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Code of Ethics: Page 2
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B. Counseling Process
  1. Counseling Plans
  2. Mental health counselors use counseling plans to direct their work with clients.
    1. Mental health counselors and their clients work jointly in devising integrated, individual counseling plans that offer reasonable promise of success and are consistent with the abilities, ethnic, social, cultural, and values backgrounds, and circumstances of the clients.
    2. Mental health counselors and clients regularly review counseling plans to ensure their continued viability and effectiveness, respecting the clients’ autonomy.


  3. Informed Consent
  4. Clients have the right to know and understand what is expected, how the information divulged will be used, and the freedom to choose whether, and with whom, they will enter into a counseling relationship.
    1. Mental health counselors provide information that allows clients to make an informed choice when selecting a provider. Such information includes but is not limited to: counselor credentials, issues of confidentiality, the use of tests and inventories, diagnosis, reports, billing, and therapeutic process. Restrictions that limit clients’ autonomy are fully explained.
    2. Informed Consent includes the mental health counselor’s professional disclosure statement and client bill of rights.
    3. When a client is a minor, or is unable to give informed consent, mental health counselors act in the client’s best interest. Parents and legal guardians are informed about the confidential nature of the counseling relationship. Mental health counselors embrace the diversity of the family system and the inherent rights and responsibilities parents/guardians have for the welfare of their children. Mental health counselors therefore strive to establish collaborative relationships with parents/guardians to best serve their minor clients.
    4. Informed consent is ongoing and needs to be reassessed throughout the counseling relationship.
    5. Mental health counselors inform the client of specific limitations, potential risks, and/or potential benefits relevant to the client’s anticipated use of online counseling services.


  5. Multiple Clients
  6. When working with multiple clients, mental health counselors respect individual client rights and maintain objectivity.
    1. When mental health counselors agree to provide counseling services to two or more persons who have a relationship (such as husband and wife, or parents and children), counselors clarify at the outset, the nature of the relationship they will have with each involved person.
    2. Collateral consent informs family members or significant others involved in counseling, of the parameters and limitations of confidentiality.
    3. If it becomes apparent that mental health counselors are unable to maintain objectivity resulting in conflicting roles, they must appropriately clarify, adjust, or withdraw from roles.
    4. Rules of confidentiality extend to all clients who receive services, not just those identified as primary clients.
    5. When working in groups, mental health counselors screen prospective group counseling/therapy participants. Every effort is made to select members whose needs and goals are compatible with goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience.
    6. In the group setting, mental health counselors take reasonable precautions to protect clients from physical, emotional, and psychological harm or trauma.


  7. Clients Served by Others
  8. Mental health counselors do not enter into counseling relationships with a person being served by another mental health professional unless all parties have been informed and agree.
    1. When clients choose to change professionals but have not terminated services with the former professional, it is important to encourage the individual to first deal with that termination prior to entering into a new therapeutic relationship.
    2. When clients work with multiple providers, it is important to secure permission to work collaboratively with the other professional involved.


  9. Termination and Referral
  10. Mental health counselors do not abandon or neglect their clients in counseling.
    1. Assistance is given in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacation and following termination.
    2. Mental health counselors terminate a counseling relationship when it is reasonably clear that the client is no longer benefiting, when services are no longer required, when counseling no longer serves the needs and/or interests of the client, or when agency or institution limits do not allow provision of further counseling services.
    3. Mental health counselors may terminate a counseling relationship when clients do not pay fees charged or when insurance denies treatment. In such cases, appropriate referrals are offered to the clients.
    4. If mental health counselors determine that services are not beneficial to the client, they avoid entering or terminate immediately the counseling relationship. In such situations, appropriate referrals are made. If clients decline the suggested referral, mental health counselors discontinue the relationship.
    5. When mental health counselors refer clients to other professionals, they will be collaborative.
    6. Mental health counselors take steps to secure a safety plan if clients are at risk of being harmed or are suicidal. If necessary, they refer to appropriate resources, and contact appropriate support.


  11. Telehealth, Distance Counseling and the Use of Social Media
  12. Recognizing that technology can be helpful in client’s mental health care management due to availability, expediency, and cost effectiveness, counselors engage in technology assisted, and or distance counseling.
    1. Counselors only engage in distance counseling when they are licensed in the state of the client. In the case of an emergency, counselors should first attempt to attain permission from the client’s state licensing entity and only proceed when failure to do so could result in harm to the client.
    2. Counselors only provide distance counseling when they have had training, experience, and supervision to do so.
    3. Written policies concerning the use of telehealth in a counseling relationship should include informed consent that is clearly set forth, understandable, and addresses the use of phone, online face to face counseling, electronic billing, text, and email contact with a client. This informed consent should clearly discuss the benefits and risks of entering into distance counseling.
      1. Email: Mental health counselors should advise clients about the risks of exchanging emails. It is recommended to include a disclaimer when sending emails. Refer to the most update to date HIPAA regulations. Email transmissions are part of the client record; copies should be maintained in the client file.
      2. Text messages: Text messages are not a secure form of communication therefore texting of personal information should be discouraged. Text messages are considered a part of the client record, and should be kept in the client file.
      3. Online scheduling: Any online scheduling software should be encrypted and secure. If not, counselors should disclose to clients the fact that the software is not encrypted and therefore is not confidential.
      4. Chat Rooms: Counselors should not include chat rooms, because these may imply that a counselor is able to intervene in the event that a crisis is mentioned.
    4. Counselors follow carefully designed security and safety guidelines when conducting online face-to-face distance counseling.
      1. Counselors endeavor to protect clients from unwanted interruptions during online face-to-face sessions.
      2. Counselors are strongly urged to employ the use of local resources in the community of the distance client should emergency care be needed. Local resources may be law enforcement, health care or EMT services, and someone trusted by the client to be available during distance counseling sessions should it become necessary to have someone close by in the event of an emergency.
    5. The counselor will evaluate the client to determine that the client is appropriate for distance counseling services.
    6. Counselors will conduct themselves in a professional manner during distance, online counseling sessions as if the client were in the counselor’s office.
    7. Counselors will disclose to clients all procedures for documenting and storing of records of distance, online counseling sessions.
      1. Counselors will safeguard and protect all records of distance counseling sessions as they would for in person sessions in accordance with all state and federal laws and regulations.
      2. Counselors should have a written policy that prohibits both the therapist and the client from recording a treatment session without the written consent of the other. If a recording of the treatment session has been authorized, the counselor,should either erase or destroy the recording as soon as it has fulfilled its intended purpose (e.g., supervision or conclusion of counseling) in order to maintain confidentiality of the contents.
    8. Counselors do not engage in virtual relationships with clients as to do so could potentially be a violation of confidentiality.
      1. If clients follow a professional blog, the counselor will not follow them back. The counselor has a responsibility to make it clear that the blog or website does not create a therapeutic relationship, therefore, professional blogs and websites should be non-interactive in nature.
      2. Twitter, Facebook, LinkedIn, Google Plus and other social media should be professional profiles that are kept separate from personal profiles. Counselors should not establish connections or engage with clients through social media. In addition, counselors need to have appropriate privacy settings so that clients cannot contact them on these professional social media sites, or access a site in any way.
      3. Counselors shall not solicit professional reviews by clients, nor respond to reviews posted, as to do so might violate client confidentiality.
      4. Counselors will only seek information about their clients through internet searches for the purpose of determining their own or their clients health and safety.
    9. Counselors endeavor to provide sensitivity to the cultural make up of all clients, as well as sensitivity to disabilities or physical condition in distance counseling as they would in a physical office.


  13. Clients' Rights
  14. In all mental health services, wherever and however they are delivered, clients have the right to be treated with dignity, consideration and respect at all times. Clients have the right:
    1. To expect quality service provided by concerned, trained, professional and competent staff.
    2. To expect complete confidentiality within the limits of both Federal and state law, and to be informed about the legal exceptions to confidentiality; and to expect that no information will be released without the client’s knowledge and written consent.
    3. To a clear working contract in which business items, such as time of sessions, payment plans/fees, absences, access, emergency procedures, third-party reimbursement procedures, termination and referral procedures, and advanced notice of the use of collection agencies, are discussed.
    4. To appropriate information regarding the mental health counselor's education, training, skills, license and practice limitations and to request and receive referrals to other clinicians when appropriate.
    5. To appropriate information regarding the mental health counselor’s education, training, skills, license and practice limitations and to request and receive referrals to other clinicians when appropriate.
    6. To full, knowledgeable, and responsible participation in the ongoing treatment plan to the maximum extent feasible.
    7. To obtain information about their case record and to have this information explained clearly and directly.
    8. To request information and/or consultation regarding the conduct and progress of their therapy.
    9. To refuse any recommended services, techniques or approaches and to be advised of the consequences of this action.
    10. To a safe environment for counseling free of emotional, physical, or sexual abuse.
    11. To a client grievance procedure, including requests for consultation and/or mediation; and to file a complaint with the mental health counselor’s supervisor (where relevant), and/or the appropriate credentialing body.
    12. To a clearly defined ending process, and to discontinue therapy at any time.


  15. End-of-Life Care for Terminally Ill Clients
    1. Mental health counselors ensure that clients receive quality end-of-life care for their physical, emotional, social, and spiritual needs. This includes providing clients with an opportunity to participate in informed decision making regarding their end-of-life care, and a thorough assessment, from a qualified end-of-life care professional, of clients’ ability to make competent decisions on their behalf.
    2. Mental health counselors are aware of their own personal, moral, and competency issues as it relates to end-of-life decisions. When mental health counselors assess that they are unable to work with clients on the exploration of end-of-life options, they make appropriate referrals to ensure clients receive appropriate help.
    3. Depending upon the applicable state laws, the circumstances of the situation, and after seeking consultation and supervision from competent professional and legal entities, mental health counselors have the options of breaking or not breaking confidentiality of terminally ill clients who plan on hastening their deaths.
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