counseling ethics

What Ethical Challenges Do Healthcare Counselors Face, and What Strategies Can They Use to Address Issues Related to Confidentiality, Boundaries, and Patient Autonomy?

Posted on by Joseph Gerard

How well a counselor listens and responds to a client is key in showing the client she is heard but also understood. Good responding skills are key to help the client express and delve deeper.

Written by Isaac Smith.

Ethical Challenges in Healthcare Counseling: Confidentiality, Boundaries, and Patient Autonomy

Healthcare counsellors are vital to patients’ mental and emotional health. However, confidentiality, professional boundaries, and patient autonomy pose significant ethical issues. When healthcare counselling meets medical billing and administration, these issues become more complicated. These ethical issues must be addressed to maintain trust, legal compliance, and professional integrity.

The foundation of counselling is ethics, which guides counsellors in making client-centered decisions. In the counselor-client relationship, ethical behaviour is crucial to building and maintaining trust. Clients must trust their counsellor to act in their best interests, maintain confidentiality, and provide a safe space to express themselves.

Why Is Ethics Important in Healthcare Professions?

Healthcare decisions must be ethical because lives are at stake. Healthcare providers who can address ethical issues can make compassionate, fair, and effective treatment decisions.

Here are some reasons why ethics in healthcare benefits patients and practitioners.

Benefits for Patients

All ethical principles ensure respect for patients’ autonomy, equitable treatment, and the best care based on their beliefs and decisions. It allows patients to trust their doctors without reservation. Many patients delay medical treatment because it is invasive and promises no benefit.

A 2021 NORC study found that only 78% of participants trusted their primary care doctor, suggesting that many Americans may be unwilling to share important health information or consent to lifesaving procedures. Maintaining a strong ethical framework for doctors can increase patient trust and save lives.

 

Benefits for Practitioners

The core ethical principles benefit patients, but they also benefit healthcare workers. Having an ethical framework lets doctors discuss end-of-life care with patients and their families or quickly inform them about emergency care options.

Here are a few ways practitioners can benefit from ethical guidelines:

  • Practitioners can recommend a patient-centered solution to ethical conflicts with patients, their families, carers, or other staff.
  • A clear conscience is maintained by having guidelines to support one’s decisions, as ethics will dictate the best decision for the best outcome.
  • An ethical framework that covers an entire facility gives healthcare workers confidence that their coworkers are acting ethically. This improves coworker communication, reduces misunderstandings, and builds trust in each other’s decisions.
  • Ethical guidelines help doctors find the least invasive and most effective treatment for a patient, reducing the risk of risky or unnecessary procedures.
  • Nonmaleficence includes patients and healthcare colleagues. Administrators can reduce stress and make healthcare workers feel safe.

Ethical Issues in Healthcare: Patient Confidentiality Challenges

The complex world of healthcare has many ethical issues that affect decision-making and patient care. Patient confidentiality, the foundation of healthcare provider-patient trust, is one of our biggest challenges. We must protect patient privacy and sensitive information as medical professionals. This duty critically affects patient welfare and raises questions about the balance between confidentiality and other healthcare ethics.

Patient confidentiality is central to healthcare ethics. It involves protecting sensitive health information and respecting patient privacy. We must ethically protect patient data as healthcare providers.

Scope of protected information

HIPAA, passed in 1996, set national standards for patient health information protection. HIPAA covers demographics, medical history, test results, and payment information as PHI. These protections apply to all communication, whether electronic, written, or spoken.

Protecting 18 PHI identifiers is crucial. Names, locations, contact info, medical records, and full-face photos are included. We manage this data to maintain patient trust.

Digital age challenges

The digital revolution has improved healthcare but created ethical issues. EHRs and telehealth have increased efficiency and access to care, but they also raise privacy concerns. Patient data protection is difficult in an increasingly interconnected world.

Cyberattacks threaten patient privacy. Data breaches can expose sensitive information to unauthorised parties. Healthcare providers must take strong security measures to prevent such incidents and comply with privacy laws.

Emerging considerations for ethical issues in healthcare

The ethics of patient confidentiality are changing rapidly. In the digital age, data ownership and informed consent are complicated. When patients provide health information, they expect it for their care only. For-profit companies’ growing interest in healthcare databases raises ethical concerns.

We must decide who owns and can access patient data. We must address the ethical issue of commercial exploitation of altruistically provided patient data.

Healthcare’s use of AI and big data analytics complicates informed consent. When using complex algorithms and predictive models, patients may not understand how their data will be used. We must find ways to protect patient autonomy and informed decision-making in a complex technological landscape.

These ethical issues in healthcare require a delicate balance. We must protect patient privacy and autonomy while advancing medical knowledge through research and providing effective, beneficial care. Digital healthcare professionals’ ethical obligations revolve around this balance.

Legal and Regulatory Landscape

Legal and regulatory factors shape patient confidentiality in healthcare ethics. We follow a complex set of laws and regulations when handling sensitive health data.

Federal laws (HIPAA, HITECH)

HIPAA of 1996 is the federal law that protects patient privacy. HIPAA set national standards for protecting individually identifiable health information. HIPAA’s Privacy Rule governs the use and disclosure of health information, and the Security Rule establishes national standards for electronic PHI confidentiality, integrity, and availability.

HIPAA’s provisions were strengthened by the 2009 HITECH Act. HITECH increased business associate responsibilities under the HIPAA Security Rule and increased penalties for noncompliance. The HIPAA Breach Notification Rule requires us to notify individuals, the Department of Health and Human Services, and the media of unauthorised PHI disclosures.

 

State-specific regulations

Many states have passed laws to supplement HIPAA’s patient confidentiality protections. State regulations often fill federal gaps and are stricter than HIPAA. The California Confidentiality of Medical Information Act (CMIA) protects abortion, contraception, and gender-affirming care data.

SB 786: Maryland’s Electronic Health Record Data Privacy bill protects reproductive health information. These state laws govern when data can be shared and when it cannot, especially for procedures that are legal in one state but not another.

 

International privacy standards

As healthcare globalises, we must consider international privacy standards. The EU’s General Data Protection Regulation (GDPR) has raised data protection standards worldwide. GDPR requires strict data protection and informed consent for data processing for U.S. healthcare providers treating European patients.

To navigate this complex landscape, we must monitor changing regulations and implement strong privacy policies. Healthcare professionals have ethical obligations beyond legal compliance to protect patients and confidentiality. Understanding and following these laws and standards can help us address healthcare ethics and maintain physician-patient trust.

Strategies to Protect Confidentiality

Healthcare counsellors and organisations must follow ethical and legal confidentiality protocols to address these issues.

  • Limit Data Access: Only authorised personnel should access patient data. Role-based access control restricts details to necessary staff.
  • Secure Documentation Practices: Counsellors should avoid detailed session notes in shared records. Instead, document general treatment information while protecting private discussions.
  • Educate Staff on HIPAA Compliance: All healthcare workers, including administrative and billing staff, should receive regular HIPAA training to understand data privacy and patient information handling.
  • Use Encrypted Communication Channels: Email and digital communication between healthcare providers should be encrypted to prevent data leaks.
  • Clarify Information Sharing Policies: Patients should know how their data is stored and shared. Providing a clear consent form with confidentiality policies builds trust.

These strategies help healthcare providers maintain patient confidentiality and comply with laws and ethics.

Maintaining Professional Boundaries

Healthcare counselling requires professional boundaries. Limits define the counselor-patient relationship and ensure professional, ethical, and effective interactions. However, when financial and administrative discussions overlap with therapeutic care, these boundaries can be difficult to maintain.

A counsellor with dual roles in healthcare faces one of the most common boundary-related ethical dilemmas. If a counsellor handles both therapeutic care and billing, the patient may feel confused about their role or pressured to make financial decisions that affect their care. Counsellors may struggle to provide impartial support due to this dual relationship.

Over-involvement in emotions can also blur professional boundaries. Counselling requires empathy, but excessive emotional attachment can cloud objectivity and clinical decisions. Counsellors must balance compassion and professional detachment to make patient-centered recommendations.

When patients cannot afford recommended treatments, financial conflicts can arise. Counsellors must balance advocating for needed care with financial constraints, creating ethical dilemmas. Counsellors may feel pressured to adjust treatment plans based on insurance rather than clinical needs. To avoid such conflicts, counselling and billing departments should have clear roles, and trained administrative staff should handle financial discussions rather than healthcare providers.

Healthcare organisations should set ethical standards, train counsellors, and promote transparency in patient interactions to maintain professional boundaries. Patients should understand the roles of each healthcare professional to avoid feeling pressured or misled during treatment.

Respecting Patient Autonomy

Ethical healthcare relies on patient autonomy, allowing patients to make informed medical decisions. This principle allows patients to give informed consent, refuse care, and understand treatment costs.

Challenges in Preserving Patient Autonomy

Financial constraints and insurance policies hinder patient autonomy. Many patients must choose treatments based on cost rather than medical necessity, which can pressure counsellors to prioritise affordability over best practices.

Another issue is health literacy. Patients often struggle to understand medical terminology, treatment options, and insurance coverage, making decisions difficult. When patients lack the knowledge to make informed decisions, their autonomy is compromised.

Refusing medically beneficial treatments also creates ethical issues. Counsellors must balance patient autonomy with professional guidance.

Strategies to Support Patient Autonomy

Counsellors can help patients make informed healthcare decisions by using these methods:

Provide Clear and Accessible Information: Medical jargon should be avoided when explaining treatment options. Illustrations, brochures, and digital tools aid comprehension.

Offer Financial Counseling: Financial advisors and medical billing specialists can help patients understand treatment costs and make informed decisions.

Encourage Open Communication: Counsellors should create a nonjudgmental space where patients can express their concerns, questions, and preferences.

Ensure Comprehensive Informed Consent: Counsellors should create a nonjudgmental space where patients can express their concerns, questions, and preferences.

Respect the Right to Refuse Treatment: Counsellors should educate patients on the benefits of recommended treatments but respect their decisions, even if they contradict medical advice.

These strategies help healthcare counsellors give patients ethical, patient-centered support while letting them make their own decisions.

Conclusion

Counsellors are vital to patients’ mental and emotional health, but confidentiality, professional boundaries, and patient autonomy are major ethical issues. Maintaining trust, legal compliance, and professional integrity requires addressing these issues. Healthcare ethics ensures autonomy, equity, and the best care based on patients’ beliefs and decisions, benefiting patients and practitioners. Ethical guidelines help doctors find the least invasive and most effective treatment for patients, reduce risky procedures, and promote nonmaleficence. HIPAA sets national standards for patient data protection, making confidentiality difficult. AI and big data analytics complicate informed consent and raise privacy concerns in the digital age.

HIPAA sets national standards for health information use and disclosure to protect patient privacy. HIPAA is supplemented by state laws like CMIA and Maryland’s Electronic Health Record Data Privacy bill. Healthcare is also affected by international privacy standards like the GDPR. Carer ethics go beyond legal compliance to protect patients and confidentiality. Healthcare providers must follow ethical protocols, limit data access, use secure documentation, educate staff on HIPAA compliance, use encrypted communication channels, and clarify information sharing policies to maintain confidentiality. Professional boundaries are important, but finances and health literacy can limit patient autonomy. Clear information, financial counselling, open communication, informed consent, and respecting the right to refuse treatment support patient autonomy.

 

Here is the bio: Isaac Smith is a writer for Medcare MSO in the ICD-10 Editorial department, where he focuses on medical billing services.

He is a highly accomplished healthcare professional with over 13 years of experience in healthcare administration, medical billing and coding, and compliance. He holds several AAPC specialty certifications and has a bachelor’s degree in health administration. He worked previously at a large, multi-physician family care and occupational health practice.

 

Please also review AIHCP’s Health Care Ethics Consultant Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

 

Counseling Pitfalls Video

Posted on by Dominick Flarey

Counselors can fall into pitfalls with clients and encounter ethical dilemmas often without knowing it.  They can sometimes be placed between two conflicting sources as well.  It is important to identify potential pitfalls and understand proper responses to avoid later ethical issues or possible termination by employer or suspension of licensure.

Counselors need to be aware of various pitfalls that can endanger their position and career. Please also review AIHCP’s various mental health certifications

 

 

 

 

 

 

 

 

 

The video below highlights and illustrates different types of scenarios and certain preventive measures to protect one’s career.  Please also review AIHCP’s various Mental Health Certifications for Human Service Professionals.  The certifications can serve both licensed and unlicensed professionals in advancing their careers.

Please review the video below

Counseling Ethics and Ethical Standards Video

Posted on by Dominick Flarey

Ethics in counseling has standards that counselors in the human service field must adhere to in regards to conduct with clients, other counselors, employers, students and other peers.  They are essential to ensure quality and standards within the field of counseling.  Various organizations such as the American Counseling Association offer lists of standards that the profession adheres to in regards to conduct.

This video below reviews in more depth counseling standards and ethics.  Please also review AIHCP’s Certifications for counselors including Grief Counseling, Christian Counseling, Crisis Intervention, Anger Management and Stress Management.

Avoiding Ethical Conflicts in Counseling

Posted on by Dominick Flarey

Whether a licensed clinical counselor or merely a pastoral unlicensed counselor, there are expectations and standards expected from a counselor.  One could be counseling as a licensed counselor or as certified Christian Counselor and find the same ethical pitfalls that may potential befall oneself with a client.   In a previous blog, we discussed the importance of standards found within the ACA, AACC, or NASW, as examples of how to interact and work with a client as a professional within the field of counseling.  In this discussion, we will review an important article from the APA that discusses how to best avoid potential ethical issues with clients.

Counseling Professionals need to adhere to ethical standards but also be aware of the numerous pitfalls that can lead to unwanted ethical dilemmas

 

We all wish to serve our clients with their best interest at heart.  Christian Counselors take it another level with spiritual emphasis and Christian doctrine.  They see their clients as spiritual children.  Some pastors serve within a clergy-penitent model where they are not merely counseling, but are spiritual mentors and advisors.   In these cases, where the ethical waters muddy, as to whether one is pastor or counselor, one must clearly delineate one’s role with the person and clearly define the lines of what type of counseling is occurring.   As well as in other cases, when counselors work with state authorities or firms in relationship to working with individuals within their scope with those authorities or firms.   One’s role, transparency, and matter of operation with mandates to report, will all fall into one’s role and status within the counseling relationship.

The article, “10 ways practitioners can avoid frequent ethical pitfalls” by Deborah Smith takes a very close look at 10 particular types of pitfalls a counselor can find oneself in with a client if not careful.  Smith not only points out these pitfalls, but also directs counselors how to better avoid and protect oneself from them.  She states,

“Talk to the ethics experts, and they’ll tell you the best defense against an ethical problems is a good offense. By looking out for foreseeable conflicts and discussing them frankly with colleagues and clients, practitioners can evade the misunderstandings, hurt feelings and sticky situations that lead to hearings before ethics boards, lawsuits, loss of license or professional membership, or even more dire consequences” (Smith, 2023,p 50).

She continues, “When psychologists do end up in ethical quandaries, it’s often because they unwittingly slid too far down a slippery slope–a result of ignorance about their ethical obligations or thinking they could handle a situation that spiraled out of control (Smith, 2023, p. 50)

To read the entire article, please access here

Relationships

One problem Smith points out is multiple relationships with the client.  Of course, relationships with any client are strictly forbidden, but sometimes other ties can emerge where the counselor and client interact whether at a social scene, or in business, especially in smaller towns.  Smith points out that due to the counselor and client relationship, other interactions can be affected due to the counselors perceived sense of power over the client.  Hence anything outside the counseling sphere should be in the very least brief and if necessary terminated.  This can prevent potential harm or confusing situations that can possibly cause ethical questions or inquiries.

In addition, counselors should not take incoming patients that are family, friends, or associates.  This prevents potential bias.

Confidentiality 

Another problem pointed out by Smith regards confidentiality issues.  Since licensed counselors are mandatory reporters of any crime, it is important for counselors to let clients know the limits of confidentiality at the very beginning within the informed consent form, as well as throughout the session.  If a client wishes to confess a secret, it may be best to again warn the client of the limitations of confidentiality.   Even, pastors, while protected in most states more so than counselors, have an ethical dilemma as to whether report a crime, or reveal possible harm to the client or others.  Unlike the Catholic or Orthodox priesthood, pastors are not held to the strict seal of the confessional, but they still have more flexibility to report things than a priest.

Ensuring that the client understands limits of confidentiality is key to preventing unwanted ethical dilemmas of possible mandatory reporting

 

In such pastoral settings, this is where the pastor or priest guides the person to the proper conclusion of reporting oneself, or turning oneself in.  In the case of a crime, a pastor can encourage oneself  to report oneself to the authorities and accept the consequences as a price of their sin, or if the person is a victim of abuse, help the person find the safety from the authorities that is needed.  While the issue of fidelity and trust is key, protecting the person and measuring trust versus harm is key.  Again, simply by reminding one the limits of confidentiality is key throughout any session.  It can show the veracity of oneself to the client but also the intent for the overall good of not only the client but others involved.  In the more severe case of the priesthood, where counseling is not occurring but instead the Seal of Confession, the priest has the unique position to incur a penance that forces one to turn oneself in if one wishes to receive absolution and can also in the most indirect ways, without names, warn others of possible harm.

Whenever, crimes such as abuse either inflicted by the client or received by the client can create an uneasy balance between confidentiality and mandated reporting.  Again, why it is important to remind individuals of the limitations of confidentiality.

In addition, Smith reminds counselors to store confidential records in the most secure locations, whether they are electronic or written and to fully understand the laws surrounding any possible surrender of these records regarding criminal or civil cases. Smith also encourages counselors to properly document everything.  This means keeping good records and fulfilling all paper work regarding.  This involves properly covering informed consent, patient history documents, dates of service and fees and any diagnostic impressions, relevant phone calls, or follow up efforts if a patient or client discontinues to attend sessions or accept calls.

Competency

Smith also discusses the importance of never taking on a client in a field that a counselor is not comfortable with in regards to practice or expertise.  It is unethical to counsel someone in grief if a person does not possess the knowledge in grief to properly help.  Hence, competence within the field requires the proper academic and professional training in that area to properly help the client.  It is critical that certified non clinical counselors never treat patients with mental pathology or falsely misrepresent themselves as licensed counselors or attempt to counsel beyond their academic and legal abilities.

Whether grief or Christian counseling, one should understand their limitations and competency if not a licensed professional counselor

 

In addition, many professionals, who possess the proper degrees and licensures, also keep their competency through continuing education or certifications.  AIHCP offers a wide variety of mental health certifications in Grief Counseling as well as Christian Counseling.

Another issue of competency would be the situation if a counselor or social worker aided in a case of child custody without enough knowledge about the legal system, court system, or the inner dynamics of the family.   It is important for those who are called to counsel, or offer expert opinion to answer questions one is only competent in.  The attempt to create a false image of genius when competency in the subject is not there is a huge pitfall.

For those with competency in the subject, avoiding bias is key in anything, especially in court cases.  This involves a comprehensive understanding of all dynamics that is not based on third party assessments.  Furthermore, any assessment needs to be completely thorough as well as based on scientific based methods.  Also, it is important to discuss any limitations one may have when counseling or discussing a case in court.  Transparency and honesty in any assessment is key.

Abandonment or Termination?

Finally, Smith points out that counselors need to understand the proper differences between abandonment and termination in practice.  Abandonment is completely unethical and involves abruptly ending all treatment without prior notice.  If a counselor for ethical purposes, or competency, feels he or she can no longer properly help the individual, this should be discussed in detail with the client.  The client should also have input and the two should find common ground in when the last meeting will take place, including any needed follow up, as well as alternative sources for therapy with other more qualified professionals. It can also be beneficial to lay out terms of termination prior to counseling so the client understands whether treatment is short term or long term.  This can lay groundwork for any possible issues or false expectations by the client.

Conclusion

Counseling is meant to cause no harm, but ethical situations can come into play that can potentially cause harm.  By adhering to standards and following protocol, one can better protect oneself and also protect one’s client from unintended harm.  Understanding the counseling system and its ethics and laws, can help the counselor better treat and counsel the client without causing any confusing situations or ethical dilemmas.  It is key to know one’s counseling role and how one is operating as well.  Is one counseling within a licensed clinical framework or pastoral sense?  These are key questions and important issues to identify that play large roles in confidentiality and competency within their legal and academic abilities.

Counselors are called to a high standard of ethics. Please review AIHCP’s Mental Health Counseling Certifications

 

Please also review AIHCP’s Mental Health Certification Programs.  The programs include topics such as grief counseling, anger management, crisis intervention, Christian or spiritual counseling, stress management, EFT, and Meditation.  The programs are online and independent study and open to qualified professionals seeking a four year certification.  Some professionals may be licensed while others may be looking into these fields as a non licensed professional but still possess the necessary academic or professional backgrounds.

Reference

Smith, D. (2003). “10 ways practitioners can avoid frequent ethical pitfalls”, Monitor on Psychology 34(1).  Access here

Additional Resources

“Counseling Ethics Code: 10 Common Ethical Issues & Studies” Smith, W. (2021). Positive Psychology.  Access here

“Ethical Dilemmas in Counseling”. Nemko, M. (2019). Psychology Today.  Access here

“Eye on Ethics”. Reamer, F. (2006). Social Work Today.  Access here

 

 

 

 

Counseling Ethics for Counselors in Grief or Christian Counseling

Posted on by Dominick Flarey

This is required reading for students taking SC 570 or GC 400.

The norms of ethics to any particular field helps maintain a standard of quality that is expected from certain professionals within a certain field.  It guides them in situations of doubt, directs them in proper procedure, and protects them and the client from unintended harm.  Dating back to the Hippocratic Oath, the idea to do no harm to those one helps is the cornerstone and foundation of all professional ethics.

Ethics in Counseling

It was not until modern era that ethics began to take a more codified form for professionals.  Thomas Percival due to poor performance in his own medical facility created the standard and blue print for modern medical ethics.  Other professional careers, including, mental health, counseling and anything within human services soon followed with their own standards.  The American Counseling Association (ACA), the American Association for Marriage and Family Therapists (AAMFT), the National Association for Social Workers (NASW), the National Organization of Human Services (NOHS) and the American Association of Christian Counselors (AACC) all have developed mission statements and standards and guidelines for professionals to adhere to.  These standards are usually divided into areas of care to the patient, the profession, other colleagues, students, payment policies and publications.   It is important if entering into the counseling field to read through these and understand the ethics one must adhere to.

Counseling involves trust and many ethical standards from various associations ensure the integrity and quality of counseling. All counselors should review the various ethical standards found in ACA or other associations

 

Bear in mind, some counselors are pastoral and others are clinical.  Different states assign different titles to licensure.  In counseling, the most common is Licensed Professional Counselor or LPC.  Other variations can include Licensed Mental Health Counselor (LMHC) or Licensed Clinical Professional Counselor (LCPC).  Most states require a graduate degree in counseling and a passing of the state board exam to become fully licensed.  Paraprofessionals are unlicensed counselors can work under licensed counselors or within a care facility but there are not able to independently operate.  As for pastoral counselors such as ministers or lay apostolates, these individuals are permitted to operate due to separation of church and state but are restricted beyond the realm of guidance.  Treatment and pathology are alone reserved for licensed professionals in social work, counseling, and psychiatry.   Whether a counselor, social worker or a psychologist, only a healthcare professional such a psychiatrist, medical doctor, or Nurse Practitioner can prescribe medications.  This is why many mental health facilities have the proper prescribers available on staff.

If a pastoral counselor with only a certification from AIHCP in Grief Counseling or Christian Counseling, one must ethically adhere to proper identification.  The term “counselor” can be very misleading because it is so generic and widely used.  Individuals use the term in everyday breath but there is a huge difference between clinical professional counselors and pastoral counselors.  Pastoral counselors operating as grief counselors or Christian counselors can help guide but never treat pathology.  They also cannot mislead clients into thinking they are licensed.  This needs to be understood and articulated upon the first day.  What one can do and not do needs to be clearly articulated to and understood by the client.  As for licensed professionals who receive certifications from AIHCP, this is clearly not an issue.

Some counselors are licensed and others are not. It is important to properly identify your credentials and operate within your legal boundaries

 

In Denise Daniel, short but concise book “Counseling Principles and Christian Beliefs: An Integrated Approach”, she lays out some important concepts not just for Christian Counselors but also any type of licensed or non-licensed counselors.  She first points out the importance of identity and what counselors are or not and what are their limitations as licensed or not licensed or the expertise they possess.  Second, she points out what is the role of the particular counselor.   She emphasizes that most counselors, according to ACA, look to create a professional relationship that empowers and strengthens diverse families and groups to better achieve mental health, wellness, education and career goals.  The aim is more centered around wellness and prevention (Daniel, 2020, p. 3).  The final third point is integration and how one’s own biases, beliefs and codes of behavior come into play as a counselor.  Fortunately, ethical codes point out numerous guide posts for professionals in where and how to integrate themselves with patient care.

According to Daniel, the ACA lays out some core principles.  Among the key themes she addressing in her book are patient autonomy, non-maleficence, beneficence, justice, fidelity and veracity (2020, p. 5).  Before we review some of the key ethical guidelines, it is important to look at some of these themes and how they apply to licensed counselors but also pastoral counselors, and in some cases, Christian Counselors.  Bear in mind, whether grief counselor, licensed or non-licensed, these themes apply to all in the counseling fields.

Important Themes in the Counseling Relationship

Autonomy refers to allowing the patient to be free to make choices in their overall health and life.  A counselor needs to respect the choices of a client whether approval or disapproval occurs.  For Christian Counselors, this may seem contrary to the goal.  There are certain moral precepts that must be obeyed but in a relationship, one must exercise patience.  Scripture points out that God gave Adam and Eve free will.  He respected autonomy and choices.  Again in the parable of the Prodigal Son, the father, permits the autonomy of his son to make poor choices but still never gives up hope that he would one day return.

Non-maleficence refers to doing no harm.  Counselors, whether they want it or not, hold all the power in the relationship and they must be very careful in not allowing that power to become corrupted.  This can happen very easily because the client is in distress and looking for guidance.  A counselor can influence and exploit a client very easily hence numerous standards exist to balance this relationship.  The goal of counseling is to heal not harm.

Beneficence refers to promoting only good for the client.  It involves helping the client with the best possible and verified studies and knowledge on the subject.  It involves looking out for the best of the client and guiding them to their ultimate best end.

Justice refers to fairness to all clients and ensuring equality to the numerous diverse groups one serves.  It also involves understanding social justice and promoting justice for those who are persecuted.

Fidelity refers to faithfulness to the client.  It involves never betraying them, keeping things confidential and not abandoning them.  It means working through the most difficult things and not giving up on them.

Finally, veracity refers to honesty.  Trust and honesty is the foundational rock of all relationships.  Without honesty, one cannot communicate facts, one cannot share realities, and one cannot heal and grow.  Honesty also involves the counselor’s assessments, promises, and outlooks.  Even when difficult situations arise, honesty with respect is expected in a counseling relationship.

Important Ethical Codes

There are a variety of critical ethical codes  that are all found within the various associations that mirror and reflect the themes above but also dictate more detailed situations.

For instance, in the ACA code of conduct A.4.b., it is clearly emphasized that an individual should never impose one’s own beliefs on another and to respect the diversity of the client.  The idea of discrimination against other faiths, cultures, sexualities or values can come into play easily.  This is why the AAMFT’s code 1.1 deals directly with this type of discrimination.  One is not to discriminate against others based on these types of differences.  The AACC has a slightly different tilt on the issue since the type of counseling itself is Biblical and certain life styles or actions are contrary to the type of counseling being sought.  This however does not present a green light for the Christian Counselor to impose own personal beliefs.  AACC’s code 1-340-a reminds the Christian Counselor that one is still to respect the autonomy and decision making process of the client.  Again, 1-530 dictates that the Christian Counselor respect other faith beliefs and only disclose upon request and only if it benefits the client.  Daniels proposes a term referred to as “bracketing” where professional opinions are laid aside and avoiding the triggering of one’s own personal views (Daniels, D., 2020. p.4).  Please also see ACA’s  A.2.c. Developmental and Cultural Sensitivity standard.

 

In all counseling, it is important to keep the counselor’s personal beliefs removed from the story. In Christian Counseling, while religious values are shared, the personal bias of the counselor must still respect the autonomy of the client, as well as never abandon the client due to immoral choice or life style

 

Common to this ideal of bias and discrimination fuels the idea of abandonment.   Counselors may feel the temptation to dismiss a client who will not listen, fulfill promises, or follow a certain value system.  This unethical practice is condemned in all guidelines.  The ACA guideline A.12. stipulates that counselors never quit seeing their clients without proper continuation of treatment through themselves or through others.  The AAMFT guideline 1.11 shares the same view that no client is to be abandoned and not seen without reasonable arrangements for continued treatment.  The AACC in its rule 1-640-a shares with all other human service entities that a client is not to abruptly abandoned and that treatments are to continue until other options are available.

Another important theme is referral.  Many times, certain counselors may become overwhelmed with a particular issue beyond their standard of care.  This can especially  happen with paraprofessionals or unlicensed counselors who are merely pastoral.  Many fall under this venue.  This does not mean they do not offer a qualify service but due to knowledge or professional and legal limitations, a referral is sometimes necessary.  The ACA guideline A.11.a stipulates that a client that is beyond their skill level or competency should be referred to another professional.  In the AAMFT guideline 1.10 also states that professionals may refer clients to others professionals when they are unable to help.  Again, in the AACC guideline, Christian Counselors 1-240-d, it is stipulated that Christian Counselors should not refer merely based on faith based issues but when situations grow beyond their skill level, they can refer to more capable authorities.

Relationships can also become toxic.  Due to the imbalance of power between in the  counselor-client relationship, abuses of power can occur.  Within the guidelines in all associations are clear cut warning regarding exploitation.  Sexual relationships are condemned in the most strict sense.  It is not uncommon for a vulnerable person sometimes to develop feelings for a counselor and it is important for the counselor to correct and document these advances.   Counselors are also ethically restricted from working with past romances, family, or close friends.  The bias can be strong in these cases in helping the individual.  Counselors also need to keep a distance in cases of friendship.  The relationship is not one of friendship in the social meaning.  Hence, counselors should avoid most social interactions with clients, such as parties, graduations, or dinners.  In some cases, if it pertains to a particular issue or healing, a counselor can appear on a professional basis only. Please refer to ACA -A.5. Prohibited Non-counseling Roles and Relationships which cover a broad array of relationships that can occur that considered illicit in counseling.  In addition a counselor is to refrain from sexual relations in the NASW handbook as well as physical contact (1:10) when such contact would cause psychological harm.  So where a hug or a touch of hand is needed is to be very carefully judged by the counselor.  In addition, language and proper presentation in how one speaks is listed in the NASW handbook under standard 1:12.

Unfortunately, sometimes, a client may become attracted to a counselor since the counselor represents a source of power and strength when the client is most vulnerable.  It is important for the counselor to be empathetic but also distant when attraction occurs, especially mutual.  In some cases, referrals may be needed.  To also help prevent such situations, physical gestures such as a touch of the hand or hug should be avoided.  In addition, one should carefully screen the acceptance of gifts, unless otherwise approved due to cultural issues and sensitivities.

Other conflicts of interests can occur within agency and client.  If dealing with one’s organization, one may also feel tugged and pushed by agency or funder agendas, over client care.  Time, funds, and allocation of resources may effect one’s success.  This can cause a grey area in client care and the client’s well being.  It can also potentially lead to not following policy of employer.  As one can see, many ethical dilemmas can spring from such actions.

Another  set of regulations we will look at involves confidentiality.  A counselor sets out on day one what he or she is willing or can do to the best of their abilities.  Within this, there exists a confidentiality that is critical to veracity and fidelity.  The boundaries of that need to be clearly laid out.  All standards assert that counselors are to keep records and conversations private.  Records are to maintained safely, whether paper or electronic, and conversations are to be kept strictly between themselves, unless otherwise dictated.  Exceptions, upon approval of client, can include access to records for particular family, or access to records via other team members treating the individual.  Again, this agreed upon in advance.  Please refer to ACA -B.1. Respecting Client Rights which covers issues of confidentiality as well as exceptions under B.2

Confidentiality is the bedrock of trust between the counselor and client and must be protected and preserved unless under certain exceptions of physical harm to the client or others

 

In cases, where an individual may cause harm to oneself or others, or upon certain legal orders, a counselor may disclose certain information for the overall safety and good of the client or others.  This is far less lax than the seal of confession.  One way to better protect and shield oneself from potential mandatory disclosure is listing limits of confidentiality with the informed consent form.  In addition, to reminding them throughout the counseling process of the limitations especially when a client seems eager to share a secret.  Clients many times feel everything is confidential and fail to understand these limitations.

It is also essential that counselors properly store and preserve documentation.  Electronic as well as hand written files needs to be clearly locked and protected and not visible to other wandering eyes.  This helps preserve confidentiality.

Another grey area that may occur is transparency in representation.  If hired by the state or an authority to review divorce cases, criminal cases, or employee evaluations, counselors need to be very transparent with all parties involved.  Documentation for any case needs to be comprehensive, unbiased and utilize accepted and modern strategies.  It is also essential to never treat someone beyond one’s ability, or promise things beyond healing.  One should also not advertise oneself as a licensed counselor if not a licensed counselor.

Conclusion

Standards and ethical codes are critical to protect counselor and client.  They also lay the groundwork for better care and healing for the client.  In additional resources and references, there is a list that includes the ACA and others.  Links are provided.  I highly recommend one reviews these regulations and completely understands the ethical expectations of counseling, whether at a pastoral or clinical level.  Whether secular or religious, there are standards that are needed within this special type of relationship.

Ethics and standards are critical to the profession of counseling. Please also review AIHCP’s Christian and also Grief Counseling Certifications

 

Please also review AIHCP’s Christian Counseling Certification as well as AIHCP’s Grief Counseling Certification.  The programs are online and independent study and open to all qualified professionals seeking certifications in Christian or Grief Counseling.

Additional References

“Counseling Principles and Christian Beliefs: An Integrated Approach”. Daniels, D. (2020). Kendal Hunt Publishing Company

American Association of Christian Counselors (AACC). (2023). Code of Ethics. https://www.aacc.net/wp-content/uploads/2023/02/AACC-Y-2023-Code-of-Ethics-FINAL-Draft.pd

American Association for Marriage and Family Therapy (AAMFT). (2023). Code of Ethics. https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

NASW, National Association of Social Workers. (n.d.). https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-Clients