Tag Archives: therapists

E is for Ethics (and also, a bit, for Exam)

So, I wrote in yesterday’s blog that I had taken and passed my licensure exam. The state licensing exam is also the exam used for those counselors who want to be recognized as Nationally Certified Counselors. It measures competence in several areas: Research, Theories, Assessment, Ethics, and a few other categories. Overall, I did okay on the exam. I didn’t ace it, but I  did far better than the minimum requirements for licensure. Also, I totally rocked the Ethics section.

I love Ethics. Ethics, like counselor self-care, permeate every aspect of counseling. Ethics play such a critical role in counseling that the ACA (American Counseling Association) has its own handbook on ethics. Every branch of health practitioner has a code of ethics by which its members choose to abide. Nurses have a code of ethics, as do doctors and nursing assistants and pharmacists. All health care professionals in Washington state have an ethical code, including chemical dependency professionals, massage therapists, physical therapists, psychologists, and so on. Strong ethics provide safeguards and protect clients at their most vulnerable: when they are sick and/or seeking help.

The ACA Code of Ethics covers everything from whether or not to accept a gift from a client (if it cost less than $20 and to not accept the gift would cause the client more harm)  to how and when to refer a client to a different therapist (when the therapist has to leave her practice or if a client is just not making progress after many sessions).

Abiding by an ethical code isn’t just good for our clients. Counselors risk losing their licenses and livelihoods if they don’t adhere to robust ethical standards. Holding firm boundaries keeps us out of trouble. I subscribe to a Dept. of Health newsletter that lists the practitioners who have run afoul of the ethics board. This list is a good reminder of the possible costs of boundary crossing, no matter how well-intentioned.

We have ethical codes governing the use of electronic devices such as smart phones, laptops, tablets (must have passcodes if client information is stored there) and software:  videoconferencing, electronic health records, email, text and voice messages, social media, and the like (ethics dictate don’t engage with clients as “friends” on social media, and we must only use text and email messages for scheduling. Personally, I’ve mostly gotten offline since becoming a counselor).

Last spring, I attended a day long workshop on the ethics of marijuana in counseling. The surprisingly diverse range of topics included whether or not a counselor or therapist could ethically accept weed as a form of payment from a client who might be strapped for cash but has a job at a pot farm and is thus awash in weed (in states where marijuana is legal, of course, and NO, NOT OKAY for many reasons, primarily because legally, in Washington at least, one can only possess a certain amount of weed at a time, and a therapist would cost more weed than she could legally possess). Also, whether or not a group of therapists and counselors could sit around a campfire, pass around a bong while discussing cases (a resounding NO, but not for obvious reasons. Turns out, sharing weed is illegal in Washington State. Even sharing a joint or giving a friend an edible is illegal). Violating these laws means losing ones license. This was one of the liveliest and most well-attended workshops I’ve been to since I got into this field. Everyone had so many questions.

We have ethics around multicultural counseling (ethical counselors have multicultural awareness training), staying within our scope of practice (only provide services you are trained in), and self-disclosure (does sharing personal information with the client, help the client? What is the point of sharing the personal stuff? Personal gain or therapeutic?)

Most importantly, ethical counselors and therapists do not engage in personal relationships, sexual or otherwise with clients. The ACA Code of Ethics states a counselor must wait five years after a client has discontinued treatment before becoming personally involved with that client. Washington State law says two years. A counselor must be able to relate to a client without the client having any worries whatsoever about the counselor’s motives. The counselor is there strictly for the client, not for themselves (except as related to salary or fees). Personal and intimate relationships with a mental health provider become problematic as boundaries get blurry. Counselors should always avoid dual relationships, i.e. providing counseling to your neighbor’s husband or to your child’s teacher.

The counseling office is a sacred space and a strong code of ethics maintains the integrity of that space. We are not there to befriend our clients, but to assist them in becoming better friends to themselves. We are there to hold up a mirror and to simply reflect.

D is for Diagnosis

I finally jumped through one of the final hoops I need to get full licensure. This morning I took, and passed, the state licensing exam. I could have done this as soon as I finished school at the end of 2017, but I did not. I put it off. So, here I am, ready to be done with supervision, primed to strike out on my own.

Anyway, one of the questions I’ve encountered on the practice exams goes something like this:  If your agency requires you diagnose a client, what are your alternatives? a) talk to your supervisor and tell her it’s against your ethics to diagnose someone b) talk to your colleagues and let them know you ethically can’t diagnose someone c) refuse to diagnose a client d) all of the above. The correct answer, apparently, is d) all of the above.  As a counselor, ethically I am not to diagnose anyone.

I’ve been trained to diagnose using the DSM, or Diagnostical and Statistical Manual, a compendium of mental health disorders cataloging the signs and symptoms of everything from adjustment disorder to xenophobia, anxiety to trichotillomania. It’s not an activity I take lightly. People seek help with mental health because they are looking for ways to feel better, to combat the distress they are experiencing. I want to empower clients to improve their lives. I don’t want to overwhelm them with a label that carries negative connotations, a diagnosis that scares them or strips them of their power and self-efficacy.

Giving someone a diagnosis is a double-edged sword—a client’s DSM diagnosis allows them to seek services utilizing their health insurance. No one has to go bankrupt to afford mental health care. If providers get paid, clients can keep coming back, and not just to counselors in private practice, but also to community mental health agencies such as the crisis center I wrote about yesterday. The money we receive from insurance companies enables us to serve a wide variety of folks, many without the means to pay privately for anything, let alone mental health care.

But a diagnosis is also a label, and a mental health diagnosis can follow someone for life, influencing not only how they think about themselves, but how others might perceive them. We’ve made a lot of progress in the past few years to destigmatize mental illness, and many more people are seeking counseling as a matter of course. Being in therapy doesn’t carry the stigma it used to. But still. Perceptions linger and diagnosing (and thus labeling) a college freshman as bipolar can have lifelong consequences. They can begin to see each themselves as more illness than person, begin to limit themselves or be limited by others, including overprotective parents and well-meaning professionals.

I don’t want to give anyone a label that will hold them back in life. I want to help clients find ways to learn, love, and live their best lives, to understand what’s happening with their mental health, and I want them to be able to keep coming back, even if they can’t afford it. So, I have to give them a diagnosis if they use insurance to pay for counseling.

But, a diagnosis should only be a means to an end, not the final word on who anyone truly is or a limit on what they can achieve or who they can become.