Client Rights and Counselor Responsibilities

• Informed consent: : Involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it
• informed consent is both an ethical and legal obligation.
• Content of Informed Consent

  • Therapeutic process, therapist background, costs, duration, and termination of therapy, consultation procedures, interruptions, benefits, risks, alternatives, confidentiality, and telecommunication usage.
• Record-Keeping

  • From a clinical perspective: Record-keeping provides a history that a therapist can use in reviewing the course of treatment.
  • From an ethical perspective: Records can assist practitioners in providing quality care to their clients.
  • From a legal perspective: State or federal law may require keeping a record. Many practitioners believe that accurate and detailed clinical records can provide an excellent defense against malpractice claims.
  • From a risk management perspective: Keeping adequate records is the standard of care.
• Content for Inclusion in Records


  Includes client data, complaints, assessments, referrals, diagnoses, treatment plans, progress notes, appointments, termination summaries, and release of information.
• Counselors have the responsibility for storing client records in a secure place and exercising care when sending records to others by mail or through electronic means.
• Helping professionals who utilize the “cloud” as an off-site storage tool may be exposing themselves and their clients to unforeseen risks
• It is the counselor’s responsibility to examine the ethical, legal, and clinical issues related to online counseling.
• Basic issues such as self-disclosure, confidentiality, boundaries, and dual relationships can take on unexpected shapes in online counseling.
• Some Advantages of Online Counseling

  1. Reaching clients who are reluctant to participate in face-to-face therapy as well as those who have certain disabilities or chronic illnesses that render them immobile
  2. Improving client access in rural areas
  3. The potential for greater numbers of people to receive services
• Some Disadvantages of Online Counseling

  1. Danger of making an inaccurate diagnosis
  2. Compromising confidentiality and privacy
  3. Difficulty in protecting clients in crisis
  4. Challenges of working through transference and countertransference
  5. Lack of competence and danger of the misrepresentation of a counselor’s qualifications
• Counselors need to stay current regarding the changing laws pertaining to counseling across states.
• Important Issues when Working with Children and Adolescent

  1. Minors’ rights regarding informed consent
  2. Parental rights to information about a minor’s treatment
  3. Minors’ assent versus consent
  4. Involving parents in the counseling process with minors
  5. Important issues to consider:
  6. Limits to confidentiality
  7. Dealing with reluctance
  8. Need for supervised clinical experience in play therapy, art and music therapy, and recreational therapy
• Parents are entitled to general information from the counselor about the child’s progress in counseling.
• Exceptions to parents informed consent regarding therapy for minors is legally when a minor is seeking counseling for dangerous drugs or narcotics, for sexually transmitted diseases, for pregnancy and birth control o for an examination following alleged sexual assault of a minor over 12 years of age
• If practitioners need to make decisions about accepting minors without parental consent, they should know the relevant statutes in their state. They should also consult other professionals in

  assessing the ethical issues involved.
• Whenever possible, involve parents of minors in the initial meeting with their child in order to arrive at a clear, mutual agreement regarding nature and extent of information that will be provided to them (disclosure guidelines).
• Allow the client to disclose on their own what they see fit. This protects the counselor.
• Although minor clients have an ethical right to privacy and confidentiality in the counseling relationship, the law still favors parents over their children.
• Provide minors with information that will help them become active participants in their treatment. Provide minors with treatment alternatives and enlist their participation in defining goals for their therapy. This demonstrates respect for them and therapeutic change is promoted.
• Resistance to therapy can be minimized if therapists are willing to openly and non defensively explore the reasons behind resistance.
• Involuntary commitment is sought only after less restrictive alternatives have failed.
• The purpose is to secure treatment for clients rather than punish them. It should not be harsh, hazardous or intrusive than necessary to achieve therapeutic aims and to protect clients and pothers from physical harm.
• Involuntary civil commitment is based on: mental illness, dangerousness to self or others, disability, refusal to consent, incapacity to decide on treatment and compliance with the least restrictive alternative
• Ignoring evidence of peer misconduct is an ethical violation in itself.
• Malpractice means “bad practice.”It is the failure to render professional services or to exercise the degree of skill that is ordinarily expected of other professionals in a similar situation
• Professional negligence can result from unjustified departure from usual practice or from failing to exercise proper care in fulfilling one’s responsibilities
• Standard of care: Standards that are commonly accepted by the profession and are considered as the acceptable standard of practice in the community
• Elements of Malpractice

  1. A professional relationship between the therapist and the client must have existed.
  2. The therapist must have acted in a negligent or improper manner, or have deviated from the “standard of care” by not providing services that are considered “standard practice in the community.”
  3. The client must have suffered harm or injury, which must be verified.
  4. There must be a legally demonstrated causal relationship between the practitioner’s negligence or breach of duty and the damage or injury claimed by the client.
• Reasons for Malpractice Suits

  1. Failure to obtain or document informed consent
  2. Refusal to counsel clients due to value differences
  3. Client abandonment or premature termination
  4. Marked departures from established therapeutic practices
  5. Sexual misconduct with a client
  6. Practicing beyond the scope of competency
  7. Negligent assessment or misdiagnosis
  8. Repressed or false memory
  9. Unhealthy transference relationships
  10. Failure to assess and manage a dangerous client
• Risk Management


  The practice of focusing on the identification, evaluation, and treatment of problems that may injure clients and lead to filing an ethics complaint or a malpractice action.
• One of the best precautions against malpractice is personal and professional honesty and openness with clients.
• Treat the malpractice lawsuit seriously
• Do not attempt to resolve the matter with the client directly
• Contact the ethics and risk management services of your professional associations
• Become familiar with your liability policy, including limits of coverage, and contact insurance company immediately
• Never destroy or alter files or reports pertinent to the client’s case
• Do not discuss the case with anyone other than your attorney
• Determine support available to you from professional associations
• Do not continue a professional relationship with a client who is bringing a suit against you