Ethical Issues In Counseling With Children And Adults

By William Drake

Updated November 20, 2019

Reviewer Kristen Hardin

Ethical issues in counseling generally fall on the therapist. This means that it is the therapist's responsibility to avoid unethical interactions with patients. This article will take a closer look at what the therapist's ethical responsibilities entail, and examine some common ethical problems faced by mental health professionals.

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Maintaining Boundaries

The most common ethical issue faced by mental health professionals is maintaining boundaries. At times it can be difficult to ensure that you are not developing a personal relationship with a patient. Sometimes patients may blur or attempt to blur the lines because of how the therapist-patient relationship develops. For example, a patient might form a strong attachment to their therapist that appears to be more than professional. It is important for the therapist to maintain and re-establish boundaries as needed.

Therapists also should not counsel someone that they know personally or are personally connected to, even if the connection is removed, such as the parent of one of their child's friends. It is outside of the ethical boundaries of the field to counsel a family member, a friend, or even a neighbor. Every patient deserves an unbiased, objective therapist and the same level of confidentiality as all other patients.

Professional Ability

Therapists are generally best trained in certain areas of therapy. A specific therapist may be skilled in working with children, helping people with marriage problems, or using specific types of treatment such as cognitive-behavioral therapy. It is essential that a therapist only provide the therapy that they have been trained to provide. If a patient needs a different type of therapy, it is the therapist's ethical responsibility to help the patient find someone else, or at least let the patient know that they need to find someone else.

Personal Problems

Therapists are responsible for maintaining a standard of professionalism. They must keep their personal and professional lives as separate as possible. This can be difficult in some instances, and mental health professionals are only human. This means that things will happen in their lives that may affect their ability to be an effective counselor for their clients. When these things happen, the therapist must find a way to work through the issue at hand.

If a therapist can separate their personal problems from their professional life and carry on with their work, they can do so ethically. If they are not able to do so, then they must take a leave or otherwise remove themselves from situations where they are responsible for counseling others. A therapist in the middle of a contentious divorce, who has recently lost a loved one, or who is experiencing addiction should seek out professional help for themselves, and they should take a break from counseling patients if their ability to counsel effectively is impaired.

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Maintaining Confidentiality

Every therapist-and indeed, every medical professional-is responsible for maintaining the confidentiality of their patients. This means they're responsible for keeping all personal information confidential, including intake forms, patient notes, and contact information. These must be stored so that they can't be accessed by anyone other than the therapist and other authorized personnel, and the therapist is not allowed to share that information with anyone else. Confidential information includes who their clients are, where their clients live, what personal problems their clients are experiencing, and anything that happens during a session, with a few exceptions that are discussed below.

Respecting Patient Differences

Patients come from different backgrounds, walks of life, and cultures. A mental health professional is required to respect all differences and to maintain a level of professionalism and courtesy with those who have different backgrounds, thoughts, beliefs, and feelings from their own. If the therapist can't do this for any reason, they should seek out professional training until they are able to do so.

Getting the Authorities Involved

As discussed above, a therapist is required to maintain patient confidentiality. Unless a patient gives them written permission, they are not allowed to talk to anyone else about the things that their patients discuss with them.

In certain situations, however, a therapist is required to get the authorities involved. Depending on the state in which a therapist practices, this may include when a patient presents an immediate risk to themselves or others. If a client gives their therapist reason to believe that they are going to harm themselves or someone else, the therapist must make the difficult decision to break confidentiality and get help for that person. In rare events, they may even have to warn another party if they have reason to believe their client is going to harm that person.

Therapists are also required to report suspected child and elder abuse and neglect. Laws vary by state, so if you have specific questions, you can check with your state's licensure board for mental health professions or talk to your own therapist.

Maintain Their Role

A therapist is intended to help an individual (or sometimes a group or couple) reach healthy decisions on their own. Therapists generally focus on helping their patients make decisions for themselves, which includes helping them consider their own values and beliefs, not the beliefs of the therapist. Therapists help clients make plans and decisions, but they don't generally tell their clients what to do, and they should never impose their own values and beliefs on their clients.

Maintaining Therapy

Once therapy begins, the therapist is required to continue working with that patient as long as the patient is benefiting from treatment and wishes to continue. If the therapist discontinues services, it could be considered abandonment.

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This does not mean, however, that the patient dictates all aspects of the therapeutic relationship. The therapist could need to change hours, move, or have a host of reasons that would make it too difficult to continue therapy with the patient. When this is the case, the therapist needs to give the patient notice and provide the patient with appropriate referrals so treatment is not disrupted.

Provide Proper Testimony

In some situations, a therapist may be called on to give expert testimony in a court case or a custody battle. In these situations, it is important that the therapist provide accurate and complete testimony about what they have found and report only the facts. Staying focused on specific clinical information and assessments is imperative. The therapist should never have a vested interest in any particular outcome from this type of testimony.

Monitoring Other Therapists

If the therapist in question is responsible for an entire office or a group of therapists, they must monitor what those other therapists are doing. They need to pay attention to whether the other therapists in their facility are also maintaining the ethical guidelines discussed in this article. If they're not, the therapist in charge would be responsible for issuing reprimands, requiring additional training, or removing specific therapists from their positions. If they don't, this could be considered an ethical violation.

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Proper Billing Procedures

What does billing have to do with ethics? In fact, there is an important connection. Therapists, just like anyone else who bills for an office call or hourly appointment, are responsible for proper billing. Whether they are billing a patient directly or an insurance company, they must make sure that they bill only for the services that are provided and accurately account for the time that is spent on a visit. These types of billing responsibilities help maintain ethical standards.

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As with most jobs, dramatic ethical issues are uncommon in therapy. Still, it is important to seek out a well-credentialed therapist who has gone through a professional vetting process. Change starts with one first step. Take that step today.

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