Understanding NBCC Code of Ethics 2023

Unlimited CEUs $59 @ALLCEUS I'd like to welcome everybody back to nbcc code of ethics 2023 now yes I know it's 2024 but they put out this code of ethics in 2023 this is part two of eight and I am Dr Dawn-Elise Snipes your host we are going to review the 2023 nbcc code of ethics Point by Point specifically today focusing on personal values unavoidable harm confidentiality bartering multiple relationships and harassment now we have to go over confidentiality and multiple relationships because when you look at ethical violations those are the two most common areas where people run into trouble and so we're going to go into detail about that again I am going to be asking you questions hopefully they're not rhetorical and to get your input about some of these things things um that we talk about today in part one we discussed the seven ethical principles and the ABCD e for ethical decisionmaking we also reviewed nbcc core values and professional responsibilities so let's move on today we're going to talk about more things that we as clinicians need to do and we need to make sure our agencies are doing counselors shall take proactive measures to avoid harming their clients and avoid imposing personal values on those who receive their Professional Services how might we or our organizations do this directly or indirectly Now by directly I mean we actually tell them you should think this way or you should feel this way you here the shs in there and the boundary violations all over the place obviously we won't don't want to do that and hopefully we don't directly come out and impose our values but indirectly we may impose our values and so again I'll ask how do you think you might see this happening for example when somebody walks into your lobby what do they see what do they hear do they hear um gospel music over the loudspeaker do they hear heavy metal what do they hear do they hear silence um what do they see in terms of your Decor are you communicating to them that it's you have a welcoming safe environment for everybody or only for people who fit a certain description and that's indirectly imposing our values another way we can indirectly impose our values is in our assessment when we're going going through and we're asking are you married or um what is your spouse's name for people who are in Partnerships that don't want to get married that feels like a judgment for people who are in polyamorous relationships that definitely feels like a judgment if we ask somebody about their partner or their spouse and we assume that it is a monogamous heterosexual ual relationship then again we are I call it indirectly imposing our values we're not coming out and saying it but we're not being respectful of the fact that other people may have different values how do we elicit our clients personal values if we're going to try to avoid imposing ours that's great but it's also important to understand what our client values are what is important to you what is helps you feel safe what helps you have your rich and meaningful life and the best way we can do this is by talking to them and and not necessarily just the assessment or in the clinical session notice how they're dressed notice you know if they come in and they've got a t-shirt on for um you know Five Finger Death Punch well then you know they probably like heavy metal and you may talk to them about that if they you know you can talk about things that you observe you can show interest in your clients to learn about their values in terms of a values activity some things that we may um impose on people Independence versus interdependence and this is a big one when in Addiction Counseling for example sometimes we're talking about setting boundaries and having to um step away or back up from a relationship and in some families cutting off somebody you know separating from your parents because they're dysfunctional um and they're contributing to your condition that's not okay um it's the family is the core unit not the individual in the United States a lot of us have been raised where the individual is the core unit and the family's there great but if they're not H you know we'll find other family that's not true with all cultures so we need to be respectful of that even if the CORE family has issues and All Families have issues we need to help the person figure out how to navigate those issues in the best possible way to help them move toward their recovery in terms of spirituality and and this can be a big one some people are very spiritual but not religious some people may have a different religion and thinking about how you talk about spirituality and what you communicate about spirituality and I'm a firm believer now this is my opinion I'm a firm believer in authenticity not having you know all my Decor in my my office being in your face this is who I am but I am not going to avoid putting things in my office that are meaningful to me however I will also tend to complement those with things that I know may be comforting and meaningful to my clients sexuality is another issue and it's not just uh your sexual orientation it also has to do with sexual practices and we talked about this a few weeks ago with Kink and BDSM some people engage in those behaviors and they find them um empowering they enjoy those behaviors they're not causing them mental distress in any sort of way but what we can cause mental distress if we are not aware of think in BDSM practices if we pathologize something that even the American Psychological Association has dep pathologized we need to be very sensitive in how we approach sexuality and relationships which takes us to relationship structures um there are a lot of people who believe in a monogamous relationship but there are also a lot of people who don't there are a lot of people who have different relationship structures that work for them there are also Blended families and depending on your views and your values about divorce for example you may inadvertently impose your values so I I encourage you to think about each of these things and look around your office and evaluate your paperwork and think about uh interactions you've had to to assess am I imposing my values am I communicating to clients in ways that might make them feel well this is not safe to talk about parenting oh that's a big one a lot of people have very different parenting Styles and while I might not agree with necessarily the way my client is parenting their child it's not for me to impose my values unless obviously the child is in um in danger if you will medication use is another value some therapists are very predication use and some clients are not some clients are very predication use and some therapists are not this is especially a poignant issue when we start start talking about uh medication assisted therapy and opioid use disorders educate yourself about medication use be understanding or willing to accept if your client is on um medication assisted therapy it's something that needs to be talked about and some people will be on it forever the um DEA guidelines are really you're supposed to be on it for like 18 months and then taper off it's supposed to be a transition thing but for a lot of people it's not however harm reduction we need to examine our beliefs about that and again recognize that the client has autonomy back to last week has autonomy to choose the interventions that they feel will be most beneficial to them some people don't think that counseling with a therapist is okay they think they can talk to their Pastor or their priest or their you know spiritual leader um and that may be okay but it's not okay to talk to some random stranger at an agency which a lot of us are in that position of being some random stranger in an agency being sensitive to that I know my grandmother was raised in in the time when you kept your dirty laundry if you will that's what she called it uh between behind closed doors you didn't go out and tell people about it therapy was not something they did back in the 40s and 50s thankfully a lot of Americans have started to embrace therapy but recognizing hey not everybody's comfortable with this and you're like well why are they in my office if they don't believe in counseling with a therapist they may be involuntary somebody may have said if you're going to stay in a relationship with me if you're going to avoid jail if you're going to keep your kids if you're going to fill in the blank you have to go to therapy so we need to be sensitive to people's values what other values might we white that wow might we impose on people while y'all are thinking about that we're going to move on to unavoidable harm now sometimes there is unanticipated and unavoid and or unavoidable harm and when that harm happens we need to seek to address it so what is unavoidable harm you're thinking I've done this whole um non- ment thing I've evaluated my practice of course I'm not going to do harm to my clients well you might and that's where it's unanticipated or unavoidable sometimes it happens um so thinking about what is unavoidable harm how is it harmful and how can you address it mandatory reporting it's there for a reason it is is there to keep people safe if you will if they're um if you know of child abuse elder abuse or if somebody is acutely suicidal or homicidal with a um intended victim you know if there's imminent harm we need to take steps to address that issue and sometimes well not sometimes always that can feel really uncom comfortable if we're having to do something that our client doesn't want us to do obviously if they're feeling suicidal and they're like hey I really need to go to the crisis stabilization unit great I'll make that transfer um but if they are not wanting to then that clinical decision comes up so what harm does this cause well let's think about it if somebody um [Music] is taking away your freedom or if somebody is telling on you if you will that can remind them of Prior traumas when they have been powerless when people have gone behind their back um how can we address this ideally you're authentic and you're upfront with your clients when it's safe to do so uh about hey I I believe that you need to go to CSU and be evaluated by a psychiatrist I believe that there is a requirement based on what you've told me that we report what's going on um because there may be some child abuse if the person maybe is in a domestically violent relationship letting them know ahead of time again when it's safe to do so for both the client that you're working with as well as unintended victims or um the children or whatever having them make the report in your presence and documenting all of that um or you making the report with them in your presence so they don't feel as anxious about well what did you say or you know you did this behind my back we want to do as much as we can to help clients recognize what's going on why it's happening and help them navigate the process now it's not always possible and when it's not possible when you have to do something without your client's knowledge for the safety of the child for example that probably means that your relationship with that client is not going to is going to be permanently damaged it's possible to work through it but the occasion is pretty rare that a client is um ready to resume treatment with you after you have made an abuse report uh regarding them okay so we do need to recognize they're coming to you they're sharing with you they're being vulnerable with you and then you say all right stop stop stop now now we got to get this other PE group involved and there's going to be an investigation or something and that can feel very traumatizing and the person can feel very powerless you mean I could lose my kids you mean I am locked up for 72 hours so we do need to consider that um relationship changes when we are doing work with people um and they are processing things and I saw this a lot in residential treatment when people would oh they'd be working hard 30 days 45 days but their family wouldn't be doing anything when in terms of changing or being part of the process so when they discharged they had changed but their relationships had stayed the same which often caused conflict and sometimes ended up causing actual relationship changes where the person in recovery said you know what I can't be in a relationship with you if you're going to continue using or I can't do this right now um and that is ultimately we hope in the best interest of the client that they're making that decision but it's still devastating when when whenever we have to end a relationship it can be devastating and the other person may experience you know uh grief over the loss if there are children involved that could be that unanticipated or unavoidable harm creating a dependence on therapy is another issue that we need to uh be very cognizant of we don't want our clients believing that they need us and I know that sounds weird um we're there to help them we are a instrument to help them move toward their rich and meaningful life we are a catalyst for change but we don't want them to think that every time the weather changes they need to come in and get our opinion we need to help them develop the skills and tools to move toward their rich and meaningful life and develop that support network that doesn't include us eventually emotional discomfort or simp symptom exacerbation this is pretty common especially if you're doing any sort of trauma work where you're having to look at some of those things the person hasn't wanted to look at for a while how can we address these things um and relationship changes dependence on therapy emotional discomfort part of of that comes with talking with the client consistently about what skills they have what they're empowered to do what they want to do engaging them in the process when you start talking about trauma making sure that they have the skills of distress tolerance and down regulation before you start opening that Pandora's Box and empowering them to set the pace of how quickly you're going through the process making sure that they have a safety plan if they're going through some intense stuff in therapy making sure that they have a plan for the rest of their life that will help support them through the process having unre unrealistic expectations by the client or the therapist some clients will here's a perfect perfect example I had one client who went went through a rapid detox program and they told him that he did this rapid detox for 72 hours and he would be completely detoxed and he'd be fine well he heard I go through this I'm not going to have postacute withdrawal my body's going to be healed and I'm going to be hunky dory and that's not the way it is 72 hours gets the drugs out of your system it doesn't give the nervous system time to repair itself it doesn't give the hormones chances to rebalance it doesn't help the person identify cognitive distortions it doesn't help the person deal with the things that they did in their act of addiction that they may feel regret about so waking up from that it was sort of a rude awakening because yes he was clean but he was still experiencing post-acute withdrawal uh so we want to make sure that clients have reasonable expectations for what we can provide them in treatment I can't fix you you have to do the work I can give you the tools I can teach you how to use them but you have to do the work something that has been going on for 20 years we're probably not going to fix in two hours helping people really wrap their head around what to expect and on what timeline likewise therapists can have unrealistic expectations that make the client feel like hey I failed if the therapist thinks okay you should be fine in you know 10 weeks and at the end of 10 weeks the client's going yeah I'm still really not feeling great that's an important thing to understand and the therapist may also feel like the client hasn't made enough progress which often instead of the therapist saying could I have done something to improve this client's treatment it often comes down to what did the client fail to do that kept them from moving forward so we end up inadvertently hopefully blaming the client for their lack of progress and that's not okay either we need to step back and look and say hm what did I miss why did this person not progress as quickly as I thought they could um if you have somebody who is chronically relapsing instead of having this expectation that you go through treatment and you're never going to relapse that's unrealistic uh looking at relapses as learning opportunities and recognizing that if somebody relapses it's not my fault as a therapist it's not the client's fault as you know a human being we missed something so we need to look at this and we need to set more realistic expectations for this person um and finally misdiagnosis particularly if there are multiple conditions sometimes people come into my office and they've got a laundry list of diagnoses and a lot of them overlap and some of them like totally overlap so and and the DSM very clearly says to give the diagnosis if it's not better explained by another diagnosis so if you have two diagnoses that thoroughly explain a person's symptoms we need to figure out which one it is um so differential diagnosis is important now why are too many diagnoses problematic well if you have this mountain of diagnoses how do you feel I mean if I have one thing to tackle or even two I'm like okay I can do this if I've got 15 I may feel helpless I may feel feel overwhelmed at even the prospect of moving forward so we want to make sure that we are not overdiagnosing people likewise we want to make sure that we're not misdiagnosing for example if something um we in my opinion we really need to examine people's behavior to identify if they are responses to trauma if they're responses to trauma we need to look to a trauma based diagnosis like PTSD or cptsd instead of something that's more pathologizing like the personality disorders and well that's that's a different class that's to two Saturdays three Saturdays from now um but we do want to recognize that the importance of making an accurate diagnosis to provide an accurate treatment one of the ways we can do this is by communicating with clients I sit down with them with the DSM you I do a lot of things with my clients because I don't want them to think what I'm doing is somehow magic we sit down with the DSM and we talk about each symptom and when I after the assessment I do my write up of their integrative summary and in the next session that we meet we go over it to see if they agree or they disagree and my goal or my hope is to really involve them in the process so they are uh so they feel empowered to address these issues when they come up again counselors shall respect each client's privacy and shall solicit only information that contributes to the identified counseling goals or facilitates the counseling process and is also consistent with counseling protocols first um Golden Rule in any of the programs that I've ever supervised and in my own practice explain the wise if I'm asking you something if I want some information I'm going to tell you why I want it it's not just because I need to fill in a blank I am asking you to do this because this is why I'm asking you to do it or asking you to tell me about it it's important that we also respect clients rights to say no standardized intakes can sometimes be very intrusive and at the beginning of the intake it can be very helpful to avoid making them feel uncomfortable to avoid un um unintentional harm letting them know hey you have the right to tell me I don't want to answer that you don't have to answer any of the questions you don't want to and that is a strategy that can be very empowering for the clients because a lot of times they've been told they have to do this they have to do that they've just met you they don't know you from Adam's house cat they may not want to tell you everything so we do want to be sensitive to what we require in our intakes to what kind of information we require people tell us and we want to make sure that we don't elicit unnecessary details if Joe is upset because something happened you know somebody died okay um we're going to meet him where he is we're going to talk about okay you're upset let's talk about this I don't need to get in down into all the details well who was this how close were you blah blah blah I'm going to let Joe tell me about that person that passed and and Empower him to sort of Take the Lead it doesn't matter to me in the big scheme of things in treatment it doesn't matter what relationship this person was to Joe if Joe's devastated about the death then we're going to deal with the grief counselors shall not share client information without specific written consent by the client or legal guardian except when necessary to prevent serious and foreseeable harm to the client or others or when otherwise mandated by law or regulation we have some mandatory reporting things if you are involved in HIV prevention you may have some mandatory reporting for communicable disorders but we need to know what we're required to tell and what we're not we need to be familiar and I have multiple classes on hippo regulations we need to be familiar with that that's our um Health Care information privacy and AC um accessibility act um we need to be familiar with all of the rules and there's a lot of them there are things that you'd be surprised like um zip code that can be considered protected health information you also if you work with people who are substance abusing you need to be familiar with CFR 42 part two this is the Federal Regulation that goes the extra step to prevent people from being penalized for seeking treatment for substance abuse ISS issues it goes the extra step to put a barrier you're supposed to actually keep the substance abuse progress notes in a different section of the uh of the file because and they have to be uh requisitioned or subpoena in a different way than other things just like when your records are subpoena that doesn't include the mental health progress notes by default they specifically have to ask for those we need to keep clients informed at the beginning about mandatory reporting and if necessary bring it up again during the treatment process if we feel that they need to be have a refresher the other issue that comes up in confidentiality is how can you ethically share information for consultation or supervision one of the most common ethical guards if you will is if in doubt seek supervision okay well but I don't have a signed release of information from my client to talk with you about this and that can be sort of circumvented as long as you don't provide any um identifying information you talk about them as client X you and if you're in a really small town this becomes very difficult and it's probably better to get a release of information um for consultation or supervision at the outset which you can do even in a big city um but eliminating any identifying information is important also recognizing that you're talking to another person that is bound by hippo regulations sorry have a tickle in my throat now this was a change it used to be prohibited to do bartering with clients and this is one of the changes that they made and it says counselors May accept Goods services or other non-monetary compensation from clients only in cases where no referrals are possible or appropriate now that has I would say if you're going to engage in bartering I would consult with at least one other professional to see if you're not thinking of a particular referral if the referral is not possible we need to ask why because a lot of people can access tele mental health now so even if you don't have a referral right in your little small town there may be one in the next town over and that the person could access virtually um if the referrals are not appropriate for some reason then okay then you can continue you seeing the person and and I have a question mark there because I really racked my brain to try to think of situations where a referral wouldn't be possible or appropriate and I was struggling to come up with some because you know tella Health has opened so many um options for us it could be that there isn't somebody who specializes in that client's particular issue that is on their insurance panel it's the best I could come up with and in in that case all right the arrangement is discussed with the client in advance obviously if you're going to engage in a bartering relationship you're going to have some sort of negotiation The Exchange is of a reasonable equivalent value and this is one that gets s for a lot of clinicians um because there are a lot of clinicians that will take you know a dozen eggs for treatment if they're inclined to engage in bartering they're likely also inclined to not um have the reasonable equivalent value there are some who also overestimate the value of their services and so so we need to make sure that it's reasonable and equivalent how can you do this you can go online and I'm going to give you some examples in a minute but you can see what that service or that um item or whatever uh would cost in fair market value The Exchange does not place the counselor in an unfair Advantage if the exchange requires an evaluation of the person 's work they're doing work for you like they're doing lawn care or painting your house or something then you have you're in the position of evaluating did they do enough did they do it well and that can get really sticky if you are engaging in bartering in an ideal situation there would be someone else that the person would be reporting to if it's a service for example the arrangement is not harmful to the client or their treatment and is documented in the counseling services agreement you got to document you got to write it down both of you sign it um and it needs to be Revisited periodically so how do we ensure equivalent equivalency and maintain fairness one of the most common bartering things is food if you're working with someone who um is in a rural area they may provide you food food Goods instead of cash money so I went online and I found in community supported agriculture the large serving large weekly serving is $42 two dozen brown eggs $12 and one gallon of goat or cow's milk $8 so that added up to 42 uh 44 uh that added up to close to a reasonable rate for counseling so you do need to look at that arts or crafts if the person is an artist and they paint this beautiful painting you want to make sure that they're getting fair market value um if they're crocheting blankets for you same sort of thing go on Etsy go um look at things that are done by hand going on Amazon is not not the equivalent because that's something that's mass-produced by machines if they're doing something by hand you need to compare it to something equivalent if they're doing if they tailor your clothes for you maybe you need somebody who knows how to sew office cleaning house painting Lawn Care all of those are things that I've heard of as far as bartering is concerned and they can get very tricky it's very important that the contract is explicit what you expect and how it's going to be evaluated or assessed if for example you're getting food from the client's farm and they bring you a box of produce and you're like o I don't like radishes I don't like asparagus I don't no Take that away that's that's not the deal in a CSA you get what you get and it's important that you're aware and you're both on the same page now for house cleaning I have a question mark after that for me my opinion um that feels too familiar I wouldn't not that I wouldn't trust my clients in my house but that feels too familiar having them in my home cleaning my house and you know my toilets and you know seeing all my stuff whatever my stuff is um because that's in my home I'm authentic and that's very personal to me and that may feel too much like a dual relationship in some ways now you may not feel that way but just being aware despite best efforts how might nonverbals contribute to harm give you the example of lawn care if you're you have an agreement that you're going to provide an hour of count Ling for the client mowing your lawn every week and you go out and they mowed your lawn and you're like what is this they did a crappy job um and your face shows that then the client may feel rejected they may feel like you you are disapproving of them um if they give you a painting and it's not exactly what you wanted but it's what you would ask asked for um and your face expresses that that can be devastating because art is very um personal to the artist if the client's part does become substandard how do you ethically terminate Services how do you say you know we had this agreement but you're not holding up your end of the bargain so um I need to refer you out how do you avoid the client feeling feeling like they're being abandoned um you know there's a lot of issues that you need to consider before bartering ideally in the bartering contract have something in there about termination of services for any reason and how you're going to make referrals multiple relationships counselors shall strive to avoid multiple relationships this is more than dual but multiple and be mindful of engaging in counseling relationships with those individuals with whom another relationship such as a Community Connection a friendship or a work relationship exists so when they talk about multiple relationships they're talking about you're seeing them as a client then they also may be your neighbor and you may be on the homeowners association with them now you're in multiple relationships with them what are multiple relationships this is not an ex exhaustive list but again if you live in the same neighborhood and you're on the same homeowners association board or going to the same home homeowners association meetings if you're part of the same PTA group or any other board or group membership even a church um it could be defined as a multiple relationship now if you're in a church that has 80 80 congregants and you both happen to go to that church acknowledging that you might see each other is one thing if you are in the same Bible study together that's when we start getting into a multiple relationship because you're not just seeing each other and passing but you're actually engaging with that other person being a pastor or spiritual leader for the person and I know it it's done um but according to nbcc and and ACA if you are seeing somebody in a spiritual setting and then you're also seeing them over here as a counselor not as a PO not as part of your pastoral duties but as part of your Counseling Practice um it can be considered a dual relationship and it can get kind of Muddy um when you're doing both of those things especially when it starts concerning other people social media or in real life friends no if they're your client they're your client they're not your friends on social media or in real life don't date your clients I mean I shouldn't even have to say that I shouldn't but I do seeing a co-worker a friend or a neighbor's spouse child or parent in therapy um one rule that a former supervisor of mine um always used to reference he called it three degrees of separation and so if you know this person you don't want to see their spouse or child um if you are seeing the their grandchild for example that's the third degree of separation and possibly it might be okay if you're seeing a friend of a friend of a friend okay but it gets very sticky when and you're seeing somebody that is close to somebody that you're close to because they can misperceive things as violations of confidentiality so that's a whole different thing we could go into but according to both ACA and um nbcc we need to be very cognizant of multiple relationships and and those aren't just romantic relationships you don't want to see a client who's distant related to distantly related to you you don't want to be seeing your third cousin in therapy um they may show up at the family reunion and that's you know going to be a problem and business relationships you don't want to open a business with a client and you want to be very careful when patronizing a client's business or practice especially if it's a service business provided by them for example you're seeing them as your doctor your vet your plumber um your auto mechanic now if the person runs a small antique shop you know that might be less problematic but you still need to be conscious of how might this impact our ability to work together when we discontinue treatment how might this impact our relationship in the event that a multiple relationship develops in an unforeseen manner for example you're seeing Sally in therapy and then two weeks ago she moved into your neighborhood and now she's um part of your HOA or she moved into your neighborhood and your kid her kids started going to school with your kids and they became Fast Friends huh okay well this is going to be a little tricky we need to discuss the potenti potential effects with the client if our kids want to play together you know that's fine I'm not going to you know break that up however I need to talk with Sally about how she feels about it and how we're NE going to negotiate this um and if she wants to start seeing a different therapist take reasonable steps to resolve the situation including termination and the provision of referrals and document the discussion in the client's record again both of you signning it's too easy I'm sorry it's unethical but I know I know of people who've done it it's too easy to write down yeah we had this discussion and sign it when you actually didn't so both people need to sign it counselors will exercise caution and avoid explo exploitation or the appearance of exploitation before entering into a non-counseling relationship with a former client for at least 5 years 5 years is our big number now it used to be two years a long time ago um some state boards still say two years but the ethical code says five years and you're going to hear that in several times over the next few weeks counselors will discuss with the former client important relevant considerations including you know if we're going to do something all right it's been at least five years all right we were in counseling relationship together for you know was it 10 weeks or was it two years you know that there's a different level of intimacy that may de may have developed and maybe a different level of dependence that may have developed the nature and circumstances of the client's counseling um if they were seeing you for example for marriage counseling and now you think you're going to start dating them uh you know I I'm thinking that feels pretty icky um so you you want to consider what you were seeing them for were they there they were an involuntary client the court said they had to come and they did their time and they got out that's somewhat different but again you still have to respect that five-year boundary the likelihood that the client will want to resume counseling once you start seeing them in a different kind of relationship that's off the table so if they want to see you again then you can't and possible negative effects or outcomes it's important to brainstorm what these outcomes might be and continue to assess with the client and or former client and yourself if there are things going wrong in the relationship is it because you had a the counseling relationship and and there's an because there is an unequal power dynamic in counseling relationships we strive to make it equal but it's not and the counselor often has a more power in the relationship in some ways and that can commun um can translate into other types of relationships 5 10 years later counselors will respect the autonomy of each former client and not use undue influence to form any sort of relationship with a former client Business Development maybe you had this client they did wonderfully in treatment and you're like hey why don't you go out and promote my practice and bring me new clients because you know you were you were just wonderful uh that's not okay and obviously you don't want to use undo influence to form any sort of personal relationship when we're working with clients we need to consistently reflect on our personal values and make sure that we're maintaining that boundary between what we value and believe and what the client values and believes we can meet we can agree we can disagree but we're going to respect that boundary and as I mentioned it's important that we we reflect on whether we are indirectly imposing our personal values um through our Decor through our approach um to treatment through our um assessment through our documentation whatever it is we do need to be consistent one of the ways that we can also protect against violating this is consistently talking with clients about whether they feel respected if they feel like their values and thoughts are being respected great um and if not then we need to say tell me about what makes you feel uncomfortable or in what ways you feel your values haven't been respected sometimes there's going to be unavoidable harm one of the most common is relationship changes when some one person goes through treatment and their family hasn't um that may end up causing distress in those relationships until the family members all come together and uh make changes or until those relationships are ended we do need to respect confidentiality um I will be doing another presentation on CFR 42 part two because they just made a bunch of changes to it um so I will be doing another just wildly exciting presentation on that in the upcoming weeks bartering is now accepted under certain conditions but we do need to be very explicit in our B in our contract and the bartering contract and it needs to be signed by both parties and re-evaluated periodically to make sure that the client feels like they're being treated fairly and obviously the clinician feels like they're being treated fairly and we need to be very aware of multiple relationships and and too often we mistake multiple relationships because we think all we're talking about is romantic relationships or maybe online relationships but no no it's not that um it's also um seeing for example seeing a coworker seeing a neighbor seeing a neighbor's husband or well I guess he'd be your neighbor too but you get my point A lot of times we don't consider the non-romantic relationships and how they may constitute a ethical breach in part three we're going to discuss something called boundary extensions avoiding harassment preventing abandonment and a whole bunch more thank you for being with me today I know this was a well it was ethics so it wasn't one of those wildly exciting things that you're going to rush back to your office and go hey I feel energized but it is a good reminder for us um of what we need to do and we need to make sure again our agencies are doing our agency policies practices environment constitute or communicate ethical behavior and create an environment that feels safe and emper EMP powering to all of our clients and all of the people served one of the ways and while I'm waiting if you have any questions what another one of the ways you can do this is by getting a focus group together of the people served or survey them when they come in if you don't want to do a focus group to find out what they might like to see hear whatever um in your organization what changes might they like to see in order to feel feel safer and more empowered

Unlimited CEUs $59 @ALLCEUS I'd like to welcome everybody back to nbcc code 
of ethics 2023 now yes I know it's 2024 but they  put out this code of ethics in 2023 this is 
part two of eight and I am Dr Dawn-Elise Snipes   your host we are going to review the 2023 nbcc 
code of ethics Point by Point specifically today   focusing on personal values unavoidable 
harm confidentiality bartering multiple   relationships and harassment now we have to go 
over confidentiality and multiple relationships   because when you look at ethical violations 
those are the two most common areas where people   run into trouble and so we're going to go into 
detail about that again I am going to be asking   you questions hopefully they're not rhetorical 
and to get your input about some of these things   things um that we talk about today in part one 
we discussed the seven ethical principles and   the ABCD e for ethical decisionmaking we also 
reviewed nbcc core values and professional responsibilities so let's move on today 
we're going to talk about more things   that we as clinicians need to do and we 
need to make sure our agencies are doing   counselors shall take proactive measures to avoid 
harming their clients and avoid imposing personal   values on those who receive their Professional 
Services how might we or our organizations do   this directly or indirectly Now by directly I 
mean we actually tell them you should think this   way or you should feel this way you here the shs 
in there and the boundary violations all over the   place obviously we won't don't want to do that and 
hopefully we don't directly come out and impose   our values but indirectly we may impose our values 
and so again I'll ask how do you think you might   see this happening for example when somebody walks 
into your lobby what do they see what do they hear   do they hear um gospel music over the loudspeaker 
do they hear heavy metal what do they hear do they   hear silence um what do they see in terms of your 
Decor are you communicating to them that it's you   have a welcoming safe environment for everybody 
or only for people who fit a certain description   and that's indirectly imposing our values another 
way we can indirectly impose our values is in our   assessment when we're going going through and 
we're asking are you married or um what is your   spouse's name for people who are in Partnerships 
that don't want to get married that feels like a   judgment for people who are in polyamorous 
relationships that definitely feels like a   judgment if we ask somebody about their partner or 
their spouse and we assume that it is a monogamous   heterosexual ual relationship then again we are 
I call it indirectly imposing our values we're   not coming out and saying it but we're not being 
respectful of the fact that other people may have   different values how do we elicit our clients 
personal values if we're going to try to avoid   imposing ours that's great but it's also important 
to understand what our client values are what is   important to you what is helps you feel safe what 
helps you have your rich and meaningful life and   the best way we can do this is by talking to them 
and and not necessarily just the assessment or in   the clinical session notice how they're dressed 
notice you know if they come in and they've got a   t-shirt on for um you know Five Finger Death Punch 
well then you know they probably like heavy metal   and you may talk to them about that if they you 
know you can talk about things that you observe   you can show interest in your clients to learn 
about their values in terms of a values activity   some things that we may um impose on people 
Independence versus interdependence and this   is a big one when in Addiction Counseling for 
example sometimes we're talking about setting   boundaries and having to um step away or back up 
from a relationship and in some families cutting   off somebody you know separating from your 
parents because they're dysfunctional um and   they're contributing to your condition that's not 
okay um it's the family is the core unit not the   individual in the United States a lot of us have 
been raised where the individual is the core unit   and the family's there great but if they're not H 
you know we'll find other family that's not true   with all cultures so we need to be respectful of 
that even if the CORE family has issues and All   Families have issues we need to help the person 
figure out how to navigate those issues in the   best possible way to help them move toward their 
recovery in terms of spirituality and and this can   be a big one some people are very spiritual but 
not religious some people may have a different   religion and thinking about how you talk about 
spirituality and what you communicate about   spirituality and I'm a firm believer now this is 
my opinion I'm a firm believer in authenticity not   having you know all my Decor in my my office 
being in your face this is who I am but I am   not going to avoid putting things in my office 
that are meaningful to me however I will also   tend to complement those with things that I know 
may be comforting and meaningful to my clients   sexuality is another issue and it's not just uh 
your sexual orientation it also has to do with   sexual practices and we talked about this a few 
weeks ago with Kink and BDSM some people engage in   those behaviors and they find them um empowering 
they enjoy those behaviors they're not causing   them mental distress in any sort of way but what 
we can cause mental distress if we are not aware   of think in BDSM practices if we pathologize 
something that even the American Psychological   Association has dep pathologized we need to be 
very sensitive in how we approach sexuality and   relationships which takes us to relationship 
structures um there are a lot of people who   believe in a monogamous relationship but there 
are also a lot of people who don't there are a   lot of people who have different relationship 
structures that work for them there are also   Blended families and depending on your views and 
your values about divorce for example you may   inadvertently impose your values so I I encourage 
you to think about each of these things and look   around your office and evaluate your paperwork 
and think about uh interactions you've had to to   assess am I imposing my values am I communicating 
to clients in ways that might make them feel well   this is not safe to talk about parenting oh that's 
a big one a lot of people have very different   parenting Styles and while I might not agree with 
necessarily the way my client is parenting their   child it's not for me to impose my values unless 
obviously the child is in um in danger if you will   medication use is another value some therapists 
are very predication use and some clients are not   some clients are very predication use and some 
therapists are not this is especially a poignant   issue when we start start talking about uh 
medication assisted therapy and opioid use disorders educate yourself about medication use 
be understanding or willing to accept if your   client is on um medication assisted therapy 
it's something that needs to be talked about   and some people will be on it forever the um 
DEA guidelines are really you're supposed to   be on it for like 18 months and then taper 
off it's supposed to be a transition thing   but for a lot of people it's not however harm 
reduction we need to examine our beliefs about   that and again recognize that the client has 
autonomy back to last week has autonomy to   choose the interventions that they feel will be 
most beneficial to them some people don't think   that counseling with a therapist is okay they 
think they can talk to their Pastor or their   priest or their you know spiritual leader um 
and that may be okay but it's not okay to talk   to some random stranger at an agency which a 
lot of us are in that position of being some   random stranger in an agency being sensitive 
to that I know my grandmother was raised in in   the time when you kept your dirty laundry if you 
will that's what she called it uh between behind   closed doors you didn't go out and tell people 
about it therapy was not something they did back   in the 40s and 50s thankfully a lot of Americans 
have started to embrace therapy but recognizing   hey not everybody's comfortable with this and 
you're like well why are they in my office if   they don't believe in counseling with a therapist 
they may be involuntary somebody may have said if   you're going to stay in a relationship with me 
if you're going to avoid jail if you're going to   keep your kids if you're going to fill in the 
blank you have to go to therapy so we need to   be sensitive to people's values what other values 
might we white that wow might we impose on people while y'all are thinking about that we're going 
to move on to unavoidable harm now sometimes there   is unanticipated and unavoid and or unavoidable 
harm and when that harm happens we need to seek   to address it so what is unavoidable harm you're 
thinking I've done this whole um non- ment thing   I've evaluated my practice of course I'm not 
going to do harm to my clients well you might   and that's where it's unanticipated or unavoidable 
sometimes it happens um so thinking about what is   unavoidable harm how is it harmful and how can 
you address it mandatory reporting it's there   for a reason it is is there to keep people safe if 
you will if they're um if you know of child abuse   elder abuse or if somebody is acutely suicidal 
or homicidal with a um intended victim you know   if there's imminent harm we need to take steps 
to address that issue and sometimes well not   sometimes always that can feel really uncom 
comfortable if we're having to do something   that our client doesn't want us to do obviously 
if they're feeling suicidal and they're like hey I   really need to go to the crisis stabilization unit 
great I'll make that transfer um but if they are   not wanting to then that clinical decision comes 
up so what harm does this cause well let's think   about it if somebody um [Music] is taking away 
your freedom or if somebody is telling on you if   you will that can remind them of Prior traumas 
when they have been powerless when people have   gone behind their back um how can we address this 
ideally you're authentic and you're upfront with   your clients when it's safe to do so uh about 
hey I I believe that you need to go to CSU and   be evaluated by a psychiatrist I believe that 
there is a requirement based on what you've told   me that we report what's going on um because 
there may be some child abuse if the person   maybe is in a domestically violent relationship 
letting them know ahead of time again when it's   safe to do so for both the client that you're 
working with as well as unintended victims or   um the children or whatever having them make 
the report in your presence and documenting all   of that um or you making the report with them in 
your presence so they don't feel as anxious about   well what did you say or you know you did this 
behind my back we want to do as much as we can   to help clients recognize what's going on 
why it's happening and help them navigate   the process now it's not always possible 
and when it's not possible when you have to   do something without your client's knowledge 
for the safety of the child for example that   probably means that your relationship with that 
client is not going to is going to be permanently   damaged it's possible to work through it but 
the occasion is pretty rare that a client is   um ready to resume treatment with you after 
you have made an abuse report uh regarding   them okay so we do need to recognize they're 
coming to you they're sharing with you they're   being vulnerable with you and then you say all 
right stop stop stop now now we got to get this   other PE group involved and there's going to 
be an investigation or something and that can   feel very traumatizing and the person can feel 
very powerless you mean I could lose my kids you   mean I am locked up for 72 hours so we do need to 
consider that um relationship changes when we are doing work with people um and they are processing 
things and I saw this a lot in residential   treatment when people would oh they'd be working 
hard 30 days 45 days but their family wouldn't be   doing anything when in terms of changing or being 
part of the process so when they discharged they   had changed but their relationships had stayed 
the same which often caused conflict and sometimes   ended up causing actual relationship changes where 
the person in recovery said you know what I can't   be in a relationship with you if you're going to 
continue using or I can't do this right now um and   that is ultimately we hope in the best interest of 
the client that they're making that decision but   it's still devastating when when whenever we have 
to end a relationship it can be devastating and   the other person may experience you know uh grief 
over the loss if there are children involved that   could be that unanticipated or unavoidable harm 
creating a dependence on therapy is another issue   that we need to uh be very cognizant of we don't 
want our clients believing that they need us and   I know that sounds weird um we're there to help 
them we are a instrument to help them move toward   their rich and meaningful life we are a catalyst 
for change but we don't want them to think that   every time the weather changes they need to 
come in and get our opinion we need to help   them develop the skills and tools to move toward 
their rich and meaningful life and develop that   support network that doesn't include us eventually 
emotional discomfort or simp symptom exacerbation   this is pretty common especially if you're 
doing any sort of trauma work where you're   having to look at some of those things the person 
hasn't wanted to look at for a while how can we   address these things um and relationship changes 
dependence on therapy emotional discomfort part   of of that comes with talking with the client 
consistently about what skills they have what   they're empowered to do what they want to 
do engaging them in the process when you   start talking about trauma making sure that they 
have the skills of distress tolerance and down   regulation before you start opening that Pandora's 
Box and empowering them to set the pace of how   quickly you're going through the process making 
sure that they have a safety plan if they're   going through some intense stuff in therapy making 
sure that they have a plan for the rest of their   life that will help support them through the 
process having unre unrealistic expectations   by the client or the therapist some clients will 
here's a perfect perfect example I had one client   who went went through a rapid detox program and 
they told him that he did this rapid detox for 72   hours and he would be completely detoxed and he'd 
be fine well he heard I go through this I'm not   going to have postacute withdrawal my body's going 
to be healed and I'm going to be hunky dory and   that's not the way it is 72 hours gets the drugs 
out of your system it doesn't give the nervous   system time to repair itself it doesn't give the 
hormones chances to rebalance it doesn't help the   person identify cognitive distortions it doesn't 
help the person deal with the things that they   did in their act of addiction that they may feel 
regret about so waking up from that it was sort of   a rude awakening because yes he was clean but he 
was still experiencing post-acute withdrawal uh so   we want to make sure that clients have reasonable 
expectations for what we can provide them in   treatment I can't fix you you have to do the work 
I can give you the tools I can teach you how to   use them but you have to do the work something 
that has been going on for 20 years we're probably   not going to fix in two hours helping people 
really wrap their head around what to expect   and on what timeline likewise therapists can have 
unrealistic expectations that make the client feel   like hey I failed if the therapist thinks okay 
you should be fine in you know 10 weeks and at the   end of 10 weeks the client's going yeah I'm still 
really not feeling great that's an important thing   to understand and the therapist may also feel like 
the client hasn't made enough progress which often   instead of the therapist saying could I have done 
something to improve this client's treatment it   often comes down to what did the client fail to 
do that kept them from moving forward so we end   up inadvertently hopefully blaming the client 
for their lack of progress and that's not okay   either we need to step back and look and say hm 
what did I miss why did this person not progress   as quickly as I thought they could um if you have 
somebody who is chronically relapsing instead of   having this expectation that you go through 
treatment and you're never going to relapse   that's unrealistic uh looking at relapses 
as learning opportunities and recognizing   that if somebody relapses it's not my fault 
as a therapist it's not the client's fault   as you know a human being we missed something 
so we need to look at this and we need to set   more realistic expectations for this person um 
and finally misdiagnosis particularly if there   are multiple conditions sometimes people come 
into my office and they've got a laundry list   of diagnoses and a lot of them overlap and some 
of them like totally overlap so and and the DSM   very clearly says to give the diagnosis if it's 
not better explained by another diagnosis so if   you have two diagnoses that thoroughly explain a 
person's symptoms we need to figure out which one   it is um so differential diagnosis is important 
now why are too many diagnoses problematic well   if you have this mountain of diagnoses how do you 
feel I mean if I have one thing to tackle or even   two I'm like okay I can do this if I've got 15 I 
may feel helpless I may feel feel overwhelmed at   even the prospect of moving forward so we want 
to make sure that we are not overdiagnosing   people likewise we want to make sure that we're 
not misdiagnosing for example if something um   we in my opinion we really need to examine 
people's behavior to identify if they are   responses to trauma if they're responses to trauma 
we need to look to a trauma based diagnosis like   PTSD or cptsd instead of something that's more 
pathologizing like the personality disorders and   well that's that's a different class that's to 
two Saturdays three Saturdays from now um but   we do want to recognize that the importance 
of making an accurate diagnosis to provide an   accurate treatment one of the ways we can do this 
is by communicating with clients I sit down with   them with the DSM you I do a lot of things with 
my clients because I don't want them to think   what I'm doing is somehow magic we sit down 
with the DSM and we talk about each symptom and when I after the assessment I do my write 
up of their integrative summary and in the   next session that we meet we go over it to see 
if they agree or they disagree and my goal or   my hope is to really involve them in the process 
so they are uh so they feel empowered to address   these issues when they come up again counselors 
shall respect each client's privacy and shall   solicit only information that contributes to 
the identified counseling goals or facilitates   the counseling process and is also consistent 
with counseling protocols first um Golden Rule   in any of the programs that I've ever supervised 
and in my own practice explain the wise if I'm   asking you something if I want some information 
I'm going to tell you why I want it it's not just   because I need to fill in a blank I am asking you 
to do this because this is why I'm asking you to   do it or asking you to tell me about it it's 
important that we also respect clients rights   to say no standardized intakes can sometimes be 
very intrusive and at the beginning of the intake   it can be very helpful to avoid making them feel 
uncomfortable to avoid un um unintentional harm   letting them know hey you have the right to tell 
me I don't want to answer that you don't have to   answer any of the questions you don't want to and 
that is a strategy that can be very empowering for   the clients because a lot of times they've been 
told they have to do this they have to do that   they've just met you they don't know you from 
Adam's house cat they may not want to tell you   everything so we do want to be sensitive to 
what we require in our intakes to what kind   of information we require people tell us and we 
want to make sure that we don't elicit unnecessary   details if Joe is upset because something happened 
you know somebody died okay um we're going to meet   him where he is we're going to talk about okay 
you're upset let's talk about this I don't need   to get in down into all the details well who was 
this how close were you blah blah blah I'm going   to let Joe tell me about that person that passed 
and and Empower him to sort of Take the Lead it   doesn't matter to me in the big scheme of things 
in treatment it doesn't matter what relationship   this person was to Joe if Joe's devastated about 
the death then we're going to deal with the grief counselors shall not share client 
information without specific written consent by   the client or legal guardian except when necessary 
to prevent serious and foreseeable harm to the   client or others or when otherwise mandated by 
law or regulation we have some mandatory reporting   things if you are involved in HIV prevention you 
may have some mandatory reporting for communicable   disorders but we need to know what we're required 
to tell and what we're not we need to be familiar   and I have multiple classes on hippo regulations 
we need to be familiar with that that's our um   Health Care information privacy and AC um 
accessibility act um we need to be familiar   with all of the rules and there's a lot of 
them there are things that you'd be surprised   like um zip code that can be considered 
protected health information you also if   you work with people who are substance abusing 
you need to be familiar with CFR 42 part two   this is the Federal Regulation that 
goes the extra step to prevent people   from being penalized for seeking treatment 
for substance abuse ISS issues it goes the   extra step to put a barrier you're supposed 
to actually keep the substance abuse progress   notes in a different section of the uh 
of the file because and they have to be   uh requisitioned or subpoena in a different way 
than other things just like when your records are   subpoena that doesn't include the mental health 
progress notes by default they specifically have   to ask for those we need to keep clients informed 
at the beginning about mandatory reporting and if   necessary bring it up again during the treatment 
process if we feel that they need to be have a refresher the other issue that comes 
up in confidentiality is how can you   ethically share information for consultation 
or supervision one of the most common ethical   guards if you will is if in doubt seek 
supervision okay well but I don't have a   signed release of information from 
my client to talk with you about this and that can be sort of circumvented as 
long as you don't provide any um identifying   information you talk about them as client X 
you and if you're in a really small town this   becomes very difficult and it's probably 
better to get a release of information   um for consultation or supervision 
at the outset which you can do even   in a big city um but eliminating any 
identifying information is important   also recognizing that you're talking to 
another person that is bound by hippo regulations sorry have a tickle in my throat now this was a change it used to be 
prohibited to do bartering with clients and   this is one of the changes that they made and 
it says counselors May accept Goods services   or other non-monetary compensation from 
clients only in cases where no referrals   are possible or appropriate now that has 
I would say if you're going to engage in   bartering I would consult with at least 
one other professional to see if you're   not thinking of a particular referral if the 
referral is not possible we need to ask why because a lot of people can access tele mental 
health now so even if you don't have a referral   right in your little small town there may be 
one in the next town over and that the person   could access virtually um if the referrals are 
not appropriate for some reason then okay then   you can continue you seeing the person and and I 
have a question mark there because I really racked   my brain to try to think of situations where 
a referral wouldn't be possible or appropriate   and I was struggling to come up with some 
because you know tella Health has opened   so many um options for us it could be that there 
isn't somebody who specializes in that client's   particular issue that is on their insurance 
panel it's the best I could come up with and   in in that case all right the arrangement 
is discussed with the client in advance   obviously if you're going to engage in 
a bartering relationship you're going   to have some sort of negotiation The 
Exchange is of a reasonable equivalent value and this is one that gets s for a lot 
of clinicians um because there are a lot of   clinicians that will take you know a dozen 
eggs for treatment if they're inclined to   engage in bartering they're likely also 
inclined to not um have the reasonable   equivalent value there are some who also 
overestimate the value of their services and   so so we need to make sure that it's reasonable 
and equivalent how can you do this you can go   online and I'm going to give you some examples in 
a minute but you can see what that service or that   um item or whatever uh would cost in fair market 
value The Exchange does not place the counselor   in an unfair Advantage if the exchange requires 
an evaluation of the person 's work they're doing   work for you like they're doing lawn care or 
painting your house or something then you have   you're in the position of evaluating did they 
do enough did they do it well and that can get   really sticky if you are engaging in bartering 
in an ideal situation there would be someone   else that the person would be reporting to if 
it's a service for example the arrangement is   not harmful to the client or their treatment and 
is documented in the counseling services agreement   you got to document you got to write it down both 
of you sign it um and it needs to be Revisited periodically so how do we ensure equivalent 
equivalency and maintain fairness one of the   most common bartering things is food if 
you're working with someone who um is in   a rural area they may provide you food food 
Goods instead of cash money so I went online   and I found in community supported agriculture 
the large serving large weekly serving is $42   two dozen brown eggs $12 and one gallon of goat 
or cow's milk $8 so that added up to 42 uh 44   uh that added up to close to a reasonable rate for 
counseling so you do need to look at that arts or   crafts if the person is an artist and they paint 
this beautiful painting you want to make sure that   they're getting fair market value um if they're 
crocheting blankets for you same sort of thing   go on Etsy go um look at things that are done by 
hand going on Amazon is not not the equivalent   because that's something that's mass-produced by 
machines if they're doing something by hand you   need to compare it to something equivalent if 
they're doing if they tailor your clothes for   you maybe you need somebody who knows how to 
sew office cleaning house painting Lawn Care   all of those are things that I've heard of 
as far as bartering is concerned and they can get very tricky it's very important that the 
contract is explicit what you expect and how   it's going to be evaluated or assessed if for 
example you're getting food from the client's   farm and they bring you a box of produce and 
you're like o I don't like radishes I don't   like asparagus I don't no Take that away that's 
that's not the deal in a CSA you get what you   get and it's important that you're aware and 
you're both on the same page now for house   cleaning I have a question mark after that for me 
my opinion um that feels too familiar I wouldn't   not that I wouldn't trust my clients in my house 
but that feels too familiar having them in my home   cleaning my house and you know my toilets and you 
know seeing all my stuff whatever my stuff is um   because that's in my home I'm authentic and 
that's very personal to me and that may feel   too much like a dual relationship in some ways 
now you may not feel that way but just being   aware despite best efforts how might nonverbals 
contribute to harm give you the example of lawn   care if you're you have an agreement that 
you're going to provide an hour of count   Ling for the client mowing your lawn every 
week and you go out and they mowed your lawn   and you're like what is this they did a crappy 
job um and your face shows that then the client   may feel rejected they may feel like you you 
are disapproving of them um if they give you   a painting and it's not exactly what you wanted 
but it's what you would ask asked for um and   your face expresses that that can be devastating 
because art is very um personal to the artist if   the client's part does become substandard how 
do you ethically terminate Services how do you   say you know we had this agreement but you're 
not holding up your end of the bargain so um I   need to refer you out how do you avoid the client 
feeling feeling like they're being abandoned um   you know there's a lot of issues that you need to 
consider before bartering ideally in the bartering   contract have something in there about termination 
of services for any reason and how you're going to   make referrals multiple relationships counselors 
shall strive to avoid multiple relationships this   is more than dual but multiple and be mindful 
of engaging in counseling relationships with   those individuals with whom another relationship 
such as a Community Connection a friendship or   a work relationship exists so when they talk 
about multiple relationships they're talking   about you're seeing them as a client then 
they also may be your neighbor and you may   be on the homeowners association with them 
now you're in multiple relationships with them what are multiple relationships this 
is not an ex exhaustive list but again if   you live in the same neighborhood and you're 
on the same homeowners association board or   going to the same home homeowners association 
meetings if you're part of the same PTA group   or any other board or group membership even 
a church um it could be defined as a multiple   relationship now if you're in a church that has 
80 80 congregants and you both happen to go to   that church acknowledging that you might see 
each other is one thing if you are in the same   Bible study together that's when we start getting 
into a multiple relationship because you're not   just seeing each other and passing but you're 
actually engaging with that other person being   a pastor or spiritual leader for the person and 
I know it it's done um but according to nbcc and   and ACA if you are seeing somebody in a spiritual 
setting and then you're also seeing them over   here as a counselor not as a PO not as part 
of your pastoral duties but as part of your   Counseling Practice um it can be considered 
a dual relationship and it can get kind of   Muddy um when you're doing both of those things 
especially when it starts concerning other people   social media or in real life friends no if 
they're your client they're your client they're   not your friends on social media or in real life 
don't date your clients I mean I shouldn't even   have to say that I shouldn't but I do seeing a 
co-worker a friend or a neighbor's spouse child   or parent in therapy um one rule that a former 
supervisor of mine um always used to reference   he called it three degrees of separation and so 
if you know this person you don't want to see   their spouse or child um if you are seeing the 
their grandchild for example that's the third   degree of separation and possibly it might be 
okay if you're seeing a friend of a friend of   a friend okay but it gets very sticky when and 
you're seeing somebody that is close to somebody   that you're close to because they can misperceive 
things as violations of confidentiality so that's   a whole different thing we could go into but 
according to both ACA and um nbcc we need to   be very cognizant of multiple relationships and 
and those aren't just romantic relationships you   don't want to see a client who's distant related 
to distantly related to you you don't want to be   seeing your third cousin in therapy um they may 
show up at the family reunion and that's you know   going to be a problem and business relationships 
you don't want to open a business with a client   and you want to be very careful when patronizing 
a client's business or practice especially if it's   a service business provided by them for example 
you're seeing them as your doctor your vet your   plumber um your auto mechanic now if the person 
runs a small antique shop you know that might   be less problematic but you still need to be 
conscious of how might this impact our ability   to work together when we discontinue treatment 
how might this impact our relationship in the   event that a multiple relationship develops in 
an unforeseen manner for example you're seeing   Sally in therapy and then two weeks ago she moved 
into your neighborhood and now she's um part of   your HOA or she moved into your neighborhood 
and your kid her kids started going to school   with your kids and they became Fast Friends 
huh okay well this is going to be a little tricky we need to discuss the potenti potential 
effects with the client if our kids want to play   together you know that's fine I'm not going to 
you know break that up however I need to talk with   Sally about how she feels about it and how we're 
NE going to negotiate this um and if she wants to   start seeing a different therapist take reasonable 
steps to resolve the situation including   termination and the provision of referrals and 
document the discussion in the client's record   again both of you signning it's too easy I'm sorry 
it's unethical but I know I know of people who've   done it it's too easy to write down yeah we had 
this discussion and sign it when you actually   didn't so both people need to sign it counselors 
will exercise caution and avoid explo exploitation   or the appearance of exploitation before entering 
into a non-counseling relationship with a former   client for at least 5 years 5 years is our big 
number now it used to be two years a long time   ago um some state boards still say two years but 
the ethical code says five years and you're going   to hear that in several times over the next few 
weeks counselors will discuss with the former   client important relevant considerations including 
you know if we're going to do something all right   it's been at least five years all right we 
were in counseling relationship together   for you know was it 10 weeks or was it two 
years you know that there's a different level   of intimacy that may de may have developed and 
maybe a different level of dependence that may   have developed the nature and circumstances of the 
client's counseling um if they were seeing you for   example for marriage counseling and now you think 
you're going to start dating them uh you know I   I'm thinking that feels pretty icky um so you you 
want to consider what you were seeing them for   were they there they were an involuntary client 
the court said they had to come and they did their   time and they got out that's somewhat different 
but again you still have to respect that five-year   boundary the likelihood that the client will 
want to resume counseling once you start seeing   them in a different kind of relationship that's 
off the table so if they want to see you again   then you can't and possible negative effects or 
outcomes it's important to brainstorm what these   outcomes might be and continue to assess with the 
client and or former client and yourself if there   are things going wrong in the relationship is it 
because you had a the counseling relationship and   and there's an because there is an unequal power 
dynamic in counseling relationships we strive to   make it equal but it's not and the counselor 
often has a more power in the relationship in   some ways and that can commun um can translate 
into other types of relationships 5 10 years   later counselors will respect the autonomy of 
each former client and not use undue influence   to form any sort of relationship with a former 
client Business Development maybe you had this   client they did wonderfully in treatment and 
you're like hey why don't you go out and promote   my practice and bring me new clients because 
you know you were you were just wonderful uh   that's not okay and obviously you don't want to 
use undo influence to form any sort of personal relationship when we're working with clients 
we need to consistently reflect on our personal   values and make sure that we're maintaining that 
boundary between what we value and believe and   what the client values and believes we can meet 
we can agree we can disagree but we're going to   respect that boundary and as I mentioned it's 
important that we we reflect on whether we are   indirectly imposing our personal values um 
through our Decor through our approach um   to treatment through our um assessment through 
our documentation whatever it is we do need to   be consistent one of the ways that we can also 
protect against violating this is consistently   talking with clients about whether they feel 
respected if they feel like their values and   thoughts are being respected great um and if 
not then we need to say tell me about what   makes you feel uncomfortable or in what ways 
you feel your values haven't been respected   sometimes there's going to be unavoidable harm 
one of the most common is relationship changes   when some one person goes through treatment and 
their family hasn't um that may end up causing   distress in those relationships until the family 
members all come together and uh make changes or   until those relationships are ended we do need 
to respect confidentiality um I will be doing   another presentation on CFR 42 part two because 
they just made a bunch of changes to it um so I   will be doing another just wildly exciting 
presentation on that in the upcoming weeks   bartering is now accepted under certain conditions 
but we do need to be very explicit in our B in our   contract and the bartering contract and it needs 
to be signed by both parties and re-evaluated   periodically to make sure that the client feels 
like they're being treated fairly and obviously   the clinician feels like they're being treated 
fairly and we need to be very aware of multiple   relationships and and too often we mistake 
multiple relationships because we think all   we're talking about is romantic relationships 
or maybe online relationships but no no it's   not that um it's also um seeing for example seeing 
a coworker seeing a neighbor seeing a neighbor's   husband or well I guess he'd be your neighbor 
too but you get my point A lot of times we don't   consider the non-romantic relationships and 
how they may constitute a ethical breach in   part three we're going to discuss something called 
boundary extensions avoiding harassment preventing   abandonment and a whole bunch more thank you 
for being with me today I know this was a   well it was ethics so it wasn't one of those 
wildly exciting things that you're going to   rush back to your office and go hey I feel 
energized but it is a good reminder for us   um of what we need to do and we need to make sure 
again our agencies are doing our agency policies   practices environment constitute or communicate 
ethical behavior and create an environment that   feels safe and emper EMP powering to all of 
our clients and all of the people served one   of the ways and while I'm waiting if you have any 
questions what another one of the ways you can do   this is by getting a focus group together of the 
people served or survey them when they come in if   you don't want to do a focus group to find out 
what they might like to see hear whatever um in   your organization what changes might they like to 
see in order to feel feel safer and more empowered

Transcript for:Understanding NBCC Code of Ethics 2023

Transcript for:
Understanding NBCC Code of Ethics 2023