1. ACA Ethics Deep Dive: Knowing the ACA Code of Ethics Inside And Out Is More Important Than Ever
Lynn E. Linde, Ed.D.
Chief Knowledge and Learning Officer
Center for Knowledge and Learning
TLPCA
June 6, 2019

2. Objectives:
Participants will:
Understand the importance of ACA Code of Ethics and the information contained in the Code;
Understand how the Code directs and impacts practice; and
Become knowledgeable about how to make ethical decisions.

3. Key concept
The 2014 COE clarifies what was always in the Code of Ethics and puts the welfare of the client first.

4. The 2014 ACA COE
Applies only to counselors in fulfilling their professional responsibilities with clients, students, supervisees, research subjects, and when consulting.

5. 11 members representing all aspects of counseling, geographical areas
2014 revision process
11 members representing all aspects of counseling, geographical areas
3 year iterative process
Input received from across the profession, incorporated into drafts
Draft code on webpage, in publications – comment period
Finalized fall 2013, approved by Governing Council March 2014

6. Preamble
Definition of counseling: Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education, and career goals.
The preamble has 2 parts, both of which are new to the 2014 COE:
Professional values
Ethical principles

7. Professional Values
Enhancing human development through the lifespan;
honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential and uniqueness of people within their social and cultural contexts;
promoting social justice;
safeguarding the integrity of the counselor-client relationship; and
practicing in a competent and ethical matter.

8. Ethical Values
Autonomy
Nonmaleficence
Beneficence
Justice
Fidelity
Veracity (new 2014)

9. COE Purpose
The Code:
sets forth the ethical obligations of ACA members and provides guidance intended to inform the ethical practice of professional counselors;
identifies ethical considerations relevant to professional counselors and counselors-in-training;
enables the Association to clarify for current and prospective members, and for those served by members, the nature of the ethical responsibilities held in common by members;

10. The Code, continued
4. serves as an ethical guide designed to assist members in constructing a course of actions that best serves those utilizing counseling services and establishes expectations of conduct with a primary emphasis on the role of the professional counselor; and
helps support the mission of ACA.
The standards contained in this Code serve as the basis for processing inquiries and ethics complaints.

11. Section A: The Counseling Relationship
Records and documentation
Avoiding harm and imposing values
Prohibits non-counseling roles and relationships
Managing and maintaining boundaries and professional relationships
Unacceptable business practices – fee splitting
Termination and referral

12. Termination and Referral
A.11.b Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

13. Section B: Confidentiality and Privacy
Exceptions (to confidentiality)
Records and documentation
Case consultation

14. Section C: Professional Responsibility
Competence
Consultations and ethical obligations
Nondiscrimination
Treatment modalities

15. How do we define competence?
Lack of competence is based on several factors and is specific to each counselor:
Scope of practice of credential held by the counselor
Education, training and experience of the counselor
Setting in which the counselor practicing – scope of work
May refer when a higher level of practice is needed than the counselor is able/qualified to provide
Does not include lack of knowledge/skills/information about any client characteristic – must educate self, seek supervision, consultation

16. Competence

17. C.5 Nondiscrimination
Counselors do not condone or engage in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/partnership status, language preference, socioeconomic status, immigration status, or any basis proscribed by law.

18. Section D: Relationships with other professionals
Relationships with colleagues, employers, and employees
Provision of consultation services

19. Section E: Evaluation, Assessment, and Interpretation
Diagnosis of mental disorders
Forensic evaluation: Evaluation for legal proceedings

20. Section F: Supervision, Training and Teaching
Supervisory relationship and supervisor responsibilities
Responsibilities of counselor educators
Student welfare
Evaluation and remediation, gatekeeping
Roles and relationships between counselor educators and students
Multicultural/diversity competence in counselor education and training programs

21. Section G: Research and Publication
Research responsibilities
Managing and maintaining boundaries
Publications and presentations

22. Section H: Distance Counseling, Technology, and Social Media
Knowledge and legal considerations
Informed consent and security
Client verification
Distance counseling relationship
Records and web maintenance
Social media

23. Section I: Resolving Ethical Issues
Standards and the law
Ethical decision making models
Suspected violations
Cooperation with ethics committees

24. Boundaries: What are they?
Boundaries are the frame around the relationship that helps define the roles of the participants in the therapeutic relationship
Helps the participants know what to expect
Helps provide consistency in the therapeutic relationship
Issues involving boundaries are variable and depend on the people involved and the situation
Not static; may change
Situational
Many types of boundaries
Critical to be aware how they impact the counseling relationship

25. Boundary crossings versus violations
Boundary crossing: a departure from a normally accepted way of doing things to benefit the client; it is situational
Boundary crossings:
Often discuss using terms such as dual relationships, beneficial vs. harmful behaviors, extending relationships beyond conventional boundaries

26. Crossing boundaries Boundary crossings, continued
Need to examine why there is a need to cross the boundary
Need to weigh the potential harm to the client against the potential benefits
Are you consistent in your boundaries? Would you do this same thing for another client in similar circumstances?
Is the behavior an accepted part of your workplace
Boundary violation: a serious breach that causes harm

27. Crossing boundaries
Occasional or some boundary crossings can be justified if there is benefit to the client and little risk of harm
But frequent crossings may place the practitioner at risk.

28. Ethical Decision Making
When counselors are faced with an ethical dilemma, they use, and document as appropriate, an ethical decision making model.
A number of models exist and more continue to be created.
No one model is more effective than others.
Some models may be more useful in certain situations that others.

29. Forrester-Miller and Davis Model 2016
1. Identify the problem.
2. Apply the ACA Code of Ethics.
3. Determine the nature and dimensions of the dilemma.
4. Generate potential courses of action.
5. Consider the potential consequences of all options and determine a course of action.
6. Evaluate the selected course of action.
7. Implement the course of action.

30. Infographic

31. HPSO 2019 Report Key Findings
2014 Report (10 years of data): 1,043 adverse incidents and claims reported
2019 Report (5 years of data): 5,626 adverse incidents and claims reported
Top finding: sexual misconduct and allegations of multiple relationships with clients despite the potential for client harm increased in severity
Increase in closed cases of allegations of failure to practice within boundaries of competence
Failure to maintain minimal professional standards, sexual misconduct, breach of confidentiality, and reporting to third parties highest distribution of license protection paid claims

32. JCD article
Wilkinson, T., Smith, D., & Wimberly, R. (2019). Trends in ethical complaints leading to profession counseling licensing boards disciplinary actions. Journal of Counseling and Development (97), DOI: cad/12239.
Surveyed state licensing boards in all states and DC for data
Looked at nature of complaints against counselors licensed to practice independently that resulted in disciplinary action
#1 – Continuing education violations (16.8%)
#2 – Nonsexual dual relationships (12.5%)
#3 – Sexual relationships (9%)
#4 – Misrepresenting credentials (6.7%)

33. Most Frequent Ethics Consultations

34. Extending the counseling relationship beyond conventional parameters
1 - Boundaries
Extending the counseling relationship beyond conventional parameters
Concept of “dual” relationships is typically outdated (check licensure laws)

35. Managing professional vs. personal accounts,
2 - Social Media
Managing professional vs. personal accounts,
Engagement with others and extending boundaries,
Referrals requests and facilitating consultations using online groups (NO!)

36. 3 - Distance Counseling Services
Point of Service
Licensure regulations
Practice within and across state / jurisdictions,
Compliance issues
Texting (communication policies and procedures)

37. Board qualifications to provide supervision Requirements for faculty
Relationship and boundary issues
Technology-Assisted Distance Supervision (TADS)
Ongoing supervision of fully-licensed subordinates

38. Business management issues Record custodian issues
5 - Private Practice
Manage the “ideal and real” regarding opening/closing a health services business (consultants from other fields are needed)
Business management issues
Record custodian issues
Preparing for retirement, disability and death

39. 6 - Minors and Custody Issues
Informed Consent
Age of Majority
Records (school vs. clinic vs. private practice)
Determining and Documenting Custody

40. 7 - Subpoenas and Testimony
Ethical vs Legal Issues
Witness of Fact or
Expert Witness,
Understanding various types of subpoenas and how to manage / respond

41. Third-party reimbursement contracts? Other documents?
8 - Counseling Records
Requirements
Code of Ethics?
Licensure?
Third-party reimbursement contracts?
Other documents?
HIPAA Audits and Releases

42. 9 - Licensure and Scope of Practice
Review licensure board website and official updates regularly
Pay attention to potential deregulation efforts
Understand the documentation requirements for faculty to support the licensure of a new professional

43. 10 - Mandated and Other Reporting
Know jurisdiction requirements
Adults, Minors, Persons with Disabilities, etc.
Be attentive to AG opinions
Local reporting HHS initiatives
Stay attentive to new legislation – stalking, ERPO laws, etc.

44. Ethics Resources
Counseling Today Ethics columns
Webinars
Podcasts
Decision making models
Infographic
Books
Other resources

45. Only I can save my client!
And other faulty thinking:
Practitioner may not be fully aware that own behavior is a boundary crossing
Normalization of deviance
Boundary crossings are the primary reason for referral for discipline/ethics committees
Whose needs are you meeting?
When is doing more enough?

46. Only I can save my client! And more….
Need to look at client autonomy and the client’s right to choose; sometimes helping involves letting our clients fail
Is what you are doing a standard practice?
Would you do this for everyone or only for this client?
What happens if you don’t help this time?
Is your help actually enabling?

47. Obtain the client’s informed consent Seek consultation
Safeguards
Obtain the client’s informed consent
Seek consultation
Engage in discussion with the client
Document, document, document….
Self monitor
Obtain supervision

48. Words of Wisdom
Just because it’s not in there (COE), doesn’t mean you can
Just because you can, doesn’t mean you should.
It’s a slippery slope…
It’s lonely out there…

50. Lynn E. Linde llinde@counseling.org
Contact information
Lynn E. Linde