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4 Ethical Loopholes strangle therapists

Posted Apr 26 2013 5:00am

4 Ethical Loopholes strangle therapists – Part 1  

Code of Ethics

Code of Ethics

Therapists who violate codes of ethics harm clients; they also may lose their licenses or ruin their carriers. Often these ethical breaches start with thinking that there might be sometimes when it is OK to make an exception to an ethical standard.

Not following ethical guidelines can harm clients. Making exceptions to ethical codes can be fatal flaws

Therapists are taught codes of ethics in school. We take exams that include questions on laws and ethics or may even need to take a separate law and ethics exam. Every few years most of us have to take a refresher course in law and ethics. Still people violate these guidelines. Why?

Somewhere down the line some professionals start looking for loopholes, exceptions to those ethical requirements. When they do this, put their head through that ethical loophole, too often they can get strangled and lose their licenses or lose the trust of their clients.  

Four ethical violations seem to create the most problems for clients and therapists. Most of these violations start with the professional think that while this rule is a good one there might be times when someone, not them of course, but another therapist, might do this and that would be OK. Once you have been able to picture a time when there might be an exception to this ethical rule it is likely that you will cross that boundary and try to put your head through that loophole.

Most therapists think immediately about the ethical standard that says no sex with clients. They know that if you think that might EVER be OK then you are at risk to do it. While this is huge for therapists, it may not be the ethical violation that harms the client the most.

Here are the Big 4 ethical violations in their order of harm to the client

1. Not keeping what clients say confidential

When I get away from other professionals, out in the community this comes up more than I thought it would. Look at the list of top posts on this blog. Month after month people search for information about what is and is not kept confidential. Unfortunately I also hear too many stories about how a therapist told that clients story somewhere, someone recognized them from the story and this has hurt them when a family member, friend or boss found out.

Knowing that the way counseling helps is because of the relationship and that strict confidentiality is fundamental to that confidentiality, how do so many professionals cross that line?

The first stretch through this loophole often happens innocently. Here is a HYPOTHICAL example. 

The therapist is somewhere and is asked about a particular mental health disorder. “Is there any treatment for Trichotillomania?”

“Sure there is” the therapist says. “I saw a client recently with Trichotillomania. She has suffered a trauma and began pulling out her hair uncontrollably, almost unconsciously. I treated her using treatment “X” and she got better.”

So far so good. But the therapist wants to sound great, impress this person and get more referrals. He or she is thinking maybe I should become the authority on treating trichotillomania in this town. So they go on to tell more.

This was a tough case you know. Her family is very influential in this town. Her father is a prominent politician in this town and he did not want this getting out in his district or it might affect his reelection campaign. That district on the “X” side of town is awful conservative.  

Is there a problem now? Sure there is. This is way too much information and has identified that client to anyone who thinks about this for over 5 seconds. 

One little story – what harm?

But the next time the story gets more elaborate and before long this clinician is talking about their clients all over. They even decide to warn their church group about that sexual offender that has moved in on the same block as the church. What harm can there be in helping people keep their child safe?

The harm comes first because they have violated that client’s trust and eventually someone will find out and then it turns major. The harm may also include attacks on that client. Sometimes that registered sex offender, the one that the counselor warned people about, what he did was when he was 18 he had sex with his 17-year-old girlfriend and her parents pressed charges. This couple since has gotten married but he could still turn up on a list of sexual offenders.

If this therapist has a private practice and people find out about this they may just stop going to see them. But if the clients are low-income and have to go to a government funded clinic they may not be allowed to change therapists. They may just stop coming and they will be counted, not as victims of the system but a treatment failures and drop outs. 

You would think a profession like counseling would police its self. Not usually. The complaint in this situation is most effective if it comes from the client. But then the client already afraid because of the harm done to them, that registered sex offender or Muslim may be getting death threats at this point, probably just wants to escape the system.

Other professionals may hesitate to report this. It is their word against the other professional. Whistle blowers can and do get punished. Also because this happened to a client there may be minimal ways that this can be reported by another counselor without violating this client’s confidentiality again. All these are ethical and practical concerns.

Oh my! I am past 900 words and have only talked about one of four ways ethical boundary violations hurt clients.

One caution here – Ethical guidelines are just that “Guidelines” not hard and fast rules. So any professional, at any point, is in danger and may have a problem with something. What I am talking about here are the big problems and the professionals who repeatedly break these ethical principles.

In the future I want to talk about the other ethical problems also. My plan is to talk about one of these problems each Friday for the next three weeks. This post was mainly aimed at counselors and would be counselors, but then I though others might be interested in the ethical dilemmas we confront.

Here are ethical issues number two, three and four.

2. Thinking that it is OK to party a little. If you just chip on the weekends how can that hurt clients?

3. Dual Relationships, hiring clients to work for you, getting them to loan you money or loaning them money, especially getting into investments together.

4. Falling in love and getting into sexual relationships with clients. We all want to believe in Snow White and Prince Charming but if a therapist falls in love with a client who came to him with a mental illness, this may turn out more like a sexual predator than a prince.

Let’s look at these three problems over the next three weeks.

Since we are over-words today I will skip the links to others stuff, you know where to find me. Check the categories to the right for more on other mental health and substance abuse issues.

David Joel Miller, LMFT, LPCC

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