Trauma, Disasters & MH Trauma, Disasters & MH Counselors: The ACA Counselors: The ACA Code of Ethics – Part ICode of Ethics – Part I

Paul David Fornell, MS, NCC, Paul David Fornell, MS, NCC, MCC, LPCC, Counselor, MCC, LPCC, Counselor, Consultant and CoachConsultant and Coach

pfornell@aol.com

505-352-4231505-352-4231

Who is this? What Who is this? What makes him an makes him an

“expert”?“expert”?Former Director, Ethics and Former Director, Ethics and

Professional Standards – ACA, Professional Standards – ACA, current Chair, NMCA Ethics current Chair, NMCA Ethics

Committee, Member, ACA Ethics Committee, Member, ACA Ethics Appeal PanelAppeal Panel

Paul Fornell, MS, NCC, MCC, LPCCPaul Fornell, MS, NCC, MCC, LPCC

40+ years in education and helping 40+ years in education and helping professionsprofessions

30+ years in counseling30+ years in counseling Past president of NMCA, CCA, ACCAPast president of NMCA, CCA, ACCA Served on last AACD Senate and first Served on last AACD Senate and first

AACD (now ACA) Governing CouncilAACD (now ACA) Governing Council Numerous committees, task forces, etc.Numerous committees, task forces, etc. Blogger at Blogger at http://my.counseling.org/

The Ethics Revision Task Force The Ethics Revision Task Force ‘05‘05

Michael Kocet (Chair)Michael Kocet (Chair) John BloomJohn Bloom Tammy BringazeTammy Bringaze Rocco CottoneRocco Cottone Harriet GlosoffHarriet Glosoff Barbara HerlihyBarbara Herlihy Courtland LeeCourtland Lee Judy MirantiJudy Miranti Chris MollChris Moll Vilia TarvydasVilia Tarvydas

Why do you need to know this?Why do you need to know this?

41,000+ professional 41,000+ professional counselors agree to abide by counselors agree to abide by

the ACA Code of Ethics the ACA Code of Ethics **

22 state licensing boards use the 22 state licensing boards use the ACA Code ofACA Code of Ethics as the basis for Ethics as the basis for

their standards of practicetheir standards of practice AlabamaAlabama

AlaskaAlaska ArizonaArizona ArkansasArkansas Colorado *Colorado * District of ColumbiaDistrict of Columbia IdahoIdaho IllinoisIllinois LouisianaLouisiana MassachusettsMassachusetts MississippiMississippi

NebraskaNebraska New York *New York * North CarolinaNorth Carolina North DakotaNorth Dakota Ohio *Ohio * South CarolinaSouth Carolina South DakotaSouth Dakota TennesseeTennessee UtahUtah West VirginiaWest Virginia WyomingWyoming

Some things stay the Some things stay the same….almostsame….almost

I have been counseling an adult woman with a presenting problem of difficulty in coping with the death of her mother. Her mother and grandmother (who is also deceased) suffered from progressive Alzheimer’s disease. My client revealed to me that she administered a lethal dose of sleeping pills to her grandmother during the final stages of the Alzheimer’s, and that she has also caused the death of her mother by withholding cardiac medication. It was then revealed that it is likely she will have to take care of a third relative with Alzheimer’s disease, an elderly Aunt.

It is important to understand that my client is not a bad person and did what she did while under tremendous stress and pressure and with feelings of compassion for the deteriorating condition of her mother and grandmother.

My question is in two parts: •First, what are my ethical obligations upon hearing the manner in which my client’s mother and grandmother died? •Second, am I responsible to do anything about the upcoming situation with the Aunt?

Three BegonesThree Begones

SOP Be Gone!SOP Be Gone!

““Clear and Imminent Clear and Imminent Danger” Be Gone!Danger” Be Gone!

Replaced by Replaced by “serious and “serious and foreseeable foreseeable

harm”harm” (section B.2.a.; page (section B.2.a.; page 7)7)

B.2.a. Danger and Legal B.2.a. Danger and Legal RequirementsRequirements

The general requirements that counselors The general requirements that counselors keep information confidential does not apply keep information confidential does not apply when disclosure is required to when disclosure is required to protect clients protect clients

or identified others from serious or or identified others from serious or foreseeable harmforeseeable harm or when legal or when legal

requirements demand that confidential requirements demand that confidential information must be revealed. Counselors information must be revealed. Counselors consult with other professionalsconsult with other professionals when in when in doubt as to the validity of an exception. doubt as to the validity of an exception.

Additional considerations apply when Additional considerations apply when addressing end-of-life issues. (addressing end-of-life issues. (see A.9.c.)see A.9.c.)

Dual Relationships Be Dual Relationships Be Gone!Gone!

Replaced by Replaced by beneficial vs. beneficial vs.

harmful harmful relationshipsrelationships

A.5.d. Potentially Beneficial InteractionsWhen a counselor–client nonprofessional

interaction with a client or former client may be potentially beneficial to the client or former client, the counselor must document in case

records, prior to the interaction (when feasible), the rationale for such an interaction, the

potential benefit, and anticipated consequences for the client or former client and other

individuals significantly involved with the client or former client. Such interactions should be

initiated with appropriate client consent.(continued)

Where unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, due to the nonprofessional interaction, the counselor must show evidence of an attempt to remedy such harm. Examples of potentially beneficial

interactions include, but are not limited to, attending a formal ceremony (e.g., a

wedding/commitment ceremony or graduation); purchasing a service or product provided by a client or former client (excepting unrestricted

bartering); hospital visits to an ill family member; mutual membership in a professional association, organization, or community. (See

A.5.c.)

What about Sex?What about Sex?

Sexual or romantic interactions with Sexual or romantic interactions with clients continues to be prohibited.clients continues to be prohibited.

The prohibition on sexual or romantic The prohibition on sexual or romantic interactions with former clients is now interactions with former clients is now increased from two to five years (A.5.a&b). increased from two to five years (A.5.a&b).

In addition, counselors are now explicitly In addition, counselors are now explicitly prohibited from having sex or a romantic prohibited from having sex or a romantic relationship with the partners or family relationship with the partners or family members of clients for a 5 year period members of clients for a 5 year period (A.5.b).(A.5.b).

Now that we covered love, Now that we covered love, what about death…what about death…

There is a new section (A.9.) that There is a new section (A.9.) that covers end of life care for terminally ill covers end of life care for terminally ill clients.clients.– Gives counselors permission to work with Gives counselors permission to work with

terminally ill clients who wish to explore terminally ill clients who wish to explore their end of life options.their end of life options.

– Gives permission to keep discussions with Gives permission to keep discussions with terminally ill clients who are considering terminally ill clients who are considering hastening their own death confidential.hastening their own death confidential.

And a new requirement to And a new requirement to protect the confidentiality of a protect the confidentiality of a

client who has died.client who has died.

B.3.f. Deceased Clients Counselors protect the confidentiality of deceased clients, consistent with legal

requirements and agency or setting policies.

A focus on cultural A focus on cultural sensitivitysensitivity

B.1.a. Multicultural/Diversity Considerations

Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure of information. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared.

A.2.c. Developmental and Cultural Sensitivity

Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and

understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language used by

counselors, they provide necessary services (e.g., arranging for a qualified interpreter or translator)

to ensure comprehension by clients. In collaboration with clients, counselors consider

cultural implications of informed consent procedures and, where possible, counselors

adjust their practices accordingly.

A new mandate about A new mandate about selecting interventions…..selecting interventions…..

C.6.e. Scientific Bases for Treatment Modalities

Counselors use techniques/ procedures/modalities that are grounded in theory and/or have an empirical or scientific

foundation. Counselors who do not must define the techniques/procedures as “unproven” or “developing” and explain the potential risks

and ethical considerations of using such techniques/procedures and take steps to

protect clients from possible harm. (See A.4.a., E.5.c., E.5.d.)

And now counselors must think And now counselors must think about the end of their practice about the end of their practice

from the very beginning...from the very beginning...

C.2.h. Counselor Incapacitation or Termination of Practice

When counselors leave a practice, they follow a prepared plan for transfer of clients and files.

Counselors prepare and disseminate to an identified colleague or “records custodian” a plan for the transfer of clients and files in the case of

their incapacitation, death, or termination of practice.

Technology gets an entire new Technology gets an entire new section (A.12. Technology section (A.12. Technology

Applications)Applications)

Counselors must give thorough informed Counselors must give thorough informed consent about the benefits and limitations consent about the benefits and limitations of IT applications.of IT applications.

When providing distance counseling, When providing distance counseling, counselors must determine that the counselors must determine that the application is appropriate for that particular application is appropriate for that particular client.client.

Counselors ensure that their use of Counselors ensure that their use of technology does not violate any laws.technology does not violate any laws.

Counselors who maintain web Counselors who maintain web sites must…sites must…

Regularly check that links work and are Regularly check that links work and are professionally appropriate.professionally appropriate.

Establish ways that the counselor can be Establish ways that the counselor can be contacted if the technology fails.contacted if the technology fails.

Provide links to relevant licensing boards Provide links to relevant licensing boards and professional certification boards.and professional certification boards.

Establish a method for verifying client Establish a method for verifying client identity.identity.

Strive to provide a site that is accessible to Strive to provide a site that is accessible to persons with disabilities.persons with disabilities.

New ethical mandates about New ethical mandates about the diagnosis of mental the diagnosis of mental

disorders disorders E.5.c. Historical and Social Prejudices in the

Diagnosis of PathologyCounselors recognize historical and social prejudices in

the misdiagnosis and pathologizing of certain individuals and groups and the role of mental health professionals in

perpetuating these prejudices through diagnosis and treatment

E.5.d. Refraining From DiagnosisCounselors may refrain from making and/or reporting a

diagnosis if they believe it would cause harm to the client or others.

Where to go for more Where to go for more informationinformation

The Code of Ethics is available at The Code of Ethics is available at www.counseling.org/ethics

ACA members with questions about ACA members with questions about the application of the new code of the application of the new code of ethics can contact Erin Martz, ACA ethics can contact Erin Martz, ACA Director, Ethics and Professional Director, Ethics and Professional Standards, at 800-347-6647 x314 or Standards, at 800-347-6647 x314 or emartz@counseling.org

Or,Or, ethics@counseling.org

Hard copies can be obtained by Hard copies can be obtained by calling ACA member services at 800-calling ACA member services at 800-347-6647x222.347-6647x222.

The The ACA Ethical Standards Casebook ACA Ethical Standards Casebook which incorporates the 2005 ethical which incorporates the 2005 ethical code is available through the ACA code is available through the ACA bookstore at bookstore at www.counseling.org/publications or or 800-347-6647x222800-347-6647x222

New book!New book!