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What are some ways we, as counselors, can ensure our practices are ethical?

Specifically, how can we ensure that patients from all demographics are receiving adequate services? Are there additional ways we can inform ourselves of their specific issues?

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Annah’s Answer

Shelby, ethics are something you will think about with every client and every day on the job as a clinical psychotherapist (counselor, psychologist, social worker, etc). Depending upon your degree and license you will be required to take a certain number of ethics credits in graduate school. This will familiarize you with the ethical code of conduct for your license and also what types of continuing education courses you need to have post-grad. My license requires a number of ethics CE's along with other types of ongoing education- for instance training in suicidal ideation and prevention. This will keep you somewhat up to date. In many situations you will either become familiar with what to do that is best practice or seek consultation or supervision. I often seek a second opinion when I am unsure how to respond or handle a situation with a client; sometimes I do this for confirmation I am doing everything I need to do. Other times I genuinely need input about what is most ethical within the context. It is always wise to have a supervisor or consultation group you are connected with. If you are in private practice, there are even more considerations as you will not be covered by a greater entity (other than your own liability insurance). But don't get overwhelmed by all this (if it happens to feel like a lot)! You learn what you need to know as you go. You learn about what not to do- and most are obvious. I find having people to talk with on an ongoing basis is useful; having a team around helps me to cover all the bases. It is good to be conscious about the power you yield as a clinician and the potential for damage. Most of the ethical code is common sense. Also know it is okay to make mistakes within the therapy relationship; these can usually be repaired. As long as you operate from a place of 'do no harm' you will be working with the intention to be of help. You are only human, after all. Your second question regarding equity is something you will encounter if you work in any public health or community health agency. Hopefully others around you will also be thinking about this and working to promote patient access. My clinic discusses barriers to care daily; sometimes it takes getting very creative in problem solving. And some issues are greater than what we can resolve due to larger external systemic issues. You may even be drawn to working in policy or administration for the opportunity to have more of a voice in such decisions. Counseling and social justice go hand in hand.
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Kerri’s Answer

Shelby, ethics in the counseling field are centered on what you do (and don't do) to assure that both you and your clients are protected. As a practitioner, your personal moral principles have a lasting impact on diverse stakeholders. Of course, your clients will be the most obvious benefactor of solid ethical counseling practices. However, taking an ethical approach to effectively supporting disadvantaged, underserved, and minority client demographics includes exploring the broader environment.

Let's take my practice as an example. I have a passion and purpose for serving injured and disabled workers. Initially, I was a fireball of unrestrained energy for every individual client. I dare say I did too much "howling at the moon" in those early days. I was so eager to solve the problems for underserved demographics that my staff ran ragged trying to keep up. Today, I have come to embrace the potential of collective effort. My clients of all demographics are part of a bigger picture. The resources necessary for success come from infinite places. Sure, I can make double double sure that all clients receive ethical care in my physical environment. From office voice mail messages to the intake paperwork, clinical interactions, staff training, and written reports - an equitable, fair approach to client service is a key goal in our vocational counseling practice. But how can I assess and evaluate if all clients are "receiving adequate services?" The answer to that question has come from external participation and feedback.

I can envision the vast resources and roadblocks ahead by putting myself in the client's shoes. I am a big advocate for developing actionable ethics game plans. Beyond individual counseling, consider efforts that IMPROVE resources and REDUCE roadblocks within the broader environments that impact clients. What does that look like? I love complaining about burdensome bureaucracy in medical care systems and state agencies, but I had to give that up. Regularly meeting with stakeholders in the systems surrounding vocational counseling has dramatically improved my knowledge and abilities to help clients. The same thing goes for my work and home families. Regular meetings to build a strong ethical framework have empowered individual accountability, proactive effort, and valuable feedback insights. Oddly enough, in my career, the ethical journey to protect and promote equity for all client demographics took an interesting twist. The most effective way to care for them is to focus on me.
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