1. LAW to ASPIRATION: Ethics for Mental Health Professionals
Stan Mahaffey, LPC-S, LMFT, NCC, ACS
CONNECTIONS COUNT CONFERENCE
LAKE CHARLES, LA
February, 2017

2. Do you know your most recent Code of Ethics?
Marriage and Family
Licensed Professional Counselors

3. Multiple licenses mean multiple codes which may conflict!
If you run afoul of the legal system, you will be subject to the MOST restrictive code.
You are required to know and comply with the ethical guidelines in EACH code.

4. WHY a CODE of ETHICS?
A code allows for the professional association to clarify to current and future members, as well as those served by it’s members, the nature of ethical behavior and responsibilities held in common by said members. The Code of Ethics helps to support the mission of the association.
The Code explains to the public the standards accepted by the profession.

5. Why a code? (Con’t)
The code establishes principles that define ethical behavior and best practices of association members.
The code serves as an ethical guide designed to assist members in constructing a professional course of action in order to serve those using mental health services and best promotes the values of the profession.
The code serves as the basis for processing ethical inquiries and complaints leveled against association members.

6. Definition of ETHICS
Ethics is the study of what is morally right or wrong, or is a set of beliefs about what is morally right or wrong.
Ethics is a system of moral principles and perceptions about right vs. wrong and the resulting philosophy of conduct that is practiced by a group, profession, or culture (Baker, 1999).

7. Evolution of Codes of Ethics
A number of societal influences have contributed to the evolution of professional codes of Ethics including:
Quality Assurance Programs
Attainment of Professional Identity
Malpractice cases
Third Party Payers/Managed Care
Technological Advances
Limited Resources

8. Ethical vs. Legal Standards
ETHICS
Standards are set by a profession.
Standards are idealistic and aspirational
Standards are found in a Code of Ethics
Actions are judged by the words in the code
Standard is: “What should an ethical professional have done in this particular situation?”

9. Ethical vs. Legal Standards
LAW
Standards are set by society
Standards are the minimum society will tolerate
Standards are found in federal and state constitutions, statutes, regulations and common law
Actions are judged by ‘law of torts’
Standard is: “What would a reasonable, similarly educated professional, practicing in this community have done in this particular situation?”

10. Standards of Practice
Standards of Practice (Code of Conduct) are “usually” subsumed within the Code of Ethics and provide standards that can be used to measure the appropriateness and quality of an individual clinician’s work. These are usually molded by the state/community in which the clinician practices.

11. Principles in Addressing Legal and Ethical Issues in Mental Health
Keep current on legal and ethical issues by reading current literature and/or attending professional development training.
When you have a question about a legal matter, consult a legal advisor
When you are exercising your professional judgment in a difficult area, consult with colleagues and experts before making a decision and/or taking action, and document it
Whenever possible, shift responsibility for legal decisions to your administrative superiors by explaining the situation and asking them to make the decision.
Be sure to maintain your own personal, professional liability insurance at all times (Remley, 1997)

12. Confidentiality and Privileged Communication
Confidentiality: Is an ethical principle that is a protected right of the client, guarantees the client’s right to privacy. This concept promotes and encourages client disclosure and is necessary for therapeutic relationships.
Privileged Communication: Is a legal principle required by statute and is afforded to other professions (e.g., physicians, clergy, lawyers, etc).

13. Exceptions to Confidentiality & Privileged Communications
We all know these: Statutory requirement ( abuse ) The person is a danger to self or others BUT there are more!

14. Exceptions to Confidentiality & Privileged Communications
The client requests the release, in writing The COURT orders the release (NOT an attorney) Systematic clinical supervision of the therapist Legal and/or clinical consultation The client raises the issue of mental health Collaterals are present at the time of discussions Client is under the age of 18 in LA (2 Exceptions) Client sues the therapist Clerical personnel who process information or documents

15. Responsibility
Each professional is responsible for his/her own actions because each one makes his/her own decisions.
Different clinicians may make different choices and still be ethical.
The basic guiding principle is: above all else do no harm and do what’s in the best interest of the client.

16. Aspirational Ethics
This is the highest standards of conduct to which the mental health therapist can aspire and requires that we do more than simply meet the letter of the law.
What are the values we aspire to use in decision-making.
What are the highest standards of conduct to which we aspire
Calls for constant and consistent self-exploration
Builds self-accountability
Develops practicing from an ethical posture, not one defined by law or codes
Creates a form of self-supervision
Accommodates the Issue of honesty - to live in a place of truth in everyday practice
Enhances competencies

17. Aspirational Core Values
The core values of AAMFT embody:
Acceptance, appreciation, and inclusion of a diverse membership.
Distinctiveness and excellence in training of marriage and family therapists and those desiring to advance their skills, knowledge and expertise in systemic and relational therapies.
Responsiveness and excellence in service to members.
Diversity, equity and excellence in clinical practice, research, education and administration.
Integrity evidenced by a high threshold of ethical and honest behavior within Association governance and by members.
Innovation and the advancement of knowledge of systemic and relational therapies

18. Moral Principles
Kitchener (1984) has identified five moral principles that are viewed as the cornerstone of our ethical guidelines.
Autonomy
Non-maleficence
Beneficence
Justice
Fidelity

19. SOLVING ETHICAL DILEMMAS
When exploring an ethical dilemma, you need to examine the situation and see how each of these principles may relate to that particular case. At times this alone will clarify the issues enough that the means for resolving the dilemma will become obvious to you. In more complicated cases it is helpful to be able to work through the steps of an ethical decision making model, and to assess which of these moral principles may be in conflict.

20. Autonomy
is the principle that addresses the concept of independence. The essence of this principle is allowing an individual the freedom of choice and action. It addresses the responsibility of the therapist to encourage clients, when appropriate, to make their own decisions and to act on their own values. There are two important considerations in encouraging clients to be autonomous. First, helping the client to understand how their decisions and their values may or may not be received within the context of the society in which they live, and how they may impinge on the rights of others. The second consideration is related to the client's ability to make sound and rational decisions. Persons not capable of making competent choices, such as children, and some individuals with mental handicaps, should not be allowed to act on decisions that could harm themselves or others.

21. Non-maleficence
is the concept of not causing harm to others. Often explained as "above all else, do no harm", this principle is considered by some to be the most critical of all the principles, even though theoretically they are all of equal weight (Kitchener, 1984; Rosenbaum, 1982; Stadler, 1986). This principle reflects both the idea of not inflicting intentional harm, and not engaging in actions that risk harming others (Forester-Miller & Rubenstein, 1992).

22. Beneficence
reflects the therapist's responsibility to contribute to the welfare of the client. Simply stated it means to do good, to be proactive and also to prevent harm when possible (Forester-Miller & Rubenstein, 1992).

23. Justice
Justice does not mean treating all individuals the same. Kitchener (1984) points out that the formal meaning of justice is "treating equals equally and unequals unequally but in proportion to their relevant differences" (p.49). If an individual is to be treated differently, the therapist needs to be able to offer a rationale that explains the necessity and appropriateness of treating this individual differently.

24. Fidelity
Fidelity involves the notions of loyalty, faithfulness, and honoring commitments. Clients must be able to trust the therapist and have faith in the therapeutic relationship if growth is to occur. Therefore, the therapist must take care not to threaten the therapeutic relationship nor to leave obligations unfulfilled.

25. Comparison of the Codes Responsibility to Clients:
LPC-Primary responsibility of counselors is to respect the dignity and to promote the welfare of their clients.
Marriage and family therapists advance the welfare of families and individuals and make reasonable efforts to find the appropriate balance between conflicting goals within the family system.

26. INFORMED CONSENT
LMFT- Marriage and family therapists obtain appropriate informed consent to therapy or related procedures as early as feasible in the therapeutic relationship, and use language that is reasonably understandable to the client.

27. INFORMED CONSENT
Informed consent generally necessitates that the client: (a) has the capacity to consent; (b) has been adequately informed of significant information concerning treatment processes and procedures; (c) has been adequately informed of potential risks and benefits of treatments for which generally recognized standards do not yet exist; (d) has freely and without undue influence expressed consent; and (e) has provided consent that is appropriately documented.

28. INFORMED CONSENT (con’t)
LPC- Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both the counselor and the client.

29. DECLARATION STATEMENTS
Effective July 18th, 2014, the Board issued a policy statement regarding the dissemination of Declaration of Practices and Procedures Statements or Statements of Practice by ALL Registrants (PLPCs and PLMFTs) and by Licensees (LPCs and LMFTs). Please review the policy statement: %20July% pdf

30. Informed Consent - Technology
LPC - Counselors inform clients of the benefits and limitations of using information technology applications in the counseling process and in business/billing procedures. Such technologies include but are not limited to computer hardware and software, telephones, the World Wide Web, the Internet, online assessment instruments, and other communication devices. LMFT - Marriage and family therapists obtain written informed consent from clients before recording any images or audio or permitting third-party observation..

31. CONFIDENTIALITY
LPC - Counselors do not share confidential information without client consent or without sound legal or ethical justification. At initiation and throughout the counseling process, counselors inform clients of the limitations of confidentiality and seek to identify foreseeable situations in which confidentiality must be breached.

32. CONFIDENTIALITY (con’t)
LMFT - Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated by law. Verbal consent will not be sufficient, except in emergency situations, unless prohibited by law. When providing couples, family, or group therapy, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couples, family, or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.

33. Confidentiality of Records
LPC - Counselors ensure that records are kept in a secure location and that only authorized persons have access to records. Counselors provide reasonable access to records and copies of records when requested by competent clients. Counselor Incapacitation or Termination of Practice - When counselors leave a practice they follow a prepared plan for the transfer or clients and files. Counselors prepare and disseminate to an identified colleague or ‘records custodian’ a plan for transfer of the clients and files in the case of their incapacitation, death, or termination of practice.

34. Confidentiality of Records (con’t)
LMFT - Marriage and family therapists store, safeguard, and dispose of client records in ways that maintain confidentiality and in accord with applicable laws and professional standards. Subsequent to the therapist moving from the area, closing the practice, or upon death of the therapist, a marriage and family therapist arranges for the storage, transfer, or disposal of client records in ways that maintain confidentiality and safeguard the welfare of the client.

35. WHAT IS YOUR PLAN?
Records must be available for____?

36. GIFTS - LMFTs
LMFT - Marriage and family therapists attend to cultural norms when considering whether to accept gifts from or give gifts to clients. Marriage and family therapists consider the potential effects that receiving or giving gifts may have on clients and on the integrity and efficacy of the therapeutic relationship.

37. GIFTS – LPCs
LPC - Receiving gifts Counselors understand the challenges of accepting gifts from clients and recognize in some cultures, small gifts are a token of respect and gratitude. When determining whether or not to accept a gift from a client, counselors take into account the therapeutic relationship, the monetary value of the gift, a client’s motivation for giving the gift, and the counselor’s motivation for wanting or declining the gift.

38. Sexual Intimacy
LMFT – Sexual intimacy with current clients or with known members of the client’s family system is prohibited. Sexual intimacy with former clients or with known members of the client’s family system is prohibited.

39. Sexual Intimacy (con’t)
LPC - Current Clients - Sexual or romantic counselor/client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. Former clients - Sexual or romantic counselor/client interactions or relationships with current clients, their romantic partners, or their family members are prohibited for a period of five years following the last professional contact, demonstrate forethought and document (in written form) whether the interactions or relationship can be viewed as expletive in some way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm the counselor avoids entering in to such an interaction or relationship.

40. Behaving Responsibly
Van Hoose & Paradise (1979) suggest that a therapist is probably acting in an ethically responsible manner concerning a client if:
The therapist has maintained personal and professional honesty, coupled with
The best interests of the client
Without malice or personal gain
And can justify his/her actions as the best judgment of what should be done based on the current state of the profession.

41. DISTANCE TECHNOLOGY SERVICES
LMFT - Technology Assisted Services.
Prior to commencing therapy or supervision services through electronic means (including but not limited to phone and Internet), marriage and family therapists ensure that they are compliant with all relevant laws for the delivery of such services.  Additionally, marriage and family therapists must: (a) determine that technologically-assisted services or supervision are appropriate for clients or supervisees, considering professional, intellectual, emotional, and physical needs; (b) inform clients or supervisees of the potential risks and benefits associated with technologically-assisted services; (c) ensure the security of their communication medium; and (d) only commence electronic therapy or supervision after appropriate education, training, or supervised experience using the relevant technology.

42. Distance Counseling, Technology, and Social Media
Counselors understand that the profession of counseling may no longer be limited to in-person, face-to-face interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to distance counseling, technology, and social media and how such resources may be used to better serve their clients. Counselors strive to become knowledgeable about these resources. Counselors understand the additional concerns related to the use of distance counseling, technology, and social media and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of such resources.

43. A Model for Ethical Decision Making
Identify the problem.
Apply the Code of Ethics.
Determine the nature and dimensions of the dilemma.
Generate potential courses of action.
Consider the potential consequences of all options and choose a course of action.
Evaluate the selected course of action.
Implement the course of action.

44. DUTY TO WARN/PROTECT/INFORM
Let’s take a look at the handout 20to%20Warn.pdf

45. ETHICAL DECISION EXERCISE