Section A

The Counseling Relationship

Introduction

Counselors facilitate client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy relationships. Trust is the cornerstone of the counseling relationship, and counselors have the responsibility to respect and safeguard the client’s right to privacy and confidentiality. Counselors actively approach the counseling relationship from a culturally sustaining perspective, in which counselors explore their own cultural identities and how these affect their values and beliefs about the counseling process. Additionally, counselors are encouraged to contribute to society by devoting a portion of their professional activities for little or no financial return (pro bono publico).

A.1. Client Welfare

A.1.a. Primary Responsibility

The primary responsibility of counselors is to respect the dignity and promote the welfare of clients. Counselors act to avoid harming their clients, and minimize or remedy unavoidable or unanticipated harm.

A.1.b. Records and Documentation for the Counseling Relationship and Counseling Plans

Counselors maintain and safeguard records and documentation in a sufficient and timely manner to facilitate the delivery and continuity of services. Counselors take reasonable steps to ensure that documentation accurately reflects client progress and services provided. If amendments are made to records and documentation, counselors take steps to properly note the amendments according to agency or institutional policies.

If counselors use technology platforms (e.g., artificial intelligence) for records and/or documentation, counselors must communicate this use to clients.

A.1.c. Counseling Plans

Counselors and clients collaboratively develop, review, and revise counseling plans to assess their continued viability and effectiveness, respecting clients’ freedom of choice.

A.1.d. Support Network Involvement

With clients’ consent, counselors explore the involvement of other support networks (e.g., religious/spiritual/community leaders, family members, friends) if they support client welfare.

A.2. Informed Consent in the Counseling Relationship

A.2.a. Informed Consent

Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both counselors and clients. Counselors respect clients’ freedom to choose whether to enter into or remain in a counseling relationship. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship. See A.9.a regarding open groups.

A.2.b. Types of Information Needed for Informed Consent

Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues including, but not limited to

• the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services;
• the counselor’s qualifications, credentials, relevant experience, and approach to counseling;
• continuation of services upon the incapacitation or death of the counselor;
• the role of technology;
• implications of diagnosis and uses of assessments and reports;
• fees and billing arrangements, including procedures for nonpayment of fees and bartering;
• right to confidentiality and limits of confidentiality, including receipt of a valid subpoena or court order;
• access to records;
• professional boundaries and limits of technology and social media;
• review of counseling plans and documentation;
• emergency/contingency plans; and
• refusal of services or modality changes, including consequences of refusal.

A.2.c. Culturally Sustaining Informed Consent

Counselors communicate information in ways that are intended to be both developmentally and culturally sustaining. When clients have difficulty understanding the language that counselors use, counselors seek to provide necessary services to ensure comprehension by clients.

A.2.d. Inability to Give Consent

When counseling minors, incapacitated adults, or other persons unable to give voluntary consent, counselors seek the assent of clients to services and include them in decision-making as appropriate. Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf.

A.2.e. Mandated Clients

Counselors discuss the required ethical and legal limits to confidentiality when working with clients who have been mandated for counseling services. Counselors also explain what type of information and with whom that information is shared prior to the beginning of counseling. If a client refuses services, counselors respect client autonomy and discuss the potential consequences of refusing counseling services with the client, including reporting noncompliance.

See Standard I.8. Mandated Clients.

A.2.f. Interdisciplinary Teams

When services provided to the client involve participation by an interdisciplinary or treatment team, the client will be informed of the team’s existence and composition, information being shared, and the purposes of sharing such information.

A.3. Personal Values

Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

A.4. Prohibited Sexual/Romantic Relationships

A.4.a. Sexual and/or Romantic Relationships Prohibited

Sexual and/or romantic counselor-client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. Counselors are prohibited from engaging in counseling relationships with persons with whom they have had a previous sexual and/or romantic relationship. This prohibition applies to both in-person and electronic interactions or relationships.

A.4.b. Sexual and/or Romantic Relationships With Former Clients

Counselors do not engage in sexual or romantic counselor-client interactions or relationships with former clients, their romantic partners, or their family members for a period of five years following the last professional contact. This prohibition applies to both in-person and electronic interactions or relationships. After the five-year period following last professional contact, counselors do not engage in these sexual or romantic interactions or relationships when they are potentially exploitive or likely to cause harm.

A.4.c. Counselors’ Friends and/or Family Members

Counselors are prohibited from engaging in counseling relationships with friends or family members with whom they have an inability to remain objective.

A.4.d. Personal Virtual Relationships With Current Clients

Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (e.g., through social and other media).

A.5. Managing Personal and Professional Relationships

A.5.a. Previous Relationships

Counselors consider the risks and benefits of accepting as clients those with whom they have had a previous relationship. These potential clients may include individuals with whom the counselor has had a casual, distant, or past relationship. When counselors accept these clients, they take appropriate professional precautions, including informed consent, consultation, supervision, and documentation, to ensure that judgment is not impaired and no exploitation or harm occurs.

A.5.b. Extending Counseling Boundaries

Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. In extending these boundaries, counselors take appropriate professional precautions, including informed consent, consultation, supervision, and documentation, to ensure that judgment is not impaired and no exploitation or harm occurs.

A.5.c. Documenting Boundary Extensions

If counselors extend boundaries as described in A.6.a. and A.6.b., they must officially document, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. When unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, the counselor must show evidence of an attempt to remedy such harm.

A.5.d. Clients Served by Others

When counselors learn that their clients are in a professional relationship with other mental health professionals, they request release from clients to inform the other professionals and strive to establish positive and collaborative professional relationships.

A.5.e. Role Changes in the Professional Relationship

Counselors avoid changing a role from the original or most recent contracted relationship. In exceptional circumstances, counselors can change a role, but should ensure that they avoid client harm. When counselors change a role from the original or most recent contracted relationship, they obtain informed consent from the client and explain the client’s right to refuse services related to the change. When roles are changed, they should be documented. Examples of role changes include, but are not limited to

• changing from individual to relationship or family counseling, or vice versa;
• changing from an evaluative role to a therapeutic role, or vice versa; and/or
• changing from a counselor to a mediator role, or vice versa.

Clients must be fully informed of any anticipated consequences (e.g., financial, legal, personal, therapeutic) of counselor role changes.

See Standard I.2.g. Mid-Process Role Changes.

A.5.f. Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships)

Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially exploitive or likely to cause harm to the client. This applies to both in-person and electronic interactions or relationships.

A.6. Counselors’ Role in Advocacy

A.6.a. Advocacy

When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients.

A.6.b. Confidentiality and Advocacy

Counselors obtain client consent prior to engaging in advocacy efforts on behalf of an identifiable client to improve the provision of services and to work toward removal of systemic barriers or obstacles that inhibit client access, growth, and development.

A.7. Multiple Clients

When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. Counselors obtain verbal and written acknowledgment. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately.

Should counselors use telehealth with two or more persons who have a relationship, counselors communicate clearly about the benefits and risks of conducting counseling with these modalities over telehealth. Counselors are responsible for establishing the protocol of the modality, such as family, couple, and relationship counseling on telehealth platforms.

See Standard H.7. Systems-Based Modalities.

A.8. Group Work

A.8.a. Screening

Counselors screen prospective group counseling/therapy participants. To the extent possible, counselors select members whose needs and goals are compatible with the goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience. Counselors identify the benefits and risks of participating in group counseling/therapy as opposed to other modalities.

A.8.b. Protecting Clients

In a group setting, counselors take reasonable precautions to protect clients from physical, emotional, or psychological trauma. Counselors safeguard the well-being of each group member while they are in the group.

A.8.c. Virtual Group Counseling Safeguards

Counselors establish safeguards for virtual group counseling formats, which can include, but are not limited to

• identity verification;
• benefits and risks of chat features;
• removal of filters, backgrounds, and distracting objects;
• minimization of background noise;
• requests for each group member to unmute; and/or
• verification of safe and secure location.

See Section H.7. Systems-Based Modalities.

A.9. Fees and Business Practices

A.9.a. Self-Referral

Counselors working in an organization (e.g., school, agency, institution) that provides counseling services do not refer clients to their private practice unless the policies of a particular organization make explicit provisions for self-referrals. In such instances, the clients must be informed of other options open to them should they seek private counseling services.

A.9.b. Unacceptable Business Practices

Counselors do not participate in fee splitting, nor do they give or receive commissions, rebates, or any other form of remuneration when referring clients for professional services.

A.9.c. Establishing Fees

In establishing fees for professional counseling services, counselors consider the financial status of clients and locality. If a counselor’s usual fees create undue hardship for the client, the counselor may adjust fees when legally permissible, or assist the client in locating comparable, affordable services.

A.9.d. Nonpayment of Fees

If counselors intend to use collection agencies or take legal measures to collect fees from clients who do not pay for services as agreed upon, they include such information in their informed consent documents and also inform clients in a timely fashion of intended actions and offer clients the opportunity to make payment.

A.9.e. Bartering

Counselors may barter only if the bartering does not result in exploitation or harm, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract.

A.9.f. Receiving Gifts

Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift.

A.10. Termination and Referral

A.10.a. Competence Within Termination and Referral

If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship.

A.10.b. Values Within Termination and Referral

Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the clients’ goals and seek training and supervision in areas in which they are at risk of imposing their values onto clients.

A.10.c. Appropriate Termination

Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client or by another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pre-termination counseling and recommend other service providers when necessary.

A.10.d. Appropriate Transfer of Services

When counselors transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed, and open communication is maintained with both clients and practitioners.

A.11. Abandonment and Client Neglect

Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.