed consent, considering whether it is appropriate to seek the consent of others who have parental responsibility for the young person, and their best interests b . demonstrates knowledge and skills about ways of working that are appropriate to the young person’s development and how relationships are formed c . demonstrates a sound knowledge of the law relevant to working with children and young people and their human rights d . is informed about the current culture and customs that affect parenting/care giving and how children and young people interact with each other and other significant people in their lives.

28 . We will give careful consideration to obtaining and respecting the consent of vulnerable adult clients, wherever they have the capacity to give consent, or involving anyone who provides care for these clients when appropriate.

29 . Our work with clients will be based on professional partnerships with them that aim to increase their wellbeing, capability and/or performance.

Building an appropriate relationship

30 . We will usually provide clients with the information they ought to know in advance in order to make an informed decision about the services they want to receive, how these services will be delivered and how information or data about them will be protected. Where the urgency or seriousness of the situation requires us to intervene before providing such information, we will do so at the first appropriate opportunity.

31 . We will give careful consideration to how we reach agreement with clients and will contract with them about the terms on which our services will be provided. Attention will be given to: a . reaching an agreement or contract that takes account of each client’s expressed needs and choices so far as possible b . communicating terms and conditions of the agreement or contract in ways easily understood by the client and appropriate to their context c . stating clearly how a client’s confidentiality and privacy will be protected and any circumstances in which confidential or private information will be communicated to others d . providing the client with a record or easy access to a record of what has been agreed  e . keeping a record of what has been agreed and of any changes or clarifications when they occur f . being watchful for any potential contractual incompatibilities between agreements with our clients and any other contractual agreements applicable to the work being undertaken and proactively strive to avoid these wherever possible or promptly alert the people with the power or responsibility to resolve these contradictions.

32 . We will periodically review each client’s progress and, when practicable, seek our client’s views on how we are working together.

33 . We will establish and maintain appropriate professional and personal boundaries in our relationships with clients by ensuring that: a . these boundaries are consistent with the aims of working together and beneficial to the client b . any dual or multiple relationships will be avoided where the risks of harm to the client outweigh any benefits to the client c . reasonable care is taken to separate and maintain a distinction between our personal and professional presence on social media where this could result in harmful dual relationships with clients d . the impact of any dual or multiple relationships will be periodically reviewed in supervision and discussed with clients when appropriate. They may also be discussed with any colleagues or managers in order to enhance the integrity of the work being undertaken.

34 . We will not have sexual relationships with or behave sexually towards our clients, supervisees or trainees.

35 . We will not exploit or abuse our clients in any way: financially, emotionally, physically, sexually or spiritually.

36 . We will avoid having sexual relationships with or behaving sexually towards people whom we know to be close to our clients in order to avoid undermining our clients’ trust in us or damaging the therapeutic relationship.

37 . We will avoid continuing or resuming any relationships with former clients that could harm the client or damage any benefits from the therapeutic work undertaken. We recognise that conflicts of interest and issues of power or dependence may continue after our working relationship with a client, supervisee or trainee has formally ended. Therefore: a . we will exercise caution before entering into personal or business relationships with former clients b . we will avoid sexual or intimate relationships with former clients or people close to them. Exceptionally, such a relationship will only be permissible following careful consideration in supervision and, whenever possible, following discussion with experienced colleagues or others concerned about the integrity of the counselling professions, when:

• enough time has elapsed or the circumstances of the people concerned have sufficiently changed to establish a distinction between the former and proposed new relationship 
• any therapeutic dynamics from the former relationship have been sufficiently resolved to enable beginning a different type of relationship. (This may not be possible with some clients or inappropriate to some therapeutic ways of working.) 
• an equivalent service to the one provided by the practitioner is available to the former client, should this be wanted in future
• the practitioner has taken demonstrable care in ensuring that the new relationship has integrity and is not exploitative

c . We will be professionally accountable if the relationship becomes detrimental to the former client or damages the standing of the profession

Breaks and endings

38 . We will inform clients about any fixed limits to the duration or number of sessions as part of the contracting process.

39 . We will endeavour to inform clients well in advance of approaching endings and be sensitive to our client’s expectations and concerns when we are approaching the end of our work together.

40 . We will inform clients in advance of any planned breaks in working together, for example, holidays or medical treatments, and give as much notice as possible.

41 . Any unplanned breaks due to illness or other causes will be managed in ways to minimise inconveniencing clients and, for extended breaks, may include offering to put clients in touch with other practitioners.

42 . In the event of death or illness of sufficient severity to prevent the practitioner communicating directly with clients, we will have appointed someone to communicate with clients and support them in making alternative arrangements where this is desired. The person undertaking this work will be bound by the confidentiality agreed between the practitioner and client, and will usually be a trusted colleague, a specially appointed trustee or a supervisor.

43 . We will maintain high standards of honesty and probity in all aspects of our work.

44 . We will be as open and as communicative with our clients, colleagues and others as is consistent with the purpose, methods and confidentiality of the service.

45 . Whenever we communicate our qualifications, professional experience and working methods, we will do so accurately and honestly. All reasonable requests for this information will be answered promptly.

46 . We will give conscientious consideration to the law and how we fulfil any legal requirements concerning our work – see also 14f , 23 and 70 . 

47 . We will promptly notify this Association about any criminal charges or disciplinary procedures brought against us. We will also notify this Association of civil claims arising from work in the counselling professions, or if we have been declared bankrupt.

48 . We will avoid any actions that will bring our profession into disrepute.

49 . We will encourage clients to raise any concerns about our work with them at the earliest possible opportunity, give any concerns careful consideration and, when appropriate, attempt to resolve them. Clients will be informed of any applicable complaints processes open to them including the Professional Conduct Procedures of this Association.

Accountability and candour

50 . We will take responsibility for how we offer our clients opportunities to work towards their desired outcomes and the safety of the services we provide or have responsibility for overseeing.

51 . We will discuss with clients how best to work towards their desired outcomes and any known risks involved in the work.

52 . We will ensure candour by being open and honest about anything going wrong and promptly inform our clients of anything in our work that places clients at risk of harm, or has caused them harm, whether or not the client(s) affected are aware of what has occurred by: a . taking immediate action to prevent or limit any harm b . repairing any harm caused, so far as possible c . offering an apology when this is appropriate d . notifying and discussing with our supervisor and/or manager what has occurred e . investigating and take action to avoid whatever has gone wrong being repeated

53 . We will consider carefully in supervision how we work with clients – see 60–73 .

54 . We will monitor how clients experience our work together and the effects of the work with them in ways appropriate to the type of service being offered.

Confidentiality

55 . We will protect the confidentiality and privacy of clients by: a . actively protecting information about clients from unauthorised access or disclosure b . informing clients about how the use of personal data and information that they share with us will be used and who is within the circle of confidentiality, particularly with access to personally identifiable information c . requiring that all recipients of personally identifiable information have agreed to treat such information as confidential in accordance with any legal requirements and what has been agreed with the client at the time of disclosure d . informing clients about any reasonably foreseeable limitations of privacy or confidentiality in advance of our work together, for example, communications to ensure or enhance the quality of work in supervision or training, to protect a client or others from serious harm including safeguarding commitments, and when legally required or authorised to disclose e . taking care that all contractual requirements concerning the management and communication of client information are mutually compatible f . ensuring that disclosure of personally identifiable information about clients is authorised by client consent or that there is a legally and ethically recognised justification g . using thoroughly anonymised information about clients where this provides a practical alternative to sharing identifiable information

Working with colleagues and in teams

56 . Professional relationships will be conducted in a spirit of mutual respect. We will endeavour to build good working relationships and systems of communication that enhance services to clients.

57 . Practitioners will treat colleagues fairly and foster their capability and equality of opportunity.

58 . Practitioners will not undermine any colleague’s relationship with clients by making unjustifiable or ill-judged comments.

59 . All communications between colleagues about clients should be on a professional basis and thus purposeful, respectful and consistent with the management of confidences agreed with clients.

Supervision

60 . Supervision is essential to how practitioners sustain good practice throughout their working life. Supervision provides practitioners with regular and ongoing opportunities to reflect in depth about all aspects of their practice in order to work as effectively, safely and ethically as possible. Supervision also sustains the personal resourcefulness required to undertake the work.

61 . Good supervision is much more than case management. It includes working in depth on the relationship between practitioner and client in order to work towards desired outcomes and positive effects. This requires adequate levels of privacy, safety and containment for the supervisee to undertake this work. Therefore a substantial part or preferably all of supervision needs to be independent of line management.

62 . Supervision requires additional skills and knowledge to those used for providing services directly to clients. Therefore supervisors require adequate levels of expertise acquired through training and/or experience. Supervisors will also ensure that they work with appropriate professional support and their own supervision.

63 . All supervisors will model high levels of good practice for the work they supervise, particularly with regard to expected levels of competence and professionalism, relationship building, the management of personal boundaries, any dual relationships, conflicts of interest and avoiding exploitation.

64 . All communications concerning clients made in the context of supervision will be consistent with confidentiality agreements with the clients concerned and compatible with any applicable agency policy.

65 . Careful consideration will be given to the undertaking of key responsibilities for clients and how these responsibilities are allocated between the supervisor, supervisee and any line manager or others with responsibilities for the service provided. Consideration needs to be given to how any of these arrangements and responsibilities will be communicated to clients in ways that are supportive of and appropriate to the work being undertaken. These arrangements will usually be reviewed at least once a year, or more frequently if required.

66 . Trainee supervision will require the supervisor to collaborate with training and placement providers in order to ensure that the trainee’s work with clients satisfies professional standards. The arrangements for collaboration will usually be agreed and discussed with the trainee in advance of working with clients.

67 . When supervising qualified and/or experienced practitioners, the weight of responsibility for ensuring that the supervisee’s work meets professional standards will primarily rest with the supervisee.

68 . Supervisors and supervisees will periodically consider how responsibility for work with clients is implemented in practice and how any difficulties or concerns are being addressed.

69 . The application of this Ethical Framework to the work with clients will be discussed in supervision regularly and not less than once a year.

70 . Supervisors will conscientiously consider the application of the law concerning supervision to their role and responsibilities.

71 . Supervisors will keep accurate records of key points discussed in supervision.

72 . Supervisees have a responsibility to be open and honest in supervision and to draw attention to any significant difficulties or challenges that they may be facing in their work with clients. Supervisors are responsible for providing opportunities for their supervisees to discuss any of their practice-related difficulties without blame or unjustified criticism and, when appropriate, to support their supervisees in taking positive actions to resolve difficulties.

73 . Supervision is recommended to anyone working in roles that require regularly giving or receiving emotionally challenging communications, or engaging in relationally complex and challenging roles.

Training and education

74 . All trainers will have the skills, attitudes and knowledge required to be competent teachers and facilitators of learning for what is being provided.

75 . Any information about the teaching, education or learning opportunities being provided will be accurate and enable potential students to make an informed choice.

76 . Any selection of students will be fair, respectful and transparent to candidates and use procedures designed to select suitable students.

77 . Any assessments of students will be fair, respectful and provide reasoned explanations for the outcome to the students.

78 . Care will be taken when using examples of work with clients for teaching purposes that the client information is used with the consent of the person or sufficiently anonymised so that the person concerned cannot be identified by any means reasonably likely to be used.

79 . Trainers and educators will model high levels of good practice in their work, particularly with regard to expected levels of competence and professionalism, relationship building, the management of personal boundaries, any dual relationships, conflicts of interest and avoiding exploitation.

80 . Trainers and educators will encourage trainees to raise any concerns at the earliest opportunity and have processes and policies for addressing any trainee’s concerns. Trainers and educators are responsible for providing opportunities for trainees to discuss any of their practice-related difficulties without blame or unjustified criticism and, when appropriate, to support trainees in taking positive actions to resolve difficulties.

81 . Trainees working with each other will: a . relate respectfully to others and endeavour to support each others’ learning b . follow good ethical practice when working with each other, for example when practising skills or in personal development 

82 . In the interests of openness and honesty with clients: a . trainees on a practitioner-qualifying course working with clients will inform clients (or ensure that clients have been informed) that they are trainees b . trainees who are undertaking post-qualification CPD or further training will be guided by any applicable training requirements when using their professional and ethical judgement about whether to inform clients that they are in training

83 . All trainees will: a . seek their clients’ permission to use any information from work with them for training purposes, for example, in presentations, case studies or as assessed practice. Alternatively, any report of work undertaken will be so thoroughly anonymised that the identity of the person concerned cannot be identified by any means reasonably likely to be used. Consent is required if anonymity cannot be assured or when required by the training provider’s instructions or regulations. b . ensure that they deliver services that satisfy the minimum professional standards when working as practitioners with members of the public. This standard may be achieved with the assistance of appropriate professional support. c . collaborate with their trainers, placement providers, supervisors and other professional advisers to provide services to their clients that satisfy professional standards by being undertaken with reasonable care and skill d . be watchful for any incompatibilities between contractual requirements that have implications for work with clients, for example, between agreements with clients, training providers and placements, and seek appropriate support in order to ensure that all contractual requirements are compatible e . be open and honest with trainers, placement providers and supervisors about all issues relevant to their selection, training, supervision and professional practice

84 . We value research and systematic inquiry by practitioners as enhancing our professional knowledge and providing an evidence-base for practice in ways that benefit our clients.

85 . We will usually support and provide opportunities for research if it is compatible with the services we provide.

86 . When undertaking research we will be rigorously attentive to the quality and integrity of the research process, the knowledge claims arising from the research and how the results are disseminated.

87 . All research that we undertake will be guided by the BACP Ethical Guidelines for Research in the Counselling Professions .

88 . All participants in research will do so on the basis of explicit informed consent.

89 . All research will be reviewed in advance to ensure that the rights and interests of participants have been considered independently of the researcher.

90 . The research methods used will comply with standards of good practice in any services being delivered and will not adversely affect clients.

Care of self as a practitioner

91 . We will take responsibility for our own wellbeing as essential to sustaining good practice with our clients by: a . taking precautions to protect our own physical safety b . monitoring and maintaining our own psychological and physical health, particularly that we are sufficiently resilient and resourceful to undertake our work in ways that satisfy professional standards c . seeking professional support and services as the need arises d . keeping a healthy balance between our work and other aspects of life

Responding to ethical dilemmas and issues

92 . We recognise that professional and ethical issues, problems and dilemmas will arise from time to time and are an unavoidable part of our practice.

93 . We will use our supervision and any other available professional resources to support and challenge how we respond to such situations. We will give careful consideration to the best approaches to ethical problem-solving.

94 . We will take responsibility for considering how best to act in such situations and will be ready to explain why we decided to respond in the way we did.

Related resources

Developing the new Ethical Framework

The Ethical Framework for the Counselling Professions 2018 will be reviewed and we want to make sure that members are involved in the process. Find out about the changes.

The meaning of words used within the Ethical Framework

Good Practice in Action resources

Supplementary resources, based on current research and evidence, to help you implement the Ethical Framework in your practice. Include commonly asked questions, fact sheets, legal resources and research overviews.