Most counselors have an appreciation for the possibility and diversity of ethical issues, but it’s easy to think they’ll never happen to you.
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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Counseling & Psychotherapy Ethics Code Explained
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.
7 Interesting Case Studies
In this section, we will describe a series of case studies, each featuring a different ethical challenge that focuses on one of the principles described above.
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.
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.
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.
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.
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.
3 Common Ethical Issues & How to Resolve Them
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.
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.
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.
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.
Ethical Considerations for Group Counseling
Group counseling can be an effective form of practice with several intuitive benefits.
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).
A Take-Home Message
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.
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- 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.
- Finn, J., & Barak, A. (2010). A descriptive study of e-counselor attitudes, ethics, and practice. Counseling and Psychotherapy Research, 10(4), 268–277.
- 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.
- Zur, O. (2008). Bartering in psychotherapy & counseling: Complexities, case studies and guidelines. New Therapist, 58, 18–26.