Section 2: Legal and Ethical Counselling Practice

Submitted by sylvia.wong@up… on Fri, 12/09/2022 - 00:55

In this section you will learn about:

  • the core legal and ethical responsibilities of a counsellor
  • common practices used to ensure adherence to both legal and ethical requirements.

Supplementary materials relevant to this section:

  • Reading D: A Quick Guide to Australian Discrimination Laws
  • Reading E: Informed Consent
  • Reading F: Ethical Considerations When Counselling Children
  • Reading G: Statutory Schemes
  • Reading H: Mandatory Reporting of Child Abuse and Neglect
  • Reading I: Dual Relationships
  • Reading J: WHS Code of Practice

In the previous section of this module, you learned about the key sources of information that guide counselling practice, including codes of ethics, practice standards, legislation, and organisational policies and procedures. In this section of the module, you will learn more about the specific legal and ethical responsibilities of effective counselling practice and how counsellors comply with these responsibilities.

Sub Topics

Legal and ethical frameworks support the safe, effective, and fair delivery of counselling services. This means practicing in a way that acknowledges, respects, and protects the rights of clients. These rights include the right to:

  • have their individuality and beliefs respected
  • be fully informed of the service to be provided
  • autonomy (to make their own decisions)
  • confidentiality; protection of their information to the greatest extent permitted under law
  • a safe therapeutic environment
  • professional and competent counselling
  • receive counselling that is responsive to their individual needs
  • make a complaint about their counselling service.

Counsellors are responsible for protecting the rights of clients. Key responsibilities include:

  1. Respecting the basic rights of clients: Counsellors must provide a respectful, non-judgemental and non-discriminatory service to clients and protect the right of the client to self-determination (i.e., to make decisions for themselves).
  2. Only working with clients who have provided informed consent: Providing the client with all relevant details of the service, confirming that the client understands these, and confirming the client’s willingness to engage in counselling.
  3. Respecting the client’s right to privacy and confidentiality: Informing the client of exceptions to confidentiality, informing the client of record-keeping practices, and ensuring that any client information is stored appropriately.
  4. Prioritising client safety and well-being: Counsellors must act in their client’s best interests, provide appropriate care, and avoid exploitation. Counsellors (and their organisations) are also responsible for the client’s safety while they are receiving counselling services.
  5. Delivering a professional and competent service: Counsellors should possess comprehensive knowledge of their chosen approach and understand its limitations as well as their own limitations. When a counsellor believes that their approach is not suitable for a client’s needs or that a client’s needs exceed their competency level, they have a responsibility to refer that client to a more suitable practitioner. Counsellors also have a responsibility to keep up with changes in the field and ensure that their knowledge is up-to-date so that they can provide relevant and professional service to their clients. This involves engaging in ongoing training, professional development, and supervision. Counsellors must also engage in regular supervision to work through any potential issues in counselling.

Some of these responsibilities are supported by legislation; others are predominantly expressed in ethical codes and practice standards. The remainder of this section of the module will explore these key counsellor responsibilities, the legal and ethical requirements underlying them, and the common practices used by counsellors and counselling organisations to promote compliance.

Legal and Ethical Issues for Mental Health Professionals

Learn how the laws impact your psychotherapy practice, as you watch this role-play of a judge and her law clerk discuss actual key cases in the creation of mental health laws, specifically: Confidentiality, Privilege, Reporting and Duty to Warn. Answer the questions that follow. 

A core responsibility is to respect the rights of clients. This includes providing respectful, non-judgemental, and non-discriminatory service to clients and promoting self-determination. These rights are protected by both legal and ethical frameworks as well as a range of typical organisational requirements. Professional standards also address these rights. For example, the ACA Code of Ethics and Practice states that counsellors are required to “offer a non-judgemental professional service, free from discrimination, honouring the individuality of the client.” (2019, p. 7). Following is specific advice in the Code of Practice relating to ethical, anti-discriminatory practice.

Code of Practice

4.3 Anti-Discriminatory Practice

(a) Client Respect

i. Counsellors work with clients in ways that affirm both the common humanity and the uniqueness of each individual. They must be sensitive to the cultural context and world-view of the client, for instance, whether the individual, family or the community is taken as central.

(b) Client Autonomy

i. Counsellors are responsible for working in ways that respect and promote the client's ability to make decisions in the light of his/her own beliefs, values and context.

(c) Counsellor Awareness

i. Counsellors are responsible for ensuring that any problems with mutual comprehension due to language, cultural differences or for any other reason are addressed at an early stage. The use of an interpreter needs to be carefully considered at the outset of counselling.

ii. Counsellors have a responsibility to consider and address their own prejudices, stereo-typing attitudes and behaviour. They are to give particular consideration to ways in which these may be affecting the counselling relationship and influencing their responses.

(ACA, 2019, p. 10)

Non-discriminatory practice is also required under legislation. There are a range of anti-discrimination laws in place that aim to protect people from certain kinds of discrimination in public life and from breaches of their human rights. As a counsellor, you need to be knowledgeable about this legislation and ensure that you comply with it. Ultimately, the Australian Human Rights Commission has statutory responsibilities under these laws and has the authority to investigate and resolve complaints related to human rights violations (which includes discrimination). The Commission can reprimand organisations, as well as report individual workers to their regulatory body if they find breaches. If the breach is serious, a worker can even lose their job and ability to work in the sector.

Read

Reading D – A Quick Guide to Australian Discrimination Laws provides a broad overview of anti-discrimination legislation in Australia, including laws that operate at a federal level and those at a state and territory level. As counsellors, you must comply with both levels of law.

Most counselling organisations also have specific policies and procedures, including those related to equal opportunity and discrimination within the workplace and client charters that set out how client rights will be protected while they engage in counselling services. Client charters typically outline what services the organisation provides, what clients should expect from their service, and the rights and responsibilities of both counsellors and clients. Additionally, most organisations will have specific policies in place to assist counsellors in working with clients from diverse cultural backgrounds, including cultural protocols and procedures for the use of language and cultural interpreters.

Let’s look at an example of how a client’s rights can be violated in the counselling context in the following case study.

Case Study
A counsellor and client talking

Malik, a 38-year-old Pakistani immigrant from Melbourne, seeks counselling from a large government-funded community services organisation. His assigned counsellor, Sarah, becomes uncomfortable when Malik tells her that he is Muslim and has sought out counselling because he is having marital difficulties with his wife. Sarah assumes that Malik is oppressing his wife and does not want to work with him even though her organisation’s services are open to all. She tells Malik that he is not eligible for the organisation’s services and that she cannot help him.

In this case, Sarah is not only breaching the ACA Code of Ethics and Practice, but she is also breaching international, Commonwealth and state legislation related to discrimination – specifically the Universal Declaration of Human Rights, the Racial Discrimination Act 1975 (Cth), and the Equal Opportunity Act 2010 (VIC).

Sarah is also breaching organisational policy, which states that client eligibility is not affected by religious affiliation. The consequences of these actions can include disciplinary action by the organisation and charges under the Acts outlined.

Following organisational policies and procedures and relevant legal and ethical requirements is central to respecting the basic rights of clients. However, counsellors need to go further and maintain an awareness of their own values and how these values can impact their counselling work with clients. In order to practice in a way that respects their clients' basic rights, it is crucial that counsellors do not impose their own values and beliefs onto clients. As such, counsellors need to examine their own value systems and consider how their personal beliefs may impact the counselling relationship.

While it is impossible to be value-free, counsellors should continuously engage in self-reflection and supervision to monitor for the impact of values and facilitate non-judgemental, non-discriminatory practice. In cases where counsellors hold particularly strong values, it is extremely important that they are aware of the potential impact of their personal values on the counselling process and monitor interactions carefully. Referral should be considered if a counsellor starts working with a client and feels that their personal values may unduly influence the counselling process and negatively impact a client’s autonomy and self-determinatioEthical

Check your understanding of the content so far!

Framework for the Counselling Profession.

The presenter discusses key factors for counsellors to consider about making ethical decisions. 

Reflection

Why do you think it is so important for counsellors to avoid imposing their own values onto their clients? What negative impacts do you think it could have on a client and the counselling relationship if a counsellor imposed their own values onto the client?

Another key counsellor responsibility is ensuring that the client has given their informed consent to counselling. Informed consent involves two core components. The first involves providing the client with the information they need to make a reasoned decision about whether to engage in the services being offered (e.g., what the service provision will involve as well as its risks and potential benefits). The second is free consent – counsellors need to ensure that this agreement is given freely and without coercion (Welfel, 2016). Informed consent means that clients have the opportunity to decline treatment once they have had an opportunity to find out about the risks and benefits of counselling interventions.

Informed consent ensures that clients are fully informed about the benefits and risks of recommended interventions before they are implemented, and are made aware of optional approaches to those being offered in the moment. A key purpose of informed consent is to protect the right of clients to self-determination. It provides an opportunity for clients to raise questions about the clinician, the work, and potential outcomes. In most circumstances, clients have the right to refuse or terminate clinical work.

Informed consent serves a number of functions. It empowers people by providing them with information that enables them to make wise decisions. It encourages conversation about realistic goals and objectives, and ways to meet them so that clients know what to expect. Informed consent not only protects the client; it may also protect clinicians from lawsuits on the part of disgruntled clients who feel harmed or misinformed by their provider.

(Murphy & Dillon, 2015, p. 55)

Read

Reading E – Informed Consent focuses on the client’s right to give informed consent within helping contexts. You will learn about the legal aspects as well as how to educate clients about informed consent.

The fundamental ethical principle underlying informed consent is that of respect for client autonomy. By engaging in informed consent processes with each client, counsellors confirm the client’s right to manage their own lives and choose their own care (Welfel, 2016). The ACA Code of Ethics and Practice requires that clients be given adequate information to make informed choices about entering and continuing the client-counsellor relationship:

Code of Ethics

iv. Ensure client understanding of the purpose, process and boundaries of the counselling relationship.

(ACA, 2019, p. 7)

Code of Practice

4.8(c) Contracting with Clients

i. Counsellors are responsible for reaching agreement with their clients about the terms on which counselling is being offered, including availability, the degree of confidentiality offered, arrangements for the payment of any fees, cancelled appointments and other significant matters. The communication of essential terms and any negotiations should be concluded by having reached a clear agreement before the client incurs any commitment or liability of any kind.

ii. The counsellor has a responsibility to ensure that the client is given a free choice whether or not to participate in counselling. Reasonable steps should be taken in the course of the counselling relationship to ensure that the client is given an opportunity to review the counselling.

(ACA, 2019, p. 10)

According to common law, adults (i.e., those over 18) can consent to and refuse treatments and interventions. Younger people also have some rights when it comes to accessing or refusing services, although these situations are more complex (refer to the following A note on working with children). Informed consent is also protected by state and territory legislation, in the form of specific mental health acts (e.g., Mental Health Act 2015 (ACT)). These acts set out the rights of people with mental health issues regarding their care, including issues of consent and guidelines for when involuntary treatment may be enforced (although counsellors are not among those who can make involuntary treatment decisions or be involved in involuntary treatment provision).

If consent is not established, there may be professional and legal consequences for anyone who provides a service. Because involuntary treatment does not apply to counsellors, you must always gain informed consent before providing a service. Of course, this is not just a legal obligation: providing clients with sufficient information to make an informed decision and obtaining consent prior to starting counselling is essential to ethical counselling practice, too.

Counselling organisations generally develop strict policies around contracting as well as formal written contracts to assist in the process of obtaining informed consent. Of course, counsellors do not just provide clients with a written contract – they also have a detailed contracting conversation with each client, including confirming the client’s understanding. This means making sure that, before counselling begins, the counsellor informs the client about their own rights and responsibilities, the counsellor’s role and responsibilities, the process of counselling, and what their engagement with counselling will involve. Contracts and contracting conversations should:

  • provide the client with information about the services offered
  • explain the counselling approach that the counsellor uses
  • provide an overview of what the client can expect to occur during counselling
  • ensure that the client is familiar with organisational requirements such as payment schedules, cancellation policies, and termination procedures
  • discuss the counselling process and the number of sessions being contracted
  • outline confidentiality and the limits to confidentiality
  • outline record-keeping procedures and how clients can access their own information
  • ensure that the client knows that they can withdraw their consent at any time and have the right to refuse to engage with any strategy or technique the counsellor uses or suggests.

Obtaining a client’s informed consent is an important legal and ethical step and it should be given due attention. As Welfel (2016) outlines, informed consent is not:

  • just some forms to be signed by the client at the initial counselling session
  • merely a brief discussion about the limits of confidentiality and nothing else
  • a risk management strategy undertaken primarily to protect counsellors from legal liability.

Following is an example of a written contract.

COUNSELLING CONTRACT

Wellness Counselling Service

Counselling approach

I believe that my clients have the desire and the capacity to grow towards fulfilling their true potential and that they are the experts in their own lives. Therefore, I will not give you advice or offer solutions, but will work with you to help you understand yourself more fully and to find your own inner resources. With greater self-awareness and trust in yourself, I hope that you will be able to make constructive changes, leading to a more satisfying and meaningful life.

Confidentiality

In general, what you share with me will be confidential. However, there are a few circumstances in which I may be required to break confidentiality:

  • If I consider you to be at risk of seriously harming yourself or someone else.
  • If your counselling records have been requested by a court of law.
  • If another party or agency has requested your information, and you have agreed and provided your written consent to this.
Sessions

Our initial contract will run for 6 sessions, after which we will review the counselling process and negotiate further sessions as appropriate. Normally we will meet on a weekly basis at a regular time. The duration of a counselling session is 1 hour.

Payments/cancellations

Each 1-hour session costs $120. Payment will be taken at the beginning of each session and may be made by cash, EFTPOS, credit card, or cheque. Late cancellation fees are payable as follows: 0-24 hours’ notice – full session fee payable. 24-48 hours’ notice – 50% of session fee is payable.

Record keeping

I will take notes during or after each session to help me keep track of our progress together. These notes will be stored in a private and secure location and may be viewed by you if you so wish. Your counselling records will be kept by the service for a period of seven (7) years from the date of your last contact with the service.

Email/telephone contact

Email or telephone contact will be limited to practical arrangements only. I will not enter into telephone or email counselling except by prior arrangement. If you are faced with an emergency in between sessions, please contact the appropriate emergency service. In a life-threatening situation, call 000 without delay.

Ending counselling

Normally, the end of counselling would be by mutual prior agreement. However, you have the right to end your counselling at any time. I would appreciate you letting me know if you decide not to return to counselling, giving at least 48 hours' notice. If at any time I feel that our counselling is no longer appropriate for you, I will discuss this with you and may suggest discontinuation or a referral to a more appropriate service.

Client signature: ________________________ Date: ______

Counsellor signature: ____________________ Date: ______

(Adapted from Crane, 2013)

Obtaining informed consent is an important process that counsellors need to take time with. It is also important to understand that it is an ongoing process. Often clients will not readily understand all aspects of an initial informed consent discussion, or will not recall initial discussions later in counselling. Therefore, counsellors should revisit informed consent when seeking to implement new interventions later in the counselling process (Welfel, 2016).

Check your understanding of the content so far!

To see how one-way things can go wrong, let’s look at an example of how a client’s right to informed consent can be violated in the following case study.

Case Study
Counsellor talking to a client

Adam attends counselling to obtain help for his crippling phobia of spiders. The counsellor says he can carry out an evidence-based treatment for phobias but does not tell Adam much more than that. Adam trusts that the counsellor knows what he is doing and consents to the treatment. The counsellor then begins a behavioural intervention involving ‘flooding’, where Adam is exposed to pictures of spiders in session for a prolonged period. Adam is inadequately prepared for the treatment and suffers from panic attacks as a result.

In this scenario, although the counsellor has obtained Adam’s consent, it has not been informed consent (i.e., he has not been adequately informed about the proposed therapeutic intervention and its possible benefits and risks). The counsellor could potentially be liable for damages if Adam decides to pursue legal action.

Reflect

What do you think the counsellor should have done in the case study situation in order to obtain Adam’s informed consent?

Client Rights and Counselor Responsibilities

This video provides a definition of informed consent and a brief example of how one might deliver the information needed to acquire informed consent. It also covers the SOAP note format and provides a brief example of how one might document a therapy session with a client.

A Note on Working with Children

There are special considerations involved in working with children. The first involves parental consent. In Australia, guidelines regarding whether minors can consent to a service without parental knowledge and consent are not clearly defined and, when they are, ages of consent can vary across jurisdictions. But as ever, there are fundamental rights (the child’s) and ethical responsibilities (the counsellor’s) here, too:

  • Children should always be made aware of what counselling will involve, as well as the limits of confidentiality and the counsellor’s duty of care.
  • The issue of the sharing of information with parents should be discussed and agreed to before counselling begins.
  • Counsellors must discuss all aspects of contracting – and conducting counselling itself – in a manner and language suitable to the child’s level of development, and use multiple strategies to assess the child’s understanding. It cannot be assumed, for example, that a child client will understand terms like ‘confidentiality’, ‘privacy’, ‘contracting’, ‘counselling’, ‘service’, ‘duty of care’, and so on.
  • Organisations that involve any degree of work with children should have specific policies and procedures in place to protect child welfare and enhance child wellbeing, by which their workers must abide.

Important note: Counselling children is a specialised area, requiring specific skills, and also invokes a range of further legal and ethical responsibilities. While we provide basic information about working with children and young people in this course, students who want to counsel children will need to undertake further study in order to gain competence in this area. Supervision with a practitioner experienced in counselling children is also necessary.

Reporting Child Abuse Ethics

In this video, the presenter answers a question about the ethics of reporting child abuse. Answer the questions that follow.

Read

Reading F – Ethical Considerations When Counselling Children discusses a range of ethical considerations in relation to counselling work with children. Some of these include issues around gaining informed consent, confidentiality, the involvement of family members and associated third parties, and the power imbalance in child-counsellor relationships and boundaries.

Clients have a legal and ethical right to have their private information kept confidential and counsellors have a responsibility to protect this right. With few exceptions, the client’s identity, the fact that they are receiving counselling (or another helping service), and everything discussed between a counsellor and their client is confidential, even if it does not seem like important or particularly sensitive information:

Confidentiality in counselling and psychotherapy encompasses not only the words spoken between professionals and their clients, but also all records related to those interactions, and the identity of the clients. A professional is obligated not to disclose even the names of clients without their permission… Mental health professionals are expected to provide a therapeutic environment in which client words cannot be overheard, their records are kept secure from unauthorised people, and their presence at the office is protected to the fullest extent possible.

(Welfel, 2016, p. 112)

ReaD

In Reading G, you will find an overview of practitioners’ responsibilities with respect to privacy and confidentiality laws that you must comply with.

Counsellors (and counselling organisations) are also required to protect client privacy. The concept of privacy is broader in scope than confidentiality and relates to the ownership of information, as well as the gathering and storing of this information (Kämpf, McSherry, Ogloff, & Rothschild, 2009). Maintaining client privacy and confidentiality is a fundamental ethical principle supported in the ACA Code of Ethics and Practice, as highlighted in the following extract:

Code of Ethics

v. Offer a promise of confidentiality and explain the limits of duty of care.

vi. For the purpose of advocacy, receive written permission from the client before divulging any information or contacting other parties.

(ACA, 2019, p. 7)

Code of Practice

4.4 Confidentiality

(a) Confidentiality is a means of providing the client with safety and privacy and thus protects client autonomy. For this reason, any limitation on the degree of confidentiality is likely to diminish the effectiveness of counselling.

(b) The counselling contract will include any agreement about the level and limits of the confidentiality offered. This agreement can be reviewed and changed by negotiation between the counsellor and the client. Agreements about confidentiality continue after the client’s death unless there are overriding legal or ethical considerations. In cases where the client’s safety is in jeopardy any confidentially agreements that may interfere with this safety are to be considered void (see 4.6 ‘Exceptional Circumstances’).

(c) Confidentiality extends to client records which must be kept securely – be they maintained as hard copy or by digital processes.

4.5 Settings

(a) Counsellors must ensure that they have taken all reasonable steps to inform the client of any limitations to confidentiality that arise within the setting of the counselling work, e.g. updating doctors in primary care, team case discussions in agencies. These are made explicit through clear contracting.

(b) Many settings place additional specific limitations on confidentiality. Counsellors considering working in these settings must think about the impact of such limitations on their practice and decide whether or not to work in such settings.

(ACA, 2019, pp. 10-11)

The ACA Code of Ethics and Practice also requires steps to be taken to protect a client’s privacy.

Code of Ethics

iii. Counsellors must provide privacy for counselling sessions. The sessions should not be overheard, recorded or observed by anyone other than the counsellor without informed consent from the client. Normally any recording would be discussed as part of the contract. Care must be taken that sessions are not interrupted.

(ACA, 2019, p. 8)

Code of Practice

4.8(c) Contracting with Clients

iv. Records of appointments should be kept and clients should be made aware of this. If records of counselling sessions are kept, clients should also be made aware of this. At the client's request information should be given about access to these records, their availability to other people, and the degree of security with which they are kept

v. Counsellors must be aware that computer-based records are subject to statutory regulations. It is the counsellor’s responsibility to be aware of any changes the government may introduce in the regulations concerning the client's right of access to his/her records.

(ACA, 2019, p. 12)

4.7 Management and Confidentiality

(a) Counsellors should ensure that records of the client’s identity are kept separately from any case notes.

(b) Arrangements must be made for the safe disposal of client records, especially in the event of the counsellor’s incapacity or death.

(c) Care must be taken to ensure that personally identifiable information is not transmitted through overlapping networks of confidential relationships.

(d) When case material is used for case studies, reports or publications the client's informed consent must be obtained wherever possible and their identity must be effectively disguised.

(e) Any discussion of their counselling work with other professionals should be purposeful and not trivialising.

(f) Counsellors must pay particular attention to protecting the identity of clients.

(ACA, 2019, p. 11)

However, there are identified circumstances where counsellors may need to breach this right. These circumstances are outlined in the following extract.

Code of Practice

4.6 Exceptional Circumstances

(a) Exceptional circumstances may arise which give the counsellor good grounds for believing that serious harm may occur to the client or to other people. In such circumstance the client’s consent to change in the agreement about confidentiality should be sought whenever possible unless there are also good grounds for believing the client is no longer willing or able to take responsibility for his/her actions. Normally, the decision to break confidentiality should be discussed with the client and should be made only after consultation with the counselling supervisor or if he/she is not available, an experienced counsellor.

(b) Any disclosure of confidential information should be restricted to relevant information, conveyed only to appropriate people and for appropriate reasons likely to alleviate the exceptional circumstances. The ethical considerations include achieving a balance between acting in the best interests of the client and the counsellor’s responsibilities under the law and to the wider community.

(c) While counsellors hold different views about grounds for breaking confidentiality, such as potential self-harm, suicide, and harm to others they must also consider those put forward in this Code, as they too should imbue their practice. These views should be communicated to both clients and significant others e.g. supervisor, agency, etc.

(ACA, 2019, p. 11)

There are also a number of laws that protect client privacy and confidentiality as well as detail exceptional circumstances when confidentiality should be breached. Some of the most important provisions can be found in privacy legislation, mental health acts, and mandatory reporting legislation (Kämpf et al., 2009). Let’s explore each of these now.

The Privacy Act 1988 (Commonwealth)

This piece of federal legislation regulates how personal information is managed. The Privacy Act includes thirteen Australian Privacy Principles (APPs), which apply to many private sector organisations as well as most government agencies and other bodies. The APPs provide specific rules to protect health information with disclosure (revealing information) prohibited “beyond its primary purpose” (i.e., diagnosis and treatment; Kämpf et al., 2009, p. 76). Disclosure is permissible only under specific circumstances, such as:

  • if it is directly related to the primary purpose and within the client’s or patient’s reasonable expectations
  • if the client or patient consents to it
  • if disclosure is required or authorised by law.

All states and territories have enacted specific health records and information privacy legislation and you should ensure you are familiar with the legislation relating to your own jurisdiction. General information on state-based requirements can be found in Reading G. However, information can become outdated very quickly, and it is your responsibility to keep your knowledge of relevant legislation and regulations current.

Mental Health Legislation

Each piece of mental health legislation incorporates specific provisions that generally protect confidentiality in mental health settings (including counselling). Although these acts may differ in some respects, they aim to protect information that clients may divulge to mental health professionals. These acts do allow for the disclosure of information in specific circumstances, such as:

  • with the client’s consent
  • when the disclosure is required or authorised by the mental health legislation or other legal provisions
  • to nominated carers or guardians in certain circumstances
  • for the purpose of criminal investigations or criminal proceedings
  • for statistical analysis and research purposes, provided that there is compliance with further requirements (e.g., that the information is de-identified).

And even where mental health provisions do not apply, common law does. Ultimately, counsellors may be sued through civil law courts for compensation if a client believes that their confidentiality has been improperly breached (Kämpf et al., 2009).

Check your understanding of the content so far!

Mandatory Reporting

Australian legislation mandates sharing otherwise confidential information in limited circumstances. One of these situations is where child abuse is suspected or confirmed. While mandatory reporting legislation does differ between jurisdictions, a child’s right to safety is considered paramount in all states and territories, and counsellors have a legal and ethical obligation to act where they have reason to believe a child has been abused, is being abused, or is at risk of abuse. There are penalties for nondisclosure where a mandatory reporter has reason to suspect abuse but fails to report this information. However, even if a counsellor works in a role or state in which they are not a mandatory reporter, they still have ethical obligations relating to child protection issues.

Read

Reading H – Mandatory Reporting of Child Abuse and Neglect provides an overview of Australian mandatory reporting laws – which vary slightly between each state and territory – and provides answers to some common questions asked about mandatory reporting.

Let’s look at an example of a counsellor dealing with the need to break client confidentiality due to mandatory reporting in the following case study.

Case Study
A counsellor and client

Tim is a counsellor working with a young mother, Renee. During one of their sessions, Renee tells Tim that she is really struggling to control her son Nathan’s temper tantrums and that, even though she knows it is wrong, she slaps or punches him when he is having a tantrum. Tim practices in the Northern Territory and, as such, is a mandatory reporter. His organisation’s policies and procedures also require him to make reports in situations of child abuse, and he is a member of the ACA, whose Code of Ethics and Practice requires him to report the matter.

At the beginning of the counselling relationship, Tim discussed the limits of confidentiality with Renee and she signed a counselling contract that noted the limits of confidentiality.

Tim addresses the need to report this matter with Renee. He says, “Renee, as we talked about at the beginning of our counselling, there are some situations that I am legally and ethically required to report – and one of those situations is when I think a child is being harmed. What this means is that I will need to make a report in relation to what you have just told me. We can still work together and get you the assistance that you need to help manage Nathan’s behaviour. Do you have any questions?” Tim then follows his organisation’s policies and procedures, discussing the situation with his manager, and making a report to the child welfare authority.

If you are ever required to make a report concerning child abuse or child protection concerns it will be vital to follow your organisation’s policies and procedures. This will generally include discussing your concerns with a manager or internal supervisor before making a report and using a specific organisational form or process to make the report. In some organisations, it may only be within a supervisor’s level of responsibility to actually make a report to the relevant child protection authority, in which case you will be required to provide your supervisor with all of the relevant information. You will also need to document that you have made such a report (to your supervisor and/or the child welfare authority), as well as the reasons why you have done so. If you fail to keep adequate records, your decision may be challenged, your employment may be terminated and you may face other professional and even legal sanctions.

All child welfare records and reports must be written in a clear, objective, and non-judgemental way. Some tips on appropriate reporting are included in the following extract:

  • Relay information that describes exactly what happened as simple statements of fact.
  • Be specific instead of vague or general.
  • Be explicit in expressing yourself.
  • Identify your sources.
  • Be specific about dates and times.
  • Be specific about the other person’s statements, writing exactly what they said, rather than your interpretation.
  • Use moderate and graduated evaluative language instead of intense or emotional evaluative language.
  • Use modality to show caution about your views or to allow room for others to disagree.
  • Use objective and inclusive language.
  • Include subjective evidence given to you by the person but make sure you identify the source.

(Adapted from Network of Community Activities, 2015)

It is also important for counsellors to limit their reporting to child welfare authorities to only the information relevant to the child protection issue – such reports should not include information that is not relevant to the child safety risk. For example, it would be inappropriate to include information about children who are not being harmed or at risk of harm; to make comments about the personalities or habits of the people involved (unless there are habits directly relevant to the harm, such as current substance use); or your own judgements.

Let’s return to the case study, and imagine that Tim makes his report, and notes in it that Renee had disclosed that she had smoked marijuana prior to her children being born; that she has asthma and needs to take preventative medication daily; or that she regularly runs late for appointments. This would be disclosing information that is not relevant to the child safety risk. In such a case, while his sharing of child risk-related information was justified, he would have breached his client’s right to confidentiality in sharing the other information about her.

Protecting and Sharing Information

Whenever a counsellor is required to breach a client’s confidentiality, they must follow their organisation’s policies and procedures. These often call for the counsellor to discuss the reasons for the breach with the client unless the counsellor believes such a discussion could have the potential to harm the client or a third party. Ultimately, if a counsellor is unsure about what to do in a particular situation they should seek out the advice of their supervisor. They also need, as mentioned, to make clear, thorough records of the decisions they have made and the actions they have taken.

In addition to legal and ethical protections for client privacy and confidentiality (other than in exceptional circumstances), most counselling and other human services organisations develop policies and procedures to assist workers in meeting their responsibilities. For example, organisations will have policies and procedures for the collection and storage of information, record keeping, referral, information sharing, and how to handle disclosures of abuse or other risks. These policies and procedures are designed to comply with legal and ethical requirements. An organisation’s record-keeping procedures, for example, might include the following:

  • Hard-copy client files are to be kept in a locked filing cabinet.
  • Electronic files are maintained on a protected intranet and client records can only be accessed by the individual counsellor allocated to that client, their supervisor, and specific members of senior management.
  • Electronic files can only be accessed by user passwords and no files are accessible to people who are not staff of the organisation.
  • Where there has been no activity on a client file for 90 days, that file is electronically closed and archived; any hard copy documents are placed in secure storage.
  • Clients may request access to information contained in their file and/or a letter or report based on information in the file.
  • Other people/services may not access information on a client file unless client consent is obtained in writing for the release of that information.
  • Only aggregate (de-identified) data is provided to external agencies (e.g. funding bodies).
Reflect

Take a few minutes to reflect on the common policies and procedures that you have learned about so far throughout your Diploma. Can you identify specific policies, procedures, or provisions that are designed to help protect client privacy and confidentiality?

Due to the important nature of client confidentiality, counselling organisations typically require clients to sign a release of confidential information form as part of the referral process. This documents the client’s consent for the counsellor’s releasing their information.

Information might be shared for a number of reasons, with client consent. For example, counsellors often need to make referrals, many counsellors engage in collaborative work (such as when the counsellor is a member of a care team or is part of a case management program), and there may be times when advocacy or liaison is required. In such cases, it is important to continue protecting client privacy and confidentiality.

The only information shared should be that which the client has consented to, and which is relevant to the purpose of the information sharing. For example, imagine you are counselling a client in the aftermath of a relationship break-up. The client has a physical disability and consents to sharing information with the home care service in the process of referral. The disability and the difficulties it causes are relevant to the referral and can be shared with the service; the recent relationship break-up is not relevant and should not be shared.

Study the following example of a Consent to release confidential information form (pdf).

A counsellor and client

Counsellors are responsible for providing counselling services that are safe, meeting practice standards, and acting in the client’s best interests. This encompasses a range of legal and ethical considerations related to duty of care. Many of the legal and ethical responsibilities we have already discussed in this section of the module also relate to duty of care considerations.

In basic terms, duty of care means that counsellors have a responsibility to take reasonable steps to avoid clients coming to harm either through their actions or lack of actions. As mentioned in Section 1, there is no direct legislation outlining what constitutes “duty of care” in a counselling role. If a counsellor is accused of failing in their duty of care to a particular client (i.e., if they are sued for negligence) then the case will be decided in the courts based upon legal precedents, community expectations, and common professional practices. Counsellors can protect themselves by remaining up-to-date with relevant legislation, following standard practices, confirming their practices with more experienced colleagues and supervisors, and complying with the appropriate codes of ethics and practice. One specific area of counselling practice that counsellors must be particularly mindful of is maintaining appropriate professional boundaries.

Counsellor-Client Boundaries and Dual Relationships

An important component of client well-being involves the principle of ‘do no harm’. The counsellor-client relationship is unequal in nature and so has the potential for exploitation. Counsellors have an ethical responsibility to maintain appropriate professional boundaries and avoid any client exploitation. This is highlighted in the ACA Code of Ethics and Practice, 4.2 Responsibility to the Client:

Code of Practice

4.2 Responsibility to the Client

(a) Client Safety

i. Counsellors must take all reasonable steps to ensure that the client does not suffer physical, emotional or psychological harm during counselling sessions.

ii. Counsellors must not exploit their clients financially, sexually, emotionally, or in any other way. Suggesting or engaging in sexual activity with a client is unethical.

(ACA, 2019, p. 8)

Dual relationships are one potentially risky area for counsellors as they have the potential to result in harm to the client. A counsellor engages in a dual relationship with a client if, during counselling, before it or after it, their relationship has more than a therapeutic function (Timulak, 2011).

Effective, beneficial counseling and psychotherapy depend on the therapist’s ability to provide objectivity and single-minded commitment to the client’s welfare. It also depends on the client’s ability to trust the professional. Implicit in that trust is confidence in the professional’s selfless interest in the client and a sense of emotional closeness to the professional. When a practitioner has an additional personal or professional relationship with a client, objectivity, selfless commitment to the client and client trust are all endangered to some degree. In other words, when a practitioner is both friend and researcher or therapist and teacher, the professional is putting him or herself in a conflict of interest situation.

(Welfel, 2012, p. 243)

Read

Reading I further explores the topic of dual relationships within psychotherapy and counselling settings. You will also learn about a four-component model for assessing the appropriateness of relationships with previous clients.

Dual relationships (note that the ‘client’ can refer to both current and previous clients) include:

  • providing counselling to an employee or supervisee
  • employing a client, or going into business with current and former clients
  • providing counselling to students, or a student or allowing a client to enrol in a course taught by the counsellor
  • inviting clients to a party or accepting a client invitation to a party
  • selling goods/services to or buying goods/services from a client
  • accepting friends as clients or clients as friends
  • engaging in any form of sexual contact with a client.

Many types of dual relationships are explicitly prohibited under ethical standards. For example, the ACA Code of Ethics and Practice states:

Code of Ethics

xi. [Members will] not initiate, develop or pursue a relationship be it sexual or nonsexual with past or current clients, within 2 years of the last counselling session.

(ACA, 2019, p. 7)

Code of Practice

4.9 Boundaries

(a) With Clients

i. Counsellors are responsible for setting and monitoring boundaries throughout the counselling sessions and will make explicit to clients that counselling is a formal and contracted relationship and nothing else.

ii. The counselling relationship must not be concurrent with a supervisory, training or other form of relationship (sexual or non-sexual).

(b) With Former Clients

i. Counsellors remain accountable for relationships with former clients and must exercise caution over entering into friendships, business relationships, training, supervising and other relationships. Any changes in relationships must be discussed in counselling supervision. The decision about any change(s) in relationships with former clients should take into account whether the issues and power dynamics presented during the counselling relationship have been resolved. Section 4.9 (b) ii below is also of relevance here.

ii. Counsellors are prohibited from sexual activity with all current and former clients for a minimum of two years from cessation of counselling.

(ACA, 2019, p. 12)

There is also a range of other counsellor behaviours that have the potential to blur the professional boundaries of the client-counsellor relationship. These are often thought of as ethical dilemmas and counsellors are required to fully evaluate the potential impact of their actions before deciding how to proceed. Examples of these include accepting a client’s invitation to an event such as a graduation, accepting a gift from a client, or attending the same social, cultural, or religious events as a client. Counsellors are required to fully consider the potential repercussions of such behaviours and act appropriately because these ‘boundary crossings’ can lead to more serious boundary violations such as engaging in complex dual relationships (Corey, Corey, & Callinan, 2011). Counsellors should always be on the lookout for potential boundary violations.

Indicators of the potential for boundary violations may include the counsellor:

  • Developing strong feelings for the client.
  • Spending more time with this client than others.
  • Engaging with a client socially outside of the service.
  • Receiving calls at home from the client.
  • Receiving gifts.
  • Doing things for a client rather than enabling the client to do it for themselves.
  • Believing only they can offer the right services to the client.
  • Physically touching the client.

Whilst in isolation none of these behaviours may indicate a potential boundary violation is happening, they could be indicators of a potential problem.

(Community Door, n.d.a)

Once professional boundaries have been crossed, there is then a higher potential for a counsellor to become over-involved with the client and potentially violate the client’s rights. Therefore, if a counsellor finds themselves in a position in which they have not maintained appropriate boundaries, they have an ethical requirement to take appropriate actions. This usually involves consulting with their supervisor to determine the most appropriate course of action to reinstate professional boundaries or to make an appropriate referral for the client.

Another important aspect of promoting client safety and well-being involves complying with work health and safety requirements.

Check your understanding of the content so far!

Work Health and Safety

Work health and safety (WHS) is a vital consideration for any workplace, and all organisations should have comprehensive WHS policies and procedures. Counsellors are required to comply with all relevant laws, regulations, policies, and procedures.

Read

Reading J – WHS Code of Practice provides a valuable overview of WHS considerations published by Safe Work Australia.

Each state/territory has its own body administering work health and safety – these are the best sources of information on WHS requirements for your own jurisdiction:

WHS Legislation – State/Territory
Australian Capital Territory www.worksafe.act.gov.au
New South Wales www.safework.nsw.gov.au
Northern Territory www.worksafe.nt.gov.au
Queensland www.worksafe.qld.gov.au
South Australia www.safework.sa.gov.au
Tasmania www.worksafe.tas.gov.au
Victoria www.worksafe.vic.gov.au
Western Australia www.commerce.wa.gov.au/Worksafe

While there is a wide range of WHS requirements, they all relate to the need to provide a safe working environment for staff, clients, and anyone else who may be present. The need to provide a safe counselling environment is also established in the ACA’s Code of Ethics and Practice:

Code of Practice

4.12 The Counselling Environment

There are two environmental factors to be considered:

i. physical factors

ii. emotional factors

because of this,

(a) Ideally the counselling room should:

i. be well lit and ventilated, and preferably have window(s), have a temperature that is set at a comfortable level for both counsellor and client.

ii. have the exit easily accessible to the client should they choose to avail themselves of it.

iii. provide for confidentiality while allowing the client to feel safe.

iv. have within it a comfortable open space between the counsellor and the client, insofar as the work environment allows.

(b) In terms of ethics, a failure to provide such an environment could be seen as leading to a breach of:

4.2 (a) i “Counsellors must take all reasonable steps to ensure that the client does not suffer physical, emotional or psychological harm during counselling sessions” depending upon the effect of the counselling environment both physically and emotionally upon the client.

(ACA, 2019, pp. 14-15)

Counselling organisations typically develop specific WHS policies and procedures in order to ensure their own legislative compliance and counsellors are required to comply with these. Everyone in a workplace is responsible for minimising risks and engaging in safe work practices. While employers are responsible for developing policies and procedures that comply with relevant WHS legislation, workers and clients are responsible for following the policies and procedures related to work health and safety in their organisation.

Workers, including counsellors, must be familiar with all WHS policies and procedures and seek clarification from their supervisor if they are unclear about anything. Ultimately, all counsellors must comply with their requirements under these policies and procedures and that they engage in appropriate hazard identification and management processes. Hazards are things that have the potential to cause harm.

While hazards will vary from workplace to workplace, in the counselling context, some core counsellor WHS responsibilities include:

  • checking that walkways and access points are clear of hazards such as power cords, furniture, and other items
  • ensuring that the chairs in the counselling room are supportive and strong
  • making sure that the counselling room is well-lit and ventilated
  • maintaining familiarity with emergency procedures, including regularly practicing evacuation drills
  • complying with policies and procedures related to personal safety and risk management.

Counsellors may be required to complete WHS checklists or other processes to check for hazards, document identified hazards, and take appropriate steps to control them. In addition, counsellors may be required to engage in consultation processes and contribute to the development of effective WHS policies and procedures within the workplace.

Specific WHS-related policies and procedures relate to the presence of children in the workplace. Children might come into the workplace as clients, the children of clients, or even the children of employees. Risk assessment and management procedures should account for the possible presence of children in the workplace. Ultimately, the counselling environment should be scanned for potential hazards to children and these should be eliminated or appropriate controls put in place. An additional consideration relates to the supervision of children.

Children should not be left unsupervised. This can become problematic if a client presents for counselling with their children with the intention of leaving their children in the waiting room during the counselling session. In such cases, the counsellor should discuss the potential safety issues with the client and reschedule the appointment for a time when the client can obtain supervision for their children.

WHS considerations are important and counsellors have a legal and ethical requirement to comply with all relevant procedures and requirements to promote workplace safety. Failure to take appropriate actions can leave the counsellor and their organisation open to civil and even criminal charges. This is why appropriate WHS documentation is also important. Counsellors must follow their organisation’s policies and procedures and complete any required documentation in relation to WHS issues (e.g., workplace checklists and critical incident reports).

Critical incident reports are used to document any events or situations in which there is a risk of or actual serious harm, injury, or death to clients, workers, or others. Because of the serious nature of these situations, it is important for there to be specific policies and procedures in place for workers to follow. The following extract details one organisation’s policy and procedure for critical incidents.

Critical Incident Report
Policy

Critical incidents involving services, employees or clients will be reported in accordance with procedures to ensure they are efficiently and effectively managed.

This policy recognises the importance of the health, safety and well-being of clients, staff, volunteers and the public. A standard system of reporting critical incidents will enhance quality service provision and minimise the risk of harm to clients, staff, volunteers and the public.

Procedure

All critical incidents must be recorded on the organisation’s Critical Incident Report and include the following actions:

At the time of the incident:

  • Contact emergency services as soon as it is safe to do so. Ensure injured and/or traumatised employees, clients or members of the public are provided with an appropriate emergency response.
  • Inform the Manager or most relevant staff member, immediately. It is the Manager’s responsibility to inform the Chairperson of the Management Committee.
  • Where the critical incident involves suspected criminal activity, the matter must be reported to the Police Service, regardless of any issues of consent or confidentiality.
  • Inform government agencies, such as funding agencies and the Department of Industrial Relations, in accordance with legislative requirements. More detailed reporting may be required in some circumstances, e.g. where the incident involves a child or an adult with impaired capacity.

Immediately after the incident:

  • Assist those involved in the incident to contact family or support persons to advise them of the situation.
  • Provide people who have been exposed to the critical incident with emotional support and practical assistance.
  • Assist in providing transport if required.
  • If the critical incident is of a Police nature or a workplace health and safety issue, ensure the area or site is not disturbed.

Following the incident:

  • Have workers involved complete a Critical Incident Report.
  • Encourage employees or clients to seek further assistance if necessary.
  • Defuse any issues for employees involved in the critical incident.
  • Provide a professional post-trauma counselling service if required.
  • Return the worksite to normal operation as soon as practicable.
  • Follow up with employee’s status at a later date as required.

(Adapted from Community Door, n.d.a) 

In the event that a counsellor is involved in a critical incident, they will be required to follow their own organisation’s policies and procedures, but this will usually involve documenting the incident in a critical incident report. Let’s have a look at an example of what that might involve in the following case study.

Case Study
A cousenllor and client

Hannah works at a service that provides counselling support for women affected by domestic violence. One day she is conducting a session with a client when the client’s partner storms into the office and threatens her and the client with a knife. Hannah has been trained in de-escalation techniques and manages to convince the client’s partner to leave, but both she and the client are left badly shaken, and she remains concerned for her client’s safety.

Hannah knows that she needs to contact the police as per the organisation’s procedures. She also needs to arrange for a debriefing session with her supervisor, arrange for psychological support for her client, and complete a critical incident report.

Following is the Critical Incident Report (pdf) that Hannah completed.

Such reports are important because they document actions taken and are also used by management to review and improve organisational policies and procedures, to promote the continued safety of workers and clients.

Check your understanding of the content so far!

As you can see, compliance with the full range of legal and ethical requirements of counselling practice is a serious issue and one that counsellors must take seriously. In this section of the module you learned about a number of key counsellor responsibilities and the specific legal and ethical requirements underpinning these. It is important for counsellors to keep these legal and ethical requirements in mind in order to help develop effective counselling practice. In the next section we will consider meeting your legal and ethical responsibilities under particular, challenging circumstances.

Australian Counselling Association (2019). Code of ethics and practice of the association for counsellors in Australia. https://www.theaca.net.au/documents/ACA%20Code%20of%20Ethics%20and%20Practice%20Ver15.pdf

Community Door. (n.d.a) Professional boundaries. Retrieved from http://etraining.communitydoor.org.au/mod/page/view.php?id=56

Community Door. (n.d.a) Critical incident report. Retrieved from http://communitydoor.org.au/organisational-resources/administration/policies-procedures-and-templates/people-working-in-the

Corey, G., Corey, M., & Callanan, P. (2011). Issues and ethics in the helping professions. Belmont, CA: Cengage Learning.

Crane, J. (2013). Counselling agreement. http://www.counsellingbristol.co.uk/wp-content/uploads/2013/01/Counselling_Contract1.pdf

Kämpf, A., McSherry, B., Ogloff, J., & Rothschild, A. (2009). Confidentiality for mental health professionals: A guide to ethical and legal principles. Bowen Hills, QLD: Australian Academic Press.

Murphy, B. & Dillon, C. (2015). Interviewing in action in a multicultural world. Stamford, CT: Cengage Learning.

Nelson-Jones, R. (2014). Practical counselling and helping skills: Text and activities for the lifeskills counselling model. London, UK: Sage Publications.

Network of Community Activities. (2015). Non-judgement report writing: Child protection. http://networkofcommunityactivities.org.au/wp-content/uploads/2015/09/non_judgemental_report_writing.pdf

Timulak, L. (2011). Developing your counselling and psychotherapy skills and practice. London, UK: Sage.

Welfel, E. R. (2016). Ethics in counseling and psychotherapy: standards, research and emerging issues (6th ed.). Boston, MA: Cengage Learning.

Module Linking
Main Topic Image
A counsellor talking to a client
Is Study Guide?
Off
Is Assessment Consultation?
Off