Current through Register Vol. 50, No. 9, September 20, 2024
A.
Licensees encourage client growth and development in ways that foster the
interest and welfare of clients and promote formation of healthy relationships.
Licensees actively attempt to understand the diverse cultural backgrounds of
the clients they serve. Licensees also explore their own cultural identities
and how these affect their values and beliefs about the counseling process.
Licensees 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).
1.
Welfare of Those Served by Licensees
a.
Primary Responsibility. The primary responsibility of licensees is to respect
the dignity and to promote the welfare of clients.
b. Records. Licensees maintain records
necessary for rendering professional services to their clients and as required
by laws (see Chapter 15,
§1505 A), regulations, or agency or
institution procedures. Licensees include sufficient and timely documentation
in their client records to facilitate the delivery and continuity of needed
services. Licensees take reasonable steps to ensure that documentation in
records accurately reflects client progress and services provided. If errors
are made in client records, licensees take steps to properly note the
correction of such errors according to agency or institutional
policies.
c. Counseling Plans.
Licensees and their clients work jointly in devising integrated, counseling
plans that offer reasonable promise of success and are consistent with
abilities and circumstances of clients. Licensees and clients regularly review
counseling plans to ensure their continued viability and effectiveness,
respecting the freedom of choice of clients.
d. Support Network Involvement. Licensees
recognize that support networks hold various meanings in the lives of clients
and consider enlisting the support, understanding, and involvement of others
(e.g., religious/spiritual/community leaders, family members, friends) as
positive resources, when appropriate, with client consent.
e. Employment Needs. Licensees work with
their clients considering employment in jobs that are consistent with the
overall abilities, vocational limitations, physical restrictions, general
temperament, interest and aptitude patterns, social skills, education, general
qualifications, and other relevant characteristics and needs of clients. When
appropriate, licensees appropriately trained in career development will assist
in the placement of clients in positions that are consistent with the interest,
culture, and the welfare of clients, employers, and/or the public.
2. Informed Consent in the
Counseling Relationship
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. Licensees have an obligation to review, in writing
and verbally with clients, the rights and responsibilities of both the licensee
and the client. Informed consent is an ongoing part of the counseling process,
and licensees appropriately document discussions of informed consent throughout
the counseling relationship.
b.
Types of Information Needed
i. Licensees
explicitly explain to clients the nature of all services provided. They inform
clients about issues such as, but not limited to, the following:
(a) the purposes, goals, techniques,
procedures, limitations, potential risks, and benefits of services;
(b) the licensees qualifications,
credentials, and relevant experience;
(c) continuation of services upon the
incapacitation or death of a counselor; and
(d). other pertinent information.
ii. Licensees take steps to ensure
that clients understand the implications of diagnosis, the intended use of
tests and reports, fees, and billing arrangements.
iii. Clients have the right:
(a). to confidentiality and to be provided
with an explanation of its limitations (including how supervisors, and/or
treatment team professionals are involved);
(b). to obtain clear information about their
records;
(c). to participate in the
ongoing counseling plans; and
(d).
to refuse any services or modality change and to be advised of the consequences
of such refusal.
c. Development and Cultural Sensitivity.
Licensees communicate information in ways that are both developmentally and
culturally appropriate. Licensees use clear and understandable language when
discussing issues related to informed consent. When clients have difficulty
understanding the language used by licensees, they provide necessary services
(e.g., arranging for a qualified interpreter or translator) to ensure
comprehension by clients. In collaboration with clients, licensees consider
cultural implications of informed consent procedures and, where possible,
licensees adjust their practices accordingly.
d. Inability to Give Consent. When counseling
minors or persons unable to give voluntary consent, licensees seek the assent
of clients to services, and include them in decision making as appropriate.
Licensees recognize the need to balance the ethical rights of clients to make
choices, their capacity 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.
3. Clients Served by Others. When licensees
learn that their clients are in a professional relationship with another mental
health professional, they request written release of information that the
clients sign in order to communicate with other professionals and strive to
establish positive and collaborative professional relationships.
4. Avoiding Harm and Imposing Values
a. Avoiding Harm. Licensees act to avoid
harming their clients, trainees, and research participants and to minimize or
to remedy unavoidable or unanticipated harm.
b. Personal Values. Licensees are aware of
their own values, attitudes, beliefs, and behaviors and avoid imposing values
that are inconsistent with counseling goals. Licensees respect the diversity of
clients, trainers, and research participants.
5. Roles and Relationships with Clients
a. Current Clients. Sexual or romantic
licensee-client interaction or relationships with current clients, their
romantic partners, or their family members are prohibited.
b. Former Clients. Sexual or romantic client
interactions or relationships with former clients, their romantic partners, or
their family members are prohibited for a period of five years following the
last professional contact. Licensees, before engaging in sexual or romantic
interactions or relationships with clients their romantic partners, or client
family members after five years following the last professional contact,
demonstrate forethought and document (in written form) whether the interactions
or relationships can be viewed as exploitive in some 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 such an interaction or
relationship.
c. Nonprofessional
Interactions or Relationships (other than sexual or romantic interactions or
relationships). Licensee-client nonprofessional relationships with clients,
former clients, their romantic partners, or their family members should be
avoided, except when the interaction is potentially beneficial to the client.
d. Potentially Beneficial
Interactions. When a licensee-client nonprofessional interaction with a client
or former client may be potentially beneficial to the client or former client,
the licensee must document in case records, 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. Such interactions
should be initiated with appropriate client consent. Where unintentional harm
occurs to the client or former client, or to an individual significantly
involved with the client or former client, due to the non professional
interaction, the licensee must show evidence of an attempt to remedy such harm.
Examples of potentially beneficial interactions include, but are not limited
to:
i. attending a formal ceremony (e.g., a
wedding/commitment ceremony or graduation);
ii. purchasing a service or product provided
by a client or former client (excepting unrestricted bartering);
iii. hospital visits to an ill family member,
mutual membership in a professional association, organization, or
community.
e. Role
Changes in the Professional Relationship. When a licensee changes a role from
the original or most recent contracted relationship, he or she obtains informed
consent from the client and explains the right of the client to refuse services
related to the change. Examples of role changes include:
i. changing from individual to relationship
or family counseling, or vice versa;
ii. changing from a nonforensic evaluative
role to a therapeutic role, or vice versa;
iii. changing from a licensee to a researcher
role (i.e., enlisting clients as research participants), or vice versa; and
iv. changing from a licensee to a
mediator role, or vice versa.
(a) Clients
must be fully informed of any anticipated consequences (e.g., financial, legal,
personal, or therapeutic) of licensee role changes.
6. Roles and
Relationships at Individual, Group, Institutional and Societal Levels
a. Advocacy. When appropriate, licensees
advocate at individual, group, institutional, and societal levels to examine
potential barriers and obstacles that inhibit access and/or the growth and
development of clients.
b.
Confidentiality and Advocacy. Licensees obtain client consent prior to engaging
in advocacy efforts on behalf 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.
7. Multiple Clients
a. When a licensee agrees to provide
counseling services to two or more persons who have a relationship, the
licensee clarifies at the outset which person or persons are clients and the
nature of the relationships the licensee will have with each involved person.
If it becomes apparent that the licensee may be called upon to perform
potentially conflicting roles, the licensee will clarify, adjust, or withdraw
from roles appropriately.
8. Group Work
a. Screening. Licensees screen prospective
group counseling/therapy participants. To the extent possible, licensees select
members whose needs and goals are compatible with goals of the group, who will
not impede the group process, and whose well-being will not be jeopardized by
the group experience.
b.
Protecting Clients. In a group setting, licensees take reasonable precautions
to protect clients from physical, emotional, or psychological trauma.
9. End-of-Life Care for Terminally
Ill Clients
a. Quality of Care. Licensees
strive to take measures that enable clients:
i. to obtain high-quality end-of-life care
for their physical, emotional, social, and spiritual needs;
ii. to exercise the highest degree of
self-determination possible;
iii.
to be given every opportunity possible to engage in informed decision making
regarding their end-of-life care; and
iv. to receive complete and adequate
assessment regarding their ability to make competent, rational decisions on
their own behalf from a mental health professional who is experienced in
end-of-life care practice.
b. Licensee Competence, Choice, and Referral.
Recognizing the personal, moral, and competence issues related to end-of-life
decisions, licensees may choose to work or not work with terminally ill clients
who wish to explore their end-of-life options. Licensees provide appropriate
referral information to ensure that clients receive the necessary
help.
c. Confidentiality. Licensees
who provide services to terminally ill individuals who are considering
hastening their own deaths have the option of breaking or not breaking
confidentiality, depending on applicable laws and the specific circumstances of
the situation and after seeking consultation or supervision from appropriate
professional and legal parties.
10. Fees and Bartering
a. Accepting Fees from Agency Clients.
Licensees refuse a private fee or other remuneration for rendering services to
persons who are entitled to such services through the licensees employing
agency or institution. The policies of a particular agency may make explicit
provisions for agency clients to receive counseling services from members of
its staff in private practice. In such instances, the clients must be informed
of other options open to them should they seek private counseling
services.
b. Establishing Fees. In
establishing fees for professional counseling services, licensees consider the
financial status of clients and locality. In the event that the established fee
structure is inappropriate for a client, licensees assist clients in attempting
to find comparable services of acceptable cost.
c. Nonpayment of Fees. If licensees intend to
use collection agencies or take legal measures to collect fees from clients who
do not pay for services as agreed upon, they first inform clients of intended
actions and offer clients the opportunity to make payment.
d. Bartering. Licensees may barter only if
the relationship is not exploitive or harmful and does not place the licensee
in an unfair advantage, if the client requests it, and if such arrangements are
an accepted practice among professionals in the community. Licensees consider
the cultural implications of bartering and discuss relevant concerns with
clients and document such agreements in a clear written contract.
e. Receiving Gifts. Licensees understand the
challenges of accepting gifts from clients and recognize that in some cultures,
small gifts are a token of respect and showing gratitude. When determining
whether or not to accept a gift from clients, licensees take into account the
therapeutic relationship, the monetary value of the gift, a clients motivation
for giving the gift, and the licensees motivation for wanting or declining the
gift.
11. Termination
and Referral
a. Abandonment Prohibited.
Licensees do not abandon or neglect clients in counseling and inform clients of
professional limitations. Licensees assist in making appropriate arrangements
for the continuation of treatment, when necessary, during interruptions such as
vacations, illness, and following termination.
b. Inability to Assist Clients. If licensees
determine an inability to be of professional assistance to clients, they avoid
entering or continuing counseling relationships. Licensees are knowledgeable
about culturally and clinically appropriate referral resources and suggest
these alternatives. If clients decline the suggested referrals, licensees
should discontinue the relationship.
c. Appropriate Termination. Licensees
terminate a counseling relationship when it becomes reasonably apparent that
the client no longer needs assistance, is not likely to benefit, or is being
harmed by continued counseling. Licensees may terminate counseling when in
jeopardy of harm by the client, or another person with whom the client has a
relationship, or when clients do not pay fees as agreed upon. Licensees provide
pretermination counseling and recommend other service providers when
necessary.
d. Appropriate Transfer
of Services. When licensees transfer or refer clients to other practitioners,
they ensure that appropriate clinical and administrative processes are
completed and open communication is maintained with both clients and
practitioners.
12.
Technology Applications
a. Benefits and
Limitations. Licensees inform clients of the benefits and limitations of using
information technology applications in the counseling process and in
business/billing procedures. Such technologies include, but are not limited to:
i. computer hardware and software;
ii. telephones;
iii. the world wide web;
iv. the internet;
v. online assessment instruments;
and
vi. other communication
devices.
b.
Technology-Assisted Services. When providing technology-assisted distance
counseling services, licensees determine that clients are intellectually,
emotionally, and physically capable of using the application and that the
application is appropriate for the needs of clients.
c. Inappropriate Services. When
technology-assisted distance counseling services are deemed inappropriate by
the licensee or client, licensees consider delivering services
face-to-face.
d. Access. Licensees
provide reasonable access to computer applications when providing
technology-assisted distance counseling services.
e. Laws and Statutes. Licensees ensure that
the use of technology does not violate the laws of any local, state, national,
or international entity and observe all relevant statutes.
f. Assistance. Licensees seek business,
legal, and technical assistance when using technology applications,
particularly when the use of such applications crosses state or national
boundaries.
g. Technology and
Informed Consent. As part of the process of establishing informed consent,
licensees do the following:
i. address issues
related to the difficulty of maintaining the confidentiality of electronically
transmitted communications;
ii.
inform clients of all colleagues, supervisors, and employees, such as
informational technology (IT) administrators, who might have authorized or
unauthorized access to electronic transmissions;
iii. urge clients to be aware of all
authorized or unauthorized user,s including family members and fellow employees
who have access to any technology clients may use in the counseling
process;
iv. inform clients of
pertinent legal rights and limitations governing the practice of a profession
over state lines or international boundaries;
v. use encrypted websites and email
communications to help ensure confidentiality when possible;
vi. when the use of encryption is not
possible, licensees notify clients of this fact and limit electronic
transmissions to general communications that are not client specific;
vii. inform clients if and for how long
archival storage of transaction records are maintained;
viii. discuss the possibility of technology
failure and alternate methods of service delivery;
ix. inform clients of emergency procedures,
such as calling 911 or a local crisis hotline, when the licensee is not
available;
x. discuss time zone
differences, local customs, and cultural or language differences that might
impact service delivery;
xi. inform
clients when technology-assisted distance counseling services are not covered
by insurance.
h. Sites
on the World Wide Web. Licensees maintaining sites on the world wide web (the
internet) do the following:
i. regularly check
that electronic links are working and professionally appropriate;
ii. establish ways clients can contact the
licensee in case of technology failure;
iii. provide electronic links to relevant
state licensure and professional certification boards to protect consumer
rights and facilitate addressing ethical concerns;
iv. establish a method for verifying client
identity;
v. obtain the written
consent of the legal guardian or other authorized legal representative prior to
rendering services in the event the client is:
(a). a minor child;
(b). an adult who is legally incompetent;
or
(c). an adult incapable of
giving informed consent;
vi. strive to provide a site that is
accessible to persons with disabilities;
vii. strive to provide translation
capabilities for clients who have a different primary language while also
addressing the imperfect nature of such translations;
viii. assist clients in determining the
validity and reliability of information found on the world wide web and other
technology applications.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
37:1101-1123.