CCPA Standards of Practice 6th Edition PDF

Standards of Practice Sixth Edition Standards of Practice 6th Edition ISBN 9780969796688 9 780969 796688 Standards of Practice i Canadian Coun...

Standards of Practice Sixth Edition Standards of Practice 6th Edition ISBN 9780969796688 9 780969 796688 Standards of Practice i Canadian Counselling and Psychotherapy Association ___________________________________________ Standards of Practice 6th Edition ___________________________________________ Approved by CCPA Board of Directors April 2021 ii Standards of Practice Copyright © 2021 by the Canadian Counselling and Psychotherapy Association All rights reserved. Canadian Counselling and Psychotherapy Association 202-245 Menten Place Ottawa, ON K2H 9E8 ISBN 978-0-9697966-8-8 Printed in Canada Standards of Practice iii Canadian Counselling and Psychotherapy Association ___________________________________________ Standards of Practice ___________________________________________ The Standards of Practice (2021) was revised from the 2015 edition and updated by a CCPA Committee consisting of: Lorna Martin – Chair Glenn Sheppard – Ethics Amicus Jean Blackler Tina Nash Louise Blanchard Simon Nuttgens Jonas Breuhan Kathy Offet-Gartner Corrine Hendricken-Eldershaw This document and its companion Code of Ethics would not be possible without the collabora- tion, consultation, and review processes undertaken by the National Board of the Canadian Counselling and Psychotherapy Association and a diverse group of independent volunteer peer reviewers from across Canada. Of particular importance has been the nuanced reviews graciously provided by Indigenous practitioners, Elders, Knowledge Keepers, scholars, authors, and researchers throughout the development process. Standards of Practice v Table of Contents Preamble.......................................................ix Relationships with Former Clients.......................30 Sexual Contact with Clients................................30 A. Professional Responsibility........................ 1 Multiple Clients: Couple, Family, and General Responsibility...........................................1 Group Counselling/Therapy.................................32 Respect for Rights................................................2 Multiple Helpers..................................................33 Boundaries of Competence...................................3 Group Work.........................................................33 Professional Impairment.......................................4 Referral...............................................................34 Clinical Supervision and Consultation...................4 Closure of Counselling/Therapy...........................34 Representation of Professional Qualifications.......5 Mandated Clients and Systems Approaches.......35 Professionalism in Advertising...............................6 Responsibility to Counsellors/Therapists and C. Assessment and Evaluation..................... 36 Other Professionals...............................................8 General Orientation.............................................36 Responsibility to Address Concerns About Informed Consent for Assessment and the Ethical Conduct of Another Professional.........8 Evaluation...........................................................36 Supporting Clients When Ethical Assessment and Evaluation Competence............37 Concerns Arise.....................................................10 Administrative and Supervisory Conditions.........38 Third Party Reporting...........................................10 Use of Technology in Assessment Sexual Harassment..............................................11 and Evaluation....................................................39 Diversity Responsiveness.....................................11 Appropriateness of Assessment Extension of Ethical Responsibilities...................11 and Evaluation....................................................40 Professional Will and Client File Directive............12 Sensitivity to Diversity When Assessing and Evaluating....................................................41 B. Counselling Relationships........................ 14 Reporting Assessment and Evaluation Results....42 Primary Responsibility.........................................14 Reporting Assessment and Evaluation Results to Third Parties........................................42 Confidentiality.....................................................14 Integrity of Instruments and Procedures..............43 Children and Confidentiality..........................16 Researcher Responsibility...................................45 Duty to Warn.......................................................17 Client’s Rights and Informed Consent.................18 D. Professional Research and Knowledge Touch in Counselling/Therapy..............................19 Translation............................................... 45 Children and Persons with Diminished Capacity.20 Participant Welfare..............................................47 Maintenance of Records......................................22 Informed Consent and Recruitment of Research Participants.........................................48 Access to Records...............................................25 Voluntary Participation........................................48 Multiple Relationships3........................................26 Research and Counsellor/Therapist Education....49 Respecting Inclusivity, Diversity, Difference, and Intersectionality...................................................28 Research Participant Right to Confidentiality.....50 Consulting with Other Professionals...................29 vi Standards of Practice Use of Confidential Information for G. Counsellor/Therapist Education Didactic or Other Purposes..................................50 and Training............................................. 76 Research Data Retention.....................................51 General Responsibility.........................................76 Further Research.................................................52 Boundaries of Competence.................................77 Research Sponsors.............................................52 Ethical Orientation.............................................77 Review of Scholarly Submissions........................52 Clarification of Roles and Responsibilities...........78 Reporting Research Results.................................53 Program Orientation............................................79 Acknowledging Research Contributions..............53 Relational Boundaries.........................................80 Submission for Publication..................................54 Confidentiality.....................................................80 Self-Development and Self-Awareness................81 E. Clinical Supervision Services................... 55 Dealing with Personal Issues...............................81 General Responsibility........................................55 Self-Growth Activities..........................................81 Informed Consent and Confidentiality.................58 Sexual Contact with Students and Trainees.........82 Boundaries of Competence.................................59 Sexual Intimidation or Harassment.....................83 Ethical Commitment...........................................60 Scholarship..........................................................83 Clarification of Roles and Responsibilities...........60 Establishing Parameters of Welfare of Clients and Protection of the Public...62 Counselling/Therapy Practice..............................84 Gatekeeping...................................................62 Clinical Supervision Orientation.........................63 H. Use of Electronic and Other Technologies............................................ 85 Fees....................................................................64 Technology-Based Administrative Functions........85 Relational Boundaries.........................................64 Permission for Technology Use............................85 Due Process and Remediation.............................66 Purpose of Technology Use..................................86 Self-Development and Self-Awareness................67 Technology-Based Service Delivery......................86 Self-Care..............................................................68 Technology-Based Counselling/Therapy Diversity Responsiveness....................................69 Education............................................................87 Personal Use of Technology.................................88 F. Consultation Services............................... 70 Jurisdictional Issues.............................................88 General Responsibility.........................................70 Undiminished Responsibility and Liability..........71 I. Indigenous Peoples, Communities, Consultative Relationships..................................72 and Contexts............................................ 90 Fees and Billing Arrangements.......................72 Awareness of Historical and Contemporary Contexts......................................90 Informed Consent..........................................73 Reflection on Self and Personal Respect for Privacy.........................................73 Cultural Identities................................................91 Recordkeeping for Consultation Services.......74 Recognition of Indigenous Diversity...................92 Conflict of Interest...............................................74 Respectful Awareness of Traditional Practices.....92 Sponsorship and Recruitment..............................75 Respectful Participation in Traditional Practices.... 93 Standards of Practice vii Strengths-Based Community Development.........94 K. Obtaining Ongoing Informed Consent... 101 Relevant Cross-Cultural Practice.........................95 L. Guidelines for Dealing with Relationships.......................................................96 Subpoenas and Court Orders.................. 103 Culturally and Ethically Reciprocal Relationships.......................................................96 M. Guidelines for the Conduct of Custody Evaluations............................. 105 Appropriate Use of Traditional Knowledge and Cultural Teachings........................................97 References.................................................. 106 Honouring Client Autonomy................................98 General References......................................106 Section References............................................107 J. P  ractice Standards as the Beginning of a Journey with Indigenous Peoples Glossary of Terms....................................... 114 and Communities...................................... 99 Standards of Practice ix Preamble These practice standards were developed by the Canadian Counselling and Psychotherapy Association to provide direction and guidelines to enable its members, and other counsellors and psychotherapists in Canada1, and counsellors/therapists-in-training, to conduct themselves in a professional manner consistent with the CCPA Code of Ethics. They are also intended to serve the following purposes: support statutory and professional self-regulation by establishing a shared set of expectations related to the many areas of counselling/therapy-related activities and responsibilities; protect the public by establishing a set of expectations for quality counselling/therapy services and for the maintenance of counsellor/therapist accountability; establish a set of expectations for ethically competent professional behaviour which counsellors/therapists may use to monitor, evaluate, and work to improve their profes- sional practices; serve as the foundation for addressing professional queries and ethics-related complaints; and, establish expectations for counsellor/therapist education, supervision, and to provide support for ongoing professional development. It is important to note that these practice standards are directly aligned to but distinct from the CCPA Code of Ethics. They contain a set of broad professional values and principles from which counsellors/therapists make professional judgments and decisions. The CCPA Standards of Practice provide action-based guidelines. Counsellors/therapists are expected to adhere to both the CCPA Code of Ethics and CCPA Standards of Practice. These practice standards are directed primarily at the professional conduct of counsellors/ therapists. However, they extend to the personal actions of counsellors/therapists when their behaviour undermines society’s trust and confidence in the integrity of the profession and when there is reasonable doubt about the ability of a counsellor/therapist to act in a profession- ally competent and ethical manner. The standards of practice provisions in this document are more fully understood and their nuanced application to various areas of professional practice better appreciated when used in combination with each other and with the CCPA Code of Ethics. Multiple new lenses are required to make full, contextualized use of the 2021 CCPA Standards of Practice. One over- arching lens that has recently emerged is the expanded use of electronic and other technology for the delivery of counselling/therapy, supervision, and consultation, which poses unique risks and opportunities throughout the full range of professional practices. Other overarching lenses are those of social justice, self-reflection, and diversity. The importance of the Calls to Action by the Truth and Reconciliation Commission (2015) has been acknowledged and these 2021 practice standards begin the process of addressing these calls as well as those of the United 1 Throughout this publication, the term counsellor/therapist shall refer to various titles used by practitioners involved in the activity of counselling including, but not restricted to, the terms psychotherapist, counselling therapist, mental health therapist, clinical counsellor, career counsellor, conseiller/conseillère d’orientation, vocational guidance counsellor, marriage and family therapist, orienteur, orienteur professionnel, and psychoéducateur. x Standards of Practice Nations Declaration of Rights of Indigenous Peoples (UNDRIP, 2007). Approaching all clients with humility and from a place of not-knowing is a core value reflected in these standards. Counsellors /therapists are encouraged to familiarize themselves with the TRC’s reports, the Calls to Action, and the UN Declaration. Throughout Standards of Practice, there are textboxes containing informational highlights inserted to succinctly capture some core ethical concept, an ethical principle or concept from case law, and to add authentic voices to enrich meaning. These insertions are intended to reflect some of the richness and diversity of the historical and contemporary strivings that constitute the ethical and legal grounding for our professional code of conduct. All of the practice standards are pinned to the generic entry-to-practice level as determined by the nationally validated competency profile for the counselling/therapy profession in Canada. Because the practice standards are generic in nature, they do not anticipate every practice situa- tion, modality of practice, or address all ethical challenges with which counsellors/therapists are confronted. Therefore, the development of standards will necessarily remain an ongoing respon- sibility to which all counsellors/therapists can contribute. Despite the value of these practice standards, the ultimate responsibility for acting ethically depends on the integrity and commit- ment of each counsellor/therapist to do so. Standards of Practice 1 A. Professional Responsibility CODE OF ETHICS STANDARDS OF PRACTICE A1 General Responsibility General Counsellors/therapists maintain high standards of professional Responsibility competence by attending to their personal well-being, partici- pating in continuing professional education and development, and Counsellors/therapists maintain high standards of professional supporting the development and delivery of continuing education competence and ethical behaviour within the counselling/therapy profession. and recognize the need for Counsellors/therapists invest time and effort in understanding continuing education and the CCPA Code of Ethics and Standards of Practice. They personal care in order to meet this responsibility. (See also C1, E1, avoid practice contexts and circumstances in which they would E11, F1, G2, Section I) knowingly have to violate these ethical requirements. If, however, counsellors/therapists discover a conflict between existing or emerging organizational policies and their ethical obligations, they commit to educating others in the setting about the ethical dilemma and work to achieve alignment between the policies and ethically congruent practice. Counsellors/therapists should become familiar with the Canadian Charter of Rights and Freedoms and, as relevant to their professional setting and services provided, review the following federal and provincial/territorial legislation: mental health acts child protection acts public schools/education administration acts privacy acts criminal codes marriage, divorce and matrimonial property acts criminal youth justice act freedom of information acts mediation acts professional statutory regulations Counsellors/therapists provide fair, equitable, and timely services, using only those therapies that are legal, ethical, helpful, evidence- informed and within their scope of practice and boundaries of competence. 2 Standards of Practice A2 Respect for Rights Respect for Rights Counsellors/therapists understand and respect the rights and freedoms of those with whom they work and others, particu- Counsellors/therapists participate in only those practices that are larly those who may be disenfranchised or negatively affected by respectful of the legal, civic, moral, political, personal, social, economic, or familial histories that may and human rights of themselves continue to resonate across the lifespan. These circumstances may and others, and act to safeguard include, but are not restricted to, colonization, poverty, oppression, the dignity and rights of their violence, structural injustice, systemic racism, war, or discrimina- clients, students, supervisees, and tory practices. research participants. (See also Counsellors/therapists convey respect for human dignity, principles D1, D9, E1, Section I) of equity, and social justice. They speak out or take other appropriate actions against practices, policies, laws, and regulations that directly or indirectly bring harm to others or violate their human rights. Counsellors/therapists refrain from providing professional infor- mation to individuals who have expressed an intention to use it to violate the human rights of others. This standard of practice may NOT be interpreted or used to justify or defend any human rights violation. Counsellors/therapists practice in a manner congruent with the overarching principles of the Universal Declaration of Human Rights, the UN Convention on the Rights of the Child and the UN Declaration on the Rights of Indigenous Peoples to which Canada is a signatory. Counsellors/therapists respect due process and demonstrate commitment to the principles of social justice by honouring diversity, upholding human rights, fostering inclusivity, working to establish equity, and seeking to ensure access to resources for all. They espouse social justice perspectives and practices in all of their paid and volunteer professional activities, including counselling/therapy, assessment and evaluation, clinical supervi- sion, consultation, counsellor/therapist education, research, and professional writing, adjudication, and review. Fiduciary Relationship A fiduciary relationship is one founded on trust or confidence relied on by one person in the integrity and fidelity of another. A fiduciary has a duty to act primarily for the client’s benefit in matters connected with the undertaking and not for their own personal interest. Black’s Law Dictionary (2004) Standards of Practice 3 A3 Boundaries of Competence Boundaries of Counsellors/therapists restrict their counselling/therapy services Competence to those areas within the boundaries of their competence by Counsellors/therapists limit their virtue of verifiable education, training, supervised experi- counselling/therapy services and ence, and other appropriate professional experience. They also practices to those which are within restrict their services based on their role and function, their legal their professional competence authority, and their jurisdiction of employment. by virtue of their education and professional experience, and Counsellors/therapists who wish to extend their professional consistent with any requirements services ensure competence in any additional areas of expertise for provincial/territorial and through extra verifiable education or training in these areas and national credentials. They seek provide service only after they have secured adequate super- supervision, consult with and/or vision from supervisors with demonstrative expertise in the refer to other professionals when practice area. Supervisors should have a high level of expertise the counselling needs of clients in the area that is certified by an independent process such as: exceed their level of competence. (See also C3, C4, D1, E4, E6, F1, F2, certification, registration, licensing, or similar independent G2, G14, H4, Section I) process that is overseen by an Elder or knowledge keeper recognized by community when the expertise is related to Indigenous competencies. When counsellors/therapists are faced with clients whose needs exceed the counsellors/therapists’ boundaries of competence, they make appropriate referrals for their clients. Counsellors/ therapists provide appropriate contact and support for their clients during any transitional period associated with referring them to other sources of professional help. When counsellors/therapists find themselves in circumstances in which access to referral agents and resources is limited, they seek consultation. For instance, rural and remote practice tends to be broader, more generalist, and more eclectic than is the case for practitioners in more densely populated areas. This is because of the wide range of client issues that must be addressed by limited resources. Counsellors/therapists living and working in rural and remote communities need to remain cognizant of the limits to their competence while working in communities that have few, if any, referral possibilities, including communities such as those that are closed, enclaved, isolated, rural, northern, or remote. Taking advantage of electronic means of consultation, referral, continuous learning, and supervision, where available, is recommended. Since consultation with the other professional or community recognized Elders is often necessary to provide the best services for clients, all contributing helping professionals may agree, with the explicit informed consent of clients, to collaborate with each other. 4 Standards of Practice Standard of Care Counsellors/therapists provide their professional services to a level consistent with the degree of skill, knowledge, and ethics ordinarily possessed and provided by the average prudent reputable member of the profession in similar circumstances in the community. (Adapted from Lanphier v. Phipos, 1833) Professional Impairment Counsellors/therapists should take steps to appropriately limit their professional responsibilities when their physical, mental, spiritual, or personal circumstances are such that they have diminished capacity to provide competent services to all or to particular clients. Counsellors/therapists in such situa- tions must seek consultation and supervision and may need to limit, suspend, or terminate their professional services. Since impairment may affect the capacity of counsellors/therapists for personal insight and self-regulation, colleagues and others may find it necessary to contact appropriate personnel and/or a regulatory body. A4 Clinical Supervision and Consultation Supervision and All counsellors/therapists should obtain supervision and/or Consultation consultation for their counselling/therapy practices. This is particularly true with respect to doubts or uncertainties, which Counsellors/therapists seek supervision and consultation may arise during their professional work. across the career span to support In school settings, counsellors/therapists should arrange regular, and enrich their ongoing profes- qualified supervision and/or consultation with other counsellors/ sional development. Supervision therapists in their school or in their school district or region wher- and consultation are warranted especially when counsellors/ ever possible, and make arrangements for supervision elsewhere if therapists are confronted with not locally available. Counsellors/therapists in other agencies/insti- dilemmas or uncertainties, and tutions and/or in private practice should organize their supervi- when they are developing a sion with other qualified professionals who have documented and new practice area or updating demonstrated expertise in relevant areas of practice (e.g., setting, knowledge and skills related to a clientele, referral issues, approaches employed). former area of practice. (See also B10, C4, C7, Section E, Section F, Counsellors/therapists have an obligation to be appropriately I5, I9, I10) accountable to their employers for their professional work. Supervision of counsellors/therapists should be conducted by someone other than a person who is responsible for evaluating their work (such as a person in a line management position). If such a situation cannot be avoided, then the counsellor/therapist should also have access to independent opportunities for supervi- sion and/or consultation. Standards of Practice 5 School counsellors often face challenges in the area of clinical supervision, particularly when they are the only school counsellor in the school building and do not have the opportunity to be supervised by other counsellors/therapists in their school district or region. This challenge is also true of many counsellor/therapists in private practice and in many other areas. Online supervision may offer an effective strategy for addressing these challenges. When counsellors/therapists seek professional consultation, they make every effort to do so in ways that will protect the identity of the client. If the client’s identity cannot be protected, then the client’s informed consent must be sought before the consulta- tion. When consulting, counsellors/therapists make every effort to ensure that the identity of the client will not create any dual relationship dilemmas for the person with whom they consult. Administrative assistants, supervisors, and all others who work with counsellors/therapists’ confidential records have a respon- sibility similar to that of the counsellors/therapists with respect to confidentiality. Counsellors/therapists must take all necessary steps to guarantee that client confidentiality is respected and maintained by others with whom they work and consult. A5 Representation of Professional Qualifications Representation of Counsellors/therapists should display their CCC certificate and/ Professional or any professional regulatory certificate in a prominent location Qualifications at their work site and place their Code of Ethics in the waiting Counsellors/therapists claim or room at their work site or display it in any other manner that imply only those professional would allow it to be readily seen by consumers of their profes- qualifications that they possess sional services. For Indigenous persons and other persons for and are responsible for correcting whom humility may inhibit such actions, it would be appropriate any known misrepresentation to have the credentials available upon request, have a visible of their qualifications by others. recognition that CCC regulations are followed, and have the Counsellors/therapists working in a province or territory with Code of Ethics document on display. professional statutory regulation Counsellors/therapists shall not use CCPA membership and/ ensure they adhere to the specific or any other professional membership as a designation on representation of professional business cards, door plates, in advertisements, directories, nor qualifications requirements that have been mandated by statute use it in any other way intended to advertise their professional and/or Regulatory College bylaw. service unless it is clearly stipulated that the member possesses (See also H7, I5) a Canadian Certified Counsellor (CCC) designation. This distinction is required because membership admission does not evaluate a member’s qualifications to practice counselling/ therapy, whereas the certification process does. Where provincial certification/licensure exists, counsellors/therapists may also use these designations to advertise their professional service, and 6 Standards of Practice only in accordance with the statutory regulations pertaining to the use of professional designations. When counsellors/therapists are involved in public activities, including the making of public statements, they do so in such a way that clarifies whether they are acting as private citizens, as designated spokespersons of a particular professional body, or as representatives of the counselling/therapy profession. Counsellors/therapists shall not misrepresent nor falsely enhance their professional qualifications, experience, or performance. When counsellors/therapists become aware of misuse or misrep- resentation of their work, they take reasonable steps to correct or minimize the misuse or misrepresentation. Counsellors/therapists avoid making public statements that are false, deceptive, or misleading. For example, it would be inap- propriate for graduates from a counselling/therapy specialty program housed in an educational psychology department to create and use a title such as “counselling psychologist” to refer to themselves. Associations and regulatory colleges have protected titles that must only be used by individuals with permission to use those titles. Counsellors/therapists also avoid other state- ments that could easily be misunderstood by virtue of what they say about their professional qualifications and services or by what they neglect to say about them. Counsellors/therapists use the title “Doctor” or reference having a doctoral degree with respect to their professional qualifica- tions only when their degree is in counselling/psychotherapy or some reasonably related field of study. Counsellors/therapists are responsible for identifying and adhering to any jurisdictional restrictions to using the title of Doctor. A6 Professionalism in Advertising Professionalism in Advertising and public statements by counsellors/ Advertising therapists should reflect honesty and accuracy. Counsellors/ Counsellors/therapists when therapists do not make deceptive statements regarding their advertising and representing academic degrees; themselves publicly, do so in training; a manner that accurately and clearly informs the public of their experience; services and areas of expertise. certification, licensure, registration; Counsellors/therapists belonging to a statutory regulatory college specialty credentials; additionally adhere to the specific awards; advertisement requirements professional memberships; as mandated by statute and/or regulatory college bylaw. university or college affiliations; Standards of Practice 7 competencies; areas of expertise; professional services offered; fees; effectiveness of services provided; additional service to the profession; publications; research; and, additional professional accomplishments. Counsellors/therapists ensure that the content of their adver- tising is accurate, ethical, professional, and based on current research and scholarship and sound counselling/therapy practices. Counsellors/therapists do not use testimonials by clients, former clients, or by relatives or friends of clients. Testimonials may be acceptable from an organization or business that receives the counsellors/therapists’ services. Professional representation and advertising (including business cards, door plates, building directories, exterior signs, etc.) must be in good taste and professional in style and tone. Counsellors/ therapists strive for straightforward advertising, without the use of clichés or jargon. They describe their professional services in an unembellished manner without reference to, or claims of, particular outcomes. Counsellors/therapists may participate in advertisements of publications for which they are authors, editors, or reviewers. Counsellors/therapists do not participate in advertisements that, explicitly or implicitly, suggest or convey that they endorse particular commercial brands or products associated with the provision of counselling/therapy services. Except for advertising their own professional services, counsel- lors/therapists do not permit their name to be associated with other advertising in such a way that implies that the counsellor’s/ therapist’s professional expertise or professional status is relevant to the service or product advertised. Counsellors/therapists do not communicate with, or encourage others to contact on their behalf, individuals, or families in an effort to solicit them as clients. However, they may contact for such purposes a representative or agent of potential clients, such as an employee assistance service, insurance companies, workers’ compensation agencies, and so forth. 8 Standards of Practice A7 Responsibility to Counsellors/Therapists and Other Responsibility to Professionals Counsellors/Therapists When the work of counsellors/therapists shares a boundary, and Other Professionals coincides or overlaps with the work of other professionals it Counsellors/therapists demon- is essential to offer respectful, timely, ethical, and appropriate strate ethical conduct, integrity, communication in the best interest of clients and the profes- and professionalism in interac- sions. This is also true when colleagues of diverse professions tions with counsellor/therapist present or publish discipline-specific information together in colleagues and with members of academic settings or when they work together in a variety of situ- other professional disciplines. ations such as in multi-disciplinary institutions, when delivering (See also Section I) team-approach services, and when serving on consultation teams, among others. Counsellors/therapists are expected to demonstrate ethical conduct, integrity and professionalism in all interactions, whether formal or informal. Counsellors/therapists promote accurate, honest, and contextual- ized information related to the efficacy of various professional disciplines. They educate themselves on the distinctions between allied mental health professions. A8 Responsibility to Address Concerns About the Ethical Responsibility to Address Conduct of Another Professional Concerns About the When counsellors/therapists have reasonable grounds to believe Ethical Conduct of that another counsellor/therapist is acting unethically, they have Another Professional an obligation to take appropriate action. The course of action Counsellors/therapists have an is dependent upon a variety of factors, including whether or obligation when they have serious not the counsellor/therapist whose behaviour is in question is a doubts as to the ethical behaviour CCPA member. First, if it is safe and appropriate to do so, they of another helping professional, should approach the counsellor/therapist in an effort to address whether that individual is a CCPA the concern. To determine whether a direct approach is safe and member or a member of another appropriate, refer to the Code of Ethics decision-making models. professional body, to respectfully address the concern and seek Some other specific, contextual reflections may be helpful, such as: an informal resolution with the Does this person hold a position of authority over me? counsellor/therapist, when feasible Does there appear to be a likelihood of aggression? and appropriate. When an informal Sabotage? resolution is not appropriate, legal or feasible, or is unsuccessful, Will confrontation negatively affect the workplace counsellors/therapists report their environment? concerns to the relevant profes- Will I be putting myself or another person at risk of sional body. Counsellors/therapists repercussions? consider whether there are any legally mandatory reporting Is there a significant risk of harm to self or others? obligations regarding the conduct Is there a safer, more effective strategy to address the of the helping professional to take conduct? appropriate action. (See also E4, E5) Standards of Practice 9 The following guidelines are suggested to assist counsellors/ therapists when they have such concerns: When counsellors/therapists hear allegations from others about the possible unethical conduct of another counsellor/therapist, they make every effort to encourage the complainant to take appropriate action with respect to their concern, and they avoid participating in the spread of unsubstantiated information. In the case of disclosures about non-CCPA members or members who belong to more than one association or regulatory body, counsellors/therapists inform the complainant of their rights to file a complaint with that professional’s association(s) or regulatory college(s). When counsellors/therapists are informed by clients of the possible unethical conduct of another counsellor/therapist, they assist the client in fully evaluating their concern and with their decision of whether or not to take action. In the case of disclosures about non-CCPA members, counsellors/ therapists inform the client of their rights to file a complaint with that professional’s association and/or regulatory college. In the case of unethical conduct by another counsellor/therapist who is a member of CCPA, such action may include contacting the CCPA Ethics Committee – Complaints Division Counsellors/therapists report their own concerns about the unethical conduct of another counsellor/therapist who is a member of CCPA directly to the CCPA Ethics Committee – Complaints Division when they have directly observed the misconduct and they fail to achieve a satisfactory resolution of the issue with the counsellor/therapist concerned, or because the nature of the suspected violation warrants this direct action. When doing so, they take into account the limits of jurisdictional law and confidentiality of client information. Suspected statutory violations, such as child abuse, must be reported both to the local authorities and to the CCPA Ethics Committee–Complaints Division. Because of the differences in provincial and territorial laws, counsel- lors/therapists need to be aware of which local authority is most appropriate in their area. When counsellors/therapists have direct knowledge that another counsellor/therapist has committed a serious ethical violation, they must report it and be prepared to participate in an ethics hearing, if asked to do so. The CCPA Ethics Committee–Complaints Division acts only on written, signed complaints made against counsellors/thera- pists who are CCPA members. Any individual with reasonable grounds to suspect that a CCPA member has committed an 10 Standards of Practice ethical violation may submit such a complaint. If the Ethics Committee–Complaints Division deems it appropriate to proceed with an investigation, the CCPA member who is the subject of the complaint will be informed of the nature of the details of the complaint and the identity of the individual who has submitted the complaint. A9 Supporting Clients When Ethical Concerns Arise Supporting Clients When Counsellors/therapists act in the best interests of their clients Ethical Concerns Arise and when they have reasonable grounds to believe their client has an ethical complaint about the conduct of a CCPA member, When counsellors/therapists have reasonable grounds to believe that they provide the client with a copy of the CCPA Procedures for a client has an ethical concern or Processing Inquiries and Complaints of an Ethical Nature or complaint about the conduct of a direct them to the appropriate page on the CCPA website. CCPA member (including oneself) Clients will have varying degrees of understanding of their role or members of another profes- in the ethical complaints procedure. Counsellors/therapists sional body, counsellors/therapists inform the client of their rights and should answer any questions clients might have and explain the options with respect to addressing procedures and the processes involved for clients so that they the concerns. When the concern clearly understand. Counsellors/therapists take into considera- regards a CCPA member, the tion that clients may be particularly vulnerable at this time. Care counsellor/therapist informs the must be taken to support the actions of the client without influ- client of the CCPA Procedures for encing the complaint process. Processing Complaints of Ethical Violations and how to access these Clients should be informed that a CCPA member may break procedures. confidentiality to defend themselves to the Ethics Committee– Complaints Division. Where appropriate, counsellors/therapists can support clients through the complaints process. Counsellors/ therapists are advised to consider consultation and supervision. A10 Third Party Reporting Third Party Reporting When counsellors/therapists are requested by a third party to When counsellors/therapists are provide a service to an individual, organization, or other entity, required or expected to share they undertake at the outset to clarify the following: counselling/therapy information nature of the role being undertaken (e.g., assessor, expert with third parties, they ensure witness, therapist, etc); that details are discussed and documented with clients as part of clarification of details related to each respective role and its the initial and ongoing informed responsibility; consent, including the nature of professional relationship with each party; information to be shared, with possible uses of information acquired; and, whom it will be shared, and when. Counsellors/therapists determine any limits to confidentiality. whether a formal, signed consent Further, the counsellor/therapist ensures that during any and all for release of information form activities related to informed consent, that there is full transpar- is warranted. (See also B18, C8, ency with the client related to the role with the third party and D5, E2) any risks/opportunities that result from accepting or rejecting counsellor/therapist services. Standards of Practice 11 A11 Sexual Harassment Sexual Harassment Counsellors/therapists do not condone or engage in sexual Counsellors/therapists do not harassment. Sexual harassment includes unwelcome sexual condone or engage in sexual advances, sexual solicitation, unnecessary touching or patting, harassment in the workplace, with compromising invitations, the unwelcome telling of sexually colleagues, students, supervisees, explicit jokes, the display of sexually explicit materials, sugges- clients, or others. These encounters tive sexual comments and other verbal and physical behaviour may be verbal, pictorial, written directed towards a person by an individual who knows or ought comments (including but not reasonably to know that such behaviour is unwanted, offensive, or exclusive of texting, messaging, taking photos, making posts and contributes to an unpleasant or hostile working environment. comments on websites, Twitter, Counsellors/therapists are expected to conduct themselves or other platforms), gestures, according to a high standard of ethical behaviour that prohibits unwanted sexual images, or actions such as sexual harassment. When counsellors/therapists physical contacts of a sexual are aware of sexual harassment, they act on their responsi- nature. (See also G11, G12) bility to address concerns about the ethical conduct of another professional. A12 Diversity Responsiveness Diversity Counsellors/therapists should grow in their understanding of Responsiveness diversity within Canada’s pluralistic society. This counselling/ therapy competency must receive attention in counsellor/thera- Counsellors/therapists continually pist education programs and be part of continuing education seek to enhance their diversity awareness, sensitivity, responsive- experiences. Such understanding must be based on knowledge ness, and competence with respect of diversity and of the ways in which differences based on ways to their own self-identities and in which ethnicity, language, gender identification, sexual/affec- those of their clients. They are tional orientation, religion, and so forth, can affect attitudes, attuned to various effects related values and behaviour. to diversity and how they may influence interactions with clients. It is incumbent on counsellors/therapists to continually work (See also B9, C10, D9, E7, E12, to recognize, understand, and respect the diversity within the Section I) communities in which they work and in which their clients reside. They address diversity by taking action against unequal power relationships and work with clients to locate supports and A13 resources to enable clients to advocate for themselves and others. Extension of Ethical Responsibilities Extension of Ethical Responsibilities Counselling/therapy services and When counsellors/therapists are employed by or contracted to products provided by counsellors/ provide services through a third party, they take proactive steps therapists through classroom to address any ethical or practice-based requirements of the instruction, public lectures, third party that have the potential to conflict with CCPA’s Code demonstrations, publications, radio of Ethics and Standards of Practice. When confronted with and television broadcasts, computer demands from an organization with which they are affiliated or technology, and other media from an employer that are in conflict with the CCPA Code of must meet the appropriate ethical standards consistent with this Code Ethics, they take steps to clarify the nature of the conflict, assert of Ethics. (See also I5, I10) their commitment to the Code and, to the extent possible, work 12 Standards of Practice to resolve the conflict in a manner that will allow adherence to their Code of Ethics (See also C2). Counsellors/therapists cooperate in ethics investigations of complaints made against them and with the appropriate related proceedings. Failure to cooperate may be considered in itself an ethical violation. However, mounting an appropriate defense against an ethical complaint and taking full advantage of the opportunities afforded in an adjudication process to do so, does not constitute non-cooperation. Malpractice is a legal, rather than an ethical term. A malpractice claim must meet the following conditions: Fiduciary relationship established (client-counsellor or client-counsellor-supervisor) Counsellor or supervisor conduct does not meet standard of care (breach of standard = negligence) Client or supervisee suffers demonstrable harm or injury Causal relationship confirmed (proximate cause) DUTY BREACH  DAMAGE CAUSATION (Truscott & Crook, 2004) A14 Professional Will and Client File Directive Professional Will and A professional will contains the name of the will executor, prefer- Client File Directive ably a trusted colleague, and all the necessary coordinators so Counsellors/therapists undertake that they can be contacted when necessary. to establish a formal stand-alone The professional will and client file directive should also include agreement with a qualified practi- information about the following: tioner to serve as executor whose professional liability certificate and the names of any sole responsibility will be to fulfil co-workers who should be notified; any ethical obligations including the management of client records clear instructions for location of critical information should their practice end due to including: death, or incapacitation such that Work schedule and daily planner; they are unable to do so. Instructions for access to client records; Instructions for access to supervisor files (for counsellors/therapists who undertake supervision duties); Instructions regarding announcement of change in circumstances via voice mail, newspaper, website, social media, answering machine, and regulatory college; and, Standards of Practice 13 codes and passwords for accessing e-mail and server accounts and information about pending billing and expenses. Counsellors/therapists may choose to include the name of their professional will executor with appropriate disclosure as part of their informed consent. 14 Standards of Practice B. Counselling Relationships CODE OF ETHICS STANDARDS OF PRACTICE B1 Primary Responsibility Primary Responsibility The fact that this ethical article is first in this “counselling rela- Counsellors/therapists respect tionships” section underscores the need for counsellors/thera- the integrity and promote the pists to be mindful of their primarily obligation to help clients. welfare of their clients. They work Counsellors/therapists enter into a collaborative dialogue with collaboratively with clients to their clients to ensure understanding of counselling/therapy devise counselling/therapy plans plans intended to address goals that are part of their thera- consistent with the needs, abilities, peutic alliance. Counsellors/therapists inform their clients of circumstances, values, cultural, or the purpose and the nature of any counselling/therapy, evalu- contextual background of clients. (See also C1, D2, E1, E4, Section I) ation, training or education service so that clients can exercise informed choice with respect to participation. Counselling/therapy plans and progress are reviewed with clients to determine their continued appropriateness and efficacy. The counsellors/therapists’ primary responsibility incorporates most aspects of CCPA’s six ethical principles: Beneficence Nonmaleficence Fidelity Justice Autonomy Societal Interest B2 Confidentiality Confidentiality Counsellors/therapists have a fundamental ethical responsibility Counselling/therapeutic relation- to take every reasonable precaution to respect and to safeguard ships and information resulting their clients’ right to confidentiality, and to protect from inappro- therefrom are kept confidential. priate disclosure, any information generated within the coun- However, there are the following selling/therapy relationship. This responsibility begins during exceptions to confidentiality: (i) the initial informed consent process before commencing work when disclosure is required to with the client, continues after a client’s death, and extends to prevent clear and imminent danger disclosing whether or not a particular individual is in fact a client. to the client or others; (ii) when levels of jurisprudence demand This general requirement for counsellors/therapists to keep all that confidential material be information confidential is not absolute since disclosure may be revealed; (iii) when a child is in required in any of the following circumstances: need of protection; (iv) persons with diminished capacity, and as there is an imminent danger to an identifiable third party or otherwise mandated by municipal, to self; provincial/territorial, and federal when a counsellor/therapist has reasonable cause to suspect law. (See also B4, B6, B13, D2, C5, abuse or neglect of a child; D5, D8, E10, G7, H1, H4, H6) when a disclosure is ordered by a court; when a client requests disclosure; or, when a client files a complaint or claims professional liability by the counsellor/therapist in a lawsuit. Standards of Practice 15 Counsellors/therapists should discuss confidentiality with their clients and any third party payers prior to beginning counsel- ling/therapy and discuss limits throughout the counselling/ therapeutic process with clients, as necessary. This includes clients who are mandated or are incarcerated. They also inform clients of the limits of confidentiality and inform them of any foreseeable circumstances in which information may have to be disclosed. These limits include informing clients that de-identi- fied information may be shared with their supervisor or with a consultant. Confidentiality has a Long History Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart therefrom, which ought not to be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets. (Hippocratic Oath) Administrative assistants, supervisees, treatment teams, and all others who work with a counsellor/therapist have a responsibility similar to that of the counsellor/therapist with respect to confi- dentiality. Counsellors/therapists must take all necessary steps to guarantee that client confidentiality is respected and maintained by others with whom they work and consult. People are more likely to know each other in small communities and the counsellor/therapist is more likely to meet up with clients in non-professional situations. Practitioners in small communi- ties protect private knowledge, and ensure confidentiality in the face of intricate social networks and lines of communication that lead to the availability of informally-gained knowledge. Counsellors/therapists need to be mindful of culturally appro- priate actions that relate to confidentiality when working in rural, remote, northern, and linguistic/cultural enclaves in urban centres. Mandated and incarcerated clients retain their autonomy and can refuse services. Counsellors/therapists have the same responsi- bilities for such clients regarding confidentiality and informed consent. Counsellors/therapists must ensure that the client, whether mandated or not and whether incarcerated or not, understands all reporting requirements, any information that will be shared and with whom, and the consequences if they do not take part in counselling/therapy. Confidentiality belongs to the client, not the counsellor. 16 Standards of Practice Children and Confidentiality Counsellors/therapists who work with children have the difficult task of protecting the minor’s right to privacy while at the same time respecting the parent’s or guardian’s right to information. Counsellors/therapists can be assisted in such dilemmas by the following considerations: Parents and guardians do not have an absolute right to know all the details of their child’s counselling/therapy, but rather, each request should be evaluated on a ‘need to know’ basis. Each school, as well as other work environments, which provides counselling/therapy services to children, should establish a protocol that should involve counsellors/thera- pists and other appropriate persons in adjudicating parental or guardian requests for information about their child’s counselling/therapy information. As a child grows and matures, the parent’s right to know will diminish and may even terminate when the child achieves the capacity and sufficient understanding to give informed consent. Counsellors/therapists who work with children should be particularly familiar with and guided by the statutory requirements within the province/territory2 in which they work regarding disclosure of confidential informa- tion related to children. This includes being informed of emerging ethical and legal obligations and attitudes with respect to the privacy rights of children. When counsellors/therapists believe that a disclosure of a child’s counselling/therapy information is not in the child’s best inter- ests, the following actions may be helpful: Invoke the protocol established within the workplace for addressing such information requests. Discuss the parental/guardian request for information with the child and determine their attitude with respect to disclosure. Explain to the parents/guardians the merits of respecting their child’s desire for privacy if the child is not willing to disclose. Conduct a joint meeting between the child and parents/ guardians, managed by the counsellor/therapist. Disclose information only after the client has been informed, and limit disclosure to the information requested. 2 As First Nations, Inuit, and Métis communities establish their own laws, including them will become more relevant in the work of counsellors/therapists. For example, there are territories and nations in BC and Quebec that have capacity to establish law pertaining to social services. Standards of Practice 17 In some cases, such as cases of suspected abuse, counsel- lors/therapists are legally compelled to deny parental requests for informational disclosure. When faced with such situations, it may be advisable for counsellors/ therapists to seek legal advice. In exceptional circumstances, they also may need to be prepared to defend in court or in a similar formal proceeding their decision not to comply with parental/guardian petitions. (see also B4, B5). In Canada, judges typically apply the Wigmore conditions in determining if confidentially obtained information should be disclosed during a legal proceeding. These are: Did the communication originate within a confidential relationship? Is the element of confidence essential to the full and satisfactory maintenance of the relationship? Is the relationship one which the community believes should be actively and constantly fostered? Will injury done to the relationship by disclosure be of greater consequence than the benefit gained to the legal proceedings by disclosure? (Cotton, n.d.) B3 Duty to Warn Duty to Warn Counsellors/therapists have a duty to use reasonable care when When counsellors/therapists they become aware of their client’s intention or potential to place become aware of the intention others in clear and imminent danger. In these circumstances, they or potential of clients to place give threatened persons such warnings as are essential to avert others in clear and imminent foreseeable dangers. danger, they use reasonable care Under this ethical obligation, counsellors/therapists should take to give threatened persons such warnings as are essential to avert protective action when clients pose a danger to themselves or to foreseeable dangers. In cases in others. Whereas ‘duty to warn’ most often refers to harm to others, which it may not be appropriate or counsellors/therapists in Canada typically extend this standard to safe for counsellors/therapists to include ‘harm to self ’. Once counsellors/therapists have reasonable intervene directly to give warnings grounds to believe that there is such imminent danger, they use the to threatened persons, they least intrusive steps to prevent harm. take appropriate steps to inform authorities to take action. When dealing with clients who may harm themselves or others, counsellors/therapists are guided by the following actions: Empower clients to take steps to minimize or eliminate the risk of harm. Use the least intrusive interventions necessary to fulfill the ethical responsibilities associated with the duty to warn. Seek collegial consultation, and when necessary, obtain legal assistance. 18 Standards of Practice With respect to suicidal clients, counsellors/therapists’ interven- tions may include such steps as: considering the potential advantages/disadvantages of negotiating safety plans with those evaluated to be at low risk; disclosing to significant others in the clients’ life; suicide watch in institutional environments; suicide watch in Indigenous communities; or, voluntary or involuntary hospitalization. When counsellors/therapists believe that their clients will harm an identifiable person, they should take steps to warn the individual of the potential danger. Depending on the particular circum- stances, counsellors/therapists may be justified in taking any number of steps, including: ensuring vigilance by a client’s family member; reporting to the police, Indigenous community health centre or nursing station; or, advising voluntary or involuntary hospitalization. Counsellors/therapists should consult with colleagues when making such decisions and may need to seek legal assistance. Counsellors/therapists may be justified in breaching confidence with clients diagnosed with communicable diseases of public health significance (as defined by the federal government) when the client’s behaviour is putting others at serious risk. Counsellors/therapists adhere to governmental directives related to communicable diseases (regardless of whether the disease has been designated as a public health significance by the federal government). However, counsellors/therapists should make every effort to encourage such clients to take responsibility for informing their contacts of associated risks. With the client’s informed permission, counsellors/therapists contact the client’s physician, and seek the consultative assistance of a supervisor or another counsellor/therapist. Legal assistance may be needed. “The protective privilege ends when the public peril begins.” (Tarasoff v. Regents of the University of California, 1974) Client’s Rights and Informed Consent Informed consent is essential to counsellors/therapists’ respect for the clients’ rights to self-determination. Consent must be given voluntarily, knowingly, and intelligently. Counsellors/therapists must provide to clients a rationale for potential treatments and procedures in easily understood terms. Any intervention offered Standards of Practice 19 B4 to a client should be grounded in an established theory or have a Client’s Rights and supporting research base. Informed Consent Voluntarily means that consent to participate in counselling/ When counselling/therapy is therapy, assessment, research or any other professional services initiated, and throughout the provided by counsellors/therapists must be given freely without counselling/therapy process as pressure, coercion, or without powerful incentives to do so. necessary, counsellors/therapists inform clients of the purposes, Knowingly means that counsellors/therapists fully disclose goals, techniques, procedures, limi- relevant information to clients so that they are briefed as to what tations, potential risks and benefits it is they are being asked to give their consent. This includes of services to be performed, and disclosing the type of information which may have to be reported other such pertinent information to a third party and the limits to confidentiality (e.g., require- that supports the informed ments of public health laws, warrants, and subpoenas) and decision making process. checking the client’s understanding through discussion, clarifica- Counsellors/therapists make tion, and opportunities to ask questions. Information must be sure that clients understand the given to clients in a manner which is sensitive to their cultural implications of diagnosis, fees and linguistic needs. and fee collection arrangements, record-keeping, and limits of Intelligently means that clients have the ability to comprehend the confidentiality. Clients have conditions for consent sufficiently to make an informed decision. the right to collaborate in the Counsellors/therapists should not equate silence with consent. development and evolution of the Counsellors/therapists should respect the right of a client to counselling/therapy plan. Clients have the right to seek a second change his or her mind and to withdraw informed consent. opinion or consultation, to refuse Counsellors/therapists should respect a client’s expressed desire any recommended services, and to to consult others with respect to informed consent decisions. be advised of the consequences of such refusal. (See also B2, B5, B8, If a written consent form is not appropriate because of consid- B15, B18, C2, D3, D4, E2, G10, H1, erations relating to culture, literacy, disability, or for any other H2, H3, H4) legitimate reason, counsellors/therapists should record the oral or expressed response to the informed consent process and docu- ment the reasons for it not being written. The use of an electronic signature or other expressed response to informed consent when undertaking counselling/psychotherapy using electronic or other technologies is acknowledged as a legitimate means of obtaining consent (see Section K). Touch in Counselling/Therapy Counsellors/therapists should always be thoughtfully aware of any boundary crossings in their counselling/therapy and be alert to their potential for both client benefit and harm. Such vigilance is particularly required when there is physical contact between a counsellor/therapist and client. Although human touch can be a normalizing and nurturing experience, during counselling/therapy it must be considered with attention to the counsellor/therapist’s intentions, the client’s 20 Standards of Practice perspective, power differentials, and such factors as age and gender differences, and the client’s cultural and personal experi- ences with touch. The following guidelines may assist counsellors/therapists in viewing touch from a therapeutic and client perspectives: What is the potentially positive role that touch might play in my relationship with this client? What are the potential risks? What is my motivation for physical contact with this client? Is it to meet my client’s needs or my own? Will this client experience touching as therapeutic, non-erotic, non-invasive contact? Do I understand the client’s personal history sufficiently to risk touching at this time? Touching, at least at an early stage in counselling/therapy, is contraindicated for clients who have been sexually abused or who have experienced inappropriate uses of power through touch. What if this client misinterprets the intention of my B5 touching? How and when will I raise it with my client in a timely way? Children and Persons with Diminished Capacity When touch is integral to any therapeutic approach or technique, clients are briefed on its nature and intended purpose prior to When working with children and/or persons with diminished the therapeutic touch and given appropriate control over it, capacity, counsellors/therapists including the right to decline the therapeutic approach. conduct the informed consent process with those who are Children and Persons with Diminished Capacity legally entitled to offer consent It is possible that adults with developmental disabilities, critical on the client’s behalf, typically illnesses, serious injury, or other disabling conditions may be parents or others appointed as declared by a court to be legally incompetent. Each province/ legal guardians. Counsellors/ therapists also seek the client’s territory has legislation that outlines the conditions and proce- assent to the proposed services dures for such a determination. When working with individuals or involvement, proportionate who have been declared incompetent, counsellors/therapists with the client’s capacity to do so. should seek informed consent from legal guardians. Counsellors/therapists understand that the parental or guardian right The parents and guardians of younger children have the legal to consent on behalf of children authority to give consent on their behalf. However, the parental diminishes commensurate with the right to give consent diminishes and may even terminate as the child’s growing capacity to provide child grows older and acquires sufficient understanding and informed consent. These dual intelligence to fully comprehend the conditions for informed processes of obtaining parental/ consent. Counsellors/therapists should be vigilant to keep guardian informed consent and themselves informed of their statutory obligations with respect client assent apply to assessment, counselling/therapy, research to the rights of children, including their right to privacy and self- participation, and other profes- determination commensurate with their ability and with regard sional activities. (See also B4, D4) to their best interests. Standards of Practice 21 Mature Minor However, there is a sufficient body of common law in Canada which is fairly clear in stating that regardless of age, a minor is capable of consenting or refusing consent to medical treatment if he or she is able to appreciate the nature and purpose of the treatment and the consequences of giving or refusing consent. (Noel, Browne, Hoegg, & Boone, 2002, p. 139) A third party, such as a Court may, by court order, require clients to receive counselling/therapy and/or to be assessed by a coun- sellor/therapist. Under such circumstances, counsellors/thera- pists should clarify their obligations, inform clients of the type of information expected by