Professional Counseling Orientation and Ethical Practice (1/2) Flashcards
Counseling
a professional relationship that empowers diverse individuals, families, groups to accomplish mental health, wellness, education, career goals
Counseling
the application of mental health, psychological or human development principles, through cognitive, affective, behavioral, or systemic interventions, strategies that address wellness, personal growth, or career development, as well as pathology
Wilhelm Wundt
established first psychological labratory
Jesse Davis
pioneer of vocational guidance counseling in schools
Current trend - upheaval in the profession
Professional issue relating to CACREP
- a significant professional issue includes the role, values, influence being exert by CACREP
- Because counseling profession (ACA) is seeking to be more unified and recognized within and outside the profession, it is focusing on CACREP as a unifying force
- As a result, outside constituencies (academic institutions, state licensure authorities, and hiring bodies are moving to include or require CACREP program graduation as a requirement for admission or eligibility
The dilemma is relating to the thousands of professional counselors who did not graduate from CACREP program
Current trend - upheaval in the profession
Master’s in Psychology and Counseling Accreditation Council (MPCAC)
a new accrediting body for psych/counseling programs not covered by the APA/CACREP
the mission is to accredit academic programs in psych/counseling, which promote training in the scientific practice of professional psychology and counseling at the master’s level
- over 55 master’s programs are now accredited by MPCAC
Disaster mental health
a number of events, circumstances, natural phenomena are leading to an increased focus of the profession on disaster, trauma, crisis counseling
- natural disasters, wars, conflicts, terrorism, other traumatic events require particular diagnostic skills and treatment interventions
- CACREP has standards for disaster, trauma, crisis counseling
Scope of counseling practice
is dynamic as changing state laws/professions exert influence on the profession
Social justice counseling
addresses issues of unequal power, unearned privilege/oppression, seeks greater balance of power and resources in society
- to better empower clients, advocacy competencies for counselors has been identified by ACA
Mind-body connections and implications
there is a need for counselors to understand relationships between body functions, nutrition, meds/drugs, and mental states and behavior
- much behavior may be rooted in biological and brain functions which cannot be overlooked to ensure proper diagnoses and counseling approaches
Distance and technology in providing counseling
distance counseling and various social media is increasing
- variety of social media may be used as an adjunct to building and maintaining a counseling relationship
- great potential to benefit or harm clients
- there are guidelines in ACA
Conversion therapy
a set of practices that intend to change a person’s sexuality/gender identity to fit cisgender/heterosexual expectations
- usually religiously motivated
- over 12 states have a ban outlawing this for people under 18 YO
Impact of COVID on profession
Impact on home and family
more time for family at home = may build stronger relationships between parents/children
May be more stress/conflict between/among family:
- little physical separation may be possible
- assisting children in remote school activities; regulating screen time; accommodating kids’ demands for attention
- parental stress about financial situation in regard to work/living expenses/food insecurity
Impact of COVID on profession
Impact on medical professionals and care givers
- nurses/medical techs more than physicians may experience anxiety, depression, trauma, PTSD, sleep disturbance, vicarious traumatization
- need for time away from work, therapy
- early retirements/profession changes
Impact of COVID on profession
Impact on counseling profession
- counselor training must change to meet new demands of changed world
- work must be integrated with other physical/behavioral health care providers
- profession must begin or expand the use of technology to serve clients
- provide clients via telehealth
- counselors must continue to address social justice and inequities which are found across cultures, races, genders, etc.
Value conflicts between counselor/client
Counselor education students
Two grad students (Eastern Michigan University, Augusta State University) refused to counsel clients because their personal values conflicted with clients values regarding LGBT
- they were in the wrong, schools were right in dismissing them bc of ACA ethics
Value conflicts between counselor/client
Tennessee
Tennessee passed law in 2016 that allowed counselors to refuse any client because the counselor’s sincerely held principles were in conflict with the client
- this violates the code of ethics
Portability
Issues of portability
- states may have different educational requirements
- titles of LPCs differ
- different licensure exams are used
- scope of practice may be different
Portability
Portability
ability of professional counselor who is licensed in one state to become licensed in another
- currently no easy transition
- must meet requirements of the new state
- licensure is controlled by the state legislators
Portability
ACA approved aspirational portability model in 2016
encourages states to permit portability if there are no disciplinary issues with the counselor
- state level exam may be administered
Portability
Portability Task Force
American Association of State Counseling Boards, Association for Counselor Education adn Supervision, American Mental Health Counselors Association, National Board for Certified Counselors created this
- must be licensed in one state, 3 years of work experience, and any required jurisprudence exam… then to move to another state, Must do ONE:
- meet all academic, exam, and experience required by the new state
- is National Certified Counselor
- has graduate degree from CACREP program
National Center for Interstate Compacts (NCIC)
may develop and adopt a compact regarding professional counseling
would identify criteria for such counselors and would need to be accepted by a minimum of 10 states
- covered counselors could practice within those states’ boundaries or provide distant telehealth to clients in those states
- counselors could advocate for adoption of compact with their state staff and elected officials
Profession
vocational activity with underlying body of theoretical and reserach knowledge, and a publicly professed, self-imposed set of behavioral guidelines
Accreditation
a process through which public recognition is granted to a college or university or specialized program of study which meets certain established qualifications or standards
CACREP
founded in 1981, the body that accredits counselor training programs at the master’s and doctoral levels
- establishes standards for professional competence and prepares future practitioners
- encourages continual review and development of academic and professional practice programs
- most state licensure boards accept CACREP program standards and requirements for licensure
Council on Rehabilitation Education (CORE) and CACREP merger agreement
a task force is developing recommendations for where and how the infusion of disability concepts into the counseling core curriculum can best be accomplished
CACREP last revised in 2016
these current standards identify eight masters level programs: addictions, career, clinical mental health, clinical rehabilitation, college counseling and student affairs, marriage/couple/family, school, rehabilitation
- one doctoral program for counselor education and supervision
- over 870 accredited programs and many institutions have 2+
- about 100 accredited doctoral programs exist
American Psychological Assocation (APA)
accredits clinical, counseling, school, combined areas psychology programs - all at doctoral level
- nearly 400 separate programs are accredited
Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE)
accredits marriage and family therapy training programs at the master’s, doctoral, and postdoctoral levels
- well over 125 programs accredited
Certification
a voluntary process throguh which recognition is granted to an individual who has met certain predetermined qualifications
Certification is a title control process
for the designation National Certified Counselor, the word controlled is Certified
- others cannot use that word without threat of lawsuit by whoever does the certification
National Board for Certified Counselors (NBCC)
progives for generic counselor certification (NCC)
- general requirements include master’s degree in counselling, coursework in 8 content areas, pre-degree field experience, 3,000 hours of post-degree supervised work experience over a 2 year time period, successful completion of NCE
- over 66,000 active certificants
Following receipt of NCC, specialty counselor certification is also possible with exam:
National Certified School Counselor (NCSC)
Certified Clinical Mental Health Counselor (CCMHC)
NBCC CEUs required
100 clock hours for each 5 years of certification
Other certifying bodies
Commission on Rehab Counselor Cert
States verify school counselors, drug/alcohol counselors, other counseling related groups
Licensure
the passing of a law at the state level to control the practice and/or title of an occupation (e.g., counseling)
- in this process, a state gives permission to an individual to practice counseling and to use a title such as LCP or something similar
- there is no licensure at the national level
General requirements around the country for licensure
master’s degree in counseling, coursework in the 8 content areas, pre-degree field experiences, post-degree supervised counseling work experience, successful completion of an exam
Variations in requirements from state to state
some require a 48-hour or 60-hour degree
- most states require between 2,000 and 4,000 hours of post-degree work experience
- most use NCE for licensure, others such NCMHCE, some allow either exam
- some states have two levels of licensure and use a different exam for each level
- most have ‘title and practice-control’ laws whcih mean no one practices counseling unless they have a license
- a few states have ‘title-control’ laws which mean anyone can practice counseling but cannot use the title LPC legally unless they are licensed
- Licensure is ‘state bound’
- does not move with you although you can go through the licensure process in another state
- can be licensured in several states simultaneously
- most states require CEUs for renewal
Threats to licensure for counselors
- as state licensure laws are revised, the scope of practice for counselors may be redefined more narrowly
- proposed changes to some states’ laws have suggested that counselors not be allowed to use psych tests
Reciprocity
a process where one credentialing agency (e.g., state) accepts the credential of another agency as equivalent to its own
Confidentiality
ethical concept
springs from the privacy expected in a counseling relationship and is respected by the counselor
Privileged communication
legal concept
granted to counselors when a state law has been passed, such as a licensure law
in court of law, counselor does not have to reveal what was said in counseling
Several circumstances under which privileged communication is waived and confidentiality is broken
- client is danger to self or others
- child abuse or neglect is alleged
- client requests that counseling records be released
- lawsuit is filed against you
- material is used in supervision
- involuntary hospitalization is being considered
- a court orders the release of info
Duty to warn (Tarasoff case)
Tarasoff family sued California university after Tatiana was murdered by a university client after he threatened to kill her
- California court ruled in 1976 that failure to warn an intended victim was professionally irresponsible
- under such circumstances, must break confidentiality and warn intended victims
Duty to protect
in case of suicidal clients, there is obligation to protect the client
extends to children, elderly, others with physical or mental disabilities
Signs in assessing seriousness of suicide risk:
- direct verbal warnings, previous attempts
- definite plan establishing and means available
- depression and sense of hopelessness
- giving possessions away
- history of alcohol or drug abuse
Physician-assisted suicide
DC, Colorado, Hawaii, Maine, NJ, Oregon, Vermont, Washington have all passed laws allowing this
individual must have terminal illness
physicians are allowed to prescribe meds to hasten death adn cannot be prosecuted for doing so
Statement of disclosure
ethical necessity and may be required by law
- may identify counseling procedures, techniques, counselor credentials, grievance procedures and is given to PC before counseling relationship begins
- can alert client in advance under what circumstances you as a counselor will break confidentiality depending upon disclosures made by client
Informed consent
includes process for releasing client info
Professional liability
counselors can be held liable, sued, and taken to court for causing harm through mental distress, defamation, sexual harassment or conduct, negligence, misrepresentation of professional service, battery
Malpractice
failure to provide professional services, or to provide those services at a level below that which would be expected of a professional in similar circumstances
in order for malpractice claim to succeed in a court, must meet these conditions:
- a professional relationship was established
- there was a breach of duty - the therapist was negligent/services did not meet community standards
- client suffered physical or psychological injury
- injury was caused by breach of duty
Professional liability insurance
highly recommended’ACA sponsers a professional liability insurance program for members throguh the Healthcare Providers Service organization (HPSO)
Family Educational Rights and Privacy Act of 1974 (FERPA)
Buckley Amendment
- intent was to protect privacy of individuals
- allows parents of students under 18 years old and students themselves if htey are at least 18 years old, access to info in their educational (not counseling) records
Title IX of educational amendments
1972 legislation bans sex discrimination in schools in academics and athletics
- focus has been mostly on providing women equal opportunities as men in sports
Third party payment
reimbursement from an insurance company (third party) to a private practice counselor who provides services to a client insured by that company, usually through client’s employer
Managed health care
requirements promoted by insurance companies to reduce health care costs
- includes strict compliance with policies regarding diagnosis, treatment plan, record-keeping etc.
- mnany mental health professionals apply for provider list status which are managed by Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs)
- without provider status, many PCs cannot be referred to them
Affordable Care Act - 2010
purpose was to increase quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, lower the costs of healthcare for individuals and gov.
- tools were designed to address this (mandates, subsidies, insurance exchanges) to increase coverage and affordability
- insurance was to cover all applicants within new minimum standards and offer same rates regardless of pre-existing conditions
- mental health services are to be treated the same as regular health care
- Extends the requirements of Mental Health Parity and Addiction Equity Act which passed in 2008
Health care plans cannot discriminate against counselors providing
services which are authorized under state’s licensure or certifications
- health care plans must cover a package of benefits including mental health and substance use disorder services, including behavioral health treatment
How many people gained health insurance coverage since 2010 through Affordable Care Act?
estimated 20 to 24 million nonelderly people
Health Insurance Portability and Accountability Act (HIPAA)
establishes standards for protecting the privacy of patient info in health industry including psychotherapy records (medication, treatment, diagnositic/clinical test info)
- regulates the transmission of cleint records and insurance claim inof including that sent electronically
- clients must sign document stating they have been informed of HIPAA rules
Health Info Technology for Economic and Clinical Health (HITECH) Act
authorizes the US Department of Health and Human Services to establish programs to improvde health care quality, safety, efficiency
- done through the use of health info technology such as electronic health records, private/secure electronic health info exchanges
HIPAA Privacy Rule
sets national standards for the protection of inidvidually identifiable health info through health plans, health care clearing houses, health care providers in electronic transactions
HIPAA Security Rule
sets national standards for protecting confidentiality, integrity, and availability of electronic protected health info
- clients must sign release before info may be shared with others
- HIPAA allows them to inspect their records and request changes
Ransomware
malicious software designed to deny access to the user’s own electronic data
- data may be held hostage until a fee ransom is paid
- counselors are encouraged to do a risk analysis or use a qualified technology professional to ensure security of their data
Mental Health Parity and Addictions Equity Act
private secor health plans covering 50+ employees and state/local gov. plans (not self-insured) must now provide the same level of coverage to individuals with mental health and addiction issues as to individuals with medical and surgical issues
- does not speak to providers of those services
TRICARE
allows active/retired military service members and their families to get services from TRICARE certified counselors without first getting referral from a physician
- other LPCs can continue to practice under supervision of a TRICARE-authorized physician
Veterans Mental Health Care Improvement Act
2020
- updates VA services related to transition asisstance, mental health care, care for women veterans, telehealth care
- one reason for this bill is high suicide rate of veterans
- requires VA to develop an occupational series for its LPCs and marriage/family therapists
Employee assistance counseling
counselors who work in employee assistance programs (EAPs) identify, counsel, refer out troubled workers
- sometimes EAP is located within company, sometimes company has contract with outside EAP provider
Counseling Program Planning
Counseling Program Planning
begins with conceptualization of the program, then proceeds to development, implementation, evaluation
Steps in Counseling Program Planning
Conceptualize the system
examine and understand the broader system in which the counseling program will be located
Steps in Counseling Program Planning
Establish philosophy and assess needs
general philosophy or mission of counseling program must be established
assessment of needs is a critical data gathering effort
Steps in Counseling Program Planning
Develop goals/objectives of counseling program
goals: broad statements of the general intentions of the program
objectives: specific, behavioral, measurable, based on goals of the program
goals and objectives are developed based, in part, on the needs assessment data collected
Steps in Counseling Program Planning
Process Information
a feedback loop of info should be in place to assure program development is proceeding appropriately, all steps are covered, etc.
Steps in Counseling Program Planning
Conduct a pilot study
a small scale pilot should be conducted in order to determine if development is on target, and any major problems may be uncovered before full-scale implementation
Steps in Counseling Program Planning
Implementation
depending on how extensive the counseling program is to be, a plan and schedule for implementation, hiring, training, related issues must be developed
Steps in Counseling Program Planning
Operate the counseling program
the doors open and clients make use of the services. Fine tuning of proceudres and services occurs
Steps in Counseling Program Planning
Evaluate the program
the process of determing whether the goals and objectives established for the counseling program have been met
Steps in Counseling Program Planning
Modify the counseling program
depending on the data gathered in the evaluation process, the program will be modified/eliminated
Needs assessment
measures discrepancies between what is and what is desired (AKA a need)
- actual form of the needs assessment may vary although written questionnaire is often used (often electronically, interviews, focus groups)
- random sampling is critical to get representative response and accurate picture of the need
- should be structured so the data gathered can be compiled, analyzed, interpreted
Counseling Program Management
Counseling Program Management
requires the knowledge and skills that other management positions require
Counseling Program Management Skills
Strategic planning
assessing the nature of the counseling program and what it might look like in the future
Counseling Program Management Skills
Program design and development
goals, objectives, performance objectives/standards must be designed or adapted from other similar counseling programs
Counseling Program Management Skills
Budgeting
forecasting and resource allocation skills are necessary
Counseling Program Management Skills
Personnel management
hiring and training staff and professional employees including attention to affirmative action issues
Counseling Program Management Skills
Supervision
program supervision and supervision of personnel around job performance and counseling skills
Counseling Program Management Skills
Evaluation
necessary to determine whether the counseling program is meeting its goals and objectives and whether staff are meeting performance standards
Counseling Program Management Skills
Marketing and public relations
developing and disseminating info about the counseling program, advocacy, fundraising efforts, etc.
Code of Ethics
professional’s statement of standards as to what is right or wrong regarding professional behavior
- comes from distilled wisdom of its members, cultured values, mores, legal judgments, opinions
Values listed in Code of Ethics
- to enhance human development for the entire life span
- embrace diversity and multicultural factors since clients are unique
- promote social justice
- safeguard integrity of the counselor-client relationship
- practice counseling in an ethical/safe manner
Ethical Decision Making
Beneficence
working for the good of the individual
Ethical Decision Making
Nonmaleficence
not doing/inflicting harm
Ethical Decision Making
Autonomy
respecting freedom of choice and self-determination
Ethical Decision Making
Justice
treating individuals equitably/fairly
Ethical Decision Making
Fidelity
honoring commitments and keeping promises
Ethical Decision Making
Veracity
being truthful with individuals
Ethical Decision Making
List all principles in ethical decision making:
Beneficence
Nonmaleficence
Autonomy
Justice
Fidelity
Veracity
Professional Standards of Practice
- know what these standards are and apply them as you can
- Use some form of diagnositic system to assess needs of clients and apply services to their needs
- Apply services which have a theoretical basis
- Training/experience must be consistent with diagnostic system and theoretical methods/techniques you use
- Must practice within boundaries of competence
- Be care not to misrepresent training/credentials
- Be prepared to terminate relationship if services are no longer helpful
Ethical Standards of Practice
- Subscribe to professional code of ethics
- Know what is ethical in your field
- Obtain informed consent
- Let clients know limits of confidentiality
- May need guardian’s consent for minors
- Let clients know if you are recording, receiving supervision, or in training program
- Sexual contact is not ethical. Hugs/touch may be used appropriately. Sexual attraction towards client should be recognized, not acted upon, and obtain supervision for it
- Sexual relationships between educators/supervisees is unethical
- Sexual contact must occur 5+ years after therapy ends
Notification of partner in relation to HIV/AIDS
Code of ethics indicates that counselors may be justified in telling a partner that the client has HIV/AIDS, life-threatening disease if the client does not do so
No state law requires disclosure to partner
Seek supervision
Limitations of confidentiality
- serious/foreseeable harm to client or others
- discussion with counseling professionals who may be helpful
- discussion with supervisors
- client requests records to be released
- lawsuit is filed against you
- when court orders it
- clerical personnel in counseling office
- managed care providers and insurance
Managing and maintaining boundaries and professional relationships may carry risks
could be power differential that could be exploitative
- sometimes such relationships cannot be avoided (small communities, rural areas)
Engaging in more than one role may be beneficial for the client and not unethical (ex. attending important event in client’s life like wedding/funeral)
Counselor sensitivity regarding diversity
necessary to increase knowledge/awareness when working with diverse client groups
must use sensitivity regarding customs/traditions
Practicing distance counseling requires informed consent about
relationship, technology, social media issues
ex. cannot google client; need separate personal/professional social media
Additional technology issues
- personal virtual relationships with clients are unethical
- distance counseling across state lines means knowing the rules/regulations of the state where client lives
- many states require a valid counselor license within those states to do distance counseling
- if distance counseling is to be used, should be noted on informed consent
- encryption must be used
Legal standards of practice
overlap of legal/ethical practice in counseling
- there are some behaviors/practices only required by law (reporting abuse of children, elderly, those with disabilities)
- sexual contact between client counselor is illegal in most states
- most states allow counselors to put ‘holds’ on clients for medical observation and assessment
- legally, parents have right to know about matters pertaining to their children (ethically could be helpful for parent to agree to need to confidentiality)
- Sometimes minors can enter into counseling without parental consent
- privileged communication is a legal right offered to counselors in most states
- assigning diagnositic codes to clients only for insurance purposes is fraud
Ethical issues in Group Counseling
Informed consent
providing info about rights and expectations to prospective group members prior to start of group
Ethical issues in Group Counseling
Confidentiality
group members have ethical obligation to maintain confidentiality. however, it can not be assured when there are multiple clients, and group members must be assured of that
exceptions to confidentiality must be identified
Ethical issues in Group Counseling
Social relationships
group members are discouraged from forming social relationships and discussing group issues outside of group
- discussion of this possibility should occur in group and agreement should be reached as to how to deal with it
Ethical issues in Group Counseling
Diverse groups
group leaders may need to discuss their values and their cultural assumptions
they need to respect cultural differences and world views of group members and model these behaviors for group members. members need to respect diversity
Ethical issues in Family Counseling
Counselor responsibility and values
who is the client? family or each member of family?
- does counselor align with abused spouse?
- what if one spouse wants to divorce and one wants to repair marriage?
Ethical issues in Family Counseling
Confidentiality and secrets
family members should discuss limitations of confidentiality
- will material brought up in individual sessions remain confidential or will they be brought up in family sessions?
- child abuse and incest must be reported
Ethical issues in Family Counseling
Custody and other legal implications
diagnositic labels on family can be used in court later
- what will be counselor’s role or how will counselor’s info be used in custory hearings? Who is client?
Ethical issues in Family Counseling
Counselors view on role of women in families
do they adhere to traditional gender roles?
Ethical issues in Family Counseling
Role values and expectations
many issues arising from working with culturally diverse families
- what are family roles and dynamics in that culture?
Chi Sigma Iota
Counseling Academic and Professional Honor Society International
began in 1985 at Ohio University
- purpose is to promote scholarship, professionalism, excellence in counseling
- members are students, educators, counseling practitioners
- over 130,000 individuals are members
- important function is development of leaders in counseling field
ACA
has 18 divisions including college counseling, counseling education/supervision, addictions, group work, social justice, etc.
I’m not writing out all of them… see page 306 in Helwig
ACA has over 55 chartered branches in US, Europe, Latin America
Total membership over 55,000
Former divisions of ACA:
- American school counselor association
- american mental health counselor association
