Ethical dilemma for small town mental health counselor

This is the post excerpt.


[The following is a discussion post addressing the ethical considerations for Linda, a 42-year-old licensed mental health counselor, and her client, Julie, a single parent, who suffers from depression and flagging self-esteem, and has difficulty forming friendships. They live in a small town, and their children have extracurricular activities in common. As a consequence, Linda and Julie have, on numerous occasions, had conversations out-of-session, and Julie has approached Linda with an interest in attending Linda’s church. Linda, along with her husband, serves on several church committees and their activities occupy a significant portion of their social lives. Julie has asked Linda if she would introduce her to a few of the members so that she may more easily integrate into the church community.]

Section A.6. of the American Counseling Association Code of Ethics (ACA, 2014) concerns maintenance of professional boundaries, a vitally important consideration when engaging any client and an aspect of professional conduct which demands vigilance on the part of the practitioner. While Linda and Julie have an established therapeutic relationship, Linda will want to consider the implications of any extension of that relationship. Julie has made clear overtures that she is interested in evolving that relationship into a friendship. In fact, what Julie has suggested with regard to becoming a part of Linda’s church community may be construed as a desire to “piggyback” on Linda’s own support network in preference over creating her own.

Standard A.5.d. of the Code of Ethics (ACA, 2014) stipulates that counselors abstain from forming a professional relationship with individuals who will challenge their ability to behave with objectivity, specifically “friends [and] family members” (p. 5). This should also act in the reverse, as Linda already has an established professional relationship with Julie, making it unlikely and a taxing proposition for Linda to cease being therapeutic ‘off hours.’ Furthermore, Julie will undoubtedly seek — and expect — from Linda the benefit of her counsel in other contexts. In fact, this is discussed in Standard A.6.e., which reminds counselors of the potential for harm that exists with assuming a role different from — and, in truth, in conflict with — the one already in place. Standard A.6.d. speaks to this, offering three examples, none of which mirror Linda’s and Julie’s situation, but which nonetheless underscore the need to carefully consider role changes, as well as the obligation to inform clients of their implications. This standard can be incorporated into Linda’s upcoming conversation with Julie, wherein she is obliged to discuss with Julie how facilitating Julie’s entrĂ©e into the church community could potentially infringe upon their professional therapeutic relationship.

A failure to maintain the professional boundary would conceivably undermine the efforts Linda has made to encourage and help empower Julie to overcome a tendency to isolate herself in the face of relationship challenges and flagging self-esteem, and to successfully manage the stressors in her life. In light of this, the blurring of boundaries could compromise Julie’s overall well-being and introduce a significant risk of harm, violating Standard A.1.a. of the Code (ACA, 2014). Further, it would negate the foundational ethical principle of autonomy found in the ACA Code of Ethics’ (ACA, 2014) Preamble, which Linda, as a professional counselor, is bound to uphold.

Given that Linda and Julie live in the same small town, share some common interests, and have children who participate in the same extracurricular activities, Linda can hardly be successful in avoiding her client outside of office hours, and it would be exhausting to try. Therefore, time is of the essence, and the onus is on Linda to broach the topic of professional boundaries with Julie — again, we hope — and impress upon Julie how relaxing those boundaries would be a grave disservice to her, and would effectively eliminate Linda as a professional resource available to Julie. This can be accomplished with sensitivity and diplomacy. Linda should emphasize the ethical constraints placed upon her, and help Julie to appreciate that, as her counselor, she has Julie’s well-being uppermost in mind. Linda could, for example, reference Standard A.1.d. (ACA, 2014), which speaks to counselors’ recognition of the important contribution to well-being made by clients’ own support networks. Linda can certainly encourage Julie to reinvest herself in creating and expanding her own social support network independent of any that Linda has established for herself, and collaborate in making this a goal of treatment if it is not already one.

While Linda might agree to introduce her to her Pastor and a few others, she will want to draw the line at including her in functions that take place within her home. And before doing so, she will want to readdress the matter of confidentiality with Julie, explaining that these introductions will lead others to naturally assume that they know one another in the context of therapy. Linda can reference the Introduction to Section B of the Code of Ethics (ACA, 2014) at this point in their conversation. Additionally, Julie might benefit from being helped to appreciate that her counselor’s support network — including Linda’s robust involvement in her church community — is a deeply personal resource imbued with meaning that cannot be ‘transferred’ to Julie. Linda can explain, too, that these connections and activities in which she invests her personal time and energies contribute to her effectiveness as a professional counselor, and that she is adamant in preserving the boundary between the personal and the professional in order to protect her licensure and remain in service to her clients.

With regard to legal ramifications, within North Carolina, Licensed Professional Counselors are obliged to adhere to the ACA Code of Ethics (ACA, 2014), as the state has adopted the Code as its own standards of practice. This can be seen as something of an advantage, as Linda needs only to navigate and invoke the professional expectations laid down by the Code (ACA, 2014).

Karen Baird Tinner


American Counseling Association (2014). ACA code of ethics. Alexandria, VA: Author.


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