NCE

Privileged Communication

The ethical obligation to protect client information from

The legal protection of confidential communications from

unauthorized disclosure. It builds trust and encourages honest

disclosure in legal proceedings. Privilege belongs to the client,

disclosure; without it, clients may withhold information essential to

who may waive it. Privilege statutes vary by state and may not

treatment.

cover every counseling relationship.

The limits of confidentiality must be explained during informed consent, at the outset of treatment.

Situation	CounselorResponse
Dangertoself	Assesssuicideriskandacttoensuresafety:hospitalization safetyplanning increasedmonitoring , , ,
	orinvolvingfamilymemberswiththeclient'sconsent
Dangertoothers	Dutytowarnanddutytoprotectwhenaclientposesimminentdangertoanidentifiablethird
	party TheTarasoffcaseestablishedthatmentalhealthprofessionalsmustacttoprotectpotential .
	victims;dependingonstatelaw thismaymeanwarningthevictim notifyinglawenforcement or , , ,
	otherprotectiveaction .
Childorelderabuse	Reportasamandatedreporterunderstatelaw
Courtorders	Discloseonlywhatthecourtorders afterconsultinglegalcounsel ,
Supervisionandconsultation	Shareinformationneededforsupervision asdisclosedtotheclientinadvance ,

HIPAA (Health Insurance Portability and Accountability Act) sets federal standards for protecting health information. Counselors must safeguard electronic and paper records, obtain authorization for most disclosures, and give clients a notice of privacy practices explaining their rights.

Record keeping serves clinical, legal, and ethical purposes. Records document assessment, treatment planning, interventions, progress, and significant communications; they must be kept secure, retained for the required period, and disposed of appropriately.

Informed consent is the process through which clients receive the information they need to make knowledgeable decisions about treatment. Valid consent requires four conditions:

➜

➜

➜

relevant information

client understands

free agreement

capacity to consent

Elements of informed consent include the nature and purpose of counseling, the techniques and procedures to be used, potential risks and benefits, alternatives to treatment, limits of confidentiality, fees and billing practices, cancellation policies, and emergency procedures. Use language clients can understand, avoid jargon, and supplement written forms with verbal discussion and an opportunity for questions.

Special considerations apply to minors, individuals with cognitive impairments, and court-mandated clients. Parents or guardians typically consent for minors, though mature minors may consent independently to certain services; obtain the minor's assent when appropriate. Informed consent is an ongoing process: revisit it when treatment approaches change, new risks emerge, or circumstances warrant.

Boundaries define the limits of the professional relationship. Clear boundaries protect clients from exploitation, maintain objectivity, and preserve the therapeutic relationship. Dual (multiple) relationships occur when a counselor has another significant relationship with a client, such as a business, social, familial, or romantic relationship. Some are unavoidable, particularly in rural communities or specialized settings.

Not all dual relationships are unethical. Evaluate potential harm, power differentials, and the impact on therapy; when a dual relationship is unavoidable, document the rationale, consult with colleagues, and put safeguards in place.

Boundary Crossing

Boundary Violation

A departure from standard practice that may or may not be

A harmful departure that exploits the client or compromises

harmful and can sometimes benefit the client: accepting a small

treatment. Violations are always unethical.

gift, attending a client's graduation, or limited self-disclosure.

Sexual or romantic relationships with current clients are never ethical. The ACA Code of Ethics also prohibits sexual or romantic relationships with former clients for five years after the last professional contact (the same rule covers clients' romantic partners and family members). After five years, the counselor must still demonstrate, and document, that the relationship is not exploitive.