Counseling Professional Ethics and Practice

How is counseling similar to other mental health professions?

Master's level or higher; all provide assessment, treatment planning, and mental health treatment

What makes counseling distinct from other mental health professions?

Philosophy of wellness, development, and empowerment; training focused on counseling skills development

Medical (illness) model

Identify the illness, diagnose it, use scientific principles to "cure" it, and return the person to former functioning; focus on symptom reduction

Wellness model

Achieve the highest level of positive mental health in all life domains; mental health is a continuum (dysfunctional to self-actualized); not "curing" an illness

What are the 3 core values of the counseling profession?

1) Holistic wellness 2) Developmental nature of problems 3) Belief in client growth and potential (client empowerment)

Developmental perspective

Problems are understood in the context of normal life transitions and growth (physical, moral, spiritual, cognitive, identity)

Client empowerment: what is the goal?

"Make ourselves obsolete": clients take responsibility, learn problem-solving, and aren't dependent on others to "cure" them

Focus on counseling skills

Primary duty is counseling individuals, groups, couples, and families; counselor preparation centers on skills development

Personal morals

An individual's own beliefs about right and wrong; counselors bracket them and avoid imposing them on clients (ACA A.4)

Professional ethics

The profession's standards (ACA Code of Ethics); Louisiana adopted it as the LPC Code of Conduct

Laws

Government rules enforced by legal penalties (e.g., La. R.S. 9:2800.2 and LPC Board rules)

Mandatory vs. aspirational ethics

Mandatory = comply with minimal standards; Aspirational = look beyond standards and ask what is best for this client in this situation

Why can an ethics violation affect an LPC's license?

Louisiana adopted the ACA Code into state law, so violations can lead to Board discipline (public record, reported to national practitioner database)

CACREP master's program length

60 semester hours

CACREP content areas

Professional orientation and ethics; social and cultural foundations; human growth and development; career and lifestyle development; helping relationships; group work; appraisal; research and program evaluation

CACREP practicum hours

100 hours

CACREP internship hours

600 hours (700 total clinical hours with 280 direct client contact hours)

Accreditation

Applies to the academic PROGRAM (CACREP), not individuals; say "I graduated from a CACREP-accredited program"

Licensure

State-regulated legal authority to practice; required for mental health counseling in Louisiana (PLPC, then LPC)

Certification

Voluntary credential from a professional organization (e.g., NCC from NBCC); does not authorize practice; required for school counselors in public schools

Which credential allows independent mental health counseling in Louisiana?

Licensure as an LPC (PLPC practices under supervision; NCC certification does not authorize practice)

PLPC requirements

3,000 post-master's hours (1,900 direct, 100 supervision, 1,000 indirect); renew every 2 years; pass the NCE; 2 to 6 years to accrue; 10 CE hours per renewal

Levels of care (least to greatest intensity)

Prevention/education; outpatient; intensive outpatient (IOP); partial hospitalization (PHP); residential; crisis/emergency management and inpatient hospitalization

Community Mental Health Act of 1963

Deinstitutionalization and outpatient care; community-based continuum of care in the "least restrictive setting"

Role of the LPC Board

Regulates the practice of mental health counseling in Louisiana: sets rules, issues PLPC/LPC licenses, approves supervisors, takes complaints, disciplines licensees

3 exceptions to the LPC license requirement

School counselors; pastoral counselors; graduate students in practicum or internship

Practice act

Protects the PRACTICE: no one may perform the activities without a license, regardless of title

Title act

Protects only the TITLE (e.g., "LPC"); others may do similar work without using the title

Is Louisiana's mental health counseling law a practice act or title act?

Practice act (license or provisional license required, with exceptions)

Why do we emphasize counselor self-care?

"You are the instrument"; counselor stress can lead to burnout and impairment, which harms clients

Counselor stress progression and related terms

Stress, burnout, impairment; related: secondary trauma, compassion fatigue, vicarious traumatization

ACA C.2.g (Impairment)

Monitor yourself for impairment, seek help, and limit, suspend, or terminate services when impaired; help colleagues who show impairment

Strategies for preventing burnout

Mindfulness; self-compassion; journaling; personal counseling for "unfinished business"; social support; stress management; overall life balance

Why is informed consent important?

Trust is the cornerstone of counseling; clients have the freedom to choose whether to enter or remain in counseling and need adequate information to do so

How do counselors obtain informed consent?

Review rights and responsibilities verbally AND in writing; signed written disclosure statement (two copies or EHR); document it; revisit throughout counseling

Louisiana written disclosure statement

Declaration of Practices and Procedures (LPC Board Rules, Chapter 21)

ACA A.2.c (Developmental and Cultural Sensitivity)

Review the statement verbally in clear language that is developmentally appropriate and culturally sensitive

ACA A.2.d (Inability to give consent)

With minors or those unable to consent, seek the client's ASSENT and include them in decisions; balance their rights with parents' or guardians' legal rights

ACA A.2.e (Mandated clients)

Discuss limits of confidentiality, what will be shared and with whom; client can always refuse services; report accurately and honestly to third parties (C.6.b)

Counselor vs. client talk time

Client does most of the talking; relationship-building is the best predictor of success

Counseling skills that support client talk time

Attending nonverbals; door openers; minimal encouragers; open questions (avoid "why"); paraphrasing; reflection of feeling and meaning; summarization

Reflection of feeling formula

"You feel ____ because ____."

Autonomy

Fostering the client's right to control the direction of their life; work to decrease dependency

Nonmaleficence

Avoiding actions that cause harm ("first do no harm")

Beneficence

Working for the good of the individual and society by promoting mental health and well-being

Justice

Treating people equitably and fostering fairness and equality

Fidelity

Honoring commitments and keeping promises, including responsibilities of trust

Veracity

Dealing truthfully with the people counselors work with

ACA B.2.a (serious and foreseeable harm)

Confidentiality doesn't apply when disclosure is required to protect clients or others from serious and foreseeable harm, or when legal requirements demand disclosure

What situations require breaking confidentiality to protect someone?

Danger to self (suicide); danger to others (duty to warn); suspected abuse or neglect of a minor, an elderly person (60+), or a dependent adult

What does the duty to protect/warn NOT include?

Mandatory reporting of past crimes or of violence against competent adults

ACA B.2.e (Minimal disclosure)

Inform the client first to the extent possible, involve them in the decision, and reveal only essential information

Louisiana privileged communication

Counselor-client communications are treated like attorney-client communications; the CLIENT holds the privilege

Subpoena

Issued by an attorney or clerk with no judge review; does NOT override privilege; don't ignore it and don't release records without client consent

Court order

Signed by a judge; can override privilege; release ONLY what the order specifically requires

Steps when you receive a subpoena

Don't ignore or release; contact the client for written consent; consult an attorney (motion to quash or protective order); document every step

Steps when you receive a court order

Verify a judge signed it; inform the client if possible; consult an attorney; disclose only what is required; document

In camera review

Judge privately reviews records to decide what, if anything, is released (nothing, portions, or everything, possibly under a protective order)

Ethical exceptions to confidentiality (B.3)

Clerical staff/assistants; consultation with colleagues/experts; supervision; treatment teams; third-party payers; other professionals involved in care; defending yourself in a malpractice suit or complaint

C-SSRS screening: which answers mean high risk?

Yes to Q4 (intent), Q5 (plan and intent), or Q6 (suicidal behavior in past 3 months): get immediate help (988, 911, or ER); yes to Q2 or Q3 means seek behavioral healthcare evaluation

IS PATH WARM

Ideation, substance abuse, purposelessness, anxiety, trapped, hopelessness, withdrawal, anger, recklessness, mood changes

SAD PERSONS scoring

0-2 keep watch; 3-4 send home but check frequently; 5-6 consider hospitalization; 7-10 likely hospitalize

When to consider hospital evaluation for suicide risk

High-risk C-SSRS answers (Q4-6); SAD PERSONS 5 or higher; plan with intent or recent behavior; client at immediate risk

Steps when a client is at immediate risk of suicide

Follow agency procedures; stay calm and don't leave client alone; contact significant other (not in front of client) to take client to hospital; if not, call 911; get release for evaluator; document

Safety plan vs. no-suicide contract

Use a safety plan (Stanley-Brown) with behavioral strategies until the next appointment, not a "no-suicide contract"

When does Louisiana's duty to warn apply?

Only when a client communicates a significant threat of physical violence against a clearly identified victim(s), coupled with apparent intent and ability to carry it out (La. R.S. 9:2800.2)

How is the Louisiana duty to warn discharged?

Make a reasonable effort to communicate the threat to the potential victim(s) AND notify law enforcement near the client's or victim's residence

Liability protection under La. R.S. 9:2800.2

No liability for breach of confidentiality or invasion of privacy for disclosures made to discharge the duty

What should be included in an informed consent document (Declaration of Practices and Procedures)?

Counselor and counseling process information; rights and responsibilities of client and counselor; supervisor information (for PLPCs); fees and termination policies; limits of confidentiality; use of technology/AI tools; must meet LPC Board rules (Chapter 21) and ACA A.2.b

What are the 4 limits of confidentiality in Louisiana's sample confidentiality statement?

1) Client signs a written release 2) Client expresses intent to harm self or others 3) Reasonable suspicion of abuse or neglect of a minor, elderly person (60+), or dependent adult 4) Court order directs disclosure

Typical A.2.b items to include in informed consent (from the ACA Code, not your slides)

Purposes, goals, techniques, procedures, risks, and benefits of counseling; counselor qualifications and credentials; fees and billing; confidentiality and its limits; role of technology; client's right to refuse or end services. Verify against the LPC Board's sample Declaration.

Duty to protect vs. duty to warn

Duty to protect = acting to keep a client safe from harming THEMSELVES (suicide); duty to warn = notifying a potential victim and law enforcement when a client threatens harm to OTHERS

Suicide Risk Curve

Suicidal risk rises and then falls over a short period; safety planning helps clients recognize warning signs early so they can act before they are in danger of acting on suicidal feelings

Steps for higher-risk suicidal ideation (not immediate risk)

Know your agency's risk policy; document that a significant person needs to be informed; inform the client and have them tell a significant other (review a safety plan); if not, explain you will contact the person; inform your supervisor and document

Which confidentiality exception applies when a client signs a release?

Client consent: written release of information with informed consent allows disclosure to the named party

Why is informed consent ongoing rather than one-time?

ACA B.1.d says counselors explain limits of confidentiality "at initiation and throughout" counseling; the standard is the client's actual understanding, not just a signed form