NCE Professional Ethics 2 — Questions and Answers
Question 1: A counselor discovers that a colleague is having a sexual relationship with a current client. According to the ACA Code of Ethics, what is the counselor's PRIMARY obligation?
- Report the colleague directly to law enforcement
- Do nothing unless the client files a formal complaint
- Take steps to address the situation, which may include reporting to licensing boards or supervisors (Correct answer)
- Confront the colleague privately and take no further action
Correct answer: Take steps to address the situation, which may include reporting to licensing boards or supervisors
The ACA Code of Ethics (Section H.2) requires counselors who have knowledge of an ethical violation to take appropriate action, which may include consulting, reporting to licensing boards, or supervisor notification, especially when clients are being harmed.
ACA Code of Ethics Section H.2.b states that counselors expect colleagues to adhere to the Code. Section H.2.c outlines a graduated response: first consult with the colleague if appropriate, then consult supervisors, ethics committees, or licensing boards. Sexual contact with current clients is an absolute prohibition (Section A.5.a). It constitutes client harm requiring reporting. Counselors who ignore known ethical violations may themselves be subject to ethical complaints.
Question 2: Which of the following BEST illustrates the ethical principle of 'nonmaleficence' in counseling?
- Advocating for a client's access to mental health services
- Avoiding techniques that are not supported by evidence and could harm the client (Correct answer)
- Respecting a client's right to make their own decisions
- Treating all clients with equal care and fairness
Correct answer: Avoiding techniques that are not supported by evidence and could harm the client
Nonmaleficence means 'do no harm.' In counseling, this includes avoiding harmful, discredited, or evidence-contradicting techniques that could cause psychological damage to clients.
The six primary ethical principles in counseling (Kitchener's model): Autonomy (respect for self-determination), Nonmaleficence (do no harm), Beneficence (promote client welfare), Justice (fairness, equitable treatment), Fidelity (keeping promises, trustworthiness), and Veracity (honesty). Nonmaleficence requires counselors to be aware of harmful practices, avoid dual relationships that compromise objectivity, and use up-to-date, evidence-based approaches. It is considered more binding than beneficence -- avoiding harm takes precedence over promoting good.
Question 3: When is it ethically permissible for a counselor to break confidentiality without the client's consent?
- When a family member demands information about the client's treatment
- When the counselor believes the client made a poor life decision
- When the client poses a serious and foreseeable danger to an identifiable third party (Correct answer)
- When the counselor is billing insurance and needs to share detailed session notes
Correct answer: When the client poses a serious and foreseeable danger to an identifiable third party
The Tarasoff duty to protect (1976) established that therapists have an obligation to warn identifiable third parties when a client poses a credible, imminent threat to their safety. This is a recognized exception to confidentiality.
Tarasoff v. Regents of the University of California (1976) held that therapists have a duty to warn/protect identifiable victims when clients make credible threats. Mandatory breaches of confidentiality include: duty to warn/protect (Tarasoff), child abuse reporting (all states), elder/dependent adult abuse reporting, and some states require reporting of communicable diseases. Billing does not require sharing detailed session notes -- only diagnosis codes and service type are typically shared with insurers.
Question 4: A counselor's client is also the counselor's neighbor. This situation represents:
- A boundary crossing that is necessarily unethical
- A potential dual relationship that requires careful ethical decision-making (Correct answer)
- An acceptable arrangement as long as both parties agree
- A conflict that requires immediate termination of the counseling relationship
Correct answer: A potential dual relationship that requires careful ethical decision-making
A dual relationship (also called a multiple relationship) exists when a counselor has two distinct roles with the same person. Living near a client is not automatically unethical but requires careful consideration of potential harm, the counselor's objectivity, and the client's welfare.
ACA Code Section A.6.a recognizes that some multiple relationships are unavoidable (e.g., in small or rural communities). The ethical question is not whether the relationship is dual but whether it risks harm to the client or impairs the counselor's professional judgment. Factors to consider: power differential, potential exploitation, client vulnerability, community context. Steps: consult with a supervisor, document decision-making, discuss the situation transparently with the client, consider referring if harm is likely.
Question 5: Under HIPAA, a counselor's psychotherapy notes have which level of protection compared to other medical records?
- Less protection -- insurance companies can always access them for billing
- The same protection as other health information in the medical record
- Greater protection -- they require specific authorization separate from general release (Correct answer)
- No legal protection in most states
Correct answer: Greater protection -- they require specific authorization separate from general release
HIPAA provides psychotherapy notes (process notes) with extra protection. They are kept separate from the medical record and require a specific, separate authorization for disclosure -- general medical release forms do not cover them.
HIPAA distinguishes between psychotherapy notes (process notes, session content details, impressions, analyses) and the medical record (diagnosis, treatment plan, session summaries, medication). Psychotherapy notes: must be kept separate, require specific written authorization for release, cannot be disclosed even to other treating providers without separate consent, and are not covered by general releases. Insurance companies cannot routinely access psychotherapy notes for billing purposes.
Question 6: A counselor is working with a client who is terminally ill and wants to discuss the option of physician-assisted dying. The MOST ethical response is to:
- Refer the client immediately because this topic falls outside counseling scope
- Refuse to discuss the topic as it conflicts with the counselor's personal values
- Explore the client's concerns openly, provide information about all options, and respect client autonomy (Correct answer)
- Report the client's statements to their physician without consent
Correct answer: Explore the client's concerns openly, provide information about all options, and respect client autonomy
Ethical counseling requires exploring the client's full range of feelings and concerns, including end-of-life options, while respecting client autonomy. Refusing to engage with the topic or acting without consent would violate multiple ethical principles.
ACA Code Section A.4.b (Personal Values) states that counselors do not impose personal values on clients but respect the diversity of client values. When a counselor's personal values conflict with a client's needs, consultation and referral may be appropriate -- but avoiding the topic entirely without cause abandons the client. End-of-life counseling competencies include: discussing medical options openly, exploring meaning, processing grief and existential concerns, and working collaboratively with the medical team.
NCE Professional Ethics 2
A counselor discovers that a colleague is having a sexual relationship with a current client.
According to the ACA Code of Ethics, what is the counselor's PRIMARY obligation?