Personal Development Review

I need assistance with a development review assignment. Attached are topics and articles for reference.

Completion of professional development paper (APA style, 5-8 pages). Basically, you are to provide an overview on issues related to your own professional development. You simply use resources already presented in this course (take a good look at the Professional Identity Article under the Content Tab), you do not need to conduct additional research. Simply use what you have learned in this course and reference readings from the course. I want you to make this paper personal…how will you develop yourself as a professional in the field of counseling? What are your values? How may they interfere with or promote your own ethical behavior? What will you do that will deepen your level of professionalism and understanding your role as a counselor? How will you maintain a healthy professional and personal life? Be specific. Give details and integrate information learned in this course into the paper. Organize your paper well, use APA format and be sure to include citations.

counseling.org

2014ACA
Code of Ethics

As approved by the ACA Governing Council

AMERICAN COUNSELING
ASSOCIATION

•  2  •

© 2014 by the American Counseling Association.
All rights reserved. Note: This document may be reproduced in its entirety without permission for non-commercial
purposes only.

ACA Code of Ethics Preamble • 3
ACA Code of Ethics Purpose • 3

Section A
The Counseling Relationship • 4

Section B
Confidentiality and Privacy • 6

Section C
Professional Responsibility • 8

Section D
Relationships With Other Professionals • 10

Section E
Evaluation, Assessment, and

Interpretation • 11

Section F
Supervision, Training, and Teaching • 12

Section G
Research and Publication • 15

Section H
Distance Counseling, Technology,

and Social Media • 17

Section I
Resolving Ethical Issues • 18

Glossary of Terms • 20

Index • 21

Mission
The mission of the American Counseling Association
is to enhance the quality of life in society by promoting
the development of professional counselors, advancing
the counseling profession, and using the profession and
practice of counseling to promote respect for human
dignity and diversity.

Contents

•  3  •

ACA Code of Ethics Purpose
The ACA Code of Ethics serves six main purposes:

1. The Code sets forth the ethical obligations of ACA members and provides guidance intended to inform the ethical
practice of professional counselors.

2. The Code identifies ethical considerations relevant to professional counselors and counselors-in-training.
3. The Code enables the association to clarify for current and prospective members, and for those served by members,

the nature of the ethical responsibilities held in common by its members.
4. The Code serves as an ethical guide designed to assist members in constructing a course of action that best serves

those utilizing counseling services and establishes expectations of conduct with a primary emphasis on the role of
the professional counselor.

5. The Code helps to support the mission of ACA.
6. The standards contained in this Code serve as the basis for processing inquiries and ethics complaints

concerning ACA members.

The ACA Code of Ethics contains nine main sections that ad-
dress the following areas:

Section A: The Counseling Relationship
Section B: Confidentiality

and Privacy

Section C: Professional

Responsibility

Section D: Relationships With Other Professionals
Section E: Evaluation, Assessment, and Interpretation
Section F: Supervision, Training, and Teaching
Section G: Research and Publication
Section H: Distance Counseling, Technology, and
Social Media
Section I: Resolving Ethical Issues

Each section of the ACA Code of Ethics begins with an
introduction. The introduction to each section describes the
ethical behavior and responsibility to which counselors aspire.
The introductions help set the tone for each particular sec-
tion and provide a starting point that invites reflection on the
ethical standards contained in each part of the ACA Code of
Ethics. The standards outline professional responsibilities and
provide direction for fulfilling those ethical responsibilities.

When counselors are faced with ethical dilemmas that
are difficult to resolve, they are expected to engage in a care-
fully considered ethical decision-making process, consulting
available resources as needed. Counselors acknowledge
that resolving ethical issues is a process; ethical reasoning
includes consideration of professional values, professional
ethical principles, and ethical standards.

Counselors’ actions should be consistent with the spirit
as well as the letter of these ethical standards. No specific
ethical decision-making model is always most effective, so
counselors are expected to use a credible model of deci-
sion making that can bear public scrutiny of its applica-
tion. Through a chosen ethical decision-making process
and evaluation of the context of the situation, counselors
work collaboratively with clients to make decisions that
promote clients’ growth and development. A breach of the
standards and principles provided herein does not neces-
sarily constitute legal liability or violation of the law; such
action is established in legal and judicial proceedings.

The glossary at the end of the Code provides a concise
description of some of the terms used in the ACA Code
of Ethics.

ACA Code of Ethics Preamble
The American Counseling Association (ACA) is an educational, scientific, and professional organization whose members
work in a variety of settings and serve in multiple capacities. Counseling is a professional relationship that empowers diverse
individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

Professional values are an important way of living out an ethical commitment. The following are core professional values
of the counseling profession:

1. enhancing human development throughout the life span;
2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and

uniqueness of people within their social and cultural contexts;
3. promoting social justice;
4. safeguarding the integrity of the counselor–client relationship; and
5. practicing in a competent and ethical manner.

These professional values provide a conceptual basis for the ethical principles enumerated below. These principles are
the foundation for ethical behavior and decision making. The fundamental principles of professional ethical behavior are

• autonomy, or fostering the right to control the direction of one’s life;
• nonmaleficence, or avoiding actions that cause harm;
• beneficence, or working for the good of the individual and society by promoting mental health and well-being;
• justice, or treating individuals equitably and fostering fairness and equality;
• fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in

professional relationships; and
• veracity, or dealing truthfully with individuals with whom counselors come into professional contact.

• ACA Code of Ethics •

•  4  •

A.2.c. Developmental and
Cultural Sensitivity

Counselors communicate information
in ways that are both developmentally
and culturally appropriate. Counselors
use clear and understandable language
when discussing issues related to
informed consent. When clients have
difficulty understanding the language
that counselors use, counselors provide
necessary services (e.g., arranging for
a qualified interpreter or translator)
to ensure comprehension by clients.
In collaboration with clients, coun-
selors consider cultural implications
of informed consent procedures and,
where possible, counselors adjust their
practices accordingly.

A.2.d. Inability to Give Consent
When counseling minors, incapaci-
tated adults, or other persons unable
to give voluntary consent, counselors
seek the assent of clients to services
and include them in decision making
as appropriate. Counselors recognize
the need to balance the ethical rights
of clients to make choices, their capac-
ity to give consent or assent to receive
services, and parental or familial legal
rights and responsibilities to protect
these clients and make decisions on
their behalf.

A.2.e. Mandated Clients
Counselors discuss the required
limitations to confidentiality when
working with clients who have been
mandated for counseling services.
Counselors also explain what type
of information and with whom that
information is shared prior to the
beginning of counseling. The client
may choose to refuse services. In this
case, counselors will, to the best of
their ability, discuss with the client
the potential consequences of refusing
counseling services.

A.3. Clients Served by Others
When counselors learn that their clients
are in a professional relationship with
other mental health professionals, they
request release from clients to inform
the other professionals and strive to
establish positive and collaborative
professional relationships.

A.4. Avoiding Harm and
Imposing Values

A.4.a. Avoiding Harm
Counselors act to avoid harming their
clients, trainees, and research par-
ticipants and to minimize or to remedy
unavoidable or unanticipated harm.

A.1.d. Support Network
Involvement

Counselors recognize that support
networks hold various meanings in
the lives of clients and consider en-
listing the support, understanding,
and involvement of others (e.g., reli-
gious/spiritual/community leaders,
family members, friends) as positive
resources, when appropriate, with
client consent.

A.2. Informed Consent
in the Counseling

Relationship

A.2.a. Informed Consent
Clients have the freedom to choose
whether to enter into or remain in
a counseling relationship and need
adequate information about the
counseling process and the counselor.
Counselors have an obligation to re-
view in writing and verbally with cli-
ents the rights and responsibilities of
both counselors and clients. Informed
consent is an ongoing part of the
counseling process, and counselors
appropriately document discussions
of informed consent throughout the
counseling relationship.

A.2.b. Types of Information
Needed

Counselors explicitly explain to clients
the nature of all services provided.
They inform clients about issues such
as, but not limited to, the follow-
ing: the purposes, goals, techniques,
procedures, limitations, potential
risks, and benefits of services; the
counselor’s qualifications, credentials,
relevant experience, and approach to
counseling; continuation of services
upon the incapacitation or death of
the counselor; the role of technol-
ogy; and other pertinent information.
Counselors take steps to ensure that
clients understand the implications of
diagnosis and the intended use of tests
and reports. Additionally, counselors
inform clients about fees and billing
arrangements, including procedures
for nonpayment of fees. Clients have
the right to confidentiality and to be
provided with an explanation of its
limits (including how supervisors
and/or treatment or interdisciplinary
team professionals are involved), to
obtain clear information about their
records, to participate in the ongoing
counseling plans, and to refuse any
services or modality changes and to
be advised of the consequences of
such refusal.

Section A
The Counseling

Relationship

Introduction
Counselors facilitate client growth
and development in ways that foster
the interest and welfare of clients and
promote formation of healthy relation-
ships. Trust is the cornerstone of the
counseling relationship, and counselors
have the responsibility to respect and
safeguard the client’s right to privacy
and confidentiality. Counselors actively
attempt to understand the diverse cul-
tural backgrounds of the clients they
serve. Counselors also explore their own
cultural identities and how these affect
their values and beliefs about the coun-
seling process. Additionally, counselors
are encouraged to contribute to society
by devoting a portion of their profes-
sional activities for little or no financial
return (pro bono publico).

A.1. Client Welfare
A.1.a. Primary Responsibility

The primary responsibility of counsel-
ors is to respect the dignity and promote
the welfare of clients.

A.1.b. Records and
Documentation

Counselors create, safeguard, and
maintain documentation necessary
for rendering professional services.
Regardless of the medium, counselors
include sufficient and timely docu-
mentation to facilitate the delivery and
continuity of services. Counselors
take reasonable steps to ensure that
documentation accurately reflects cli-
ent progress and services provided.
If amendments are made to records
and documentation, counselors take
steps to properly note the amendments
according to agency or institutional
policies.

A.1.c. Counseling Plans
Counselors and their clients work
jointly in devising counseling plans
that offer reasonable promise of
success and are consistent with the
abilities, temperament, developmental
level, and circumstances of clients.
Counselors and clients regularly re-
view and revise counseling plans to
assess their continued viability and
effectiveness, respecting clients’ free-
dom of choice.

• ACA Code of Ethics •

•  5  •

A.4.b. Personal Values
Counselors are aware of—and avoid
imposing—their own values, attitudes,
beliefs, and behaviors. Counselors
respect the diversity of clients, train-
ees, and research participants and
seek training in areas in which they
are at risk of imposing their values
onto clients, especially when the
counselor ’s values are inconsistent
with the client’s goals or are discrimina-
tory in nature.

A.5. Prohibited
Noncounseling Roles
and Relationships

A.5.a. Sexual and/or
Romantic Relationships
Prohibited

Sexual and/or romantic counselor–
client interactions or relationships with
current clients, their romantic partners,
or their family members are prohibited.
This prohibition applies to both in-
person and electronic interactions or
relationships.

A.5.b. Previous Sexual and/or
Romantic Relationships

Counselors are prohibited from engag-
ing in counseling relationships with
persons with whom they have had
a previous sexual and/or romantic
relationship.

A.5.c. Sexual and/or Romantic
Relationships With
Former Clients

Sexual and/or romantic counselor–
client interactions or relationships with
former clients, their romantic partners,
or their family members are prohibited
for a period of 5 years following the last
professional contact. This prohibition
applies to both in-person and electronic
interactions or relationships. Counsel-
ors, before engaging in sexual and/or
romantic interactions or relationships
with former clients, their romantic
partners, or their family members, dem-
onstrate forethought and document (in
written form) whether the interaction or
relationship can be viewed as exploitive
in any way and/or whether there is still
potential to harm the former client; in
cases of potential exploitation and/or
harm, the counselor avoids entering
into such an interaction or relationship.

A.5.d. Friends or Family
Members

Counselors are prohibited from engaging
in counseling relationships with friends
or family members with whom they have
an inability to remain objective.

A.5.e. Personal Virtual
Relationships With
Current Clients

Counselors are prohibited from
engaging in a personal virtual re-
lationship with individuals with
whom they have a current counseling
relationship (e.g., through social and
other media).

A.6. Managing and
Maintaining Boundaries
and Professional
Relationships

A.6.a. Previous Relationships
Counselors consider the risks and
benefits of accepting as clients those
with whom they have had a previous
relationship. These potential clients
may include individuals with whom
the counselor has had a casual, distant,
or past relationship. Examples include
mutual or past membership in a pro-
fessional association, organization, or
community. When counselors accept
these clients, they take appropriate pro-
fessional precautions such as informed
consent, consultation, supervision, and
documentation to ensure that judgment
is not impaired and no exploitation
occurs.

A.6.b. Extending Counseling
Boundaries

Counselors consider the risks and
benefits of extending current counsel-
ing relationships beyond conventional
parameters. Examples include attend-
ing a client’s formal ceremony (e.g., a
wedding/commitment ceremony or
graduation), purchasing a service or
product provided by a client (excepting
unrestricted bartering), and visiting a cli-
ent’s ill family member in the hospital. In
extending these boundaries, counselors
take appropriate professional precau-
tions such as informed consent, consul-
tation, supervision, and documentation
to ensure that judgment is not impaired
and no harm occurs.

A.6.c. Documenting Boundary
Extensions

If counselors extend boundaries as
described in A.6.a. and A.6.b., they
must officially document, prior to the
interaction (when feasible), the rationale
for such an interaction, the potential
benefit, and anticipated consequences
for the client or former client and other
individuals significantly involved with
the client or former client. When un-
intentional harm occurs to the client
or former client, or to an individual

significantly involved with the client
or former client, the counselor must
show evidence of an attempt to remedy
such harm.

A.6.d. Role Changes in the
Professional Relationship

When counselors change a role from
the original or most recent contracted
relationship, they obtain informed
consent from the client and explain the
client’s right to refuse services related
to the change. Examples of role changes
include, but are not limited to

1. changing from individual to re-
lationship or family counseling,
or vice versa;

2. changing from an evaluative
role to a therapeutic role, or vice
versa; and

3. changing from a counselor to a
mediator role, or vice versa.

Clients must be fully informed of
any anticipated consequences (e.g.,
financial, legal, personal, therapeutic)
of counselor role changes.

A.6.e. Nonprofessional
Interactions
or Relationships (Other
Than Sexual or Romantic
Interactions or
Relationships)

Counselors avoid entering into non-
professional relationships with former
clients, their romantic partners, or their
family members when the interaction is
potentially harmful to the client. This
applies to both in-person and electronic
interactions or relationships.

A.7. Roles and Relationships
at Individual, Group,
Institutional, and
Societal Levels

A.7.a. Advocacy
When appropriate, counselors advocate
at individual, group, institutional, and
societal levels to address potential bar-
riers and obstacles that inhibit access
and/or the growth and development
of clients.

A.7.b. Confidentiality and
Advocacy

Counselors obtain client consent prior
to engaging in advocacy efforts on be-
half of an identifiable client to improve
the provision of services and to work
toward removal of systemic barriers
or obstacles that inhibit client access,
growth, and development.

• ACA Code of Ethics •

•  6  •

being harmed by continued counseling.
Counselors may terminate counseling
when in jeopardy of harm by the client
or by another person with whom the cli-
ent has a relationship, or when clients do
not pay fees as agreed upon. Counselors
provide pretermination counseling and
recommend other service providers
when necessary.

A.11.d. Appropriate Transfer of
Services

When counselors transfer or refer clients
to other practitioners, they ensure that
appropriate clinical and administra-
tive processes are completed and open
communication is maintained with both
clients and practitioners.

A.12. Abandonment and
Client Neglect
Counselors do not abandon or neglect
clients in counseling. Counselors assist in
making appropriate arrangements for the
continuation of treatment, when neces-
sary, during interruptions such as vaca-
tions, illness, and following termination.

Section B
Confidentiality

and Privacy

Introduction
Counselors recognize that trust is a cor-
nerstone of the counseling relationship.
Counselors aspire to earn the trust of cli-
ents by creating an ongoing partnership,
establishing and upholding appropriate
boundaries, and maintaining confi-
dentiality. Counselors communicate
the parameters of confidentiality in a
culturally competent manner.

B.1. Respecting Client Rights
B.1.a. Multicultural/Diversity

Considerations
Counselors maintain awareness and sen-
sitivity regarding cultural meanings of
confidentiality and privacy. Counselors
respect differing views toward disclosure
of information. Counselors hold ongo-
ing discussions with clients as to how,
when, and with whom information is
to be shared.

B.1.b. Respect for Privacy
Counselors respect the privacy of
prospective and current clients. Coun-
selors request private information from
clients only when it is beneficial to the
counseling process.

A.8. Multiple Clients
When a counselor agrees to provide
counseling services to two or more
persons who have a relationship, the
counselor clarifies at the outset which
person or persons are clients and the
nature of the relationships the counselor
will have with each involved person. If
it becomes apparent that the counselor
may be called upon to perform poten-
tially conflicting roles, the counselor will
clarify, adjust, or withdraw from roles
appropriately.

A.9. Group Work
A.9.a. Screening

Counselors screen prospective group
counseling/therapy participants. To
the extent possible, counselors select
members whose needs and goals are
compatible with the goals of the group,
who will not impede the group process,
and whose well-being will not be jeop-
ardized by the group experience.

A.9.b. Protecting Clients
In a group setting, counselors take rea-
sonable precautions to protect clients
from physical, emotional, or psychologi-
cal trauma.

A.10. Fees and Business
Practices

A.10.a. Self-Referral
Counselors working in an organization
(e.g., school, agency, institution) that
provides counseling services do not
refer clients to their private practice
unless the policies of a particular orga-
nization make explicit provisions for
self-referrals. In such instances, the cli-
ents must be informed of other options
open to them should they seek private
counseling services.

A.10.b. Unacceptable Business
Practices

Counselors do not participate in fee
splitting, nor do they give or receive
commissions, rebates, or any other form
of remuneration when referring clients
for professional services.

A.10.c. Establishing Fees
In establishing fees for professional
counseling services, counselors con-
sider the financial status of clients and
locality. If a counselor’s usual fees cre-
ate undue hardship for the client, the
counselor may adjust fees, when legally
permissible, or assist the client in locat-
ing comparable, affordable services.

A.10.d. Nonpayment of Fees
If counselors intend to use collection
agencies or take legal measures to col-

lect fees from clients who do not pay for
services as agreed upon, they include
such information in their informed
consent documents and also inform
clients in a timely fashion of intended
actions and offer clients the opportunity
to make payment.

A.10.e. Bartering
Counselors may barter only if the bar-
tering does not result in exploitation
or harm, if the client requests it, and
if such arrangements are an accepted
practice among professionals in the
community. Counselors consider the
cultural implications of bartering and
discuss relevant concerns with clients
and document such agreements in a
clear written contract.

A.10.f. Receiving Gifts
Counselors understand the challenges
of accepting gifts from clients and rec-
ognize that in some cultures, small gifts
are a token of respect and gratitude.
When determining whether to accept
a gift from clients, counselors take into
account the therapeutic relationship, the
monetary value of the gift, the client’s
motivation for giving the gift, and the
counselor’s motivation for wanting to
accept or decline the gift.

A.11. Termination and
Referral

A.11.a. Competence Within
Termination and Referral

If counselors lack the competence to
be of professional assistance to clients,
they avoid entering or continuing
counseling relationships. Counselors
are knowledgeable about culturally and
clinically appropriate referral resources
and suggest these alternatives. If clients
decline the suggested referrals, counsel-
ors discontinue the relationship.

A.11.b. Values Within
Termination and Referral

Counselors refrain from referring pro-
spective and current clients based solely
on the counselor’s personally held val-
ues, attitudes, beliefs, and behaviors.
Counselors respect the diversity of
clients and seek training in areas in
which they are at risk of imposing their
values onto clients, especially when the
counselor’s values are inconsistent with
the client’s goals or are discriminatory
in nature.

A.11.c. Appropriate Termination
Counselors terminate a counseling re-
lationship when it becomes reasonably
apparent that the client no longer needs
assistance, is not likely to benefit, or is

• ACA Code of Ethics •

•  7  •

B.1.c. Respect for
Confidentiality

Counselors protect the confidential
information of prospective and current
clients. Counselors disclose information
only with appropriate consent or with
sound legal or ethical justification.

B.1.d. Explanation of
Limitations

At initiation and throughout the counsel-
ing process, counselors inform clients of
the limitations of confidentiality and seek
to identify situations in which confiden-
tiality must be breached.

B.2. Exceptions
B.2.a. Serious and Foreseeable

Harm and Legal
Requirements

The general requirement that counsel-
ors keep information confidential does
not apply when disclosure is required
to protect clients or identified others
from serious and foreseeable harm or
when legal requirements demand that
confidential information must be re-
vealed. Counselors consult with other
professionals when in doubt as to the
validity of an exception. Additional
considerations apply when addressing
end-of-life issues.

B.2.b. Confidentiality Regarding
End-of-Life Decisions

Counselors who provide services to
terminally ill individuals who are con-
sidering hastening their own deaths have
the option to maintain confidentiality,
depending on applicable laws and the
specific circumstances of the situation
and after seeking consultation or super-
vision from appropriate professional and
legal parties.

B.2.c. Contagious, Life-
Threatening Diseases

When clients disclose that they have a
disease commonly known to be both
communicable and life threatening,
counselors may be justified in disclos-
ing information to identifiable third
parties, if the parties are known to be
at serious and foreseeable risk of con-
tracting the disease. Prior to making a
disclosure, counselors assess the intent
of clients to inform the third parties
about their disease or to engage in
any behaviors that may be harmful to
an identifiable third party. Counselors
adhere to relevant state laws concern-
ing disclosure about disease status.

B.2.d. Court-Ordered Disclosure
When ordered by a court to release
confidential or privileged information

without a client’s permission, coun-
selors seek to obtain written, informed
consent from the client or take steps to
prohibit the disclosure or have it limited
as narrowly as possible because of po-
tential harm to the client or counseling
relationship.

B.2.e. Minimal Disclosure
To the extent possible, clients are
informed before confidential infor-
mation is disclosed and are involved
in the disclosure decision-making
process. When circumstances require
the disclosure of confidential infor-
mation, only essential information
is revealed.

B.3. Information Shared
With Others

B.3.a. Subordinates
Counselors make every effort to ensure
that privacy and confidentiality of
clients are maintained by subordi-
nates, including employees, supervisees,
students, clerical assistants, and
volunteers.

B.3.b. Interdisciplinary Teams
When services provided to the client
involve participation by an interdisci-
plinary or treatment team, the client
will be informed of the team’s existence
and composition, information being
shared, and the purposes of sharing
such information.

B.3.c. Confidential Settings
Counselors discuss confidential infor-
mation only in settings in which they
can reasonably ensure client privacy.

B.3.d. Third-Party Payers
Counselors disclose information to
third-party payers only when clients
have authorized such disclosure.

B.3.e. Transmitting Confidential
Information

Counselors take precautions to ensure
the confidentiality of all information
transmitted through the use of any
medium.

B.3.f. Deceased Clients
Counselors protect the confidentiality
of deceased clients, consistent with le-
gal requirements and the documented
preferences of the client.

B.4. Groups and Families
B.4.a. Group Work

In group work, counselors clearly
explain the importance and param-
eters of confidentiality for the specific
group.

B.4.b. Couples and Family
Counseling

In couples and family counseling, coun-
selors clearly define who is considered
“the client” and discuss expectations and
limitations of confidentiality. Counselors
seek agreement and document in writing
such agreement among all involved parties
regarding the confidentiality of informa-
tion. In the absence of an agreement to the
contrary, the couple or family is considered
to be the client.

B.5. Clients Lacking Capacity
to Give Informed
Consent

B.5.a. Responsibility to Clients
When counseling minor clients or adult
clients who lack the capacity to give
voluntary, informed consent, counselors
protect the confidentiality of informa-
tion received—in any medium—in the
counseling relationship as specified by
federal and state laws, written policies,
and applicable ethical standards.

B.5.b. Responsibility to Parents
and Legal Guardians

Counselors inform parents and legal
guardians about the role of counselors
and the confidential nature of the coun-
seling relationship, consistent with cur-
rent legal and custodial arrangements.
Counselors are sensitive to the cultural
diversity of families and respect the
inherent rights and responsibilities of
parents/guardians regarding the wel-
fare of their children/charges according
to law. Counselors work to establish,
as appropriate, collaborative relation-
ships with parents/guardians to best
serve clients.

B.5.c. Release of Confidential
Information

When counseling minor clients or
adult clients who lack the capacity
to give voluntary consent to release
confidential information, counselors
seek permission from an appropriate
third party to disclose information.
In such instances, counselors inform
clients consistent with their level of
understanding and take appropriate
measures to safeguard client confi-
dentiality.

B.6. Records and
Documentation

B.6.a. Creating and Maintaining
Records and Documentation

Counselors create and maintain records
and documentation necessary for ren-
dering professional services.

• ACA Code of Ethics •

•  8  •

B.6.i. Reasonable Precautions
Counselors take reasonable precautions
to protect client confidentiality in the
event of the counselor’s termination of
practice, incapacity, or death and ap-
point a records custodian when identi-
fied as appropriate.

B.7. Case Consultation
B.7.a. Respect for Privacy

Information shared in a consulting
relationship is discussed for profes-
sional purposes only. Written and oral
reports present only data germane to the
purposes of the consultation, and every
effort is made to protect client identity
and to avoid undue invasion of privacy.

B.7.b. Disclosure of
Confidential Information

When consulting with colleagues,
counselors do not disclose confidential
information that reasonably could lead
to the identification of a client or other
person or organization with whom they
have a confidential relationship unless
they have obtained the prior consent
of the person or organization or the
disclosure cannot be avoided. They
disclose information only to the extent
necessary to achieve the purposes of the
consultation.

Section C
Professional

Responsibility

Introduction
Counselors aspire to open, honest,
and accurate communication in deal-
ing with the public and other profes-
sionals. Counselors facilitate access to
counseling services, and they practice
in a nondiscriminatory manner within
the boundaries of professional and
personal competence; they also have
a responsibility to abide by the ACA
Code of Ethics. Counselors actively
participate in local, state, and national
associations that foster the develop-
ment and improvement of counseling.
Counselors are expected to advocate
to promote changes at the individual,
group, institutional, and societal lev-
els that improve the quality of life for
individuals and groups and remove
potential barriers to the provision or
access of appropriate services being of-
fered. Counselors have a responsibility
to the public to engage in counseling
practices that are based on rigorous re-

B.6.b. Confidentiality of Records
and Documentation

Counselors ensure that records and
documentation kept in any medium are
secure and that only authorized persons
have access to them.

B.6.c. Permission to Record
Counselors obtain permission from cli-
ents prior to recording sessions through
electronic or other means.

B.6.d. Permission to Observe
Counselors obtain permission from cli-
ents prior to allowing any person to ob-
serve counseling sessions, review session
transcripts, or view recordings of sessions
with supervisors, faculty, peers, or others
within the training environment.

B.6.e. Client Access
Counselors provide reasonable access
to records and copies of records when
requested by competent clients. Coun-
selors limit the access of clients to their
records, or portions of their records,
only when there is compelling evidence
that such access would cause harm to
the client. Counselors document the
request of clients and the rationale for
withholding some or all of the records
in the files of clients. In situations
involving multiple clients, counselors
provide individual clients with only
those parts of records that relate directly
to them and do not include confidential
information related to any other client.

B.6.f. Assistance With Records
When clients request access to their re-
cords, counselors provide assistance and
consultation in interpreting counseling
records.

B.6.g. Disclosure or Transfer
Unless exceptions to confidentiality
exist, counselors obtain written permis-
sion from clients to disclose or transfer
records to legitimate third parties. Steps
are taken to ensure that receivers of
counseling records are sensitive to their
confidential nature.

B.6.h. Storage and Disposal
After Termination

Counselors store records following ter-
mination of services to ensure reasonable
future access, maintain records in ac-
cordance with federal and state laws and
statutes such as licensure laws and policies
governing records, and dispose of client
records and other sensitive materials in a
manner that protects client confidentiality.
Counselors apply careful discretion and
deliberation before destroying records
that may be needed by a court of law, such
as notes on child abuse, suicide, sexual
harassment, or violence.

search methodologies. Counselors are
encouraged to contribute to society by
devoting a portion of their professional
activity to services for which there is
little or no financial return (pro bono
publico). In addition, counselors engage
in self-care activities to maintain and
promote their own emotional, physical,
mental, and spiritual well-being to best
meet their professional responsibilities.

C.1. Knowledge of and
Compliance With
Standards
Counselors have a responsibility to
read, understand, and follow the ACA
Code of Ethics and adhere to applicable
laws and regulations.

C.2. Professional Competence
C.2.a. Boundaries of

Competence
Counselors practice only within the
boundaries of their competence, based
on their education, training, super-
vised experience, state and national
professional credentials, and appropri-
ate professional experience. Whereas
multicultural counseling competency is
required across all counseling specialties,
counselors gain knowledge, personal
awareness, sensitivity, dispositions, and
skills pertinent to being a culturally
competent counselor in working with a
diverse client population.

C.2.b. New Specialty Areas
of Practice

Counselors practice in specialty areas
new to them only after appropriate
education, training, and supervised
experience. While developing skills
in new specialty areas, counselors
take steps to ensure the competence
of their work and protect others from
possible harm.

C.2.c. Qualified for Employment
Counselors accept employment only
for positions for which they are quali-
fied given their education, training,
supervised experience, state and
national professional credentials, and
appropriate professional experience.
Counselors hire for professional coun-
seling positions only individuals who
are qualified and competent for those
positions.

C.2.d. Monitor Effectiveness
Counselors continually monitor their effec-
tiveness as professionals and take steps to
improve when necessary. Counselors take
reasonable steps to seek peer supervision
to evaluate their efficacy as counselors.

• ACA Code of Ethics •

•  9  •

C.2.e. Consultations on
Ethical Obligations

Counselors take reasonable steps to
consult with other counselors, the
ACA Ethics and Professional Standards
Department, or related professionals
when they have questions regarding
their ethical obligations or professional
practice.

C.2.f. Continuing Education
Counselors recognize the need for con-
tinuing education to acquire and main-
tain a reasonable level of awareness
of current scientific and professional
information in their fields of activity.
Counselors maintain their competence
in the skills they use, are open to new
procedures, and remain informed re-
garding best practices for working with
diverse populations.

C.2.g. Impairment
Counselors monitor themselves for
signs of impairment from their own
physical, mental, or emotional problems
and refrain from offering or providing
professional services when impaired.
They seek assistance for problems that
reach the level of professional impair-
ment, and, if necessary, they limit,
suspend, or terminate their professional
responsibilities until it is determined
that they may safely resume their
work. Counselors assist colleagues or
supervisors in recognizing their own
professional impairment and provide
consultation and assistance when war-
ranted with colleagues or supervisors
showing signs of impairment and
intervene as appropriate to prevent
imminent harm to clients.

C.2.h. Counselor Incapacitation,
Death, Retirement, or
Termination of Practice

Counselors prepare a plan for the trans-
fer of clients and the dissemination of
records to an identified colleague or
records custodian in the case of the
counselor’s incapacitation, death, retire-
ment, or termination of practice.

C.3. Advertising and
Soliciting Clients

C.3.a. Accurate Advertising
When advertising or otherwise rep-
resenting their services to the public,
counselors identify their credentials
in an accurate manner that is not false,
misleading, deceptive, or fraudulent.

C.3.b. Testimonials
Counselors who use testimonials do
not solicit them from current clients,
former clients, or any other persons who

may be vulnerable to undue influence.
Counselors discuss with clients the
implications of and obtain permission
for the use of any testimonial.

C.3.c. Statements by Others
When feasible, counselors make reason-
able efforts to ensure that statements
made by others about them or about
the counseling profession are accurate.

C.3.d. Recruiting Through
Employment

Counselors do not use their places of
employment or institutional affiliation to
recruit clients, supervisors, or consultees
for their private practices.

C.3.e. Products and Training
Advertisements

Counselors who develop products
related to their profession or conduct
workshops or training events ensure
that the advertisements concerning
these products or events are accurate
and disclose adequate information for
consumers to make informed choices.

C.3.f. Promoting to Those Served
Counselors do not use counseling,
teaching, training, or supervisory rela-
tionships to promote their products or
training events in a manner that is de-
ceptive or would exert undue influence
on individuals who may be vulnerable.
However, counselor educators may
adopt textbooks they have authored for
instructional purposes.

C.4. Professional Qualifications
C.4.a. Accurate Representation

Counselors claim or imply only profes-
sional qualifications actually completed
and correct any known misrepresenta-
tions of their qualifications by others.
Counselors truthfully represent the qual-
ifications of their professional colleagues.
Counselors clearly distinguish between
paid and volunteer work experience
and accurately describe their continuing
education and specialized training.

C.4.b. Credentials
Counselors claim only licenses or certifica-
tions that are current and in good standing.

C.4.c. Educational Degrees
Counselors clearly differentiate be-
tween earned and honorary degrees.

C.4.d. Implying Doctoral-Level
Competence

Counselors clearly state their highest
earned degree in counseling or a closely
related field. Counselors do not imply
doctoral-level competence when pos-
sessing a master’s degree in counseling
or a related field by referring to them-

selves as “Dr.” in a counseling context
when their doctorate is not in counsel-
ing or a related field. Counselors do not
use “ABD” (all but dissertation) or other
such terms to imply competency.

C.4.e. Accreditation Status
Counselors accurately represent the
accreditation status of their degree pro-
gram and college/university.

C.4.f. Professional Membership
Counselors clearly differentiate between
current, active memberships and former
memberships in associations. Members
of ACA must clearly differentiate be-
tween professional membership, which
implies the possession of at least a mas-
ter’s degree in counseling, and regular
membership, which is open to indi-
viduals whose interests and activities are
consistent with those of ACA but are not
qualified for professional membership.

C.5. Nondiscrimination
Counselors do not condone or engage
in discrimination against prospective or
current clients, students, employees, su-
pervisees, or research participants based
on age, culture, disability, ethnicity, race,
religion/spirituality, gender, gender
identity, sexual orientation, marital/
partnership status, language preference,
socioeconomic status, immigration
status, or any basis proscribed by law.

C.6. Public Responsibility
C.6.a. Sexual Harassment

Counselors do not engage in or condone
sexual harassment. Sexual harassment
can consist of a single intense or severe act,
or multiple persistent or pervasive acts.

C.6.b. Reports to Third Parties
Counselors are accurate, honest, and
objective in reporting their professional
activities and judgments to appropriate
third parties, including courts, health
insurance companies, those who are
the recipients of evaluation reports,
and others.

C.6.c. Media Presentations
When counselors provide advice or com-
ment by means of public lectures, dem-
onstrations, radio or television programs,
recordings, technology-based applica-
tions, printed articles, mailed material,
or other media, they take reasonable
precautions to ensure that

1. the statements are based on ap-
propriate professional counsel-
ing literature and practice,

2. the statements are otherwise
consistent with the ACA Code of
Ethics, and

• ACA Code of Ethics •

•  10  •

3. the recipients of the information
are not encouraged to infer that a
professional counseling relation-
ship has been established.

C.6.d. Exploitation of Others
Counselors do not exploit others in their
professional relationships.

C.6.e. Contributing to the
Public Good
(Pro Bono Publico)

Counselors make a reasonable effort
to provide services to the public for
which there is little or no financial
return (e.g., speaking to groups, shar-
ing professional information, offering
reduced fees).

C.7. Treatment Modalities
C.7.a. Scientific Basis for

Treatment
When providing services, counselors use
techniques/procedures/modalities that
are grounded in theory and/or have an
empirical or scientific foundation.

C.7.b. Development and
Innovation

When counselors use developing or
innovative techniques/procedures/
modalities, they explain the potential
risks, benefits, and ethical considerations
of using such techniques/procedures/
modalities. Counselors work to minimize
any potential risks or harm when using
these techniques/procedures/modalities.

C.7.c. Harmful Practices
Counselors do not use techniques/pro-
cedures/modalities when substantial
evidence suggests harm, even if such
services are requested.

C.8. Responsibility to
Other Professionals

C.8.a. Personal Public
Statements

When making personal statements in a
public context, counselors clarify that they
are speaking from their personal perspec-
tives and that they are not speaking on
behalf of all counselors or the profession.

Section D
Relationships With
Other Professionals

Introduction
Professional counselors recognize
that the quality of their interactions

with colleagues can influence the
quality of services provided to clients.
They work to become knowledgeable
about colleagues within and outside
the field of counseling. Counselors
develop positive working relation-
ships and systems of communication
with colleagues to enhance services
to clients.

D.1. Relationships With
Colleagues, Employers,
and Employees

D.1.a. Different Approaches
Counselors are respectful of approaches
that are grounded in theory and/or
have an empirical or scientific founda-
tion but may differ from their own.
Counselors acknowledge the expertise
of other professional groups and are
respectful of their practices.

D.1.b. Forming Relationships
Counselors work to develop and
strengthen relationships with col-
leagues from other disciplines to best
serve clients.

D.1.c. Interdisciplinary
Teamwork

Counselors who are members of in-
terdisciplinary teams delivering mul-
tifaceted services to clients remain
focused on how to best serve clients.
They participate in and contribute to
decisions that affect the well-being of
clients by drawing on the perspectives,
values, and experiences of the counsel-
ing profession and those of colleagues
from other disciplines.

D.1.d. Establishing
Professional and
Ethical Obligations

Counselors who are members of inter-
disciplinary teams work together with
team members to clarify professional
and ethical obligations of the team as
a whole and of its individual members.
When a team decision raises ethical
concerns, counselors first attempt to
resolve the concern within the team.
If they cannot reach resolution among
team members, counselors pursue
other avenues to address their concerns
consistent with client well-being.

D.1.e. Confidentiality
When counselors are required by law,
institutional policy, or extraordinary
circumstances to serve in more than one
role in judicial or administrative pro-
ceedings, they clarify role expectations
and the parameters of confidentiality
with their colleagues.

D.1.f. Personnel Selection and
Assignment

When counselors are in a position
requiring personnel selection and/or
assigning of responsibilities to others,
they select competent staff and assign
responsibilities compatible with their
skills and experiences.

D.1.g. Employer Policies
The acceptance of employment in an
agency or institution implies that counsel-
ors are in agreement with its general poli-
cies and principles. Counselors strive to
reach agreement with employers regard-
ing acceptable standards of client care
and professional conduct that allow for
changes in institutional policy conducive
to the growth and development of clients.

D.1.h. Negative Conditions
Counselors alert their employers of inap-
propriate policies and practices. They
attempt to effect changes in such policies
or procedures through constructive action
within the organization. When such poli-
cies are potentially disruptive or damaging
to clients or may limit the effectiveness of
services provided and change cannot be af-
fected, counselors take appropriate further
action. Such action may include referral to
appropriate certification, accreditation, or
state licensure organizations, or voluntary
termination of employment.

D.1.i. Protection From
Punitive Action

Counselors do not harass a colleague
or employee or dismiss an employee
who has acted in a responsible and
ethical manner to expose inappropriate
employer policies or practices.

D.2. Provision of
Consultation Services

D.2.a. Consultant Competency
Counselors take reasonable steps to
ensure that they have the appropri-
ate resources and competencies when
providing consultation services. Coun-
selors provide appropriate referral
resources when requested or needed.

D.2.b. Informed Consent in
Formal Consultation

When providing formal consultation
services, counselors have an obligation to
review, in writing and verbally, the rights
and responsibilities of both counselors
and consultees. Counselors use clear
and understandable language to inform
all parties involved about the purpose
of the services to be provided, relevant
costs, potential risks and benefits, and
the limits of confidentiality.

• ACA Code of Ethics •

•  11  •

Section E
Evaluation, Assessment,

and Interpretation

Introduction
Counselors use assessment as one com-
ponent of the counseling process, taking
into account the clients’ personal and
cultural context. Counselors promote the
well-being of individual clients or groups
of clients by developing and using ap-
propriate educational, mental health,
psychological, and career assessments.

E.1. General
E.1.a. Assessment

The primary purpose of educational,
mental health, psychological, and career
assessment is to gather information
regarding the client for a variety of
purposes, including, but not limited
to, client decision making, treatment
planning, and forensic proceedings. As-
sessment may include both qualitative
and quantitative methodologies.

E.1.b. Client Welfare
Counselors do not misuse assessment
results and interpretations, and they
take reasonable steps to prevent others
from misusing the information pro-
vided. They respect the client’s right
to know the results, the interpretations
made, and the bases for counselors’
conclusions and recommendations.

E.2. Competence to Use and
Interpret Assessment
Instruments

E.2.a. Limits of Competence
Counselors use only those testing and as-
sessment services for which they have been
trained and are competent. Counselors
using technology-assisted test interpreta-
tions are trained in the construct being
measured and the specific instrument
being used prior to using its technology-
based application. Counselors take reason-
able measures to ensure the proper use of
assessment techniques by persons under
their supervision.

E.2.b. Appropriate Use
Counselors are responsible for the
appropriate application, scoring, inter-
pretation, and use of assessment instru-
ments relevant to the needs of the client,
whether they score and interpret such
assessments themselves or use technol-
ogy or other services.

E.2.c. Decisions Based on
Results

Counselors responsible for decisions
involving individuals or policies that are
based on assessment results have a thor-
ough understanding of psychometrics.

E.3. Informed Consent
in Assessment

E.3.a. Explanation to Clients
Prior to assessment, counselors explain
the nature and purposes of assessment
and the specific use of results by po-
tential recipients. The explanation will
be given in terms and language that
the client (or other legally authorized
person on behalf of the client) can
understand.

E.3.b. Recipients of Results
Counselors consider the client’s and/
or examinee’s welfare, explicit under-
standings, and prior agreements in de-
termining who receives the assessment
results. Counselors include accurate
and appropriate interpretations with
any release of individual or group as-
sessment results.

E.4. Release of Data to
Qualified Personnel
Counselors release assessment data in
which the client is identified only with
the consent of the client or the client’s
legal representative. Such data are
released only to persons recognized
by counselors as qualified to interpret
the data.

E.5. Diagnosis of
Mental Disorders

E.5.a. Proper Diagnosis
Counselors take special care to provide
proper diagnosis of mental disorders.
Assessment techniques (including
personal interviews) used to determine
client care (e.g., locus of treatment, type
of treatment, recommended follow-up)
are carefully selected and appropri-
ately used.

E.5.b. Cultural Sensitivity
Counselors recognize that culture
affects the manner in which clients’
problems are defined and experienced.
Clients’ socioeconomic and cultural
experiences are considered when diag-
nosing mental disorders.

E.5.c. Historical and Social
Prejudices in the
Diagnosis of Pathology

Counselors recognize historical and so-
cial prejudices in the misdiagnosis and

pathologizing of certain individuals and
groups and strive to become aware of
and address such biases in themselves
or others.

E.5.d. Refraining From
Diagnosis

Counselors may refrain from making
and/or reporting a diagnosis if they
believe that it would cause harm to the
client or others. Counselors carefully
consider both the positive and negative
implications of a diagnosis.

E.6. Instrument Selection
E.6.a. Appropriateness of

Instruments
Counselors carefully consider the
validity, reliability, psychometric limi-
tations, and appropriateness of instru-
ments when selecting assessments and,
when possible, use multiple forms of
assessment, data, and/or instruments
in forming conclusions, diagnoses, or
recommendations.

E.6.b. Referral Information
If a client is referred to a third party
for assessment, the counselor provides
specific referral questions and suf-
ficient objective data about the client
to ensure that appropriate assessment
instruments are utilized.

E.7. Conditions of
Assessment
Administration

E.7.a. Administration
Conditions

Counselors administer assessments
under the same conditions that were
established in their standardization.
When assessments are not administered
under standard conditions, as may be
necessary to accommodate clients with
disabilities, or when unusual behavior
or irregularities occur during the admin-
istration, those conditions are noted in
interpretation, and the results may be
designated as invalid or of question-
able validity.

E.7.b. Provision of Favorable
Conditions

Counselors provide an appropriate
environment for the administration
of assessments (e.g., privacy, comfort,
freedom from distraction).

E.7.c. Technological
Administration

Counselors ensure that technologi-
cally administered assessments func-
tion properly and provide clients with
accurate results.

• ACA Code of Ethics •

•  12  •

adults who lack the capacity to give
voluntary consent are being evaluated,
informed written consent is obtained
from a parent or guardian.

E.13.c. Client Evaluation
Prohibited

Counselors do not evaluate current or
former clients, clients’ romantic partners,
or clients’ family members for forensic
purposes. Counselors do not counsel
individuals they are evaluating.

E.13.d. Avoid Potentially
Harmful Relationships

Counselors who provide forensic
evaluations avoid potentially harmful
professional or personal relationships
with family members, romantic part-
ners, and close friends of individuals
they are evaluating or have evaluated
in the past.

Section F
Supervision, Training,

and Teaching

Introduction
Counselor supervisors, trainers, and
educators aspire to foster meaningful
and respectful professional relation-
ships and to maintain appropriate
boundaries with supervisees and
students in both face-to-face and elec-
tronic formats. They have theoretical
and pedagogical foundations for their
work; have knowledge of supervision
models; and aim to be fair, accurate,
and honest in their assessments of
counselors, students, and supervisees.

F.1. Counselor Supervision
and Client Welfare

F.1.a. Client Welfare
A primary obligation of counseling
supervisors is to monitor the services
provided by supervisees. Counseling
supervisors monitor client welfare and
supervisee performance and profes-
sional development. To fulfill these
obligations, supervisors meet regularly
with supervisees to review the super-
visees’ work and help them become
prepared to serve a range of diverse
clients. Supervisees have a responsibil-
ity to understand and follow the ACA
Code of Ethics.

F.1.b. Counselor Credentials
Counseling supervisors work to ensure
that supervisees communicate their

E.7.d. Unsupervised
Assessments

Unless the assessment instrument is
designed, intended, and validated for
self-administration and/or scoring,
counselors do not permit unsupervised
use.

E.8. Multicultural Issues/
Diversity in Assessment
Counselors select and use with cau-
tion assessment techniques normed
on populations other than that of the
client. Counselors recognize the effects
of age, color, culture, disability, ethnic
group, gender, race, language pref-
erence, religion, spirituality, sexual
orientation, and socioeconomic status
on test administration and interpre-
tation, and they place test results in
proper perspective with other relevant
factors.

E.9. Scoring and Interpretation
of Assessments

E.9.a. Reporting
When counselors report assessment re-
sults, they consider the client’s personal
and cultural background, the level of
the client’s understanding of the results,
and the impact of the results on the
client. In reporting assessment results,
counselors indicate reservations that
exist regarding validity or reliability
due to circumstances of the assessment
or inappropriateness of the norms for
the person tested.

E.9.b. Instruments With
Insufficient Empirical
Data

Counselors exercise caution when
interpreting the results of instruments
not having sufficient empirical data to
support respondent results. The specific
purposes for the use of such instruments
are stated explicitly to the examinee.
Counselors qualify any conclusions, di-
agnoses, or recommendations made that
are based on assessments or instruments
with questionable validity or reliability.

E.9.c. Assessment Services
Counselors who provide assessment,
scoring, and interpretation services to
support the assessment process confirm
the validity of such interpretations.
They accurately describe the purpose,
norms, validity, reliability, and applica-
tions of the procedures and any special
qualifications applicable to their use.
At all times, counselors maintain their
ethical responsibility to those being
assessed.

E.10. Assessment Security
Counselors maintain the integrity
and security of tests and assessments
consistent with legal and contractual
obligations. Counselors do not appro-
priate, reproduce, or modify published
assessments or parts thereof without
acknowledgment and permission from
the publisher.

E.11. Obsolete Assessment
and Outdated Results
Counselors do not use data or results
from assessments that are obsolete or
outdated for the current purpose (e.g.,
noncurrent versions of assessments/
instruments). Counselors make every
effort to prevent the misuse of obsolete
measures and assessment data by others.

E.12. Assessment
Construction
Counselors use established scientific
procedures, relevant standards, and
current professional knowledge for
assessment design in the development,
publication, and utilization of assess-
ment techniques.

E.13. Forensic Evaluation:
Evaluation for
Legal Proceedings

E.13.a. Primary Obligations
When providing forensic evaluations,
the primary obligation of counselors is
to produce objective findings that can be
substantiated based on information and
techniques appropriate to the evalua-
tion, which may include examination of
the individual and/or review of records.
Counselors form professional opinions
based on their professional knowledge
and expertise that can be supported
by the data gathered in evaluations.
Counselors define the limits of their
reports or testimony, especially when
an examination of the individual has
not been conducted.

E.13.b. Consent for Evaluation
Individuals being evaluated are in-
formed in writing that the relationship
is for the purposes of an evaluation and
is not therapeutic in nature, and enti-
ties or individuals who will receive the
evaluation report are identified. Coun-
selors who perform forensic evalua-
tions obtain written consent from those
being evaluated or from their legal
representative unless a court orders
evaluations to be conducted without
the written consent of the individuals
being evaluated. When children or

• ACA Code of Ethics •

•  13  •

qualifications to render services to their
clients.

F.1.c. Informed Consent and
Client Rights

Supervisors make supervisees aware of
client rights, including the protection
of client privacy and confidentiality in
the counseling relationship. Supervis-
ees provide clients with professional
disclosure information and inform
them of how the supervision process
influences the limits of confidential-
ity. Supervisees make clients aware of
who will have access to records of the
counseling relationship and how these
records will be stored, transmitted, or
otherwise reviewed.

F.2. Counselor Supervision
Competence

F.2.a. Supervisor Preparation
Prior to offering supervision services,
counselors are trained in supervision
methods and techniques. Counselors
who offer supervision services regularly
pursue continuing education activities,
including both counseling and supervi-
sion topics and skills.

F.2.b. Multicultural Issues/
Diversity in Supervision

Counseling supervisors are aware of and
address the role of multiculturalism/
diversity in the supervisory relationship.

F.2.c. Online Supervision
When using technology in supervision,
counselor supervisors are competent in
the use of those technologies. Supervi-
sors take the necessary precautions
to protect the confidentiality of all
information transmitted through any
electronic means.

F.3. Supervisory Relationship
F.3.a. Extending Conventional

Supervisory Relationships
Counseling supervisors clearly define
and maintain ethical professional,
personal, and social relationships with
their supervisees. Supervisors con-
sider the risks and benefits of extend-
ing current supervisory relationships
in any form beyond conventional
parameters. In extending these bound-
aries, supervisors take appropriate
professional precautions to ensure that
judgment is not impaired and that no
harm occurs.

F.3.b. Sexual Relationships
Sexual or romantic interactions or rela-
tionships with current supervisees are
prohibited. This prohibition applies to

both in-person and electronic interac-
tions or relationships.

F.3.c. Sexual Harassment
Counseling supervisors do not con-
done or subject supervisees to sexual
harassment.

F.3.d. Friends or Family
Members

Supervisors are prohibited from engag-
ing in supervisory relationships with
individuals with whom they have an
inability to remain objective.

F.4. Supervisor
Responsibilities

F.4.a. Informed Consent for
Supervision

Supervisors are responsible for incor-
porating into their supervision the
principles of informed consent and
participation. Supervisors inform su-
pervisees of the policies and procedures
to which supervisors are to adhere and
the mechanisms for due process appeal
of individual supervisor actions. The
issues unique to the use of distance
supervision are to be included in the
documentation as necessary.

F.4.b. Emergencies and
Absences

Supervisors establish and communi-
cate to supervisees procedures for con-
tacting supervisors or, in their absence,
alternative on-call supervisors to assist
in handling crises.

F.4.c. Standards for Supervisees
Supervisors make their supervisees
aware of professional and ethical
standards and legal responsibilities.

F.4.d. Termination of the
Supervisory Relationship

Supervisors or supervisees have the
right to terminate the supervisory
relationship with adequate notice. Rea-
sons for considering termination are
discussed, and both parties work to
resolve differences. When termination
is warranted, supervisors make appro-
priate referrals to possible alternative
supervisors.

F.5. Student and Supervisee
Responsibilities

F.5.a. Ethical Responsibilities
Students and supervisees have a re-
sponsibility to understand and follow
the ACA Code of Ethics. Students and
supervisees have the same obligation to
clients as those required of professional
counselors.

F.5.b. Impairment
Students and supervisees monitor
themselves for signs of impairment
from their own physical, mental, or
emotional problems and refrain from
offering or providing professional
services when such impairment is
likely to harm a client or others. They
notify their faculty and/or supervi-
sors and seek assistance for problems
that reach the level of professional
impairment, and, if necessary, they
limit, suspend, or terminate their
professional responsibilities until it
is determined that they may safely
resume their work.

F.5.c. Professional Disclosure
Before providing counseling services,
students and supervisees disclose
their status as supervisees and explain
how this status affects the limits of
confidentiality. Supervisors ensure
that clients are aware of the services
rendered and the qualifications of the
students and supervisees rendering
those services. Students and super-
visees obtain client permission before
they use any information concerning
the counseling relationship in the
training process.

F.6. Counseling Supervision
Evaluation, Remediation,
and Endorsement

F.6.a. Evaluation
Supervisors document and provide
supervisees with ongoing feedback
regarding their performance and
schedule periodic formal evaluative
sessions throughout the supervisory
relationship.

F.6.b. Gatekeeping and
Remediation

Through initial and ongoing evalua-
tion, supervisors are aware of super-
visee limitations that might impede
performance. Supervisors assist su-
pervisees in securing remedial assis-
tance when needed. They recommend
dismissal from training programs,
applied counseling settings, and state
or voluntary professional credential-
ing processes when those supervisees
are unable to demonstrate that they
can provide competent professional
services to a range of diverse clients.
Supervisors seek consultation and
document their decisions to dismiss or
refer supervisees for assistance. They
ensure that supervisees are aware of
options available to them to address
such decisions.

• ACA Code of Ethics •

•  14  •

F.6.c. Counseling for
Supervisees

If supervisees request counseling, the
supervisor assists the supervisee in
identifying appropriate services. Su-
pervisors do not provide counseling
services to supervisees. Supervisors
address interpersonal competencies in
terms of the impact of these issues on
clients, the supervisory relationship,
and professional functioning.

F.6.d. Endorsements
Supervisors endorse supervisees for
certification, licensure, employment,
or completion of an academic or train-
ing program only when they believe
that supervisees are qualified for the
endorsement. Regardless of qualifi-
cations, supervisors do not endorse
supervisees whom they believe to be
impaired in any way that would inter-
fere with the performance of the duties
associated with the endorsement.

F.7. Responsibilities of
Counselor Educators

F.7.a. Counselor Educators
Counselor educators who are respon-
sible for developing, implementing,
and supervising educational programs
are skilled as teachers and practitio-
ners. They are knowledgeable regard-
ing the ethical, legal, and regulatory
aspects of the profession; are skilled
in applying that knowledge; and
make students and supervisees aware
of their responsibilities. Whether in
traditional, hybrid, and/or online
formats, counselor educators conduct
counselor education and training
programs in an ethical manner and
serve as role models for professional
behavior.

F.7.b. Counselor Educator
Competence

Counselors who function as counselor
educators or supervisors provide in-
struction within their areas of knowl-
edge and competence and provide
instruction based on current informa-
tion and knowledge available in the
profession. When using technology to
deliver instruction, counselor educators
develop competence in the use of the
technology.

F.7.c. Infusing Multicultural
Issues/Diversity

Counselor educators infuse material
related to multiculturalism/diver-
sity into all courses and workshops
for the development of professional
counselors.

F.7.d. Integration of Study
and Practice

In traditional, hybrid, and/or online
formats, counselor educators establish
education and training programs that
integrate academic study and super-
vised practice.

F.7.e. Teaching Ethics
Throughout the program, counselor
educators ensure that students are
aware of the ethical responsibilities
and standards of the profession and the
ethical responsibilities of students to the
profession. Counselor educators infuse
ethical considerations throughout the
curriculum.

F.7.f. Use of Case Examples
The use of client, student, or supervisee
information for the purposes of case ex-
amples in a lecture or classroom setting
is permissible only when (a) the client,
student, or supervisee has reviewed the
material and agreed to its presentation
or (b) the information has been suf-
ficiently modified to obscure identity.

F.7.g. Student-to-Student
Supervision and
Instruction

When students function in the role of
counselor educators or supervisors,
they understand that they have the
same ethical obligations as counselor
educators, trainers, and supervisors.
Counselor educators make every effort
to ensure that the rights of students are
not compromised when their peers lead
experiential counseling activities in tra-
ditional, hybrid, and/or online formats
(e.g., counseling groups, skills classes,
clinical supervision).

F.7.h. Innovative Theories and
Techniques

Counselor educators promote the use
of techniques/procedures/modalities
that are grounded in theory and/or
have an empirical or scientific founda-
tion. When counselor educators discuss
developing or innovative techniques/
procedures/modalities, they explain the
potential risks, benefits, and ethical con-
siderations of using such techniques/
procedures/modalities.

F.7.i. Field Placements
Counselor educators develop clear
policies and provide direct assistance
within their training programs regard-
ing appropriate field placement and
other clinical experiences. Counselor
educators provide clearly stated roles
and responsibilities for the student or
supervisee, the site supervisor, and the
program supervisor. They confirm that

site supervisors are qualified to provide
supervision in the formats in which
services are provided and inform site
supervisors of their professional and
ethical responsibilities in this role.

F.8. Student Welfare
F.8.a. Program Information and

Orientation
Counselor educators recognize that
program orientation is a developmen-
tal process that begins upon students’
initial contact with the counselor educa-
tion program and continues throughout
the educational and clinical training
of students. Counselor education fac-
ulty provide prospective and current
students with information about the
counselor education program’s expecta-
tions, including

1. the values and ethical principles
of the profession;

2. the type and level of skill and
knowledge acquisition required
for successful completion of the
training;

3. technology requirements;
4. program training goals, objectives,

and mission, and subject matter to
be covered;

5. bases for evaluation;
6. training components that encour-

age self-growth or self-disclosure
as part of the training process;

7. the type of supervision settings
and requirements of the sites for
required clinical field experiences;

8. student and supervisor evalua-
tion and dismissal policies and
procedures; and

9. up-to-date employment pros-
pects for graduates.

F.8.b. Student Career Advising
Counselor educators provide career
advisement for their students and make
them aware of opportunities in the field.

F.8.c. Self-Growth Experiences
Self-growth is an expected component
of counselor education. Counselor edu-
cators are mindful of ethical principles
when they require students to engage
in self-growth experiences. Counselor
educators and supervisors inform stu-
dents that they have a right to decide
what information will be shared or
withheld in class.

F.8.d. Addressing Personal
Concerns

Counselor educators may require stu-
dents to address any personal concerns
that have the potential to affect profes-
sional competency.

• ACA Code of Ethics •

•  15  •

F.11.b. Student Diversity
Counselor educators actively attempt
to recruit and retain a diverse student
body. Counselor educators demonstrate
commitment to multicultural/diversity
competence by recognizing and valuing
the diverse cultures and types of abili-
ties that students bring to the training
experience. Counselor educators pro-
vide appropriate accommodations that
enhance and support diverse student
well-being and academic performance.

F.11.c. Multicultural/Diversity
Competence

Counselor educators actively infuse
multicultural/diversity competency in
their training and supervision practices.
They actively train students to gain
awareness, knowledge, and skills in the
competencies of multicultural practice.

Section G
Research and
Publication

Introduction
Counselors who conduct research are
encouraged to contribute to the knowl-
edge base of the profession and promote
a clearer understanding of the condi-
tions that lead to a healthy and more
just society. Counselors support the
efforts of researchers by participating
fully and willingly whenever possible.
Counselors minimize bias and respect
diversity in designing and implement-
ing research.

G.1. Research Responsibilities
G.1.a. Conducting Research

Counselors plan, design, conduct, and
report research in a manner that is con-
sistent with pertinent ethical principles,
federal and state laws, host institutional
regulations, and scientific standards
governing research.

G.1.b. Confidentiality in
Research

Counselors are responsible for under-
standing and adhering to state, federal,
agency, or institutional policies or appli-
cable guidelines regarding confidential-
ity in their research practices.

G.1.c. Independent Researchers
When counselors conduct independent
research and do not have access to an
institutional review board, they are
bound to the same ethical principles and

F.9. Evaluation and
Remediation

F.9.a. Evaluation of Students
Counselor educators clearly state to stu-
dents, prior to and throughout the train-
ing program, the levels of competency
expected, appraisal methods, and timing
of evaluations for both didactic and clini-
cal competencies. Counselor educators
provide students with ongoing feedback
regarding their performance throughout
the training program.

F.9.b. Limitations
Counselor educators, through ongoing
evaluation, are aware of and address
the inability of some students to achieve
counseling competencies. Counselor
educators do the following:

1. assist students in securing reme-
dial assistance when needed,

2. seek professional consultation
and document their decision to
dismiss or refer students for
assistance, and

3. ensure that students have recourse
in a timely manner to address
decisions requiring them to seek
assistance or to dismiss them and
provide students with due process
according to institutional policies
and procedures.

F.9.c. Counseling for Students
If students request counseling, or if
counseling services are suggested as
part of a remediation process, counselor
educators assist students in identifying
appropriate services.

F.10. Roles and Relationships
Between Counselor
Educators and Students

F.10.a. Sexual or Romantic
Relationships

Counselor educators are prohibited
from sexual or romantic interactions or
relationships with students currently
enrolled in a counseling or related pro-
gram and over whom they have power
and authority. This prohibition applies
to both in-person and electronic interac-
tions or relationships.

F.10.b. Sexual Harassment
Counselor educators do not condone or
subject students to sexual harassment.

F.10.c. Relationships With
Former Students

Counselor educators are aware of the
power differential in the relationship
between faculty and students. Faculty

members discuss with former students
potential risks when they consider
engaging in social, sexual, or other in-
timate relationships.

F.10.d. Nonacademic
Relationships

Counselor educators avoid nonacademic
relationships with students in which
there is a risk of potential harm to the
student or which may compromise the
training experience or grades assigned.
In addition, counselor educators do not
accept any form of professional services,
fees, commissions, reimbursement, or
remuneration from a site for student or
supervisor placement.

F.10.e. Counseling Services
Counselor educators do not serve
as counselors to students currently
enrolled in a counseling or related pro-
gram and over whom they have power
and authority.

F.10.f. Extending Educator–
Student Boundaries

Counselor educators are aware of the
power differential in the relationship
between faculty and students. If they
believe that a nonprofessional relation-
ship with a student may be potentially
beneficial to the student, they take pre-
cautions similar to those taken by
counselors when working with clients.
Examples of potentially beneficial in-
teractions or relationships include, but
are not limited to, attending a formal
ceremony; conducting hospital visits;
providing support during a stressful
event; or maintaining mutual mem-
bership in a professional association,
organization, or community. Coun-
selor educators discuss with students
the rationale for such interactions, the
potential benefits and drawbacks, and
the anticipated consequences for the
student. Educators clarify the specific
nature and limitations of the additional
role(s) they will have with the student
prior to engaging in a nonprofessional
relationship. Nonprofessional relation-
ships with students should be time
limited and/or context specific and
initiated with student consent.

F.11. Multicultural/Diversity
Competence in
Counselor Education
and Training Programs

F.11.a. Faculty Diversity
Counselor educators are committed
to recruiting and retaining a diverse
faculty.

• ACA Code of Ethics •

•  16  •

federal and state laws pertaining to the
review of their plan, design, conduct,
and reporting of research.

G.1.d. Deviation From
Standard Practice

Counselors seek consultation and ob-
serve stringent safeguards to protect
the rights of research participants when
research indicates that a deviation from
standard or acceptable practices may be
necessary.

G.1.e. Precautions to
Avoid Injury

Counselors who conduct research are
responsible for their participants’ wel-
fare throughout the research process
and should take reasonable precautions
to avoid causing emotional, physical, or
social harm to participants.

G.1.f. Principal Researcher
Responsibility

The ultimate responsibility for ethical
research practice lies with the principal
researcher. All others involved in the re-
search activities share ethical obligations
and responsibility for their own actions.

G.2. Rights of Research
Participants

G.2.a. Informed Consent in
Research

Individuals have the right to decline
requests to become research partici-
pants. In seeking consent, counselors
use language that
1. accurately explains the purpose

and procedures to be followed;
2. identifies any procedures that

are experimental or relatively
untried;

3. describes any attendant discom-
forts, risks, and potential power
differentials between researchers
and participants;

4. describes any benefits or changes
in individuals or organizations
that might reasonably be expected;

5. discloses appropriate alternative
procedures that would be advan-
tageous for participants;

6. offers to answer any inquiries
concerning the procedures;

7. describes any limitations on
confidentiality;

8. describes the format and potential
target audiences for the dissemi-
nation of research findings; and

9. instructs participants that they
are free to withdraw their con-
sent and discontinue participa-
tion in the project at any time,
without penalty.

G.2.b. Student/Supervisee
Participation

Researchers who involve students or
supervisees in research make clear to
them that the decision regarding par-
ticipation in research activities does
not affect their academic standing or
supervisory relationship. Students or
supervisees who choose not to partici-
pate in research are provided with an
appropriate alternative to fulfill their
academic or clinical requirements.

G.2.c. Client Participation
Counselors conducting research involv-
ing clients make clear in the informed
consent process that clients are free to
choose whether to participate in re-
search activities. Counselors take neces-
sary precautions to protect clients from
adverse consequences of declining or
withdrawing from participation.

G.2.d. Confidentiality of
Information

Information obtained about research
participants during the course of re-
search is confidential. Procedures are
implemented to protect confidentiality.

G.2.e. Persons Not
Capable of Giving
Informed Consent

When a research participant is not
capable of giving informed consent,
counselors provide an appropriate
explanation to, obtain agreement for
participation from, and obtain the ap-
propriate consent of a legally authorized
person.

G.2.f. Commitments to
Participants

Counselors take reasonable measures
to honor all commitments to research
participants.

G.2.g. Explanations After
Data Collection

After data are collected, counselors
provide participants with full clarifi-
cation of the nature of the study to re-
move any misconceptions participants
might have regarding the research.
Where scientific or human values
justify delaying or withholding infor-
mation, counselors take reasonable
measures to avoid causing harm.

G.2.h. Informing Sponsors
Counselors inform sponsors, insti-
tutions, and publication channels
regarding research procedures and
outcomes. Counselors ensure that
appropriate bodies and authorities
are given pertinent information and
acknowledgment.

G.2.i. Research Records
Custodian

As appropriate, researchers prepare and
disseminate to an identified colleague or
records custodian a plan for the transfer
of research data in the case of their inca-
pacitation, retirement, or death.

G.3. Managing and
Maintaining Boundaries

G.3.a. Extending Researcher–
Participant Boundaries

Researchers consider the risks and ben-
efits of extending current research rela-
tionships beyond conventional param-
eters. When a nonresearch interaction
between the researcher and the research
participant may be potentially ben-
eficial, the researcher must document,
prior to the interaction (when feasible),
the rationale for such an interaction, the
potential benefit, and anticipated con-
sequences for the research participant.
Such interactions should be initiated
with appropriate consent of the research
participant. Where unintentional harm
occurs to the research participant, the
researcher must show evidence of an
attempt to remedy such harm.

G.3.b. Relationships With
Research Participants

Sexual or romantic counselor–research
participant interactions or relationships
with current research participants are
prohibited. This prohibition applies to
both in-person and electronic interactions
or relationships.

G.3.c. Sexual Harassment and
Research Participants

Researchers do not condone or subject re-
search participants to sexual harassment.

G.4. Reporting Results
G.4.a. Accurate Results

Counselors plan, conduct, and report
research accurately. Counselors do not
engage in misleading or fraudulent re-
search, distort data, misrepresent data,
or deliberately bias their results. They
describe the extent to which results are
applicable for diverse populations.

G.4.b. Obligation to Report
Unfavorable Results

Counselors report the results of any
research of professional value. Results
that reflect unfavorably on institutions,
programs, services, prevailing opinions,
or vested interests are not withheld.

G.4.c. Reporting Errors
If counselors discover significant errors
in their published research, they take

• ACA Code of Ethics •

•  17  •

G.5.e. Agreement of
Contributors

Counselors who conduct joint research
with colleagues or students/supervi-
sors establish agreements in advance re-
garding allocation of tasks, publication
credit, and types of acknowledgment
that will be received.

G.5.f. Student Research
Manuscripts or professional presen-
tations in any medium that are sub-
stantially based on a student’s course
papers, projects, dissertations, or theses
are used only with the student’s permis-
sion and list the student as lead author.

G.5.g. Duplicate Submissions
Counselors submit manuscripts for con-
sideration to only one journal at a time.
Manuscripts that are published in whole
or in substantial part in one journal or
published work are not submitted for
publication to another publisher with-
out acknowledgment and permission
from the original publisher.

G.5.h. Professional Review
Counselors who review material sub-
mitted for publication, research, or
other scholarly purposes respect the
confidentiality and proprietary rights
of those who submitted it. Counselors
make publication decisions based on
valid and defensible standards. Coun-
selors review article submissions in a
timely manner and based on their scope
and competency in research methodolo-
gies. Counselors who serve as reviewers
at the request of editors or publishers
make every effort to only review ma-
terials that are within their scope of
competency and avoid personal biases.

Section H
Distance Counseling,

Technology, and
Social Media

Introduction
Counselors understand that the profes-
sion of counseling may no longer be
limited to in-person, face-to-face inter-
actions. Counselors actively attempt to
understand the evolving nature of the
profession with regard to distance coun-
seling, technology, and social media and
how such resources may be used to bet-
ter serve their clients. Counselors strive
to become knowledgeable about these
resources. Counselors understand the

reasonable steps to correct such errors
in a correction erratum or through other
appropriate publication means.

G.4.d. Identity of Participants
Counselors who supply data, aid in
the research of another person, report
research results, or make original data
available take due care to disguise the
identity of respective participants in
the absence of specific authorization
from the participants to do otherwise.
In situations where participants self-
identify their involvement in research
studies, researchers take active steps
to ensure that data are adapted/
changed to protect the identity and
welfare of all parties and that discus-
sion of results does not cause harm to
participants.

G.4.e. Replication Studies
Counselors are obligated to make
available sufficient original research
information to qualified professionals
who may wish to replicate or extend
the study.

G.5. Publications and
Presentations

G.5.a. Use of Case Examples
The use of participants’, clients’, stu-
dents’, or supervisees’ information
for the purpose of case examples in a
presentation or publication is permis-
sible only when (a) participants, clients,
students, or supervisees have reviewed
the material and agreed to its presenta-
tion or publication or (b) the informa-
tion has been sufficiently modified to
obscure identity.

G.5.b. Plagiarism
Counselors do not plagiarize; that is,
they do not present another person’s
work as their own.

G.5.c. Acknowledging
Previous Work

In publications and presentations,
counselors acknowledge and give rec-
ognition to previous work on the topic
by others or self.

G.5.d. Contributors
Counselors give credit through joint
authorship, acknowledgment, foot-
note statements, or other appropriate
means to those who have contributed
significantly to research or concept
development in accordance with such
contributions. The principal contribu-
tor is listed first, and minor technical
or professional contributions are ac-
knowledged in notes or introductory
statements.

additional concerns related to the use
of distance counseling, technology, and
social media and make every attempt
to protect confidentiality and meet any
legal and ethical requirements for the
use of such resources.

H.1. Knowledge and
Legal Considerations

H.1.a. Knowledge and
Competency

Counselors who engage in the use of
distance counseling, technology, and/
or social media develop knowledge and
skills regarding related technical, ethical,
and legal considerations (e.g., special
certifications, additional course work).

H.1.b. Laws and Statutes
Counselors who engage in the use of dis-
tance counseling, technology, and social
media within their counseling practice
understand that they may be subject to
laws and regulations of both the coun-
selor’s practicing location and the client’s
place of residence. Counselors ensure
that their clients are aware of pertinent
legal rights and limitations governing the
practice of counseling across state lines
or international boundaries.

H.2. Informed Consent
and Security

H.2.a. Informed Consent
and Disclosure

Clients have the freedom to choose
whether to use distance counseling,
social media, and/or technology within
the counseling process. In addition to
the usual and customary protocol of
informed consent between counselor
and client for face-to-face counseling,
the following issues, unique to the use of
distance counseling, technology, and/
or social media, are addressed in the
informed consent process:

• distance counseling credentials,
physical location of practice, and
contact information;

• risks and benefits of engaging in
the use of distance counseling,
technology, and/or social media;

• possibility of technology failure
and alternate methods of service
delivery;

• anticipated response time;
• emergency procedures to follow

when the counselor is not available;
• time zone differences;
• cultural and/or language differ-

ences that may affect delivery of
services;

• ACA Code of Ethics •

•  18  •

H.5.b. Client Rights
Counselors who offer distance counseling
services and/or maintain a professional
website provide electronic links to rel-
evant licensure and professional certifica-
tion boards to protect consumer and client
rights and address ethical concerns.

H.5.c. Electronic Links
Counselors regularly ensure that elec-
tronic links are working and are profes-
sionally appropriate.

H.5.d. Multicultural and
Disability Considerations

Counselors who maintain websites
provide accessibility to persons with
disabilities. They provide translation ca-
pabilities for clients who have a different
primary language, when feasible. Coun-
selors acknowledge the imperfect nature
of such translations and accessibilities.

H.6. Social Media
H.6.a. Virtual Professional

Presence
In cases where counselors wish to
maintain a professional and personal
presence for social media use, separate
professional and personal web pages
and profiles are created to clearly distin-
guish between the two kinds of virtual
presence.

H.6.b. Social Media as Part of
Informed Consent

Counselors clearly explain to their clients,
as part of the informed consent procedure,
the benefits, limitations, and boundaries
of the use of social media.

H.6.c. Client Virtual Presence
Counselors respect the privacy of
their clients’ presence on social media
unless given consent to view such
information.

H.6.d. Use of Public
Social Media

Counselors take precautions to avoid
disclosing confidential information
through public social media.

Section I
Resolving Ethical

Issues

Introduction
Professional counselors behave in an
ethical and legal manner. They are
aware that client welfare and trust in

• possible denial of insurance
benefits; and

• social media policy.

H.2.b. Confidentiality
Maintained by the
Counselor

Counselors acknowledge the limitations
of maintaining the confidentiality of
electronic records and transmissions.
They inform clients that individuals
might have authorized or unauthorized
access to such records or transmissions
(e.g., colleagues, supervisors, employ-
ees, information technologists).

H.2.c. Acknowledgment
of Limitations

Counselors inform clients about the
inherent limits of confidentiality when
using technology. Counselors urge
clients to be aware of authorized and/
or unauthorized access to information
disclosed using this medium in the
counseling process.

H.2.d. Security
Counselors use current encryption stan-
dards within their websites and/or tech-
nology-based communications that meet
applicable legal requirements. Counselors
take reasonable precautions to ensure the
confidentiality of information transmitted
through any electronic means.

H.3. Client Verification
Counselors who engage in the use of
distance counseling, technology, and/
or social media to interact with clients
take steps to verify the client’s identity
at the beginning and throughout the
therapeutic process. Verification can
include, but is not limited to, using
code words, numbers, graphics, or other
nondescript identifiers.

H.4. Distance Counseling
Relationship

H.4.a. Benefits and Limitations
Counselors inform clients of the benefits
and limitations of using technology ap-
plications in the provision of counseling
services. Such technologies include, but are
not limited to, computer hardware and/or
software, telephones and applications, so-
cial media and Internet-based applications
and other audio and/or video communi-
cation, or data storage devices or media.

H.4.b. Professional
Boundaries in Distance
Counseling

Counselors understand the necessity of
maintaining a professional relationship
with their clients. Counselors discuss

and establish professional boundaries
with clients regarding the appropriate
use and/or application of technology
and the limitations of its use within
the counseling relationship (e.g., lack
of confidentiality, times when not ap-
propriate to use).

H.4.c. Technology-Assisted
Services

When providing technology-assisted
services, counselors make reasonable
efforts to determine that clients are
intellectually, emotionally, physically,
linguistically, and functionally capable
of using the application and that the ap-
plication is appropriate for the needs of
the client. Counselors verify that clients
understand the purpose and operation
of technology applications and follow
up with clients to correct possible mis-
conceptions, discover appropriate use,
and assess subsequent steps.

H.4.d. Effectiveness of Services
When distance counseling services are
deemed ineffective by the counselor or
client, counselors consider delivering
services face-to-face. If the counselor is
not able to provide face-to-face services
(e.g., lives in another state), the coun-
selor assists the client in identifying
appropriate services.

H.4.e. Access
Counselors provide information to
clients regarding reasonable access to
pertinent applications when providing
technology-assisted services.

H.4.f. Communication
Differences in
Electronic Media

Counselors consider the differences be-
tween face-to-face and electronic com-
munication (nonverbal and verbal cues)
and how these may affect the counseling
process. Counselors educate clients on
how to prevent and address potential
misunderstandings arising from the
lack of visual cues and voice intonations
when communicating electronically.

H.5. Records and
Web Maintenance

H.5.a. Records
Counselors maintain electronic records
in accordance with relevant laws and
statutes. Counselors inform clients on
how records are maintained electroni-
cally. This includes, but is not limited
to, the type of encryption and security
assigned to the records, and if/for how
long archival storage of transaction
records is maintained.

• ACA Code of Ethics •

•  19  •

the profession depend on a high level of
professional conduct. They hold other
counselors to the same standards and
are willing to take appropriate action
to ensure that standards are upheld.
Counselors strive to resolve ethical
dilemmas with direct and open commu-
nication among all parties involved and
seek consultation with colleagues and
supervisors when necessary. Counselors
incorporate ethical practice into their
daily professional work and engage
in ongoing professional development
regarding current topics in ethical and
legal issues in counseling. Counselors
become familiar with the ACA Policy
and Procedures for Processing Com-
plaints of Ethical Violations1 and use
it as a reference for assisting in the
enforcement of the ACA Code of Ethics.

I.1. Standards and the Law
I.1.a. Knowledge

Counselors know and understand the
ACA Code of Ethics and other applicable
ethics codes from professional organiza-
tions or certification and licensure bod-
ies of which they are members. Lack of
knowledge or misunderstanding of an
ethical responsibility is not a defense
against a charge of unethical conduct.

I.1.b. Ethical Decision Making
When counselors are faced with an eth-
ical dilemma, they use and document,
as appropriate, an ethical decision-
making model that may include, but
is not limited to, consultation; consid-
eration of relevant ethical standards,
principles, and laws; generation of
potential courses of action; deliberation
of risks and benefits; and selection of
an objective decision based on the cir-
cumstances and welfare of all involved.

I.1.c. Conflicts Between Ethics
and Laws

If ethical responsibilities conflict with
the law, regulations, and/or other gov-

erning legal authority, counselors make
known their commitment to the ACA
Code of Ethics and take steps to resolve
the conflict. If the conflict cannot be re-
solved using this approach, counselors,
acting in the best interest of the client,
may adhere to the requirements of the
law, regulations, and/or other govern-
ing legal authority.

I.2. Suspected Violations
I.2.a. Informal Resolution

When counselors have reason to believe
that another counselor is violating or has
violated an ethical standard and substan-
tial harm has not occurred, they attempt
to first resolve the issue informally with
the other counselor if feasible, provided
such action does not violate confidential-
ity rights that may be involved.

I.2.b. Reporting Ethical
Violations

If an apparent violation has substantially
harmed or is likely to substantially harm
a person or organization and is not ap-
propriate for informal resolution or is not
resolved properly, counselors take fur-
ther action depending on the situation.
Such action may include referral to state
or national committees on professional
ethics, voluntary national certification
bodies, state licensing boards, or ap-
propriate institutional authorities. The
confidentiality rights of clients should be
considered in all actions. This standard
does not apply when counselors have
been retained to review the work of
another counselor whose professional
conduct is in question (e.g., consultation,
expert testimony).

I.2.c. Consultation
When uncertain about whether a
particular situation or course of ac-
tion may be in violation of the ACA
Code of Ethics, counselors consult with
other counselors who are knowledge-
able about ethics and the ACA Code

of Ethics, with colleagues, or with
appropriate authorities, such as the
ACA Ethics and Professional Stan-
dards Department.

I.2.d. Organizational Conflicts
If the demands of an organization with
which counselors are affiliated pose
a conflict with the ACA Code of Ethics,
counselors specify the nature of such
conflicts and express to their supervi-
sors or other responsible officials their
commitment to the ACA Code of Ethics
and, when possible, work through the
appropriate channels to address the
situation.

I.2.e. Unwarranted Complaints
Counselors do not initiate, participate
in, or encourage the filing of ethics com-
plaints that are retaliatory in nature or are
made with reckless disregard or willful
ignorance of facts that would disprove
the allegation.

I.2.f. Unfair Discrimination
Against Complainants
and Respondents

Counselors do not deny individuals
employment, advancement, admission
to academic or other programs, tenure,
or promotion based solely on their
having made or their being the subject
of an ethics complaint. This does not
preclude taking action based on the
outcome of such proceedings or con-
sidering other appropriate information.

I.3. Cooperation With
Ethics Committees
Counselors assist in the process of
enforcing the ACA Code of Ethics.
Counselors cooperate with investiga-
tions, proceedings, and requirements
of the ACA Ethics Committee or eth-
ics committees of other duly consti-
tuted associations or boards having
jurisdiction over those charged with
a violation.

1See the American Counseling Association web site at http://www.counseling.org/knowledge-center/ethics

• ACA Code of Ethics •

•  20  •

Glossary of Terms
Abandonment – the inappropriate ending or arbitrary ter-

mination of a counseling relationship that puts the client
at risk.

Advocacy – promotion of the well-being of individuals, groups,
and the counseling profession within systems and organiza-
tions. Advocacy seeks to remove barriers and obstacles that
inhibit access, growth, and development.

Assent – to demonstrate agreement when a person is oth-
erwise not capable or competent to give formal consent
(e.g., informed consent) to a counseling service or plan.

Assessment – the process of collecting in-depth information
about a person in order to develop a comprehensive plan
that will guide the collaborative counseling and service
provision process.

Bartering – accepting goods or services from clients in ex-
change for counseling services.

Client – an individual seeking or referred to the professional
services of a counselor.

Confidentiality – the ethical duty of counselors to protect a
client’s identity, identifying characteristics, and private
communications.

Consultation – a professional relationship that may include,
but is not limited to, seeking advice, information, and/
or testimony.

Counseling – a professional relationship that empowers
diverse individuals, families, and groups to accomplish
mental health, wellness, education, and career goals.

Counselor Educator – a professional counselor engaged
primarily in developing, implementing, and supervising
the educational preparation of professional counselors.

Counselor Supervisor – a professional counselor who en-
gages in a formal relationship with a practicing counselor
or counselor-in-training for the purpose of overseeing that
individual’s counseling work or clinical skill development.

Culture – membership in a socially constructed way of liv-
ing, which incorporates collective values, beliefs, norms,
boundaries, and lifestyles that are cocreated with others
who share similar worldviews comprising biological,
psychosocial, historical, psychological, and other factors.

Discrimination – the prejudicial treatment of an individual
or group based on their actual or perceived membership
in a particular group, class, or category.

Distance Counseling – The provision of counseling services
by means other than face-to-face meetings, usually with
the aid of technology.

Diversity – the similarities and differences that occur within
and across cultures, and the intersection of cultural and
social identities.

Documents – any written, digital, audio, visual, or artistic
recording of the work within the counseling relationship
between counselor and client.

Encryption – process of encoding information in such a way
that limits access to authorized users.

Examinee – a recipient of any professional counseling ser-
vice that includes educational, psychological, and career
appraisal, using qualitative or quantitative techniques.

Exploitation – actions and/or behaviors that take advantage
of another for one’s own benefit or gain.

Fee Splitting – the payment or acceptance of fees for client
referrals (e.g., percentage of fee paid for rent, referral fees).

Forensic Evaluation – the process of forming professional opin-
ions for court or other legal proceedings, based on professional
knowledge and expertise, and supported by appropriate data.

Gatekeeping – the initial and ongoing academic, skill, and
dispositional assessment of students’ competency for pro-
fessional practice, including remediation and termination
as appropriate.

Impairment – a significantly diminished capacity to perform
professional functions.

Incapacitation – an inability to perform professional functions.
Informed Consent – a process of information sharing as-

sociated with possible actions clients may choose to take,
aimed at assisting clients in acquiring a full appreciation
and understanding of the facts and implications of a given
action or actions.

Instrument – a tool, developed using accepted research
practices, that measures the presence and strength of a
specified construct or constructs.

Interdisciplinary Teams – teams of professionals serving
clients that may include individuals who may not share
counselors’ responsibilities regarding confidentiality.

Minors – generally, persons under the age of 18 years, un-
less otherwise designated by statute or regulation. In
some jurisdictions, minors may have the right to consent
to counseling without consent of the parent or guardian.

Multicultural/Diversity Competence – counselors’ cul-
tural and diversity awareness and knowledge about
self and others, and how this awareness and knowledge
are applied effectively in practice with clients and cli-
ent groups.

Multicultural/Diversity Counseling – counseling that recog-
nizes diversity and embraces approaches that support the
worth, dignity, potential, and uniqueness of individuals
within their historical, cultural, economic, political, and
psychosocial contexts.

Personal Virtual Relationship – engaging in a relationship
via technology and/or social media that blurs the profes-
sional boundary (e.g., friending on social networking
sites); using personal accounts as the connection point for
the virtual relationship.

Privacy – the right of an individual to keep oneself and one’s
personal information free from unauthorized disclosure.

Privilege – a legal term denoting the protection of confidential
information in a legal proceeding (e.g., subpoena, deposi-
tion, testimony).

Pro bono publico – contributing to society by devoting a por-
tion of professional activities for little or no financial return
(e.g., speaking to groups, sharing professional information,
offering reduced fees).

Professional Virtual Relationship – using technology and/
or social media in a professional manner and maintain-
ing appropriate professional boundaries; using business
accounts that cannot be linked back to personal accounts
as the connection point for the virtual relationship (e.g., a
business page versus a personal profile).

Records – all information or documents, in any medium, that
the counselor keeps about the client, excluding personal
and psychotherapy notes.

Records of an Artistic Nature – products created by the client
as part of the counseling process.

Records Custodian – a professional colleague who agrees to
serve as the caretaker of client records for another mental
health professional.

Self-Growth – a process of self-examination and challeng-
ing of a counselor’s assumptions to enhance professional
effectiveness.

• ACA Code of Ethics •

•  21  •

Serious and Foreseeable – when a reasonable counselor
can anticipate significant and harmful possible conse-
quences.

Sexual Harassment – sexual solicitation, physical advances,
or verbal/nonverbal conduct that is sexual in nature; oc-
curs in connection with professional activities or roles;
is unwelcome, offensive, or creates a hostile workplace
or learning environment; and/or is sufficiently severe
or intense to be perceived as harassment by a reason-
able person.

Social Justice – the promotion of equity for all people and
groups for the purpose of ending oppression and injustice
affecting clients, students, counselors, families, communi-
ties, schools, workplaces, governments, and other social
and institutional systems.

Social Media – technology-based forms of communica-
tion of ideas, beliefs, personal histories, etc. (e.g., social
networking sites, blogs).

Student – an individual engaged in formal graduate-level
counselor education.

Supervisee – a professional counselor or counselor-in-train-
ing whose counseling work or clinical skill development

is being overseen in a formal supervisory relationship by
a qualified trained professional.

Supervision – a process in which one individual, usually a
senior member of a given profession designated as the
supervisor, engages in a collaborative relationship with
another individual or group, usually a junior member(s)
of a given profession designated as the supervisee(s) in
order to (a) promote the growth and development of the
supervisee(s), (b) protect the welfare of the clients seen by
the supervisee(s), and (c) evaluate the performance of the
supervisee(s).

Supervisor – counselors who are trained to oversee the profes-
sional clinical work of counselors and counselors-in-training.

Teaching – all activities engaged in as part of a formal edu-
cational program that is designed to lead to a graduate
degree in counseling.

Training – the instruction and practice of skills related
to the counseling profession. Training contributes to
the ongoing proficiency of students and professional
counselors.

Virtual Relationship – a non–face-to-face relationship (e.g.,
through social media).

Index
ACA Code of Ethics Preamble …………………… 3
ACA Code of Ethics Purpose …………………….. 3
Section A: The Counseling

Relationship …………………………………….. 4
Section A: Introduction ………………………….. 4
A.1. Client Welfare …………………………………. 4
A.1.a. Primary Responsibility ………………… 4
A.1.b. Records and Documentation ……….. 4
A.1.c. Counseling Plans …………………………. 4
A.1.d. Support Network Involvement …… 4
A.2. Informed Consent in the

Counseling Relationship ………………….. 4
A.2.a. Informed Consent ……………………….. 4
A.2.b. Types of Information Needed ……… 4
A.2.c. Developmental and

Cultural Sensitivity ………………………….. 4
A.2.d. Inability to Give Consent …………….. 4
A.2.e. Mandated Clients ………………………… 4
A.3. Clients Served by Others ……………….. 4
A.4. Avoiding Harm and

Imposing Values ……………………………….. 4
A.4.a. Avoiding Harm ……………………………. 4
A.4.b. Personal Values …………………………… 5
A.5. Prohibited Noncounseling Roles

and Relationships …………………………….. 5
A.5.a. Sexual and/or Romantic

Relationships Prohibited ………………….. 5
A.5.b. Previous Sexual and/or

Romantic Relationships ……………………. 5
A.5.c. Sexual and/or Romantic

Relationships With Former
Clients ………………………………………………. 5

A.5.d. Friends or Family Members ………… 5
A.5.e. Personal Virtual Relationships

With Current Clients ………………………… 5
A.6. Managing and Maintaining

Boundaries and Professional
Relationships…………………………………….. 5

A.6.a. Previous Relationships ………………… 5
A.6.b. Extending Counseling

Boundaries ………………………………………. 5
A.6.c. Documenting Boundary

Extensions ……………………………………….. 5
A.6.d. Role Changes in the

Professional Relationship …………………. 5
A.6.e. Nonprofessional Interactions or

Relationships (Other Than Sexual or
Romantic Interactions or
Relationships) ………………………………….. 5

A.7. Roles and Relationships at
Individual, Group, Institutional,
and Societal Levels ……………………………. 5

A.7.a. Advocacy …………………………………….. 5
A.7.b. Confidentiality and Advocacy …….. 5
A.8. Multiple Clients ……………………………… 6
A.9. Group Work ……………………………………. 6
A.9.a. Screening …………………………………….. 6
A.9.b. Protecting Clients ………………………… 6
A.10. Fees and Business Practices …………… 6
A.10.a. Self-Referral ………………………………. 6
A.10.b. Unacceptable Business

Practices …………………………………………… 6
A.10.c. Establishing Fees ……………………….. 6
A.10.d. Nonpayment of Fees …………………. 6
A.10.e. Bartering ……………………………………. 6
A.10.f. Receiving Gifts …………………………… 6
A.11. Termination and Referral ………………. 6
A.11.a. Competence Within

Termination and Referral …………………. 6
A.11.b. Values Within Termination

and Referral ……………………………………… 6
A.11.c. Appropriate Termination …………… 6
A.11.d. Appropriate Transfer of

Services ……………………………………………. 6
A.12. Abandonment and

Client Neglect ………………………………….. 6

Section B: Confidentiality and Privacy …. 6
Section B: Introduction ………………………….. 6
B.1. Respecting Client Rights ………………….. 6
B.1.a. Multicultural/Diversity

Considerations …………………………………. 6
B.1.b. Respect for Privacy ………………………. 6
B.1.c. Respect for Confidentiality …………… 7
B.1.d. Explanation of Limitations ………….. 7
B.2. Exceptions ……………………………………….. 7
B.2.a. Serious and Foreseeable Harm

and Legal Requirements ………………….. 7
B.2.b. Confidentiality Regarding

End-of-Life Decisions ………………………. 7
B.2.c. Contagious, Life-Threatening

Diseases …………………………………………… 7
B.2.d. Court-Ordered Disclosure ……………. 7
B.2.e. Minimal Disclosure ……………………… 7
B.3. Information Shared With Others ……… 7
B.3.a. Subordinates ………………………………… 7
B.3.b. Interdisciplinary Teams ……………….. 7
B.3.c. Confidential Settings ……………………. 7
B.3.d. Third-Party Payers ………………………. 7
B.3.e. Transmitting Confidential

Information ……………………………………… 7
B.3.f. Deceased Clients …………………………… 7
B.4. Groups and Families ………………………. 7
B.4.a. Group Work …………………………………. 7
B.4.b. Couples and Family Counseling ………7
B.5. Clients Lacking Capacity to

Give Informed Consent ……………………. 7
B.5.a. Responsibility to Clients ………………. 7
B.5.b. Responsibility to Parents and

Legal Guardians ………………………………. 7
B.5.c. Release of Confidential

Information ……………………………………… 7
B.6. Records and Documentation ……………. 7
B.6.a. Creating and Maintaining Records

and Documentation ………………………………7

• ACA Code of Ethics •

•  22  •

B.6.b. Confidentiality of Records
and Documentation …………………………. 8

B.6.c. Permission to Record ……………………. 8
B.6.d. Permission to Observe …………………. 8
B.6.e. Client Access ………………………………… 8
B.6.f. Assistance With Records ………………. 8
B.6.g. Disclosure or Transfer ………………….. 8
B.6.h. Storage and Disposal

After Termination …………………………….. 8
B.6.i. Reasonable Precautions ………………… 8
B.7. Case Consultation ……………………………. 8
B.7.a. Respect for Privacy ………………………. 8
B.7.b. Disclosure of Confidential

Information ……………………………………… 8
Section C: Professional Responsibility ……..8
Section C: Introduction …………………………… 8
C.1. Knowledge of and Compliance

With Standards ………………………………… 8
C.2. Professional Competence ……………….. 8
C.2.a. Boundaries of Competence ………….. 8
C.2.b. New Specialty Areas of Practice ….. 8
C.2.c. Qualified for Employment …………… 8
C.2.d. Monitor Effectiveness ………………….. 8
C.2.e. Consultations on Ethical

Obligations ……………………………………….. 9
C.2.f. Continuing Education ………………….. 9
C.2.g. Impairment …………………………………. 9
C.2.h. Counselor Incapacitation,

Death, Retirement, or Termination
of Practice ………………………………………… 9

C.3. Advertising and Soliciting Clients …… 9
C.3.a. Accurate Advertising …………………… 9
C.3.b. Testimonials ………………………………… 9
C.3.c. Statements by Others …………………… 9
C.3.d. Recruiting Through

Employment …………………………………….. 9
C.3.e. Products and Training

Advertisements ………………………………… 9
C.3.f. Promoting to Those Served ………….. 9
C.4. Professional Qualifications ……………… 9
C.4.a. Accurate Representation ……………… 9
C.4.b. Credentials ………………………………….. 9
C.4.c. Educational Degrees ……………………. 9
C.4.d. Implying Doctoral-Level

Competence …………………………………….. 9
C.4.e. Accreditation Status …………………….. 9
C.4.f. Professional Membership …………….. 9
C.5. Nondiscrimination …………………………. 9
C.6. Public Responsibility ……………………… 9
C.6.a. Sexual Harassment ………………………. 9
C.6.b. Reports to Third Parties ………………. 9
C.6.c. Media Presentations …………………….. 9
C.6.d. Exploitation of Others ……………….. 10
C.6.e. Contributing to the Public Good

(Pro Bono Publico) ……………………………. 10
C.7. Treatment Modalities …………………….. 10
C.7.a. Scientific Basis for Treatment ……… 10
C.7.b. Development and Innovation ……. 10
C.7.c. Harmful Practices ………………………. 10
C.8. Responsibility to Other

Professionals …………………………………… 10
C.8.a. Personal Public Statements ………… 10
Section D: Relationships With

Other Professionals ………………………. 10
Section D: Introduction ……………………….. 10
D.1. Relationships With Colleagues,

Employers, and Employees …………….. 10
D.1.a. Different Approaches ………………… 10
D.1.b. Forming Relationships ………………. 10
D.1.c. Interdisciplinary Teamwork ………. 10
D.1.d. Establishing Professional and

Ethical Obligations …………………………. 10
D.1.e. Confidentiality …………………………… 10

D.1.f. Personnel Selection and
Assignment ……………………………………. 10

D.1.g. Employer Policies ……………………… 10
D.1.h. Negative Conditions …………………. 10
D.1.i. Protection From Punitive Action
D.2. Provision of Consultation Services … 10
D.2.a. Consultant Competency ……………. 10
D.2.b. Informed Consent in

Formal Consultation ………………………. 10
Section E: Evaluation, Assessment,

and Interpretation …………………………. 11
Section E: Introduction ………………………… 11
E.1. General …………………………………………. 11
E.1.a. Assessment …………………………………. 11
E.1.b. Client Welfare …………………………….. 11
E.2. Competence to Use and

Interpret Assessment Instruments …… 11
E.2.a. Limits of Competence ………………… 11
E.2.b. Appropriate Use ………………………… 11
E.2.c. Decisions Based on Results ………… 11
E.3. Informed Consent in Assessment ….. 11
E.3.a. Explanation to Clients ………………… 11
E.3.b. Recipients of Results ………………….. 11
E.4. Release of Data to Qualified

Personnel ……………………………………….. 11
E.5. Diagnosis of Mental Disorders ………. 11
E.5.a. Proper Diagnosis ………………………… 11
E.5.b. Cultural Sensitivity ……………………. 11
E.5.c. Historical and Social Prejudices

in the Diagnosis of Pathology ………… 11
E.5.d. Refraining From Diagnosis ………… 11
E.6. Instrument Selection………………………. 11
E.6.a. Appropriateness of Instruments …. 11
E.6.b. Referral Information ………………….. 11
E.7. Conditions of Assessment

Administration ………………………………. 11
E.7.a. Administration Conditions ………… 11
E.7.b. Provision of Favorable

Conditions ……………………………………… 11
E.7.c. Technological Administration …….. 11
E.7.d. Unsupervised Assessments ……….. 12
E.8. Multicultural Issues/Diversity

in Assessment ………………………………… 12
E.9. Scoring and Interpretation

of Assessments ……………………………….. 12
E.9.a. Reporting …………………………………… 12
E.9.b. Instruments With Insufficient

Empirical Data ………………………………… 12
E.9.c. Assessment Services …………………… 12
E.10. Assessment Security …………………….. 12
E.11. Obsolete Assessment and

Outdated Results …………………………….. 12
E.12. Assessment Construction ……………. 12
E.13. Forensic Evaluation: Evaluation

for Legal Proceedings …………………….. 12
E.13.a. Primary Obligations …………………. 12
E.13.b. Consent for Evaluation …………….. 12
E.13.c. Client Evaluation

Prohibited ………………………………………. 12
E.13.d. Avoid Potentially Harmful

Relationships ………………………………….. 12
Section F: Supervision, Training,

and Teaching …………………………………. 12
Section F: Introduction …………………………. 12
F.1. Counselor Supervision and

Client Welfare …………………………………. 12
F.1.a. Client Welfare ……………………………… 12
F.1.b. Counselor Credentials ………………… 12
F.1.c. Informed Consent and

Client Rights ………………………………….. 13
F.2. Counselor Supervision

Competence …………………………………… 13
F.2.a. Supervisor Preparation ……………….. 13

F.2.b. Multicultural Issues/Diversity
in Supervision ………………………………… 13

F.2.c. Online Supervision ………………………. 13
F.3. Supervisory Relationship ……………….. 13
F.3.a. Extending Conventional

Supervisory Relationships ………………. 13
F.3.b. Sexual Relationships …………………… 13
F.3.c. Sexual Harassment ……………………… 13
F.3.d. Friends or Family Members ……….. 13
F.4. Supervisor Responsibilities …………….. 13
F.4.a. Informed Consent for

Supervision ……………………………………. 13
F.4.b. Emergencies and Absences …………. 13
F.4.c. Standards for Supervisees …………… 13
F.4.d. Termination of the Supervisory

Relationship …………………………………… 13
F.5. Student and Supervisee

Responsibilities ……………………………….. 13
F.5.a. Ethical Responsibilities ……………….. 13
F.5.b. Impairment ………………………………… 13
F.5.c. Professional Disclosure ……………….. 13
F.6. Counseling Supervision Evaluation,

Remediation, and Endorsement ……… 13
F.6.a. Evaluation ………………………………….. 13
F.6.b. Gatekeeping and Remediation ……. 13
F.6.c. Counseling for Supervisees …………. 14
F.6.d. Endorsements …………………………….. 14
F.7. Responsibilities of Counselor

Educators ………………………………………… 14
F.7.a. Counselor Educators …………………… 14
F.7.b. Counselor Educator Competence .. 14
F.7.c. Infusing Multicultural

Issues/Diversity …………………………….. 14
F.7.d. Integration of Study and Practice …. 14
F.7.e. Teaching Ethics …………………………… 14
F.7.f. Use of Case Examples …………………. 14
F.7.g. Student-to-Student Supervision

and Instruction ………………………………. 14
F.7.h. Innovative Theories and

Techniques ……………………………………… 14
F.7.i. Field Placements ………………………….. 14
F.8. Student Welfare …………………………….. 14
F.8.a. Program Information and

Orientation ……………………………………… 14
F.8.b. Student Career Advising …………….. 14
F.8.c. Self-Growth Experiences …………….. 14
F.8.d. Addressing Personal Concerns …… 14
F.9. Evaluation and Remediation ………….. 15
F.9.a. Evaluation of Students ……………….. 15
F.9.b. Limitations …………………………………. 15
F.9.c. Counseling for Students ……………… 15
F.10. Roles and Relationships

Between Counselor Educators
and Students …………………………………… 15

F.10.a. Sexual or Romantic
Relationships ………………………………….. 15

F.10.b. Sexual Harassment …………………… 15
F.10.c. Relationships With Former

Students …………………………………………. 15
F.10.d. Nonacademic Relationships ……… 15
F.10.e. Counseling Services ………………….. 15
F.10.f. Extending Educator–Student

Boundaries ……………………………………… 15
F.11. Multicultural/Diversity Competence

in Counselor Education and
Training Programs…………………………… 15

F.11.a. Faculty Diversity ………………………. 15
F.11.b. Student Diversity ……………………… 15
F.11.c. Multicultural/Diversity

Competence …………………………………… 15
Section G: Research and Publication ….. 15
Section G: Introduction ……………………….. 15
G.1. Research Responsibilities ……………… 15

• ACA Code of Ethics •

•  23  •

G.1.a. Conducting Research …………………. 15
G.1.b. Confidentiality in Research ……….. 15
G.1.c. Independent Researchers …………… 15
G.1.d. Deviation From Standard

Practice …………………………………………… 16
G.1.e. Precautions to Avoid Injury ……….. 16
G.1.f. Principal Researcher

Responsibility ………………………………… 16
G.2. Rights of Research Participants ……… 16
G.2.a. Informed Consent in Research …… 16
G.2.b. Student/Supervisee

Participation …………………………………… 16
G.2.c. Client Participation ……………………. 16
G.2.d. Confidentiality of Information ……. 16
G.2.e. Persons Not Capable of Giving

Informed Consent …………………………… 16
G.2.f. Commitments to Participants …….. 16
G.2.g. Explanations After Data

Collection ……………………………………….. 16
G.2.h. Informing Sponsors …………………… 16
G.2.i. Research Records Custodian ………. 16
G.3. Managing and Maintaining

Boundaries …………………………………….. 16
G.3.a. Extending Researcher–

Participant Boundaries …………………… 16
G.3.b. Relationships With Research

Participants ……………………………………. 16
G.3.c. Sexual Harassment and

Research Participants ……………………… 16
G.4. Reporting Results ………………………….. 16
G.4.a. Accurate Results ………………………… 16
G.4.b. Obligation to Report

Unfavorable Results ……………………….. 16
G.4.c. Reporting Errors ………………………… 16

G.4.d. Identity of Participants ……………… 17
G.4.e. Replication Studies ……………………. 17
G.5. Publications and Presentations ……… 17
G.5.a. Use of Case Examples ………………… 17
G.5.b. Plagiarism …………………………………. 17
G.5.c. Acknowledging Previous Work …… 17
G.5.d. Contributors ……………………………… 17
G.5.e. Agreement of Contributors ………… 17
G.5.f. Student Research ………………………… 17
G.5.g. Duplicate Submissions ………………. 17
G.5.h. Professional Review ………………….. 17
Section H: Distance Counseling,

Technology, and
Social Media …………………………………… 17

Section H: Introduction ………………………… 17
H.1. Knowlede and

Legal Considerations ……………………… 17
H.1.a. Knowledge and Competency …….. 17
H.1.b. Laws and Statutes ……………………… 17
H.2. Informed Consent and Security …….. 17
H.2.a. Informed Consent and Disclosure …. 17
H.2.b. Confidentiality Maintained by

the Counselor …………………………………. 18
H.2.c. Acknowledgment of

Limitations ……………………………………… 18
H.2.d. Security ……………………………………… 18
H.3. Client Verification ………………………… 18
H.4. Distance Counseling

Relationship …………………………………… 18
H.4.a. Benefits and Limitations …………….. 18
H.4.b. Professional Boundaries in

Distance Counseling ……………………….. 18
H.4.c. Technology-Assisted Services …….. 18
H.4.d. Effectiveness of Services …………….. 18

H.4.e. Access ………………………………………… 18
H.4.f. Communication Differences in

Electronic Media ……………………………… 18
H.5. Records and Web Maintenance ……… 18
H.5.a. Records ………………………………………. 18
H.5.b. Client Rights ………………………………. 18
H.5.c. Electronic Links …………………………. 18
H.5.d. Multicultural and Disability

Considerations ……………………………….. 18
H.6. Social Media………………………………….. 18
H.6.a. Virtual Professional Presence …….. 18
H.6.b. Social Media as Part of

Informed Consent …………………………… 18
H.6.c. Client Virtual Presence ………………. 18
H.6.d. Use of Public Social Media ………… 18
Section I: Resolving Ethical Issues ……… 18
Section I: Introduction ………………………….. 18
I.1. Standards and the Law …………………… 19
I.1.a. Knowledge ………………………………….. 19
I.1.b. Ethical Decision Making ……………… 19
I.1.c. Conflicts Between Ethics

and Laws ……………………………………….. 19
I.2. Suspected Violations ………………………. 19
I.2.a. Informal Resolution …………………….. 19
I.2.b. Reporting Ethical Violations ……….. 19
I.2.c. Consultation ………………………………… 19
I.2.d. Organizational Conflicts ……………… 19
I.2.e. Unwarranted Complaints
I.2.f. Unfair Discrimination Against

Complainants and
Respondents …………………………………… 19

I.3. Cooperation With Ethics
Committees ……………………………………. 19

Glossary of Terms ……………………………….. 20

Ethics Related Resources
From ACA!

• Free consultation on ethics for ACA Members

• Bestselling publications revised in accordance with the
2014 Code of Ethics, including ACA Ethical Standards
Casebook, Boundary Issues in Counseling, Ethics Desk
Reference for Counselors, and The Counselor and the Law

• Podcast and six-part webinar series on the 2014 Code

• The latest information on ethics at counseling.org/ethics

AMERICAN COUNSELING
ASSOCIATION

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Alexandria, VA 22304

counseling.org • 800-422-2648 x222
Note: This document may be reproduced in its entirety
without permission for non-commercial purposes only.

A s professionals working with people in distress,
practicing psychologists themselves tend to face
undue stress. Some practitioners functioning in

the role of helper are far more concerned with their clients’
well-being than with their own.

Yet a proactive approach to self-care is crucial for effectively
managing occupational and personal stressors and for
maintaining optimal wellness. Good self-care is sound
prevention – guarding you against severe or chronic
distress or even professional impairment.

The global economic downturn may intensify the challenges
facing practitioners. For example, stress levels may spike for
psychologists experiencing financial concerns or hardship
while they work with clients in similar or worse situations.
In a December 2008 survey of American Psychological

Association (APA) members, up to one-third reported that
the economy had a negative impact on the number of
clients seen, income and employment security.

In good economic times and bad, practicing psychologists
have an abiding ethical imperative to engage in self-care.
The APA Ethical Principles of Psychologists and Code of Conduct
(2002, Principal A) states that: “Psychologists strive to be
aware of the possible effect of their own physical and
mental health on their ability to help those with whom they
work.”

The same self-care guidance that psychologists offer to
clients is useful for the caregivers themselves. Consider the
following self-care pointers:

� Make personal and professional self-care a priority.

� Honestly assess your psychological and physical health.
Focus on prevention rather than simply on remedying
problems such as inactivity, over commitment or poor
nutrition.

� Find time for activities that are personally restorative
such as brisk walking or other forms of exercise, yoga,
pleasure reading, journaling, meditation and massage.

16 APA PRACTICE ORGANIZATION

An Action Plan for Self-Care

EIGHT BENEFITS OF SELF-CARE

� Reduces occupational hazards such as burnout
and compassion fatigue

� Helps build resilience

� Models healthy behavior for clients

� Promotes quality of caring

� Increases the capacity for empathy

� Fortifies relationships with clients and others

� Enhances self-esteem and confidence

� Contributes to realistic goal setting

Consider how guidance for patients may apply to you

TAKING CARE OF YOURSELF

� Avoid isolation. Identify sources of social support and
use them. In addition to close family members and
friends, sources of social support might include local
civic groups or spiritual organizations, for example.

� Establish and maintain professional connections that
offer an opportunity to discuss the specific nature and
stressors of your work. Consider when it may be helpful
or necessary to tap into peer support groups or
consultation, make connections with colleagues through
professional associations or engage in personal
psychotherapy. Pay attention to possible warning signs
such as feelings of helplessness, emotional swings,
tendency to ruminate, loss of empathy or disconnecting
from family and friends.

� Take occupational risks seriously, and be aware of the
particular risks facing practicing psychologists. If
necessary, educate yourself more fully about topics such
as professional burnout, vicarious traumatization,
compassion fatigue and colleague assistance.
Incorporate this learning into your professional training
and continuing education.

� Develop realistic and reasonable expectations about
work and your capabilities at any given time. Make
appropriate accommodations or adjustments – such as
limiting your caseload or consulting with peers – in light
of professional stressors and risks that you are
experiencing.

� Pay attention to the need for balance in work, rest and
play. If your schedule is packed, be prepared to say “no”
to additional demands on your time. Take vacations or
other appropriate breaks from work. Monitor carefully
the substances and/or processes you use for relaxation
or entertainment.

� Pursue opportunities for intellectual stimulation,
including some outside the profession. Nurture interests
apart from psychology.

� Take steps to enhance your career satisfaction. Many
psychologists find it satisfying to diversify their pro-
fessional activities, perhaps incorporating a niche practice
area when the market opportunity arises. Some find it
stimulating to combine clinical and non-clinical work.

� Adopt a long-range perspective, recognizing that you
likely will have different needs at various stages of your
career. Beginning to engage in self-care practices as an
early career professional can help them become a habit.

Self-care activities should be tailored to your individual
circumstances and needs. The pointers above are intended
as healthy food for thought to help you develop a personal
action plan that works for you.

GOOD PRACTICE Spring/Summer 2009 17

PROBLEMS MOST LIKELY TO AFFECT
PSYCHOLOGIST FUNCTIONING

Problem Percentage*

Traumatic events (such as being affected by 100
war or natural disaster)

Licensing board complaints 86

Stress/burnout 54

Vicarious trauma/compassion fatigue 48

Anxiety 25

MOST FREQUENT RESPONSES
TO PROBLEMS

Response Percentage**

Talk to a colleague 34

Exercise 27

Seek family or social support 24

Consultation/supervision 23

Psychotherapy/counseling 18

Reduce clinical load 16

Participate in hobbies 16

Source: APA Board of Professional Affairs Advisory
Committee on Colleague Assistance (ACCA), 2007 pilot
survey of licensed APA members

* Percentage of respondents (n = 169) reporting that this
problem was likely to affect functioning.

** Percentage of respondents utilizing this response.

This material was developed in collaboration with the APA Board of
Professional Affairs’ Advisory Committee on Colleague Assistance (ACCA).

• 016_GoodPractice_SprSum09
• 017_GoodPractice_SprSum09

Journal of Counseling & Development ■ Winter 2007 ■ Volume 8524
© 2007 by the American Counseling Association. All rights reserved.

For many decades, counselors and counseling psychologists
have been concerned with the relationship between individu-
als’ mental health and the social milieus in which people live.
As the racial and ethnic diversity of the United States con-
tinues to increase, the need for mental health professionals
to tailor their mental health services to the needs of various
cultural populations has become more germane (Constantine,
Kindaichi, Arorash, Donnelly, & Jung, 2002). In particular,
the growing recognition of the negative consequences of
oppression in the lives of people of color has been crucial
in helping many counselors and counseling psychologists to
identify effective interventions to address such issues and to
work more broadly to effect social change (Hage, 2003; Vera
& Speight, 2003). Such awareness and actions have paralleled
the emergence of the multicultural competence movement
(Arredondo & Perez, 2003; Sue et al., 1982).

Multicultural competence generally is defined as the extent
to which counselors possess appropriate levels of self-aware-
ness, knowledge, and skills in working with individuals from
diverse cultural backgrounds (Arredondo et al., 1996; Sue,
Arredondo, & McDavis, 1992). In particular, self-aware-
ness entails being cognizant of one’s attitudes, beliefs, and
values regarding race, ethnicity, and culture, along with
one’s awareness of the sociopolitical relevance of cultural
group membership in terms of issues of cultural privilege,
discrimination, and oppression. The knowledge dimension
of multicultural competence refers to information one has
about various worldview orientations, histories of oppression
endured by marginalized populations, and culture-specific
values that influence the subjective and collective experi-
ences of marginalized populations. The skills component of
multicultural competence involves the ability to draw from an

existing fund of cultural knowledge to design mental health
interventions that are relevant to marginalized populations.
In many respects, multicultural competence has become
inextricably linked to counselors’ and counseling psycholo-
gists’ ability to commit to and actualize an agenda of social
justice (Kiselica & Robinson, 2001).

Social justice reflects a fundamental valuing of fairness
and equity in resources, rights, and treatment for marginal-
ized individuals and groups of people who do not share equal
power in society because of their immigration, racial, ethnic,
age, socioeconomic, religious heritage, physical ability, or
sexual orientation status groups (Fondacaro & Weinberg,
2002; Prilleltensky & Nelson, 1997). In order to address
social justice issues, some counselors and counseling psy-
chologists in the United States have adopted a professional
commitment to ensuring global or international social change
(Osborne et al., 1998). Others have been involved primar-
ily at a domestic level by being concerned with helping
members of U.S. society to deal with the personal, societal,
and institutional barriers that impede their academic, per-
sonal, social, or career development. Both of these levels
of involvement in social justice issues, however, are critical
in understanding the interdependence of macrosystems and
microsystems in people’s lives, especially in the lives of
marginalized populations.

In this article, we discuss the historical and contemporary
connection to social justice issues in the fields of counsel-
ing and counseling psychology vis-à-vis the multicultural
counseling movement. In addition, we underscore ways that
social justice issues can be incorporated into counselors’ and
counseling psychologists’ work with culturally diverse clients
and into the curricula of academic training programs.

Madonna G. Constantine, Sally M. Hage, and Mai M. Kindaichi, Department of Counseling and Clinical Psychology, all at Teach-
ers College, Columbia University; Rhonda M. Bryant, Department of Counseling, Educational Leadership and Foundations, Albany
State University. Correspondence concerning this article should be addressed to Madonna G. Constantine, Department of Counsel-
ing and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 92, New York, NY 10027 (e-mail:
mc81�@columbia.edu).

Social Justice and Multicultural Issues:
Implications for the Practice and
Training of Counselors and
Counseling Psychologists
Madonna G. Constantine, Sally M. Hage, Mai M. Kindaichi, and
Rhonda M. Bryant

The authors discuss the historical and contemporary connection to social justice issues in the fields of counseling and
counseling psychology via the multicultural counseling movement. In addition, the authors present ways in which social
justice issues can be addressed in counselors’ and counseling psychologists’ work with clients from diverse cultural
backgrounds and in graduate training programs.

Journal of Counseling & Development ■ Winter 2007 ■ Volume 85 25

Social Justice and Multicultural Issues

Social Justice and the Multicultural
Competencies: Their Connections
to the Fields of Counseling and
Counseling Psychology

Within the fields of counseling and counseling psychology,
the holistic, strengths-based philosophy about human nature
and its emphasis on instituting culturally relevant psychoedu-
cational, developmental, social, and vocational interventions
for diverse populations have provided fertile ground for many
social justice initiatives (Vera & Speight, 2003). In fact, many
counselors and counseling psychologists have functioned
as leaders in identifying and implementing guidelines that
address multicultural competence in mental health profes-
sionals (e.g., American Psychological Association [APA],
2003; Arredondo et al., 1996; Sue et al., 1992; Sue et al.,
1982; Sue et al., 1998). The development of such guidelines
or “competencies” has exemplified these fields’ commitment
to social change and remedying social injustices by assisting
various mental health professionals to understand individuals’
circumstances and concerns from a more ecological perspec-
tive (Fondacaro & Weinberg, 2002; Vera & Speight, 2003).
Moreover, the Multicultural Competencies have contributed to
greater awareness of the potentially oppressive roles that these
professionals could unintentionally play through unfounded
assumptions about the universality of cultures and human
experiences (Arredondo & Perez, 2003).

The original presentation of the Multicultural Counseling
Competencies was published in a counseling psychology
journal in the early 1980s (i.e., Sue et al., 1982). Ten years
later, under the leadership of Thomas A. Parham, then-
president of the Association for Counseling and Multicultural
Development, the second iteration of the Multicultural Coun-
seling Competencies was presented (i.e., Sue et al., 1992). In
1996, Arredondo et al. issued a framework that operationalized
the revised version of the Multicultural Counseling Competen-
cies. In 1998, Sue et al. added two competencies related to
organizational multicultural competence. Previous delineations
of the Multicultural Counseling Competencies served as the
backbone of the recent “Guidelines on Multicultural Educa-
tion, Training, Research, Practice, and Organizational Change
for Psychologists” (APA, 2003), which was endorsed by the
APA Council of Representatives in August 2002. Thus, the
broader field of psychology was challenged to adhere to these
aspirational guidelines to promote multicultural competence
in various dimensions of professional practice (e.g., service
delivery, research, and training).

The Multicultural Counseling Competencies (Sue et
al., 1992) were developed as an independent social justice
movement devoted to increasing the relevance of mental
health practice, research, and training to diverse populations
(Arredondo & Perez, 2003). However, most of the existing

literature related to the Multicultural Competencies reflects
attention to issues of social justice at a microlevel (e.g.,
individual counseling and small-group interventions). Such
interventions, however, are generally limited in their ability to
foster broader social change and, consequently, to bring about
true social justice (Helms, 2003). Fairly recent writings (e.g.,
Blustein, Elman, & Gerstein, 2001; Eriksen, 1999; Fox, 2003;
Jackson, 2000; Lee, 1997; Prilleltensky & Prilleltensky, 2003;
Vera & Speight, 2003) have called for increasing numbers of
counselors and counseling psychologists to engage in profes-
sional roles that attend more fully to social and contextual
forces that affect people’s mental health and well-being. As
such, in conducting social justice work, some of these mental
health professionals have adopted roles that have taken them
beyond their offices to settings such as community centers,
churches, school systems, and even legislative bodies for
the purpose of facilitating systemic changes in response to
social injustices (Hage, 2003; Kiselica & Robinson, 2001;
Thompson, Murry, Harris, & Annan, 2003). In addition, coun-
selors and counseling psychologists have been encouraged
to assume preventive mental health roles (e.g., Hage, 2003;
Romano & Hage, 2000) as extensions of social justice and
multicultural agendas.

In our clinical and research work in the areas of multicul-
tural competence and social justice, we have identified nine
specific social justice competencies that we believe are impor-
tant for counselors and counseling psychologists to consider
as they work with increasingly diverse cultural populations in
the United States. These competencies are as follows:

1. Become knowledgeable about the various ways op-
pression and social inequities can be manifested at
the individual, cultural, and societal levels, along
with the ways such inequities might be experienced
by various individuals, groups, organizations, and
macrosystems.

2. Participate in ongoing critical reflection on issues of
race, ethnicity, oppression, power, and privilege in
your own life.

3. Maintain an ongoing awareness of how your own
positions of power or privilege might inadvertently
replicate experiences of injustice and oppression in in-
teracting with stakeholding groups (e.g., clients, com-
munity organizations, and research participants).

4. Question and challenge therapeutic or other interven-
tion practices that appear inappropriate or exploitative
and intervene preemptively, or as early as feasible,
to promote the positive well-being of individuals or
groups who might be affected.

5. Possess knowledge about indigenous models of health
and healing and actively collaborate with such entities,
when appropriate, in order to conceptualize and imple-
ment culturally relevant and holistic interventions.

Journal of Counseling & Development ■ Winter 2007 ■ Volume 852�

Constantine, Hage, Kindaichi, & Bryant

6. Cultivate an ongoing awareness of the various types of
social injustices that occur within international contexts;
such injustices frequently have global implications.

7. Conceptualize, implement, and evaluate comprehen-
sive preventive and remedial mental health interven-
tion programs that are aimed at addressing the needs
of marginalized populations.

8. Collaborate with community organizations in
democratic partnerships to promote trust, minimize
perceived power differentials, and provide culturally
relevant services to identified groups.

9. Develop system intervention and advocacy skills to
promote social change processes within institutional
settings, neighborhoods, and communities.

Social Justice Issues and
Counseling Practice

Active involvement in advocacy, community outreach, and
public policy making are prime examples of interventions that
can promote attention to social justice issues among practic-
ing counselors and counseling psychologists (Eriksen, 1999;
Hage, 2003; Vera & Speight, 2003). In the spirit of encour-
aging mental health professionals to broaden their potential
repertoire of helping behaviors beyond those associated with
providing individual counseling or psychotherapy, Atkinson,
Thompson, and Grant (1993) presented a framework that
addressed eight potential helping roles in relation to working
with diverse cultural populations: (a) facilitator of indigenous
healing methods, (b) facilitator of indigenous support systems,
(c) adviser, (d) advocate, (e) change agent, (f) consultant, (g)
counselor, and (h) psychotherapist. Atkinson et al. proposed
that the assumption of any given role(s) depended on the
interaction of three client-based factors: clients’ level of ac-
culturation (i.e., the degree to which clients identify with the
values, beliefs, customs, and institutions of their culture of
origin and the host culture), the locus of the etiology of clients’
presenting problem(s) (i.e., the extent to which clients’ pre-
senting issues stem from internal issues or dynamics or from
external sources), and the goals of intervention or treatment
(i.e., the desired outcomes of helping).

Mental health professionals often adopt the counselor and
psychotherapist roles because they have been taught almost
exclusively to do so in the context of their training programs
(Constantine et al., 2002). However, the assumption of such
roles without full consideration of clients’ level of accultura-
tion, problem etiology, and treatment goals might result in the
delivery of ineffective or culturally irrelevant services. For
example, some low-acculturated individuals might experi-
ence interpersonal difficulties stemming from internal issues
(e.g., low self-esteem), but these individuals may not feel
comfortable or safe in helping relationships with counselors
or counseling psychologists who are not members of their
indigenous frameworks of helping (e.g., family members or

close friends). In such cases, these clients might benefit more
from working with counselors or counseling psychologists
who are able to serve as facilitators of indigenous support
systems or facilitators of indigenous healing methods. In
adopting either of these latter roles, these mental health
professionals should be aware of the potential functions and
importance of indigenous cultural resources, such as family
and friendship networks, religious figures and institutions,
respected community elders or leaders, and “energy healers,”
who could provide assistance that might be more synchronous
with some clients’ worldviews and values.

The roles of adviser, consultant, advocate, and change
agent embody tenets of social justice and activism through
client empowerment and advocacy. In particular, counselors
and counseling psychologists serve as advocates and change
agents when they communicate or interface with structures,
organizations, or institutions that marginalized or disenfran-
chised individuals or groups of people perceive as inherently
oppressive to their well-being. For example, a Black gay
male real estate agent, repeatedly overlooked for promotions
despite an exceptional sales record, might seek counseling or
psychotherapy to address his depressive symptoms arising
from a sense of feeling powerless at work. Although counsel-
ing or psychotherapy might assist this client in achieving his
stated presenting goal, the client also might be helped by a
counselor or counseling psychologist who could assume other
roles such as (a) aiding the client to identify his experiences
regarding racial and/or sexual discrimination and (b) helping
the client to identify potential legal recourses related to his
experiences of discrimination on the job (e.g., serving as an
adviser or consultant). The client also could be encouraged to
join a gay men’s support group or a support group consisting
of men of color in order to obtain support for discussing is-
sues of discrimination based on race or sexual orientation (i.e.,
serving as a facilitator of an indigenous support system). This
example shows that counselors and counseling psychologists
committed to principles of social justice must develop skills in
creativity and courage in order to ameliorate the consequences
of social injustice.

Using the following case example, we illustrate some ways
in which several of Atkinson et al.’s (1993) helping roles
outside of those of counselor and psychotherapist might be
assumed by a counselor or counseling psychologist working
with an international college student.

Case Example

Lydia (a pseudonym) is a 20-year-old, 3rd-year college student
from Lima, Peru, who attends a predominantly White univer-
sity in the midwestern United States. According to the intake
counselor at the university college center, Lydia presented
with issues related to feelings of homesickness. Throughout
her college experience, Lydia stated that she has struggled to
“fit” into the campus community. She also indicated that she
daydreams about her life in Peru, especially her friends and

Journal of Counseling & Development ■ Winter 2007 ■ Volume 85 27

Social Justice and Multicultural Issues

family, and that she misses speaking Spanish. Lydia spoke fluent
English, with a very slight Peruvian accent. At the end of her
intake session, Lydia requested to work with a Latina therapist,
preferably one who spoke Spanish. However, no Latina counselor
was available for ongoing counseling sessions, so Lydia was as-
signed to work with an Asian American female counselor.

During her initial counseling sessions, Lydia discussed her
erratic sleeping patterns, noting that her sleep cycles had been
short and interrupted over the past 3 weeks. She also stated that
she often had to remind herself to eat and that she had been
feeling lethargic and disinterested in her academic courses.
In addition, she reported that she had begun to withdraw from
her friends in the dorm because, she said, she “doesn’t want
to burden them with my problems.”

Lydia indicated that her symptoms began shortly after the
semester had begun, about 1 month ago. After 2 years of work-
ing part time as a teller with a Latino male supervisor with
whom she was on friendly terms, the supervisor left and was
replaced by a White woman. When Lydia was under review
for a salary increase, a financial discrepancy arose in which
the bank till was short. The female supervisor denied Lydia a
raise, despite a flawless work record, and then accused Lydia of
stealing from the bank. During this same time period, Lydia’s
philosophy professor asked her to respond to a question in
class, to which she hesitated because she felt “self-conscious”
about her accent and ability to articulate her thoughts clearly.
In the middle of Lydia’s response, her professor interrupted
and said, “Hurry up, chica,” to which her classmates laughed.
Lydia felt mortified, and, shortly after these incidents, she
became easily distracted from her studies and cared less about
schoolwork in general. Lydia remarked,

It’s not only that I think I don’t fit in here, but it’s like nobody
really wants me here, and I don’t want to be here either. I work
20 hours a week at the bank with that woman and twice as
long as other students [in completing homework assignments].
Somehow, even though my grades are good, I feel down and
drained. I try to show my teachers that I’m as smart as every-
body else, but they keep asking me if I need a tutor and to speak
quicker. I feel like no one else is going through what I’m going
through. Maybe I should just go back home to Lima.

Discussion of the Case Example

Lydia’s intake counselor initially had conceptualized her
situation as involving feelings of homesickness. However,
as Lydia worked with her assigned counselor, it appeared
that her experiences of cultural discrimination in her work
setting and in her classes had precipitated some depressive
symptoms. Lydia’s counselor explored her feelings about her
employment and educational experiences as related to ethnic
and gender discrimination and considered additional ways she
might be able to help address some of Lydia’s concerns in ways
that extended beyond their direct one-on-one work together.
For example, her counselor assumed the role of adviser by

educating Lydia about how to access civil protections against
discrimination, such as consulting with the campus Affirma-
tive Action Office and the Equal Employment Opportunity
Commission. The counselor also undertook a change agent
role on the university campus by offering cultural sensitivity
workshops to faculty members and students, focusing on rais-
ing participants’ awareness of international college students’
cultural adjustment experiences. Such a role could represent
one potential way of indirectly helping Lydia and other inter-
national students to experience less distress related to cultural
insensitivities or racism on campus. Lydia’s counselor also
served as a facilitator of an indigenous support system by
referring Lydia to a Latino(a) student organization so that she
could interact with and obtain support from other Latino(a)s
on campus who might be experiencing similar issues.

Social Justice Issues and
Counseling Training

To prepare future counselors and counseling psychologists
to assume social justice roles, it is vital that the structure,
requirements, and goals of many graduate training programs
are modified to assist students in developing competencies to
intervene at broader levels. Social justice training initiatives,
which often include applied service delivery components
(e.g., Kenny & Gallagher, 2000; Pearlman & Bilodeau, 1999;
Victims’ Service Program, 1992), have offered some graduate
students in counseling and counseling psychology with oppor-
tunities to translate their academic knowledge into real-world
contexts by developing and implementing innovative models
and programs within large community sites and by becoming
involved in social policy work (Pearlman & Bilodeau, 1999).
For example, service-learning training programs can provide
students with a practical understanding of large-scale societal
inequities, along with mechanisms by which they may intervene
to effect change (Kenny & Gallagher, 2000). In addition,
service-learning programs could offer opportunities to gain
valuable research, evaluation, and program development skills
in the context of community mental health settings, which coun-
selor and counseling psychology trainees could then transfer to
other related settings (Kenny & Gallagher, 2000).

Some counselor and counseling psychology training pro-
grams also might consider including educational, legal, and
public policy institutions as experiential or applied learning
sites for the development of critical social justice competen-
cies among their students. For example, Boston College has
partnered with the Boston Public School System’s School-to-
Career program to facilitate academic–community collabora-
tion and to provide trainees with an opportunity to learn from
educational empowerment programs (Hartung & Blustein,
2002). Within this partnership, trainees work with ninth-grade
students by offering career counseling psychoeducational
services focusing on four areas (i.e., identity development, rec-
ognizing resources and barriers to academic and career goals,

Journal of Counseling & Development ■ Winter 2007 ■ Volume 8528

Constantine, Hage, Kindaichi, & Bryant

bridging school and work, and building personal strengths).
Academic–legal collaborations also may offer counselor and
counseling psychology trainees with opportunities to witness
litigation issues related to the victimization of specific groups
of people, such as racial discrimination and sexual harassment
cases. Furthermore, collaborations with legal entities or insti-
tutions might provide these trainees with increased fluency in
navigating bureaucratic processes (Fox, 1993, 1999).

Working in social justice training settings that emphasize
less traditional helping roles could challenge some counselor
and counseling psychology trainees to work outside of their
comfort zones. Moreover, trainees who work with some com-
munity action organizations might encounter difficulties in the
initial stages of establishing trust with some of these entities,
particularly if these students and the community’s constituents
are racially, ethnically, and/or socioeconomically different from
each other. Hence, it is vital that counselor and counseling
psychology trainees who engage in social advocacy work with
organizations reflect on their personal ecological histories and
how their values, beliefs, and privileges can either facilitate or
undermine their work efforts (Prilleltensky, 2001). Experience
in community-based social justice settings also could contribute
to these trainees’ abilities to self-reflect about issues of race,
ethnicity, oppression, power, and privilege relative to their own
lives (Mulvey et al., 2000) and to nurture their competence in
working with a broader array of individuals.

Another potential issue related to counselor and counseling
psychology training and social justice initiatives pertains to
the importance of trainees critically examining their ethical
judgment and decision-making styles in relation to clients
from diverse cultural populations. For example, Welfel and
Lipsitz (1983) reported that counselors’ ethical orientation
was positively correlated with moral reasoning, counseling
experience, and number of contributions made to profes-
sional and social action organizations. If attention is given to
understanding how ethical orientation and decision-making
processes of counselor and counseling psychology trainees
might relate to the assumption of social justice initiatives in
a professional context, it might encourage these students to
recognize areas that might need attention with regard to their
competence as service providers.

Lee (1997) asserted that mental health professionals should
become better trained to understand social justice issues from a
more global perspective. This point is based on the notion that
as the interconnectedness of the world becomes increasingly
acknowledged in psychology, social and economic forces will
continue to reshape the composition of societies throughout
the world and narrow the physical and social distance between
groups of people. As such, counselor and counseling psychol-
ogy training programs also should focus on worldwide social
transformation and the need for mental health intervention at
the individual, group, organizational, societal, and interna-
tional levels. Hence, counselor and counseling psychology
trainees should be encouraged and required to understand

how mental health issues may be manifested in populations
residing outside of the United States.

One mechanism that could provide counseling and counseling
psychology students with applied training in this vein would be
the opportunity to conduct a practicum or internship outside of
the United States (Lee, 1997). For example, in a collection of
narratives by feminist community psychologists (Mulvey et al.,
2000), Ingrid Huygens described how her efforts to engage Maori
women in a lesbian health promotion group forced her to reevalu-
ate her notions of relationship building, in comparison with Maori
cultural practices that initiate collaborations. Her efforts also led
her to realize that the numerical or physical representation of
people from marginalized groups within certain contexts was
not necessarily equivalent to the sharing of procedural power in
such contexts. Thus, opportunities for counselor and counseling
psychology trainees to participate in foreign exchange programs
would expose students to different cultural ecologies and racial
landscapes that could encourage them to reflect more deliberately
on their status as helpers and as cultural beings (Lee, 1997).

Finally, counselor and counseling psychology training pro-
grams might consider increasing the emphasis given to preven-
tion in their curricula and research initiatives (Conyne, 1997;
Romano & Hage, 2000). In addition to developing practicums
that give greater emphasis to applying and evaluating preven-
tion interventions, a prevention focus could be achieved either
through freestanding courses or through infusion into existing
courses. Romano and Hage suggested eight training domains
relevant to prevention that could be the content of such course
work: community and multidisciplinary collaboration, social
and political history, protective factors and risk-reduction
strategies, systemic intervention, political and social environ-
ment, psychoeducational groups for prevention, prevention
research and evaluation, and prevention ethics. These training
domains could provide students with knowledge and skills to
engage effectively in the practice of prevention.

Conclusion
Counselors and counseling psychologists must continue to
think creatively about how to address social justice issues
in their own work with clients and with students in training
in their fields. As leaders in the multicultural competence
movement, counselors and counseling psychologists are also
in unique and powerful positions to educate their peers about
the importance of mental health professionals achieving
appropriate levels of competence in working with diverse
cultural populations. Counselors and counseling psycholo-
gists are situated in an optimal position to help society’s in-
habitants understand the undue effects of social injustices for
the well-being of the larger society. The increasing cultural
diversity of the United States underscores the importance
and timeliness of these issues, which ultimately could have
profound implications for the well-being of individuals
around the world.

Journal of Counseling & Development ■ Winter 2007 ■ Volume 85 29

Social Justice and Multicultural Issues

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Journal of Counseling & Development ■ April 2014 ■ Volume 92 131

Special Section:
Professionalism, Ethics, and
Value-Based Conflicts in Counseling

© 2014 by the American Counseling Association. All rights reserved.

DOI: 10.1002/j.1556-6676.2014.00138.x

The primary purpose of a code of ethics, for any profession, is
to establish norms and expectations for practitioners in order
to collectively minimize the risk of harm to clients and the
general public (Welfel, 2010). In a broader sense, a code of
ethics is also a reflection of the profession’s collective values
and moral principles. Indeed, the establishment of a code of
ethics, which communicates a normative orientation to the
service of others and a commitment to protect the welfare
of clients, is considered the “hallmark of professionalism”
(Gorman & Sandefur, 2011, p. 279). Promulgation of a code
of ethics places the needs and interests of clients over and
above the personal needs or values of any individual member
of the profession (DeMitchell, Hebert, & Phan, 2013; Gor-
man & Sandefur, 2011). A code of ethics helps to ensure
the primacy of client welfare by articulating a profession’s
collective set of values and communicating standards of prac-
tice for all members of that profession. Because laws set the
minimum standards of acceptable behavior, ethical standards
often exceed the legal requirements articulated in federal and
state laws (Corey, Corey, & Callanan, 2011). Entry into and
continued association with a profession requires all of its
practitioners to make a commitment that they will abide by
the profession’s code of ethics and the profession’s collective
values as reflected in that code.

By all measures, counseling is a profession (Gorman
& Sandefur, 2011). Counseling is a vocation that requires
individuals to obtain specific, university-based training to
acquire expertise in a specialized set of knowledge and
skills; confers status and power upon its members; has an

Perry C. Francis and Suzanne M. Dugger, Department of Leadership and Counseling, Eastern Michigan University. Correspon-
dence concerning this article should be addressed to Perry C. Francis, Department of Leadership and Counseling, Eastern Michigan
University, 135 Porter Building, Ypsilanti, MI 48197 (e-mail: pfrancis@emich.edu).

Professionalism, Ethics, and
Value-Based Conflicts in Counseling:
An

Introduction to the Special Section

Perry C. Francis and Suzanne M. Dugger, Guest Editors

This introduction to this special section of the Journal of Counseling & Development explores the importance of a code
of ethics to the establishment and maintenance of a profession. Recognizing a code of ethics as a communication of
a profession’s collective values and expectations, the editors of this special section acknowledge the dilemmas that
arise when a counselor’s personal values do not align with the profession’s collective values. The authors of each
article address value-based conflicts in counseling.

Keywords: counselor training, ethics, litigation, religion, LGBT

established national association through which it establishes
a collective identity, communicates professional values, dis-
seminates scholarly research, and advocates for its members;
and regulates itself through licensure and a code of ethics.

Although counselors vary with regard to specializations
and/or the settings in which they practice, they are united as a
single profession through the American Counseling Associa-
tion (ACA). Through this umbrella association, counselors
of varied specializations come together for the purposes of
promoting a shared professional identity, protecting clients,
and promulgating the ACA Code of Ethics (ACA, 2005) to
which all members must adhere. In addition, many counselors
join divisions within ACA, which are focused on more spe-
cialized areas of practice (e.g., college or school counseling)
or shared goals or ideals (e.g., social justice). When these
divisions have established their own code of ethics, those
codes are designed to supplement, not supplant, the ACA
Code of Ethics. As such, their members are responsible for
adhering to those specialized ethical standards and the ACA
Code of Ethics.

Values and Expectations Communicated
by the ACA Code of Ethics

The collective values of the counseling profession are com-
municated in the ACA Code of Ethics (ACA, 2005). Included
within these values and most relevant to this special section
are the recognition of each client’s inherent worth and dignity;
a respect for each client’s uniqueness, autonomy, and right

Journal of Counseling & Development ■ April 2014 ■ Volume 92132

Francis & Dugger

to self-determination; an honoring of human growth and
development; and a respect for diversity within our clientele
and a valuing of cultural competence in counselors. Related
to the communication of these values, ACA (2005) also com-
municated expectations for professional behavior, stating “the
primary responsibility of counselors is to respect the dignity
and promote the welfare of clients” (Standard A.1.a.).

Toward this goal, professional counselors are expected
to conduct themselves in ways that demonstrate a genuine
valuing of each client as a unique individual, that honor each
client’s right to make choices in accordance with his or her
own personal beliefs and standards, and that facilitate each
client’s growth within a myriad of developmental domains
(ACA, 2005, preamble). Professional counselors are also ex-
pected to constantly strive toward increased levels of cultural
competence (Standard C.2.a.) and to avoid discriminatory
practices with respect to a wide variety of cultural dimen-
sions (Standard C.5.). Indeed, competence as a professional
counselor is contingent upon one’s ability to “embrace a
cross-cultural approach in support of the worth, dignity,
potential, and uniqueness of people within their social and
cultural contexts” (ACA, 2005, preamble). In respecting the
diversity of clients, professional counselors must be “aware
of their own values, attitudes, beliefs, and behaviors and avoid
imposing values” (ACA, 2005, Standard A.4.b.).

Values, Power, and Potential for Harm
In light of the prohibition against counselors imposing their
values on clients, counselors should recognize the ways in
which their personal values may be directly or indirectly
communicated to clients and be aware of how the power
differential that exists within each counseling relationship
may result in the imposition of their values. Although most
counselors understand that directly communicating their
values to clients is unacceptable, concerted effort and con-
stant vigilance are necessary to avoid communicating their
values indirectly. Without such vigilance, counselors may
inadvertently communicate their personal values through
nonverbal and extraverbal responses to client disclosures,
by which client stories they focus on and which they avoid,
by how convincingly they communicate caring and respect
for a client, by which interventions they select, by the sug-
gestions they make or the homework they assign, and by
their willingness to continue seeing a client. In such ways,
counselors may intentionally or inadvertently communicate
their personal values to their clients.

Although communication of one’s own values within an
equal, reciprocal relationship would not constitute an imposi-
tion of values, communication of one’s personal values within
an unequal relationship with a vulnerable client can result in
the imposition of values. Zinnbauer and Pargament (2000)
showed that, when a counselor’s values are communicated
during psychotherapy, clients demonstrate a tendency to

move toward adopting those values. Factors likely to contrib-
ute to such influence include the power differential present
within the counseling relationship, the counselor’s perceived
expertise, and the client’s vulnerability. Individuals who are
most vulnerable to this potential imposition of values include
clients or students in any setting where the choice of a coun-
selor may be restricted (e.g., K–12 schools, small colleges
and universities) or where professional services are limited
to a handful of potential practitioners (e.g., clients in rural
or underserved areas).

To be sure, though, the potential for an abuse of power
exists in every counseling relationship, and clients are vul-
nerable to undue influence and microaggressions that can
occur when a counselor communicates any personal values
that are contrary to those of the client (Sue, 2010; Zinnbauer
& Pargament, 2000). When clients are struggling with issues
about which they feel confused, conflicted, or ambivalent,
even the most subtle communication of personal values has
a likelihood of swaying a client to act in accordance with
the counselor’s values rather than facilitating the client’s
exploration of his or her own values. In this way, values can
be imposed. Therefore, the expectation that counselors take
special care in not imposing their values is especially impor-
tant in demonstrating respect for each client’s right to make
choices in accordance with his or her own personal beliefs
and standards and in avoiding discriminatory practices. In the
absence of such restraint, counselors place clients at risk for
harm in ways that may be blatant or subtle and rationalized
as a means to providing the best care for the client (Shiles,
2009; Sue, 2010).

Value Conflicts
Although the ACA Code of Ethics (ACA, 2005) prescribes
expectations for professional behavior, the ultimate hope is
that each individual counselor will internalize the profession’s
collective values. The preamble of the ACA Code of Ethics
delineates this:

Professional values are an important way of living out an
ethical commitment. Values inform principles. Inherently held
values that guide our behaviors or exceed prescribed behaviors
are deeply ingrained in the counselor and developed out of
personal dedication, rather than the mandatory requirement
of an external organization. (ACA, 2005, preamble)

Such internalization, however, does not always occur. This
lack of internalization is most likely when there are areas of
conflict between an individual’s personal values and the pro-
fession’s collective values as articulated by the ACA Code of
Ethics (ACA, 2005). Such value conflicts are the focus of this
special section. Specifically, this special section is designed
to address the dilemmas that occur when an individual coun-
selor’s personal values conflict with the profession’s collective

Journal of Counseling & Development ■ April 2014 ■ Volume 92 133

Introduction to the Special Section

values as communicated in its code of ethics. At the heart of
these dilemmas is the issue of how best to protect clients from
harm that may result from counselors acting in accordance
with their personal values and in violation of the collective
values of the profession.

Recent and Not-So-Recent
Value Conflicts

Recent court cases (i.e., Keeton v. Anderson-Wiley, 2010; Ward
v. Wilbanks, 2009) challenged the profession about what to do
when the personally held values of counselors are in conflict
with the ACA Code of Ethics (ACA, 2005). The aformentioned
court cases focused on a specific conflict between the personal
values of some counselors and the collective values of the
profession. Whereas the profession values diversity, prohibits
discrimination on the basis of sexual orientation (and many
other factors), and requires that “counselors gain knowledge,
personal awareness, sensitivity, and skills pertinent to work-
ing with a diverse client population” (ACA, 2005, Standard
C.2.a.), some counselors and counselors-in-training object to
the idea of providing counseling services to nonheterosexual
clients in any manner that could be mistaken for acceptance
of their lifestyle. They contend that any requirement for them
to do so is discriminatory against their constitutional right to
practice in accordance with their religious beliefs. In contrast,
the profession (via ACA) argued that communication of
such beliefs reflects an imposition of one’s personal values
and that a refusal to see nonheterosexual clients represents
discrimination on the basis of sexual orientation (Ex. at Sep.
30, 2009; see also http://www.counseling.org/resources/pdfs/
EMUamicusbrief ).

Central to this dilemma for some counselors is a belief
that the only ways to honor their personal and/or religious
beliefs as counselors are by directly communicating one’s
values to the client, refusing to discuss same-sex relation-
ships with clients, or implementing a policy of automatically
referring nonheterosexual clients to other counselors. We
respectfully disagree with this belief and offer a discussion
of a much less recent dilemma to illustrate another pos-
sibility. Whereas sexual orientation and gay rights are the
hot-button issues of the day that most frequently conflict
with religious beliefs, a different issue caused similar con-
troversy in the 1960s. That decade was marked by the sexual
revolution and an increasing level of societal acceptance of
sexual activity outside of marriage. This issue, too, caused
great consternation for people who held religious beliefs
against such activity.

One can easily imagine a counselor in 1965 feeling deeply
conflicted when faced with a client engaged in sexual activ-
ity outside of marriage; the counselor’s conflict would have
reflected religious beliefs that were opposed to such activity.
If counselors also believed that the only way they could honor

their religious convictions was to communicate their values to
the client, refuse to discuss extramarital sexual relationships
with clients, or implement a policy of automatically referring
those clients to other counselors, how would this action have
affected those clients? As it happens, Carl Rogers encountered
just such a client, and his session with “Gloria” was recorded
on a widely disseminated training video that is still used today
(Shostrom, 1965) and is now available on YouTube.

Although we do not know what religious beliefs Carl
Rogers held or whether he experienced any value conflict
when counseling Gloria, we do know that (a) Gloria revealed
her participation in casual sexual relationships after her re-
cent divorce and (b) her counselor could have experienced
a value conflict in this situation. In a particularly tender
point in the session, Gloria expressed feeling guilty about
engaging in these sexual relationships and guilty for lying
to her daughter about it. When Gloria directly asked Carl
Rogers what she should do, she was clearly vulnerable to
an imposition of his values. Consider how the following
possible responses—none of which were made by Carl
Rogers—could have affected Gloria:

• “This is your life and you can do as you like, but I
believe that sex outside of marriage is a sin.”

• “Your sexual relationships aren’t something I am
comfortable discussing with you. What else would
you like to talk about?”

• “I know a great counselor across town who specializes
in these issues, and I would like to refer you.”

Our hope is that the potential harm that could befall Glo-
ria as a result of such responses is clearly evident. Already
feeling guilty, Gloria was especially vulnerable to signs
of disapproval or rejection. Carl Rogers’s actual response
offered neither. Additionally, and very importantly, his
response also did not communicate acceptance. Instead, he
acknowledged hearing Gloria’s plea for advice about what
to do and communicated that, although he wished he could
tell her what she should do, this was a very personal deci-
sion that only she could make.

For counselors facing any similar dilemma involving a
conflict between their personal value system and the pro-
fession’s values, we suggest that this approach may offer
a way to resolve the conflict. This nondirective approach
does not violate the ACA Code of Ethics (ACA, 2005) and
allows a counselor to honor personal religious beliefs. It
simply does not involve communicating those beliefs to the
client via direct statements; indirect, selective attention to
topics; or referrals.

Focus of the Special Section
Each of the articles in this special section addresses the issue
of value conflicts and explores means by which they might be

Journal of Counseling & Development ■ April 2014 ■ Volume 92134

Francis & Dugger

reconciled. The section begins with three articles addressing
the recent Ward v. Wilbanks (2009) court case. In the open-
ing article, Suzanne Dugger and Perry Francis describe the
case and offer insights into the lessons learned. Next, ACA’s
chief professional officer, David Kaplan, analyzes the ethi-
cal implications of the case and describes ACA’s position on
the issues raised by this case. Then, Barbara Herlihy, Mary
Hermann, and Leigh Greden explore the legal and ethical
implications of using religious beliefs as the basis for refusing
to counsel certain clients.

The section then shifts from this narrow focus on the
Ward v. Wilbanks (2009) case to a broader exploration of
value-based conflicts within the counseling profession. In her
article, Irene Ametrano addresses ways in which counselor
educators can teach ethical decision making and help students
reconcile their personal values with the profession’s values.
Also addressing ways to prepare future counselors to deal
with values conflicts, Joy Whitman and Markus Bidell’s article
explores ways to bridge the gap between religious beliefs and
affirmative counselor education. In the next article, Markus
Bidell explores the experience of individual counselors expe-
riencing discord between their conservative religious beliefs
and the expectation that they, as professional counselors,
will not discriminate in offering positive regard to clients.
Next, Michael Kocet and Barbara Herlihy reveal their newly
developed model for ethical decision making. This model is
focused on addressing value-based conflicts that may arise
within a counseling relationship.

Finally, this special section concludes with two articles
dedicated to exploring the perspectives of various religions
pertaining to sexual orientation and value conflicts. Richard
Balkin, Richard Watts, and Saba Ali offer Jewish, Christian,
and Muslim perspectives on the intersection of faith, race,
and sexual orientation. In the final article, Devika Choudhuri

and Kurt Kraus address ways in which Buddhist perspec-
tives may be useful in reconciling value conflicts that arise
in counseling.

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articles for individual use.

Online Counseling: A Narrative and Critical Review of the Literature
Derek Richards1 and Noemi Viganó2

1University of Dublin, Trinity College
2Alliance Counselling, Dublin, Ireland

Objective: This article aimed to critically review the literature on online counseling.
Method: Database and hand-searches were made using search terms and eligibility criteria, yielding
a total of 123 studies. Results: The review begins with what characterizes online counseling. Out-
come and process research in online counseling is reviewed. Features and cyberbehaviors of online
counseling such as anonymity and disinhibition, convenience, time-delay, the loss of social signal-
ing, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client
suitability, and clients’ and therapists’ attitudes and experiences of online counseling are reviewed.
Conclusion: A growing body of knowledge to date is positive in showing that online counseling can
have a similar impact and is capable of replicating the facilitative conditions as face-to-face encounters.
A need remains for stronger empirical evidence to establish efficacy and effectiveness and to under-
stand better the unique mediating and facilitative variables. C© 2013 Wiley Periodicals, Inc. J. Clin.
Psychol. 69:994–1011, 2013.

Keywords: online counseling; outcomes and process research; therapeutic relationship; cyberbehaviors;
ethics; attitudes and experiences; suitability and training

The field of cyberpsychology involves the study of human experiences (cognitive, emotional,
and behavioral) that are related to or effected by developing technologies, in other words the
psychological study of human-technology interaction (Richards & Viganó, 2012). One area of
cyberpsychology is online counseling, also referred to as e-therapy, e-counseling, or cyberther-
apy. While the very nature and definition of online counseling have been debated, we will use the
one employed by Richards and Viganó (2012), defining online counseling as the delivery of ther-
apeutic interventions in cyberspace where the communication between a trained professional
counselor and client(s) is facilitated using computer-mediated communication (CMC) technolo-
gies, provided as a stand-alone service or as an adjunct to other therapeutic interventions.

Alongside technological developments online counseling has grown in the past 15 or so years.
Researchers in online counseling have been considering the potential effectiveness of online
counseling and whether it is possible to establish a therapeutic relationship in cyberspace. Re-
search studies have focused on establishing its potential benefits and challenges, client suitability
for online counseling, therapists’ and clients’ attitudes and experiences of online counseling, and
professional training for working online with clients. Additionally, its very nature and definition
as a therapeutic intervention has been debated. Researchers have been exploring newly observed
phenomena that form part of understanding the psychology of online counseling behavior. Ar-
eas of interest include the effects of apparent anonymity and distance, disinhibition, identity and
impression management, writing and emotional expression in cyberspace, and ethical behavior
in cyberspace.

While other reviews of online counseling have been written, notably, the special issue from the
Journal of Clinical Psychology, 2004, and the volume from The Counseling Psychologist, 2005,
the contribution of the current article is the systematic nature of the work, and we believe the
extensiveness and thoroughness of the work will provide the discipline with a comprehensive
review of the field and also an evaluation of the present empirical knowledge and suggestions
for the future clinical practice and research. The paper reviews, among others, research relat-
ing to process and outcome, the therapeutic relationship, the characteristic features of online
counseling, and ethical considerations for delivering therapeutic interventions online.

Please address correspondence to: Derek Richards, University of Dublin, Trinity College. Dublin. E-mail:
derek.richards@tcd.ie

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 69(9), 994–1011 (2013) C© 2013 Wiley Periodicals, Inc.
Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.21974

Online Counseling: A Narrative Review 995

Method

Literature Search and Selection of Studies

The aim of the literature search was to find all references related to online counseling. We drew
on our research experience and knowledge of the field and we reached agreement regarding
the means to carry out the search and the search terms to be used. A search of three leading
databases for psychology (EMBASE, PubMed, and PsychINFO including PsychARTICLES)
was conducted for studies published in peer-reviewed journals. Based on the literature, eight
search terms were employed–online counseling and online counselling, cybercounseling and
cybercounselling, web therapy, web counseling and web counselling, e-therapy, e-counseling
and e-counselling, cybertherapy, and web consulting–culminating in a total of 24 searches.

Results, which included original research, meta-analysis, and other reviews, were assessed
at title, abstract, or by reading the full paper to determine whether they met our eligibility
criteria. Studies were included when they met (a) the definition of online counseling employed
by Richards and Viganó (2012): involving the delivery of a therapeutic intervention by a trained
professional to client(s) using synchronous or asynchronous computer mediated communication
(CMC). Included were (b) papers that addressed any aspect of this encounter such as process
and outcome studies, ethics, online behaviors associated with the encounter, training, suitability,
its definition and nature, attitudes, experiences, (c) and all age groups. Papers were excluded (a)
if they did not involve a trained professional counselor and client(s), (b) that did not deliver a
therapeutic intervention e.g., careers guidance counseling or medical therapeutics, (c) and that
did not use CMC, but instead telephone, or was solely a self-administered program.

We rejected duplicates and we assessed each of the studies for inclusion, any difficulties we
discussed and a final decision was made. Further, a hand search was made of papers to identify
other relevant studies for inclusion. Reasons for rejecting papers included that they were not
a therapeutic intervention, were not in English, did not employ CMC, were an unpublished
thesis, or a conference paper (see Figure 1). A comprehensive summary of information extracted
from the papers was written, considering the characteristics of online counseling, associated
process and outcome research, the therapeutic relationship in cyberspace, potential benefits
and challenges, client suitability for online counseling, therapists’ and clients’ attitudes and
experiences of online counseling, and professional training for working online with clients.
Further, the review considered online behavior as it applies to online counseling: anonymity and
distance, disinhibition, identity and impression management, writing and emotional expression,
and ethical online behavior.

The subheadings under which the papers were reviewed evolved from the study of the pa-
pers and also from our own experience with online counseling. Therefore, some subheadings
were initially derived as needing to be represented such as outcome and process research, the
therapeutic relationship, benefits, and challenges, while others evolved more naturally from the
literature and include attitudes, training, suitability, and unique features of online counseling
behavior.

Results and Discussion

Three databases, PubMed (n = 1,163), EMBASE (n = 1,124), and PsychINFO including Psy-
chARTICLES (n = 185), were searched. Identified papers (n = 2,319) were screened against the
established eligibility criteria, yielding 85 papers. A further 38 papers were identified through
hand-search. Figure 1 shows the results of the systematic search.

Characteristics of Online Counseling

Providing a definition for online counseling is somewhat problematic as the exact nature of
interventions involving therapists and clients online have been in flux and are a continued
source of debate. Recently, Barak, Klein, and Proudfoot (2009) have tried to bring some clarity
by providing some guiding definitions, classifications, and descriptions of a range of online

996 Journal of Clinical Psychology, September 2013

Figure 1. Results from the systematic search.

Online Counseling: A Narrative Review 997

therapeutic interventions. However, definitions still remain unspecific regarding any theoretical
or technical approach, and professionals’ level of training (Rochlen, Zack, & Speyer, 2004).

Synchronous (chat and video conferencing) and more popularly asynchronous (e-mail) com-
munication, as well as combinations of these have been employed to deliver online counseling
as a standalone service and as an adjunct to other services. Some web-based, self-administered
treatments for a variety of disorders have included online counseling support, usually in the form
of asynchronous postsession feedback, which appears to increase adherence and yield enhanced
outcomes (Newman, Szkodny, Llera, & Przeworski, 2011; Richards & Richardson, 2012).

Some (Castelnuovo, Gaggioli, Mantovani, & Riva, 2003) consider that online counseling is a
transposition of face-to-face (F:F) counseling online, with technologies mediating the therapeu-
tic communication and affecting the process with their associated advantages and limitations.
However, others (Fenichel et al., 2002; Grohol, 1999, 2001) consider that online counseling
should be considered a new type of therapeutic intervention, a distinct way of engaging thera-
peutically and therefore needing a different theoretical framework from F:F counseling. From
this perspective online counseling is considered a new, versatile, and flexible resource with the
potential to complement and support other types of interventions.

A number of issues that have been debated in the literature from the beginning have been raised
as criticisms by both professionals and laypeople (Barak, Hen, Boniel-Nissim, & Shapira, 2008):
the effect of the loss of cues on the process of therapy and consequently whether counseling
can occur in such a context; ethical issues and in some cases their potential legal implications
regarding the delivery of online counseling; and practical issues have arisen concerning training
for conducting online counseling and concerns about relying on technology. Yet in spite of strong
criticisms being put forward, from its beginning the various technology-delivered psychological
interventions have flourished. Barak et al. (2009) state that this is likely due to several factors
including:

� Increasing acceptability of the Internet as a legitimate social tool
� Computer hardware and software developments (especially in relation to ease of use, privacy

protection, and online communication capabilities)
� Development of ethical guidelines by various professional organizations
� Growing research
� Establishment of online training for professionals

Outcomes and Process Research in Online Counseling

The goal of counseling is to alleviate the distress, anxiety, and concerns that clients can present.
Counseling attempts to return a client to precrisis functioning and in doing so foster clients’
well-being, build on a client’s strengths, and help improve overall functioning (Mallen, Vogel,
Rochlen, & Day, 2005). It is our opinion that online counseling must also adhere to the same
objectives, because it seems reasonable to assume that that is what users of counseling (online
or F:F) are seeking.

Efficacy and effectiveness of online counseling. Cohen and Kerr’s (1998) analogue
study using the State-Trait Anxiety Inventory measured participants’ anxiety before and after
being assigned (N = 24 students) to one session of either F:F or online synchronous (chat)
counseling. Both groups showed a decrease in anxiety outcomes posttreatment. Although the
study was somewhat artificial, as it used students to deliver and receive treatment, it screened out
participants with high levels of distress, and the sample was small; nevertheless, it represented a
worthwhile beginning.

The series of studies by Glueckauf and colleagues (1999, 2002) attempted to assess outcomes
by randomizing teenagers (N = 39) with epilepsy and their parents for six sessions of fam-
ily counseling among video, audio, F:F counseling, and a waitlist control. They employed a
number of measures such as the Problem Severity and Frequency Scale, Social Skills Rating
System Scale, and a modified form of the Working Alliance Inventory, and they also tracked
treatment adherence. Twenty-two families completed the treatment and data were collected at

998 Journal of Clinical Psychology, September 2013

week 1 and 6 months posttreatment. They found that the teenagers and parents in each of the
treatment groups demonstrated significant reductions in both problem severity and frequency
at both posttreatment and 6-month follow-up. At posttreatment, prosocial behaviors increased,
as reported by parents, and these were maintained at follow-up. However there didn’t seem to be
any changes in problem behaviors over time. The sample size was small and also the population
very specific, thereby limiting generalizability of the results.

Day and Schneider (2002) randomized 80 clients and compared process and outcome variables
across three treatment groups: F:F, telephone, and video psychotherapy. Participants completed
five sessions and measures of working alliance, session outcome, and satisfaction. The results
showed no statistically significant differences between the three delivery modes for either working
alliance or outcomes. However, they found a statistically significant difference in the level of
participation: clients in distance therapy participated more actively than those in F:F therapy.
The researchers speculated that the clients in the distance modes perhaps made more of an effort
to communicate or took more responsibility for the interaction, or perhaps the distance made
those participants feel safer. Although the study is an important contribution to empirically
establish online counseling, it is limited by sample size and the broad range of presenting issues
included (Day & Schneider, 2002).

Robinson and Serfaty (2001, 2008) employed qualified therapists who corresponded with
clients with an official Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Amer-
ican Psychiatric Association, 2000) diagnosis for an eating disorder via e-mail at least twice a
week for a period of 3 months. The therapists were supervised by specialists with experience in
eating disorders psychiatry, who received each e-mail correspondence, annotated it, and returned
it to the therapist. Robinson and Serfaty (2001) reported significant improvements in bulimic
symptoms for participants at 3-month follow-up and a significant reduction in the number of
participants fulfilling DSM-IV eating disorder criteria at posttreatment (50% of the 19 partici-
pants), compared with a waitlist control group. Although the samples were small and the design
did not include a comparison with F:F treatment, the results are encouraging for the use of
online counseling for eating disorders.

A number of studies employed videoconferencing technology to deliver therapy for the treat-
ment of eating disorders. For instance Mitchell et al. (2008) delivered 20 sessions of cognitive-
behavioral therapy (CBT) over a 16-week period for the treatment of bulimia nervosa (BN) in
a sample of 128 adults meeting the DSM-IV criteria for BN or eating disorder not otherwise
specified (EDNOS). Participants were randomly assigned to either F:F CBT or online-delivered
CBT. Participants were assessed by interview at posttreatment, and at 3-month and 12-month
follow-up. Retention was comparable in both groups, and abstinence rates were higher for the
online group compared with the F:F group, but not statistically significant. They concluded that
delivering online treatment was acceptable to many patients and roughly equivalent in outcome
to F:F therapy.

Simpson and colleagues (Simpson, Bell, Knox, & Mitchell, 2001; Simpson, Deans, & Brebner,
2005) have reported on the use of videoconferencing technology to deliver treatments for BN
and eating disorders to remote and geographically distant populations. The first study (2001)
assessed participants (N = 10) F:F, and then assigned them to 10 sessions via teleconferencing.
Prescores and postscores from the General Health Questionnaire (Goldberg, 1972) and post-
session Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM;Barkham et
al., 2010) scores revealed that participants showed a decrease in symptamotology and increases
in well-being. In a second study (2005) of six participants meeting DSM-IV criteria for BN
or EDNOS, Simpson and colleagues reported finding that most participants made clinically
important improvements in terms of bulimic symptoms, levels of depression, and borderline
symptomatology. Although the studies included official diagnostic assessment of symptoms,
they had small samples and lacked follow-up.

Zabinski and colleagues (Zabinski et al., 2001; Zabinski, Wilfley, Calfas, Winzelberg, & Taylor,
2004) examined the use of synchronous Internet-delivered group chat for the prevention of eating
disorders in four female students. The program was advertised as an educational intervention
for women with elevated weight and shape concerns. It consisted of eight 1-hour weekly sessions.
All sessions were moderated by an advanced graduate student in clinical psychology specializing

Online Counseling: A Narrative Review 999

in eating disorders. The study employed a number of standard self-report instruments, such as
the Body Shape Questionnaire, Eating Disorders Inventory, and Eating Disorders Examination
Questionnaire, and reported improvements ranging from small to medium effect sizes in eating
disordered behavior and body image attitudes (Zabinski et al., 2001). A follow-up randomized
controlled study demonstrated that intervention participants showed significant improvements
over the waitlist control participants on most subscales of eating pathology with robust effect
sizes, particularly from baseline to follow-up as measured by the Eating Disorder Examination
Questionnaire (Zabinski et al., 2004).

Hopps, Pépin, and Boisvert (2003) employed chat technology to investigate the effect of
cognitive-behavioral group therapy on feelings of loneliness among a sample (N = 19) of chron-
ically lonely people with physical disabilities. The study, using a waitlist control randomized
design, employed a number of outcome assessments including the Loneliness Scale, Emotional
Versus Social Loneliness Scale, and personal definitions of loneliness. The results showed signifi-
cant improvements for participants on items regarding personal, social, and emotional loneliness
and these were maintained at 4-month follow-up. Generalizing results is, however, limited by the
sample size and the particular population studied.

Other online counseling interventions have been experimented with where users (adults and
teenagers) have presented a broad variety of presenting concerns. At the University of Athens,
students who used online asynchronous counseling noted advantages, including ease of use,
speed, and anonymity, followed by ambivalence about traditional counseling (Efstathiou, 2009).
The traditional social stigma toward seeking help and social factors hindering help-seeking
behaviors (e.g., gender and physical appearance) appeared to be reduced (Efstathiou, 2009).
Richards (2009), investigating asynchronous online counseling with students, highlighted the
benefits for users in having one single session online with a counselor. Apparent anonymity
and distance, the therapeutic benefits of writing, the cultivating of a zone of reflection, and the
resourcefulness of young adult students were suggested to be important variables mediating
the success of single-session online counseling. The single-session model employed also allowed
content to become a resource for all users (Efstathiou, 2009). The building of such a database is
also supported by the work of Michaud and Colom (2003), where after 4 years of operation, the
number of teenage visitors continued to increase but the number of questions dropped to half.

A meta-analysis of Internet-based psychotherapeutic interventions (Barak et al., 2008) re-
ported an overall weighted mean pre-post effect size of d = .53. More precisely, the effects
achieved for studies (n = 27) that represented work conducted synchronously (d = .49) and
asynchronously (d = .44) were not statistically different, although chat and e-mail modes were
statistically superior to forum, audio, or webcam. The study provides evidence for the use of on-
line interventions, concluding that online interventions are as efficacious or nearly as efficacious
as F:F ones. However, the study did not discriminate on the basis of quality, and was based on
a wide variety of studies with mixed methods, approaches, and objectives.

Several randomized controlled trials that have included a treatment condition using syn-
chronous or asynchronous online counseling have reported significant posttreatment and follow-
up effects (Kessler et al., 2009; Vernmark et al., 2010), demonstrating the efficacy of delivering
structured, online CBT treatments for depression (Richards & Richardson, 2012). Similarly, a
broad range of mental health issues have been addressed through the delivery of various online
interventions, for instance, interventions for panic disorder (Carlbring et al., 2006; Carlbring,
Ekselius, & Andersson, 2003), insomnia (Ström, Pattersson, & Andersson, 2004), and smoking
cessation (Strecher, Shiffman, & West, 2005), to name a few. Interventions included therapist
support and counseling delivered through a range of technologies and communication modes,
synchronously and asynchronously (Newman, et al., 2011).

Process variables in online counseling. The study by Cohen and Kerr (1998) described
earlier reported that while clients rated higher levels of arousal in F:F encounters, there were
no differences found regarding ratings of depth, smoothness, or positivity between online and
F:F clients. Barak and Bloch (2006) using 140 transcripts investigated the perceived helpfulness
of emotional support carried on by professional helpers through Internet chat with distressed
individuals. They reported positive outcomes for clients who had used the service. They found

1000 Journal of Clinical Psychology, September 2013

no significant difference in clients’ perceived session helpfulness for online than would be found
with F:F services. Barak and Bloch (2006) have also demonstrated that perceived helpfulness
correlated highly with impact from both clients’ and therapists’ perspectives. Similar to F:F ther-
apy, deep, smooth conversations that yielded positive responses and aroused clients’ emotions
were helpful. This is in contrast with the common criticism that online therapeutic conversations
might be shallow, superficial, or distant (Barak & Bloch, 2006).

Their findings have also been confirmed by Reynolds, Stiles, and Grohol (2006), who studied
session impact and alliance in online counseling with 16 therapists and 17 clients over the course
of a total of 178 sessions and reported that session impact and alliance were similar between
online and F:F treatments. This has also been a point noted in other studies, and perhaps session
impact may be a variable more closely related to outcomes in online counseling than is the
therapeutic alliance (King, Bambling, Reid, & Thomas, 2006; Reynolds, Stiles, & Grohol, 2006).

Liebert, Archer, Munson, and York (2006) using the Client Satisfaction Inventory (CSI;
McMurtry & Hudson, 2000) investigated satisfaction with online counseling, establishing a
mean satisfaction rating of 67.8 (out of 100) for a sample of 81 participants. When benchmarked
with F:F studies of satisfaction the authors concluded that clients were reporting satisfaction
but less so than in F:F counseling (Liebert et al., 2006). For example, a validation study of
the CSI in a F:F counseling sample generated a client satisfaction score of 88.1 (out of 100;
McMurtry & Hudson, 2000). The authors found that the more hours respondents spent online,
the more likely they were to make use of online counseling. Noted advantages in using such a
service included convenience, anonymity, and privacy. It can be speculated that some individuals
presenting with specific issues, such as trauma, phobia, or social marginalization, may “need to
communicate without fear of the listener’s first reaction” (Liebert et al., 2006, p. 83).

In a more recent study the authors reported no statistically significant difference in satisfaction
scores for F:F and online clients (Murphy et al., 2009). It would seem that satisfaction rating
for online counseling have been high, yet perhaps not as high as those found in F:F studies, but,
again, the studies were limited by small samples and there is only a small number of studies
available.

Much valuable work has been achieved to investigate and establish an empirical base for
online counseling. Yet the existing empirical literature that supports any in-session effects and
the achievement of outcomes from online counseling, while positive, is limited at present. Con-
sequently, apart from stating that it seems to work like it does in the F:F context, it is difficult to
draw precise conclusions as to the efficacy and effectiveness of online counseling. Robust empir-
ical investigations with larger samples and comparisons to F:F clients and/ or control groups
of some type would strengthen the empirical base. Additionally, investigating process variables
that contribute to in-session events and eventual outcomes need further research, especially to
find out whether they are the same predictors of outcomes as exist in F:F counseling.

The Therapeutic Relationship in Online Counseling

At the center of the therapeutic endeavor is the belief that a responsive relationship produces
changes in cognition, feelings, and behaviors (Holmes & Lisndley, 1989). In F:F counseling it
has been noted that the early absence of the therapeutic alliance or the failure of it to develop
is a likely indication that the therapy will be unsuccessful (Gelso & Hayes, 1998). Research has
demonstrated the importance of the working alliance to successful outcome in F:F counseling
(Horvath & Bedi, 2002; Martin, Garske, & Davis, 2000). A significant challenge for online
counseling is establishing the possibility to create equally meaningful relationships through
CMC.

The study described earlier by Glueckauf and colleagues (1999, 2002) used the Working
Alliance Inventory (WAI) to compare the alliance in videoconferencing, audio phone, and F:F
counseling for teenagers. While clients reported higher levels of alliance in the F:F condition,
there did not exist any significant differences across the three treatment groups for the alliance.
Another early study (Cohen & Kerr, 1998) that compared the effects of computer-mediated
online counseling and traditional F:F counseling on levels of anxiety and attitudes toward

Online Counseling: A Narrative Review 1001

counseling reported that participants in both modes of delivery reported similar ratings regarding
clients’ perceptions of therapists’ expertness, attractiveness, and trustworthiness.

Cook and Doyle (2002) in their study of 15 clients of online therapy–e-mail and chat-based–
compared with a F:F sample (N = 25), found equivalent alliance scores for both groups on the
WAI. They reported significantly higher means on the goal subscale and the composite score
for the WAI, suggesting that a working alliance as a central ingredient to outcome could also be
established in online counseling. However, the study did not include a F:F comparison group
and the self-selected sample were small. Qualitatively online clients reported experiencing strong
bonds with their therapists and benefiting from the effects of disinhibition. This latter point
perhaps supports McKenna and Bargh (2000) findings that individuals who are socially isolated
and anxious and who have difficulties forming relationships are more likely to form deep and
lasting relationships online than in person.

A review of the literature concluded that studies concerning the therapeutic alliance in online
counseling were scarce, yielding mixed results (Mallen, Vogel, Rochlen, & Day, 2005). How-
ever, the review (Mallen et al., 2005) considered only three studies regarding the therapeutic
relationship in online counseling and, while they found that F:F contact was superior to online
communication in establishing a relationship, no significant difference was found for emotional
understanding. Since that literature review subsequent research seems to increasingly support
the feasibility of developing therapeutic relationships online with modest to high alliance scores
being consistently found.

For instance, Prado and Meyer (2004) in a study of the alliance in asynchronous online therapy
reported that clients (N = 53) and therapists (N = 20) created solid working alliances as measured
by the WAI. The study revealed significant differences in working alliance levels reported, greater
for those who completed treatment (n = 29) compared with those who abandoned treatment
early (n = 19). However, they concluded that it was possible to conduct therapy asynchronously
online and the therapeutic relationship was similar to what is generally found in F:F studies.

Using a convenience sample of 81 participants Leibert, Archer, Munson, and York (2006)
examined levels of therapeutic alliance in online counseling and compared them against levels
found in F:F counseling. They showed that clients from F:F reported significantly higher ratings
than those in online counseling; this was found to be the case on the composite and each of
the three subscales of the WAI. Additionally, alliance scores significantly predicted respondent
satisfaction with online counseling.

Reynolds, Stiles, and Grohol (2006) over a 3-year period recruited 30 clients for online
counseling and examined session impact and alliance in online compared with F:F counseling
and found that ratings of session impact, using the Session Evaluation Scale, and alliance, using
the WAI, were similar between the two modes. Online therapists evaluated session impacts
including depth, smoothness, and positivity alongside confidence aspects of the therapeutic
alliance more highly than F:F therapists.

Hanley (2009) in a study of working alliance with young people (N = 46) in online counseling
reported that the majority (77%) found the alliance to be of medium to high quality as rated by
the Therapeutic Alliance Quality Scale. This research supports what King, Bambling, Reid, and
Thomas (2006) found regarding the potential to create a working alliance of sufficient quality
in online counseling that could have a positive impact on outcomes. The study investigated the
alliance as measured by the Therapeutic Alliance Scale in a sample of young people (N = 86)
using a single session of online counseling.

This small collection of studies seems to demonstrate that alliance online appears to be
capable of being equivalent to F:F. However, the fundamental question remains as to whether
the same process variables that are strong predictors of success in F:F interventions play the
same facilitative role in online interventions. King, Bambling, Reid, et al. (2006), for instance,
found session impact to be a stronger mediator in online counseling than the working alliance.
Given that these common factors of alliance and impact can be achieved online further research
is welcome to investigate how these critical elements relate to outcome. One study of alliance
quality and whether it could predict outcome (Knaevelsrud & Maercker, 2006) found that
although alliance in online treatment was one standard deviation higher than in F:F, there was

1002 Journal of Clinical Psychology, September 2013

only a low to modest association between alliance and outcome. They employed the short form
of the WAI; their sample, however, was small (N = 48) and all were being treated for trauma.

Although the research to date is largely positive, further research is needed to understand the
nature and dynamics of online therapeutic relationships. Whether the therapeutic relationship
is or is not a key facilitative element in online counseling still needs to be established. However,
it would seem that for an interaction to have therapeutic value the basic principles of providing
a supportive, empathic, and empowering relationship need to be present.

Features and Cyberbehaviors of Online Counseling

Online counseling is characterized by unique features and behaviors such as apparent anonymity,
disinhibition, distance, time delay, convenience, and loss of social signaling. Such features and
cyberbehaviors that characterize online counseling have associated benefits and challenges (Chil-
dress, 1998). For the most part these have been addressed adequately for the ethical and profes-
sional practice of online counseling through the provision of ethical and practice guidelines.

Anonymity and disinhibition. Traditionally, users of online counseling services enjoyed
the apparent anonymity that the online environment provided, often using nicknames and not
divulging many personal identifying details. However, this is becoming less the case; profes-
sional guidelines and ethical standards have brought about changes in how clients are recruited,
identified, and assessed. This does not necessarily dissolve the potential of maintaining relative
anonymity and especially geographical distance, which have been theorized to facilitate psy-
chological safety, disinhibition, and increased self-disclosure (Suler, 2000, 2004). Disinhibition
seems to aid clients to express themselves more openly and honestly (Cook & Doyle, 2002); it
is a powerful and distinct feature of online counseling and it is believed to have the potential
to reduce the social stigma and anxieties that some experience in seeking professional support
(Suler, 2004).

More sinister behaviors have the potential to arise from disinhibition, such as acting out
behaviors with, for instance, the client engaging in identity and impression management (Suler,
2000). Although it is a point worth considering, it is not necessarily a behavior unique to online
counseling, nor is there evidence to support its presence. Joinson (2001) examined the concept
of self-disclosure by comparing dyads of undergraduate students interacting F:F and online.
He found that instances of negative self-disclosure were rare and that participants in the CMC
condition had significantly higher levels of self-disclosure, supporting the notion of positive
disinhibition and demonstrating that acting out arising from disinhibition was uncommon.

Convenience. Both clients and therapists have identified convenience as a principal reason
for choosing online counseling (Chester & Glass, 2006; Mallen et al., 2005; Young, 2005). The
accessibility of online counseling can overcome many barriers to accessing treatment including
limited mobility due to geographical isolation or physical disability, language barriers, personal
stigma in seeking help, or time availability (Rochlen, Zack et al., 2004). Online counseling, too,
has the potential to extend access to specialized services that might otherwise be beyond the
reach of clients (Young, 2005). One example is the use of videoconferencing to deliver specialized
care and treatment to clients who were geographically isolated from specialist eating disorder
treatment centers (Simpson et al., 2005).

Time delay. Using synchronous communication to provide online counseling can facilitate
immediate clarification of what is being discussed between the therapist and the client. However,
in asynchronous communication a time delay is built into the counseling process. This can
potentially lead to anxieties for both therapists and clients in wondering about a perceived or
unexplained delay in response. In turn, the ambiguity in the no-reply can become a blank screen
where one can easily project one’s own expectations, emotions, and anxieties, i.e., the “black
hole phenomenon” (Suler, 2004).

At the same time, and unlike the urgency and immediacy characteristic of synchronous
communication, asynchronous communication can facilitate the development of a zone of

Online Counseling: A Narrative Review 1003

reflection where therapists and clients can take the time to reflect upon and respond to the
others message (Suler, 2000). The process brings with it advantages for the client, principally
a relief from any pressure of urgency or immediacy, and this in turn can facilitate time to
process experiences and emotions; it can promote self-observation, increase awareness, reduce
impulsivity, and enable clients to engage in deeper reflection and focus on self-expression (Hanley,
2009). Time delay is also a potential advantage for therapists as it can help with better observation
and management of countertransference reactions.

Loss of cues. The fact that all of the visual and verbal cues that conveys subtle information
about the person and their affect in F:F interactions are missing in text-based online counseling
has been a point of debate in the literature (Suler, 2000). Suler (2004) argues that this feature is
precisely a benefit in online counseling as it can lead to disinhibition. Disinhibition can occur as
there is the potential to remove any concerns about the other person’s reaction to one’s narrative
and presence. Feelings of psychological safety and disinhibition can arise from the lack of social
signals, which in turn have the potential to reach clients who are particularly sensitive to the
physical presence of another person and to cues indicating disapproval or judgment (Fenichel
et al., 2002; Leibert, Archer, Munson, & York, 2006). Leibert et al. (2006) concluded that the
disinhibition effect reported by participants seemed to be stronger and offset the impact of the
lack of cues.

Further derivates of the loss of cues include facilitating the disclosure of sensitive or embar-
rassing information. Clients can appreciate such an environment as it can increase their sense
of control over what they disclose (Cohen & Kerr, 1998; King, Bambling, Lloyd, et al., 2006;
Simpson et al., 2005). A study by Hanley (2009) reported on young people’s experience of on-
line counseling and described how some users appreciated having the control over whether to
disclose to their counselor that they were crying. However, a consideration needs to be that for
some clients the experience of counseling that lacks the reassurance of regular social signaling
may be distressing (Alleman, 2002).

Online counseling, in its many forms, brings with it features and newly observed behaviors.
Some work has captured these phenomena, yet a more thorough investigation of these elements
is worth considering, so as to, first, describe more thoroughly the phenomenon that is online
counseling and, second, to contribute to the debate as to whether it is simply transferring what
usually occurs in the F:F setting and now mediated by CMC or whether it is to be considered
an entirely new and distinct intervention. Additionally, more needs to be explored about the
therapeutic significance of different aspects (such as control over disclosure that ordinarily in
face-to-face would be obvious such as crying) and unique features (disinhibition and time-delay)
of online counseling.

Writing behavior and expression. The majority of online counseling has taken place
through asynchronous text-based communication. Cook and Doyle (2002) reported that partic-
ipants appreciated that they could re-read the responses received from the therapist, feeling this
allowed them more time to process the content than verbal communication would have. Beattie,
Shaw, Kaur, and Kessler (2009) in a study of online synchronous counseling with 24 primary
care patients reported that on seeing their thoughts and emotions in writing online clients were
effected and this also facilitated further self-reflection.

The positive benefit that writing can have on psychological and physical health has already
been widely documented (Pennebaker, Kiecolt-Glaser, & Glaser, 1988). The process of writing
can, for instance, be cathartic in translating emotional experiences into words and this has also
been found to be the case in the use of e-mail (Sheese, Brown, & Graziano, 2004).

It is interesting to reflect that in writing the writer is in control of the content, the pace, and
depth of the written material, which can potentially foster a sense of psychological safety (Wright
& Chung, 2001). Additionally, the permanency of the written record can be referred to again and
again. The use of text as the means of communication, similar to narrative approaches to therapy
and journal writing, can potentially facilitate the user’s construction of a personal narrative
(Suler, 2000). Indeed, writing may be a preferred or more suitable modality of self-expression

1004 Journal of Clinical Psychology, September 2013

for some individuals who are less comfortable in F:F interactions, while being unsuitable for
individuals with limited writing skills (Suler, 2000).

Apart from any therapeutic intervention, the therapeutic benefit of writing in online coun-
seling deserves more attention. It seems that writing can be of benefit to users of its own right.
Additionally, practically nothing is known of counselors’ experience of using writing to deliver
interventions.

Ethics

Ethical concerns have been at the center of the debate regarding the practice of online counseling.
Sampson, Kolodinsky, and Greeno (1997) identified ethical issues such as confidentiality, the
validity of the data delivered via computer networks, the adequacy of counselor interventions,
potential misuse of computer applications, a lack of awareness of location-specific factors,
the effect of the digital divide, privacy concerns, credentialing, and issues that concerned the
development of a therapeutic relationship. Many of the ethical concerns identified regarding the
practice of online counseling also carry with them potential legal implications regarding duty of
care (Shapiro & Schulman, 1996).

Online counseling caused trepidation among professionals whom raised concerns regarding
issues of informed consent, contracting, confidentiality of records, privacy, diagnosis, and duty
of care (Bloom, 1998; Childress, 1998; Shapiro & Schulman, 1996). However, Skinner and Zack
(2004), for instance, maintain that the issues posed online are no more insurmountable than
those faced in traditional practices. Nonetheless the concerns raised are legitimate and posed
the question as to how was it going to be possible for professionals to practice ethically online?

In 1995, the American Psychology Association Ethics Board described the ethics code appli-
cable to therapists using telephone, teleconferencing, and Internet services (Shapiro & Schulman,
1996). The National Board for Certified Counselors (NBCC) developed standards for online
practice (Bloom, 1998). These can be seen as early attempts to address ethical concerns and
regulate the delivery of online counseling practice.

In 1997 the International Society for Mental Health Online (ISMHO) was formed with a clear
mission to promote the understanding, use, and development of online communication in mental
health. They, too, have produced guiding principles for the ethical practice of online counseling
(ISMHO, 2000). Indeed, many professional counseling and therapy accrediting bodies have
followed suit and produced guidelines for online clinical practice that are regularly revised as the
evidence-base from practice and research grows (Anthony & Goss, 2009; Anthony & Jamieson,
2005). The development of ethical frameworks has been significant in contributing to regulate
and standardize the practice of online counseling.

However, despite the many developments that have occurred in recent years, a number of
studies have surveyed online counseling websites (Chester & Glass, 2006; Heinlen, Welfel, Rich-
mond, & Rak, 2003; Shaw & Shaw, 2006) and reported that practitioner credentials varied
widely, only 32% of practitioners requested that clients sign an informed consent form, and 42%
of participants did not use any encryption to protect confidentiality, and they reported finding
very low compliance with established ethical standards for online counseling. However, a high
number of practitioners provided information about the limitations of online counseling.

In their study of 93 e-counselors attitudes, ethics, and practice, Finn and Barak (2010) reported
that 62% of e-counselor practitioners were confident that their online sessions were confidential,
24% somewhat confident, and 14% not at all confident. They also described how only 28% of
practitioners felt it important to confirm the identity of their users. Almost one fourth (26%)
had encountered a situation where a client was a danger to themselves or others. However, and
worryingly, less than half (46%) reported it to an appropriate authority (Finn & Barak, 2010).

One can speculate that until online counseling is adopted and incorporated as a legitimate
form of delivery of therapeutic interventions, thereby included in training courses for psychol-
ogists and as part of the broader field of psychology, regulated by appropriate and established
accrediting bodies, it will continue to be considered by some as a renegade. Additionally, its
incorporation would potentially ensure the industry is standardized and regulated and therefore
more trustworthy for the consumer and other professionals.

Online Counseling: A Narrative Review 1005

Attitudes and Experiences

The literature on attitudes and experiences towards online counseling supports the view that
users of online counseling and potential users seem to have been more accepting of online
counseling than professionals (Mallen et al., 2005). One study that investigated psycholo-
gists (N = 1040) attitudes towards delivering therapeutic interventions online found that the
majority held a neutral attitude and only 3% viewed such delivery as unacceptable (Wang-
berg, Gammon, & Spitznogle, 2007). However, the neutral attitudes found may suggest a
lack of knowledge or simply a statement of not knowing or uncertainty. The study high-
lighted that those who frequently use the Internet or had experience using e-mail in clini-
cal practice were more favorable towards online counseling. Chester and Glass (2006) in a
survey of the attitudes of 67 online counselors reported that 57% of respondents believed
that online counseling was as effective as F:F counseling while 42% believed it was less
effective.

Contracting, confidentiality, and informed consent have been some of the issues raised
by professionals regarding their concerns about online counseling (Hanley, 2006). However,
Hanley (2006) found that such concerns expressed by practitioners in developing an on-
line counseling service for young people mirrored those that would be considered when es-
tablishing a F:F practice. Finn and Barak (2010) reported that the majority (74%) of the
e-counselors they surveyed were satisfied with their experience of their online counseling
service.

At the same time therapists have also reported advantages about online counseling including
that it can be of a lower emotional intensity, there is more time to think, the power balance seems
more equal between the parties, and clients can be more focused and expressive (Bambling, King,
Reid, & Wegner, 2008). In relation to written and spoken records being kept verbatim, while
potentially useful in supervision, they also increase the level of accountability for therapists
(Murphy & Mitchell, 1998). Certainly what seems evident is the level of ambivalence that
therapists hold regarding delivering counseling online. One could speculate that it is largely
because of a lack of exposure to online counseling and uncertainty, and a lack of knowledge
regarding how it is operated and the benefits it can realize for users in particular.

Mallen et al. (2005) write how clients appear to have embraced online counseling with more
ease than have professionals. However, an early study assessing attitudes towards online and F:F
counseling noted that respondents had significantly more positive attitudes towards F:F than
online counseling (Rochlen, Beretvas, & Zack, 2004). However, the study sample comprised
participants who had no experience with online counseling, and, therefore, the situation was
presented as hypothetical. The study did show that unlike the traditional gender divide found in
attitudes towards traditional counseling, there were no gender differences in attitudes towards
online counseling, with an overall neutral to slightly positive attitude. The neutral result could
be a similar response to the earlier study by Wangberg et al. (2007) regarding therapists attitudes,
and could be referencing a lack of knowledge or uncertainty.

Anonymity, convenience, counselor credentials, access, and cost have been cited as primary
reasons why someone would seek online counseling (Young, 2005). Qualitative studies have also
identified the motivations for seeking online counseling; participants have reported their belief
in the effectiveness of online counseling, and reported advantages included enhanced freedom of
expression through writing, reduced costs, and convenience (Bambling et al., 2008; Beattie et al.,
2009; Cook & Doyle, 2002). On the contrary, concerns that users have about online counseling
include the lack of privacy associated with the use of technology, the security of the technology
being used, and being caught using online counseling (Young, 2005).

One thing that is unique is that attitudes and experiences toward online counseling seem to
be effected by the level of comfort with the use of Internet technology (Leibert et al., 2006;
Wangberg et al., 2007). As the pervasiveness of technology in people’s lives grows, especially
for younger generations, one can imagine that in the future seeking online counseling would
not seem such a novelty but that there would be an expectation for counseling to be available
online.

1006 Journal of Clinical Psychology, September 2013

Suitability

The question as to who and what type of presenting issues are suitable to be dealt with through
the medium of online counseling are still very much points of debate in the literature. Some
practitioners advocate for this to be restricted to less serious issues (Haberstroh et al., 2008),
some note specific advantages for specific populations and presentations (Simpson et al., 2005),
while others advocate that the medium is adequate to address most issues at any level of severity
(Fenichel et al., 2002). The lack of empirical research means that the opinions to date are largely
anecdotal.

Very limited empirical research exists about the issues presented by online clients. Most
services have dealt with a broad range of presenting issues, and some have targeted specific
issues (Abroms, Gill, Windsor, & Simons-Morton, 2009; Alemi et al., 2007; Mitchell et al.,
2008; Robinson & Serfaty, 2008; Simpson, 2009; Simpson et al., 2001; Zabinski et al., 2004).
Apparently, however, there exists no difference between the presenting issues in online compared
with F:F counseling (Leibert et al., 2006; Richards, 2009). Barak et al. (2008) reported that
while all age groups showed benefits in online interventions individuals aged 19-39 years range
appeared to benefit the most. Mostly, online counseling seems to attract female clients in the
20-40 years of age group which in fact mirrors the F:F counseling demographic (Chester &
Glass, 2006).

Finn and Barak (2010) reported that the majority of e-counselors (95%) in their survey
believed that e-counseling is appropriate for interpersonal and social issues and personal devel-
opment. There was less agreement on issues that are considered a higher risk to a user’s personal
safety or well-being including suicidal thoughts, domestic violence, substance abuse, child abuse,
and sexual assault.

It can, however, be stated that the use of the medium, as is true for other types of communi-
cation, may not suit everybody and that individual factors may be important in determining the
success of online counseling (Fenichel et al., 2002). For instance, clients and therapists need to
have a good ability for written expression and reading, as well as computer literacy (Fenichel et
al., 2002; Rochlen, Zack, et al., 2004). Users, both therapists and clients, should also believe in
the therapeutic benefits of online counseling (Fenichel et al., 2002).

Training

Finn and Barak (2010) reported that the majority of e-counselors (94%) included in their
survey reported that their professional training program did not include training in e-counseling.
Instead, counselors learned about e-counseling through personal reading on the subject (92%),
informal consultation with colleagues (80%), attending an e-counseling workshop (20%), and
attending an e-counseling training program (16%). Their research concluded that the lack of
consensus about ethical obligations and practice suggest the need for formal professional training
in e-counseling and international cooperation in formulating practice ethics.

Training programs have been developed that offer certification in online counseling, to raise
the awareness of ethical issues and promote the development of specialized skills for the effective
provision of online counseling (Anthony & Goss, 2003). Typically, participants are brought
through a variety of theoretical and experiential modules, learning about the ethics of practice,
establishing a relationship online, communicating effectively using CMC, and establishing an
online practice. Alongside training courses several practitioner guidebooks and other written
resources have been published (Grohol, 2003; Jones & Stokes, 2009; Kraus, Striker, & Zack,
2010; Maheu, Pulier, Wilhelm, & McMenamin, 2004).

Future Research

The research to date has been largely positive in showing that online interventions can have a
similar effect and are capable of replicating some of the facilitative conditions as F:F encounters.
A need remains for stronger empirical evidence to establish efficacy and effectiveness and to
provide a deeper understanding of the specific mediating and facilitative variables.

Online Counseling: A Narrative Review 1007

A particular area that appears to be underdeveloped in the literature concerns the role of
the counselor: What now is the role of the counselor in the context of online counseling? Has
it changed or is it changing, and if so how? Perhaps online counseling should be considered
as a new type of intervention. A framework to define online counseling as a distinctive type
of therapeutic intervention is therefore needed. Future theory and research would benefit from
focusing on providing a clear theoretical framework for online counseling and on furthering our
understanding of the suitability and adaptability of different therapeutic approaches for online
delivery.

As a largely users’ led development of the field, and with evidence suggesting that clients
increasingly seek and adopt counseling online, the main duty of professionals is to ensure that
there is an evidence base to guide best practice. A key aspect will be identifying the mechanisms
that may be driving positive outcomes in online counseling. At present, we are dependent on the
factors that drive change in F:F counseling, such as the therapeutic relationship, but as research
develops it is likely that new factors will be identified, which may be responsible for change, for
example, the distance between client and counselor may be an important factor that facilitates
therapeutic change for some individuals.

Conclusion

What appears to emerge from reviewing the literature on online counseling to date is a picture
of a growing body of knowledge forming a foundation for a more solid evidence base to be
established. Urgency transpires in the literature in attempting to establish an evidence base to
ensure safety in delivering therapeutic interventions online. The provision of ethical guidelines
have provided for this need up to a point; however, alarming issues of noncompliance and lack of
specialized training for professionals have been highlighted, and as the field develops, adherence
to guidelines and the development of specialized skills would need to be pushed forward with
professionals.

Increasing awareness among professionals in highlighting the distinct nature of online coun-
seling, its defining features, dynamics, and issues to be considered in delivering online counseling
would seem to be fundamental items to be put on the agenda for future clinical guidance. This
could be achieved through the inclusion of training in online counseling in professional courses
as well as part of continued professional development.

In spite of criticisms and skepticism coming from professionals more so than clients, there
seems to have been a tacit acknowledgment that online counseling is an inevitable branching of
the field, reflecting changes in how individuals relate and access services due to wider changes
in society.

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articles for individual use.

NAVIGATING DUAL RELATIONSHIPS IN RURAL
COMMUNITIES

Jennifer L. J. Gonyea and David W. Wright
The University of Georgia

Terri Earl-Kulkosky
Fort Valley State University

The literature examining dual relationships in rural communities is limited, and existing ethi-
cal guidelines lack guidelines about how to navigate these complex relationships. This study
uses grounded theory to explore rural therapists’ perceptions of dual relationship issues, the
perceived impact of minority and/or religious affiliation on the likelihood of dual relation-
ships, and the ways rural therapists handle inevitable dual relationship situations. All of the
therapists who participated in the study practiced in small communities and encountered dual
relationship situations with regularity. The overarching theme that emerged from the data
was that of using professional judgment in engaging in the relationship, despite the fact that
impairment of professional judgment is the main objection to dual relationships. This overall
theme contained three areas where participants felt they most needed to use their judgment:
the level of benefit or detriment to the client, the context, and the nature of the dual relation-
ship. Surprisingly, supervision and/or consultation were not mentioned by the participants as
strategies for handling dual relationships. The results of this study are compared with estab-
lished ethical decision-making models, and implications for the ethical guidelines and appro-
priate ethical training are suggested.

The authors’ collective experiences of practicing in small communities led us to question how
therapists in these communities handle the inevitability of dual relationships. As we discussed
anecdotes from our respective practices, it became apparent that tension exists between a client’s
desire to have a familiar therapist and the ethical standards of our field. We turned to the American
Association for Marriage and Family Therapy (AAMFT) Code of Ethics for answers about how
to navigate these delicate situations. Couple and family therapists are admonished to “make every
effort to avoid [dual relationships] at all costs” (AAMFT, 2001; p. 1); however, no mention is made
of how to accomplish this in settings with limited alternatives.

The issue of dual relationships in areas with limited alternatives is complicated by clients’
attempts to self-match. Self-matching occurs when clients select a therapist who shares their atti-
tudes, race, education, social class, and/or religion (Jones, Botsco & Gorman, 2003; Whalley &
Hyland, 2009; Willging, Salvador & Kano, 2006; Wintersteen, Mesinger & Diamond, 2005). Cli-
ents feel more comfortable discussing their lives and presenting issues when they believe their ther-
apist holds the same values or shared cultural experience. A large percentage of Americans living
in small communities may be able to achieve this owing to homogeneity in small communities, but
not without creating ethical challenges for the therapist.

The ethical challenges for rural therapists are compounded when they also belong to a minor-
ity group. In addition to the limited number of available therapists in a small community, there are

Jennifer L. J. Gonyea, PhD, is a Lecturer and Undergraduate Coordinator, Department of Child and Family

Development, The University of Georgia and in practice at Samaritan Counseling Center of Northeast Georgia,

Athens Georgia; David W. Wright, PhD, is an Associate Professor, Department of Child & Family Development,

The University of Georgia, Athens, Georgia; Terri Earl-Kulkosky, PhD, is an Assistant Professor, Department of

Behavioral Sciences, Fort Valley State University, Fort Valley, Georgia.

This research was made possible through consultation with Edwin Risler, PhD (Athens, GA) and the Georgia

Association for Marriage and Family Therapy Board and members.

Address correspondence to Jennifer L. J. Gonyea, Department of Child and Family Development, The

University of Georgia, Dawson 123, Athens, Georgia 30602; E-mail: jlgonyea@uga.edu.

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 125

Journal of Marital and Family Therapy
doi: 10.1111/j.1752-0606.2012.00335.x
January 2014, Vol. 40, No. 1, 125–136

far fewer minority therapists in general (AAMFT, 2004). Therefore, when minority clients attempt
to self-match, there is a strong likelihood that a dual relationship dilemma will be encountered.

This studyaims to exploreareasnotpreviously considered in the ethics literature, payingparticu-
lar attention to how therapists practicing in rural areas navigate these complex relationships. The
next section provides the foundation for this study by reviewing the unique set of circumstances and
community variables that increase the likelihood of dual relationships in rural areas and the ways
existing ethical decision-makingmodels fail to consider the challenges of rural practice.

CHALLENGES OF RURAL PRACTICE

Rural communities are partially defined by their isolation that forces residents to rely more
heavily upon one another. Smaller communities have increased potential for dual relationships, in
general, and those between clients and therapists in particular (Erickson, 2001). Although the lack
of boundaries may seem natural and is often used as fodder for sitcoms set in small communities,
in real-life, it sets the stage for dual relationship dilemmas.

For many residents, this closeness is positive and helps build identity and sense of belonging
to that community in terms of Us versus Them. Therefore, residents of rural areas are often hesi-
tant to seek services from an outsider (Murry, Heflinger, Suiter & Brody, 2011) because they are
not to be trusted, which can lead to multiple levels of personal and professional relationships. Fur-
ther, persons from rural areas may resent an outsider offering assistance (Erickson, 2001; Jesse,
Dolbier & Blanchard, 2008).

Similarly, those who belong to a religious community or a minority group may prefer profes-
sional services from someone within their group or at least from someone who may share familiar
values. Research has found that people want a therapist and they believe to be like themselves
(Jones et al., 2003; Wintersteen et al., 2005) and when clients’ ethnicity matches that of their thera-
pist, they attend more sessions and have a greater likelihood of treatment completion (Erdur, Rude
& Baron, 2003).

Competing Ethical Principles
The absence of attention to how therapists in rural settings navigate potential dual relation-

ships is compounded by the ambiguous and vague discussion of dual relationships in the AAMFT
Code of Ethics, which states:

Marriage and family therapists are aware of their influential positions with respect to
clients, and they avoid exploiting the trust and dependency of such persons. Therapists,
therefore, make every effort to avoid conditions and multiple relationships with clients
that could impair professional judgment or increase the risk of exploitation (American
Association for Marriage & Family Therapy, 2001; p. 1).

If one’s interpretation of the code is that when multiple relationship situations arise, MFTs
should ensure that these relationships do not impair professional judgment or increase the risk of
client exploitation, then the dilemma is not “how to avoid dual relationships,” but “how does one
tell when multiple relationships will impair professional judgment” and “what is the obligation of
the therapist in warning or explaining the dilemma to the client?”

It quickly becomes clear that the real problem is how to address inevitable dual relationships,
rather than how to avoid them. Some suggestions include openly discussing the inevitability and
potential of out of session contacts between therapist and client (Faulkner & Faulkner, 1997) or
having a preconceived plan to negotiate social contacts with clients and seek immediate consulta-
tion if boundaries feel threatened (Jennings, 1992).

Rural clinicians are likely to be professionally isolated, making it difficult to obtain supervi-
sion or consultation. These clinicians may be secluded from the mainstream of their profession and
may have limited colleagues from whom they can seek support, collaboration, or supervision.
Rural therapists’ sense of isolation is also compounded by fewer opportunities for professional
development, continuing education, and limited access to support services.

These collegial issues also create a challenge to maintaining client confidentiality (Weigel &
Baker, 2002). A client’s confidentiality can be compromised through the “grapevine” in small

126 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

communities when the client is seen leaving the therapist’s office, parked in front of it, or even while
sitting in the waiting room. The few therapists in a rural area often have regular contact with one
another, and informal conversations between providers can increase threats to client confidential-
ity. Rural therapists rely on one another for professional development and resources. Withdrawing
from such informal exchanges could alienate close colleagues and leave a rural therapist with even
fewer resources. Rural therapists are left with the choice between increased threats to clients’ rights
to privacy or alienation of a close colleague.

Models of Ethical Decision-Making
Many ethical decision-making models suggest the following for the resolution of ethical dilem-

mas: (a) consulting the ethical guidelines of therapy professions; (b) seeking supervision or consul-
tation with peers; (c) creating a pros and cons list to determine the possible consequences and/or
alternative courses of action; or (d) some combination thereof (Corey, Corey & Callahan, 1998;
Erickson, 2001; Forester-Miller & Davis, 1996; Smith & Smith, 2001; Steinman, Richardson &
McEnroe, 1998; Tarvydas, 1998; Welfel, 1998). As noted previously, these guidelines may not pro-
vide enlightenment because they are ambiguous and require interpretation, the very foundation of
the original dilemma!

Few existing models specifically refer to issues of power and maneuverability, that is, the roles
and positions therapists take with clients. The professional guidelines assume therapists hold the
position of power when interacting with clients. Yet, depending on the nature of the out-of-session
contact, the client may occupy a powerful position in the relationship. In a unique acknowledg-
ment of potential limitations to both sides of a dual relationship, Haas and Malouf (1995) suggest
therapists ask themselves and their supervisors specific questions prior to engaging in a potential
dual relationship. For example, how might engaging in the dual relationship inhibit clients’ ability
to make autonomous decisions; how might the therapist acknowledge his or her privileged position
in the relationship; will the dual relationship affect the therapist’s ability to intervene effectively
and congruently. The suggested questions imply that the therapist is able to conceive a number of
alternatives and have insight into multiple perspectives on the situation, yet the inability to do so
when interacting with friends and relatives is precisely why dual relationships are discouraged.

Most ethical decision-making models assume that therapists have equal access to professional
resources across community types (rural compared to urban). In fact, models ignore the existence
of barriers to obtaining supervision and consultation in rural areas even though the limited avail-
ability of these in small communities has been well documented (Weigel & Baker, 2002). None of
the models reviewed suggest alternatives to supervision or ways of navigating a dual relationship
if, indeed, it is unavoidable. The potential consequences to seeking consultation with peers or feed-
back from supervisors in rural communities are also not addressed in the ethical decision-making
models reviewed for this study.

Clearly, one model or set of ethical standards does not encompass all possible dual relation-
ship dilemmas or all the factors contributing to it. Therefore, a more comprehensive exploration of
the processes through which clinicians make ethical decisions is called for. To meet that goal, this
study specifically examines (a) the ways rural therapists perceive dual relationships and the result-
ing impact on clinical practice; (b) the strategies clinicians believe they employ to negotiate dual
relationships; and (c) the perceived influence of minority or religious affiliation on dual relation-
ship situations.

METHOD

Design of the Study
This study used a naturalistic paradigm to explore the experiences of therapists in rural set-

tings. Among Lincoln and Guba’s (1985) naturalistic paradigm axioms, several were relevant here:
(a) realities are multiple, constructed, and holistic; (b) the knower and the known are inseparable;
therefore, the participant and researcher influence one another; (c) generalization is only possible
through the formulation of working hypotheses that are context and time specific; and (d) unlike
traditional inquiry that is value-free, the naturalist paradigm states that inquiry is value-bound by
the choice of the problem, theory, and context.

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 127

This study sought to explore how rural therapists interpreted the AAMFT ethical guidelines
as they made decisions about whether to have dual relationships with the clients they served. Their
experiences then constituted multiple realities and, while tied professionally to the ethical guide-
lines, their interpretation of the guidelines allowed the therapist to construct their understanding
and approaches to ethical dilemmas of dual relationships. This qualitative approach allowed for
an emphasis on the participant’s view (Creswell, 1998) of their experience of dual relationships in
rural areas and how they navigate such situations. Specifically, the present study questions how
the experience of dual relationships decision-making is handled when the therapist’s professional
supports are limited.

Description of Participants and Selection Process
Participants were Clinical and Associate members of an AAMFT Division in the Southeast

practicing in rural areas. Rural areas were selected using the categories of urbanicity established by
Bachtel (2004) at the county level: Urban, Suburban, Rural Growth, and Rural Decline. Approxi-
mately, 50 members were in the pool of potential participants.

Once the purposive sample was drawn from the current listing of active members of the Divi-
sion, participants were contacted via telephone based on information provided in the Division
directory. After providing verbal consent, telephone interviews were conducted. Multiple research-
ers were involved in gathering the data through phone interviews, and this served as one of the
forms of investigator triangulation (Denzin, 1978). Attempts to contact the 50 members were
made, and six therapists participated in the phone interviews. Some participants expressed a desire
to have more time to reflect on the questions. The researchers experience confirmed that additional
data collection methods could provide more respondents and richer data. Therefore, researchers
decided on an additional data collection method, which would be to collect data at the annual
Division Spring Conference.

Conference attendees self-selected to participate in the study after hearing it described and
announced. An additional screening by the authors was used to ensure that participants met the
criteria established at the outset of the study. Attendees were provided consent forms and study
questions on the first day of the conference and asked to return both by noon on the last day. This
ensured that participants were able to reflect on their experiences and practices to give as detailed
explanations as possible. Participants provided information about the population size in their
practicing area and completed survey forms where they provided demographic information such
as age, race, type of practice, and length of practice. In addition, participants provided their
perception of the degree to which their minority or religious affiliation influenced requests for
therapeutic services from acquaintances in other settings, and how they make decisions in response
to these requests.

Between telephone interviews and the annual Division conference, fifteen therapists pro-
vided data for this study. Of these, five self-identified as African American, one self-identified
as racially mixed (Caucasian and Phillipina), and the remaining nine participants self-identified
as Caucasian. Participant ages ranged from 29 to 60; however, most participants reported
having been in practice for over 20 years. All practiced in areas designated as rural according
to Bachtel (2004). Participants practiced in either private (N = 6) or public settings (N = 6),
while three practiced in both types of settings. Seven participants practiced in catchment areas
whose populations were 20,000–50,000, six practiced in catchment areas whose populations
were 50,000–100,000, and two of the participant’s catchment areas were over 100,000 people.
Some worked in communities that served more than one county, or in counties that served
multiple cities.

A detailed description of participant demographics is provided to illustrate several consider-
ations regarding the results. First, the participants in this study represent very experienced clini-
cians, the majority having practiced more than 20 years. The perception of one’s ability to
navigate complex dual relationships may be related to a sense of clinical competency evident in an
experienced sample. Second, how long clinicians had lived in their rural community is unknown, a
factor that may influence the likelihood of dual relationships. And lastly, most of the participants
worked at least part time in public settings where they may or may not have control over the
decision to see the a client known in another setting.

128 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Data Analysis
An interview guide (see Appendix A) was developed with open-ended questions that invited

the participants to convey their experiences with dual relationships in rural communities. This
interview guide provided a common set of questions for all participants, and left room to explore
new areas that might emerge. Data were analyzed using a sorting procedure that calls for searching
for what Wolcott (1994) terms patterned regularities in the data. We looked for common themes
and patterns of behavior that would give an understanding of the experiences of the participants.
Participant responses were then compared with the suggested procedures for ethical decision-
making reported earlier.

Our analysis process was guided by grounded theory (Charmaz, 2002; Glaser & Strauss,
1967); a qualitative methodology used with the goal of finding new theory or emerging themes in
phenomena studied. This method seemed most appropriate to the limited understanding of how
dual relationship dilemmas are handled by clinicians when such dilemmas are frequent or inevita-
ble. Consistent with a grounded theory approach, data collected from the first interview were
compared with data from the second interview, and this process of comparison was repeated with
each data collection (Strauss & Corbin, 1998).

Each phone interview was transcribed by the research interviewer, and non-phone written
interviews were reviewed. The interviewers (J.G. and T.K.) recorded notes immediately following
the data collection. These process notes included clarification questions asked, information on the
date and type of contact, insights, questions, and connections to other responses.

The research investigators then carefully examined the data and completed the task of com-
parison, developing new categories relative to the answers. Open coding methods (Charmaz, 2002)
were used to organize the data, and initial categories were developed. Themes emerged from the
categories and subcategories as data analysis continued. These themes are discussed in detail in the
results section that follows.

Trustworthiness and Credibility
To ensure trustworthiness (Merriam, 1998) and credibility, qualitative terms that are similar

to reliability and external validity, we used detailed descriptions of the research methods and credi-
bility audits to review the research methods, interviews, and findings. A licensed marital and family
therapy (MFT), who has practiced for more than 20 years, served as an internal auditor of the data
to open code the data from the interviews and written responses. In addition, an external auditor
(2nd author) reviewed all drafts of the results to verify that the categories and themes were consis-
tent with the interviews.

Transferability, the degree to which a study can be applied to other contexts by different
researchers, was established by providing detailed information about the participants and contex-
tual factors that may be relevant to future research efforts. For example, the Appendix A reports
the guiding questions used and the demographic information, such as practice setting, catchment
population, and years in practice are reported in the following section.

RESULTS

Although interviews varied somewhat, participant responses reflected the inevitability of dual
relationships in rural areas, consistentwith the existing literature. As expected, a common experience
among participants was receiving referrals for persons that they knew in other settings on a frequent
or occasional basis. Also as expected, participants received referrals based on religious andminority
affiliation,althoughmost of thesewere basedon religious as opposed tominority affiliation.

Similar themes emerged across clinicians in terms of how they handled potential dual relation-
ship situations. The therapists who participated in this study universally referred the potential
client elsewhere when the referral was well known. Among those that made referrals to avoid the
dual relationship, they took care to explain the dual relationship dilemma to clients in order to
preserve the existing relationship and ease the transition to a trusted colleague. For example:

The most common type of referral comes from my church. I usually refer them on and
explain the problem inherent in dual relationships. Generally, people are clueless about

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 129

this [dual relationships] issue and appear disappointed but do okay once they get started
with a colleague.

Even among those who reported engaging in the relationship initially, all stressed the impor-
tance of evaluation and assessment at the beginning of therapy. For example, several participants
engaged in two to four sessions during which they assessed the clients’ needs, their own ability to
meet those needs, and the likelihood that the therapeutic relationship might violate the ethical
guidelines by potentially “exploiting the trust and dependency of such persons” or “impair profes-
sional judgment or increase the risk of exploitation” (American Association for Marriage &
Family Therapy, 2001; p. 1). One participant reported engaging in the relationship:

depending on my conversation with the referral, for a 3 or 4 session evaluation with the
clear understanding that I may make a referral, continue to see the client myself, or have
a professional consultant in the fourth session to help us decide the appropriate next
phase.

Strategies for Handling Dual Relationships
During the open coding procedure, responses developed into the overarching theme of profes-

sional judgment which contained three areas where participants felt they most needed to use this
judgment: (a) level of benefit or detriment to the client; (b) the context; and (c) the nature of the
dual relationship.

Professional judgment. Whether explicit or implied, participants’ approach suggested they
had used professional guidelines as the source of their decision-making. One participant discussed
the “limits of therapy,” while another came to an agreement that “boundaries will be kept” with
the clients with whom he or she entered into a dual relationship. Elaborating on how boundaries
were kept, one participant stated:

NOT discussing client info with staff. When necessary for support, speak vaguely to the
school counselor. Make it clear to students and any others I see in community that I do
not/will not identify them seek them out in public social settings. I also make it clear that
I do not/will not identify other clients—or talk about them any professional relationship
to anyone. Clarity around boundaries is extremely important in maintaining them.

Several participants appeared to use a strict interpretation of the AAMFT ethical guidelines
concerning therapy with persons known from other contexts, unequivocally stating that they
would refer the client elsewhere based on their understanding of “making every effort to avoid . . .
multiple relationships” (American Association for Marriage & Family Therapy, 2001; p. 1). These
participants did not disclose any conditions under which they would agree to conduct therapy with
persons known from other contexts.

Professional judgment is a broad category and precisely the aspect of navigating complex rela-
tionships that this study was undertaken to explore.When prompted about how they used their pro-
fessional judgment, participants elaborated on how they make the decision to refer the client or
engage in the dual relationship. Participants were aware of the people or groups with whom they are
most experiencedor those the therapist feltmost competent inhelping andwithwhomtheyweremost
likely to engage in therapy: one partipant reported, “I know Iwork best with couples, single adults of
adolescents, not children and not addictive adults.” Several noted the client’s need for treatment, the
severity of the presenting issue, intake information, or expertise in couples versus family work as
issues to consider when deciding to take the case. For example, when participants felt that the client
needed immediate intervention andmaking a referral might delay treatment, they were more willing
to engage in a dual relationship. In this case, ensuring that the client received timely therapywas tem-
porarily prioritizedover the admonishment to avoid adual relationship.

The remaining three emergent themes reflect specific aspects of the dual relationships decision-
making articulated by participants. Although participants used their professional judgment in each
of these areas, they were specific enough to warrant separate elements.

Level of benefit or detriment to client. Promoting clients’ well-being was a factor in most deci-
sions therapists’ decision-making in their clinical practice. Specifically, they used their judgment

130 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

about the degree of benefit to the client when deciding whether or not to engage in a dual
relationship: one stated “professional judgment and instinct regarding my ability to be helpful to
the client.” In the words of one participant, he or she was aware of the potential “negative impact
of a dual relationship” on the clients well-being and the existing relationship. Despite this senti-
ment, many participants specifically mentioned that the dual relationship was a lesser concern than
promoting client safety. For example, one therapist would “suggest another referral unless an
emergency or crisis is presented.”

Another aspect of benefit to the client used as a deciding factor in engaging in the dual rela-
tionship was whether or not the client would not have sought therapy. A participant provided an
example of such a circumstance:

I have made one exception and accepted a client who told me she checked me out care-
fully at church and would otherwise not go to another therapist. She disclosed a ritual
abuse history and indicated a need to feel safe first since some of her abusers were trusted
people in positions of authority.

For this therapist, engaging in the relationship meant the particular client was able to receive
services. Other participants’ responses suggest that they use their judgment about what the client
needs and what they can offer at that time as means of determining whether or not to pursue the
dual relationship.

Context. Participants indicated concerns about the context within which they knew the
potential client. One participant differentiated between contexts such as “church affiliate versus
friend,” while another made the distinction between “whether I know them personally or profes-
sionally” as influential factors in their decision to pursue a therapeutic relationship or refer a client
to another therapist. Participants were more willing to conduct therapy with a professional associ-
ate than with a personal associate. A few were very specific in their understanding of a need to keep
personal and professional relationships separate, responding “I would not see someone with whom
I have a personal relationship” or “I don’t see family members of friends or acquaintances.” Others
made decisions based on a more graduated sense of the personal acquaintance. One participant
considered taking the case of someone with whom he or she had a professional relationship to be
unlikely to impair professional judgment or exploit clients and therefore upholding the ethical
standards of the field. Another participant noted receiving referrals from a sister program and
would engage in the dual relationship in the interest of “continuum of care.”

Therapist participants were more likely to engage in the dual relationship if he or she has
expertise with a particular population or presenting issue that was otherwise unavailable in the
area, in part out of the belief that the particular treatment the therapist offers is unique and that it
would be an undue hardship to the client to pursue this unique help elsewhere. For example:

Trauma using Eye Movement Desensitization and Reprocessing (EMDR) is my specialty
—if it is a very slight acquaintance (i.e., plumber, workman, etc) I would have to think
about it as I am, to the best of my knowledge, the only one using EMDR.

Nature of relationship. The nature of the relationship was considered a separate theme from
that of context and was based on a distinction between type of relationship (context) and the level
of intimacy or closeness in the relationship with a client (nature of the relationship). Examples
from responses include the influence of “the degree of interaction outside therapy,” “if I do not
have an intimate relationship with them I will see them,” and “if I know we will socialize I will
refer” as more intimate levels of contact with potential clients that would preclude a therapeutic
relationship. Participants distinguished between a high level of intimacy (personal relationships)
and low levels of intimacy (professional relationships) and considered high levels of intimacy to be
a barrier to a successful therapeutic relationship. Participants defined knowing someone “well” in
one or more of the following ways: (a) persons with whom they socialized; (b) persons with whom
their children played; (c) friends; (d) family members/acquaintances of friends; (e) students where a
spouse works; and (f) sharing a specific activity.

Participants might engage in a professional relationship with someone known from the gym
or an exercise class owing to the low levels of intimacy involved, but they were aware of their influ-
ential positions and potential likelihood of their impaired professional judgment when the current

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 131

relationship was one where there was a high frequency of contact and a high degree of intimacy,
such as a through a Bible study group or book club.

DISCUSSION

The strategies participants used to determine whether or not to refer a potential client reflect
several aspects of the ethical decision-making models reviewed, although they did not use any
model in its entirety. The four strategy themes derived from participant responses are present in
some of the ethical decision-making models previously outlined. Conversely, seemingly, important
aspects of the models are absent from participant responses and discussed below.

Professional Judgment
Despite the underlying assumptions about the inherent risks to judgment in a dual relation-

ship, the primary tool for navigating the complexity of a dual relationship among our participants
was the use of their professional judgment. Consistent with the question posed in the conceptuali-
zation of this study, therapists practicing in small communities appear to be aware of this integral
conflict and ask themselves, “How do I tell when multiple relationships will impair my professional
judgment?” These results indicate that therapists are intentional in handling potential dual rela-
tionships to minimize the impact on their ability to effectively manage the therapy process.

Although not explicitly stated in any of the models reviewed for this study, virtually all of
them imply using professional judgment. Several advise generating a list of potential courses of
action along with the possible consequences of these actions (Corey et al., 1998; Forester-Miller &
Davis, 1996; Smith & Smith, 2001; Steinman et al., 1998; Tarvydas, 1998; Welfel, 1998). The
results of this study add to the ethical decision-making literature and supplement the AAMFT
Code of Ethics by indicating specific aspects of the therapeutic relationship therapists in practice
should consider when exploring courses of action and their consequences, for example, judgments
about client motivation, the therapists’ ability to be helpful to the client, the potential for triangu-
lation, and the three specific themes discussed below.

Level of Benefit or Detriment
It is clear that dual relationships are discouraged, yet therapists may engage in them anyway if

they believe it will yield more benefit than harm for the client. A therapists’ main goal is for clients
to grow, improve, and heal. Toward this end, therapists were intentional in assessing the potential
harm to the client and the probable benefits.

This theme reflects themodels that suggest therapistsweigh thepotential risks andbenefits to see-
ing the client. Only Gottlieb (1993) proposes discussing with the client the potential consequences or
what their relationship posttherapy might entail should they engage in the dual relationship. The
majority of attention is focused on how contact outside of sessions prior to and during therapymight
impede the therapeutic process. Posttherapy contact is particularly important for those practicing in
a small communitywhere the likelihoodof such contacts in the community is very high.

Haas and Malouf (1995) suggest therapists ask themselves to reflect on their ability to be help-
ful. It is a therapist’s obligation to best meet the needs of their client, but also their prerogative to
refuse cases when they are not able to meet those needs. For example, if a therapist realizes that
she would be limited in what issues she can address and how she can address them, she might not
be able to provide quality therapy and would consider discussing that with the clients. An impor-
tant point for consideration is that the results of this study indicate that therapists practicing in
small communities may not feel they have the same latitude to refuse a case when the assessment of
the situation suggests that the client would be more harmed by their refusal.

Kitchener’s (1988) model also addresses power, but through the understanding of the different
roles, one might have in dual relationships. For example, one partner in a couple’s session is the
principal of the school the therapist’s child attends. In session, the therapist may be perceived as
having power. During interactions with the school, the principal is clearly in a position of power,
not only with the therapist, but also her or his child. Therapists who practice in small communities
are well aware of these types of power dynamics and considered them in assessing the level of bene-
fit or detriment to the client as well as the context and nature of the relationship discussed below.

132 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Context and Nature of the Relationship
The models reviewed herein do not attend to contexts in which decisions are made about

ethical dilemmas. The lack of distinction between contexts may lead to the assumption that all out
of session contacts between client and therapist are equally problematic to the process and
outcome of therapy. The therapists in this study felt that there are differences between types of
relationships (context) and the levels of intimacy (nature of the relationship) inherent in the
different types.

Most therapists have encountered a client outside of therapy, either at the grocery store, the
dry cleaners, or a physician’s office. Usually these meetings are unexpected and spontaneous. In the
case of a dual relationship, the assumption is that meetings outside of therapy are expected and at
times may even be regular, as in the case of a fellow parishioner. A consistent theme in the responses
of the participants reflected an attempt to understand the context and the nature of the relationship
between therapist and client outside of the therapy room, or in other words, attempt to determine
the regularity with which they might see one another and the quality of their out of session relation-
ship, consistent with the models proposed by Smith and Smith (2001) andGottlieb (1993).

This is an important point because the limited number of couple and family therapists who
represent cultural or religious minorities is likely to present an increased potential for dual rela-
tionships as clients attempt to self-match. This is underscored by a survey of AAMFT membership
(2004), which reported that the overwhelming majority of their members reported being White/
NonHispanic (93%: n = 2236) with approximately only 2% of respondents falling in each of the
following groups: African American, Hispanic/Latino, Asian, American Indian, and Other/Prefer
not to answer.

The energy and attention necessary for handling a dual relationship is usually greater than
that of another client. The therapist participants acknowledged this additional investment by
considering whether or not they actually have enough time to handle such a case and its unique
circumstances. This very specific, and practical consideration is not present in the reviewed models.
In fact, a number of everyday impediments to rural practice are not mentioned in the models, but
should be added to the list of practical obstacles to rural practice.

Supervision and/or Consultation
The literature on ethical dilemmas in rural areas notes the increased likelihood of encounter-

ing dual relationships and limited access to supervision. Two points strongly reflected in the results
of this study; one through its prominence and the other through its absence. The rural therapists in
this study generated the same concerns and issues that are represented in the literature regarding
the increased potential for dual relationships. Study participants received referrals or were sought
out by persons known to them in other settings and that these referrals came from a number of
community sources: fellow church members, family members of friends, parents of children’s class-
mates, persons with whom spouse has a professional relationship, and persons with whom the
therapist has a professional relationship (e.g., dentist, plumber, other therapist).

Notably, absent in participants’ responses was mention of bringing these dual relationship
issues to supervision to reflect on the potential consequences; however, it is unclear whether the
availability of supervision is limited in the areas where participants practice or whether the partici-
pants do not consider supervision as one of the tools useful in navigating dual relationships. As
noted earlier, one participant did report using a consultant “in the fourth session to help us decide
the appropriate next phase.” This participant used consultation as part of the therapeutic decision-
making process rather than as a means of determining, a priori, potential problems associated with
the dual relationship or as feedback in maintaining healthy boundaries in an ongoing dual rela-
tionship. Although intended to clarify the dual relationship, it is equally likely that the use of a
consultant, a role different from a supervisor, may create an additional dual relationship that rural
therapists must navigate.

A lack of supervision and consultation opportunities may possibly contribute to ethical con-
cerns resulting from limited access to clinical resources. Suggestions for therapists to remedy this
concern and obtain supervision have included group, telephone, and Internet supervision, yet each
presents problems (Kanz, 2001; Weigel & Baker, 2002). For group supervision, practitioners from
rural areas may have to drive several hundred miles to receive supervision or risk discussing a client

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 133

with whom someone else in the group has a relationship. Telephone supervision provides one
option for supervisees who may be geographically isolated, but there are still some ethical consid-
erations. Sending recorded sessions in the mail increases threats to confidentiality; cell phones are
an insecure method of discussing client information that could potentially be intercepted, and the
amount of time and expense to send recordings via postal service may be prohibitive. The availabil-
ity of Internet supervision is alluring, yet presents concerns about (a) divulging confidential infor-
mation over an insecure mode of communication; (b) the difficulty in obtaining informed consent
from clients for this type of supervision; (c) the importance of nonverbal cues of the therapist,
supervisor, and client; and (d) liability and licensure issues when Internet supervision takes place
across state lines (Kanz, 2001).

CONCLUSION

An objective of this study was to gather data to illustrate the complexities of dual relationships
in rural areas. The overwhelming majority of the rural therapists who participated in this study did
face the dilemmas of dual relationships. Indeed, most had fairly well-established strategies for han-
dling these relationships both before and during treatment.

The hope is that this research will foster a better understanding of the complexities of dual
relationships in rural areas as well as support further research in this area. The results of this study
may serve to clarify ethical guidelines around dual relationships in both the literature and practice.
The qualitative exploration utilized in this study allowed the researchers to begin to understand
the way therapists think about their process for ethical decision-making. Follow-up interviews with
therapists who are in the process of evaluating a dual relationship situation in their rural communi-
ties would greatly enhance our understanding of the practice of ethical decision-making. Also,
interviews focusing on the themes derived from this study would address the multiple obstacles to
confidentiality and maintaining therapeutic boundaries in small communities.

The implications of this study are significant: it seems clear that the nature of these relation-
ships is more than duality. Participants noted that whether a relationship is personal or profes-
sional, the types of boundaries regulating it, and the context of out-of-session contacts as
important factors in making ethical decisions. The consideration of these factors in decision-mak-
ing reflects the reality that dual relationships are inevitable in small communities and places more
emphasis on evaluating the process of therapy than on the duality. In the words of one participant,
“I live in a community of 5,000—if I am going to work, I must navigate these crossovers.”

This has implications for MFT training programs’ curriculum regarding AAMFT ethical
guidelines and the ethical guidelines in general. The current guidelines do not address the process
for decision-making with regard to dual relationships. Programs can help therapists in training
develop a more introspective and less legalistic decision-making process, which would address the
complexity of mitigating factors and provide an opportunity for them to explore their own biases
in a supportive environment.

Clients want to be in relationships with people like themselves and often look for therapists
that they believe have similar values or experience. Unfortunately, in rural communities where the
pool of available therapists is often limited, practicing therapists have little guidance in how to
make an ethical decision because of the ambiguity of the ethical guidelines and the neglect of the
challenges to rural practice in existing ethical decision-making models. These therapists may also
have difficulty navigating complex dual relationships because there are few opportunities for super-
vision in their communities. Instead, they learn to rely on their professional judgment about the
level of benefit or detriment to the client and therapeutic relationship and the context and the
nature of the relationship as they make their decisions about engaging in it.

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AAPPENDIX

GUIDING INTERVIEW QUESTIONS FOR CLINICIANS

The following questions were used as a guideline during phone interviews and distributed to partici-
pants at the annual Division Spring Conference for review. The researchers gave a brief description of
the purpose of the study and a consent script, either at the beginning of the interview or in writing for
those recruited at the Division Conference.

1. I am interested in knowing more about your experiences as a family therapist practicing
in a small community. Do you receive referrals for clients that you already know from
another setting?
a. (If yes) Help us understand how you think about these referrals? (factors you con-

sider, type of relationships, specific examples).
2. What are the settings that you might know some of these referrals from?
3. Describe how you respond to these requests for therapy from people you already know?

(Appropriate follow-up questions as needed to understand the factors.)
4. What influences your decision to see the client? (Appropriate follow-up questions as

needed to understand the factors.)
5. What influences your decision to refer the client? (Appropriate follow-up questions as

needed to understand the factors.)
6. Tell us about a time you received a referral from your religious or minority community?

a. Which affiliation?
b. How do you think knowing the person/family impacts your ability to conduct ther-

apy with the person or family?
7. What is your perception of how often you get referrals based on this affiliation?

136 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Copyright of Journal of Marital & Family Therapy is the property of Wiley-Blackwell and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder’s express written permission. However, users may print, download, or email
articles for individual use.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 3

Research

© 2014 by the American Counseling Association. All rights reserved.

Received 09/06/12
Revised 02/12/13

Accepted 02/18/13
DOI: 10.1002/j.1556-6676.2014.00124.x

Julie M. Moss, Hand Middle School, Columbia, South Carolina; Donna M. Gibson, Department of Educational Studies, University of
South Carolina; Colette T. Dollarhide, Department of Counselor Education and School Psychology, Ohio State University. Donna M.
Gibson is now at Department of Counselor Education, Virginia Commonwealth University. This research was made possible through
partial funding provided by a grant from the Chi Sigma Iota Counseling Academic and Professional Honor Society International.
Correspondence concerning this article should be addressed to Donna M. Gibson, Department of Counselor Education, School of
Education, Virginia Commonwealth University, PO Box 842020, Richmond, VA 23284-2020 (e-mail: dgibson7@vcu.edu).

Counselor professional identity encapsulates the idea of con-
tinuous growth and development within a certified context.
Counselor growth and development is a continuous and lifelong
process (Borders & Usher, 1992). It begins as individuals enter
counseling training programs and continues until they retire.
Professional identity is part of being a counselor (Gazzola &
Smith, 2007; Gibson, Dollarhide, & Moss, 2010) and is the
integration of the professional self and personal self (including
values, theories, and techniques). Personal attributes combine
with professional training as a counselor forms his or her own
professional identity. Within an ethical context, counselors rely
on their professional identity as a frame of reference as they
make decisions regarding their work with clients (Brott & My-
ers, 1999; Friedman & Kaslow, 1986; Skovholt & Rønnestad,
1992). In essence, counselor professional identity includes
interpersonal and intrapersonal dimensions.

Interpersonal dimensions of professional identity involve
one’s relationship to society and the professional community
(Gibson et al., 2010). The professional community includes
professional organizations, licensing boards and credentialing
bodies, and accrediting agencies. Interpersonal aspects also
involve the professional community of counselors. Emerg-
ing counselors learn about the culture of the counseling
profession through supervision and experience (Dollarhide
& Miller, 2006).

Professional identity is also shaped from within a person
and comprises the intrapersonal dimensions of professional
identity (Gibson et al., 2010). Personal definitions of coun-
seling evolve, locus of evaluation changes, and reflection

Professional Identity Development:
A Grounded Theory of Transformational
Tasks of Counselors
Julie M. Moss, Donna M. Gibson, and Colette T. Dollarhide

The purpose of this qualitative grounded theory study was to investigate practicing counselors’ professional identity
development at nodal points during their career. Through the use of 6 focus groups of beginning, experienced, and
expert counselors, 26 participants shared their experiences, and 6 themes emerged to form a theory of transformational
tasks of professional identity development. Through these tasks, counselors encountered issues of idealism toward
realism, burnout toward rejuvenation, and compartmentalization toward congruency.

Keywords: professional identity development, practicing counselors

becomes increasingly important as counselor identity is
solidified. New professionals move from an external to an
internal locus of evaluation and from a reliance on experts
to a reliance on their own experience and training (Auxier,
Hughes, & Kline, 2003; Brott & Myers, 1999; Gibson et al.,
2010; Skovholt & Rønnestad, 2003). The majority of research
pertaining to counselors’ identity development centers on the
professional identity development of counselors-in-training
rather than working professional counselors (Auxier et al.,
2003; Howard, Inman, & Altman, 2006; Gibson et al., 2010;
Nelson & Jackson, 2003; Woodside, Oberman, Cole, & Car-
ruth, 2007). Theories of identity development of counselors-
in-training (Auxier et al., 2003; Gibson et al., 2010) showed
that through experience, course work, and a commitment to
the profession, identity develops over time.

However, there is limited research about counselor identity
development at various points in the career life span. Mellin,
Hunt, and Nichols (2011) found that counselors believe their
work to be different from other helping professions and that
counselors’ identity focused on a developmental, prevention,
and wellness orientation. Several studies cite the need for
greater information about the development of professional
identity during the professional life span (Bischoff, Barton,
Thober, & Hawley, 2002; Brott, 2006; Brott & Myers, 1999;
Dollarhide, Gibson, & Moss, 2013; Gibson et al., 2010; Howard
et al., 2006; Rønnestad & Skovholt, 2003; Skovholt & Røn-
nestad, 1992). Rønnestad and Skovholt (2003) provided a phase
model that described “central processes of counselor/therapist
development” (p. 5) from the novice professional to the senior

Journal of Counseling & Development ■ January 2014 ■ Volume 924

Moss, Gibson, & Dollarhide

professional. The postgraduate professionals interviewed in
their cross-sectional, grounded theory qualitative study had an
average of 5, 15, and 25 years of professional experience with
doctoral degrees in professional psychology. On the basis of the
data, the following themes emerged: (a) There is an increasing
higher order integration of professional and personal selves;
(b) continuous reflection is required for optimal learning; (c)
an intense commitment to learning drives development; (d)
professional development is continuous, is lifelong, and can
be erratic; (e) clients are influential to counselor development;
(f) personal life experiences are influential to counselor devel-
opment; (g) interpersonal sources (i.e., mentors, supervisors,
counselors, peers, family) are influential to counselor develop-
ment; and (h) thinking and feeling about the profession and
clients change over time.

Conceptual Framework of Current Study
Although many of the professional identity development
studies in the literature are focused on one specific type of
population and at one point in time, a few longitudinal studies
in other disciplines indicate that there are specific influences
on professional identity development over time (Dobrow &
Higgins, 2005; Monrouxe, 2009). Rønnestad and Skovholt’s
(2003) work provided a foundation for the current study.
Because Rønnestad and Skovholt focused on postgraduates
with doctoral degrees in professional psychology, for the
current study, we determined that more research including
participants who were professional counselors (with and
without doctoral degrees) could determine if similar themes
are experienced. Hence, we created a series of four separate
cross-sectional studies to examine the professional identity
development of individuals in the counseling profession. The
four studies investigate counselors-in-training (Gibson et al.,
2010), practicing professional counselors, doctoral students
in counselor education programs (Dollarhide et al., 2013),
and counselor educators. No data were used more than once
in data analysis and reporting across the four studies. The
cross-sectional design allowed us to determine what transfor-
mational tasks were occurring for these groups of participants
and if longitudinal research was warranted for further study.

Transformational tasks describe the work counselors
must accomplish at each stage of their professional life span.
Counselors’ professional identity is transformed in response
to completing each task. For example, Gibson et al. (2010)
found three transformational tasks that counselors-in-training
must accomplish to develop a firm professional identity:
defining counseling, transitioning responsibility for growth,
and integrating a systemic identity. They found that course
work, experience, and commitment were significant events
as counselors-in-training moved from external validation to
self-validation. These results led us to question if the trans-
formation of counselor identity is mirrored in practicing
counselors. Therefore, we posed the following question in

our study: What is the process of counselors’ professional
identity development at nodal points in their career life span
as beginning, experienced, and expert counselors?

Method
For the current study, we used a grounded theory approach to
generate an explanation of the process of professional identity
development as it was viewed by the participants (Corbin &
Strauss, 2008). A grounded theory approach was most ap-
propriate for this study because it focused on developing an
explanation of a process that involved many individuals. Other
qualitative approaches did not allow a focus on the process.
All participants in the study had experiences that related to
professional identity development, and the research sought to
explain the process (Creswell, 2007). The characteristics of
grounded theory include the theory being grounded in data, use
of a constant comparative method, the use of memo writing by
the researchers, and theoretical sampling (Heppner & Heppner,
2004). The constant comparative method found in grounded
theory enabled us to identify similarities and differences be-
tween school and community-based counselors’ experiences.

Researchers and Trustworthiness

We were the primary instrument in the data collection. It is
especially important to recognize our assumptions and biases
in qualitative research because the data were filtered through
our lenses (Heppner & Heppner, 2004). We controlled for
this by first recognizing the assumptions and biases we held
relating to counselors’ professional identity development.

All three researchers are women. The first author, a middle
school counselor and doctoral candidate, had participated in
previous research relating to professional identity develop-
ment. She has 7 years of experience as a school counselor at
the elementary and middle school levels. The second author
has 13 years of experience as a counselor educator and 8 years
as a licensed professional counselor (LPC), and the third
author has 20 years of experience as a counselor educator
and 10 years as an LPC and school counselor.

When designing this study, we attempted to make the
study more rigorous. Acknowledging biases, using multiple
researchers during the coding process, and member checking
helped ensure the trustworthiness of data analyses. Because
this was a qualitative study, researcher biases were inherent.
Among our biases was the belief that counselor identity is
important to counselors and counselor educators. One of
our central assumptions relates to professional identity and
its progression during the course of one’s career. That is, we
believe that interactions with clients and colleagues, continued
professional development, successes, and failures shape how
counselors view themselves and their profession and that these
ideas evolved from the beginning of graduate school until the
present time. We anticipated that these ideas will continue to
change as counselors’ professional growth occurs.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 5

Professional Identity Development

To control for biases and to embrace subjectivity, we took
field notes and wrote reflexive journals (Heppner & Heppner,
2004). After leaving the data collection sites, we used reflexive
memo writing to write about emotions and reactions during
the study. Memo writing was also used to write down ideas
about the evolving theory during the data analysis process.
Using three researchers during the coding process ensured
that the themes and process formed were grounded in data.
The use of multiple researchers added credibility by involving
multiple perspectives, opinions, and experiences.

Participants had the opportunity to review our preliminary
analysis and take part in member checking (Creswell, 2007).
Some participants who noted that they would be available
for follow-up questions were asked to review the initial data
findings. Preliminary data were presented to the participants
via e-mail.

Participants

We used stratified purposeful sampling to select participants
for the study. This type of sampling identified the subgroups
and allowed for comparison between the groups being studied
(Creswell, 2007). Using Rønnestad and Skovholt’s (2003)
stratified sampling method, we invited school and community-
based counselors (with an LPC or LPC intern credential) to
participate and divided them into groups based on years of
experience (i.e., 1–2, 5–15, and 20+ years). School counselors
were solicited through a state mailing list and through local
school districts. We obtained contact information for LPCs
in the area from the state’s Department of Labor and Licens-
ing. Also, we used contact information for graduates from a
local university.

Twenty-six participants met the criteria and were able
to participate in the study. Demographic information was
collected relating to participants’ ethnicity, gender, high-
est degree earned, and work setting. Of the 26 participants,
15 were school counselors and 11 were community-based
counselors. The majority of the participants were female (n =
21) and five were male. Twenty-two participants identified as
White and four participants identified as African American.
Their work settings varied among the groups. For the school
groups, four were elementary counselors, six were middle
school counselors, and five were high school counselors.
Among community-based counselors, four worked in private
practice; one worked in college counseling; two worked in a
hospital setting; and one each worked in a residential treat-
ment facility, a community college, a mental health center,
and an employee assistance program.

Data Collection

Questions were developed based on research on professional
identity development (Rønnestad & Skovholt, 2003) and
the focus group questions used in Gibson et al.’s (2010)
study. We designed questions to elicit participants’ experi-
ence of their professional identity development during their

career. The questions addressed the following: definition of
counseling and any changes over time, professional identity
and factors that influenced it (i.e., Define your professional
identity at the current moment), and needs to progress in
their professional identity (i.e., What do you think you need
to progress to the next level of development of your profes-
sional identity?). Data were collected through recorded focus
groups that were scheduled in advance. The goal of this
qualitative data collection was to capture rich descriptions
of the process of professional identity development that
accurately represented participants’ lived experiences. The
advantage of using focus groups for data collection is that
it is more “socially oriented, often creating a more relaxed
feel than individual interviewing” (Hays & Singh, 2012, p.
253). The combination of grouping participants by work set-
ting, years of experience, and focus groups promoted robust
exploration and processing of the topic. The processing that
occurred in a focus group was essential to spark additional
thoughts relating to professional identity. By hearing other
counselors’ experiences in similar work settings, participants
gained insight into the construct of professional identity and
could provide more meaningful answers to questions. Focus
group sessions lasted 60 to 90 minutes.

The focus groups were formed on the basis of participants’
experience and area of expertise. We avoided mixing people
with different expertise or work settings because the goal was
for all participants to feel comfortable sharing their thoughts
and feelings (Krueger & Casey, 2009). Being comfortable in
the group increases the likelihood of participant involvement.
The focus groups were formed and coded with letters A (for
school and community-based counselors with 1–2 years of
experience), B (for school and community-based counsel-
ors with 5–15 years of experience), and C (for school and
community-based counselors with 20+ years of experience);
this coding system is used in the Results section.

Data Analysis

After focus group interviews were completed, each session
was transcribed verbatim. We used manual line-by-line open
coding to focus on coding for differences based on years of
experience and work setting and looked for concepts, catego-
ries, and properties that characterized each level of experience
and setting. We agreed that participants did not differ on the
basis of work setting. The idea of professional identity was
conceptualized as a continuum (Strauss & Corbin, 1998).
The transcripts of counselors with 1–2 years of experience
and those of counselors with 20+ years of experience were
coded for concepts and categories to anchor the ends of the
continuum. Next, the transcripts of counselors with 5–15
years of experience were coded.

In axial coding, the categories were refined as we sought
to identify the causes, influences, outcomes, and conse-
quences of counselors’ identity development. Participant
transitions were noted that would be used in the construction

Journal of Counseling & Development ■ January 2014 ■ Volume 926

Moss, Gibson, & Dollarhide

of the grounded theory (Corbin & Strauss, 2008). Finally, we
used selective coding to develop hypotheses to connect the
ideas of professional identity development among counsel-
ors. A model or theory was developed from the information
gathered (Creswell, 2007) that suggested transformational
tasks specific to practicing counselors. These transforma-
tional tasks were different from the transformational tasks
discovered in the previous studies (Dollarhide et al., 2013;
Gibson et al., 2010).

Results
The findings from the analyses suggested that six themes were
influential to counselors’ professional identity development:
(a) adjustment to expectations, (b) confidence and freedom,
(c) separation versus integration, (d) experienced guide, (e)
continuous learning, and (f) work with clients. Within three
of the themes—adjustment to expectations, confidence and
freedom, and separation versus integration—there was move-
ment as counselors gained experience working. The other
three themes—experienced guide, work with clients, and con-
tinuous learning—were catalysts for the movement that took
place. Although the process was different from the process
for counselors-in-training (Gibson et al., 2010), there were
transformational tasks completed by counselors during nodal
points in their counseling career that developed their profes-
sional identity. Within each of the groups, or career life stages,
there was a transformational task that enabled the counselor
to continue to grow and develop professionally (see Figure 1).

The three tasks were idealism toward realism, burnout toward
rejuvenation, and compartmentalization toward congruency.
Counselors were able to accomplish these tasks through the
processes of continuous learning, work with clients, and help
from an experienced guide. In this section, the results of the
themes with counselors’ quotes are presented. The section
ends with an explanation of how the themes are integrated
into the transformational tasks in the professional identity
development of counselors.

Participants were identified with anonymous codes based
on the group they were in: A = beginning counselors with
1–2 years of experience; B = experienced counselors with
5–15 years of experience; and C = expert counselors with
20+ years of experience. As mentioned earlier, participants
did not differ by work setting; therefore, school counselors
and community-based counselors are combined. Within each
group, participants are assigned an identifying number (1, 2,
3, etc.). For example, C2 is the second counselor in the group
of expert counselors with 20+ years of experience.

Themes and Theory

Adjustment to expectations. This theme represented the
counselors’ perceptions of their own expectations as coun-
selors versus the expectations others had of them in this role.
Counselors, especially beginning and experienced counselors,
expressed frustrations about their work environment. Beginning
counselors found reality different from the idealized role they
had imagined. As years progressed, this frustration led to coun-
selors in the middle of their career life span feeling dissatisfied

FiGurE 1

Professional identity Development Model of the Transformational Tasks of Counseling Practitioners

i

External
Validation

Experienced
guide

TIME

ii

Experience and
Professional
Development

• Continuous
learning

• Working with
clients

iii
Self-Validation

• Realistic sense
of work

• Rejuvenation
• Congruency of

work and life

AT
T

IT
U

D
E

T
O

W
A

R
D

W
O

R

K

E
N

E
R

G
Y

F
O

R
W

O
R

K

IN
T

E
G

R
AT

E
D

P
E

R
S

O
N

From idealism To realism

From burnout To rejuvenation

From compartmentalization To congruency

Transformational Tasks for Practitioners

Journal of Counseling & Development ■ January 2014 ■ Volume 92 7

Professional Identity Development

with their jobs. Counselors were asked how their definition of
counseling had changed for them, when it had happened, and
if working as a counselor was what they imagined it would be.

Beginning counselors grappled with the realization that
the realities of the workplace were different from graduate
training. One beginning counselor said, “It is one thing when
you are a student and there is someone actually kind of guid-
ing you but when you are out there doing it on your own, that
has definitely been an eye-opener” (A3). The idealized view
counselors had developed during training was different from
their actual job setting. Another beginning counselor stated,
“Now that I am actually in the school system, it is a little bit
different” (A2). These counselors reported feeling frustrated
as they recognized the difference.

Counselors expressed frustration with noncounseling
duties, administrative tasks, and paperwork. They reported
realizing how these other tasks interfered with their actual
counseling. As one beginning counselor explained, “I can’t
really get done what I want to get done and be as effective
as I can be because I am constantly doing other things like
paperwork” (A2). The counselors felt that these other or-
ganizations were dictating the services they provided and,
as a result, defined counselors’ identity. An experienced
counselor said,

Where I work it is almost like the establishments that we work
for really are defining our professional identity. . . . Insurance
dictates what kind of crisis a patient really needs to be having
in order to have the service they will pay for. (B13)

Experienced counselors were tired after years of confront-
ing the same struggles and were in need of rejuvenation. One
counselor shared,

I guess at this point in my career, I am feeling a bit I don’t
know if burned out is the word but I have gotten to where
I am used to doing the same thing. . . . I feel like I used to
have a lot more passion or hope than I do at this point. (B5)

After years of confronting these realities, expert counselors
felt continued frustration, which led to job dissatisfaction.

Confidence and freedom. As participants discussed how they
felt as counselors and what they needed to progress to the next
level of development in their professional identity, beginning
counselors expressed emerging doubts about their abilities and
desired more confidence. As these counselors gained experi-
ence, they felt more confidence and freedom in acknowledging
their limitations. A beginning counselor captured the insecu-
rities of new counselors by saying, “I feel like I have to put
up this, be as professional as I can be and you know talk as
technically as I can about what I do and what I am doing” (A4).
At the beginning stage of the counseling profession, there was
recognition that confidence struggles were part of the process.
Another beginning counselor said, “I almost think it is probably

a good place not to feel comfortable. . . . I definitely would like
to feel really confident. It’s all a process” (A5).

Whereas beginning counselors struggled to have confi-
dence within their professional role, experienced counselors
had gained confidence and felt freedom in recognizing their
limitations. One experienced counselor stated,

Early on when I was scared, I was fearful and not confident
. . . but for me now, I do think that it is probably, it’s really
awesome. . . . I still screw things up. I am just brave enough
now to own up when I do. (B11)

With an increase in confidence and freedom, counselors
also appreciated the community of counselors that they used
for client referrals. Instead of feeling that they needed to
know everything, they developed a network of people who
supported their practice and their clients. This idea was de-
scribed by an expert counselor:

I also am appreciative of a network of folks who have a wider
range of skills in their specialties than I do and I feel much
more comfortable in my own skin saying, hey could you work
with this person. . . . I think there is a little bit more confidence
I have in relinquishing and not thinking I have to have all the
answers for everybody, every case. (C6)

Separation versus integration. In this theme, counselors
actively separated and integrated both personal and profes-
sional aspects of their lives into their professional identities.
When beginning counselors talked about their identity, they
spoke of separating work from other areas of their life. Upon
gaining experience, counselors developed a sense of their pro-
fessional self and personal self integrating into one identity.
As counselors talked about their definition of counseling and
how they had imagined counseling to be, it was evident that
change occurred over their professional life span. A beginning
counselor reported how she compartmentalized her roles:

I am also a [sports team] coach so I am in an out-of-counselor
role. I am not a counselor on the court. . . . You can’t be both
all the time. . . . I kind of turn it on, turn it off. (A2)

This counselor viewed counseling as something she
could leave once she stepped out of her office to assume
another role.

Counselors reported that they believed that this idea of
separation was part of their training. One experienced coun-
selor stated, “In school they teach you to leave it [work] and
take care of yourself, but it is hard when you are in it. . . . It
is hard to leave that office and go home” (B13).

Through more experience, counselors viewed the differ-
ent facets of their job as part of a larger purpose for helping
clients. An expert counselor said, “I think when I first started,
it used to be really compartmentalized . . . then like you said,

Journal of Counseling & Development ■ January 2014 ■ Volume 928

Moss, Gibson, & Dollarhide

jack-of-all-trades, you do whatever it takes to get that child,
do whatever you have to do” (C3). There was a realization
that clients are important, and there was a desire to give extra
effort to best help them.

Expert counselors reached a level of congruency with their
professional and personal selves. They were able to reflect and
see how personal experiences affected them professionally
and how professional experiences affected their personal life.
One expert counselor shared,

I think the thing that has shaped my life as a counselor is
probably my son’s death . . . my own grieving journey just
really brought everything out and I went back, I went head
long into training for the grief and loss. (C5)

Experienced guide. Counselors at all levels expressed the
importance of having a mentor, supervisor, peer supervision,
or some form of experienced guide to help them in their pro-
fessional development. Participants talked about the need to
learn from an experienced counselor when discussing what
they needed to progress to the next level of development of
their professional identity, experiences that had contributed
most to their professional identity, and experiences that had
resonated most with them as a counselor.

A beginning counselor looked for “someone to say I expe-
rienced the same thing and this is what I did” (A3). Another
beginning counselor spoke about the impact that a mentor
had on her professional development: “I don’t know where I
would be had I not had that mentor which has probably been
the most beneficial thing as far as my professional identity
goes and learning about who I am professionally” (A1). Be-
ginning counselors look to counselors with more experience
to give them ideas, advice, and support.

Peer supervision is another type of supervision that coun-
selors found beneficial. Within the relationship, counselors
assumed roles of both supervisor and supervisee, and there
was a recognition that counselors with varying years of expe-
rience brought strengths to the relationship. An experienced
counselor talked about the power of peer supervision:

There are three other counselors, so we have a lot of time
to talk about cases and support each other, so I think other
professionals who have been in it longer than I have and new
professionals that come in and have a new energy and a dif-
ferent idea about things. (B10)

The value in continuing a mentoring relationship was also
reported by expert counselors. One expert counselor discussed
the impact his mentor continues to have on him as a professional:

Watching him present, watching him work with families and
demonstrations, having a chance to affiliate with him. That it
continues to be kind of like, boy that’s sort of who, that’s the
arena I’d like to be when I grow up. (C6)

Continuous learning. Each group of counselors recognized
learning as a lifelong endeavor and discussed ways to acquire
additional professional knowledge. Counselors were energized
as they talked about what they needed to progress to the next
level of development of their professional identity; they also
spoke of learning from classes, conferences, and trainings.

Beginning counselors expressed excitement about the
vast amount of information in the field. For example, one
beginning counselor said, “I think that is exciting about our
profession because we have to stay somewhat fluid and just
keep on changing” (A1). Participants were comfortable with
the idea that they would have to continue to learn to continue
developing as a professional.

As counselors gained experience, their learning became
more focused on their areas of expertise and interest. An ex-
perienced counselor said, “I study, study, study, study because
I am always interested in what is working, and I am always
searching out what’s going to help [clients], and I use every-
thing” (B12). Participants reported a desire to study specific
topics that would best help their clients and the populations
that they work with daily. An experienced counselor talked
about wanting “training on specific things, bullying, ADHD
[attention-deficit/hyperactivity disorder], autism” (B2).

Although they had many years of counseling experience,
expert counselors embraced the idea of continuous learning.
An expert counselor talked about his comfort level with
continuing to be a student at a conference:

They had all these labels and badges that you could attach
to your name tag, “Presenter,” or you know, “First Time At-
tendee,” and I don’t know whether it was what I wanted to be
as far as my next level, or if it was the contrarian in me, but I
picked up a “Student” badge and attached it to my name tag.
And actually I began to feel very, very comfortable with that.
There’s this, there is more for me to learn. (C6)

Conversations about additional educational experi-
ences energized counselors at all levels. For counselors,
learning was a lifelong endeavor because the f ield is
constantly evolving.

Work with clients. Clients provided the needed positive
reinforcements for counselors to do their job. A beginning
counselor stated, “I feel I am making a small difference and
constantly getting those reinforcers and motivators” (A4). Cli-
ents made the counselors’ learning, frustrations, and struggles
worthwhile. Participants were able to point to specific success
stories or instances of failure that had a lasting impact on
them professionally. Across all levels and work settings, work
with clients was most meaningful to counselors’ professional
identity development. Participants in every group discussed
their work with clients when asked about the experiences
that had contributed most to their professional identity, the
experiences that had resonated most with them, and how they
felt about themselves as counselors.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 9

Professional Identity Development

Beginning counselors were surprised at the strength people
showed despite their circumstances. Instead of being the ex-
pert, counselors found themselves learning from their clients.
One beginning counselor said, “I have been surprised, which
I am ashamed to say, that I just discovered more about how
people are strong and resilient . . . nothing seems to have gone
well but they were just incredibly strong” (A7).

Experienced counselors were pleased when they saw
clients grow and reach their counseling goals. Termination
was viewed as a graduation from counseling and a time when
both the client and counselor were proud of themselves. An
experienced counselor shared,

I terminated [counseling] a young college girl whom I had
been working with for about two and half years. . . . When we
finally met for the last time last week, it was mixed feelings.
I was almost sad because I was saying good-bye to her, but
then I was very proud of her work, but then I was proud of
myself because I stuck with her and saw her through. (B13)

Success stories involved clients in crisis and times when
counselors were able to help. The counselors realized that they
had made a difference in another person’s life. For example,
one experienced counselor stated, “It has been the children
who have been sexually abused, or the children who have
had physical abuse or witnessed you know things that were
traumatic for them and I know that those children really, re-
ally need me” (B6).

Emergence of Theory

In analyzing the current data, we determined that the themes
found in the participants’ experiences were part of the trans-
formational tasks associated with counselors’ professional
identity development. Counselors’ professional identity was
transformed in response to completing each task. The three
tasks the practicing counselors worked to accomplish were
idealism toward realism, burnout toward rejuvenation, and
compartmentalization toward congruency (see Figure 1).
These tasks served as a foundation to the process reported
by the participants within the themes of adjustment to ex-
pectations, confidence and freedom, and separation versus
integration. As counselors talked about each of these areas,
they reported factors that prompted their movement. These
factors were the catalysts for a changing identity. The same
transformational process was used at each stage: work with
clients, experienced guide, and continuous learning. In es-
sence, the grounded theory of this study was based on the
transformational tasks of professional identity development
of counselors.

Beginning counselors’ idealistic views were confronted
with the reality of the work world. This transformational task
involved the themes of adjustment to expectations and confidence/
freedom. The task at this stage was for new counselors to
reconcile their idealized visions with reality. Participants

reported entering the workforce unprepared, and new coun-
selors often experienced disillusionment with their graduate
training (Skovholt & Rønnestad, 1992). As counselors worked
to accomplish the task, they experienced self-doubt and con-
fidence struggles. Other studies found that new counselors
lacked confidence and needed external validation (Auxier
et al., 2003; Brott & Myers, 1999; Skovholt & Rønnestad,
2003). Participants reported that external validation came
from experienced guides and clients. As counselors received
external validation from an experienced guide or a client and
gained additional knowledge, they were able to accomplish
this task. The challenge of this task was for counselors to
become realistic about their abilities and their role.

Experienced counselors were challenged with the task
of burnout toward rejuvenation, which also addressed the
theme of adjustment to expectations. Participants reported
feeling dissatisfied with their jobs after years of dealing
with continual frustrations. As Gibson et al. (2010) found,
counselors reported that the public had misperceptions about
the counseling profession. Daily, counselors are advocates
for the profession to educators and insurance companies,
and these other entities influence counselors’ role and affect
their identity (Brott & Myers, 1999). Nevertheless, there was
a sense that counselors came to terms with these frustrations
and found a way to move forward professionally. The cata-
lysts for this movement were continuous learning, work with
clients, and an experienced guide. Counselors in this study
were energized by continuing to learn. They reported that
learning new techniques, taking classes, or making a change
in their counseling approach rejuvenated their professional
outlook. Successes with clients made the frustrations worth-
while. Knowing that they had made a difference or saved a
life was the reinforcement counselors needed to continue to do
their job. Participants also discussed how support from other
counselors helped them move forward during stressful times.

The third transformational task challenged counselors to
move from compartmentalizing counseling to having a con-
gruent view of the self. This task included the themes sepa-
ration versus integration as well as confidence and freedom.
The movement from compartmentalization to congruency was
a slow process fostered by experiences with others (clients,
experienced guides, and learning opportunities). Through
these interactions and personal experiences, counselors ex-
perienced a merging of their professional and personal selves
into a congruent identity.

Participants reported viewing counseling as something
separate from other aspects of their lives. They wanted to keep
their professional and personal lives separate in order to have
balance. However, congruency was observed in expert coun-
selors. Skovholt and Rønnestad (1992) found an authenticity-
to-self in experienced counselors in which role, working style,
and personality complemented one another. Expert counselors
in the current study accepted that being a counselor was a
core part of who they were as a person. They were confident,

Journal of Counseling & Development ■ January 2014 ■ Volume 9210

Moss, Gibson, & Dollarhide

were able to find balance, and experienced the freedom to take
professional risks. With the freedom to refer clients to other
counselors came a recognition of the professional commu-
nity. In contrast to Gazzola and Smith (2007) and Gibson et
al. (2010), in the current study, counselors did not consider
the professional community as comprising only counselors.
Instead, they seemed to include other helping professionals
in the professional community, such as psychologists, social
workers, and educators. This suggests a broader view of the
professional community as counselors looked beyond the
counseling profession for support and information.

The expert counselors were aware of their limitations and
experienced freedom in knowing their limitations. Their per-
sonal and professional selves had merged to create a congru-
ent self in which life experiences and professional experiences
were valued. Friedman and Kaslow (1986) found that coun-
selors became authentic and congruent as their professional
and personal selves merged. Participants in the current study
understood the value of their life experiences, including their
religious beliefs, values, interests, and personal losses such as
divorce or death in shaping who they were as a professional.

Discussion
The themes reported in this study were found to be important
to counselors’ professional identity development. They pro-
vided information about the process of identity development
over the course of the professional life span. The findings
are consistent with previous studies, which have found that
students developed an idealistic view of counseling during
training (Cave & Clandinin, 2007; Nyström, Dahlgren, &
Dahlgren, 2008; Swennen, Volman, & van Essen, 2008;
Troman, 2008) and that counselors entered the workforce
with unrealistic expectations (Rønnestad & Skovholt, 2003).
Participants in the current study discussed how their precon-
ceived view of counseling was challenged by the realities of
the workplace environment. Also, counselors with 1–2 years
of experience reported confidence struggles and feelings of
self-doubt that are consistent with previous studies (Bischoff
et al., 2002; Rønnestad & Skovholt, 2003; Skovholt & Røn-
nestad, 1992; Woodside et al., 2007). It was observed that
confidence grew as counselors gained experience. This is
consistent with previous studies that found counselors gained
confidence through experience, successes, and earning respect
from others (Magnuson, Black, & Lahman, 2006; Magnuson,
Shaw, Tubin, & Norem, 2004; R. G. Smith, 2007; Swennen
et al., 2008). As counselors gained confidence, they reported
realizing that they could handle their job, experiencing free-
dom to make mistakes, and understanding their limitations.

In addition, the data support how counselors become
congruent as their professional and personal selves merge
(Friedman & Kaslow, 1986). Three of the themes—work with
clients, experienced guide, and continuous learning—proved
to be change agents as counselors developed. Clients provided

positive reinforcements for counselors to do their job, and suc-
cesses and failures shaped the counselors’ identity. Findings
support previous studies that found that successes and failures
with clients had a profound impact on counselors’ identity
(Bischoff et al., 2002; Brott & Myers, 1999). When counselors
realized that they helped someone, they were empowered; this
led to more confidence and energy. Previous studies found
that work with clients validated new professionals (Bischoff et
al., 2002; Rønnestad & Skovholt, 2003; Studer, 2007). Also,
previous studies have found that supervision was helpful in
developing a strong identity as a counselor (Bischoff et al.,
2002; Brott & Myers, 1999). Other studies (Cave & Clan-
dinin, 2007; Dollarhide & Miller, 2006; Magnuson, 2002;
Magnuson et al., 2006) found supervisors to be important
to new counselors as they adjusted to the counseling profes-
sion. Positive feedback helped validate them as professionals
(Cave & Clandinin, 2007). The current data support these
findings in addition to suggesting that supervision affected
counselors at all experience levels. Each group admitted that
they needed help moving forward, which is consistent with
Gibson et al.’s (2010) findings. Previous research indicated
that new counselors wanted to fill in knowledge gaps and that
they had the desire and excitement to learn (Nyström et al.,
2008; R. G. Smith, 2007).

Limitations and Implications
The results of this study may not be applicable to all
counselors because of the limited number of participants
found within focus groups. The study investigated the
experiences of 26 participants in the southeastern United
States. Cultural limitations may exist (McGowen & Hart,
1990; K. L. Smith, 2007) because most of the participants
in our study were White women and were not representative
of all counselors. Also, the use of focus groups to collect
data limited the amount of in-depth exploration individual
interviews may have provided. If participants had sensitive
or threatening input, they may have been hesitant to share
their perspective with their peers in a group setting. How-
ever, the author who conducted the interviews made efforts
to create a welcoming and open environment in which par-
ticipants felt comfortable sharing their experience. Future
studies can strive to have a more representative sample of
the counseling population from various geographic areas.
Additionally, the use of individual interviews may elicit
more in-depth information from interview content and ob-
servation. Furthermore, longitudinal research is warranted
because of the transformational tasks and processes that
occur within each task at each nodal point. Future research
in professional identity development needs to consider the
years of experience not captured in the current study. The
results of this study have implications for counselors-in-
training, counselor educators, counselors, supervisors,
professional organizations, and future research.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 11

Professional Identity Development

First, counselor educators have the responsibility to
foster and develop the professional identity of counselors-
in-training (Council for Accreditation of Counseling and
Related Educational Programs, 2009). Counselor educators
can use the information about transformational tasks and
how to accomplish the tasks to better prepare emerging coun-
selors. When counselors-in-training enter programs, they
can be given assignments such as interviewing or shadowing
practicing counselors to gain a more realistic perspective of
the workforce. Also, counselor educators can give practical
perspectives by inviting guest speakers who are practicing
counselors into all classes. Counselor educators who are also
practitioners can use examples in their teaching from their
current practice to illustrate a reasonable view of counsel-
ing. In addition, counselor educators can strive to ensure
that practicum and internship experiences are realistic and
are best preparing counselors-in-training for the realities of
the work environment. Therefore, counselors entering the
workplace will have more reasonable expectations of the
counseling profession. They can also know what to expect
as they grow and develop within the profession. Realistic
expectations can lead to less frustration, which would help
both counselors and clients.

Second, this study provides counselors with a process
of their professional identity development. Recognition
of the transformational tasks can normalize the counselor
experience. There can be comfort in knowing that others
are facing the same issues and frustrations. Knowledge that
counselors at each stage face a similar struggle can lead to
greater peer support. As counselors feel self-doubt, burn-
out, or incongruence, they will know the tools (continuous
learning, work with clients, and experienced guide) to help
them work through their struggles.

Finally, the results of this study reinforce the benefits of
supervision at all levels of counseling. Counselors should be
encouraged to seek out an experienced guide to help them
navigate their professional growth. Also, supervisors can use
the knowledge about the struggles at each stage of develop-
ment to better support their supervisees. Supervisors can
use the information about the need for continuous learning
to help their supervisees by providing additional learning
opportunities. Supervisors can tailor their trainings to the
developmental needs of their supervisees.

Conclusion
Results of this study indicated that six themes were important
to counselors’ identity development: adjustment to expecta-
tions, confidence and freedom, separation versus integra-
tion, experienced guide, continuous learning, and work with
clients. In addition, a process emerged that included trans-
formational tasks at each professional life stage. This study
highlights the process of counselors’ professional identity
development and how it changes during the professional life

span. Identity development is a lifelong process. As counsel-
ors gain awareness of this process, they can be more effective
and experience greater job satisfaction.

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Report of the Task Force on

Test User Qualifications

Practice and Science Directorates

American Psychological Association

Approved by the APA Council of Representatives

August, 2000

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Task Force Members

Stephen T. DeMers, EdD (Cochair)
Samuel M. Turner, PhD (Cochair)

Marcia Andberg, PhD
William Foote, PhD
Leaetta Hough, PhD
Robert Ivnik, PhD
Scott Meier, PhD

Kevin Moreland, PhD (deceased)
Celiane M. Rey-Casserly, PhD

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Table of Contents

Title Page………………………………………………………………………………………….1
Task Force Members……………………………………………………………………………….2
Table of Contents………………………………………………………………….………….……3
Preface………………………………………………………………….………….………………4

I. Introduction

…………………………………………………………………………………………………………..6
Definition of Key Terms ………………………………………………………………………………7
Scope of the Guidelines ……………………………………………………………………………….8
Historical Background ……………………………………………………………………………….11

Efforts in the United States. ……………………………………………………………..11
International Efforts ………………………………………………………………………..14

APA’s Role in Defining Test User Qualifications………………………………………….15

II. Core Knowledge and Skills for Test Users………………………………………………………………17
Psychometric and Measurement Knowledge…………………………………………………17
Selection of Appropriate Test(s) ………………………………………………………………….22
Test Administration Procedures…………………………………………………………………..26
Ethnic, Racial, Cultural, Gender, Age, and Linguistic Variables ……………………..27
Testing Individuals With Disabilities …………………………………………………………..29
Supervised Experience……………………………………………………………………………….31
Summary of Core Knowledge and Skills………………………………………………………32

III. Test User Qualifications in Specific Contexts ………………………………………………………….33
Employment Context …………………………………………………………………………………34
Educational Context…………………………………………………………………………………..39

Career/Vocational Counseling Context

………………………………………………………..48

Health Care Context

…………………………………………………………………………………..54

Forensic Context

……………………………………………………………………………………….60

IV. A Look Forward…………………………………………………………………………………………………..68

References …………………………………………………………………………………………………………………….69

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Preface

In response to an increasing number of requests from members and the public for

guidance on the qualifications that the American Psychological Association (APA) considers

important for test use, the APA Council of Representatives convened a Task Force on Test User

Qualifications in August 1996. The Board of Scientific Affairs appointed Samuel M. Turner,

PhD, as co-chair, and the Board of Professional Affairs and the Committee for the Advancement

of Professional Practice appointed Stephen DeMers, EdD, as the other co-chair. An additional

seven members were appointed by an extended consultative process and represent the following

areas of expertise specified by the Board and Council: clinical, industrial/organizational, school,

counseling, educational, forensic, and neuropsychology.

The Task Force met seven times between 1996 and 1999. Between and after these

meetings, drafts of the report were circulated, revised, and revised again. At various stages,

drafts of the document were reviewed by the governing bodies of APA, division associations,

state associations, APA members, and several outside organizations whose members use tests.

The members of the Task Force would like to thank the numerous psychologists and other test

users who reviewed and commented on earlier versions of this report. Many of their helpful

responses were incorporated in this final version, and we are grateful for their assistance. In

particular, the task force acknowledges the comments of APA members Wayne Camara, PhD;

Rodney Lowman, PhD; Kathleen O’Brien, PhD, Nancy T. Tippins, Ph.D, and Mary V. McGuire,

PhD, JD.

Support for the project was provided by the staff of the Practice and Science Directorates

of APA. In particular, the Task Force would like to thank Heather Roberts Fox, PhD, Geoffrey

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M. Reed, PhD, Dianne L. Schneider, PhD, and Dianne Brown Maranto. APA’s General Counsel

and outside legal counsel conducted the legal review of the report. The Task Force thanks Donna

Beavers for her assistance with coordinating recommendations regarding legal issues. The Task

Force also thanks Georgia Sargeant and Brendon MacBryde for copyediting the report.

The late Kevin L. Moreland, PhD, served as a member of the task force from 1996 to

1999. Without his gentle humor and talent for easing the most rancorous of debates, it is quite

likely that this report would not have been completed. As an acknowledgment of Dr. Moreland’s

contribution to the project and to the discipline of psychology, the Task Force dedicates this

report to his memory.

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I. Introduction

At the direction of the Council of Representatives of the American Psychological

Association (APA), the Task Force on Test User Qualifications (TFTUQ) was established in

October 1996. The goal of the task force was to develop guidelines that inform test users and the

general public of the qualifications that the APA considers important for the competent and

responsible use of

psychological tests.

The phrase test user qualifications refers to the

combination of knowledge, skills, abilities, training, experience, and, where appropriate,

credentials that the APA considers optimal for psychological test use. The guidelines in this

report are intended to apply to persons who use psychological tests in a variety of settings and

for diverse purposes. This report describes test user qualifications that the APA believes will best

serve the public.

The TFTUQ was established in part because of evidence that some current users of

psychological tests may not possess the knowledge and skill that the APA considers desirable for

optimal test use (e.g., Aiken, West, Sechrest, & Reno, 1990). Thus, it is hoped that these

guidelines will encourage training programs to make curricular changes that provide future test

users with a strong background in measurement theory and psychometrics, along with improved

skill in the administration, interpretation, and communication of test results. In addition, these

guidelines should encourage groups or individuals to obtain continuing education to improve

their use of psychological tests. The APA’s goal in promulgating these guidelines is to encourage

the development of the knowledge, skills, abilities, and experiences that promote optimal testing

practices for the purpose of maintaining high standards in professional test use with the public.

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Definition of Key Terms

Critical terms used in this document are defined as follows:

Psychological test: a measurement procedure for assessing psychological characteristics in

which a sample of an examinee’s behavior is obtained and subsequently

evaluated and scored using a standardized process.

Test user: the person or persons responsible for the selection, administration, and

scoring of tests; for the analysis, interpretation, and communication of test

results; and for any decisions or actions that are based, in part, on test

scores. Generally, individuals who simply administer tests, score tests and

communicate simple or “canned” test results are not test users.

Test user qualifications: knowledge, skills, abilities, training, experience, and, where

appropriate, credentials important for optimal use of psychological tests.

Assessment: a process that integrates test information with information from other

sources; a process for evaluating behavior, psychological constructs,

and/or characteristics of individuals or groups for the purpose of making

decisions regarding classification, selection, placement, diagnosis, or

intervention.

Context: the situation, purpose, or setting in which a test is being used;

circumstances that determine when testing is appropriate for a person or

group.

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Scoring: application of test-specific rules to the responses or behavior of the test

taker to produce quantitative or qualitative data about the test taker or a

group of test takers.

Interpretation: application of scientific knowledge and professional judgment to test data

to describe and/or make inferences about individual or group

characteristics or behavior.

Communication of test results: oral or written description and explanation of test findings to

others.

Supervision: the process of overseeing, directing, and assuming responsibility for the

actions of others involved in the testing process.

Scope of the Guidelines

The APA’s purpose in developing these guidelines is to inform test users as well as

individuals involved with training programs, regulatory and credentialing bodies, and the public

about the qualifications that the APA considers important for the optimal use of tests. These

guidelines describe two types of test user qualifications: (a) generic qualifications that serve as a

basis for most of the typical uses of tests and (b) specific qualifications for the optimal use of tests

in particular settings or for specific purposes. They are aspirational because they identify

qualifications for the optimal use of tests in a competent and responsible manner. These

guidelines describe qualifications that apply to a variety of testing settings and for multiple

purposes; therefore, it is unlikely that a single test user possesses all the qualifications described

here. The qualifications should also be considered in relation to the context, setting, and purpose

of test use.

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The guidelines apply most directly to standardized tests, such as measures of ability,

aptitude, achievement, attitudes, interests, personality, cognitive functioning, and mental health.

These guidelines apply to psychological tests whether or not they are administered by paper-and-

pencil or electronically and whether or not they are scored and interpreted by a test user or

electronically. The guidelines do not apply to unstandardized questionnaires and unstructured

behavior samples or to teacher- or trainer-made tests to evaluate performance in education or

training.

Various activities included in the testing process may be appropriately conducted by

different people working collaboratively. Each participant should possess the knowledge, skills,

and abilities relevant to his or her role. For example, different individuals may be responsible for

deciding what constructs, conditions, or characteristics need to be assessed; selecting the

appropriate tests; administering and scoring tests; and interpreting and communicating the

results. Moreover, some testing activities may involve tasks that require limited professional

knowledge (e.g., administering or scoring some tests, communicating simple test results). In such

circumstances, test use should be directed by a qualified test user. It is this test user to whom

these guidelines apply.

Persons whose psychological test use is confined to research will find that the degree to

which these guidelines apply to their work depends on their research focus and the research

setting. The sections that address knowledge and skills in relation to psychometrics, statistics,

test administration, and scoring are applicable to research that uses psychological tests. When

research is conducted with clinical populations or in settings where there are likely to be real or

perceived implications for the test taker, additional guidelines may be applicable.

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Testing and assessment. The use of psychological tests should typically be viewed within

the context of the broader concept of assessment. Psychological assessment is a complex activity

requiring the interplay of knowledge of psychometric concepts with expertise in an area of

professional practice or application. Assessment is a conceptual, problem-solving process of

gathering dependable, relevant information about an individual, group, or institution in order to

make informed decisions. This process of data gathering and decision making involves a number

of activities, including the

following:

1. Recognizing the nature of the decisions to be made or the questions to be addressed;

2. Deciding what information is needed to answer these questions;

3. Selecting appropriate methods for acquiring this information, including tests,

interviews, observations, surveys, or other data-gathering techniques;

4. Competently administering and scoring the selected tests according to standardized

procedures when available and appropriate;

5. Accurately interpreting information, which may include knowing when to question

the usual interpretation of a procedure because of intervening or mitigating

circumstances;

6. Using assessment data and resultant interpretation to make a professionally sound

decision; and

7. When appropriate, communicating assessment results in a way that is understandable

to the client.

Many problems or questions to be addressed through assessment must be approached with a

recognition of the potential for multiple coexisting or competing explanations. Such recognition

Test User Qualifications 11
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comes from the professional knowledge and judgment associated with advanced professional

training and experience and not just from the ability to administer and score a particular test or

other assessment instruments. This decision-making process is best conducted or directed by a

professional with expertise in psychological assessment in a particular testing context.

Historical Background

In delineating the knowledge and skills important for the use of tests, the Task Force

reviewed recent U.S. and international efforts to develop guidelines on test user qualifications.

Several national and international professional organizations whose members use tests have

addressed the issue of test user qualifications over the years. Their efforts are described briefly

below.

Efforts in the United States. The APA appears to have been one of the first

groups

concerned with test user qualifications. The APA formed the Committee on Ethical Standards for

Psychology in the late 1940s to develop its first set of ethical principles. The first topic in these

ethical standards addressed the sale and distribution of psychological tests and diagnostic aids

(Hobbs, 1951). The Committee released the ethical standards for the distribution of

psychological tests in 1950. The complete set of ethical standards was adopted in 1953 (Golann,

1970). Since 1950, the APA has addressed the issue of test user qualifications broadly in

subsequent revisions of its ethical principles (APA, 1981, 1992). The current version of the

APA’s ethical principles (APA, 1992) contains a number of standards that are related to

appropriate test use, including specific principles related to the boundaries of competence for

psychologists and the appropriate application and use of psychological assessment techniques.

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Other professional groups that use psychological tests also have promulgated ethical

guidelines (e.g., American Association for Counseling and Development [now the American

Counseling Association; ACA], 1988; American Association for Marriage and Family Therapy,

1998; National Association of School Psychologists [NASP], 1992; National Council on

Measurement in Education [NCME], 1995). Indeed, the ACA has a specific set of

Responsibilities of Users of Standardized Tests (American Association for Counseling and

Development, 1988), popularly known as the RUST document. This document suggests that the

qualifications of test users depend on four factors: (a) the role of the user (e.g., administration

and scoring), (b) the setting, (c) the nature of the test, and (d) the purpose of testing.

In addition to developing its own ethical principles on test use by psychologists, the APA

has participated in formulating standards on the development and use of psychological and

educational tests (APA, American Educational Research Association [AERA], & NCME, 1954,

1966, 1974; AERA, APA, & NCME, 1985, 1999). The 1954 Technical Recommendations for

Psychological Tests and Diagnostic Techniques and the 1966 Standards for Educational and

Psychological Tests and Manual both referred to a categorization of test user qualifications first

approved by APA’s Council of Representatives in 1950. The policy was referred to as the

“Ethical Standards for the Distribution of Psychological Tests and Diagnostic Aids” (APA,

1950) and included a three-level system for classifying test user qualifications.

This three-tiered system labeled some tests Level A (e.g., vocational proficiency tests)

and designated them as appropriate for administration and interpretation by nonpsychologists.

The next level of tests (e.g., general intelligence tests and interest inventories) was

labeled Level B. Qualifications for administering them included “some technical knowledge of

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test construction and use, and of supporting psychological and educational subjects such as

statistics, individual differences, the psychology of adjustment, personnel psychology, and

guidance” (APA, 1950, p. 622). Over time, however, all those sanctioned “by an established

school, government agency, or business enterprise” (APA, 1950, p. 622) were reclassified as

eligible test users of Level B tests. Subsequent evidence suggests that those institutions did not

provide the oversight necessary to ensure that these test users were in fact qualified (Eyde et al.,

1993).

Finally, qualifications for the use of Level C tests (e.g., individually administered tests of

intelligence, personality tests, and projective methods) restricted their use to “persons with at

least a Master’s degree in psychology, who have had at least one year of supervised experience

under a psychologist” (APA, 1950, p. 622). The Level C qualification also had some exceptions.

The reference to the three-tiered system was dropped from the 1974 (and subsequent)

Standards without a replacement, but casual inspection of test publishers’ current catalogs

reveals that it is still in widespread use (cf. Robertson & Eyde, 1986).

An attempt to define test use was undertaken by an interdisciplinary group beginning in

1985. In that year, the APA, the AERA, the NCME, and test publishers formed the Joint

Committee on Testing Practices (JCTP).1 The TUQWoG, a subgroup of the JCTP, immediately

set about developing a data-based approach to promoting good test use. TUQWoG conducted

several empirical studies designed to elucidate the types of competence problems exhibited by

1Before the work of the Test User Qualifications Working Group (TUQWoG) was
completed, the ACA and the American Speech-Language-Hearing Association had joined the
JCTP. The NASP has subsequently joined. The original requirement that one of the two
representatives of each organization be employed by a test publisher was dropped.

Test User Qualifications 14
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test users. The results of these studies were reported in a 1988 publication entitled Test User

Qualifications: A Data-Based Approach to Promoting Good Test Use (Eyde, Moreland,

Robertson, Primoff, & Most, 1988); in an article by Moreland, Eyde, Robertson, Primoff, and

Most (1995); and in a book of case studies (Eyde et al., 1993).

Despite all these efforts, evidence suggests that most of the problems associated with test

use are related to the competence of individual test users, although the uneven quality of test

construction and the ease with which test instruments can be obtained from some test publishers

also contribute to these problems (Tyler, 1986). In devising the present set of guidelines, the

TFTUQ kept in mind the types of problems identified by the empirical research and the

conclusion that much of the difficulty lies with test users. Thus, these guidelines were formulated

primarily to address characteristics of test users. This document does not pertain to the

development of tests, which is addressed in the Standards for Educational and Psychological

Testing

(AERA, APA, & NCME, 1999).

International efforts. The Task Force found that concern over the misuse of tests has been

growing in the international psychology community over the past few years. Several countries

and international groups, including the International Test Commission (ITC), the British

Psychological Society (BPS), and the Canadian Psychological Association (CPA), have launched

initiatives to address concerns about test user qualifications.

In 1992, the CPA released a report on the adequacy of typical safeguards used by test

publishers to limit test access to qualified individuals (Simner, 1994). The report suggested that

test publishers did not uniformly apply the system of classifying tests according to three levels.

Some publishers did not use the three-tier system to screen test users, and those who did often

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did not agree on the qualifications required for a particular test. In fact, there was disagreement

on the classification of about two thirds of the tests (Simner, 1994). The CPA report contained

recommendations for improving safeguards to protect the public from test misuse. These

recommendations ranged from replacing or supplementing the test-rating system used by the

publishers to requiring all first-time test users to complete a qualifications statement.

The BPS implemented a competence-based approach to certify test users (BPS, 1995,

1996). To date, the BPS certification system has focused on testing in occupational settings,

although the system may ultimately be expanded to address test user qualifications in educational

and health care settings as well. In the BPS system, test users are evaluated by assessors,

overseen by BPS-appointed verifiers, for demonstrated competence to use tests appropriately.

Those who are judged competent can apply for the BPS certificate in test competence and are

listed in a register that can be used by those purchasing testing services.

Finally, the Council of the ITC adopted international guidelines on core standards for test

use at its June 1999 meeting in Graz, Austria (ITC, 2000). The aim of this ITC project included

the production of a set of competencies (i.e., knowledge, abilities, and skills) for test use by

psychologists and nonpsychologists who use tests. The ITC guidelines represent the work of

specialists in psychological and educational testing (i.e., psychologists, psychometricians, test

publishers, and test developers) from the United States, Canada, Australia, and Europe.

APA’s Role in Defining Test User Qualifications

The reason that the APA has sought to develop and promulgate guidelines for the use of

psychological tests evolves from a number of sources. As described above, historically, the APA

has recognized the need for and devoted considerable attention to the development of test user

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qualifications. Although professionals from a variety of disciplines develop and use tests,

graduates from doctoral programs in psychology and educational and psychological

measurement have provided significant contributions to the science of testing and assessment.

The discipline of psychology is the historical root for psychological testing and provides the

research evidence and professional training to advance competent psychological assessment. The

APA formed the TFTUQ in 1996 in the belief that previous efforts, although useful, did not

provide the kind of specific guidance that many APA members and others were seeking. It is

appropriate for the discipline of psychology to establish guidelines for the proper use of

psychological tests.

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II. Core Knowledge and Skills for Test Users

This section addresses the knowledge and skills that are important when test users make

decisions or formulate policies that directly affect the lives of test takers. The knowledge and

skills listed in this section are generic; however, the level of skill and depth of knowledge in

these areas may vary depending on the testing purpose and context. The next section describes

additional knowledge and skills that are relevant to the purpose or context in which tests are

used. These generic qualifications, in combination with the context-relevant qualifications

described later, are important for optimal test use. The Standards for Educational and

Psychological Testing (AERA, APA, & NCME, 1999) is an excellent resource for more

information on many of the concepts presented below.

1. Psychometric and Measurement Knowledge

It is important for test users to understand Classical Test Theory and, when

appropriate or necessary, Item Response Theory (IRT). The essential elements of

Classical Test Theory are outlined below. When test users are making

assessments on the basis of IRT, such as adaptive testing, they should be familiar

with the concepts of Item Parameters (e.g., item difficulty, item discrimination,

and guessing), Item and Test Information Functions, and Ability Parameters (e.g.,

theta).

1.1 Descriptive statistics. Test users should be able to define, apply, and interpret

concepts of descriptive statistics. For example, means and standard deviations are

often used in comparing different groups on test scales, whereas correlations are

frequently used for examining the degree of convergence and divergence between

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two or more scales. Similarly, test users should understand how frequency

distributions describe the varying levels of a behavior across a group of persons.

Test users should have sufficient knowledge and understanding of

descriptive statistics to select and use appropriate test instruments, as well as

score and interpret results. The most common descriptive statistics relevant to test

use include the following:

1.1.1 Frequency distributions (e.g., cumulative frequency distributions)

1.1.2 Descriptive statistics characterizing the normal curve (e.g., kurtosis,

skewness)

1.1.3 Measures of central tendency (e.g., mean, median, and mode)

1.1.4 Measures of variation (e.g., variance and standard deviation)

1.1.5 Indices of relationship (e.g., correlation coefficient)

1.2 Scales, scores, and transformations. Test results frequently represent information

about individuals’ characteristics, skills, abilities, and attitudes in numeric form.

Test users should understand issues related to scaling, types of scores, and

methods of score transformation. For example, test users should understand and

know when to apply the various methods for representing test information (e.g.,

raw scores, standard scores, and percentiles). Relevant concepts include the

following:

1.2.1 Types of scales

a. Nominal scales

b. Ordinal scales

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c. Interval scales

d. Ratio scales

1.2.2 Types of scores

a. Raw scores

b. Transformed scores

i. Percentile scores

ii. Standard scores

iii. Normalized scores

1.2.3 Scale score equating

1.2.4 Cut scores

1.3 Reliability and measurement error. Test users should understand issues of test

score reliability and measurement error as they apply to the specific test being

used, as well as other factors that may be influencing test results. Test users

should also understand the appropriate interpretation and application of different

measures of reliability (e.g., internal consistency, test–retest reliability, interrater

reliability, and parallel forms reliability). Similarly, test users should understand

the standard error of measurement, which presents a numerical estimate of the

range of scores consistent with the individual’s level of performance. It is

important that test users have knowledge of the following:

1.3.1 Sources of variability or measurement error

a. Characteristics of test taker (e.g., motivation)

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b. Characteristics of test (e.g., domain sampling, test length, and test

heterogeneity)

c. Characteristics of construct and intended use of test scores (e.g.,

stability of characteristic)

d. Characteristics and behavior of test administrator (e.g., importance

of standardized verbal instructions,)

e. Characteristics of the testing environment

f. Test administration procedures

g. Scoring accuracy

1.3.2 Types of reliability and their appropriateness for different types of tests and

test use

a. Test–retest reliability

b. Parallel or alternative forms reliability

c. Internal consistency

d. Scorer and interrater reliability

1.3.3 Change scores (or difference scores)

1.3.4 Standard error of measurement (i.e., standard error of a score)

1.4 Validity and meaning of test scores. The interpretations and uses of test scores,

and not the test itself, are evaluated for validity. Responsibility for validation

belongs both to the test developer, who provides evidence in support of test use

for a particular purpose, and to the test user, who ultimately evaluates that

evidence, other available data, and information gathered during the testing process

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to support interpretations of test scores. Test users have a larger role in evaluating

validity evidence when the test is used for purposes different from those

investigated by the test developer.

Contemporary discussions of validity have focused on evidence that

supports the test as a measure of a construct (sometimes called construct validity).

For example, evidence for the uses and interpretations of test scores may come

through evaluation of the test content (content representativeness), through

evidence of predictions of relevant outcomes (criterion-related validity), or from a

number of other sources of evidence. Test users should understand the

implications associated with the different sources of evidence that contribute to

construct validity, as well as the limits of any one source of validity evidence.

1.4.1 Types of evidence contributing to construct validity

a. Content

b. Criterion related

c. Convergent

d. Discriminant

1.4.2 Normative interpretation of test scores. Norms describe the distribution of

test scores in a sample from a particular population. Test users should

understand how differences between the test taker and the particular

normative group affect the interpretation of test scores.

a. Types of norms and relevance for interpreting test taker score (e.g.,

standard scores and percentile norms)

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b. Characteristics of the normative group and the generalizability

limitations of the normative group

c. Type of score referent

i. Norm referenced

ii. Domain referenced (criterion referenced)

iii. Self-referenced (ipsative scales)

d. Expectancy tables

2. Selection of Appropriate Test(s)

To select the best test or test version for a specific purpose, test users should have

knowledge of testing practice in the context area and the most appropriate norms when more

than one normative set is available. Knowledge of test characteristics such as psychometric

properties (presented above), basis in theory and research, and normative data (where

appropriate) should influence test selection. For example, normative data or decision rules may

not be accurate when (a) important characteristics of the examinee are not represented in the

norm group, (b) administration or scoring procedures do not follow those used in standardizing

the test, (c) characteristics of the test may affect its utility for the situation (e.g., ceiling and floor

effects), (d) the test contains tasks that are not culturally relevant to the test taker, or (e) the

validity evidence does not support decisions made on the basis of the test scores.

Test users should have an understanding of how the construction, administration, scoring,

and interpretation of tests under consideration match the current needs. Mismatches in these

dimensions between the selected test and the current testing situation represent important factors

that should be considered and which may invalidate usual test interpretation.

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More specifically, to select an appropriate test for a particular use, it is important that test

users understand and consider the following:

2.1 Intended use of the test score

2.2 Knowledge of the method and procedures used to develop or revise the test being

considered

2.2.1 Definition of the construct that the test purports to measure

2.2.2 Definition of the test purpose and its intended context of use

2.2.3 Type of keying or scaling used

a. Rational or theoretical

b. Empirical

c. Internal consistency or construct homogeneity (e.g., factor

analysis)

2.2.4 Scoring procedures (e.g., clinical, mechanical, and correction for guessing)

2.2.5 Type of score interpretation

a. Criterion or domain referenced

b. Norm referenced

c. Ipsative

2.2.6 Item and scale score characteristics

a. Item format

b. Difficulty level

c. Reliability (e.g., internal consistency and test–retest)

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2.2.7 Validity evidence of test scores

a. Construct validity evidence

i. Content representativeness

ii. Criterion related

iii. Convergent

iv. Discriminant validity

v. Cross-validation

vi. Validity generalization (e.g., the effects of sample size, test

and criterion reliability and range restriction , and

dichotomization of variables)

vii. Criterion Characteristics (e.g., sufficiency, relevance)

2.2.8 Test bias (see 4.2 below for details)

2.2.9 Description of validation, normative, and/or standardization group(s)

a. Characteristics of groups (such as age, gender, race, culture,

language, disabilities, geographic region, socioeconomic status

[SES], educational or grade level, motivational set, mental status,

and item format familiarity)

b. Sample size(s)

c. Recency of data

2.2.10 Test administration procedures

a. Standardization procedures

b. Time limits (power vs. speed)

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2.3 Knowledge of test taker variables that may moderate validity and interpretation of

scores (such as age, gender, race, culture, language, disabilities, geographic

region, era or time period tests, SES, educational or grade level, motivational set,

mental status, and item format familiarity)

2.4 Other or special requirements and limitations of test

2.5 Adequacy of the match between test characteristics and present need in terms of

the following:

2.5.1 Construct measured

2.5.2 Difficulty level

2.5.3 Validity

2.5.4 Reliability

2.5.5 Test bias

2.5.6 Normative data

2.5.7 Similarity of normative group with present group

2.5.8 Test administration procedures

a. Accommodations for disabilities (when

appropriate)

b. Characteristics of test administrator

c. Adaptation for individuals with different primary language (when

appropriate)

2.5.9 Special requirements and limitations of test

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3. Test Administration Procedures

Knowledge about procedural requirements, confidentiality of test information,

communication of results, and test security is important for many testing applications, as is

familiarity with standardized administration and scoring procedures and understanding a test

user’s ethical and legal responsibilities and the legal rights of test takers. Similarly, it is

important that test users understand the legal and ethical issues related to the release of test

materials, including issues of confidentiality, depending on the context of the testing and the

characteristics of the test taker.

Test users should be able to explain test results and test limitations to diverse audiences.

Written communications should include the purpose of the test and the setting in which the

testing occurred. In preparing written reports on test results, test users should be aware that the

test scores might become separated from the interpretive report over time.

More specifically, test users should be familiar with the following:

3.1 Legal rights of test takers

3.2 Standardized administration procedures

3.3 Scoring procedures

3.4 Confidentiality of test materials and test information

3.4.1 Safeguards for protecting test materials

a. Protection against copyright infringement

b. Protection against unauthorized dissemination of test

items/keys/scoring procedures

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3.4.2 Safeguards for protecting protocols and test

results

a. Legal issues

b. Ethical issues

3.5 Reporting results to the test taker, caregiver, or others as appropriate

3.5.1 Characteristics of meaningful reports

3.5.2 Amount of information to report

3.5.3 Legal and ethical issues

4. Ethnic, Racial, Cultural, Gender, Age, and Linguistic Variables

Consideration of these variables may be important to the proper selection and use of

psychological tests. For certain purposes, legal requirements influence or restrict the testing,

scoring, interpretation, analysis, and use of test data of individuals in different subgroups. In

some cases (e.g., employment testing), the use of gender, race, and/or ethnicity in test

interpretation is illegal. Test users should consider and, where appropriate, obtain legal advice

on legal and regulatory requirements to use test information in a manner consistent with legal

and regulatory standards. Issues associated with testing individuals from particular subgroups,

such as race or ethnicity, culture, language, gender, age, or other classifications, are addressed in

greater detail in the 1999 version of the Standards for Educational and Psychological Testing

(AERA, APA, & NCME, 1999).

The APA’s promulgated Guidelines and Principles for Accreditation of Programs in

Professional Psychology (APA, 1996) discussed the need for psychology training programs to

address issues of cultural diversity. The APA demonstrated its interest in and sensitivity to these

issues by establishing the Commission on Ethnic Minority Recruitment and Training in

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Psychology. In addition, the Task Force on Delivery of Services to Ethnic Minority Groups,

under the auspices of the Board of Ethnic Minority Affairs, published Guidelines for Providers

of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (APA,

1990). These guidelines were approved by the APA’s Council of Representatives. In addition,

the ITC has issued “Guidelines for Adapting Educational and Psychological Tests: A Progress

Report” (Hambleton, 1994), which provides recommendations about adapting tests for cross-

cultural testing.

For test users using tests with different ethnic, racial, cultural, gender, and language

groups, knowledge of the following is important:

4.1 Construct equivalence. Test users strive to be familiar with the literature regarding

issues of construct equivalence (e.g., cultural equivalence) in its various forms and

how this might affect the selection, use, and interpretation of psychological tests for

individuals whose dominant language is not the language of the test or who are from

different racial, ethnic, or gender groups.

4.1.1 Information concerning the influence of psychological characteristics

(e.g., motivation, attitudes, and stereotype threat) on test performance

4.1.2 Orientations and values that may alter the definition of the constructs(s)

being assessed and how those factors may affect the interpretation of test

results

4.1.3 Requirements of the testing environment and how that may affect the

performance of different groups

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4.2 Test bias. Test users should be familiar with the legal and psychometric literature

pertaining to test bias for different racial, ethnic, cultural, gender, and linguistic

groups and how this might affect decisions pertaining to selection of tests and

interpretation of test results. It is important that test users know the following:

4.2.1 Laws and public policies concerning use of tests that may have

implications for test selection, as well as administration and interpretation

4.2.2 Procedures for examining between-groups differences in test performance

4.2.3 Empirical literature concerning differential validity for racial or cultural

groups

5. Testing Individuals with Disabilities

Tests are administered to increasing numbers of persons with disabilities in a variety of

settings and for a multitude of purposes. The requirement to accommodate an individual with a

disability in the testing situation raises many complex issues for test users. Test users must

frequently make decisions regarding the use of tests that were not developed and normed for

individuals with disabilities. In such circumstances, confidence in the inferences drawn from test

results may be diminished. There may be legal requirements concerning the accommodation of

individuals with disabilities in test administration and the use of modified tests. Test users should

consider and, where appropriate, obtain legal advice on legal and regulatory requirements

regarding appropriate administration of tests and use of test data.

Several efforts were initiated during the mid-1990s to provide guidance to test users for

assessing individuals with disabilities. The APA Task Force on Test Interpretation and Diversity

published a book identifying the scientific and policy issues related to the interpretation of tests

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used with individuals for whom the tests were not developed, standardized, and validated

(Sandoval, Frisby, Geisinger, Scheuneman, & Grenier, 1998). This text identified important

considerations in assessing individuals with specific types of disabilities (e.g., deafness,

blindness, and learning disabilities). Additionally, a working group of the JCTP published a

sourcebook on assessing individuals with disabilities. This sourcebook for practitioners describes

some of the pertinent legal and regulatory information, as well as types of accommodations,

required documentation, and the use of tests in various contexts (e.g., employment, admissions,

and counseling; Ekstrom & Smith, in press). Finally, the 1999 Standards for Educational and

Psychological Testing (AERA, APA, & NCME, 1999) includes a chapter on technical

considerations for testing individuals with disabilities. Those who administer tests to individuals

with disabilities should be familiar with the legal, technical, and professional issues governing

the use of tests with individuals with disabilities, including the following:

5.1 Legal issues. Test users involved in assessing individuals with disabilities should be

familiar with the relevant legal requirements and enforcement guidance for assessing

individuals with disabilities for specific purposes (e.g., Section 504 of the

Rehabilitation Act, the Individuals With Disabilities Education Act, and the

Americans With Disabilities Act) and obtain legal advice in these matters where

appropriate.

5.2 Test selection. Test users should possess the knowledge to make an appropriate

selection of measures. Test users strive to have current information regarding

availability of modified forms of the tests in question.

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5.3 Test accommodation. Test users strive to be familiar with the available literature

addressing the various accommodations appropriate for individuals with disabilities

and, to the extent available, on the effects of test accommodation on test score

interpretation and use. When there is a need to modify a test, test users should have

the knowledge and skills needed to modify the test appropriately for the test taker

while maintaining all feasible standardized features and to communicate those

modifications as appropriate.

5.4 Interpretation of test results of individuals with disabilities. Test users strive to be

familiar with the literature regarding how external factors and characteristics

associated with the disability may affect the interpretation of test scores, such as the

following:

5.4.1 Effects of the testing environment and the tests being used on the

performance of individuals with disabilities

5.4.2 Inferences based on the test scores accurately reflect the construct, rather

than construct-irrelevant, characteristics associated with the disability

5.4.3 Knowledge of whether regular norms or special norms are appropriate for

the characteristic in question

6. Supervised Experience

In addition to having certain knowledge and skills needed for appropriate test use, it is

important that test users have the opportunity to develop and practice their skills under the

supervision of appropriately experienced professionals. This supervision typically begins in

graduate school and continues throughout training until any credentials that are necessary to

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practice independently have been attained. The structure and focus of supervision will vary

depending on the domain(s) in which supervision is being administered. Because testing is

conducted by psychologists with different specialties, as well as by nonpsychologists, this report

cannot prescribe a specific format or mechanism for supervision. However, focused and setting-

specific supervision of sufficient intensity and duration is important for those engaged in testing.

7. Summary of Core Knowledge and Skills

The intent of this section is to delineate the multiple domains and competencies important

for users of psychological tests. Although qualifications may vary by practice area, a

combination of high-level skill and professional judgment is important. The test user’s key

function is to make valid interpretations of test scores and data, often collected from multiple

sources, using proper test selection, administration, and scoring procedures. To provide valid

interpretations, it is important that test users be able to integrate knowledge of applicable

psychometric and methodological principles, the theory behind the measured construct and

related empirical literature, the characteristics of the particular tests used, and the relationship

between the selected test and the particular testing purpose, the testing process, and, in some

contexts, the individual test taker.

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III. Test User Qualifications in Specific Contexts

The context in which psychological tests are used includes both the setting and the

purpose of testing. Test user qualifications vary across settings, as well as within settings,

depending on the purpose of testing. This section addresses the context-relevant qualifications

that build on the generic qualifications described above.

Regardless of the setting, psychological tests are typically used for the following

purposes:

1. Classification. To analyze or describe test results or conclusions in relation to a

specific taxonomic system and other relevant variables to arrive at a classification or diagnosis.

2. Description. To analyze or interpret test results to understand the strengths and

weaknesses of an individual or group. This information is integrated with theoretical models and

empirical data to improve inferences.

3. Prediction. To relate or interpret test results with regard to outcome data to predict

future behavior of the individual or group of individuals.

4. Intervention planning. To use test results to determine the appropriateness of different

interventions and their relative efficacy within the target population.

5. Tracking. To use test results to monitor psychological characteristics over time.

This section describes five major contexts in which tests are commonly used:

employment, educational, vocational/career counseling, health care, and forensic. There also

may be other contexts that require specific qualifications. The qualifications important in the

major contexts, as well as appropriate training and supervision, are discussed below.

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Employment Context

Many employers use tests as part of the assessment process to develop work-related

information and recommendations or decisions about people who work for them or are seeking

employment with them. Test users in this context should have not only the qualifications

identified as core knowledge and skills but also an understanding of the work setting, the work

itself, and the worker characteristics required of the work situation. They strive to know what

skills, abilities, or other individual difference characteristics enable people to perform effectively

(as defined in a variety of ways) in a particular work setting. Test users consider the strengths

and weaknesses of different methods for determining the human requirements of the work

situation and how to conduct such job, work, or practice analyses. They also should consider

and, where appropriate, obtain legal advice about employment law and relevant court decisions

(see Dunnette & Hough, 1990, 1991, 1992, 1994; Guion, 1998).

Some persons who administer tests and communicate test results in an employment

setting (e.g. Human Resources personnel and recruiters) may not be considered test users by this

document. This document applies to those who select tests for use and determine how test results

are to be used in employment decision-making. Under this scenario, the test user may be a

company employee, a test vendor employee, or a consultant.

Classification. Organizations seek to classify or place people in jobs to maximize overall

utility to both the individuals and the institution. To perform these activities well, test users strive

to be knowledgeable about job clustering (e.g., creation of job families), validity, cost-benefit

analysis, utility analysis, and measurement of work outcomes (Alley, 1994; Bobko, 1994;

Zeidner & Johnson, 1994).

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Psychological tests are sometimes used to certify people as qualified to perform certain

job or work activities. Test takers unable to pass these certification tests are deemed unqualified

at present to perform particular tasks, activities, or jobs at a defined level of competence and may

not be eligible to practice the profession or perform those tasks. Test users should have

knowledge of the task or work and knowledge of the level of performance required for

competent practice. This means that test users define the task or criterion, measure the required

knowledge and skills, and identify the required performance level (i.e., set cut scores that reflect

the level of task, skill, and knowledge required for competent practice). They strive to have a

thorough knowledge of job, work, or practice analysis and of content validation principles and

strategies (Knapp & Knapp, 1995; K. Schmitt & Shimberg, 1996).

Description. Description of an individual’s current abilities, skills, interests, personality,

knowledge, or other personal characteristics can be a significant part of the assessment process in

industrial, business, or governmental settings concerned with human resources management.

This information is the starting point for determining the fit between an individual and work in a

given setting; identifying areas of needed individual, team, or organizational development;

providing feedback about likely success in different work activities and settings; planning career

choices and paths; and auditing organizational or unit readiness. Those who use psychological

tests to describe individual, team, or organizational characteristics in the employment setting

should consider information about the work and its setting. Thus, knowledge about job, work, or

career analysis is important (see Campion, 1994; Dawis & Lofquist, 1984; Fleishman &

Quaintance, 1984; Gael, 1988; Goldstein, Zedeck, & Schneider, 1993; Hall, 1986; Peterson,

Mumford, Borman, Jeanneret, & Fleishman, 1999).

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Prediction. Psychological tests may be used as part of a larger assessment process to help

make predictions about an individual’s future training performance, job performance,

trustworthiness, attrition, or a variety of other work-related criteria. These predictions are often

made to facilitate recommendations or decisions about selection, promotion, or succession

planning.

Test users involved in testing to predict future employment criteria make every effort to

be knowledgeable about the work setting and the work itself and, hence, job or work analysis

methods. They understand the principles of psychological measurement as they apply to tests and

as they apply to criteria. They also should understand performance measurement, criterion

constructs and their measurement, relationships between various predictor constructs and

criterion constructs, research methods and design, validity concepts and evidence, test bias,

adverse impact analysis, utility analysis, validity generalization, and group differences, and

consider and, where appropriate, obtain legal advice regarding applicable collective bargaining

and contract requirements, federal and state guidelines on employment testing, employment law,

and relevant court decisions (see Anderson & Herriot, 1997; Campbell, 1996; Campbell &

Campbell, 1988; Cascio, 1990, 1991; Dunnette & Hough, 1990, 1991; Guion, 1998; Hakel,

1998; Howard, 1995; Murphy, 1996; N. Schmitt & Borman, 1993). Those who use tests for

selection, promotion, and succession planning purposes should also be aware of motivational set

and its possible effect on applicant responses and the validity of inferences based on them

(Anastasi, 1988; Hough, 1998).

Intervention planning. Employment testing may be part of an analysis of the test taker’s

training and development needs. Test results may provide information for developing plans to

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improve skill and performance of current work responsibilities and anticipated work

responsibilities. Test results may also be used as part of career planning activities. When tests are

used for these purposes, test users make every effort to be knowledgeable about such matters as

the work itself, the work setting, performance appraisal and performance measurement, criterion

constructs and their measurement, training and development, career development, coaching and

mentoring, and training needs analysis (Goldstein, 1989; Hall, 1986; London, 1995; Ostroff &

Ford, 1989).

Employment testing may be part of an outplacement process. If testing is done as part of

an involuntary process that determines who is to be retained and who is to be laid off, test users

should be knowledgeable about the work itself and the work setting (hence, job, work, or

practice analysis methods), performance measurement, criterion constructs and their

measurement, validity concepts and evidence, test bias, adverse impact analysis, and group

differences, and consider and, where appropriate, obtain legal advice regarding collective

bargaining and contract requirements applicable to the particular organization or work setting,

federal and state guidelines on employment testing, employment law, and relevant court

decisions (see Arvey & Faley, 1988; Colarelli & Beehr, 1993; Guion, 1998; Kozlowski, Chao,

Smith, & Hedlund, 1993; Landy & Farr, 1983; Murphy & Cleveland, 1995). If testing is done as

part of an outplacement, voluntary job search process, test users should be knowledgeable about

vocational and career guidance, job loss, and labor markets (see Caplan, Vinokur, Price, & van

Ryn, 1989; Dawis, 1991; Dawis & Lofquist, 1984; Hall, 1986; Holland, 1976; Pickman, 1994).

Employment testing may also be a part of a monitoring system designed to identify

individuals who are at risk for performing below an acceptable level. The individuals may be

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employed in sensitive-duty (high cost for mistakes) jobs. Airline pilots, nuclear power plant

operators, and undercover police officers or agents are examples. Those who use tests to identify

at-risk individuals should have the qualifications listed under the Classification and Prediction

sections above. When the assessment of risk involves the identification of psychopathology or

other health issues, the test user qualifications described in the Health Care Context section

below also apply.

Tracking. Psychological tests may be used in predictive, criterion-related validation

studies in which individuals and their performance are tracked over time. In addition to the

knowledge recommended for the use of psychological tests for prediction purposes (see the

Prediction section above), test users who track individuals or their performance also need to

understand how task or work performance and criterion performance requirements may change

over time (Ackerman, 1987; Borman, 1991; Fleishman & Fruchter, 1960; Ghiselli, 1956; Kane,

1986; Komaki, Collins, & Penn, 1982). In addition, test users who conduct reassessments should

be familiar with the effects of repeated use of assessment procedures on both the individual and

the findings obtained. For example, frequent retesting of a skill might appear advisable but could

produce practice effects and spuriously inflated results, unless alternative forms of the tests are

available (Chall & Curtis, 1990).

Training and supervision. Training for test use in the employment context is best

obtained by successful completion of an integrated program of study that includes industrial

psychology, psychology of individual differences, measurement theory, job/work/practice

analysis, performance measurement, and employment law relevant to the testing situation.

Experience and supervision using tests in settings similar to those in which employment tests are

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used is important. For test users who provide assessment of health outcomes or understanding of

health problems of individuals and groups (e.g., those working in employee assistance programs

[EAPs]), the qualifications described in the Health Care Context section below also apply.

Educational Context

The results of psychological tests often serve as relevant information to guide educational

decisions about both students and programs (AERA, APA, & NCME, 1999). This section

addresses the use of psychological tests to assess educational outcomes or educational processes

pertaining to an individual, a group of individuals, or an educational institution. Psychological

tests are used in a variety of educational settings, including preschools, elementary and

secondary schools, colleges, universities, technical schools, business training programs,

counseling centers, health and mental health settings that offer educational services, and

educational consulting practices. Psychological tests are typically used to acquire information

about students to make informed decisions about such issues as student admissions and

placement, educational programming, student performance, and teacher or school effectiveness.

Given the wide range of educational settings and the multiple uses for group and individual test

data, it is likely that more individuals are administered tests in an educational context than in any

other setting (Bersoff, 1979, 1999).

On an individual level, psychological tests are often used to describe a student’s learning

or behavioral strengths and weaknesses. The results may then be used to develop educational

interventions, to determine appropriate educational placements (e.g., special education, gifted

education, magnet school program, or alternative educational setting), or as part of clinical

diagnostic assessment to guide therapeutic services (Fagan & Wise, 1995).

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Assessment of groups of individuals, often called large-scale testing, typically addresses

questions or concerns about educational programs or policies (Hambleton & Jurgensen, 1990).

Decision makers may aggregate results from psychological tests and use this information to

evaluate program effectiveness and develop recommendations for changes to educational

programs or systems. Test users in these cases may use standardized tests or nonstandardized

procedures (e.g., performance events or portfolios of student work) to obtain information about

cognitive ability or academic achievement levels of a group of students (Fuchs & Fuchs, 1990).

A majority of states require students to complete large-scale test batteries to determine their

proficiency relative to state standards. In some instances, results from such large-scale tests are

reported only at the aggregate level, providing district, school, or classroom results. In other

instances, results are reported for individual students as well as districts, schools, or classrooms.

The qualifications described above in the section on Core Knowledge and Skills for Test

Users apply to individuals using psychological tests in an educational context. Topics that have

particular relevance in educational settings include the representativeness of the test sample,

attention to language and cultural diversity, and the use of cut scores in selection for special

programs (Henning-Stout & Brown-Cheatham, 1999; Kranzler, 1999; Reynolds & Kamphaus,

1990; Salvia & Ysseldyke, 1995). Test users should also understand the cognitive and emotional

factors that affect student learning, as well as the social and political factors that affect schools as

learning environments (Gettinger & Stoiber, 1999; Medway & Cafferty, 1999; Tharinger &

Lambert, 1999; Ysseldyke & Elliott, 1999). Those who use psychological tests in social

institutions like schools should be particularly skilled at communicating the results of testing to

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many different audiences, including educational decision makers, teachers, students, parents, and

the public (AERA, APA, & NCME, 1999; Illback, Zins, & Maher, 1999).

The specific nature of the qualifications that are important to test use in the educational

context depend on both the purpose for which tests are used (e.g., classification or prediction)

and the level of focus (e.g., individual or large-scale testing). The knowledge, skills, and abilities

associated with optimal test use at both the individual and group level are described in relation to

the purpose for which the test is used in an educational context.

Classification. Tests are often used to identify or classify individual students or groups of

students for admission to special programs. In public elementary and secondary schools, the

most frequently used formal classification system is probably the one used to determine

eligibility for special education services as required by federal and state law (e.g., the Individuals

With Disabilities Education Act). Therefore, test users in educational contexts should consider

and, where appropriate, obtain legal advice regarding state and federal laws related to the

provision of educational and related services to disabled students (Jacob-Timm & Hartshorne,

1998; Reschly & Bersoff, 1999). Many schools also use curriculum-tracking schemes (e.g.,

general vs. college preparatory classes), which categorize and then place students in separate

instructional tracks or ability groupings, each with its own eligibility criteria. Schools also use

classification systems to identify individuals at risk for school failure, eligible for gifted and

talented programs, or for admission to magnet programs. Individuals using psychological tests

for classification purposes, both in individual and large-scale assessments, should be familiar

with the taxonomic systems used by schools and other educational settings as well as the

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psychometric limitations of the tests used (Kamphaus, Reynolds, & Imperato-McCammon, 1999;

Macmann & Barnett, 1999; Reynolds, 1990).

Test users should also possess the knowledge to select instruments that are appropriate

for the characteristics of the student being evaluated (AERA, APA, & NCME, 1999). For

example, tests that have adequate reliability and validity for assessing school-age students may

be inappropriate for use with preschool children (Bracken, 1987, 1994; Nuttall, Romero, &

Kalesnik, 1999). If a test has been developed, normed, and validated for use with individuals

from one language, culture, race, or ethnic group, it may not be appropriate for individuals from

other cultural or ethnic populations (Figueroa, 1990). For individual assessment, test users

consider and, when appropriate, integrate information from multiple sources, such as

psychological and educational test data, behavioral observations and ratings, school records, and

interviews with parents and teachers (Salvia & Ysseldyke, 1995).

Large-scale tests are used for a variety of purposes, including program accountability and

decisions related to admissions and educational placement. In most instances, important

decisions about students should not be based on a student’s performance on a single test (AERA,

APA, & NCME, 1999). When schools, districts, or states develop or select a test to determine

student achievement relative to state standards, test users should have the skills and knowledge

to determine the degree of correspondence among the standards, curricula, and test content.

When critical decisions, such as graduation or retention, are based on test results, test users strive

to consider students’ opportunity to learn the stated content and identify other sources of relevant

data that reflect student proficiency. When tests are used for college placement, test users

determine the degree of alignment between the test’s content and the college courses, as well as

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understand the relationship between predicted and actual performance in subsequent courses

before determining a cut score or other classification criteria. Legal requirements may influence

or restrict the use of rank ordering or cut scores, particularly if these practices have a

disproportionate effect on one or more subgroups.

Description. Psychological tests are also used in educational settings to describe aspects

of learners’ skills and abilities, such as learning styles, motivation, reading readiness, and

emotional maturity. These student characteristics may be assessed to describe a student’s

academic strengths or weaknesses or to differentiate educational approaches based on individual

need. Group measures of interests, attitudes, cognitive abilities, or emotional adjustment may

also provide a basis for interventions designed to remediate current problems or to prevent future

difficulties.

Large-scale assessments are often used by schools, districts, and states to measure the

general level of student performance. Often such test use is designed to evaluate the effects of

curricular decisions or program outcomes. In some instances, schools or teachers may be held

accountable for their students’ test results, with penalties imposed for scores below expectations.

Therefore, it is important that test users attend to the multiple factors that contribute to test score

differences between schools, classrooms, or districts (e.g., student motivation, quality of prior

educational experiences, and parental support of educational goals).

Prediction. In the educational context, tests are often used to predict the future behavior

or academic success of a student or group of students. In individual assessment, tests are often

used to screen students for placement in special programs (e.g., gifted education, programs for

students at risk of educational or behavioral problems, and magnet programs for special interests

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or abilities) or to place them in an instructional group or track based on a prediction of expected

future performance.

In large-scale testing, admissions tests are required for entry into most undergraduate,

graduate, and professional programs. These tests help the institution estimate the students’

readiness for an academic program and provide a means to compare the academic preparation of

students who have attended different schools, who have completed different courses, and who

have been graded according to different criteria. Admissions tests are also useful in college

counseling, providing students with useful information on their potential for academic success at

different colleges and universities. In addition, most colleges use specially developed placement

tests to determine a student’s eligibility for particular courses.

Whether the focus of the assessment is an individual student or a group of students, the

test user should recognize that each student’s future performance is affected by many factors. In

addition to examining a student’s abilities, characteristics, and motivation, test users should have

the skills and knowledge to evaluate the relative contribution of teacher competence and

motivation, school and classroom climate, peer group influence, class size, and other factors that

play a critical role in determining a student’s future performance (Gettinger & Stoiber, 1999).

They also strive to understand the likely course of learning difficulties and developmental

variations in the acquisition of academic skills (Tharinger & Lambert, 1999). Finally, test users

strive to be familiar with the literature on how group differences (e.g., ethnicity, gender, race,

and SES) may affect performance on standardized tests, grades, school completion, and other

outcomes that may be used in predicting academic success (Figueroa, 1990; Henning-Stout &

Brown-Cheatam, 1999).

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Intervention planning. Psychological tests are frequently used to plan interventions for

one student or a group of students. Psychological tests are commonly used as part of the

individual diagnostic assessment of students with learning or behavioral problems (Kamphaus et

al., 1999; Salvia & Ysseldyke, 1995; Woody, La Voie, & Epps, 1992). The results from these

tests help to describe or diagnose the educational strengths and weaknesses of students or their

behavioral difficulties and contribute to the development of educational, behavioral, or mental

health interventions. Test users involved in intervention planning for individual students strive to

be knowledgeable about alternative instructional approaches; school curriculum; special

education services; and therapeutic interventions, such as counseling, group dynamics, and

behavioral interventions (Hughes, 1999; Shapiro & Cole, 1994). Those who use tests to prescribe

interventions based on assessed student characteristics should be familiar with the empirical

evidence for using test data to make such decisions.

Test results sometimes provide a rationale for educational interventions that affect a large

number of students, such as a modification in instructional approach (Algozzine & Ysseldyke,

1992; Gettinger & Stoiber, 1999; Illback et al., 1999). One example is the decision to replace a

phonics approach in reading instruction with a whole-language approach. Test users strive to

clearly communicate to decision makers the appropriateness of inferences based on test data and

the likely effects of program changes on various groups of students. Test results may also be

used as a basis for individual interventions, such as removing a student from school (e.g., school

suspension) or placing that individual in a private residential program for severely disturbed or

impaired individuals. Here, test users should consider how significantly a change in educational

placement may affect a student’s self-concept, educational achievement, and overall well-being

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(Jacob-Timm & Hartshorne, 1998; Woody et al., 1992). Test users should consider and, where

appropriate, obtain legal advice about relevant state and federal laws dealing with changes in

placement and the use of educational interventions that affect school placement (Jacob-Timm &

Hartshorne, 1998; Reschly & Bersoff, 1999) as well as the legal protections afforded to parents

and students, including, where applicable, due process rights and requirements of informed

consent (Jacob-Timm & Hartshorne, 1998).

Tracking. Test users in school settings often administer tests multiple times to track the

effects of educational programming or interventions. In individual assessment, special education

law requires that students classified as disabled be reassessed at least every 3 years so that

students are given a periodic review of their status (Jacob-Timm & Hartshorne, 1998; Reschly &

Bersoff, 1999; Salvia & Ysseldyke, 1995). Even students who are not classified as having a

disability but who receive a modification in their educational programming are reassessed

periodically to determine if the interventions are having the desired outcomes and are still

warranted.

Groups of students may be assessed yearly to document academic progress or to evaluate

a program’s effectiveness (Algozzine & Ysseldyke, 1992; Illback et al., 1999). Such aggregated

student data are frequently used as the basis for modifying instructional programs and policies.

In some cases, the school is required to obtain evidence of program effectiveness to receive

continued funding for that program.

When tests are used for tracking purposes in educational settings, test users should

understand the effects of repeated test administrations on the students and on the findings

obtained. For example, frequent retesting of reading achievement to guide instruction might

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appear advisable but could produce serious practice effects and spuriously inflated results, unless

alternative forms of the reading tests are available (Chall & Curtis, 1990; Shapiro & Elliott,

1999). Those who use tests to track student performance also strive to be aware of the social and

instructional context variables that may influence student performance, so that changes in test

scores are not automatically attributed to changes in student abilities (Greenwood, Carta, &

Atwater, 1991; Ysseldyke & Elliott, 1999).

Training and supervision. In addition to the knowledge, skills, and abilities outlined for

all test users, the user of psychological tests in the educational context should be knowledgeable

in the content areas of educational and psychological theory and practice, as well as the legal

requirements and protections for test takers that are relevant to the type of assessment being

conducted. This combination of generic psychometric knowledge and context-relevant expertise

is best acquired in an integrated program of advanced professional preparation, such as that

acquired in a doctoral program in school or educational psychology or educational measurement.

As noted earlier, the type of training and the breadth and depth of knowledge in each of these

domains may vary for different test users depending on whether they are responsible for

individual diagnostic testing or large-scale testing. Test users in an educational environment

should possess an appropriate practice credential where such credential is legally required to

provide the type of testing being offered. It is also important that they receive supervised

experience appropriate to their role and setting in the use of tests to address educational problems

or questions.

Individuals using psychological tests to place children in special education programs

should be knowledgeable in areas such as developmental and social psychology, diagnostic

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decision making, child psychopathology, and special education practices. They should consider

and, where appropriate, obtain legal advice on special education law. Furthermore, test users

involved in individual diagnostic testing strive to be competent in communicating and translating

assessment results into educationally relevant and appropriate recommendations that are likely to

result in meaningful improvement.

Individuals using psychological tests to address large-scale testing questions related to

admissions, student grouping, or instructional programming should be particularly

knowledgeable in the domains dealing with psychometrics, instructional design, educational and

developmental psychology, and measurement theory. In addition, individuals doing large-scale

testing or research in school settings should be knowledgeable and skilled in communicating the

results of tests to diverse audiences including school personnel, students, parents, policymakers,

the media, and the public in general. Individuals using tests for college or graduate school

admissions, for counseling, or for placement also strive to be knowledgeable about the empirical

evidence related to using tests to make such decisions in higher education. They should consider

and, where appropriate, obtain legal advice regarding the legal protections for test takers in

higher education settings.

Career/Vocational Counseling Context

Psychological testing in the career/vocational counseling context is used to help people

make appropriate educational, occupational, retirement, and recreational choices and to assess

difficulties that impede the career decision-making process. Career/vocational counselors

integrate their knowledge of career demands with information about beliefs, attitudes, values,

personalities, mental health, and abilities, with the goal of promoting beneficial career

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development, life planning, and decision making. Successful career adjustment is based on

occupational, intellectual, personal, developmental, educational, and societal factors. Information

about values, interests, abilities, achievements, mental health, and work experience is important

to the process (Zunker, 1990). The individual’s self-knowledge about values, strengths,

weaknesses, motivation, psychological characteristics, and interests are also relevant (Herr &

Cramer, 1996).

Career/vocational testing overlaps somewhat with employment testing, but the two often

serve different purposes. In employment testing, typically the job is already defined, whereas in

career/vocational psychology tests are used to help individuals make personally relevant career

choices. Another distinction is that in employment testing the client is the employer (not the test

taker), whereas in career/vocational testing the client is usually the test taker, even when a parent

or school is financially responsible for the testing. Another distinction between the fields is that

there are many more legal issues governing the use of psychological tests in personnel selection

than there are in career/vocational assessment.

Psychological tests in the career/vocational counseling context are used to help

individuals make decisions about career and life planning. Testing can provide persons

knowledge about their work-related and avocational interests, their abilities, and their values and

help them understand how these fit into the existing opportunities and requirements of the

workplace and into their leisure activities. Along with the knowledge, skills, and abilities

identified earlier, test users strive to understand how individuals’ particular interests, values,

abilities, and skills relate to their choice of work and leisure activities. Test users also should

have substantive knowledge in related areas of psychology, such as adolescent and adult

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development, personality, and psychopathology, as well as detailed and current knowledge of

measurement questions involved with assessing interests, abilities, personality dimensions, and

values. Test users should be able to integrate complex results that cross these multiple domains

of assessment.

Test users also make every effort to be knowledgeable about types of work settings, work

cultures and values, and the characteristics and requirements of types of jobs. They strive to

integrate the results of multiple measures from a number of different domains with their

knowledge of vocational theories (Osipow & Fitzgerald, 1996) and career taxonomies (Holland,

1997; Lowman, 1991).

Test users identify and work with individual difference and systemic variables that may

influence the person–environment fit. Such factors include the individual’s family system,

gender, ethnicity, cultural background, physical ability, SES, and psychological problems. Test

users should be able to recognize and work not only with the problems explicitly presented by

the test taker but also with other problems, including underlying emotional difficulties or

environmental impediments that could affect the way the test taker uses test results. For example,

a test taker’s family or cultural background might deem certain careers unacceptable and

therefore require the test user to process this perception and assist in generating viable vocational

options.

Often the person seeking career or leisure counseling is experiencing a life transition that

brings additional personal, developmental, and emotional stress. In addition, such individuals

may struggle with emotional problems that make deciding on a career difficult. For example,

those who lack self-esteem and confidence may find it challenging to engage in self-assessment,

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reflect on the world of work, and confidently select an occupation. To deal effectively with such

complex mixtures of career, developmental, and emotional concerns, vocational test users should

have qualifications similar to those required in the health care context (see the Health Care

Context section below).

Classification. The primary focus of vocational classification is to identify an individual’s

career-related skills, abilities, and characteristics (e.g., interests and personality factors) and then

match them with the requirements of specific jobs or job categories. Vocational classification

may also be used to match an individual with a specific school or program or to help a person

identify satisfying leisure activities or outlets for prized abilities.

Knowledge of individual differences in cognition and personality are central in the

assessment of person–environment fit. Career/vocational counselors may administer cognitive,

achievement, and aptitude tests to determine a test taker’s skills or special competencies (Kapes,

Mastie, & Whitfield, 1994; Lowman, 1991). Differential patterns of abilities may be as important

as scores on individual ability measures, so testing may need to cover a wide range of

competencies. Career/vocational counselors may use personality inventories, interest inventories,

and other assessment procedures to help them understand the test taker’s preferences, values,

learning history, and occupational or leisure goals. By effectively communicating test results to

test takers, career/vocational counselors help their clients to better understand the fit of their

characteristics with their environment.

Description. Similar to the health care context, a holistic description of the individual’s

personality and mental health is important in the career/vocational counseling context (Gysbers,

Heppner, & Johnston, 1999). The coexistence and interaction of career and mental health

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problems (Blustein & Spengler, 1995; L. Lucas & Epperson, 1988; M. S. Lucas, 1992) support

the need for test users to assess personality and mental health problems that may impede

successful career development. Moreover, test users may want to assess important constructs,

such as career indecision and career choice anxiety, with those who have a history of difficulty in

vocational decision making. Thus, test users in the career/vocational counseling context should

be qualified to assess the mental health functioning of individuals seeking career counseling in

order to determine the most effective approach (refer to the following section on Health Care

Context).

Prediction. Prediction is often a central concern for vocational assessors. That is, the

results of a variety of vocational tests are assumed to reflect stable, enduring traits that are

relevant to future work performance and satisfaction. Although related constructs such as

interests and cognitive abilities demonstrate stability over a period of years, the degree of

consistency partly depends on the developmental level of the test taker. For example, students

may lack the experience necessary to crystallize vocational interests until they have reached

college age (Blustein, Pauling, DeMania, & Faye, 1994; Tinsley & Barrett, 1977). Vocational

test users should temper predictions of future behavior with the knowledge that test takers’

further development and specific situations may strongly influence their work behaviors.

Intervention planning. In some cases, the vocational intervention consists entirely of the

administration and interpretation of tests and the communication of assessment findings. This is

often true when the test taker’s increased self-knowledge regarding interests, values, personality,

and the world of work is the goal of the intervention. In these cases, test users strive to engage

the individual actively in the process of test interpretation (Tinsley & Bradley, 1986).

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In other cases, additional vocational interventions may be used in conjunction with

psychological assessment (Fouad, 1994) or may be identified as needed by the career assessment

process. For example, testing may yield a list of potentially suitable occupations that the test

taker can investigate and experience in internships and part-time work. Or the test results may

indicate a lack of differentiation among the test taker’s vocational interests, suggesting that

additional experience is needed before more specific work preferences can be developed. To

perform effective career/vocational interventions, test users should have knowledge of career

development theories and skills in interviewing and history taking, as well as knowledge of

relevant educational and career information resources. Test users strive to be aware of

discriminatory patterns that exist in various careers.

In some cases, evaluation of test results shows that further psychological intervention is

needed. Test users should be able to evaluate patterns of behavior and test results, recognize test

takers who will not be able to benefit from vocational information because of significant

developmental, cognitive, emotional, or physical problems, and treat or refer them appropriately.

Tracking. Tests used for career and vocational assessment may provide standards against

which to compare patterns of subsequent growth or deterioration. Tests may be useful, on an

individual level, in revealing patterns of change after traumatic or remediative experiences.

Grouped test data can provide important information for uses such as determining the

characteristics of employees in occupations or organizations or students in particular majors and

how they may change over time. Test users should be knowledgeable about the psychometric

and context-related implications of assessing career development over time.

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Training and supervision. The use of psychological tests in career and vocational

assessment, as described above, requires complex skills in career and mental health assessment,

not just simply learning to use tests in isolation. Appropriate training (e.g., that obtained through

doctoral programs in relevant areas of psychology) includes coursework in adolescent and adult

development, as well as the domain of vocational/career psychology. Test users engaged in

career counseling and testing should be knowledgeable about measurement theory, as described

earlier. They strive to be skilled in involving clients in the interpretation of vocational tests.

Finally, it is important that their training include supervised experience in the use of

psychological tests in vocational/career settings, and relevant experience in educational,

counseling, health care, and occupational settings.

Health Care Context

Health care is the provision of services to individuals who seek help in enhancing their

physical or mental well-being or in dealing with behaviors, emotions, or issues that are

associated with suffering, disease, disablement, illness, risk of harm, or risk of loss of

independence. Health care assessment commonly occurs in private practice, rehabilitation,

medical or psychiatric inpatient or outpatient settings, schools, EAPs, and other settings that

address health care needs.

Psychological tests are used as part of the assessment process to develop health-related

information and recommendations or decisions about people to improve their physical or mental

health. Those who use tests for this purpose should have thorough grounding both in the core

knowledge and skills enumerated earlier and in the specialized knowledge, training, or

experience of specific substantive areas of health care. With so many specialized areas in health

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care, it is impractical to specify any single set of core knowledge requirements, technical

competencies, or supervised training experiences for test users. More detailed guidance is often

provided in the guidelines and standards developed by professionals working in a specialized

health care area.

Because health care providers’ decisions and actions can have very important and

sometimes very dramatic effects on the lives of the people they serve, the health care profession

is heavily regulated. Test users should keep abreast of ethical standards relative to psychological

assessment (Bersoff, 1999; Koocher, 1993; Koocher & Keith-Spiegel, 1998) as well as

regulations and laws at both state and federal levels on such subjects as confidentiality, duty to

warn, mandated reporting, and patient rights (APA Committee on Legal Issues, 1996; APA

Committee on Psychological Tests and Assessment, 1996; Koocher, Norcross, & Hill, 1998) and

obtain legal advice in these matters where appropriate.

In the health care context, psychological test data are typically used to augment

information gathered from other sources (e.g., patient and collateral interviews, behavioral

observations, and laboratory results). Health care providers who use psychological tests strive to

effectively integrate results from multiple tests and sources of information. Psychological test

users strive to understand how the nature of the setting (e.g., psychiatric hospital) and the

characteristics of test takers (e.g., those who have a physical illness or disability or who are on

medication) might affect the process of test administration, the results, and the interpretation.

Test users strive to communicate the technical aspects of their findings to other professionals as

well as to health care consumers in language that is appropriate and understandable to each.

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Classification. When psychological tests are used for classification purposes, the most

common goal is the assignment of a mental health, medical, or other diagnosis. In these

instances, psychological test findings are generally combined with interview and historical data,

behavioral observations, and data from other sources to derive a formal diagnosis. When

diagnosis is the goal of testing, test users combine the skills associated with competent testing

with a separate set of knowledge, skills, and experiences related to classification and diagnosis in

the population of interest.

Test users should be able to identify and evaluate factors that may influence diagnostic

determinations and that are frequently not accounted for in the development, standardization, and

norming of psychological tests. For example, when working with persons whose physical

symptoms may affect test performance, test users should be knowledgeable about and

experienced at distinguishing illness-related test results from other determinants for a person’s

test performance (e.g., motivation, demographics, personality traits, or other medical

considerations).

Test users seek to understand determinants of diagnostic accuracy in relation to both the

specific assessment procedures being used and the decisions that need to be made. For example,

when psychological tests are used to screen for specific health problems such as alcoholism or

dementia, test users should consider how fluctuations in base rates in different populations may

affect the sensitivity and specificity of test results (Ivnik et al., in press).

Description. Psychological tests are also used in health care to provide a more

comprehensive description of individuals by delineating their unique personality, emotional,

cognitive, or other characteristics. For example, a combination of personality, academic,

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aptitude, interest, and cognitive tests may be used to help describe the areas of both preserved

and compromised functioning for a young person who is in a rehabilitation facility in hope of

returning to work after suffering a head injury in a motor vehicle accident (MVA). When

performing primarily descriptive assessments in health care, test users should consider the

construct validity of the tests that they select and how these constructs are manifested in day-to-

day behavior. To avoid misinterpreting normal inter- and intratest variance as pathology, test

users who work in health care should consider the limits of normal variance when different

psychological characteristics are simultaneously measured. When individuals are followed over

time and psychological tests are repeated one or more times, test users are attentive to issues that

relate to how “meaningful change” is distinguished from normal test–retest variability (Ivnik et

al., 1999; Jacobson & Truax, 1991; Sawrie, Chelune, Naugle, & Luders, 1996).

Prediction. Health care professionals are frequently asked to make predictions (i.e.,

prognoses) about the persons they serve, and psychological test users may specifically be asked

to make testing-based predictions. For example, the person who tested the MVA victim

mentioned above may be asked to “predict” when this person might return to work or to school

or the person’s final level of recovery. In these instances, test users strive to be knowledgeable

about the predictive limits of testing. When tests are used to make predictions in health care

settings, test users strive to understand the patient’s unique characteristics (e.g., personality

features, special strengths, disabilities or disorders, and sociocultural issues), the natural course

of medical conditions, the likely efficacy of planned interventions, and relevant base-rate

information. Test users strive to understand the empirical evidence of a test’s ability to make

accurate predictions. For example, neuropsychologists who make predictions about a person’s

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need for assistance in daily activities should know how well their test instruments predict

relevant functional capacities (Lemsky, Smith, Malec, & Ivnik, 1996).

Intervention planning. In health care settings, data from psychological tests may be used

in planning interventions. Intervention planning refers to the selection of specific remediation

activities based on a thorough knowledge of the problem being addressed and available treatment

options. Test users involved in intervention planning may use tests to provide information on an

individual’s particular problem (classification), strengths and weaknesses (description), and the

efficacy of treatment options (prediction). The same set of knowledge and skills required for

competent classification, description, and prediction are also important in the development of an

optimal treatment plan. For example, personality tests may be used to modify treatment

approaches in a therapeutic setting (Maruish, 1999). Because intervention planning involves a

specific type of prediction (i.e., the likelihood that a patient will benefit from a particular form of

treatment), test users strive to be aware of the limitations discussed above related to prediction

and the scientific evidence supporting available treatments.

Tracking. In some circumstances, multiple sequential administrations of the same test(s)

are frequently needed to document how psychological characteristics change over time or as a

consequence of treatment (e.g., to track the course of a patient’s illness or recovery). To interpret

these results, test users strive to be knowledgeable about how repeated exposures to test

procedures and test content influence subsequent test performances (e.g., practice effects),

including how conditions (e.g., memory deficits) present during one examination may affect the

results of later testing. Test users also strive to understand how to distinguish measurement error

from reliable test score change (e.g., Ivnik et al., 1999; Jacobson & Truax, 1991; Sawrie et al.,

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1996). Psychological tests are sometimes used to measure treatment outcome. For example, test

results may help determine eligibility for health care services or to monitor treatment efficacy. If

this application is different from the test’s original purpose, test users should be aware of

potential factors that may limit the usefulness or validity of the test data as an indicator of

treatment outcome.

Training, supervision, and licensure. In the health care context, the qualifications

described above are best obtained through doctoral training in psychology, which includes

psychological testing supervision in one or more health care settings that are similar to the

setting(s) in which a specific test user intends to practice. The APA’s model licensing act (APA,

1987) recommends for health care psychologists that state credentialing bodies require 2 years of

full-time supervised experience with a minimum of 1 hr/week of individual supervision provided

by an appropriately credentialed professional. Also, guidelines for training programs such as the

APA’s Guidelines and Principles for the Accreditation of Programs in Professional Psychology

(APA, 1996) include requirements for supervised experience in graduate training, predoctoral

internship, and mandated postdoctoral supervision. Finally, some health care specialties have

defined the core knowledge, training, and supervised experiences that are needed for fully

competent test use (e.g., neuropsychology; Hannay et al., 1998). The specific health care setting

in which a test user works (e.g., mental health facilities or EAPs) will define the added content

areas that a test user should master.

In addition to coursework in psychological testing, personality theory and assessment,

and measurement theory, independent health services providers who use tests for health care

needs should be particularly knowledgeable in psychopathology, health psychology, life-span

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developmental psychology, and the biological bases of behavior. Test users in the health care

context should also be skillful in clinical diagnostic interviewing and familiar with mental health

diagnostic and classification systems. As noted earlier, the breadth and depth of knowledge in

each of these domains, as well as additional technical qualifications, may vary depending on the

specific area of specialized functioning.

Health care professionals who use psychological tests are credentialed by the state or

province in which they work. Credential renewal in many states requires documentation of

continuing professional education. Those who use psychological tests in a health care context

strive to obtain knowledge, supervised training, and professional experiences that go beyond the

profession-specific knowledge, training, and experiences they obtained during graduate

education, practica, internship, residency, or fellowship. For some test users whose original

graduate education and training were not in clinical areas, graduate-level respecialization

programs can provide additional education and training.

Forensic Context

In forensic settings, psychological tests are used to gather information and develop

recommendations about people who are involved in legal proceedings. Test users in forensic

settings should possess a working knowledge of the functioning of the administrative,

correctional, or court system in which they practice. They strive to be familiar with the statutory,

administrative, or case law in the specific legal context where the testing occurs or, where

appropriate, obtain legal advise on the pertinent laws. They strive to communicate test results in

a way that is useful for the finder of fact (i.e., the judge, the administrative body, or the jury).

This includes communicating verbally with lawyers, writing formal reports, and giving sworn

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testimony in deposition or court.

The problems encountered in forensic settings are varied and complex, often involving

medical illnesses, developmental problems, and multiple forms of psychopathology, so test use

often requires expertise in multiple health care areas. This section addresses those who use

clinical, rehabilitation, and neuropsychological tests in legal contexts, as well as those who

believe that their test data will serve as a foundation for legal consultation or testimony. Thus, in

addition to the core qualifications identified earlier, the qualifications described above for test

users in health care contexts typically apply to test users in forensic settings.

This section does not address test use by two groups of experts who also may work in

forensic settings. Specifically, this section does not apply to those who use psychological tests to

conduct research in applied areas of forensics, such as memory, social psychology, or human

factors. Nor does it apply to those who use tests in applied areas, such as clinical, rehabilitation,

or neuropsychological practice or industrial/organizational or educational psychology and who

may be asked to provide consultation or testimony based on their training, education, or

experience about work with their clients. However, these test users should be sensitive to the

potential ramifications of assuming multiple roles (Greenberg & Shuman, 1997; Shuman,

Greenberg, Heilbrun, & Foote, 1999).

Those who use tests for forensic purposes should possess substantive knowledge in areas

of psychology related to the forensic issues. For example, in correctional or criminal settings,

knowledge about violence, criminality, and the relationship of psychopathology to those

behaviors and activities is germane (Heilbrun et al., 1998). Similarly, when assessing families in

child custody or parental rights cases, it is important for test users to understand family

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dynamics, parenting, and different forms of child custody (APA Committee on Professional

Practice and Standards, 1994).

Assessments for forensic purposes often occur in outpatient, inpatient, and correctional

settings (Heilbrun, 1992; Melton, Petrila, Poythress, & Slobogin, 1997). Each of these settings

exerts specific influences that may significantly alter how tests are administered and interpreted.

For example, in correctional settings test users strive to understand how the test results may be

affected by the level of privacy of the testing location, the noise in the area, and even the degree

of objective danger and threat to the inmate from other residents. Further, test users strive to be

knowledgeable about the effect of incarceration on the presentation of psychopathology, possible

effects of the trial or litigation process on client presentation, and the assessment of response set

issues (Rogers, 1997).

Classification. Diagnostic skills are important for the use of psychological tests in forensic

settings. In most situations, the assessment will include multiple measures to provide a thorough

and legally defensible diagnosis (Heilbrun, 1992; Heinze & Grisso, 1996). Thus, test users in

forensic settings strive to integrate results from multiple tests with knowledge of accepted

diagnostic taxonomies (e.g., the Diagnostic and Statistical Manual of Mental Disorders [4th ed.;

American Psychiatric Association, 1994) and knowledge about how test findings relate to these

systems (Talge, 1995).

Test users strive to identify and evaluate critical factors that may influence diagnostic

determinations. Among these factors are the defendant’s response set and the effects of

incarceration and litigation on the defendant’s test results. A thorough knowledge of response set

and its influence on test results (Rogers, 1997) may be needed for accurate interpretation of test

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results.

Because of the high stakes in legal proceedings (monetary settlements, child custody, jail

sentences, and even the death penalty), test takers may be motivated to exaggerate or minimize

their symptoms. Because diagnosis may be complicated by these response biases, test users in

forensic settings strive to recognize these factors and account for them in the interpretation.

Additionally, test users in forensic settings should understand that psychopathology as measured

by tests may be improved or exacerbated by incarceration and that trial proceedings and litigation

may affect test data by increasing or decreasing the litigant’s anxiety, depression, or anger

(Weissman, 1991).

Test users are often required to evaluate historical information to help the court arrive at a

determination of causation or to review events that have occurred in the past to ascertain whether

those events relate in some way to a legal standard. Consultation with family members or friends

of the examinee may also add to the accuracy of the interpretation of test results.

For example, in criminal settings, test users may be asked to assist the court in

determining whether the defendant was criminally responsible for his or her behavior at the time

of the offense. Or a test user may be asked to assess the defendant’s capacity to waive his or her

Fourth and Fifth Amendment (Miranda) rights—critical for determining whether a confession is

admissible in court (Grisso, 1986). In tort (civil lawsuit) settings, determination of causation (the

legal nexus between a specific event and a psychopathological condition) is often a critical

element for determining whether even the minimum basis for a lawsuit exists. Even in contexts

where causation involves strictly technical knowledge from other fields (e.g., chemistry or

physiology), test users may be asked to provide legally admissible information on the

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psychological or neuropsychological status of an examinee without attributing

causation.

Those using tests in forensic settings to determine the causation of legally relevant

conditions or events strive to be knowledgeable about how the tests are used to determine the

origins or natural histories of mental disorders. Users of neuropsychological tests may use

patterns of scores on those tests to inform opinions about the cause of specific behaviors (e.g.,

Martzke, Swan, & Varney, 1991; Varney & Menefee, 1993). Assessment of brain trauma or

toxic chemical reactions may fall into this category. Test users assessing traumatic emotional

reactions should have knowledge about the relationship of specific score patterns with specific

types of emotional trauma. Test users also should have knowledge of relevant epidemiological

studies (Kilpatrick & Resnick, 1993; Swanson, 1994) and etiology of mental conditions.

Description. In forensic settings, clients are described in relation to a legal standard in a

particular context. The most obvious example is the application of the standards for legal

competency (to stand trial, to execute a legal document, and to be executed). These standards are

established by legislation and case law (see Grisso, 1986).

Standards are applied to clients for a variety of forensic purposes. In criminal cases, a

major focus has been the assessment of individuals for determining criminal responsibility or

insanity at the time of the offense (Rogers, 1986). In correctional settings, assessment results in

conjunction with historical or behavioral data may determine whether an inmate is described as a

high-, medium-, or low-security risk (see Megargee, 1979, 1994). In tort or disability settings,

the standard may be a legal description of an emotional condition, which will be applied to

examinees to determine their eligibility for compensation under administrative regulations (e.g.,

Social Security) or laws (Sales & Perrin, 1993).

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To perform these descriptive activities, test users should consider and, where appropriate,

obtain legal advice on the applicable legal standard to craft the appropriate assessment strategy to

produce a legally useful result and to interpret the assessment results in light of that standard

(Heilbrun, 1992). Test users may be called upon to explain how the test data are relevant to the

applicable legal standards.

Prediction. In forensic practice, test users are often asked to make a statement about the

future behavior of a test taker (Otto, 1992). In civil commitment settings, for example, most

states’ criteria for involuntary commitment include the examinee’s dangerousness to self or

others (Monahan & Steadman, 1996). In criminal settings, statements concerning the examinee’s

potential for recidivism on parole from prison may be a critical element of a prerelease

evaluation (Borum & Grisso, 1995; Webster, Douglas, Eaves, & Hart, 1997). In tort settings,

predictions about the prognosis of an emotional condition may be necessary for determining

damages in a lawsuit (Sales & Perrin, 1993). In domestic relations settings, predictions of a

child’s reaction to a specific custody arrangement may be a critical part of the custody

evaluation.

To use test results for prediction, test user should be knowledgeable about the base rates

of legally relevant behaviors (e.g., violence, suicide, or posttraumatic states) and the contribution

of situational factors (e.g., life stresses, substance abuse, or treatment with psychotherapy or

medication) to these behaviors.

Intervention planning. Intervention planning based on test data may be an important part

of the test user’s responsibilities in forensic settings. For example, in divorce, adoption, or abuse

and neglect cases, recommendations for treatment for a child or family may be integral to the

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child custody recommendation. In a sentencing evaluation, recommendations for treatment may

be included in deliberations and influence the duration or location of the convicted person’s

incarceration. In tort settings, treatment recommendations may, in part, determine the amount of

monetary compensation provided for the plaintiff.

In addition to the prediction skills indicated above, skills important for intervention

planning in forensic settings include both knowledge of how test data may be helpful for

selecting appropriate treatment strategies and knowledge of how test data may assist in

predicting response to treatment.

Tracking. In forensic settings, it is often important to know how test data may be affected

by the passage of time and by events that occur between repeated test administrations. In

working with children, for example, test users should consider the effects of developmental

sequences in the assessment of the child’s current emotional condition to trace the origins of that

condition to specific events such as traumatic experiences or changes in custody. Tests may

assist in the process of ruling out alternative causes of conditions. Although the determination of

causation is generally a classification activity (see the Classification section above), a test user

may be called upon to review a sequence of test data generated through a series of testing

periods. This is most likely to occur in cases where the test user has an opportunity to review test

data that were gathered before the commission of a criminal offense or before the injury that is

the focus of subsequent litigation. Such data may assist the test user in assessing issues of legal

causation.

Training and supervision. The knowledge, skills, and abilities identified in this section

are best obtained through doctoral training in psychology and relevant supervised experience, as

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described in the Health Care Context section. Licensure requirements for those who use

psychological tests in the forensic context are similar to those required of practitioners in the

health care context.

The coursework and training for individuals who use tests in the forensic context are very

comparable with the coursework and training for those who use tests for health care needs,

although a basic introduction to psychology and the law is also desirable. In addition, training in

the specific area of law (e.g., criminal responsibility) may be important. This may be acquired

through formal or continuing education course work (Bersoff et al., 1997; Ogloff, Tomkins, &

Bersoff, 1996) or through mentoring by, or consultation with, someone trained and

knowledgeable in the relevant statutes (e.g., a lawyer specializing in the field in question).

Supervised experience in the conduct of a particular type of forensic evaluation may also be

critical. Experience in one forensic area (e.g., child custody evaluation) does not necessarily

prepare the test user for functioning in another forensic area (e.g., death penalty phase testimony;

Haas, 1993; White, 1987).

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IV. A Look Forward

The psychological testing process has undergone significant technological change over

the past few decades. The use of computers to administer tests and to score and interpret test

results is already an important part of everyday testing. Emerging technologies of the Internet

and other innovations that expand applications across vast distances may significantly alter the

relationship of the test user, test taker, and the consumer of testing results.

Some of the positive changes resulting from these new technologies include wider

availability, greater accuracy, and increased accessibility of tests. Continuing improvements in

the development of interpretive algorithms and expert systems are leading to diminishing

concurrent human oversight of the testing process. This technology will simplify some aspects of

the assessment process. As the application of new technology to the testing process produces

improved but more complex testing services, it may become necessary for the knowledge and

skills articulated in this document to be supplemented with increased technological

sophistication. Ironically, this increased complexity may mandate more extensive education and

training in the fundamentals of test use. The knowledge and skills articulated here will become

even more important as test users are required to distinguish technology-based style from

science-based substance.

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Table of Contents

I. Introduction

Definition of Key Terms

Scope of the Guidelines

Many problems or questions to be addressed through assessment must be approached with a recognition of the potential for multiple coexisting or competing explanations. Such recognition comes from the professional knowledge and judgment associated with ad

Historical Background

APA’s Role in Defining Test User Qualifications

Educational Context

Career/Vocational Counseling Context

Health Care Context

Forensic Context

The American Journal of Family Therapy, 40:

369

–384, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926187.2012.677705

What Are the Confidentiality Rights
of Collaterals in Family Therapy?

ELIZABETH M. ELLIS
Private Practice, Atlanta, Georgia, USA

The privacy rights of collateral family members constitute one of the
most complex ethical issues in the field of family therapy. The author
opens with four case studies which illustrate some of the dilemmas.
The opening section reviews the APA Ethics Code on this topic,
followed by an in depth analysis of confidentiality issues in marital
therapy and the special ethical dilemmas of high conflict, child
custody cases. The author reviews the scant case law on this topic
and closes with a set of best practices guidelines for the clinician.

CASE #1

Psychologist X was the treating therapist for a 13 year old girl who had been the
subject of an intense and bitter child custody dispute. Treatment was initiated
by the mother. As part of the child’s treatment, the psychologist met with the
mother from time to time to provide feedback and recommendations. In some
of these meetings, the mother disclosed that she was still struggling with her
alcohol addiction. The father requested a meeting with the psychologist and
asked for a complete copy of the daughter’s treatment record. The psychologist
refused on the grounds that he had to shield the mother’s disclosures from the
father. The father sought consultation from Psychologist Y about his rights.
Psychologist Y advised the father that since he had joint legal custody of the
daughter, he had a legal right to the entire record, including the mother’s
individual visits with Psychologist X. The father left Psychologist Y’s office
stating he intended to file a complaint against Psychologist X with the state
licensing board.

Q. Does the father have a basis for a complaint against Psychologist
X? Should Psychologist X have given the entire record to the father? If he

Address correspondence to Elizabeth M. Ellis, Ph.D., 2400 Pleasant Hill Road, Suite 165,
Duluth, GA 30096. E-mail: elizabethphd@bellsouth.net

369

370 E. M. Ellis

had done so, and it had an adverse impact on the mother’s custodial rights,
would she have a basis for making a complaint against Psychologist X?

CASE #2

A couple was in the process of divorcing and were litigating over custody of
their eight year old child. The father took the child to Psychologist B for treat-
ment without the knowledge or consent of the mother. He hoped to establish
that the mother was mentally unstable and that her condition put the child
at risk in her care. The mother, in treatment with Psychologist Y, found out
about this and asked what she should do about it. She was advised by Psy-
chologist Y to seek a meeting with Psychologist B in which she would request
the boy’s diagnosis, the presenting problems, and the goals in treatment. Psy-
chologist Y also advised her that she was well within her rights to ask for a
copy of the child’s records. The mother did so, but Psychologist B said he had
met several times individually with the father in conjunction with the child’s
treatment, and that he had to consider how to release the child’s records to
her. He finally met with the mother and gave her a copy of the child’s records
but redacted (blacked out) all comments that the father made about himself
in his meetings with Psychologist B, citing doctor-patient privilege.

The mother returned to treatment with Psychologist Y and asked, “Is this
permissible for him to do this?” Psychologist Y advised the mother that under
the law in the state she had a right to everything in the child’s file, and that
Psychologist B had acted improperly. The mother considered whether to file a
formal complaint against Psychologist B, to demand the full record, and/or
to advise Psychologist B to stop treatment of her son.

Q. Was Psychologist B correct in redacting the boy’s records before
releasing them to the mother? Should he have consulted an attorney? If he
had not redacted the record, could he have exposed himself to a potential
lawsuit by the father for failing to notify him that he had no privilege when
he was being interviewed?

CASE #3

A woman sought treatment for depression with Psychologist Y, complaining of
emotional distress about her marriage, especially with regard to the problem
of her husband’s drinking. Over a series of office visits, she detailed a pattern
of behavior on the part of her husband that included withdrawal from the
family on a nightly basis while he drank excessively. She also discussed his
job losses due to his excessive drinking, losing his temper with the children
when drinking, concerns about his drinking and driving with the children
in the car, etc.

Confidentiality Rights of Collaterals 371

The husband then came in with his wife for a series of five conjoint
marital sessions to try to address the marital problems and his use of alcohol.
The marriage continued to deteriorate and the couple separated. The husband
sought custody of the two minor children on the basis that his wife was
mentally unstable. The wife sought custody of the children, alleging the father
was unfit because of his drinking. The wife’s attorney asked Psychologist Y to
testify about her mental stability, her diagnosis, the treatment plan, and her
prognosis.

In pretrial motions, the husband’s attorney requested that Psychologist
Y be barred from disclosing any information from the conjoint visits, citing
doctor-patient privilege. The mother’s attorney argued that the husband was
a collateral family member and thus had no privilege. The judge took it under
advisement. One week later, the judge issued his ruling and sustained (agreed
with) the husband’s attorney’s motion. The judge did so on the premise that
the husband had the privilege because he “perceived that he was a patient” of
Psychologist Y.

Q. Is a spouse in conjoint marital sessions a patient or a collateral family
member? If the spouse is a collateral family member, does he own a privilege
regarding his remarks?

CASE #4

Following a bitter custody battle, the court awarded care of A 15 year old boy
to his father (see: Ellis, 2009). Treatment was initiated with Psychologist Y
who then had one office visit with the father to obtain history, and two office
visits with the adolescent. The mother then requested the therapist terminate
treatment, and the psychologist complied. One year later the mother requested
the boy’s records in order to use them in a libel suit against the father. The
father, consulting with the adolescent, said the boy didn’t wish the records to
be released, citing fear of reprisal from the mother. Psychologist Y attempted to
strike several compromises with the mother, but was unsuccessful. The mother
then filed a complaint against Psychologist Y with the state licensing board.

The board heard the case and ordered Psychologist Y to “turn over the
boy’s records” to another professional who would review them and pass them
on to the mother. Psychologist Y complied but did not turn over the notes of the
meeting with the father. Given the court’s ruling in Case #3, concerned that
the father may “perceive that he had a doctor-patient privilege,” Psychologist
Y interpreted the board’s order narrowly. Psychologist Y reasoned that the
court would have to issue a ruling on the status of the notes with the father,
since they lie in a gray area before the law.

Four years later the mother filed a petition seeking notes of the meeting
with the father, and any and all reports, journals, and documents the father
may have given the psychologist. The boy, now 19, submitted a statement in

372 E. M. Ellis

writing requesting that nothing from his file be released to his mother. The
mother’s attorney pushed forward with a subpoena to depose Psychologist Y
and demand the records. Psychologist Y’s attorney requested a hearing before
a superior court judge, in order to obtain a ruling in the case. The judge heard
arguments and ruled that the notes of the meeting with the father, and the
documents given to the psychologist by the father, were not protected by the
boy’s privilege, and that they should be turned over to the mother. In effect,
the court ruled that a collateral family member had no privilege and that a
patient’s privilege is limited only to direct communications between the doctor
and the patient.

Q. Was the judge correct in her ruling? Can the patient assert the privi-
lege over all materials contained in his/her file? Or is the privilege limited to
only those direct communications between the patient and the psychologist?

INTRODUCTION

The privacy rights of patients and other family members in marital and family
treatment cases is one of the most complex areas at the intersection of law
and ethics. As the cases above indicate, psychologists do not have clear
guidelines as to how to handle requests for records that involve notes by
and about family members who participate in a patient’s treatment. Taking
a term from forensic psychology, we refer to these as “collateral” family
members. Family therapists typically use their best judgment to arrive at
a solution which they hope will appease various competing interests. In
so doing, they easily run afoul of angry family members, licensing boards
and the courts. Even judges, after researching legal precedents, may issue
different rulings from one case to the next.

In general, most of the papers written on the subject of confidentiality
rights in psychotherapy refer to individual, adult psychotherapy patients. The
issue of who is the “patient” is simple and clear in those cases. The patient is
the one who is requesting treatment, who is given a diagnosis and treatment
plan, who signs the informed consent agreement, whose name is on the
chart, whose name is on the insurance claim and on any bills which are
mailed to the patient. When copies of records are requested, it is clear that
only the patient can give permission to release them, unless compelled to
do so by judicial order. Doverspike (2008); Knapp and VandeCreek (2003);
and Bennett et al. (2006) are good general references in this area of ethics.

In the case of marital therapy, the issue of who is the patient, and thus
who owns the privilege, is not as clear. One or both of the couple may
be considered the “patient” in a clinical sense. Many clinicians may view
the couple seeking treatment conceptually as a dysfunctional dyad, and the
clinician will craft interventions with that perspective in mind. In fact, in
this author’s experience, many, if not most, couples who request marital

Confidentiality Rights of Collaterals 373

therapy do so with the expectation that “both of us” are the patient. They
may use language such as “we need help.” This clinician has observed that
many couples go so far as to put both names in the patient space on the
application in order to be fair and balanced in their presentation.

Similarly, in family therapy, the therapist may refrain from designating
a particular member of the family as a patient, and may convey the view
to the family that the whole family, or perhaps some subsystem of the
family—including stepparents and grandparents for example—is the patient
in a clinical sense. This is often understandable and agreeable to the family.
Many families requesting family therapy will make requests such as “we all
need help getting along as a family.” Some request help for a subsystem,
such as “My new husband needs help getting along with my teenage son.”
Even more unclear but quite common are requests such as “My husband
and I are sleepless, stressed, and fighting over how to handle our daughter
who is using drugs again.” Some families will ask for multiple authorizations
from the health insurance plan and fill out multiple patient applications “so
we can all be the patient.”

While this may be desirable from a clinical perspective to regard couples,
or dyads, or whole families as the therapeutic unit, and while it may fit with
the perspective of the treatment requests, this collides with the realities of
third party reimbursement and with the courts. From the perspective of the
health insurance company, mental health billing must fit the medical model.
Only one person in the room at the time the service is rendered is the patient.
In order to be a patient, the person must request treatment if an adult (or
one of the parents must request the treatment for the child, if the patient is a
child), and the patient must have symptoms that warrant a DSM IV diagnosis
that is covered by the plan. The treatment must be medically necessary, and
a treatment plan for that individual must be in the patient’s chart.

In the case of marital therapy, the therapist must discuss the issue of who
the patient is fully and openly with the couple in order to come to a mutual
agreement. They must be informed that in order for the health insurance plan
to cover their services, one person must be the patient and they must meet
the above criteria set out by the health insurance plan. This step alone, done
at the outset of treatment, may subtly change the dynamics of how couples
therapy proceeds from that point forward. However, it is an essential part
of the informed consent process. Likewise, the parents of a child who are
requesting family therapy must agree that the child is the patient, and must
be informed as to the child’s diagnosis and the treatment plan.

In an idealized setting where all clients pay for psychotherapy out of
pocket, the therapist may draw up individualized informed consent agree-
ments which specify that both marital partners (or life partners) have a
privilege to the records of their couples treatment. In the case of family ther-
apy, the parties may sign an agreement which specifies that all of the family
members seen have equal rights to the confidentiality of their remarks in

374 E. M. Ellis

the psychotherapy process and that no records can be released without the
group consent of all the parties.

However, the reality of private practice is far from this ideal. In this
author’s practice in a middle class suburb of a large metropolitan area, a
survey of the three practitioners indicated that less than 5% of their caseloads
were private pay, and those were essentially the uninsured. Less than one
percent of their patient population had private health insurance but chose to
pay out of pocket rather than use their insurance. There are no large scale
studies on the topic of what portion of psychotherapy patients are private
paying patients. The economic reality is that probably the majority of patients
are willing to agree on one person being designated the patient in order to
make use of the health insurance benefits.

Most texts on ethics which address the issue of clarifying who the patient
is simply recommend that the therapist discuss issues of confidentiality with
family members before beginning treatment and to have the parties read and
sign lengthy, detailed informed consent contracts which spell out who owns
the privilege in these cases and who can access the records that accumu-
late from family treatment (Bennett et al., 2006; Doverspike, 2008; Knapp
& VandeCreek, 2003). While this may seem to address the issue legally, it
is a recommendation that is not practical or feasible from the perspective
of one who runs a clinical practice. The early stages of treatment with a
new patient must focus on rapidly identifying the patient’s needs and estab-
lishing a rapport with the patient in the first 50 minutes by understanding,
empathizing, clarifying the problem, setting goals, and offering hope of a
positive outcome. A lengthy discussion of possible adverse legal outcomes
is not what patients are expecting when they enter a psychologist’s office
requesting treatment.

In reality, the issue of who owns the rights to the treatment notes that
are made when collateral family members participate in treatment is rarely an
issue. This author (Psychologist Y) has seen perhaps 4,000 to 5,000 children
and families in treatment, and no disputes over the records have arisen in
cases where divorce conflicts were not part of the landscape. Even in cases
where a couple who was seen for marital therapy is subsequently divorcing,
it would be rare for them to request the records in those cases where they
have no children under the age of eighteen. The opening four cases which
occurred in the course of this author’s practice over the last five years capture
the types of cases in which these dilemmas arise.

PSYCHOLOGISTS’ ETHICAL GUIDELINES

The APA Ethics Code (2002) offers no specific guidelines on the privacy rights
of collateral family members in family therapy. In section 3.10 “Informed
Consent,” the psychologist who is engaged in counseling or psychotherapy

Confidentiality Rights of Collaterals 375

is advised to obtain the informed consent of the “individual or individuals”
using language which is understandable to that adult or child. In section
10.01 “Informed consent to therapy,” this principle is reiterated but made
more specific to patients who are in a treatment setting. Most informed
consent agreements are tailored toward the concept that only one individual
is a patient. In couples therapy, the identified patient signs the consent form.
The other partner may not even review it or be aware of it. When working
with children, it is the parent who presents a child for treatment who typically
reviews and signs the informed consent agreement. The other parent may not
be present and thus may not review it. In cases where parents are divorced,
it is predominantly the parent with primary physical custody who initiates
treatment and who reviews and signs the informed consent agreement. The
other parent, who may even live out of state, may not be aware of it, or see
it, much less sign it.

In section 4.02 “Discussing the limits of confidentiality,” the psychologist
is advised to “discuss with persons. . . (1) the relevant limits of confidentiality
and (2) the foreseeable uses of the information generated through their
psychological activities.” For example, standard informed consent contracts
typically notify the patient that in the event that the person poses an imminent
danger to himself or a clear risk of harm to an identifiable person, or in
the event that the patient discloses acts of abuse toward a child or elderly
person, confidentiality must be waived. Most informed consent agreements
also include language that notifies the patient that in the event of a personal
injury lawsuit, the psychotherapy records will likely be requested and must
be released for the suit to proceed.

Section 10.02 “Therapy involving couples or families,” addresses the
complex nature of confidentiality when several persons are involved in
the patient’s treatment. This section advises the psychologist to “clarify at
the outset (1) which of the individuals are clients/ patients and (2) the
relationship the psychologist will have with each person.” This includes the
psychologist’s role and “the probable uses of the services provided or the in-
formation obtained . . .” In this section, most clinician’s notify the patient that
certain kinds of information will be sent to the patient’s insurance plan, for
example.

Some family therapists have the “patients” sign a contract in which they
agree to have the records sealed in the event of a divorce or litigation and
that they will not subpoena the therapist to testify for or against either one in
a legal matter (Doverspike, 2008; Ellis, 2006). Such agreements, while noble
in aspiration, are not legally enforceable. Under HIPAA, Section 164.524, the
identified patient is entitled to his/her entire record. The person who is the
patient in couples therapy owns the legal rights to the records. If the patient
is a child or adolescent, and if the parents are married to each other, the
parents are joint custodians of the child’s records and both may be entitled
to a copy of the entire record. If the parents are divorced, the most recent

376 E. M. Ellis

court order regarding the custodial rights of the parents will govern who
has access to the records. The exceptions may be where the adolescent is a
“mature minor” (age 15 or older), and where the parent is not acting in the
child’s best interests and thus not entitled to act as the child’s representative
under HIPAA (Section 164.502, para.s (g) 5, I and ii). Seeking the child’s
records specifically for use in a child custody proceeding has been defined,
by some courts, as not acting in the child’s best interests. Exceptions are
also made in states where adolescents’ rights to their treatment records have
prevailed in the courts (see: Ellis, 2009, for a fuller discussion).

SPECIAL ISSUES IN COUPLES THERAPY

The issue of who is the patient and who is the collateral family member in
couples therapy is complex and controversial. In the past the advice from
ethics experts was to see couples together in all visits and advise them
that no information will be released from their file without the written con-
sent of both parties (Harris, 1997). This policy was endorsed and reiterated
by Doverspike (2008, p. 134) when discussing policies on release of in-
formation. What is lacking here is the recognition that only one person,
legally, is the patient. Thus, this agreement is not binding. In fact, Dover-
spike (2008) contradicts this position in his discussion on identifying “Who is
the client?” Here he suggests that when bringing a collateral family member
into a client’s session, “it is important to obtain informed consent of the col-
lateral after clarifying the collateral’s role” (p. 94). He suggests the reader use
the APAIT Outpatient Services Agreement for Collaterals available at http://
www.apait.org.

Bennett et al. (2006) are more direct about who is the client or patient
and who is the collateral contact. In a case study which they present, a wife
is seen for individual therapy and her husband joins her for couples sessions.
The psychologist is advised to explain to the husband at the outset that the
wife is the patient and that the husband is there “as a collateral contact only,
to further the treatment of the wife.” (p. 90). Presumably this would offer the
spouse an opportunity to ask questions about whether his remarks would
be privileged.

This is the same scenario as that presented in Case #3. Psychologist Y
could have notified the husband that he was a collateral contact and thus
had no basis to assume that his remarks were confidential. In fact, some legal
experts (Corey, Corey, & Callanan, 2007) assert that confidentiality is lost at
any point where there is a third party in the consulting room (the patient
and the therapist being the first and second parties). The husband and wife
in Case #3 both heard the remarks of the other and both were free to testify
to the court as to what was disclosed in the office visits. The husband might
have disclosed less information about his drinking habits had he been put

Confidentiality Rights of Collaterals 377

on notice. However, it is equally likely that he did not anticipate a divorce,
much less a child custody dispute, and would have freely disclosed such
information, even if he had been given advance notification.

In a recent newsletter article, APA’s ethics expert, Jeff Younggren, and
attorney Stephen Hjelt (2010), addressed the issue of collaterals in marital
therapy. They argue that marital therapy is properly an endeavor in which
both parties are seen together, neither is the identified patient, thus no
claim is filed with a health plan, and both parties are joint custodians of the
record. In fact, Younggren and Hjelt go so far as to assert that if the therapist
identifies one of the parties as a “patient,” and upgrades their symptoms to
the level of a clinical diagnosis, so that the marital therapy is covered by
the health plan, then the health insurance company has been deceived into
paying for a “non covered service.” Thus, it has adequate grounds to charge
the therapist with fraud and professional misconduct and take legal action.

Younggren and Hjelt assert that the practice of identifying one person
in couples therapy as the patient also runs the risk of encountering ethical
dilemmas regarding the privacy rights of the non-patient in marital therapy.
If one person is identified as the patient, and the other is designated a non-
patient, then the patient has sole access to the records. If the marital therapy
process fails, and the couple proceeds toward divorce, the identified patient
can use the records against the non-patient of the couple. If the non-patient
thus loses the protections afforded in traditional individual treatment and
thus loses control of his/her records, Younggren and Hjelt argue that the
therapist’s conduct could be seen as a “violation of professional standards
and of the duty owed to the client/patient,” thus opening the door for the
non-patient collateral to file a lawsuit against the therapist.

While Younggren and Hjelt’s model for marital therapy is ideal, it is not
realistic. This psychologist would argue that only a small, affluent minority
of clients would seek marital therapy and be willing to pay the therapist’s
fee out of pocket. The vast majority of middle class couples seeking marital
therapy fully intend to use their health insurance plan to cover the services,
and demand that the service be offered to them in that manner. Typically,
at least one of the parties meets criteria for a DSM IV diagnosis of Adjust-
ment Disorder, and that person may qualify as the identified patient. What
Younggren and Hjelt consider fraud—seeing the couple together, identifying
one as the patient, and filing the claim with the patient’s health insurance
plan—is likely the prevailing norm in clinical practices today. The only part
of the process that may be fraudulent is fabricating a diagnosis for one of
the parties in couples therapy in order to obtain coverage for a service that
would not otherwise be covered.

Younggren and Hjelt’s paper generated “questions and concerns” from
many readers. In a follow-up article, Younggren and Harris (2011) clarified
their position. They acknowledge that if the identified patient actually did
meet criteria for a DSM IV diagnosis (Axis 1-IV), then this billing practice

378 E. M. Ellis

would be acceptable. However, their position as to who owns the privilege
in this case is unclear. They state that “confidentiality issues are matters of
concern with this type of treatment.” (p. 9). In “true couples therapy” the
protection of privacy of both parties is crucial for success. They suggest that
in this model of couples therapy—where one person is the identified patient
and the partner is the collateral contact—issues of informed consent should
be discussed at the outset “along with the fact that no information about or
records of the treatment will be released without both parties’ permission”
(p. 9). In reality, if the identified patient requests his or her records, they must
be granted, regardless of the wishes of the spouse or partner. HIPAA strength-
ened the patient’s rights to obtain their records, not in part, but in their en-
tirety. Younggren and Harris state that “a majority of states would respect the
privilege of both parties equally,” but give no citation. They acknowledge
that some states, such as New York, and Washington, “may be different.”

SPECIAL ISSUES IN TREATING CHILDREN FROM HIGH
CONFLICT FAMILIES

Treating children who come from high conflict families is a complex and high
risk endeavor (Bennett et. al, 2006). Unlike typical families who may present
the child for treatment, and who both have the same goal—reduction of
the child’s symptoms—parents in high conflict families often have not only
different agendas, but competing agendas (Ellis, 2006). One parent may
exaggerate the child’s symptoms in order to portray the other parent as a
poor caregiver. Likewise, one parent may minimize the child’s symptoms and
even deny symptoms, in an effort to put forth a positive picture of themselves
as good caregivers, and to “look good” at trial. One parent may not be
seeking treatment, but intends to use the professional to gather information
about what goes in the other parent’s home and to document a pattern of
abuse or poor judgment by the other parent. It is common for one parent to
seek treatment for the child without the knowledge or permission of the other
parent. In all these cases, the unstated goal is to use the documentation to the
parent’s advantage in a court proceeding. In many of these cases, the parent
also intends to subpoena the family therapist to testify at a subsequent trial.
In some cases, the parents have been court ordered to participate in family
therapy. They have followed the court order with bitterness and resentment
and have no interest in furthering any goals in treatment.

In cases where a couple is contemplating divorce, or where parents are
in the midst of divorce, or have litigated over child custody in the past, or
those who are re-litigating post-divorce due to a change of circumstances,
the risk of a dispute over the records may be fairly high. The psychotherapy
notes can be requested specifically for the purpose of gaining legal advantage
over a family member. Parents who have joint legal custody of their children

Confidentiality Rights of Collaterals 379

jointly own the privilege and can demand copies of the child’s records in
most states, including the notes of meetings with collateral family members
and any and all materials that were given to the child’s therapist. These
records may include the parent’s personal journal of events that had occurred
with the child. They may include statements the parent may have made to
the therapist which, if revealed, would be very detrimental to their case
legally. Examples would be the parent’s statement that he or she intended
to block the other parent from having contact with the child, or that they
intended to go into hiding with the child. They may include damaging self
disclosures such as the parent’s admission that his or her current marriage
is deteriorating, that he or she consumed too much alcohol in the child’s
presence, or lost their temper with the child and became verbally abusive.

These kinds of disclosures can be devastating to a parent’s position in
child custody litigation. Some psychotherapists may decline to release the
records to a parent, citing the child’s confidentiality. However, this is not
defensible. Most state laws uphold parents’ rights to their children’s records.
In fact, HIPAA (the Health Insurance Portability and Accountability Act) also
strengthened the rights of parents to all of the materials in their child’s
treatment files (see: HIPAA, Privacy Rule, Section 164.502).

There is very little case law on the legal rights regarding collateral family
members who are seen as part of a child’s treatment. The Georgia case of
Mrozinski v. Pogue (1992) has a direct bearing on this issue. In this case Mr.
Mrozinski’s 14 year old daughter was in treatment with Dr. Pogue, an Atlanta
psychiatrist, for drug addiction and other mental health problems while she
was a resident of an inpatient psychiatric program. The drug use began while
she was in her mother’s care, and the court had intervened and placed her in
the custody of the father. The father participated in family therapy while the
daughter was hospitalized. Upon release, the mother obtained the discharge
summary. Dr. Pogue also gave the mother an affidavit which contained
negative remarks about Mr. Mrozinski’s relationship with his daughter and
recommending custody be transferred to the mother. Mr. Mrozinski sued
Dr. Pogue claiming that he received treatment from Dr. Pogue by virtue
of participating in family therapy, and that his rights were violated. Dr.
Pogue asked for summary judgment (immediate dismissal), asserting that
the only patient was the 14 year old, and that he had no doctor-patient
relationship with Mr. Mrozinski. Summary judgment was granted. Mrozinski
filed an appeal. He countered that he had sought advice and assistance
from Dr. Pogue and that he was assured the visits were confidential. The
affidavit recommended that he “continue therapy,” implying that he had
received treatment from Dr. Pogue. The appellate court upheld the lower
court’s ruling, and the suit for wrongful disclosure was dismissed. Thus, in
this case, the court ruled that a collateral family member had no rights to
the confidentiality of statements which were made by them in the context of
family therapy.

380 E. M. Ellis

This case illustrates the myriad of dilemmas regarding who is the patient,
who has the rights to what information, and how it is to be used. In Case #1,
the mother sought legitimate treatment for her child but disclosed sensitive
information to the therapist, not knowing that the father could have access
to that information and use it against her. In Case #2, the father presented
the child for “treatment” with questionable motives and without the mother’s
knowledge. In this case, however, he felt that he, too, was the patient and
had some rights to the confidentiality of his remarks to the therapist. Family
therapy in such contexts is a virtual minefield.

Bennett et al. (2006) recommend that one not see a child in such a
situation without the knowledge and permission of the other parent. These
authors recommend that as with cases of family therapy with multiple family
members, one would do well to have an informed consent agreement that is
specific regarding requests for information about the child, requests for the
child’s records, and what information in particular is to be regarded as part
of the child’s file.

BEST PRACTICES

From the previous discussion, the following are offered as suggested guide-
lines for the clinician regarding the confidentiality rights of collateral family
members in couples and family therapy.

Identify High Risk Cases From the Outset

This is a small subset of most family therapy cases, but many can be recog-
nized at the outset. These are parents who are threatening to divorce, are in
the midst of a divorce, or have divorced and are contemplating re-litigating.
They are characterized by high levels of bitterness and rancor, allegations of
abuse and betrayal, and vague threats to take legal action. They are may have
a past history of litigating against each other and/or filing complaints against
other professionals—e.g., other therapists, attorneys, judges, guardians, and
child custody evaluators.

In the above case studies, Case #1 had had a prior history of child
custody litigation and could have been identified as a high risk case. The
parents in Case #2 were in the midst of a divorce, and were the parents of a
five year old child, and also could have been identified as a high risk case.
Case #3 could not have been identified at the outset because it began as
a routine individual psychotherapy case. Case #4 had had a history of past
child custody litigation, but it had been resolved, and there was no current
litigation pending. Thus the dispute over the child’s records might or might
not have been anticipated.

Bennett et al. (2006) go so far as to recommend that one may ultimately
develop a practice of refusing to take such cases. This may not only be

Confidentiality Rights of Collaterals 381

for the protection of the therapist who has a high risk of being sued in
such cases or subject to a licensing board complaint, but may also be an
acknowledgement of the reality that good treatment of the child cannot
take place in such an incendiary atmosphere. Since all the case studies
presented at the outset which focused on disputes over records and the
rights of collaterals, the clinician who avoids these types of cases altogether
will minimize the possibility of being involved in such a dispute.

Do a Careful and Thorough Informed Consent Process
in High Risk Cases

Identifying high risk cases at the outset and having them sign informed
consent agreements would be the ideal. The informed consent agreement
should specify clearly who the patient is and who has access to the records.
In couples and family therapy cases, the parties may be asked to sign agree-
ments not to request copies of the record if the purpose is to use them in
court proceedings, or not to subpoena the therapist to testify for one side in
court. As stated before, it is rendered moot by state law and HIPAA.

If the therapist wishes to shield the spouse of the patient, or the child
in treatment, or one of the parents who participated in the child’s treatment
from possible harm, the therapist might first defer to the informed consent
agreement in the interest of coming to a mutually satisfying solution. If this
fails, the next alternative is for the therapist to retain an attorney and file a
motion to quash, or dismiss, the subpoena. In such cases a hearing would be
scheduled and arguments would be made from both sides as to whether the
therapist’s objection to the subpoena (or the objection of one of the parties
in the case) should be sustained (upheld) or over-ridden. The judge has the
option to review the records in camera (in the privacy of the judge’s cham-
bers) before ruling on the issue. Another alternative, if subpoena-ed to testify
in court, is to appear at the hearing with the requested records but to raise an
objection to the judge regarding the release of the records. Providing a copy
of the informed consent agreement to the judge may be very advantageous.

Most couples who seek marital therapy, as well as parents who seek
family therapy with their child, do not realize that if the parties are involved in
child custody litigation at a later date, they may have to surrender all rights
to these psychotherapy records. It is common practice for child custody
evaluators to demand that the parents surrender all rights to all previous
psychotherapy records, including records of individual treatment (see: Ellis,
2010, for a fuller discussion). If they were made aware of this from the outset,
they might be more careful with the disclosures that they make in individual,
marital, and family therapy. Therefore, the clinician may want to go so far as
to include a warning in the informed consent agreement that begins, “In the
event of a divorce and the litigation that may ensue, and/or child custody
litigation, you might have to waive your rights to confidentiality whether you

382 E. M. Ellis

are the patient or a collateral family member participating in your spouse’s
or your child’s treatment.”

Minimize Individual Meetings With Collateral Family Members

Many family therapists are aware of the possibilities of ethical dilemmas that
may occur when the therapist meets with one member of a couple or family
in treatment (Margolis, 2008). Material may be disclosed in confidence that
the family member wishes not to be shared with the other family members.
This person, who is not the patient, then requests that this material be
regarded as “confidential.” Many couples therapists are prepared for this and
either refuse to see one partner alone or explain at the outset that there is
no privilege that extends to the notes of that session. The clinician who is
treating a couple who have young children and who are moving toward
divorce may want to be especially cautious about seeing the non-patient
partner alone.

In cases where a child is the patient, Bennett et al. (2006) recommend
that the clinician always have the consent of both parents at the outset. It
would be wise also to meet with both parents jointly when a feedback session
is needed. However, refusing to meet with one parent may be difficult to
enforce, especially where the parents are separated or divorced and are not
speaking to each other. One parent may be only marginally involved in the
child’s life. Even when both parents intend to be present at the session, one
parent may have a busy work schedule and can’t be in attendance at the
parent meeting.

In Case #1, Psychologist X could have requested to see the divorced
parents together to provide feedback on the child’s treatment. If the parents
had been seen together, it is unlikely that the mother would have disclosed
sensitive information about herself. Similarly, in Case #2, Psychologist B may
have requested to see the parents together to provide history at the outset of
treatment and at the feedback session. It is likely that the father would not
have complied, given that his motive for seeking treatment for the child was
to gather information to use against the mother in his petition for primary
custody. This strategy would, on the other hand, have averted the dispute
over the records.

If One Sees a Family Member Individually, Give
a Cautionary Warning

In Case #1, identified as a high risk case, Psychologist X who was treating
the 13 year old girl might have given the mother a cautionary warning, i.e.,
“I will be taking notes of our session today. Keep in mind that you and the
father both have access to your child’s treatment record. Both of you can at
any time request copies of these notes and I am obligated under state law

Confidentiality Rights of Collaterals 383

to provide them to you or the other parent with joint legal custody. Once I
release these notes to the parents, I have no control over how they may be
used. You or the other parent may provide copies of them to family members,
teachers, attorneys, or officers of the court. There have been occasions when
psychotherapy notes of a child’s treatment have been used against a parent
in a child custody proceeding.” When this author has used such a warning,
the parents have been surprised at first that their remarks were not protected,
then thankful that they were notified ahead of time. In Case #2 and Case
#4, the psychologist could have notified the parent at the outset that their
remarks were not protected. It would have been advisable to document such
notification in the record as well. This might have prevented conflicts that
arose over the records at a later time.

Some psychotherapists may want to use caution in whether to accept
personal materials from the parents to include in the child’s records. Sen-
sitive material such as journals, diaries, emails, letters, greeting cards, pho-
tographs, may be viewed in the session and given back to the parent (or
husband/wife). In Case #4, Psychologist Y was given a large three ring binder
with over one hundred pages of material. It was briefly reviewed and given
back to the father. Thus, when the mother requested it four years later, it was
not in the psychologist’s possession, and the issue of releasing it was moot.

The psychotherapist would have to use his/her judgment as to whether
to write down personal disclosures by the spouse of the patient or the parent
or other family member–disclosures which may be used against them at a
later time. Certainly disclosures from the person’s distant past or which have
no bearing on the patient’s treatment do not need to be written down.

Seek Ways to Shield the Privacy of Meetings With Collateral Family
Members Who Are Seen Individually

Gerald Koocher (2008) and Eric Harris (1997) recommend that notes of
meetings with collateral family members, particularly the parents, be kept in
a separate file. Thus, if one parent requests the “child’s records,” only the
notes in the child’s chart are surrendered, not the notes of separate meetings
with a parent. Both are recognized experts in the area of psychologist ethics
and have conducted seminars on risk management for the APA. APA ethics
expert, Jeff Younggren (2009) was asked about this practice. He stated that
keeping the notes of the meetings with the parents in a separate file was
unethical and improper. All the notes and documents must be kept in one
file. Thus, it appears that three of the top experts in the country may disagree
on this issue.

Another option is to advise the family that when the therapist needs to
meet individually with one parent (in order to obtain history, or be given
an update on progress in treatment), it is best to open a second chart and
account in the parent’s name. The psychotherapist might code the service as

384 E. M. Ellis

a “consultation” since no treatment is rendered. It would not be covered by
the health insurance plan, but the parent would control access to the notes
in their own file.

As stated in the opening remarks, the area of confidentiality rights of
collaterals in family therapy is very complex. Clinical goals, medical billing
procedures, professional ethics, and the law may clash when requests are
made for records. The practice suggestions made here are not agreed upon
by a majority of clinicians and are bound to be controversial. Hopefully, they
will open up a dialogue which will ultimately result in clearer standards in
the future.

REFERENCES

American Psychological Association. (2002). Ethical principles of psychologists and
codes of conduct. Washington, DC: Author. Retrieved January 1, 2011, from
http://www.apa.org/ethics/code/index.aspx

Bennett, B., Bricklin, P., Harris, E., Knapp, S., VandeCreek, L., & Younggren, J.
(2006). Assessing and managing risk in psychological practice. Rockville, MD:
The Trust.

Corey, G., Corey, M., & Callanan, M. (2007). Issues and ethics in the helping profes-
sions. Pacific Grove, CA: Brooks/Cole.

Doverspike, W. (2008). Risk management: Clinical, ethical, & legal guidelines for
successful practice. Sarasota, FL: Professional Resource Press.

Ellis, E. (2006). Ten ethical pitfalls to avoid when doing child and family forensic
work. Georgia Psychologist, 60(2), 12–14.

Ellis, E. (2009). Should a psychotherapist be compelled to release an adolescent’s
treatment records to a parent in a contested custody case? Professional Psychol-
ogy: Research and Practice, 440(6), 557–563.

Ellis, E. M. (2010). Should participation in a child custody evaluation compel the
release of psychotherapy records? Journal of Child Custody, 7, 138–154.

Harris, E. (1997, May 15). Advanced risk management: Working with kids, families,
and child custody. Atlanta, GA: Annual convention of the Georgia Psychological
Association.

HIPAA Privacy Rule. Section 164.502. See: (g) 5, i and ii. Retrieved September 5,
2011, from http://aspe.hhs.gov/admnsimp/final/PvcTxt01.htm

Koocher, G. (2008). Ethical challenges in mental health services to children and
families. Journal of Clinical Psychology, 64, 601–612.

Margolin, G. (2008). Ethical and legal considerations in marital and family therapy.
American Psychologist, 37, 788–801.

Mrozinski v. Pogue, 205 Ga. App. 731, 423 S.Ed. 405 (1992). Retrieved September 5,
2011, from http://www.lawskiis.com/case/ga/id/328/26/index.html

Younggren, J. (2009, May). Ethics workshop. Atlanta, GA: Annual meeting of the
Georgia Psychological Association.

Younggren, J., & Harris, E. (2011, Jan./Feb.). Risk management: When marital therapy
is. The National Psychologist, 9.

Younggren, J., & Hjelt, S. (2010, Sept./Oct.). When marital therapy isn’t. The National
Psychologist, 9.

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Completion of professional development paper (APA style, 5-8 pages). Basically, you are to provide an overview on issues related to your own professional development. You simply use resources already presented in this course (take a good look at the Professional Identity Article under the Content Tab), you do not need to conduct additional research. Simply use what you have learned in this course and reference readings from the course. I want you to make this paper personal…how will you develop yourself as a professional in the field of counseling? What are your values? How may they interfere with or promote your own ethical behavior? What will you do that will deepen your level of professionalism and understanding your role as a counselor? How will you maintain a healthy professional and personal life? Be specific. Give details and integrate information learned in this course into the paper. Organize your paper well, use APA format and be sure to include citations.

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Code of Ethics

As approved by the ACA Governing Council

AMERICAN COUNSELING
ASSOCIATION

•  2  •

© 2014 by the American Counseling Association.
All rights reserved. Note: This document may be reproduced in its entirety without permission for non-commercial
purposes only.

ACA Code of Ethics Preamble • 3
ACA Code of Ethics Purpose • 3

Section A
The Counseling Relationship • 4

Section B
Confidentiality and Privacy • 6

Section C
Professional Responsibility • 8

Section D
Relationships With Other Professionals • 10

Section E
Evaluation, Assessment, and

Interpretation • 11

Section F
Supervision, Training, and Teaching • 12

Section G
Research and Publication • 15

Section H
Distance Counseling, Technology,

and Social Media • 17

Section I
Resolving Ethical Issues • 18

Glossary of Terms • 20

Index • 21

Mission
The mission of the American Counseling Association
is to enhance the quality of life in society by promoting
the development of professional counselors, advancing
the counseling profession, and using the profession and
practice of counseling to promote respect for human
dignity and diversity.

Contents

•  3  •

ACA Code of Ethics Purpose
The ACA Code of Ethics serves six main purposes:

1. The Code sets forth the ethical obligations of ACA members and provides guidance intended to inform the ethical
practice of professional counselors.

2. The Code identifies ethical considerations relevant to professional counselors and counselors-in-training.
3. The Code enables the association to clarify for current and prospective members, and for those served by members,

the nature of the ethical responsibilities held in common by its members.
4. The Code serves as an ethical guide designed to assist members in constructing a course of action that best serves

those utilizing counseling services and establishes expectations of conduct with a primary emphasis on the role of
the professional counselor.

5. The Code helps to support the mission of ACA.
6. The standards contained in this Code serve as the basis for processing inquiries and ethics complaints

concerning ACA members.

The ACA Code of Ethics contains nine main sections that ad-
dress the following areas:

Section A: The Counseling Relationship
Section B: Confidentiality

and Privacy

Section C: Professional

Responsibility

Section D: Relationships With Other Professionals
Section E: Evaluation, Assessment, and Interpretation
Section F: Supervision, Training, and Teaching
Section G: Research and Publication
Section H: Distance Counseling, Technology, and
Social Media
Section I: Resolving Ethical Issues

Each section of the ACA Code of Ethics begins with an
introduction. The introduction to each section describes the
ethical behavior and responsibility to which counselors aspire.
The introductions help set the tone for each particular sec-
tion and provide a starting point that invites reflection on the
ethical standards contained in each part of the ACA Code of
Ethics. The standards outline professional responsibilities and
provide direction for fulfilling those ethical responsibilities.

When counselors are faced with ethical dilemmas that
are difficult to resolve, they are expected to engage in a care-
fully considered ethical decision-making process, consulting
available resources as needed. Counselors acknowledge
that resolving ethical issues is a process; ethical reasoning
includes consideration of professional values, professional
ethical principles, and ethical standards.

Counselors’ actions should be consistent with the spirit
as well as the letter of these ethical standards. No specific
ethical decision-making model is always most effective, so
counselors are expected to use a credible model of deci-
sion making that can bear public scrutiny of its applica-
tion. Through a chosen ethical decision-making process
and evaluation of the context of the situation, counselors
work collaboratively with clients to make decisions that
promote clients’ growth and development. A breach of the
standards and principles provided herein does not neces-
sarily constitute legal liability or violation of the law; such
action is established in legal and judicial proceedings.

The glossary at the end of the Code provides a concise
description of some of the terms used in the ACA Code
of Ethics.

ACA Code of Ethics Preamble
The American Counseling Association (ACA) is an educational, scientific, and professional organization whose members
work in a variety of settings and serve in multiple capacities. Counseling is a professional relationship that empowers diverse
individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

Professional values are an important way of living out an ethical commitment. The following are core professional values
of the counseling profession:

1. enhancing human development throughout the life span;
2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and

uniqueness of people within their social and cultural contexts;
3. promoting social justice;
4. safeguarding the integrity of the counselor–client relationship; and
5. practicing in a competent and ethical manner.

These professional values provide a conceptual basis for the ethical principles enumerated below. These principles are
the foundation for ethical behavior and decision making. The fundamental principles of professional ethical behavior are

• autonomy, or fostering the right to control the direction of one’s life;
• nonmaleficence, or avoiding actions that cause harm;
• beneficence, or working for the good of the individual and society by promoting mental health and well-being;
• justice, or treating individuals equitably and fostering fairness and equality;
• fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in

professional relationships; and
• veracity, or dealing truthfully with individuals with whom counselors come into professional contact.

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A.2.c. Developmental and
Cultural Sensitivity

Counselors communicate information
in ways that are both developmentally
and culturally appropriate. Counselors
use clear and understandable language
when discussing issues related to
informed consent. When clients have
difficulty understanding the language
that counselors use, counselors provide
necessary services (e.g., arranging for
a qualified interpreter or translator)
to ensure comprehension by clients.
In collaboration with clients, coun-
selors consider cultural implications
of informed consent procedures and,
where possible, counselors adjust their
practices accordingly.

A.2.d. Inability to Give Consent
When counseling minors, incapaci-
tated adults, or other persons unable
to give voluntary consent, counselors
seek the assent of clients to services
and include them in decision making
as appropriate. Counselors recognize
the need to balance the ethical rights
of clients to make choices, their capac-
ity to give consent or assent to receive
services, and parental or familial legal
rights and responsibilities to protect
these clients and make decisions on
their behalf.

A.2.e. Mandated Clients
Counselors discuss the required
limitations to confidentiality when
working with clients who have been
mandated for counseling services.
Counselors also explain what type
of information and with whom that
information is shared prior to the
beginning of counseling. The client
may choose to refuse services. In this
case, counselors will, to the best of
their ability, discuss with the client
the potential consequences of refusing
counseling services.

A.3. Clients Served by Others
When counselors learn that their clients
are in a professional relationship with
other mental health professionals, they
request release from clients to inform
the other professionals and strive to
establish positive and collaborative
professional relationships.

A.4. Avoiding Harm and
Imposing Values

A.4.a. Avoiding Harm
Counselors act to avoid harming their
clients, trainees, and research par-
ticipants and to minimize or to remedy
unavoidable or unanticipated harm.

A.1.d. Support Network
Involvement

Counselors recognize that support
networks hold various meanings in
the lives of clients and consider en-
listing the support, understanding,
and involvement of others (e.g., reli-
gious/spiritual/community leaders,
family members, friends) as positive
resources, when appropriate, with
client consent.

A.2. Informed Consent
in the Counseling

Relationship

A.2.a. Informed Consent
Clients have the freedom to choose
whether to enter into or remain in
a counseling relationship and need
adequate information about the
counseling process and the counselor.
Counselors have an obligation to re-
view in writing and verbally with cli-
ents the rights and responsibilities of
both counselors and clients. Informed
consent is an ongoing part of the
counseling process, and counselors
appropriately document discussions
of informed consent throughout the
counseling relationship.

A.2.b. Types of Information
Needed

Counselors explicitly explain to clients
the nature of all services provided.
They inform clients about issues such
as, but not limited to, the follow-
ing: the purposes, goals, techniques,
procedures, limitations, potential
risks, and benefits of services; the
counselor’s qualifications, credentials,
relevant experience, and approach to
counseling; continuation of services
upon the incapacitation or death of
the counselor; the role of technol-
ogy; and other pertinent information.
Counselors take steps to ensure that
clients understand the implications of
diagnosis and the intended use of tests
and reports. Additionally, counselors
inform clients about fees and billing
arrangements, including procedures
for nonpayment of fees. Clients have
the right to confidentiality and to be
provided with an explanation of its
limits (including how supervisors
and/or treatment or interdisciplinary
team professionals are involved), to
obtain clear information about their
records, to participate in the ongoing
counseling plans, and to refuse any
services or modality changes and to
be advised of the consequences of
such refusal.

Section A
The Counseling

Relationship

Introduction
Counselors facilitate client growth
and development in ways that foster
the interest and welfare of clients and
promote formation of healthy relation-
ships. Trust is the cornerstone of the
counseling relationship, and counselors
have the responsibility to respect and
safeguard the client’s right to privacy
and confidentiality. Counselors actively
attempt to understand the diverse cul-
tural backgrounds of the clients they
serve. Counselors also explore their own
cultural identities and how these affect
their values and beliefs about the coun-
seling process. Additionally, counselors
are encouraged to contribute to society
by devoting a portion of their profes-
sional activities for little or no financial
return (pro bono publico).

A.1. Client Welfare
A.1.a. Primary Responsibility

The primary responsibility of counsel-
ors is to respect the dignity and promote
the welfare of clients.

A.1.b. Records and
Documentation

Counselors create, safeguard, and
maintain documentation necessary
for rendering professional services.
Regardless of the medium, counselors
include sufficient and timely docu-
mentation to facilitate the delivery and
continuity of services. Counselors
take reasonable steps to ensure that
documentation accurately reflects cli-
ent progress and services provided.
If amendments are made to records
and documentation, counselors take
steps to properly note the amendments
according to agency or institutional
policies.

A.1.c. Counseling Plans
Counselors and their clients work
jointly in devising counseling plans
that offer reasonable promise of
success and are consistent with the
abilities, temperament, developmental
level, and circumstances of clients.
Counselors and clients regularly re-
view and revise counseling plans to
assess their continued viability and
effectiveness, respecting clients’ free-
dom of choice.

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A.4.b. Personal Values
Counselors are aware of—and avoid
imposing—their own values, attitudes,
beliefs, and behaviors. Counselors
respect the diversity of clients, train-
ees, and research participants and
seek training in areas in which they
are at risk of imposing their values
onto clients, especially when the
counselor ’s values are inconsistent
with the client’s goals or are discrimina-
tory in nature.

A.5. Prohibited
Noncounseling Roles
and Relationships

A.5.a. Sexual and/or
Romantic Relationships
Prohibited

Sexual and/or romantic counselor–
client interactions or relationships with
current clients, their romantic partners,
or their family members are prohibited.
This prohibition applies to both in-
person and electronic interactions or
relationships.

A.5.b. Previous Sexual and/or
Romantic Relationships

Counselors are prohibited from engag-
ing in counseling relationships with
persons with whom they have had
a previous sexual and/or romantic
relationship.

A.5.c. Sexual and/or Romantic
Relationships With
Former Clients

Sexual and/or romantic counselor–
client interactions or relationships with
former clients, their romantic partners,
or their family members are prohibited
for a period of 5 years following the last
professional contact. This prohibition
applies to both in-person and electronic
interactions or relationships. Counsel-
ors, before engaging in sexual and/or
romantic interactions or relationships
with former clients, their romantic
partners, or their family members, dem-
onstrate forethought and document (in
written form) whether the interaction or
relationship can be viewed as exploitive
in any way and/or whether there is still
potential to harm the former client; in
cases of potential exploitation and/or
harm, the counselor avoids entering
into such an interaction or relationship.

A.5.d. Friends or Family
Members

Counselors are prohibited from engaging
in counseling relationships with friends
or family members with whom they have
an inability to remain objective.

A.5.e. Personal Virtual
Relationships With
Current Clients

Counselors are prohibited from
engaging in a personal virtual re-
lationship with individuals with
whom they have a current counseling
relationship (e.g., through social and
other media).

A.6. Managing and
Maintaining Boundaries
and Professional
Relationships

A.6.a. Previous Relationships
Counselors consider the risks and
benefits of accepting as clients those
with whom they have had a previous
relationship. These potential clients
may include individuals with whom
the counselor has had a casual, distant,
or past relationship. Examples include
mutual or past membership in a pro-
fessional association, organization, or
community. When counselors accept
these clients, they take appropriate pro-
fessional precautions such as informed
consent, consultation, supervision, and
documentation to ensure that judgment
is not impaired and no exploitation
occurs.

A.6.b. Extending Counseling
Boundaries

Counselors consider the risks and
benefits of extending current counsel-
ing relationships beyond conventional
parameters. Examples include attend-
ing a client’s formal ceremony (e.g., a
wedding/commitment ceremony or
graduation), purchasing a service or
product provided by a client (excepting
unrestricted bartering), and visiting a cli-
ent’s ill family member in the hospital. In
extending these boundaries, counselors
take appropriate professional precau-
tions such as informed consent, consul-
tation, supervision, and documentation
to ensure that judgment is not impaired
and no harm occurs.

A.6.c. Documenting Boundary
Extensions

If counselors extend boundaries as
described in A.6.a. and A.6.b., they
must officially document, prior to the
interaction (when feasible), the rationale
for such an interaction, the potential
benefit, and anticipated consequences
for the client or former client and other
individuals significantly involved with
the client or former client. When un-
intentional harm occurs to the client
or former client, or to an individual

significantly involved with the client
or former client, the counselor must
show evidence of an attempt to remedy
such harm.

A.6.d. Role Changes in the
Professional Relationship

When counselors change a role from
the original or most recent contracted
relationship, they obtain informed
consent from the client and explain the
client’s right to refuse services related
to the change. Examples of role changes
include, but are not limited to

1. changing from individual to re-
lationship or family counseling,
or vice versa;

2. changing from an evaluative
role to a therapeutic role, or vice
versa; and

3. changing from a counselor to a
mediator role, or vice versa.

Clients must be fully informed of
any anticipated consequences (e.g.,
financial, legal, personal, therapeutic)
of counselor role changes.

A.6.e. Nonprofessional
Interactions
or Relationships (Other
Than Sexual or Romantic
Interactions or
Relationships)

Counselors avoid entering into non-
professional relationships with former
clients, their romantic partners, or their
family members when the interaction is
potentially harmful to the client. This
applies to both in-person and electronic
interactions or relationships.

A.7. Roles and Relationships
at Individual, Group,
Institutional, and
Societal Levels

A.7.a. Advocacy
When appropriate, counselors advocate
at individual, group, institutional, and
societal levels to address potential bar-
riers and obstacles that inhibit access
and/or the growth and development
of clients.

A.7.b. Confidentiality and
Advocacy

Counselors obtain client consent prior
to engaging in advocacy efforts on be-
half of an identifiable client to improve
the provision of services and to work
toward removal of systemic barriers
or obstacles that inhibit client access,
growth, and development.

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being harmed by continued counseling.
Counselors may terminate counseling
when in jeopardy of harm by the client
or by another person with whom the cli-
ent has a relationship, or when clients do
not pay fees as agreed upon. Counselors
provide pretermination counseling and
recommend other service providers
when necessary.

A.11.d. Appropriate Transfer of
Services

When counselors transfer or refer clients
to other practitioners, they ensure that
appropriate clinical and administra-
tive processes are completed and open
communication is maintained with both
clients and practitioners.

A.12. Abandonment and
Client Neglect
Counselors do not abandon or neglect
clients in counseling. Counselors assist in
making appropriate arrangements for the
continuation of treatment, when neces-
sary, during interruptions such as vaca-
tions, illness, and following termination.

Section B
Confidentiality

and Privacy

Introduction
Counselors recognize that trust is a cor-
nerstone of the counseling relationship.
Counselors aspire to earn the trust of cli-
ents by creating an ongoing partnership,
establishing and upholding appropriate
boundaries, and maintaining confi-
dentiality. Counselors communicate
the parameters of confidentiality in a
culturally competent manner.

B.1. Respecting Client Rights
B.1.a. Multicultural/Diversity

Considerations
Counselors maintain awareness and sen-
sitivity regarding cultural meanings of
confidentiality and privacy. Counselors
respect differing views toward disclosure
of information. Counselors hold ongo-
ing discussions with clients as to how,
when, and with whom information is
to be shared.

B.1.b. Respect for Privacy
Counselors respect the privacy of
prospective and current clients. Coun-
selors request private information from
clients only when it is beneficial to the
counseling process.

A.8. Multiple Clients
When a counselor agrees to provide
counseling services to two or more
persons who have a relationship, the
counselor clarifies at the outset which
person or persons are clients and the
nature of the relationships the counselor
will have with each involved person. If
it becomes apparent that the counselor
may be called upon to perform poten-
tially conflicting roles, the counselor will
clarify, adjust, or withdraw from roles
appropriately.

A.9. Group Work
A.9.a. Screening

Counselors screen prospective group
counseling/therapy participants. To
the extent possible, counselors select
members whose needs and goals are
compatible with the goals of the group,
who will not impede the group process,
and whose well-being will not be jeop-
ardized by the group experience.

A.9.b. Protecting Clients
In a group setting, counselors take rea-
sonable precautions to protect clients
from physical, emotional, or psychologi-
cal trauma.

A.10. Fees and Business
Practices

A.10.a. Self-Referral
Counselors working in an organization
(e.g., school, agency, institution) that
provides counseling services do not
refer clients to their private practice
unless the policies of a particular orga-
nization make explicit provisions for
self-referrals. In such instances, the cli-
ents must be informed of other options
open to them should they seek private
counseling services.

A.10.b. Unacceptable Business
Practices

Counselors do not participate in fee
splitting, nor do they give or receive
commissions, rebates, or any other form
of remuneration when referring clients
for professional services.

A.10.c. Establishing Fees
In establishing fees for professional
counseling services, counselors con-
sider the financial status of clients and
locality. If a counselor’s usual fees cre-
ate undue hardship for the client, the
counselor may adjust fees, when legally
permissible, or assist the client in locat-
ing comparable, affordable services.

A.10.d. Nonpayment of Fees
If counselors intend to use collection
agencies or take legal measures to col-

lect fees from clients who do not pay for
services as agreed upon, they include
such information in their informed
consent documents and also inform
clients in a timely fashion of intended
actions and offer clients the opportunity
to make payment.

A.10.e. Bartering
Counselors may barter only if the bar-
tering does not result in exploitation
or harm, if the client requests it, and
if such arrangements are an accepted
practice among professionals in the
community. Counselors consider the
cultural implications of bartering and
discuss relevant concerns with clients
and document such agreements in a
clear written contract.

A.10.f. Receiving Gifts
Counselors understand the challenges
of accepting gifts from clients and rec-
ognize that in some cultures, small gifts
are a token of respect and gratitude.
When determining whether to accept
a gift from clients, counselors take into
account the therapeutic relationship, the
monetary value of the gift, the client’s
motivation for giving the gift, and the
counselor’s motivation for wanting to
accept or decline the gift.

A.11. Termination and
Referral

A.11.a. Competence Within
Termination and Referral

If counselors lack the competence to
be of professional assistance to clients,
they avoid entering or continuing
counseling relationships. Counselors
are knowledgeable about culturally and
clinically appropriate referral resources
and suggest these alternatives. If clients
decline the suggested referrals, counsel-
ors discontinue the relationship.

A.11.b. Values Within
Termination and Referral

Counselors refrain from referring pro-
spective and current clients based solely
on the counselor’s personally held val-
ues, attitudes, beliefs, and behaviors.
Counselors respect the diversity of
clients and seek training in areas in
which they are at risk of imposing their
values onto clients, especially when the
counselor’s values are inconsistent with
the client’s goals or are discriminatory
in nature.

A.11.c. Appropriate Termination
Counselors terminate a counseling re-
lationship when it becomes reasonably
apparent that the client no longer needs
assistance, is not likely to benefit, or is

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B.1.c. Respect for
Confidentiality

Counselors protect the confidential
information of prospective and current
clients. Counselors disclose information
only with appropriate consent or with
sound legal or ethical justification.

B.1.d. Explanation of
Limitations

At initiation and throughout the counsel-
ing process, counselors inform clients of
the limitations of confidentiality and seek
to identify situations in which confiden-
tiality must be breached.

B.2. Exceptions
B.2.a. Serious and Foreseeable

Harm and Legal
Requirements

The general requirement that counsel-
ors keep information confidential does
not apply when disclosure is required
to protect clients or identified others
from serious and foreseeable harm or
when legal requirements demand that
confidential information must be re-
vealed. Counselors consult with other
professionals when in doubt as to the
validity of an exception. Additional
considerations apply when addressing
end-of-life issues.

B.2.b. Confidentiality Regarding
End-of-Life Decisions

Counselors who provide services to
terminally ill individuals who are con-
sidering hastening their own deaths have
the option to maintain confidentiality,
depending on applicable laws and the
specific circumstances of the situation
and after seeking consultation or super-
vision from appropriate professional and
legal parties.

B.2.c. Contagious, Life-
Threatening Diseases

When clients disclose that they have a
disease commonly known to be both
communicable and life threatening,
counselors may be justified in disclos-
ing information to identifiable third
parties, if the parties are known to be
at serious and foreseeable risk of con-
tracting the disease. Prior to making a
disclosure, counselors assess the intent
of clients to inform the third parties
about their disease or to engage in
any behaviors that may be harmful to
an identifiable third party. Counselors
adhere to relevant state laws concern-
ing disclosure about disease status.

B.2.d. Court-Ordered Disclosure
When ordered by a court to release
confidential or privileged information

without a client’s permission, coun-
selors seek to obtain written, informed
consent from the client or take steps to
prohibit the disclosure or have it limited
as narrowly as possible because of po-
tential harm to the client or counseling
relationship.

B.2.e. Minimal Disclosure
To the extent possible, clients are
informed before confidential infor-
mation is disclosed and are involved
in the disclosure decision-making
process. When circumstances require
the disclosure of confidential infor-
mation, only essential information
is revealed.

B.3. Information Shared
With Others

B.3.a. Subordinates
Counselors make every effort to ensure
that privacy and confidentiality of
clients are maintained by subordi-
nates, including employees, supervisees,
students, clerical assistants, and
volunteers.

B.3.b. Interdisciplinary Teams
When services provided to the client
involve participation by an interdisci-
plinary or treatment team, the client
will be informed of the team’s existence
and composition, information being
shared, and the purposes of sharing
such information.

B.3.c. Confidential Settings
Counselors discuss confidential infor-
mation only in settings in which they
can reasonably ensure client privacy.

B.3.d. Third-Party Payers
Counselors disclose information to
third-party payers only when clients
have authorized such disclosure.

B.3.e. Transmitting Confidential
Information

Counselors take precautions to ensure
the confidentiality of all information
transmitted through the use of any
medium.

B.3.f. Deceased Clients
Counselors protect the confidentiality
of deceased clients, consistent with le-
gal requirements and the documented
preferences of the client.

B.4. Groups and Families
B.4.a. Group Work

In group work, counselors clearly
explain the importance and param-
eters of confidentiality for the specific
group.

B.4.b. Couples and Family
Counseling

In couples and family counseling, coun-
selors clearly define who is considered
“the client” and discuss expectations and
limitations of confidentiality. Counselors
seek agreement and document in writing
such agreement among all involved parties
regarding the confidentiality of informa-
tion. In the absence of an agreement to the
contrary, the couple or family is considered
to be the client.

B.5. Clients Lacking Capacity
to Give Informed
Consent

B.5.a. Responsibility to Clients
When counseling minor clients or adult
clients who lack the capacity to give
voluntary, informed consent, counselors
protect the confidentiality of informa-
tion received—in any medium—in the
counseling relationship as specified by
federal and state laws, written policies,
and applicable ethical standards.

B.5.b. Responsibility to Parents
and Legal Guardians

Counselors inform parents and legal
guardians about the role of counselors
and the confidential nature of the coun-
seling relationship, consistent with cur-
rent legal and custodial arrangements.
Counselors are sensitive to the cultural
diversity of families and respect the
inherent rights and responsibilities of
parents/guardians regarding the wel-
fare of their children/charges according
to law. Counselors work to establish,
as appropriate, collaborative relation-
ships with parents/guardians to best
serve clients.

B.5.c. Release of Confidential
Information

When counseling minor clients or
adult clients who lack the capacity
to give voluntary consent to release
confidential information, counselors
seek permission from an appropriate
third party to disclose information.
In such instances, counselors inform
clients consistent with their level of
understanding and take appropriate
measures to safeguard client confi-
dentiality.

B.6. Records and
Documentation

B.6.a. Creating and Maintaining
Records and Documentation

Counselors create and maintain records
and documentation necessary for ren-
dering professional services.

• ACA Code of Ethics •

•  8  •

B.6.i. Reasonable Precautions
Counselors take reasonable precautions
to protect client confidentiality in the
event of the counselor’s termination of
practice, incapacity, or death and ap-
point a records custodian when identi-
fied as appropriate.

B.7. Case Consultation
B.7.a. Respect for Privacy

Information shared in a consulting
relationship is discussed for profes-
sional purposes only. Written and oral
reports present only data germane to the
purposes of the consultation, and every
effort is made to protect client identity
and to avoid undue invasion of privacy.

B.7.b. Disclosure of
Confidential Information

When consulting with colleagues,
counselors do not disclose confidential
information that reasonably could lead
to the identification of a client or other
person or organization with whom they
have a confidential relationship unless
they have obtained the prior consent
of the person or organization or the
disclosure cannot be avoided. They
disclose information only to the extent
necessary to achieve the purposes of the
consultation.

Section C
Professional

Responsibility

Introduction
Counselors aspire to open, honest,
and accurate communication in deal-
ing with the public and other profes-
sionals. Counselors facilitate access to
counseling services, and they practice
in a nondiscriminatory manner within
the boundaries of professional and
personal competence; they also have
a responsibility to abide by the ACA
Code of Ethics. Counselors actively
participate in local, state, and national
associations that foster the develop-
ment and improvement of counseling.
Counselors are expected to advocate
to promote changes at the individual,
group, institutional, and societal lev-
els that improve the quality of life for
individuals and groups and remove
potential barriers to the provision or
access of appropriate services being of-
fered. Counselors have a responsibility
to the public to engage in counseling
practices that are based on rigorous re-

B.6.b. Confidentiality of Records
and Documentation

Counselors ensure that records and
documentation kept in any medium are
secure and that only authorized persons
have access to them.

B.6.c. Permission to Record
Counselors obtain permission from cli-
ents prior to recording sessions through
electronic or other means.

B.6.d. Permission to Observe
Counselors obtain permission from cli-
ents prior to allowing any person to ob-
serve counseling sessions, review session
transcripts, or view recordings of sessions
with supervisors, faculty, peers, or others
within the training environment.

B.6.e. Client Access
Counselors provide reasonable access
to records and copies of records when
requested by competent clients. Coun-
selors limit the access of clients to their
records, or portions of their records,
only when there is compelling evidence
that such access would cause harm to
the client. Counselors document the
request of clients and the rationale for
withholding some or all of the records
in the files of clients. In situations
involving multiple clients, counselors
provide individual clients with only
those parts of records that relate directly
to them and do not include confidential
information related to any other client.

B.6.f. Assistance With Records
When clients request access to their re-
cords, counselors provide assistance and
consultation in interpreting counseling
records.

B.6.g. Disclosure or Transfer
Unless exceptions to confidentiality
exist, counselors obtain written permis-
sion from clients to disclose or transfer
records to legitimate third parties. Steps
are taken to ensure that receivers of
counseling records are sensitive to their
confidential nature.

B.6.h. Storage and Disposal
After Termination

Counselors store records following ter-
mination of services to ensure reasonable
future access, maintain records in ac-
cordance with federal and state laws and
statutes such as licensure laws and policies
governing records, and dispose of client
records and other sensitive materials in a
manner that protects client confidentiality.
Counselors apply careful discretion and
deliberation before destroying records
that may be needed by a court of law, such
as notes on child abuse, suicide, sexual
harassment, or violence.

search methodologies. Counselors are
encouraged to contribute to society by
devoting a portion of their professional
activity to services for which there is
little or no financial return (pro bono
publico). In addition, counselors engage
in self-care activities to maintain and
promote their own emotional, physical,
mental, and spiritual well-being to best
meet their professional responsibilities.

C.1. Knowledge of and
Compliance With
Standards
Counselors have a responsibility to
read, understand, and follow the ACA
Code of Ethics and adhere to applicable
laws and regulations.

C.2. Professional Competence
C.2.a. Boundaries of

Competence
Counselors practice only within the
boundaries of their competence, based
on their education, training, super-
vised experience, state and national
professional credentials, and appropri-
ate professional experience. Whereas
multicultural counseling competency is
required across all counseling specialties,
counselors gain knowledge, personal
awareness, sensitivity, dispositions, and
skills pertinent to being a culturally
competent counselor in working with a
diverse client population.

C.2.b. New Specialty Areas
of Practice

Counselors practice in specialty areas
new to them only after appropriate
education, training, and supervised
experience. While developing skills
in new specialty areas, counselors
take steps to ensure the competence
of their work and protect others from
possible harm.

C.2.c. Qualified for Employment
Counselors accept employment only
for positions for which they are quali-
fied given their education, training,
supervised experience, state and
national professional credentials, and
appropriate professional experience.
Counselors hire for professional coun-
seling positions only individuals who
are qualified and competent for those
positions.

C.2.d. Monitor Effectiveness
Counselors continually monitor their effec-
tiveness as professionals and take steps to
improve when necessary. Counselors take
reasonable steps to seek peer supervision
to evaluate their efficacy as counselors.

• ACA Code of Ethics •

•  9  •

C.2.e. Consultations on
Ethical Obligations

Counselors take reasonable steps to
consult with other counselors, the
ACA Ethics and Professional Standards
Department, or related professionals
when they have questions regarding
their ethical obligations or professional
practice.

C.2.f. Continuing Education
Counselors recognize the need for con-
tinuing education to acquire and main-
tain a reasonable level of awareness
of current scientific and professional
information in their fields of activity.
Counselors maintain their competence
in the skills they use, are open to new
procedures, and remain informed re-
garding best practices for working with
diverse populations.

C.2.g. Impairment
Counselors monitor themselves for
signs of impairment from their own
physical, mental, or emotional problems
and refrain from offering or providing
professional services when impaired.
They seek assistance for problems that
reach the level of professional impair-
ment, and, if necessary, they limit,
suspend, or terminate their professional
responsibilities until it is determined
that they may safely resume their
work. Counselors assist colleagues or
supervisors in recognizing their own
professional impairment and provide
consultation and assistance when war-
ranted with colleagues or supervisors
showing signs of impairment and
intervene as appropriate to prevent
imminent harm to clients.

C.2.h. Counselor Incapacitation,
Death, Retirement, or
Termination of Practice

Counselors prepare a plan for the trans-
fer of clients and the dissemination of
records to an identified colleague or
records custodian in the case of the
counselor’s incapacitation, death, retire-
ment, or termination of practice.

C.3. Advertising and
Soliciting Clients

C.3.a. Accurate Advertising
When advertising or otherwise rep-
resenting their services to the public,
counselors identify their credentials
in an accurate manner that is not false,
misleading, deceptive, or fraudulent.

C.3.b. Testimonials
Counselors who use testimonials do
not solicit them from current clients,
former clients, or any other persons who

may be vulnerable to undue influence.
Counselors discuss with clients the
implications of and obtain permission
for the use of any testimonial.

C.3.c. Statements by Others
When feasible, counselors make reason-
able efforts to ensure that statements
made by others about them or about
the counseling profession are accurate.

C.3.d. Recruiting Through
Employment

Counselors do not use their places of
employment or institutional affiliation to
recruit clients, supervisors, or consultees
for their private practices.

C.3.e. Products and Training
Advertisements

Counselors who develop products
related to their profession or conduct
workshops or training events ensure
that the advertisements concerning
these products or events are accurate
and disclose adequate information for
consumers to make informed choices.

C.3.f. Promoting to Those Served
Counselors do not use counseling,
teaching, training, or supervisory rela-
tionships to promote their products or
training events in a manner that is de-
ceptive or would exert undue influence
on individuals who may be vulnerable.
However, counselor educators may
adopt textbooks they have authored for
instructional purposes.

C.4. Professional Qualifications
C.4.a. Accurate Representation

Counselors claim or imply only profes-
sional qualifications actually completed
and correct any known misrepresenta-
tions of their qualifications by others.
Counselors truthfully represent the qual-
ifications of their professional colleagues.
Counselors clearly distinguish between
paid and volunteer work experience
and accurately describe their continuing
education and specialized training.

C.4.b. Credentials
Counselors claim only licenses or certifica-
tions that are current and in good standing.

C.4.c. Educational Degrees
Counselors clearly differentiate be-
tween earned and honorary degrees.

C.4.d. Implying Doctoral-Level
Competence

Counselors clearly state their highest
earned degree in counseling or a closely
related field. Counselors do not imply
doctoral-level competence when pos-
sessing a master’s degree in counseling
or a related field by referring to them-

selves as “Dr.” in a counseling context
when their doctorate is not in counsel-
ing or a related field. Counselors do not
use “ABD” (all but dissertation) or other
such terms to imply competency.

C.4.e. Accreditation Status
Counselors accurately represent the
accreditation status of their degree pro-
gram and college/university.

C.4.f. Professional Membership
Counselors clearly differentiate between
current, active memberships and former
memberships in associations. Members
of ACA must clearly differentiate be-
tween professional membership, which
implies the possession of at least a mas-
ter’s degree in counseling, and regular
membership, which is open to indi-
viduals whose interests and activities are
consistent with those of ACA but are not
qualified for professional membership.

C.5. Nondiscrimination
Counselors do not condone or engage
in discrimination against prospective or
current clients, students, employees, su-
pervisees, or research participants based
on age, culture, disability, ethnicity, race,
religion/spirituality, gender, gender
identity, sexual orientation, marital/
partnership status, language preference,
socioeconomic status, immigration
status, or any basis proscribed by law.

C.6. Public Responsibility
C.6.a. Sexual Harassment

Counselors do not engage in or condone
sexual harassment. Sexual harassment
can consist of a single intense or severe act,
or multiple persistent or pervasive acts.

C.6.b. Reports to Third Parties
Counselors are accurate, honest, and
objective in reporting their professional
activities and judgments to appropriate
third parties, including courts, health
insurance companies, those who are
the recipients of evaluation reports,
and others.

C.6.c. Media Presentations
When counselors provide advice or com-
ment by means of public lectures, dem-
onstrations, radio or television programs,
recordings, technology-based applica-
tions, printed articles, mailed material,
or other media, they take reasonable
precautions to ensure that

1. the statements are based on ap-
propriate professional counsel-
ing literature and practice,

2. the statements are otherwise
consistent with the ACA Code of
Ethics, and

• ACA Code of Ethics •

•  10  •

3. the recipients of the information
are not encouraged to infer that a
professional counseling relation-
ship has been established.

C.6.d. Exploitation of Others
Counselors do not exploit others in their
professional relationships.

C.6.e. Contributing to the
Public Good
(Pro Bono Publico)

Counselors make a reasonable effort
to provide services to the public for
which there is little or no financial
return (e.g., speaking to groups, shar-
ing professional information, offering
reduced fees).

C.7. Treatment Modalities
C.7.a. Scientific Basis for

Treatment
When providing services, counselors use
techniques/procedures/modalities that
are grounded in theory and/or have an
empirical or scientific foundation.

C.7.b. Development and
Innovation

When counselors use developing or
innovative techniques/procedures/
modalities, they explain the potential
risks, benefits, and ethical considerations
of using such techniques/procedures/
modalities. Counselors work to minimize
any potential risks or harm when using
these techniques/procedures/modalities.

C.7.c. Harmful Practices
Counselors do not use techniques/pro-
cedures/modalities when substantial
evidence suggests harm, even if such
services are requested.

C.8. Responsibility to
Other Professionals

C.8.a. Personal Public
Statements

When making personal statements in a
public context, counselors clarify that they
are speaking from their personal perspec-
tives and that they are not speaking on
behalf of all counselors or the profession.

Section D
Relationships With
Other Professionals

Introduction
Professional counselors recognize
that the quality of their interactions

with colleagues can influence the
quality of services provided to clients.
They work to become knowledgeable
about colleagues within and outside
the field of counseling. Counselors
develop positive working relation-
ships and systems of communication
with colleagues to enhance services
to clients.

D.1. Relationships With
Colleagues, Employers,
and Employees

D.1.a. Different Approaches
Counselors are respectful of approaches
that are grounded in theory and/or
have an empirical or scientific founda-
tion but may differ from their own.
Counselors acknowledge the expertise
of other professional groups and are
respectful of their practices.

D.1.b. Forming Relationships
Counselors work to develop and
strengthen relationships with col-
leagues from other disciplines to best
serve clients.

D.1.c. Interdisciplinary
Teamwork

Counselors who are members of in-
terdisciplinary teams delivering mul-
tifaceted services to clients remain
focused on how to best serve clients.
They participate in and contribute to
decisions that affect the well-being of
clients by drawing on the perspectives,
values, and experiences of the counsel-
ing profession and those of colleagues
from other disciplines.

D.1.d. Establishing
Professional and
Ethical Obligations

Counselors who are members of inter-
disciplinary teams work together with
team members to clarify professional
and ethical obligations of the team as
a whole and of its individual members.
When a team decision raises ethical
concerns, counselors first attempt to
resolve the concern within the team.
If they cannot reach resolution among
team members, counselors pursue
other avenues to address their concerns
consistent with client well-being.

D.1.e. Confidentiality
When counselors are required by law,
institutional policy, or extraordinary
circumstances to serve in more than one
role in judicial or administrative pro-
ceedings, they clarify role expectations
and the parameters of confidentiality
with their colleagues.

D.1.f. Personnel Selection and
Assignment

When counselors are in a position
requiring personnel selection and/or
assigning of responsibilities to others,
they select competent staff and assign
responsibilities compatible with their
skills and experiences.

D.1.g. Employer Policies
The acceptance of employment in an
agency or institution implies that counsel-
ors are in agreement with its general poli-
cies and principles. Counselors strive to
reach agreement with employers regard-
ing acceptable standards of client care
and professional conduct that allow for
changes in institutional policy conducive
to the growth and development of clients.

D.1.h. Negative Conditions
Counselors alert their employers of inap-
propriate policies and practices. They
attempt to effect changes in such policies
or procedures through constructive action
within the organization. When such poli-
cies are potentially disruptive or damaging
to clients or may limit the effectiveness of
services provided and change cannot be af-
fected, counselors take appropriate further
action. Such action may include referral to
appropriate certification, accreditation, or
state licensure organizations, or voluntary
termination of employment.

D.1.i. Protection From
Punitive Action

Counselors do not harass a colleague
or employee or dismiss an employee
who has acted in a responsible and
ethical manner to expose inappropriate
employer policies or practices.

D.2. Provision of
Consultation Services

D.2.a. Consultant Competency
Counselors take reasonable steps to
ensure that they have the appropri-
ate resources and competencies when
providing consultation services. Coun-
selors provide appropriate referral
resources when requested or needed.

D.2.b. Informed Consent in
Formal Consultation

When providing formal consultation
services, counselors have an obligation to
review, in writing and verbally, the rights
and responsibilities of both counselors
and consultees. Counselors use clear
and understandable language to inform
all parties involved about the purpose
of the services to be provided, relevant
costs, potential risks and benefits, and
the limits of confidentiality.

• ACA Code of Ethics •

•  11  •

Section E
Evaluation, Assessment,

and Interpretation

Introduction
Counselors use assessment as one com-
ponent of the counseling process, taking
into account the clients’ personal and
cultural context. Counselors promote the
well-being of individual clients or groups
of clients by developing and using ap-
propriate educational, mental health,
psychological, and career assessments.

E.1. General
E.1.a. Assessment

The primary purpose of educational,
mental health, psychological, and career
assessment is to gather information
regarding the client for a variety of
purposes, including, but not limited
to, client decision making, treatment
planning, and forensic proceedings. As-
sessment may include both qualitative
and quantitative methodologies.

E.1.b. Client Welfare
Counselors do not misuse assessment
results and interpretations, and they
take reasonable steps to prevent others
from misusing the information pro-
vided. They respect the client’s right
to know the results, the interpretations
made, and the bases for counselors’
conclusions and recommendations.

E.2. Competence to Use and
Interpret Assessment
Instruments

E.2.a. Limits of Competence
Counselors use only those testing and as-
sessment services for which they have been
trained and are competent. Counselors
using technology-assisted test interpreta-
tions are trained in the construct being
measured and the specific instrument
being used prior to using its technology-
based application. Counselors take reason-
able measures to ensure the proper use of
assessment techniques by persons under
their supervision.

E.2.b. Appropriate Use
Counselors are responsible for the
appropriate application, scoring, inter-
pretation, and use of assessment instru-
ments relevant to the needs of the client,
whether they score and interpret such
assessments themselves or use technol-
ogy or other services.

E.2.c. Decisions Based on
Results

Counselors responsible for decisions
involving individuals or policies that are
based on assessment results have a thor-
ough understanding of psychometrics.

E.3. Informed Consent
in Assessment

E.3.a. Explanation to Clients
Prior to assessment, counselors explain
the nature and purposes of assessment
and the specific use of results by po-
tential recipients. The explanation will
be given in terms and language that
the client (or other legally authorized
person on behalf of the client) can
understand.

E.3.b. Recipients of Results
Counselors consider the client’s and/
or examinee’s welfare, explicit under-
standings, and prior agreements in de-
termining who receives the assessment
results. Counselors include accurate
and appropriate interpretations with
any release of individual or group as-
sessment results.

E.4. Release of Data to
Qualified Personnel
Counselors release assessment data in
which the client is identified only with
the consent of the client or the client’s
legal representative. Such data are
released only to persons recognized
by counselors as qualified to interpret
the data.

E.5. Diagnosis of
Mental Disorders

E.5.a. Proper Diagnosis
Counselors take special care to provide
proper diagnosis of mental disorders.
Assessment techniques (including
personal interviews) used to determine
client care (e.g., locus of treatment, type
of treatment, recommended follow-up)
are carefully selected and appropri-
ately used.

E.5.b. Cultural Sensitivity
Counselors recognize that culture
affects the manner in which clients’
problems are defined and experienced.
Clients’ socioeconomic and cultural
experiences are considered when diag-
nosing mental disorders.

E.5.c. Historical and Social
Prejudices in the
Diagnosis of Pathology

Counselors recognize historical and so-
cial prejudices in the misdiagnosis and

pathologizing of certain individuals and
groups and strive to become aware of
and address such biases in themselves
or others.

E.5.d. Refraining From
Diagnosis

Counselors may refrain from making
and/or reporting a diagnosis if they
believe that it would cause harm to the
client or others. Counselors carefully
consider both the positive and negative
implications of a diagnosis.

E.6. Instrument Selection
E.6.a. Appropriateness of

Instruments
Counselors carefully consider the
validity, reliability, psychometric limi-
tations, and appropriateness of instru-
ments when selecting assessments and,
when possible, use multiple forms of
assessment, data, and/or instruments
in forming conclusions, diagnoses, or
recommendations.

E.6.b. Referral Information
If a client is referred to a third party
for assessment, the counselor provides
specific referral questions and suf-
ficient objective data about the client
to ensure that appropriate assessment
instruments are utilized.

E.7. Conditions of
Assessment
Administration

E.7.a. Administration
Conditions

Counselors administer assessments
under the same conditions that were
established in their standardization.
When assessments are not administered
under standard conditions, as may be
necessary to accommodate clients with
disabilities, or when unusual behavior
or irregularities occur during the admin-
istration, those conditions are noted in
interpretation, and the results may be
designated as invalid or of question-
able validity.

E.7.b. Provision of Favorable
Conditions

Counselors provide an appropriate
environment for the administration
of assessments (e.g., privacy, comfort,
freedom from distraction).

E.7.c. Technological
Administration

Counselors ensure that technologi-
cally administered assessments func-
tion properly and provide clients with
accurate results.

• ACA Code of Ethics •

•  12  •

adults who lack the capacity to give
voluntary consent are being evaluated,
informed written consent is obtained
from a parent or guardian.

E.13.c. Client Evaluation
Prohibited

Counselors do not evaluate current or
former clients, clients’ romantic partners,
or clients’ family members for forensic
purposes. Counselors do not counsel
individuals they are evaluating.

E.13.d. Avoid Potentially
Harmful Relationships

Counselors who provide forensic
evaluations avoid potentially harmful
professional or personal relationships
with family members, romantic part-
ners, and close friends of individuals
they are evaluating or have evaluated
in the past.

Section F
Supervision, Training,

and Teaching

Introduction
Counselor supervisors, trainers, and
educators aspire to foster meaningful
and respectful professional relation-
ships and to maintain appropriate
boundaries with supervisees and
students in both face-to-face and elec-
tronic formats. They have theoretical
and pedagogical foundations for their
work; have knowledge of supervision
models; and aim to be fair, accurate,
and honest in their assessments of
counselors, students, and supervisees.

F.1. Counselor Supervision
and Client Welfare

F.1.a. Client Welfare
A primary obligation of counseling
supervisors is to monitor the services
provided by supervisees. Counseling
supervisors monitor client welfare and
supervisee performance and profes-
sional development. To fulfill these
obligations, supervisors meet regularly
with supervisees to review the super-
visees’ work and help them become
prepared to serve a range of diverse
clients. Supervisees have a responsibil-
ity to understand and follow the ACA
Code of Ethics.

F.1.b. Counselor Credentials
Counseling supervisors work to ensure
that supervisees communicate their

E.7.d. Unsupervised
Assessments

Unless the assessment instrument is
designed, intended, and validated for
self-administration and/or scoring,
counselors do not permit unsupervised
use.

E.8. Multicultural Issues/
Diversity in Assessment
Counselors select and use with cau-
tion assessment techniques normed
on populations other than that of the
client. Counselors recognize the effects
of age, color, culture, disability, ethnic
group, gender, race, language pref-
erence, religion, spirituality, sexual
orientation, and socioeconomic status
on test administration and interpre-
tation, and they place test results in
proper perspective with other relevant
factors.

E.9. Scoring and Interpretation
of Assessments

E.9.a. Reporting
When counselors report assessment re-
sults, they consider the client’s personal
and cultural background, the level of
the client’s understanding of the results,
and the impact of the results on the
client. In reporting assessment results,
counselors indicate reservations that
exist regarding validity or reliability
due to circumstances of the assessment
or inappropriateness of the norms for
the person tested.

E.9.b. Instruments With
Insufficient Empirical
Data

Counselors exercise caution when
interpreting the results of instruments
not having sufficient empirical data to
support respondent results. The specific
purposes for the use of such instruments
are stated explicitly to the examinee.
Counselors qualify any conclusions, di-
agnoses, or recommendations made that
are based on assessments or instruments
with questionable validity or reliability.

E.9.c. Assessment Services
Counselors who provide assessment,
scoring, and interpretation services to
support the assessment process confirm
the validity of such interpretations.
They accurately describe the purpose,
norms, validity, reliability, and applica-
tions of the procedures and any special
qualifications applicable to their use.
At all times, counselors maintain their
ethical responsibility to those being
assessed.

E.10. Assessment Security
Counselors maintain the integrity
and security of tests and assessments
consistent with legal and contractual
obligations. Counselors do not appro-
priate, reproduce, or modify published
assessments or parts thereof without
acknowledgment and permission from
the publisher.

E.11. Obsolete Assessment
and Outdated Results
Counselors do not use data or results
from assessments that are obsolete or
outdated for the current purpose (e.g.,
noncurrent versions of assessments/
instruments). Counselors make every
effort to prevent the misuse of obsolete
measures and assessment data by others.

E.12. Assessment
Construction
Counselors use established scientific
procedures, relevant standards, and
current professional knowledge for
assessment design in the development,
publication, and utilization of assess-
ment techniques.

E.13. Forensic Evaluation:
Evaluation for
Legal Proceedings

E.13.a. Primary Obligations
When providing forensic evaluations,
the primary obligation of counselors is
to produce objective findings that can be
substantiated based on information and
techniques appropriate to the evalua-
tion, which may include examination of
the individual and/or review of records.
Counselors form professional opinions
based on their professional knowledge
and expertise that can be supported
by the data gathered in evaluations.
Counselors define the limits of their
reports or testimony, especially when
an examination of the individual has
not been conducted.

E.13.b. Consent for Evaluation
Individuals being evaluated are in-
formed in writing that the relationship
is for the purposes of an evaluation and
is not therapeutic in nature, and enti-
ties or individuals who will receive the
evaluation report are identified. Coun-
selors who perform forensic evalua-
tions obtain written consent from those
being evaluated or from their legal
representative unless a court orders
evaluations to be conducted without
the written consent of the individuals
being evaluated. When children or

• ACA Code of Ethics •

•  13  •

qualifications to render services to their
clients.

F.1.c. Informed Consent and
Client Rights

Supervisors make supervisees aware of
client rights, including the protection
of client privacy and confidentiality in
the counseling relationship. Supervis-
ees provide clients with professional
disclosure information and inform
them of how the supervision process
influences the limits of confidential-
ity. Supervisees make clients aware of
who will have access to records of the
counseling relationship and how these
records will be stored, transmitted, or
otherwise reviewed.

F.2. Counselor Supervision
Competence

F.2.a. Supervisor Preparation
Prior to offering supervision services,
counselors are trained in supervision
methods and techniques. Counselors
who offer supervision services regularly
pursue continuing education activities,
including both counseling and supervi-
sion topics and skills.

F.2.b. Multicultural Issues/
Diversity in Supervision

Counseling supervisors are aware of and
address the role of multiculturalism/
diversity in the supervisory relationship.

F.2.c. Online Supervision
When using technology in supervision,
counselor supervisors are competent in
the use of those technologies. Supervi-
sors take the necessary precautions
to protect the confidentiality of all
information transmitted through any
electronic means.

F.3. Supervisory Relationship
F.3.a. Extending Conventional

Supervisory Relationships
Counseling supervisors clearly define
and maintain ethical professional,
personal, and social relationships with
their supervisees. Supervisors con-
sider the risks and benefits of extend-
ing current supervisory relationships
in any form beyond conventional
parameters. In extending these bound-
aries, supervisors take appropriate
professional precautions to ensure that
judgment is not impaired and that no
harm occurs.

F.3.b. Sexual Relationships
Sexual or romantic interactions or rela-
tionships with current supervisees are
prohibited. This prohibition applies to

both in-person and electronic interac-
tions or relationships.

F.3.c. Sexual Harassment
Counseling supervisors do not con-
done or subject supervisees to sexual
harassment.

F.3.d. Friends or Family
Members

Supervisors are prohibited from engag-
ing in supervisory relationships with
individuals with whom they have an
inability to remain objective.

F.4. Supervisor
Responsibilities

F.4.a. Informed Consent for
Supervision

Supervisors are responsible for incor-
porating into their supervision the
principles of informed consent and
participation. Supervisors inform su-
pervisees of the policies and procedures
to which supervisors are to adhere and
the mechanisms for due process appeal
of individual supervisor actions. The
issues unique to the use of distance
supervision are to be included in the
documentation as necessary.

F.4.b. Emergencies and
Absences

Supervisors establish and communi-
cate to supervisees procedures for con-
tacting supervisors or, in their absence,
alternative on-call supervisors to assist
in handling crises.

F.4.c. Standards for Supervisees
Supervisors make their supervisees
aware of professional and ethical
standards and legal responsibilities.

F.4.d. Termination of the
Supervisory Relationship

Supervisors or supervisees have the
right to terminate the supervisory
relationship with adequate notice. Rea-
sons for considering termination are
discussed, and both parties work to
resolve differences. When termination
is warranted, supervisors make appro-
priate referrals to possible alternative
supervisors.

F.5. Student and Supervisee
Responsibilities

F.5.a. Ethical Responsibilities
Students and supervisees have a re-
sponsibility to understand and follow
the ACA Code of Ethics. Students and
supervisees have the same obligation to
clients as those required of professional
counselors.

F.5.b. Impairment
Students and supervisees monitor
themselves for signs of impairment
from their own physical, mental, or
emotional problems and refrain from
offering or providing professional
services when such impairment is
likely to harm a client or others. They
notify their faculty and/or supervi-
sors and seek assistance for problems
that reach the level of professional
impairment, and, if necessary, they
limit, suspend, or terminate their
professional responsibilities until it
is determined that they may safely
resume their work.

F.5.c. Professional Disclosure
Before providing counseling services,
students and supervisees disclose
their status as supervisees and explain
how this status affects the limits of
confidentiality. Supervisors ensure
that clients are aware of the services
rendered and the qualifications of the
students and supervisees rendering
those services. Students and super-
visees obtain client permission before
they use any information concerning
the counseling relationship in the
training process.

F.6. Counseling Supervision
Evaluation, Remediation,
and Endorsement

F.6.a. Evaluation
Supervisors document and provide
supervisees with ongoing feedback
regarding their performance and
schedule periodic formal evaluative
sessions throughout the supervisory
relationship.

F.6.b. Gatekeeping and
Remediation

Through initial and ongoing evalua-
tion, supervisors are aware of super-
visee limitations that might impede
performance. Supervisors assist su-
pervisees in securing remedial assis-
tance when needed. They recommend
dismissal from training programs,
applied counseling settings, and state
or voluntary professional credential-
ing processes when those supervisees
are unable to demonstrate that they
can provide competent professional
services to a range of diverse clients.
Supervisors seek consultation and
document their decisions to dismiss or
refer supervisees for assistance. They
ensure that supervisees are aware of
options available to them to address
such decisions.

• ACA Code of Ethics •

•  14  •

F.6.c. Counseling for
Supervisees

If supervisees request counseling, the
supervisor assists the supervisee in
identifying appropriate services. Su-
pervisors do not provide counseling
services to supervisees. Supervisors
address interpersonal competencies in
terms of the impact of these issues on
clients, the supervisory relationship,
and professional functioning.

F.6.d. Endorsements
Supervisors endorse supervisees for
certification, licensure, employment,
or completion of an academic or train-
ing program only when they believe
that supervisees are qualified for the
endorsement. Regardless of qualifi-
cations, supervisors do not endorse
supervisees whom they believe to be
impaired in any way that would inter-
fere with the performance of the duties
associated with the endorsement.

F.7. Responsibilities of
Counselor Educators

F.7.a. Counselor Educators
Counselor educators who are respon-
sible for developing, implementing,
and supervising educational programs
are skilled as teachers and practitio-
ners. They are knowledgeable regard-
ing the ethical, legal, and regulatory
aspects of the profession; are skilled
in applying that knowledge; and
make students and supervisees aware
of their responsibilities. Whether in
traditional, hybrid, and/or online
formats, counselor educators conduct
counselor education and training
programs in an ethical manner and
serve as role models for professional
behavior.

F.7.b. Counselor Educator
Competence

Counselors who function as counselor
educators or supervisors provide in-
struction within their areas of knowl-
edge and competence and provide
instruction based on current informa-
tion and knowledge available in the
profession. When using technology to
deliver instruction, counselor educators
develop competence in the use of the
technology.

F.7.c. Infusing Multicultural
Issues/Diversity

Counselor educators infuse material
related to multiculturalism/diver-
sity into all courses and workshops
for the development of professional
counselors.

F.7.d. Integration of Study
and Practice

In traditional, hybrid, and/or online
formats, counselor educators establish
education and training programs that
integrate academic study and super-
vised practice.

F.7.e. Teaching Ethics
Throughout the program, counselor
educators ensure that students are
aware of the ethical responsibilities
and standards of the profession and the
ethical responsibilities of students to the
profession. Counselor educators infuse
ethical considerations throughout the
curriculum.

F.7.f. Use of Case Examples
The use of client, student, or supervisee
information for the purposes of case ex-
amples in a lecture or classroom setting
is permissible only when (a) the client,
student, or supervisee has reviewed the
material and agreed to its presentation
or (b) the information has been suf-
ficiently modified to obscure identity.

F.7.g. Student-to-Student
Supervision and
Instruction

When students function in the role of
counselor educators or supervisors,
they understand that they have the
same ethical obligations as counselor
educators, trainers, and supervisors.
Counselor educators make every effort
to ensure that the rights of students are
not compromised when their peers lead
experiential counseling activities in tra-
ditional, hybrid, and/or online formats
(e.g., counseling groups, skills classes,
clinical supervision).

F.7.h. Innovative Theories and
Techniques

Counselor educators promote the use
of techniques/procedures/modalities
that are grounded in theory and/or
have an empirical or scientific founda-
tion. When counselor educators discuss
developing or innovative techniques/
procedures/modalities, they explain the
potential risks, benefits, and ethical con-
siderations of using such techniques/
procedures/modalities.

F.7.i. Field Placements
Counselor educators develop clear
policies and provide direct assistance
within their training programs regard-
ing appropriate field placement and
other clinical experiences. Counselor
educators provide clearly stated roles
and responsibilities for the student or
supervisee, the site supervisor, and the
program supervisor. They confirm that

site supervisors are qualified to provide
supervision in the formats in which
services are provided and inform site
supervisors of their professional and
ethical responsibilities in this role.

F.8. Student Welfare
F.8.a. Program Information and

Orientation
Counselor educators recognize that
program orientation is a developmen-
tal process that begins upon students’
initial contact with the counselor educa-
tion program and continues throughout
the educational and clinical training
of students. Counselor education fac-
ulty provide prospective and current
students with information about the
counselor education program’s expecta-
tions, including

1. the values and ethical principles
of the profession;

2. the type and level of skill and
knowledge acquisition required
for successful completion of the
training;

3. technology requirements;
4. program training goals, objectives,

and mission, and subject matter to
be covered;

5. bases for evaluation;
6. training components that encour-

age self-growth or self-disclosure
as part of the training process;

7. the type of supervision settings
and requirements of the sites for
required clinical field experiences;

8. student and supervisor evalua-
tion and dismissal policies and
procedures; and

9. up-to-date employment pros-
pects for graduates.

F.8.b. Student Career Advising
Counselor educators provide career
advisement for their students and make
them aware of opportunities in the field.

F.8.c. Self-Growth Experiences
Self-growth is an expected component
of counselor education. Counselor edu-
cators are mindful of ethical principles
when they require students to engage
in self-growth experiences. Counselor
educators and supervisors inform stu-
dents that they have a right to decide
what information will be shared or
withheld in class.

F.8.d. Addressing Personal
Concerns

Counselor educators may require stu-
dents to address any personal concerns
that have the potential to affect profes-
sional competency.

• ACA Code of Ethics •

•  15  •

F.11.b. Student Diversity
Counselor educators actively attempt
to recruit and retain a diverse student
body. Counselor educators demonstrate
commitment to multicultural/diversity
competence by recognizing and valuing
the diverse cultures and types of abili-
ties that students bring to the training
experience. Counselor educators pro-
vide appropriate accommodations that
enhance and support diverse student
well-being and academic performance.

F.11.c. Multicultural/Diversity
Competence

Counselor educators actively infuse
multicultural/diversity competency in
their training and supervision practices.
They actively train students to gain
awareness, knowledge, and skills in the
competencies of multicultural practice.

Section G
Research and
Publication

Introduction
Counselors who conduct research are
encouraged to contribute to the knowl-
edge base of the profession and promote
a clearer understanding of the condi-
tions that lead to a healthy and more
just society. Counselors support the
efforts of researchers by participating
fully and willingly whenever possible.
Counselors minimize bias and respect
diversity in designing and implement-
ing research.

G.1. Research Responsibilities
G.1.a. Conducting Research

Counselors plan, design, conduct, and
report research in a manner that is con-
sistent with pertinent ethical principles,
federal and state laws, host institutional
regulations, and scientific standards
governing research.

G.1.b. Confidentiality in
Research

Counselors are responsible for under-
standing and adhering to state, federal,
agency, or institutional policies or appli-
cable guidelines regarding confidential-
ity in their research practices.

G.1.c. Independent Researchers
When counselors conduct independent
research and do not have access to an
institutional review board, they are
bound to the same ethical principles and

F.9. Evaluation and
Remediation

F.9.a. Evaluation of Students
Counselor educators clearly state to stu-
dents, prior to and throughout the train-
ing program, the levels of competency
expected, appraisal methods, and timing
of evaluations for both didactic and clini-
cal competencies. Counselor educators
provide students with ongoing feedback
regarding their performance throughout
the training program.

F.9.b. Limitations
Counselor educators, through ongoing
evaluation, are aware of and address
the inability of some students to achieve
counseling competencies. Counselor
educators do the following:

1. assist students in securing reme-
dial assistance when needed,

2. seek professional consultation
and document their decision to
dismiss or refer students for
assistance, and

3. ensure that students have recourse
in a timely manner to address
decisions requiring them to seek
assistance or to dismiss them and
provide students with due process
according to institutional policies
and procedures.

F.9.c. Counseling for Students
If students request counseling, or if
counseling services are suggested as
part of a remediation process, counselor
educators assist students in identifying
appropriate services.

F.10. Roles and Relationships
Between Counselor
Educators and Students

F.10.a. Sexual or Romantic
Relationships

Counselor educators are prohibited
from sexual or romantic interactions or
relationships with students currently
enrolled in a counseling or related pro-
gram and over whom they have power
and authority. This prohibition applies
to both in-person and electronic interac-
tions or relationships.

F.10.b. Sexual Harassment
Counselor educators do not condone or
subject students to sexual harassment.

F.10.c. Relationships With
Former Students

Counselor educators are aware of the
power differential in the relationship
between faculty and students. Faculty

members discuss with former students
potential risks when they consider
engaging in social, sexual, or other in-
timate relationships.

F.10.d. Nonacademic
Relationships

Counselor educators avoid nonacademic
relationships with students in which
there is a risk of potential harm to the
student or which may compromise the
training experience or grades assigned.
In addition, counselor educators do not
accept any form of professional services,
fees, commissions, reimbursement, or
remuneration from a site for student or
supervisor placement.

F.10.e. Counseling Services
Counselor educators do not serve
as counselors to students currently
enrolled in a counseling or related pro-
gram and over whom they have power
and authority.

F.10.f. Extending Educator–
Student Boundaries

Counselor educators are aware of the
power differential in the relationship
between faculty and students. If they
believe that a nonprofessional relation-
ship with a student may be potentially
beneficial to the student, they take pre-
cautions similar to those taken by
counselors when working with clients.
Examples of potentially beneficial in-
teractions or relationships include, but
are not limited to, attending a formal
ceremony; conducting hospital visits;
providing support during a stressful
event; or maintaining mutual mem-
bership in a professional association,
organization, or community. Coun-
selor educators discuss with students
the rationale for such interactions, the
potential benefits and drawbacks, and
the anticipated consequences for the
student. Educators clarify the specific
nature and limitations of the additional
role(s) they will have with the student
prior to engaging in a nonprofessional
relationship. Nonprofessional relation-
ships with students should be time
limited and/or context specific and
initiated with student consent.

F.11. Multicultural/Diversity
Competence in
Counselor Education
and Training Programs

F.11.a. Faculty Diversity
Counselor educators are committed
to recruiting and retaining a diverse
faculty.

• ACA Code of Ethics •

•  16  •

federal and state laws pertaining to the
review of their plan, design, conduct,
and reporting of research.

G.1.d. Deviation From
Standard Practice

Counselors seek consultation and ob-
serve stringent safeguards to protect
the rights of research participants when
research indicates that a deviation from
standard or acceptable practices may be
necessary.

G.1.e. Precautions to
Avoid Injury

Counselors who conduct research are
responsible for their participants’ wel-
fare throughout the research process
and should take reasonable precautions
to avoid causing emotional, physical, or
social harm to participants.

G.1.f. Principal Researcher
Responsibility

The ultimate responsibility for ethical
research practice lies with the principal
researcher. All others involved in the re-
search activities share ethical obligations
and responsibility for their own actions.

G.2. Rights of Research
Participants

G.2.a. Informed Consent in
Research

Individuals have the right to decline
requests to become research partici-
pants. In seeking consent, counselors
use language that
1. accurately explains the purpose

and procedures to be followed;
2. identifies any procedures that

are experimental or relatively
untried;

3. describes any attendant discom-
forts, risks, and potential power
differentials between researchers
and participants;

4. describes any benefits or changes
in individuals or organizations
that might reasonably be expected;

5. discloses appropriate alternative
procedures that would be advan-
tageous for participants;

6. offers to answer any inquiries
concerning the procedures;

7. describes any limitations on
confidentiality;

8. describes the format and potential
target audiences for the dissemi-
nation of research findings; and

9. instructs participants that they
are free to withdraw their con-
sent and discontinue participa-
tion in the project at any time,
without penalty.

G.2.b. Student/Supervisee
Participation

Researchers who involve students or
supervisees in research make clear to
them that the decision regarding par-
ticipation in research activities does
not affect their academic standing or
supervisory relationship. Students or
supervisees who choose not to partici-
pate in research are provided with an
appropriate alternative to fulfill their
academic or clinical requirements.

G.2.c. Client Participation
Counselors conducting research involv-
ing clients make clear in the informed
consent process that clients are free to
choose whether to participate in re-
search activities. Counselors take neces-
sary precautions to protect clients from
adverse consequences of declining or
withdrawing from participation.

G.2.d. Confidentiality of
Information

Information obtained about research
participants during the course of re-
search is confidential. Procedures are
implemented to protect confidentiality.

G.2.e. Persons Not
Capable of Giving
Informed Consent

When a research participant is not
capable of giving informed consent,
counselors provide an appropriate
explanation to, obtain agreement for
participation from, and obtain the ap-
propriate consent of a legally authorized
person.

G.2.f. Commitments to
Participants

Counselors take reasonable measures
to honor all commitments to research
participants.

G.2.g. Explanations After
Data Collection

After data are collected, counselors
provide participants with full clarifi-
cation of the nature of the study to re-
move any misconceptions participants
might have regarding the research.
Where scientific or human values
justify delaying or withholding infor-
mation, counselors take reasonable
measures to avoid causing harm.

G.2.h. Informing Sponsors
Counselors inform sponsors, insti-
tutions, and publication channels
regarding research procedures and
outcomes. Counselors ensure that
appropriate bodies and authorities
are given pertinent information and
acknowledgment.

G.2.i. Research Records
Custodian

As appropriate, researchers prepare and
disseminate to an identified colleague or
records custodian a plan for the transfer
of research data in the case of their inca-
pacitation, retirement, or death.

G.3. Managing and
Maintaining Boundaries

G.3.a. Extending Researcher–
Participant Boundaries

Researchers consider the risks and ben-
efits of extending current research rela-
tionships beyond conventional param-
eters. When a nonresearch interaction
between the researcher and the research
participant may be potentially ben-
eficial, the researcher must document,
prior to the interaction (when feasible),
the rationale for such an interaction, the
potential benefit, and anticipated con-
sequences for the research participant.
Such interactions should be initiated
with appropriate consent of the research
participant. Where unintentional harm
occurs to the research participant, the
researcher must show evidence of an
attempt to remedy such harm.

G.3.b. Relationships With
Research Participants

Sexual or romantic counselor–research
participant interactions or relationships
with current research participants are
prohibited. This prohibition applies to
both in-person and electronic interactions
or relationships.

G.3.c. Sexual Harassment and
Research Participants

Researchers do not condone or subject re-
search participants to sexual harassment.

G.4. Reporting Results
G.4.a. Accurate Results

Counselors plan, conduct, and report
research accurately. Counselors do not
engage in misleading or fraudulent re-
search, distort data, misrepresent data,
or deliberately bias their results. They
describe the extent to which results are
applicable for diverse populations.

G.4.b. Obligation to Report
Unfavorable Results

Counselors report the results of any
research of professional value. Results
that reflect unfavorably on institutions,
programs, services, prevailing opinions,
or vested interests are not withheld.

G.4.c. Reporting Errors
If counselors discover significant errors
in their published research, they take

• ACA Code of Ethics •

•  17  •

G.5.e. Agreement of
Contributors

Counselors who conduct joint research
with colleagues or students/supervi-
sors establish agreements in advance re-
garding allocation of tasks, publication
credit, and types of acknowledgment
that will be received.

G.5.f. Student Research
Manuscripts or professional presen-
tations in any medium that are sub-
stantially based on a student’s course
papers, projects, dissertations, or theses
are used only with the student’s permis-
sion and list the student as lead author.

G.5.g. Duplicate Submissions
Counselors submit manuscripts for con-
sideration to only one journal at a time.
Manuscripts that are published in whole
or in substantial part in one journal or
published work are not submitted for
publication to another publisher with-
out acknowledgment and permission
from the original publisher.

G.5.h. Professional Review
Counselors who review material sub-
mitted for publication, research, or
other scholarly purposes respect the
confidentiality and proprietary rights
of those who submitted it. Counselors
make publication decisions based on
valid and defensible standards. Coun-
selors review article submissions in a
timely manner and based on their scope
and competency in research methodolo-
gies. Counselors who serve as reviewers
at the request of editors or publishers
make every effort to only review ma-
terials that are within their scope of
competency and avoid personal biases.

Section H
Distance Counseling,

Technology, and
Social Media

Introduction
Counselors understand that the profes-
sion of counseling may no longer be
limited to in-person, face-to-face inter-
actions. Counselors actively attempt to
understand the evolving nature of the
profession with regard to distance coun-
seling, technology, and social media and
how such resources may be used to bet-
ter serve their clients. Counselors strive
to become knowledgeable about these
resources. Counselors understand the

reasonable steps to correct such errors
in a correction erratum or through other
appropriate publication means.

G.4.d. Identity of Participants
Counselors who supply data, aid in
the research of another person, report
research results, or make original data
available take due care to disguise the
identity of respective participants in
the absence of specific authorization
from the participants to do otherwise.
In situations where participants self-
identify their involvement in research
studies, researchers take active steps
to ensure that data are adapted/
changed to protect the identity and
welfare of all parties and that discus-
sion of results does not cause harm to
participants.

G.4.e. Replication Studies
Counselors are obligated to make
available sufficient original research
information to qualified professionals
who may wish to replicate or extend
the study.

G.5. Publications and
Presentations

G.5.a. Use of Case Examples
The use of participants’, clients’, stu-
dents’, or supervisees’ information
for the purpose of case examples in a
presentation or publication is permis-
sible only when (a) participants, clients,
students, or supervisees have reviewed
the material and agreed to its presenta-
tion or publication or (b) the informa-
tion has been sufficiently modified to
obscure identity.

G.5.b. Plagiarism
Counselors do not plagiarize; that is,
they do not present another person’s
work as their own.

G.5.c. Acknowledging
Previous Work

In publications and presentations,
counselors acknowledge and give rec-
ognition to previous work on the topic
by others or self.

G.5.d. Contributors
Counselors give credit through joint
authorship, acknowledgment, foot-
note statements, or other appropriate
means to those who have contributed
significantly to research or concept
development in accordance with such
contributions. The principal contribu-
tor is listed first, and minor technical
or professional contributions are ac-
knowledged in notes or introductory
statements.

additional concerns related to the use
of distance counseling, technology, and
social media and make every attempt
to protect confidentiality and meet any
legal and ethical requirements for the
use of such resources.

H.1. Knowledge and
Legal Considerations

H.1.a. Knowledge and
Competency

Counselors who engage in the use of
distance counseling, technology, and/
or social media develop knowledge and
skills regarding related technical, ethical,
and legal considerations (e.g., special
certifications, additional course work).

H.1.b. Laws and Statutes
Counselors who engage in the use of dis-
tance counseling, technology, and social
media within their counseling practice
understand that they may be subject to
laws and regulations of both the coun-
selor’s practicing location and the client’s
place of residence. Counselors ensure
that their clients are aware of pertinent
legal rights and limitations governing the
practice of counseling across state lines
or international boundaries.

H.2. Informed Consent
and Security

H.2.a. Informed Consent
and Disclosure

Clients have the freedom to choose
whether to use distance counseling,
social media, and/or technology within
the counseling process. In addition to
the usual and customary protocol of
informed consent between counselor
and client for face-to-face counseling,
the following issues, unique to the use of
distance counseling, technology, and/
or social media, are addressed in the
informed consent process:

• distance counseling credentials,
physical location of practice, and
contact information;

• risks and benefits of engaging in
the use of distance counseling,
technology, and/or social media;

• possibility of technology failure
and alternate methods of service
delivery;

• anticipated response time;
• emergency procedures to follow

when the counselor is not available;
• time zone differences;
• cultural and/or language differ-

ences that may affect delivery of
services;

• ACA Code of Ethics •

•  18  •

H.5.b. Client Rights
Counselors who offer distance counseling
services and/or maintain a professional
website provide electronic links to rel-
evant licensure and professional certifica-
tion boards to protect consumer and client
rights and address ethical concerns.

H.5.c. Electronic Links
Counselors regularly ensure that elec-
tronic links are working and are profes-
sionally appropriate.

H.5.d. Multicultural and
Disability Considerations

Counselors who maintain websites
provide accessibility to persons with
disabilities. They provide translation ca-
pabilities for clients who have a different
primary language, when feasible. Coun-
selors acknowledge the imperfect nature
of such translations and accessibilities.

H.6. Social Media
H.6.a. Virtual Professional

Presence
In cases where counselors wish to
maintain a professional and personal
presence for social media use, separate
professional and personal web pages
and profiles are created to clearly distin-
guish between the two kinds of virtual
presence.

H.6.b. Social Media as Part of
Informed Consent

Counselors clearly explain to their clients,
as part of the informed consent procedure,
the benefits, limitations, and boundaries
of the use of social media.

H.6.c. Client Virtual Presence
Counselors respect the privacy of
their clients’ presence on social media
unless given consent to view such
information.

H.6.d. Use of Public
Social Media

Counselors take precautions to avoid
disclosing confidential information
through public social media.

Section I
Resolving Ethical

Issues

Introduction
Professional counselors behave in an
ethical and legal manner. They are
aware that client welfare and trust in

• possible denial of insurance
benefits; and

• social media policy.

H.2.b. Confidentiality
Maintained by the
Counselor

Counselors acknowledge the limitations
of maintaining the confidentiality of
electronic records and transmissions.
They inform clients that individuals
might have authorized or unauthorized
access to such records or transmissions
(e.g., colleagues, supervisors, employ-
ees, information technologists).

H.2.c. Acknowledgment
of Limitations

Counselors inform clients about the
inherent limits of confidentiality when
using technology. Counselors urge
clients to be aware of authorized and/
or unauthorized access to information
disclosed using this medium in the
counseling process.

H.2.d. Security
Counselors use current encryption stan-
dards within their websites and/or tech-
nology-based communications that meet
applicable legal requirements. Counselors
take reasonable precautions to ensure the
confidentiality of information transmitted
through any electronic means.

H.3. Client Verification
Counselors who engage in the use of
distance counseling, technology, and/
or social media to interact with clients
take steps to verify the client’s identity
at the beginning and throughout the
therapeutic process. Verification can
include, but is not limited to, using
code words, numbers, graphics, or other
nondescript identifiers.

H.4. Distance Counseling
Relationship

H.4.a. Benefits and Limitations
Counselors inform clients of the benefits
and limitations of using technology ap-
plications in the provision of counseling
services. Such technologies include, but are
not limited to, computer hardware and/or
software, telephones and applications, so-
cial media and Internet-based applications
and other audio and/or video communi-
cation, or data storage devices or media.

H.4.b. Professional
Boundaries in Distance
Counseling

Counselors understand the necessity of
maintaining a professional relationship
with their clients. Counselors discuss

and establish professional boundaries
with clients regarding the appropriate
use and/or application of technology
and the limitations of its use within
the counseling relationship (e.g., lack
of confidentiality, times when not ap-
propriate to use).

H.4.c. Technology-Assisted
Services

When providing technology-assisted
services, counselors make reasonable
efforts to determine that clients are
intellectually, emotionally, physically,
linguistically, and functionally capable
of using the application and that the ap-
plication is appropriate for the needs of
the client. Counselors verify that clients
understand the purpose and operation
of technology applications and follow
up with clients to correct possible mis-
conceptions, discover appropriate use,
and assess subsequent steps.

H.4.d. Effectiveness of Services
When distance counseling services are
deemed ineffective by the counselor or
client, counselors consider delivering
services face-to-face. If the counselor is
not able to provide face-to-face services
(e.g., lives in another state), the coun-
selor assists the client in identifying
appropriate services.

H.4.e. Access
Counselors provide information to
clients regarding reasonable access to
pertinent applications when providing
technology-assisted services.

H.4.f. Communication
Differences in
Electronic Media

Counselors consider the differences be-
tween face-to-face and electronic com-
munication (nonverbal and verbal cues)
and how these may affect the counseling
process. Counselors educate clients on
how to prevent and address potential
misunderstandings arising from the
lack of visual cues and voice intonations
when communicating electronically.

H.5. Records and
Web Maintenance

H.5.a. Records
Counselors maintain electronic records
in accordance with relevant laws and
statutes. Counselors inform clients on
how records are maintained electroni-
cally. This includes, but is not limited
to, the type of encryption and security
assigned to the records, and if/for how
long archival storage of transaction
records is maintained.

• ACA Code of Ethics •

•  19  •

the profession depend on a high level of
professional conduct. They hold other
counselors to the same standards and
are willing to take appropriate action
to ensure that standards are upheld.
Counselors strive to resolve ethical
dilemmas with direct and open commu-
nication among all parties involved and
seek consultation with colleagues and
supervisors when necessary. Counselors
incorporate ethical practice into their
daily professional work and engage
in ongoing professional development
regarding current topics in ethical and
legal issues in counseling. Counselors
become familiar with the ACA Policy
and Procedures for Processing Com-
plaints of Ethical Violations1 and use
it as a reference for assisting in the
enforcement of the ACA Code of Ethics.

I.1. Standards and the Law
I.1.a. Knowledge

Counselors know and understand the
ACA Code of Ethics and other applicable
ethics codes from professional organiza-
tions or certification and licensure bod-
ies of which they are members. Lack of
knowledge or misunderstanding of an
ethical responsibility is not a defense
against a charge of unethical conduct.

I.1.b. Ethical Decision Making
When counselors are faced with an eth-
ical dilemma, they use and document,
as appropriate, an ethical decision-
making model that may include, but
is not limited to, consultation; consid-
eration of relevant ethical standards,
principles, and laws; generation of
potential courses of action; deliberation
of risks and benefits; and selection of
an objective decision based on the cir-
cumstances and welfare of all involved.

I.1.c. Conflicts Between Ethics
and Laws

If ethical responsibilities conflict with
the law, regulations, and/or other gov-

erning legal authority, counselors make
known their commitment to the ACA
Code of Ethics and take steps to resolve
the conflict. If the conflict cannot be re-
solved using this approach, counselors,
acting in the best interest of the client,
may adhere to the requirements of the
law, regulations, and/or other govern-
ing legal authority.

I.2. Suspected Violations
I.2.a. Informal Resolution

When counselors have reason to believe
that another counselor is violating or has
violated an ethical standard and substan-
tial harm has not occurred, they attempt
to first resolve the issue informally with
the other counselor if feasible, provided
such action does not violate confidential-
ity rights that may be involved.

I.2.b. Reporting Ethical
Violations

If an apparent violation has substantially
harmed or is likely to substantially harm
a person or organization and is not ap-
propriate for informal resolution or is not
resolved properly, counselors take fur-
ther action depending on the situation.
Such action may include referral to state
or national committees on professional
ethics, voluntary national certification
bodies, state licensing boards, or ap-
propriate institutional authorities. The
confidentiality rights of clients should be
considered in all actions. This standard
does not apply when counselors have
been retained to review the work of
another counselor whose professional
conduct is in question (e.g., consultation,
expert testimony).

I.2.c. Consultation
When uncertain about whether a
particular situation or course of ac-
tion may be in violation of the ACA
Code of Ethics, counselors consult with
other counselors who are knowledge-
able about ethics and the ACA Code

of Ethics, with colleagues, or with
appropriate authorities, such as the
ACA Ethics and Professional Stan-
dards Department.

I.2.d. Organizational Conflicts
If the demands of an organization with
which counselors are affiliated pose
a conflict with the ACA Code of Ethics,
counselors specify the nature of such
conflicts and express to their supervi-
sors or other responsible officials their
commitment to the ACA Code of Ethics
and, when possible, work through the
appropriate channels to address the
situation.

I.2.e. Unwarranted Complaints
Counselors do not initiate, participate
in, or encourage the filing of ethics com-
plaints that are retaliatory in nature or are
made with reckless disregard or willful
ignorance of facts that would disprove
the allegation.

I.2.f. Unfair Discrimination
Against Complainants
and Respondents

Counselors do not deny individuals
employment, advancement, admission
to academic or other programs, tenure,
or promotion based solely on their
having made or their being the subject
of an ethics complaint. This does not
preclude taking action based on the
outcome of such proceedings or con-
sidering other appropriate information.

I.3. Cooperation With
Ethics Committees
Counselors assist in the process of
enforcing the ACA Code of Ethics.
Counselors cooperate with investiga-
tions, proceedings, and requirements
of the ACA Ethics Committee or eth-
ics committees of other duly consti-
tuted associations or boards having
jurisdiction over those charged with
a violation.

1See the American Counseling Association web site at http://www.counseling.org/knowledge-center/ethics

• ACA Code of Ethics •

•  20  •

Glossary of Terms
Abandonment – the inappropriate ending or arbitrary ter-

mination of a counseling relationship that puts the client
at risk.

Advocacy – promotion of the well-being of individuals, groups,
and the counseling profession within systems and organiza-
tions. Advocacy seeks to remove barriers and obstacles that
inhibit access, growth, and development.

Assent – to demonstrate agreement when a person is oth-
erwise not capable or competent to give formal consent
(e.g., informed consent) to a counseling service or plan.

Assessment – the process of collecting in-depth information
about a person in order to develop a comprehensive plan
that will guide the collaborative counseling and service
provision process.

Bartering – accepting goods or services from clients in ex-
change for counseling services.

Client – an individual seeking or referred to the professional
services of a counselor.

Confidentiality – the ethical duty of counselors to protect a
client’s identity, identifying characteristics, and private
communications.

Consultation – a professional relationship that may include,
but is not limited to, seeking advice, information, and/
or testimony.

Counseling – a professional relationship that empowers
diverse individuals, families, and groups to accomplish
mental health, wellness, education, and career goals.

Counselor Educator – a professional counselor engaged
primarily in developing, implementing, and supervising
the educational preparation of professional counselors.

Counselor Supervisor – a professional counselor who en-
gages in a formal relationship with a practicing counselor
or counselor-in-training for the purpose of overseeing that
individual’s counseling work or clinical skill development.

Culture – membership in a socially constructed way of liv-
ing, which incorporates collective values, beliefs, norms,
boundaries, and lifestyles that are cocreated with others
who share similar worldviews comprising biological,
psychosocial, historical, psychological, and other factors.

Discrimination – the prejudicial treatment of an individual
or group based on their actual or perceived membership
in a particular group, class, or category.

Distance Counseling – The provision of counseling services
by means other than face-to-face meetings, usually with
the aid of technology.

Diversity – the similarities and differences that occur within
and across cultures, and the intersection of cultural and
social identities.

Documents – any written, digital, audio, visual, or artistic
recording of the work within the counseling relationship
between counselor and client.

Encryption – process of encoding information in such a way
that limits access to authorized users.

Examinee – a recipient of any professional counseling ser-
vice that includes educational, psychological, and career
appraisal, using qualitative or quantitative techniques.

Exploitation – actions and/or behaviors that take advantage
of another for one’s own benefit or gain.

Fee Splitting – the payment or acceptance of fees for client
referrals (e.g., percentage of fee paid for rent, referral fees).

Forensic Evaluation – the process of forming professional opin-
ions for court or other legal proceedings, based on professional
knowledge and expertise, and supported by appropriate data.

Gatekeeping – the initial and ongoing academic, skill, and
dispositional assessment of students’ competency for pro-
fessional practice, including remediation and termination
as appropriate.

Impairment – a significantly diminished capacity to perform
professional functions.

Incapacitation – an inability to perform professional functions.
Informed Consent – a process of information sharing as-

sociated with possible actions clients may choose to take,
aimed at assisting clients in acquiring a full appreciation
and understanding of the facts and implications of a given
action or actions.

Instrument – a tool, developed using accepted research
practices, that measures the presence and strength of a
specified construct or constructs.

Interdisciplinary Teams – teams of professionals serving
clients that may include individuals who may not share
counselors’ responsibilities regarding confidentiality.

Minors – generally, persons under the age of 18 years, un-
less otherwise designated by statute or regulation. In
some jurisdictions, minors may have the right to consent
to counseling without consent of the parent or guardian.

Multicultural/Diversity Competence – counselors’ cul-
tural and diversity awareness and knowledge about
self and others, and how this awareness and knowledge
are applied effectively in practice with clients and cli-
ent groups.

Multicultural/Diversity Counseling – counseling that recog-
nizes diversity and embraces approaches that support the
worth, dignity, potential, and uniqueness of individuals
within their historical, cultural, economic, political, and
psychosocial contexts.

Personal Virtual Relationship – engaging in a relationship
via technology and/or social media that blurs the profes-
sional boundary (e.g., friending on social networking
sites); using personal accounts as the connection point for
the virtual relationship.

Privacy – the right of an individual to keep oneself and one’s
personal information free from unauthorized disclosure.

Privilege – a legal term denoting the protection of confidential
information in a legal proceeding (e.g., subpoena, deposi-
tion, testimony).

Pro bono publico – contributing to society by devoting a por-
tion of professional activities for little or no financial return
(e.g., speaking to groups, sharing professional information,
offering reduced fees).

Professional Virtual Relationship – using technology and/
or social media in a professional manner and maintain-
ing appropriate professional boundaries; using business
accounts that cannot be linked back to personal accounts
as the connection point for the virtual relationship (e.g., a
business page versus a personal profile).

Records – all information or documents, in any medium, that
the counselor keeps about the client, excluding personal
and psychotherapy notes.

Records of an Artistic Nature – products created by the client
as part of the counseling process.

Records Custodian – a professional colleague who agrees to
serve as the caretaker of client records for another mental
health professional.

Self-Growth – a process of self-examination and challeng-
ing of a counselor’s assumptions to enhance professional
effectiveness.

• ACA Code of Ethics •

•  21  •

Serious and Foreseeable – when a reasonable counselor
can anticipate significant and harmful possible conse-
quences.

Sexual Harassment – sexual solicitation, physical advances,
or verbal/nonverbal conduct that is sexual in nature; oc-
curs in connection with professional activities or roles;
is unwelcome, offensive, or creates a hostile workplace
or learning environment; and/or is sufficiently severe
or intense to be perceived as harassment by a reason-
able person.

Social Justice – the promotion of equity for all people and
groups for the purpose of ending oppression and injustice
affecting clients, students, counselors, families, communi-
ties, schools, workplaces, governments, and other social
and institutional systems.

Social Media – technology-based forms of communica-
tion of ideas, beliefs, personal histories, etc. (e.g., social
networking sites, blogs).

Student – an individual engaged in formal graduate-level
counselor education.

Supervisee – a professional counselor or counselor-in-train-
ing whose counseling work or clinical skill development

is being overseen in a formal supervisory relationship by
a qualified trained professional.

Supervision – a process in which one individual, usually a
senior member of a given profession designated as the
supervisor, engages in a collaborative relationship with
another individual or group, usually a junior member(s)
of a given profession designated as the supervisee(s) in
order to (a) promote the growth and development of the
supervisee(s), (b) protect the welfare of the clients seen by
the supervisee(s), and (c) evaluate the performance of the
supervisee(s).

Supervisor – counselors who are trained to oversee the profes-
sional clinical work of counselors and counselors-in-training.

Teaching – all activities engaged in as part of a formal edu-
cational program that is designed to lead to a graduate
degree in counseling.

Training – the instruction and practice of skills related
to the counseling profession. Training contributes to
the ongoing proficiency of students and professional
counselors.

Virtual Relationship – a non–face-to-face relationship (e.g.,
through social media).

Index
ACA Code of Ethics Preamble …………………… 3
ACA Code of Ethics Purpose …………………….. 3
Section A: The Counseling

Relationship …………………………………….. 4
Section A: Introduction ………………………….. 4
A.1. Client Welfare …………………………………. 4
A.1.a. Primary Responsibility ………………… 4
A.1.b. Records and Documentation ……….. 4
A.1.c. Counseling Plans …………………………. 4
A.1.d. Support Network Involvement …… 4
A.2. Informed Consent in the

Counseling Relationship ………………….. 4
A.2.a. Informed Consent ……………………….. 4
A.2.b. Types of Information Needed ……… 4
A.2.c. Developmental and

Cultural Sensitivity ………………………….. 4
A.2.d. Inability to Give Consent …………….. 4
A.2.e. Mandated Clients ………………………… 4
A.3. Clients Served by Others ……………….. 4
A.4. Avoiding Harm and

Imposing Values ……………………………….. 4
A.4.a. Avoiding Harm ……………………………. 4
A.4.b. Personal Values …………………………… 5
A.5. Prohibited Noncounseling Roles

and Relationships …………………………….. 5
A.5.a. Sexual and/or Romantic

Relationships Prohibited ………………….. 5
A.5.b. Previous Sexual and/or

Romantic Relationships ……………………. 5
A.5.c. Sexual and/or Romantic

Relationships With Former
Clients ………………………………………………. 5

A.5.d. Friends or Family Members ………… 5
A.5.e. Personal Virtual Relationships

With Current Clients ………………………… 5
A.6. Managing and Maintaining

Boundaries and Professional
Relationships…………………………………….. 5

A.6.a. Previous Relationships ………………… 5
A.6.b. Extending Counseling

Boundaries ………………………………………. 5
A.6.c. Documenting Boundary

Extensions ……………………………………….. 5
A.6.d. Role Changes in the

Professional Relationship …………………. 5
A.6.e. Nonprofessional Interactions or

Relationships (Other Than Sexual or
Romantic Interactions or
Relationships) ………………………………….. 5

A.7. Roles and Relationships at
Individual, Group, Institutional,
and Societal Levels ……………………………. 5

A.7.a. Advocacy …………………………………….. 5
A.7.b. Confidentiality and Advocacy …….. 5
A.8. Multiple Clients ……………………………… 6
A.9. Group Work ……………………………………. 6
A.9.a. Screening …………………………………….. 6
A.9.b. Protecting Clients ………………………… 6
A.10. Fees and Business Practices …………… 6
A.10.a. Self-Referral ………………………………. 6
A.10.b. Unacceptable Business

Practices …………………………………………… 6
A.10.c. Establishing Fees ……………………….. 6
A.10.d. Nonpayment of Fees …………………. 6
A.10.e. Bartering ……………………………………. 6
A.10.f. Receiving Gifts …………………………… 6
A.11. Termination and Referral ………………. 6
A.11.a. Competence Within

Termination and Referral …………………. 6
A.11.b. Values Within Termination

and Referral ……………………………………… 6
A.11.c. Appropriate Termination …………… 6
A.11.d. Appropriate Transfer of

Services ……………………………………………. 6
A.12. Abandonment and

Client Neglect ………………………………….. 6

Section B: Confidentiality and Privacy …. 6
Section B: Introduction ………………………….. 6
B.1. Respecting Client Rights ………………….. 6
B.1.a. Multicultural/Diversity

Considerations …………………………………. 6
B.1.b. Respect for Privacy ………………………. 6
B.1.c. Respect for Confidentiality …………… 7
B.1.d. Explanation of Limitations ………….. 7
B.2. Exceptions ……………………………………….. 7
B.2.a. Serious and Foreseeable Harm

and Legal Requirements ………………….. 7
B.2.b. Confidentiality Regarding

End-of-Life Decisions ………………………. 7
B.2.c. Contagious, Life-Threatening

Diseases …………………………………………… 7
B.2.d. Court-Ordered Disclosure ……………. 7
B.2.e. Minimal Disclosure ……………………… 7
B.3. Information Shared With Others ……… 7
B.3.a. Subordinates ………………………………… 7
B.3.b. Interdisciplinary Teams ……………….. 7
B.3.c. Confidential Settings ……………………. 7
B.3.d. Third-Party Payers ………………………. 7
B.3.e. Transmitting Confidential

Information ……………………………………… 7
B.3.f. Deceased Clients …………………………… 7
B.4. Groups and Families ………………………. 7
B.4.a. Group Work …………………………………. 7
B.4.b. Couples and Family Counseling ………7
B.5. Clients Lacking Capacity to

Give Informed Consent ……………………. 7
B.5.a. Responsibility to Clients ………………. 7
B.5.b. Responsibility to Parents and

Legal Guardians ………………………………. 7
B.5.c. Release of Confidential

Information ……………………………………… 7
B.6. Records and Documentation ……………. 7
B.6.a. Creating and Maintaining Records

and Documentation ………………………………7

• ACA Code of Ethics •

•  22  •

B.6.b. Confidentiality of Records
and Documentation …………………………. 8

B.6.c. Permission to Record ……………………. 8
B.6.d. Permission to Observe …………………. 8
B.6.e. Client Access ………………………………… 8
B.6.f. Assistance With Records ………………. 8
B.6.g. Disclosure or Transfer ………………….. 8
B.6.h. Storage and Disposal

After Termination …………………………….. 8
B.6.i. Reasonable Precautions ………………… 8
B.7. Case Consultation ……………………………. 8
B.7.a. Respect for Privacy ………………………. 8
B.7.b. Disclosure of Confidential

Information ……………………………………… 8
Section C: Professional Responsibility ……..8
Section C: Introduction …………………………… 8
C.1. Knowledge of and Compliance

With Standards ………………………………… 8
C.2. Professional Competence ……………….. 8
C.2.a. Boundaries of Competence ………….. 8
C.2.b. New Specialty Areas of Practice ….. 8
C.2.c. Qualified for Employment …………… 8
C.2.d. Monitor Effectiveness ………………….. 8
C.2.e. Consultations on Ethical

Obligations ……………………………………….. 9
C.2.f. Continuing Education ………………….. 9
C.2.g. Impairment …………………………………. 9
C.2.h. Counselor Incapacitation,

Death, Retirement, or Termination
of Practice ………………………………………… 9

C.3. Advertising and Soliciting Clients …… 9
C.3.a. Accurate Advertising …………………… 9
C.3.b. Testimonials ………………………………… 9
C.3.c. Statements by Others …………………… 9
C.3.d. Recruiting Through

Employment …………………………………….. 9
C.3.e. Products and Training

Advertisements ………………………………… 9
C.3.f. Promoting to Those Served ………….. 9
C.4. Professional Qualifications ……………… 9
C.4.a. Accurate Representation ……………… 9
C.4.b. Credentials ………………………………….. 9
C.4.c. Educational Degrees ……………………. 9
C.4.d. Implying Doctoral-Level

Competence …………………………………….. 9
C.4.e. Accreditation Status …………………….. 9
C.4.f. Professional Membership …………….. 9
C.5. Nondiscrimination …………………………. 9
C.6. Public Responsibility ……………………… 9
C.6.a. Sexual Harassment ………………………. 9
C.6.b. Reports to Third Parties ………………. 9
C.6.c. Media Presentations …………………….. 9
C.6.d. Exploitation of Others ……………….. 10
C.6.e. Contributing to the Public Good

(Pro Bono Publico) ……………………………. 10
C.7. Treatment Modalities …………………….. 10
C.7.a. Scientific Basis for Treatment ……… 10
C.7.b. Development and Innovation ……. 10
C.7.c. Harmful Practices ………………………. 10
C.8. Responsibility to Other

Professionals …………………………………… 10
C.8.a. Personal Public Statements ………… 10
Section D: Relationships With

Other Professionals ………………………. 10
Section D: Introduction ……………………….. 10
D.1. Relationships With Colleagues,

Employers, and Employees …………….. 10
D.1.a. Different Approaches ………………… 10
D.1.b. Forming Relationships ………………. 10
D.1.c. Interdisciplinary Teamwork ………. 10
D.1.d. Establishing Professional and

Ethical Obligations …………………………. 10
D.1.e. Confidentiality …………………………… 10

D.1.f. Personnel Selection and
Assignment ……………………………………. 10

D.1.g. Employer Policies ……………………… 10
D.1.h. Negative Conditions …………………. 10
D.1.i. Protection From Punitive Action
D.2. Provision of Consultation Services … 10
D.2.a. Consultant Competency ……………. 10
D.2.b. Informed Consent in

Formal Consultation ………………………. 10
Section E: Evaluation, Assessment,

and Interpretation …………………………. 11
Section E: Introduction ………………………… 11
E.1. General …………………………………………. 11
E.1.a. Assessment …………………………………. 11
E.1.b. Client Welfare …………………………….. 11
E.2. Competence to Use and

Interpret Assessment Instruments …… 11
E.2.a. Limits of Competence ………………… 11
E.2.b. Appropriate Use ………………………… 11
E.2.c. Decisions Based on Results ………… 11
E.3. Informed Consent in Assessment ….. 11
E.3.a. Explanation to Clients ………………… 11
E.3.b. Recipients of Results ………………….. 11
E.4. Release of Data to Qualified

Personnel ……………………………………….. 11
E.5. Diagnosis of Mental Disorders ………. 11
E.5.a. Proper Diagnosis ………………………… 11
E.5.b. Cultural Sensitivity ……………………. 11
E.5.c. Historical and Social Prejudices

in the Diagnosis of Pathology ………… 11
E.5.d. Refraining From Diagnosis ………… 11
E.6. Instrument Selection………………………. 11
E.6.a. Appropriateness of Instruments …. 11
E.6.b. Referral Information ………………….. 11
E.7. Conditions of Assessment

Administration ………………………………. 11
E.7.a. Administration Conditions ………… 11
E.7.b. Provision of Favorable

Conditions ……………………………………… 11
E.7.c. Technological Administration …….. 11
E.7.d. Unsupervised Assessments ……….. 12
E.8. Multicultural Issues/Diversity

in Assessment ………………………………… 12
E.9. Scoring and Interpretation

of Assessments ……………………………….. 12
E.9.a. Reporting …………………………………… 12
E.9.b. Instruments With Insufficient

Empirical Data ………………………………… 12
E.9.c. Assessment Services …………………… 12
E.10. Assessment Security …………………….. 12
E.11. Obsolete Assessment and

Outdated Results …………………………….. 12
E.12. Assessment Construction ……………. 12
E.13. Forensic Evaluation: Evaluation

for Legal Proceedings …………………….. 12
E.13.a. Primary Obligations …………………. 12
E.13.b. Consent for Evaluation …………….. 12
E.13.c. Client Evaluation

Prohibited ………………………………………. 12
E.13.d. Avoid Potentially Harmful

Relationships ………………………………….. 12
Section F: Supervision, Training,

and Teaching …………………………………. 12
Section F: Introduction …………………………. 12
F.1. Counselor Supervision and

Client Welfare …………………………………. 12
F.1.a. Client Welfare ……………………………… 12
F.1.b. Counselor Credentials ………………… 12
F.1.c. Informed Consent and

Client Rights ………………………………….. 13
F.2. Counselor Supervision

Competence …………………………………… 13
F.2.a. Supervisor Preparation ……………….. 13

F.2.b. Multicultural Issues/Diversity
in Supervision ………………………………… 13

F.2.c. Online Supervision ………………………. 13
F.3. Supervisory Relationship ……………….. 13
F.3.a. Extending Conventional

Supervisory Relationships ………………. 13
F.3.b. Sexual Relationships …………………… 13
F.3.c. Sexual Harassment ……………………… 13
F.3.d. Friends or Family Members ……….. 13
F.4. Supervisor Responsibilities …………….. 13
F.4.a. Informed Consent for

Supervision ……………………………………. 13
F.4.b. Emergencies and Absences …………. 13
F.4.c. Standards for Supervisees …………… 13
F.4.d. Termination of the Supervisory

Relationship …………………………………… 13
F.5. Student and Supervisee

Responsibilities ……………………………….. 13
F.5.a. Ethical Responsibilities ……………….. 13
F.5.b. Impairment ………………………………… 13
F.5.c. Professional Disclosure ……………….. 13
F.6. Counseling Supervision Evaluation,

Remediation, and Endorsement ……… 13
F.6.a. Evaluation ………………………………….. 13
F.6.b. Gatekeeping and Remediation ……. 13
F.6.c. Counseling for Supervisees …………. 14
F.6.d. Endorsements …………………………….. 14
F.7. Responsibilities of Counselor

Educators ………………………………………… 14
F.7.a. Counselor Educators …………………… 14
F.7.b. Counselor Educator Competence .. 14
F.7.c. Infusing Multicultural

Issues/Diversity …………………………….. 14
F.7.d. Integration of Study and Practice …. 14
F.7.e. Teaching Ethics …………………………… 14
F.7.f. Use of Case Examples …………………. 14
F.7.g. Student-to-Student Supervision

and Instruction ………………………………. 14
F.7.h. Innovative Theories and

Techniques ……………………………………… 14
F.7.i. Field Placements ………………………….. 14
F.8. Student Welfare …………………………….. 14
F.8.a. Program Information and

Orientation ……………………………………… 14
F.8.b. Student Career Advising …………….. 14
F.8.c. Self-Growth Experiences …………….. 14
F.8.d. Addressing Personal Concerns …… 14
F.9. Evaluation and Remediation ………….. 15
F.9.a. Evaluation of Students ……………….. 15
F.9.b. Limitations …………………………………. 15
F.9.c. Counseling for Students ……………… 15
F.10. Roles and Relationships

Between Counselor Educators
and Students …………………………………… 15

F.10.a. Sexual or Romantic
Relationships ………………………………….. 15

F.10.b. Sexual Harassment …………………… 15
F.10.c. Relationships With Former

Students …………………………………………. 15
F.10.d. Nonacademic Relationships ……… 15
F.10.e. Counseling Services ………………….. 15
F.10.f. Extending Educator–Student

Boundaries ……………………………………… 15
F.11. Multicultural/Diversity Competence

in Counselor Education and
Training Programs…………………………… 15

F.11.a. Faculty Diversity ………………………. 15
F.11.b. Student Diversity ……………………… 15
F.11.c. Multicultural/Diversity

Competence …………………………………… 15
Section G: Research and Publication ….. 15
Section G: Introduction ……………………….. 15
G.1. Research Responsibilities ……………… 15

• ACA Code of Ethics •

•  23  •

G.1.a. Conducting Research …………………. 15
G.1.b. Confidentiality in Research ……….. 15
G.1.c. Independent Researchers …………… 15
G.1.d. Deviation From Standard

Practice …………………………………………… 16
G.1.e. Precautions to Avoid Injury ……….. 16
G.1.f. Principal Researcher

Responsibility ………………………………… 16
G.2. Rights of Research Participants ……… 16
G.2.a. Informed Consent in Research …… 16
G.2.b. Student/Supervisee

Participation …………………………………… 16
G.2.c. Client Participation ……………………. 16
G.2.d. Confidentiality of Information ……. 16
G.2.e. Persons Not Capable of Giving

Informed Consent …………………………… 16
G.2.f. Commitments to Participants …….. 16
G.2.g. Explanations After Data

Collection ……………………………………….. 16
G.2.h. Informing Sponsors …………………… 16
G.2.i. Research Records Custodian ………. 16
G.3. Managing and Maintaining

Boundaries …………………………………….. 16
G.3.a. Extending Researcher–

Participant Boundaries …………………… 16
G.3.b. Relationships With Research

Participants ……………………………………. 16
G.3.c. Sexual Harassment and

Research Participants ……………………… 16
G.4. Reporting Results ………………………….. 16
G.4.a. Accurate Results ………………………… 16
G.4.b. Obligation to Report

Unfavorable Results ……………………….. 16
G.4.c. Reporting Errors ………………………… 16

G.4.d. Identity of Participants ……………… 17
G.4.e. Replication Studies ……………………. 17
G.5. Publications and Presentations ……… 17
G.5.a. Use of Case Examples ………………… 17
G.5.b. Plagiarism …………………………………. 17
G.5.c. Acknowledging Previous Work …… 17
G.5.d. Contributors ……………………………… 17
G.5.e. Agreement of Contributors ………… 17
G.5.f. Student Research ………………………… 17
G.5.g. Duplicate Submissions ………………. 17
G.5.h. Professional Review ………………….. 17
Section H: Distance Counseling,

Technology, and
Social Media …………………………………… 17

Section H: Introduction ………………………… 17
H.1. Knowlede and

Legal Considerations ……………………… 17
H.1.a. Knowledge and Competency …….. 17
H.1.b. Laws and Statutes ……………………… 17
H.2. Informed Consent and Security …….. 17
H.2.a. Informed Consent and Disclosure …. 17
H.2.b. Confidentiality Maintained by

the Counselor …………………………………. 18
H.2.c. Acknowledgment of

Limitations ……………………………………… 18
H.2.d. Security ……………………………………… 18
H.3. Client Verification ………………………… 18
H.4. Distance Counseling

Relationship …………………………………… 18
H.4.a. Benefits and Limitations …………….. 18
H.4.b. Professional Boundaries in

Distance Counseling ……………………….. 18
H.4.c. Technology-Assisted Services …….. 18
H.4.d. Effectiveness of Services …………….. 18

H.4.e. Access ………………………………………… 18
H.4.f. Communication Differences in

Electronic Media ……………………………… 18
H.5. Records and Web Maintenance ……… 18
H.5.a. Records ………………………………………. 18
H.5.b. Client Rights ………………………………. 18
H.5.c. Electronic Links …………………………. 18
H.5.d. Multicultural and Disability

Considerations ……………………………….. 18
H.6. Social Media………………………………….. 18
H.6.a. Virtual Professional Presence …….. 18
H.6.b. Social Media as Part of

Informed Consent …………………………… 18
H.6.c. Client Virtual Presence ………………. 18
H.6.d. Use of Public Social Media ………… 18
Section I: Resolving Ethical Issues ……… 18
Section I: Introduction ………………………….. 18
I.1. Standards and the Law …………………… 19
I.1.a. Knowledge ………………………………….. 19
I.1.b. Ethical Decision Making ……………… 19
I.1.c. Conflicts Between Ethics

and Laws ……………………………………….. 19
I.2. Suspected Violations ………………………. 19
I.2.a. Informal Resolution …………………….. 19
I.2.b. Reporting Ethical Violations ……….. 19
I.2.c. Consultation ………………………………… 19
I.2.d. Organizational Conflicts ……………… 19
I.2.e. Unwarranted Complaints
I.2.f. Unfair Discrimination Against

Complainants and
Respondents …………………………………… 19

I.3. Cooperation With Ethics
Committees ……………………………………. 19

Glossary of Terms ……………………………….. 20

Ethics Related Resources
From ACA!

• Free consultation on ethics for ACA Members

• Bestselling publications revised in accordance with the
2014 Code of Ethics, including ACA Ethical Standards
Casebook, Boundary Issues in Counseling, Ethics Desk
Reference for Counselors, and The Counselor and the Law

• Podcast and six-part webinar series on the 2014 Code

• The latest information on ethics at counseling.org/ethics

AMERICAN COUNSELING
ASSOCIATION

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Alexandria, VA 22304

counseling.org • 800-422-2648 x222
Note: This document may be reproduced in its entirety
without permission for non-commercial purposes only.

A s professionals working with people in distress,
practicing psychologists themselves tend to face
undue stress. Some practitioners functioning in

the role of helper are far more concerned with their clients’
well-being than with their own.

Yet a proactive approach to self-care is crucial for effectively
managing occupational and personal stressors and for
maintaining optimal wellness. Good self-care is sound
prevention – guarding you against severe or chronic
distress or even professional impairment.

The global economic downturn may intensify the challenges
facing practitioners. For example, stress levels may spike for
psychologists experiencing financial concerns or hardship
while they work with clients in similar or worse situations.
In a December 2008 survey of American Psychological

Association (APA) members, up to one-third reported that
the economy had a negative impact on the number of
clients seen, income and employment security.

In good economic times and bad, practicing psychologists
have an abiding ethical imperative to engage in self-care.
The APA Ethical Principles of Psychologists and Code of Conduct
(2002, Principal A) states that: “Psychologists strive to be
aware of the possible effect of their own physical and
mental health on their ability to help those with whom they
work.”

The same self-care guidance that psychologists offer to
clients is useful for the caregivers themselves. Consider the
following self-care pointers:

� Make personal and professional self-care a priority.

� Honestly assess your psychological and physical health.
Focus on prevention rather than simply on remedying
problems such as inactivity, over commitment or poor
nutrition.

� Find time for activities that are personally restorative
such as brisk walking or other forms of exercise, yoga,
pleasure reading, journaling, meditation and massage.

16 APA PRACTICE ORGANIZATION

An Action Plan for Self-Care

EIGHT BENEFITS OF SELF-CARE

� Reduces occupational hazards such as burnout
and compassion fatigue

� Helps build resilience

� Models healthy behavior for clients

� Promotes quality of caring

� Increases the capacity for empathy

� Fortifies relationships with clients and others

� Enhances self-esteem and confidence

� Contributes to realistic goal setting

Consider how guidance for patients may apply to you

TAKING CARE OF YOURSELF

� Avoid isolation. Identify sources of social support and
use them. In addition to close family members and
friends, sources of social support might include local
civic groups or spiritual organizations, for example.

� Establish and maintain professional connections that
offer an opportunity to discuss the specific nature and
stressors of your work. Consider when it may be helpful
or necessary to tap into peer support groups or
consultation, make connections with colleagues through
professional associations or engage in personal
psychotherapy. Pay attention to possible warning signs
such as feelings of helplessness, emotional swings,
tendency to ruminate, loss of empathy or disconnecting
from family and friends.

� Take occupational risks seriously, and be aware of the
particular risks facing practicing psychologists. If
necessary, educate yourself more fully about topics such
as professional burnout, vicarious traumatization,
compassion fatigue and colleague assistance.
Incorporate this learning into your professional training
and continuing education.

� Develop realistic and reasonable expectations about
work and your capabilities at any given time. Make
appropriate accommodations or adjustments – such as
limiting your caseload or consulting with peers – in light
of professional stressors and risks that you are
experiencing.

� Pay attention to the need for balance in work, rest and
play. If your schedule is packed, be prepared to say “no”
to additional demands on your time. Take vacations or
other appropriate breaks from work. Monitor carefully
the substances and/or processes you use for relaxation
or entertainment.

� Pursue opportunities for intellectual stimulation,
including some outside the profession. Nurture interests
apart from psychology.

� Take steps to enhance your career satisfaction. Many
psychologists find it satisfying to diversify their pro-
fessional activities, perhaps incorporating a niche practice
area when the market opportunity arises. Some find it
stimulating to combine clinical and non-clinical work.

� Adopt a long-range perspective, recognizing that you
likely will have different needs at various stages of your
career. Beginning to engage in self-care practices as an
early career professional can help them become a habit.

Self-care activities should be tailored to your individual
circumstances and needs. The pointers above are intended
as healthy food for thought to help you develop a personal
action plan that works for you.

GOOD PRACTICE Spring/Summer 2009 17

PROBLEMS MOST LIKELY TO AFFECT
PSYCHOLOGIST FUNCTIONING

Problem Percentage*

Traumatic events (such as being affected by 100
war or natural disaster)

Licensing board complaints 86

Stress/burnout 54

Vicarious trauma/compassion fatigue 48

Anxiety 25

MOST FREQUENT RESPONSES
TO PROBLEMS

Response Percentage**

Talk to a colleague 34

Exercise 27

Seek family or social support 24

Consultation/supervision 23

Psychotherapy/counseling 18

Reduce clinical load 16

Participate in hobbies 16

Source: APA Board of Professional Affairs Advisory
Committee on Colleague Assistance (ACCA), 2007 pilot
survey of licensed APA members

* Percentage of respondents (n = 169) reporting that this
problem was likely to affect functioning.

** Percentage of respondents utilizing this response.

This material was developed in collaboration with the APA Board of
Professional Affairs’ Advisory Committee on Colleague Assistance (ACCA).

• 016_GoodPractice_SprSum09
• 017_GoodPractice_SprSum09

Journal of Counseling & Development ■ Winter 2007 ■ Volume 8524
© 2007 by the American Counseling Association. All rights reserved.

For many decades, counselors and counseling psychologists
have been concerned with the relationship between individu-
als’ mental health and the social milieus in which people live.
As the racial and ethnic diversity of the United States con-
tinues to increase, the need for mental health professionals
to tailor their mental health services to the needs of various
cultural populations has become more germane (Constantine,
Kindaichi, Arorash, Donnelly, & Jung, 2002). In particular,
the growing recognition of the negative consequences of
oppression in the lives of people of color has been crucial
in helping many counselors and counseling psychologists to
identify effective interventions to address such issues and to
work more broadly to effect social change (Hage, 2003; Vera
& Speight, 2003). Such awareness and actions have paralleled
the emergence of the multicultural competence movement
(Arredondo & Perez, 2003; Sue et al., 1982).

Multicultural competence generally is defined as the extent
to which counselors possess appropriate levels of self-aware-
ness, knowledge, and skills in working with individuals from
diverse cultural backgrounds (Arredondo et al., 1996; Sue,
Arredondo, & McDavis, 1992). In particular, self-aware-
ness entails being cognizant of one’s attitudes, beliefs, and
values regarding race, ethnicity, and culture, along with
one’s awareness of the sociopolitical relevance of cultural
group membership in terms of issues of cultural privilege,
discrimination, and oppression. The knowledge dimension
of multicultural competence refers to information one has
about various worldview orientations, histories of oppression
endured by marginalized populations, and culture-specific
values that influence the subjective and collective experi-
ences of marginalized populations. The skills component of
multicultural competence involves the ability to draw from an

existing fund of cultural knowledge to design mental health
interventions that are relevant to marginalized populations.
In many respects, multicultural competence has become
inextricably linked to counselors’ and counseling psycholo-
gists’ ability to commit to and actualize an agenda of social
justice (Kiselica & Robinson, 2001).

Social justice reflects a fundamental valuing of fairness
and equity in resources, rights, and treatment for marginal-
ized individuals and groups of people who do not share equal
power in society because of their immigration, racial, ethnic,
age, socioeconomic, religious heritage, physical ability, or
sexual orientation status groups (Fondacaro & Weinberg,
2002; Prilleltensky & Nelson, 1997). In order to address
social justice issues, some counselors and counseling psy-
chologists in the United States have adopted a professional
commitment to ensuring global or international social change
(Osborne et al., 1998). Others have been involved primar-
ily at a domestic level by being concerned with helping
members of U.S. society to deal with the personal, societal,
and institutional barriers that impede their academic, per-
sonal, social, or career development. Both of these levels
of involvement in social justice issues, however, are critical
in understanding the interdependence of macrosystems and
microsystems in people’s lives, especially in the lives of
marginalized populations.

In this article, we discuss the historical and contemporary
connection to social justice issues in the fields of counsel-
ing and counseling psychology vis-à-vis the multicultural
counseling movement. In addition, we underscore ways that
social justice issues can be incorporated into counselors’ and
counseling psychologists’ work with culturally diverse clients
and into the curricula of academic training programs.

Madonna G. Constantine, Sally M. Hage, and Mai M. Kindaichi, Department of Counseling and Clinical Psychology, all at Teach-
ers College, Columbia University; Rhonda M. Bryant, Department of Counseling, Educational Leadership and Foundations, Albany
State University. Correspondence concerning this article should be addressed to Madonna G. Constantine, Department of Counsel-
ing and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 92, New York, NY 10027 (e-mail:
mc81�@columbia.edu).

Social Justice and Multicultural Issues:
Implications for the Practice and
Training of Counselors and
Counseling Psychologists
Madonna G. Constantine, Sally M. Hage, Mai M. Kindaichi, and
Rhonda M. Bryant

The authors discuss the historical and contemporary connection to social justice issues in the fields of counseling and
counseling psychology via the multicultural counseling movement. In addition, the authors present ways in which social
justice issues can be addressed in counselors’ and counseling psychologists’ work with clients from diverse cultural
backgrounds and in graduate training programs.

Journal of Counseling & Development ■ Winter 2007 ■ Volume 85 25

Social Justice and Multicultural Issues

Social Justice and the Multicultural
Competencies: Their Connections
to the Fields of Counseling and
Counseling Psychology

Within the fields of counseling and counseling psychology,
the holistic, strengths-based philosophy about human nature
and its emphasis on instituting culturally relevant psychoedu-
cational, developmental, social, and vocational interventions
for diverse populations have provided fertile ground for many
social justice initiatives (Vera & Speight, 2003). In fact, many
counselors and counseling psychologists have functioned
as leaders in identifying and implementing guidelines that
address multicultural competence in mental health profes-
sionals (e.g., American Psychological Association [APA],
2003; Arredondo et al., 1996; Sue et al., 1992; Sue et al.,
1982; Sue et al., 1998). The development of such guidelines
or “competencies” has exemplified these fields’ commitment
to social change and remedying social injustices by assisting
various mental health professionals to understand individuals’
circumstances and concerns from a more ecological perspec-
tive (Fondacaro & Weinberg, 2002; Vera & Speight, 2003).
Moreover, the Multicultural Competencies have contributed to
greater awareness of the potentially oppressive roles that these
professionals could unintentionally play through unfounded
assumptions about the universality of cultures and human
experiences (Arredondo & Perez, 2003).

The original presentation of the Multicultural Counseling
Competencies was published in a counseling psychology
journal in the early 1980s (i.e., Sue et al., 1982). Ten years
later, under the leadership of Thomas A. Parham, then-
president of the Association for Counseling and Multicultural
Development, the second iteration of the Multicultural Coun-
seling Competencies was presented (i.e., Sue et al., 1992). In
1996, Arredondo et al. issued a framework that operationalized
the revised version of the Multicultural Counseling Competen-
cies. In 1998, Sue et al. added two competencies related to
organizational multicultural competence. Previous delineations
of the Multicultural Counseling Competencies served as the
backbone of the recent “Guidelines on Multicultural Educa-
tion, Training, Research, Practice, and Organizational Change
for Psychologists” (APA, 2003), which was endorsed by the
APA Council of Representatives in August 2002. Thus, the
broader field of psychology was challenged to adhere to these
aspirational guidelines to promote multicultural competence
in various dimensions of professional practice (e.g., service
delivery, research, and training).

The Multicultural Counseling Competencies (Sue et
al., 1992) were developed as an independent social justice
movement devoted to increasing the relevance of mental
health practice, research, and training to diverse populations
(Arredondo & Perez, 2003). However, most of the existing

literature related to the Multicultural Competencies reflects
attention to issues of social justice at a microlevel (e.g.,
individual counseling and small-group interventions). Such
interventions, however, are generally limited in their ability to
foster broader social change and, consequently, to bring about
true social justice (Helms, 2003). Fairly recent writings (e.g.,
Blustein, Elman, & Gerstein, 2001; Eriksen, 1999; Fox, 2003;
Jackson, 2000; Lee, 1997; Prilleltensky & Prilleltensky, 2003;
Vera & Speight, 2003) have called for increasing numbers of
counselors and counseling psychologists to engage in profes-
sional roles that attend more fully to social and contextual
forces that affect people’s mental health and well-being. As
such, in conducting social justice work, some of these mental
health professionals have adopted roles that have taken them
beyond their offices to settings such as community centers,
churches, school systems, and even legislative bodies for
the purpose of facilitating systemic changes in response to
social injustices (Hage, 2003; Kiselica & Robinson, 2001;
Thompson, Murry, Harris, & Annan, 2003). In addition, coun-
selors and counseling psychologists have been encouraged
to assume preventive mental health roles (e.g., Hage, 2003;
Romano & Hage, 2000) as extensions of social justice and
multicultural agendas.

In our clinical and research work in the areas of multicul-
tural competence and social justice, we have identified nine
specific social justice competencies that we believe are impor-
tant for counselors and counseling psychologists to consider
as they work with increasingly diverse cultural populations in
the United States. These competencies are as follows:

1. Become knowledgeable about the various ways op-
pression and social inequities can be manifested at
the individual, cultural, and societal levels, along
with the ways such inequities might be experienced
by various individuals, groups, organizations, and
macrosystems.

2. Participate in ongoing critical reflection on issues of
race, ethnicity, oppression, power, and privilege in
your own life.

3. Maintain an ongoing awareness of how your own
positions of power or privilege might inadvertently
replicate experiences of injustice and oppression in in-
teracting with stakeholding groups (e.g., clients, com-
munity organizations, and research participants).

4. Question and challenge therapeutic or other interven-
tion practices that appear inappropriate or exploitative
and intervene preemptively, or as early as feasible,
to promote the positive well-being of individuals or
groups who might be affected.

5. Possess knowledge about indigenous models of health
and healing and actively collaborate with such entities,
when appropriate, in order to conceptualize and imple-
ment culturally relevant and holistic interventions.

Journal of Counseling & Development ■ Winter 2007 ■ Volume 852�

Constantine, Hage, Kindaichi, & Bryant

6. Cultivate an ongoing awareness of the various types of
social injustices that occur within international contexts;
such injustices frequently have global implications.

7. Conceptualize, implement, and evaluate comprehen-
sive preventive and remedial mental health interven-
tion programs that are aimed at addressing the needs
of marginalized populations.

8. Collaborate with community organizations in
democratic partnerships to promote trust, minimize
perceived power differentials, and provide culturally
relevant services to identified groups.

9. Develop system intervention and advocacy skills to
promote social change processes within institutional
settings, neighborhoods, and communities.

Social Justice Issues and
Counseling Practice

Active involvement in advocacy, community outreach, and
public policy making are prime examples of interventions that
can promote attention to social justice issues among practic-
ing counselors and counseling psychologists (Eriksen, 1999;
Hage, 2003; Vera & Speight, 2003). In the spirit of encour-
aging mental health professionals to broaden their potential
repertoire of helping behaviors beyond those associated with
providing individual counseling or psychotherapy, Atkinson,
Thompson, and Grant (1993) presented a framework that
addressed eight potential helping roles in relation to working
with diverse cultural populations: (a) facilitator of indigenous
healing methods, (b) facilitator of indigenous support systems,
(c) adviser, (d) advocate, (e) change agent, (f) consultant, (g)
counselor, and (h) psychotherapist. Atkinson et al. proposed
that the assumption of any given role(s) depended on the
interaction of three client-based factors: clients’ level of ac-
culturation (i.e., the degree to which clients identify with the
values, beliefs, customs, and institutions of their culture of
origin and the host culture), the locus of the etiology of clients’
presenting problem(s) (i.e., the extent to which clients’ pre-
senting issues stem from internal issues or dynamics or from
external sources), and the goals of intervention or treatment
(i.e., the desired outcomes of helping).

Mental health professionals often adopt the counselor and
psychotherapist roles because they have been taught almost
exclusively to do so in the context of their training programs
(Constantine et al., 2002). However, the assumption of such
roles without full consideration of clients’ level of accultura-
tion, problem etiology, and treatment goals might result in the
delivery of ineffective or culturally irrelevant services. For
example, some low-acculturated individuals might experi-
ence interpersonal difficulties stemming from internal issues
(e.g., low self-esteem), but these individuals may not feel
comfortable or safe in helping relationships with counselors
or counseling psychologists who are not members of their
indigenous frameworks of helping (e.g., family members or

close friends). In such cases, these clients might benefit more
from working with counselors or counseling psychologists
who are able to serve as facilitators of indigenous support
systems or facilitators of indigenous healing methods. In
adopting either of these latter roles, these mental health
professionals should be aware of the potential functions and
importance of indigenous cultural resources, such as family
and friendship networks, religious figures and institutions,
respected community elders or leaders, and “energy healers,”
who could provide assistance that might be more synchronous
with some clients’ worldviews and values.

The roles of adviser, consultant, advocate, and change
agent embody tenets of social justice and activism through
client empowerment and advocacy. In particular, counselors
and counseling psychologists serve as advocates and change
agents when they communicate or interface with structures,
organizations, or institutions that marginalized or disenfran-
chised individuals or groups of people perceive as inherently
oppressive to their well-being. For example, a Black gay
male real estate agent, repeatedly overlooked for promotions
despite an exceptional sales record, might seek counseling or
psychotherapy to address his depressive symptoms arising
from a sense of feeling powerless at work. Although counsel-
ing or psychotherapy might assist this client in achieving his
stated presenting goal, the client also might be helped by a
counselor or counseling psychologist who could assume other
roles such as (a) aiding the client to identify his experiences
regarding racial and/or sexual discrimination and (b) helping
the client to identify potential legal recourses related to his
experiences of discrimination on the job (e.g., serving as an
adviser or consultant). The client also could be encouraged to
join a gay men’s support group or a support group consisting
of men of color in order to obtain support for discussing is-
sues of discrimination based on race or sexual orientation (i.e.,
serving as a facilitator of an indigenous support system). This
example shows that counselors and counseling psychologists
committed to principles of social justice must develop skills in
creativity and courage in order to ameliorate the consequences
of social injustice.

Using the following case example, we illustrate some ways
in which several of Atkinson et al.’s (1993) helping roles
outside of those of counselor and psychotherapist might be
assumed by a counselor or counseling psychologist working
with an international college student.

Case Example

Lydia (a pseudonym) is a 20-year-old, 3rd-year college student
from Lima, Peru, who attends a predominantly White univer-
sity in the midwestern United States. According to the intake
counselor at the university college center, Lydia presented
with issues related to feelings of homesickness. Throughout
her college experience, Lydia stated that she has struggled to
“fit” into the campus community. She also indicated that she
daydreams about her life in Peru, especially her friends and

Journal of Counseling & Development ■ Winter 2007 ■ Volume 85 27

Social Justice and Multicultural Issues

family, and that she misses speaking Spanish. Lydia spoke fluent
English, with a very slight Peruvian accent. At the end of her
intake session, Lydia requested to work with a Latina therapist,
preferably one who spoke Spanish. However, no Latina counselor
was available for ongoing counseling sessions, so Lydia was as-
signed to work with an Asian American female counselor.

During her initial counseling sessions, Lydia discussed her
erratic sleeping patterns, noting that her sleep cycles had been
short and interrupted over the past 3 weeks. She also stated that
she often had to remind herself to eat and that she had been
feeling lethargic and disinterested in her academic courses.
In addition, she reported that she had begun to withdraw from
her friends in the dorm because, she said, she “doesn’t want
to burden them with my problems.”

Lydia indicated that her symptoms began shortly after the
semester had begun, about 1 month ago. After 2 years of work-
ing part time as a teller with a Latino male supervisor with
whom she was on friendly terms, the supervisor left and was
replaced by a White woman. When Lydia was under review
for a salary increase, a financial discrepancy arose in which
the bank till was short. The female supervisor denied Lydia a
raise, despite a flawless work record, and then accused Lydia of
stealing from the bank. During this same time period, Lydia’s
philosophy professor asked her to respond to a question in
class, to which she hesitated because she felt “self-conscious”
about her accent and ability to articulate her thoughts clearly.
In the middle of Lydia’s response, her professor interrupted
and said, “Hurry up, chica,” to which her classmates laughed.
Lydia felt mortified, and, shortly after these incidents, she
became easily distracted from her studies and cared less about
schoolwork in general. Lydia remarked,

It’s not only that I think I don’t fit in here, but it’s like nobody
really wants me here, and I don’t want to be here either. I work
20 hours a week at the bank with that woman and twice as
long as other students [in completing homework assignments].
Somehow, even though my grades are good, I feel down and
drained. I try to show my teachers that I’m as smart as every-
body else, but they keep asking me if I need a tutor and to speak
quicker. I feel like no one else is going through what I’m going
through. Maybe I should just go back home to Lima.

Discussion of the Case Example

Lydia’s intake counselor initially had conceptualized her
situation as involving feelings of homesickness. However,
as Lydia worked with her assigned counselor, it appeared
that her experiences of cultural discrimination in her work
setting and in her classes had precipitated some depressive
symptoms. Lydia’s counselor explored her feelings about her
employment and educational experiences as related to ethnic
and gender discrimination and considered additional ways she
might be able to help address some of Lydia’s concerns in ways
that extended beyond their direct one-on-one work together.
For example, her counselor assumed the role of adviser by

educating Lydia about how to access civil protections against
discrimination, such as consulting with the campus Affirma-
tive Action Office and the Equal Employment Opportunity
Commission. The counselor also undertook a change agent
role on the university campus by offering cultural sensitivity
workshops to faculty members and students, focusing on rais-
ing participants’ awareness of international college students’
cultural adjustment experiences. Such a role could represent
one potential way of indirectly helping Lydia and other inter-
national students to experience less distress related to cultural
insensitivities or racism on campus. Lydia’s counselor also
served as a facilitator of an indigenous support system by
referring Lydia to a Latino(a) student organization so that she
could interact with and obtain support from other Latino(a)s
on campus who might be experiencing similar issues.

Social Justice Issues and
Counseling Training

To prepare future counselors and counseling psychologists
to assume social justice roles, it is vital that the structure,
requirements, and goals of many graduate training programs
are modified to assist students in developing competencies to
intervene at broader levels. Social justice training initiatives,
which often include applied service delivery components
(e.g., Kenny & Gallagher, 2000; Pearlman & Bilodeau, 1999;
Victims’ Service Program, 1992), have offered some graduate
students in counseling and counseling psychology with oppor-
tunities to translate their academic knowledge into real-world
contexts by developing and implementing innovative models
and programs within large community sites and by becoming
involved in social policy work (Pearlman & Bilodeau, 1999).
For example, service-learning training programs can provide
students with a practical understanding of large-scale societal
inequities, along with mechanisms by which they may intervene
to effect change (Kenny & Gallagher, 2000). In addition,
service-learning programs could offer opportunities to gain
valuable research, evaluation, and program development skills
in the context of community mental health settings, which coun-
selor and counseling psychology trainees could then transfer to
other related settings (Kenny & Gallagher, 2000).

Some counselor and counseling psychology training pro-
grams also might consider including educational, legal, and
public policy institutions as experiential or applied learning
sites for the development of critical social justice competen-
cies among their students. For example, Boston College has
partnered with the Boston Public School System’s School-to-
Career program to facilitate academic–community collabora-
tion and to provide trainees with an opportunity to learn from
educational empowerment programs (Hartung & Blustein,
2002). Within this partnership, trainees work with ninth-grade
students by offering career counseling psychoeducational
services focusing on four areas (i.e., identity development, rec-
ognizing resources and barriers to academic and career goals,

Journal of Counseling & Development ■ Winter 2007 ■ Volume 8528

Constantine, Hage, Kindaichi, & Bryant

bridging school and work, and building personal strengths).
Academic–legal collaborations also may offer counselor and
counseling psychology trainees with opportunities to witness
litigation issues related to the victimization of specific groups
of people, such as racial discrimination and sexual harassment
cases. Furthermore, collaborations with legal entities or insti-
tutions might provide these trainees with increased fluency in
navigating bureaucratic processes (Fox, 1993, 1999).

Working in social justice training settings that emphasize
less traditional helping roles could challenge some counselor
and counseling psychology trainees to work outside of their
comfort zones. Moreover, trainees who work with some com-
munity action organizations might encounter difficulties in the
initial stages of establishing trust with some of these entities,
particularly if these students and the community’s constituents
are racially, ethnically, and/or socioeconomically different from
each other. Hence, it is vital that counselor and counseling
psychology trainees who engage in social advocacy work with
organizations reflect on their personal ecological histories and
how their values, beliefs, and privileges can either facilitate or
undermine their work efforts (Prilleltensky, 2001). Experience
in community-based social justice settings also could contribute
to these trainees’ abilities to self-reflect about issues of race,
ethnicity, oppression, power, and privilege relative to their own
lives (Mulvey et al., 2000) and to nurture their competence in
working with a broader array of individuals.

Another potential issue related to counselor and counseling
psychology training and social justice initiatives pertains to
the importance of trainees critically examining their ethical
judgment and decision-making styles in relation to clients
from diverse cultural populations. For example, Welfel and
Lipsitz (1983) reported that counselors’ ethical orientation
was positively correlated with moral reasoning, counseling
experience, and number of contributions made to profes-
sional and social action organizations. If attention is given to
understanding how ethical orientation and decision-making
processes of counselor and counseling psychology trainees
might relate to the assumption of social justice initiatives in
a professional context, it might encourage these students to
recognize areas that might need attention with regard to their
competence as service providers.

Lee (1997) asserted that mental health professionals should
become better trained to understand social justice issues from a
more global perspective. This point is based on the notion that
as the interconnectedness of the world becomes increasingly
acknowledged in psychology, social and economic forces will
continue to reshape the composition of societies throughout
the world and narrow the physical and social distance between
groups of people. As such, counselor and counseling psychol-
ogy training programs also should focus on worldwide social
transformation and the need for mental health intervention at
the individual, group, organizational, societal, and interna-
tional levels. Hence, counselor and counseling psychology
trainees should be encouraged and required to understand

how mental health issues may be manifested in populations
residing outside of the United States.

One mechanism that could provide counseling and counseling
psychology students with applied training in this vein would be
the opportunity to conduct a practicum or internship outside of
the United States (Lee, 1997). For example, in a collection of
narratives by feminist community psychologists (Mulvey et al.,
2000), Ingrid Huygens described how her efforts to engage Maori
women in a lesbian health promotion group forced her to reevalu-
ate her notions of relationship building, in comparison with Maori
cultural practices that initiate collaborations. Her efforts also led
her to realize that the numerical or physical representation of
people from marginalized groups within certain contexts was
not necessarily equivalent to the sharing of procedural power in
such contexts. Thus, opportunities for counselor and counseling
psychology trainees to participate in foreign exchange programs
would expose students to different cultural ecologies and racial
landscapes that could encourage them to reflect more deliberately
on their status as helpers and as cultural beings (Lee, 1997).

Finally, counselor and counseling psychology training pro-
grams might consider increasing the emphasis given to preven-
tion in their curricula and research initiatives (Conyne, 1997;
Romano & Hage, 2000). In addition to developing practicums
that give greater emphasis to applying and evaluating preven-
tion interventions, a prevention focus could be achieved either
through freestanding courses or through infusion into existing
courses. Romano and Hage suggested eight training domains
relevant to prevention that could be the content of such course
work: community and multidisciplinary collaboration, social
and political history, protective factors and risk-reduction
strategies, systemic intervention, political and social environ-
ment, psychoeducational groups for prevention, prevention
research and evaluation, and prevention ethics. These training
domains could provide students with knowledge and skills to
engage effectively in the practice of prevention.

Conclusion
Counselors and counseling psychologists must continue to
think creatively about how to address social justice issues
in their own work with clients and with students in training
in their fields. As leaders in the multicultural competence
movement, counselors and counseling psychologists are also
in unique and powerful positions to educate their peers about
the importance of mental health professionals achieving
appropriate levels of competence in working with diverse
cultural populations. Counselors and counseling psycholo-
gists are situated in an optimal position to help society’s in-
habitants understand the undue effects of social injustices for
the well-being of the larger society. The increasing cultural
diversity of the United States underscores the importance
and timeliness of these issues, which ultimately could have
profound implications for the well-being of individuals
around the world.

Journal of Counseling & Development ■ Winter 2007 ■ Volume 85 29

Social Justice and Multicultural Issues

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Journal of Counseling & Development ■ April 2014 ■ Volume 92 131

Special Section:
Professionalism, Ethics, and
Value-Based Conflicts in Counseling

© 2014 by the American Counseling Association. All rights reserved.

DOI: 10.1002/j.1556-6676.2014.00138.x

The primary purpose of a code of ethics, for any profession, is
to establish norms and expectations for practitioners in order
to collectively minimize the risk of harm to clients and the
general public (Welfel, 2010). In a broader sense, a code of
ethics is also a reflection of the profession’s collective values
and moral principles. Indeed, the establishment of a code of
ethics, which communicates a normative orientation to the
service of others and a commitment to protect the welfare
of clients, is considered the “hallmark of professionalism”
(Gorman & Sandefur, 2011, p. 279). Promulgation of a code
of ethics places the needs and interests of clients over and
above the personal needs or values of any individual member
of the profession (DeMitchell, Hebert, & Phan, 2013; Gor-
man & Sandefur, 2011). A code of ethics helps to ensure
the primacy of client welfare by articulating a profession’s
collective set of values and communicating standards of prac-
tice for all members of that profession. Because laws set the
minimum standards of acceptable behavior, ethical standards
often exceed the legal requirements articulated in federal and
state laws (Corey, Corey, & Callanan, 2011). Entry into and
continued association with a profession requires all of its
practitioners to make a commitment that they will abide by
the profession’s code of ethics and the profession’s collective
values as reflected in that code.

By all measures, counseling is a profession (Gorman
& Sandefur, 2011). Counseling is a vocation that requires
individuals to obtain specific, university-based training to
acquire expertise in a specialized set of knowledge and
skills; confers status and power upon its members; has an

Perry C. Francis and Suzanne M. Dugger, Department of Leadership and Counseling, Eastern Michigan University. Correspon-
dence concerning this article should be addressed to Perry C. Francis, Department of Leadership and Counseling, Eastern Michigan
University, 135 Porter Building, Ypsilanti, MI 48197 (e-mail: pfrancis@emich.edu).

Professionalism, Ethics, and
Value-Based Conflicts in Counseling:
An

Introduction to the Special Section

Perry C. Francis and Suzanne M. Dugger, Guest Editors

This introduction to this special section of the Journal of Counseling & Development explores the importance of a code
of ethics to the establishment and maintenance of a profession. Recognizing a code of ethics as a communication of
a profession’s collective values and expectations, the editors of this special section acknowledge the dilemmas that
arise when a counselor’s personal values do not align with the profession’s collective values. The authors of each
article address value-based conflicts in counseling.

Keywords: counselor training, ethics, litigation, religion, LGBT

established national association through which it establishes
a collective identity, communicates professional values, dis-
seminates scholarly research, and advocates for its members;
and regulates itself through licensure and a code of ethics.

Although counselors vary with regard to specializations
and/or the settings in which they practice, they are united as a
single profession through the American Counseling Associa-
tion (ACA). Through this umbrella association, counselors
of varied specializations come together for the purposes of
promoting a shared professional identity, protecting clients,
and promulgating the ACA Code of Ethics (ACA, 2005) to
which all members must adhere. In addition, many counselors
join divisions within ACA, which are focused on more spe-
cialized areas of practice (e.g., college or school counseling)
or shared goals or ideals (e.g., social justice). When these
divisions have established their own code of ethics, those
codes are designed to supplement, not supplant, the ACA
Code of Ethics. As such, their members are responsible for
adhering to those specialized ethical standards and the ACA
Code of Ethics.

Values and Expectations Communicated
by the ACA Code of Ethics

The collective values of the counseling profession are com-
municated in the ACA Code of Ethics (ACA, 2005). Included
within these values and most relevant to this special section
are the recognition of each client’s inherent worth and dignity;
a respect for each client’s uniqueness, autonomy, and right

Journal of Counseling & Development ■ April 2014 ■ Volume 92132

Francis & Dugger

to self-determination; an honoring of human growth and
development; and a respect for diversity within our clientele
and a valuing of cultural competence in counselors. Related
to the communication of these values, ACA (2005) also com-
municated expectations for professional behavior, stating “the
primary responsibility of counselors is to respect the dignity
and promote the welfare of clients” (Standard A.1.a.).

Toward this goal, professional counselors are expected
to conduct themselves in ways that demonstrate a genuine
valuing of each client as a unique individual, that honor each
client’s right to make choices in accordance with his or her
own personal beliefs and standards, and that facilitate each
client’s growth within a myriad of developmental domains
(ACA, 2005, preamble). Professional counselors are also ex-
pected to constantly strive toward increased levels of cultural
competence (Standard C.2.a.) and to avoid discriminatory
practices with respect to a wide variety of cultural dimen-
sions (Standard C.5.). Indeed, competence as a professional
counselor is contingent upon one’s ability to “embrace a
cross-cultural approach in support of the worth, dignity,
potential, and uniqueness of people within their social and
cultural contexts” (ACA, 2005, preamble). In respecting the
diversity of clients, professional counselors must be “aware
of their own values, attitudes, beliefs, and behaviors and avoid
imposing values” (ACA, 2005, Standard A.4.b.).

Values, Power, and Potential for Harm
In light of the prohibition against counselors imposing their
values on clients, counselors should recognize the ways in
which their personal values may be directly or indirectly
communicated to clients and be aware of how the power
differential that exists within each counseling relationship
may result in the imposition of their values. Although most
counselors understand that directly communicating their
values to clients is unacceptable, concerted effort and con-
stant vigilance are necessary to avoid communicating their
values indirectly. Without such vigilance, counselors may
inadvertently communicate their personal values through
nonverbal and extraverbal responses to client disclosures,
by which client stories they focus on and which they avoid,
by how convincingly they communicate caring and respect
for a client, by which interventions they select, by the sug-
gestions they make or the homework they assign, and by
their willingness to continue seeing a client. In such ways,
counselors may intentionally or inadvertently communicate
their personal values to their clients.

Although communication of one’s own values within an
equal, reciprocal relationship would not constitute an imposi-
tion of values, communication of one’s personal values within
an unequal relationship with a vulnerable client can result in
the imposition of values. Zinnbauer and Pargament (2000)
showed that, when a counselor’s values are communicated
during psychotherapy, clients demonstrate a tendency to

move toward adopting those values. Factors likely to contrib-
ute to such influence include the power differential present
within the counseling relationship, the counselor’s perceived
expertise, and the client’s vulnerability. Individuals who are
most vulnerable to this potential imposition of values include
clients or students in any setting where the choice of a coun-
selor may be restricted (e.g., K–12 schools, small colleges
and universities) or where professional services are limited
to a handful of potential practitioners (e.g., clients in rural
or underserved areas).

To be sure, though, the potential for an abuse of power
exists in every counseling relationship, and clients are vul-
nerable to undue influence and microaggressions that can
occur when a counselor communicates any personal values
that are contrary to those of the client (Sue, 2010; Zinnbauer
& Pargament, 2000). When clients are struggling with issues
about which they feel confused, conflicted, or ambivalent,
even the most subtle communication of personal values has
a likelihood of swaying a client to act in accordance with
the counselor’s values rather than facilitating the client’s
exploration of his or her own values. In this way, values can
be imposed. Therefore, the expectation that counselors take
special care in not imposing their values is especially impor-
tant in demonstrating respect for each client’s right to make
choices in accordance with his or her own personal beliefs
and standards and in avoiding discriminatory practices. In the
absence of such restraint, counselors place clients at risk for
harm in ways that may be blatant or subtle and rationalized
as a means to providing the best care for the client (Shiles,
2009; Sue, 2010).

Value Conflicts
Although the ACA Code of Ethics (ACA, 2005) prescribes
expectations for professional behavior, the ultimate hope is
that each individual counselor will internalize the profession’s
collective values. The preamble of the ACA Code of Ethics
delineates this:

Professional values are an important way of living out an
ethical commitment. Values inform principles. Inherently held
values that guide our behaviors or exceed prescribed behaviors
are deeply ingrained in the counselor and developed out of
personal dedication, rather than the mandatory requirement
of an external organization. (ACA, 2005, preamble)

Such internalization, however, does not always occur. This
lack of internalization is most likely when there are areas of
conflict between an individual’s personal values and the pro-
fession’s collective values as articulated by the ACA Code of
Ethics (ACA, 2005). Such value conflicts are the focus of this
special section. Specifically, this special section is designed
to address the dilemmas that occur when an individual coun-
selor’s personal values conflict with the profession’s collective

Journal of Counseling & Development ■ April 2014 ■ Volume 92 133

Introduction to the Special Section

values as communicated in its code of ethics. At the heart of
these dilemmas is the issue of how best to protect clients from
harm that may result from counselors acting in accordance
with their personal values and in violation of the collective
values of the profession.

Recent and Not-So-Recent
Value Conflicts

Recent court cases (i.e., Keeton v. Anderson-Wiley, 2010; Ward
v. Wilbanks, 2009) challenged the profession about what to do
when the personally held values of counselors are in conflict
with the ACA Code of Ethics (ACA, 2005). The aformentioned
court cases focused on a specific conflict between the personal
values of some counselors and the collective values of the
profession. Whereas the profession values diversity, prohibits
discrimination on the basis of sexual orientation (and many
other factors), and requires that “counselors gain knowledge,
personal awareness, sensitivity, and skills pertinent to work-
ing with a diverse client population” (ACA, 2005, Standard
C.2.a.), some counselors and counselors-in-training object to
the idea of providing counseling services to nonheterosexual
clients in any manner that could be mistaken for acceptance
of their lifestyle. They contend that any requirement for them
to do so is discriminatory against their constitutional right to
practice in accordance with their religious beliefs. In contrast,
the profession (via ACA) argued that communication of
such beliefs reflects an imposition of one’s personal values
and that a refusal to see nonheterosexual clients represents
discrimination on the basis of sexual orientation (Ex. at Sep.
30, 2009; see also http://www.counseling.org/resources/pdfs/
EMUamicusbrief ).

Central to this dilemma for some counselors is a belief
that the only ways to honor their personal and/or religious
beliefs as counselors are by directly communicating one’s
values to the client, refusing to discuss same-sex relation-
ships with clients, or implementing a policy of automatically
referring nonheterosexual clients to other counselors. We
respectfully disagree with this belief and offer a discussion
of a much less recent dilemma to illustrate another pos-
sibility. Whereas sexual orientation and gay rights are the
hot-button issues of the day that most frequently conflict
with religious beliefs, a different issue caused similar con-
troversy in the 1960s. That decade was marked by the sexual
revolution and an increasing level of societal acceptance of
sexual activity outside of marriage. This issue, too, caused
great consternation for people who held religious beliefs
against such activity.

One can easily imagine a counselor in 1965 feeling deeply
conflicted when faced with a client engaged in sexual activ-
ity outside of marriage; the counselor’s conflict would have
reflected religious beliefs that were opposed to such activity.
If counselors also believed that the only way they could honor

their religious convictions was to communicate their values to
the client, refuse to discuss extramarital sexual relationships
with clients, or implement a policy of automatically referring
those clients to other counselors, how would this action have
affected those clients? As it happens, Carl Rogers encountered
just such a client, and his session with “Gloria” was recorded
on a widely disseminated training video that is still used today
(Shostrom, 1965) and is now available on YouTube.

Although we do not know what religious beliefs Carl
Rogers held or whether he experienced any value conflict
when counseling Gloria, we do know that (a) Gloria revealed
her participation in casual sexual relationships after her re-
cent divorce and (b) her counselor could have experienced
a value conflict in this situation. In a particularly tender
point in the session, Gloria expressed feeling guilty about
engaging in these sexual relationships and guilty for lying
to her daughter about it. When Gloria directly asked Carl
Rogers what she should do, she was clearly vulnerable to
an imposition of his values. Consider how the following
possible responses—none of which were made by Carl
Rogers—could have affected Gloria:

• “This is your life and you can do as you like, but I
believe that sex outside of marriage is a sin.”

• “Your sexual relationships aren’t something I am
comfortable discussing with you. What else would
you like to talk about?”

• “I know a great counselor across town who specializes
in these issues, and I would like to refer you.”

Our hope is that the potential harm that could befall Glo-
ria as a result of such responses is clearly evident. Already
feeling guilty, Gloria was especially vulnerable to signs
of disapproval or rejection. Carl Rogers’s actual response
offered neither. Additionally, and very importantly, his
response also did not communicate acceptance. Instead, he
acknowledged hearing Gloria’s plea for advice about what
to do and communicated that, although he wished he could
tell her what she should do, this was a very personal deci-
sion that only she could make.

For counselors facing any similar dilemma involving a
conflict between their personal value system and the pro-
fession’s values, we suggest that this approach may offer
a way to resolve the conflict. This nondirective approach
does not violate the ACA Code of Ethics (ACA, 2005) and
allows a counselor to honor personal religious beliefs. It
simply does not involve communicating those beliefs to the
client via direct statements; indirect, selective attention to
topics; or referrals.

Focus of the Special Section
Each of the articles in this special section addresses the issue
of value conflicts and explores means by which they might be

Journal of Counseling & Development ■ April 2014 ■ Volume 92134

Francis & Dugger

reconciled. The section begins with three articles addressing
the recent Ward v. Wilbanks (2009) court case. In the open-
ing article, Suzanne Dugger and Perry Francis describe the
case and offer insights into the lessons learned. Next, ACA’s
chief professional officer, David Kaplan, analyzes the ethi-
cal implications of the case and describes ACA’s position on
the issues raised by this case. Then, Barbara Herlihy, Mary
Hermann, and Leigh Greden explore the legal and ethical
implications of using religious beliefs as the basis for refusing
to counsel certain clients.

The section then shifts from this narrow focus on the
Ward v. Wilbanks (2009) case to a broader exploration of
value-based conflicts within the counseling profession. In her
article, Irene Ametrano addresses ways in which counselor
educators can teach ethical decision making and help students
reconcile their personal values with the profession’s values.
Also addressing ways to prepare future counselors to deal
with values conflicts, Joy Whitman and Markus Bidell’s article
explores ways to bridge the gap between religious beliefs and
affirmative counselor education. In the next article, Markus
Bidell explores the experience of individual counselors expe-
riencing discord between their conservative religious beliefs
and the expectation that they, as professional counselors,
will not discriminate in offering positive regard to clients.
Next, Michael Kocet and Barbara Herlihy reveal their newly
developed model for ethical decision making. This model is
focused on addressing value-based conflicts that may arise
within a counseling relationship.

Finally, this special section concludes with two articles
dedicated to exploring the perspectives of various religions
pertaining to sexual orientation and value conflicts. Richard
Balkin, Richard Watts, and Saba Ali offer Jewish, Christian,
and Muslim perspectives on the intersection of faith, race,
and sexual orientation. In the final article, Devika Choudhuri

and Kurt Kraus address ways in which Buddhist perspec-
tives may be useful in reconciling value conflicts that arise
in counseling.

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its content may not be copied or emailed to multiple sites or posted to a listserv without the
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articles for individual use.

Online Counseling: A Narrative and Critical Review of the Literature
Derek Richards1 and Noemi Viganó2

1University of Dublin, Trinity College
2Alliance Counselling, Dublin, Ireland

Objective: This article aimed to critically review the literature on online counseling.
Method: Database and hand-searches were made using search terms and eligibility criteria, yielding
a total of 123 studies. Results: The review begins with what characterizes online counseling. Out-
come and process research in online counseling is reviewed. Features and cyberbehaviors of online
counseling such as anonymity and disinhibition, convenience, time-delay, the loss of social signal-
ing, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client
suitability, and clients’ and therapists’ attitudes and experiences of online counseling are reviewed.
Conclusion: A growing body of knowledge to date is positive in showing that online counseling can
have a similar impact and is capable of replicating the facilitative conditions as face-to-face encounters.
A need remains for stronger empirical evidence to establish efficacy and effectiveness and to under-
stand better the unique mediating and facilitative variables. C© 2013 Wiley Periodicals, Inc. J. Clin.
Psychol. 69:994–1011, 2013.

Keywords: online counseling; outcomes and process research; therapeutic relationship; cyberbehaviors;
ethics; attitudes and experiences; suitability and training

The field of cyberpsychology involves the study of human experiences (cognitive, emotional,
and behavioral) that are related to or effected by developing technologies, in other words the
psychological study of human-technology interaction (Richards & Viganó, 2012). One area of
cyberpsychology is online counseling, also referred to as e-therapy, e-counseling, or cyberther-
apy. While the very nature and definition of online counseling have been debated, we will use the
one employed by Richards and Viganó (2012), defining online counseling as the delivery of ther-
apeutic interventions in cyberspace where the communication between a trained professional
counselor and client(s) is facilitated using computer-mediated communication (CMC) technolo-
gies, provided as a stand-alone service or as an adjunct to other therapeutic interventions.

Alongside technological developments online counseling has grown in the past 15 or so years.
Researchers in online counseling have been considering the potential effectiveness of online
counseling and whether it is possible to establish a therapeutic relationship in cyberspace. Re-
search studies have focused on establishing its potential benefits and challenges, client suitability
for online counseling, therapists’ and clients’ attitudes and experiences of online counseling, and
professional training for working online with clients. Additionally, its very nature and definition
as a therapeutic intervention has been debated. Researchers have been exploring newly observed
phenomena that form part of understanding the psychology of online counseling behavior. Ar-
eas of interest include the effects of apparent anonymity and distance, disinhibition, identity and
impression management, writing and emotional expression in cyberspace, and ethical behavior
in cyberspace.

While other reviews of online counseling have been written, notably, the special issue from the
Journal of Clinical Psychology, 2004, and the volume from The Counseling Psychologist, 2005,
the contribution of the current article is the systematic nature of the work, and we believe the
extensiveness and thoroughness of the work will provide the discipline with a comprehensive
review of the field and also an evaluation of the present empirical knowledge and suggestions
for the future clinical practice and research. The paper reviews, among others, research relat-
ing to process and outcome, the therapeutic relationship, the characteristic features of online
counseling, and ethical considerations for delivering therapeutic interventions online.

Please address correspondence to: Derek Richards, University of Dublin, Trinity College. Dublin. E-mail:
derek.richards@tcd.ie

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 69(9), 994–1011 (2013) C© 2013 Wiley Periodicals, Inc.
Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.21974

Online Counseling: A Narrative Review 995

Method

Literature Search and Selection of Studies

The aim of the literature search was to find all references related to online counseling. We drew
on our research experience and knowledge of the field and we reached agreement regarding
the means to carry out the search and the search terms to be used. A search of three leading
databases for psychology (EMBASE, PubMed, and PsychINFO including PsychARTICLES)
was conducted for studies published in peer-reviewed journals. Based on the literature, eight
search terms were employed–online counseling and online counselling, cybercounseling and
cybercounselling, web therapy, web counseling and web counselling, e-therapy, e-counseling
and e-counselling, cybertherapy, and web consulting–culminating in a total of 24 searches.

Results, which included original research, meta-analysis, and other reviews, were assessed
at title, abstract, or by reading the full paper to determine whether they met our eligibility
criteria. Studies were included when they met (a) the definition of online counseling employed
by Richards and Viganó (2012): involving the delivery of a therapeutic intervention by a trained
professional to client(s) using synchronous or asynchronous computer mediated communication
(CMC). Included were (b) papers that addressed any aspect of this encounter such as process
and outcome studies, ethics, online behaviors associated with the encounter, training, suitability,
its definition and nature, attitudes, experiences, (c) and all age groups. Papers were excluded (a)
if they did not involve a trained professional counselor and client(s), (b) that did not deliver a
therapeutic intervention e.g., careers guidance counseling or medical therapeutics, (c) and that
did not use CMC, but instead telephone, or was solely a self-administered program.

We rejected duplicates and we assessed each of the studies for inclusion, any difficulties we
discussed and a final decision was made. Further, a hand search was made of papers to identify
other relevant studies for inclusion. Reasons for rejecting papers included that they were not
a therapeutic intervention, were not in English, did not employ CMC, were an unpublished
thesis, or a conference paper (see Figure 1). A comprehensive summary of information extracted
from the papers was written, considering the characteristics of online counseling, associated
process and outcome research, the therapeutic relationship in cyberspace, potential benefits
and challenges, client suitability for online counseling, therapists’ and clients’ attitudes and
experiences of online counseling, and professional training for working online with clients.
Further, the review considered online behavior as it applies to online counseling: anonymity and
distance, disinhibition, identity and impression management, writing and emotional expression,
and ethical online behavior.

The subheadings under which the papers were reviewed evolved from the study of the pa-
pers and also from our own experience with online counseling. Therefore, some subheadings
were initially derived as needing to be represented such as outcome and process research, the
therapeutic relationship, benefits, and challenges, while others evolved more naturally from the
literature and include attitudes, training, suitability, and unique features of online counseling
behavior.

Results and Discussion

Three databases, PubMed (n = 1,163), EMBASE (n = 1,124), and PsychINFO including Psy-
chARTICLES (n = 185), were searched. Identified papers (n = 2,319) were screened against the
established eligibility criteria, yielding 85 papers. A further 38 papers were identified through
hand-search. Figure 1 shows the results of the systematic search.

Characteristics of Online Counseling

Providing a definition for online counseling is somewhat problematic as the exact nature of
interventions involving therapists and clients online have been in flux and are a continued
source of debate. Recently, Barak, Klein, and Proudfoot (2009) have tried to bring some clarity
by providing some guiding definitions, classifications, and descriptions of a range of online

996 Journal of Clinical Psychology, September 2013

Figure 1. Results from the systematic search.

Online Counseling: A Narrative Review 997

therapeutic interventions. However, definitions still remain unspecific regarding any theoretical
or technical approach, and professionals’ level of training (Rochlen, Zack, & Speyer, 2004).

Synchronous (chat and video conferencing) and more popularly asynchronous (e-mail) com-
munication, as well as combinations of these have been employed to deliver online counseling
as a standalone service and as an adjunct to other services. Some web-based, self-administered
treatments for a variety of disorders have included online counseling support, usually in the form
of asynchronous postsession feedback, which appears to increase adherence and yield enhanced
outcomes (Newman, Szkodny, Llera, & Przeworski, 2011; Richards & Richardson, 2012).

Some (Castelnuovo, Gaggioli, Mantovani, & Riva, 2003) consider that online counseling is a
transposition of face-to-face (F:F) counseling online, with technologies mediating the therapeu-
tic communication and affecting the process with their associated advantages and limitations.
However, others (Fenichel et al., 2002; Grohol, 1999, 2001) consider that online counseling
should be considered a new type of therapeutic intervention, a distinct way of engaging thera-
peutically and therefore needing a different theoretical framework from F:F counseling. From
this perspective online counseling is considered a new, versatile, and flexible resource with the
potential to complement and support other types of interventions.

A number of issues that have been debated in the literature from the beginning have been raised
as criticisms by both professionals and laypeople (Barak, Hen, Boniel-Nissim, & Shapira, 2008):
the effect of the loss of cues on the process of therapy and consequently whether counseling
can occur in such a context; ethical issues and in some cases their potential legal implications
regarding the delivery of online counseling; and practical issues have arisen concerning training
for conducting online counseling and concerns about relying on technology. Yet in spite of strong
criticisms being put forward, from its beginning the various technology-delivered psychological
interventions have flourished. Barak et al. (2009) state that this is likely due to several factors
including:

� Increasing acceptability of the Internet as a legitimate social tool
� Computer hardware and software developments (especially in relation to ease of use, privacy

protection, and online communication capabilities)
� Development of ethical guidelines by various professional organizations
� Growing research
� Establishment of online training for professionals

Outcomes and Process Research in Online Counseling

The goal of counseling is to alleviate the distress, anxiety, and concerns that clients can present.
Counseling attempts to return a client to precrisis functioning and in doing so foster clients’
well-being, build on a client’s strengths, and help improve overall functioning (Mallen, Vogel,
Rochlen, & Day, 2005). It is our opinion that online counseling must also adhere to the same
objectives, because it seems reasonable to assume that that is what users of counseling (online
or F:F) are seeking.

Efficacy and effectiveness of online counseling. Cohen and Kerr’s (1998) analogue
study using the State-Trait Anxiety Inventory measured participants’ anxiety before and after
being assigned (N = 24 students) to one session of either F:F or online synchronous (chat)
counseling. Both groups showed a decrease in anxiety outcomes posttreatment. Although the
study was somewhat artificial, as it used students to deliver and receive treatment, it screened out
participants with high levels of distress, and the sample was small; nevertheless, it represented a
worthwhile beginning.

The series of studies by Glueckauf and colleagues (1999, 2002) attempted to assess outcomes
by randomizing teenagers (N = 39) with epilepsy and their parents for six sessions of fam-
ily counseling among video, audio, F:F counseling, and a waitlist control. They employed a
number of measures such as the Problem Severity and Frequency Scale, Social Skills Rating
System Scale, and a modified form of the Working Alliance Inventory, and they also tracked
treatment adherence. Twenty-two families completed the treatment and data were collected at

998 Journal of Clinical Psychology, September 2013

week 1 and 6 months posttreatment. They found that the teenagers and parents in each of the
treatment groups demonstrated significant reductions in both problem severity and frequency
at both posttreatment and 6-month follow-up. At posttreatment, prosocial behaviors increased,
as reported by parents, and these were maintained at follow-up. However there didn’t seem to be
any changes in problem behaviors over time. The sample size was small and also the population
very specific, thereby limiting generalizability of the results.

Day and Schneider (2002) randomized 80 clients and compared process and outcome variables
across three treatment groups: F:F, telephone, and video psychotherapy. Participants completed
five sessions and measures of working alliance, session outcome, and satisfaction. The results
showed no statistically significant differences between the three delivery modes for either working
alliance or outcomes. However, they found a statistically significant difference in the level of
participation: clients in distance therapy participated more actively than those in F:F therapy.
The researchers speculated that the clients in the distance modes perhaps made more of an effort
to communicate or took more responsibility for the interaction, or perhaps the distance made
those participants feel safer. Although the study is an important contribution to empirically
establish online counseling, it is limited by sample size and the broad range of presenting issues
included (Day & Schneider, 2002).

Robinson and Serfaty (2001, 2008) employed qualified therapists who corresponded with
clients with an official Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Amer-
ican Psychiatric Association, 2000) diagnosis for an eating disorder via e-mail at least twice a
week for a period of 3 months. The therapists were supervised by specialists with experience in
eating disorders psychiatry, who received each e-mail correspondence, annotated it, and returned
it to the therapist. Robinson and Serfaty (2001) reported significant improvements in bulimic
symptoms for participants at 3-month follow-up and a significant reduction in the number of
participants fulfilling DSM-IV eating disorder criteria at posttreatment (50% of the 19 partici-
pants), compared with a waitlist control group. Although the samples were small and the design
did not include a comparison with F:F treatment, the results are encouraging for the use of
online counseling for eating disorders.

A number of studies employed videoconferencing technology to deliver therapy for the treat-
ment of eating disorders. For instance Mitchell et al. (2008) delivered 20 sessions of cognitive-
behavioral therapy (CBT) over a 16-week period for the treatment of bulimia nervosa (BN) in
a sample of 128 adults meeting the DSM-IV criteria for BN or eating disorder not otherwise
specified (EDNOS). Participants were randomly assigned to either F:F CBT or online-delivered
CBT. Participants were assessed by interview at posttreatment, and at 3-month and 12-month
follow-up. Retention was comparable in both groups, and abstinence rates were higher for the
online group compared with the F:F group, but not statistically significant. They concluded that
delivering online treatment was acceptable to many patients and roughly equivalent in outcome
to F:F therapy.

Simpson and colleagues (Simpson, Bell, Knox, & Mitchell, 2001; Simpson, Deans, & Brebner,
2005) have reported on the use of videoconferencing technology to deliver treatments for BN
and eating disorders to remote and geographically distant populations. The first study (2001)
assessed participants (N = 10) F:F, and then assigned them to 10 sessions via teleconferencing.
Prescores and postscores from the General Health Questionnaire (Goldberg, 1972) and post-
session Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM;Barkham et
al., 2010) scores revealed that participants showed a decrease in symptamotology and increases
in well-being. In a second study (2005) of six participants meeting DSM-IV criteria for BN
or EDNOS, Simpson and colleagues reported finding that most participants made clinically
important improvements in terms of bulimic symptoms, levels of depression, and borderline
symptomatology. Although the studies included official diagnostic assessment of symptoms,
they had small samples and lacked follow-up.

Zabinski and colleagues (Zabinski et al., 2001; Zabinski, Wilfley, Calfas, Winzelberg, & Taylor,
2004) examined the use of synchronous Internet-delivered group chat for the prevention of eating
disorders in four female students. The program was advertised as an educational intervention
for women with elevated weight and shape concerns. It consisted of eight 1-hour weekly sessions.
All sessions were moderated by an advanced graduate student in clinical psychology specializing

Online Counseling: A Narrative Review 999

in eating disorders. The study employed a number of standard self-report instruments, such as
the Body Shape Questionnaire, Eating Disorders Inventory, and Eating Disorders Examination
Questionnaire, and reported improvements ranging from small to medium effect sizes in eating
disordered behavior and body image attitudes (Zabinski et al., 2001). A follow-up randomized
controlled study demonstrated that intervention participants showed significant improvements
over the waitlist control participants on most subscales of eating pathology with robust effect
sizes, particularly from baseline to follow-up as measured by the Eating Disorder Examination
Questionnaire (Zabinski et al., 2004).

Hopps, Pépin, and Boisvert (2003) employed chat technology to investigate the effect of
cognitive-behavioral group therapy on feelings of loneliness among a sample (N = 19) of chron-
ically lonely people with physical disabilities. The study, using a waitlist control randomized
design, employed a number of outcome assessments including the Loneliness Scale, Emotional
Versus Social Loneliness Scale, and personal definitions of loneliness. The results showed signifi-
cant improvements for participants on items regarding personal, social, and emotional loneliness
and these were maintained at 4-month follow-up. Generalizing results is, however, limited by the
sample size and the particular population studied.

Other online counseling interventions have been experimented with where users (adults and
teenagers) have presented a broad variety of presenting concerns. At the University of Athens,
students who used online asynchronous counseling noted advantages, including ease of use,
speed, and anonymity, followed by ambivalence about traditional counseling (Efstathiou, 2009).
The traditional social stigma toward seeking help and social factors hindering help-seeking
behaviors (e.g., gender and physical appearance) appeared to be reduced (Efstathiou, 2009).
Richards (2009), investigating asynchronous online counseling with students, highlighted the
benefits for users in having one single session online with a counselor. Apparent anonymity
and distance, the therapeutic benefits of writing, the cultivating of a zone of reflection, and the
resourcefulness of young adult students were suggested to be important variables mediating
the success of single-session online counseling. The single-session model employed also allowed
content to become a resource for all users (Efstathiou, 2009). The building of such a database is
also supported by the work of Michaud and Colom (2003), where after 4 years of operation, the
number of teenage visitors continued to increase but the number of questions dropped to half.

A meta-analysis of Internet-based psychotherapeutic interventions (Barak et al., 2008) re-
ported an overall weighted mean pre-post effect size of d = .53. More precisely, the effects
achieved for studies (n = 27) that represented work conducted synchronously (d = .49) and
asynchronously (d = .44) were not statistically different, although chat and e-mail modes were
statistically superior to forum, audio, or webcam. The study provides evidence for the use of on-
line interventions, concluding that online interventions are as efficacious or nearly as efficacious
as F:F ones. However, the study did not discriminate on the basis of quality, and was based on
a wide variety of studies with mixed methods, approaches, and objectives.

Several randomized controlled trials that have included a treatment condition using syn-
chronous or asynchronous online counseling have reported significant posttreatment and follow-
up effects (Kessler et al., 2009; Vernmark et al., 2010), demonstrating the efficacy of delivering
structured, online CBT treatments for depression (Richards & Richardson, 2012). Similarly, a
broad range of mental health issues have been addressed through the delivery of various online
interventions, for instance, interventions for panic disorder (Carlbring et al., 2006; Carlbring,
Ekselius, & Andersson, 2003), insomnia (Ström, Pattersson, & Andersson, 2004), and smoking
cessation (Strecher, Shiffman, & West, 2005), to name a few. Interventions included therapist
support and counseling delivered through a range of technologies and communication modes,
synchronously and asynchronously (Newman, et al., 2011).

Process variables in online counseling. The study by Cohen and Kerr (1998) described
earlier reported that while clients rated higher levels of arousal in F:F encounters, there were
no differences found regarding ratings of depth, smoothness, or positivity between online and
F:F clients. Barak and Bloch (2006) using 140 transcripts investigated the perceived helpfulness
of emotional support carried on by professional helpers through Internet chat with distressed
individuals. They reported positive outcomes for clients who had used the service. They found

1000 Journal of Clinical Psychology, September 2013

no significant difference in clients’ perceived session helpfulness for online than would be found
with F:F services. Barak and Bloch (2006) have also demonstrated that perceived helpfulness
correlated highly with impact from both clients’ and therapists’ perspectives. Similar to F:F ther-
apy, deep, smooth conversations that yielded positive responses and aroused clients’ emotions
were helpful. This is in contrast with the common criticism that online therapeutic conversations
might be shallow, superficial, or distant (Barak & Bloch, 2006).

Their findings have also been confirmed by Reynolds, Stiles, and Grohol (2006), who studied
session impact and alliance in online counseling with 16 therapists and 17 clients over the course
of a total of 178 sessions and reported that session impact and alliance were similar between
online and F:F treatments. This has also been a point noted in other studies, and perhaps session
impact may be a variable more closely related to outcomes in online counseling than is the
therapeutic alliance (King, Bambling, Reid, & Thomas, 2006; Reynolds, Stiles, & Grohol, 2006).

Liebert, Archer, Munson, and York (2006) using the Client Satisfaction Inventory (CSI;
McMurtry & Hudson, 2000) investigated satisfaction with online counseling, establishing a
mean satisfaction rating of 67.8 (out of 100) for a sample of 81 participants. When benchmarked
with F:F studies of satisfaction the authors concluded that clients were reporting satisfaction
but less so than in F:F counseling (Liebert et al., 2006). For example, a validation study of
the CSI in a F:F counseling sample generated a client satisfaction score of 88.1 (out of 100;
McMurtry & Hudson, 2000). The authors found that the more hours respondents spent online,
the more likely they were to make use of online counseling. Noted advantages in using such a
service included convenience, anonymity, and privacy. It can be speculated that some individuals
presenting with specific issues, such as trauma, phobia, or social marginalization, may “need to
communicate without fear of the listener’s first reaction” (Liebert et al., 2006, p. 83).

In a more recent study the authors reported no statistically significant difference in satisfaction
scores for F:F and online clients (Murphy et al., 2009). It would seem that satisfaction rating
for online counseling have been high, yet perhaps not as high as those found in F:F studies, but,
again, the studies were limited by small samples and there is only a small number of studies
available.

Much valuable work has been achieved to investigate and establish an empirical base for
online counseling. Yet the existing empirical literature that supports any in-session effects and
the achievement of outcomes from online counseling, while positive, is limited at present. Con-
sequently, apart from stating that it seems to work like it does in the F:F context, it is difficult to
draw precise conclusions as to the efficacy and effectiveness of online counseling. Robust empir-
ical investigations with larger samples and comparisons to F:F clients and/ or control groups
of some type would strengthen the empirical base. Additionally, investigating process variables
that contribute to in-session events and eventual outcomes need further research, especially to
find out whether they are the same predictors of outcomes as exist in F:F counseling.

The Therapeutic Relationship in Online Counseling

At the center of the therapeutic endeavor is the belief that a responsive relationship produces
changes in cognition, feelings, and behaviors (Holmes & Lisndley, 1989). In F:F counseling it
has been noted that the early absence of the therapeutic alliance or the failure of it to develop
is a likely indication that the therapy will be unsuccessful (Gelso & Hayes, 1998). Research has
demonstrated the importance of the working alliance to successful outcome in F:F counseling
(Horvath & Bedi, 2002; Martin, Garske, & Davis, 2000). A significant challenge for online
counseling is establishing the possibility to create equally meaningful relationships through
CMC.

The study described earlier by Glueckauf and colleagues (1999, 2002) used the Working
Alliance Inventory (WAI) to compare the alliance in videoconferencing, audio phone, and F:F
counseling for teenagers. While clients reported higher levels of alliance in the F:F condition,
there did not exist any significant differences across the three treatment groups for the alliance.
Another early study (Cohen & Kerr, 1998) that compared the effects of computer-mediated
online counseling and traditional F:F counseling on levels of anxiety and attitudes toward

Online Counseling: A Narrative Review 1001

counseling reported that participants in both modes of delivery reported similar ratings regarding
clients’ perceptions of therapists’ expertness, attractiveness, and trustworthiness.

Cook and Doyle (2002) in their study of 15 clients of online therapy–e-mail and chat-based–
compared with a F:F sample (N = 25), found equivalent alliance scores for both groups on the
WAI. They reported significantly higher means on the goal subscale and the composite score
for the WAI, suggesting that a working alliance as a central ingredient to outcome could also be
established in online counseling. However, the study did not include a F:F comparison group
and the self-selected sample were small. Qualitatively online clients reported experiencing strong
bonds with their therapists and benefiting from the effects of disinhibition. This latter point
perhaps supports McKenna and Bargh (2000) findings that individuals who are socially isolated
and anxious and who have difficulties forming relationships are more likely to form deep and
lasting relationships online than in person.

A review of the literature concluded that studies concerning the therapeutic alliance in online
counseling were scarce, yielding mixed results (Mallen, Vogel, Rochlen, & Day, 2005). How-
ever, the review (Mallen et al., 2005) considered only three studies regarding the therapeutic
relationship in online counseling and, while they found that F:F contact was superior to online
communication in establishing a relationship, no significant difference was found for emotional
understanding. Since that literature review subsequent research seems to increasingly support
the feasibility of developing therapeutic relationships online with modest to high alliance scores
being consistently found.

For instance, Prado and Meyer (2004) in a study of the alliance in asynchronous online therapy
reported that clients (N = 53) and therapists (N = 20) created solid working alliances as measured
by the WAI. The study revealed significant differences in working alliance levels reported, greater
for those who completed treatment (n = 29) compared with those who abandoned treatment
early (n = 19). However, they concluded that it was possible to conduct therapy asynchronously
online and the therapeutic relationship was similar to what is generally found in F:F studies.

Using a convenience sample of 81 participants Leibert, Archer, Munson, and York (2006)
examined levels of therapeutic alliance in online counseling and compared them against levels
found in F:F counseling. They showed that clients from F:F reported significantly higher ratings
than those in online counseling; this was found to be the case on the composite and each of
the three subscales of the WAI. Additionally, alliance scores significantly predicted respondent
satisfaction with online counseling.

Reynolds, Stiles, and Grohol (2006) over a 3-year period recruited 30 clients for online
counseling and examined session impact and alliance in online compared with F:F counseling
and found that ratings of session impact, using the Session Evaluation Scale, and alliance, using
the WAI, were similar between the two modes. Online therapists evaluated session impacts
including depth, smoothness, and positivity alongside confidence aspects of the therapeutic
alliance more highly than F:F therapists.

Hanley (2009) in a study of working alliance with young people (N = 46) in online counseling
reported that the majority (77%) found the alliance to be of medium to high quality as rated by
the Therapeutic Alliance Quality Scale. This research supports what King, Bambling, Reid, and
Thomas (2006) found regarding the potential to create a working alliance of sufficient quality
in online counseling that could have a positive impact on outcomes. The study investigated the
alliance as measured by the Therapeutic Alliance Scale in a sample of young people (N = 86)
using a single session of online counseling.

This small collection of studies seems to demonstrate that alliance online appears to be
capable of being equivalent to F:F. However, the fundamental question remains as to whether
the same process variables that are strong predictors of success in F:F interventions play the
same facilitative role in online interventions. King, Bambling, Reid, et al. (2006), for instance,
found session impact to be a stronger mediator in online counseling than the working alliance.
Given that these common factors of alliance and impact can be achieved online further research
is welcome to investigate how these critical elements relate to outcome. One study of alliance
quality and whether it could predict outcome (Knaevelsrud & Maercker, 2006) found that
although alliance in online treatment was one standard deviation higher than in F:F, there was

1002 Journal of Clinical Psychology, September 2013

only a low to modest association between alliance and outcome. They employed the short form
of the WAI; their sample, however, was small (N = 48) and all were being treated for trauma.

Although the research to date is largely positive, further research is needed to understand the
nature and dynamics of online therapeutic relationships. Whether the therapeutic relationship
is or is not a key facilitative element in online counseling still needs to be established. However,
it would seem that for an interaction to have therapeutic value the basic principles of providing
a supportive, empathic, and empowering relationship need to be present.

Features and Cyberbehaviors of Online Counseling

Online counseling is characterized by unique features and behaviors such as apparent anonymity,
disinhibition, distance, time delay, convenience, and loss of social signaling. Such features and
cyberbehaviors that characterize online counseling have associated benefits and challenges (Chil-
dress, 1998). For the most part these have been addressed adequately for the ethical and profes-
sional practice of online counseling through the provision of ethical and practice guidelines.

Anonymity and disinhibition. Traditionally, users of online counseling services enjoyed
the apparent anonymity that the online environment provided, often using nicknames and not
divulging many personal identifying details. However, this is becoming less the case; profes-
sional guidelines and ethical standards have brought about changes in how clients are recruited,
identified, and assessed. This does not necessarily dissolve the potential of maintaining relative
anonymity and especially geographical distance, which have been theorized to facilitate psy-
chological safety, disinhibition, and increased self-disclosure (Suler, 2000, 2004). Disinhibition
seems to aid clients to express themselves more openly and honestly (Cook & Doyle, 2002); it
is a powerful and distinct feature of online counseling and it is believed to have the potential
to reduce the social stigma and anxieties that some experience in seeking professional support
(Suler, 2004).

More sinister behaviors have the potential to arise from disinhibition, such as acting out
behaviors with, for instance, the client engaging in identity and impression management (Suler,
2000). Although it is a point worth considering, it is not necessarily a behavior unique to online
counseling, nor is there evidence to support its presence. Joinson (2001) examined the concept
of self-disclosure by comparing dyads of undergraduate students interacting F:F and online.
He found that instances of negative self-disclosure were rare and that participants in the CMC
condition had significantly higher levels of self-disclosure, supporting the notion of positive
disinhibition and demonstrating that acting out arising from disinhibition was uncommon.

Convenience. Both clients and therapists have identified convenience as a principal reason
for choosing online counseling (Chester & Glass, 2006; Mallen et al., 2005; Young, 2005). The
accessibility of online counseling can overcome many barriers to accessing treatment including
limited mobility due to geographical isolation or physical disability, language barriers, personal
stigma in seeking help, or time availability (Rochlen, Zack et al., 2004). Online counseling, too,
has the potential to extend access to specialized services that might otherwise be beyond the
reach of clients (Young, 2005). One example is the use of videoconferencing to deliver specialized
care and treatment to clients who were geographically isolated from specialist eating disorder
treatment centers (Simpson et al., 2005).

Time delay. Using synchronous communication to provide online counseling can facilitate
immediate clarification of what is being discussed between the therapist and the client. However,
in asynchronous communication a time delay is built into the counseling process. This can
potentially lead to anxieties for both therapists and clients in wondering about a perceived or
unexplained delay in response. In turn, the ambiguity in the no-reply can become a blank screen
where one can easily project one’s own expectations, emotions, and anxieties, i.e., the “black
hole phenomenon” (Suler, 2004).

At the same time, and unlike the urgency and immediacy characteristic of synchronous
communication, asynchronous communication can facilitate the development of a zone of

Online Counseling: A Narrative Review 1003

reflection where therapists and clients can take the time to reflect upon and respond to the
others message (Suler, 2000). The process brings with it advantages for the client, principally
a relief from any pressure of urgency or immediacy, and this in turn can facilitate time to
process experiences and emotions; it can promote self-observation, increase awareness, reduce
impulsivity, and enable clients to engage in deeper reflection and focus on self-expression (Hanley,
2009). Time delay is also a potential advantage for therapists as it can help with better observation
and management of countertransference reactions.

Loss of cues. The fact that all of the visual and verbal cues that conveys subtle information
about the person and their affect in F:F interactions are missing in text-based online counseling
has been a point of debate in the literature (Suler, 2000). Suler (2004) argues that this feature is
precisely a benefit in online counseling as it can lead to disinhibition. Disinhibition can occur as
there is the potential to remove any concerns about the other person’s reaction to one’s narrative
and presence. Feelings of psychological safety and disinhibition can arise from the lack of social
signals, which in turn have the potential to reach clients who are particularly sensitive to the
physical presence of another person and to cues indicating disapproval or judgment (Fenichel
et al., 2002; Leibert, Archer, Munson, & York, 2006). Leibert et al. (2006) concluded that the
disinhibition effect reported by participants seemed to be stronger and offset the impact of the
lack of cues.

Further derivates of the loss of cues include facilitating the disclosure of sensitive or embar-
rassing information. Clients can appreciate such an environment as it can increase their sense
of control over what they disclose (Cohen & Kerr, 1998; King, Bambling, Lloyd, et al., 2006;
Simpson et al., 2005). A study by Hanley (2009) reported on young people’s experience of on-
line counseling and described how some users appreciated having the control over whether to
disclose to their counselor that they were crying. However, a consideration needs to be that for
some clients the experience of counseling that lacks the reassurance of regular social signaling
may be distressing (Alleman, 2002).

Online counseling, in its many forms, brings with it features and newly observed behaviors.
Some work has captured these phenomena, yet a more thorough investigation of these elements
is worth considering, so as to, first, describe more thoroughly the phenomenon that is online
counseling and, second, to contribute to the debate as to whether it is simply transferring what
usually occurs in the F:F setting and now mediated by CMC or whether it is to be considered
an entirely new and distinct intervention. Additionally, more needs to be explored about the
therapeutic significance of different aspects (such as control over disclosure that ordinarily in
face-to-face would be obvious such as crying) and unique features (disinhibition and time-delay)
of online counseling.

Writing behavior and expression. The majority of online counseling has taken place
through asynchronous text-based communication. Cook and Doyle (2002) reported that partic-
ipants appreciated that they could re-read the responses received from the therapist, feeling this
allowed them more time to process the content than verbal communication would have. Beattie,
Shaw, Kaur, and Kessler (2009) in a study of online synchronous counseling with 24 primary
care patients reported that on seeing their thoughts and emotions in writing online clients were
effected and this also facilitated further self-reflection.

The positive benefit that writing can have on psychological and physical health has already
been widely documented (Pennebaker, Kiecolt-Glaser, & Glaser, 1988). The process of writing
can, for instance, be cathartic in translating emotional experiences into words and this has also
been found to be the case in the use of e-mail (Sheese, Brown, & Graziano, 2004).

It is interesting to reflect that in writing the writer is in control of the content, the pace, and
depth of the written material, which can potentially foster a sense of psychological safety (Wright
& Chung, 2001). Additionally, the permanency of the written record can be referred to again and
again. The use of text as the means of communication, similar to narrative approaches to therapy
and journal writing, can potentially facilitate the user’s construction of a personal narrative
(Suler, 2000). Indeed, writing may be a preferred or more suitable modality of self-expression

1004 Journal of Clinical Psychology, September 2013

for some individuals who are less comfortable in F:F interactions, while being unsuitable for
individuals with limited writing skills (Suler, 2000).

Apart from any therapeutic intervention, the therapeutic benefit of writing in online coun-
seling deserves more attention. It seems that writing can be of benefit to users of its own right.
Additionally, practically nothing is known of counselors’ experience of using writing to deliver
interventions.

Ethics

Ethical concerns have been at the center of the debate regarding the practice of online counseling.
Sampson, Kolodinsky, and Greeno (1997) identified ethical issues such as confidentiality, the
validity of the data delivered via computer networks, the adequacy of counselor interventions,
potential misuse of computer applications, a lack of awareness of location-specific factors,
the effect of the digital divide, privacy concerns, credentialing, and issues that concerned the
development of a therapeutic relationship. Many of the ethical concerns identified regarding the
practice of online counseling also carry with them potential legal implications regarding duty of
care (Shapiro & Schulman, 1996).

Online counseling caused trepidation among professionals whom raised concerns regarding
issues of informed consent, contracting, confidentiality of records, privacy, diagnosis, and duty
of care (Bloom, 1998; Childress, 1998; Shapiro & Schulman, 1996). However, Skinner and Zack
(2004), for instance, maintain that the issues posed online are no more insurmountable than
those faced in traditional practices. Nonetheless the concerns raised are legitimate and posed
the question as to how was it going to be possible for professionals to practice ethically online?

In 1995, the American Psychology Association Ethics Board described the ethics code appli-
cable to therapists using telephone, teleconferencing, and Internet services (Shapiro & Schulman,
1996). The National Board for Certified Counselors (NBCC) developed standards for online
practice (Bloom, 1998). These can be seen as early attempts to address ethical concerns and
regulate the delivery of online counseling practice.

In 1997 the International Society for Mental Health Online (ISMHO) was formed with a clear
mission to promote the understanding, use, and development of online communication in mental
health. They, too, have produced guiding principles for the ethical practice of online counseling
(ISMHO, 2000). Indeed, many professional counseling and therapy accrediting bodies have
followed suit and produced guidelines for online clinical practice that are regularly revised as the
evidence-base from practice and research grows (Anthony & Goss, 2009; Anthony & Jamieson,
2005). The development of ethical frameworks has been significant in contributing to regulate
and standardize the practice of online counseling.

However, despite the many developments that have occurred in recent years, a number of
studies have surveyed online counseling websites (Chester & Glass, 2006; Heinlen, Welfel, Rich-
mond, & Rak, 2003; Shaw & Shaw, 2006) and reported that practitioner credentials varied
widely, only 32% of practitioners requested that clients sign an informed consent form, and 42%
of participants did not use any encryption to protect confidentiality, and they reported finding
very low compliance with established ethical standards for online counseling. However, a high
number of practitioners provided information about the limitations of online counseling.

In their study of 93 e-counselors attitudes, ethics, and practice, Finn and Barak (2010) reported
that 62% of e-counselor practitioners were confident that their online sessions were confidential,
24% somewhat confident, and 14% not at all confident. They also described how only 28% of
practitioners felt it important to confirm the identity of their users. Almost one fourth (26%)
had encountered a situation where a client was a danger to themselves or others. However, and
worryingly, less than half (46%) reported it to an appropriate authority (Finn & Barak, 2010).

One can speculate that until online counseling is adopted and incorporated as a legitimate
form of delivery of therapeutic interventions, thereby included in training courses for psychol-
ogists and as part of the broader field of psychology, regulated by appropriate and established
accrediting bodies, it will continue to be considered by some as a renegade. Additionally, its
incorporation would potentially ensure the industry is standardized and regulated and therefore
more trustworthy for the consumer and other professionals.

Online Counseling: A Narrative Review 1005

Attitudes and Experiences

The literature on attitudes and experiences towards online counseling supports the view that
users of online counseling and potential users seem to have been more accepting of online
counseling than professionals (Mallen et al., 2005). One study that investigated psycholo-
gists (N = 1040) attitudes towards delivering therapeutic interventions online found that the
majority held a neutral attitude and only 3% viewed such delivery as unacceptable (Wang-
berg, Gammon, & Spitznogle, 2007). However, the neutral attitudes found may suggest a
lack of knowledge or simply a statement of not knowing or uncertainty. The study high-
lighted that those who frequently use the Internet or had experience using e-mail in clini-
cal practice were more favorable towards online counseling. Chester and Glass (2006) in a
survey of the attitudes of 67 online counselors reported that 57% of respondents believed
that online counseling was as effective as F:F counseling while 42% believed it was less
effective.

Contracting, confidentiality, and informed consent have been some of the issues raised
by professionals regarding their concerns about online counseling (Hanley, 2006). However,
Hanley (2006) found that such concerns expressed by practitioners in developing an on-
line counseling service for young people mirrored those that would be considered when es-
tablishing a F:F practice. Finn and Barak (2010) reported that the majority (74%) of the
e-counselors they surveyed were satisfied with their experience of their online counseling
service.

At the same time therapists have also reported advantages about online counseling including
that it can be of a lower emotional intensity, there is more time to think, the power balance seems
more equal between the parties, and clients can be more focused and expressive (Bambling, King,
Reid, & Wegner, 2008). In relation to written and spoken records being kept verbatim, while
potentially useful in supervision, they also increase the level of accountability for therapists
(Murphy & Mitchell, 1998). Certainly what seems evident is the level of ambivalence that
therapists hold regarding delivering counseling online. One could speculate that it is largely
because of a lack of exposure to online counseling and uncertainty, and a lack of knowledge
regarding how it is operated and the benefits it can realize for users in particular.

Mallen et al. (2005) write how clients appear to have embraced online counseling with more
ease than have professionals. However, an early study assessing attitudes towards online and F:F
counseling noted that respondents had significantly more positive attitudes towards F:F than
online counseling (Rochlen, Beretvas, & Zack, 2004). However, the study sample comprised
participants who had no experience with online counseling, and, therefore, the situation was
presented as hypothetical. The study did show that unlike the traditional gender divide found in
attitudes towards traditional counseling, there were no gender differences in attitudes towards
online counseling, with an overall neutral to slightly positive attitude. The neutral result could
be a similar response to the earlier study by Wangberg et al. (2007) regarding therapists attitudes,
and could be referencing a lack of knowledge or uncertainty.

Anonymity, convenience, counselor credentials, access, and cost have been cited as primary
reasons why someone would seek online counseling (Young, 2005). Qualitative studies have also
identified the motivations for seeking online counseling; participants have reported their belief
in the effectiveness of online counseling, and reported advantages included enhanced freedom of
expression through writing, reduced costs, and convenience (Bambling et al., 2008; Beattie et al.,
2009; Cook & Doyle, 2002). On the contrary, concerns that users have about online counseling
include the lack of privacy associated with the use of technology, the security of the technology
being used, and being caught using online counseling (Young, 2005).

One thing that is unique is that attitudes and experiences toward online counseling seem to
be effected by the level of comfort with the use of Internet technology (Leibert et al., 2006;
Wangberg et al., 2007). As the pervasiveness of technology in people’s lives grows, especially
for younger generations, one can imagine that in the future seeking online counseling would
not seem such a novelty but that there would be an expectation for counseling to be available
online.

1006 Journal of Clinical Psychology, September 2013

Suitability

The question as to who and what type of presenting issues are suitable to be dealt with through
the medium of online counseling are still very much points of debate in the literature. Some
practitioners advocate for this to be restricted to less serious issues (Haberstroh et al., 2008),
some note specific advantages for specific populations and presentations (Simpson et al., 2005),
while others advocate that the medium is adequate to address most issues at any level of severity
(Fenichel et al., 2002). The lack of empirical research means that the opinions to date are largely
anecdotal.

Very limited empirical research exists about the issues presented by online clients. Most
services have dealt with a broad range of presenting issues, and some have targeted specific
issues (Abroms, Gill, Windsor, & Simons-Morton, 2009; Alemi et al., 2007; Mitchell et al.,
2008; Robinson & Serfaty, 2008; Simpson, 2009; Simpson et al., 2001; Zabinski et al., 2004).
Apparently, however, there exists no difference between the presenting issues in online compared
with F:F counseling (Leibert et al., 2006; Richards, 2009). Barak et al. (2008) reported that
while all age groups showed benefits in online interventions individuals aged 19-39 years range
appeared to benefit the most. Mostly, online counseling seems to attract female clients in the
20-40 years of age group which in fact mirrors the F:F counseling demographic (Chester &
Glass, 2006).

Finn and Barak (2010) reported that the majority of e-counselors (95%) in their survey
believed that e-counseling is appropriate for interpersonal and social issues and personal devel-
opment. There was less agreement on issues that are considered a higher risk to a user’s personal
safety or well-being including suicidal thoughts, domestic violence, substance abuse, child abuse,
and sexual assault.

It can, however, be stated that the use of the medium, as is true for other types of communi-
cation, may not suit everybody and that individual factors may be important in determining the
success of online counseling (Fenichel et al., 2002). For instance, clients and therapists need to
have a good ability for written expression and reading, as well as computer literacy (Fenichel et
al., 2002; Rochlen, Zack, et al., 2004). Users, both therapists and clients, should also believe in
the therapeutic benefits of online counseling (Fenichel et al., 2002).

Training

Finn and Barak (2010) reported that the majority of e-counselors (94%) included in their
survey reported that their professional training program did not include training in e-counseling.
Instead, counselors learned about e-counseling through personal reading on the subject (92%),
informal consultation with colleagues (80%), attending an e-counseling workshop (20%), and
attending an e-counseling training program (16%). Their research concluded that the lack of
consensus about ethical obligations and practice suggest the need for formal professional training
in e-counseling and international cooperation in formulating practice ethics.

Training programs have been developed that offer certification in online counseling, to raise
the awareness of ethical issues and promote the development of specialized skills for the effective
provision of online counseling (Anthony & Goss, 2003). Typically, participants are brought
through a variety of theoretical and experiential modules, learning about the ethics of practice,
establishing a relationship online, communicating effectively using CMC, and establishing an
online practice. Alongside training courses several practitioner guidebooks and other written
resources have been published (Grohol, 2003; Jones & Stokes, 2009; Kraus, Striker, & Zack,
2010; Maheu, Pulier, Wilhelm, & McMenamin, 2004).

Future Research

The research to date has been largely positive in showing that online interventions can have a
similar effect and are capable of replicating some of the facilitative conditions as F:F encounters.
A need remains for stronger empirical evidence to establish efficacy and effectiveness and to
provide a deeper understanding of the specific mediating and facilitative variables.

Online Counseling: A Narrative Review 1007

A particular area that appears to be underdeveloped in the literature concerns the role of
the counselor: What now is the role of the counselor in the context of online counseling? Has
it changed or is it changing, and if so how? Perhaps online counseling should be considered
as a new type of intervention. A framework to define online counseling as a distinctive type
of therapeutic intervention is therefore needed. Future theory and research would benefit from
focusing on providing a clear theoretical framework for online counseling and on furthering our
understanding of the suitability and adaptability of different therapeutic approaches for online
delivery.

As a largely users’ led development of the field, and with evidence suggesting that clients
increasingly seek and adopt counseling online, the main duty of professionals is to ensure that
there is an evidence base to guide best practice. A key aspect will be identifying the mechanisms
that may be driving positive outcomes in online counseling. At present, we are dependent on the
factors that drive change in F:F counseling, such as the therapeutic relationship, but as research
develops it is likely that new factors will be identified, which may be responsible for change, for
example, the distance between client and counselor may be an important factor that facilitates
therapeutic change for some individuals.

Conclusion

What appears to emerge from reviewing the literature on online counseling to date is a picture
of a growing body of knowledge forming a foundation for a more solid evidence base to be
established. Urgency transpires in the literature in attempting to establish an evidence base to
ensure safety in delivering therapeutic interventions online. The provision of ethical guidelines
have provided for this need up to a point; however, alarming issues of noncompliance and lack of
specialized training for professionals have been highlighted, and as the field develops, adherence
to guidelines and the development of specialized skills would need to be pushed forward with
professionals.

Increasing awareness among professionals in highlighting the distinct nature of online coun-
seling, its defining features, dynamics, and issues to be considered in delivering online counseling
would seem to be fundamental items to be put on the agenda for future clinical guidance. This
could be achieved through the inclusion of training in online counseling in professional courses
as well as part of continued professional development.

In spite of criticisms and skepticism coming from professionals more so than clients, there
seems to have been a tacit acknowledgment that online counseling is an inevitable branching of
the field, reflecting changes in how individuals relate and access services due to wider changes
in society.

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articles for individual use.

NAVIGATING DUAL RELATIONSHIPS IN RURAL
COMMUNITIES

Jennifer L. J. Gonyea and David W. Wright
The University of Georgia

Terri Earl-Kulkosky
Fort Valley State University

The literature examining dual relationships in rural communities is limited, and existing ethi-
cal guidelines lack guidelines about how to navigate these complex relationships. This study
uses grounded theory to explore rural therapists’ perceptions of dual relationship issues, the
perceived impact of minority and/or religious affiliation on the likelihood of dual relation-
ships, and the ways rural therapists handle inevitable dual relationship situations. All of the
therapists who participated in the study practiced in small communities and encountered dual
relationship situations with regularity. The overarching theme that emerged from the data
was that of using professional judgment in engaging in the relationship, despite the fact that
impairment of professional judgment is the main objection to dual relationships. This overall
theme contained three areas where participants felt they most needed to use their judgment:
the level of benefit or detriment to the client, the context, and the nature of the dual relation-
ship. Surprisingly, supervision and/or consultation were not mentioned by the participants as
strategies for handling dual relationships. The results of this study are compared with estab-
lished ethical decision-making models, and implications for the ethical guidelines and appro-
priate ethical training are suggested.

The authors’ collective experiences of practicing in small communities led us to question how
therapists in these communities handle the inevitability of dual relationships. As we discussed
anecdotes from our respective practices, it became apparent that tension exists between a client’s
desire to have a familiar therapist and the ethical standards of our field. We turned to the American
Association for Marriage and Family Therapy (AAMFT) Code of Ethics for answers about how
to navigate these delicate situations. Couple and family therapists are admonished to “make every
effort to avoid [dual relationships] at all costs” (AAMFT, 2001; p. 1); however, no mention is made
of how to accomplish this in settings with limited alternatives.

The issue of dual relationships in areas with limited alternatives is complicated by clients’
attempts to self-match. Self-matching occurs when clients select a therapist who shares their atti-
tudes, race, education, social class, and/or religion (Jones, Botsco & Gorman, 2003; Whalley &
Hyland, 2009; Willging, Salvador & Kano, 2006; Wintersteen, Mesinger & Diamond, 2005). Cli-
ents feel more comfortable discussing their lives and presenting issues when they believe their ther-
apist holds the same values or shared cultural experience. A large percentage of Americans living
in small communities may be able to achieve this owing to homogeneity in small communities, but
not without creating ethical challenges for the therapist.

The ethical challenges for rural therapists are compounded when they also belong to a minor-
ity group. In addition to the limited number of available therapists in a small community, there are

Jennifer L. J. Gonyea, PhD, is a Lecturer and Undergraduate Coordinator, Department of Child and Family

Development, The University of Georgia and in practice at Samaritan Counseling Center of Northeast Georgia,

Athens Georgia; David W. Wright, PhD, is an Associate Professor, Department of Child & Family Development,

The University of Georgia, Athens, Georgia; Terri Earl-Kulkosky, PhD, is an Assistant Professor, Department of

Behavioral Sciences, Fort Valley State University, Fort Valley, Georgia.

This research was made possible through consultation with Edwin Risler, PhD (Athens, GA) and the Georgia

Association for Marriage and Family Therapy Board and members.

Address correspondence to Jennifer L. J. Gonyea, Department of Child and Family Development, The

University of Georgia, Dawson 123, Athens, Georgia 30602; E-mail: jlgonyea@uga.edu.

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 125

Journal of Marital and Family Therapy
doi: 10.1111/j.1752-0606.2012.00335.x
January 2014, Vol. 40, No. 1, 125–136

far fewer minority therapists in general (AAMFT, 2004). Therefore, when minority clients attempt
to self-match, there is a strong likelihood that a dual relationship dilemma will be encountered.

This studyaims to exploreareasnotpreviously considered in the ethics literature, payingparticu-
lar attention to how therapists practicing in rural areas navigate these complex relationships. The
next section provides the foundation for this study by reviewing the unique set of circumstances and
community variables that increase the likelihood of dual relationships in rural areas and the ways
existing ethical decision-makingmodels fail to consider the challenges of rural practice.

CHALLENGES OF RURAL PRACTICE

Rural communities are partially defined by their isolation that forces residents to rely more
heavily upon one another. Smaller communities have increased potential for dual relationships, in
general, and those between clients and therapists in particular (Erickson, 2001). Although the lack
of boundaries may seem natural and is often used as fodder for sitcoms set in small communities,
in real-life, it sets the stage for dual relationship dilemmas.

For many residents, this closeness is positive and helps build identity and sense of belonging
to that community in terms of Us versus Them. Therefore, residents of rural areas are often hesi-
tant to seek services from an outsider (Murry, Heflinger, Suiter & Brody, 2011) because they are
not to be trusted, which can lead to multiple levels of personal and professional relationships. Fur-
ther, persons from rural areas may resent an outsider offering assistance (Erickson, 2001; Jesse,
Dolbier & Blanchard, 2008).

Similarly, those who belong to a religious community or a minority group may prefer profes-
sional services from someone within their group or at least from someone who may share familiar
values. Research has found that people want a therapist and they believe to be like themselves
(Jones et al., 2003; Wintersteen et al., 2005) and when clients’ ethnicity matches that of their thera-
pist, they attend more sessions and have a greater likelihood of treatment completion (Erdur, Rude
& Baron, 2003).

Competing Ethical Principles
The absence of attention to how therapists in rural settings navigate potential dual relation-

ships is compounded by the ambiguous and vague discussion of dual relationships in the AAMFT
Code of Ethics, which states:

Marriage and family therapists are aware of their influential positions with respect to
clients, and they avoid exploiting the trust and dependency of such persons. Therapists,
therefore, make every effort to avoid conditions and multiple relationships with clients
that could impair professional judgment or increase the risk of exploitation (American
Association for Marriage & Family Therapy, 2001; p. 1).

If one’s interpretation of the code is that when multiple relationship situations arise, MFTs
should ensure that these relationships do not impair professional judgment or increase the risk of
client exploitation, then the dilemma is not “how to avoid dual relationships,” but “how does one
tell when multiple relationships will impair professional judgment” and “what is the obligation of
the therapist in warning or explaining the dilemma to the client?”

It quickly becomes clear that the real problem is how to address inevitable dual relationships,
rather than how to avoid them. Some suggestions include openly discussing the inevitability and
potential of out of session contacts between therapist and client (Faulkner & Faulkner, 1997) or
having a preconceived plan to negotiate social contacts with clients and seek immediate consulta-
tion if boundaries feel threatened (Jennings, 1992).

Rural clinicians are likely to be professionally isolated, making it difficult to obtain supervi-
sion or consultation. These clinicians may be secluded from the mainstream of their profession and
may have limited colleagues from whom they can seek support, collaboration, or supervision.
Rural therapists’ sense of isolation is also compounded by fewer opportunities for professional
development, continuing education, and limited access to support services.

These collegial issues also create a challenge to maintaining client confidentiality (Weigel &
Baker, 2002). A client’s confidentiality can be compromised through the “grapevine” in small

126 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

communities when the client is seen leaving the therapist’s office, parked in front of it, or even while
sitting in the waiting room. The few therapists in a rural area often have regular contact with one
another, and informal conversations between providers can increase threats to client confidential-
ity. Rural therapists rely on one another for professional development and resources. Withdrawing
from such informal exchanges could alienate close colleagues and leave a rural therapist with even
fewer resources. Rural therapists are left with the choice between increased threats to clients’ rights
to privacy or alienation of a close colleague.

Models of Ethical Decision-Making
Many ethical decision-making models suggest the following for the resolution of ethical dilem-

mas: (a) consulting the ethical guidelines of therapy professions; (b) seeking supervision or consul-
tation with peers; (c) creating a pros and cons list to determine the possible consequences and/or
alternative courses of action; or (d) some combination thereof (Corey, Corey & Callahan, 1998;
Erickson, 2001; Forester-Miller & Davis, 1996; Smith & Smith, 2001; Steinman, Richardson &
McEnroe, 1998; Tarvydas, 1998; Welfel, 1998). As noted previously, these guidelines may not pro-
vide enlightenment because they are ambiguous and require interpretation, the very foundation of
the original dilemma!

Few existing models specifically refer to issues of power and maneuverability, that is, the roles
and positions therapists take with clients. The professional guidelines assume therapists hold the
position of power when interacting with clients. Yet, depending on the nature of the out-of-session
contact, the client may occupy a powerful position in the relationship. In a unique acknowledg-
ment of potential limitations to both sides of a dual relationship, Haas and Malouf (1995) suggest
therapists ask themselves and their supervisors specific questions prior to engaging in a potential
dual relationship. For example, how might engaging in the dual relationship inhibit clients’ ability
to make autonomous decisions; how might the therapist acknowledge his or her privileged position
in the relationship; will the dual relationship affect the therapist’s ability to intervene effectively
and congruently. The suggested questions imply that the therapist is able to conceive a number of
alternatives and have insight into multiple perspectives on the situation, yet the inability to do so
when interacting with friends and relatives is precisely why dual relationships are discouraged.

Most ethical decision-making models assume that therapists have equal access to professional
resources across community types (rural compared to urban). In fact, models ignore the existence
of barriers to obtaining supervision and consultation in rural areas even though the limited avail-
ability of these in small communities has been well documented (Weigel & Baker, 2002). None of
the models reviewed suggest alternatives to supervision or ways of navigating a dual relationship
if, indeed, it is unavoidable. The potential consequences to seeking consultation with peers or feed-
back from supervisors in rural communities are also not addressed in the ethical decision-making
models reviewed for this study.

Clearly, one model or set of ethical standards does not encompass all possible dual relation-
ship dilemmas or all the factors contributing to it. Therefore, a more comprehensive exploration of
the processes through which clinicians make ethical decisions is called for. To meet that goal, this
study specifically examines (a) the ways rural therapists perceive dual relationships and the result-
ing impact on clinical practice; (b) the strategies clinicians believe they employ to negotiate dual
relationships; and (c) the perceived influence of minority or religious affiliation on dual relation-
ship situations.

METHOD

Design of the Study
This study used a naturalistic paradigm to explore the experiences of therapists in rural set-

tings. Among Lincoln and Guba’s (1985) naturalistic paradigm axioms, several were relevant here:
(a) realities are multiple, constructed, and holistic; (b) the knower and the known are inseparable;
therefore, the participant and researcher influence one another; (c) generalization is only possible
through the formulation of working hypotheses that are context and time specific; and (d) unlike
traditional inquiry that is value-free, the naturalist paradigm states that inquiry is value-bound by
the choice of the problem, theory, and context.

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 127

This study sought to explore how rural therapists interpreted the AAMFT ethical guidelines
as they made decisions about whether to have dual relationships with the clients they served. Their
experiences then constituted multiple realities and, while tied professionally to the ethical guide-
lines, their interpretation of the guidelines allowed the therapist to construct their understanding
and approaches to ethical dilemmas of dual relationships. This qualitative approach allowed for
an emphasis on the participant’s view (Creswell, 1998) of their experience of dual relationships in
rural areas and how they navigate such situations. Specifically, the present study questions how
the experience of dual relationships decision-making is handled when the therapist’s professional
supports are limited.

Description of Participants and Selection Process
Participants were Clinical and Associate members of an AAMFT Division in the Southeast

practicing in rural areas. Rural areas were selected using the categories of urbanicity established by
Bachtel (2004) at the county level: Urban, Suburban, Rural Growth, and Rural Decline. Approxi-
mately, 50 members were in the pool of potential participants.

Once the purposive sample was drawn from the current listing of active members of the Divi-
sion, participants were contacted via telephone based on information provided in the Division
directory. After providing verbal consent, telephone interviews were conducted. Multiple research-
ers were involved in gathering the data through phone interviews, and this served as one of the
forms of investigator triangulation (Denzin, 1978). Attempts to contact the 50 members were
made, and six therapists participated in the phone interviews. Some participants expressed a desire
to have more time to reflect on the questions. The researchers experience confirmed that additional
data collection methods could provide more respondents and richer data. Therefore, researchers
decided on an additional data collection method, which would be to collect data at the annual
Division Spring Conference.

Conference attendees self-selected to participate in the study after hearing it described and
announced. An additional screening by the authors was used to ensure that participants met the
criteria established at the outset of the study. Attendees were provided consent forms and study
questions on the first day of the conference and asked to return both by noon on the last day. This
ensured that participants were able to reflect on their experiences and practices to give as detailed
explanations as possible. Participants provided information about the population size in their
practicing area and completed survey forms where they provided demographic information such
as age, race, type of practice, and length of practice. In addition, participants provided their
perception of the degree to which their minority or religious affiliation influenced requests for
therapeutic services from acquaintances in other settings, and how they make decisions in response
to these requests.

Between telephone interviews and the annual Division conference, fifteen therapists pro-
vided data for this study. Of these, five self-identified as African American, one self-identified
as racially mixed (Caucasian and Phillipina), and the remaining nine participants self-identified
as Caucasian. Participant ages ranged from 29 to 60; however, most participants reported
having been in practice for over 20 years. All practiced in areas designated as rural according
to Bachtel (2004). Participants practiced in either private (N = 6) or public settings (N = 6),
while three practiced in both types of settings. Seven participants practiced in catchment areas
whose populations were 20,000–50,000, six practiced in catchment areas whose populations
were 50,000–100,000, and two of the participant’s catchment areas were over 100,000 people.
Some worked in communities that served more than one county, or in counties that served
multiple cities.

A detailed description of participant demographics is provided to illustrate several consider-
ations regarding the results. First, the participants in this study represent very experienced clini-
cians, the majority having practiced more than 20 years. The perception of one’s ability to
navigate complex dual relationships may be related to a sense of clinical competency evident in an
experienced sample. Second, how long clinicians had lived in their rural community is unknown, a
factor that may influence the likelihood of dual relationships. And lastly, most of the participants
worked at least part time in public settings where they may or may not have control over the
decision to see the a client known in another setting.

128 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Data Analysis
An interview guide (see Appendix A) was developed with open-ended questions that invited

the participants to convey their experiences with dual relationships in rural communities. This
interview guide provided a common set of questions for all participants, and left room to explore
new areas that might emerge. Data were analyzed using a sorting procedure that calls for searching
for what Wolcott (1994) terms patterned regularities in the data. We looked for common themes
and patterns of behavior that would give an understanding of the experiences of the participants.
Participant responses were then compared with the suggested procedures for ethical decision-
making reported earlier.

Our analysis process was guided by grounded theory (Charmaz, 2002; Glaser & Strauss,
1967); a qualitative methodology used with the goal of finding new theory or emerging themes in
phenomena studied. This method seemed most appropriate to the limited understanding of how
dual relationship dilemmas are handled by clinicians when such dilemmas are frequent or inevita-
ble. Consistent with a grounded theory approach, data collected from the first interview were
compared with data from the second interview, and this process of comparison was repeated with
each data collection (Strauss & Corbin, 1998).

Each phone interview was transcribed by the research interviewer, and non-phone written
interviews were reviewed. The interviewers (J.G. and T.K.) recorded notes immediately following
the data collection. These process notes included clarification questions asked, information on the
date and type of contact, insights, questions, and connections to other responses.

The research investigators then carefully examined the data and completed the task of com-
parison, developing new categories relative to the answers. Open coding methods (Charmaz, 2002)
were used to organize the data, and initial categories were developed. Themes emerged from the
categories and subcategories as data analysis continued. These themes are discussed in detail in the
results section that follows.

Trustworthiness and Credibility
To ensure trustworthiness (Merriam, 1998) and credibility, qualitative terms that are similar

to reliability and external validity, we used detailed descriptions of the research methods and credi-
bility audits to review the research methods, interviews, and findings. A licensed marital and family
therapy (MFT), who has practiced for more than 20 years, served as an internal auditor of the data
to open code the data from the interviews and written responses. In addition, an external auditor
(2nd author) reviewed all drafts of the results to verify that the categories and themes were consis-
tent with the interviews.

Transferability, the degree to which a study can be applied to other contexts by different
researchers, was established by providing detailed information about the participants and contex-
tual factors that may be relevant to future research efforts. For example, the Appendix A reports
the guiding questions used and the demographic information, such as practice setting, catchment
population, and years in practice are reported in the following section.

RESULTS

Although interviews varied somewhat, participant responses reflected the inevitability of dual
relationships in rural areas, consistentwith the existing literature. As expected, a common experience
among participants was receiving referrals for persons that they knew in other settings on a frequent
or occasional basis. Also as expected, participants received referrals based on religious andminority
affiliation,althoughmost of thesewere basedon religious as opposed tominority affiliation.

Similar themes emerged across clinicians in terms of how they handled potential dual relation-
ship situations. The therapists who participated in this study universally referred the potential
client elsewhere when the referral was well known. Among those that made referrals to avoid the
dual relationship, they took care to explain the dual relationship dilemma to clients in order to
preserve the existing relationship and ease the transition to a trusted colleague. For example:

The most common type of referral comes from my church. I usually refer them on and
explain the problem inherent in dual relationships. Generally, people are clueless about

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 129

this [dual relationships] issue and appear disappointed but do okay once they get started
with a colleague.

Even among those who reported engaging in the relationship initially, all stressed the impor-
tance of evaluation and assessment at the beginning of therapy. For example, several participants
engaged in two to four sessions during which they assessed the clients’ needs, their own ability to
meet those needs, and the likelihood that the therapeutic relationship might violate the ethical
guidelines by potentially “exploiting the trust and dependency of such persons” or “impair profes-
sional judgment or increase the risk of exploitation” (American Association for Marriage &
Family Therapy, 2001; p. 1). One participant reported engaging in the relationship:

depending on my conversation with the referral, for a 3 or 4 session evaluation with the
clear understanding that I may make a referral, continue to see the client myself, or have
a professional consultant in the fourth session to help us decide the appropriate next
phase.

Strategies for Handling Dual Relationships
During the open coding procedure, responses developed into the overarching theme of profes-

sional judgment which contained three areas where participants felt they most needed to use this
judgment: (a) level of benefit or detriment to the client; (b) the context; and (c) the nature of the
dual relationship.

Professional judgment. Whether explicit or implied, participants’ approach suggested they
had used professional guidelines as the source of their decision-making. One participant discussed
the “limits of therapy,” while another came to an agreement that “boundaries will be kept” with
the clients with whom he or she entered into a dual relationship. Elaborating on how boundaries
were kept, one participant stated:

NOT discussing client info with staff. When necessary for support, speak vaguely to the
school counselor. Make it clear to students and any others I see in community that I do
not/will not identify them seek them out in public social settings. I also make it clear that
I do not/will not identify other clients—or talk about them any professional relationship
to anyone. Clarity around boundaries is extremely important in maintaining them.

Several participants appeared to use a strict interpretation of the AAMFT ethical guidelines
concerning therapy with persons known from other contexts, unequivocally stating that they
would refer the client elsewhere based on their understanding of “making every effort to avoid . . .
multiple relationships” (American Association for Marriage & Family Therapy, 2001; p. 1). These
participants did not disclose any conditions under which they would agree to conduct therapy with
persons known from other contexts.

Professional judgment is a broad category and precisely the aspect of navigating complex rela-
tionships that this study was undertaken to explore.When prompted about how they used their pro-
fessional judgment, participants elaborated on how they make the decision to refer the client or
engage in the dual relationship. Participants were aware of the people or groups with whom they are
most experiencedor those the therapist feltmost competent inhelping andwithwhomtheyweremost
likely to engage in therapy: one partipant reported, “I know Iwork best with couples, single adults of
adolescents, not children and not addictive adults.” Several noted the client’s need for treatment, the
severity of the presenting issue, intake information, or expertise in couples versus family work as
issues to consider when deciding to take the case. For example, when participants felt that the client
needed immediate intervention andmaking a referral might delay treatment, they were more willing
to engage in a dual relationship. In this case, ensuring that the client received timely therapywas tem-
porarily prioritizedover the admonishment to avoid adual relationship.

The remaining three emergent themes reflect specific aspects of the dual relationships decision-
making articulated by participants. Although participants used their professional judgment in each
of these areas, they were specific enough to warrant separate elements.

Level of benefit or detriment to client. Promoting clients’ well-being was a factor in most deci-
sions therapists’ decision-making in their clinical practice. Specifically, they used their judgment

130 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

about the degree of benefit to the client when deciding whether or not to engage in a dual
relationship: one stated “professional judgment and instinct regarding my ability to be helpful to
the client.” In the words of one participant, he or she was aware of the potential “negative impact
of a dual relationship” on the clients well-being and the existing relationship. Despite this senti-
ment, many participants specifically mentioned that the dual relationship was a lesser concern than
promoting client safety. For example, one therapist would “suggest another referral unless an
emergency or crisis is presented.”

Another aspect of benefit to the client used as a deciding factor in engaging in the dual rela-
tionship was whether or not the client would not have sought therapy. A participant provided an
example of such a circumstance:

I have made one exception and accepted a client who told me she checked me out care-
fully at church and would otherwise not go to another therapist. She disclosed a ritual
abuse history and indicated a need to feel safe first since some of her abusers were trusted
people in positions of authority.

For this therapist, engaging in the relationship meant the particular client was able to receive
services. Other participants’ responses suggest that they use their judgment about what the client
needs and what they can offer at that time as means of determining whether or not to pursue the
dual relationship.

Context. Participants indicated concerns about the context within which they knew the
potential client. One participant differentiated between contexts such as “church affiliate versus
friend,” while another made the distinction between “whether I know them personally or profes-
sionally” as influential factors in their decision to pursue a therapeutic relationship or refer a client
to another therapist. Participants were more willing to conduct therapy with a professional associ-
ate than with a personal associate. A few were very specific in their understanding of a need to keep
personal and professional relationships separate, responding “I would not see someone with whom
I have a personal relationship” or “I don’t see family members of friends or acquaintances.” Others
made decisions based on a more graduated sense of the personal acquaintance. One participant
considered taking the case of someone with whom he or she had a professional relationship to be
unlikely to impair professional judgment or exploit clients and therefore upholding the ethical
standards of the field. Another participant noted receiving referrals from a sister program and
would engage in the dual relationship in the interest of “continuum of care.”

Therapist participants were more likely to engage in the dual relationship if he or she has
expertise with a particular population or presenting issue that was otherwise unavailable in the
area, in part out of the belief that the particular treatment the therapist offers is unique and that it
would be an undue hardship to the client to pursue this unique help elsewhere. For example:

Trauma using Eye Movement Desensitization and Reprocessing (EMDR) is my specialty
—if it is a very slight acquaintance (i.e., plumber, workman, etc) I would have to think
about it as I am, to the best of my knowledge, the only one using EMDR.

Nature of relationship. The nature of the relationship was considered a separate theme from
that of context and was based on a distinction between type of relationship (context) and the level
of intimacy or closeness in the relationship with a client (nature of the relationship). Examples
from responses include the influence of “the degree of interaction outside therapy,” “if I do not
have an intimate relationship with them I will see them,” and “if I know we will socialize I will
refer” as more intimate levels of contact with potential clients that would preclude a therapeutic
relationship. Participants distinguished between a high level of intimacy (personal relationships)
and low levels of intimacy (professional relationships) and considered high levels of intimacy to be
a barrier to a successful therapeutic relationship. Participants defined knowing someone “well” in
one or more of the following ways: (a) persons with whom they socialized; (b) persons with whom
their children played; (c) friends; (d) family members/acquaintances of friends; (e) students where a
spouse works; and (f) sharing a specific activity.

Participants might engage in a professional relationship with someone known from the gym
or an exercise class owing to the low levels of intimacy involved, but they were aware of their influ-
ential positions and potential likelihood of their impaired professional judgment when the current

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 131

relationship was one where there was a high frequency of contact and a high degree of intimacy,
such as a through a Bible study group or book club.

DISCUSSION

The strategies participants used to determine whether or not to refer a potential client reflect
several aspects of the ethical decision-making models reviewed, although they did not use any
model in its entirety. The four strategy themes derived from participant responses are present in
some of the ethical decision-making models previously outlined. Conversely, seemingly, important
aspects of the models are absent from participant responses and discussed below.

Professional Judgment
Despite the underlying assumptions about the inherent risks to judgment in a dual relation-

ship, the primary tool for navigating the complexity of a dual relationship among our participants
was the use of their professional judgment. Consistent with the question posed in the conceptuali-
zation of this study, therapists practicing in small communities appear to be aware of this integral
conflict and ask themselves, “How do I tell when multiple relationships will impair my professional
judgment?” These results indicate that therapists are intentional in handling potential dual rela-
tionships to minimize the impact on their ability to effectively manage the therapy process.

Although not explicitly stated in any of the models reviewed for this study, virtually all of
them imply using professional judgment. Several advise generating a list of potential courses of
action along with the possible consequences of these actions (Corey et al., 1998; Forester-Miller &
Davis, 1996; Smith & Smith, 2001; Steinman et al., 1998; Tarvydas, 1998; Welfel, 1998). The
results of this study add to the ethical decision-making literature and supplement the AAMFT
Code of Ethics by indicating specific aspects of the therapeutic relationship therapists in practice
should consider when exploring courses of action and their consequences, for example, judgments
about client motivation, the therapists’ ability to be helpful to the client, the potential for triangu-
lation, and the three specific themes discussed below.

Level of Benefit or Detriment
It is clear that dual relationships are discouraged, yet therapists may engage in them anyway if

they believe it will yield more benefit than harm for the client. A therapists’ main goal is for clients
to grow, improve, and heal. Toward this end, therapists were intentional in assessing the potential
harm to the client and the probable benefits.

This theme reflects themodels that suggest therapistsweigh thepotential risks andbenefits to see-
ing the client. Only Gottlieb (1993) proposes discussing with the client the potential consequences or
what their relationship posttherapy might entail should they engage in the dual relationship. The
majority of attention is focused on how contact outside of sessions prior to and during therapymight
impede the therapeutic process. Posttherapy contact is particularly important for those practicing in
a small communitywhere the likelihoodof such contacts in the community is very high.

Haas and Malouf (1995) suggest therapists ask themselves to reflect on their ability to be help-
ful. It is a therapist’s obligation to best meet the needs of their client, but also their prerogative to
refuse cases when they are not able to meet those needs. For example, if a therapist realizes that
she would be limited in what issues she can address and how she can address them, she might not
be able to provide quality therapy and would consider discussing that with the clients. An impor-
tant point for consideration is that the results of this study indicate that therapists practicing in
small communities may not feel they have the same latitude to refuse a case when the assessment of
the situation suggests that the client would be more harmed by their refusal.

Kitchener’s (1988) model also addresses power, but through the understanding of the different
roles, one might have in dual relationships. For example, one partner in a couple’s session is the
principal of the school the therapist’s child attends. In session, the therapist may be perceived as
having power. During interactions with the school, the principal is clearly in a position of power,
not only with the therapist, but also her or his child. Therapists who practice in small communities
are well aware of these types of power dynamics and considered them in assessing the level of bene-
fit or detriment to the client as well as the context and nature of the relationship discussed below.

132 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Context and Nature of the Relationship
The models reviewed herein do not attend to contexts in which decisions are made about

ethical dilemmas. The lack of distinction between contexts may lead to the assumption that all out
of session contacts between client and therapist are equally problematic to the process and
outcome of therapy. The therapists in this study felt that there are differences between types of
relationships (context) and the levels of intimacy (nature of the relationship) inherent in the
different types.

Most therapists have encountered a client outside of therapy, either at the grocery store, the
dry cleaners, or a physician’s office. Usually these meetings are unexpected and spontaneous. In the
case of a dual relationship, the assumption is that meetings outside of therapy are expected and at
times may even be regular, as in the case of a fellow parishioner. A consistent theme in the responses
of the participants reflected an attempt to understand the context and the nature of the relationship
between therapist and client outside of the therapy room, or in other words, attempt to determine
the regularity with which they might see one another and the quality of their out of session relation-
ship, consistent with the models proposed by Smith and Smith (2001) andGottlieb (1993).

This is an important point because the limited number of couple and family therapists who
represent cultural or religious minorities is likely to present an increased potential for dual rela-
tionships as clients attempt to self-match. This is underscored by a survey of AAMFT membership
(2004), which reported that the overwhelming majority of their members reported being White/
NonHispanic (93%: n = 2236) with approximately only 2% of respondents falling in each of the
following groups: African American, Hispanic/Latino, Asian, American Indian, and Other/Prefer
not to answer.

The energy and attention necessary for handling a dual relationship is usually greater than
that of another client. The therapist participants acknowledged this additional investment by
considering whether or not they actually have enough time to handle such a case and its unique
circumstances. This very specific, and practical consideration is not present in the reviewed models.
In fact, a number of everyday impediments to rural practice are not mentioned in the models, but
should be added to the list of practical obstacles to rural practice.

Supervision and/or Consultation
The literature on ethical dilemmas in rural areas notes the increased likelihood of encounter-

ing dual relationships and limited access to supervision. Two points strongly reflected in the results
of this study; one through its prominence and the other through its absence. The rural therapists in
this study generated the same concerns and issues that are represented in the literature regarding
the increased potential for dual relationships. Study participants received referrals or were sought
out by persons known to them in other settings and that these referrals came from a number of
community sources: fellow church members, family members of friends, parents of children’s class-
mates, persons with whom spouse has a professional relationship, and persons with whom the
therapist has a professional relationship (e.g., dentist, plumber, other therapist).

Notably, absent in participants’ responses was mention of bringing these dual relationship
issues to supervision to reflect on the potential consequences; however, it is unclear whether the
availability of supervision is limited in the areas where participants practice or whether the partici-
pants do not consider supervision as one of the tools useful in navigating dual relationships. As
noted earlier, one participant did report using a consultant “in the fourth session to help us decide
the appropriate next phase.” This participant used consultation as part of the therapeutic decision-
making process rather than as a means of determining, a priori, potential problems associated with
the dual relationship or as feedback in maintaining healthy boundaries in an ongoing dual rela-
tionship. Although intended to clarify the dual relationship, it is equally likely that the use of a
consultant, a role different from a supervisor, may create an additional dual relationship that rural
therapists must navigate.

A lack of supervision and consultation opportunities may possibly contribute to ethical con-
cerns resulting from limited access to clinical resources. Suggestions for therapists to remedy this
concern and obtain supervision have included group, telephone, and Internet supervision, yet each
presents problems (Kanz, 2001; Weigel & Baker, 2002). For group supervision, practitioners from
rural areas may have to drive several hundred miles to receive supervision or risk discussing a client

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 133

with whom someone else in the group has a relationship. Telephone supervision provides one
option for supervisees who may be geographically isolated, but there are still some ethical consid-
erations. Sending recorded sessions in the mail increases threats to confidentiality; cell phones are
an insecure method of discussing client information that could potentially be intercepted, and the
amount of time and expense to send recordings via postal service may be prohibitive. The availabil-
ity of Internet supervision is alluring, yet presents concerns about (a) divulging confidential infor-
mation over an insecure mode of communication; (b) the difficulty in obtaining informed consent
from clients for this type of supervision; (c) the importance of nonverbal cues of the therapist,
supervisor, and client; and (d) liability and licensure issues when Internet supervision takes place
across state lines (Kanz, 2001).

CONCLUSION

An objective of this study was to gather data to illustrate the complexities of dual relationships
in rural areas. The overwhelming majority of the rural therapists who participated in this study did
face the dilemmas of dual relationships. Indeed, most had fairly well-established strategies for han-
dling these relationships both before and during treatment.

The hope is that this research will foster a better understanding of the complexities of dual
relationships in rural areas as well as support further research in this area. The results of this study
may serve to clarify ethical guidelines around dual relationships in both the literature and practice.
The qualitative exploration utilized in this study allowed the researchers to begin to understand
the way therapists think about their process for ethical decision-making. Follow-up interviews with
therapists who are in the process of evaluating a dual relationship situation in their rural communi-
ties would greatly enhance our understanding of the practice of ethical decision-making. Also,
interviews focusing on the themes derived from this study would address the multiple obstacles to
confidentiality and maintaining therapeutic boundaries in small communities.

The implications of this study are significant: it seems clear that the nature of these relation-
ships is more than duality. Participants noted that whether a relationship is personal or profes-
sional, the types of boundaries regulating it, and the context of out-of-session contacts as
important factors in making ethical decisions. The consideration of these factors in decision-mak-
ing reflects the reality that dual relationships are inevitable in small communities and places more
emphasis on evaluating the process of therapy than on the duality. In the words of one participant,
“I live in a community of 5,000—if I am going to work, I must navigate these crossovers.”

This has implications for MFT training programs’ curriculum regarding AAMFT ethical
guidelines and the ethical guidelines in general. The current guidelines do not address the process
for decision-making with regard to dual relationships. Programs can help therapists in training
develop a more introspective and less legalistic decision-making process, which would address the
complexity of mitigating factors and provide an opportunity for them to explore their own biases
in a supportive environment.

Clients want to be in relationships with people like themselves and often look for therapists
that they believe have similar values or experience. Unfortunately, in rural communities where the
pool of available therapists is often limited, practicing therapists have little guidance in how to
make an ethical decision because of the ambiguity of the ethical guidelines and the neglect of the
challenges to rural practice in existing ethical decision-making models. These therapists may also
have difficulty navigating complex dual relationships because there are few opportunities for super-
vision in their communities. Instead, they learn to rely on their professional judgment about the
level of benefit or detriment to the client and therapeutic relationship and the context and the
nature of the relationship as they make their decisions about engaging in it.

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AAPPENDIX

GUIDING INTERVIEW QUESTIONS FOR CLINICIANS

The following questions were used as a guideline during phone interviews and distributed to partici-
pants at the annual Division Spring Conference for review. The researchers gave a brief description of
the purpose of the study and a consent script, either at the beginning of the interview or in writing for
those recruited at the Division Conference.

1. I am interested in knowing more about your experiences as a family therapist practicing
in a small community. Do you receive referrals for clients that you already know from
another setting?
a. (If yes) Help us understand how you think about these referrals? (factors you con-

sider, type of relationships, specific examples).
2. What are the settings that you might know some of these referrals from?
3. Describe how you respond to these requests for therapy from people you already know?

(Appropriate follow-up questions as needed to understand the factors.)
4. What influences your decision to see the client? (Appropriate follow-up questions as

needed to understand the factors.)
5. What influences your decision to refer the client? (Appropriate follow-up questions as

needed to understand the factors.)
6. Tell us about a time you received a referral from your religious or minority community?

a. Which affiliation?
b. How do you think knowing the person/family impacts your ability to conduct ther-

apy with the person or family?
7. What is your perception of how often you get referrals based on this affiliation?

136 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Copyright of Journal of Marital & Family Therapy is the property of Wiley-Blackwell and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder’s express written permission. However, users may print, download, or email
articles for individual use.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 3

Research

© 2014 by the American Counseling Association. All rights reserved.

Received 09/06/12
Revised 02/12/13

Accepted 02/18/13
DOI: 10.1002/j.1556-6676.2014.00124.x

Julie M. Moss, Hand Middle School, Columbia, South Carolina; Donna M. Gibson, Department of Educational Studies, University of
South Carolina; Colette T. Dollarhide, Department of Counselor Education and School Psychology, Ohio State University. Donna M.
Gibson is now at Department of Counselor Education, Virginia Commonwealth University. This research was made possible through
partial funding provided by a grant from the Chi Sigma Iota Counseling Academic and Professional Honor Society International.
Correspondence concerning this article should be addressed to Donna M. Gibson, Department of Counselor Education, School of
Education, Virginia Commonwealth University, PO Box 842020, Richmond, VA 23284-2020 (e-mail: dgibson7@vcu.edu).

Counselor professional identity encapsulates the idea of con-
tinuous growth and development within a certified context.
Counselor growth and development is a continuous and lifelong
process (Borders & Usher, 1992). It begins as individuals enter
counseling training programs and continues until they retire.
Professional identity is part of being a counselor (Gazzola &
Smith, 2007; Gibson, Dollarhide, & Moss, 2010) and is the
integration of the professional self and personal self (including
values, theories, and techniques). Personal attributes combine
with professional training as a counselor forms his or her own
professional identity. Within an ethical context, counselors rely
on their professional identity as a frame of reference as they
make decisions regarding their work with clients (Brott & My-
ers, 1999; Friedman & Kaslow, 1986; Skovholt & Rønnestad,
1992). In essence, counselor professional identity includes
interpersonal and intrapersonal dimensions.

Interpersonal dimensions of professional identity involve
one’s relationship to society and the professional community
(Gibson et al., 2010). The professional community includes
professional organizations, licensing boards and credentialing
bodies, and accrediting agencies. Interpersonal aspects also
involve the professional community of counselors. Emerg-
ing counselors learn about the culture of the counseling
profession through supervision and experience (Dollarhide
& Miller, 2006).

Professional identity is also shaped from within a person
and comprises the intrapersonal dimensions of professional
identity (Gibson et al., 2010). Personal definitions of coun-
seling evolve, locus of evaluation changes, and reflection

Professional Identity Development:
A Grounded Theory of Transformational
Tasks of Counselors
Julie M. Moss, Donna M. Gibson, and Colette T. Dollarhide

The purpose of this qualitative grounded theory study was to investigate practicing counselors’ professional identity
development at nodal points during their career. Through the use of 6 focus groups of beginning, experienced, and
expert counselors, 26 participants shared their experiences, and 6 themes emerged to form a theory of transformational
tasks of professional identity development. Through these tasks, counselors encountered issues of idealism toward
realism, burnout toward rejuvenation, and compartmentalization toward congruency.

Keywords: professional identity development, practicing counselors

becomes increasingly important as counselor identity is
solidified. New professionals move from an external to an
internal locus of evaluation and from a reliance on experts
to a reliance on their own experience and training (Auxier,
Hughes, & Kline, 2003; Brott & Myers, 1999; Gibson et al.,
2010; Skovholt & Rønnestad, 2003). The majority of research
pertaining to counselors’ identity development centers on the
professional identity development of counselors-in-training
rather than working professional counselors (Auxier et al.,
2003; Howard, Inman, & Altman, 2006; Gibson et al., 2010;
Nelson & Jackson, 2003; Woodside, Oberman, Cole, & Car-
ruth, 2007). Theories of identity development of counselors-
in-training (Auxier et al., 2003; Gibson et al., 2010) showed
that through experience, course work, and a commitment to
the profession, identity develops over time.

However, there is limited research about counselor identity
development at various points in the career life span. Mellin,
Hunt, and Nichols (2011) found that counselors believe their
work to be different from other helping professions and that
counselors’ identity focused on a developmental, prevention,
and wellness orientation. Several studies cite the need for
greater information about the development of professional
identity during the professional life span (Bischoff, Barton,
Thober, & Hawley, 2002; Brott, 2006; Brott & Myers, 1999;
Dollarhide, Gibson, & Moss, 2013; Gibson et al., 2010; Howard
et al., 2006; Rønnestad & Skovholt, 2003; Skovholt & Røn-
nestad, 1992). Rønnestad and Skovholt (2003) provided a phase
model that described “central processes of counselor/therapist
development” (p. 5) from the novice professional to the senior

Journal of Counseling & Development ■ January 2014 ■ Volume 924

Moss, Gibson, & Dollarhide

professional. The postgraduate professionals interviewed in
their cross-sectional, grounded theory qualitative study had an
average of 5, 15, and 25 years of professional experience with
doctoral degrees in professional psychology. On the basis of the
data, the following themes emerged: (a) There is an increasing
higher order integration of professional and personal selves;
(b) continuous reflection is required for optimal learning; (c)
an intense commitment to learning drives development; (d)
professional development is continuous, is lifelong, and can
be erratic; (e) clients are influential to counselor development;
(f) personal life experiences are influential to counselor devel-
opment; (g) interpersonal sources (i.e., mentors, supervisors,
counselors, peers, family) are influential to counselor develop-
ment; and (h) thinking and feeling about the profession and
clients change over time.

Conceptual Framework of Current Study
Although many of the professional identity development
studies in the literature are focused on one specific type of
population and at one point in time, a few longitudinal studies
in other disciplines indicate that there are specific influences
on professional identity development over time (Dobrow &
Higgins, 2005; Monrouxe, 2009). Rønnestad and Skovholt’s
(2003) work provided a foundation for the current study.
Because Rønnestad and Skovholt focused on postgraduates
with doctoral degrees in professional psychology, for the
current study, we determined that more research including
participants who were professional counselors (with and
without doctoral degrees) could determine if similar themes
are experienced. Hence, we created a series of four separate
cross-sectional studies to examine the professional identity
development of individuals in the counseling profession. The
four studies investigate counselors-in-training (Gibson et al.,
2010), practicing professional counselors, doctoral students
in counselor education programs (Dollarhide et al., 2013),
and counselor educators. No data were used more than once
in data analysis and reporting across the four studies. The
cross-sectional design allowed us to determine what transfor-
mational tasks were occurring for these groups of participants
and if longitudinal research was warranted for further study.

Transformational tasks describe the work counselors
must accomplish at each stage of their professional life span.
Counselors’ professional identity is transformed in response
to completing each task. For example, Gibson et al. (2010)
found three transformational tasks that counselors-in-training
must accomplish to develop a firm professional identity:
defining counseling, transitioning responsibility for growth,
and integrating a systemic identity. They found that course
work, experience, and commitment were significant events
as counselors-in-training moved from external validation to
self-validation. These results led us to question if the trans-
formation of counselor identity is mirrored in practicing
counselors. Therefore, we posed the following question in

our study: What is the process of counselors’ professional
identity development at nodal points in their career life span
as beginning, experienced, and expert counselors?

Method
For the current study, we used a grounded theory approach to
generate an explanation of the process of professional identity
development as it was viewed by the participants (Corbin &
Strauss, 2008). A grounded theory approach was most ap-
propriate for this study because it focused on developing an
explanation of a process that involved many individuals. Other
qualitative approaches did not allow a focus on the process.
All participants in the study had experiences that related to
professional identity development, and the research sought to
explain the process (Creswell, 2007). The characteristics of
grounded theory include the theory being grounded in data, use
of a constant comparative method, the use of memo writing by
the researchers, and theoretical sampling (Heppner & Heppner,
2004). The constant comparative method found in grounded
theory enabled us to identify similarities and differences be-
tween school and community-based counselors’ experiences.

Researchers and Trustworthiness

We were the primary instrument in the data collection. It is
especially important to recognize our assumptions and biases
in qualitative research because the data were filtered through
our lenses (Heppner & Heppner, 2004). We controlled for
this by first recognizing the assumptions and biases we held
relating to counselors’ professional identity development.

All three researchers are women. The first author, a middle
school counselor and doctoral candidate, had participated in
previous research relating to professional identity develop-
ment. She has 7 years of experience as a school counselor at
the elementary and middle school levels. The second author
has 13 years of experience as a counselor educator and 8 years
as a licensed professional counselor (LPC), and the third
author has 20 years of experience as a counselor educator
and 10 years as an LPC and school counselor.

When designing this study, we attempted to make the
study more rigorous. Acknowledging biases, using multiple
researchers during the coding process, and member checking
helped ensure the trustworthiness of data analyses. Because
this was a qualitative study, researcher biases were inherent.
Among our biases was the belief that counselor identity is
important to counselors and counselor educators. One of
our central assumptions relates to professional identity and
its progression during the course of one’s career. That is, we
believe that interactions with clients and colleagues, continued
professional development, successes, and failures shape how
counselors view themselves and their profession and that these
ideas evolved from the beginning of graduate school until the
present time. We anticipated that these ideas will continue to
change as counselors’ professional growth occurs.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 5

Professional Identity Development

To control for biases and to embrace subjectivity, we took
field notes and wrote reflexive journals (Heppner & Heppner,
2004). After leaving the data collection sites, we used reflexive
memo writing to write about emotions and reactions during
the study. Memo writing was also used to write down ideas
about the evolving theory during the data analysis process.
Using three researchers during the coding process ensured
that the themes and process formed were grounded in data.
The use of multiple researchers added credibility by involving
multiple perspectives, opinions, and experiences.

Participants had the opportunity to review our preliminary
analysis and take part in member checking (Creswell, 2007).
Some participants who noted that they would be available
for follow-up questions were asked to review the initial data
findings. Preliminary data were presented to the participants
via e-mail.

Participants

We used stratified purposeful sampling to select participants
for the study. This type of sampling identified the subgroups
and allowed for comparison between the groups being studied
(Creswell, 2007). Using Rønnestad and Skovholt’s (2003)
stratified sampling method, we invited school and community-
based counselors (with an LPC or LPC intern credential) to
participate and divided them into groups based on years of
experience (i.e., 1–2, 5–15, and 20+ years). School counselors
were solicited through a state mailing list and through local
school districts. We obtained contact information for LPCs
in the area from the state’s Department of Labor and Licens-
ing. Also, we used contact information for graduates from a
local university.

Twenty-six participants met the criteria and were able
to participate in the study. Demographic information was
collected relating to participants’ ethnicity, gender, high-
est degree earned, and work setting. Of the 26 participants,
15 were school counselors and 11 were community-based
counselors. The majority of the participants were female (n =
21) and five were male. Twenty-two participants identified as
White and four participants identified as African American.
Their work settings varied among the groups. For the school
groups, four were elementary counselors, six were middle
school counselors, and five were high school counselors.
Among community-based counselors, four worked in private
practice; one worked in college counseling; two worked in a
hospital setting; and one each worked in a residential treat-
ment facility, a community college, a mental health center,
and an employee assistance program.

Data Collection

Questions were developed based on research on professional
identity development (Rønnestad & Skovholt, 2003) and
the focus group questions used in Gibson et al.’s (2010)
study. We designed questions to elicit participants’ experi-
ence of their professional identity development during their

career. The questions addressed the following: definition of
counseling and any changes over time, professional identity
and factors that influenced it (i.e., Define your professional
identity at the current moment), and needs to progress in
their professional identity (i.e., What do you think you need
to progress to the next level of development of your profes-
sional identity?). Data were collected through recorded focus
groups that were scheduled in advance. The goal of this
qualitative data collection was to capture rich descriptions
of the process of professional identity development that
accurately represented participants’ lived experiences. The
advantage of using focus groups for data collection is that
it is more “socially oriented, often creating a more relaxed
feel than individual interviewing” (Hays & Singh, 2012, p.
253). The combination of grouping participants by work set-
ting, years of experience, and focus groups promoted robust
exploration and processing of the topic. The processing that
occurred in a focus group was essential to spark additional
thoughts relating to professional identity. By hearing other
counselors’ experiences in similar work settings, participants
gained insight into the construct of professional identity and
could provide more meaningful answers to questions. Focus
group sessions lasted 60 to 90 minutes.

The focus groups were formed on the basis of participants’
experience and area of expertise. We avoided mixing people
with different expertise or work settings because the goal was
for all participants to feel comfortable sharing their thoughts
and feelings (Krueger & Casey, 2009). Being comfortable in
the group increases the likelihood of participant involvement.
The focus groups were formed and coded with letters A (for
school and community-based counselors with 1–2 years of
experience), B (for school and community-based counsel-
ors with 5–15 years of experience), and C (for school and
community-based counselors with 20+ years of experience);
this coding system is used in the Results section.

Data Analysis

After focus group interviews were completed, each session
was transcribed verbatim. We used manual line-by-line open
coding to focus on coding for differences based on years of
experience and work setting and looked for concepts, catego-
ries, and properties that characterized each level of experience
and setting. We agreed that participants did not differ on the
basis of work setting. The idea of professional identity was
conceptualized as a continuum (Strauss & Corbin, 1998).
The transcripts of counselors with 1–2 years of experience
and those of counselors with 20+ years of experience were
coded for concepts and categories to anchor the ends of the
continuum. Next, the transcripts of counselors with 5–15
years of experience were coded.

In axial coding, the categories were refined as we sought
to identify the causes, influences, outcomes, and conse-
quences of counselors’ identity development. Participant
transitions were noted that would be used in the construction

Journal of Counseling & Development ■ January 2014 ■ Volume 926

Moss, Gibson, & Dollarhide

of the grounded theory (Corbin & Strauss, 2008). Finally, we
used selective coding to develop hypotheses to connect the
ideas of professional identity development among counsel-
ors. A model or theory was developed from the information
gathered (Creswell, 2007) that suggested transformational
tasks specific to practicing counselors. These transforma-
tional tasks were different from the transformational tasks
discovered in the previous studies (Dollarhide et al., 2013;
Gibson et al., 2010).

Results
The findings from the analyses suggested that six themes were
influential to counselors’ professional identity development:
(a) adjustment to expectations, (b) confidence and freedom,
(c) separation versus integration, (d) experienced guide, (e)
continuous learning, and (f) work with clients. Within three
of the themes—adjustment to expectations, confidence and
freedom, and separation versus integration—there was move-
ment as counselors gained experience working. The other
three themes—experienced guide, work with clients, and con-
tinuous learning—were catalysts for the movement that took
place. Although the process was different from the process
for counselors-in-training (Gibson et al., 2010), there were
transformational tasks completed by counselors during nodal
points in their counseling career that developed their profes-
sional identity. Within each of the groups, or career life stages,
there was a transformational task that enabled the counselor
to continue to grow and develop professionally (see Figure 1).

The three tasks were idealism toward realism, burnout toward
rejuvenation, and compartmentalization toward congruency.
Counselors were able to accomplish these tasks through the
processes of continuous learning, work with clients, and help
from an experienced guide. In this section, the results of the
themes with counselors’ quotes are presented. The section
ends with an explanation of how the themes are integrated
into the transformational tasks in the professional identity
development of counselors.

Participants were identified with anonymous codes based
on the group they were in: A = beginning counselors with
1–2 years of experience; B = experienced counselors with
5–15 years of experience; and C = expert counselors with
20+ years of experience. As mentioned earlier, participants
did not differ by work setting; therefore, school counselors
and community-based counselors are combined. Within each
group, participants are assigned an identifying number (1, 2,
3, etc.). For example, C2 is the second counselor in the group
of expert counselors with 20+ years of experience.

Themes and Theory

Adjustment to expectations. This theme represented the
counselors’ perceptions of their own expectations as coun-
selors versus the expectations others had of them in this role.
Counselors, especially beginning and experienced counselors,
expressed frustrations about their work environment. Beginning
counselors found reality different from the idealized role they
had imagined. As years progressed, this frustration led to coun-
selors in the middle of their career life span feeling dissatisfied

FiGurE 1

Professional identity Development Model of the Transformational Tasks of Counseling Practitioners

i

External
Validation

Experienced
guide

TIME

ii

Experience and
Professional
Development

• Continuous
learning

• Working with
clients

iii
Self-Validation

• Realistic sense
of work

• Rejuvenation
• Congruency of

work and life

AT
T

IT
U

D
E

T
O

W
A

R
D

W
O

R

K

E
N

E
R

G
Y

F
O

R
W

O
R

K

IN
T

E
G

R
AT

E
D

P
E

R
S

O
N

From idealism To realism

From burnout To rejuvenation

From compartmentalization To congruency

Transformational Tasks for Practitioners

Journal of Counseling & Development ■ January 2014 ■ Volume 92 7

Professional Identity Development

with their jobs. Counselors were asked how their definition of
counseling had changed for them, when it had happened, and
if working as a counselor was what they imagined it would be.

Beginning counselors grappled with the realization that
the realities of the workplace were different from graduate
training. One beginning counselor said, “It is one thing when
you are a student and there is someone actually kind of guid-
ing you but when you are out there doing it on your own, that
has definitely been an eye-opener” (A3). The idealized view
counselors had developed during training was different from
their actual job setting. Another beginning counselor stated,
“Now that I am actually in the school system, it is a little bit
different” (A2). These counselors reported feeling frustrated
as they recognized the difference.

Counselors expressed frustration with noncounseling
duties, administrative tasks, and paperwork. They reported
realizing how these other tasks interfered with their actual
counseling. As one beginning counselor explained, “I can’t
really get done what I want to get done and be as effective
as I can be because I am constantly doing other things like
paperwork” (A2). The counselors felt that these other or-
ganizations were dictating the services they provided and,
as a result, defined counselors’ identity. An experienced
counselor said,

Where I work it is almost like the establishments that we work
for really are defining our professional identity. . . . Insurance
dictates what kind of crisis a patient really needs to be having
in order to have the service they will pay for. (B13)

Experienced counselors were tired after years of confront-
ing the same struggles and were in need of rejuvenation. One
counselor shared,

I guess at this point in my career, I am feeling a bit I don’t
know if burned out is the word but I have gotten to where
I am used to doing the same thing. . . . I feel like I used to
have a lot more passion or hope than I do at this point. (B5)

After years of confronting these realities, expert counselors
felt continued frustration, which led to job dissatisfaction.

Confidence and freedom. As participants discussed how they
felt as counselors and what they needed to progress to the next
level of development in their professional identity, beginning
counselors expressed emerging doubts about their abilities and
desired more confidence. As these counselors gained experi-
ence, they felt more confidence and freedom in acknowledging
their limitations. A beginning counselor captured the insecu-
rities of new counselors by saying, “I feel like I have to put
up this, be as professional as I can be and you know talk as
technically as I can about what I do and what I am doing” (A4).
At the beginning stage of the counseling profession, there was
recognition that confidence struggles were part of the process.
Another beginning counselor said, “I almost think it is probably

a good place not to feel comfortable. . . . I definitely would like
to feel really confident. It’s all a process” (A5).

Whereas beginning counselors struggled to have confi-
dence within their professional role, experienced counselors
had gained confidence and felt freedom in recognizing their
limitations. One experienced counselor stated,

Early on when I was scared, I was fearful and not confident
. . . but for me now, I do think that it is probably, it’s really
awesome. . . . I still screw things up. I am just brave enough
now to own up when I do. (B11)

With an increase in confidence and freedom, counselors
also appreciated the community of counselors that they used
for client referrals. Instead of feeling that they needed to
know everything, they developed a network of people who
supported their practice and their clients. This idea was de-
scribed by an expert counselor:

I also am appreciative of a network of folks who have a wider
range of skills in their specialties than I do and I feel much
more comfortable in my own skin saying, hey could you work
with this person. . . . I think there is a little bit more confidence
I have in relinquishing and not thinking I have to have all the
answers for everybody, every case. (C6)

Separation versus integration. In this theme, counselors
actively separated and integrated both personal and profes-
sional aspects of their lives into their professional identities.
When beginning counselors talked about their identity, they
spoke of separating work from other areas of their life. Upon
gaining experience, counselors developed a sense of their pro-
fessional self and personal self integrating into one identity.
As counselors talked about their definition of counseling and
how they had imagined counseling to be, it was evident that
change occurred over their professional life span. A beginning
counselor reported how she compartmentalized her roles:

I am also a [sports team] coach so I am in an out-of-counselor
role. I am not a counselor on the court. . . . You can’t be both
all the time. . . . I kind of turn it on, turn it off. (A2)

This counselor viewed counseling as something she
could leave once she stepped out of her office to assume
another role.

Counselors reported that they believed that this idea of
separation was part of their training. One experienced coun-
selor stated, “In school they teach you to leave it [work] and
take care of yourself, but it is hard when you are in it. . . . It
is hard to leave that office and go home” (B13).

Through more experience, counselors viewed the differ-
ent facets of their job as part of a larger purpose for helping
clients. An expert counselor said, “I think when I first started,
it used to be really compartmentalized . . . then like you said,

Journal of Counseling & Development ■ January 2014 ■ Volume 928

Moss, Gibson, & Dollarhide

jack-of-all-trades, you do whatever it takes to get that child,
do whatever you have to do” (C3). There was a realization
that clients are important, and there was a desire to give extra
effort to best help them.

Expert counselors reached a level of congruency with their
professional and personal selves. They were able to reflect and
see how personal experiences affected them professionally
and how professional experiences affected their personal life.
One expert counselor shared,

I think the thing that has shaped my life as a counselor is
probably my son’s death . . . my own grieving journey just
really brought everything out and I went back, I went head
long into training for the grief and loss. (C5)

Experienced guide. Counselors at all levels expressed the
importance of having a mentor, supervisor, peer supervision,
or some form of experienced guide to help them in their pro-
fessional development. Participants talked about the need to
learn from an experienced counselor when discussing what
they needed to progress to the next level of development of
their professional identity, experiences that had contributed
most to their professional identity, and experiences that had
resonated most with them as a counselor.

A beginning counselor looked for “someone to say I expe-
rienced the same thing and this is what I did” (A3). Another
beginning counselor spoke about the impact that a mentor
had on her professional development: “I don’t know where I
would be had I not had that mentor which has probably been
the most beneficial thing as far as my professional identity
goes and learning about who I am professionally” (A1). Be-
ginning counselors look to counselors with more experience
to give them ideas, advice, and support.

Peer supervision is another type of supervision that coun-
selors found beneficial. Within the relationship, counselors
assumed roles of both supervisor and supervisee, and there
was a recognition that counselors with varying years of expe-
rience brought strengths to the relationship. An experienced
counselor talked about the power of peer supervision:

There are three other counselors, so we have a lot of time
to talk about cases and support each other, so I think other
professionals who have been in it longer than I have and new
professionals that come in and have a new energy and a dif-
ferent idea about things. (B10)

The value in continuing a mentoring relationship was also
reported by expert counselors. One expert counselor discussed
the impact his mentor continues to have on him as a professional:

Watching him present, watching him work with families and
demonstrations, having a chance to affiliate with him. That it
continues to be kind of like, boy that’s sort of who, that’s the
arena I’d like to be when I grow up. (C6)

Continuous learning. Each group of counselors recognized
learning as a lifelong endeavor and discussed ways to acquire
additional professional knowledge. Counselors were energized
as they talked about what they needed to progress to the next
level of development of their professional identity; they also
spoke of learning from classes, conferences, and trainings.

Beginning counselors expressed excitement about the
vast amount of information in the field. For example, one
beginning counselor said, “I think that is exciting about our
profession because we have to stay somewhat fluid and just
keep on changing” (A1). Participants were comfortable with
the idea that they would have to continue to learn to continue
developing as a professional.

As counselors gained experience, their learning became
more focused on their areas of expertise and interest. An ex-
perienced counselor said, “I study, study, study, study because
I am always interested in what is working, and I am always
searching out what’s going to help [clients], and I use every-
thing” (B12). Participants reported a desire to study specific
topics that would best help their clients and the populations
that they work with daily. An experienced counselor talked
about wanting “training on specific things, bullying, ADHD
[attention-deficit/hyperactivity disorder], autism” (B2).

Although they had many years of counseling experience,
expert counselors embraced the idea of continuous learning.
An expert counselor talked about his comfort level with
continuing to be a student at a conference:

They had all these labels and badges that you could attach
to your name tag, “Presenter,” or you know, “First Time At-
tendee,” and I don’t know whether it was what I wanted to be
as far as my next level, or if it was the contrarian in me, but I
picked up a “Student” badge and attached it to my name tag.
And actually I began to feel very, very comfortable with that.
There’s this, there is more for me to learn. (C6)

Conversations about additional educational experi-
ences energized counselors at all levels. For counselors,
learning was a lifelong endeavor because the f ield is
constantly evolving.

Work with clients. Clients provided the needed positive
reinforcements for counselors to do their job. A beginning
counselor stated, “I feel I am making a small difference and
constantly getting those reinforcers and motivators” (A4). Cli-
ents made the counselors’ learning, frustrations, and struggles
worthwhile. Participants were able to point to specific success
stories or instances of failure that had a lasting impact on
them professionally. Across all levels and work settings, work
with clients was most meaningful to counselors’ professional
identity development. Participants in every group discussed
their work with clients when asked about the experiences
that had contributed most to their professional identity, the
experiences that had resonated most with them, and how they
felt about themselves as counselors.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 9

Professional Identity Development

Beginning counselors were surprised at the strength people
showed despite their circumstances. Instead of being the ex-
pert, counselors found themselves learning from their clients.
One beginning counselor said, “I have been surprised, which
I am ashamed to say, that I just discovered more about how
people are strong and resilient . . . nothing seems to have gone
well but they were just incredibly strong” (A7).

Experienced counselors were pleased when they saw
clients grow and reach their counseling goals. Termination
was viewed as a graduation from counseling and a time when
both the client and counselor were proud of themselves. An
experienced counselor shared,

I terminated [counseling] a young college girl whom I had
been working with for about two and half years. . . . When we
finally met for the last time last week, it was mixed feelings.
I was almost sad because I was saying good-bye to her, but
then I was very proud of her work, but then I was proud of
myself because I stuck with her and saw her through. (B13)

Success stories involved clients in crisis and times when
counselors were able to help. The counselors realized that they
had made a difference in another person’s life. For example,
one experienced counselor stated, “It has been the children
who have been sexually abused, or the children who have
had physical abuse or witnessed you know things that were
traumatic for them and I know that those children really, re-
ally need me” (B6).

Emergence of Theory

In analyzing the current data, we determined that the themes
found in the participants’ experiences were part of the trans-
formational tasks associated with counselors’ professional
identity development. Counselors’ professional identity was
transformed in response to completing each task. The three
tasks the practicing counselors worked to accomplish were
idealism toward realism, burnout toward rejuvenation, and
compartmentalization toward congruency (see Figure 1).
These tasks served as a foundation to the process reported
by the participants within the themes of adjustment to ex-
pectations, confidence and freedom, and separation versus
integration. As counselors talked about each of these areas,
they reported factors that prompted their movement. These
factors were the catalysts for a changing identity. The same
transformational process was used at each stage: work with
clients, experienced guide, and continuous learning. In es-
sence, the grounded theory of this study was based on the
transformational tasks of professional identity development
of counselors.

Beginning counselors’ idealistic views were confronted
with the reality of the work world. This transformational task
involved the themes of adjustment to expectations and confidence/
freedom. The task at this stage was for new counselors to
reconcile their idealized visions with reality. Participants

reported entering the workforce unprepared, and new coun-
selors often experienced disillusionment with their graduate
training (Skovholt & Rønnestad, 1992). As counselors worked
to accomplish the task, they experienced self-doubt and con-
fidence struggles. Other studies found that new counselors
lacked confidence and needed external validation (Auxier
et al., 2003; Brott & Myers, 1999; Skovholt & Rønnestad,
2003). Participants reported that external validation came
from experienced guides and clients. As counselors received
external validation from an experienced guide or a client and
gained additional knowledge, they were able to accomplish
this task. The challenge of this task was for counselors to
become realistic about their abilities and their role.

Experienced counselors were challenged with the task
of burnout toward rejuvenation, which also addressed the
theme of adjustment to expectations. Participants reported
feeling dissatisfied with their jobs after years of dealing
with continual frustrations. As Gibson et al. (2010) found,
counselors reported that the public had misperceptions about
the counseling profession. Daily, counselors are advocates
for the profession to educators and insurance companies,
and these other entities influence counselors’ role and affect
their identity (Brott & Myers, 1999). Nevertheless, there was
a sense that counselors came to terms with these frustrations
and found a way to move forward professionally. The cata-
lysts for this movement were continuous learning, work with
clients, and an experienced guide. Counselors in this study
were energized by continuing to learn. They reported that
learning new techniques, taking classes, or making a change
in their counseling approach rejuvenated their professional
outlook. Successes with clients made the frustrations worth-
while. Knowing that they had made a difference or saved a
life was the reinforcement counselors needed to continue to do
their job. Participants also discussed how support from other
counselors helped them move forward during stressful times.

The third transformational task challenged counselors to
move from compartmentalizing counseling to having a con-
gruent view of the self. This task included the themes sepa-
ration versus integration as well as confidence and freedom.
The movement from compartmentalization to congruency was
a slow process fostered by experiences with others (clients,
experienced guides, and learning opportunities). Through
these interactions and personal experiences, counselors ex-
perienced a merging of their professional and personal selves
into a congruent identity.

Participants reported viewing counseling as something
separate from other aspects of their lives. They wanted to keep
their professional and personal lives separate in order to have
balance. However, congruency was observed in expert coun-
selors. Skovholt and Rønnestad (1992) found an authenticity-
to-self in experienced counselors in which role, working style,
and personality complemented one another. Expert counselors
in the current study accepted that being a counselor was a
core part of who they were as a person. They were confident,

Journal of Counseling & Development ■ January 2014 ■ Volume 9210

Moss, Gibson, & Dollarhide

were able to find balance, and experienced the freedom to take
professional risks. With the freedom to refer clients to other
counselors came a recognition of the professional commu-
nity. In contrast to Gazzola and Smith (2007) and Gibson et
al. (2010), in the current study, counselors did not consider
the professional community as comprising only counselors.
Instead, they seemed to include other helping professionals
in the professional community, such as psychologists, social
workers, and educators. This suggests a broader view of the
professional community as counselors looked beyond the
counseling profession for support and information.

The expert counselors were aware of their limitations and
experienced freedom in knowing their limitations. Their per-
sonal and professional selves had merged to create a congru-
ent self in which life experiences and professional experiences
were valued. Friedman and Kaslow (1986) found that coun-
selors became authentic and congruent as their professional
and personal selves merged. Participants in the current study
understood the value of their life experiences, including their
religious beliefs, values, interests, and personal losses such as
divorce or death in shaping who they were as a professional.

Discussion
The themes reported in this study were found to be important
to counselors’ professional identity development. They pro-
vided information about the process of identity development
over the course of the professional life span. The findings
are consistent with previous studies, which have found that
students developed an idealistic view of counseling during
training (Cave & Clandinin, 2007; Nyström, Dahlgren, &
Dahlgren, 2008; Swennen, Volman, & van Essen, 2008;
Troman, 2008) and that counselors entered the workforce
with unrealistic expectations (Rønnestad & Skovholt, 2003).
Participants in the current study discussed how their precon-
ceived view of counseling was challenged by the realities of
the workplace environment. Also, counselors with 1–2 years
of experience reported confidence struggles and feelings of
self-doubt that are consistent with previous studies (Bischoff
et al., 2002; Rønnestad & Skovholt, 2003; Skovholt & Røn-
nestad, 1992; Woodside et al., 2007). It was observed that
confidence grew as counselors gained experience. This is
consistent with previous studies that found counselors gained
confidence through experience, successes, and earning respect
from others (Magnuson, Black, & Lahman, 2006; Magnuson,
Shaw, Tubin, & Norem, 2004; R. G. Smith, 2007; Swennen
et al., 2008). As counselors gained confidence, they reported
realizing that they could handle their job, experiencing free-
dom to make mistakes, and understanding their limitations.

In addition, the data support how counselors become
congruent as their professional and personal selves merge
(Friedman & Kaslow, 1986). Three of the themes—work with
clients, experienced guide, and continuous learning—proved
to be change agents as counselors developed. Clients provided

positive reinforcements for counselors to do their job, and suc-
cesses and failures shaped the counselors’ identity. Findings
support previous studies that found that successes and failures
with clients had a profound impact on counselors’ identity
(Bischoff et al., 2002; Brott & Myers, 1999). When counselors
realized that they helped someone, they were empowered; this
led to more confidence and energy. Previous studies found
that work with clients validated new professionals (Bischoff et
al., 2002; Rønnestad & Skovholt, 2003; Studer, 2007). Also,
previous studies have found that supervision was helpful in
developing a strong identity as a counselor (Bischoff et al.,
2002; Brott & Myers, 1999). Other studies (Cave & Clan-
dinin, 2007; Dollarhide & Miller, 2006; Magnuson, 2002;
Magnuson et al., 2006) found supervisors to be important
to new counselors as they adjusted to the counseling profes-
sion. Positive feedback helped validate them as professionals
(Cave & Clandinin, 2007). The current data support these
findings in addition to suggesting that supervision affected
counselors at all experience levels. Each group admitted that
they needed help moving forward, which is consistent with
Gibson et al.’s (2010) findings. Previous research indicated
that new counselors wanted to fill in knowledge gaps and that
they had the desire and excitement to learn (Nyström et al.,
2008; R. G. Smith, 2007).

Limitations and Implications
The results of this study may not be applicable to all
counselors because of the limited number of participants
found within focus groups. The study investigated the
experiences of 26 participants in the southeastern United
States. Cultural limitations may exist (McGowen & Hart,
1990; K. L. Smith, 2007) because most of the participants
in our study were White women and were not representative
of all counselors. Also, the use of focus groups to collect
data limited the amount of in-depth exploration individual
interviews may have provided. If participants had sensitive
or threatening input, they may have been hesitant to share
their perspective with their peers in a group setting. How-
ever, the author who conducted the interviews made efforts
to create a welcoming and open environment in which par-
ticipants felt comfortable sharing their experience. Future
studies can strive to have a more representative sample of
the counseling population from various geographic areas.
Additionally, the use of individual interviews may elicit
more in-depth information from interview content and ob-
servation. Furthermore, longitudinal research is warranted
because of the transformational tasks and processes that
occur within each task at each nodal point. Future research
in professional identity development needs to consider the
years of experience not captured in the current study. The
results of this study have implications for counselors-in-
training, counselor educators, counselors, supervisors,
professional organizations, and future research.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 11

Professional Identity Development

First, counselor educators have the responsibility to
foster and develop the professional identity of counselors-
in-training (Council for Accreditation of Counseling and
Related Educational Programs, 2009). Counselor educators
can use the information about transformational tasks and
how to accomplish the tasks to better prepare emerging coun-
selors. When counselors-in-training enter programs, they
can be given assignments such as interviewing or shadowing
practicing counselors to gain a more realistic perspective of
the workforce. Also, counselor educators can give practical
perspectives by inviting guest speakers who are practicing
counselors into all classes. Counselor educators who are also
practitioners can use examples in their teaching from their
current practice to illustrate a reasonable view of counsel-
ing. In addition, counselor educators can strive to ensure
that practicum and internship experiences are realistic and
are best preparing counselors-in-training for the realities of
the work environment. Therefore, counselors entering the
workplace will have more reasonable expectations of the
counseling profession. They can also know what to expect
as they grow and develop within the profession. Realistic
expectations can lead to less frustration, which would help
both counselors and clients.

Second, this study provides counselors with a process
of their professional identity development. Recognition
of the transformational tasks can normalize the counselor
experience. There can be comfort in knowing that others
are facing the same issues and frustrations. Knowledge that
counselors at each stage face a similar struggle can lead to
greater peer support. As counselors feel self-doubt, burn-
out, or incongruence, they will know the tools (continuous
learning, work with clients, and experienced guide) to help
them work through their struggles.

Finally, the results of this study reinforce the benefits of
supervision at all levels of counseling. Counselors should be
encouraged to seek out an experienced guide to help them
navigate their professional growth. Also, supervisors can use
the knowledge about the struggles at each stage of develop-
ment to better support their supervisees. Supervisors can
use the information about the need for continuous learning
to help their supervisees by providing additional learning
opportunities. Supervisors can tailor their trainings to the
developmental needs of their supervisees.

Conclusion
Results of this study indicated that six themes were important
to counselors’ identity development: adjustment to expecta-
tions, confidence and freedom, separation versus integra-
tion, experienced guide, continuous learning, and work with
clients. In addition, a process emerged that included trans-
formational tasks at each professional life stage. This study
highlights the process of counselors’ professional identity
development and how it changes during the professional life

span. Identity development is a lifelong process. As counsel-
ors gain awareness of this process, they can be more effective
and experience greater job satisfaction.

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Report of the Task Force on

Test User Qualifications

Practice and Science Directorates

American Psychological Association

Approved by the APA Council of Representatives

August, 2000

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Task Force Members

Stephen T. DeMers, EdD (Cochair)
Samuel M. Turner, PhD (Cochair)

Marcia Andberg, PhD
William Foote, PhD
Leaetta Hough, PhD
Robert Ivnik, PhD
Scott Meier, PhD

Kevin Moreland, PhD (deceased)
Celiane M. Rey-Casserly, PhD

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Table of Contents

Title Page………………………………………………………………………………………….1
Task Force Members……………………………………………………………………………….2
Table of Contents………………………………………………………………….………….……3
Preface………………………………………………………………….………….………………4

I. Introduction

…………………………………………………………………………………………………………..6
Definition of Key Terms ………………………………………………………………………………7
Scope of the Guidelines ……………………………………………………………………………….8
Historical Background ……………………………………………………………………………….11

Efforts in the United States. ……………………………………………………………..11
International Efforts ………………………………………………………………………..14

APA’s Role in Defining Test User Qualifications………………………………………….15

II. Core Knowledge and Skills for Test Users………………………………………………………………17
Psychometric and Measurement Knowledge…………………………………………………17
Selection of Appropriate Test(s) ………………………………………………………………….22
Test Administration Procedures…………………………………………………………………..26
Ethnic, Racial, Cultural, Gender, Age, and Linguistic Variables ……………………..27
Testing Individuals With Disabilities …………………………………………………………..29
Supervised Experience……………………………………………………………………………….31
Summary of Core Knowledge and Skills………………………………………………………32

III. Test User Qualifications in Specific Contexts ………………………………………………………….33
Employment Context …………………………………………………………………………………34
Educational Context…………………………………………………………………………………..39

Career/Vocational Counseling Context

………………………………………………………..48

Health Care Context

…………………………………………………………………………………..54

Forensic Context

……………………………………………………………………………………….60

IV. A Look Forward…………………………………………………………………………………………………..68

References …………………………………………………………………………………………………………………….69

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Preface

In response to an increasing number of requests from members and the public for

guidance on the qualifications that the American Psychological Association (APA) considers

important for test use, the APA Council of Representatives convened a Task Force on Test User

Qualifications in August 1996. The Board of Scientific Affairs appointed Samuel M. Turner,

PhD, as co-chair, and the Board of Professional Affairs and the Committee for the Advancement

of Professional Practice appointed Stephen DeMers, EdD, as the other co-chair. An additional

seven members were appointed by an extended consultative process and represent the following

areas of expertise specified by the Board and Council: clinical, industrial/organizational, school,

counseling, educational, forensic, and neuropsychology.

The Task Force met seven times between 1996 and 1999. Between and after these

meetings, drafts of the report were circulated, revised, and revised again. At various stages,

drafts of the document were reviewed by the governing bodies of APA, division associations,

state associations, APA members, and several outside organizations whose members use tests.

The members of the Task Force would like to thank the numerous psychologists and other test

users who reviewed and commented on earlier versions of this report. Many of their helpful

responses were incorporated in this final version, and we are grateful for their assistance. In

particular, the task force acknowledges the comments of APA members Wayne Camara, PhD;

Rodney Lowman, PhD; Kathleen O’Brien, PhD, Nancy T. Tippins, Ph.D, and Mary V. McGuire,

PhD, JD.

Support for the project was provided by the staff of the Practice and Science Directorates

of APA. In particular, the Task Force would like to thank Heather Roberts Fox, PhD, Geoffrey

Test User Qualifications 5
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M. Reed, PhD, Dianne L. Schneider, PhD, and Dianne Brown Maranto. APA’s General Counsel

and outside legal counsel conducted the legal review of the report. The Task Force thanks Donna

Beavers for her assistance with coordinating recommendations regarding legal issues. The Task

Force also thanks Georgia Sargeant and Brendon MacBryde for copyediting the report.

The late Kevin L. Moreland, PhD, served as a member of the task force from 1996 to

1999. Without his gentle humor and talent for easing the most rancorous of debates, it is quite

likely that this report would not have been completed. As an acknowledgment of Dr. Moreland’s

contribution to the project and to the discipline of psychology, the Task Force dedicates this

report to his memory.

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I. Introduction

At the direction of the Council of Representatives of the American Psychological

Association (APA), the Task Force on Test User Qualifications (TFTUQ) was established in

October 1996. The goal of the task force was to develop guidelines that inform test users and the

general public of the qualifications that the APA considers important for the competent and

responsible use of

psychological tests.

The phrase test user qualifications refers to the

combination of knowledge, skills, abilities, training, experience, and, where appropriate,

credentials that the APA considers optimal for psychological test use. The guidelines in this

report are intended to apply to persons who use psychological tests in a variety of settings and

for diverse purposes. This report describes test user qualifications that the APA believes will best

serve the public.

The TFTUQ was established in part because of evidence that some current users of

psychological tests may not possess the knowledge and skill that the APA considers desirable for

optimal test use (e.g., Aiken, West, Sechrest, & Reno, 1990). Thus, it is hoped that these

guidelines will encourage training programs to make curricular changes that provide future test

users with a strong background in measurement theory and psychometrics, along with improved

skill in the administration, interpretation, and communication of test results. In addition, these

guidelines should encourage groups or individuals to obtain continuing education to improve

their use of psychological tests. The APA’s goal in promulgating these guidelines is to encourage

the development of the knowledge, skills, abilities, and experiences that promote optimal testing

practices for the purpose of maintaining high standards in professional test use with the public.

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Definition of Key Terms

Critical terms used in this document are defined as follows:

Psychological test: a measurement procedure for assessing psychological characteristics in

which a sample of an examinee’s behavior is obtained and subsequently

evaluated and scored using a standardized process.

Test user: the person or persons responsible for the selection, administration, and

scoring of tests; for the analysis, interpretation, and communication of test

results; and for any decisions or actions that are based, in part, on test

scores. Generally, individuals who simply administer tests, score tests and

communicate simple or “canned” test results are not test users.

Test user qualifications: knowledge, skills, abilities, training, experience, and, where

appropriate, credentials important for optimal use of psychological tests.

Assessment: a process that integrates test information with information from other

sources; a process for evaluating behavior, psychological constructs,

and/or characteristics of individuals or groups for the purpose of making

decisions regarding classification, selection, placement, diagnosis, or

intervention.

Context: the situation, purpose, or setting in which a test is being used;

circumstances that determine when testing is appropriate for a person or

group.

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Scoring: application of test-specific rules to the responses or behavior of the test

taker to produce quantitative or qualitative data about the test taker or a

group of test takers.

Interpretation: application of scientific knowledge and professional judgment to test data

to describe and/or make inferences about individual or group

characteristics or behavior.

Communication of test results: oral or written description and explanation of test findings to

others.

Supervision: the process of overseeing, directing, and assuming responsibility for the

actions of others involved in the testing process.

Scope of the Guidelines

The APA’s purpose in developing these guidelines is to inform test users as well as

individuals involved with training programs, regulatory and credentialing bodies, and the public

about the qualifications that the APA considers important for the optimal use of tests. These

guidelines describe two types of test user qualifications: (a) generic qualifications that serve as a

basis for most of the typical uses of tests and (b) specific qualifications for the optimal use of tests

in particular settings or for specific purposes. They are aspirational because they identify

qualifications for the optimal use of tests in a competent and responsible manner. These

guidelines describe qualifications that apply to a variety of testing settings and for multiple

purposes; therefore, it is unlikely that a single test user possesses all the qualifications described

here. The qualifications should also be considered in relation to the context, setting, and purpose

of test use.

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The guidelines apply most directly to standardized tests, such as measures of ability,

aptitude, achievement, attitudes, interests, personality, cognitive functioning, and mental health.

These guidelines apply to psychological tests whether or not they are administered by paper-and-

pencil or electronically and whether or not they are scored and interpreted by a test user or

electronically. The guidelines do not apply to unstandardized questionnaires and unstructured

behavior samples or to teacher- or trainer-made tests to evaluate performance in education or

training.

Various activities included in the testing process may be appropriately conducted by

different people working collaboratively. Each participant should possess the knowledge, skills,

and abilities relevant to his or her role. For example, different individuals may be responsible for

deciding what constructs, conditions, or characteristics need to be assessed; selecting the

appropriate tests; administering and scoring tests; and interpreting and communicating the

results. Moreover, some testing activities may involve tasks that require limited professional

knowledge (e.g., administering or scoring some tests, communicating simple test results). In such

circumstances, test use should be directed by a qualified test user. It is this test user to whom

these guidelines apply.

Persons whose psychological test use is confined to research will find that the degree to

which these guidelines apply to their work depends on their research focus and the research

setting. The sections that address knowledge and skills in relation to psychometrics, statistics,

test administration, and scoring are applicable to research that uses psychological tests. When

research is conducted with clinical populations or in settings where there are likely to be real or

perceived implications for the test taker, additional guidelines may be applicable.

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Testing and assessment. The use of psychological tests should typically be viewed within

the context of the broader concept of assessment. Psychological assessment is a complex activity

requiring the interplay of knowledge of psychometric concepts with expertise in an area of

professional practice or application. Assessment is a conceptual, problem-solving process of

gathering dependable, relevant information about an individual, group, or institution in order to

make informed decisions. This process of data gathering and decision making involves a number

of activities, including the

following:

1. Recognizing the nature of the decisions to be made or the questions to be addressed;

2. Deciding what information is needed to answer these questions;

3. Selecting appropriate methods for acquiring this information, including tests,

interviews, observations, surveys, or other data-gathering techniques;

4. Competently administering and scoring the selected tests according to standardized

procedures when available and appropriate;

5. Accurately interpreting information, which may include knowing when to question

the usual interpretation of a procedure because of intervening or mitigating

circumstances;

6. Using assessment data and resultant interpretation to make a professionally sound

decision; and

7. When appropriate, communicating assessment results in a way that is understandable

to the client.

Many problems or questions to be addressed through assessment must be approached with a

recognition of the potential for multiple coexisting or competing explanations. Such recognition

Test User Qualifications 11
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comes from the professional knowledge and judgment associated with advanced professional

training and experience and not just from the ability to administer and score a particular test or

other assessment instruments. This decision-making process is best conducted or directed by a

professional with expertise in psychological assessment in a particular testing context.

Historical Background

In delineating the knowledge and skills important for the use of tests, the Task Force

reviewed recent U.S. and international efforts to develop guidelines on test user qualifications.

Several national and international professional organizations whose members use tests have

addressed the issue of test user qualifications over the years. Their efforts are described briefly

below.

Efforts in the United States. The APA appears to have been one of the first

groups

concerned with test user qualifications. The APA formed the Committee on Ethical Standards for

Psychology in the late 1940s to develop its first set of ethical principles. The first topic in these

ethical standards addressed the sale and distribution of psychological tests and diagnostic aids

(Hobbs, 1951). The Committee released the ethical standards for the distribution of

psychological tests in 1950. The complete set of ethical standards was adopted in 1953 (Golann,

1970). Since 1950, the APA has addressed the issue of test user qualifications broadly in

subsequent revisions of its ethical principles (APA, 1981, 1992). The current version of the

APA’s ethical principles (APA, 1992) contains a number of standards that are related to

appropriate test use, including specific principles related to the boundaries of competence for

psychologists and the appropriate application and use of psychological assessment techniques.

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Other professional groups that use psychological tests also have promulgated ethical

guidelines (e.g., American Association for Counseling and Development [now the American

Counseling Association; ACA], 1988; American Association for Marriage and Family Therapy,

1998; National Association of School Psychologists [NASP], 1992; National Council on

Measurement in Education [NCME], 1995). Indeed, the ACA has a specific set of

Responsibilities of Users of Standardized Tests (American Association for Counseling and

Development, 1988), popularly known as the RUST document. This document suggests that the

qualifications of test users depend on four factors: (a) the role of the user (e.g., administration

and scoring), (b) the setting, (c) the nature of the test, and (d) the purpose of testing.

In addition to developing its own ethical principles on test use by psychologists, the APA

has participated in formulating standards on the development and use of psychological and

educational tests (APA, American Educational Research Association [AERA], & NCME, 1954,

1966, 1974; AERA, APA, & NCME, 1985, 1999). The 1954 Technical Recommendations for

Psychological Tests and Diagnostic Techniques and the 1966 Standards for Educational and

Psychological Tests and Manual both referred to a categorization of test user qualifications first

approved by APA’s Council of Representatives in 1950. The policy was referred to as the

“Ethical Standards for the Distribution of Psychological Tests and Diagnostic Aids” (APA,

1950) and included a three-level system for classifying test user qualifications.

This three-tiered system labeled some tests Level A (e.g., vocational proficiency tests)

and designated them as appropriate for administration and interpretation by nonpsychologists.

The next level of tests (e.g., general intelligence tests and interest inventories) was

labeled Level B. Qualifications for administering them included “some technical knowledge of

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test construction and use, and of supporting psychological and educational subjects such as

statistics, individual differences, the psychology of adjustment, personnel psychology, and

guidance” (APA, 1950, p. 622). Over time, however, all those sanctioned “by an established

school, government agency, or business enterprise” (APA, 1950, p. 622) were reclassified as

eligible test users of Level B tests. Subsequent evidence suggests that those institutions did not

provide the oversight necessary to ensure that these test users were in fact qualified (Eyde et al.,

1993).

Finally, qualifications for the use of Level C tests (e.g., individually administered tests of

intelligence, personality tests, and projective methods) restricted their use to “persons with at

least a Master’s degree in psychology, who have had at least one year of supervised experience

under a psychologist” (APA, 1950, p. 622). The Level C qualification also had some exceptions.

The reference to the three-tiered system was dropped from the 1974 (and subsequent)

Standards without a replacement, but casual inspection of test publishers’ current catalogs

reveals that it is still in widespread use (cf. Robertson & Eyde, 1986).

An attempt to define test use was undertaken by an interdisciplinary group beginning in

1985. In that year, the APA, the AERA, the NCME, and test publishers formed the Joint

Committee on Testing Practices (JCTP).1 The TUQWoG, a subgroup of the JCTP, immediately

set about developing a data-based approach to promoting good test use. TUQWoG conducted

several empirical studies designed to elucidate the types of competence problems exhibited by

1Before the work of the Test User Qualifications Working Group (TUQWoG) was
completed, the ACA and the American Speech-Language-Hearing Association had joined the
JCTP. The NASP has subsequently joined. The original requirement that one of the two
representatives of each organization be employed by a test publisher was dropped.

Test User Qualifications 14
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test users. The results of these studies were reported in a 1988 publication entitled Test User

Qualifications: A Data-Based Approach to Promoting Good Test Use (Eyde, Moreland,

Robertson, Primoff, & Most, 1988); in an article by Moreland, Eyde, Robertson, Primoff, and

Most (1995); and in a book of case studies (Eyde et al., 1993).

Despite all these efforts, evidence suggests that most of the problems associated with test

use are related to the competence of individual test users, although the uneven quality of test

construction and the ease with which test instruments can be obtained from some test publishers

also contribute to these problems (Tyler, 1986). In devising the present set of guidelines, the

TFTUQ kept in mind the types of problems identified by the empirical research and the

conclusion that much of the difficulty lies with test users. Thus, these guidelines were formulated

primarily to address characteristics of test users. This document does not pertain to the

development of tests, which is addressed in the Standards for Educational and Psychological

Testing

(AERA, APA, & NCME, 1999).

International efforts. The Task Force found that concern over the misuse of tests has been

growing in the international psychology community over the past few years. Several countries

and international groups, including the International Test Commission (ITC), the British

Psychological Society (BPS), and the Canadian Psychological Association (CPA), have launched

initiatives to address concerns about test user qualifications.

In 1992, the CPA released a report on the adequacy of typical safeguards used by test

publishers to limit test access to qualified individuals (Simner, 1994). The report suggested that

test publishers did not uniformly apply the system of classifying tests according to three levels.

Some publishers did not use the three-tier system to screen test users, and those who did often

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did not agree on the qualifications required for a particular test. In fact, there was disagreement

on the classification of about two thirds of the tests (Simner, 1994). The CPA report contained

recommendations for improving safeguards to protect the public from test misuse. These

recommendations ranged from replacing or supplementing the test-rating system used by the

publishers to requiring all first-time test users to complete a qualifications statement.

The BPS implemented a competence-based approach to certify test users (BPS, 1995,

1996). To date, the BPS certification system has focused on testing in occupational settings,

although the system may ultimately be expanded to address test user qualifications in educational

and health care settings as well. In the BPS system, test users are evaluated by assessors,

overseen by BPS-appointed verifiers, for demonstrated competence to use tests appropriately.

Those who are judged competent can apply for the BPS certificate in test competence and are

listed in a register that can be used by those purchasing testing services.

Finally, the Council of the ITC adopted international guidelines on core standards for test

use at its June 1999 meeting in Graz, Austria (ITC, 2000). The aim of this ITC project included

the production of a set of competencies (i.e., knowledge, abilities, and skills) for test use by

psychologists and nonpsychologists who use tests. The ITC guidelines represent the work of

specialists in psychological and educational testing (i.e., psychologists, psychometricians, test

publishers, and test developers) from the United States, Canada, Australia, and Europe.

APA’s Role in Defining Test User Qualifications

The reason that the APA has sought to develop and promulgate guidelines for the use of

psychological tests evolves from a number of sources. As described above, historically, the APA

has recognized the need for and devoted considerable attention to the development of test user

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qualifications. Although professionals from a variety of disciplines develop and use tests,

graduates from doctoral programs in psychology and educational and psychological

measurement have provided significant contributions to the science of testing and assessment.

The discipline of psychology is the historical root for psychological testing and provides the

research evidence and professional training to advance competent psychological assessment. The

APA formed the TFTUQ in 1996 in the belief that previous efforts, although useful, did not

provide the kind of specific guidance that many APA members and others were seeking. It is

appropriate for the discipline of psychology to establish guidelines for the proper use of

psychological tests.

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II. Core Knowledge and Skills for Test Users

This section addresses the knowledge and skills that are important when test users make

decisions or formulate policies that directly affect the lives of test takers. The knowledge and

skills listed in this section are generic; however, the level of skill and depth of knowledge in

these areas may vary depending on the testing purpose and context. The next section describes

additional knowledge and skills that are relevant to the purpose or context in which tests are

used. These generic qualifications, in combination with the context-relevant qualifications

described later, are important for optimal test use. The Standards for Educational and

Psychological Testing (AERA, APA, & NCME, 1999) is an excellent resource for more

information on many of the concepts presented below.

1. Psychometric and Measurement Knowledge

It is important for test users to understand Classical Test Theory and, when

appropriate or necessary, Item Response Theory (IRT). The essential elements of

Classical Test Theory are outlined below. When test users are making

assessments on the basis of IRT, such as adaptive testing, they should be familiar

with the concepts of Item Parameters (e.g., item difficulty, item discrimination,

and guessing), Item and Test Information Functions, and Ability Parameters (e.g.,

theta).

1.1 Descriptive statistics. Test users should be able to define, apply, and interpret

concepts of descriptive statistics. For example, means and standard deviations are

often used in comparing different groups on test scales, whereas correlations are

frequently used for examining the degree of convergence and divergence between

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two or more scales. Similarly, test users should understand how frequency

distributions describe the varying levels of a behavior across a group of persons.

Test users should have sufficient knowledge and understanding of

descriptive statistics to select and use appropriate test instruments, as well as

score and interpret results. The most common descriptive statistics relevant to test

use include the following:

1.1.1 Frequency distributions (e.g., cumulative frequency distributions)

1.1.2 Descriptive statistics characterizing the normal curve (e.g., kurtosis,

skewness)

1.1.3 Measures of central tendency (e.g., mean, median, and mode)

1.1.4 Measures of variation (e.g., variance and standard deviation)

1.1.5 Indices of relationship (e.g., correlation coefficient)

1.2 Scales, scores, and transformations. Test results frequently represent information

about individuals’ characteristics, skills, abilities, and attitudes in numeric form.

Test users should understand issues related to scaling, types of scores, and

methods of score transformation. For example, test users should understand and

know when to apply the various methods for representing test information (e.g.,

raw scores, standard scores, and percentiles). Relevant concepts include the

following:

1.2.1 Types of scales

a. Nominal scales

b. Ordinal scales

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c. Interval scales

d. Ratio scales

1.2.2 Types of scores

a. Raw scores

b. Transformed scores

i. Percentile scores

ii. Standard scores

iii. Normalized scores

1.2.3 Scale score equating

1.2.4 Cut scores

1.3 Reliability and measurement error. Test users should understand issues of test

score reliability and measurement error as they apply to the specific test being

used, as well as other factors that may be influencing test results. Test users

should also understand the appropriate interpretation and application of different

measures of reliability (e.g., internal consistency, test–retest reliability, interrater

reliability, and parallel forms reliability). Similarly, test users should understand

the standard error of measurement, which presents a numerical estimate of the

range of scores consistent with the individual’s level of performance. It is

important that test users have knowledge of the following:

1.3.1 Sources of variability or measurement error

a. Characteristics of test taker (e.g., motivation)

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b. Characteristics of test (e.g., domain sampling, test length, and test

heterogeneity)

c. Characteristics of construct and intended use of test scores (e.g.,

stability of characteristic)

d. Characteristics and behavior of test administrator (e.g., importance

of standardized verbal instructions,)

e. Characteristics of the testing environment

f. Test administration procedures

g. Scoring accuracy

1.3.2 Types of reliability and their appropriateness for different types of tests and

test use

a. Test–retest reliability

b. Parallel or alternative forms reliability

c. Internal consistency

d. Scorer and interrater reliability

1.3.3 Change scores (or difference scores)

1.3.4 Standard error of measurement (i.e., standard error of a score)

1.4 Validity and meaning of test scores. The interpretations and uses of test scores,

and not the test itself, are evaluated for validity. Responsibility for validation

belongs both to the test developer, who provides evidence in support of test use

for a particular purpose, and to the test user, who ultimately evaluates that

evidence, other available data, and information gathered during the testing process

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to support interpretations of test scores. Test users have a larger role in evaluating

validity evidence when the test is used for purposes different from those

investigated by the test developer.

Contemporary discussions of validity have focused on evidence that

supports the test as a measure of a construct (sometimes called construct validity).

For example, evidence for the uses and interpretations of test scores may come

through evaluation of the test content (content representativeness), through

evidence of predictions of relevant outcomes (criterion-related validity), or from a

number of other sources of evidence. Test users should understand the

implications associated with the different sources of evidence that contribute to

construct validity, as well as the limits of any one source of validity evidence.

1.4.1 Types of evidence contributing to construct validity

a. Content

b. Criterion related

c. Convergent

d. Discriminant

1.4.2 Normative interpretation of test scores. Norms describe the distribution of

test scores in a sample from a particular population. Test users should

understand how differences between the test taker and the particular

normative group affect the interpretation of test scores.

a. Types of norms and relevance for interpreting test taker score (e.g.,

standard scores and percentile norms)

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b. Characteristics of the normative group and the generalizability

limitations of the normative group

c. Type of score referent

i. Norm referenced

ii. Domain referenced (criterion referenced)

iii. Self-referenced (ipsative scales)

d. Expectancy tables

2. Selection of Appropriate Test(s)

To select the best test or test version for a specific purpose, test users should have

knowledge of testing practice in the context area and the most appropriate norms when more

than one normative set is available. Knowledge of test characteristics such as psychometric

properties (presented above), basis in theory and research, and normative data (where

appropriate) should influence test selection. For example, normative data or decision rules may

not be accurate when (a) important characteristics of the examinee are not represented in the

norm group, (b) administration or scoring procedures do not follow those used in standardizing

the test, (c) characteristics of the test may affect its utility for the situation (e.g., ceiling and floor

effects), (d) the test contains tasks that are not culturally relevant to the test taker, or (e) the

validity evidence does not support decisions made on the basis of the test scores.

Test users should have an understanding of how the construction, administration, scoring,

and interpretation of tests under consideration match the current needs. Mismatches in these

dimensions between the selected test and the current testing situation represent important factors

that should be considered and which may invalidate usual test interpretation.

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More specifically, to select an appropriate test for a particular use, it is important that test

users understand and consider the following:

2.1 Intended use of the test score

2.2 Knowledge of the method and procedures used to develop or revise the test being

considered

2.2.1 Definition of the construct that the test purports to measure

2.2.2 Definition of the test purpose and its intended context of use

2.2.3 Type of keying or scaling used

a. Rational or theoretical

b. Empirical

c. Internal consistency or construct homogeneity (e.g., factor

analysis)

2.2.4 Scoring procedures (e.g., clinical, mechanical, and correction for guessing)

2.2.5 Type of score interpretation

a. Criterion or domain referenced

b. Norm referenced

c. Ipsative

2.2.6 Item and scale score characteristics

a. Item format

b. Difficulty level

c. Reliability (e.g., internal consistency and test–retest)

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2.2.7 Validity evidence of test scores

a. Construct validity evidence

i. Content representativeness

ii. Criterion related

iii. Convergent

iv. Discriminant validity

v. Cross-validation

vi. Validity generalization (e.g., the effects of sample size, test

and criterion reliability and range restriction , and

dichotomization of variables)

vii. Criterion Characteristics (e.g., sufficiency, relevance)

2.2.8 Test bias (see 4.2 below for details)

2.2.9 Description of validation, normative, and/or standardization group(s)

a. Characteristics of groups (such as age, gender, race, culture,

language, disabilities, geographic region, socioeconomic status

[SES], educational or grade level, motivational set, mental status,

and item format familiarity)

b. Sample size(s)

c. Recency of data

2.2.10 Test administration procedures

a. Standardization procedures

b. Time limits (power vs. speed)

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2.3 Knowledge of test taker variables that may moderate validity and interpretation of

scores (such as age, gender, race, culture, language, disabilities, geographic

region, era or time period tests, SES, educational or grade level, motivational set,

mental status, and item format familiarity)

2.4 Other or special requirements and limitations of test

2.5 Adequacy of the match between test characteristics and present need in terms of

the following:

2.5.1 Construct measured

2.5.2 Difficulty level

2.5.3 Validity

2.5.4 Reliability

2.5.5 Test bias

2.5.6 Normative data

2.5.7 Similarity of normative group with present group

2.5.8 Test administration procedures

a. Accommodations for disabilities (when

appropriate)

b. Characteristics of test administrator

c. Adaptation for individuals with different primary language (when

appropriate)

2.5.9 Special requirements and limitations of test

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3. Test Administration Procedures

Knowledge about procedural requirements, confidentiality of test information,

communication of results, and test security is important for many testing applications, as is

familiarity with standardized administration and scoring procedures and understanding a test

user’s ethical and legal responsibilities and the legal rights of test takers. Similarly, it is

important that test users understand the legal and ethical issues related to the release of test

materials, including issues of confidentiality, depending on the context of the testing and the

characteristics of the test taker.

Test users should be able to explain test results and test limitations to diverse audiences.

Written communications should include the purpose of the test and the setting in which the

testing occurred. In preparing written reports on test results, test users should be aware that the

test scores might become separated from the interpretive report over time.

More specifically, test users should be familiar with the following:

3.1 Legal rights of test takers

3.2 Standardized administration procedures

3.3 Scoring procedures

3.4 Confidentiality of test materials and test information

3.4.1 Safeguards for protecting test materials

a. Protection against copyright infringement

b. Protection against unauthorized dissemination of test

items/keys/scoring procedures

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3.4.2 Safeguards for protecting protocols and test

results

a. Legal issues

b. Ethical issues

3.5 Reporting results to the test taker, caregiver, or others as appropriate

3.5.1 Characteristics of meaningful reports

3.5.2 Amount of information to report

3.5.3 Legal and ethical issues

4. Ethnic, Racial, Cultural, Gender, Age, and Linguistic Variables

Consideration of these variables may be important to the proper selection and use of

psychological tests. For certain purposes, legal requirements influence or restrict the testing,

scoring, interpretation, analysis, and use of test data of individuals in different subgroups. In

some cases (e.g., employment testing), the use of gender, race, and/or ethnicity in test

interpretation is illegal. Test users should consider and, where appropriate, obtain legal advice

on legal and regulatory requirements to use test information in a manner consistent with legal

and regulatory standards. Issues associated with testing individuals from particular subgroups,

such as race or ethnicity, culture, language, gender, age, or other classifications, are addressed in

greater detail in the 1999 version of the Standards for Educational and Psychological Testing

(AERA, APA, & NCME, 1999).

The APA’s promulgated Guidelines and Principles for Accreditation of Programs in

Professional Psychology (APA, 1996) discussed the need for psychology training programs to

address issues of cultural diversity. The APA demonstrated its interest in and sensitivity to these

issues by establishing the Commission on Ethnic Minority Recruitment and Training in

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Psychology. In addition, the Task Force on Delivery of Services to Ethnic Minority Groups,

under the auspices of the Board of Ethnic Minority Affairs, published Guidelines for Providers

of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (APA,

1990). These guidelines were approved by the APA’s Council of Representatives. In addition,

the ITC has issued “Guidelines for Adapting Educational and Psychological Tests: A Progress

Report” (Hambleton, 1994), which provides recommendations about adapting tests for cross-

cultural testing.

For test users using tests with different ethnic, racial, cultural, gender, and language

groups, knowledge of the following is important:

4.1 Construct equivalence. Test users strive to be familiar with the literature regarding

issues of construct equivalence (e.g., cultural equivalence) in its various forms and

how this might affect the selection, use, and interpretation of psychological tests for

individuals whose dominant language is not the language of the test or who are from

different racial, ethnic, or gender groups.

4.1.1 Information concerning the influence of psychological characteristics

(e.g., motivation, attitudes, and stereotype threat) on test performance

4.1.2 Orientations and values that may alter the definition of the constructs(s)

being assessed and how those factors may affect the interpretation of test

results

4.1.3 Requirements of the testing environment and how that may affect the

performance of different groups

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4.2 Test bias. Test users should be familiar with the legal and psychometric literature

pertaining to test bias for different racial, ethnic, cultural, gender, and linguistic

groups and how this might affect decisions pertaining to selection of tests and

interpretation of test results. It is important that test users know the following:

4.2.1 Laws and public policies concerning use of tests that may have

implications for test selection, as well as administration and interpretation

4.2.2 Procedures for examining between-groups differences in test performance

4.2.3 Empirical literature concerning differential validity for racial or cultural

groups

5. Testing Individuals with Disabilities

Tests are administered to increasing numbers of persons with disabilities in a variety of

settings and for a multitude of purposes. The requirement to accommodate an individual with a

disability in the testing situation raises many complex issues for test users. Test users must

frequently make decisions regarding the use of tests that were not developed and normed for

individuals with disabilities. In such circumstances, confidence in the inferences drawn from test

results may be diminished. There may be legal requirements concerning the accommodation of

individuals with disabilities in test administration and the use of modified tests. Test users should

consider and, where appropriate, obtain legal advice on legal and regulatory requirements

regarding appropriate administration of tests and use of test data.

Several efforts were initiated during the mid-1990s to provide guidance to test users for

assessing individuals with disabilities. The APA Task Force on Test Interpretation and Diversity

published a book identifying the scientific and policy issues related to the interpretation of tests

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used with individuals for whom the tests were not developed, standardized, and validated

(Sandoval, Frisby, Geisinger, Scheuneman, & Grenier, 1998). This text identified important

considerations in assessing individuals with specific types of disabilities (e.g., deafness,

blindness, and learning disabilities). Additionally, a working group of the JCTP published a

sourcebook on assessing individuals with disabilities. This sourcebook for practitioners describes

some of the pertinent legal and regulatory information, as well as types of accommodations,

required documentation, and the use of tests in various contexts (e.g., employment, admissions,

and counseling; Ekstrom & Smith, in press). Finally, the 1999 Standards for Educational and

Psychological Testing (AERA, APA, & NCME, 1999) includes a chapter on technical

considerations for testing individuals with disabilities. Those who administer tests to individuals

with disabilities should be familiar with the legal, technical, and professional issues governing

the use of tests with individuals with disabilities, including the following:

5.1 Legal issues. Test users involved in assessing individuals with disabilities should be

familiar with the relevant legal requirements and enforcement guidance for assessing

individuals with disabilities for specific purposes (e.g., Section 504 of the

Rehabilitation Act, the Individuals With Disabilities Education Act, and the

Americans With Disabilities Act) and obtain legal advice in these matters where

appropriate.

5.2 Test selection. Test users should possess the knowledge to make an appropriate

selection of measures. Test users strive to have current information regarding

availability of modified forms of the tests in question.

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5.3 Test accommodation. Test users strive to be familiar with the available literature

addressing the various accommodations appropriate for individuals with disabilities

and, to the extent available, on the effects of test accommodation on test score

interpretation and use. When there is a need to modify a test, test users should have

the knowledge and skills needed to modify the test appropriately for the test taker

while maintaining all feasible standardized features and to communicate those

modifications as appropriate.

5.4 Interpretation of test results of individuals with disabilities. Test users strive to be

familiar with the literature regarding how external factors and characteristics

associated with the disability may affect the interpretation of test scores, such as the

following:

5.4.1 Effects of the testing environment and the tests being used on the

performance of individuals with disabilities

5.4.2 Inferences based on the test scores accurately reflect the construct, rather

than construct-irrelevant, characteristics associated with the disability

5.4.3 Knowledge of whether regular norms or special norms are appropriate for

the characteristic in question

6. Supervised Experience

In addition to having certain knowledge and skills needed for appropriate test use, it is

important that test users have the opportunity to develop and practice their skills under the

supervision of appropriately experienced professionals. This supervision typically begins in

graduate school and continues throughout training until any credentials that are necessary to

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practice independently have been attained. The structure and focus of supervision will vary

depending on the domain(s) in which supervision is being administered. Because testing is

conducted by psychologists with different specialties, as well as by nonpsychologists, this report

cannot prescribe a specific format or mechanism for supervision. However, focused and setting-

specific supervision of sufficient intensity and duration is important for those engaged in testing.

7. Summary of Core Knowledge and Skills

The intent of this section is to delineate the multiple domains and competencies important

for users of psychological tests. Although qualifications may vary by practice area, a

combination of high-level skill and professional judgment is important. The test user’s key

function is to make valid interpretations of test scores and data, often collected from multiple

sources, using proper test selection, administration, and scoring procedures. To provide valid

interpretations, it is important that test users be able to integrate knowledge of applicable

psychometric and methodological principles, the theory behind the measured construct and

related empirical literature, the characteristics of the particular tests used, and the relationship

between the selected test and the particular testing purpose, the testing process, and, in some

contexts, the individual test taker.

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III. Test User Qualifications in Specific Contexts

The context in which psychological tests are used includes both the setting and the

purpose of testing. Test user qualifications vary across settings, as well as within settings,

depending on the purpose of testing. This section addresses the context-relevant qualifications

that build on the generic qualifications described above.

Regardless of the setting, psychological tests are typically used for the following

purposes:

1. Classification. To analyze or describe test results or conclusions in relation to a

specific taxonomic system and other relevant variables to arrive at a classification or diagnosis.

2. Description. To analyze or interpret test results to understand the strengths and

weaknesses of an individual or group. This information is integrated with theoretical models and

empirical data to improve inferences.

3. Prediction. To relate or interpret test results with regard to outcome data to predict

future behavior of the individual or group of individuals.

4. Intervention planning. To use test results to determine the appropriateness of different

interventions and their relative efficacy within the target population.

5. Tracking. To use test results to monitor psychological characteristics over time.

This section describes five major contexts in which tests are commonly used:

employment, educational, vocational/career counseling, health care, and forensic. There also

may be other contexts that require specific qualifications. The qualifications important in the

major contexts, as well as appropriate training and supervision, are discussed below.

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Employment Context

Many employers use tests as part of the assessment process to develop work-related

information and recommendations or decisions about people who work for them or are seeking

employment with them. Test users in this context should have not only the qualifications

identified as core knowledge and skills but also an understanding of the work setting, the work

itself, and the worker characteristics required of the work situation. They strive to know what

skills, abilities, or other individual difference characteristics enable people to perform effectively

(as defined in a variety of ways) in a particular work setting. Test users consider the strengths

and weaknesses of different methods for determining the human requirements of the work

situation and how to conduct such job, work, or practice analyses. They also should consider

and, where appropriate, obtain legal advice about employment law and relevant court decisions

(see Dunnette & Hough, 1990, 1991, 1992, 1994; Guion, 1998).

Some persons who administer tests and communicate test results in an employment

setting (e.g. Human Resources personnel and recruiters) may not be considered test users by this

document. This document applies to those who select tests for use and determine how test results

are to be used in employment decision-making. Under this scenario, the test user may be a

company employee, a test vendor employee, or a consultant.

Classification. Organizations seek to classify or place people in jobs to maximize overall

utility to both the individuals and the institution. To perform these activities well, test users strive

to be knowledgeable about job clustering (e.g., creation of job families), validity, cost-benefit

analysis, utility analysis, and measurement of work outcomes (Alley, 1994; Bobko, 1994;

Zeidner & Johnson, 1994).

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Psychological tests are sometimes used to certify people as qualified to perform certain

job or work activities. Test takers unable to pass these certification tests are deemed unqualified

at present to perform particular tasks, activities, or jobs at a defined level of competence and may

not be eligible to practice the profession or perform those tasks. Test users should have

knowledge of the task or work and knowledge of the level of performance required for

competent practice. This means that test users define the task or criterion, measure the required

knowledge and skills, and identify the required performance level (i.e., set cut scores that reflect

the level of task, skill, and knowledge required for competent practice). They strive to have a

thorough knowledge of job, work, or practice analysis and of content validation principles and

strategies (Knapp & Knapp, 1995; K. Schmitt & Shimberg, 1996).

Description. Description of an individual’s current abilities, skills, interests, personality,

knowledge, or other personal characteristics can be a significant part of the assessment process in

industrial, business, or governmental settings concerned with human resources management.

This information is the starting point for determining the fit between an individual and work in a

given setting; identifying areas of needed individual, team, or organizational development;

providing feedback about likely success in different work activities and settings; planning career

choices and paths; and auditing organizational or unit readiness. Those who use psychological

tests to describe individual, team, or organizational characteristics in the employment setting

should consider information about the work and its setting. Thus, knowledge about job, work, or

career analysis is important (see Campion, 1994; Dawis & Lofquist, 1984; Fleishman &

Quaintance, 1984; Gael, 1988; Goldstein, Zedeck, & Schneider, 1993; Hall, 1986; Peterson,

Mumford, Borman, Jeanneret, & Fleishman, 1999).

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Prediction. Psychological tests may be used as part of a larger assessment process to help

make predictions about an individual’s future training performance, job performance,

trustworthiness, attrition, or a variety of other work-related criteria. These predictions are often

made to facilitate recommendations or decisions about selection, promotion, or succession

planning.

Test users involved in testing to predict future employment criteria make every effort to

be knowledgeable about the work setting and the work itself and, hence, job or work analysis

methods. They understand the principles of psychological measurement as they apply to tests and

as they apply to criteria. They also should understand performance measurement, criterion

constructs and their measurement, relationships between various predictor constructs and

criterion constructs, research methods and design, validity concepts and evidence, test bias,

adverse impact analysis, utility analysis, validity generalization, and group differences, and

consider and, where appropriate, obtain legal advice regarding applicable collective bargaining

and contract requirements, federal and state guidelines on employment testing, employment law,

and relevant court decisions (see Anderson & Herriot, 1997; Campbell, 1996; Campbell &

Campbell, 1988; Cascio, 1990, 1991; Dunnette & Hough, 1990, 1991; Guion, 1998; Hakel,

1998; Howard, 1995; Murphy, 1996; N. Schmitt & Borman, 1993). Those who use tests for

selection, promotion, and succession planning purposes should also be aware of motivational set

and its possible effect on applicant responses and the validity of inferences based on them

(Anastasi, 1988; Hough, 1998).

Intervention planning. Employment testing may be part of an analysis of the test taker’s

training and development needs. Test results may provide information for developing plans to

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improve skill and performance of current work responsibilities and anticipated work

responsibilities. Test results may also be used as part of career planning activities. When tests are

used for these purposes, test users make every effort to be knowledgeable about such matters as

the work itself, the work setting, performance appraisal and performance measurement, criterion

constructs and their measurement, training and development, career development, coaching and

mentoring, and training needs analysis (Goldstein, 1989; Hall, 1986; London, 1995; Ostroff &

Ford, 1989).

Employment testing may be part of an outplacement process. If testing is done as part of

an involuntary process that determines who is to be retained and who is to be laid off, test users

should be knowledgeable about the work itself and the work setting (hence, job, work, or

practice analysis methods), performance measurement, criterion constructs and their

measurement, validity concepts and evidence, test bias, adverse impact analysis, and group

differences, and consider and, where appropriate, obtain legal advice regarding collective

bargaining and contract requirements applicable to the particular organization or work setting,

federal and state guidelines on employment testing, employment law, and relevant court

decisions (see Arvey & Faley, 1988; Colarelli & Beehr, 1993; Guion, 1998; Kozlowski, Chao,

Smith, & Hedlund, 1993; Landy & Farr, 1983; Murphy & Cleveland, 1995). If testing is done as

part of an outplacement, voluntary job search process, test users should be knowledgeable about

vocational and career guidance, job loss, and labor markets (see Caplan, Vinokur, Price, & van

Ryn, 1989; Dawis, 1991; Dawis & Lofquist, 1984; Hall, 1986; Holland, 1976; Pickman, 1994).

Employment testing may also be a part of a monitoring system designed to identify

individuals who are at risk for performing below an acceptable level. The individuals may be

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employed in sensitive-duty (high cost for mistakes) jobs. Airline pilots, nuclear power plant

operators, and undercover police officers or agents are examples. Those who use tests to identify

at-risk individuals should have the qualifications listed under the Classification and Prediction

sections above. When the assessment of risk involves the identification of psychopathology or

other health issues, the test user qualifications described in the Health Care Context section

below also apply.

Tracking. Psychological tests may be used in predictive, criterion-related validation

studies in which individuals and their performance are tracked over time. In addition to the

knowledge recommended for the use of psychological tests for prediction purposes (see the

Prediction section above), test users who track individuals or their performance also need to

understand how task or work performance and criterion performance requirements may change

over time (Ackerman, 1987; Borman, 1991; Fleishman & Fruchter, 1960; Ghiselli, 1956; Kane,

1986; Komaki, Collins, & Penn, 1982). In addition, test users who conduct reassessments should

be familiar with the effects of repeated use of assessment procedures on both the individual and

the findings obtained. For example, frequent retesting of a skill might appear advisable but could

produce practice effects and spuriously inflated results, unless alternative forms of the tests are

available (Chall & Curtis, 1990).

Training and supervision. Training for test use in the employment context is best

obtained by successful completion of an integrated program of study that includes industrial

psychology, psychology of individual differences, measurement theory, job/work/practice

analysis, performance measurement, and employment law relevant to the testing situation.

Experience and supervision using tests in settings similar to those in which employment tests are

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used is important. For test users who provide assessment of health outcomes or understanding of

health problems of individuals and groups (e.g., those working in employee assistance programs

[EAPs]), the qualifications described in the Health Care Context section below also apply.

Educational Context

The results of psychological tests often serve as relevant information to guide educational

decisions about both students and programs (AERA, APA, & NCME, 1999). This section

addresses the use of psychological tests to assess educational outcomes or educational processes

pertaining to an individual, a group of individuals, or an educational institution. Psychological

tests are used in a variety of educational settings, including preschools, elementary and

secondary schools, colleges, universities, technical schools, business training programs,

counseling centers, health and mental health settings that offer educational services, and

educational consulting practices. Psychological tests are typically used to acquire information

about students to make informed decisions about such issues as student admissions and

placement, educational programming, student performance, and teacher or school effectiveness.

Given the wide range of educational settings and the multiple uses for group and individual test

data, it is likely that more individuals are administered tests in an educational context than in any

other setting (Bersoff, 1979, 1999).

On an individual level, psychological tests are often used to describe a student’s learning

or behavioral strengths and weaknesses. The results may then be used to develop educational

interventions, to determine appropriate educational placements (e.g., special education, gifted

education, magnet school program, or alternative educational setting), or as part of clinical

diagnostic assessment to guide therapeutic services (Fagan & Wise, 1995).

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Assessment of groups of individuals, often called large-scale testing, typically addresses

questions or concerns about educational programs or policies (Hambleton & Jurgensen, 1990).

Decision makers may aggregate results from psychological tests and use this information to

evaluate program effectiveness and develop recommendations for changes to educational

programs or systems. Test users in these cases may use standardized tests or nonstandardized

procedures (e.g., performance events or portfolios of student work) to obtain information about

cognitive ability or academic achievement levels of a group of students (Fuchs & Fuchs, 1990).

A majority of states require students to complete large-scale test batteries to determine their

proficiency relative to state standards. In some instances, results from such large-scale tests are

reported only at the aggregate level, providing district, school, or classroom results. In other

instances, results are reported for individual students as well as districts, schools, or classrooms.

The qualifications described above in the section on Core Knowledge and Skills for Test

Users apply to individuals using psychological tests in an educational context. Topics that have

particular relevance in educational settings include the representativeness of the test sample,

attention to language and cultural diversity, and the use of cut scores in selection for special

programs (Henning-Stout & Brown-Cheatham, 1999; Kranzler, 1999; Reynolds & Kamphaus,

1990; Salvia & Ysseldyke, 1995). Test users should also understand the cognitive and emotional

factors that affect student learning, as well as the social and political factors that affect schools as

learning environments (Gettinger & Stoiber, 1999; Medway & Cafferty, 1999; Tharinger &

Lambert, 1999; Ysseldyke & Elliott, 1999). Those who use psychological tests in social

institutions like schools should be particularly skilled at communicating the results of testing to

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many different audiences, including educational decision makers, teachers, students, parents, and

the public (AERA, APA, & NCME, 1999; Illback, Zins, & Maher, 1999).

The specific nature of the qualifications that are important to test use in the educational

context depend on both the purpose for which tests are used (e.g., classification or prediction)

and the level of focus (e.g., individual or large-scale testing). The knowledge, skills, and abilities

associated with optimal test use at both the individual and group level are described in relation to

the purpose for which the test is used in an educational context.

Classification. Tests are often used to identify or classify individual students or groups of

students for admission to special programs. In public elementary and secondary schools, the

most frequently used formal classification system is probably the one used to determine

eligibility for special education services as required by federal and state law (e.g., the Individuals

With Disabilities Education Act). Therefore, test users in educational contexts should consider

and, where appropriate, obtain legal advice regarding state and federal laws related to the

provision of educational and related services to disabled students (Jacob-Timm & Hartshorne,

1998; Reschly & Bersoff, 1999). Many schools also use curriculum-tracking schemes (e.g.,

general vs. college preparatory classes), which categorize and then place students in separate

instructional tracks or ability groupings, each with its own eligibility criteria. Schools also use

classification systems to identify individuals at risk for school failure, eligible for gifted and

talented programs, or for admission to magnet programs. Individuals using psychological tests

for classification purposes, both in individual and large-scale assessments, should be familiar

with the taxonomic systems used by schools and other educational settings as well as the

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psychometric limitations of the tests used (Kamphaus, Reynolds, & Imperato-McCammon, 1999;

Macmann & Barnett, 1999; Reynolds, 1990).

Test users should also possess the knowledge to select instruments that are appropriate

for the characteristics of the student being evaluated (AERA, APA, & NCME, 1999). For

example, tests that have adequate reliability and validity for assessing school-age students may

be inappropriate for use with preschool children (Bracken, 1987, 1994; Nuttall, Romero, &

Kalesnik, 1999). If a test has been developed, normed, and validated for use with individuals

from one language, culture, race, or ethnic group, it may not be appropriate for individuals from

other cultural or ethnic populations (Figueroa, 1990). For individual assessment, test users

consider and, when appropriate, integrate information from multiple sources, such as

psychological and educational test data, behavioral observations and ratings, school records, and

interviews with parents and teachers (Salvia & Ysseldyke, 1995).

Large-scale tests are used for a variety of purposes, including program accountability and

decisions related to admissions and educational placement. In most instances, important

decisions about students should not be based on a student’s performance on a single test (AERA,

APA, & NCME, 1999). When schools, districts, or states develop or select a test to determine

student achievement relative to state standards, test users should have the skills and knowledge

to determine the degree of correspondence among the standards, curricula, and test content.

When critical decisions, such as graduation or retention, are based on test results, test users strive

to consider students’ opportunity to learn the stated content and identify other sources of relevant

data that reflect student proficiency. When tests are used for college placement, test users

determine the degree of alignment between the test’s content and the college courses, as well as

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understand the relationship between predicted and actual performance in subsequent courses

before determining a cut score or other classification criteria. Legal requirements may influence

or restrict the use of rank ordering or cut scores, particularly if these practices have a

disproportionate effect on one or more subgroups.

Description. Psychological tests are also used in educational settings to describe aspects

of learners’ skills and abilities, such as learning styles, motivation, reading readiness, and

emotional maturity. These student characteristics may be assessed to describe a student’s

academic strengths or weaknesses or to differentiate educational approaches based on individual

need. Group measures of interests, attitudes, cognitive abilities, or emotional adjustment may

also provide a basis for interventions designed to remediate current problems or to prevent future

difficulties.

Large-scale assessments are often used by schools, districts, and states to measure the

general level of student performance. Often such test use is designed to evaluate the effects of

curricular decisions or program outcomes. In some instances, schools or teachers may be held

accountable for their students’ test results, with penalties imposed for scores below expectations.

Therefore, it is important that test users attend to the multiple factors that contribute to test score

differences between schools, classrooms, or districts (e.g., student motivation, quality of prior

educational experiences, and parental support of educational goals).

Prediction. In the educational context, tests are often used to predict the future behavior

or academic success of a student or group of students. In individual assessment, tests are often

used to screen students for placement in special programs (e.g., gifted education, programs for

students at risk of educational or behavioral problems, and magnet programs for special interests

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or abilities) or to place them in an instructional group or track based on a prediction of expected

future performance.

In large-scale testing, admissions tests are required for entry into most undergraduate,

graduate, and professional programs. These tests help the institution estimate the students’

readiness for an academic program and provide a means to compare the academic preparation of

students who have attended different schools, who have completed different courses, and who

have been graded according to different criteria. Admissions tests are also useful in college

counseling, providing students with useful information on their potential for academic success at

different colleges and universities. In addition, most colleges use specially developed placement

tests to determine a student’s eligibility for particular courses.

Whether the focus of the assessment is an individual student or a group of students, the

test user should recognize that each student’s future performance is affected by many factors. In

addition to examining a student’s abilities, characteristics, and motivation, test users should have

the skills and knowledge to evaluate the relative contribution of teacher competence and

motivation, school and classroom climate, peer group influence, class size, and other factors that

play a critical role in determining a student’s future performance (Gettinger & Stoiber, 1999).

They also strive to understand the likely course of learning difficulties and developmental

variations in the acquisition of academic skills (Tharinger & Lambert, 1999). Finally, test users

strive to be familiar with the literature on how group differences (e.g., ethnicity, gender, race,

and SES) may affect performance on standardized tests, grades, school completion, and other

outcomes that may be used in predicting academic success (Figueroa, 1990; Henning-Stout &

Brown-Cheatam, 1999).

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Intervention planning. Psychological tests are frequently used to plan interventions for

one student or a group of students. Psychological tests are commonly used as part of the

individual diagnostic assessment of students with learning or behavioral problems (Kamphaus et

al., 1999; Salvia & Ysseldyke, 1995; Woody, La Voie, & Epps, 1992). The results from these

tests help to describe or diagnose the educational strengths and weaknesses of students or their

behavioral difficulties and contribute to the development of educational, behavioral, or mental

health interventions. Test users involved in intervention planning for individual students strive to

be knowledgeable about alternative instructional approaches; school curriculum; special

education services; and therapeutic interventions, such as counseling, group dynamics, and

behavioral interventions (Hughes, 1999; Shapiro & Cole, 1994). Those who use tests to prescribe

interventions based on assessed student characteristics should be familiar with the empirical

evidence for using test data to make such decisions.

Test results sometimes provide a rationale for educational interventions that affect a large

number of students, such as a modification in instructional approach (Algozzine & Ysseldyke,

1992; Gettinger & Stoiber, 1999; Illback et al., 1999). One example is the decision to replace a

phonics approach in reading instruction with a whole-language approach. Test users strive to

clearly communicate to decision makers the appropriateness of inferences based on test data and

the likely effects of program changes on various groups of students. Test results may also be

used as a basis for individual interventions, such as removing a student from school (e.g., school

suspension) or placing that individual in a private residential program for severely disturbed or

impaired individuals. Here, test users should consider how significantly a change in educational

placement may affect a student’s self-concept, educational achievement, and overall well-being

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(Jacob-Timm & Hartshorne, 1998; Woody et al., 1992). Test users should consider and, where

appropriate, obtain legal advice about relevant state and federal laws dealing with changes in

placement and the use of educational interventions that affect school placement (Jacob-Timm &

Hartshorne, 1998; Reschly & Bersoff, 1999) as well as the legal protections afforded to parents

and students, including, where applicable, due process rights and requirements of informed

consent (Jacob-Timm & Hartshorne, 1998).

Tracking. Test users in school settings often administer tests multiple times to track the

effects of educational programming or interventions. In individual assessment, special education

law requires that students classified as disabled be reassessed at least every 3 years so that

students are given a periodic review of their status (Jacob-Timm & Hartshorne, 1998; Reschly &

Bersoff, 1999; Salvia & Ysseldyke, 1995). Even students who are not classified as having a

disability but who receive a modification in their educational programming are reassessed

periodically to determine if the interventions are having the desired outcomes and are still

warranted.

Groups of students may be assessed yearly to document academic progress or to evaluate

a program’s effectiveness (Algozzine & Ysseldyke, 1992; Illback et al., 1999). Such aggregated

student data are frequently used as the basis for modifying instructional programs and policies.

In some cases, the school is required to obtain evidence of program effectiveness to receive

continued funding for that program.

When tests are used for tracking purposes in educational settings, test users should

understand the effects of repeated test administrations on the students and on the findings

obtained. For example, frequent retesting of reading achievement to guide instruction might

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appear advisable but could produce serious practice effects and spuriously inflated results, unless

alternative forms of the reading tests are available (Chall & Curtis, 1990; Shapiro & Elliott,

1999). Those who use tests to track student performance also strive to be aware of the social and

instructional context variables that may influence student performance, so that changes in test

scores are not automatically attributed to changes in student abilities (Greenwood, Carta, &

Atwater, 1991; Ysseldyke & Elliott, 1999).

Training and supervision. In addition to the knowledge, skills, and abilities outlined for

all test users, the user of psychological tests in the educational context should be knowledgeable

in the content areas of educational and psychological theory and practice, as well as the legal

requirements and protections for test takers that are relevant to the type of assessment being

conducted. This combination of generic psychometric knowledge and context-relevant expertise

is best acquired in an integrated program of advanced professional preparation, such as that

acquired in a doctoral program in school or educational psychology or educational measurement.

As noted earlier, the type of training and the breadth and depth of knowledge in each of these

domains may vary for different test users depending on whether they are responsible for

individual diagnostic testing or large-scale testing. Test users in an educational environment

should possess an appropriate practice credential where such credential is legally required to

provide the type of testing being offered. It is also important that they receive supervised

experience appropriate to their role and setting in the use of tests to address educational problems

or questions.

Individuals using psychological tests to place children in special education programs

should be knowledgeable in areas such as developmental and social psychology, diagnostic

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decision making, child psychopathology, and special education practices. They should consider

and, where appropriate, obtain legal advice on special education law. Furthermore, test users

involved in individual diagnostic testing strive to be competent in communicating and translating

assessment results into educationally relevant and appropriate recommendations that are likely to

result in meaningful improvement.

Individuals using psychological tests to address large-scale testing questions related to

admissions, student grouping, or instructional programming should be particularly

knowledgeable in the domains dealing with psychometrics, instructional design, educational and

developmental psychology, and measurement theory. In addition, individuals doing large-scale

testing or research in school settings should be knowledgeable and skilled in communicating the

results of tests to diverse audiences including school personnel, students, parents, policymakers,

the media, and the public in general. Individuals using tests for college or graduate school

admissions, for counseling, or for placement also strive to be knowledgeable about the empirical

evidence related to using tests to make such decisions in higher education. They should consider

and, where appropriate, obtain legal advice regarding the legal protections for test takers in

higher education settings.

Career/Vocational Counseling Context

Psychological testing in the career/vocational counseling context is used to help people

make appropriate educational, occupational, retirement, and recreational choices and to assess

difficulties that impede the career decision-making process. Career/vocational counselors

integrate their knowledge of career demands with information about beliefs, attitudes, values,

personalities, mental health, and abilities, with the goal of promoting beneficial career

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development, life planning, and decision making. Successful career adjustment is based on

occupational, intellectual, personal, developmental, educational, and societal factors. Information

about values, interests, abilities, achievements, mental health, and work experience is important

to the process (Zunker, 1990). The individual’s self-knowledge about values, strengths,

weaknesses, motivation, psychological characteristics, and interests are also relevant (Herr &

Cramer, 1996).

Career/vocational testing overlaps somewhat with employment testing, but the two often

serve different purposes. In employment testing, typically the job is already defined, whereas in

career/vocational psychology tests are used to help individuals make personally relevant career

choices. Another distinction is that in employment testing the client is the employer (not the test

taker), whereas in career/vocational testing the client is usually the test taker, even when a parent

or school is financially responsible for the testing. Another distinction between the fields is that

there are many more legal issues governing the use of psychological tests in personnel selection

than there are in career/vocational assessment.

Psychological tests in the career/vocational counseling context are used to help

individuals make decisions about career and life planning. Testing can provide persons

knowledge about their work-related and avocational interests, their abilities, and their values and

help them understand how these fit into the existing opportunities and requirements of the

workplace and into their leisure activities. Along with the knowledge, skills, and abilities

identified earlier, test users strive to understand how individuals’ particular interests, values,

abilities, and skills relate to their choice of work and leisure activities. Test users also should

have substantive knowledge in related areas of psychology, such as adolescent and adult

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development, personality, and psychopathology, as well as detailed and current knowledge of

measurement questions involved with assessing interests, abilities, personality dimensions, and

values. Test users should be able to integrate complex results that cross these multiple domains

of assessment.

Test users also make every effort to be knowledgeable about types of work settings, work

cultures and values, and the characteristics and requirements of types of jobs. They strive to

integrate the results of multiple measures from a number of different domains with their

knowledge of vocational theories (Osipow & Fitzgerald, 1996) and career taxonomies (Holland,

1997; Lowman, 1991).

Test users identify and work with individual difference and systemic variables that may

influence the person–environment fit. Such factors include the individual’s family system,

gender, ethnicity, cultural background, physical ability, SES, and psychological problems. Test

users should be able to recognize and work not only with the problems explicitly presented by

the test taker but also with other problems, including underlying emotional difficulties or

environmental impediments that could affect the way the test taker uses test results. For example,

a test taker’s family or cultural background might deem certain careers unacceptable and

therefore require the test user to process this perception and assist in generating viable vocational

options.

Often the person seeking career or leisure counseling is experiencing a life transition that

brings additional personal, developmental, and emotional stress. In addition, such individuals

may struggle with emotional problems that make deciding on a career difficult. For example,

those who lack self-esteem and confidence may find it challenging to engage in self-assessment,

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reflect on the world of work, and confidently select an occupation. To deal effectively with such

complex mixtures of career, developmental, and emotional concerns, vocational test users should

have qualifications similar to those required in the health care context (see the Health Care

Context section below).

Classification. The primary focus of vocational classification is to identify an individual’s

career-related skills, abilities, and characteristics (e.g., interests and personality factors) and then

match them with the requirements of specific jobs or job categories. Vocational classification

may also be used to match an individual with a specific school or program or to help a person

identify satisfying leisure activities or outlets for prized abilities.

Knowledge of individual differences in cognition and personality are central in the

assessment of person–environment fit. Career/vocational counselors may administer cognitive,

achievement, and aptitude tests to determine a test taker’s skills or special competencies (Kapes,

Mastie, & Whitfield, 1994; Lowman, 1991). Differential patterns of abilities may be as important

as scores on individual ability measures, so testing may need to cover a wide range of

competencies. Career/vocational counselors may use personality inventories, interest inventories,

and other assessment procedures to help them understand the test taker’s preferences, values,

learning history, and occupational or leisure goals. By effectively communicating test results to

test takers, career/vocational counselors help their clients to better understand the fit of their

characteristics with their environment.

Description. Similar to the health care context, a holistic description of the individual’s

personality and mental health is important in the career/vocational counseling context (Gysbers,

Heppner, & Johnston, 1999). The coexistence and interaction of career and mental health

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problems (Blustein & Spengler, 1995; L. Lucas & Epperson, 1988; M. S. Lucas, 1992) support

the need for test users to assess personality and mental health problems that may impede

successful career development. Moreover, test users may want to assess important constructs,

such as career indecision and career choice anxiety, with those who have a history of difficulty in

vocational decision making. Thus, test users in the career/vocational counseling context should

be qualified to assess the mental health functioning of individuals seeking career counseling in

order to determine the most effective approach (refer to the following section on Health Care

Context).

Prediction. Prediction is often a central concern for vocational assessors. That is, the

results of a variety of vocational tests are assumed to reflect stable, enduring traits that are

relevant to future work performance and satisfaction. Although related constructs such as

interests and cognitive abilities demonstrate stability over a period of years, the degree of

consistency partly depends on the developmental level of the test taker. For example, students

may lack the experience necessary to crystallize vocational interests until they have reached

college age (Blustein, Pauling, DeMania, & Faye, 1994; Tinsley & Barrett, 1977). Vocational

test users should temper predictions of future behavior with the knowledge that test takers’

further development and specific situations may strongly influence their work behaviors.

Intervention planning. In some cases, the vocational intervention consists entirely of the

administration and interpretation of tests and the communication of assessment findings. This is

often true when the test taker’s increased self-knowledge regarding interests, values, personality,

and the world of work is the goal of the intervention. In these cases, test users strive to engage

the individual actively in the process of test interpretation (Tinsley & Bradley, 1986).

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In other cases, additional vocational interventions may be used in conjunction with

psychological assessment (Fouad, 1994) or may be identified as needed by the career assessment

process. For example, testing may yield a list of potentially suitable occupations that the test

taker can investigate and experience in internships and part-time work. Or the test results may

indicate a lack of differentiation among the test taker’s vocational interests, suggesting that

additional experience is needed before more specific work preferences can be developed. To

perform effective career/vocational interventions, test users should have knowledge of career

development theories and skills in interviewing and history taking, as well as knowledge of

relevant educational and career information resources. Test users strive to be aware of

discriminatory patterns that exist in various careers.

In some cases, evaluation of test results shows that further psychological intervention is

needed. Test users should be able to evaluate patterns of behavior and test results, recognize test

takers who will not be able to benefit from vocational information because of significant

developmental, cognitive, emotional, or physical problems, and treat or refer them appropriately.

Tracking. Tests used for career and vocational assessment may provide standards against

which to compare patterns of subsequent growth or deterioration. Tests may be useful, on an

individual level, in revealing patterns of change after traumatic or remediative experiences.

Grouped test data can provide important information for uses such as determining the

characteristics of employees in occupations or organizations or students in particular majors and

how they may change over time. Test users should be knowledgeable about the psychometric

and context-related implications of assessing career development over time.

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Training and supervision. The use of psychological tests in career and vocational

assessment, as described above, requires complex skills in career and mental health assessment,

not just simply learning to use tests in isolation. Appropriate training (e.g., that obtained through

doctoral programs in relevant areas of psychology) includes coursework in adolescent and adult

development, as well as the domain of vocational/career psychology. Test users engaged in

career counseling and testing should be knowledgeable about measurement theory, as described

earlier. They strive to be skilled in involving clients in the interpretation of vocational tests.

Finally, it is important that their training include supervised experience in the use of

psychological tests in vocational/career settings, and relevant experience in educational,

counseling, health care, and occupational settings.

Health Care Context

Health care is the provision of services to individuals who seek help in enhancing their

physical or mental well-being or in dealing with behaviors, emotions, or issues that are

associated with suffering, disease, disablement, illness, risk of harm, or risk of loss of

independence. Health care assessment commonly occurs in private practice, rehabilitation,

medical or psychiatric inpatient or outpatient settings, schools, EAPs, and other settings that

address health care needs.

Psychological tests are used as part of the assessment process to develop health-related

information and recommendations or decisions about people to improve their physical or mental

health. Those who use tests for this purpose should have thorough grounding both in the core

knowledge and skills enumerated earlier and in the specialized knowledge, training, or

experience of specific substantive areas of health care. With so many specialized areas in health

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care, it is impractical to specify any single set of core knowledge requirements, technical

competencies, or supervised training experiences for test users. More detailed guidance is often

provided in the guidelines and standards developed by professionals working in a specialized

health care area.

Because health care providers’ decisions and actions can have very important and

sometimes very dramatic effects on the lives of the people they serve, the health care profession

is heavily regulated. Test users should keep abreast of ethical standards relative to psychological

assessment (Bersoff, 1999; Koocher, 1993; Koocher & Keith-Spiegel, 1998) as well as

regulations and laws at both state and federal levels on such subjects as confidentiality, duty to

warn, mandated reporting, and patient rights (APA Committee on Legal Issues, 1996; APA

Committee on Psychological Tests and Assessment, 1996; Koocher, Norcross, & Hill, 1998) and

obtain legal advice in these matters where appropriate.

In the health care context, psychological test data are typically used to augment

information gathered from other sources (e.g., patient and collateral interviews, behavioral

observations, and laboratory results). Health care providers who use psychological tests strive to

effectively integrate results from multiple tests and sources of information. Psychological test

users strive to understand how the nature of the setting (e.g., psychiatric hospital) and the

characteristics of test takers (e.g., those who have a physical illness or disability or who are on

medication) might affect the process of test administration, the results, and the interpretation.

Test users strive to communicate the technical aspects of their findings to other professionals as

well as to health care consumers in language that is appropriate and understandable to each.

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Classification. When psychological tests are used for classification purposes, the most

common goal is the assignment of a mental health, medical, or other diagnosis. In these

instances, psychological test findings are generally combined with interview and historical data,

behavioral observations, and data from other sources to derive a formal diagnosis. When

diagnosis is the goal of testing, test users combine the skills associated with competent testing

with a separate set of knowledge, skills, and experiences related to classification and diagnosis in

the population of interest.

Test users should be able to identify and evaluate factors that may influence diagnostic

determinations and that are frequently not accounted for in the development, standardization, and

norming of psychological tests. For example, when working with persons whose physical

symptoms may affect test performance, test users should be knowledgeable about and

experienced at distinguishing illness-related test results from other determinants for a person’s

test performance (e.g., motivation, demographics, personality traits, or other medical

considerations).

Test users seek to understand determinants of diagnostic accuracy in relation to both the

specific assessment procedures being used and the decisions that need to be made. For example,

when psychological tests are used to screen for specific health problems such as alcoholism or

dementia, test users should consider how fluctuations in base rates in different populations may

affect the sensitivity and specificity of test results (Ivnik et al., in press).

Description. Psychological tests are also used in health care to provide a more

comprehensive description of individuals by delineating their unique personality, emotional,

cognitive, or other characteristics. For example, a combination of personality, academic,

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aptitude, interest, and cognitive tests may be used to help describe the areas of both preserved

and compromised functioning for a young person who is in a rehabilitation facility in hope of

returning to work after suffering a head injury in a motor vehicle accident (MVA). When

performing primarily descriptive assessments in health care, test users should consider the

construct validity of the tests that they select and how these constructs are manifested in day-to-

day behavior. To avoid misinterpreting normal inter- and intratest variance as pathology, test

users who work in health care should consider the limits of normal variance when different

psychological characteristics are simultaneously measured. When individuals are followed over

time and psychological tests are repeated one or more times, test users are attentive to issues that

relate to how “meaningful change” is distinguished from normal test–retest variability (Ivnik et

al., 1999; Jacobson & Truax, 1991; Sawrie, Chelune, Naugle, & Luders, 1996).

Prediction. Health care professionals are frequently asked to make predictions (i.e.,

prognoses) about the persons they serve, and psychological test users may specifically be asked

to make testing-based predictions. For example, the person who tested the MVA victim

mentioned above may be asked to “predict” when this person might return to work or to school

or the person’s final level of recovery. In these instances, test users strive to be knowledgeable

about the predictive limits of testing. When tests are used to make predictions in health care

settings, test users strive to understand the patient’s unique characteristics (e.g., personality

features, special strengths, disabilities or disorders, and sociocultural issues), the natural course

of medical conditions, the likely efficacy of planned interventions, and relevant base-rate

information. Test users strive to understand the empirical evidence of a test’s ability to make

accurate predictions. For example, neuropsychologists who make predictions about a person’s

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need for assistance in daily activities should know how well their test instruments predict

relevant functional capacities (Lemsky, Smith, Malec, & Ivnik, 1996).

Intervention planning. In health care settings, data from psychological tests may be used

in planning interventions. Intervention planning refers to the selection of specific remediation

activities based on a thorough knowledge of the problem being addressed and available treatment

options. Test users involved in intervention planning may use tests to provide information on an

individual’s particular problem (classification), strengths and weaknesses (description), and the

efficacy of treatment options (prediction). The same set of knowledge and skills required for

competent classification, description, and prediction are also important in the development of an

optimal treatment plan. For example, personality tests may be used to modify treatment

approaches in a therapeutic setting (Maruish, 1999). Because intervention planning involves a

specific type of prediction (i.e., the likelihood that a patient will benefit from a particular form of

treatment), test users strive to be aware of the limitations discussed above related to prediction

and the scientific evidence supporting available treatments.

Tracking. In some circumstances, multiple sequential administrations of the same test(s)

are frequently needed to document how psychological characteristics change over time or as a

consequence of treatment (e.g., to track the course of a patient’s illness or recovery). To interpret

these results, test users strive to be knowledgeable about how repeated exposures to test

procedures and test content influence subsequent test performances (e.g., practice effects),

including how conditions (e.g., memory deficits) present during one examination may affect the

results of later testing. Test users also strive to understand how to distinguish measurement error

from reliable test score change (e.g., Ivnik et al., 1999; Jacobson & Truax, 1991; Sawrie et al.,

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1996). Psychological tests are sometimes used to measure treatment outcome. For example, test

results may help determine eligibility for health care services or to monitor treatment efficacy. If

this application is different from the test’s original purpose, test users should be aware of

potential factors that may limit the usefulness or validity of the test data as an indicator of

treatment outcome.

Training, supervision, and licensure. In the health care context, the qualifications

described above are best obtained through doctoral training in psychology, which includes

psychological testing supervision in one or more health care settings that are similar to the

setting(s) in which a specific test user intends to practice. The APA’s model licensing act (APA,

1987) recommends for health care psychologists that state credentialing bodies require 2 years of

full-time supervised experience with a minimum of 1 hr/week of individual supervision provided

by an appropriately credentialed professional. Also, guidelines for training programs such as the

APA’s Guidelines and Principles for the Accreditation of Programs in Professional Psychology

(APA, 1996) include requirements for supervised experience in graduate training, predoctoral

internship, and mandated postdoctoral supervision. Finally, some health care specialties have

defined the core knowledge, training, and supervised experiences that are needed for fully

competent test use (e.g., neuropsychology; Hannay et al., 1998). The specific health care setting

in which a test user works (e.g., mental health facilities or EAPs) will define the added content

areas that a test user should master.

In addition to coursework in psychological testing, personality theory and assessment,

and measurement theory, independent health services providers who use tests for health care

needs should be particularly knowledgeable in psychopathology, health psychology, life-span

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developmental psychology, and the biological bases of behavior. Test users in the health care

context should also be skillful in clinical diagnostic interviewing and familiar with mental health

diagnostic and classification systems. As noted earlier, the breadth and depth of knowledge in

each of these domains, as well as additional technical qualifications, may vary depending on the

specific area of specialized functioning.

Health care professionals who use psychological tests are credentialed by the state or

province in which they work. Credential renewal in many states requires documentation of

continuing professional education. Those who use psychological tests in a health care context

strive to obtain knowledge, supervised training, and professional experiences that go beyond the

profession-specific knowledge, training, and experiences they obtained during graduate

education, practica, internship, residency, or fellowship. For some test users whose original

graduate education and training were not in clinical areas, graduate-level respecialization

programs can provide additional education and training.

Forensic Context

In forensic settings, psychological tests are used to gather information and develop

recommendations about people who are involved in legal proceedings. Test users in forensic

settings should possess a working knowledge of the functioning of the administrative,

correctional, or court system in which they practice. They strive to be familiar with the statutory,

administrative, or case law in the specific legal context where the testing occurs or, where

appropriate, obtain legal advise on the pertinent laws. They strive to communicate test results in

a way that is useful for the finder of fact (i.e., the judge, the administrative body, or the jury).

This includes communicating verbally with lawyers, writing formal reports, and giving sworn

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testimony in deposition or court.

The problems encountered in forensic settings are varied and complex, often involving

medical illnesses, developmental problems, and multiple forms of psychopathology, so test use

often requires expertise in multiple health care areas. This section addresses those who use

clinical, rehabilitation, and neuropsychological tests in legal contexts, as well as those who

believe that their test data will serve as a foundation for legal consultation or testimony. Thus, in

addition to the core qualifications identified earlier, the qualifications described above for test

users in health care contexts typically apply to test users in forensic settings.

This section does not address test use by two groups of experts who also may work in

forensic settings. Specifically, this section does not apply to those who use psychological tests to

conduct research in applied areas of forensics, such as memory, social psychology, or human

factors. Nor does it apply to those who use tests in applied areas, such as clinical, rehabilitation,

or neuropsychological practice or industrial/organizational or educational psychology and who

may be asked to provide consultation or testimony based on their training, education, or

experience about work with their clients. However, these test users should be sensitive to the

potential ramifications of assuming multiple roles (Greenberg & Shuman, 1997; Shuman,

Greenberg, Heilbrun, & Foote, 1999).

Those who use tests for forensic purposes should possess substantive knowledge in areas

of psychology related to the forensic issues. For example, in correctional or criminal settings,

knowledge about violence, criminality, and the relationship of psychopathology to those

behaviors and activities is germane (Heilbrun et al., 1998). Similarly, when assessing families in

child custody or parental rights cases, it is important for test users to understand family

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dynamics, parenting, and different forms of child custody (APA Committee on Professional

Practice and Standards, 1994).

Assessments for forensic purposes often occur in outpatient, inpatient, and correctional

settings (Heilbrun, 1992; Melton, Petrila, Poythress, & Slobogin, 1997). Each of these settings

exerts specific influences that may significantly alter how tests are administered and interpreted.

For example, in correctional settings test users strive to understand how the test results may be

affected by the level of privacy of the testing location, the noise in the area, and even the degree

of objective danger and threat to the inmate from other residents. Further, test users strive to be

knowledgeable about the effect of incarceration on the presentation of psychopathology, possible

effects of the trial or litigation process on client presentation, and the assessment of response set

issues (Rogers, 1997).

Classification. Diagnostic skills are important for the use of psychological tests in forensic

settings. In most situations, the assessment will include multiple measures to provide a thorough

and legally defensible diagnosis (Heilbrun, 1992; Heinze & Grisso, 1996). Thus, test users in

forensic settings strive to integrate results from multiple tests with knowledge of accepted

diagnostic taxonomies (e.g., the Diagnostic and Statistical Manual of Mental Disorders [4th ed.;

American Psychiatric Association, 1994) and knowledge about how test findings relate to these

systems (Talge, 1995).

Test users strive to identify and evaluate critical factors that may influence diagnostic

determinations. Among these factors are the defendant’s response set and the effects of

incarceration and litigation on the defendant’s test results. A thorough knowledge of response set

and its influence on test results (Rogers, 1997) may be needed for accurate interpretation of test

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results.

Because of the high stakes in legal proceedings (monetary settlements, child custody, jail

sentences, and even the death penalty), test takers may be motivated to exaggerate or minimize

their symptoms. Because diagnosis may be complicated by these response biases, test users in

forensic settings strive to recognize these factors and account for them in the interpretation.

Additionally, test users in forensic settings should understand that psychopathology as measured

by tests may be improved or exacerbated by incarceration and that trial proceedings and litigation

may affect test data by increasing or decreasing the litigant’s anxiety, depression, or anger

(Weissman, 1991).

Test users are often required to evaluate historical information to help the court arrive at a

determination of causation or to review events that have occurred in the past to ascertain whether

those events relate in some way to a legal standard. Consultation with family members or friends

of the examinee may also add to the accuracy of the interpretation of test results.

For example, in criminal settings, test users may be asked to assist the court in

determining whether the defendant was criminally responsible for his or her behavior at the time

of the offense. Or a test user may be asked to assess the defendant’s capacity to waive his or her

Fourth and Fifth Amendment (Miranda) rights—critical for determining whether a confession is

admissible in court (Grisso, 1986). In tort (civil lawsuit) settings, determination of causation (the

legal nexus between a specific event and a psychopathological condition) is often a critical

element for determining whether even the minimum basis for a lawsuit exists. Even in contexts

where causation involves strictly technical knowledge from other fields (e.g., chemistry or

physiology), test users may be asked to provide legally admissible information on the

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psychological or neuropsychological status of an examinee without attributing

causation.

Those using tests in forensic settings to determine the causation of legally relevant

conditions or events strive to be knowledgeable about how the tests are used to determine the

origins or natural histories of mental disorders. Users of neuropsychological tests may use

patterns of scores on those tests to inform opinions about the cause of specific behaviors (e.g.,

Martzke, Swan, & Varney, 1991; Varney & Menefee, 1993). Assessment of brain trauma or

toxic chemical reactions may fall into this category. Test users assessing traumatic emotional

reactions should have knowledge about the relationship of specific score patterns with specific

types of emotional trauma. Test users also should have knowledge of relevant epidemiological

studies (Kilpatrick & Resnick, 1993; Swanson, 1994) and etiology of mental conditions.

Description. In forensic settings, clients are described in relation to a legal standard in a

particular context. The most obvious example is the application of the standards for legal

competency (to stand trial, to execute a legal document, and to be executed). These standards are

established by legislation and case law (see Grisso, 1986).

Standards are applied to clients for a variety of forensic purposes. In criminal cases, a

major focus has been the assessment of individuals for determining criminal responsibility or

insanity at the time of the offense (Rogers, 1986). In correctional settings, assessment results in

conjunction with historical or behavioral data may determine whether an inmate is described as a

high-, medium-, or low-security risk (see Megargee, 1979, 1994). In tort or disability settings,

the standard may be a legal description of an emotional condition, which will be applied to

examinees to determine their eligibility for compensation under administrative regulations (e.g.,

Social Security) or laws (Sales & Perrin, 1993).

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To perform these descriptive activities, test users should consider and, where appropriate,

obtain legal advice on the applicable legal standard to craft the appropriate assessment strategy to

produce a legally useful result and to interpret the assessment results in light of that standard

(Heilbrun, 1992). Test users may be called upon to explain how the test data are relevant to the

applicable legal standards.

Prediction. In forensic practice, test users are often asked to make a statement about the

future behavior of a test taker (Otto, 1992). In civil commitment settings, for example, most

states’ criteria for involuntary commitment include the examinee’s dangerousness to self or

others (Monahan & Steadman, 1996). In criminal settings, statements concerning the examinee’s

potential for recidivism on parole from prison may be a critical element of a prerelease

evaluation (Borum & Grisso, 1995; Webster, Douglas, Eaves, & Hart, 1997). In tort settings,

predictions about the prognosis of an emotional condition may be necessary for determining

damages in a lawsuit (Sales & Perrin, 1993). In domestic relations settings, predictions of a

child’s reaction to a specific custody arrangement may be a critical part of the custody

evaluation.

To use test results for prediction, test user should be knowledgeable about the base rates

of legally relevant behaviors (e.g., violence, suicide, or posttraumatic states) and the contribution

of situational factors (e.g., life stresses, substance abuse, or treatment with psychotherapy or

medication) to these behaviors.

Intervention planning. Intervention planning based on test data may be an important part

of the test user’s responsibilities in forensic settings. For example, in divorce, adoption, or abuse

and neglect cases, recommendations for treatment for a child or family may be integral to the

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child custody recommendation. In a sentencing evaluation, recommendations for treatment may

be included in deliberations and influence the duration or location of the convicted person’s

incarceration. In tort settings, treatment recommendations may, in part, determine the amount of

monetary compensation provided for the plaintiff.

In addition to the prediction skills indicated above, skills important for intervention

planning in forensic settings include both knowledge of how test data may be helpful for

selecting appropriate treatment strategies and knowledge of how test data may assist in

predicting response to treatment.

Tracking. In forensic settings, it is often important to know how test data may be affected

by the passage of time and by events that occur between repeated test administrations. In

working with children, for example, test users should consider the effects of developmental

sequences in the assessment of the child’s current emotional condition to trace the origins of that

condition to specific events such as traumatic experiences or changes in custody. Tests may

assist in the process of ruling out alternative causes of conditions. Although the determination of

causation is generally a classification activity (see the Classification section above), a test user

may be called upon to review a sequence of test data generated through a series of testing

periods. This is most likely to occur in cases where the test user has an opportunity to review test

data that were gathered before the commission of a criminal offense or before the injury that is

the focus of subsequent litigation. Such data may assist the test user in assessing issues of legal

causation.

Training and supervision. The knowledge, skills, and abilities identified in this section

are best obtained through doctoral training in psychology and relevant supervised experience, as

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described in the Health Care Context section. Licensure requirements for those who use

psychological tests in the forensic context are similar to those required of practitioners in the

health care context.

The coursework and training for individuals who use tests in the forensic context are very

comparable with the coursework and training for those who use tests for health care needs,

although a basic introduction to psychology and the law is also desirable. In addition, training in

the specific area of law (e.g., criminal responsibility) may be important. This may be acquired

through formal or continuing education course work (Bersoff et al., 1997; Ogloff, Tomkins, &

Bersoff, 1996) or through mentoring by, or consultation with, someone trained and

knowledgeable in the relevant statutes (e.g., a lawyer specializing in the field in question).

Supervised experience in the conduct of a particular type of forensic evaluation may also be

critical. Experience in one forensic area (e.g., child custody evaluation) does not necessarily

prepare the test user for functioning in another forensic area (e.g., death penalty phase testimony;

Haas, 1993; White, 1987).

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IV. A Look Forward

The psychological testing process has undergone significant technological change over

the past few decades. The use of computers to administer tests and to score and interpret test

results is already an important part of everyday testing. Emerging technologies of the Internet

and other innovations that expand applications across vast distances may significantly alter the

relationship of the test user, test taker, and the consumer of testing results.

Some of the positive changes resulting from these new technologies include wider

availability, greater accuracy, and increased accessibility of tests. Continuing improvements in

the development of interpretive algorithms and expert systems are leading to diminishing

concurrent human oversight of the testing process. This technology will simplify some aspects of

the assessment process. As the application of new technology to the testing process produces

improved but more complex testing services, it may become necessary for the knowledge and

skills articulated in this document to be supplemented with increased technological

sophistication. Ironically, this increased complexity may mandate more extensive education and

training in the fundamentals of test use. The knowledge and skills articulated here will become

even more important as test users are required to distinguish technology-based style from

science-based substance.

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Table of Contents

I. Introduction

Definition of Key Terms

Scope of the Guidelines

Many problems or questions to be addressed through assessment must be approached with a recognition of the potential for multiple coexisting or competing explanations. Such recognition comes from the professional knowledge and judgment associated with ad

Historical Background

APA’s Role in Defining Test User Qualifications

Educational Context

Career/Vocational Counseling Context

Health Care Context

Forensic Context

The American Journal of Family Therapy, 40:

369

–384, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926187.2012.677705

What Are the Confidentiality Rights
of Collaterals in Family Therapy?

ELIZABETH M. ELLIS
Private Practice, Atlanta, Georgia, USA

The privacy rights of collateral family members constitute one of the
most complex ethical issues in the field of family therapy. The author
opens with four case studies which illustrate some of the dilemmas.
The opening section reviews the APA Ethics Code on this topic,
followed by an in depth analysis of confidentiality issues in marital
therapy and the special ethical dilemmas of high conflict, child
custody cases. The author reviews the scant case law on this topic
and closes with a set of best practices guidelines for the clinician.

CASE #1

Psychologist X was the treating therapist for a 13 year old girl who had been the
subject of an intense and bitter child custody dispute. Treatment was initiated
by the mother. As part of the child’s treatment, the psychologist met with the
mother from time to time to provide feedback and recommendations. In some
of these meetings, the mother disclosed that she was still struggling with her
alcohol addiction. The father requested a meeting with the psychologist and
asked for a complete copy of the daughter’s treatment record. The psychologist
refused on the grounds that he had to shield the mother’s disclosures from the
father. The father sought consultation from Psychologist Y about his rights.
Psychologist Y advised the father that since he had joint legal custody of the
daughter, he had a legal right to the entire record, including the mother’s
individual visits with Psychologist X. The father left Psychologist Y’s office
stating he intended to file a complaint against Psychologist X with the state
licensing board.

Q. Does the father have a basis for a complaint against Psychologist
X? Should Psychologist X have given the entire record to the father? If he

Address correspondence to Elizabeth M. Ellis, Ph.D., 2400 Pleasant Hill Road, Suite 165,
Duluth, GA 30096. E-mail: elizabethphd@bellsouth.net

369

370 E. M. Ellis

had done so, and it had an adverse impact on the mother’s custodial rights,
would she have a basis for making a complaint against Psychologist X?

CASE #2

A couple was in the process of divorcing and were litigating over custody of
their eight year old child. The father took the child to Psychologist B for treat-
ment without the knowledge or consent of the mother. He hoped to establish
that the mother was mentally unstable and that her condition put the child
at risk in her care. The mother, in treatment with Psychologist Y, found out
about this and asked what she should do about it. She was advised by Psy-
chologist Y to seek a meeting with Psychologist B in which she would request
the boy’s diagnosis, the presenting problems, and the goals in treatment. Psy-
chologist Y also advised her that she was well within her rights to ask for a
copy of the child’s records. The mother did so, but Psychologist B said he had
met several times individually with the father in conjunction with the child’s
treatment, and that he had to consider how to release the child’s records to
her. He finally met with the mother and gave her a copy of the child’s records
but redacted (blacked out) all comments that the father made about himself
in his meetings with Psychologist B, citing doctor-patient privilege.

The mother returned to treatment with Psychologist Y and asked, “Is this
permissible for him to do this?” Psychologist Y advised the mother that under
the law in the state she had a right to everything in the child’s file, and that
Psychologist B had acted improperly. The mother considered whether to file a
formal complaint against Psychologist B, to demand the full record, and/or
to advise Psychologist B to stop treatment of her son.

Q. Was Psychologist B correct in redacting the boy’s records before
releasing them to the mother? Should he have consulted an attorney? If he
had not redacted the record, could he have exposed himself to a potential
lawsuit by the father for failing to notify him that he had no privilege when
he was being interviewed?

CASE #3

A woman sought treatment for depression with Psychologist Y, complaining of
emotional distress about her marriage, especially with regard to the problem
of her husband’s drinking. Over a series of office visits, she detailed a pattern
of behavior on the part of her husband that included withdrawal from the
family on a nightly basis while he drank excessively. She also discussed his
job losses due to his excessive drinking, losing his temper with the children
when drinking, concerns about his drinking and driving with the children
in the car, etc.

Confidentiality Rights of Collaterals 371

The husband then came in with his wife for a series of five conjoint
marital sessions to try to address the marital problems and his use of alcohol.
The marriage continued to deteriorate and the couple separated. The husband
sought custody of the two minor children on the basis that his wife was
mentally unstable. The wife sought custody of the children, alleging the father
was unfit because of his drinking. The wife’s attorney asked Psychologist Y to
testify about her mental stability, her diagnosis, the treatment plan, and her
prognosis.

In pretrial motions, the husband’s attorney requested that Psychologist
Y be barred from disclosing any information from the conjoint visits, citing
doctor-patient privilege. The mother’s attorney argued that the husband was
a collateral family member and thus had no privilege. The judge took it under
advisement. One week later, the judge issued his ruling and sustained (agreed
with) the husband’s attorney’s motion. The judge did so on the premise that
the husband had the privilege because he “perceived that he was a patient” of
Psychologist Y.

Q. Is a spouse in conjoint marital sessions a patient or a collateral family
member? If the spouse is a collateral family member, does he own a privilege
regarding his remarks?

CASE #4

Following a bitter custody battle, the court awarded care of A 15 year old boy
to his father (see: Ellis, 2009). Treatment was initiated with Psychologist Y
who then had one office visit with the father to obtain history, and two office
visits with the adolescent. The mother then requested the therapist terminate
treatment, and the psychologist complied. One year later the mother requested
the boy’s records in order to use them in a libel suit against the father. The
father, consulting with the adolescent, said the boy didn’t wish the records to
be released, citing fear of reprisal from the mother. Psychologist Y attempted to
strike several compromises with the mother, but was unsuccessful. The mother
then filed a complaint against Psychologist Y with the state licensing board.

The board heard the case and ordered Psychologist Y to “turn over the
boy’s records” to another professional who would review them and pass them
on to the mother. Psychologist Y complied but did not turn over the notes of the
meeting with the father. Given the court’s ruling in Case #3, concerned that
the father may “perceive that he had a doctor-patient privilege,” Psychologist
Y interpreted the board’s order narrowly. Psychologist Y reasoned that the
court would have to issue a ruling on the status of the notes with the father,
since they lie in a gray area before the law.

Four years later the mother filed a petition seeking notes of the meeting
with the father, and any and all reports, journals, and documents the father
may have given the psychologist. The boy, now 19, submitted a statement in

372 E. M. Ellis

writing requesting that nothing from his file be released to his mother. The
mother’s attorney pushed forward with a subpoena to depose Psychologist Y
and demand the records. Psychologist Y’s attorney requested a hearing before
a superior court judge, in order to obtain a ruling in the case. The judge heard
arguments and ruled that the notes of the meeting with the father, and the
documents given to the psychologist by the father, were not protected by the
boy’s privilege, and that they should be turned over to the mother. In effect,
the court ruled that a collateral family member had no privilege and that a
patient’s privilege is limited only to direct communications between the doctor
and the patient.

Q. Was the judge correct in her ruling? Can the patient assert the privi-
lege over all materials contained in his/her file? Or is the privilege limited to
only those direct communications between the patient and the psychologist?

INTRODUCTION

The privacy rights of patients and other family members in marital and family
treatment cases is one of the most complex areas at the intersection of law
and ethics. As the cases above indicate, psychologists do not have clear
guidelines as to how to handle requests for records that involve notes by
and about family members who participate in a patient’s treatment. Taking
a term from forensic psychology, we refer to these as “collateral” family
members. Family therapists typically use their best judgment to arrive at
a solution which they hope will appease various competing interests. In
so doing, they easily run afoul of angry family members, licensing boards
and the courts. Even judges, after researching legal precedents, may issue
different rulings from one case to the next.

In general, most of the papers written on the subject of confidentiality
rights in psychotherapy refer to individual, adult psychotherapy patients. The
issue of who is the “patient” is simple and clear in those cases. The patient is
the one who is requesting treatment, who is given a diagnosis and treatment
plan, who signs the informed consent agreement, whose name is on the
chart, whose name is on the insurance claim and on any bills which are
mailed to the patient. When copies of records are requested, it is clear that
only the patient can give permission to release them, unless compelled to
do so by judicial order. Doverspike (2008); Knapp and VandeCreek (2003);
and Bennett et al. (2006) are good general references in this area of ethics.

In the case of marital therapy, the issue of who is the patient, and thus
who owns the privilege, is not as clear. One or both of the couple may
be considered the “patient” in a clinical sense. Many clinicians may view
the couple seeking treatment conceptually as a dysfunctional dyad, and the
clinician will craft interventions with that perspective in mind. In fact, in
this author’s experience, many, if not most, couples who request marital

Confidentiality Rights of Collaterals 373

therapy do so with the expectation that “both of us” are the patient. They
may use language such as “we need help.” This clinician has observed that
many couples go so far as to put both names in the patient space on the
application in order to be fair and balanced in their presentation.

Similarly, in family therapy, the therapist may refrain from designating
a particular member of the family as a patient, and may convey the view
to the family that the whole family, or perhaps some subsystem of the
family—including stepparents and grandparents for example—is the patient
in a clinical sense. This is often understandable and agreeable to the family.
Many families requesting family therapy will make requests such as “we all
need help getting along as a family.” Some request help for a subsystem,
such as “My new husband needs help getting along with my teenage son.”
Even more unclear but quite common are requests such as “My husband
and I are sleepless, stressed, and fighting over how to handle our daughter
who is using drugs again.” Some families will ask for multiple authorizations
from the health insurance plan and fill out multiple patient applications “so
we can all be the patient.”

While this may be desirable from a clinical perspective to regard couples,
or dyads, or whole families as the therapeutic unit, and while it may fit with
the perspective of the treatment requests, this collides with the realities of
third party reimbursement and with the courts. From the perspective of the
health insurance company, mental health billing must fit the medical model.
Only one person in the room at the time the service is rendered is the patient.
In order to be a patient, the person must request treatment if an adult (or
one of the parents must request the treatment for the child, if the patient is a
child), and the patient must have symptoms that warrant a DSM IV diagnosis
that is covered by the plan. The treatment must be medically necessary, and
a treatment plan for that individual must be in the patient’s chart.

In the case of marital therapy, the therapist must discuss the issue of who
the patient is fully and openly with the couple in order to come to a mutual
agreement. They must be informed that in order for the health insurance plan
to cover their services, one person must be the patient and they must meet
the above criteria set out by the health insurance plan. This step alone, done
at the outset of treatment, may subtly change the dynamics of how couples
therapy proceeds from that point forward. However, it is an essential part
of the informed consent process. Likewise, the parents of a child who are
requesting family therapy must agree that the child is the patient, and must
be informed as to the child’s diagnosis and the treatment plan.

In an idealized setting where all clients pay for psychotherapy out of
pocket, the therapist may draw up individualized informed consent agree-
ments which specify that both marital partners (or life partners) have a
privilege to the records of their couples treatment. In the case of family ther-
apy, the parties may sign an agreement which specifies that all of the family
members seen have equal rights to the confidentiality of their remarks in

374 E. M. Ellis

the psychotherapy process and that no records can be released without the
group consent of all the parties.

However, the reality of private practice is far from this ideal. In this
author’s practice in a middle class suburb of a large metropolitan area, a
survey of the three practitioners indicated that less than 5% of their caseloads
were private pay, and those were essentially the uninsured. Less than one
percent of their patient population had private health insurance but chose to
pay out of pocket rather than use their insurance. There are no large scale
studies on the topic of what portion of psychotherapy patients are private
paying patients. The economic reality is that probably the majority of patients
are willing to agree on one person being designated the patient in order to
make use of the health insurance benefits.

Most texts on ethics which address the issue of clarifying who the patient
is simply recommend that the therapist discuss issues of confidentiality with
family members before beginning treatment and to have the parties read and
sign lengthy, detailed informed consent contracts which spell out who owns
the privilege in these cases and who can access the records that accumu-
late from family treatment (Bennett et al., 2006; Doverspike, 2008; Knapp
& VandeCreek, 2003). While this may seem to address the issue legally, it
is a recommendation that is not practical or feasible from the perspective
of one who runs a clinical practice. The early stages of treatment with a
new patient must focus on rapidly identifying the patient’s needs and estab-
lishing a rapport with the patient in the first 50 minutes by understanding,
empathizing, clarifying the problem, setting goals, and offering hope of a
positive outcome. A lengthy discussion of possible adverse legal outcomes
is not what patients are expecting when they enter a psychologist’s office
requesting treatment.

In reality, the issue of who owns the rights to the treatment notes that
are made when collateral family members participate in treatment is rarely an
issue. This author (Psychologist Y) has seen perhaps 4,000 to 5,000 children
and families in treatment, and no disputes over the records have arisen in
cases where divorce conflicts were not part of the landscape. Even in cases
where a couple who was seen for marital therapy is subsequently divorcing,
it would be rare for them to request the records in those cases where they
have no children under the age of eighteen. The opening four cases which
occurred in the course of this author’s practice over the last five years capture
the types of cases in which these dilemmas arise.

PSYCHOLOGISTS’ ETHICAL GUIDELINES

The APA Ethics Code (2002) offers no specific guidelines on the privacy rights
of collateral family members in family therapy. In section 3.10 “Informed
Consent,” the psychologist who is engaged in counseling or psychotherapy

Confidentiality Rights of Collaterals 375

is advised to obtain the informed consent of the “individual or individuals”
using language which is understandable to that adult or child. In section
10.01 “Informed consent to therapy,” this principle is reiterated but made
more specific to patients who are in a treatment setting. Most informed
consent agreements are tailored toward the concept that only one individual
is a patient. In couples therapy, the identified patient signs the consent form.
The other partner may not even review it or be aware of it. When working
with children, it is the parent who presents a child for treatment who typically
reviews and signs the informed consent agreement. The other parent may not
be present and thus may not review it. In cases where parents are divorced,
it is predominantly the parent with primary physical custody who initiates
treatment and who reviews and signs the informed consent agreement. The
other parent, who may even live out of state, may not be aware of it, or see
it, much less sign it.

In section 4.02 “Discussing the limits of confidentiality,” the psychologist
is advised to “discuss with persons. . . (1) the relevant limits of confidentiality
and (2) the foreseeable uses of the information generated through their
psychological activities.” For example, standard informed consent contracts
typically notify the patient that in the event that the person poses an imminent
danger to himself or a clear risk of harm to an identifiable person, or in
the event that the patient discloses acts of abuse toward a child or elderly
person, confidentiality must be waived. Most informed consent agreements
also include language that notifies the patient that in the event of a personal
injury lawsuit, the psychotherapy records will likely be requested and must
be released for the suit to proceed.

Section 10.02 “Therapy involving couples or families,” addresses the
complex nature of confidentiality when several persons are involved in
the patient’s treatment. This section advises the psychologist to “clarify at
the outset (1) which of the individuals are clients/ patients and (2) the
relationship the psychologist will have with each person.” This includes the
psychologist’s role and “the probable uses of the services provided or the in-
formation obtained . . .” In this section, most clinician’s notify the patient that
certain kinds of information will be sent to the patient’s insurance plan, for
example.

Some family therapists have the “patients” sign a contract in which they
agree to have the records sealed in the event of a divorce or litigation and
that they will not subpoena the therapist to testify for or against either one in
a legal matter (Doverspike, 2008; Ellis, 2006). Such agreements, while noble
in aspiration, are not legally enforceable. Under HIPAA, Section 164.524, the
identified patient is entitled to his/her entire record. The person who is the
patient in couples therapy owns the legal rights to the records. If the patient
is a child or adolescent, and if the parents are married to each other, the
parents are joint custodians of the child’s records and both may be entitled
to a copy of the entire record. If the parents are divorced, the most recent

376 E. M. Ellis

court order regarding the custodial rights of the parents will govern who
has access to the records. The exceptions may be where the adolescent is a
“mature minor” (age 15 or older), and where the parent is not acting in the
child’s best interests and thus not entitled to act as the child’s representative
under HIPAA (Section 164.502, para.s (g) 5, I and ii). Seeking the child’s
records specifically for use in a child custody proceeding has been defined,
by some courts, as not acting in the child’s best interests. Exceptions are
also made in states where adolescents’ rights to their treatment records have
prevailed in the courts (see: Ellis, 2009, for a fuller discussion).

SPECIAL ISSUES IN COUPLES THERAPY

The issue of who is the patient and who is the collateral family member in
couples therapy is complex and controversial. In the past the advice from
ethics experts was to see couples together in all visits and advise them
that no information will be released from their file without the written con-
sent of both parties (Harris, 1997). This policy was endorsed and reiterated
by Doverspike (2008, p. 134) when discussing policies on release of in-
formation. What is lacking here is the recognition that only one person,
legally, is the patient. Thus, this agreement is not binding. In fact, Dover-
spike (2008) contradicts this position in his discussion on identifying “Who is
the client?” Here he suggests that when bringing a collateral family member
into a client’s session, “it is important to obtain informed consent of the col-
lateral after clarifying the collateral’s role” (p. 94). He suggests the reader use
the APAIT Outpatient Services Agreement for Collaterals available at http://
www.apait.org.

Bennett et al. (2006) are more direct about who is the client or patient
and who is the collateral contact. In a case study which they present, a wife
is seen for individual therapy and her husband joins her for couples sessions.
The psychologist is advised to explain to the husband at the outset that the
wife is the patient and that the husband is there “as a collateral contact only,
to further the treatment of the wife.” (p. 90). Presumably this would offer the
spouse an opportunity to ask questions about whether his remarks would
be privileged.

This is the same scenario as that presented in Case #3. Psychologist Y
could have notified the husband that he was a collateral contact and thus
had no basis to assume that his remarks were confidential. In fact, some legal
experts (Corey, Corey, & Callanan, 2007) assert that confidentiality is lost at
any point where there is a third party in the consulting room (the patient
and the therapist being the first and second parties). The husband and wife
in Case #3 both heard the remarks of the other and both were free to testify
to the court as to what was disclosed in the office visits. The husband might
have disclosed less information about his drinking habits had he been put

Confidentiality Rights of Collaterals 377

on notice. However, it is equally likely that he did not anticipate a divorce,
much less a child custody dispute, and would have freely disclosed such
information, even if he had been given advance notification.

In a recent newsletter article, APA’s ethics expert, Jeff Younggren, and
attorney Stephen Hjelt (2010), addressed the issue of collaterals in marital
therapy. They argue that marital therapy is properly an endeavor in which
both parties are seen together, neither is the identified patient, thus no
claim is filed with a health plan, and both parties are joint custodians of the
record. In fact, Younggren and Hjelt go so far as to assert that if the therapist
identifies one of the parties as a “patient,” and upgrades their symptoms to
the level of a clinical diagnosis, so that the marital therapy is covered by
the health plan, then the health insurance company has been deceived into
paying for a “non covered service.” Thus, it has adequate grounds to charge
the therapist with fraud and professional misconduct and take legal action.

Younggren and Hjelt assert that the practice of identifying one person
in couples therapy as the patient also runs the risk of encountering ethical
dilemmas regarding the privacy rights of the non-patient in marital therapy.
If one person is identified as the patient, and the other is designated a non-
patient, then the patient has sole access to the records. If the marital therapy
process fails, and the couple proceeds toward divorce, the identified patient
can use the records against the non-patient of the couple. If the non-patient
thus loses the protections afforded in traditional individual treatment and
thus loses control of his/her records, Younggren and Hjelt argue that the
therapist’s conduct could be seen as a “violation of professional standards
and of the duty owed to the client/patient,” thus opening the door for the
non-patient collateral to file a lawsuit against the therapist.

While Younggren and Hjelt’s model for marital therapy is ideal, it is not
realistic. This psychologist would argue that only a small, affluent minority
of clients would seek marital therapy and be willing to pay the therapist’s
fee out of pocket. The vast majority of middle class couples seeking marital
therapy fully intend to use their health insurance plan to cover the services,
and demand that the service be offered to them in that manner. Typically,
at least one of the parties meets criteria for a DSM IV diagnosis of Adjust-
ment Disorder, and that person may qualify as the identified patient. What
Younggren and Hjelt consider fraud—seeing the couple together, identifying
one as the patient, and filing the claim with the patient’s health insurance
plan—is likely the prevailing norm in clinical practices today. The only part
of the process that may be fraudulent is fabricating a diagnosis for one of
the parties in couples therapy in order to obtain coverage for a service that
would not otherwise be covered.

Younggren and Hjelt’s paper generated “questions and concerns” from
many readers. In a follow-up article, Younggren and Harris (2011) clarified
their position. They acknowledge that if the identified patient actually did
meet criteria for a DSM IV diagnosis (Axis 1-IV), then this billing practice

378 E. M. Ellis

would be acceptable. However, their position as to who owns the privilege
in this case is unclear. They state that “confidentiality issues are matters of
concern with this type of treatment.” (p. 9). In “true couples therapy” the
protection of privacy of both parties is crucial for success. They suggest that
in this model of couples therapy—where one person is the identified patient
and the partner is the collateral contact—issues of informed consent should
be discussed at the outset “along with the fact that no information about or
records of the treatment will be released without both parties’ permission”
(p. 9). In reality, if the identified patient requests his or her records, they must
be granted, regardless of the wishes of the spouse or partner. HIPAA strength-
ened the patient’s rights to obtain their records, not in part, but in their en-
tirety. Younggren and Harris state that “a majority of states would respect the
privilege of both parties equally,” but give no citation. They acknowledge
that some states, such as New York, and Washington, “may be different.”

SPECIAL ISSUES IN TREATING CHILDREN FROM HIGH
CONFLICT FAMILIES

Treating children who come from high conflict families is a complex and high
risk endeavor (Bennett et. al, 2006). Unlike typical families who may present
the child for treatment, and who both have the same goal—reduction of
the child’s symptoms—parents in high conflict families often have not only
different agendas, but competing agendas (Ellis, 2006). One parent may
exaggerate the child’s symptoms in order to portray the other parent as a
poor caregiver. Likewise, one parent may minimize the child’s symptoms and
even deny symptoms, in an effort to put forth a positive picture of themselves
as good caregivers, and to “look good” at trial. One parent may not be
seeking treatment, but intends to use the professional to gather information
about what goes in the other parent’s home and to document a pattern of
abuse or poor judgment by the other parent. It is common for one parent to
seek treatment for the child without the knowledge or permission of the other
parent. In all these cases, the unstated goal is to use the documentation to the
parent’s advantage in a court proceeding. In many of these cases, the parent
also intends to subpoena the family therapist to testify at a subsequent trial.
In some cases, the parents have been court ordered to participate in family
therapy. They have followed the court order with bitterness and resentment
and have no interest in furthering any goals in treatment.

In cases where a couple is contemplating divorce, or where parents are
in the midst of divorce, or have litigated over child custody in the past, or
those who are re-litigating post-divorce due to a change of circumstances,
the risk of a dispute over the records may be fairly high. The psychotherapy
notes can be requested specifically for the purpose of gaining legal advantage
over a family member. Parents who have joint legal custody of their children

Confidentiality Rights of Collaterals 379

jointly own the privilege and can demand copies of the child’s records in
most states, including the notes of meetings with collateral family members
and any and all materials that were given to the child’s therapist. These
records may include the parent’s personal journal of events that had occurred
with the child. They may include statements the parent may have made to
the therapist which, if revealed, would be very detrimental to their case
legally. Examples would be the parent’s statement that he or she intended
to block the other parent from having contact with the child, or that they
intended to go into hiding with the child. They may include damaging self
disclosures such as the parent’s admission that his or her current marriage
is deteriorating, that he or she consumed too much alcohol in the child’s
presence, or lost their temper with the child and became verbally abusive.

These kinds of disclosures can be devastating to a parent’s position in
child custody litigation. Some psychotherapists may decline to release the
records to a parent, citing the child’s confidentiality. However, this is not
defensible. Most state laws uphold parents’ rights to their children’s records.
In fact, HIPAA (the Health Insurance Portability and Accountability Act) also
strengthened the rights of parents to all of the materials in their child’s
treatment files (see: HIPAA, Privacy Rule, Section 164.502).

There is very little case law on the legal rights regarding collateral family
members who are seen as part of a child’s treatment. The Georgia case of
Mrozinski v. Pogue (1992) has a direct bearing on this issue. In this case Mr.
Mrozinski’s 14 year old daughter was in treatment with Dr. Pogue, an Atlanta
psychiatrist, for drug addiction and other mental health problems while she
was a resident of an inpatient psychiatric program. The drug use began while
she was in her mother’s care, and the court had intervened and placed her in
the custody of the father. The father participated in family therapy while the
daughter was hospitalized. Upon release, the mother obtained the discharge
summary. Dr. Pogue also gave the mother an affidavit which contained
negative remarks about Mr. Mrozinski’s relationship with his daughter and
recommending custody be transferred to the mother. Mr. Mrozinski sued
Dr. Pogue claiming that he received treatment from Dr. Pogue by virtue
of participating in family therapy, and that his rights were violated. Dr.
Pogue asked for summary judgment (immediate dismissal), asserting that
the only patient was the 14 year old, and that he had no doctor-patient
relationship with Mr. Mrozinski. Summary judgment was granted. Mrozinski
filed an appeal. He countered that he had sought advice and assistance
from Dr. Pogue and that he was assured the visits were confidential. The
affidavit recommended that he “continue therapy,” implying that he had
received treatment from Dr. Pogue. The appellate court upheld the lower
court’s ruling, and the suit for wrongful disclosure was dismissed. Thus, in
this case, the court ruled that a collateral family member had no rights to
the confidentiality of statements which were made by them in the context of
family therapy.

380 E. M. Ellis

This case illustrates the myriad of dilemmas regarding who is the patient,
who has the rights to what information, and how it is to be used. In Case #1,
the mother sought legitimate treatment for her child but disclosed sensitive
information to the therapist, not knowing that the father could have access
to that information and use it against her. In Case #2, the father presented
the child for “treatment” with questionable motives and without the mother’s
knowledge. In this case, however, he felt that he, too, was the patient and
had some rights to the confidentiality of his remarks to the therapist. Family
therapy in such contexts is a virtual minefield.

Bennett et al. (2006) recommend that one not see a child in such a
situation without the knowledge and permission of the other parent. These
authors recommend that as with cases of family therapy with multiple family
members, one would do well to have an informed consent agreement that is
specific regarding requests for information about the child, requests for the
child’s records, and what information in particular is to be regarded as part
of the child’s file.

BEST PRACTICES

From the previous discussion, the following are offered as suggested guide-
lines for the clinician regarding the confidentiality rights of collateral family
members in couples and family therapy.

Identify High Risk Cases From the Outset

This is a small subset of most family therapy cases, but many can be recog-
nized at the outset. These are parents who are threatening to divorce, are in
the midst of a divorce, or have divorced and are contemplating re-litigating.
They are characterized by high levels of bitterness and rancor, allegations of
abuse and betrayal, and vague threats to take legal action. They are may have
a past history of litigating against each other and/or filing complaints against
other professionals—e.g., other therapists, attorneys, judges, guardians, and
child custody evaluators.

In the above case studies, Case #1 had had a prior history of child
custody litigation and could have been identified as a high risk case. The
parents in Case #2 were in the midst of a divorce, and were the parents of a
five year old child, and also could have been identified as a high risk case.
Case #3 could not have been identified at the outset because it began as
a routine individual psychotherapy case. Case #4 had had a history of past
child custody litigation, but it had been resolved, and there was no current
litigation pending. Thus the dispute over the child’s records might or might
not have been anticipated.

Bennett et al. (2006) go so far as to recommend that one may ultimately
develop a practice of refusing to take such cases. This may not only be

Confidentiality Rights of Collaterals 381

for the protection of the therapist who has a high risk of being sued in
such cases or subject to a licensing board complaint, but may also be an
acknowledgement of the reality that good treatment of the child cannot
take place in such an incendiary atmosphere. Since all the case studies
presented at the outset which focused on disputes over records and the
rights of collaterals, the clinician who avoids these types of cases altogether
will minimize the possibility of being involved in such a dispute.

Do a Careful and Thorough Informed Consent Process
in High Risk Cases

Identifying high risk cases at the outset and having them sign informed
consent agreements would be the ideal. The informed consent agreement
should specify clearly who the patient is and who has access to the records.
In couples and family therapy cases, the parties may be asked to sign agree-
ments not to request copies of the record if the purpose is to use them in
court proceedings, or not to subpoena the therapist to testify for one side in
court. As stated before, it is rendered moot by state law and HIPAA.

If the therapist wishes to shield the spouse of the patient, or the child
in treatment, or one of the parents who participated in the child’s treatment
from possible harm, the therapist might first defer to the informed consent
agreement in the interest of coming to a mutually satisfying solution. If this
fails, the next alternative is for the therapist to retain an attorney and file a
motion to quash, or dismiss, the subpoena. In such cases a hearing would be
scheduled and arguments would be made from both sides as to whether the
therapist’s objection to the subpoena (or the objection of one of the parties
in the case) should be sustained (upheld) or over-ridden. The judge has the
option to review the records in camera (in the privacy of the judge’s cham-
bers) before ruling on the issue. Another alternative, if subpoena-ed to testify
in court, is to appear at the hearing with the requested records but to raise an
objection to the judge regarding the release of the records. Providing a copy
of the informed consent agreement to the judge may be very advantageous.

Most couples who seek marital therapy, as well as parents who seek
family therapy with their child, do not realize that if the parties are involved in
child custody litigation at a later date, they may have to surrender all rights
to these psychotherapy records. It is common practice for child custody
evaluators to demand that the parents surrender all rights to all previous
psychotherapy records, including records of individual treatment (see: Ellis,
2010, for a fuller discussion). If they were made aware of this from the outset,
they might be more careful with the disclosures that they make in individual,
marital, and family therapy. Therefore, the clinician may want to go so far as
to include a warning in the informed consent agreement that begins, “In the
event of a divorce and the litigation that may ensue, and/or child custody
litigation, you might have to waive your rights to confidentiality whether you

382 E. M. Ellis

are the patient or a collateral family member participating in your spouse’s
or your child’s treatment.”

Minimize Individual Meetings With Collateral Family Members

Many family therapists are aware of the possibilities of ethical dilemmas that
may occur when the therapist meets with one member of a couple or family
in treatment (Margolis, 2008). Material may be disclosed in confidence that
the family member wishes not to be shared with the other family members.
This person, who is not the patient, then requests that this material be
regarded as “confidential.” Many couples therapists are prepared for this and
either refuse to see one partner alone or explain at the outset that there is
no privilege that extends to the notes of that session. The clinician who is
treating a couple who have young children and who are moving toward
divorce may want to be especially cautious about seeing the non-patient
partner alone.

In cases where a child is the patient, Bennett et al. (2006) recommend
that the clinician always have the consent of both parents at the outset. It
would be wise also to meet with both parents jointly when a feedback session
is needed. However, refusing to meet with one parent may be difficult to
enforce, especially where the parents are separated or divorced and are not
speaking to each other. One parent may be only marginally involved in the
child’s life. Even when both parents intend to be present at the session, one
parent may have a busy work schedule and can’t be in attendance at the
parent meeting.

In Case #1, Psychologist X could have requested to see the divorced
parents together to provide feedback on the child’s treatment. If the parents
had been seen together, it is unlikely that the mother would have disclosed
sensitive information about herself. Similarly, in Case #2, Psychologist B may
have requested to see the parents together to provide history at the outset of
treatment and at the feedback session. It is likely that the father would not
have complied, given that his motive for seeking treatment for the child was
to gather information to use against the mother in his petition for primary
custody. This strategy would, on the other hand, have averted the dispute
over the records.

If One Sees a Family Member Individually, Give
a Cautionary Warning

In Case #1, identified as a high risk case, Psychologist X who was treating
the 13 year old girl might have given the mother a cautionary warning, i.e.,
“I will be taking notes of our session today. Keep in mind that you and the
father both have access to your child’s treatment record. Both of you can at
any time request copies of these notes and I am obligated under state law

Confidentiality Rights of Collaterals 383

to provide them to you or the other parent with joint legal custody. Once I
release these notes to the parents, I have no control over how they may be
used. You or the other parent may provide copies of them to family members,
teachers, attorneys, or officers of the court. There have been occasions when
psychotherapy notes of a child’s treatment have been used against a parent
in a child custody proceeding.” When this author has used such a warning,
the parents have been surprised at first that their remarks were not protected,
then thankful that they were notified ahead of time. In Case #2 and Case
#4, the psychologist could have notified the parent at the outset that their
remarks were not protected. It would have been advisable to document such
notification in the record as well. This might have prevented conflicts that
arose over the records at a later time.

Some psychotherapists may want to use caution in whether to accept
personal materials from the parents to include in the child’s records. Sen-
sitive material such as journals, diaries, emails, letters, greeting cards, pho-
tographs, may be viewed in the session and given back to the parent (or
husband/wife). In Case #4, Psychologist Y was given a large three ring binder
with over one hundred pages of material. It was briefly reviewed and given
back to the father. Thus, when the mother requested it four years later, it was
not in the psychologist’s possession, and the issue of releasing it was moot.

The psychotherapist would have to use his/her judgment as to whether
to write down personal disclosures by the spouse of the patient or the parent
or other family member–disclosures which may be used against them at a
later time. Certainly disclosures from the person’s distant past or which have
no bearing on the patient’s treatment do not need to be written down.

Seek Ways to Shield the Privacy of Meetings With Collateral Family
Members Who Are Seen Individually

Gerald Koocher (2008) and Eric Harris (1997) recommend that notes of
meetings with collateral family members, particularly the parents, be kept in
a separate file. Thus, if one parent requests the “child’s records,” only the
notes in the child’s chart are surrendered, not the notes of separate meetings
with a parent. Both are recognized experts in the area of psychologist ethics
and have conducted seminars on risk management for the APA. APA ethics
expert, Jeff Younggren (2009) was asked about this practice. He stated that
keeping the notes of the meetings with the parents in a separate file was
unethical and improper. All the notes and documents must be kept in one
file. Thus, it appears that three of the top experts in the country may disagree
on this issue.

Another option is to advise the family that when the therapist needs to
meet individually with one parent (in order to obtain history, or be given
an update on progress in treatment), it is best to open a second chart and
account in the parent’s name. The psychotherapist might code the service as

384 E. M. Ellis

a “consultation” since no treatment is rendered. It would not be covered by
the health insurance plan, but the parent would control access to the notes
in their own file.

As stated in the opening remarks, the area of confidentiality rights of
collaterals in family therapy is very complex. Clinical goals, medical billing
procedures, professional ethics, and the law may clash when requests are
made for records. The practice suggestions made here are not agreed upon
by a majority of clinicians and are bound to be controversial. Hopefully, they
will open up a dialogue which will ultimately result in clearer standards in
the future.

REFERENCES

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Bennett, B., Bricklin, P., Harris, E., Knapp, S., VandeCreek, L., & Younggren, J.
(2006). Assessing and managing risk in psychological practice. Rockville, MD:
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Corey, G., Corey, M., & Callanan, M. (2007). Issues and ethics in the helping profes-
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Doverspike, W. (2008). Risk management: Clinical, ethical, & legal guidelines for
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Ellis, E. (2006). Ten ethical pitfalls to avoid when doing child and family forensic
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Ellis, E. M. (2010). Should participation in a child custody evaluation compel the
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Harris, E. (1997, May 15). Advanced risk management: Working with kids, families,
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HIPAA Privacy Rule. Section 164.502. See: (g) 5, i and ii. Retrieved September 5,
2011, from http://aspe.hhs.gov/admnsimp/final/PvcTxt01.htm

Koocher, G. (2008). Ethical challenges in mental health services to children and
families. Journal of Clinical Psychology, 64, 601–612.

Margolin, G. (2008). Ethical and legal considerations in marital and family therapy.
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Mrozinski v. Pogue, 205 Ga. App. 731, 423 S.Ed. 405 (1992). Retrieved September 5,
2011, from http://www.lawskiis.com/case/ga/id/328/26/index.html

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