Ethical and Legal Dilemmas in Counseling

Abstract

In this essay, we discuss the ethical and legal dilemmas in counseling.  While many people talk about the benefits of counseling, there is no question that mental health professionals are often confronted with tricky and complex legal and ethical issues.  In this article, we discuss some of those issues, how counselors confront them, and what legal obligations attach to them.  We begin with an introduction of the American Psychological Organization’s Ethical Principles of Psychologists and Code of Conduct, and then discuss potential scenarios where practitioners may face ethical dilemmas.  Because every counseling relationship is unique and because counselors help people in a wide variety of different areas, the overview will not include every potential ethical or legal dilemma.  However, once you have finished reading the overview, you should have a comfortable working knowledge of the types of scenarios that could be legally or ethically troublesome for mental health practitioners.  Furthermore, the article will also provide you with an example of a properly written academic essay.  The basic structure provides a template for correct format.  As a result, in this article, you can expect to find: an introduction, a hook, a thesis statement, a structured body with evidence and analysis of that evidence, a conclusion, and a reference section.  Additionally, any sources used in the essay will be properly cited and referenced in a works cited/ bibliography/ references section. Therefore, the essay serves two functions: informing readers about ethical and legal dilemmas in counseling and providing an example for a properly written essay.   

Related Topics

Professional Ethics- Almost all professions have stated ethical guidelines, and, for those that do not, there are often unstated ethical expectations.  This essay would discuss the basic ethical principles that guide most professional relationships, as well as delve into ethical guidelines that only apply in specific professional situations.  

Counseling Relationships- The goal of counseling is often to help people improve their interpersonal skills, which often begins with the development of a good relationship with the counselor.  This essay would explore what type of boundaries are appropriate in a relationship between a therapist and a client.  It would look into whether there are different perspectives about what type of boundaries a therapist should establish with a counselor?  

Power Imbalance Between Therapist and Client- Many people are aware that therapists and clients have a professional relationship, but in a therapeutic setting it is not unusual for clients to feel like they are talking to a good friend or confidante, rather than a professional.  In addition, outside of the relationship, the client may actually have more power and influence than the therapist.  This essay would explore whether there is an inherent power imbalance between therapists and clients and whether that imbalance exists in all therapeutic relationships.  

Outline

I. Introduction

II. Body

A. Counselors

B. Legal obligations

C. Ethical obligations

D. Beneficence and Nonmaleficence

III. Conclusion 

Introduction

According to Dictionary.com, counseling refers to “professional guidance in resolving personal conflicts and emotional problems.” A wide range of people serve as counselors in their professional capacity, from psychologists and psychiatrists to attorneys, clergy, crises counselors, and social workers.  While each of these professionals may rely on a slightly different set of professional ethical rules and guidelines to govern their counselor-client relationships, all of them have to be prepared to deal with potential ethical and legal dilemmas that can arise from the counseling relationship.  Most of these dilemmas focus on the counselor’s role as helper to the client, and are designed at ensuring that the counseling relationship is always guided by the client’s interests.  However, in some circumstances a counselor’s legal and ethical obligations may actually require the professional to engage in behaviors that could lead to harm for the client.     

Essay Hook

Because they are situationally-specific, determining legal and ethical guidelines for counselors can be extremely complex, requiring professionals to seek guidance from others in their field when confronted with particularly difficult dilemmas. 

Thesis Statement

However, when broken down to their most basic precepts, the legal and ethical obligations of counseling require a counselor to work to further a client’s best interests, except for very specific situations where working to help a client achieve their goals could create a lasting harm for a third-party.   

Body

Counselors

Counseling is a very broad term and can encompass a wide range of different relationships between professionals and clients.  In fact, in many places, one need not even be a professional to qualify as a counselor.  For example, in many states clergy can play the role of counselor, even without any training to be a counselor.  In addition, in some states crises or emergency counselors can receive training and be permitted to provide counseling that is specific to an emergency scenario; for example rape crises counselor and suicide hotline counselors are often lay people with no professional counseling training or experience.  Attorneys are often referred to as counselors, as well, because they are expected to give their clients professional counsel and advice.  However, there are five professions that generally come to mind when one hears the term counselor: psychiatrists, psychologists, counselors, social workers, and advanced psychiatric nurses (Cherry, 2019).   Each group of counselors has a different set of training and qualifications.  More importantly, each group is governed by a different professional body.  This means that their professional ethical guidelines, and, in some instances, their legal obligations, may differ slightly.  

When many people think of mental health professionals, they think of psychiatrists.  Psychiatrists are medical doctors who have focused their practice on psychiatric care.  Psychiatrists can diagnose and treat mental illness.  What differentiates them from most counselors is that, as medical doctors, psychiatrists can also prescribe medications to their clients.  While psychiatrists can provide counseling as part of their treatment services, most modern psychiatrists do not work as counselors, but, instead, either work as part of a treatment team or refer their patients who need counseling to counselors.  As medical professionals, psychiatrists are under the auspices of the American Medical Association.  

Although often confused with psychiatrists, psychologists are not medical doctors.  Instead, these doctors, who have non-medical doctorate degrees, have received training focused specifically on psychology and mental health.  Psychologists must have a PhD or a PsyD in order to operate independently as psychologists.  In addition, most states require new psychologists to initially participate in supervised practice at the beginning of their careers.  Psychologists provide both group and individual therapy sessions.  In most states, psychologists cannot provide medication, though they often work with psychiatrists and other medical doctors when a patient needs medication as part of a treatment regime. The professional organization for psychologists is the American Psychological Association.   

Licensed counselors consist of a rather varied group of people who are not psychiatrists or psychologists, but who have usually obtained additional graduate training in counseling.  The requirements to become a licensed counselor vary from state-to-state.  However, there is a national organization, the National Board for Certified Counselors (NBCC), which can grant the title National Certified Counselor.  Many, but not all, states require counselors to have NBCC certification in order to be licensed counselors. 

One of the largest group of practicing counselors in the United States consists of licensed clinical social workers (LCSWs).  These professionals have some type of post-graduate training in therapy, which may or may not include a Master’s degree in social work, as well as internship or supervised clinical experience.  The National Association for Social Workers and the Association for Social Work Boards are two professional groups for social workers, though states have different guidelines about how individuals become licensed social workers. 

Advanced psychiatric nurses are another group of healthcare professionals that may provide counseling services.  These nurses hold Master’s degrees or higher in nursing, with an emphasis on psychiatric nursing and mental health issues.  They are, more or less, nurse-practitioners who serve the same functions as psychiatrists.  They can assess and diagnosis disorders, provide therapy, and even prescribe medications in most states, though states can vary tremendously in their recognition of nurse practitioners as stand-alone medical care providers.  The American Psychiatric Nurse Association is one of the professional organizations for psychiatric nurses.  

Legal Obligations

Attempting to determine a counselor’s legal responsibilities can be very difficult, because each state has its own rules and laws governing what type of counseling behavior is legal or illegal.  In addition, these legal rules may not all be located in the same part of a state’s code.  Health and safety regulations, professional licensing regulations, family codes, and even criminal codes may all dictate a counselor’s legal obligations to his or her clients.  Each of these different laws can create different legal obligations, which depend on a number of factors, including where a therapist and a client are located.  

While some of these details may seem like minutia, these differences can have a profound impact on clients.   For example, homosexuality was once considered a mental disorder and conversion therapy for minors identifying as lesbian or gay was somewhat commonplace. Research has revealed that this type of therapy is very harmful to children, and, as a result, 18 states, Puerto Rico, and the District of Columbia have banned conversion therapy for minors; however, it remains legal in 32 states and 4 U.S. territories (Movement Advancement Project, 2019).  This is one example where the location of the counselor and the client can impact what type of behavior is considered legal in their relationship and helps demonstrate how changing societal ideals can have an impact on the legal obligations of counselors.  It also highlights why it is difficult to provide blanket statements about the legal obligations of counselors, since those obligations can and do vary from state-to-state. 

Looking at one state’s legal guidelines for counselors provides some insight into the legal obligations of counselors.  Texas’s ethical guidelines for counselors are contained in Part 30 of Title 22 of the Texas Administrative Code §§ 681.41-681.51.  Under these legal rules, licensed counselors: are prohibited from making false claims about their services; must obtain informed consent from their clients; cannot pay for referrals; cannot have sexual relationships with clients or certain other individuals during the period of therapy and for a specified time period after the therapeutic relationship concludes; cannot engage in activities for personal gain at the client’s expense; must set professional boundaries; must not give or accept gifts from clients; cannot counsel people with whom the counselor has a previous personal relationship; must keep accurate records; and can breach confidentiality to prevent a client from harming himself or others. While these laws are specific to the state of Texas, they are representative of the type of legal obligations that counselors have around the United States.  

Ethical Obligations

In addition to legal obligations, a counselor may have professional ethical obligations that are related to the counselor-client relationship.  The nature of these obligations may depend on the type of professional counselor involved in the relationship, but the ethical obligations are fairly consistent across the counseling professions. An examination of these ethical obligations reveals that there is an over-arching theme that the role of the counselor is to help the client and that the counselor is obligated to put the client’s interests above the counselor’s interests, at least in regards to the therapist-client relationship. 

According to the Ethical Principles of Psychologists and Code of Conduct published by the American Psychological Association, there are five general principles that should govern the counselor-client relationship: beneficence and nonmaleficence; fidelity and responsibility; integrity; justice; and respect for people’s rights and dignity (APA, 2019).  The American Counseling Association has a similar, but slightly different list of general principles, which includes: autonomy; nonmaleficence; beneficence; justice; fidelity; and veracity (ACA, 2014).  While there are some differences in the guiding principles, looking at the rules of various professional organizations makes it clear that professional counselors really need to focus on three main areas: beneficence and nonmaleficence; conflicts of interest; and respects for people’s rights and dignity.  

Beneficence and Nonmaleficence

The saying “first, do no harm” is often associated with the provision of healthcare, and it is an important one to keep in mind when thinking about a counseling relationship.  The goal of a counselor is to help the client, and, part of helping the client is avoiding doing anything that would harm the client.  This general principle is embodied in some way in the ethical rules for almost every professional counseling organization.  However, while this principle may seem very straightforward, it can actually become a very complex issue when one deals with the realities of actual counseling scenarios.