ACA Code of Ethics
Table of Contents
The Purpose of This Guide
The purpose of this pocket-guide is to simplify the ACA Code of Ethics for counselors. This guide is not intended to replace the ACA code of ethics, but rather to provide a practical tool to aid the counselor in implementing the ethics policies for safe and ethical counseling practice.
What follows is how violations of the nine (9) sections of content could directly result in either a licensing board complaint or lawsuit and allegations of malpractice. In other words, this companion guide can be used to resolve the day-to-day problems that every counselor faces in their practice.
First, the most important ethics violations to be aware of are boundary violations. Violations of other ACA Code of Ethics sections are frequently determined to be boundary violations.
Who Developed This ACA Companion Guide
This companion guide to the ACA code of ethics was developed jointly with Eric Groh LPC, a former state licensing counseling board complaints investigator. Over the course of 7 years he processed over 200 consumer complaints against counselor, social work and marriage and family therapy licensees in the state of Georgia. He has also served as a consultant to attorneys representing licensees in both civil suits, board complaints and LPC licensing matters.
Boundary Violations and The ACA Code of Ethics
What Is The ACA Code of Ethics
The ACA Code of Ethics helps counselors make ethical decisions to protect clients rights, but it’s long and difficult to understand.
Still, It guides behavior while covering topics such as confidentiality and multiculturalism. Not following the code can in some cases lead to disciplinary action by regulatory boards. Counselors must assess their actions to ensure they uphold the profession’s integrity and act in the client’s best interest.
Abiding by the ACA code of ethics may not prevent state board disciplinary action as the two ethics codes may conflict. Examples are bartering and patients with communicable diseases.
The Powers Of The ACA American Counseling Association
Second to your state counseling board code of ethics, the ACA Code of ethics is the most referenced ethical code for counseling practice.
LPCs/LMHCs should also understand the American Counseling Association may possess powers with certain state counseling boards when licensees of those states are subject to disciplinary action.
There are several manners in which some states have adopted the ACA Code of ethics as their board code of ethics:
1) States have adopted the ACA Code of Ethics by reference. In other words, they don’t have the text of the ACA code in law or rules, but suggest those are the ethics their licensees should abide.
2) The state has written into law that licensees need to follow the ACA code of ethics. If the ACA Code of Ethics conflicts state law prevails.
3) It is not written into state law, but is written into board rules.
4) Still other states, the ACA Code of Ethics has been formally adopted as law as the code their licensees are required to follow.
Conflicts Between The ACA and State LPC Licensing Board Codes of Ethics
The ACA has disciplinary powers over it’s members and can suspend or revoke membership. The ACA powers are limited for non-members.
However, in some states portions of the ACAs code of ethics may conflict with your state licensing law. In most cases, ACA refers the reader to their state laws.
Read your licensing board ethics carefully.
Is There a 2023 ACA Code of Ethics
For 2023, the ACA Code of Ethics has not changed. The most current version is the 2014 ACA Code of Ethics.
This comprehensive guide provides clarification that can be applied to real-world clinical situations. There are nine (9) ACA Code of Ethics content areas:
Section A The Counseling Relationship
Section B Confidentiality and Privacy
Section C Professional Responsibility
Section D Relationships With Other Professionals
Section E Evaluation, Assessment, and Interpretation
Section F Supervision, Training, and Teaching
Section G Research and Publication
Section H Distance Counseling, Technology, and Social Media
Section I Resolving Ethical Issues
Section A: The Counseling Relationship
The counseling relationship is the most important professional ethic. The 8 additional sections of the ACA Code of Ethics rest squarely upon Section A. Consequences of mismanaging Section A can directly result in clients feeling or being hurt and betrayed.
Of all sections, it is the most direct violation of counselors’ fundamental oath: do no harm. Betrayed clients are more likely to file civil suits and board complaints.
Intimate Relationships With Current or Previous Counseling Clients
When there is a conflict in law, your state board ethics prevail.
LPCs cannot engage a patient for counseling if they are in a current intimate relationship.
The ACA Code of Ethics states that counselors are prohibited from engaging in intimate relationships with clients for 5 years from the last date of contact. Important: ACA ethics requirements may conflict with your state licensing law and rules. As regards intimate relationships with clients, read your state law carefully. Seek legal counsel if necessary.
Records and Documentation
Counselors maintain accurate and secure records aimed at documenting a timeline of client progress.
Documentation should tell a story about clients’ personal and life struggles and mental health.
It is especially important to document psychotherapeutic interventions that would be irresponsible to not document.
One the most important of these is documenting suicide risk.
Further, thorough record keeping is important with therapists specializing in couples or therapy with minors is critical.
Example. You are sued by a parent because their minor child suicided. You spoke with your client’s psychiatrist but are unable to produce documentation that you coordinated care with the person who was monitoring the child’s medication.
Suicide Risk
Generally, handling of all ethical dilemmas should be guided by potential consequences to the client or to the therapist. Importantly, by protecting your client from yourself you are also protecting your privilege to practice.
Ask regards suicide risk, all handling of suicide or severe depression management should include:
Risk scale of patient acting out on suicidal thoughts including plan, means, intent and buffers (or what prevents acting out such as beliefs of devastation to family members, children and others.
Assessment of level of care required and causing that level of care to be provided to the client. For example, if a client can safely be managed with outpatient weekly therapy, this should be supported in the therapists documentation.
Lack of responsible intervention in the above areas can raise concerns about therapist competence and practice within an area of expertise.
Family or Child Counseling
Family and child therapy is highly specialized work that is complicated by unique legal issues with minors and boundary management.
Some of the most frequent civil suits of allegations of incompetent practice are a result of poorly managing the boundaries between parents and a child and lack of competence in custody and reporting requirements.
Therapists working with minor children should seek continuing education in legal issues of minors and marriage and family therapy. A counselor should document training in family/child counseling.
Top priority for a court or licensing board investigation is determining whether a therapist is trained to do the work.
Example: You are sued and are unable to produce an adequate informed consent about your role in seeing a couple with minor children involved in a custody dispute. This scenario is a boundary crossing because it is a dual relationship.
Informed Consent
Elements of informed consent that should be considered:
Written and on-going verbal informed consent. Verbal informed consent should be entered into clients’ clinical notes. Counselors should ‘check-in’ regularly to ensure clients understand methods of the therapy.
In short, counselors should inform clients of every intervention or therapy they will may subject the client. Examples of these interventions include delivering sex therapy and crisis intervention and involuntary hospitalization.
Gaining clients consent to all non-talk therapies such as hypnosis and EMDR.
Developmental and Cultural Sensitivity
The 2014 ACA Code of Ethics addresses cultural competence as matters of clarity of language appropriate for the culture. There should be a means for explaining in clear terms informed consent. The risks, however, in cultural competence are often inability to competently treat due to biases or ambivalence about learning clients’ cultures. Therefore as regards licensing and liability issues the allegations are often related to competence/incompetence.
Example: A client files a board complaint against a counselor because of an insensitive remark. The board processes it as an incompetence or scope of practice allegation.
Inability To Give Consent
A counselor should seek training to understand cognitive or other impairments related to mental function. A counselor should be competent in rendering a full and accurate assessment of clients’ capability of understanding treatment.
Inability to give consent to treatment should be carefully balanced with depriving clients of their rights to make decisions about their care.
Clients Served By Others
When there are other professionals providing mental health services, care should be coordinated.
If a client is being treated by a psychiatrist, the counselor should either have direct contact with the psychiatrist or ensure they have reliable knowledge via the client.
Counselors should monitor client progress with medication and ensure timely follow up medication management appointments.
Bartering
The ACA Code of Ethics position on bartering:
“Counselors may barter if the arrangement is not exploitive and does not cause the patient harm. If the client consents in writing and it is culturally appropriate bartering is permissible.”
However, it is important to note that bartering is unethical by it’s very nature. Bartering creates a dual relationship since the counselor has become the client’s customer. It is therefore a boundary crossing.
Example: a client files a board complaint over a disagreement on the value of items exchanged and failure to deliver a promised product. This scenario is a boundary crossing since it is a dual relationship
Receiving Gifts
The ACA Code of Ethics states that culture, the dollar value of the gift, and both counselor and client’s motivations for the gift.
Of these, most important is that counselors examine their motivation for accepting a gift from a client and consult with a peer as needed.
Termination and Abandonment
Counselors must often make difficult decisions between transferring a client and abandonment or neglect.
This decision can be guided by the client’s need for a higher level of care that may require transfer from telemental health to a higher level of care.
When a client relocates to another state, a rapid transfer can be made since it may be illegal for the counselor to provide services in that state.
A rapid transfer may be necessary. When a counselor for various reasons no longer wants to treat a client, summary sessions should be aimed at affirming with a client the progress they have made over the entire period of the counseling.
Example: failure to quickly terminate and transfer an acute client to a higher level of care resulting in suicide.
Section B: Confidentiality and Privacy
Respecting Client Confidentiality
Section B focuses on the legal requirement of confidentiality, legal exceptions, and respect for a client when sharing information with others even if a release of information has been provided.
Often clients do not fully understand repercussions when signing a release of information. The purpose and what information will be released should be made clear to the client verbally and in the written releases.
Clients Lacking Capacity To Provide Informed Consent
Parents and Legal Guardians
Often parents do not clearly understand their role in their child’s therapy.
Relationships between the counselor, parents and a minor client should be made clear verbally and in a written informed consent prior to engaging in therapy.
It is equally important the counselor then abide and adhere to this informed consent.
The overriding goal should be a plan that best serves the interest of the minor client.
Storage and Disposal of Records
The ACA Code of Ethics states that counselors should refer to their state law when determining length of time to retain client records after treatment is terminated.
However, states often do not have law that specifically address retention of psychotherapy records. Counselors should consult with legal counsel, but if the state does not have specific law it is wise to retain psychotherapy records for the same period of time as under state general medical records law.
Section C: Professional Responsibility
Nondiscrimination
The ACA Code of Ethics position on discrimination is strict and broad.
“Counselors do not discriminate based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/partnership status, language preference,
socioeconomic status, immigration status, or any basis proscribed by law.”
Does this require we treat every client regardless of the above factors?
1) We are required to cause treatment to occur if necessary with individuals seeking services. We are not required to treat every client we encounter.
2) Discriminatory counseling is often disciplined by the board as incompetence or working out of one’s area of expertise.
3) We are required to protect our clients from harm.
There are instances when it is not possible for a therapist or they are not willing to change their viewpoints on a demographic. For example, a counselor’s religious beliefs could cause harm to a client.
Example: A client files a board complaint against a counselor because of an insensitive remark. The board processes it as an incompetence or scope of practice allegation.
Client Access To Records
There is some confusion about client access to records. ACA’s ethics policy is the counselor provides the minimum necessary information when a patient requests a copy of their records. Particularly whether the client “owns” the records.
Psychotherapy notes are treated uniquely by HIPAA. Clients do not own their psychotherapy notes. Importantly, clinical notes should be limited to mental status exams, coordination of care, medication of care, treatment goals.
Alternately, psychotherapy notes should be limited to half-formed hypotheses, working notes and clinical impressions.
Psychotherapy notes are a living roadmap for the direction of therapy. These should be kept separately in the patient chart.
When there is a conflict, state or federal law prevails.
ACA refers to a general requirement to protect clients from harm that could be caused by the patient records. For example, a therapist may note that a client has narcissistic traits. In addition, whereas master’s therapists can legally diagnose in most states, personality disorders are best formally diagnosed through psychological testing.
When a client requests the entire record including psychotherapy notes it is usually for a specific purpose. For example, the client needs an attorney to review them or for documenting medical disability.
Whenever possible, a counselor should explain to the client the notes will be released directly to that entity with instructions to the recipient to not re-release the notes/records. This solution is acceptable to clients in most cases.
Testimonials
“Counselors do not solicit testimonials from current or former patients or others who may be vulnerable to undue influence.”
The primary consideration is the power differential of the counselor over a client or current supervisee. There is a power differential with former patients and it is wise to consider that power as permanent.
ACA strongly takes into consideration the power differential between the counselor and patients or others.
By default, it is the counselor’s responsibility to determine the level of power differential.
In contrast, when supervision is terminated the supervisor/supervisee have become peers in the counseling profession. Each becomes individually responsible for their counseling licenses and the power differential has been eliminated.
Section D: Relationships With Other Professionals
“Counselors alert their employers of inappropriate policies and practices. They attempt to effect changes…through constructive action…When such policies are …damaging to client…take appropriate further action. Such action may include…voluntary termination of employment.”
“Counselors do not initiate, participate in, or encourage the fling of ethics complaints that are retaliatory in nature or are made with reckless disregard or willful ignorance of facts that would disprove the allegation.”
It is not uncommon for counselor/employer relationships to become adversarial. When a counselor has determined the organizational policies are harmful to clients or require them to practice unethically, they may need to make difficult decisions. Among them are leaving the counseling center.
“Counselors do not harass a colleague or employee or dismiss an employee who has acted in a responsible and ethical manner to expose inappropriate employer policies or practices.”
A counselor supervisor who is simultaneously in a position of administrative oversight does not harass or retaliate against the colleague/ employee.
Counselors should be cautious when accepting employment. Anyone terminated from employment has a right to defend themselves. Counselors should aim to legally support if it was an employer/employer dispute that is unrelated to any allegation of ethics violations.
Example: a common scenario is a supervisor being sued for failing to recommend for licensure due to the supervisee not following agency policy.
Section E: Evaluation, Assessment and Interpretation
A short summary of Section E– it should be the counselor’s aim in psychological assessment is to use it carefully, prudently and responsibly.
Psychological testing instruments are powerful tools for making diagnoses and producing a personality profile of a client. They create a detailed record of a client’s mental and psychological function.
Competence to Use and Interpret Assessment Instruments
Counselors should be confident in their training to administer and interpret psychological tests.
It is important to note that some state laws may strictly limit counselors in their use of psychological assessment.
If a counselor is actively developing a testing/ assessment practice it is important to review all factors involved in performing these assessments and evaluation. Note the range and complexity of the following:
Forensic evaluations
Competency to stand trial assessments
Immigration Assessments
Substance Abuse Assessments
Sexual Abuse Assessments
Disability Evaluations Accommodations
Health Related Evaluations
Gender Reassignment Surgery Assessments
Bariatric Surgery Evaluations
Surrogacy Evaluations
Untrained administering and interpretation of psychological assessments can cause significant legal and licensing risk to the counselor. For example, child custody evaluations and family violence assessments.
Counselor Incapacitation, Death, Retirement, or Termination of Practice
“In the event of death, the counselor prepares and identifies a third party licensed mental health professional who will become the custodian of patient records.”
Some states have laws governing mental health records retention. Many states do not have specific retention requirements. Often the law that is cited is that which governs general medical records.
Section F: Supervision, Training and Teaching
Introduction
- Counselors are fair and accurate in their assessment of supervisees.
- Counselors foster respectful relationships with their supervisees.
Multicultural Issues/ Diversity in Supervision
“Counselors seek to understand cultural considerations in their work with supervisors.”
There are problems inherent in a counselor treating a patient from a culture foreign to them.
2) A discriminatory action is often disciplined by the board as incompetence or working out of one’s area of expertise.
3) We are required to protect our clients from harm.
There are instances when it is not possible for a therapist or they are not willing to change their viewpoints on a demographic. For example, a counselor’s religious beliefs could cause harm to a client. In this case, referral to another therapist may be the most responsible clinical intervention.
Sexual Relationships With Supervisees
Inappropriate intimacy and sexual relationships with current or former supervisees is prohibited.
There are fundamental differences between the therapeutic relationship and boundaries of an LPC supervisor/supervisee relationship:
Mentoring and Development
Because of the mentoring, guiding and development objectives in supervision, it follows that boundaries are more flexible. For example, an intimacy often develops as the counselor supervisor shares their own failures, mistakes and mission to build confidence. These disclosures, whereas not appropriate when counseling, are often necessary in the clinical supervision relationship. As counselor supervisors finalize supervision, it may be natural to welcome the supervisee into the profession and develop a friendship when supervision is complete.
Legal Confidentiality and Supervision
Most states do not have a legal protection of communications between counselor supervisor and supervisee. Information shared about specific patients is usually protected.
Multiple Relationships and Supervision
Whereas multiple client relationships are generally prohibited. Counselor supervision is a necessary dual relationship–supervisee/ supervisor and professional peers since the supervision must be provided by another licensed mental health professional.
Section G: Research and Publication
Research on human subjects is a serious endeavor that is highly regulated by academic policies and state and federal law. Counselors should conduct research and collect and publish data within the framework of a bona-fide research setting. If the subjects are clients, the collective ACA Code of Ethics largely applies.
Section H: Distance Counseling, Technology and Social Media
Counselors don’t search for clients’ presence on social media unless given consent to view such information.
Counselors maintain separate professional pages for interacting with clients and the public at-large. Social media account settings should block counselor personal profiles from public viewing. There are over 100 documented risks of telemental health.
It has become common practice for websites and social media to track site visitors. This raises the problem of following the client in an inappropriate manner.
Distance Counseling Relationship
Counselors state in their patient informed consent both the benefits and limitations of telemental health and complete appropriate telemental health training and continuing education.
Section I Resolving Ethical Issues
It is a long-held misconception the ACA Code of Ethics mandates that counselors report all suspected ethical violations.
It is important for a counselor to have a personal decision making model for handling conduct of peers:
Unwarranted Complaints
“Counselors do not initiate, participate in, or encourage the filing of ethics complaints that are retaliatory in nature or are made with reckless disregard or willful ignorance of facts that would disprove the allegation.”
Counselors should understand reports should not be made based upon second or third-hand information.
It is the job of licensing boards to collect evidence and proof of an allegation. Only licensing boards have the resources and legal power to investigate and collect evidence of counselor misconduct.
Example: a reckless complaint is field and an equally retaliatory counter complaint is field.
First, counselors should approach peers and inquire about the suspected unethical conduct– the public can allege misconduct. Only the ACA or counselor licensing board determines whether there has been a violation.
Reporting Ethics Violations: A Decision Making Model
A pocket guide to reporting allegations of ethical misconduct:
1) Is the violation apparent?
2) Could the report result in a confidentiality breach of the involved client?
3) Is the counselor’s conduct likely to cause substantial harm?
4) Is it appropriate to attempt a formal resolution with the counselor.
5) Has the counselor made an attempt to approach the individual about the misconduct?
6) Has the counselor provided the individual opportunity to provide an explanation or “their side of the story”?
7) The counselor can then make a personal decision to file a complaint.
