LMHC Professional Practice and Ethics 2 — Questions and Answers
Question 1: A licensed mental health counselor is asked by a client to write a letter supporting their disability claim. According to ethical guidelines, the counselor should:
- Refuse all requests for letters outside of therapy notes
- Only write such a letter if it is consistent with the clinical record and the counselor has sufficient knowledge of the client's condition (Correct answer)
- Write the letter to support the client regardless of clinical findings
- Refer the client to another provider to avoid dual relationships
Correct answer: Only write such a letter if it is consistent with the clinical record and the counselor has sufficient knowledge of the client's condition
Counselors must only provide documentation consistent with their clinical assessment and what they can professionally support — advocacy must be grounded in clinical facts.
Writing letters for disability claims or legal purposes creates potential for advocacy bias. Ethical guidelines require that counselors only provide documentation they can professionally support based on their clinical assessment. The letter must be factually accurate, reflect the counselor's actual findings, and avoid overstating or understating the client's condition. If the counselor lacks sufficient information or the request conflicts with clinical judgment, the counselor should decline.
Question 2: Which of the following represents an ethical violation of professional boundaries?
- Attending a client's graduation ceremony at the client's specific invitation, with appropriate clinical discussion
- Providing a client with a brief, warm handshake if culturally appropriate
- Accepting a small, culturally significant gift that would be offensive to refuse
- Entering into a business partnership with a current client (Correct answer)
Correct answer: Entering into a business partnership with a current client
Entering into a business relationship with a current client represents a harmful dual relationship that creates conflicts of interest and exploits the professional relationship.
The ACA Code of Ethics prohibits harmful dual or multiple relationships — those where a counselor occupies two roles with a client simultaneously in ways that create exploitation or impair judgment. A business partnership with a current client is a clear ethical violation because it creates financial entanglement, power imbalances, and conflicting loyalties that compromise the therapeutic relationship.
Question 3: The ACA ethical standard on informed consent requires that clients be informed of all EXCEPT:
- The limitations of confidentiality
- The counselor's theoretical orientation
- The counselor's personal values and religious beliefs (Correct answer)
- Their right to refuse treatment or withdraw consent
Correct answer: The counselor's personal values and religious beliefs
Informed consent covers goals, techniques, risks, benefits, confidentiality limits, and client rights — not the counselor's personal religious or spiritual beliefs.
Informed consent (ACA Code A.2) requires disclosure of qualifications, the purposes and limitations of services, confidentiality and its limits, fees, risks and benefits of treatment, alternatives, and client rights including the right to withdraw. The counselor's personal religious beliefs are not required disclosure. However, counselors must refer clients when their values impair their ability to provide competent services.
Question 4: A counselor is providing telehealth services to a client who lives in a different state than where the counselor is licensed. Ethically and legally, the counselor should:
- Continue services as long as the client's state does not prosecute violations
- Verify and comply with the licensing requirements of both the counselor's state and the client's state (Correct answer)
- Only obtain licensure in the client's state and allow the home state license to lapse
- Assume federal telehealth regulations override all state licensing requirements
Correct answer: Verify and comply with the licensing requirements of both the counselor's state and the client's state
Counselors providing telehealth must be licensed in the state where the client is located; many states require dual licensure for interstate telehealth.
The general legal principle is that counseling practice is regulated by the state where the client is physically present during the session, not where the counselor is located. Counselors providing telehealth to clients in other states must research and comply with the licensing requirements of those states. The LMHC Compact and other interstate practice agreements are emerging to simplify this process, but counselors must verify requirements before providing services across state lines.
Question 5: According to the HIPAA Privacy Rule, which of the following is a permissible disclosure of protected health information (PHI) WITHOUT client authorization?
- Disclosing records to the client's employer at the employer's request
- Treatment, payment, and healthcare operations (TPO) (Correct answer)
- Sharing information with the client's family members for any purpose
- Providing records to research institutions for commercial purposes
Correct answer: Treatment, payment, and healthcare operations (TPO)
HIPAA permits disclosure of PHI without authorization for treatment, payment, and healthcare operations (TPO), which are essential to healthcare delivery.
Under HIPAA, covered entities may use or disclose PHI without patient authorization for treatment (coordinating care with other providers), payment (billing insurance), and healthcare operations (quality improvement, training). Other disclosures require written authorization, except for specific exceptions such as mandatory reporting, public health, law enforcement under court order, and other narrowly defined circumstances.
Question 6: A counselor discovers that a client they terminated services with six months ago has begun dating the counselor's close friend. What is the MOST ethical course of action?
- Disclose all clinical information to the friend to protect them
- Consult with a supervisor and consider whether any action is needed, maintaining confidentiality throughout (Correct answer)
- Contact the former client and request they end the relationship
- Take no action because the therapeutic relationship has ended
Correct answer: Consult with a supervisor and consider whether any action is needed, maintaining confidentiality throughout
Counselors must maintain confidentiality of former clients and consult carefully about any potential conflicts without disclosing clinical information.
Confidentiality obligations survive termination of the therapeutic relationship. The counselor must not disclose any clinical information about the former client to the friend. However, the counselor may face a personal boundary challenge — knowing clinically sensitive information about someone now close in their social circle. Consultation with a supervisor or ethics consultant is recommended to navigate this situation thoughtfully while protecting the former client's privacy.
LMHC Professional Practice and Ethics 2
A licensed mental health counselor is asked by a client to write a letter supporting their disability claim.
According to ethical guidelines, the counselor should: