Ethical Issues In Counseling With Children And Adults

By Samantha Dewitt

Updated May 17, 2019

Reviewer Kristen Hardin

When it comes to counseling the ethical issues that can arise are generally on behalf of the therapist. This means that it is the burden of the therapist to attempt to avoid any type of conflict as well as to avoid any type of interaction that would show a relationship. Even still, it's something that definitely comes up, and many people wonder about ethical issues in counseling. So, just to take a closer look at what those responsibilities are, what are some of the common ethical problems that therapists and other mental health professionals face?

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Maintaining Boundaries

The biggest and the most common ethical issue that mental health professionals face is maintaining boundaries. At times it can be difficult to make sure that you are not developing a personal relationship with a patient. Sometimes patients may blur the lines, or attempt to blur the lines, because of the way that the therapist-patient relationship develops. It can cause the patient to form a strong attachment that appears to be more than that of friendship, for example. It is then important for the therapist to maintain and re-establish the boundaries as needed.

On the opposite side of this, therapists should definitely not be involved in the counseling of someone that they know personally or have an ongoing connection to, even if more removed, such as the parent of one of your child's friends. It is outside of the ethical boundaries to counsel a family member, a friend or even a neighbor. It might not seem like it would be a problem, but this is not fair to the client. They deserve an unbiased, objective therapist and the same level of confidentiality as all other clients.

Professional Ability

Therapists are generally trained in certain areas of therapy. This means that a specific therapist may be skilled in working with children or helping people with marriage problems or using specific types of treatment. It is essential that a therapist only provide therapy that they have been trained and licensed to provide. Part of their ethical responsibilities is to make sure that they are only providing counseling in areas that they are skilled. If the patient needs a different type of therapy or needs additional help in something else, it is their responsibility to help the patient find someone else or at least let the patient know that they need to find someone else.

Personal Problems

As in any form of a professional job, a therapist is responsible for maintaining a standard of professionalism. They are responsible for keeping their personal life, and their professional life separated as much as possible. This can be difficult in some instances, and mental health professionals are most definitely only human. This means that things will happen in their lives that will affect them and affect their ability to be an effective counselor or therapist 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 and professional lives and carry on with their work, they can do so ethically. If they are not able to do so, however, then they must take a leave or otherwise remove themselves from a situation where they are responsible for counseling others. A therapist who is in the middle of a divorce or who have lost a loved one or who is experiencing an addiction should seek out professional help for themselves if needed and should stop counseling others until their ability to counsel effectively is resumed.

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Maintaining Confidentiality

Every therapist and every medical professional in any capacity is responsible for maintaining the confidentiality of their patients. This means they're responsible for keeping all personal information including intake forms, patient notes and contact information confidential. It must be stored in a way that it can't be accessed by anyone, but authorized personnel and the therapist is not allowed to share that information with anyone else. That means they are never allowed to share information about who their clients are, where their clients live, what personal problems their clients are experiencing or anything that happens during a session, with a few exceptions that are discussed later in this post.

Respecting Patient Differences

Patients come from different backgrounds, different walks of life and different cultures. A mental health professional or anyone in the medical profession 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 isn't able to do this or does not 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 confidentiality for their patients. This means that they are not allowed to talk to anyone about the things that they discuss with their patients. In certain situations, however, a therapist is required to get the authorities involved. This may include when the patient presents an immediate risk to themselves or others. If a client gives her therapist reason to believe that she is going to harm herself or someone else, the therapist has the difficult decision to break confidentiality and get the help for that person. They could in rare events have to warn another party if they have reason to believe their client is going to harm them. 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 and talk to your therapist if you have one.

Maintain Their Role

A therapist is intended to help an individual (or sometimes a group or couple) to come to understandings on their own. Therapists generally focus on helping their patients to make these decisions for themselves and help them learn how to make healthy decisions based on their own values and beliefs, not the beliefs of the therapist. Therapists help clients make plans and decisions, but don't generally tell their clients what to do and should not ever impose their own values and beliefs on their clients.

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Maintaining Therapy

Once therapy begins, the therapist is required to continue that therapy with the client as long as the client is benefiting from treatment and wishes to continue. If the therapist discontinued services, it could be considered abandonment. This does not mean, however, that the client dictates the therapeutic relationship. The therapist could need to change hours, move, or have a host of reasons that would make it a hardship to continue to therapy with the client. If this is the case, the therapist needs to give the client notice and provide the client with appropriate referrals to the client's 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 that they report only the facts. Staying focused on specific clinical information and assessments that the therapist knows to be true 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 actually responsible for an entire office or a group of therapists they must monitor what those other therapists are doing. That means they need to pay attention to whether the other therapists in their facility are also maintaining all of the ethical considerations that we have talked about. If they're not, the therapist in charge would be responsible for issuing reprimands, requiring additional training or removing specific therapists from their position. If they don't this could be considered an ethical violation of their own, and it's considered a serious problem for any patients being treated.

Proper Billing Procedures

Many people don't think of billing as having anything to do with ethics, but it's extremely important. Therapists, just like anyone else who bills for an office call or hourly appointment, are responsible for proper billing. Whether they are billing directly to a patient or an insurance company or anyone else, they must make sure that they provide a 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 to maintain ethical standards throughout the patients time with that therapist.

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Seeking Professional Help

If you are seeking professional counseling and aren't sure where to turn, you can log on to BetterHelp. You'll be able to find a mental health professional that can talk to you about anything that you're experiencing and you can do it right from the comfort of your own home. All you need is a smartphone, tablet, or computer to get started.


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