Am I Acting Ethically and Effectively? Signs You Need Support
By Shannon Heers
Therapists in private practice often face difficult ethical situations, and may not know what the “correct” answer is. If you are independently licensed as a counselor or social worker and are no longer under the supervision of your clinical supervisor, it is usually up to you to make ethical decisions and provide ethically sound treatment to your clients.
But, that’s not as easy as it seems. Some ethical situations have clear, black-and-white answers. But more often, your dilemma may not have an obvious answer. Where do you turn in these cases? You want to know that you are acting ethically, and effectively, with your clients and in your practice. Here are several signs that you may need some support around ethical issues.
Know Your Code of Ethics
Different ethics codes exist for each specific license type. For counselors, the code of ethics is from the American Counseling Association (ACA), and for Psychologists, it is the American Psychological Association (APA). Social workers fall under the National Association of Social Workers (NASW) code of ethics, and Marriage and Family Counselors use the American Association of Marriage and Family Therapy (AAMFT).
Sure, back in grad school you probably reviewed your code of ethics. Reading case examples with challenging ethical situations was part of your required Ethics course. And when you became independently licensed you were probably required to take a jurisprudence test for your state that included different ethical scenarios.
But that might have been a long time ago – I know that my brain has absorbed a lot more information since the days I knew the code of ethics, so it always helps to take a few minutes to review this to stay up to date. Knowing your ethical guidelines is important for many reasons, including maintaining trust and professionalism with your clients and colleagues.
The Top Common Ethical Dilemmas
Ethical dilemmas pop up all over the place, and can occur at any time, in any setting. Private practice therapists in general tend to practice more in isolation than therapists that work within agency or treatment settings. So that means that if you are a private practice therapist, you need to be constantly on the lookout for ethical challenges.
Some of the more popular types of ethical dilemmas that arise in private practice are as follows:
- Failure to maintain client confidentiality
- Dual relationships and boundary violations
- Informed consent issues
There are innumerable ways that the above ethical standards can be violated, whether intentionally or unintentionally, so it helps to be on the lookout for this in your practice.
Client confidentiality is drummed into us as therapists as perhaps the #1 ethical issue to be aware of and adhere to. And yet, it is the most violated. How many times have you seen or heard other therapists discussing real cases without proper anonymization? I belong to several local and national social media therapist networking groups, and daily I see therapists asking for clinical consultation on a case without protecting PHI (protected health information) of the client.
Dual relationships also pop up often in our practice, and the opportunity for lax boundaries with clients. Some examples could be identifying potential conflicts of interest, and knowing when personal relationships may impact your professional judgment. As social people who crave connection with others, maintaining strong boundaries regarding dual relationships can be a challenge for therapists.
Informed consent, and the improper use of this, occurs in counseling far more often than you may think. Informed consent is providing your client with accurate information about their treatment while avoiding unethical forms of bias. An example of this may be a therapist practicing EMDR on a client without first providing the client accurate and thorough information about the treatment. Clients need to fully understand the therapeutic process in order to consent to treatment.
Signs of Ineffective Practice
While practicing ineffectively is not synonymous with ethical issues, it is often related. Therapists can practice ineffectively if they are not properly trained in the theoretical interventions they are using. And therapists can also be ineffective when they are ignoring signs of burnout and not practicing good self-care.
Inadequate professional development means that you may become stagnant, and even behind the times, with your clinical skills and knowledge. Imagine seeing a therapist that has been in the field for 30 years but has not done any new trainings or learned any new skills since then. So much has changed with our understanding of mental health treatment and how people change, and heal.
A lack of self-awareness around burnout signs is also dangerous and can lead to practicing non-ethically. It is so important to be able to recognize your own personal signs of burnout, or compassion fatigue. Because it’s not unusual to experience burnout, and burnout can be turned around if it is still in the early stages. However, if you get to the end stages of burnout, therapists simply stop caring. And that can definitely lead to making poor decisions and perhaps getting into sticky ethical situations.
Seeking Support and Supervision
Yes, even therapists need support. Regardless if you are a newbie in the field, have taken a break and are returning after several years, or have been practicing for 20 years, you can still benefit from clinical supervision. Acknowledging that you need support, both professionally and clinically, is the first step.
If you have found yourself in some sticky ethical situations where you think “I could really use some trusted consultation or supervision around this issue”, then listen to yourself, and seek out what you need. I find it very interesting, and sad, to note how few solo private practice therapists seek regular clinical consultation. Overcoming the stigma of seeking support is a sign of professionalism and self-awareness.
Ongoing and regular clinical consultation can be found in many different places. Of course, you want to make sure you’re consulting with someone that you know and trust, not a random therapist in another state that you met once on Facebook. Start with your own professional network of therapists and supervisors, and see who might be a good fit working with you. Seek out peer consultation groups, or online clinical consultation groups where you get to know the other members of your group more deeply.
Sharing your experiences with others in an authentic and honest way can actually help you work through ethical dilemmas. Getting different perspectives from colleagues that you know and trust is not only important, but it also supports your own professional development. Who knows what you might learn?
Counseling is a supportive field, and you might be surprised to find there are others just like you who are seeking connection and support. Remember to be aware of your code of ethics, know the top common ethical dilemmas, and seek support and supervision however you can find it. Therapy is a tough discipline, but you are a therapist for a reason.
If you are seeking clinical consultation as an independently licensed therapist, check out our Clinical Consultation Community for private practice therapists just like you. Connect, engage, and feel better about protecting yourself from ethical pitfalls!
Shannon Heers is a psychotherapist, approved clinical supervisor, guest blogger, and the owner of a group psychotherapy practice in the Denver area. Shannon helps adults in professional careers manage anxiety, depression, work-life balance, and grief and loss. Follow Firelight Supervision on Instagram and Facebook.