A.4.b. Personal Values. Counselors are aware of, and avoid imposing, their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

Identify the problem. The primary problem is that a conflict exists among Joseph’s values, the values of the institution where he is employed, and, to some extent, the values of the counseling profession. Joseph believes that Mary should be able to have an abortion if she chooses, but he needs to be sure that he does not allow this value to skew the intervention or support he provides. The university believes that Mary should not be able to have an abortion and that Joseph should refrain from any indication, through direct guidance or by refusing to provide direct guidance, that suggests otherwise. Finally, the values of the counseling profession seem to suggest that Mary should have the autonomy to make whatever choice she feels is in her best interest, regardless of the beliefs of her counselor or the university she attends.

Apply the ACA Code of Ethics. This section of the code (A) is clear that counselors should not impose their own values on their clients. The code also indicates that counselors should avoid discriminating against clients where religion is concerned (C.5) and are obligated to accept the policies of any institution where they are employed (D.1.g.). They should, however, alert employers when policies are inappropriate or potentially harmful to clients (D.1.h.).

Determine the nature and dimensions of the dilemma. One of the major areas of concern is how Joseph should handle a discrepancy between the ethics of the profession and the values of his employer. If he tacitly supports Mary’s decision to have an abortion and the university finds out, he could lose his job. If Joseph imposes the will of the university by suggesting to his client that it is against the rules of the Church to have an abortion, he is violating his own values and refusing to allow his client autonomy.

It should be noted that the institution in this case has the right to promote and uphold whatever values it chooses. Christian universities reserve the right to promote a specific mission that contains specific values (see Bryn Athyn College, 2019), and the university’s refusal to condone abortion is not necessarily a violation of student rights.

Generate potential courses of action. One possible option would be to simply listen to Mary as she navigates this dilemma, providing support and refraining from offering any specific direction. This is likely in keeping with the humanistic fundamentals of the profession (e.g., Wampold, 2012), though it may contradict the values of the institution. If so, Joseph could follow up by bringing this to the attention of his supervisors, as it may be important for them to understand that counseling requires clients be granted autonomy. It might be helpful to work toward negotiating a change in policy regarding the regulations applicable to the counseling center if possible.

Joseph could also allow Mary the space to go over her own list of possible choices but reiterate to her that as an employee of an institution committed to Christian values, he could not explicitly advocate that she have an abortion. He could highlight to her that while this particular stance is not in keeping with the values of professional counseling, it is the rule in place at their university.

Consider the potential consequences of all options and determine a course of action. If Joseph decides on the first option (to simply listen to Mary as she navigates this dilemma, providing support and refraining from offering any specific direction), he should likely follow up with his supervisor immediately to outline his concerns and to see if any institutional change is possible. If so, he should advocate that a counselor’s role is not to direct people in any choice but to allow them the freedom to explore all options available. If the university refuses to agree to this, Joseph will have to make a difficult decision between keeping his job and adhering to his own values. If the institution decides that anything less than a pro-life stance is unacceptable, they are likely within their right to do so.

If Joseph decides on the second option (to allow Mary the space to explore her options but also reminding her of the values of the institution), this reminder may serve as little more than a disclaimer about the values of the institution. Joseph will need to carefully monitor the delivery of his statement (e.g., is he saying it in a way that indicates he believes it, or does it sound like he disagrees?) to ensure that it serves only as a reminder and is not intended to steer her in any particular direction. He should use this same caution in allowing Mary to explore the extent to which her own values affect her decision-making process, particularly to ensure that his pro-choice beliefs are kept in check.

Evaluate the selected course of action. Of the two options, transparency with the institution seems to be the better course of action. If Joseph can run this situation past his supervisor and superiors at the university, there is a good chance of advocating for the profession of counseling in an important way. This would also provide him the possibility of engaging in the second option during a future session if his employer enforces this value as a requirement for employment.

Implement the course of action. This situation is likely to create a number of challenging conversations, particularly if it requires Joseph to discuss policies with his supervisors and administrators within the university. Difficult conversations are never fun (especially when they involve topics as heavy as employment and religious values), but this might be a necessary course of action if the university’s policies affect all individuals receiving help at the university counseling center.

A.5.e. Personal Virtual Relationships With Current Clients. Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (e.g., through social and other media).

A.6.e. Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships). Counselors should avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships.

Identify the problem. In this case, the problem is relatively simple: Tim is attempting to maintain a personal relationship with Annaliese after treatment has ended. Though his overture is connected to his interest in music, the description clearly indicates that Tim has expressed an interest in “maintaining contact.”

Apply the ACA Code of Ethics. The code appears to be very straightforward with matters such as these: Virtual relationships are to be avoided both during treatment (A.5.e.) and after treatment has concluded (A.6.e.). It should be noted, however, that the wording for both is slightly different: While virtual relationships with current clients are “prohibited,” relationships with former clients are to be “avoid[ed].”

Determine the nature and dimensions of the dilemma. The main concern here is that while Tim is no longer an active client, denying his request could potentially cause him emotional hurt. This is in no way guaranteed, but how to tactfully deny unwanted friend requests on social media has been a cause of great discomfort for many since its inception (Baum, 2010). The concern is that anytime a person expresses an interest in a social connection that is denied, the rejection creates a potential to offend or hurt.

Generate potential courses of action. One option would be for Annaliese to simply cite the code of ethics, stating that social media connections of any kind with former clients are to be avoided. Another option would be for her to interpret a connection through an artist page as something other than a relationship and to accept this request on the contingency that it go no further.

Consider the potential consequences of all options and determine a course of action. If Annaliese decides to reject this request by way of directly citing the code, she still risks the chance of offending or harming a client that is being discharged following a recent struggle with substance abuse. If she opts to accept this request, she will publicly express interest in a former client’s social media, which the code (at the very least) indicates is to be avoided. Were a colleague or supervisor to become aware of this, it is unlikely that it would result in anything as severe as the loss of her license, but Annaliese should likely consult the relevant employee handbook(s) or related literature available through her place of employment. Also, this creates a problem for future counseling for Annaliese and Tim. If Tim returns to her for treatment in a few months’ time, her connection to him through social media has now shifted from ethically questionable to something the code states is “forbidden.”

Evaluate the selected course of action. Of the two options, the risk of offense to the client seems to bring about the lesser possibility of harm overall. If Tim is unable to accept that this type of interaction is inappropriate as outlined in the code of ethics, it may be an indication that, as he stated in the initial request, this is less about sharing his art and more about maintaining a connection with his former counselor.

Implement the course of action. If Annaliese is able to respond to Tim in the moment, she can directly tell him no and cite the code as one reason why and the importance of keeping a return to treatment as a potential option as another. If the request comes in writing by way of a social media message, she can say the same thing in a short, polite missive.

A.9.a. Screening. Counselors screen prospective group counseling/therapy participants. To the extent possible, counselors select members whose needs and goals are compatible with the goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience.

A.9.b. Protecting Clients. In a group setting, counselors take reasonable precautions to protect clients from physical, emotional, or psychological trauma.

Identify the problem. The primary problem is that Mildred has accidentally divulged personal information to a group of individuals without the client’s consent. A secondary concern is whether it is appropriate for Mildred to see clients for both individual and group counseling concurrently.

Apply the ACA Code of Ethics. The decision to see clients for both individual and group work is not specifically supported or prohibited in the code, though addressing the changing nature of relationships within counseling is discussed in section A.6.d. Mildred should have screened her potential participants carefully (particularly her current individual clients) to make sure that there were no concerns that would jeopardize the group or individuals’ well-being.

How to screen for this kind of information is a difficult question to address. What constitutes such concerns (e.g., compatible needs, will not impede the group process) is unclear and may vary from setting to setting or client to client. In the case of a basic support group for adolescents, it seems unlikely that G.G.’s history of abuse would have in any way precluded her from attending in the first place. However, counselors who decide to see clients in individual and group settings concurrently should at the very least discuss these potential concerns as part of informed consent and throughout treatment.

Determine the nature and dimensions of the dilemma. Though screening participants may or may not have been a dilemma initially, the concern at present is how to handle the slip of information that has occurred. Mildred may have been in the right to see G.G. in both settings, but the primary concern at the moment is that information that a client did not consent to be released has been disclosed in a group setting.

Generate potential courses of action. One possible option would be to address the breach immediately within the group setting. The group as a whole appears aware of what has happened, and it may be unavoidable to process this in the moment. Another option might be to “table” discussion of the incident until Mildred is able to meet privately with G.G. to determine how she would like to handle the matter.

Consider the potential consequences of all options and determine a course of action. If Mildred decides on the first option, processing the incident in the moment, she is addressing the concern as it occurs in the present, which seems ideal in some ways. It seems that both the group and G.G. are aware of what has happened in this moment, and to push ahead without addressing what has happened would be questionable. This would require Mildred to openly admit fault to the group as a whole, as she would need to first indicate that she accidentally betrayed the confidence of a group member, and then ask G.G. how she would like to proceed.

If Mildred decides on the second option—to table discussion of the incident until she is able to meet with G.G. privately—she runs the risk of damaging rapport with the entire group. While this may allow G.G. the opportunity to make a more informed decision about how to handle the matter, it would likely be complicated to continue the group without discussing what is both an obvious error on behalf of the leader and a compelling disclosure about one of its members.

Evaluate the selected course of action. Of the two basic options, processing the incident in the moment seems inevitable. Mildred will have to determine how to proceed with this course of action in a way that affords respect to both the group and G.G. She could begin by addressing the incident outright, admitting that she clearly just made a disclosure accidentally, apologize to both G.G. and to the group overall, and then ask G.G. how she would like to proceed.

Implement the course of action. In doing so, Mildred will have to be willing to accept that both G.G. and the group could be angry at her for what has happened. Her slip up was an honest mistake, and even with appropriate screening of group members, it may not have been avoided. It is to be hoped that Mildred had informed group members of the risks inherent in seeing individuals in two settings and that she did not guarantee that missteps would never occur.

A.11.a. Competence Within Termination and Referral. If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship.

A.11.b. Values Within Termination and Referral. Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

Identify the problem. The primary problem is that Petra feels uncomfortable on a personal level working with Dylan, now that he has disclosed his paraphilia. Her competence may be in question as well, as she indicates having training in sexual dysfunction but not paraphilias specifically.

Apply the ACA Code of Ethics. The code permits termination and referral for issues of competence, but not for conflicts of values. Petra can refer Dylan to a separate provider if she determines her decision is motivated by a lack of sufficient training or experience to provide a specific treatment that is required. If, however, she believes her actions are motivated by personal bias, Petra is obligated to seek support through additional training or supervision.

Competence is difficult to define, though Petra could likely contend that her training in CBT for sexual dysfunction, while not an indication of expertise, is sufficient enough to qualify as competence. Treatment for pedophilia typically focuses on relapse prevention, with CBT having some support for its ability to reduce recidivism (Lösel & Schmucker, 2005).

Determine the nature and dimensions of the dilemma. Another problem is that, in this case, the line between competence and value is decidedly thin. If Petra did choose to refer Dylan to another provider, could she say with absolute certainty that this was in his best interest and not a function of her own needs and values? Or can she justify her decision by suggesting that her values would have led to a concern of competence? Assuming the latter, can Petra have personal values that are not in accordance with the ACA?

Generate potential courses of action. Depending on how she actually feels, Petra could likely validate either continuing with treatment or referring to another provider. Regarding the decision to refer out, she could argue that she has training in CBT but that she is not experienced enough in the treatment of paraphilias to be of help to Dylan. Regarding the decision to continue treatment, she could certainly justify continuing treatment while obtaining additional training or supervision from a mental health professional with greater experience in the treatment of sexual attraction to children.

Consider the potential consequences of all options and determine a course of action. If Petra decides to continue treatment, she would need to offer Dylan the option of seeking treatment from another provider with greater experience. The decision to continue treatment would need to be made by the client once Petra clearly explains what options are available (i.e., to stay with a provider with less experience with whom he feels connected, or to transfer to a provider with more experience where he will essentially be restarting treatment). She would also have to make clear (and follow through on) her efforts to continue with training and supervision necessary to provide competent treatment. Petra will likely have to work closely with a clinical supervisor throughout this process to ensure that treatment is in no way seriously compromised by her beliefs and biases.

If Petra instead decides that her competence is in question such that she risks harming Dylan, she should clearly outline why she is unable to continue treatment with him and provide referrals to providers that are within reason both financially and geographically. This in and of itself may prove to be problematic given the social stigma among mental health professionals in the United States attached to sexual attraction to children (Jahnke, Philipp, & Hoyer, 2015), as providers willing to take the referral may be few and far between. Petra will also have to consider that the decision to refer to a separate provider may cause harm to Dylan. If the implicit message from this encounter is that the counselor was uncomfortable with Dylan’s presenting concerns, he may be unlikely to seek treatment from another clinician or be less inclined to engage in an honest discussion of his problem in the future.

Evaluate the selected course of action. Unless Petra honestly believes that she lacks competence to treat Dylan, she seems to have little choice but to continue with treatment at this time. The ACA’s decision to discourage referrals based on personal values has received some criticism (see Herlihy, Hermann, & Greden, 2014 for a detailed review), but is ultimately grounded in counseling’s humanistic roots. If Petra refuses to treat Dylan, she could be causing him harm, and counselors are obligated to refrain from discrimination of any kind in their clinical practice.

Implement the course of action. As stated earlier, Petra will have to seek additional training if she feels this is required, but she will, at the very least, need to process these concerns in clinical supervision.

A.5.a. Sexual and/or Romantic Relationships Prohibited. Sexual and/or romantic counselor–client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. This prohibition applies to both in person and electronic interactions or relationships.

A.10.f. Receiving Gifts. Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift.

Identify the problem. It seems evident that Juan has a different perception of his relationship with Kathy and that she is obviously uncomfortable with his overture. At the same time, he is showing gratitude for the help and support Kathy has provided, and there may need to be some consideration of cultural contextual factors.

Obviously, it is unacceptable for Kathy to engage in a romantic relationship with a former client. However, as a new counselor, Kathy may be unsure of what her school’s policy is for accepting gifts. In some schools, it may be common practice for students to give teachers gifts during the holidays or at the end of the school year as a token of appreciation. The problem in this case is predominantly connected to how the gift was presented and the way in which Kathy should respond.

Apply the ACA Code of Ethics. Per the American School Counselor Association (ASCA) ethical code, there is nothing that states a school counselor cannot accept gifts, so referring to ACA is the best first course of action. The ACA code is clear that romantic relationships are wholly inappropriate, but the language regarding gifts is more equivocal. What constitutes a “small” gift is unclear, and the motivations behind accepting or receiving are also hazy. Does a $20 bouquet of flowers meet the criteria for “small?” Does the romantic flavor of the attached poem sully the intentions of the flowers such that accepting them would be inappropriate?

Context needs to be considered in this case as well. Kathy should refer to the school board policy, as many institutions may have protocols in place that are more direct than what the ACA code outlines. Also, in some cultures, it is disrespectful to not accept a gift. It is expected that Kathy had training as part of her graduate program in working with diverse populations and knows the cultural norms related to receiving gifts, but the individual context that Juan presents needs to be considered carefully.

Determine the nature and dimensions of the dilemma. The core issue here is whether Kathy should accept or decline the gift and how (or if) to address this with the client moving forward. In consideration of nonmaleficence, Kathy may be concerned that declining the gift could cause more harm than benefit. However, the gift’s romantic overtones bring into question Juan’s motivations.

Generate potential courses of action. One option would be for Kathy to accept the flowers, tell Juan “Thank you” when she sees him next, and have that be the end of it. Another option would be to set up a meeting with Juan to discuss and process what has occurred and establish what constitutes acceptable boundaries in their interactions moving forward.

Consider the potential consequences of all options and determine a course of action. If Kathy accepts the flowers without comment, there are concerns regarding both what Juan will interpret from this action and what other students in the school or faculty will think. If Kathy responds with a scheduled meeting and review of intentions and protocol, she may embarrass Juan and hurt his feelings.

Evaluate the selected course of action. Of the two options, simply discussing the gift with Juan seems to make the most sense. It is to be hoped that Kathy has established enough of a rapport with Juan such that a discussion such as this would be possible.

Implement the course of action. While the selected course of action might be a difficult conversation to have with Juan, it would potentially create further problems if Juan left the counseling relationship with a profound misunderstanding about its parameters. Maintaining a person-centered approach may help facilitate this conversation, and hopefully, it can be done without tremendous hurt on Juan’s end.

A.12. Abandonment and Client Neglect. Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

A.11.c. Appropriate Termination. Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client or by another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pretermination counseling and recommend other service providers when necessary.

Identify the problem. All counselors deserve a break, and Wendy is no exception. However, she did not know of this vacation, or she would have started to prepare her clients in the past month. The concern is clearly related to Wendy’s obligations as a practicing counselor and not abandoning, neglecting, or terminating her clients without notice. Wendy has 2 days over a holiday weekend to figure out who will be the on-call counselor and how she will get this information to each of her clients and the three new ones scheduled for intakes.

Apply the ACA Code of Ethics. Counselors do not leave or terminate the counselor–client relationship without making arrangements in their absence or providing pretermination counseling, respectively. Since there are potential new clients scheduled, Wendy may also need to consider transferring these cases to a new counselor.

Determine the nature and dimensions of the dilemma. Wendy needs to act with fidelity and honor the appointments and obligations made to current and potential clients. She is also entitled to a vacation to practice self-care and reduce burnout.

This example details a vacation, but emergencies occur, and counselors are at times placed in positions where they are incapable of honoring the needs of their clients. If, instead of a vacation, Wendy had suddenly needed to go out of state to care for a sick relative, the problem would be more or less the same. However, the nature of the dilemma is still important to consider. Specifically, if one of her clients were to make a complaint to a licensing board, a sick family member would likely garner more sympathy than a spontaneous luxury vacation.

Generate potential courses of action. One option would be to simply reach out to all of her clients via phone and inform them that she will need to reschedule their appointments 4 weeks out. In this case, Wendy would also need to provide contact information for another practicing clinician, emergency support numbers (e.g., a 24-hour crisis hotline), and be certain to document this in all of her clients’ charts. Another option would be to refuse the vacation out of concern for her clients’ well-being.

Consider the potential consequences of all options and determine a course of action. If Wendy chooses to go, it is unlikely that she would meet the criteria for abandonment, as she is only leaving for a set period of time. However, if something were to happen to one of her clients (e.g., an increase in depression followed by a suicide attempt) that led to an inquiry of some kind, Wendy would have to admit that she left her clients suddenly for an entire month to take a last-minute vacation to Hawaii. If she chooses not to go, she is acting in the best interest of her practice, but this may have an impact on her relationship with her partner.

Evaluate the selected course of action. Life happens, and it is expected that counselors may have to take leaves of absence for unexpected reasons. If Wendy can quickly determine the needs of her clients, provide appropriate support in her absence, and contact all of them in the brief window available, she can probably go on her vacation.

Implement the course of action. It looks as if Wendy is going to have a busy weekend making phone calls to all of her clients and checking in with other therapists in the area who can provide support in her absence.

A.6.b. Extending Counseling Boundaries. Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs.

Identify the problem. Jill is conflicted as she wants to go to the wedding but knows that this could have an impact on Tim’s treatment and well-being. She is concerned that if she attends the wedding, it will make Tim feel uncomfortable, both because it may identify him as a client in counseling and because it may have an impact on their development or maintenance of rapport.

Apply the ACA Code of Ethics. As a certified school counselor, Jill should also consult the American School Counselor Association’s (ASCA) 2016 Code of Ethics for best practice. She should also refer to school board policy; however, most school districts do not have policies that pertain to attending weddings. In applying the code A.6.b. Extending Counseling Boundaries, Jill is considering attending the wedding and whether to give a gift. She is also considering the complexity of this situation since she is Tim’s current counselor. The code does not provide clear guidance in this situation; it only acknowledges that such actions are not outside the realm of acceptable ethical behaviors.

Determine the nature and dimensions of the dilemma. The core concern is not just whether Jill should go to the wedding but also how this will impact her relationship with Tim. It is important to consider the principle of nonmaleficence. Specifically, Tim appears to be struggling more than his sister, and attending the wedding may cause harm to Tim. However, not going to the wedding could cause harm to Marney, as it may be seen as a betrayal from a trusted former counselor (though this appears unlikely based on the information provided so far).

Generate potential courses of action. Jill could meet with Tim and discuss her concerns. She could attend the wedding, in which case she might also consider if buying a gift is appropriate. She could also simply decide not to go and send a gift instead.

Consider the potential consequences of all options and determine a course of action. Jill could speak with Tim before deciding what to do, though this may exacerbate some of his angst regarding his relationship with his sister. If she attends the wedding without consulting Tim first, this would likely cause him some amount of discomfort. However, if Jill decides not to attend the wedding and simply sends a gift, she avoids the entire debacle altogether (albeit at the expense of missing a wedding she would have liked to attend).

Evaluate the selected course of action. The best course of action is consultation first. Jill should consult with a counselor in a neighboring district who could help process different solutions and serve as a professional precaution. However, it seems that it would cause the least amount of harm to all involved if Jill simply opted not to attend.

Implement the course of action. If she does decide not to attend, Jill will have to take care to explore her emotional response to this decision in her ongoing work with Tim. It would be important to ensure that she does not harbor resentment toward him for missing the wedding or to work in supervision to manage these emotions if she does.