4.2 Contemporary Issues in Theory and Practice

Limitations of the Ethical Codes

When beginning the journey of ethical decision-making in counseling, one will often find resources, policies, and laws directing counselors to refer to the appropriate ethical codes to aid in decision-making, only to find that in most cases, the ethical codes do not provide a concrete solution to the issue at hand. However, this may be frustrating initially, especially for those with occupational or personal backgrounds that have not historically tolerated ambiguity. It is essential to remember that the ethical codes are intended as guidelines for practice rather than a source of solutions for problems. If ethical practice were as simple as cross-referencing a given situation with an ethical rulebook, textbooks such as this would not need to exist. Keeping this in mind, when faced with an ethical dilemma, it is essential to consult with various potential sources to reach an ethically sound conclusion. Widely accepted ethical decision-making models serve as guides in working through this limitation of the ethical codes, directing users to consult various sources such as laws, organizational policies, scholarly ethical writings, and supervisory experiences when the ethics codes provide insufficient information to address a given issue.

Conflicts Between Ethics and Laws

Counselors must often balance the demands of ethical standards and legal obligations in counseling, which can sometimes conflict. Professional organizations create ethical guidelines to promote best practices and guide counselors in their work with clients. These ethical standards emphasize client autonomy, confidentiality, beneficence (promoting good), and nonmaleficence (avoiding harm). However, laws governing counseling practice—such as mandated reporting requirements, confidentiality laws like HIPAA (Health Insurance Portability and Accountability Act) and 42 CFR Part 2, and state regulations—often focus on protecting public safety and ensuring compliance with legal standards. While ethics and laws frequently align, conflicts arise when ethical duties contradict legal mandates, leaving counselors with challenging decisions.

One of the most common areas where ethics and laws clash is confidentiality and mandated reporting. Ethically, counselors must protect their client’s privacy, which is fundamental to establishing trust in the therapeutic relationship. However, legal requirements often demand that counselors breach confidentiality in cases where clients present a risk of harm to themselves or others or when there is suspected child or elder abuse. This creates an ethical dilemma, as the counselor must decide between respecting client confidentiality and complying with the law to protect vulnerable individuals. For example, suppose a client confides in their counselor about ongoing child abuse. In that case, the counselor is ethically bound to keep the session confidential, but the law mandates reporting the abuse to the authorities.

Another significant conflict can arise between the principle of client autonomy and legal requirements for involuntary treatment. Counselors are ethically committed to respecting clients’ right to make decisions. Still, in cases where a client is deemed a danger to themselves or others—such as with suicidal ideation—laws may require involuntary hospitalization or intervention, even if the client opposes it. Similarly, counselors may face legal subpoenas or court orders to disclose client records, which conflicts with their ethical responsibility to maintain confidentiality. In such instances, counselors must navigate the complex decision of releasing sensitive information or protecting their client’s privacy, often requiring legal consultation to ensure they follow the law while respecting their ethical obligations as much as possible.

The issue of informed consent also presents potential conflicts between ethics and legal mandates. Ethically, counselors must obtain informed consent from clients, ensuring that participation in therapy is voluntary and based on a complete understanding of the process. However, clients in certain legal situations, such as those mandated by courts to attend counseling for substance use disorders, may feel that their participation is optional. This can create an ethical challenge for the counselor, who is expected to foster a trusting relationship while recognizing that the client may be resistant or disengaged due to the legal nature of their therapy.

Navigating these conflicts requires careful consideration and a commitment to ethical and legal responsibilities. Counselors should seek supervision or consultation when faced with difficult situations, consult with legal professionals when necessary, and document their decision-making processes to protect themselves and their clients. Counselors can better balance the sometimes competing demands by staying informed about ethical standards and legal obligations. Continuing professional development, supervision, and consultation with peers or ethics boards can help counselors make informed, ethical decisions in challenging circumstances. In doing so, they ensure that their practice complies with the law and upholds the core ethical principles that define the counseling profession.

Conflicts Between Professional Ethics and Organizational Policy

Though uncommon, there may come times when, in one’s capacity as a counselor, an organization of employment directs them to act in a manner that conflicts directly with the ethics codes. This may occur covertly through policies that promote unethical practice (e.g., Differential compensation for referring clients to a particular program) or overtly from a supervisor or colleague asking you to perform an unethical action (e.g., Misrepresenting a client’s diagnosis for insurance reimbursement). The ACA (2014) and NAADAC (2021) speak extensively on this topic.

According to the ACA (2014) Code of Ethics:

NAADAC (2021) also writes extensively on this topic, stating that:

In cases with minimal potential for harm to clients, the NAADAC (2021) encourages counselors to address their grievances informally without filing a formal complaint. However, in the event a practice is identified that has actively caused harm to clients or could foreseeably do so, NAADAC (2021) states that:

And

Though the stance of the ethical codes on this topic may appear complex, when comparing and contextualizing their prescriptions, a concrete picture begins to emerge. Unlike conflicts with legal mandates, organizational policy does not supersede the authority of the ethics codes. Thus, counselors cannot continue to be complicit in the ongoing unethical conduct of an organization without engaging in dishonest practices themselves and risking potential sanctions from ethics and licensure boards.

Identifying unethical conduct within an organization can be challenging as covertly unethical practices are often insidious. For example, one may hear of a policy during orientation that leaves them with an uneasy feeling that they cannot readily identify, or they may encounter coworkers exhibiting borderline unethical behavior and laughing it off as “part of the job.” Luckily, free and confidential resources are available for counselors struggling to determine whether organizational conduct constitutes an ethical violation. Many malpractice insurers provide free legal and ethical consultation networks, and the ACA provides members with a free ethics consultation network, which can be found at https://www.counseling.org/resources/ethics.

If you determine that an ethical violation is occurring, the codes encourage an informal resolution unless the unethical practices result in foreseeable or identifiable harm. Meeting with your supervisor to discuss your grievances and attempting to resolve the unethical practice is the first step in this process. Though this is a daunting prospect, many organizations will be receptive to feedback on unethical practices as they are vested in remaining in good standing with licensure and accreditation bodies. Furthermore, the ACA (2014) and NAADAC (2021) codes and many state and federal laws protect against retaliation for individuals making a good-faith effort to report and resolve unethical or illegal practices.

Though some instances of unethical practice can be resolved with minimal intervention, there may be times when an organization remains inflexible in light of unethical practices or organizational policies that are actively causing harm to clients. In these cases, a formal complaint must be made. When submitting a formal ethics or regulatory complaint, we recommend first consulting with a legal professional specializing in healthcare law or professional malpractice to familiarize yourself with your complaint’s process and legal implications. As mentioned, these can often be found at little to no cost through professional malpractice insurance.

Once you have gathered sufficient information, if it is safe to do so, we recommend informing your organization about your intent to submit an ethics or regulatory complaint. In cases where the ethical dilemma can be resolved informally, this offers a final chance to proceed with the informal resolution. At the very least, this courtesy can be likened to the organizational equivalent of informed consent and provides ongoing evidence of your attempts to act in good faith with the organization. Ethics and organizational malpractice complaints that have progressed to this point leave the complainant in a difficult position. Remaining employed at one’s site after submitting an ethics complaint is possible. However, despite the best efforts to handle an ethical concern in good faith, we cannot deny the possibility of hurt feelings among colleagues and supervisors. Feelings of duty towards long-term clients, coworkers, and populations served must be carefully balanced against the impact that continued employment at a particular site in the face of ongoing conflict will have on the counselor.

Finally, continued employment with your organization requires you to be complicit with unethical conduct or harm caused to clients. In that case, the ethics codes recommend voluntary termination of employment to minimize the role you may play in causing ongoing harm to clients (ACA, 2014; NAADAC, 2021). We provide a decision-making flowchart below for addressing potentially unethical organizational conduct.

Conflicts Between Ethics and Personal Beliefs

Counselors sometimes experience situations where ethical obligations may clash with personal beliefs. Navigating these conflicts requires a firm understanding of professional ethics, a commitment to client welfare, and the ability to self-reflect.

The ACA (2014) Code of Ethics highlights the importance of avoiding conflicts between value systems and ethical practice in its Code of Ethics:

The counseling profession prioritizes client autonomy, beneficence, and justice, as outlined in various ethical codes. Personal beliefs, often shaped by cultural, religious, or personal experiences, may sometimes create internal tension for counselors when engaging with clients whose values or behaviors differ. The potential for conflict underscores the importance of maintaining professionalism and adhering to ethical standards. For example, a counselor with deeply held religious beliefs may encounter discomfort when working with a client seeking support for same-sex relationship issues. However, the counselor’s ethical responsibility is to provide affirming and unbiased care, regardless of personal convictions. Referring to the client solely due to discomfort or bias rather than lack of competence would violate ethical principles and potentially harm the client. In this situation, a counselor must practice ethical bracketing, as described in this textbook (Kocet & Herlihy, 2014).

Another common scenario arises when working with clients who have made decisions that contradict a counselor’s moral values. A counselor might personally oppose abortion but must still provide a supportive and nonjudgmental space for a client considering or having undergone the procedure. Acting otherwise risks breaching the ethical principles of respect for client autonomy and nonmaleficence. Similarly, if a client discloses having committed a past violent crime without being apprehended, the counselor’s instinct may be to report this information. However, unless the counselor determines an ongoing threat of harm to others, ethical obligations such as confidentiality precede personal moral reactions.

Unconscious biases may also contribute to conflicts between ethics and beliefs. For instance, a counselor raised in a culture that stigmatizes substance use may struggle to empathize fully with a client in recovery. Reflective practice and supervision are essential in identifying and addressing these biases to avoid unintentional harm.

As previously described, ethical decision-making models can serve as valuable tools in navigating these conflicts. Deliberative steps, such as consulting ethical codes, seeking supervision, and evaluating potential impacts on the client, can guide counselors in resolving dilemmas. Continuous professional development and cultural humility further equip counselors to manage the intersection of personal beliefs and professional obligations effectively. Personal values inevitably influence how counselors perceive and interpret their work. However, professional ethical standards exist to ensure that clients receive equitable and effective care. Recognizing and addressing conflicts between ethics and personal beliefs is a hallmark of professionalism and a critical competency for counselors committed to fostering client well-being.