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Article 39

Licensure Board Actions Against Professional Counselors

Implications for Counselor Training and Practice

C. Emmanuel Ahia and Peter J. Boccone

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The history of counselor licensure laws in the United States spans 35 years, starting with the state of Virginia in 1976 and ending with California in 2011. The passing of these laws led to the establishment of state boards to administer the licensing process, which typically require that candidates complete a graduate degree (master’s, EdS, EdD, or PhD) in counseling, pass a qualifying examination, and complete about 3,000 post-graduation supervised clinical hours. These requirements can vary slightly depending on the state. For example, Virginia counselors are required to pass the National Clinical Mental Health Counseling Examination and complete 3,400 hours of supervised counseling, with a minimum of 200 hours of supervision (Virginia Board of Counseling, 2017). The New Jersey State Board of Marriage and Family Examiners stipulates that counselor applicants pass the National Counselor Examination for Licensure and Examination and complete 4,500 hours of supervised counseling, with at least 50 supervision hours per year (New Jersey Division of Consumer Affairs, 2016). These boards also have oversight for required continuing education credits/hours that licensed counselors must maintain for license renewals and are authorized to take disciplinary actions against transgressing licensed counselors.

As the legal and ethical landscape becomes more complex, it becomes more important for new and senior counselors alike to be knowledgeable of the pitfalls that await them in the field. Those pitfalls are diverse, however, and may be more prevalent across states depending upon environmental circumstances, demographics, culture, or state-specific interpretations of various legal/ethical issues (e.g., scenarios that warrant breaking confidentiality to ensure safety). A more in-depth understanding of the most common legal and ethical issues associated with disciplinary actions taken against licensed counselors would better prepare counselors to navigate the field responsibly. Beyond its value for navigating the field, a better understanding of legal and ethical pitfalls in counseling would also improve a counselor’s ability to be a professional custodian. Despite their reluctance to do so (Lowman, 2006), counselors are responsible for policing their peers and reporting unethical behavior when it is observed. Being aware of the most common legal and ethical issues would improve each counselor’s ability to be vigilant in their overseeing of the profession.

Previous studies have been conducted that provide us with some insight into the issues that often prompt ethical complaints. Keith-Spiegel (2014) suggested that some common precipitating events include disclosing personal information, bartering, vengeful acts, and losing one’s temper. Neukrug, Milliken, and Walden (2001) completed a study similar the one conducted here in which they surveyed state boards about the ethical issues associated with complaints against counselors (see also Herlihy, Healy, Cook, & Hudson, 1987). At the time, only 45 states along with the District of Columbia had licensure boards. Of the 45, there were four states whose licensure boards were in their infancy and thus had no data to contribute. Of the 30 states that responded, Neukrug et al. found that the most common ethical issues associated with complaints against counselors were dual relationships (24%), incompetence (17%) professional misrepresentation (8%), sexual relationships with clients (7%), breach of confidentiality (5%), inappropriate fee assessments (4%), failure to obtain informed consent (1%), and failure to report abuse (1%).

As will be shown below, the results of the current study indicate that although many of the issues Neukrug et al. (2001) identified are still significant (e.g., dual relationships), there are a number of new categories of complaints that have been documented. It is difficult to say whether this is an indication that these newly observed issues were less prevalent in 2001 or were perhaps simply unreported. Our hope, however, is that by continuing the efforts to survey the landscape of ethical issues in the field, we will be able to better equip counselors and counselor educators to address the pitfalls that are most common today.

This study looked at the disciplinary actions taken by licensure boards against licensed professional counselors in 28 states. These states were used in the study because their disciplinary action data was provided online. Although we generically used the title licensed professional counselor (LPC) to embody all categories, it should be noted that the actual title of licensed counselors vary from state to state and include licensed professional counselor (LPC), licensed professional clinical counselor (LPCC), licensed clinical professional counselor (LCPC), licensed clinical pastoral counselor (LPCC), etc. We found no evidence in our study that the sanctions were in any way based on the difference in titles.

This study reveals, among other things, the differing criteria on which disciplinary actions were based. It also shows the different forms of discipline that the boards handed down during the period of this study. Based on the results of the study, we believe that one desirable objective of an ethics course in counseling programs should be an understanding of disciplinary actions taken by state licensure boards against practicing professionals. Should this information become appropriately integrated into a counseling ethics course, the following are likely to result:

• Counseling students and graduates will become equipped to avoid disciplinary pitfalls.

• The number of penalized counselors will decrease and lead to a reduction of overall negative public image of the profession.

• Counseling faculty will become knowledgeable and aware of the categories of disciplinary actions that many professionals may not have imagined.

• Faculty, students and graduates will develop the habit of being in tune with legal, ethical happenings in their state.

Methodology

The sample consisted of a total of 28 states across the United States. All disciplinary actions recorded between 2009 and 2013 were included. It should be noted that the authors initially attempted to survey all states; however, the data was not always accessible. This will be addressed below in terms of limitations to the study.

Records on disciplinary actions were obtained using online databases for each individual state. Once the data was collected, records were analyzed and categorized based on the type of violation (e.g., professional misrepresentation, failure to meet CE requirements) as well as the type of disciplinary action taken by the board (e.g., licensure revocation, suspension, fine). Descriptive statistics were then calculated as they related to the total number of each violation as well the number of states with that violation. The same was done for the type of disciplinary action taken.

It is important to point out that many individual incidents/cases brought before the boards were associated with multiple violations as well as multiple disciplinary actions. For example, in one incident a counselor may have been found guilty of providing counseling without the proper license as well as violating confidentiality. For that one incident, the counselor may have received both a fine as well as a reprimand. With that being said, data was collected and sorted based on violations and disciplinary actions, not incidents.

Results

Violations

The ethical violations that a counselor may commit exist on a spectrum in terms of severity as well as potential impact on the client. In this study, 30 categories of violations were identified. The types of violations were diverse and included everything from failure to properly maintain clinical records to being convicted of a non-counseling related crime/issue. From 2009 to 2013, across the 28 states surveyed, there were 999 violations that resulted in disciplinary actions against professional counselors. Appendix A describes the categories for each of the violations observed as well as the frequency with which they were observed.

Frequency. The most frequently observed violation was failure to meet continuing education (CE) requirements (n = 263, 31.53%). It is important to mention however that 95 of those incidents originated from Tennessee. If those incidents were omitted from the results, failure to meet CE credits would still have been the most common violation; however, they would have made up a smaller percentage of violations overall (18.59%). The second most common type of violation observed were those related to dual relationships (n = 145, 17.39%). Finally, unprofessional conduct was the third most common violation from 2009 to 2013 (n = 78, 9.35%).

Violations across states. Of the 30 types of violations, dual relationships occurred in the majority of the 28 states surveyed (n = 26, 92.86). The second most common was unprofessional conduct (n = 23, 82.14). Two violations were identified as the third most common: professional misrepresentation (n = 16, 57.14%) and being convicted of a non-counseling related crime (n = 16, 57.14%). Appendix B indicates whether or not each of the violations identified in Appendix A were reported in each of states surveyed.

Disciplinary Actions

The authors identified 29 categories of disciplinary actions (e.g., suspension, formal warning) taken from 2009 to 2013. As the result of the 999 violations recorded, there were 1,774 subsequent disciplinary actions. Appendix C lists each category of disciplinary action taken by the states surveyed as well as the frequency with which those actions were handed down. The most common of those actions was a fine (n = 450, 53.96%). The second most common was mandatory continuing education (n = 374, 44.84%) with reprimands coming in third (n = 235, 28.18%). Appendix D indicates whether or not each of the disciplinary actions identified in Appendix C were reported in each of states surveyed.

Curriculum Implications

Given the fact that state licensure boards are here to stay and have jurisdiction over the practice of counseling in each state, there are a number of curriculum changes that seem reasonable and that could lend themselves to better preparing counselors to navigate the field. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) governs many of the counseling programs the prepare students to enter the field. CACREP dictates, among other things, topics to be covered in classes (e.g., ethics) as well as specific elements of those topics that should be addressed (e.g., duty to warn). In response to current research, one suggestion could be for CACREP standards to be amended to stipulate that ethics courses expressly include awareness of state disciplinary actions. This can be accomplished by including a reading assignment on the state board action. This assignment can further invite students to react and integrate the specific action to the American Counseling Association Code of Ethics (2014), the National Board for Certified Counselors Code of Ethics (2016), and/or the American School Counselor Association (2016) Ethical Standards for School Counselors. Students could also be asked to reflect on what pitfalls, as indicated by their state-based research, they are most likely to encounter based on their professional specializations, interests, and aspirations. These reflections could also compel students to draft a plan for how to resolve any of the identified ethical dilemmas based on previously covered ethical decision making models. Ethics courses could also show evidence that this content (state board disciplinary actions) is covered in the course. This can be accomplished by including state board newsletters or bulletins on the required reading list. These are easily available through each state board’s Web site.

Another suggestion is that students should be required to take the ethics course before they take field/experiential courses. Although something can be said for learning through experience, sending ethically-informed students into the field seems the best mechanism for avoiding student missteps and ensuring client safety. Engaging in internships before taking the ethics course can also provide a fertile ground for difficult cross-examinations during a litigation involving a student’s negligence or that of the student’s supervisor. Compelling students to complete their ethics-based courses prior to internship will ensure that they are entering the field with as much ethics-based, state-specific knowledge as possible.

One final suggestion could be for ethics professors to take deliberate steps to address often overlooked, non-ethical/legal actions. As evidenced by the data collected here, violations on the periphery of ethics, such as failing to meet continuing education requirements or being convicted of a non-counseling related crime, still represent a significant pitfall for counselors. As such, board actions not based on ethical, legal, or professional violations, such as non-payment of student loans etc., should still be discussed and students discouraged from their violation since publicity of any violation by a licensed counselor can affect the public image of our profession.

Limitations

There were a number of limitations to this study that had an impact on the results rendered. The bulk of these limitations were related to the accessibility or organization of the data on the part of the state-specific licensure boards. In some cases, the licensure board representative reported that their records were not organized by profession, thereby making it difficult to release counseling-specific information. In other cases, board representatives were reluctant to release any information beyond the number of disciplinary actions for a given year. As was addressed above, the information gathered here could be invaluable when crafting legal and ethical curriculum. Improved accessibility to such records could contribute to a richer collection of data and ultimately incentivize counselor educators to seek out this information.

Accessibility could be improved in a number of ways. Perhaps the most significant improvement that could be made is increasing the number of states whose licensure boards use online databases to make information available to the public. For example, states such as Arkansas, Massachusetts, Montana, and West Virginia, provided a means to look up individual counselors; however, they did not provide any extensive record of disciplinary actions over time. It is interesting to note that the licensure boards from those same states also failed to respond to the survey conducted by Neukrug et al. (2001).

The process of analyzing such data could also be improved if states began to use a similar level of depth when describing incidents. While some boards provided actual documentation to describe the specific events that led to the violation in question, others only identified the general nature of the violation (e.g., dual relationship). This is particularly significant given the range of severity among violations. For example, one dual relationship-related violation included in this analysis was particularly egregious. In this case, a counselor in Idaho sent a message on Facebook and offered services, free of charge, to women who described themselves as having a sexual addiction or were victims of sexual assault. Approximately 20 women responded and engaged the counselor in online services that became sexually explicit and inappropriate. In Texas, however, there were a number of violations reported that were simply described as “dual relationships.” It is clearly difficult to compare the two, presumably related violations due to the differing levels of detail provided and having access to more in depth information about violations would ultimately render richer results.

Conclusion

The legal and ethical landscape is constantly evolving. As such, the pitfalls of the field are always shifting with the times. For a counselor to successfully navigate the field, it is essential that they be informed as to the most pertinent legal and ethical issues. An ongoing analysis of common legal and ethical issues associated with disciplinary actions against licensed counselors can provide the concrete data necessary to prepare counselors-in-training to enter the field with a deeper understanding of the issues they are likely to face.

Appendix A

Category and Frequency of Violations

Appendix B

Violations by State

Note. “Y” = yes. “N” = no. Violation abbreviations correspond to the descriptions in Appendix A.

Appendix B (continued)

Violations by State

Appendix C

Frequency of Disciplinary Actions

Appendix D

Disciplinary Actions by State

Note. “Y” = yes. “N” = no. Violation abbreviations correspond to the descriptions in Appendix C.

Appendix D (continued)

Disciplinary Actions by State