Saying good bye to your therapist.

By David Joel Miller.

When is it time to end therapy?

Counseling

Counseling, Coaching or Therapy
Photo courtesy of Pixabay.com

How do you know when it is time to end therapy? Some people go for a few sessions and then they are done, while others, well they keep going for years. How would you know it is time to end the therapy sessions? And what should you be doing after the time with your counselor ends?

This parting of the ways can be hard for both of you. Therapists study in school a process called “termination.”  We know that ending a relationship, especially one as emotionally close as counseling, can be difficult. Sometimes this ending the counseling relationship needs to happen over several sessions. This is especially true if you have trust or abandonment issues.

Sometimes we counselors hate to see a client stop coming, not just for the money but because the counselor will miss them.

Of course, there are times you need to keep going to therapy even when you don’t feel like it. Working on issues can be painful at times and perseverance pays off. But other times it is best to end or take a break from therapy.

If you have been questioning whether you still need to go see the counselor every week please talk this over with them. They may have suggestions about other things you need to work on and you can make a decision about those things. Remember the final decision is yours. Here are some times you may need to stop going to therapy.

You have accomplished the counseling goals you set.

The thing that pushes many people into therapy is a crisis or acute problem in your life. You go, you work on your issue and then things start getting better. If you find yourself looking for things to talk about rather than having pressing needs to talk then you may be ready to end therapy.

Think carefully about the thing that brought you to the therapist’s office in the first place. Was this an unexpected problem, a job loss or death in the family?  Or was this breakup or job loss a recurring pattern in your life that needs complete examination if you are to rid your life of this recurring issue.

Do you think of the counselor as a friend instead of a professional helper?

If you find you are going because your therapist is your friend then you may be ready to end this relationship. A counselor’s job is to help you develop the skills you need to move on in life. You should be working on making other friends and developing a support a system.

No one person in your life can be your one and only support system. If you are dependent on your counselor because you have no friends outside that relationship you need to be working on how to create that support system. The counselor can support you in the process of creating other supports but they should avoid creating a situation where you become dependent on them.

If you start worrying about your therapist’s feelings and how they will take your desire to end treatment, then you have shifted from being the client to trying to caretake the counselor’s feelings. You probably are done, at least for now.

You find it hard to give up other activities to go to therapy.

If you find that you are passing up on other activates you would like to participate in to go see the counselor this suggests you are getting ready to end the sessions. The goals of therapy, depending on the identified problem, should be for you to reach the point you can function at work, with family and friends and that there are things you enjoy doing.

If this problem is no longer interfering with those social and job-related activities and you are not feeling distressed over your problems then you are getting ready to transition to living life without that weekly therapy visit.

What was the problem? IT’s time to end therapy if you can’t remember why you are going.

If you talked all up and down and around and now find that you can’t identify a problem that needs work you are ready to end treatment. If you have moved from getting treatment for a problem to just wanting advice and ideas on how to be happier or more productive you have transitioned from doing therapy to something more like life coaching. Licensed Therapists and Counselors can do life coaching. If you have any mental or emotional issues I recommend you get your coaching from someone trained in mental health. Remember though that life coaching is a different skill from therapy and probably is not covered by your insurance.

You are not making any progress on your issues.

At times there are periods where work is going on and you do not yet see the results. Do not give up before the miracles happen. But if you feel you have moved as far as you can with this provider or this therapeutic approach. Talk this over with your counselor and see what insight they can offer. Sometimes you need a break from therapy and at other times you may need to work with a new person who can offer you a new perspective.

There are other reasons that you may want or need to end counseling, but those are some of the bigger ones. Have you found it hard to end therapy? Have you stopped going and how did that work out for you?

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Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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Choosing between the law or your ethics, a dilemma for counselors.

By David Joel Miller.

What if the law says the counselor should do something but doing it will hurt someone?

Law or EthicsOccasionally a reader sends in a question that has far-reaching consequences. The question below made me stop and think about what we counselors and therapists do, and how that fits into the larger context of the world around us and the issues of what is right and wrong.

“What if a 16-year-old girl is being sexually abused by her uncle and he threatens her not to tell anybody, but she tells her therapist. On the other in the girl’s culture, any girl who lost her virginity before marriage should be killed, what would a therapist do in this situation?”

Every profession has those times when the ethics of that profession conflict with the laws of that time and place. Psychiatry and mental health are not immune to these conflicts.

In past posts, I have written a lot about what counselors have to report and what they can keep confidential. My posts were based on the laws and customs of America, California in particular. They assume that the people who live here all adhere to the dominant culture and values and that things will work out the way they are supposed to.

What about the times that things do not go according to plan?

Psychotherapy as it is currently practiced, talk therapy, has a distinctly western flavor. The things we take as givens here in America may not be truths in other places. What is true today has not always been true even here in the United States.

The status of Women and Children has changed dramatically in the history of the United States. The standing of women, their rights to education, the vote and the treatment that they can expect are all very recent developments here. As recent news stories have demonstrated the consequences of violence towards women and children continue to evolve.

We have heard older colleagues, those who lived in Europe during the time of World War II and the Holocaust, told in detail why they would resist telling any government what a client reveals in therapy for any reason. This question from a reader suggests just such a reason for not revealing a mandated report.

Making exceptions to confidentiality is and always has been a slippery slope. Trying to apply current American standards to the practice of therapy in another place is highly problematic. Lest the reader think this is only a problem in some countries somewhere over there, I need to remind them throughout this essay of the times that American Therapists have been asked to lower the bar and report crimes of all sorts.

First, let me deal with the specifics of this question as it might happen here in California, then what might happen if American therapy was being practiced in a country with non-western laws and lastly how these values creep may affect clients everywhere in the future.

To try to navigate this conflict between confidentiality and the government’s desire to know what people in therapy say we have created a host of laws and those laws have been modified by further statutes and court decisions. I am no lawyer but the lawyer’s rigged this game by telling us that “ignorance of the laws is no excuse.” Here is my lay understanding of our laws and an encouragement to anyone who is faced with these kinds of situations to consult your own legal advisor rather than rely on my imperfect understandings.

In the question above. The client is over 16. There would be different rules if she were 14-15 and other laws if she was under 14.  A client over 16 can consent to most kinds of sex. If the uncle is younger than age 26 and the sex is vaginal, no report. We report child sexual abuse, not crimes. What if the Uncle was 40 or he sodomized her? Then by law, we need to make this report.

A goal of child abuse reporting is to protect children. So if Child Protective Services believed that, based on cultural values, this family might kill this daughter for not being a virgin they could ask for a hold and remove the child from the family to protect her. Will they? That is questionable. The police or courts may not approve the removal. The family may deny that they will harm the child and the child may stay in the home.

There have been cases reported in the media here were women committed adultery and the family knowing that they could not harm her here have returned to the country they came from where she could be stoned to death for that adultery. If this situation happened here in California could the family still kill this child or send her back to their home village where she would be killed? I think this is possible. Should our system protect her? Absolutely. Can we guarantee this? Maybe not.

This is a case where the therapist will need to consult with an attorney and then may elect to talk with the Child Protective Services or not depending on their belief that the system could protect this client, that and their sense of right and wrong. This is one reason that “informed consent” is so important. This client and all clients should be told upfront what will and will not be reportable. In practice this means trying to guess what things the client will want to talk about and doing the informed part, having long documents explaining informed consent or having to stop if things are getting into an area that may be a problem and explain this as it applies to that client.

What if this therapist is practicing in a country where killing women who lost their virginity before marriage is an accepted practice? I think that American notions of ethical behavior may not apply well when a professional tries to practice western style therapy in a place that does not uphold western values.

Take an extreme case. If a counselor was still practicing in an area now controlled by ISIS (ISIL) they may be required to report clients who are practicing a “heretical religion” the result might be therapists who are ferreting out infidels and marking them for elimination. A therapist working in a totalitarian country would have to be very careful to not become a tool of the state in finding undesirables. Think about therapists who practiced in Nazi-occupied areas. See why they might be opposed to any requirement to report anything to the government?

Is America asking therapists to become informants?

I think that there is an increasing pressure to have therapist’s spot people who are doing illegal things and tell on them. Every time there is a violent crime on the news there are questions about why some mental health person did not spot this and report or stop it. There are many reasons why this does not work. The majority of people do not see therapists at all, ever, even when they need to. Those who do see a counselor often do not tell us that they are planning to do something.

Every therapist sees lots of people who have anger issues or emotional regulation problems and who MIGHT get violent. So far I have seen no system that predicts potential violence accurately enough that we could start locking people up who may do something in the future. There are just so many potentially violent people that the jails would not hold them all. Only a small fraction of those who “might become violent” ever do.

We have gone a long way to prevent people being locked up for what they think or what someone else thinks they may do. There was a time when any man could get his wife locked up in a mental hospital for years just by saying she was crazy. Now the standards to detain people are pretty high and then only for a few days to be sure.

So what other things are therapists being asked to report?

Think of some of the things that could be potential reports and therefore exceptions to confidentiality. How about domestic violence? Or cruelty to animals? What about someone with AIDS who is not using protection and has multiple sexual partners. Are they doing something that could kill another person? Should we tell women if their partners are having affairs or what about homosexual experiences?

What about people who drive drunk? Or do drugs? If someone is selling drugs to elementary school kids? Should that get reported? Or maybe just drug dealing in general? How about cheating on your taxes or financial fraud?

While we are at it what about reporting terrorist activities?

There are some things, like child abuse and plans to kill yourself that most of us would agree need to be reported. I very much believe that therapists and society in general needs to keep all these exceptions to confidentiality at a minimum otherwise we will be turning therapist into practitioners of “enhanced interrogation techniques.”  Any of you who say that those techniques are not torture, would you like your ex and her lawyer to question you that way?

In a free society, we need to maximize people’s ability to be safe in what they tell their counselor. We also need to recognize that it can be a short hop from mandated reporting to fingering people who are members of an unpopular religion or political group. Remember that many societies are not as free and safe as we are here and in America. Staying this free requires vigilance and it means keeping the standards of confidentiality as high as possible.

To the reader who asked this question my suggestion is that someone in this situation should not be talking about this unless they can be sure about their safety. They should look for someone who can help them get to safety if possible. Try to find a way to end this situation soon or an unwanted pregnancy may end you.

Sometimes all a counselor can do is to help a client learn to cope with the situation and hope that situation will change. Hope this long answer shed some small light on the topic of confidentiality and mandated reports.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What is an evidence based practice?

By David Joel Miller

Which therapy methods really work?

Counseling

Counseling, Coaching or Therapy
Photo courtesy of Pixabay.com

If you have a particular “mental illness” what treatment would be best for you and how would you find someone who did that type of therapy? Should you seek out a CBT therapist or a DBT one? Is there really a difference?

The answer is more difficult to find that you might think.

The fields of counseling and therapy are full of practitioners who each have created their own varieties of treatment. Unfortunate what works for one client does not always work for another. Also what works when one therapist uses it does not always seem to work when another counselor tries it.

So how do we establish what methods work and what are wastes of time and money? If insurance, private or public programs, are going to provide or pay for treatment they want some assurance that the treatment will work. If you are paying out of your own pocket you deserve the same level of confidence.

Some “schools” of therapy have been very resistant to being evaluated; others have embraced the processes of evaluation. There are at this point in time more questions than answers.

National Registry of Evidence-Based Programs and Practices.

Creating a list or registry of therapies that work is one possible solution. Here in the U. S., the most comprehensive list is found at the National Registry of Evidence-Based Programs and Practices. This is however not the only list.

The last time I looked, this database contained 340 different programs or practices that had been registered and evaluated. Not all of these programs are equal. Some have many studies and are deemed very reliable and others have few studies, with only small groups of people and are still questionable.

Nevertheless, having a list that we can look at helps narrow down the range of treatments that may be helpful. This list also seems to rule out some treatments that are questionable or unhelpful.

Just looking up your condition and finding a treatment that was shown to work in a particular study is not the whole answer. Given one treatment model, not all therapists are equally good at using it. A treatment that worked well with military veterans may not be right for teens. The group or “population” being treated matters.

Another factor is how closely to the original method a therapist works. Some providers will stay very close to the original model and others will vary what they do depending on the client. Some methods seem to work best when the practitioner sticks to the “script.” Other methods work better when tailored to the client. Some practices have detailed manuals the provider is supposed to follow and others are more general theories

No matter what theory or method a therapist uses the success of treatment is hugely influenced by the relationship between the therapist and the client. If you think this person can help you then they can. If you do not believe in what the therapist is doing then it is much less likely to be helpful.

While professions continue to develop ways to be helpful to clients what you should be looking for is someone who can help you with your particular problem. Find someone who feels right to you if possible. Expect that you will need to do some work and sometimes that work will feel uncomfortable. Therapy may even feel painful at times when you have to face traumas and hurts from the past.

Keep in mind that good therapy is not something the therapist does to you, but a process you and they do together that helps you create the best life possible.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Who should treat mental illness?

By David Joel Miller

Who should treat mental illness, where and how should it be treated?

The mental health field is changing. A host of events and forces have intersected to influence our feelings on the proper response of society to this thing we are calling mental illness. Lots of things are happening or about to happen in this mental health field.

Here in America, the very ground underneath mental health treatment is moving.

In 1900, here in America, less than 10% of doctors had ever been to college. Until 1914 drugs were legal and you could openly buy them anywhere. As late as 1950 there were no meds to treat mental illness and those who were given a diagnosis could be tucked away first in barns and attics and later in sanitariums.

The talk therapies are just past their hundredth birthday and many people have still never been to see a therapist. Three months ago more Americans were without health care than there were those who had coverage. The few who did have heath insurance here in America did not have coverage for mental illness or substance abuse. Treatment of those disorders while improving is still not on an even footing with most physical illnesses.

Less than a year ago the American Psychiatric Association released the new DSM-5 which redefined, reclassified and altered our understanding of what is and is not a mental, emotional or behavioral disorder. The new version of the International Classification of Diseases is due out soon which will change the field of treating mental health problems also.

This alteration in the landscape of the treatment of mental disorders is not solely confined to the United States of America. Blog readers and commenters from all over the world are asking similar questions and telling similar stories of their efforts to recover from an emotional or mental problem. They are also telling tales of less than helpful services.

The very mention of mental illness can evoke some pretty strong emotions. Some cultures, religions and even professions still are denying the existence of such a thing as a Mental Illness.

People leave comments and they send me emails. The comments of every reader of counselorssoapbox.com are valued. Some of them I answer briefly as soon as I can. Others require longer blog posts to give them the space they call for. A few are so angry or personal I have hesitated to approve them.

Some of you have left comments or sent me emails about how we are doing things here in America and how that might differ from the way things are done in other places. I have been having an interesting ongoing conversation with Ellen in the U. K. about how they do things there. I will fill you all in on that discussion as soon as possible.

Let me offer this invitation to all of you out there to share your experiences and how the mental health delivery system works in your part of our planet. I will share my clearly limited perspective from here in Fresno, California, one of the more diverse places in this United States of America. I feel sure the view of the mental health landscape will look a lot different from other points of view.

We should be talking about how we have been treating mental illness, how we should be treating it and how we get from where we are to where we need to be.

That discussion also implies some understanding of what “mental illness” is and how people develop a mental disorder. What a mental illness is, implies a view of what causes it, how it progresses, how to treat it. The view you take of this phenomenon also influences your view of the possibility it could be cured and if so how.

Knowing what mental illness is and what needs to be done about this leads us to the answer to my first question about who should be treating this problem.

We also have the added problem that no matter how sure we are of causes and treatments we need to know who is going to pay for these efforts. How treatment is delivered is strongly controlled by those who handle the money.

Let’s take a look at some of these questions and together see if we can find some solutions.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at  Recommended books.

If you would like to stay connected to the posts on counselors soapbox, hear about the progress of my book in progress or the flow of the conversation about mental health and substance abuse issues – please subscribe or follow counselorssoapbox.com

What is a Licensed Counselor?

By David Joel Miller.

What is a Licensed Counselor?

I wrote this in response to a question from U. K. on how our mental health system works. It has since occurred to me that one major difference between the U. S. system and those in other countries is the funding source. When you have a national health care system most of the expenditures are paid for by the government so if you get on the list and can provide services or you work for the government you get paid. The government can have some amount of control over quality.

Here in the U. S. most service is paid for by the individual directly or indirectly through the purchase of insurance. No money or insurance and you may get no services. This requires the government to regulate who can open an office and then sell medical or psychological services.

We have a licensing system for most professions so that just anyone does not open up an office and then start doing surgeries which kill people before they get sued and have to stop. The point of licensing is to control entry into a profession and ensure some minimum level of consumer protection.

Here then is the somewhat edited version of my reply to her question about how we do things in the American Mental health system.

Thanks for the comment. Interesting question. It had not occurred to me that there might be such differences on the U.K. Now I am thinking that given the number of readers of counselorssoapbox.com from countries other than the U. S.

Most of this has to do with our legal and governmental system. Not being either a lawyer or a politician. (We do not have separate Barristers and Solicitors but combined most of what they do into one group – lawyers who are also called Attorneys, and sometimes counselors in the sense of legal counselors.)

This whole area is a bit complicated.

Regulation of professions is left to what we call states. Each of the 50 states may have their own law or some may not require a license to practice a particular profession. So in one of our states if you graduate from a school with a degree in counseling you may be able to open and office and charge people for counseling. In another, there may be strict regulations on the quality of your degree, your internship and your experience under another professional before you can get a license. If a state has high standards other states may accept that license. People who come from states with no or low standards will find that if they move to a state with high standards their background may not allow them to practice that profession. For example, if you became a doctor in a third world country many U. S. states will require that person to do more work and take more tests before they can become a doctor in that state. The big states like New York and California generally have the highest standards.

(With the health care expansion this year the ability to bill federal programs may alter this thinking a bit.)

In California, we have 29 separate codes and the one of those that regulates counselors and other professionals is called the “Business and Professions Code (BPC.)”

In the BPC there are sections for each regulated profession. Contractors have a section, hairdressers and so on. Doctors and nurses have their own section also.

In the mental health field in California, we recognize a number of professions.

Psychiatrists are licensed as Medical Doctors.

Psychologists are licensed by the board of psychology

The Department of Health Care Services, Alcohol and Drug Programs licenses drug and alcohol programs but not drug counselors. So the programs have a set of standards on who they can hire.

The Board of Behavioral Sciences licenses Clinical Social Workers, Marriage and Family Therapists and Professional Clinical Counselors.

Without a state-issued license, you may not practice a profession except in a few places specifically listed in the law as “exempt settings.”  (Schools can hire school counselors who do not have to be licensed.)

The goal of this procedure is to protect the public from people who do not have the training and skills doing work that might harm or cheat the client. This process also gives clients some redress for wrongs short of a suit in court.

The law sets out the specific things you need to do to be issued a license. And each profession has their separate list of the things they can do and the requirements to qualify to do those things.

For example:

A Professional Clinical Counselor would need to possess a Bachelor’s degree (4 years), in most any subject, or take some remedial classes called prerequisites, to enter a masters in counseling program. They would then need to complete and graduate from an accredited or approved Master’s program (5th and 6th-year college.)

After graduation, that person must register with the Board of Behavioral Science (BBS) who evaluated the education they have and if it meets the board’s requirement the candidate receives an intern number.

From this point on the prospective counselor is required to be supervised by a licensed person until they receive their own license.

They must accumulate a total of 3,000 hours of supervised experience.  There are some complicated rules on what counts and what doesn’t count and how much supervision they need for each hour of client contact.

When they have accumulated those supervised hours, the applicant submits the paperwork to BBS and if this is approved they are eligible to test. In my own experience, I took first a long test on specific questions to show that I understood the process of doing therapy, the laws and the ethics and so on. If you pass that first test you then return for a second test in which you are given stories (vignettes) and you apply your knowledge to answer questions about Howe you would work with these people.

If you pass both tests you are then sent an application for a license.

At each step of this process, you pay a fee for BBS to handle your paperwork.

Once you send in your approved application and pay the fee, if all has gone well you will be issued a license to practice Professional Clinical Counseling in California. You can then work for someone else or open your own office.

But it does not end there

Every two years you will need to complete a certain number of approved continuing education classes, and pay a fee to renew your license.

After the first two years of being licensed, you can take a class and then you are eligible to begin supervising newly registered people.

So do things operate differently in the area in which you reside?

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended books.

If you would like to stay connected to the posts on counselors soapbox, hear about the progress of my book in progress or the flow of the conversation about mental health and substance abuse issues – please subscribe or follow counselorssoapbox.com

Do counselors have to follow ethical codes?

By David Joel Miller.

If a therapist does not belong to a professional group do they have to follow an ethics code?

Code of Ethics

Code of Ethics

There are a lot of rules about the relationships between a client and the treating professional. There are things that the professional can do, can’t do, has to do and is required to not do. Sometimes these rules get confusing for the professional as well as the client.

Recently a situation came up in which a professional was not a member of any professional organization, so the client left that visit with the impression that this professional did not need to follow any ethics code. This report of a problem left me thinking we need to talk about some of these codes of ethics and why a professional would need to follow them and what happens if they do not belong to any organization.

Turns out there may well be a time when a mental health professional needs to follow the standards of a code of ethics even if they chose to not belong to the professional organization. More on that later in this post.

To be a mental health professional you need a license in the jurisdiction in which you intend to practice your trade. Joining a professional organization does not allow to practice this profession. So while all professionals are encouraged to join a professional group some choose not to be members.

Here in the United States of America, the various states license the various mental health professions. Not all states license the same professions. There can be states that allow a particular profession to practice even if they do not issue a license to that profession. For example “Life Coaches” are not licensed anywhere I know. They can do all sorts of coaching on how to have a better life. What a Life coach should not do is treat a person for a mental illness if the state in which they are practicing requires that license.

This situation of when and how to follow a code of ethics is made more complicated by the multiplicity of professions and professional licenses. There are Licensed Social Workers (LCSW’s and ASW’s), Licensed Professional Clinical Counselors (LPCC’s and PCCI’s), Licensed Marriage and Family Therapists (LMFT, MFT, and MFT interns.)

Here in California, we make it even more complicated with 9 or so different registries for Registered or Certified Substance Abuse or Drug and Alcohol Counselors, each of which presumably has their own code of ethics. Here is the code of ethics for CAADE, the program in which I teach is CAADE accredited.

Recently all these registries came together to create a Uniform Code of Conduct” for California’s substance abuse counselors.

The code of ethics varies depending on your profession and the particular organization you belong to. So someone could belong to several organizations (I do), one organization or no organizations.

What if there are contradictions between the various codes of ethics? What if the professional decides to not join any group to avoid having to worry about ethical behavior? We have come up with some principles to handle those situations.

California was the last state to grant licenses to Professional Clinical Counselors. Most Licensed Professional Clinical Counselors (LPCC’s) belong to CALPCC. The exact name of the counseling professional and the specifics of what they do can vary from state to state. Many California Counselors may also be members of the American Counseling Association (ACA.) In this case, the problem was easily solved. CALPCC adopted the ACA code of ethics.  

California was the first state to licensed Marriage and Family Therapists (originally called Marriage, Family and Child Counselors.) There are more MFT’s in California that the rest of the country combined. (LMFT, MFT, MFCC are all the same thing.)

The California Association for MFT’s (CAMFT), which has members from a bunch of other states and even some other countries, is larger, so I am told, than the American Association of Marriage and Family Therapists (AAMFT.) Both of these groups have their own codes of ethics.

The Social Workers, mostly belong to the National Association of Social Workers (NASW), which has its own code of ethics.

So now we can look at problems with which code to follow if you are members of more than one group, and what happens if the counselor tries to duck ethical behavior by not being a member of any association.

Let’s use an easy to understand example for this.

Can a counselor date and have sex with a client? If so how long do they have to wait to do the dating-sex thing?

For starters no behavioral health profession I know of thinks it is ok to have sex with a current client. That is taking advantage of a weak person and frankly sounds predatory.

The rule for substance abuse counselors is that they must wait 3 years after the client stops attending their PROGRAM (not just after no longer being their client) before they can date that former client.

Now, this substance abuse counselor decides to go on and become a professional counselor and while in school they join a professional counseling association. The norm in these groups is that you have to wait 5 years before dating a former client.

Now say this same person decides to become a Licensed Social Worker. The rule for the NASW is the professional may NEVER get sexually involved with a former client.

So which waiting period does this person need to observe 3 years, 5 years or never?

The rule is that you observe whichever code of ethics has the HIGHER ethical requirement. So, in this case, the answer to how long to wait would be forever.

Can this person get out of this bind by not being a member of the Social Workers Association?

Not really.

Most licensing laws require the professional to follow the customary ethics of the profession whether the professional is a member of that group or not. See if most other professionals think it is unethical then that behavior is probably illegal also.

Even if that behavior, dating or some other “dual relationship” is not outright illegal, should the professional get into that sexual relationship and then break up with that former client, they might get sued and in that case, code of ethics or not, the former client will probably win.

So the bottom line is that professional should always adhere to the highest possible standard of ethical behavior whether they are members of a group or not.

Just not belong to a professional group does not allow you to do things the rest of the profession thinks are unethical.

Hope that helped explain this ethical issues problem. If you are not sure, you may need to contact the appropriate professional association and remember the client should be contacting an attorney or making a complaint to the appropriate licensing board if they think the professional harmed them.

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CAMFT – CALPCC and the future of mental health in California

By David Joel Miller

If you are not a Marriage and Family Therapist (LMFT) or a Professional Clinical Counselor (LPCC) you may not have heard about the commotion going on here in California.

CAMFT has for a very long time been the primary voice of MFT’s both in California and Nationally. CAMFT membership exceeds 30,000 MFTs, far more than the membership of the American Association of Marriage and Family Therapists.

While California was an early adopter of the MFT profession it was the last state to adopt the licensing of Professional Clinical Counselors.

CALPCC has become the state-wide organization for the Licensed Professional Clinical Counselors. This new sister profession is off to a dramatic start.

Some of you may be aware that I hold both licenses. I elected to become dually licensed because I feel that there are differences in the things that the two specialties do and personally I have times when I practice both professions.

Since I have two licensees I am a member of both CALPCC and CAMFT. I also have been honored to serve on the board of directors for CALPCC.

Now that there are three mental health licenses (LCSW’s MFT’s and LPCC’s) here in California we are still sorting things out. (Four if you count the registration and certification of Substance abuse counselors.)

Both the LMFT’s and the LPCC’s face challenges ahead.

MFT’s were founded on system theory and the requisite skill set includes couples or marriage counseling. Some but not all LPCC’s are trained to do marriage counseling. The challenge for MFT’s consists of maintaining that there is something different about what they do. This becomes a particular challenge as more and more MFT’s are working in county agencies with individual clients rather than seeing couples and families.

LPCC’s have specialized training that some, but not all MFT’s received, particularly in the areas of career counseling and substance abuse work. LPCC’s also have skills in working with nonverbal clients. Because LPCC’s are the newest profession there has been a reluctance to open jobs, especially in the public, governmental sector for LPCC’s even when their skill set might be a better match than an MFT’s.

Recently CAMFT’s board of directors proposed changing their bylaws so that all mental health professionals could become members. This would leave MFT’s with no organization to represent their interests and two competing organizations for LPCC’s.

Now a group of CAMFT members has succeeded in triggering a vote on the CAMFT bylaws to return CAMFT to an MFT only organization.

No less than H. Dan Smith, two-time CAMFT president, has sent out a letter in support of retaining the old bylaws to keep CAMFT an MFT only organization.

Personally, I think this is a good idea.

If you are an MFT, MFT student or intern, and plan to continue to practice Marriage and Family therapy as a specialty then I believe you should vote for the old bylaws and become or stay a member of CAMFT.

If you consider yourself a counselor and are a counseling student, PCCI (intern) or a Licensed Professional Clinical Counselor (LPCC) then I encourage you to join and support CALPCC. You might also want to like CALPCC on FaceBook.

If you are one of that group that now holds both licenses I believe you owe it to yourself to continue membership in both groups.