Ethical Considerations for Christian Mental Health Clinicians

TheNetworkofChristianCounselors13February2017

Copyright©2017.HarryMorgan,M.A.,M.Div.,Th.M.,Ph.D.AllRightsReservedPermissiongrantedtoreproducewithattribution&citationofwww.http://networkofchristiancounselors.com/

Part I. Fundamental Ethical Considerations for Christian Mental Health Clinicians

Part II. Online-line Ethical Considerations for Christian Mental Health Clinicians

Part III. Avoiding Common Security Breaches & HIPPA Violations

1. Increaseunderstandingofkeydefinitionsassociatedwithethicsincounseling.

2. Understandtheimportanceofprofessionalvaluesandethicsincounseling

3. GainknowledgeoftheCodeofEthicsforAACC4. Identifyappropriateboundariesincounseling

relationships5. Assistpractitionersinresolvingethicaldilemmas6. Appreciatethefoundationsofethicalthoughtand

behavior7. IncreaseawarenessofStateofFloridadisciplinary

actions3

Part I.

• Morality

DEFINITIONS:

• Law

• Ethics

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• Counseling

• ChristianCounseling

• σύµβουλος (sumboulos)=(σύµ) with+(βουλή)advice,direction

(kho-bal)derivedfromthenounsחבלaropeorחבל aropepuller,asailor,apilot(plur.fem.rule,government)

תחבלה

Theprovisionofassistanceandguidanceinresolvingpersonal,social,orpsychologicalproblemsanddifficulties,especiallybyaprofessional.

"Clinicalmentalhealthcounselingisadistinctprofessionwithnationalstandardsforeducation,trainingandclinicalpractice.Clinicalmentalhealthcounselorsarehighly-skilledprofessionalswhoprovideflexible,consumer-orientedtherapy.Theycombinetraditionalpsychotherapywithapractical,problem-solvingapproachthatcreatesadynamicandefficientpathforchangeandproblemresolution."

American Mental Health Counselors Association (AMHCA), http://www.amhca.org/about/facts.aspx

WARNING:NotallCounselingisthesame!

Proverbs14:12Thereisawaythatseemsrighttoaman,butitsendis thewayofdeath.(cf.also16:25)

Proverbs1:5Awisemanwillhearandincrease

learning,andamanofunderstandingwillattainwisecounsel

Hobart Mowrer(1907-1982)

“Forseveraldecadeswepsychologistslookeduponthewholematterofsinandmoralaccountabilityasagreatincubusandacclaimedourliberationfromitasepochmaking.Butatlengthwehavediscoveredthattobefreeinthissense,thatis,tohavetheexcuseofbeingsickratherthansinful,istocourtthedangerofalsobecominglost…Inbecomingamoral,ethicallyneutralandfree,wehavecuttheveryrootsofourbeing,lostourdeepestsenseofselfhoodandidentity,andwithneurotics,themselves,wefindourselvesasking:WhoamI,whatismydeepestdestiny,whatdoeslivingmean?”“Sin,theLesserofTwoEvils,”AmericanPsychologist,15(1960):301-30

“Thedeeperone’sthoughtpenetrateinthefieldofpsychotherapy,thecloseronecomestotherealmoftheology…Thefundamentalquestionswithwhichpsychotherapyendscanonlybeansweredwiththeology.”

(RolloMay,1967,page218)

Itisnottheexperienceoflife,buttheexperienceofthecrossthatmakesoneaworthyhearerofconfessions.ThemostexperiencedpsychologistorobserverofhumannatureknowsinfinitelylessofthehumanheartthesimplestChristianwholivesbeneaththecrossofJesus.Thegreatestpsychologicalinsight,ability,andexperiencecannotgraspthisBonhoeffer

onething:whatsinis.Worldlywisdomknowswhatdistressandweaknessandfailureare,butitdoesnotknowthegodlessnessofmen.Andsoitalsodoesnotknowthatmanisdestroyedonlybyhissinandcanbehealedonlybyforgiveness.OnlytheChristianknowsthis.Inthepresenceofapsychiatrist,Icanonlybeasickman;inthepresenceoftheChristianbrother,Icandaretobeasinner.

Ø Makingdecisionsofamoralnatureaboutpeopleandtheirinteractioninthesociety.(Kitchener,1986,p.306)

Ø Usedsynonymouslywithmorality.Ethicsandmoralityoverlap.Bothdealwith“whatisgoodandbadorthestudyofhumanconductandvalues.”(VanHoose&Kottler,1985,p.2)

Ø Yeteachhasadifferentmeaning.Ø Ethicsareaphilosophicaldisciplinethatisconcerned

withhumanconductandmoraldecisionmaking.(VanHoose&Kottler,1985,p.2)

Ø Ethicsare normativeinnature.Ø Ethicsfocusonprinciplesandstandardsthatgovern

relationshipsbetweenindividuals.

Ø Adescriptionofwhatis – thecustomsthatgovernagivengroupofpeople

Latin:moralis – manner,custom,moréØ Judgmentorevaluationofaction.Ø Associatedwithwordssuchasgood,bad,right,

wrong,oughtandshould. (Grant,1992)Ø Thetheoriescounselorsemployhaveembedded

withinthemmoralpresuppositionsabouthumannaturethatimplicitlyandexplicitlyquestionfirst-

“whatshouldapersonbeorbecome?”(Christopher,1996,p.18)

• Ethicsdeclareswhatought tobe– howagivengroupofpeopleshould behaveasmeasuredagainstsomehigherstandardofrightandwrong

R.C.Sproul

Rejectingabsolutes,ahigherstandard,(universals)hasresultedin“statisticalethics”– asystembasedonwhatisnormal.

Ø Theprecisecodificationofgoverningstandardsthatareestablishedtoensurelegalandmoraljustice.(Remley &Herlihy,2010)

Ø Lawiscreatedbylegislation,courtdecision,andtradition.

Ø Thelawdictateswhatislegalandnotwhatisethical.

Ø Sometimeswhatislegalisconsideredasimmoralbythesociety.

Forexample– 1857DredScottv.Sanford;1927Buckv.Bell

• Anunderstandingofwhatisrightandwrong?• Howcanweknowwhatisrightandwrong?

Hebrew:amen

Greek:alethia

Latin:veritas

1. An argument that presents two alternatives, each of which has risks and benefits.

2. A situation that requires a choice between options that are or seem equally unfavorable or mutually exclusive.

3. A problem that seems to defy a satisfactory solution.

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Ø Providesclinicianswithguidance.Ø Protectsthepublicfromincompetentclinicians.Ø Protectsprofessionalsfromlitigation.Ø Allowsforself-regulationratherthan

governmentcontrol.Ø Enablescolleaguestoliveinharmonywitheach

other.Ø Providesconsistencyinpracticeandvalues.

Levinson,op.cit.

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“Conflictswithmanaged-carecompanies,theurgencyofpatient’sneeds,thelackofadequatesupport,thepossibilityofformalcomplaints,mind-deafeningroutines,endlesspaperwork,worryingaboutmakingendsmeet,fatigue,andsomuchelsecanbegintoblockourpersonresponsivenessandalloursenseofpersonalresponsibility.Theycanoverwhelmus,drainus,distractus,andlawlessintoethicalsleep.Itiscrucialtopracticecontinuedalertnessandmindfulawarenessoftheethicalimplicationsofwhatwechoosetodoandnotdo.”

Levinson,op.cit.

A continuous, active process that involves constant questioning and personal responsibility.

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“Awarenessoftheevolvingresearchandtheoryinthescientificandprofessionalliteratureisanotherimportantaspectofethicalconfidence,buttheclaimsandconclusionsemergingintheliteraturecanneverbepassivelyacceptedorreflexivelyappliednomatterhowpopular,authoritative,orseeminglyobvious.Anecessaryresponsetopublishedclaimsandconclusionsisactive,careful,informed,persistent,andcomprehensivequestioning.”

Levinson,op.cit.

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“Webelievethattheoverwhelmingmajorityoftherapistsandcounselorsareconscientious,dedicated,caringindividuals,committedtoethicalbehavior.Butnoneofusisinfallible.Allofuscan– anddo– makemistakes,overlooksomethingimportant,workfromalimitedperspective,reachconclusionsthatarewrong,holdtighttoacherishedbeliefthatismisguided.Animportantpartofourworkisquestioningourselves,asking“whatifI’mwrongaboutthis?IstheresomethingI’moverlooking?Couldtherebeanotherwayofunderstandingthesituation?Arethereotherpossibilities?Couldtherebemorecreative,moreeffective,betterwayofresponding?”

Levinson,op.cit.24

Ø Non-Malfeasance1. Avoidharm2. Donoharm3. Publicperceptionofprofession4. Avoidconflictsofinterest5. Integrity6. Confidence

Ø SocialJustice1. Equaltreatment2. Nondiscrimination3. Respectfordiversity

Levinson,op.cit.25

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The American Mental Health Counselors Association

http://www.amhca.org/page/codeofethics

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http://www.counseling.org/knowledge-center/ethics

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http://www.socialworkers.org/pubs/code/default.asp

National Association of Social Workers

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http://www.nbcc.org/Certification/Ethics

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http://www.aamft.org/iMIS15/AAMFT/

TheCodeisprimarilyorganizedalong8foundationalpillarsthatformthebasisforethicalandChrist-centeredpractice.TheseCorePrinciplesinclude:

Ø CompassioninChristianCounseling–ACalltoServanthood

Ø CompetenceinChristianCounseling–ACalltoExcellence

Ø ConsentinChristianCounseling–ACalltoIntegrity

Ø ConfidentialityinChristianCounseling–ACalltoTrustworthiness

Ø CulturalRegardinChristianCounseling–ACalltoDignity

Ø CaseManagementinChristianCounseling–ACalltoSoundness

Ø CollegialityinChristianCounseling–ACalltoRelationship

Ø CommunityPresenceinChristianCounseling–ACalltoHumility

ThisCode—beyonddefiningtheboundariesofunethicalpractice—affirmativelyeducatescounselorsinthedirectionofbecominghelpersofethicalexcellence,capableofmoreconsistentlysecuringthebestcounselingoutcomes.4streamsofinfluenceareevident:1. TheBible(botholdandnewtestaments)andhistoric

orthodoxChristiantheology;2. Acceptedstandardsofcounselingandclinicalpractice

fromChristiancaregivingandtheestablishedmentalhealthdisciplines;

3. CodesofethicsfromotherChristianandmentalhealthprofessions;and

4. Currentanddevelopingstandardsderivedfrommentalhealthandministry-relatedlaw.

Strom-Gottfried(2000)reviewed894ethicscasesfiledwithNASW1986- 1997

1. Boundaries2. Poorpractice3. competence4. Recordkeeping5. Honesty6. Confidentiality7. Informedconsent8. Collegialactions9. Reimbursement10. Conflictsofinterest

RecentDisciplinaryActionsTakenby

FLORIDA BOARDOFCLINICALSOCIALWORK,MARRIAGE&FAMILY

THERAPY,ANDMENTALHEALTHCOUNSELING

Arthur H. Mencher, LMHC, Case No. 2009-16602 Mr. Mencher was not present and was represented by Patrick Dahl, Esq. A two count administrative complaint filed June 22, 2011 alleged violations of s. 491.009(1)(w), F.S., by violation of rule 64B4-9.009(2), F.A.C., and s. 491.009(1)(r), F.S., regarding records that do not reflect dates of sessions, treatment plan, financial transactions, lack of reporting patient to DCF due to addictions; respondent engaged in personal relationship with patient; failure to meet minimum standards. A settlement agreement was presented to the Board with the following terms: letter of concern, fine of $1,000.00 payable within 4 years of order; costs of $5,803.00 payable within 4 years; completion of the PBI Professional Boundaries Course within one year; probation for one year; appearance at first meeting after probation commences and last meeting preceding termination of probation. Practice under indirect supervision with probationary terms.

Ricardo W. McQueen, Registered MHC Intern Applicant

Mr. McQueen was not present and was not represented by counsel. Mr. McQueen holds a Master of Arts in Christian Counseling Psychology from Cornerstone Christian University. This university is not accredited by a regional accrediting body. Following discussion, the following action was taken by the Board: Motion: by Ms. Macomber to deny his application to become a registered MHC intern because he does not meet the statutory requirements.

Rhonda C. Grant, Registered CSW Intern, Case No. 2013-11022 Ms. Grant was not present and was not represented by counsel. An administrative complaint filed August 20, 2014 alleged violations of s. 491.009(1)(w) and s. 491.0045(3), F.S., regarding respondent not supervised by a Department approved supervisor since at least 2009. A settlement agreement was presented to the Board with the following terms: reprimand, fine of $500.00 payable within 6 months of the final order, costs not to exceed $4,289.64 to be paid within 180 days of the order. Actual costs in this case are $3,003.74.

Harry Stack Sullivan

“Psychotherapy is a unique profession in that it requires therapists to set aside their own needs in the service of addressing the patient’s needs. Because the needs of the psychotherapists often get in the way of the therapy, the mental health professions have established guidelines, often referred to as boundaries, that are designed to minimize the opportunity for therapists to use their patients for their own gratification” (p. 283).

InappropriateBehaviorsidentifiedintheStrom-Gottfried(2000)study:

• Useofphysicalcontactintreatment• Pursuitofsexualactivitywithclients,

eitherduringorimmediately (?)aftertreatment

• Socialrelationship• Businessrelationships• Bartering

• Autonomy – Theprincipleofhavingcontrol/freedomtomakedecisionsconcerningone’smedicalcare/treatments.

• Veracity – theprincipleoftellingthetruth.• Fidelity – theprincipleofpromisekeeping• InformedConsent– themoralandlegaldoctrinethatpatientsandresearchsubjectsareentitledtogivetheirpermissionforinvolvementintreatment

• Nonmaleficence – firsttodonoharm• Beneficence – considerationofthe“benefit”ofanytreatment

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• American Association of Marriage and Family Therapists. (2015). Code of Ethics . Alexandria, VA: Author.

• American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA: Author.

• American Psychological Association. (2010). American Psychological Association Ethical Principles of Psychologists and Code of Conduct . Washington, DC: Author.

• National Association of Social Workers. (2008). Code of Ethics . Washington, DC: Author.

• National Board for Certified Counselors. (2012). Code of Ethics . Greensboro, NC: Author.

• US Dept. of Health and Human Services. (2006). HIPAA Administrative Simplification . Washington, DC: Author.

• US Dept. of Health and Human Services. (2007). Basics of Risk Analysis and Risk Management. Retrieved Feb 6, 2014, from HHS.gov: http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/riskassessment.pdf

• US Dept. of Health and Human Services. (2013). HIPAA Omnibus Final Rule . Washington, DC: Author.

FloridaStatutesChapter491: 491,Clinical,Counseling,andPsychotherapyServicesChapter456: HealthProfessionsandOccupations:GeneralProvisionsChapter120: AdministrativeProcedureActChapter39: ProceedingsRelatedtoChildrenChapter90: EvidenceCodeChapter394: MentalHealthChapter397: SubstanceAbuseServicesChapter415: AdultProtectiveServices

FloridaAdministrativeCode(F.A.C.)Rules:Chapter64B4: BoardofClinicalSocialWork,Marriage&FamilyTherapy&MentalHealthCounseling

http://floridasmentalhealthprofessions.gov/

BakerActInformationMarchmanActInformationProfessionalResourceNetworkPublicRecordsLicenseLook-UpFLHealthSourceLicenseCertificationReportsandPublicationsPublicSchoolVolunteerPractitionerProgramNewestlegislationregardinghealthcareregulationNewestlegislationregardinghealthcarefraudandconvictionsDeclaratoryStatementsandPetitionsforVarianceorWaiversNewReportingRequirementsforSexuallyTransmittedDiseasesNewestlegislationregardinghealthcareregulationNewestlegislationregardinghealthcarefraudandconvictions

CentersforMedicareandMedicaidServicesPublicLaw104-91HHS.Gov- HealthInformationPrivacy

HHS.Gov- HIPAAStatuteandRuleInformation

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YoucancontactHarryat:

BiblicalCounselingCenter145059th StreetWestUnit101Bradenton,FL34209

941-729-6600

Sanctitas@aol.comwww.TRUTHtransforms.com