Category Archives: ethics

April 16, 2014 · 1:10 pm

New Pennsylvania Mandated Reporting Bills Signed Into Law


My local newspaper informs me that Governor Corbett signed into law HB 431 436 and SB 21 and 33 into law today. The paper reports what this means:

“Senate Bill 21 ensures that virtually anyone who works with children in a professional or volunteer capacity, including school personnel, personnel at colleges and universities, youth sports coaches, child care providers, religious leaders, physicians and other health care workers, social services workers, law enforcement officers, librarians, emergency medical service providers and employees and independent contractors for each of those entities are required to report suspected child abuse.

“House Bill 436,” Stephens continued, “adds attorneys for organizations caring for children to this list of reporters, while preserving the attorney client privilege, bringing Pennsylvania in line with a majority of states across the U.S.”

So, anyone who works with or volunteers with children is now considered a mandatory reporter. Attorneys who work for those organizations who serve children cannot keep quiet when child abuse is reported to them. Mental health and other health professionals continue to be mandated reporters when potentially abused children present to them or their colleagues.

Besides expanding who is mandated to report suspected child abuse, HB431 also now requires evidence of 3 hours of training on child abuse recognition and reporting for all seeking PA licenses AND evidence of 2 hours of continuing education on the same subject for all who seek to renew their PA licenses. 30 CE hours are still the minimum required per licensing period, but now 2 of those 30 must be about child abuse recognition and reporting. Not sure if that means the existing mandate to take at least 3 hours in ethics will be on top of the 2 for child abuse reporting or if the 2 for child abuse reporting will count towards the 3 in ethics.

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April 15, 2014 · 5:59 am

Comparing ACA and AACC ethics codes: Multiple Relationships


Continuing our review of the ACA and the AACC codes for counselors, let’s take a look at how both codes address the matter of multiple or dual relationships. (See first and second posts about comparing the ACA and AACC code of ethics for counselors and mental health professionals.)

Multiple or dual relationships between counselor and client (or client’s family) are those that combine the professional relationship with one of another sort. If a counselor of a client is also that client’s pastor, that would be a multiple relationship. Other types could combine counselor and friend, counselor and business partner, counselor and employer, and increasingly possible, counselor and social media “friend.” Both codes are concerned about the formation of dual relationships because they become fertile ground for counselor judgment bias and harm to the client. Both see that once a counseling relationship has been formed, that relationship ought to be clear take priority over all others.

The ACA code of ethics prohibits outright the following dual relationships:

  1. Counselor and sexual partner: Counselors may not have sex with clients or their family members
  2. Counselors may not start counseling work with former sexual partners
  3. Counselors must wait at least 5 years before engaging in sexual activity with former clients (and even then may be prohibited)
  4. Counselors may not provide services to friends and family
  5. Counselors are prohibited from engaging in personal virtual relationships (social media) with current clients

Beyond the sexual arena, the ACA code warns counselors to avoid dual relationships or “extending the boundary” of the counselor or supervisor relationship

Counselors 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. (A.6.e)

When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. (A.8)

So, notice the focus: avoid “extending the boundary” or what we used to call forming multiple relationships with current or former counselees or their family members. Document when you do so to illustrate informed consent, limiting of potential harm, and efforts made to rectify harm when it unintentionally happens

What about the AACC code?  It begins (ES1-140) with these paragraphs,

Dual relationships involve the breakdown of proper professional or ministerial boundaries. A dual relationship exists when two or more roles are mixed in a manner that can harm the counseling relationship and/or the therapeutic process. This includes counseling, as well as personal, fraternal, business, financial, or sexual and romantic relationships. Not all dual relationships are necessarily unethical—it is client exploitation that is wrong, not the dual relationship in and of itself. However, it remains the responsibility of the counselor to monitor and evaluate any potential harm to clients. (emphasis mine)

While in a counseling relationship, or when counseling relationships become imminent, or for an appropriate time after the termination of counseling, Christian counselors do not engage in dual relationships with clients. Some dual relationships are always avoided—sexual or romantic relations, and counseling close friends, family members, employees, business partners/associates or supervisees. Other dual relationships should be presumed as potentially troublesome and avoided wherever possible. (emphasis mine)

The AACC code then prohibits counseling relationships with family and close friends and warns against those “best avoided” (e.g., business associates, club members, etc.). Finally the code addresses counseling relationships within the church,

Christian counselors do not provide counseling to fellow church members with whom they have close personal, business, or shared ministry relations. Dual relationships with any other church members who are clients are potentially troublesome and best avoided, otherwise requiring justification. Pastors and church staff helpers should take all reasonable precautions to limit the adverse impact of any dual relationships. (ES-140-f)

This wording marks a change from the previous AACC code where dual relationships were more positively addressed. The old rule stated this, “Based on an absolute application that harms membership bonds in the Body of Christ, we oppose the ethical-legal view that all dual relationships are per se harmful and therefore invalid on their face.  Many dual relations are wrong and indefensible, but some dual relationships are worthwhile and defensible.”

Agreements? Disagreements? Both codes ban the ending of counseling relationships for the purpose of changing the professional relationship to different relationship, or to engage in sexual activity with a client or a member of the client’s family. The AACC codes requires 3 years before marrying a former client (assuming all other concerns raised are not an issue) whereas the ACA code requires 5 years before engaging in an intimate relationship. The ACA code as extensive concerns about the teacher/student relationship as well as the supervisor/supervisee relationship. The AACC code says little about these (though some can be inferred). The biggest difference, however, is found in the stronger language banning dual relationships in the ACA code where the AACC code warns against possible harm but leaves the door open as long as the counselor knows they have to prove no harm happened and informed consent.

 

 

 

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December 3, 2012 · 11:37 am

Repost at AACC: Seven Questions About Your Church Abuse Prevention Policy


The AACC has reposted my blog designed to help church leaders and counselors review current child abuse prevention policies. You can see the post at their site by clicking here.

As I say in the post, every church with any insurance policy likely has some measure of policy. However, why settle for something designed only to limit liability? Such an approach does not seek first the protection of the vulnerable. Rather, limiting liability places the protection of the organization ahead of the protection of children. In fact, policies that are tools of protection of children will also limit liability. We just need to get the order straight.

For further information and help with child protection, don’t forget to check out G.R.A.C.E.

 

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July 20, 2012 · 11:22 am

Abuse in the Church Course/Conference Begins Tonight!


At 6 pm, our class/conference kicks off at BranchCreek church (Harleysville, PA) and runs through tomorrow afternoon. Boz Tchividjian of GRACE and myself will be providing plenary and breakouts on a variety of topics designed to help church leaders and counselors prevent and respond well to abuse within the church family. We are expecting a good crowd of pastors, church leaders, mental health workers, and of course, grad students!

Still want to come?

It is not too late. Information here. Bring payment (CC or cash/check) to the door. We’ll fit you in!

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April 6, 2012 · 10:16 am

Ethics violations: Why we all think we won’t screw up…and one thing you need to protect yourself from you


Every counselor, social worker, psychologist, and other mental health workers get professional ethics education. Such training is designed to teach us to “do no harm.” What mental health professional gets into the field to do harm? We all believe we are going to work for the betterment of our clients.

So, why do we sometimes fail to act in accord with good professional ethics?

Rarely is it because we don’t know the rules. Consider the most recent issue of the APA Monitor on Psychology and the short ethics piece by Alan Tjeltveit (a colleague of mine and fellow CAPS member) and Michael Gottlieb. (You can read the electronic version here; turn to page 68.)  In it, the authors nail the reason why with this quote,

Too many professionals complete their training without the emotional education and awareness needed to avoid self-deception and to act in the prudent, considered manner that society expects and that represents professional ethical excellence. (p. 72)

Self deception

We fail to take a skeptical (note…not fearful) stance toward our own thoughts, feelings, and attitudes. Since we know we are going to work for the good of others we often stop considering that some other values that we hold might get in the way. For example, I might value avoiding conflict and so not address a safety concern with my client for fear they will get angry with me. Or, as the authors of the article point out, I might practice when I am too distressed to help others–because I believe I can still manage the situation (see page. 70).

The One Protection You Most Need

As necessary as it is to keep taking ethics updates from continuing education providers, it is even more important to have a close colleague who doesn’t take you too seriously and is willing to ask the hard questions. Yes, we need an operating sense of values. We need to be tuned to our conscience. We need the Holy Spirit’s help in loving our neighbor as ourself. But, more importantly, we need to stop trusting in our own judgment and acknowledge that hidden values sometimes operate more powerfully than we expect. Desires to be liked, to avoid conflict, to maintain power, to satisfy longings have ways of creeping in. One of the reasons God puts us in community is that we need others to speak into our lives.

Do you want to avoid ethical missteps? Who exists in your life who has the access and capacity to speak into your life; to ask questions others might not think to ask?

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November 11, 2011 · 5:17 am

Counseling as Global Mission of the Church


A few days ago I wrote this for our seminary’s blog regarding how counseling supports the global mission of the church. If you are interested in international counseling work…you need to read this blog and follow the link I promote.

Counseling as Global Mission of the Church.

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July 13, 2011 · 5:51 am

Book Note: “Why the Church Needs Bioethics”


Just received a copy of Why the Church Needs Bioethics: A Guide to Wise Engagement with Life’s Challenges (Edited by John F. Kilner; published 2011, Zondervan). Using 3 case studies, a wide variety of authors discuss “better birth” (fertility), “better life”, and “better death.”

Authors include Richard Averbeck (OT and Counseling), Kevin Vanhoozer (theology), DA Carson (NT), and Stephen Greggo and Miriam Stark Parent (Counseling). In addition, there are business, law, medical, education, pastoral care, bioethics, and intercultural ministry authors.

I got a little chance to play a part in this book as a “critiquer” (p. 9) Stephen Greggo authors chapter 3, “Wisdom from Counseling” as a counseling response to the case study of Betty and Tom, a couple who are considering using Betty’s sister’s eggs and Tom’s sperm and to implant embryos into Betty. I got a chance to read and react to this chapter some time ago all because of a little article my wife and I wrote in 2002 and published in 2005.

On page 71, Greggo and Parent say,

A recent search of the leading peer-reviewed journals that inform Christian MHPs [mental health providers] and pastoral counselors yielded only a single article to guide a Christian counselor who might be dialoging with  Betty and Tom.

Their footnotes reveal that they searched The Journal of Biblical Counseling, The Journal of Psychology and Christianity and the Journal of Psychology and Theology between the years 2000 and 2009.

I find it surprising that there are no other articles than ours (full text here) and gratifying to see our essay summarized in this volume. While there are a number of good full length books, there is a serious need for good Christian counseling articles dealing with infertility and assisted reproductive technology (ART) because this is where many counselors start their study on a given topic.

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June 7, 2011 · 2:42 pm

Multiple relationships: Just how many is too many?


Last night in our ethics class we took up the issue of multiple or dual relationships. For those of you who haven’t heard of either term, it refers to the situation where a counselor is not only a person’s counselor but they also have another relationship with the client as well: counselor and pastor, counselor and friend, counselor and business partner, counselor and friend of a child, and the like.

Every professional ethics code (secular or not) raises concerns about dual relationships given their potential for causing harm to the client. The AACC code recognizes that dual relationships are a given in Christian communities and something not to be banned outright. But even this code suggests that forming a dual relationship is a breakdown of professional relationships.

Over the years, I would estimate that 2/3 of the students in my program come thinking that dual relationships are good, even optimal and that those who would outright refuse more influenced by old psychotherapy models. So, part of my class is to talk about the benefits and liabilities of dual relationships. There are success stories and horror stories. But what is the value behind limiting these kinds of counseling relationships? It is to, “Do no harm,” to work for the client’s best interest and not one’s own.

Here’s what I asked my students last night. In an area filled with counselors, why would you think YOU ought to engage in a dual relationship? I want to push them to consider their reasons. Is it people pleasing? Is it to feel valued? Is it arrogance that no one else can help?

I am not against dual relationships and have engaged in some superficial one’s myself. But I do think we ought not engage in them without having forced ourselves to consider that maybe the reasons we do so are not really for our client’s best interests.

What do you think?

Of course, the answer to my title question is this: Even one unexplored dual relationship (exploring reasons why, options not to, possible dangers, informed consent, etc.) is too many.

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October 19, 2010 · 5:46 pm

Suffering for Christ? How should we respond to discrimination due to faith?


In 1 Peter 2: 12 we are commanded to, “live such good lives among the pagans that, though they accuse you of doing wrong, they may see your good deeds and glorify God on the day he visits us.” Peter goes on to tell us that our good deeds include showing proper respect for everyone. And still later he reminds us to follow the actions of Jesus who did not retaliate when he was insulted and mistreated at the cross.

Recently, a friend was mistreated due to her faith. Actually, the mistreatment was based on assumptions rather than facts. The one doing the mistreatment made false allegations about my friend’s beliefs and attitudes. This was in a professional setting where my friend expected to be treated as any other and not singled out like this. Thankfully, the episode was brief. But what if it wasn’t? How should we respond to mistreatment for reasons of faith?

Some things we shouldn’t do:

1. Sarcasm and biting back. One of the things that bothers me in the political arena is the amount of sarcasm and belittling used against each other. Not that this behavior is new–it isn’t–but it does seem more intense than before. It would seem that the goal for liberals is to catch conservative family values defenders not living up to their standards.  And conservatives put down liberals for being open to anything and everything (except conservatives). When attacked for reasons of faith, let’s not spend our time making public comments about the missteps of our accusers.

2. Say nothing at all. Silence isn’t always wrong but it may not be right either. It can be good to overlook some mistreatment as a mercy to the attacker. Sometimes when we know someone is having a bad day or is themselves a recipient of mistreatment, we may choose to overlook hateful comments. However, saying nothing as a matter of course may also eliminate an opportunity to speak truth in love to the offending party.

What can we do?

1. Deserved or undeserved? First, we can check to see if we have brought an attack on by our own behavior. If we have, we ought to address the matter right away. If the attack is not the result of our own foolish actions, then this is not about us but about God. Hopefully, this little bit of assessment can take the personalized part of the pain out of the equation.

2. Work to understand. Where are these comments coming from? What might be revealed behind the hurtful statements about our attackers experiences? It is possible that their attack comes from a bad experience from another person of faith who did not represent well the true meaning of Christianity. We can then validate their pain even if not their expression of it.

3. Speak the truth in love via a point of contact. Look for the value that you share together. Speak to that issue first. Often, some issue of respect, justice or shared concern can be a point of contact to engage an attacker. MLK wrote a letter from his jail cell in Birmingham, AL to white evangelicals who had written to ask him to stop raising tensions via nonviolent protests. He begins with a point of contact–their shared faith, their genuine good will and sincerity regarding their concerns. He attempts to speak their language first about the necessity of prophetic voices among God’s people. Surely he moves on to accuse them of inaction and maintaining the status quo–thus not caring for all of God’s people. But he ends with invitations to dialogue more and even requests that they forgive him if he has overstated their complicity in the problem of Jim Crow. In professional worlds, we may begin with discussions of shared ethical standards. We may want to point out failures by our accusers to keep their own standards, but first we need to establish common ground.

4. Bless, do not curse. Look for ways to bless and/or encourage an accuser if at all possible. Find reason to offer mercy rather than retaliation.

5. Activate, do not withdraw. In professional settings, use the existing system well so you can to gain a hearing,  and not just for yourself. Remember, the Apostle Paul uses his Roman citizenship to seek justice against false accusers and abusers. Using his right to appeal to Caesar enabled him to speak to numerous individuals and groups that he might not otherwise have met. It was this simple act that God used to spread the Gospel to Europe and then to the whole world.

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June 22, 2010 · 4:40 pm

Christian interventions in counseling


Regular readers of this blog will know that I believe that Christian counseling is not merely counseling done by Christians or merely the use of specific christian interventions. Rather, Christian counseling is founded on Christian/biblical ways of perceiving the world, the problems in it, and the goal of imaging Christ from start to finish.

However, it is good to think about the specific use of certain christian practices in counseling: meditation, prayer, bible reading and application, casting out demons, absolution, etc. How are we to think about these practices? Do they have a place in professional counseling? What are limits we ought to place on them? When should we refrain? How do we secure informed consent?

Elsewhere I have published on the guidelines we ought to consider when using Scripture in counseling. I will not repeat them here but for those who have not read that article, I do think Scripture is something that CAN be used in counseling–even OUGHT to at times. What is of more importance to me is HOW and WHEN and WHY.

Let me here consider the most commonly used practice: prayer. Here are some shaping values before we consider any practical application.

1. Prayer is talking and listening to God. It is not a technique and should not be treated as such. It is not magic. It is, from a Christian perspective, sharing one’s heart, praising, questioning, interacting with the Creator of the universe who remarkably wants to relate to me. At its heart prayer is submissive acknowledgment of God–even when praying like Job.

2. Prayer then needs to be a free act without trace of coercion. The one praying must not be coercive (you talk to God not at another person). The one being prayed for ought not feel obligated to say anything.

3. People have diverse (and not always happy) experiences regarding prayer, faith, relationship with God, etc. So, what is comforting to you may be triggering for another.

4. Prayer is intimate. Prayer often results in our setting aside defenses and becoming vulnerable and needy.

5. Prayer is power. Praying for someone gives the one praying a position of power.

So, how might a counselor consider these values and use prayer in counseling.

1. Assessment of client. What is my client’s faith tradition, experiences with prayer, history of abuse by leaders of the church, understanding of God? Have they ever felt coerced to pray, coerced by the prayers of others? Have they been publicly prayed against? Do they value prayer?

2. Assessment of self. Why am I praying for my clients (out loud)? What messages am I trying to communicate? What do my prayers reveal about my own faith?

3. Consent. Have I explained why I pray for my clients? Do they really have the right to say no?

4. Review. How are my prayers received? What impact, if any, do they have?

What does this look like for me? I don’t pray with every client. I don’t choose to start my sessions with prayer (at least the first one) until I have a better sense of my client’s experience with prayer. I work very hard not to use prayer as an effort to disarm (though I think it can do this) or to preach a message, but only to make supplication to God for healing, for care for the downtrodden. When I use imagery in prayer I make sure that it is grounded in common biblical images (God as shepherd, Christ as lamb, etc.). I never ask clients to pray but many of them choose to do so. And, I do let clients pray for me when they want to. It is part of how believers care for each other.

I do believe that prayer is extremely important but that I do not need to do it to be actively asking God for healing or guidance. I will say that when conflictual couples pray, they often find that it is hard to stay angry and embittered and pray. It can be helpful, either in reducing bitterness or by discussing bitterness and its impact.

It should not be used when clients do not want it, might be confused by it, or if it is not authentic to the counselor. It is considered good professional ethics to utilize resources from a client’s life. However, it would not be good to fake (e.g., my praying in a way that would please a member of a cult, an atheist praying as if he or she believed what she said, my talking to God even though I am no longer practicing as a Christian, etc.).

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