Ethics and Risk Management 2 - s3.amazonaws.com · education, an array of broad-based conferences and live training events, radio programs, regulatory and advocacy efforts on behalf

Ethicsand

RiskManagement2.0

P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net

EthicsandRiskManagement2.0

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WelcometoLightUniversityandthe“EthicsandRiskManagement2.0”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity


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TheAmericanAssociationofChristianCounselors

• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.

• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.

• With the needed vision and practical support necessary, the AACC helped launch the

International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.

OurMission

The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.


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OurVision

TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

OurCoreValues

InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:

VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.


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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).

• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover over 40 relevant core areas in Christian—

counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

OurMissionStatement

TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian


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Video-basedCurriculum

• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

• Learning is self-directed and pacing is determined according to the individual time

parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official

Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.

Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

Credentialing

• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.

Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.

Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.


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OnlineTesting

TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.

• TOLOGINTOYOURACCOUNT

Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.

• MYDASHBOARDPAGE

Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill include studentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.

• QUIZZES

Ø Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE

Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.


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Presentersfor:

Ethicsand

RiskManagement2.0


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PresenterBiographies

LoisDodds,Ph.D., isa licensedcounselorwithyearsofexperience inmulticulturalandcross-culturalsettingswithinternational,humanitarianworkers.Becauseofthisextensiveexperiencein nearly fifty countries, she has a keen sense of what “works” in Christian contexts. HerapproachincounselingisinformedbyherdecadesofservingtheBodyofChristworldwide.Shehasalsowrittenandtaughtwidely,withfifteenpublishedbooks,overonehundredarticles,anddozensofpresentationsatWorldCongresses,conferencesandretreats.Further,shehasalsobeenanadjunctprofessor forAzusaPacificUniversity for20years in theoverseasextensionprogramcalledOperationImpactthatgivesaMaster’sDegree inLeadershipandisoffered in20 countrieseachyear. She is co-founder,president, anddirectorofHeartstreamResources,which serves missionaries and other humanitarian workers. Her recently published series,GlobalServants:InternationalHumanitarianHeroes,providestheoryandpracticalapproachestoethicalandotherissues.JohnSandy, J.D.,Esq., is a licensedattorney inCaliforniaand Illinois.Hemaintainsaprivatelegalpractice inRiverside,California,whereheconcentrates in church law,business lawandlegal issues relevant to professional, pastoral and church-based counseling. John is also anordained minister, Board Certified Christian Counselor (BCBC), and Board Certified PastoralCounselor(BCPC).AsaministrypartneroftheCalifornia-basedInlandEmpireSouthernBaptistAssociation,Johnprovidespastoralcounselingtoindividuals,couplesandfamilies,andspiritualcaretoministryleadersandtheirfamilies,aswellasworkshopsandconsultingforchurchesonpastoralcounselingandministryadministrativeissues.DerrickStevenson,Ph.D.,iscurrentlythedirectorofTherapeuticServicesforWillis-Knighton’sInstitute for Behavioral Medicine and provides the leadership for Louisiana’s only RAPHAprogram. Prior to that, he was the coordinator of Willis-Knighton’s Hospice Program. Dr.StevensonholdsaMaster’sDegreefromNewOrleansBaptistSeminary,aswellasaMaster’sinSocial Work from Southern University of New Orleans, and a Doctorate in Counseling fromLouisianaBaptistUniversity.Dr.Stevenson is licensed inbothLouisianaandTexasasaSocialWorkPractitionerandiscertifiedbytheAmericanAssociationofChristianCounselors.Hehasservedon theGovernor’sAdvisoryCommitteeonHospiceCare andprovidedmany inservicetrainingsandlecturesongriefandloss.Currently,Dr.Stevensonoperatesasuccessfulprivatepractice in Shreveport and was the Host of the KWKH 1130AM daily radio show “The NextStep.”


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EthicsandRiskManagement2.0TableofContents:

ERM101:LegalandEthicalRiskManagement.......................................................................11JohnSandy,J.D.

ERM102:DualandMultipleRelationshipsforCounselors.....................................................37LoisDodds,Ph.D.ERM103:SuicideRiskAssessment.........................................................................................51DerrickStevenson,Ph.D.


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ERM101:

LegalandEthicalRiskManagement

JohnSandy,J.D.


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Abstract

Tomeet the growing needs of hurting people in the congregation, an increasing number of

churchesarecreatinglaycounselingministries.Additionally,localchurchesarealsoorganizing

anumberofspiritualcareministriesandinformalcareprograms.Bydevelopinglaycounseling

and spiritual care ministries, churches act in accordance with Scripture. Lawsuits against

churcheshave increasedover thepastdecade.Church leadersneedtobeawareof the legal

risks associated with spiritual care ministries, and they need to take preventative steps to

protectthechurchanditsworkersfromunnecessarylegalliability.Thissessionoverviewsthe

implementation of policies and procedures that reduce the risk for liability among lay

counselingministries.

LearningObjectives

1. Participants will learn important legal and liability issues relevant to church lay

counselingandspiritualcareministries.

2. Participantswillbeabletodevelopachurchlaycounselingand/orspiritualcareministry

policytoreducerisks.

3. Participantswill become familiarwith insurance riskmanagementoptions for church-

basedcounselingandspiritualcareministries.


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I. Introduction

A. TheHurtingChurch

1. In today’s society, church leaders recognize that the local churchmust serve as a

safeplaceforspiritualcareandbiblicalguidanceforlife’sproblemsanddecisions.

2. Spiritual care of the church flock should not merely be the responsibility of the

pastorsofyourchurch.

3. To meet the growing needs of hurting people in the congregation, an increasing

numberofchurchesarecreatinglaycounselingministries.

• Laycounselingministriesinvolvelayhelperscomingalongsidehurtingpeople.

• Theyprovidehopeandcareforlife’sproblemsbasedonbiblicalprinciples.

4. Inadditiontolaycounselingministries,localchurchesarealsoorganizinganumber

ofspiritualcareministriesandinformalcareprograms.

• Topicalsupportgroupministriesexistforgrief,divorce,parentingteensorthose

dealingwithpastsexualabuse.

• Recoveryprogramsprovideteachingsandtestimoniesofpeoplewhohavegone

throughstrugglesrelatedtovariousaddictionsandobtainedvictory.

• Marriagementoringprogramsenable trained couples to comealongsideother

couples.

5. By developing lay counseling and spiritual care ministries, churches act in

accordancewithScripture.

“Bearoneanother’sburdens,andtherebyfulfillthelawofChrist.”—Galatians6:2

“Andletusconsiderhowtostimulateoneanothertoloveandgooddeeds.”

—Hebrews10:24


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6. Spiritualcareministriescanbuildfellowshipandaccountabilityinchurches.

• They can serve as an effective and valuable outreach care ministry to the

community.

• They can greatly help the pastors by serving as an additional resource for

counselingandcongregationalcareneeds.

7. Organizingachurchspiritualcareministrycallsforprayer,planningandleadership

tocarryoutdesiredgoals.

• Thisisnotjustalegallydrivenguideline.Itisbiblical.

“Theprudentseestheevilandhideshimself,butthenaivegoon,andarepunished

forit.”—Proverbs22:3

“Without consultation, plans are frustrated, but with many counselors they

succeed.”—Proverbs15:22

B. ChurchLegality

1. Church leaders need to be aware of the legal risks associated with spiritual care

ministries, and theyneed to takepreventative steps toprotect the churchand its

workersfromunnecessarylegalliability.

2. Lawsuitsagainstchurcheshaveincreasedoverthepastdecade.

3. According to Peacemaker Ministries, born again Christians in the United States

annuallyfile4-8millionlawsuits,oftenagainstotherChristiansandcosting$20-40

billion.


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4. Brotherhood Mutual Insurance Company receives notice of an average of 80-90

sexualactsclaimsperyear.

• Brotherhood is a church insurance company of about 30,000 policyholders of

churchesinrelatedministries.

• On average, between 1-5 potential claim reports turn into actual counseling

claimseachyear.

• Whilecounselingclaimsarerelativelyrare,whentheydooccur,thepayoutcan

begreat.Thatisparticularlythecaseforsexualmisconduct.

5. By implementing risk management programs, a church can avoid unnecessary

litigation and its emotionally and financially destructive effects on the church and

thepeopleinvolved.

6. Churchleadersshouldaskthemselvesthefollowingquestions:

• Is the church aware of its legal and ethical risks regarding lay counseling and

otherspiritualcareministries?

• Is the church leadership involved in developing policies and procedures to

legally,ethicallyandbiblicallyaddresstheserisks?

• Arespiritualcareandcounselingpoliciesandproceduresregularly reviewedto

ensurethattheycomplywiththelaw?

• Are pastoral staff members and lay counselors trained to understand these

policiesandprocedures?

II. LegalandEthicalLiabilityIssues

A. SexualMisconduct

1. Sexual misconduct claims result in the costliest verdicts and settlements for

churchestoday.


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2. Sexual misconduct in churches also causes significant emotional damage for the

victims,theirfamilies,congregationandstaffmembersofthechurch.

3. InanarticleinAACC’sChristianCounselingConnection,RalphEarldiscusseswhathe

seesasthetrendinanumberofministerswhofallintosinandboundaryviolations.

• He referencesa surveyby theFuller InstituteofChurchGrowth reporting that

37%ofclergysurveyedhavebeeninvolvedininappropriatesexualbehaviorwith

someonetheyworkwith.

4. According toa2009studyreleasebyBaylorUniversity,one inevery33women in

thecongregationor3%whoattendworshipserviceshavebeenthetargetofsexual

advancesbyareligiousleader.

5. Ministerswhoengage in sexualmisconductwith adults orminors potentially face

criminalandcivilliability.

• A minority of states has criminal laws relating to unlawful sexual contact

betweenaministerandacounselee.

• Civil liability for clergy who engage in sexual relations with adults or minors

resultsfromplaintiffswhosuefromtheoriessuchasclergymalpractice,breach

offiduciaryduty,intentionalinflictionofemotionaldistress,assaultandbattery

andsexualharassmentbetweencoworkers.

B. Negligence:Selection,RetentionandSupervisionofEmployeesandVolunteers

1. Thisriskisextremelyhighforlaycounselingministriesinthelocalchurch.

2. Negligenceisgenerallydefinedasthefailuretoexercisereasonablecare.


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3. Churchescannotguaranteesafety,butgenerallytheyareresponsiblefortheirown

negligenceiftheyassumeadutyofcarewithrespecttolaycounselingministries.

4. Examplenotes:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

C. Confidentiality

1. Ifapersonbeingcounseleddisclosesprivate,confidentialinformationtoapastoror

lay counselor in a non-public setting, the counselor must not divulge the

information.

“Ineverything,therefore,treatpeoplethesamewayyouwantthemtotreatyou,for

thisistheLawandtheProphets.”—Matthew7:12

2. Generally, courts will determine if there is a duty to keep communication

confidentialbyconsideringwhetherthepersoncommunicatingtheinformationhad

a reasonable expectation to believe that the information would be held in

confidence.

3. Breach of confidentiality can lead to liability for legal action such as slander,

defamationofcharacter, invasionofprivacyand intentional inflictionofemotional

distress.


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4. Therearesomeexceptionstokeepinginformationconfidential.Forexample,when

itislegallyrequiredtobedisclosed:

• Stateabusereportinglawrequirements

• Subpoena

5. Thecounseleemayalsospecificallyauthorizesharingconfidentialinformation.

D. AbuseReporting

1. TheUnitedStatesDepartmentofHealthandHumanServicesreportedthatin2009,

there were referrals to child protective services agencies across the nation of

approximately6millionchildren.

2. AWANAClubs International Inc. reporteda fewyearsago thatmore than30%of

girlsand10-20%ofboyswouldbeabusedbytheageof18.

3. Itisabsolutelycriticalthatyourchurchleaders,staffandlaycounselorsunderstand

the legal requirements forabusereporting inyourstateandcomplywiththe law

immediatelywhenevertheyidentifysuchasituation.

4. Ignoring an allegation of abuse and improperly responding to your state’s child

abuse reporting laws may subject your church and its leaders to civil and/or

criminalliabilityrisks.

5. Ingeneral,thestatechildabusereportinglawsdothefollowing:

• Definethetypeofchildabusethatisreportable.

• Describe what types of individuals are mandatory reporters and permissive

reporters.


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• Describereportingproceduresincludingstricttimetablesforreportingandwhat

agenciessuspectedchildabuseshouldbereportedto.

• Provideinformationaboutimmunityfromprosecutionforreportingabuse.

• Describethepenaltiesfornotreportingandfalsereporting.

6. Whatisreportablechildabuse?

• Inmoststates,childabuseisdefinedasincludingthefollowingtypesofactivity

thatimpactapersonundertheageof18:

Ø Physicalabuse

Ø Sexualabuse

Ø Emotionalabuse

Ø Neglect

• Thelawsgenerallyrequirereportingofactualandreasonablysuspectedcasesof

childabuse.

7. All states define the categories of personswhomust report abuse to designated

civilauthorities.

• Inafewstates,anypersonisrequiredtoreportabuse.

• Manystatesdefinegroupsofoccupationsthataremandatoryreporterssuchas:

doctors,dentists,schoolpersonnel,licensedpsychologistsandlawenforcement

officers.

• Manystatesrequiremembersoftheclergytobemandatoryreporters.

8. Evenifastate’slawrequiresclergytoreportchildabuse,pastorsneedtobeaware

that a number of states have exempted licensed, commissioned or ordained

ministers fromadutytoreportchildabuse if theabuse isdisclosed inasituation

thatwouldbeprotectedbythestate’sclergy-penitentprivilege.

• Since thisprivilege isa ruleofevidenceor civilprocedureapplicable toa trial,

the language of your state law must be reviewed carefully by your church’s


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attorney to determine the reasonableness of using this privilege as a defense

fromreportingchildabuse.

9. The state child abuse reporting statues generally encourage, but do not require,

personswhoarenotmandatoryreportersfromreportingreasonablesuspectedor

knownchildabuse.

10. Reportingprocedures:

• Generally, child abuse reporting statutes designate that amandatory reporter

filesanoralreportimmediatelytoaspecificstateagency.Thiscanbebetween

12-72hours.

• Statetoll-freenumberstocontactarecommon.

• Moststatesrequireafollow-upreportinwriting.

11. Generally, the laws in various United States’ jurisdictions allow for immunity for

legalliabilityfrommakinggoodfaithreportsofsuspectedchildabuse.

12. Criminalprosecution for failure to report childabuse isnotcommon,but itdoes

happen.

• Penaltiesforfailuretoreportchildabusevarybystate,buttheytypicallycallfor

shortprisontermsandfines.

13. Civillawsinafewstatesenablevictimsofchildabusetosuemandatoryreporters

formoneydamagesiftheyfailedtoproperlyreportchildabuse.

14. Anothercommonstatereportingabuseissueiselderabuse.

• Laws in many United States’ jurisdictions have developed over the past few

decades through the reporting of abuse to elders or adults with diminished

physicalormentalcapabilities.


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• Reportable abuse under these laws can include: physical, emotional or sexual

abuse, neglect, intimidation, physical restraint, abandonment and financial

manipulation.

15. Theelderabusereportinglawsaresimilartothechildabusereportinglawsinthat

they call for reporting to government agencies by mandated reporters within

certaintimeframes.

16. The lawsgenerally set forthcivilandcriminalpenalties for failure tocomplywith

thelaw.

E. StateLicensingLawsforMentalHealthPractitioners

1. Theselawsvarybystate.

2. Generally,pastorsemployedinachurcharefreetoprovidepastoralcounselingto

churchmembersandareexemptfromlicensing.

3. States differ, though, when there are exemptions for laypersons who do provide

counselingonbehalfofthechurch.

4. Statementalhealthlicensinglawswillnecessarilyimpactthechurch’slaycounseling

policyinanumberofways:

• Manystatesmerelyprohibitanon-licensedpersonfromrepresentingthatheor

she is licensed. Some states prohibit non-licensed persons from using certain

titlesordescriptionsofservice.

• Somestatesprovideexemptionsfromlicensureforemployeesorvolunteersfor

anonprofitorganizationsuchasyourchurch.


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• Churchestypicallydonotchargefeesforpastoralcounseling,butbeawarethat

theremaybealegalimpactifachurchdoeschargesometypeofremuneration

forservices.

• Be aware that state laws regarding advertising to the publicmay impact your

counseling ministry. Some states require licensure of individual counselors in

ordertoadvertisecounselingtothepublicatlarge.

• Moreandmorestatesaresettingforthguidelinesfore-counseling,andthelaw

variesbystate.

• Pastoral and lay counselors could be held to liability standards of secular

counselors if their counseling goes beyond spiritual counseling under some

state’slaws.

F. EthicalIssues

1. A lay counselor is likely to be confronted with counselee issues of depression,

suicideanddrugandalcoholabuse.

2. Counseling services must never be offered beyond the skill and training of the

counselor.

3. Recognizing which counseling situations aremost likely to expose a pastor or lay

counselortoariskofalawsuitifnotproperlyreferredisimportanttoknow.

4. Achurch’s lay counselingministrypolicy should set forthguidelines inadvance to

assurethatcounseleesareproperlyreferred.

5. Lay counselors and pastoral counselors must be discouraged from ever advising

counseleestoavoidmedicationsprescribedbytheirphysicians.


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• In general, church counselors and ministers should not interfere with a

counselee’s medical treatment or discourage a counselee from seeing a

physician.

III. DevelopingaLayCounselingMinistryPolicy

A. PracticalApplication

1. Howdoesachurchcreateasafeministryenvironment?

2. Managinglegalriskisapartofministrytoday.

3. Taking proactive preventative riskmanagement steps tomanage legal risks helps

churchleadersbegoodstewardsoftheresourcesentrustedtothem.

B. First

1. Developministrygoals.

2. Churchleadersshoulddeterminewhomtheministrywouldserve.

• Willchurchcounselingbeavailabletochurchmembersandattendeesonly?

• Willitbeopentothecommunityatlarge?

• Willthechurchallowlaycounselorstoworkwithminors?

• Willdonationsbeaccepted?

3. Church leaders should also determinewhat issues the lay counselingministrywill

address and what issues will be beyond the competence and scope of ministry

workersbothethicallyandlegally.


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C. Second

1. Getthesupportofchurchleadership.

2. Itiscrucialtohavethefullunderstandingandsupportofchurchleadership.

3. Includechurchleadersinyourplanningprocess.Ensurethatthegoverningbodyof

your church not only understands the rationale for your ministry, but also fully

approvesoftheproposedguidelinesandpolicyofyourministry.

4. It is important to confirm that the policies and procedure you develop do not

conflictwiththechurch’sbylawsorothergoverningdocuments.

D. Third

1. Consultwithanattorney.

2. Theattorneyyourchurch selects shouldbe familiarwithvarious federalandstate

lawsthathaveanimpactonchurchesandspiritualcareministries.

3. Veryfewattorneysconcentrateonchurchlaworcounselinglawsoyoumaywantto

seekattorneyrecommendationsfromotherchurchesortrustedsources.

E. Fourth

1. Developalaycounselingpolicyandappropriateforms.

2. Theprimaryformsinclude:

• InformedConsentorLayCounselingAgreement

• Intakeforcounselees


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• Laycounselorapplicationform

3. Achurch’spoliciesandproceduresforlaycounselingandanyspiritualcareministry

shouldincludethefollowingessentialelements:

• Ascreeningprogramthatincludesallemployeesandvolunteersinvolvedinthe

ministry’sadministrationandcounselingactivities

• Administration guidelines that include confidentiality, abuse reporting, record

keepingandotheractivities

• Trainingforandsupervisionofthelaycounselors

• Acommunicationplanthatinformsleadersandmembersabouttheprogram

IV. EssentialElements

A. Screening

1. The success of your spiritual careministry depends greatly on the character and

qualityofyourlaycounselors.

2. Developing screening guidelines that can be consistently appliedwill benefit your

ministryinseveralways:

• Itallowschurch leaderstomakesurethattheapplicantsarespirituallymature

believerswhoareappropriateforlaycounselingministry.

• Itheightenstheprotectionfromincidencesofsexualabuse.

• Itdemonstrates to thoseseekingcounsel,and toacourt ifnecessary, that the

churchhasnotbeennegligentinscreeningpotentiallaycounselors.

3. Consider a potential lay counselor’s spiritual and emotional maturity and

appropriatespiritualgiftingsuchasmercy,exhortation,wisdomandteaching.

• ReviewtheprinciplesfoundinRomans12,Ephesians4and1Corinthians12.


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4. Evaluate the demographics of your congregation when choosing a team of lay

counselors.

• Considerthetypicalissuesthattheteamoflaycounselorswilllikelybeexpected

tohandle.

• Whenchoosingworkers forotherspiritual careministries, consider theunique

backgroundsthattheybringtotheministry(i.e.,divorce,grief,recovery,etc.).

5. The six-month rule: volunteers of spiritual careministries should bemembers or

regular attenders of the church for at least sixmonths before being put into the

positionoflaycounselor.

6. Nooneshouldbeexemptfromcompletinganapplication.

7. Require applicants to provide the names of at least two independent references

whocanbeaskedtoprovideinputontheapplicant’squalifications.

8. Criminalbackgroundchecksshouldbeapartofthechurch’shiringpolicy.

9. Consider developing a uniform set of questions that will help you gain a greater

understandingoftheapplicant’scharacterandbackground.

10. Volunteersshouldcompletearenewalapplicationeachyear.

B. AdministrativeGuidelines

1. Theformalityandthedetailsofcounselingpoliciesandprocedureswilldependon

thenumberofpastorsandtrainedvolunteersthattheministryhas.


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2. Knowing your state laws is critical in organizing a spiritual care ministry in your

church.

3. Church leaders should consultwith an attorney todeterminehow some key legal

issuesshouldbeplacedwithinthepolicies.

4. Understand what issues may impact your program due to state mental health

licensinglaws.

• Canlaycounselorsprovidelaycounselingforthechurch?

• Canthewordcounselingbeused?

• Whattitlescannotbeused?

• Canthechurchadvertiseitsservicestothegeneralpublic?

• Canfeesbecharged?

C. Confidentiality

1. If a counselee discloses confidential information to a pastor or lay counselor in a

non-public setting, then the information should not be divulged except for a

legitimatereasonthatcanbelegallyjustified.

2. There may be times when it is biblically or legally necessary to share certain

informationtoothers.

3. Churches are encouraged to set fourth an Informed Consent or Lay Counseling

Agreement.

4. Specifically, the counselee should understand the legal and biblical exceptions to

confidentialityinacounselingsituation.


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5. Examplesofexceptions:

• Statemandatedchildabuseandelderabuserequirements

• Disclosurerequiredbylaw(subpoena)

• Harmthreatenedtoothersorself

• Pastoralsupervisor

• Parentsandguardiansofminors

• Couples

6. Counselees should review, understand and sign an informed consent or lay

counselingagreement.

• Bysigningthisform,thecounseleemakesavoluntarydecisionastowhetherhe

orshewantstoconsenttothewaythechurchhandlesconfidentialinformation.

D. ChildandElderAbuse

1. Childandelderabusecanremainasecretforsometime.

2. Manytimespastorsandlayministersdonotreadilydetectorrespondtoincidences

of abuse because they are unaware of the behavioral or emotional signals that

accompanyabuse.

3. Forthesafetyofchildrenandelders,it isvitallyimportantthatcounselorsbecome

awareofhowtoidentifyvictimsofabuse.

4. Therearemanyverbal/behavioralindicatorsthatworkersshouldbecomeawareof.

• Your church or ministry may desire to invite a licensed psychologist or other

mental health practitioner to a lay counselor training meeting to discuss

indicatorsofabuse.


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5. Church leaders, staffand laycounselors shouldunderstand the legal requirements

forabusereportinginthestateandcomplywiththelaw.

6. Alllaycounselorsshouldknowwhichleadertocontactimmediatelyiftheysuspect

anystatemandatedreportingmatter.

7. Workcloselywithyourchurch’sattorneytodevelopproperprocedures.

E. RecordKeeping

1. Counseling files should be confidentiallymaintained in a safe and secure place at

yourchurch.

2. Any counselee information on computer hard drives, disks or other electronic

storagedevicesshouldbesecurefromunauthorizedaccess.

• Counseling files or other private information contained on portable devices

shouldbeencrypted.

3. Church leaders should discuss record retention guidelines with the church’s

attorney.

• For potential insurance or litigation purposes, it may be wise to keep some

recordsindefinitely.

F. SexualMisconduct

1. Achurchmusttakestepstodetersexualmisconduct.

2. Prohibit any minister or lay counselor from providing counseling privately with a

memberoftheoppositesex.


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3. Haveaparentorsecondadultpresentwhencounselingaminor.

4. Limitthehourswhencounselingwillbeavailableatthechurch.

5. Limit counseling sessions to 45-minute sessions to an hour and establish a set

numberofsessions.

6. Counselonlyinaspecificallylocatedofficeorroomthathasawindoworisinview

ofasecretaryoranotheradult.

7. Cautioncounselorsaboutphysicaltouchingthatmightbemisinterpreted.

G. EthicalConsiderations

1. Laycounselorsshouldunderstandandfollowthechurch’sguidelinesforreferralof

counselees to physicians, mental health practitioners and other professional

caregivers.

2. Lay counselors should not interfere with a counselee’s medically prescribed drug

regimen.

H. Forms

1. Informed consent or lay counseling agreement: sets forth the conditions under

whichthechurchwillprovidelaycounseling.

2. Inadditiontoconfidentiality,thisdocumentcouldalsodiscuss:

• Thenumberofcounselingsessionavailable

• Theabilityofthecounselororcounseleetoterminatecounselingatanytime


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• Conflictresolution(mediationparagraph)

• Clarity that lay counselorswill provide biblical counseling and not guidance as

licensedmentalhealthpractitioners

3. In situations where minors are being counseled, use a separate form that

accommodates confidentiality issues. If the counselee is aminor, have his or her

parentorguardiansignthedocument.

4. Theintakeformcontainsstandardbackgroundinformationaboutthecounselee.

5. Counselingprogressnotesarealsoimportant.

I. SpiritualCareMinistries

1. Other spiritual care ministries may not have the same formalized counseling

components.

2. However,manyspiritualcareministriesinvolvefacilitatordrivensmallgroupswhere

someofthesameissuesapply.

3. Policies:Thegroupleaderwillnotprovidecounseling,butwillfacilitatediscussions,

set protections to guard against sexual misconduct, disallow dating between

facilitatorandattendees,considermeetinglocationsatthechurchratherthanatthe

home,guardagainstafacilitatormeetingalonewithanattendeeoftheoppositesex

andexplaintheimportanceofriskmanagementguidelinestoparticipants.

J. TrainingandSupervision

1. Itisessentialforaccountabilityandbuildingasafeenvironment.


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2. Well-organized training and supervision processes that address spiritual needs,

counseling methods, risk management and administrative protocols enhance the

successofyourministry.

3. Whoevermanagesthelaycounselingministryservesasthegatekeeperinhelpingto

protectcounselorsandthepeopletheyarecounseling.

• The manager’s role is twofold. The manager assures that the counselors are

effectively trained to provide competent spiritual care and provides

accountabilityandriskmanagementoversightoftheministry.

• Alaycounselingmanagershouldeitherbeapastorwithextensiveexperiencein

counselingoraChristianlicensedmentalhealthpractitioner.

• This manager can provide individuals with the informed consent and intake

form.

• Themanager can review the completed formsanddecidewhich lay counselor

shouldcounselaparticularindividual.

• Themanagercanmakereferrals.

4. Trainingprocedurescanvaryaccordingtothescopeofyourprogram.

5. Recommendingmodulesforinitiallaycounselingtraininginclude:

• Routineproblemsthatcounseleeswillbringaspresentingproblems

• Biblicalguidancepertainingtotypicalcounselingproblems

• Opportunitiestoroleplayandpracticetheskillsofcounseling

• Thechurch’slaycounselingpolicy

• Thelegalandethicalissuesinlaycounseling

• Referrals

6. The church should schedule ameeting for lay counselors to review and reinforce

theseguidelinesandprovideanynewinformation.


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7. Forotherspiritualcareministriesoutsideoflaycounselingthereshouldbetraining.

8. Thereareprepackagedprogramsforlaycounseling.

• Determineifitprovidesriskmanagementguidelinesforyourministry.

9. Leader training for all spiritual care ministries should include discussion of the

church’svolunteersfromalegalandethicalperspective.

10. Thereshouldbepropersupervisionofthelaycounselorsandforanyspiritualcare

ministryworker.

K. CommunicationsPlan

1. Educationaboutachurch’sspiritualcareministriesisimportant.

2. Potentialaudiencesinclude:

• Churchleaders

• Ministerialstaff

• SmallgroupandSundayschoolleaders

• Churchmembersandregularattenders

• Membersofthecommunity

3. The level of detail you provide about your program depends on whom you are

talkingto.

L. Insurance

1. Insuranceplays a key role inmanaging risks related to lay counseling and general

churchoperations.


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2. Insurance companies pay for risk-associated losses that a churchmay experience,

butcannoteasilyaffordtopay.

3. Itisrecommendedthatchurcheshaveaninsuranceauditonanannualbasis.

4. When you choose an insurance agent, be sure that the person is knowledgeable

aboutthechurchinsurancemarket.

5. Whenchoosinganinsurer,itisimportanttorememberthatthereismoretomaking

insurancedecisionsthansimplylookingatthecostofthecoverage.

• Thebestinsurancevaluemaynotbereflectedinthelowestprice.

• Lookatthebreadthofcoverage,theservicerecordandvalueaddedbenefits.

6. Ageneral liabilitypolicy:providescoverageforbodily injuryandpropertydamage

that results from negligent acts of the insurer (i.e., church, ministers, leaders,

volunteers,etc.).Itcanalsoincludecoverageformedicalpaymentsandpersonalor

emotionalinjurysuchasclaimsofdefamationorinvasionofprivacy.

7. Counseling acts liability coverage: optional coverage endorsement to a general

liabilitypolicy. Itprovides liabilityprotectionagainstclaimsofbodily,emotionalor

personalinjurythatresultfromcounselingactsofchurch,pastoralorlaycounselors.

8. Sexual acts liability coverage: protects against claims resulting from the alleged

sexual misconduct of individuals involved in church activities while performing

ministry duties. Usually this coverage is offered as an optional coverage

endorsementtoageneralliabilitypolicy.

9. Directors' and officers' liability coverage: People who sue a church also often

indicate members of the church board as additional named defendants. This


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coverage should provide liability protection and legal defense for most financial

damage claims that result from leadership decisions made on behalf of the

organization.

10. Excess umbrella liability coverage: Generally this optional coverage expands the

financial limits of protection beyond those that certain primary liability insurance

policiesprovide.

11. Professional liability insurancepolicies:Pastorsand licensedcounselorsmayhave

their own professional liability insurance policies. Coverage usually includes

protectionfromclaimsmadeagainstthemandtheirprofessionalcounselingduties

forwhichtheyarelicensed,certifiedortrained.Theyshouldcomparethecoverage

offered in their professional liability policies with the coverage included in the

church’sinsurancecoverage.

M. Conclusion

1. Anyministryatyourchurchinvolvessomedegreeofrisks.

2. Taking precautions to prevent liability exposure should be a part of the strategic

ministryplanningofeverychurchandministryorganization.

3. What action is your church taking to reduce the risks of liability in the counseling

ministry?

4. Whatelsecouldyourchurchbedoing?


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5. Taking the time to develop and implement a risk management policy for lay

counseling and all spiritual care ministries is an important act of service and

stewardship.


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ERM102:

DualandMultipleRelationshipsforCounselors

LoisDodds,Ph.D.


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AbstractForcounselors,understandingtheroleofdualrelationshipsiscritical.AsaChristian,thecallto

loveimploresthequestionofhowtoenterintoameaningfulrelationshipwithaclientwithout

crossingethicalboundaries.ThissessionexplorestheroleofthecounseloraspartoftheBody

ofChristandhisorherdutytobeinrelationshipwithclientswhilemaintaininganadherenceto

currentethicalstandards.

LearningObjectives

1. Participantswilllookatcurrentethicalstandardsrelatedtodualrelationships.

2. ParticipantswillinvestigatetheprimaryroleofacounselorasindicatedbyScripture.

3. ParticipantswillbeabletounderstandtheimportanceoftheBodyofChrist.


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I. Introduction

A. DualRelationships

1. BeingapartofacommunityisofhighvalueinaChristiancommunityoffaith.

2. Yousimplycannotisolateyourselffromthepeoplewhoyouserve.

• Ifyoudo,itreducestrust.Itcannotactuallydoharminthatsense.

3. Itisalsohardonyouifyouhappentobethecounselorbecausethosearethevery

peoplewhoyouneedforyourinteractionsinthecommunity.

• The larger communitywill really not be your own spiritual or social source of

help.

B. HistoricalPerspective

1. Thewaywepractice,orthewaywehavebeentaughttopracticeinthelastcouple

ofdecades,isanartifactofindustrializationandurbanization.

2. Industrializationandurbanizationhaverobbedpeopleofextendedfamily.

3. Thistrendisseenworldwide.

4. AsChristiancounselors,itistimetolookmorecloselyathowwepractice.

II. TheBodyofChrist

A. Introduction

1. ItisreallythebodyofChristthatshouldbeourfirstallegianceandmodel.

2. Whatdidtheselossesleadto?


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• Family

• Extendedfamily

• Tribe

• Clan

• Subculture

• Church

3. Wheredopeopleturnwhentheyneedhelp?

4. People are always searching for someway to get help and for someonewho can

helpandunderstand.

5. Intothisvacuumhasmovedwhatwecallprofessionalcounseling.

• Therearemanykindsofcounselors,andpeoplehavemanychoices.

6. If we look into Scripture to see what our primarymodel should be, it gives us a

beautifulpicture.

7. We need to figure out ways that we can show to people the love, respect and

couragethatChristwouldshow.

• Jesusmodeledforusawaytorelatetopeople.

• Itappliestousascounselors,anditappliestoeveryrealmofourlives.

• Wewant to impartknowledge,buildup, showempathyand strengthen.Allof

these,whichwewanttodoascounselors,arepartofwhatwedointhebodyof

Christ.

8. Jesusgaveuswhatwewouldcallahigherlaw:thelawoflove.

• Whilewedonotignoreorblotoutwhatisinourcodesofethics,wedowantto

lookcarefullyatwhattheyimply.


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• GodHimselfislove.TheTrinityisrelationship.

“Greaterlovehasnoonethanthis,thatonelaydownhislifeforhisfriends.”—John

15:13

9. Hecallsustolaydownourlivesforeachother.

“ThisisMycommandment,thatyouloveoneanother,justasIhavelovedyou.”

—John15:12

10. Ourfirstcallingisthelawoflove.

“Owenothingtoanyoneexceptto loveoneanother; forhewholoveshisneighbor

hasfulfilledthelaw.”—Romans13:8

11. If this is our first calling, then our practice needs to bewrapped in thismodel of

Jesus.

• Jesusrelatedtopeopleinmanyways.

B. WhatKindofLove?

“JustastheFatherhaslovedMe,Ihavealsolovedyou;abideinMylove.”

—John15:9

1. WearethechildrenofGod.

2. Loveisthegreatesthealer.

• Whatwepracticeincounselingarewaystomakethisloverealforpeople.


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C. Practice

1. Learntopracticethelawoflove.

2. Makethisadailyhabit.

3. InallofourinteractionswearetopracticetheloveofGod.

4. Wearetolivelivesworthyofourcalling.

• OurcallingistomakeGodvisible.Wedothatthroughourprofessionalrolesand

throughallofourrelationships.

• WearetobeimitatorsofGodasdearlylovedchildren.

D. Scriptures

1. ThelawofloveincludesmanyScripturesthathavetodowithoneanother.

2. AswethinkaboutbeingoneanotherinChristinourrelationshipsascounselors, it

includesmanythings:

• Thereisnohierarchy.Tobeagenuinepersonwhoistransparentandopen,does

not require any hierarchy. We are all considered to be of equal value. That

attitudeshouldpermeateourprofessionalrelationshipswiththosewecarefor.

Wecanhelppeoplebyrelatingtothemattheirlevel.

• WeareonebodyinChrist.Weareallneeded.Welookateachotherasequals.

Every person has a gift and brings it into the community. We may have a

specialized function, but we still participate as members of one body in

community.

3. Onefactorthatinfluencestoday’scodeofethicsisthematterofpeoplewhoviolate

barriersorboundaries.


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4. Incommunityweactuallyhavegreateraccountability.

• Rethinkwhatprovidesthebestaccountability.

5. Manycodesofethicshavebeenwrittenbecausesomebodyviolatedaboundaryof

somekind.

• Topreventthat,thevariouscodesofethicsbecamestricterandstricter.

6. Wehavemuchgreateraccountabilitywhenwearerelatingtogetherinacommunity

offaith.

E. Community

1. Whatiscommunity?

2. Communityisshared,voluntaryexperienceinwhichwecommitourselvestoagoal

andapurpose.

3. Wesharevalues.

4. Whenweareincommunity,wearenotlivinginisolation.

5. Community places particular values on the individual. Community implies

interpersonalrelationships.

6. Incommunity,westriveforimmediacyandopenness.Wequicklylearntotalkthings

overwitheachother.

7. Wehavetrustandaccountability.


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• InthebodyofChrist,thisistheforemostvenueinwhichwecanworkouthow

togrowup.

8. Incommunity,wealsohaveanappropriatedefinitionofboundaries.

9. Partofourroleincommunityistomodelhealthyliving.

• If we are isolated from community, then we are not going to be the kind of

modelthatGodcallsustobe.

10. Wehaveacceptance,affirmationandaplaceofbelonging.

• Thisisabsolutelycrucialforsomeonetogrowintoahealthyperson.Theyhave

tohaveawayofbelonging.

11. Incommunitywehavemutualityandreciprocity.

“Fathers,donotprovokeyourchildrentoanger,butbringthemupinthediscipline

andinstructionoftheLord.”—Ephesians6:4

12. Nurtureisawordthatisalmostlostinourculture.

• Nurtureisemotionalfood.

13. Wevaluediversityanduniqueness.

14. WearetomodeltheunityoftheTrinitywhenweareintheBodyofChrist.

15. Wearecreatedforgrowth.

• Communityistheoptimalplaceforgrowth.

16. WearecreatedintheimageofGod.


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• Ifwewanttogrowascounselors,wemustbeintheBodyofChristourselves.

17. Lovingcommunitybringshealing.

18. Thebasisforourworshipandserviceisspiritual.

19. Godgivesusdivineresources.

• Wecannotaskpeopletoliveadivinelifewithnaturalpower.

• Ifwearegoing to teachpeople to livegodly lives,offer themdivine resources

(i.e.,theBible,HisSpirit,HisWordwithinus,songs,etc.).

20. Wehavetofightevil.

21. Whenwepracticethisway,wearestrengthenedandallthosewhowecomfortand

counselwillalsobestrengthened.

• WhenweloveeachotherincommunityandinthebodyofChristitchangeswho

weareandwhatwehavetogivetoeachother.

22. WepracticetheknowledgeofGod.

23. Whenwelovepeople,weareincreasingwhatwecallthetherapeuticbenefit.

• Afteraperson’sdecision tochange, themost important thing thatweoffer in

counselingistherelationshipwiththeperson.

• Hisorherdesiretochangeandourabilitytorelatearethingsthatwehaveto

givetoeachother.

• YoucanalignyourselfwiththatpersonthroughtheloveofGod.

• Youalsomodel throughyour interactionwiththatpersonwhat itmeanstobe

healthyandhowtogrow.


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24. Wealsocanbringauniqueperspectiveintowhatevercontextorvenuewearein.

• Our humanness is such a powerful bond that many things in culture are less

important.

• ThebondofChrististhemostbeautifulandpowerfulthingthatwegivetoeach

other.

III. TheChallenge,EthicsandConclusion

A. TheSecular

1. Whatisthechallengethatwefaceifwearecounselorsinasecularsettingyetalso

inthebodyofChrist?

2. Wehavetosortoutthedissonancebetweencodesofethicsanddualrelationships.

• Wheredoesmyallegiancelie?

• Whatismyfirstmodel?

• HowcanIasaChristianbetotallyprofessionalandalsoahumanpersonwhois

abletolovetheotherperson?

3. AscounselorsintheBodyofChrist,wehavemanychallenges.

• Oneofthemistomaintainourownhealth.

• Ifwewithholdfromcommunity,thenitisgoingtobehardtokeepgoodhealth

becauseweneedeachother.

B. EightCodesofEthics

1. The term reasonable means the prevailing judgment of psychologists involved in

similaractivitiesandcircumstances.1


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• Psychologists may consider other materials and guidelines that have been

adoptedorendorsedbyscientificandprofessionalorganizationsaswellas the

dictatesoftheirownconscious.

2. Multiplerelationshipsthatwouldnotreasonablybeexpectedtocauseimpairment

orriskexploitationorharmarenotunethical.2

• Psychological protection and respect of civil and human rights is the central

importance of freedom of inquiry and expression in research, teaching and

publication.3

• Aphysicianshallrecognizearesponsibilitytoparticipateinactivitiescontributing

totheimprovementofacommunityandthebettermentofpublichealth.4

• Thephysicianshallnotbepartytoanytypeofpolicythatexcludes,segregatesor

demeansthedignityofanypatients.5

3. In addition to clients, the pastoral counselor interacts with other professionals,

studentsandemployers.Heorshemustconductalloftheserelationshipswithhigh

ethicalstandardsandneverexploitthepositionofauthorityortheinfluenceheor

sheholds.Thismeansnevertakingadvantageofanotherinanyway.6

4. Instead of banning dual relationships across the board, the recent revision of the

ethicalcodenowallowsprofessionalcounselorstointeractwithclientsoutsideofa

counselingsessionundercertaincircumstances.7

• Counselorsmaynowinteractwithaclientinanonprofessionalactivityaslongas

theinteractionispotentiallybeneficial.

• Focusingonassessingbeneficialversusharmfulinteractionsallowsthecounselor

toreallypartnerwiththeclient.


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5. Dual relationships that might impair the certified counselor’s objectivity and

professional judgment must be avoided and/or the counseling relationship

terminatedthroughreferraltoanotherprofessional.8

6. Somedualrelationshipsarenotunethical.Itiswrongwhenitisexploited.Basedon

an absolute application that harms membership bonds in the body of Christ, we

oppose the ethical legal view that all dual relationships are harmful. Some dual

relationshipsareworthwhileanddefensible.9

7. Therapistsareawareof their influentialpositionswith respect toclients,and they

avoid exploiting the trust and dependency of such persons. Therapists therefore

make every effort to avoid conditions andmultiple relationshipswith clients that

couldimpairthem,theirjudgmentorincreaserisks.10

8. TheNationalAssociationofSocialWorkers11:

• Principlesofsocialjustice

• Dignityandworthofpersons

• Importanceofhumanrelationships

• Integrity

• Culturalcompetency

• Socialdiversity

C. Conclusion

1. Howshouldwepracticegiventhesecodesofethics?

2. WearefirstofallpersonscreatedbyChristinhisimagetoserveoneanother.

• Ourprofessionalfulfillmentisaddedontothat.Itshouldnevertakeprecedence

overit.


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3. Godusesallofourgiftsandtalentstoserveothers.

4. WecanenjoymutualrelationshipsinthebodyofChristbecausetheyarenotabout

hierarchy,buttheyarereallyaboutbeingpersonstogether.

“Beyondallthesethingsputonlove,whichistheperfectbondofunit.”—Colossians

3:14

5. Aboveallelse,putonloveineveryrelationship.


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Endnotes1“EthicalPrinciplesofPsychologistsandCodeofConduct,”AmericanPsychologicalAssociation,accessedApril8,2014,www.apa.org/ethics/code/principles.pdf.2“MultipleRelationshipsandAPA’sNewEthicsCode:ValuesandApplications,”AmericanPsychologicalAssociation,accessedApril8,2014,www.apa.org/monitor/jan04/ethics.aspx.3“EthicalPrinciplesofPsychologistsandCodeofConduct,”AmericanPsychologicalAssociation,accessedApril8,2014,www.apa.org/ethics/code/code-1992.aspx.4“E-PrinciplesofMedicalEthics,”AmericanMedicalAssociation,accessedApril8,2014,www.utcourts.gov/resources/attorney/Convenience_Brief/American_Medical_Record_83-85.pdf.5AmericanPsychiatricAssociation,EthicsPrimeroftheAmericanPsychiatricAssociation(Arlington,Virginia:AmericanPsychiatricPublishing,2001).6“CodeofEthics,”AmericanAssociationofPastoralCounselors,accessedApril8,2014,www.aapc.org/policies/code-of-ethics/.7“AllowingDualRelationships,”AmericanCounselingAssociation,accessedApril8,2014,www.ct.counseling.org/2006/03/ct-online-ethics-update-9/.8“CodeofEthics,”NationalBoardofCertifiedCounselors,accessedApril8,2014,www.c.ymcdn.com/sites/www.flacounseling.org/resource/resmgr/imported/nbcc-codeofethics.pdf.9“AACCCodeofEthics,”AmericanAssociationofChristianCounselors,accessedApril8,2014,www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCgQFjAA&url=http%3A%2F%2Faacc.net%2Fwp-images%2Ffammed%2Faacc_code_of_ethics.doc&ei=9T1EU5QZ6tGxBPvwgcgP&usg=AFQjCNFby-fRXzXpE8iwD3JL5eBEZStedQ&bvm=bv.64367178,d.cWc.10“CodeofEthics,”AmericanAssociationforMarriageandFamilyTherapy,accessedApril8,2014,www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx.11“CodeofEthicsoftheNationalAssociationofSocialWorkers,”NationalAssociationofSocialWorkers,accessedApril8,2014,www.socialworkers.org/pubs/code/code.asp.


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ERM103:

SuicideRiskAssessment

DerrickStevenson,Ph.D.


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AbstractSuicideisofhighconcernamongtheUnitedStates’population.Thissessiongoesoverstatistics,

definitionsandconsiderationsofsuicide.Therearecertainpredictorsofsuicide,butnosingle

predictororassessmentwillalwaysbe indicativeofsuicideorasuicideattemptbecause it is

statistically impossible to predict with 100% accuracy. In addition to implementing suicide

assessments,theprofessionalistheessentialelementofthesuicideriskassessmentprocessas

it:allowsfortheidentificationoffactorsthatincreaseordecreaserisks,addressesthepatient’s

immediate safety and develops a multiaxial diagnosis. At the conclusion of the session, the

presenter addresses interview questions for suicide risk assessment alongwith detailing the

importanceofdocumentation.

LearningObjectives

1. Participantswilloverviewsuicidestatistics.

2. Participantswilllearnpracticalapplicationsofriskassessments.

3. Participantswilllearntheimportanceofaprofessionalinterviewandevaluation.


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I. Introduction

A. Statistics

1. 1.3%ofalldeathsarefromsuicideintheUnitedStates.1

2. Onesuicideoccursevery16-17minutes.2

3. In2007,itwasthe11thleadingcauseofdeathforallAmericans.3

4. Thereare30,000suicideseveryyearintheUnitedStates.4

5. Suicidalideationisexperiencedbyatleast4%ofthegeneralpopulation.

6. 5-6%ofsuicidesoccurduringhospitalizations.

• 25%hadbeenadmittedtothehospitalduetoasuicideattempt

• 39%hadbeenadmittedforhavingsuicidalideations

• 78%deniedanysuicidalideationattheirlastcommunication

• 51%wereon15-minutechecks

• 54%diditinthebathroom

• 76%hungthemselves

B. Considerations

1. Evenpeoplewhoareseekingtreatmentafterasuicideattemptarestillabletofind

waystocommitsuicide.

2. Therefore, the problem is that we need to find a way to avert some of these

suicides.


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3. The better our assessments can be, the better our evaluations can be of these

patients.

C. APADefinitions

1. Suicide:aself-inflicteddeathwithevidencethatthepersonintendedtodie.

2. Suicide attempt: self-injurious behavior with a nonfatal outcome, usually

accompaniedbysomeevidencethatthepersonintendedtodie.

3. Aborted suicide attempt: the potential or potentially self-injurious behavior with

evidencethatthepersonintendedtodie,butstoppedtheattemptbeforeheorshe

wassuccessful.

4. Suicidalideation:thoughtsofservingastheagentofone’sowndeath.

5. Lethality of suicidal behavior: the objective danger to life associated with the

suicidalmethod.

6. Self-harm:thewillfulself-inflictingofapainful,destructiveorinjuriousactwithout

theintenttodie.

D. Predictors

1. Studies have recently shown us that white males over the age of 65 are at the

highestriskforsuicide.

• Amongblackmales,thesuicideriskpeaksbetweentheagesof35-45.


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2. Suicideisuncommoninchildren.Suicideratesjumpupinteenageyears,andthose

rateshaveincreasedeachyearsincethe1950s.

3. Havingevidenceofapsychiatricdiagnosisisagoodindicatorofsuicidepotential.

• Thehighestratesareamongpeoplewitheatingdisorders(38.4%).

• Thesuicidemortalityrateamongthosewithdepressionis23.1%.

• Consider people withmixed drug abuse, bipolar disorder, dysthymic disorder,

obsessive-compulsivedisorderandpanicdisorder.

• Whenyougettoschizophreniaandotherpersonalitydisorders,theratesdrop.

• Alcohol abuse has a comparatively lower rate of suicide as compared to

depression.

4. Amongthegeneralpopulation,thesuiciderateisonly0.1%(10.7per100,000)since

1990.5

5. Amongdepressedpeople,thesuicideratesare106per1000,000.

6. If you add in a family history of suicide and depression, it increases 15-25 times

higherthannormalratesamongthegeneralpopulation.

7. The higher predictors of suicide among depressed patients would include people

whohaveanintensesenseofhopelessness.

8. Peopleatriskforsuicidealsohavealossofcapacitytoreacttopositiveevents.

9. Moodcyclingisalsoaprettygoodindicator.

10. Therecanalsobeunusualpsychoticthinking.


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11. Whenpeoplearedepressed,theyexperienceturmoil(agitation,pacing,etc.).

12. Therearealsosomeweakerpredictors.

• Alcoholandsubstanceabuse

• Thelossofrolefunction

• Greatdissatisfactionwithlife

• Notlivingwithachildwhoislessthan18yearsold

• Sociallywithdrawn

13. Poorindicators:

• Suicidalideation

• Apriorsuicideattempt

• Medicalseverity

• Hospitalizationforattemptedsuicide

Ø 69% of patients hospitalized for a suicide attempt said that they were

depressed.

Ø 50%hadahistoryofnopriorattempts.

Ø Amongpatientswhocommitted suicidewhilehospitalized,only41% of

themwereexperiencingaformofpsychosis.

Ø 9% of those who commit suicide while in the hospital were on 1 to 1

checks.

14. High risks for suicide among thosewith a history ofmental illnesses (i.e., bipolar

disorder,depression,dysthymicdisorder,schizophrenia,etc.)arepeoplewhohave

globalinsomnia,anintensesenseofhopelessnessandimpulsivity.

15. Among patients that have been successful at committing suicide, there usually is

somerecentalcoholordrugabuse.


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16. Whenan individual firstenters treatmentandends treatment,heor she is at the

highestriskforsuicide.

17. Somepatientschronicallyhavesuicidalthoughtsandfrequentlyattemptsuicide.

• These are some of the most difficult people to deal with because they are

constantlytryingtoescapefromsomesevereemotionalpain.

• Takeitseriously,buttrytoassesstherisks.

18. Thereisanincreasedriskforsuicideifyoufindthatthepatienthashadanearlethal

orsevereattemptinthepast,isimpulsiveorhasexperiencedincest/sexualabuse.

19. Peoplewhohaveahistoryofabortedattemptsoraworseningmood,addictionor

anxietydisorderareatgreaterrisk.

20. Apersonwithanewemotionalturbulenceinhisorherlifeisalsoanindicatorthat

oneneedstobecomeawareof.

21. Frequentintensethoughtsofsuicidemaybethebestpredictorofsuicide,but75%

ofthosepatientsdenyorminimizetheriskfromthosethoughts.

II. SuicideAssessment

A. Overview

1. Noscale,testorquestionnaireisenough.Weneedtodomorethanthat.

2. Newresearchtellsusthatthedenialofsuicidalideationisnotenough.

• Weneedtoverifyotherissuesrelatedtothepatient.

• Justthemsayingthattheyarenotsuicidalisnotenough.


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B. Goals

1. Weneedtobeabletosetrealisticgoalswhenitcomestosuicideriskassessment.

2. Itisstatisticallyimpossibletopredictsuicide.

3. We can gather enough information so that we can somehow categorize an

individual’srelativerisk.

C. HighRiskAlarms

1. Arecentsuicideattempt,particularlywithafirearmandanolderperson(overthe

ageof65),shouldbearedflag.

2. Accesstoafirearm:Anytimeapersonisthinkingaboutsuicide,youneedtoaskif

theyhaveaccesstofirearms.

• Doyouhavetheabilitytolockit?

• Whohasthecombination?

• Whohasthekey?

• Canyourfamilyremovethegunsandkeepthemtemporarily?

3. Thepresenceofasuicidenote:Ifsomeonehasgonethroughthetroubleofwriting

anote,thenthisissomethingyouneedtotakeextremelyseriously.

D. Factors

1. Considerbiologicalfactors.

• Familyriskfactors

• Demographics

• Pathology


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2. Lookatpredisposingfactors.

• Substanceabuse

• Difficultpersonalities

• Severeneurologicalproblems

3. Proximalfactors:

• Senseofhopelessness

• Intoxication

• Impulsivity

• Aggressiveness

• Negativeexpectancyfortreatment

• Severchronicpain

4. Immediatetriggers:

• Publichumiliationorshame

• Recentdefeat

• Majorlosses

• Worseningprognosis

E. Remember

1. Everypatientisanindividual,andeverystoryisuniqueanddifferent.

2. Thereisnotoneassessmentthatisgoingtopredicteverythingforthesepeople.

3. However,thereareriskassessmentsouttherethatarebeneficialtouse.


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F. RiskAssessment

1. Atypicalsuicideriskassessmentmightaskquestionslike:

• “Haveyoueverattemptedsuicidebefore?”

• “Areyoufeelinghopelessandhelplesstoday?”

2. Somesuicideriskassessmentsmighthavescalesonthem.

• “Onascaleof1to10,howwouldyourankyourchronicpain?”

• “Onascaleof1to10,areyoufeelingsuicidaltoday?”

3. Overtheyears,manyorganizationshavedevelopedtheirownuniquescales.

4. Ingeneral,suicideriskassessmentscaleshaverelativelylowpredictivevalue.

• They can, however, be a means for opening communication and testing the

sincerityandambivalenceofthepatient.

5. Thescorethatisproducedbythisscalemighthavevalidityintermsofclinicaldata

andstatisticalwork,butoveralltheuseofanassessmentscalealoneisabadidea.

6. Froma legalperspective,most courts considerassessmentsas tools,but theyare

nottheonlytools.

7. APA:“Ariskassessmentscalemaybeusedasaidstosuicideassessment,butshould

not be used as predictive instruments or as a substitute for a thorough clinical

evaluation.”

G. ScreeningTools

1. The Brief Symptom Inventory (BSI): It was formerly known as the Symptom

Checklist90.


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2. ThereisalsoatoolcalledtheBehavioralHealthMonitor.

3. TheOutcomeQuestionnaire45.2

4. ThemosteffectivetoolistheSuicideStatusFormIII(SSF-III).

5. Thebestriskassessmentisnotascale.Itisaprofessionalinterview.

H. TheProfessionalInterview

1. Theprofessionalevaluation istheessentialelementofthesuicideriskassessment

process.

2. Itallowsfortheidentificationoffactorsthatincreaseordecreaserisks.

3. Itaddressesthepatient’simmediatesafety.

4. Itdevelopsamultiaxialdiagnosis.

I. StrategiesforInterviews

1. Helpthepatientchronologizethediscussion.

• “Helpmeunderstandwhathashappenedtoyourecently.”

• “Walkmethrougheverystepofthelasttwodays.”

• “Whenpeopleareveryupsetthey_____________________.”

• “Describedyourthoughts.”

• “Whatareyouthinkingmostseriouslyabout?”


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2. Seekcollaborationwheneverthereisapotentialsuiciderisk.

• Asktheirfamily.

3. Normalizeanduseoverstatement.

• “Whensomeone isdepressedand feels veryupset, it isnormal to thinkabout

suicideorharmingoneself.”

4. Askthemchallengingorprohibitivequestionslike:

• “Youwillhavetopersuademethatyoudon’twanttodoit.”

• “Whatwouldittaketoleadyoutowanttoescapefromthisworld?”

• “Whatthingswouldhelpyoutogoonliving?”

5. Itisalsoimportantforyoutoconsiderhowimpulsivethepatientis.

• “Haveyoustartedtoactonasuicideplanbutstoppedbeforeyoudidanything?”

• “Howeasyisitforyoutoobtainafirearm?”

6. Itisalsoimportanttoaskquestionsaboutpastattempts.

• “Whatwasyourmostseriouspastsuicideattempt?”

• “Describe your thoughts at the time that you most seriously thought about

suicide.”

7. Otherimportantthingstocollect:

• Isthereasuicideplanandwhatisit?

• Hastherebeenanythingdonetoprepare(suicidalpreparation)?

• Hastherebeenanyrehearsal(suicidalrehearsal)?

• Lookatthehistoryofsuicide.

• Lookattheircurrentintent.

• Lookattheirimpulsivity,substanceabuse,significantlossfactorsandiftheyare

havinganyinterpersonalisolationandrelationshipproblems.

• Lookathealthproblems(chronicpain),legalproblemsandshame.


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8. Alwaysfindoutwhatyouragencyandstate’spoliciesare,relatedtohospitalization.

9. Itisimportantthatwealsolookatthenosuicidecontract.

• Inthepastthiswasconsideredaveryvalidthing.

• Ifyouaregoingtodoasuicideriskcontract,makesuretogetitinwriting,have

thepatientsignitandletitbeinhisorherownwords.

10. Whenyougetreadytodischargeorreleaseapatient,considerthefollowing:

• Haveyouseenimprovementintheriskfactorsthatyouhaveidentifiedandwere

reportedtoyou?

• Whathaschangedinthisperson’slifethatmakeshimorhernowwanttolive?

• Whatisgoingtobedifferentwhentheygohome?

• Isthispersonawillingpartnerinchanging?

• Howrealisticistheirsafetyplan?

• Dothetherapeuticexpectationsmatchthepatient’sskillsandabilities?

11. Guidelinesfordocumentation:

• Documentthereasonfortheassessment.

• Always talk about the strategies and procedures that you are using in your

assessment.

• Talkabout the factors thatpertain to the risksand identify those risks in your

assessment.

• Useclinical reasoningand judgmentsaspartofyourdocumentationas towhy

youcametothatconclusionaboutthepatient.

• Talkaboutprotections,treatmentsandrecommendations.

• Cover yourself by talking about alternatives that thepatient had andwhy you

chosetoleadthepatienttoaparticularalternative.


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12. The first rule of risk management is to carefully document your work and your

thinking. If the outcome is adverse, then there needs to be some clear rational

reasoningtowhatyoudid.

• Whatweretheexpectedbenefitstowhatyourecommended?

13. Ifyourdocumentationreflectsthatyoudideverythingthatyoupossiblycould,then

youareinabetterposition.

“Suicideispreparedwithintheabsenceoftheheartasagreatworkofart.”—Albert

Camus

14. Everysuicidehasitsownstory.

15. When the risk is the highest, that is the time when the patients are the most

secretiveabouttheirtrueintentions.

16. It is our job as clinicians to identify situations when patients are most likely to

developsuicidalideationandtakewhatevernecessarystepswecantoalleviatethat.

17. Once the story is known, the appropriate interventions must be administered to

preventthepatientfromeverwritinghisorherlastchapter.


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Endnotes1“SuicideStatistics,”Suicide.org,accessedApril17,2014,www.suicide.org/suicide-statistics.html.2Ibid.3“Suicides—UnitedStates,1999-2007,”CenterforDiseaseControlandPrevention,accessedApril17,2014,www.cdc.gov/mmwr/preview/mmwrhtml/su6001a11.htm.4“SuicideFacts,”SuicideAwarenessVoicesofEducation,accessedApril17,2014,www.save.org/index.cfm?fuseaction=home.viewPage&page_id=705D5DF4-055B-F1EC-3F66462866FCB4E6.5“SuicideRatesforAllAges,2010,”AmericanAssociationofSuicidology,accessedApril17,2014,www.suicidology.org/c/document_library/get_file?folderId=248&name=DLFE-800.pdf.


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