Government Issue

by The Advocacy Project

Key Ethical Issues In Christian Counseling

These words apply to every aspect of our lives, including our calling to be Christian counselors. We are admonished to walk circumspectly (prudently, cautiously, discreetly, watchfully) before both God and man. We are regulated by both laws and ethical codes. In our profession, guidelines for this circumspect behavior are provided in the form of ethical codes. While laws reveal the minimum standards that society will accept/tolerate; ethical codes establish the rules of conduct. Christian counselors are required to adhere to the ethical codes of their profession. Ethical issues occur in various areas of counseling; however, there are two areas that evoke the largest number of complaints filed with ethical boards: issues of confidentiality and dual relationships.

CONFIDENTIALITY  Confidentiality is an ethical concept, and simply put, means that what is shared within the therapeutic relationship will not be voluntarily disclosed by the counselor. Confidentiality is essential because it fosters trust, which is the bedrock of the therapeutic alliance. Christian counselors maintain client confidentiality to the fullest extent allowed by law, professional ethics, and church or organizational rules. I-410 – Confidentiality, Privacy, and Privileged Communication. The AACC Christian Counseling Code of Ethics (hereinafter noted as AACC code).2 The ACA (American Counseling Association) code of ethics, A2a, states that clients “have the right to expect confidentiality and to be provided with an explanation of its limitations…”  Privilege and Privacy  Two related concepts are privileged communication and privacy.

Privilege is a legal concept that protects clients from their counselor being forced to disclose confidential material. Privilege is distinguished from confidentiality in that the disclosure is typically involuntary. “In other words, confidentiality binds the counselor not to reveal client material even if the counselor feels inclined to do so, and privilege protects client information from inappropriate disclosure pressed for by legal authorities, rather than entertained by the counselor.” 4 Each state determines whether it ascribes to the doctrine of privilege, therefore, it is important for counselors to know their state’s statutes. Protecting confidential communication, including the assertion of privilege in the face of legal or court demands shall be the first response of counselors to demands or requests for client communications and records. I-420 – Disclosure of Confidential Client Communication, AACC Code. Privacy refers to the individual’s constitutional right to decide the time, place, manner, and extent of self-disclosure.5 Respect for Privacy.

Counselors respect their client’s right to privacy and avoid illegal and unwarranted disclosures of confidential information. B.1.a. – Right to Privacy. ACA Code of Ethics. Client information should not be revealed, orally or in writing, without formal consent. This even includes the fact that the client is engaging in counseling. 6 These prohibitions result in specific restrictions on the disclosure of information as illustrated below. Example: A counselor has been working with a woman who has been experiencing marital difficulties; her husband has been working with a different counselor. The husband decides to seek a divorce and wants his wife to allow access to her counseling records to support their efforts in resolving the marital problems. The wife has the right to: 1) refuse, 2) fully consent, or 3) specify what, when, and to whom information can be released. This could be only the fact that she has been receiving counseling or any other degree of disclosure that she chooses.

The client (the wife) holds the “right” to the waiver, the right to give her consent for the release of information. However, the “court” (not his lawyer) can require disclosure. In this event, the counselor could ask the court to recognize “privileged communication” which would probably be granted if the state has such a statute. Again, it is important to know your state’s laws on privileged communication. When court ordered to release con- fidential information without a client’s permission, counselors request to the court that the disclosure not be required due to potential harm to the client or counseling relationship. B.1.e – Court-ordered Disclosure. ACA Code of Ethics. Exceptions and Limitations to Confidentiality  With regard to confidentiality, while it is the client’s right to expect that disclosures in the counseling sessions will remain confidential and privacy will be respected, there are some limitations to the guarantee of full confidentiality.

These limitations tend to fall into legal and non-legal categories. Legal limitations. The law compelled breaches of confidentiality are related to mandatory reporting and the release of information. As previously stated, if the court orders the counselor to disclose information, the counselor must comply or be subject to penalty, even incarceration. Also, if the client waives the right to privacy (or any aspect of privacy), the counselor must concur (note: signing insurance forms gives consent to disclose specific information). Keep in mind that a waiver from the client does not give the counselor “carte blanche” to release information indiscriminately. Some exceptions have been made when, in the counselor’s judgment, disclosure would be harmful to the client. These are case-by-case exceptions and seldom required. The counselor has a duty to help the client determine the ramifications of disclosure.

When circumstances require the disclosure of confidential information, only essential information is revealed. To the extent possible, clients are informed before confidential information is disclosed. B.1.f. – Minimal Disclosure. ACA Code of Ethics. Christian counselors disclose only that client information they have written permission from the client to disclose or that which is required by legal or ethical mandates. The counselor shall maintain con- fidentiality of client information outside the bounds of that narrowly required to fulfill the disclosure and shall limit disclosures only to those people who have a direct professional interest in the case. 1-421. – Disclosure of Confidential Client Communication.

AACC Code. Within the legal framework of con- fidentiality, privilege, and privacy is the right of the counselor to break confi- dentiality if there is client malpractice litigation against the counselor. In order to construct an adequate defense, the counselor has the right to all relevant material.7  Mandatory Reporting  Mandatory reporting is the legal concept of required disclosure (breaching confidentiality) when certain offenses are suspected by, or revealed to, the counselor. These offenses include child abuse and neglect, elder abuse or neglect, and abuse of “vulnerable” (mentally ill, physically handicapped, and/or mentally handicapped) adults. “The legislatures have reasoned that the public interest in protecting those who cannot protect themselves from abuse far outweighs the obligation to confidentiality.”8 Again, it is incumbent upon the counselor to know the statutes of his/her state and the procedures for reporting.

The Federal Child Abuse and Treatment Act (1987) mandates the reporting of child abuse. The general requirement that counselors keep information confidential does not apply when disclosure is required to prevent clear and imminent danger to the client or others or when legal requirements demand that confidential information be revealed. B.1.c. ACA Code of Ethics. Christian counselors accept the limits of confidentiality when human life is imperiled or abused. We will take appropriate action, including necessary disclosures of confidential information, to protect life in the face of client threats of suicide, homicide, and/or the abuse of children, elders, and dependent persons. I-430. Protecting Persons from Deadly Harm: The Rule of Mandatory Disclosure. AACC Code.

Example: During the course of counseling, a 13-year-old boy discloses his sexual involvement with a neighbor, a 21-year-old male. Under the mandatory reporting statutes, this must be reported immediately to the appropriate authorities, typically child protective services and/or law enforcement. Clients who are deemed a danger to themselves or to others present another limitation to confidentiality. A landmark court case in California (Tarasoff vs. Regents of the University of California, 1974) resulted in many states invoking “duty to warn” mandates for mental health professionals. In the Tarasoff case, a psychologist at the University’s student health center was seeing a university student. He disclosed to the psychologist that he intended to kill a young woman who was readily identi- fied as Tatiana Tarasoff, a student who had spurned his romantic advances. The young man did, indeed, kill Tatiana a short time later. Her parents prevailed in the lawsuit on the grounds that there was a duty to warn the intended victim or her parents of the clear and imminent danger.

Action to protect third-persons from client violence may involve or, in states that have a third-person protection (Tarasoff) duty, require disclosure of imminent harm to the intended victim, to their family or close friends, and to law enforcement. I- 433 – Special Guidelines When Violence is Threatened Against Others. AACC Code. States vary in their interpretation of the doctrine of duty to warn, so counselors must be familiar with their state laws in order to determine their legal responsibilities. Some states reject it, some adhere to it, and some modify it. Knowing your state’s statutes is critical. Some subsequent court cases have expanded upon the Tarasoff decision as follows:  • Bradley Center vs. Wessner (1982)— duty not to negligently release a dangerous client  • Jablonski vs. United States (1983)— duty to commit a dangerous client • Hedlund vs. Superior Court (1983)— duty to warn to persons near the potential victim of danger  • Jafee vs. Redmond (1996)—Supreme Court decision that ruled in cases arising under federal law, privileged communication exists between all psychotherapists and their clients when governed by the Federal Rules of Evidence (this case also stands for the right to assert privilege in all cases where disclosure of a client record is sought by governmental authorities). Suicidal threats. In addition to the mandatory reporting of abuse and cases of imminent danger, counselors need to understand their obligations regarding potential suicides. “The evaluation and management of suicidal risk is a source of great stress for most therapists… Determinations are difficult to make, but counselors are expected to recognize the warning signs.”9 The ethical and legal responsibility to do whatever necessary to protect the client is clear.

Welfel outlines some of the options: intensify treatment; notify law enforcement and/ or family/relatives; or hospitalize the individual. 10 While any of these options require breaching confidentiality, counselors should disclose only the information required to provide assistance. In many states, the “duty to warn” mandates are not applied to suicide, or applied less stringently. Knowing the signs of suicide and your state’s statutes is essential. “The Christian counselor has a general duty to intervene in the life of the suicidal person to give that person a fair chance to live.”Other Limits of Confidentiality  While many issues of confidentiality fall within the legal realm, there are other limitations that need to be clarified.

In most counseling centers, clerical assistants handle confidential information. This can take various forms that may include: processing insurance forms; scheduling or canceling appointments; receiving phone messages; and/ or processing information for release. In situations that result in hospitalizations, confidentiality is typically breached. In addition, when a counselor is working under supervision or consults professionally with another counselor regarding the course of treatment or an ethical issue, confidentiality is compromised. It is always the counselor’s responsibility to protect the client’s identity. Also, any professional participating in a consulting or supervisory role is bound by the same rules of confidentiality as the counselor. Confidentiality and the Christian Counselor  How do the rules of confidentiality impact Christians in the counseling field? First and foremost, Christian counselors should adhere to the ethical codes of their profession.

While this is abun- dantly clear for the counselor who holds professional licensure, there is often some confusion for the lay counselor (church-based counselor). What obligation does a lay counselor have to uphold ethical standards? This may seem like an absurd question, but for some, there is a perception that these are manmade restrictions and they are not required to adhere to “man’s rules”—only to God’s rules. In some areas of one’s personal life this may be the case, however, in the role of counselor, laws and ethical codes have provided guidelines for the protection of the counselee. Within the Christian community we share a sense of family and there seems to be an expectation for disclosing personal aspects of our lives. One example of this can be observed in the sharing of prayer requests with enough details so we can “pray intelligently.” The Christian counselor must guard against the temptation to share any facet of a client’s “story.” Example: A Christian counselor was having lunch with a friend and asked her friend to pray for one of her clients who was going through a bitter divorce.

The counselor was careful to not reveal the identity of the “wife” as she disclosed details of the proceedings. A woman sitting in the next booth overheard the “story,” recognized the details, and readily identified the “wife” as her sister. She reported the incident to her sister (the client) who was devastated by the betrayal of confidence. In recent years there has been a distinctive rise in litigation against pastoral counselors, lay counselors, and churches. A major reason for this increase is that more people seek legal action to address their complaints (also true among Christians). The Church is no longer exempt from lawsuits. In a court of law, the counselor will be expected to provide a standard of care that is considered acceptable by a jury of his/her peers. Lay counselors will be well served to explore the AACC and/ or AAPC (pastoral counselors) codes of ethics and abide by their professional guidelines.  Dual Relationships Counselors have a duty to promote the client’s well-being.

In legal terms, this constitutes a fiduciary relationship.12 To the degree possible, counselors should avoid entering into a dual relationship with a client. A dual relationship is basically the participation in more than one role with the same client. Most professional codes of ethics warn of the potential dangers of dual relationships. For more detailed information on dual relationships, read the appropriate code of ethics for your profession.Counselors are aware of their in- fluential positions with respect to clients, and they avoid exploiting the trust and dependency of clients. Counselors make every effort to avoid dual relationships with clients that could impair professional judgment or increase the risk of harm to clients. (Examples of such relationships include, but are not limited to familial, social, financial, business, or close personal relationships with clients.) A.6.a – Dual Relationships. ACA Code of Ethics. Dual relationships involve the breakdown of proper professional or ministerial boundaries. A dual relationship is where two or more roles are mixed in a manner that can harm the counseling relationship. Examples include counseling plus personal, fraternal, business, financial, or sexual and romantic relations.

1-140 – Dual and Multiple Relationships. AACC Code. Christian counselors do not provide counseling to fellow church members with whom they have close personal, business, or shared ministry relations. We presume that dual relations with any other church members who are clients are potentially troublesome and best avoided, otherwise requiring justification. 1-145 – Counseling with Fellow Church Members. AACC Code.  Exploitation  Exploiting a client for self-interests is the underlying danger of the dual relationship. This is a violation of the fiduciary relationship. While exploitation can occur in numerous ways, there are two specific factors that need to be addressed: power differential and intimacy. Within the context of the counseling relationship is an imbalance of power. The counselee is seeking help from the counselor, which results in a power differential. A misuse of this power (or the use of undue influence) by the counselor is unethical. Counselors must be aware of the potential of the abuse of power and maintain their fiduciary responsibility to the client.

When a counselor enters into a therapeutic relationship with a client, the counselor has an obligation to promote client well-being and not succumb to self-interests. One aspect of the counseling relationship that opens the door to exploitation is intimacy. Intimacy is defined as a close relationship marked by the exclusive sharing of thoughts and feelings. In the therapeutic relationship the client discloses information that in many cases has not previously been shared with anyone. Deeply personal sharing is encouraged to facilitate the healing process. The counselor listens attentively and does not judge the client. The client responds with relief and admiration to this kind and caring person. If the counselor does not have well-established boundaries, he/she may be vulnerable to the client’s “admiration.” In our society, intimacy is equated with sexual behavior—hence, the stage is set.

Given the dynamics of this alliance, it is not surprising that sexual misconduct ranks number one for complaints filed with ethical committees and licensing boards. How do counselors maintain healthy boundaries with their clients? The responsibility rests squarely on the counselor; any type of sexual involvement is always unethical. The first line of defense is the informed consent, which can state that the counselor does not engage in socializing with clients. In the event the counselor experiences an attraction to the client, it is essential that the counselor seek out a trusted and experienced colleague to assist in exploring these feelings and establishing accountability. In some cases personal therapy may be necessary, but under no conditions should the counselor act on his/her feelings. Counseling never includes sex. If the counselor cannot resolve his/her feelings, termination and/or referral may be required. Care must be taken to assure that the client does not feel any responsibility—the problem is the counselor’s. Conclusion This is only a brief overview of the issues of confidentiality and dual relationships.Web counselor plays a vital role for the welfare of society.

It is strongly recommended that counselors, whether clinical, pastoral, or lay counselors, stay current in their understanding of ethical codes and legal statutes that impact the profession. Workshops, seminars, and articles/books are available on ethical behavior. It is interesting to note that all mental health professions stipulate a specific number of required continuing education units in ethics. While we are accountable to our profession and its codes of ethics, our ultimate level of accountability rests with God. As Christian counselors, we must aspire to the highest level of ethical behavior.  Jacqueline Gatewood, Psy.D., is an assistant professor at Regent University in Virginia Beach, Virginia. She specializes in ethics, family systems, school counseling, grief and loss and divorce late in life.

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