Professional Documents
Culture Documents
Ethics in A Canadian Counselling and Psychotherapy Context - Digital
Ethics in A Canadian Counselling and Psychotherapy Context - Digital
CANADIAN
COUNSELLING
and
PSYCHOTHERAPY CONTEXT
Editors
MICHAEL N. SORSDAHL, ROBERTA A. BORGEN, WILLIAM A. BORGEN
ETHICS IN A
CANADIAN
COUNSELLING
AND
PSYCHOTHERAPY
CONTEXT
MICHAEL N. SORSDAHL
Editors
ROBERTA A. BORGEN
WILLIAM A. BORGEN
ADOBE STOCK
Copyright © 2023 by the Canadian Counselling and Psychotherapy Association
ISBN: 978-0-9952097-8-7
Printed in Canada
CONTENTS
CHAPTER ONE
THE HISTORICAL EVOLUTION OF ETHICAL PRACTICE 1
Within the Canadian Counselling and Psychotherapy Association
CHAPTER TWO
LEGAL / REGULATORY IMPLICATIONS FOR ETHICAL PRACTICE 21
CHAPTER THREE
ETHICAL DECISION- MAKING MODELS 37
CHAPTER FOUR
PROFESSIONAL RESPONSIBILITY 61
CHAPTER FIVE
COUNSELLING / THERAPY RESPONSIBILITIES 77
CHAPTER SIX
ASSESSMENT AND EVALUATION 95
CHAPTER SEVEN
PROFESSIONAL RESEARCH AND KNOWLEDGE TRANSLATION 115
i
CONTENTS
CHAPTER EIGHT
CLINICAL SUPERVISION SERVICES 129
CHAPTER NINE
CONSULTATION SERVICES 149
CHAPTER TEN
COUNSELLOR / THERAPIST EDUCATION AND TRAINING 159
CHAPTER ELEVEN
USE OF ELECTRONIC AND OTHER TECHNOLOGIES 179
CHAPTER TWELVE
INDIGENOUS PEOPLE, COMMUNITIES AND CONTEXTS 197
CHAPTER THIRTEEN
ETHICAL COMPLEXITY IN PRACTICE 227
CHAPTER FOURTEEN
ETHICAL DILEMMAS 243
APPENDIX - A
CODE OF ETHICS (Excerpt) 403
ii
ADOBE STOCK
iii
ABOUT THE EDITORS, AUTHORS,
AND CONTRIBUTORS
EDITORS
Dr. Michael N. Sorsdahl, CCC, RCC, GCDFi, has over 20 years of ex-
perience in group, family, couples, and individual counselling/psychother-
apy. Michael is the current chair of the Canadian Counselling and Psycho-
therapy Association (CCPA) Ethics Committee – Complaints Division, and
is a past-president of the Counsellor Educators and Supervisor’s Chapter.
Michael has served as an instructor with several institutions in their coun-
selling programs including University of Victoria, University of British Co-
lumbia, University of Lethbridge, and Yorkville University. Michael is also
a registered psychologist in BC and Alberta in private practice based on his
MA in counselling psychology.
Dr. Roberta A. Borgen (Neault), CCC, CCDP, GCDFi, has over 30
years of experience in career and employment counselling, counsellor-ed-
ucation, and program and curriculum development. Roberta has served as
a instructor within a variety of counselling programs including Athabasca
University, Simon Fraser University, Trinity Western University, the Uni-
versity of Lethbridge, and the University of British Columbia. Additionally,
she’s served as a core faculty member and Associate Dean within the Faculty
of Behavioural Sciences at Yorkville University. Roberta has served on the
executives of several CCPA chapters including the Counsellor Educator and
Supervisors Chapter, Career Counsellors Chapter, and the BC Chapter.
Dr. William A. Borgen, is a professor of Counselling Psychology at the
University of British Columbia. He has extensive experience conducting re-
search and developing programs regarding life transitions and career devel-
opment. His work has been translated and adapted for use in a number of
countries. The University of Umea awarded him an honorary doctorate for
his leadership in counsellor education in Sweden. Dr. Borgen is a past-Pres-
ident of CCPA and has co-chaired the CACEP since 2003. He is an Hon-
orary Life Member of CCPA and a Fellow of the Canadian Psychological
Association. He was elected President of the International Association for
Counselling in May 2019.
iv
INVITED AUTHORS
In several chapters, the editorial team invited chapter contributions
from experienced counsellors/psychotherapists, counsellor educators, and
researchers.
Andrea Rivera and Sherry Law, TISC, have been members of the exec-
utive for the Technology and Innovative Solutions Chapter of the Canadian
Counselling and Psychotherapy Association since 2018 and 2016 respec-
tively. They have their own private practices in the Maritimes. They have
both taken interest in learning about relevant technologies in practice as
well as emergent technologies and their ethical applications.
Dr. Glenn Sheppard is a President Emeritus of CCPA and was a pres-
ident of the CCPA Counsellor Educators Chapter. He was a counsellor
educator for 25 years at Memorial University of Newfoundland. Glenn is
co-author of the book Counselling Ethics: Issues and Cases and author of the
Collection of Notebooks on Ethics, Legal Issues, and Standards of Practice for
Counsellors and Psychotherapists. He lead the development and writing of
the CCPA Code of Ethics (1999) and Standards of Practice for Counsellors
(2001) and contributed to subsequent revisions of them including to the
latest editions (2020).. Glenn initiated and maintains the Cognica Notebook
on Ethics, Legal Issues, and Standards of Practice for Counsellors and Psycho-
therapists. He has served as Chair the CCPA Ethics Committee and chaired
the CCPA Adjudication Complaints Tribunal and currently serves as CCPA
Ethics Amicus. Glenn was co-chair of the CCPA National Working Group
on Labour Mobility 2008-2011 and its three national symposia (2008,2009
and 2011). He lives in St. John’s and works in private practice.
Kim Bayer (Métis) is a registered clinical counsellor practicing in Van-
couver and Coast Salish territory. She has worked nationally, provincial-
ly, and in community-based roles in health and social services sectors. As
a lifelong learner, Kim draws from holistic Indigenous ways, being, and
knowing, as well as Western therapeutic tools to facilitate psycho-education
groups, talking circles, and individual counselling.
v
Lawrence Murphy is the founder of Worldwide Therapy Online, the
world’s first online clinical practice, established in 1994. He received his MA
in Counselling Psychology from UBC in 1995. During the pandemic Law-
rence delivered 140 webinars to more than 15,000 mental health profession-
als across the country. Mr. Murphy and his team publish regularly in the
academic literature, and he is widely considered one of the world’s foremost
experts in online counselling. Lawrence also teaches in the Department of
Psychology at Wilfrid Laurier University and in the School of Continuing
Studies at the University of Toronto.
Pamela Patterson PhD., R. Psych. (She/Her) is a professional mem-
ber of CCPA. She is in private practice in Vancouver, BC on the tradition-
al, ancestral and unceded territories of the Musqueam and Tsleil-Waututh
nations. She teaches and provides supervision at the University of British
Columbia and Adler University. She is a member of CCPA’s CACEP Board
and the advising committee for CACEP. She is a writer and author. She par-
ticipates locally and internationally in counselling supervision. She is part of
a peer consultation group and she both employs and provides consultation
with counsellors and psychologists.
Sharon E. Robertson is Professor Emerita and Faculty Professor at the
Werklund School of Education, University of Calgary, where she taught in
the Counselling Psychology program and served as Director of Training
for many years. She is a registered psychologist in Alberta and served as
CCPA President (1991-93). She has been Co-Chair of the CCPA Council on
Accreditation of Counsellor Education Programs (CACEP) since 2001 and
co-authored the 2002 and 2022 accreditation standards. Her main research
interests centre on counsellor education and supervision; program quality
assurance; psychosocial, cross-cultural, and life transitions; stress, coping,
and social support.
vi
LIST OF CONTRIBUTERS
Throughout the duration of this project, the editorial team sourced
contributions from counsellors/psychotherapists who described ethical di-
lemmas they are grappling with and/or employed ethical decision-making
models to illustrate approaches for working through those cases. Their brief
biographies are included here:
Charlena Marcuccio, is a student with Yorkville University in their
Masters of Arts and Counselling Psychology (MACP) program and expect-
ing to graduate in December 2023. She has been working as a student liaison
with CCPA for the Spirituality Chapter.
Dr. Colleen Haney, Associate Professor (Emeritus), Educational and
Counselling Psychology, and Special Education (ECPS); Faculty of Educa-
tion, UBC; Registered Psychologist, BC; Member of College of BC Teach-
ers; Past Director of Clinics and Practicum in ECPS. Currently focusing on
An Equine Program to Reduce PTSD and Anxiety Symptoms in Veterans
and First Responders.
Gail Smillie, has worked in the area of child and family counselling for
the past 40 years, and has been a member of the CCPA for the past 20 years
and a member of the CCPA Ethics Committee, Complaint Division since
October 2019. While working in BC she was a Registered Clinical Coun-
sellor with BCACC working with Kamloops Youth Resources, Kamloops
Head Injury Society, University of Victoria, and as a mental health therapist
with the Ministry for Children & Families. In Alberta, she specialized in
trauma and attachment working with adoptions, kinship, early childhood
development, and family therapy. Gail is currently in private practice in
Canmore, AB doing counselling, consultation & clinical supervision.
Laura Crossley, MA, CCC-Q, is a counsellor and also Male to Female
Transgender, working with adults and youth seeking possible gender transi-
tion. Member of the World Professional Association for Transgender Health
(WPATH) and strong advocate for Trans Healthcare in BC.
Laurie Ponsford-Hill, CCC, Clinical Director, has been the Clinical
Director of The Counselling House for the past 15 years. As a clinical su-
pervisor for art therapists, social workers, marriage and family therapists,
and psychotherapists, Laurie has had the opportunity to work through
many ethical dilemmas with her supervisees. Laurie has been a member
of the ethics complaints committee for the CCPA for the past 4 years and
has learned a tremendous amount while working through a wide range of
complaint issues.
vii
Dr. Lorraine Smith-MacDonald, is a Postdoctoral Fellow at the Uni-
versity of Alberta. Her research specializes in spirituality and moral injury
and how it intersects with other stress-related psychological injuries in mil-
itary, veteran, and public safety personnel.
Marita Poll, RCC, M.Ed worked at BC Cancer for over 19 years as
a Clinical Counsellor, with the last 5 years as the Practice Leader for the
counselling department as well. In semi-retirement now, Marita is using
her training in Somatic Psychotherapy and Emotion-Focused Therapy to
provide counselling services for Healthcare professionals, family caregivers,
and the bereaved.
Dr. Marla Buchanan is a Professor in the Counselling Psychology Pro-
gram in the Faculty of Education at the University of British Columbia. She
is the co-ordinator for the School Counselling Program and her research
interests are in the field of traumatic stress studies.
Meghan Scott, RCT-C, CCC, works largely with couples using the Gott-
man method of couples counselling, although she is integrative and flexible
in her approach. Meghan also works with individuals experiencing numer-
ous presenting issues including, but not limited to: trauma, mood disorders,
stress management, and personality disorders. Meghan has worked mostly
in private practice but has also worked for a non-profit. Meghan has been
licensed for about a year and a half. The majority of her clientele are adults
who self-refer, although she also occasionally works with teenagers and in-
dividuals who have been mandated to attend counselling.
Dr. Michele P. Mannion, LCPC, ACS, has 25 years of graduate teaching
experience, in addition to extensive experience supervising graduate stu-
dents, both in onsite clinical settings and as a faculty supervisor. A member
of CCPA, she has taught for 15 years in the Counselling Psychology pro-
gram at Yorkville University. Michele has clinical experience across a wide
variety of settings, including community mental health, college counselling,
and school-based clinical services. Presently in private practice, she utilizes
an existential-humanistic approach in her work with clients.
Monica Verbosky, MACP, has 20+ years of experience in technology
worldwide, and currently is sitting as Technology and Innovative Solutions
Chapter (TISC) President and Member at Large for the Spirituality Chapter
of CCPA.
In addition, several contributors served as chapter reviewers.
Angela Grier, Piiohksopanskii (Singing Loudly Far Away) is from the
Piikani Nation, of the Blackfoot Confederacy. She is the Indigenous Initia-
tives Lead for CCPA’s National Office and a Registered Provisional Psychol-
ogist in Alberta. Angela has been working with advocacy issues for over 25
viii
years at First Nation, regional, provincial, and national levels. Her career
has explored the impacts of colonization, Indigenous cultural revitalization,
systemic decolonization, environmental and Indigenous rights advocacy,
and post-secondary involvement. Her graduate publication explored Black-
foot spirituality as a framework for wellness towards the decolonization of
counselling. Angela resides in her traditional territory of the Blackfoot peo-
ple.
Dawn Schnell, MA, CCC, CCDP has been a counsellor for over 35
years. She has worked for non-profit agencies and educational institutions
and has volunteered with the CCPA on a variety of chapter boards. Dawn
specializes in the uses of technology in counselling and psychotherapy and
career counselling.
Fiona J. Trend-Cunningham, MEd, MA, CCC, has been a mental
health practitioner in Newfoundland and Labrador for over 20 years. Her
training and experience in both counselling and clinical psychology, as well
community, academia, and public and private practice settings. She is a re-
searcher of posttraumatic growth and women’s health and has presented
research internationally. Her clinical work is focused on women’s mental
health and supporting diverse neurotypes in adult women. Her clinical
work is from a post-modern feminist perspective and her anti-oppression
work includes the accessibility of psychology training practices and the
teaching of psychology.
Michele Mani, M.Ed., RP, CCC, is a Registered Psychotherapist and
Clinical Supervisor with decades of experience providing (asynchronous
and synchronous) virtual and online therapy as well as supervising qual-
ifying and fully registered therapists. Michèle has a private practice where
she is honored to support therapists and clients; is a Board Member of the
CCPA TISC Chapter, and collaborator for the CCPA Supervisory Circle of
Practice.
Lastly, our Copy Editor
Lisa Vanderstelt completed a BA in Psychology and English and an
MA in Vocational Rehabilitation Counselling at the University of British
Columbia. Since completing her master’s degree, Lisa has worked in disabil-
ity management for over 10 years. She is known for her compassionate and
empathic approach and her desire to make a positive difference in the lives
of others. She is also known for the excellence of her writing and her keen
attention to detail.
ix
ACKNOWLEDGEMENTS
The editorial team would like to acknowledge the commitment of Ca-
nadian Counselling and Psychotherapy Association (CCPA) in financially
supporting the development of a relevant, timely, and thorough ethical re-
source to meet the needs of counsellors and psychotherapists, educators,
and supervisors. This project wouldn’t be possible without the leadership
and guidance of CCPA. In addition, the availability and willingness of the
invited authors to lend their expertise and insights to the chapter contribu-
tions were essential in developing a rich resource rooted in the realities of
practice. The final compilation represents a true collaboration amongst di-
verse thought leaders to meet the needs of equally diverse contexts in which
Canadian counsellors and psychotherapists work, learn, and grow.
The editorial team would also like to thank the countless counsellors/
psychotherapists who provided their input during the consultation and
conceptualization phase of this publication – sharing their insights into the
ethical landscape they’re traversing, providing case examples of ethical di-
lemmas, and agreeing to illustrate ethical decision-making processes and/or
reviewing chapters, cases, and/or ethical decision- making responses. Spe-
cial gratitude to the members of the CCPA’s ethics review committee (Mary
Hernandez, Daniel Nadon, Laurie Ponsford-Hill, Patricia Jones, Patricia
Wentzell, and Gail Smillie) who also played an integral role with the ethical
decision-making vignette solution review process.
Lastly, we’d like to acknowledge our amazing administrative team (Cas-
sie Taylor, Desiree Carlson, Leor Elizur, and Michael Partridge) who worked
closely with editors, authors, and contributors throughout the research, de-
velopment, writing, and design phases of this project.
x
OVERVIEW
xi
chapter concludes with thoughtful discussion prompts and relevant case ex-
amples. We invite you to work through the case examples using an ethical
decision-making model of your choosing, referring to Part IV, to compare
and contrast potential solutions.
Section 3 provides additional, multidimensional and complex cases to
stimulate further reflection and discussion as you gain familiarity with ethi-
cal decision-making processes. We invite you to refer to these cases to deep-
en your understanding of ethical practice and to gain experience in applying
the decision-making models.
Section 4 presents alternative approaches to conceptualizing, analyz-
ing, and resolving dilemmas related to those cases introduced within Part II.
We invite you to review and learn from alternative approaches to working
through ethical dilemmas by using the ethical decision-making models to
explore different viewpoints.
xii
Using this Book
This hybrid text and casebook seeks to address the needs of counsel-
lor educators & supervisors, counsellors-in-training, as well as practicing
counsellors and psychotherapists.
Counsellor Educators & Supervisors: As a textbook, this book serves
as a valuable, comprehensive, Canadian resource that addresses the full
spectrum of ethical constructs. It can be easily integrated into curriculum
and supervision plans with thoughtful discussion questions to deepen stu-
dents’ reflections. The book also offers diverse examples of ethical dilem-
mas to which different ethical decision-making models have been applied,
illustrating more than one perspective for each case.
Counsellors-in-Training: This book invites you to dive deeply into
ethical principles, standards, dilemmas, and practice implications with spe-
cific links to CCPA’s (2020) Code of Ethics and Standards of Practice (CCPA,
2021). Leave with a deepened understanding of ethical practice grounded
in recommendations drawn from experienced counsellors/psychotherapists
across diverse settings.
Practicing Counsellors/Psychotherapists: Beyond providing a re-
fresher for ethical practice, this book presents tools for self-reflection that
can extend and improve your ethical practice. The case examples with cor-
responding ethical decision-making model illustrations and, also, the sec-
tion with complex cases will be particularly useful.
xiii
SECTION 1 Contextualizing Ethical
Practice for Today’s
Counsellors / Therapists
CHAPTER ONE
THE HISTORICAL
EVOLUTION OF
ETHICAL PRACTICE
Within the Canadian Counselling
and Psychotherapy Association
Sharon E. Robertson
INTRODUCTION / CONTEXT
The purpose of this chapter is to trace the evolution of ethical practice
within counselling in Canada through the Canadian Counselling and Psy-
chotherapy Association (CCPA), given the significant role CCPA has played
in the development of counselling in this country. Not only does this pro-
vide a historical record of that evolution, but it will also allow counsellors/
therapists to familiarize themselves with the historical evolution of ethical
practice.
An important milestone in the history of the development of counsel-
ling in Canada was the formation of the Canadian Guidance and Counsel-
ling Association (CGCA) at a conference in Niagara Falls, Ontario in 1965
(Robertson & Borgen, 2016a). In 1999, the Board of Directors approved a
2 CHAPTER 1
The 1980s
An important initiative undertaken by CGCA in the early 1980s result-
ed in a document, Guidelines for Ethical Behaviour, which was published in
1981 under the authorship of Mike Springer (Kelly, 1983). This document
outlined guidelines in four areas (General, Counsellor-Counsellee Rela-
tionships, Measurement and Evaluation, and Research and Publication),
with a total of 46 guidelines” (W. E. Schulz, 2000, p. 3).
In 1987, at the request of CGCA, Dr. Bill Schulz revised the 1981 guide-
lines, resulting in new Guidelines for Ethical Behaviour, published in 1989
(W. E. Schulz, 2000). The 1989 guidelines were grounded in three basic
principles: “the respect of the dignity and integrity of persons, responsi-
ble caring in counselling relationships and responsibility to society” (W. E.
Schulz, 1994, p. 185). The revisions included replacement of two existing ar-
eas (measurement and evaluation; research and publication) with one area
(testing, research, and publication) and the addition of two new areas (con-
sulting and private practice; counselling preparation). The 1989 guidelines
then focused on five areas (General [i.e., professional behaviour]; Counsel-
ling Relationships; Testing, Research and Publication; Consulting and Pri-
vate Practice; and Counsellor Preparation), with a total of 63 ethical articles
overall (W. E. Schulz, 1994).
During the 1980s the process of refining and extending the existing eth-
ical guidelines was well underway and CGCA had established some founda-
tions for developing better ethical practice.
The 1990s
The 1990s was a decade in which CCPA moved ahead with new initia-
tives in the ethics portfolio. During this decade, it enhanced its role in mon-
itoring ethical behaviour, extended its efforts in educating members about
ethical practice, changed its name, and revitalized its guidelines for ethical
behaviour.
Recognizing a need to educate its membership about professional ethics
and to become more active in monitoring the professional conduct of its
members, CGCA formed an Ethics Committee in 1992. The role, functions,
and composition of the committee, as well as procedures for submitting and
processing alleged violations of the CGCA Guidelines for Ethical Behaviour,
were outlined in a document, Procedures for Processing Complaints of Ethi-
cal Violations (W. E. Schulz, 1994, pp. 185-187).
4 CHAPTER 1
communication including the Wigmore criteria for establishing privileged
communication, and informed consent (e.g., dealing with requests for in-
formation). The Ethics Notebook also contained a draft preamble of a new
Code of Ethics, a copy of the CGCA. Procedures for Processing Complaints
of Ethical Violations, and an invitation to review and provide feedback on
a draft of the new CGCA Code of Ethics. In the July 1999 Ethics Notebook
column in COGNICA, Dr. Glenn Sheppard (1999) noted:
The past two years has been a very busy period for the CGCA
Ethics Committee. There has been a considerable increase in
the number of consultations with the Committee by members
concerned about ethical issues. Some members were seeking
information or clarification with respect to related articles of the
current Guidelines on Ethical Behaviour. Others needed assis-
tance with clarifying or resolving their position with respect to
some ethical challenges with which they were faced. (p. 8)
The ethical issues on which consultations took place during the prior 24
months pertained to dual relationships, access to records, and responsibility
for files and clients when leaving a private practice partnership. The Eth-
ics Committee dealt with three complaints made against CGCA members
during that 24-month period. The Committee also received queries about
CGCA accountability provisions for members with counsellor certification
status (Sheppard, 1999). Overall, the ethics column in COGNICA not only
served an educational function but also served as a means through which
the Ethics Committee could communicate directly with CCPA members
and vice-versa.
In addition to setting up the Ethics Committee, publishing the Ethics
Casebook, and beginning the Ethics: Issues and Cases column in COGNI-
CA, several other important initiatives pertaining to ethics were undertaken
within CGCA in the 1990s. One of these was the appointment of a region-
ally based ethics committee to act as consultants and to assist in processing
any complaints. The Committee was made up of members from every prov-
ince in Canada (Borgen, 1995). Another professional development initiative
related to ethics was initiated by Drs. Bill Schulz and Max Uhleman. They
developed a 2-day ethics workshop that could be offered by CGCA in dif-
ferent regions of the country and would be eligible for CGCA Continuing
Education Credits. Indeed, the workshop outline, including the course de-
scription and objectives, instructional format, requirements and expecta-
tions, required text, and a list of topics with approximate time allocated, was
published in COGNICA (W. E. Schulz, 1995).
6 CHAPTER 1
became Counsellor Education, Training, and Supervision. The change to
Counsellor Education, Training, and Supervision in the 1999 Code of Ethics
(Sheppard et al., 1999) is noteworthy as it was in keeping with CCA’s grow-
ing interest in that area more broadly and presaged further developments to
come in subsequent decades.
To summarize, during this decade, CGCA had established an Ethics
Committee, with both educational and monitoring responsibilities. It had
developed policies and procedures for dealing with complaints regarding
ethical violations and established a committee of consultants to draw on
for ethics matters. It had published an ethics casebook to supplement the
1989 ethical guidelines and subsequently published a code of ethics in 1999.
Besides that, it had established an ethics column in COGNICA and begun
offering ethics workshops. In short, by the end of the decade, CCA had
moved a long way forward in instituting policies and procedures related to
ethics that are fundamental to professional organizations.
The 2000s
The decade of the 2000s was marked by continued work on another
counselling ethics casebook, new standards of practice, a revised code of
ethics, and the counselling ethics column in COGNICA. In keeping with
the ongoing need to help educate counsellors, counsellor educators, and
counselling researchers about counselling ethics, ethical issues, and ethical
decision-making and to clarify some of the ethical issues and dilemmas that
could not be fully addressed in the 1999 Code of Ethics, CCA published
another edition of the counselling ethics casebook in 2000. This second edi-
tion of the Counselling Ethics Casebook (W. E. Schulz, 2000) focussed on the
principles, values, and articles outlined in the 1999 code, provided 280 case
examples of both positive and negative ethical behaviour, and included a
range of essays to clarify ethical issues pertaining to the articles. For exam-
ple, the following essays provided greater clarity around issues in counsel-
ling relationships: (a) Confidentiality: Dialogue and Discernment; (b) The
Counsellor as Custodian: Protecting Our Clients’ Personal Information; (c)
The Duty to Protect; and (d) Boundary Violations in Counsellor-Client Re-
lationships (W. E. Schulz, 2000).
A new development during the 2000s was the introduction of standards
of practice to accompany the CCA code of ethics. A code of ethics consists of
a set of principles and values that underly a profession and that are designed
to facilitate ethical decision-making. Standards of practice, on the other
hand, are designed to accompany a code of ethics and indicate the mini-
8 CHAPTER 1
then cross-referenced with one another as appropriate (W. E. Schulz et al.,
2006). According to Schulz and his colleagues (2006, p. 20), a CCA Code of
Ethics was produced in 2006 and the document (CCA, 2006) was referenced
in their book. According to CCPA (2007), a copy of the revised document
was approved by the CCA Board of Directors and published in 2007. Both
documents refer to the same content as a copy of the same 73 ethical articles
appears in both W. E. Schulz et al. (2006, pp. 338-348) and CCPA (2007).
In 2006, CCA also published a new ethics casebook (W. E. Schulz et
al., 2006) to accompany the new Code of Ethics. This book was divided into
two sections: an ethical issues section and a cases section. It was intended
to serve not only as a casebook, but also as a textbook for courses in coun-
selling ethics. The ethical issues section included chapters in the following
six areas: (a) client rights, counsellor responsibilities, and informed con-
sent; (b) privacy, confidentiality, and privileged information; (c) managing
boundary issues; (d) diversity issues; research and publication issues; and
(f) counsellor education, training, and supervision issues. These chapters
reflected critical emerging ethical issues in counselling and a growing rec-
ognition of their increasing complexity and scope. The second part of the
book contained cases organized according to each of the six main sections
in the new Code of Ethics. It is noteworthy that in this version of the case-
book, significant attention was given to diversity issues through the chapter
on counselling in a culturally diverse society and through the many cases
involving diversity in the second section of the book. This focus was timely
and imperative as counsellors were being challenged and continue to be
challenged to provide contextually sensitive counselling “taking into con-
sideration the client’s culture, race, religion, [gender], sexual orientation,
disabilities, ethnic background and any other characteristics that are gen-
erally viewed as somewhat unique” (W. E. Schulz et al., 2006, p. i). In addi-
tion, the increased focus on ethical issues in counsellor education, training,
and supervision corresponded with another CCA initiative at the time, the
development of standards and processes for the accreditation of master’s
level counsellor education programs in Canada and the establishment of
the CCA Council on Accreditation of Counsellor Education Programs (CA-
CEP) in 2002 (Robertson & Borgen, 2016b). The casebook also included
copies of the CCA Code of Ethics, the National Board of Certified Coun-
selors’ The Practice of Internet Counseling, and CCA Procedures for Process-
ing Complaints of Ethical Violations. In this and the previous version of the
code of ethics and the counselling ethics casebook, there appeared to be a
growing momentum towards internet counselling, precipitating a need to
develop ethical guidelines/articles in this area.
10 CHAPTER 1
significant advancement in CCA/CCPA professional ethics policies and
procedures.
The 2010s
Moving into the next decade, there was considerable momentum pro-
vincially in the establishment of regulatory processes for counselling with
great variation in the title assigned to those who engaged in providing such
services. Given the generic nature of the term, “counselling,” in May 2011,
CCPA adopted the following definition:
Counselling is a relational process based upon the ethical use of specific
professional competencies to facilitate human change. Counselling address-
es wellness, relationships, personal growth, career development, mental
health, and psychological illness or distress.
The Counselling process is characterized by the application of recog-
nized cognitive, affective, expressive, somatic, spiritual, developmental, be-
havioural, learning, and systemic principles. (CCPA, 2013).
From 2010 to 2015, work on revising and updating the CCPA Standards
of Practice and developing a new ethics casebook continued. Revision of
the 2008 Standards of Practice resulted in a new document in 2015. In this
edition of the Standards, “all of the standards of practice were pinned to
the generic entry-to-practice level as determined by the nationally validated
competency profile for the counselling profession in Canada” (CCPA, 2015,
p. 1).
Another counselling ethics casebook, Canadian Counselling and Psy-
chotherapy Experience: Ethics-Based Issues and Cases, was also published
by CCPA in 2015. This book, edited by Drs. Lorna Martin, Blythe Shepard,
and Ron Lehr, was based on the 2006 CCA Code of Ethics. The book was
organized into the two-part structure (an ethical issues section followed by
a cases section) that was used in the previous casebook (W. E. Schulz et al.,
2006). At the same time, in this edition the number of essay chapters was
increased, to provide a more contextualized approach to ethical issues and
cases and to cover many areas that had not been focussed on previously.
The chapters highlighted the interaction between “specific ethical codes and
standards of practice in various contexts of counselling, such as working in
rural or remote areas, via electronic platforms, in private practice, and with
a variety of client groups” (Martin et al., 2015, p. 6), taking into account
diversity in client culture, race, religion, gender, sexual orientation, disabili-
ties, ethnic background; counselling couples, families, children, youth, and
2020 Onward
Three major CCPA undertakings came to fruition with new editions of
the CCPA Code of Ethics in 2020, the revised CCPA Standards of Practice in
2021, and the Council on Accreditation of Counsellor Education Programs
(CACEP) Accreditation Procedures and Standards for Counselling Education
Programs at the Master’s Level in 2022. In all three of these documents, there
is an increased focus on diversity, indigeneity, supervision, and technology.
The revisions in the 2020 Code of Ethics and 2021 Standards of Practice were
prepared by CCPA Committees chaired by Dr. Lorna Martin.
As noted in the preamble to the new Code, “Since the last revision of the
CCPA Code of Ethics, there have been major shifts in the use of technology
in the counselling and psychotherapy profession as well as changes in Cana-
dian demographics and social, political, economic, and cultural awareness”
(CCPA, 2020, p. iii). Taking this into account in the development of the
new code resulted in a revitalized emphasis on these aspects as well as those
related to “social justice, self-reflection, and diversity” (CCPA, 2020, p. iii).
Particular attention was given to incorporating important concepts and
contexts addressed by the Truth and Reconciliation Commission, “to ensure
that CCPA members understood the ethical imperative to seek knowledge
12 CHAPTER 1
and understanding and commit to self-reflection before engaging with In-
digenous clients and communities.” (CCPA, 2020, p. iii).
In the 2020 edition of the Code of Ethics, the ethical principles and ethi-
cal decision-making processes remained essentially the same as those in the
2006 code. The ethical principles were as follows:
a) Beneficence Being proactive in promoting the best
interests of clients
b) Fidelity Honouring commitments to clients and
maintaining integrity in counselling
relationships
c) Nonmaleficence Refraining from actions that risk harm
and not willfully harming clients
d) Autonomy Respecting the rights of clients to agen-
cy and self-determination
e) Justice Respecting the dignity of all persons
and honouring their right to just treat-
ment
f ) Societal Interest Upholding responsibility to act in the
best interests of society
(CCPA, 2020, p. 2)
An important change to the CCPA ethical decision-making process was
the addition of the “wise practices lens” model of decision-making (Wes-
ley-Esquimaux & Snowball, 2010, p. 230 as cited in CCPA, 2020, p. 5).
Counsellors/therapists are encouraged to approach all ways of
knowing when engaging in decision-making. Using Etuaptmunk
(two-eyed seeing) is of immense assistance. This way of perceiv-
ing situations refers to “learning to see from one eye with the
strengths of Indigenous knowledges and ways of knowing and
from the other eye with the strength of Western knowledges
and ways of knowing...and learning to use both eyes together
for the benefit of all.” (Marshall, A., 2004, http://www.integrative-
science.ca/Principles/TwoEyed Seeing/ as cited in CCPA, 2020, p.
5)
14 CHAPTER 1
counsellors/therapists make professional judgments and decisions. The
CCPA Standards of Practice provide action-based guidelines. Counsel-
lor/therapists are expected to adhere to both the CCPA Code of Ethics and
CCPA Standards of Practice. (CCPA, 2021, p. ix)
A particularly innovative aspect of the new Standards is that they may
be viewed through multiple overarching lenses such as those of “social jus-
tice, self-reflection and diversity” (CCPA, 2021, p. ix), as well as the use of
electronic and other technology for the delivery of various counselling-re-
lated services. Furthermore, counsellors/therapists are strongly encouraged
to view the standards through multiple overarching lenses to be able to situ-
ate and understand them within a larger context. It is also important to note
that the 2021 standards represent an effort to begin the process of address-
ing the Calls to Action by the Truth and Reconciliation Commission (2015)
and those of the United 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” (CCPA, 2021, p. x).
In keeping with the changes to the Code and the Standards, revised ac-
creditation standards were approved by the CCPA Board of Directors in
August 2022. Major changes to the CACEP standards include emphasis on
culturally responsive education (social justice and diversity) and acknowl-
edgement of the Truth and Reconciliation Commission of Canada: Calls to
Action, acceptance of diversity of program delivery methods given techno-
logical advances and resources (on and off campus), and the consideration
of core content areas and competencies, including (supervised) practice
within a changing regulatory environment (CCPA, 2022).
The issues addressed in CCPA’s recent code of ethics, standards of prac-
tice, and accreditation standards are in keeping with the directions being
taken by other professional counselling and psychotherapy associations in
North America. The issues have been highly prominent in codes of ethics,
standards of practice, and accreditation standards published by the Ameri-
can Psychological Association, the American Counselling Association, the
Canadian Psychological Association, and Career Development Profession-
als (CDP) – Canada (2021).
The Ethics Notebook in COGNICA from 2020 – 2023 included discus-
sion of topics such as counsellor impairment, access to records, protecting
privacy and confidentiality in the virtual world, statutory regulation, and
title protection in keeping with the changing status of counselling as a reg-
ulated profession.
To summarize, since the beginning of the decade, CCPA had produced
three documents that diverge from the past in major ways. The three doc-
uments include a code of ethics, standards of practice, and accreditation
CONCLUSION
Overall, it is clear that CCPA has come a long way in its development as
a professional organization since its early beginnings in 1965. Throughout
its history, it has continued to promote the development of counselling and
psychotherapy as a profession within the Canadian context. During that
time, it has strongly supported the development of ethical codes and stan-
dards of practice with recent changes placing it at the cutting edge of this
field. As noted in the next chapter and the rest of the book, the ethical issues
identified here are also given prominence in this casebook.
DISCUSSION QUESTIONS
1. Reflect on any insights or surprises that came up as you read about
the expansion and evolution of the ethical issues seen to be important
across the decades.
2. Discuss the notion that a code of ethics is a dynamic, living document
and how that is illustrated throughout this chapter. What changes to the
Code of Ethics or Standards of Practice do you anticipate might be con-
sidered in the next revisions? Why do you perceive these as important?
3. Reflect on how best to use the Code of Ethics, both in training and in
practice. Consider some of the ways that counsellors/therapists and stu-
dents in the field can be introduced to the contents of the Code?
4. Imagine serving on an ethics committee for your professional associ-
ation or regulatory college. What do you think you would enjoy about
the role? What might you find difficult?
5. Reviewing the Table of Contents and the structure of this book, what are
you most looking forward to reading and learning more about? Why?
16 CHAPTER 1
REFERENCES
Borgen, B. (1995). Past President’s report. COGNICA, XXVII(4), July/Au-
gust, 4-5, 7-8.
Canadian Counselling and Psychotherapy Association. (2007). CCPA code
of ethics. Author. Retrieved from https://www.capda.ca/_Library/re-
sources_ethics_codes_and_practice_guidelines/canadian-counsel-
ling-association-code-of-ethics-2007.pdf
Canadian Counselling and Psychotherapy Association. (2008). CCPA stan-
dards of practice for counsellors. Author. (Approved by the CCPA Board
of Directors 2008; Copyright received 2012).
Canadian Counselling and Psychotherapy Association. (2013). Who are
counsellors/psychotherapists? Retrieved from https://www.ccpa-accp.
ca/profession-and-regulation/
Canadian Counselling and Psychotherapy Association. (2015). CCPA stan-
dards of practice. (5th ed.). Author.
Canadian Counselling and Psychotherapy Association. (2020). CCPA code
of ethics. Author.
Canadian Counselling and Psychotherapy Association. (2021). CCPA stan-
dards of practice. (6th ed.). Author.
Canadian Counselling and Psychotherapy Association (2022). CCPA ac-
creditation standards for Master’s level counselling programs in Can-
ada. (Author).
Canadian Counselling Association. (2006). CCA code of ethics. Author.
Canadian Guidance and Counselling Association. (1999). Guidelines for
CGCA members who own and/or work as counsellors at private coun-
selling agencies. COGNICA, XXXI(1), January, 19.
Kelly, M. (1983). Ethical standards casebook. COGNICA, XV(9), May/June,
11.
Martin, L., Shepard, B., & Lehr, R. (Eds.). 2015. Canadian counselling and
psychotherapy experience: Ethics-based issues and cases. Canadian
Counselling and Psychotherapy Association.
Paterson, J. G., Robertson, S. E., & Bain, H. C. (1979). Characteristics of
guidance and counselling services in Canada. In V. J. Drapela (Ed.),
Guidance and counselling around the world. (27-40). University Press
of America.
18 CHAPTER 1
Truscott, D., & Crook, K. H. (2013). Ethics for the practice of psychology in
Canada. The University of Alberta Press.
Van Hestern, F. N. (1971). Foundations of the guidance movement in Cana-
da. (Unpublished doctoral dissertation). University of Alberta, Edmon-
ton, AB.
ADOBE STOCK
LEGAL / REGULATORY
IMPLICATIONS FOR
ETHICAL PRACTICE
Michael N. Sorsdahl & Glenn W. Sheppard
INTRODUCTION / CONTEXT
The fundamentals of ethics for the counselling profession and for the
law are interconnected. However, it is important to keep in mind that the
law does not dictate ethical practice, it only informs it (Fisher, 2022). To be
found in violation of an ethical code does not mean that a person is legally
liable for their actions, and just because a person is found not to be legally
liable for their actions in a court of law does not mean they acted ethically
in the view of a college or an association to which they belong. Nevertheless,
many elements of the Canadian Counselling and Psychotherapy (CCPA)
Code of Ethics (2020) and Standards of Practice (2021) have evolved over
time based on what occurs in law in order to bring ethical practices in line
with the legal expectations for the profession. Counsellors/therapists have
overlapping legal and ethical obligations by the nature of their work, which
includes their responsibility to clients, their employers, society, and their
certifying regulatory college or association. Understanding those respon-
sibilities, and understanding how to navigate the challenges that emerge,
becomes a major consideration in everything they do. A sensitivity to all
the relevant laws that impact the profession helps to maintain professional
integrity (Fisher, 2022).
22 CHAPTER 2
is no crossover. Combining services that are regulated by different colleges/
associations can create complications regarding what professional service is
being offered, and under which licencing. There are legal and ethical impli-
cations that occur around merging services that would typically belong to
different regulated professions.
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. (Garner, 2004, as cited in CCPA, 2021, p. 11).
Standard of Care:
Every person who enters into a learned profession under-
takes to bring to the exercise of it a reasonable degree of care
and skill. He does not undertake, if he is an attorney, that at all
events you shall gain your cause, nor does a surgeon undertake
that he will perform a cure; nor does he undertake to use the
highest possible degree of skill. There may be persons who have
a higher education and greater advantages than he has, but he
undertakes to bring a fair, reasonable, and competent degree of
skill... (Lamphier v. Phipos, 1838)
The court will approach its decision in this matter by having an “expert”
member of the profession testify in court as to what the normal standard of
conduct for dealing with the client issues should have been. This witness
will not judge the case before the court but only establish criterion against
which the counsellor’s/therapist’s professional behaviour will be judged.
3. Causation:
The plaintiff must prove causation. This is sometimes called a proxi-
mate cause. It means that the counsellor’s/therapist’s failure to provide an
appropriate standard of care is sufficiently related to the client’s harm to be
considered its cause. This is the biggest challenge in malpractice cases and
often very difficult to prove.
4. Damages:
If all of these conditions are proven in court and the counsellor/therapist
is found liable for the harm to the client, then the court must decide how to
bring judicial relief for these consequences. Often the only relief possible is
a monetary one which can include both compensatory and punitive costs.
Counsellors and psychotherapists are usually in double jeopardy when
facing a malpractice suit because if they are found liable, their regulatory
college or certifying agency will likely sanction them for ethical misconduct
24 CHAPTER 2
as well. Malpractice can result from many different examples of negligence
and can occur in the following types of circumstances:
• A breach of confidentiality.
• The treatment used by the counsellor/therapist was outside the area
of accepted professional practice.
• The counsellor/therapist failed to warn about the imminent risk of
serious harm by a client.
• Informed consent was not obtained.
• The counsellor/therapist failed to inform the client of the possible
consequences of a particular counselling procedure.
Consent
When considering the legal aspects of consent, we think about who
is giving consent to whom and for what. There are specific principles for
consent, which come from legislative acts that practitioners need to know
and understand (Solomon, 2023). As these acts are approved provincially,
exploring what the principles of consent are, and the legal limits of consent
within your province, becomes essential in properly conducting this aspect
of the counselling process. If there are no acts that govern the process of
consent (e.g., the Health Care Consent Act in Ontario), then the common
law principles of consent apply (Solomon, 2023).
Signed consent is only one way of capturing the act of gaining consent,
for legal purposes, and is only one piece of evidence to support that con-
sent was gained before any treatment was provided. It is also important to
note that consent is only as good as the information on the consent form,
and therefore careful consideration of what is listed in the informed consent
form is essential. Having clients sign a waiver that would indicate that they
forgo the right to complain or sue does not protect the practitioner from the
repercussions and consequences of their practice (Solomon, 2023).
Age of consent can vary across provinces, and this is important to con-
sider when gaining consent from a client. However, it is also important to
consider who is capable of giving consent to whom and for what. In general,
individuals are capable of consenting if if they have the cognitive capacity
to understand information concerning treatment, including understanding
both the benefits and the reasonably foreseeable consequences (Solomon,
2023). This capacity can change over time, and depending on the nature of
the treatment, someone may be able to consent to some kinds of treatments
and not others (Fisher, 2022). What is important to remember is that it is
Documentation (Recordkeeping)
The legal responsibility of a counsellor/therapist to maintain proper
client records cannot be overstated. The record itself can be considered ev-
idence and is admissible in a legal proceeding where the practitioner can
rely on a client’s record to give testimony (Solomon, 2023). Solomon (2023)
explained further that the practitioner’s credibility is influenced by the clar-
ity and state of the clinical record, and the clinical record could be critical
in litigation processes as there is rarely physical or objective evidence. Many
health professionals have been the recipient of professional disciplinary
26 CHAPTER 2
consequences due to not maintaining clear, complete, and reliable records.
The CCPA Standards of Practice (2021, B6) has some specific information
about what should be included in counselling records. Some guidelines to
follow include: remaining objective and within the sphere of competence of
the practitioner, the entries should be chronological and legible, ensure the
name of the practitioner is on each record, have no omissions, information
included must be relevant to the client’s treatment, and recording the infor-
mation should occur as soon as practical after the session is complete.
Clients have access to their records, so ensuring completeness is essen-
tial. It is important to note, however, that there are circumstances when
counsellors/therapists can withhold records from clients. Solomon (2023)
outlined two examples of when it may not be necessary to release records to
clients: 1) if by doing so it would create a risk of serious harm to the client
or another, or 2) the release of information would reasonably be expected
to reveal the identity of a third party who provided information in confi-
dence. If the records are for a group, family, or couple, it must be clear to
all involved and documented how these files will be managed and released
(Fisher, 2022). In the Supreme Court’s decision in McInerney v. MacDonald
it was determined that clients have a general right to access their treatment
records unless a specific statute indicates differently.
For legal purposes regarding format and content of records, the first
step is to review any statute regulations on the matter in your area of juris-
diction. Solomon (2023) explained that the content of those records should
generally speak to statements of facts only, and if there is inclusion of state-
ments of opinions or other non-factual material, it must be clear that it is an
opinion and not fact. Solomon (2023) explained that information provided
by a client about a third party without the third party’s consent would only
be recorded if it is relevant to the treatment plan. Likewise, information
provided by a third party about a client without the client’s consent may be
recorded if it is relevant to treatment and if it is not otherwise available from
the client. These records must be kept securely for however long the statute
that governs your health profession in your province or territory requires.
For example, in Ontario and Alberta it is 10 years, while in BC it is 7 years.
Regardless of such local requirements members of the Canadian Counsel-
ling and Psychotherapy Association are advised to keep counselling records
for a minimum of 7 years, as that is the minimum that any provincial or
territorial statutes direct.
28 CHAPTER 2
It does appear that judges usually require a compelling reason to require
a counsellor/therapist to breach confidentiality. Fortunately, they have avail-
able to them a general framework for adjudicating any such consideration.
It is called the Wigmore Criteria. John Henry Wigmore (1863-1943) was an
American jurist and an expert on the law of evidence. He presented the fol-
lowing four requirements for jurists when determining if a particular com-
munication is confidential and the factors to be considered when deciding
to protect it or compel its disclosure:
1. The communications must originate in a confidence
that they will not be disclosed.
2. This element of confidentiality must be essential to the
full and satisfactory maintenance of the relation be-
tween the parties.
3. The relationship must be one that, in the opinion of the
community, ought to be sedulously fostered.
4. The injury to the relationship that disclosure of the
communications would cause must be greater than the
benefit gained for the correct disposal of the litigation.
(Emphasis in original)
Here are a number of cases in which the Wigmore criteria was used to
render a court decision regarding the disclosure of counselling records.
1. In RCL v. SCF (2011) before the Supreme Court of British Columbia,
the judge had to decide whether or not to require the disclosure of the
plaintiff’s counselling records from the Elizabeth Fry Society where he
had gone for counselling. He decided that the counselling met the Wig-
more Criteria 1 to 3. With respect to Criterion 4 he denied access to the
counselling records for the following reasons:
“the defendant already knows that the plaintiff was abused
as a child; that this caused him emotional pain; that he attempted
suicide; that he sought help from the Elizabeth Fry Society...” He
concluded “I am not satisfied that these records will assist in prov-
ing any material fact.”
2. In R. v. Gruenke (1991, 3 SCR 263) Gruenke and Fosty were convicted
of first-degree murder. They were appealing based on an argument that
Gruenke’s disclosure of the murder to a church spiritual counsellor and
to the pastor were privileged communications. The court decided that
it was not privileged. Applying the Wigmore criteria, it concluded that
there was not an expectation of confidentiality at the time of the dis-
closure and there were compelling reasons to allow it as evidence. The
appeal was dismissed.
30 CHAPTER 2
A CBC news report in April 2014 revealed that some Canadians were
denied access to the United States when their mental health records were
shared with the US Department of Homeland Security. Canadian police of-
ficers apparently take notes when they apprehend a person in response to a
911 call. These notes can contain personal information including any histo-
ry of mental illness and suicide attempts. Such notes may be entered in the
Canadian Police Information Centre which is accessible to some American
authorities.
32 CHAPTER 2
who your clients are, is essential in navigating this difficult situation. The
specific obligations for mandatory reporting may differ within the various
provincial statutes, so all practitioners must understand the mandatory re-
porting requirements for the jurisdiction in which they work. Common
examples of mandatory reporting include reporting suspected abuse of
children or adults under care, or the duty to warn if a counsellor/therapist
is aware that a client’s intention could place a specific person in clear and
imminent danger.
CONCLUSION
This chapter has outlined some major areas of counsellor/therapist pro-
fessional responsibilities that intersect with the law. A common theme is that
ignorance in understanding the laws within the practitioner’s jurisdiction
is not an excuse, and so it behooves all practitioners to become very con-
versant with what those laws and precedents are, and how they influence
ethical decision-making. As was noted at the beginning, law does not direct
ethics; however, it does inform ethics. CCPA provides many supportive doc-
uments within their resources that speak to some of the specifics we have
noted here. Ethics, Legal Issues and Standards of Practice for Counsellors and
Psychotherapists by Glenn Sheppard (2017) is a useful resource that goes
into further detail and provides examples of how to deal with some of these
difficult challenges.
34 CHAPTER 2
REFERENCES
CCPA (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/up-
loads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf
CCPA (2021). Standards of practice. https://www.ccpa-accp.ca/wp-content/
uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-
file.pdf
Fisher, C. B. (2022). Decoding the ethics code: A practical guide for psycholo-
gists (5th ed.). SAGE.
Garner, B. A. (Ed.) (2004). Black’s law dictionary (9th ed.). West Publishing
Company.
Lamphire V Phipos 8 C P 475 (High Court England and Wales, 1838).
The Personal Information Protection and Electronic Documents Act (2015).
Privacy Commissioner of Canada. https://laws-lois.justice.gc.ca/eng/
acts/P-8.6/page-1.html#docCont
Sheppard, G. W. (2017). Collection of notebooks on ethics, legal issues & stan-
dards of practice for counsellors and psychotherapists. Dr. Glenn Shep-
pard Psychological Services.
Solomon, R. (2023, May). It’s the law! Understanding legal issues in counsel-
ling and psychotherapy. Leading Edge Seminars.
ETHICAL DECISION-
MAKING MODELS
Roberta A. Borgen, William A. Borgen, and Michael N. Sorsdahl
INTRODUCTION / CONTEXT
Ethical decision-making for counsellors/therapists is one of the major
pillars for ethical practice. Understanding the ethical codes, standards of
practice, codes of conduct, and other sources of guidance and directions
within a profession is only the first step. Learning how to effectively apply
them becomes the cornerstone of ethical conduct and practice. Burkholder
et al. (2020) found that when counsellors/psychotherapists were not well-
versed in ethical decision-making models (EDMs) and processes, they felt
both insecure and, at times, overly confident in their ethical decisions. Many
counsellors/therapists reported that, although their formal education/train-
ing emphasized their professional responsibility to ensure ethical practice,
the depth of their understanding was insufficient to help them navigate the
ethical dilemmas and challenging situations they ultimately found them-
selves in when entering practice (Levitt et al., 2015).
Corey et al. (2023) explained that one of the major challenges when
entering into a profession guided by EDMs is that most people want clear
guidance about the right answers to the dilemmas or situations they are
faced with. Unfortunately, as associations and regulatory colleges in the
helping field have such a diverse and nuanced focus on human interactions,
there are no codes of ethics, standards of practice, codes of conduct, or oth-
38 CHAPTER 3
on the other hand, have a tendency to feel confident in their actions, believ-
ing that their approach was the “right” one. An added challenge highlighted
by Burkholder et al. (2020), that occurs when EDMs are not incorporated
into practice, is that counsellors tend to make decision-making shortcuts
by going with “what feels right”; however, this can create biased and prob-
lematic decisions through prioritizing personal values instead of the values
of the profession. Another ethical issue can occur when counsellors/ther-
apists or trainees have values conflicts with their clients that impact their
work (Kocet & Herlihy, 2014). By working through the ethical issues and
dilemmas that you are faced with, you are better able to systematically move
through important considerations, facilitating a more rounded and robust
decision-making process, that helps promote better ethical practice over the
long-term.
EDMs clearly help counsellors/therapists to navigate the vagueness
and ambiguity inherent in the profession that occur through interactions
with clients, supervisees, trainees, and other professionals. Understanding
that there are different approaches to ethical-decision making is also going
to be helpful in working through ethical issues and dilemmas. Choosing
amongst the different models can be influenced based on preference as well
as situation, and more often a combination of the two factors. CCPA (2020)
highlights four EDMs in the Code of Ethics - Principle-Based Ethical De-
cision-Making, Virtue-Based Ethical Decision-Making, Quick Check, and
Wise Practices Lens - which will be explained below and then applied to
the following vignette to illustrate the similarities and differences in ethical
decisions when using these different EDM approaches.
40 CHAPTER 3
regulations, or other sources of guidance. Step 3 requires identification and
prioritization of the most relevant ethical principles and may also involve
consultation. The next step (4) is to consider how the articles and standards
can be applied to the situation and how any conflicts between ethical prin-
ciples might be resolved. Risks and benefits of the potential solutions are
carefully examined at this stage before moving on, in Step 5, to examining
how the potential solution fits with your intuitions and how you’d feel about
proceeding in that way. In the final step (6), a plan of action that appears to
be most helpful is enacted and then the outcome is evaluated, and any need-
ed adjustments are recommended – either to optimize the current situation
or to maximize effectiveness of the solution should something similar come
up again.
42 CHAPTER 3
it would make sense to talk with the school psychologist, for
which they have Steve’s consent.
B13. Multiple Clients
» If the family meeting proceeds, it will be important to clarify
who the primary client is (i.e., Steve) and the purpose of the
meeting, as well as to discuss confidentiality, the risks and ben-
efits of the meeting, and what information will be shared (and
with whom) after the meeting.
B15. Group Counselling / Therapy
» Although the proposed meeting isn’t being characterized as
group therapy, as there will be a group involved and emotions
seem to be running high on the topic, it will be important to
discuss rights, responsibilities, and confidentiality, and to facil-
itate setting some group norms.
C6. Appropriateness of Assessment and Evaluation
» Shayna and Kam wouldn’t be involved in administering or
scoring the assessment tools, and can’t ethically speak to the
appropriateness of the proposed approach as they’ve identi-
fied school-based assessments to be beyond their professional
competency. Consulting with the school psychologist to better
understand the psychologist’s theoretical orientation, cultural
competence, and approach to assessment could prepare them
for a more general psycho-educational discussion with the fam-
ily about common issues in culturally appropriate assessment.
C10. Sensitivity to Diversity When Assessing and Evaluating
» Again, although not in the role of the assessors, Shayna and
Kam recognize the need to be particularly cautious if the local
community isn’t represented in the norm groups of the stan-
dardized assessment tools.
E4. Welfare of Clients and Protection of the Public
» As Shayna’s supervisor, Kam has some additional consider-
ations. Despite Shayna’s limited competency specific to assess-
ment, she has built a trusting working relationship with Steve
and, together, they have responsibility for Steve’s wellbeing (the
panic attacks are a concern) as well as the wellbeing of his child
(i.e., will the potential benefits of the assessments outweigh the
risks?). Kam has a long history in the area of knowing that re-
ferrals generally aren’t followed up on, so supporting Shayna to
work with Steve and his family may be the most viable option.
44 CHAPTER 3
racism, privilege, assumptions, and her previous learning.
I4. Respectful Awareness of Traditional Practices
» Both Shayna and Kam recognize the important role that elders
play in the local First Nations communities. They recognize a
need to learn more about why Steve’s parents are opposed to
the assessment – is this an example of wisdom from Elders, fear
from residential school survivors, grandparental concern based
on experiences with other family members, or something else?
Shayna and Kam wonder if there might be other Elders within
the community with whom they could consult to untangle these
possibilities before holding a family meeting. Before such con-
sultation proceeds, it would be important to get consent from
Steve and the members of his family whom Steve would like to
invite to the family meeting.
I6. Strengths-Based Community Development
» Kam is aware that Steve’s First Nation has worked very hard
to generate additional funding and support for their children
in the local schools. Funding for assessments is one of the sig-
nificant outcomes of their advocacy – the hope is that better
targeted supports for children in elementary schools will equip
more of them to succeed in high school and eventually move on
to post-secondary education and meaningful, sustainable work.
I8. Relationships
» The opportunity to include Steve’s parents in a counselling
meeting about Steve and his son may strengthen relationships
between the clinic and Steve’s community. Steve’s aunt is a re-
ceptionist at the clinic – Kam wonders what insights she may
have and whether or not it would be appropriate to talk with
her about this.
I11. Honouring Client Self-Identification
» As Kam and Shayna identify relevant articles from the Code of
Ethics, this last one really makes them pause and reflect. When
asked by Kam, Shayna realizes that she and Steve have never
really talked about his identity. Although she had made some
assumptions based on his registration for the Indigenous lan-
guage classes, and Steve ticked off “First Nations” on the intake
form, she doesn’t really know whether he participates in tra-
ditional or cultural practices and how that might impact the
proposed meeting with his family.
46 CHAPTER 3
Although Kam knows that many other children from the community
have previously been assessed and that the school district has embraced
trauma-informed care and cultural safety practices, before engaging in any
discussions with Steve’s family about the assessment battery, both Kam and
Shayna need more information about the cultural appropriateness of the
assessment approach and confirmation that the results will be interpret-
ed with cultural humility and sensitivity (C6, C10). Unfortunately, Kam
is aware that past assessments, conducted by a few different psychologists,
have varied in this regard. Therefore, Kam and Shayna will need to secure
Steve’s informed consent for gathering information (B4) and explain the
risks of unintentionally breaching confidentiality due to the multiple rela-
tionships within the clinic team and broader community (B8), even if an
attempt is made not to reveal any identifying information. After a general
conversation with the school psychologist and the principal (A7), should
Shayna and Kam have any ethical concerns about the assessment process,
they realize they will need to address those concerns with Steve, the profes-
sionals involved, and perhaps the other professionals’ association or regula-
tory college (A8, A9).
After becoming more informed about the proposed assessments and
the community history with intergenerational trauma related to residential
schools, both Kam and Shayna will need to reflect on their own cultural
identities (I2) and how their power, privilege, assumptions, and prior expe-
riences might be impacting their decisions and approach. They will also be
better able to situate the assessment within a larger perspective of building
a stronger and healthier community (I6) as it is hoped to provide direc-
tion and support for better accommodating the unique needs of Steve’s son,
contributing to his future success in school, at work, and as a community
member.
Shayna has, to this point in her career, had no experience with counsel-
ling couples or families (A3, B8, B13, B15) so this is another area where she
will require close supervision (A4). This is an area that Kam has extensive
experience in, so he feels quite confident in his ability to guide and supervise
the family meeting, especially if he is onsite with Shayna as a co-facilitator.
48 CHAPTER 3
with Kam to learn more about the historical context within the community,
and also to gain from Kam’s experience in working with family groups. She
would also prepare a brief letter of introduction for Steve to give to his wife
and parents (and other family members he’d like to include) to invite them
to the family meeting. She would schedule a meeting with Steve and Kam
in her office a few days after the family meeting to debrief the outcome and
discuss any needed next steps. Finally, she would book another supervision
session with Kam to discuss what worked well, what didn’t, and what they
might do differently in a similar situation in the future.
50 CHAPTER 3
Solution Using Quick Check and Wise Practices Lens
In looking at CCPA’s (2020) Quick Check and the Wise Practices Lens
decision-making models, you can see they approach the decision-making
process through a reflective stance. Whether these models are used to guide
the counsellor/therapist’s reflection on the situation to make a decision,
or as a post-decision review before implementation, both ways incorpo-
rate CCPA’s (2020) Code of Ethics and Standards of Practice (CCPA, 2021)
to guide those decisions. In this example, first a solution will be provided
based on CCPA’s Code and Standards, followed by reviews of that solution
by applying the Quick Check method and then the Wise Practices Lens.
Solution
There are a number of ethical considerations in making a decision on
how to proceed in this instance. There is the concern around A3 (Bound-
aries of Competence) and C3 (Assessment and Evaluation Competence) as
Shayna does not have the expertise around school-based assessments. Al-
though Shayna is not administering the assessments to the child, as she is
being asked to work in the role of consultant to the family about the use of
assessments or not for the client’s child, these are still considerations. An-
other ethical concern is around A4 (Supervision and Consultation), where
consideration is needed as to how the supervisor will be involved in this
situation. B1 (Primary Responsibility) would also need to be considered,
as Shayna is working with the client to devise the best approach to coun-
selling/therapy, which seems to be involving the client’s family in this in-
stance, and is connected to understanding the cultural aspect of family deci-
sion-making. B8 (Multiple Relationships) is also a concern here as her client
is a fellow student in a language course, and is the clinic receptionist’s neph-
ew. Counsellors/therapists are advised to avoid, or at least address, multiple
relationships in order to clarify understanding of the various roles and how
they impact the counselling relationship. F1 (General Responsibility) ex-
plains that counsellors/therapists only provide consultative practices and
services they have competency in through their education and experience,
and as Shayna is being asked to help the client with their family around de-
cision-making about the use of assessments with the client’s son, this must
be considered. I9 (Culturally Embedded Relationships) is another article in
the code that is important to consider, as it speaks to how there are distinct
cultural differences regarding dual relationships and multiple relationships
that exist, and that this takes priority over rule-based contexts.
Quick Check
Although the Quick Check approach can appear quite simple at first
glance, the three prompts encourage you to carefully consider the impact of
your decision at multiple levels. The first prompt relates to publicity, asking
you to reflect on how comfortable you would be to see your decision be-
come front-page news! Next, you are prompted to consider the universality
of your decision – both locally (i.e., would you be able and willing to make
the same decision for all of the people you serve) and more globally (i.e.,
what would happen if every counsellor/psychotherapist were to make a sim-
ilar decision?). Finally, you are prompted to consider your decision through
the lens of justice, asking if everyone would be treated fairly as a result of the
decision you are contemplating.
52 CHAPTER 3
Quick Check Example
Applying the Quick-Check approach, a look at this decision from three
perspectives is necessary.
Publicity – If this decision was reported as front-page news, it does
take into consideration the appropriate ethical articles from the
CCPA Code of Ethics (2020) and Standards of Practice (2021), and
works to find a solution that considers the competing elements.
Universality of Decision – This is a bit more complicated of a per-
spective, as not everyone comes from the same culture. This being
said, in this case, for anyone seeking help to involve their family in
a complicated situation where that family influence is important to
the client, this action would fit – especially around the involvement
of someone to consult, supervise, or even assist in further under-
standing school-based assessments. From a global perspective, if
every counsellor made this decision, it would still be grounded in a
clear ethical decision-making process.
Justice – I believe everyone is being treated fairly in this decision, up-
holding the principles of beneficence and nonmaleficence.
54 CHAPTER 3
Wise Practices Lens Example:
When looking at the decision from a Wise Practices Lens, there are Sev-
en Sacred Values to consider.
Courage – In this decision, the focus was on collaboration and consul-
tation to best help the client. Being open to acknowledging limited
competence to self and client, going to the client’s home, to reflect
on what concerns come up, and to consider the risks and conse-
quences, all speak to this value.
Honesty – by sharing the client’s concerns, consulting with the su-
pervisor and other experts, and being open about the limits of the
counsellor’s competency, this allows all concerns to be seen clearly
and understood from multiple perspectives.
Humility – this value is best considered through the acknowledgement
that the client is clear about what he needs, and the counsellor lis-
tens to that, as opposed to applying hard and fast rules that do not
serve both of them. In addition, the acknowledgement of the lim-
itations of knowledge in assessment and working with First Nations
populations, and the desire to seek support in making this decision
speaks to this value.
Respect – by listening to the needs of the client, and understanding the
counsellor’s limits of knowledge, there is a respect for both people.
In addition, respect for the importance of the family, and the incor-
poration of them into therapy to help the client, is clear. There is
sense of building of community that supports the family’s perspec-
tives as well as the client’s in this decision, that honours the impor-
tance of all perspectives as opposed to privileging one.
Truth – the counsellor acknowledging limitations of knowledge, as
well as hearing the truth and importance of family and the circum-
stances that the family are in considering how best to help the client
speaks to honouring this value.
Love – the counsellor worked to accept herself and what is important to
her, by exploring the concerns and voicing them both to the client
and the supervisor, as well as still honouring the needs of the client
in this circumstance.
Wisdom – being open to different paths of wellness and the need to
support the client, as well as honouring the situation of all parties
involved, allows for a greater view of the world, which speaks to
this value.
56 CHAPTER 3
REFERENCES
Burkholder, J., Burkholder, D., & Gavin, M. (2020). The role of decision-
making models and reflection in navigating ethical dilemmas. Coun-
seling and Values, 65(1), 108-121. https://psycnet.apa.org/doi/10.1002/
cvj.12125
Canadian Counselling and Psychotherapy Association (2020). Code of eth-
ics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-
2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Stan-
dards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/up-
loads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Corey, G., Corey, M. S., & Corey, C. (2023). Issues and ethics in the helping
professions (11th ed.). Cengage.
Kocet, M. M., & Herlihy, B. J. (2014). Addressing value-based conflicts with-
in the counseling relationship: A decision-making model. Journal of
Counseling & Development, 92(2), 180-186. https://psycnet.apa.org/
doi/10.1002/j.1556-6676.2014.00146.x
Levitt, D. H., Farry, T. J., & Mazzarella, J. R. (2015). Counselor ethical rea-
soning: Decision-making practice versus theory. Counseling and Val-
ues, 60(1), 84-99. https://doi.org/10.1002/j.2161-007X.2015.00062.x
Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, men-
tal illness and addiction through a Wise Practices lens. Internation-
al Journal of Mental Health and Addiction, 8, 390-407. https://doi.
org/10.1007/s11469-009-9265-6
PROFESSIONAL
RESPONSIBILITY
Michael N. Sorsdahl
INTRODUCTION / CONTEXT
According to the Canadian Counselling and Psychotherapy Association
(2020) Code of Ethics, counsellors/therapists have a professional responsibil-
ity to demonstrate integrity, professionalism, and ethical care in all aspects
of their work. This responsibility is not limited to working with clients; it
extends to all those with whom they come into professional contact. Pro-
fessionalism is what brings counsellors/therapists together as a community
and identifies them as fundamental contributors to mental health support
services in Canada. Before looking at the services provided to clients, it is
essential to consider what being a professional in this field requires.
Being a professional is not a simple task, especially in a developing field
such as counselling. In Canada, statutory regulation of many professions is
under the jurisdiction of provinces or territories, and the roles of many men-
tal health professionals (e.g., in the fields of psychology, social work, and
psychiatry) are regulated within each province (Martin et al., 2015). Coun-
selling/psychotherapy, as a growing mental health profession in Canada has
become regulated in many provinces (i.e., Alberta, New Brunswick, Nova
Scotia, Ontario, Prince Edward Island, Quebec), and is in various stages of
the creation of regulation in the other provinces. The trend in Canada to-
wards regulation of this profession will help solidify its identity, important
PROFESSIONAL RESPONSIBILITY 61
both for the protection of the public, and for supporting the professionals
who work within it. The ethical principles focused on guiding Professional
Responsibility are necessary to navigate the diversity of practices within the
counselling profession and inform ethical decision making.
As you review the CCPA (2020) Code of Ethics and Standards of Practice
(CCPA, 2021), in the Professional Responsibility section you will find many
issues to consider. There are articles about your general responsibilities as
a professional, as well as how to advertise ethically, present yourself to the
public, create a supportive environment, conduct administrative responsi-
bilities, and recognize the impact of your behaviour on others.
With so many things to consider, it is difficult to imagine being able
to remember and manage them all. It is important to acknowledge that all
counsellors/therapists experience ethical dilemmas. The expectation that
you would know everything is unrealistic, and as the profession evolves, so
do the recommended practices and ethical codes/standards of practice that
guide it. We encourage you to stay humble and open, not trying to figure out
challenging ethical dilemmas on your own. The importance of consulting
as part of the ethical decision-making process cannot be overstated. Hiding
complex and challenging situations and dealing with them in isolation may
only make the situation worse and must be avoided to ensure ongoing ethi-
cal practices that demonstrate professional responsibility.
Recommended Practices
When it comes to Professional Responsibility recommended practices,
consider the behaviours and approaches that will help you to integrate each
of the articles in this section into your practice. Although some articles have
specific expectations outlined in the CCPA (2021) Standards of Practice,
many are left to you to decide how to best apply them. Consultation can help
you to better understand the current recommended practices in applying
these articles to inform ethical decision making. The recommended practic-
es are not meant to be prescriptive, as there are always differences based on
context and situation; however, they offer a good place to begin.
62 CHAPTER 4
practitioners, and to engage in self-care. As the subsequent review of these
articles and recommended practices will get into specifics, this section on
recommended practices will be on professional responsibility related to
your self-care.
Self-care for counsellors/therapists is an ethical imperative and can-
not be overstated as an indispensable piece of maintaining competence. As
Steele (2020) pointed out, burnout, compassion fatigue, vicarious trauma,
and stress are all natural consequences of therapeutic work. Understand-
ing the symptoms and behaviours associated with these conditions can
help you to be more reflexive and proactive in countering those effects and
finding balance (Neimeyer & Taylor, 2019). It is not only essential to en-
gage in healthy activities to help strengthen your body and mind against
the impacts of being in helping relationships; you must also incorporate
enjoyable activities (Butler et al., 2019). Another way to look at it is that the
healthy activities (e.g., exercise, proper eating, sleeping, avoiding negative
coping mechanisms/behaviours) are like strengthening the container that
holds your resources; however, that is not sufficient to fill that bucket with
the energy needed to deal with the demands of your work. We encourage
you to find ways to remain self-full as explained here, which looks very dif-
ferent from being selfish or selfless. Activities that you truly enjoy need to
be incorporated into your everyday living to help fill your bucket of energy
resources, in addition to being healthy.
2 https://www.unicef.org/child-rights-convention/convention-text
3 https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples.
html
PROFESSIONAL RESPONSIBILITY 63
rights, it is necessary for you to be aware of current views regarding social
justice issues.
Sexual harassment by a counsellor/therapist is not tolerated within a
professional relationship. Understanding what sexual harassment is, and
how it can be eliminated, becomes a continued source of development and
education. For example, Morris et al. (2020) explained how easily micro-ag-
gressive behaviours were directed towards transgender clients, where the
professionals might have been unaware of their impact. Therefore, recog-
nizing, and continually striving to learn more about sexual harassment is a
beneficial strategy for creating a supportive environment that respects the
rights of all people.
When it comes to diversity responsiveness and having a nuanced under-
standing of the needs and perspectives of others, recommended practices
require you to develop awareness of your own self-location, biases, and cul-
tural influences (Kottler & Balkin, 2017; Young, 2021). Addressing power
differences directly with clients, supervisees, or trainees helps to mitigate
the impact of those differences and to reduce the potential for disrespectful
behaviour to occur (Trevino et al., 2021).
64 CHAPTER 4
Kivlighan (2018) explained that it is difficult to measure competence, and
that self-report is biased. Regularly monitoring outcomes and progress to-
wards goals is helpful to see if your approach is working. If what the client
needs or wants is not within your scope or competence, or if therapeutic
interventions are not working, then assisting a client to find someone who
can work effectively with them would be the next step. If, due to extenuating
circumstances, a referral cannot be made, then arranging for clinical super-
vision to support effective work in a new area of focus would be considered
the recommended practice (Frank et al., 2020; McMahan, 2014).
Supervision and consultation throughout your entire professional life
are key components of continued counsellor/therapist competence and
learning (CCPA, 2021). When expanding competence, it is crucial to choose
a competent supervisor that is a good fit within the area of expansion de-
sired, and ensure a clear contract and structure is in place that explains the
relationship, as well as how that relationship will be explained to clients
(Smout, 2020). Ongoing professional growth and development is also an
expectation for all counsellors/therapists (Young, 2021). Therefore, abiding
by the concept of working within competence is not intended to suggest
that you should not work to expand your skills and abilities; rather, when
you do, taking the most appropriate actions to build that competence while
working safely and effectively with your clients is expected.
Considering the unique challenges of remote locations is also necessary
(Rowen et al., 2022). Creating strong structures that incorporate supervi-
sion and consultation can mitigate risks to clients. In some areas, and even
in some organizations with the rapid expansion of practice online, there is
limited local support available; in such cases, it may be essential to bring
in external supports, sometimes using virtual technologies. Creating and
sustaining a community of support that includes access to consultation and
supervision, no matter your specific place of employment, is a valuable part
of the process of ensuring competence and continued development.
PROFESSIONAL RESPONSIBILITY 65
and professional. Wording is very important in advertising, so ensuring that
advertisements are accurate and do not violate regulated terms is recom-
mended practice.
Third-Party Reporting
Whenever working with a third-party referral source for clients, it is
necessary to be very clear on the nature of that relationship, and how confi-
dentiality works with the clients, the practitioner, and the organization. This
information must be fully explained and agreed upon by the client before
services are provided. Having conversations with the client around what
they want released to the third-party, as opposed to either sharing all or
none of the records, is a valuable aspect of this conversation. Transparency,
and even providing a preview to the client(s) of what will be released to the
third-party can help in ensuring that what is provided is understood by the
client. The client may not be clear about what type of information is in their
records, or what will be released to the third-party. So, when they agree to
sharing of information between their counsellor/therapist and a third-party,
explaining what options exist, and being clear on both the way the infor-
66 CHAPTER 4
mation will be provided (e.g., progress notes, summary letters, telephone
discussions), as well as what kind of information will be held and/or shared
through those methods becomes an important aspect of informed consent.
Your responsibility to abide by the CCPA Code of Ethics (2020) and Stan-
dards of Practice (CCPA, 2021) remains even if there are requirements by
the third-party organization that would result in you violating those codes
and standards. When agreeing to work with a third-party, from the very
beginning it is necessary to review all the operating procedures and look for
any potential conflicts.
Pitfalls/Challenges
One of the major challenges that counsellors/therapists face is the in-
ternal struggle between desiring to help others, and ensuring that they have
the capacity and competency to work with the people they wish to help. It
is not unusual for the demands of the organization, or even their clients,
to put them in a position where they sacrifice their own well-being to help
others, or they begin working in areas in which they are not yet competent.
Being self-reflective is one of the key skills you will need (Kottler & Balkin,
2017; Young, 2021); this includes understanding what is occurring within
yourself as you interact with others. Self-reflection can foster self-care and
will identify where and how to build competence. You are not alone; there
are supportive communities that can help you to navigate ethically challeng-
ing situations.
One common challenge for many counsellors/therapists is working
outside of their competence, often because they simply “don’t know what
they don’t know”; this is especially true for novices at the beginning of their
careers. Unfortunately, this can place practitioners in very challenging situ-
ations that lead to potential violations. A recommended practice, therefore,
is to have access to a supervisor or consultant who can help you navigate po-
tentially challenging situations, even when you may not be aware that they
are evolving. Talking with a supervisor about the goals and focus of coun-
selling and what has been happening in client sessions can help to identify
areas that may be out of your boundaries of competence; you can then work
on expanding competence with the aid of an appropriate supervisor and/
or training. One specific example of a competence challenge is conducting
custody evaluations; as explained in the CCPA (2021) Standards of Practice,
counsellors/therapists must be able to show evidence of competence to en-
gage in these kinds of evaluations, which typically require specific training
and supervision.
PROFESSIONAL RESPONSIBILITY 67
Professional impairment is another important issue to watch for, when
you are no longer able to provide competent services to clients, supervis-
ees, or trainees due to your own limitations (CCPA, 2021). This once again
speaks to the importance of self-reflection, being aware of the impacts of
what is happening to you due to the professional and personal factors in
your life. The push to put others’ needs before your own can often lead to
over-extension, stress, compassion fatigue, or burnout. When you are not
capable of continuing service due to any type of limitation, it is essential to
seek supervision and/or consultation, and to limit/suspend services until
you recover.
When it comes to advertising your credentials and services to the public,
there are a few pitfalls to avoid. Using a degree or an affiliation to an asso-
ciation to imply certification in counselling is problematic. As counselling/
psychotherapy is not a regulated profession in all provinces, but psychology
is regulated across Canada, it is imperative not to mislead the public about
credentials; educating clients and the public through accurate advertising is
required. Another major advertising-related pitfall is the use of testimoni-
als by clients, former clients, or relatives/friends of clients. Within CCPA’s
(2020) Code of Ethics, using testimonials in advertising is not permitted un-
less the testimonial has been provided by an organization that refers clients.
A related challenge comes from public sites that may have comments made
on them that are not controlled by the practitioner. If you find a testimonial
about you on such a site, it is incumbent upon you to do your best to have it
removed by making a request to whoever controls that site. Confirming the
expectations around advertisement and limits as expressed by your regula-
tory association or college is a significant aspect of due diligence.
68 CHAPTER 4
CASE EXPLORATION
Case 4.1
PROFESSIONAL RESPONSIBILITY 69
Case 4.2
An inquiry to the counsellor came via email from a
trans woman. The potential client had been working with a
counsellor for 7 years, and conveyed that for the past sever-
al months, boundaries within the therapeutic relationship
became “weird.” The potential client reported she socialized
with the counsellor (i.e., dinner with the counsellor and her
partner), went on walks, and met the counsellor’s family;
the potential client expressed that nothing sexual occurred
and that she could not imagine this happening. Recently,
the counsellor “gently pressured” the potential client to end
the therapeutic relationship and is “pulling back” from what
is identified as a friendship. Extreme pain and confusion
are expressed by the potential client, and she would like
to process her experience with a new counsellor. Howev-
er, the potential client is asking for a “guarantee” that any-
thing conveyed about this situation remains confidential.
She reports being very attached to her previous counsel-
lor and would be devastated if anything happened profes-
sionally to her previous counsellor due to a report made to
a professional body. The potential client is employed in a
research-oriented field and conveyed she has conducted
extensive research on boundary issues, dual relationships
in post-therapy time frames, and professional duty to re-
port. She indicated she contacted another counsellor who
agreed they could guarantee confidentiality; however, an-
other counsellor conveyed they could not. Frustration is
reported by the potential client, given the honesty shared
about her situation with potential new counsellors. Addi-
tionally, based on her research, she reported counsellors
either assign a label of BPD to clients in her situation (i.e.,
who bring circumstances on themselves) or have a desire
to report the “bad” counsellor and prevent them from prac-
ticing. The potential client communicated that she feels she
has nowhere to turn for help.
70 CHAPTER 4
Case 4.3
Iris is a Southeast Asian first generation Canadian; she
identifies as female. She has been progressively getting
more anxious and depressed. She feels that this is for two
main reasons: Her family has become increasingly out of
balance with their chosen religion and harsher with her as
a result, and she doesn’t feel she can confide in anyone at
her place of worship or in her family about her struggles,
which they are shrugging off with greater regularity. Iris is
hurt and angry with God over her situation, her perceived
rejection from her family, and her isolation and mistrust of
the leadership that cannot offer her the psychotherapy that
she needs, nor the spiritual support she desires, leaving
her feeling that she would be judged if she expressed her
thoughts and feelings.
Iris comes to counselling to see Rose for depression
and anxiety. Rose has been told by her supervisor to stay
away from any religious or spiritual topics even for the pur-
pose of understanding the correlation to the client’s pre-
senting issues and if they are related to the main struggle
of the client. Rose understands and respects the need for
the client to lead in this area but is struggling with her su-
pervisor’s guidance not to explore the associated anger,
isolation, betrayal, and loneliness potentially related to the
client’s experience with spirituality and faith in the session.
Her supervisor’s guidance has left little room to explore pros
and cons on the issue. Rose’s training taught her that such
exploration could reveal either spiritual injury or conversely
spiritual gain (e.g., spirituality, in many adults, can contrib-
ute to improved personal resiliency and mental health).
PROFESSIONAL RESPONSIBILITY 71
Rose would like to ask about Iris’s main triggers to feel-
ing depressed and anxious even if her answers open up a
religious or spiritual conversation and Rose clearly indicates
that her area of competence is in dealing with anxiety and
depression, not deep spiritual guidance, though this is a
safe and judgement-free space. She further indicates that
her approach would be client led, not directive spiritual
guidance, though any topic Iris needs to discuss is welcome
there.
Case 4.4
72 CHAPTER 4
DISCUSSION QUESTIONS
1. What self-care strategies do you use to keep yourself healthy (physically
and mentally), and what strategies do you use to bring yourself enjoy-
ment? How can you make these more part of your routine by creating
a structure that is specific enough to implement (i.e., includes duration,
frequency, and periodicity) and flexible enough to accommodate the
unexpected changes in your schedule and capacity?
2. What is your understanding of the social justice issues relevant to coun-
selling/psychotherapy, and what are the steps you can take to increase
your awareness and approaches? How would you address power differ-
entials in the therapy setting?
3. Consider what your boundaries of competence are, and how you could
begin to expand your practice into other areas. How would you work
with a client and a supervisor when expanding your practice?
4. Consider how you are advertising, or will advertise, yourself as a coun-
sellor/therapist and create a strategy to minimize confusion.
5. How would you approach another counsellor/therapist when you have a
concern about their ethical practice?
PROFESSIONAL RESPONSIBILITY 73
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Butler, L. D., Mercer, K. A., McClain-Meeder, K., Horne, D. M., & Dud-
ley, M. (2019). Six domains of self-care: Attending to the whole person.
Journal of Human Behavior in the Social Environment, 29(1), 107-124.
CCPA. (2020). Code of ethics. https://www.ccpa-accp.ca/wp-content/up-
loads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf
CCPA. (2021). Standards of practice (6th ed.). https://www.ccpa-accp.ca/
wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-
Sept-29-Web-file.pdf
DeAngelis, T. (2018, May). What should you do if a case is outside your skill
set? CE Corner, 49(5). https://www.apa.org/monitor/2018/05/ce-cor-
ner
Frank, H. E., Becker-Haimes, E. M., & Kendall, P. C. (2020). Therapist
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PROFESSIONAL RESPONSIBILITY 75
The specific responsibilities of counsellors/therapists
vary across time and multiple geographic, environmental,
social, cultural, economic, and political contexts. Despite the
variety of situations in which counsellors/therapists may find
themselves, their responsibility for safeguarding the welfare
of clients, maintaining their trust, and protecting their per-
sonal data is constant across time and consistent across con-
texts.
B1. Primary Responsibility
B2. Confidentiality
B3. Duty to Warn
B4. Client’s Rights and Informed Consent
B5. Children and Persons with Diminished Capacity
B6. Maintenance of Records
B7. Access to Records
B8. Multiple Relationships
B9. Respecting Inclusivity, Diversity, Difference and Intersec-
tionality
B10. Consulting with Other Professionals
B11. Relationship with Former Clients
B12. Sexual Contact
B13. Multiple Clients
B14. Multiple Helpers
B15. Group Counselling/Therapy
B16. Referral
B17. Closure of Counselling/Therapy
B18. Mandated Clients and Systems Approaches
CHAPTER FIVE
COUNSELLING
/ THERAPY
RESPONSIBILITIES
William A. Borgen
INTRODUCTION / CONTEXT
The central focus of Section B of CCPA’s (2020) Code of Ethics is on all
of the factors that come into play when the counsellor works for the client.
It includes:
• the orientation and context that both the client and the counsellor
bring to the work that they do together,
• the responsibility of the counsellor for the psychological safety of
the client,
• the competence of the counsellor in working with the issues pre-
sented by the client, and
• the importance and limitations to the confidentiality of all written
and verbal communication involved in their work together.
Your level of understanding regarding the complexities and nuances of
each aspect of this section of the code will play a large part in determining
your ability to engage in best practices in your work with clients, and to
minimize the challenges you encounter in navigating your work with them.
RECOMMENDED PRACTICES
Primary Responsibility
The first article of this section of the code (B1: Primary Responsibility)
illustrates the complexity of what you need to consider in promoting the
welfare of your clients.
Best practice here involves ensuring that the approach to counselling
that you are able to offer will accommodate the range of needs that clients
may bring. These are often determined by a number of personal and contex-
tual variables that may not be readily apparent to you.
78 CHAPTER 5
Administration and Logistics
The next articles of the code, B2 – B7, focus on administrative and logis-
tical considerations that the counsellor/therapist needs to take into account
when working with a client.
Articles B2 and B3 focus on the confidential nature of all verbal and
written material and specify limits to that confidentiality. Best practice in-
volves making informed and justified decisions regarding when confiden-
tiality needs to be maintained, and when it needs to be broken. As noted
in the CCPA Standards of Practice (2021), “Confidentiality belongs to the
client, not the counsellor” (p. 15).
Articles B4 (Informed Consent) and B5 (Children and Persons with Di-
minished Capacity) both highlight the ethical considerations in securing
truly informed consent (Blease et al, 2020). Respecting every client’s right
to provide informed consent (B4) also presents another set of complex re-
quirements. Often, the discussion regarding informed consent occurs in
initial sessions, along with providing information about limits to confiden-
tiality. However, Article B4 makes it clear that gaining informed consent is
an ongoing process across sessions, and includes informing clients about
the nature of counselling/therapy offered, along with information about po-
tential risks and benefits, and inviting the client to collaborate in decisions
regarding the goals for, and the interventions involved in, the counselling/
therapy offered. The aim is to try to ensure that the client is making an in-
formed decision in working with you. (See also CCPA Standards of Practice
Section K: Obtaining Ongoing Informed Consent, 2021, p. 101). It is also
important for the client to know that they have a right to a second opinion
or not to engage in a specific aspect of the service being offered, along with
the consequences of that decision.
Informed consent becomes more complex when your client is a minor
or a person of diminished capacity (B5). In those cases, consent can be pro-
vided by a parent or guardian, and assent by the client, corresponding to the
ability of the client to provide it. As noted in the code: “These dual processes
of obtaining parental/guardian informed consent and client assent apply to
assessment, counselling/therapy, research participation, and other profes-
sional activities” (CCPA, 2020, p. 10). As with all other clients there is the
same requirement, to continue to check that consent/assent is provided as
counselling/psychotherapy proceeds. In addition, when working with chil-
dren it is essential to be informed by the CCPA (2021) Standards of Practice
section on Children and Confidentiality (p. 16), in determining the child’s
right to confidentiality and a parent’s right to know.
Multiple Relationships
Article B8 points to the perils of dual relationships that may affect your
judgement in a way that could cause harm to the client. The challenge here is
to be able to distinguish between dual or multiple relationships that may be
benign and those that represent conflicts of interest (Brownlee et al., 2019).
In either case, it is necessary to consider how those involved may view the
situation as well as considering the potential views of those not involved. As
noted in the code: “Multiple relationships are avoided unless justified by the
nature of the activity, limited by time and context, and entered into with the
informed consent of the parties involved after assessment of the rationale,
risks, benefits, and alternative options” (CCPA, 2020, p. 10).
80 CHAPTER 5
within and across groups of people in their life experiences and in their
responses to those experiences (Beagan, 2018). In the current and emerging
context, it is critical to develop a broader understanding of a range of people
whose life experience and values are different from yours, especially those
who may have experienced marginalization and/or discrimination. With
this perspective in mind, your focus is on approaching clients with a sense
of cultural humility. This leads to an openness to learning from their per-
spectives, the ability to focus on issues as they have experienced them, and
collaborating with them to deepen your and their understanding of these
issues and ways to move forward (Mosher et al., 2017). As noted in the Code
of Ethics (CCPA, 2020), that frame of reference allows you to “seek aware-
ness and understanding of client identities, identification, and historical and
current contexts,” (p. 11) which facilitates your ability to remain empathic,
and not fall into sympathy on one hand, or judgement on the other. In either
of those situations, your ability to help the client identify their strengths can
be compromised, and your judgement about any advocacy activities that
may be needed to support the client may be impaired.
82 CHAPTER 5
established at the beginning of the group, and that members and the leader
will be expected to speak and behave accordingly.
Referral
Article B16 is focused on situations where you need to consider whether
you are able to be of assistance to a client. This can arise when you are con-
sidering beginning to work with a client or, as counselling /psychotherapy
proceeds and you do not seem to be able to work effectively with them. As
the code indicates, you have a number of alternatives to consider in obtain-
ing support, including co-counselling, consultation, or supervision. If none
of these seem, or prove to be, effective you can opt to refer the client to a
professional you believe may be able to better serve their needs.
84 CHAPTER 5
Other challenges and potential pitfalls relate to Articles B6 and B7, that
provide ethical considerations related to maintaining client records and
providing access to them when necessary. Regarding your client notes (B6),
one question to ask yourself is, if I state an inference about the client in my
notes, have I provided evidence prior to stating the inference to make it
credible to a third party, including if I was called to defend it in court? For
B7, regarding access to notes, an important question to consider is whether
you have obtained legal advice about the client records access processes you
are developing or have in place. Issues of importance here include appro-
priately redacting files before releasing them, ensuring that they are sent
securely, and storing all files in a secure environment. When your records
are requested for legal proceedings, please refer to CCPA (2021) Standards
of Practice Section L: Guidelines for Dealing with Subpoenas and Court
Orders (p. 103).
In smaller communities/rural areas, or in situations where there are
small groups that are connected in multiple ways, such as in the LGBTQIA2+
community, ethnic groups, or other minority or marginalized groups, as
highlighted in Article B8, dual or multiple relationships may be difficult or
impossible to avoid. As noted in the code, when entering into these rela-
tionships, boundaries and time limits need to be set, and there needs to be
regular check-ins with everyone involved. Even with these safeguards, it is
necessary to ask yourself if the client feels free to state their concerns, given
the perceived power differential between the two of you.
The focus of Article B9 is on diversity, equity, inclusion, and intersec-
tionality. Questions that are helpful to ask here are: How much can I identify
with the situations of oppression that clients may bring to me? How can I
recognize times when I am in danger of projecting my own life experience
on to them? How susceptible am I to going into rescue mode on the one
hand, or judgement mode on the other, especially if the values expressed
are very different from mine? In any of these challenging situations, how do
I know when I am off track and need to consult for assistance, or refer the
client to someone else?
Of course, Consulting with Other Professionals (B10) can be challeng-
ing as well. It is possible that when you identify the need to consult you
will feel embarrassed or somehow lesser, rather than seeing it as learning
opportunity or as a way to expand your band of competence. The major
danger here is to give in to the feelings of fear and continue to stagnate or to
move out of your area of competence without knowing it, and potentially do
harm. In this situation, it is essential to seek consultation to help you avoid
the pitfalls associated with your biases and blind spots. Questions to ask
here are: When I am feeling less than competent with a client, what are the
86 CHAPTER 5
and other group members evolves and grows? In the initial session, have I
helped the group to develop norms for their interactions that allow them to
feel safe and accepted enough to be contributing group members? If a group
member violates a group norm, do I have ways to effectively address the re-
sulting challenges for the other members related to a feeling and experience
of safety or a sense of inclusion ?
A fundamental challenge related to Article B16 (Referral) may be to not
blame yourself or the client, but to use it as an opportunity for reflection on
the possible learning opportunities it may present in considering what made
it so difficult to help the client progress - was it something about you, the
client, or the context for one or both of you? In addition, were you able to
discuss it with the client so they felt supported acting on the referral?
Except in situations where the goals of counselling/psychotherapy have
been reached, the challenges involved in ending therapy (B17) often involve
weighing your needs with those of the client, and in looking for referral
sources that are accessible to them. In making a referral it is not sufficient
to pull a name out of a counsellor directory or to provide a list of resources.
Rather, it would be better for the counsellor/therapist to be able to provide
some information about the referral, including areas of expertise, length of
waitlist, approaches to counselling/therapy, and location (including wheth-
er or not e-counselling is available).
The challenge related to Article B18 (Mandated Clients and Systems
Approaches) is for you to understand that you have two clients – the person
referred and the system referring them. You also need to be aware of the lim-
its of freedom your client has in their decision to be your client, or to what
they disclose. It is also important to expect that the situation may influence
the level of trust you are able to develop with your client, and the effective-
ness of the work you can do with them.
Case 5.1
88 CHAPTER 5
Case 5.2
Case 5.3
90 CHAPTER 5
Case 5.5
92 CHAPTER 5
REFERENCES
Beagan, B. L. (2018). A critique of cultural competence: Assumptions, lim-
itations, and alternatives. In C. Frisby & W. O’Donohue, W. (Eds.),
Cultural Competence in Applied Psychology. Springer. https://doi.
org/10.1007/978-3-319-78997-2_6
Blease, C. R., Walker, J., Torous, J., & O’Neill, S. (2020). Sharing clinical notes
in psychotherapy: a new tool to strengthen patient autonomy. Frontiers
in Psychiatry, 11, 1095. https://doi.org/10.3389/fpsyt.2020.527872
Brownlee, K., LeBlanc, H., Halverson, G., Piché, T., & Brazeau,
J. (2019). Exploring self-reflection in dual relationship deci-
sion-making. Journal of Social Work, 19(5), 629-641. https://doi.
org/10.1177/1468017318766423
Canadian Counselling and Psychotherapy Association. (2020). Code of
ethics.https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-
2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Stan-
dards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/up-
loads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Erickson Cornish, J. A., Smith, R. D., Holmberg, J. R., Dunn, T. M., & Side-
rius, L. L. (2019). Psychotherapists in danger: The ethics of responding
to client threats, stalking, and harassment. Psychotherapy, 56(4), 441.
https://doi.org/10.1037/pst0000248
Mosher, D. K., Hook, J. N., Captari, L. E., Davis, D. E., DeBlaere, C., &
Owen, J. (2017). Cultural humility: A therapeutic framework for en-
gaging diverse clients. Practice Innovations, 2(4), 221–233. https://doi.
org/10.1037/pri0000055
ASSESSMENT AND
EVALUATION
Roberta A. Borgen
INTRODUCTION / CONTEXT
In Covey’s (2020) famous habits for highly effective people, “begin with
the end in mind” is almost top of the list. Within counselling/therapy, this
is particularly important when it comes to integrating assessment tools and
approaches into your practice. There are hundreds, perhaps thousands, of
formal and informal counselling-related assessment tools to choose from –
in some cases, freely available online; in other cases, available for a fee to the
general public; and, for specialized tools, restricted for purchase by only test
users with specific qualifications.
Foundational to the ethical use of assessment tools and processes in
counselling/therapy is adequate training (CCPA, 2020; 2021; C1). Al-
though basic psychometric assessment training is provided in most grad-
uate programs in counselling/therapy, it may be necessary for counsellors/
therapists to access specific training and/or supervision when adding new
tests to their toolkits. Many test publishers use a standard coding system,
where “A-Level” assessment tools are available for purchase without spe-
cialized training, “B-Level” tools require graduate-level training in tests and
measurements, and “C-Level” tools generally require advanced training and
supervision, typically at a doctoral level (CLSR, n.d.; MHS, n.d.; PAR, n.d.;
Pearson, n.d.; Psychometrics, n.d.; Sigma Assessment Systems, n.d.). Most
counsellors who have graduated with a Masters degree in counselling psy-
chology or a closely related area have access to B-Level assessment tools.
96 CHAPTER 6
benefits of using formal or informal assessment tools or processes. This is
where Covey’s (2020) “Begin with the end in mind” habit is especially rele-
vant. How will the results of the assessment process be used? What potential
harm could come to the client based on the assessment results? Does the
potential for a positive outcome outweigh the risk of a negative outcome?
Another important type of assessment that counsellors/therapists often
conduct, at times quite informally, is suicide risk assessment. This, however,
is not without controversy. Fowler (2012) emphasized the importance of
suicide risk assessments within the safety of a strong therapeutic alliance,
rather than administering an assessment on, or to, the client, it’s important
to collaborate with the client to assess risk. Smith (2022) also discussed how
the client’s autonomy may be breached unintentionally (i.e., if a client is
unaware of being screened for suicide risk, how can informed consent be
given?) Although training in suicide risk assessment is beyond the scope
of this chapter, which is focused on ethical considerations to do with as-
sessment and evaluation, such assessment is an important competency for
counsellors/therapists to develop.
Finally, counsellors may use assessment tools to evaluate their own prog-
ress with clients. This process falls under the umbrella of “routine outcome
monitoring” (ROM) and there are many different tools available to support
this (Muir et al., 2019). As with all aspects of assessment and evaluation in
counselling, there are pros and cons to consider. Muir et al. (2019) report-
ed that ROM outperformed clinical judgement in determining whether or
not clients are on track for success in achieving their counselling goals and
ROM-based feedback also resulted in improved client outcomes and helped
clinicians to better understand, and also to expand, their band of profes-
sional competence. However, it can be difficult to encourage clinicians to
embed ROM into their practice; as a result, it may be used inconsistently
or, in some cases, not at all, despite an agency investing in a robust ROM
system.
Although assessment and evaluation are ongoing processes throughout
counselling, the following sections on Recommended Practices and Pitfalls/
Challenges will address considerations within three stages: before the assess-
ment or evaluation begins, during the assessment or evaluation process, and
after the assessment or evaluation has been completed.
98 CHAPTER 6
It’s also important to consider any unique characteristics of the client
that may impact the assessment process or results (C10); such consider-
ations may include the client’s age, level of education, cultural background,
ethnicity, literacy, technical competency, and familiarity with the language
in which the assessment is written or conducted. Counsellors/therapists are
called to be sensitive to cultural differences and other aspects of diversity
when selecting assessment tools and processes (C10); however, the good
news is that recent research has found that most standardized achievement
and aptitude tests are not culturally biased (Reynolds et al., 2021). Not all
assessment and evaluation tools have been standardized, however, so it’s
essential that you carefully evaluate the appropriateness of any tool you are
considering for the specific client/groups you will be assessing – for exam-
ple, tools that are developed for youth may be inappropriate for older adults
(and vice versa) and tools designed for use with Indigenous populations in
remote rural communities may be inappropriate for immigrants who are
newcomers to Canada in a large urban community (C10).
After careful consideration of assessment pros and cons, it will be im-
portant to discuss options with your client (including information about
costs, time commitments, value added by testing, and how information will
be scored or transmitted electronically) and secure their informed consent
(C2, C5). Including information from multiple sources, rather than relying
on a single assessment tool, will provide a more holistic picture of your cli-
ent (C6).
Should you choose to move forward with formal assessments, it will
then be important to consider where and how to proceed (C4, C5). De-
pending on your purpose for assessment, your client’s capacity to work in-
dependently, and the complexity of the assessments being administered, it
may be possible to simply send your client some online codes and instruc-
tions to proceed on their own after discussing the assessments with you
and giving their informed consent; this may be appropriate, for example,
for some self-assessment tools designed to support deeper self-awareness
or career decision-making. However, other assessment tools (e.g., aptitude
or achievement tests) require a standardized administration under super-
vision. If the client can’t be onsite with you, you may need to arrange su-
pervision (sometimes called “proctoring”) in a remote location. In some
cases, videoconferencing may also be an option for test administration in
remote locations, with the test-taker either completing an online assessment
or a paper-based format which has been sent securely in advance. Such ar-
rangements can’t be arranged on the spur of the moment, so thinking ahead
about your assessment process is very important.
100 CHAPTER 6
Although you may have carefully planned ahead for an appropriate
space in which to conduct the assessments (C4), unexpected changes may
be required at the last minute. In the real world of assessment, I have had
clients:
• realize they were allergic to the building
» we moved outdoors to the parking lot to conduct the assess-
ments
• unable to sit at a table
» we moved into an office that had a filing cabinet at the right
height for the client to write on
• reveal an inability to read
» we had an assistant read the questions for self-assessment tools
and write the responses or type them on a computer
• walk into a room where a group was completing assessments, only
to find an ex-spouse’s new partner sitting at the table
» we arranged a private office, and allowed extra time for the
trauma reaction to subside
• struggling with test anxiety
» we took extra time to discuss the purpose and use of assessment
and began with less “test-like” tools, such as card sorts
• acknowledge after completing a standardized aptitude assessment
that they didn’t recognize the mathematical symbol indicating “di-
vided by” as it was different in Europe than in North America
» we took that into consideration in interpreting the assessment
results on scales impacted by that difference.
Aside from last minute client considerations, I have also had what
should have been a very quiet space without distractions become the exact
opposite – with a jackhammer starting up right outside the ground-floor
window! All these examples serve to illustrate that, no matter how prepared
you may be, you will also require flexibility and professional discernment
in what types of accommodations may be needed and ethically appropriate.
In the cases of self-assessment tools, there is typically more room to adjust
than with standardized assessment tools. With the latter, it may be neces-
sary to reschedule the assessment, using a different “form” of the tool (many
standardized assessment tools come with a Form A and a Form B that can
facilitate a fresh start if needed).
102 CHAPTER 6
If assessment results will be shared with a third party, clarify with the
client exactly what may be shared and how (C8). In some cases, a high-level
integrated summary will be sufficient; in other cases, the third party (per-
haps who requested and paid for the assessment process) may expect a more
detailed report, including scores, profiles, and/or graphs). It is the counsel-
lor/assessor’s ethical responsibility not to release test materials that are to
be kept secure (e.g., the question booklets) and also to ensure that reports
are written in such a way to be understandable and easily interpreted by the
third party (e.g., a different level of technical language would be appropriate
for a teenaged client, the client’s parents, a teacher, an employer, or a psy-
chologist). Assessment reports should also provide relevant context to aid in
accurate interpretation by readers (C8).
According to the CCPA (2021) Standards of Practice, there are also
times when the most ethical choice will be not to release assessment results
at all. This includes when the results may be harmful to the client (or oth-
ers), the data may be misused, the client refuses to sign a release form, or the
person intended to receive the report is not qualified to use the results in a
way that will benefit the client (C8).
PITFALLS / CHALLENGES
Although many of the pitfalls and challenges with assessment and eval-
uation have already been mentioned directly or implied, the following sec-
tions will highlight a few considerations to help you avoid common prob-
lems and navigate the assessment process more smoothly.
104 CHAPTER 6
During Assessment / Evaluation
During the assessment/evaluation process, you may notice your client
struggling – perhaps with the level of language, the amount of reading re-
quired, unfamiliar cultural references, or the amount of time the testing is
taking. Consider whether the planned assessment process can be adjusted
to make it more manageable, maximizing the chances of getting meaningful
assessment results. Counsellors/therapists are to “refrain from [testing] . .
. that may reasonably have the potential to produce harmful or invalid re-
sults” (CCPA, 2021, p. 38; C4) – examples may include clients with recent
exposure to test items; severe test anxiety; conducting an assessment after
an accident or injury or other stressful events such as a death in the imme-
diate family; or testing someone when it seems likely that the “results will be
used to violate the fundamental rights of the client or others” (CCPA, 2021,
p. 38).
Some clients may be triggered by the notion of being tested or the sim-
ilarity of aptitude/achievement assessment tools to what they had struggled
with in school (C4, C6). Clients may also find back-to-back assessments
overwhelming – be sure to allow time for breaks and energizing activities
and, where possible, vary the type of assessment to keep your clients inter-
ested and engaged.
106 CHAPTER 6
CONCLUSION
Assessment and evaluation in counselling/therapy is both an art and a
science. It’s essential to have solid foundational training, ongoing access to
relevant supervision, and a commitment to continuing professional devel-
opment as you add assessment tools to your professional toolkit or as the
tools you’ve become familiar with are revised or critiqued. Ensuring that
your clients fully understand their options regarding assessment, including
the risks, benefits, and added value for each option, is crucial. Especial-
ly when using standardized assessment tools, ensure testing conditions are
appropriate and closely follow all required procedures. Present assessment
results tentatively, integrating information from multiple sources, and en-
sure that reports and other related communication explain results in plain
language and with sufficient context to maximize understanding and mini-
mize risk of misinterpreting or overinterpreting the findings. Engage clients
in making sense of their assessment results and choosing to whom to release
information. Keep all standardized testing materials secure to preserve their
integrity. Finally, carefully attend to the intersectionality of diversity and its
impact on assessment and evaluation results.
Case 6.1
108 CHAPTER 6
Case 6.2
110 CHAPTER 6
then, on the third day, before flying home, to provide the
assessment results in three 1.5-hour meetings (one for each
test-taker, to include the test-taker, family members, and at
least one elder from the community). Collin has never deliv-
ered assessment results to third parties before.
When raising concerns with the agency director, Collin
was told not to worry - they had been successfully using
this standard battery for years, mostly in the city but at least
twice before in this community, and the instructions in the
manual were really easy to follow.
Case 6.4
112 CHAPTER 6
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Fowler, J. C. (2012). Suicide risk assessment in clinical practice: Pragmatic
guidelines for imperfect assessments. Psychotherapy, 49(1), 81.
Hays, D. G. (2017). Assessment in counseling: Procedures and practices (6th
ed.). American Counseling Association. https://psycnet.apa.org/re-
cord/2017-25892-000
Multi Health Systems (n.d.). Ordering from MHS. https://mhs.com/order-
ing-from-mhs/
Muir, H. J., Coyne, A. E., Morrison, N. R., Boswell, J. F., & Constantino,
M. J. (2019). Ethical implications of routine outcomes monitoring for
patients, psychotherapists, and mental health care systems. Psychother-
apy, 56(4), 459.
Pearson. (n.d.). Qualifications. https://www.pearsonclinical.ca/en/order-
ing/how-to-order/qualifications.html
Psychological Assessment Resources. (n.d.). Qualification levels. https://
www.parinc.com/Support/Qualification-Levels
Psychometrics (n.d.). Qualification levels. https://www.psychometrics.com/
qualification-levels/
Reynolds, C. R., Altmann, R. A., & Allen, D. N. (2021). The problem of bias
in psychological assessment. In Mastering modern psychological testing
(pp. 573-613). Springer.
Sigma Assessment Systems. (n.d.). Testing qualification levels. https://www.
sigmaassessmentsystems.com/place-an-order/testing-qualification/
Smith, M. (2022). Suicide risk assessments: A scientific and ethical critique.
Journal of Bioethical Inquiry, 19, 481-493. https://doi.org/10.1007/
s11673-022-10189-5.
PROFESSIONAL
RESEARCH AND
KNOWLEDGE
TRANSLATION
William A. Borgen
INTRODUCTION / CONTEXT
Our profession has gained credibility over the years by increasingly en-
gaging in evidence-based and evidence-informed counselling and therapy
practice. Ongoing research programs and projects have provided a broad
range of information that has increased our understanding of what makes
our work effective.
The purpose of Section D of the Canadian Counselling and Psychother-
apy Association’s Code of Ethics (CCPA, 2020) is to point out key ethical is-
sues that need to be addressed from the point of considering and developing
a research idea, to conducting the research and disseminating the results.
You will note that the overarching aims of this section of the code are to
protect the confidentiality and psychological safety of research participants
throughout the research process, and to help you make ethical decisions
regarding appropriate recognition of members of the research team.
Research is often conducted within postsecondary institutions that have
116 CHAPTER 7
RECOMMENDED PRACTICES
Researcher Responsibility
Article D1 elaborates and makes more specific the responsibilities of
researchers by stating:
Counsellors/therapists plan, conduct, and report on research
in a manner consistent with relevant ethical principles, pro-
fessional standards of practice, federal and provincial laws,
institutional regulations, cultural norms, and, when applicable,
standards governing research with human participants. These
ethical obligations are shared by all members of the research
team, each of whom assumes full responsibility for their own
decisions and actions. Before engaging in any study involving
human participants, the principal researcher seeks independent
ethical review and approval. (See also A2, A3, I3, I6, I8, I9, I10;
CCPA, 2020, p. 45).
The 10 articles that follow in Section D can be grouped into three gener-
al clusters: Articles D2 and D3 focus on the ethical issues regarding welfare
of the participants in your research; Articles D4 – D6 are concerned with
the rights of your participant; Articles D7 – D11 provide guidance regarding
the ethical care that you need to take in the activities that result from your
research, including storage of research data and the activities involved in
disseminating your results – that is, in how to ethically participate in re-
search communities.
Welfare of Participants
Articles D2 and D3 (CCPA, 2020) focus on the welfare of research par-
ticipants, particularly their psychological safety. When thinking about the
participants in your study it is important to consider the extent to which
the topic of your study, along with the quantitative measures or qualitative
interviews that you will use, may cause them distress (D2). If there is a pos-
sibility that your study may create difficulties for some potential participants
you need to create strategies to mitigate these effects. This can involve re-
viewing the measures or interviewing approach that may be used; recon-
sidering who to recruit for your study; considering the way data is collected
so that support is available if a participant is in distress; making it clear to
participants that their participation is voluntary, and that they are free to
Participant Rights
Articles D4 (Informed Consent of Research Participants), D5 (Research
Participant Right to Confidentiality), and D6 (Research Data Retention) ex-
tend the issues of concern regarding protection of the welfare and rights of
research participants (CCPA, 2020). Ethical issues in these three articles
are similar to the corresponding articles for clients receiving counselling/
therapy. Regarding informed consent, as with clients, it is understood to be
a process rather than a one-time event. In order for research participants to
be able to provide informed consent they must be made aware of all aspects
of the research, possible risks, level of disclosure required and limits to con-
fidentiality (D4). The process of obtaining informed consent should involve
a discussion with the participant rather than a one-way process of informa-
tion giving. The process should be repeated for components of the research
that may pose a higher level of risk for participants, or if the participant
seems to be reluctant to continue. These are also times where the participant
should be reminded that their participation is voluntary and they can with-
draw from the study, should they choose to do that.
In some cases, research review boards may be open to consider waiving
the informed consent if, for example, deception is used to mask the aim of
the study and there is no apparent risk to participants in the study. In these
cases, the risk factor must be minimal and the guarantee of confidentially
must be very strong. As an example, a researcher wanted to see if coun-
sellors reacted differently to seeing clients based on the implied culture of
their name. The research involved potential clients contacting counsellors
by email and tracking the number of call backs from the counsellors.
Regarding the right of research participants to confidentiality (D5), this
extends to all aspects of the research being conducted, including masking
participants’ names and identities and maintaining their anonymity in any
knowledge dissemination activities. In some instances, participants do not
want to be anonymous. When this occurs, it is vital to inform participants
about the possible range of publicity that may occur, so they are able to make
an informed decision. It is also important to be sure that all communication
with these participants is in written form, and includes their signatures.
Similar requirements for client confidentiality arise regarding research
data retention (D6). It is imperative that paper copies of all written material
be kept in a deidentified format in a locked filing cabinet in a safe location,
118 CHAPTER 7
or in an encrypted digital format for the number of years required by law or
the institution that provided ethical approval for the study to be conducted.
It then needs to be destroyed. One reason for retaining the raw data for a
number of years is that this information may be useful to other researchers
who are interested in replicating the study’s finding or research processes.
Researcher Responsibility
Adhering to the CCPA’s Code of Ethics (CCPA, 2020); the Tri-Council
Policy Statement: Ethical Conduct for Research Involving Humans; First
Nation’s Principles of Ownership, Control, Access, and Possession; and
institutional research guidelines is essential in Professional Research and
Knowledge Translation (D1). These documents may provide a number of
content and procedural requirements that are new to you. If that is the case,
it is important to take preventive action in gaining the required knowledge
and skills before you proceed, and consult with individuals and groups who
can mentor and guide you. It is also crucial to understand that any conflicts
in the requirements set out in the CCPA’s Code of Ethics (CCPA, 2020);
the Tri-Council Policy Statement: Ethical Conduct for Research Involving
Humans; First Nation’s Principles of Ownership, Control, Access, and Pos-
session; and institutional research guidelines need to be reconciled by the
researcher, and that the researcher is held responsible for the decisions that
are made.
Welfare of Participants
As the possible risk to participants increases, so does the need to con-
sider Articles D2 and D3 in the code (CCPA, 2020). A possible challenge
can involve collecting your quantitative or interview data remotely. With
quantitative data you may not know if the participant was experiencing a
challenge that will require assistance. With an interview study conducted
remotely, you will not be present to offer assistance and may not know of
local resources to recommend. Regarding Article D3, participants may feel
hesitant to withdraw from the study and you may not want to lose them as
part of your study. The message here is to watch for signs of distress so it can
be discussed with the participant, and so you can remind them that they are
free to withdraw without penalty.
120 CHAPTER 7
Participant Rights
Common challenges involving informed consent (D4) include consid-
ering it to be a one-time event or treating it as a one-way information ses-
sion, instead of involving the potential participant in a conversation where
they are encouraged to ask questions. If it is not treated as an ongoing pro-
cess, the researcher may be vulnerable to not engaging in due diligence to
ensure ongoing informed consent, and be open to challenge. In terms of
the participants’ right to confidentiality (D5), issues can arise if their names
and identities are not masked throughout the data collection, data analy-
sis, and knowledge dissemination phases of the research. This can happen
as easily as having a member of the research team use a participant’s real
name in discussing a surprising result of the research with a colleague, or
during a presentation of the results. It can also happen if a member of the
team meets a participant at a social gathering. Regarding D6, participants’
anonymity can be compromised if sufficient care is not utilized in deiden-
tifying their identity in research files, if research materials are not stored in
a safe or sufficiently encrypted space, or if the information is not destroyed
at the required time. It can be a challenge to retain research file information
in a locked and safe space for the required number of years so that other
researchers have access to it. In institutional settings it is less of a problem,
since there is likely a process in place for storing this material. For those not
in institutional settings, storing research materials along with your other
confidential files is a good option. In practice, if you have published your
study, the publication itself will likely provide all of the information they
may need, so requests for your research files should be minimal.
122 CHAPTER 7
CASE EXPLORATION
Case 7.1
124 CHAPTER 7
Case 7.3
126 CHAPTER 7
REFERENCES
Canadian Counselling and Psychotherapy Association. (2020). Code of eth-
ics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-
2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Stan-
dards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/up-
loads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
First Nations Information Governance Centre (2022). First Nation’s prin-
ciples of ownership, control, access, and possession. https://fnigc.ca/oc-
ap-training/
Government of Canada (2018). Tri-council policy statement: Ethical con-
duct for research involving humans. tcps2-2018-en-interactive-final.pdf
(ethics.gc.ca)
CLINICAL
SUPERVISION
SERVICES
Pamela Patterson & Michael N. Sorsdahl
INTRODUCTION / CONTEXT
The ethical standard of clinical supervision services, as laid out by
the CCPA Code of Ethics (2020) in Section E, provides a comprehensive
structuring of ethical practice in clinical supervision. Although this stan-
dard primarily addresses the work of the supervisor, there is a network of
stakeholders in supervision. The ethical standards of clinical supervision
services concern the supervisor, the supervisee, the client, the welfare of the
public, and the representation of the profession in terms of ethics and legal
accountability, as well as the policies and conduct of personnel at the site
where the supervision is conducted.
Shepard (2020) referred to clinical supervision as a “carefully orches-
trated relationship.” (p.2). Describing the supervisor/supervisee/client rela-
tionship specifically. Shepard summarized the work:
Clinical supervisors oversee quality control of supervisees’
work by regularly monitoring and reviewing their client work.
Certainly, a substantial part of the supervisory function is to
make sure that supervisees grow and develop into the best
130 CHAPTER 8
and social justice priorities has broad implications that are discussed in this
section of the code, including professional identity development, informed
consent practices, and relational boundaries and evaluation procedures.
There are many reasons why one might supervise or become a supervis-
ee. The possibilities include: basic training in counselling/therapy, address-
ing the requirements for membership in regulatory bodies or associations,
achieving additional certification and training, updating specialized skills,
or as the result of ethical sanctions by a regulatory body. Further, various
work settings may require supervision as a regular practice, perhaps due
to specialized services or populations. Even experienced counsellors/ther-
apists are encouraged to access supervision throughout their career span.
The approach and format of the supervision service is designed according
to the specific purpose of the supervision and, in this sense, it may vary
widely.
As the supervision purpose varies, so do the dynamics of power and re-
sponsibility in the supervisor and supervisee relationship. The articles with-
in this section of the code provide guidelines for ethical clinical supervisory
services to support the supervisee’s professional development. In an envi-
ronment of anti-oppression and decolonization, the thoughtful integration
of these ethical standards requires reflection and intention on the part of all
interested stakeholders to appropriately engage within the given dynamics
of power inherent in the supervisor/supervisee relationship (Peters et al.,
2022).
RECOMMENDED PRACTICES
The following discussion reviews ethical practice in Clinical Supervi-
sion Services as laid out in the CCPA (2020) Code of Ethics and Standards of
Practice (CCPA, 2021). The first article, General Responsibility (E1), pro-
vides a broad overview of what this work is about. Following this broad
introductory article, the subsequent articles look more closely at facets of
ethical supervision services. For the reader, this means a continuous circling
of some of the same material, considering increasingly detailed aspects of
what is involved. For example, some of the themes you may see examined
repeatedly include: expectations of the supervisor, the supervisor/super-
visee relationship, and/or the incorporation of diversity. The sum of these
articles is a thorough work-up of this critical practice which will serve as a
reliable resource and premise for effective clinical supervision processes.
132 CHAPTER 8
or supervisees practice in remote or northern-based communities where
there may be reduced access to professional development opportunities and
supervision.
Another important consideration is the fact that a supervisor is not
counselling their supervisee; rather, they are educating supervisees regard-
ing the necessity and practices of self-care. Supervisors can encourage su-
pervisees to engage in personal counselling and professional supervision
throughout their career because these are worthwhile self-care and personal
development activities. By incorporating these activities, counsellors/ther-
apists are participating in the development of competencies, professional
networking, and growth in self-efficacy and personal wellbeing, with relat-
ed benefits for practice and the welfare of clients and society.
As supervision is a specialty area of professional practice that requires
the time and skill of an identified professional, payment for this service is
relevant. The CCPA Code of Ethics and Standards of Practice, combined,
lay out ethical considerations that may inform decision-making regarding
a suitable fee. In the formation of the supervisory relationship, identifying
a fee may entail consideration of the supervisee’s ability to pay and whether
fees could be a barrier to obtaining supervision. Sliding scale fees for super-
vision can be one way to allow for greater access to supervision. In any case,
the recommended ethical practice is to come to an agreement about fees,
capturing this in the informed consent form in order to properly track and
record it. An agreement needs to clearly indicate the regularity of supervi-
sion sessions, the amount, method of payment, and due date for payment of
fees. The importance of this article is the identification of an ethical process
for identifying and forming a fee structure for clinical supervision in a man-
ner that is transparent and accountable.
Boundaries of Competence
The Standards of Practice (2021) address the issue of competence that a
supervisor needs to have. Supervisor competence pertains to the theory and
practice of counselling/therapy as well as supervision. In addition, super-
visors need to understand the continually expanding processes of teaching
and learning as well as ethics, and the personal and relational implications
of diversity. For example, with the infusion of multicultural and social jus-
tice considerations in counselling/therapy and supervision, pedagogical
tools and participation in the supervisor/supervisee relationship must in-
corporate expanding complexity and awareness (Cohen et al., 2022; Schultz
et al., 2020).
Supervisors also need to understand their suitability for the work at the
site where supervision will take place. Different sites have particular require-
ments for supervision. For each situation, supervisors must understand the
supervision needs and dynamics of the supervisees (Cook & Sackett, 2018).
For example, the supervision needs of a student in training are substan-
tially different from those of a mature practitioner independently seeking
supervision for development into a new area of practice. The supervisor
must understand these differences and respond accordingly. To this end,
the supervisor should prepare a statement regarding their competence in-
corporating the specific needs of the site and supervisee, which can then be
shared and discussed with the supervisee and others who have an interest in
the supervisory process.
Gatekeeping
Ethical Commitment (E3) highlights the central importance of ethi-
cal practice spanning counselling/therapy practice as well as supervision.
“Clinical supervisors are conversant with ethical, legal and regulatory issues
relevant to the practices of counselling/therapy and clinical supervision”
134 CHAPTER 8
(CCPA, 2020, p. 21). As discussed, supervisors model ethical behavior and
engage in ethical decision-making processes, actively incorporating their
awareness of diversity and individual differences in these actions. Clinical
supervisors ensure that supervisees are also knowledgeable regarding the
relevant codes, standards, and other documents, recognizing personal and
professional responsibility for ethical commitment in all their activities.
Through this process of education and supervision, the supervisor acts as
a gatekeeper to the profession, ensuring that supervisees understand their
professional obligations.
Although conducting a supervisory review of client sessions is an im-
portant component to ensuring the supervisee meets all the required com-
petencies, it is not recommended as an exclusive focus of supervision. In-
corporating regular reviews of the ethical code and standards of practice,
legal requirements and case law, ethical decision-making processes (beyond
what is relevant in a session review), and skill development makes for a
richer experience for the supervisee and helps to ensure a clear assessment
of competency for entry into practice. This allows for a more comprehensive
professional identity development approach to supervision (Cruikshanks et
al., 2017).
Welfare of the Client and Protection of the Public (E4) identifies that the
supervisor has a primary responsibility to protect society and must exercise
their role as gatekeeper in their oversight and assessment of the supervis-
ee. The supervisor is required to continually determine the competency of
supervisees by responsibly identifying whether or not they are reliable and
prepared to engage in the work of counselling/therapy. The supervisor ed-
ucates, models, and demonstrates competent engagement as a counsellor/
therapist. A supervisor may be required to redirect or overrule supervisees’
activities with clients in order to mitigate the risk of harm to those clients or
to protect the public.
Supervisors must address the personal growth and unique training
needs of supervisees. Due Process and Remediation (E10) outlines this re-
quirement of supervisors and how to negotiate such challenges ethically.
There can be complex and difficult circumstances to negotiate when spe-
cific training limitations, or ethical or practice violations, are identified in
a supervisee’s practice of counselling/therapy. In these circumstances, the
supervisor formulates remediation requirements that support the supervis-
ee’s development in specific areas. This article provides guidelines and sug-
gestions regarding responsibilities, tasks, documentation, and remediation
plans.
Supervisors also provide supervisees with opportunities for self-dis-
closure and self-growth which support the development of professional
Relational Boundaries
Ethical Commitment (E3) is an active relational practice of supervisor
and supervisee. Article E3 specifies the need to discuss the triadic and dy-
adic relationships of supervisor, supervisee, and client with thoughtful at-
tention to risk management. As an example, the CCPA (2021) Standards of
Practice state “[c]ounsellor/therapist clinical supervisors must, at all times,
keep in mind that they are ultimately responsible for the actions of their
supervisees, and the welfare of clients must be their main concern” (p. 62).
The supervisor continuously engages the supervisee using informed con-
sent and ongoing assessment to address the learning needs of supervisees,
but their primary responsibility is the welfare of the client. In situations
where the supervisor must act to protect the client’s welfare, the supervisor
and supervisee must be clear regarding the supervisor’s primary responsi-
bility. Ethical Commitment (E3) highlights the necessity for supervisor and
supervisee to actively engage with the CCPA (2020) Code of Ethics and Stan-
dards of Practice (CCPA, 2021) in order to effectively execute the divergent
responsibilities of supervisor and supervisee in clinical supervision services.
Ethical Commitment (E3) also addresses the necessity of intentionality
regarding boundaries in supervisory relationships. Relational boundaries
can be breached when there is blurring of personal and professional bound-
aries of the supervisor and supervisee. For example, the supervisor and su-
pervisee can become too friendly, creating conflict or uncertainty in some
of the responsibilities or evaluations that they must engage in. Alternatively,
it could refer to multiple roles that are adopted, for instance when there is
a co-existing business relationship between supervisor and supervisee, or
when both the supervisor and supervisee serve on a community board or
outside organization. In these situations, the supervisory relationship may
be affected by competing relationships. Dedicated attention to maintaining
an appropriate relational boundary is required for the benefit of the super-
visory task. This is similar to the challenge of multiple relationships in coun-
selling/therapy, where a careful review of ethical practice and clarity of roles
136 CHAPTER 8
must be explored. It is recommended that such clarifications and boundary
discussions be denoted in a supervision contract and agreed to in writing.
Article E3 also accommodates those situations when it is appropriate to
bring human compassion, understanding, and support into the supervisory
relationship. Ethical intentionality in the relationship does not mean rigid-
ity. The focus and intent of this article is important because it highlights
the necessity of relational limits in the supervisory relationship, balanced
against the needs of the situation.
Welfare of Supervisees (E5) highlights the clinical supervisor’s respon-
sibility to prioritize the supervisee’s wellbeing and success through the su-
pervisory process. While striving to facilitate and guide the supervisee’s
work, the supervisor aims to “foster a reciprocal sense of safety, trust, and
predictability” (CCPA, 2020, p. 21). Suggestions are provided in the Stan-
dards of Practice (CCPA, 2021) regarding how to approach difficulties that
may arise in this process including: revising the supervision plan or forming
a remedial plan, personal counselling, mediation, taking a break, or trans-
ferring supervision to another supervisor. The supervisor’s attention to the
wellbeing of the supervisee aids in the development of the supervisee and
models the importance of a caring dynamic between the supervisee and
their clients.
Program Orientation (E8) addresses the formation of transparency and
collaboration between supervisor and supervisee regarding the responsibil-
ities and obligations of supervision. The supervisor is responsible for orien-
tation of the supervisee about the requirements of the supervisory process.
Continuing discussion can address informed consent including reporting to
licensing agencies, the dynamics of the professional relationship, the means
to address serious concerns, the supervisee’s rights to privacy, as well as the
requirement of self-disclosure and self-growth activities. The CCPA (2021)
Standards of Practice recommend a supervisory contract which outlines
the functional and supportive structure of the supervisory process. Such a
contract includes practical details such as the schedule and timeline for su-
pervision, the means of monitoring and evaluation, protocols pertaining to
the use of technology, and considerations such as how to handle absences,
emergencies, or evening shifts. Supervisory policies, expectations, responsi-
bilities, documentation, fees, written processes for evaluation, remediation,
dismissal, and due process are to be included in the consent and fully ad-
dressed with the supervisee.
138 CHAPTER 8
tifies the necessity of an appropriate and scholarly preparation of the clinical
supervisor and the demonstration of excellence in clinical practice. Clinical
supervision as a distinct practice in counselling/therapy requires specific
training. The supervisor requires familiarity with the CCPA (2020) Code of
Ethics and Standards of Practice (CCPA, 2021) in order to understand their
ethical roles and responsibilities. The clinical supervisor should be able to
identify their competence as it relates to the supervisory requirements of
their supervisees, the needs of the supervisory context, and the needs of the
client population. This recommended practice is the backbone of effective
provision of clinical supervision services because the supervisor requires
depth and range to engage the myriad relationships and responsibilities of
supervision. Clearly supervision is a demanding and specialized role requir-
ing training and experience. Supervision certification can be sought through
CCPA (https://www.ccpa-accp.ca/membership/supervisor-certification/).
To support the supervisor in this demanding role, a recommended prac-
tice is for the supervisor to access supervision for themselves while engag-
ing in the supervision of others (i.e., supervision of supervision). Because
this work relies so centrally on a range of personal competencies and an
emerging supervisory relationship, the provision of supervision for super-
visors can enhance understanding as well as support supervisors in working
through the complexities that are likely to emerge in this relational process.
This recommended practice is in line with the principle that supervision
itself is an ongoing component of maintaining and growing counselling
skills; therefore, for those engaging in supervision of counsellor/therapists,
continued development and growth through supervision is ideal.
140 CHAPTER 8
PITFALLS / CHALLENGES
The challenges or pitfalls of the Clinical Supervision Services section
in the CCPA (2020) Code of Ethics relate to the central task of an orches-
trated relationship. Although there may be many reasons for challenges to
emerge in the supervisory process, the supervisory relationship becomes
the site of most of these challenges. Issues identified through the standard
may include: the supervisor’s lack of competence for the role, their misun-
derstanding of their primary responsibilities to the welfare of the client and
the protection of the public, or their failure to understand their responsibil-
ity in engaging and educating the supervisee. For the supervisee, a lack of
clarity regarding procedures such as what to do in a clinical emergency, how
to handle absences, or how to conduct themselves in an ethical manner with
clients can lead to mishaps and misunderstanding. Relationally, confusion
can arise around the processes of assessment and evaluation or there can
be breaches in the supervisory relationship. Ensuring that these issues and
potential concerns are discussed, and also explained within the superviso-
ry contract, helps to mitigate misconceptions and misunderstandings. The
CCPA (2021) Standards of Practice among other sources (e.g., Cohen et al.,
2022; Peters et al., 2022) provides helpful content for such a discussion.
Perhaps the key pitfall in Clinical Supervision Services is the neglect
of familiarity with the CCPA (2020) Code of Ethics and the Standards of
Practice (CCPA, 2021) because they provide a key representation of the di-
mensions and responsibilities of the supervisory task. Failures of the super-
visor and/or supervisee to understand their ethical and professional roles
and responsibilities can lead to failure in the supervisory process. A lack of
engagement in the activities of growth, understanding of diversity, self-care
practices, or commitment to building and protecting a collaborative rela-
tionship between supervisor and supervisee can undermine the potential of
the supervisory process. When the provision of clinical supervision services
is not working well, there is a poor working relationship between supervisor
and supervisee; the supervisee may be working with insufficient oversight
by the supervisor, processes of assessment and evaluation are underutilized,
there is a lack of ethical accountability, and the welfare of clients and the
protection of the public are at risk. When supervisor or supervisee do not
recognize the primary responsibility of the supervisor towards the welfare
of the client and the protection of the public, there is a risk of a gross ethical
failure.
142 CHAPTER 8
CASE EXPLORATION
Case 8.1
144 CHAPTER 8
DISCUSSION QUESTIONS
1. Which of the articles of this section of the code and standards do you
consider to be the most important? Why? Would your opinion change
depending on whether you were a supervisor or a supervisee? In what
way(s)?
2. What are the best supervision experiences you have had? Discuss what
made them work. (Also discuss what are the worst supervision experi-
ences you have had and why they did not work.)
3. What are your thoughts about the responsibilities of the supervisor?
Would you want these responsibilities? Why or why not?
4. How does the supervisor/supervisee relationship differ from a relation-
ship with a colleague, a client, or an office administrator? How are they
the same?
5. What would you consider in a situation where you disagreed with a
supervisor’s remediation plan for you? What actions would you take?
What do you need to know?
6. What are your thoughts about supervision as an exercise in self-care?
Under what circumstances does it make sense? When would it be inap-
propriate?
7. If you are supervising someone who is being disciplined by their reg-
ulatory body, what steps would you take in preparing for supervision?
Who are you accountable to and in what way? What relationship con-
siderations would you think are important? What are your thoughts
about your responsibility to the regulatory body?
146 CHAPTER 8
ADOBE STOCK
CONSULTATION
SERVICES
Michael N. Sorsdahl & Pamela Patterson
INTRODUCTION / CONTEXT
The CCPA (2020) Code of Ethics and Standards of Practice (CCPA,
2021) clarifies consultation services due to the prevalence of consultation
within the counselling/psychotherapy profession, with very little previous
direction on the ethical conduct of this practice. Consultation services, as
defined by this section of the code, make take many forms; “[counsellors/
therapists] may undertake a consultative role a) informally with colleagues
or peers, b) formally with agencies or institutions, c) as a private practice
service, and d) informally or formally on an ad hoc and/or pro bono basis”
(CCPA, 2020, p. 23). Informal consultation includes any time information
is shared between two practitioners, about their thoughts or opinions about
a specific issue (client issues or professional issues). The person consulting
and the person being consulted are not in any formal arrangement that re-
quires the consultee to follow the advice/recommendations of the consul-
tant. A formal consulting arrangement is where there is a clear agreement
regarding expectations of service being provided by the consultant. This
type of consultation requires a formal arrangement and agreements, and
is what is more spoken to within the Consultation Services section of the
CCPA (2020) Code of Ethics and Standards of Practice (CCPA, 2021).
150 CHAPTER 9
Supervisory Services Compared to Consultation Services
Another important distinction is that neither formal nor informal cos-
ultation services are the same as supervision services; this will be further
addressed below. Although the term consultation has been used in reference
to supervisory services in counselling and psychotherapy practice, there
are key differences that are important to identify. Supervision refers to a
continuing relationship between a supervisor and supervisee which is or-
ganized within a specific service context and addresses the welfare of the
client and the protection of the public. Supervision is a distinct practice
within counselling/therapy that benefits from educational training/courses
that help better prepare practitioners to provide this service. Consultative
services, on the other hand, are much less delineated. The Code of Ethics
(CCPA, 2020) notes that specific training and expertise is required in the
counselling/psychotherapy area(s) in which one practices consultation, but
the possibilities here are more broad ranging, unlike the specified training
and certification currently available for the role of supervision. Review of
these two separate roles as outlined in the Code of Ethics and Standards of
Practice will clarify further meaningful differences.
RECOMMENDED PRACTICES
Although informal consultation is encouraged and is viewed as an
important component of ethical practice for counsellors/psychotherapists,
the recommendations in this section will focus on more structured formal
consultation services.
152 CHAPTER 9
sultation from someone with more experience working with a specific client
group. The consultation note should include: with whom (and perhaps why
that specific consultant was selected), about what specific topics, and key
takeaways from the conversation. The consultant may similarly document
the date, information about the individual seeking consultation, topics ad-
dressed, and any suggested clinical recommendations or referral.
Record Keeping/Management
Another important consideration is how to manage the consultation re-
cord keeping and maintenance of privacy for all involved. The CCPA (2021)
Standards of Practice offer specific recommendations to encourage practi-
tioners to have a clear process in place with regards to managing their con-
sultation services. Practitioners are encouraged to consider: (1) How will
consultation records be maintained? (2) What is included in the records?
(3) How will they be stored and destroyed in alignment with provincial
regulations? Consultation services comprise part of the services that coun-
sellors/therapists provide, and so therefore fall under the purview of the
Freedom of Information and Protection of Privacy Act.
PITFALLS / CHALLENGES
Consultation services and supervision services can both face similar
challenges. However, consultation services are unique services provided
by counsellors/therapists that are distinct from supervisory services. Two
major areas of challenge in offering these services include administrative
pitfalls and working outside of one’s scope of competence.
Administrative Pitfalls
One of the major pitfalls for practitioners providing any informal ser-
vices (including information consultation) is to treat them so informally that
they would not be considered professional services. Consultation, however,
is a service that is within the scope of practice of counsellors/therapists and,
therefore, subject to the ethical codes, legal requirements, and standards of
practice of the professional. Ignorance of the requirements for the provi-
sion of consultation is insufficient to defend against improper or unethical
practice. Being aware of the expectations of consultation services, having
Scope of Competence
It is essential that the professional provides consultation only within
their scope of practice and expertise. Article F1 (CCPA, 2020) emphasizes
that consultants only provide services for which they are trained and com-
petent. When seeking out consultation, it is imperative to consider who is
going to be retained for this service (whether paid or otherwise). If providing
this consultation service, it is essential to outline the focus of competence
and expertise, and to clearly explain the limits. Only provide consultation
services within current areas of expertise and avoid offering consultation for
issues that are beyond that boundary.
154 CHAPTER 9
CASE EXPLORATION
Case 9.1
Case 9.2
DISCUSSION QUESTIONS
1. What is the difference between supervision and formal consultation?
2. What is the difference between formal consultation and informal con-
sultation?
3. What makes a good consultation arrangement, and what does someone
look for in a good consultant?
4. What can you do to improve your skills as a consultant within the coun-
selling/psychotherapy profession?
5. What are the legal considerations when providing consultation services,
and how can the risks associated with them be mitigated?
6. What are some important considerations and practices in starting a
peer consultation group?
156 CHAPTER 9
REFERENCES
Balderman, L. Why clinical consultation is important for therapists. (2022,
April 15). Linkedin. Retrieved from https://www.linkedin.com/pulse/
why-clinical-consultation-important-therapists-lisa-balderman-lcs-
wr?trk=public_profile_article_view
Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Train-
ing and consultation to promote implementation of an empirically
supported treatment: A randomized trial. Psychiatric Services, 63(7),
660-665.
Canadian Counselling and Psychotherapy Association. (2020). Code of eth-
ics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-
2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Stan-
dards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/up-
loads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Rantanen, A. P., & Soini, H. S. (2018). Changes in counsellor trainee re-
sponses to client’s message after
peer group consultation (PGC) training. British Journal of Guidance &
Counselling, 46(5), 531-542. https://doi.org/10.1080/03069885.2016.1
277381.
COUNSELLOR
/ THERAPIST
EDUCATION AND
TRAINING
Roberta A. Borgen
INTRODUCTION / CONTEXT
Effective counselling, regardless of theoretical orientation, is a process
that facilitates desired changes in clients. Teaching this process, and provid-
ing opportunities for supervised practice, is the role of counsellor educators
– this group of counselling and psychotherapy professionals is the focus of
this chapter. Counsellor educators are bound by the same ethical principles
and standards that guide their own counselling practices but, as outlined in
Section G of CCPA’s (2020) Code of Ethics, they also have additional roles
and responsibilities.
Counselling diverse individuals who are experiencing complex prob-
lems within dynamic and interconnected systems is inherently messy. Effec-
tively training students to perform this role to at least a minimal standard
requires a systematic, comprehensive, scaffolded approach. Educational
psychologist, Vygotsky (1978), introduced the notion of scaffolding to de-
scribe how a safe space for learning complex concepts can be constructed,
160 CHAPTER 10
RECOMMENDED PRACTICES
Counsellor educators are ethically responsible for facilitating safe and
respectful spaces for learning, providing clear and transparent orientations
to their programs and courses, maintaining their own competence as coun-
sellors and educators, ensuring the competence of any individuals to whom
they delegate responsibilities, protecting the public, engaging in reflection
and self-care, and engaging fairly and equitably in scholarly activities. Rec-
ommendations related to all of these topics are provided below.
162 CHAPTER 10
flection and personal growth. It is considered good practice not to grade
self-disclosure and self-growth activities – students need to be confident
that sharing their vulnerabilities, biases, and areas for growth will not be
held against them.
As highlighted in Articles G4 and G6, educators need to be aware of
their positions of power and privilege, and intentionally use those positions
to benefit their students and supervisees. Similar to the process of securing
informed consent before beginning to work with clients, counsellor/thera-
pist educators need to clearly inform students about their respective respon-
sibilities and requirements, and to address power differentials, especially
in cases where there may be multiple relationships in place. For example,
a student may be taught by a faculty member, employed as a research or
teaching assistant by that individual, travel to conferences as a member of
a research team (often involving social events), receive clinical supervision
from the same individual in a practicum course, and also serve with that
individual on a university committee or a community board. Such multiple
relationships can offer important professional development and networking
opportunities to students but, as discussed in previous chapters regarding
multiple relationships with clients, must be managed well to be effective
and not unintentionally harm the student. Transparency in roles, and re-
sponsibilities within those roles, becomes a helpful recommended practice.
Transitioning roles from one form to another is another area of focus for
counsellor/therapist educators; as students graduate, the roles can change.
Clarity about roles and responsibilities is especially important in practi-
cum courses and clinics where instructors have dual responsibilities as clin-
ical supervisors (ensuring clients receive appropriate care) and evaluators
(i.e., grading students, identifying when remediation may be necessary, and
determining whether or not students have demonstrated sufficient compe-
tency and self-awareness to pass the course and, in some cases, to continue
in the program). Counsellors/therapists use themselves as the primary tool
in working with their clients. The counsellor competency framework en-
dorsed by the College of Regulated Psychotherapists of Ontario makes sev-
eral references to “safe and effective use of self” (SEUS; CRPO, n.d.; CRPO,
2017). One approach to handling training clinics and practicum courses
safely and effectively is to run them in a similar way as counselling groups –
setting group norms and clearly acknowledging each participant’s roles and
responsibilities.
Part of safe and effective learning spaces and educator-student relation-
ships is the confidence that boundaries will be maintained and respected
across contexts. The Code of Ethics (2020) specifically mentions in Article
G11 that “Counsellor/therapist educators do not engage in intimate contact
164 CHAPTER 10
Several counsellor education programs in Canada are accredited
(CCPA, 2023); CACEP-accredited programs are subject to regular exter-
nal reviews and must meet specific standards. If you are teaching in an ac-
credited program, it will be important to understand the CACEP standards
and requirements that impact your courses and the students you are super-
vising, especially before making any modifications to course syllabi or stu-
dents’ study plans. Regardless of whether or not your program is accredited,
your syllabi serve as contracts between you and your students; they must
align to the stated description of the course and the learning objectives set
by the program, and the evaluation criteria must clearly measure the learn-
ing outcomes of the course.
Students must also be informed early on about limits to confidentiality
and how information will be shared amongst the program team. Similar to
securing informed consent with counselling clients, students need to know
the reporting requirements associated with any threats of harm to others,
when protection of a child or vulnerable adult warrants it, or when legally
required. Beyond this, however, they also need to fully understand how the
faculty/instructional/supervisory/administrative team works together to
contribute to students’ development and, ultimately, to protect the public.
Competence
Clearly, the primary purpose of counsellor/therapist education and
training is to develop and maintain the requisite counselling competencies
(CRPO, 2017; FACTBC, 2019; NSCCT, 2020). Although there are nuanced
differences between approaches to training and various competency frame-
works (e.g., although CRPO and NSCCT both use the term “safe and ef-
fective use of self,” FACTBC refers to “awareness of self” and “safety” but
doesn’t explicitly link the two), CCPA’s (2021) Standards of Practice (G14)
highlights the important role that counsellor educators play in providing
opportunities for students to practice counselling under supervision, with
the fully informed consent of their clients. It also emphasizes that students
are not asked to engage in counselling activities that are beyond their de-
velopmental level (i.e., clinical and practicum experiences must be carefully
scaffolded and supervised to protect both students and their clients). Vetting
potential clients through a thorough intake process is particularly import-
ant. Finding innovative ways to train students without putting vulnerable
clients at risk is also important; emerging technologies may offer effective
solutions. Demasi et al. (2019), for example, developed a “CRISISbot” to
support the training of crisis counsellors, drawing from counsellor role-play
transcripts to simulate a suicide hot line visitor for counsellors to practice
with.
166 CHAPTER 10
Self-Awareness, Self-Care, and Self-Growth
Counsellor educators also need to support their students’ self-develop-
ment and self-awareness (G8), as well as support students who are dealing
with personal issues (G9). Most graduate students in counsellor education
programs are adults with full and complex lives. Aside from raising aware-
ness of their assumptions, biases, and privilege, which are all important to
consider in developing counselling competence, a focus on self-care is also
essential. Counselling students, and counsellors-in-practice, need to under-
stand their capacity limits and take preventative action to avoid compas-
sion fatigue, vicarious trauma, or burnout. It is typical not to grade personal
reflections or self-awareness activities but, rather, to create a safe learning
environment in which students can reflect and continue to grow.
When personal issues arise for your students, it’s essential to differen-
tiate between your own competency and training as a counsellor/therapist
and your specific role as an educator or clinical supervisor. You can offer
support through referrals and can normalize the value of counsellors engag-
ing in their own personal counselling (G9).
Students, understandably, may have questions about future career pos-
sibilities as counsellors/therapists. As mentioned previously, it is helpful if
counsellor educators stay connected to their professional associations, at-
tend conferences (where possible, inviting students to co-present), and have
a good understanding of the types of work that alumni from the program
have been able to secure. For a more general coverage of careers within
counselling psychology, see “Applications and careers for counsellors and
counselling psychologists” (Borgen & Neault, 2019).
Scholarly Activities
Although research, writing, and conference presentations are addressed
in more detail in other parts of this book, counsellor educators sometimes
find themselves wearing multiple hats with their students (e.g., teaching a
required course to a student who is also in your research lab and working
as a teaching assistant for another course). Mentoring students into the full-
ness of their potential future roles as counsellors can be the most rewarding
part of a counsellor educator’s job (G13) but it needs to be carefully struc-
tured, ensuring fairness and equity.
168 CHAPTER 10
recognizing enough key elements of a story that they can identify the indi-
viduals involved! Counsellor educators can caution students to use pseud-
onyms for clients in case presentations and written assignments and also, as
part of the informed consent process, to let clients know with whom their
information will be shared. In clinical and practicum courses, counsellor
educators hold the ultimate responsibility for ensuring safe storage of videos
(and that those videos are erased at the end of the course or an agreed-upon
time), locked or password-protected storage of case notes and client files,
and that online correspondence (e.g., email) is encrypted and on a secure
system.
Another significant challenge for counsellor educators can be the mul-
tiple roles and relationships between them and their students (G6). It can
be problematic to juggle the role of supporter/encourager with the respon-
sibility to assess and evaluate competency, for example. Other potentially
challenging multiple relationships may include employer/instructor, thesis
supervisor/instructor, or even serving on university committees or commu-
nity boards together. As previously described, such roles, relationships, and
responsibilities can be managed effectively with clear boundaries and open
communication. However, recognizing the difference between boundary
crossings and boundary violations is important here. Many multiple rela-
tionships, such as working closely with a faculty member as a thesis su-
pervisor, being employed as a teaching assistant by that same individual,
and travelling to an international conference to present with that profes-
sor and network with internationally recognized experts in the field can
offer incredibly important professional development support to a student.
Although this could result in boundary crossings at times, they would not
necessarily be problematic. Boundary crossings become violations and, as
such, serious ethical concerns, when the power imbalance leads to exploita-
tion, compromises the supervisor’s/instructor’s objectivity, or causes harm
to the student or others.
Particularly problematic is when a counsellor educator uses an inher-
ent position of privilege and power to take advantage of students (e.g., only
taking thesis students who fit the instructor’s specific research agenda; tak-
ing information from students’ course assignment submissions to shortcut
the educator’s own research, without permission or crediting the students’
work; assignment structures and grading criteria that are focussed more on
the instructor’s need to minimize workload than on the course learning ob-
jectives or students’ need for feedback; only providing reference letters to
students who volunteer on the instructor’s research projects). Of course,
sexual harassment and romantic relationships between counsellor/therapist
educators and their students are never considered appropriate – very sim-
170 CHAPTER 10
CASE EXPLORATION
Case 10.1
172 CHAPTER 10
Case 10.3
DISCUSSION QUESTIONS
1. As a student, what characteristics do you appreciate in counsellor edu-
cators?
2. Think of a counsellor educator with whom you have multiple relation-
ships (e.g., course instructor / research supervisor; thesis supervisor /
employer). How has this individual structured a safe and effective envi-
ronment for you to work together in these multiple ways?
3. Describe your favourite learning experience as you’ve been training to
become a counsellor/therapist. What made that experience so memora-
ble and meaningful?
4. As you reflect on this chapter, and the complex responsibilities of a coun-
sellor educator, what new insights do you have about why programs are
structured as they are, or why specific course/program requirements are
in place?
5. It could be argued that becoming a counsellor educator requires a
unique set of competencies. What additional training might you require
before you would feel ready to teach or train others in this field?
174 CHAPTER 10
REFERENCES
Borgen, W. A., & Neault, R. A. (2019). Applications and careers for coun-
sellors and counselling psychologists. In M. E. Norris (Ed.), The Cana-
dian Handbook for Careers in Psychological Science. eCampus Ontario.
https://ecampusontario.pressbooks.pub/psychologycareers/chapter/
applications-and-careers-for-counsellors-and-counselling-psycholo-
gists/
Canadian Counselling and Psychotherapy Association. (n.d.). The profes-
sion & regulation: Who are counsellors/psychotherapists? https://www.
ccpa-accp.ca/profession-and-regulation/
Canadian Counselling and Psychotherapy Association. (2020). Code of eth-
ics. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-
2020-Code-of-Ethics-E-Book-EN.pdf
Canadian Counselling and Psychotherapy Association. (2021). Stan-
dards of practice (6th ed.). https://www.ccpa-accp.ca/wp-content/up-
loads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.
pdf
Canadian Counselling and Psychotherapy Association. (2023). Accredita-
tion. https://www.ccpa-accp.ca/accreditation/
College of Registered Psychotherapists of Ontario. (n.d.) Definitions. https://
www.crpo.ca/definitions/
College of Registered Psychotherapists of Ontario. (2012). Entry-to-practice
competency profile for registered psychotherapists. https://www.crpo.ca/
wp-content/uploads/2017/08/RP-Competency-Profile.pdf
Demasi, O., Hearst, M. A., & Recht, B. (2019). Towards augmenting crisis
counselor training by improving message retrieval. In Proceedings of
the Sixth Workshop on Computational Linguistics and Clinical Psychol-
ogy, 1-11.
Federation of Associations for Counselling Therapists in British Columbia.
(2019). Entry-to-practice competency profile for counselling therapists.
https://www.cctpei.ca/sitefiles/Documents/External/2019-Counsel-
ling-Therapist-Competency-Profile-approved-2019-Nov-15.pdf
Giordano, A. L., Bevly, C. M., Tucker, S., & Prosek, E. A. (2018). Psycho-
logical safety and appreciation of differences in counselor training pro-
grams: Examining religion, spirituality, and political beliefs. Journal of
Counseling & Development, 96(3), 278-288.
Haddock, L., Cannon, K., & Grey, E. (2020). A comparative analysis of tra-
ditional and online counselor training program delivery and instruc-
176 CHAPTER 10
ADOBE STOCK
USE OF ELECTRONIC
AND OTHER
TECHNOLOGIES
Andrea Rivera, Sherry Law, and Lawrence Murphy
INTRODUCTION / CONTEXT
Technology has transformed the practice of counselling/psychotherapy,
making it more convenient and open to clients and counsellors/therapists
(Bakshi & Goss, 2019). You must have the technical literacy of the technolo-
gies you are employing, be able to use these tools effectively, understand the
inherent benefits and drawbacks of employing technologies in your prac-
tice, and be able to troubleshoot typical problems (Johnson, 2017). These
are ongoing requirements because technology continues to develop and
take on a bigger role in the delivery of therapy services. This chapter will
draw from Section H of the Canadian Counselling and Psychotherapy As-
sociation’s (CCPA, 2020) Code of Ethics and Standards of Practice (CCPA,
2021), with a specific focus on four key factors: cybersecurity, social media
impacts, technology impacts on therapeutic relationships and prepared-
ness, and how to address fast-changing technological developments.
180 CHAPTER 11
4. Are you storing files on a cloud server?
5. Are you storing your files on a jump/thumb drive?
6. Are your files or the jump/thumb drive encrypted?
7. Do you know what two-step verification is and what it can do?
There are many questions that can be helpful in making better ethical
choices as a counselling therapist and more still as these technologies con-
tinue to advance. CCPA has dedicated resources in the form of guidelines
to help counsellors to evaluate appropriate technological solutions (Schell,
2019). Remember that these guidelines are not meant to be laws. Not every
single security measure must be perfect. As a matter of fact, it can’t be. Even
experts can make mistakes.
No matter what protocol or guide you use, what matters is that you take
time to approach technology thoughtfully. Research has shown that a major
vector of security breaches is human error (Liginlal et al., 2009). There-
fore, people’s electronic security often becomes compromised not because
of hardware or software issues, but because people click on links, or divulge
sensitive information to others willingly.
Jurisdiction
Another issue that comes up regularly is the question of jurisdiction;
when we are online where can we practice? There is no simple answer to
this question, and the reality is that, over the last 2 decades, the goalposts
have moved often. Part of the reason for this is that Canadian law generally
continues to face significant challenges in determining jurisdiction.
Article H7 describes how the counsellor/therapist may be subject to the
laws and regulations of where the counsellor/therapist is located as well as
where the client resides. A third issue sometimes comes into play when, for
example, a resident of Ontario is visiting family in Alberta and, suddenly,
requires our services. Here the location of the client may also be relevant.
Further, the location of the server where data is stored or passed through
may also be relevant (Johnson, 2017).
The recommended strategy for counsellors/therapists to take is to con-
tact both their professional association/college and their liability insurance
provider. The latter will always have clear explicit rules about what you can
and cannot do. For example, one of the authors who runs a counselling and
training practice was told that one of their therapists who spent a good deal
of time in the USA (she was Canadian and had married an American) could
teach courses and provide supervision from the United States regardless of
the location of the student or counsellor. However, when she was delivering
counselling, she had to cross the border into Canada for the duration of the
182 CHAPTER 11
with social media thoughtlessly can skew a person’s perceptions. Commu-
nities within social media platforms can quickly become echo chambers
where opinions, attitudes, and claims are repeated and often weaponized
(purposefully or not). We are likely all familiar with platforms and apps
which create a filter on pictures and videos, often slimming the face, widen-
ing the eyes, and uplifting the brows to create a type of look. These filters,
when used and consumed often, can set an unrealistic standard of beauty
for people.
As such technology becomes more sophisticated, you may find yourself
working with a client whose video image is slightly, or even entirely, differ-
ent from their real appearance. Even their voice may be altered. In-person,
a client’s appearance can give us clues to their physical and mental health
(e.g., whether they look haggard or well-rested, whether the pallor of their
skin is notable, whether their eyes are bloodshot or pupils dilated). The abil-
ity to hide such facial aspects could get in the way of us doing our best work
for our clients. If in doubt, it is worth broaching the subject.
In the same way, communities that amplify certain opinions may lead
one to believe that the world agrees, or that the opinion is popular when
it might be the case that these opinions are unpopular, harmful, or even
dangerous. Joining these communities can happen naturally, whether one is
a counsellor/therapist or a client, and can become an increasingly involved
extension of our lives. For example, if we love our pets and are concerned
about animal welfare, it is natural to gravitate to communities that share
similar values. We take advice from community members, request feedback,
and build trust overall over time. When these communities develop more
polarizing beliefs and share posts making claims that are not verified, it is
easy for members to get swept up emotionally into those beliefs and perpet-
uate inaccurate or inflammatory stances. It is helpful to learn about the dif-
ferent communities that our clients may be a part of (in the physical world
as well as digitally) so we can support them in managing their wellness out-
comes. It is also just as important that we are mindful of what communities
we decide to engage in as practitioners and how they may impact our biases
and judgment. Creating healthy boundaries with technology can help us
to disentangle from potentially harmful digital communities. However, it is
still important to keep abreast of what these communities can look like and
feel like so we can best understand and support those in our care.
Social media can also be used to spread misinformation about mental
health and therapy. This can lead to clients self-diagnosing, seeking treat-
ment for conditions that they do not have, or refusing to seek treatment for
conditions that they do have. This can have serious consequences for the cli-
ent’s mental health and overall well-being. Though many practitioners can-
184 CHAPTER 11
Therapists need to have the ability to effectively use technology to
communicate with their clients. This can look very different depending on
which technology is being used; however, in all instances, verifying the true
identity of the client is important (Johnson, 2017), especially when working
with youths to verify the age for consent (Teufel-Prida et al., 2018) which,
when not done properly, can have heavy ethical impacts. Some referral
sources provide identifiers. In absence of that, some counsellors request ID
at the first session (e.g., a driver’s license) or, if working over the phone,
hold the first session via video-conferencing to verify that the person is of
age to consent to counselling. To confirm location, some counsellors ask cli-
ents to take their laptop or phone outside to show, via videocam, the address
number on the building, ensuring it matches the address on the intake form.
However, caution is recommended on becoming overly strict on confirming
identity that could interfere with building the therapeutic relationship. As
long as the person who presents as the client appears to be telling the truth
and demonstrates capacity to provide consent to counselling then, legally,
the counsellor/psychotherapist has done what was reasonably expected to
confirm the identity and capacity of the client.
The strategies one would use for communicating over the phone with a
client will be very different from communication using video-conferencing
software or texting. For example, phone counselling lacks non-verbal com-
munication and text-based counselling lacks both non-verbals and tone of
voice (Harris & Birnbaum, 2014). This can lead to miscommunications, and
misunderstandings of the intent of the message (Bakshi & Goss, 2019). Un-
derstanding how (and when) to compensate for these missing components
is critical to good communication and to establishing and enhancing the
therapeutic alliance. Even video is not immune to these considerations. Sit
at your computer and look at a colleague with whom you’re video chatting.
You typically cannot see below the middle of their body. Non-verbals that
are off-camera (e.g., the anxious tapping of a leg or the wringing of hands)
may well be critical to understanding the client’s state of mind. By not seeing
them, we (unintentionally) ignore them.
Technology use also risks blurring boundaries. Drum and Littleton
(2014) highlighted three main boundaries that can easily be broken: time,
setting (i.e., where the session is being held), and personal boundaries of
therapists. They provided nine recommendations to support the healthy
growth of therapeutic relationships, confidentiality, and ethical care:
1. Maintain professional hours and respect the timing of
sessions.
2. Ensure timely and consistent feedback and manage
excessive communications.
Growing Technologies
The quick advancement of technology is not new. Consider the last time
you used a flip phone and then recall when the first touchscreen phone came
about - not so far apart in time! Technology changes quickly, and people
depend on it more and more for communication, efficiency, and support.
Psychological flexibility as “the capacity to persist or to change behaviour
in a way that includes conscious and open contact with thoughts and feel-
ings, appreciates what the situation affords, and is guided by one’s goals and
values” (McCracken & Morley, 2014, p. 8) can support you greatly in main-
taining your skills and adjusting to developments regarding the changes in
technology. As such, it’s important to look inwards and build awareness of
the idea of maintaining your skills in an ever-growing and ever-changing
environment. This is true for both the delivery of services (Article H4) and
the education and training of counsellors/therapists (Article H5).
A clear example was how quickly counsellors/therapists had to adapt to
the use of technology to be able to continue supporting their clients through
COVID-19 closures (Comer, 2021). Those who adapted quickly were able to
support their clients in one of the most difficult moments in current histo-
ry. Having that flexibility allowed many to use technologies they had never
186 CHAPTER 11
used before; both hardware and software. However, some were blindsided
by this drastic change and were seriously challenged in their ability to pro-
vide services to their clients. And, of course, this also affected clients in vari-
ous ways as many did not have the skills to manage the shift from in-person
sessions to e-counselling.
The ability to maintain psychological flexibility and adaptability in the
face of rapidly changing technology is a crucial skill for counsellors/thera-
pists. By staying up-to-date with the latest developments and advancements
in technology, you can ensure that you are equipped to provide the best pos-
sible care to your clients, regardless of the challenges and obstacles that you
may face. The COVID-19 pandemic has shown all of us just how import-
ant it is to be flexible and adaptable in the face of change (Prudenzi et al.,
2022), and has highlighted the need for us to continue learning and growing
as professionals. By embracing the opportunities that technology provides,
you can continue to help your clients navigate their mental health journeys
with confidence, competence, and compassion. To maintain a high level of
ethical proactivity in areas such as informed consent, confidentiality, and
data privacy, you will likely need to seek out ongoing training in these areas.
Clients deserve nothing less.
PITFALLS/CHALLENGES
Counsellors/therapists are not typically cybersecurity experts and, as
such, they face several challenges when dealing with cybersecurity issues.
For one, they may not have the knowledge or training necessary to identify
potential cybersecurity risks or to make informed decisions about how to
best protect their clients’ information. This can lead to a sense of paralysis
by analysis, where counselling therapists may feel overwhelmed by the com-
plexity of the issues and unsure of what steps to take. Additionally, therapists
may also be constrained by factors such as budget and time, which can fur-
ther complicate their ability to address cybersecurity concerns. To mitigate
these challenges, technological considerations will have to be incorporated
with the modules introduced in the standard curriculum across Canada.
Until these curriculum changes have been made, it will be up to you to em-
power yourself to take cybersecurity and other issues technologies present
into your own hands. Through doing so, help to build the landscape for
change in our profession. This is most easily done by accessing available
training in e-counselling and associated issues.
188 CHAPTER 11
5. What is your plan if your client answers their call and someone else is
there with them?
6. Whom do you contact if you are impacted by a hack or malware and
your files are corrupted?
These considerations impact both cybersecurity and the clinical aspects
of sessions. We need not only to know the tools we are working with but also
to be prepared to troubleshoot situations and circumstances as they arise. In
this our grandmothers were right: an ounce of prevention equals a pound
of cure.
It is important to also note that with the continuous advancement of
technology, you need to be mindful of the possible ethical considerations
these advancements may take and how these may impact your work. An ex-
ample of this is the current discussion surrounding biases within algorithms
used in various technologies that lead to the notion of nonmaleficence as
needing further consideration. (e.g., What human biases have been built
into algorithms? How might computer dependence impact individuals?;
Fiske et al., 2019). You need to be cautious when recommending tools to
clients, such as apps that may support clients’ journal habits or emotional
tracking. Although these apps can enhance the counselling relationship and
support the client’s goals, you also need to be mindful of how these apps
may not be affiliated with mental health professionals or associations, and
in other cases lack resources to support clients in emergencies, which could
jeopardize their safety. (Palmer & Burrows, 2021). A great pitfall here is to
not be well informed about these tools, particularly if you are planning to
use them in your work with clients.
One final consideration, which falls slightly outside ethical consider-
ations but overlaps, is the clinical impact of these online environments. We
have briefly referenced the fact that the lack of tone of voice needs to be
compensated for in text-based communication. And we have noted that
non-verbals need to be focused on in all online methods, video included.
But there is more.
Online environments alter human behaviour. One example of this
is what we call disinhibition (Bakshi & Goss, 2019), wherein individuals
engage in behaviours online that they would not normally engage in in-per-
son. Online we tend to be more open and forthright. We tend to be more
willing to speak our truth and say what is on our minds. Within the comfort
of their homes, people may be more open to sharing emotions that they
might not in a different setting (Teufel-Prida et al., 2018).
In some ways, this can be a good thing therapeutically in that clients
will disclose earlier and more completely in online environments. But they
190 CHAPTER 11
CASE EXPLORATION
Case 11.1
Suzie has been a counsellor for 25 years. They have
been working at the same agency for their entire career,
and recently a new executive director has come on board.
The agency is looking to make changes and digitize busi-
ness processes. The executive director seems excited about
this switch as it will produce more clients locally and across
provinces as well as improve efficiencies in the administra-
tive, bookkeeping and client record processes. The execu-
tive director seems focused on increasing client volume, has
no background in ethical health management, and is focus-
ing on the financial aspect of the organization. Additional-
ly, the executive director wants to expand service provision
across provinces and internationally to gain more financial
resources for the agency. The executive director wants to
have a conversation with the counsellors in the agency to
understand the impact that these changes may have on
the counsellors, and to find ways to support them so they
may go through the changes rapidly and effectively. Suz-
ie is grateful for the upcoming meeting. However, Suzie is
unsure about the changes, feeling uncomfortable with be-
ing responsible for client booking, communications, record
keeping, and invoicing digitally since they were previously
only responsible for these processes in paper form. Suzie is
also unfamiliar with all the platforms associated with this
switch, such as social media pages, websites, and manage-
ment systems. They are nervous about talking to their em-
ployer about their discomfort and they don’t know their
responsibilities or how to approach the topic. Suzie is also
concerned about the timelines as these changes will occur
rather quickly. Suzie is aware that they are not the only one
concerned about these changes; other counsellors in the
agency have expressed concerns too. Suzie is afraid of los-
ing their job and feels entirely out of their depth.
192 CHAPTER 11
DISCUSSION QUESTIONS
1. How many devices are you using? Do you have 2-factor authentication
on the most important accounts?
2. Do you know what a backup is? Do you back up the files for your private
practice?
3. Do you know what your liability insurance says about remote work with
clients and across jurisdictions?
4. Do you know if your province is regulated for counselling therapy? Do
you know what your regulatory body says about technology use and
remote clients?
5. What would be some appropriate methods of storing client notes dig-
itally? Hard drive, cloud storage, USB devices? Is each file encrypted?
Why or why not? Explore.
6. Do you have an alternative plan in case your online platform (e.g.,
Zoom, Owl, Jane) is out of service for a period of time? What are the
steps you need to take to provide sessions and inform your clients of the
changes?
7. What are the steps you need to take in case your computer becomes
compromised (hacked)?
8. What are the steps you need to take in case your online platform hold-
ing your electronic health records is compromised?
9. When did you last review that your online platform holding your elec-
tronic health records is PHI and PIPEDA compliant? How have you
recorded this information?
10. What is your organization/private practice policy on liability for being
hacked?
11. What is the last time you received training on cybersecurity and best
practices?
194 CHAPTER 11
McCracken, L. M., & Morley, S. (2014). The psychological flexibility mod-
el: A basis for integration and progress in psychological approaches
to chronic pain management. Journal of Pain, 15(3), 221–234. doi:
10.1016/j.jpain.2013.10.014
Office of the Privacy Commissioner in Canada (2019). PIPEDA in brief.
https://www.priv.gc.ca/en/privacy-topics/privacy-laws-in-can-
ada/the-personal-information-protection-and-electronic-docu-
ments-act-pipeda/pipeda_brief/
Palmer, K. M., & Burrows, V. (2021). Ethical and safety concerns regarding
the use of mental health–related apps in counseling: Considerations for
counselors. Journal of Technology in Behavioral Science, 6(1), 137-150.
Prudenzi, A., Graham, C. D., Rogerson, O., & O’Connor, D. B. (2022).
Mental health during the COVID-19 pandemic: Exploring the role of
psychological flexibility and stress-related variables. Journal of Social
Psychology, 162(3), 239-255. https://doi.org/10.1080/08870446.2021.2
020272
Teufel-Prida, L. A., Raglin, M., Long, S. C., & Wirick, D. M. (2018). Tech-
nology-assisted counseling for couples and families. The Family Jour-
nal, 26(2), 134-142.
INDIGENOUS
PEOPLES,
COMMUNITIES, AND
CONTEXTS
Kim Bayer
INTRODUCTION / CONTEXT
This chapter expands upon Section I of the CCPA (2020) Code of Ethics,
which stressed the importance for counsellors/therapists, including trainees
and supervisors, to deepen their understanding of, strengthen their respect
for, and engage in meaningful ways with Indigenous Peoples, Communities
and Contexts.
As the author, I write from the traditional, ancestral, and unceded
territory of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish),
and səlilwətaɬ (Tsleil-Waututh) Nations. I am an uninvited guest here as
my mother’s family settled on Coast Salish territory after Métis land scrip
policies removed our ancestors from land near the Red River, Manitoba.
They lived in Edmonton, Alberta before coming to the Westcoast of British
Columbia in 1948. After leaving Germany in the 1930s, my father’s family
also settled near Winnipeg, Manitoba before moving to the coast in 1938.
Connected with cultural history and family, my heart lies with commu-
198 CHAPTER 12
colonization for Indigenous peoples (Duran, 2006). Moreover, when coun-
sellors/therapists impose a different worldview on the Indigenous client it
“can be understood as a form of violence against the [client’s] knowledge
life-world” (Duran, 2006, p. 9).
This chapter comprises four sections, each focusing on several articles
from Section I. Indigenous Peoples, Communities, and Contexts from the
Code of Ethics (CCPA, 2020): History and Context (I1); Relationships and
Cross-Cultural Practice (I7, I8, I9); Traditional Practices: Respect, Partici-
pation, and Appropriate Use (I4, I5, I10); and Identity, Diversity, and Com-
munity Development (I2, I3, I6, I11). This chapter is constructed differently
than the other chapters in the text due to the nature and intent behind the
ethical codes, which emphasize a need to create relationships that do not
perpetuate colonization and systemic oppression. As the themes are pre-
sented, a Case Scenario is provided to help understand the practice con-
siderations in applying the ethical codes and standards of practice. Ques-
tions are provided for your consideration, to encourage self-reflection about
knowledge limits, and to help highlight the Recommended Practices. This
chapter is designed to provide ethical considerations and practice approach-
es when working with Indigenous clients and communities; however, it is
not designed to be an instruction manual on how to work with Indigenous
clients.
RECOMMENDED PRACTICES
Key practices that demonstrate counsellor/therapist Awareness of His-
torical and Contemporary Contexts (I1) include ongoing professional devel-
opment to understand the impacts of colonization such as intergenerational
trauma by assimilation policies (e.g., residential schools), and practicing
in ways that decolonize (e.g., drawing from a lens of anti-oppression, such
as locating and linking sources of oppression to the present). This also in-
cludes knowledge of the Canadian Constitution (Sec. 35) (Government of
Canada, 1982), which recognizes the distinct identity of First Nations, Inuit,
and Métis peoples.
Additionally, working in culturally safe ways with Indigenous clients
involves ongoing counsellor/therapist efforts to deprivilege Western ap-
proaches, respect for the client’s proximal and local Indigenous practices,
and practice with knowledge and understanding of cultural safety; for exam-
ple, as outlined by the College of Psychologists of British Columbia (2018),
recognizing the diversity between and within Indigenous groups, the role
of the social determinants of health (e.g., colonial systems and policies con-
tinue to negatively impact Indigenous peoples), and client preferences (i.e.,
the choice of Indigenous clients to participate in cultural healing practices,
or not; Western approaches; or combinations of both ways of knowing and
doing).
Knowledge and understanding of cultural safety practice-related issues
is also important (College of Psychologists of British Columbia, 2018; see
the reference section for a link to this cultural safety work), including at-
tention to client/therapist values and beliefs, particularly when rooted in
Western values and approaches, conscious and unconscious biases and ste-
reotypes about Indigenous peoples, as well as the role of cultural humility in
creating safe therapeutic space for Indigenous clients. Cultural humility in-
volves approaching each new relationship with openness (e.g., to learning,
self-reflection, and challenging cultural biases). It also involves addressing
power imbalances in practice and in the profession, as well as institutional
accountability (Waters & Asbill, 2013).
200 CHAPTER 12
Article A12 of the CCPA (2020) Code of Ethics speaks to the ethical re-
sponsibility of all counsellors/therapists to enhance their diversity aware-
ness, sensitivity, responsiveness, and competence with respect to their own
self-identities and those of their clients. Article B1 speaks to the role of
counsellors/therapists to respect the integrity of, promote the welfare of,
and work collaboratively with clients to devise counselling/therapy plans
consistent with client needs, abilities, circumstances, values, and their cul-
tural or contextual background. In practice, this involves minimizing the
impulse to privilege Western forms of training that place the counsellor/
therapist in the expert role. Colonial policies and practices were institut-
ed to assimilate Indigenous peoples and this continues to be reinforced in
Western practices, while undermining Indigenous culture (Rogers et al.,
2019). In response, with Indigenous clients, ethical counsellors/therapists
place Indigenous ways of being and knowing first.
Similarly, Article B9 emphasizes the importance of respecting inclusivi-
ty, diversity, difference, and intersectionality, and for counsellors/therapists
who conduct clinical supervision, Article E12 emphasizes the importance
of continually seeking to enhance their diversity awareness, sensitivity, re-
sponsiveness, and competence, and to explore with their supervisees the
various aspects of cultural diversity. Although these diversity-related parts
of the Code are not specific to working with Indigenous peoples, knowledge
of the impacts of intersectionality will be a key indicator of ethical prac-
tice; for example, it is important to recognize the oppression and inequality
Indigenous peoples face because of structural, institutional, and systemic
biases. Also, as highlighted in Article I3, there is significant diversity with-
in Indigenous individuals and communities. Curiosity, openness, and re-
sponding with cultural humility, listening to needs, and respecting Indige-
nous interests, values, and practices, are a few ways to begin this work.
PITFALLS / CHALLENGES
One of the major pitfalls that counsellors/therapists face is practicing
without cultural humility – in other words, without active listening for the
client’s sense of cultural self, the creation of a safe space, and efforts to check
for bias and stereotypes that create client mistrust. Similarly, another pitfall
is not consistently recognizing cultural diversity both within and between
groups. Clients who identify from shared Nations or cultures will have
unique identities, connections, and experiences. Key pitfalls to avoid are
practices that generalize knowledge about one culture to another; that is,
Case Scenario
202 CHAPTER 12
Questions to Consider
As a counsellor/therapist working ethically, consider these questions:
• How can you create cultural safety and respond with humility as
you begin work with this client?
• How do you formulate your initial understanding of the problem?
• What biases have you identified in trying to understand the prob-
lem?
• The client is Indigenous but their cultural connection has not been
shared. How will you as a counsellor/therapist approach the client’s
Indigeneity (e.g., identity and their relationship to Indigenous cul-
ture)?
• What are the historical impacts (e.g., intergenerational trauma
through residential school) that might be impacting the client?
• How does the client describe the complexity of the issues? (e.g., stu-
dent life, current triggers and anxiety, historical trauma and trig-
gers, fear of asking administrators for help, and alcohol misuse).
• How might the client and you as the counsellor/therapist collabo-
rate to contextually understand the problem?
• What strengths does the client draw from (e.g., the client’s wellbe-
ing practices, advocacy, and/or agency toward the problem)?
• How might the client and you as the counsellor/therapist collabo-
rate to explore responses to the problem?
• How will you as the counsellor/therapist assess whether the client
felt heard, respected, and supported in this session?
• How will you as the counsellor/therapist:
» assess cultural safety and humility as the session ends?
» create space for session feedback from the client?
» integrate this feedback into future sessions and/or ways of prac-
ticing?
Recommended Practices
Counselling/therapy practice considerations include integrating mul-
tidisciplinary approaches to Western healthcare with Indigenous healing
practices. Arguments for, at minimum, traditional healing modalities and
integrated Western approaches for individuals of diverse, ethnic, and cultur-
al backgrounds are supported in the research literature. In line with health
care practices, mental health practitioners also acknowledge the value of tra-
ditional healing practices with mainstream practices (Oulanova & Moodley,
2017).
However, key differences emerge and indicate an ethical focus for coun-
sellors/therapists. Specifically, traditional Indigenous ways of healing draw
from holistic worldviews and recognize the interrelationship between mind,
heart, body, and spirit. This departs from Western psychological theories
and practices which generally focus on mental and emotional components
(Duran, 1990, in Oulanova & Moodley, 2017). Moreover, this view can be
distilled further into four considerations as “the conceptualization of well-
ness and healing, the place of spirituality, the nature of the therapeutic re-
lationship, and the role of the client’s environment” (Oulanova & Moodley,
2017, p. 92). Accordingly, as counsellors/therapists develop integrative ap-
proaches they consider the following practice anchor points, as highlighted
by Oulanova and Moodley (2017), ensuring that:
• the approach is holistic, trauma-informed, oppres-
sion-informed, and culturally-based;
• mainstream education is ongoing (training in counsel-
ling/therapeutic techniques);
204 CHAPTER 12
• referral involves collaboration (Indigenous Elders, tra-
ditional healers, and mainstream mental health practi-
tioners); as well as ongoing learning about:
• Indigenous communities (learning and respecting
local protocols and Elders’ teachings)
• the role of ancestors (learning and respecting the role
of traditional self-care and family helpers)
• traditional elements (healing practices, plant medi-
cines, on the land/out of office settings).
(p. 92)
Pitfalls / Challenges
Challenges and pitfalls emerge where there is a lack of respect and con-
sideration for “centering Indigenous voices” (Fellner, 2016, in Beech, 2021,
p. 24). More specifically, in some situations, counsellors/therapists lack en-
gagement and avoid efforts to decolonize practice through lifelong learning
(e.g., as a first step, learning the truth about Indigenous histories). Devalu-
ing holistic approaches and Indigenous ways of knowing, and losing sight
of Two-Eyed ways of being (Fish et al., 2020), which draws from Indigenous
approaches and Western modalities (Beech, 2021), is another common pit-
fall.
A third pitfall arises when counsellors/therapists attempt to build rela-
tionships from a place of practitioner as expert, and a deficit view, which
often leads to focus on “pathology, dysfunction, and victimization” (Linkla-
ter, 2011, p. 41), instead of resiliency. A lens of resiliency is strength-based,
recognizing protective factors such as family and community support, while
simultaneously regarding the conditions Indigenous clients may be endur-
ing (Linklater, 2011).
In terms of relationships, a fourth pitfall/challenge has relevance for
rural communities because there may be situations where dual relation-
ships exist (e.g., community members holding multiple roles that require
engagement or collaboration). Boundary issues can also emerge where there
are limited mental health resources to meet community needs, and where
counsellors/therapists, social and health practitioners, and community
members, as mentioned, take on multiple roles.
Probing this further and following a call for literature on opportuni-
Case Scenario
206 CHAPTER 12
Questions to Consider
• As a counsellor/therapist, what are your initial ethical responses to
the client deciding not to follow through with sessions?
• How can you ethically:
» make your office a culturally safe place?
» ensure cultural sensitivity in your office space without appropri-
ating culture (e.g., taking, extracting culture for personal gain)?
» find the balance between the client’s cultural ways of healing
with mainstream approaches (e.g., psychoeducation)?
» respectfully collaborate and develop relationships with Indige-
nous Elders/knowledge keepers/healers/helpers? How will you
learn about the local protocols to begin this work?
TRADITIONAL PRACTICES:
RESPECT, PARTICIPATION, AND
APPROPRIATE USE
This section explores three articles that have relevance for tradition-
al practices and appropriate use: I4. Respectful Awareness of Traditional
Practices, I5. Appropriate Participation in Traditional Practices, and I10.
Appropriate Use. Indigenous clients who seek counselling might also be
engaged with traditional healing practices. Therefore, it is important for
counsellors/therapists to recognize that there is no universal application of
traditional healing practices, either between or within cultures. Teachings
pass through generations, from Elders and knowledge keepers, and have
local applications. In other words, “there is no single source on traditional
healing” (Reeves & Stewart, 2017, p. 126).
However, several themes weave across traditional practices: Concepts
of wholeness, relationships, interrelationships, connectedness, growth, bal-
ance, and harmony as well as respect for land, water, nature, animals, plants,
and elements such as sun and moon (Hart, 2002; Reeves & Stewart, 2017).
208 CHAPTER 12
and is client-indicated, moving from topic to topic, for the exploration of
social realities (Dei, 2000, in Waterfall et al., 2017, p. 4). The purpose of this
approach is to respect client agency and explore ways that oppression has
impacted the client’s life, moving to reclaim agency and self-determination,
while viewing personal narratives from a social justice lens. In other words,
the feminist discursive lens recognizes that the counsellor/therapist is not
the expert in the lives of Indigenous clients. Similarly, one way to begin this
work is by “centering the traditional mutual-aid paradigm and traditional
healing ways and practices” (Waterfall et al., 2017, p. 4) – more specifically,
to begin the work by inviting Indigenous collaboration, as indicated by the
client.
Pitfalls / Challenges
Counsellors/therapists may be invited to witness or participate in Indig-
enous community events, ceremonies, circles, or other cultural activities,
including arts, music, and wellness events and activities. Subsequently, this
experience does not imply counsellor/therapist ownership or possession
of these knowledges, teachings, or practices. Respect for Indigenous pro-
tocol is a paramount ethical concern. Indigenous teachings and practices
are passed through the generations often with oral traditions, and it is not
for outsiders or guests to translate or share this information (Waterfall et
al., 2017). The Intellectual Property Issues in the Cultural Heritage Project
(2015) defined appropriation as “taking something that belongs to someone
else for one’s own use. In the case of heritage, appropriation happens when
a cultural element is taken from its cultural context and used in another”
(p. 2). Similarly, issues of appropriation arise when non-members of Indig-
enous communities take, extract, and/or share knowledge, teachings, and
practices for personal gain, especially financial gain. For example, attending
a medicine bag making workshop and, in turn, offering the workshop for a
fee would be cultural appropriation.
Questions to Consider
As a counsellor/therapist working ethically, consider these questions:
• What are some of the ways that you can learn about traditional In-
digenous cultural practices?
• How can you show respect for the client’s traditional Indigenous
cultural practices?
• Are you aware of any personal negative biases towards Indigenous
cultural practices?
• Are these specific cultural practices accessible to you? For example,
where can you collaborate and integrate practices with the invita-
tion of an Indigenous healer, cultural knowledge keeper, or Elder?
What are the protocols around this invitation?
• Describe “appropriate use” of traditional cultural knowledge and
practices in counselling/therapy.
210 CHAPTER 12
IDENTITY, DIVERSITY, AND
COMMUNITY DEVELOPMENT
This section explores four articles that call for counsellors/therapists to
reflect upon their own identity, and recognize and honour cultural diversity
with strengths-based approaches: I2. Reflection on Self and Personal Cul-
tural Identities, I3. Recognition of Indigenous Diversity, I6. Strengths-Based
Community Development, and I11. Honouring Client Self-Identification. It
is essential to recognize that approaches to Indigenous knowledge are con-
textual, developmental, dynamic, and relational (Fellner, 2016). This also
includes counsellors/therapists taking time to reflect on Self and Personal
Cultural Identities (I2), particularly in relationship to clinical work with In-
digenous clients regarding “their locations with current colonial contexts
and question, challenge and discard beliefs that reinforce colonial ideals”
(Fellner, 2016, p. 48).
Recommended Practices
Beginning from a place of humility, counsellors/therapists build rela-
tionships with Indigenous clients through a balance of self-disclosure (lo-
cating themselves in the work), openness to client spirituality, and client-di-
rective therapeutic approaches, and with caution regarding assessments
and diagnostic information. Additionally, ethical practice, as noted above,
derives from a social justice lens (e.g., recognizing social inequities); values
storytelling, humour, and dreamwork; works with family and community;
as well as offers flexibility with times and locations (Fellner, 2016).
Ethical practice also centres around the principles of relationality (e.g.,
the Indigenous client’s relationship with their identity and sense of be-
longing, their place in community and wider contexts, such as living away
from their home community); similarly, it validates and facilitates the In-
digenous client’s gifts and purpose (Fellner, 2016). Counselling/therapy
that is grounded in these approaches is more likely to lead to collaborative
strength-based community development.
Case Scenario
212 CHAPTER 12
Questions to Consider
• What is your familiarity and competence level regarding work with
complex trauma?
• How will a strengths-based approach inform your work together?
• How will knowledge about cultural diversity inform your work with
Indigenous clients – more specifically, in your work with this Indig-
enous client?
• If you are the counsellor/therapist:
» how would you consider your location in relation to the Indig-
enous community and its history?
» what is your relationship to the systems and structures of op-
pression?
» how would you consider the Indigenous client’s relationship to
the systems and structures of oppression?
214 CHAPTER 12
CASE EXPLORATION
Case 12.1
216 CHAPTER 12
Case 12.3
218 CHAPTER 12
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Oulanova, O., & Moodley, R. (2017). Lessons from clinical practice. Some
of the ways in which Canadian mental health professionals practice
integration. In S. Stewart, R. Moodley, & A. Hyatt (Eds.). Indigenous
cultures and mental health counselling: Four directions for integra-
tion with counselling psychology (pp.141-154). Routledge. https://doi.
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Reeves, A., & Stewart, S. (2017). Historical perspectives on Indigenous
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cultures and mental health counselling: Four directions for integra-
tion with counselling psychology (pp.125-140). Routledge. https://doi.
org/10.4324/9781315681467
Rogers, B. J., Swift, K., van der Woerd, K., Auger, M., Halseth, R., Atkinson,
D., et al. (2019). At the interface: Indigenous health practitioners and
evidence-based practice. National Collaborating Centre for Aboriginal
Health. https://www.nccih.ca/495/At_the_interface__Indigenous_
health_practitioners_and_evidence-based_practice.nccih?id=249
Statistics Canada. (2023). Indigenous peoples. Health and well-being. https://
www150.statcan.gc.ca/n1/en/subjects/indigenous_peoples/health_
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Waterfall, B., Smoke, D., & Smoke, M. (2017). Reclaiming grassroots tradi-
tional indigenous healing ways and practices within urban indigenous
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digenous cultures and mental health counselling: Four directions for in-
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Waters, A., & Asbill., L. (2013, August). Reflections on cultural humility.
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tural-humility
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INDIGENOUS PEOPLES, COMMUNITIES, AND CONTEXTS 223
SECTION 3
Bringing it All Together:
Ethical Complexity in Practices
CHAPTER THIRTEEN
BRINGING IT ALL
TOGETHER
Ethical Complexity in Practice
INTRODUCTION
The following section contains additional cases containing ethical sit-
uations and dilemmas for exploration and discussions. These cases do not
have proposed solutions in Section 4, and at times contain more complex
scenarios than seen in the cases presented throughout Section 3. We invite
you to review the process of using the ethical decision-making models in
Chapter 3 of this text to remind you how to explore the cases from different
models while using the CCPA (2020) Code of Ethics and Standards of Prac-
tice (CCPA, 2021).
228 CHAPTER 13
Parker raised several ethical concerns with his practi-
cum course instructor, wondering whether or not the su-
pervisor could or should be reported for ethical violations
related to lack of an opportunity for remediation, improper
termination of counselling with vulnerable clients, and in-
appropriate use of power by the supervisor given his own
vulnerability as a student. He stated that ethical moral con-
cerns superseded respect for the supervisor’s authority.
Parker reported not feeling safe with the site supervisor;
interestingly the site supervisor had also used those same
words when debriefing with the practicum course instruc-
tor – not feeling safe with Parker.
230 CHAPTER 13
Double-Dipping
232 CHAPTER 13
Counsellor Training and Regulation
234 CHAPTER 13
The Ethics of Accepting Gifts
236 CHAPTER 13
Narrative vs. CBT
Supervising Tallie
Shania is working with a group of supervisees who
have been progressing well and are in the 8th month of a
12-month supervision program. However, Tallie, one of the
supervisees, has been arriving late for client appointments,
participates minimally in group supervision discussions,
and consistently arrives unprepared for individual super-
vision. Shania has noticed that Tallie’s skills have not pro-
gressed in a satisfactory manner. In contrast to this, Tallie
is frequently proclaiming at the end of their counselling
sessions that they “nailed it!”, referring to their evaluation
of their work in the counselling session. In watching Tallie
at work, Shania is increasingly concerned at Tallie’s tenden-
cy to be directive with clients; for example, although the
client states that they are feeling like they’re doing “okay,”
Tallie highlights to them that they are “really struggling”
and need ongoing counselling. Most recently Shania was
observing while Tallie laid out a client’s “problems” for them
concluding, “You need to be much more assertive with
your partner.” As the final few months of this training are
approaching, Shania is wondering what her supervisory re-
sponsibilities are and what she should do.
Addictions Therapist
238 CHAPTER 13
Western-Designed Instruments
WORKING THROUGH
ETHICAL DILEMMAS
INTRODUCTION
244 CHAPTER 14
Work Through A: Virtue-Based
The following text is a breakdown of the ethical dilemmas and ethical
actions relevant to the case of Cassandra and Gabe (clients) using the Vir-
tue-Based Ethical Decision-Making Model (CCPA, 2020), while also incor-
porating relevant ethical articles from the CCPA (2020) Code of Ethics.
How can my values best show care for the client’s wellbeing?
I value human well-being on all dimensions: emotionally, mentally,
spiritually, physically, relationally, and any others. This encompasses the
protection of vulnerable individuals so that they may be, and continue to
develop, in good health. I also value human autonomy, respect for all living
things, and a curious and compassionate approach in all cases, including
in the face of potential “evil.” These values demonstrate care for Cassandra,
my client, in maintaining an open, honest, supportive, and collaborative
approach to the necessary reporting of her partner, Gabe. Not only is Cas-
sandra in the midst of a confusing and uncomfortable situation with her
child’s behaviour at school, the involvement of Child Protective Services,
and her partner’s confession of concerning interests and behaviours, but the
intensity of her situation is about to increase (as a transitionary stage) with
the reporting of Gabe. As discussed in the previous section, the reporting of
Gabe is necessary at this time for the protection of her children (and poten-
tially others in the community), and remaining present, connected, under-
standing, and respectful of Cassandra throughout this process is supportive
towards Cassandra’s wellbeing and that of her children.
246 CHAPTER 14
port him based on his actions, remaining open and curious while accepting
that Gabe’s behaviours pose a threat to children and require investigation
and potentially treatment, as well as intending to be a supportive therapeu-
tic presence for Cassandra, decreases the chance of my personal precon-
ceived notions adding unnecessary intensity to the situation, which affects
Gabe and all others involved.
Cassandra’s children will also be affected by my decision; reporting
Gabe may prevent the worst-case scenario (i.e., that Gabe has directly or
indirectly harmed them) from occurring or continuing. The children may
also be affected by Cassandra’s stress resulting from my decision, as well as,
potentially, by the absence of Gabe in their lives. Offering an understanding,
supportive, and respectful therapeutic space for Cassandra may indirectly
lessen the negative impact of my necessary and protective decision on Cas-
sandra’s children.
248 CHAPTER 14
Case 4.2
250 CHAPTER 14
Ultimately, as I have not dealt with an issue like this personally, I would
seek consultation on this case with professionals who have experienced sim-
ilar situations (CCPA, 2020, A4). In responding to the prospective client, I
would express remorse for what they have experienced with their past ther-
apist and validate their desire to work through what they experienced with
a therapist. I would let them know that I would love to be that therapist,
but I do however have some ethical concerns regarding specific parts of
our Code of Ethics (CCPA, 2020) and I would be interested in collaborating
with them alongside supervision or consultation in attempting to determine
the best actions forward for all involved (support for the prospective client,
protection of my professional and ethical conduct, and protection of the
public from unprofessional and unethical behaviour of the past therapist,
hopefully in a fashion that respects the client’s wishes). I would highlight
that we can discuss the situation, and if they do not give permission for me
to disclose the situation, I would maintain that confidence. I would explain
the conflict between ethical obligations to report the unethical behaviour of
other counsellors (A8) and respecting client confidentiality (B2), but I do
respect the complexity of the situation that the client is facing and would be
interested in collaborating with them if they are interested. I would discuss
with my potential client that there are other ways for me to still uphold the
ethical requirement to work to correct unethical behaviour of fellow pro-
fessionals while also maintaining the confidentiality of the content of work.
252 CHAPTER 14
Work Through B: Principle-Based
Step One – Possible key ethical issues of concern. Responsibility and
support to client who reported dual relationship with a previous counsellor
via email. CCPA (2020) Articles A8 and A10. Confidentiality and Informed
Consent (B2 and B4).
Step Two – Articles from the CCPA (2020) Code relevant to this situa-
tion: A8 (Responsibility to Address Concerns About Another Professional),
A10 (Third-Party Reporting), B2 (Confidentiality), and B4 (Informed Con-
sent). Other relevant articles include B10 (Consulting with Other Profes-
sionals), B8 (Multiple Relationships), and B11 (Relationships with Former
Clients). B11 is relevant because, for example, many regulations in the area
state that, due to power issues, counsellors refrain from initiating person-
al relationships with clients for at least 3 years after therapy has stopped.
The dilemma involves whether the apparent boundary breach by the first
counsellor is serious enough to report them, despite the prospective client’s
request that the counsellor not be reported.
Step Three – Most important Ethical Principles: Beneficence, Nonma-
leficence, Social Interest.
Step Four – In this specific circumstance, it is unclear if there has been
actual contact or interaction including the signing and explaining of confi-
dentiality and informed consent with the person who sent the email. If this
is a prospective client, it is likely that the formal steps of obtaining consent
within the context of the limits of confidentiality have been taken.
The potential client does not want the previous counsellor to be re-
ported but does not feel comfortable continuing with the counsellor and
is reaching out for support. Part of the ethical conflict is that the client has
been given mixed messages – one counsellor saying they would maintain
confidentiality another saying they could not guarantee confidentiality. This
creates further uncertainty for the client.
One way to reduce this uncertainty is to get the informed consent and
limits of confidentiality signed and listen to the client’s issues without judg-
ing them. I would also make sure there had been no inappropriate sexu-
al advances (which does not seem to be the case). One solution would be
for the new counsellor to seek consultations without identifying the client
and informing the client that this is ethical and common behaviour. The
results of the consultation will inform the conversation with the client about
whether to report the first counsellor.
Step Five – Most of the intuitions I have are addressed in Step 4. It is
important for counsellors to consult with colleagues and/or supervisors in
Case 4.3
254 CHAPTER 14
spiritual gain (e.g., spirituality, in many adults, can contrib-
ute to improved personal resiliency and mental health).
Rose would like to ask about Iris’s main triggers to feel-
ing depressed and anxious even if her answers open up a
religious or spiritual conversation and Rose clearly indicates
that her area of competence is in dealing with anxiety and
depression, not deep spiritual guidance, though this is a
safe and judgement-free space. She further indicates that
her approach would be client led, not directive spiritual
guidance, though any topic Iris needs to discuss is welcome
there.
256 CHAPTER 14
Work Through B: Virtue-Based
This case concerns a depressed and anxious client who feels that her
symptoms are getting worse because of her family’s choice of religion. She is
feeling rejected by her family and contacts within her place of worship. Her
counsellor, Rose, has been told by her supervisor to stay away from religious
topics.
What are the emotions expressed by each party and how do they
impact suggestions for solving the discomfort?
Iris (client) reports that she feels rejection and a lack of trust with her
family and others as well as anger with God and is unable to express her
feelings to her family.
Rose, Iris’ counsellor, feels frustrated by the notion that her supervisor
has told her to stay away from religious topics with clients. Rose feels re-
stricted in what she can offer the client because the client’s issues with family
are intertwined with spirituality and her faith.
I am aware that the supervisor has power over the counsellor. However,
the supervisor needs to communicate with the counsellor to discuss the cli-
ent’s treatment. Also, the counsellor hopes to create trust and support with
the client by listening (and exploring with empathic responses) to her story,
which is in itself healing.
I think the counsellor and supervisor need to communicate and identify
the needs of the client (i.e., to express herself) and how depression and anx-
iety are affecting the client. They also need to discuss the process of coun-
selling: What helps? What hinders? How can Rose best support the client?
How can my values best show care for the client’s wellbeing?
Two of the key ethical principles involved are: Beneficence (i.e., being
proactive in promoting the best interests of the client) and Autonomy (i.e.,
respecting the rights of clients to agency and self-determination).
Listening is key no matter what the issue is. In order to build a trusting
relationship with Iris, the client, she needs to be heard and valued. Perhaps
when Iris feels less vulnerable, a family session with another counsellor may
be of value. Or, Iris may gain self-confidence from Rose using a client-cen-
tred approach (e.g., empathy, unconditional positive regard, and genuine-
ness) thus reducing her anger, loneliness, and lack of trust which will reduce
her anxiety. I would also include some communication skills (e.g., role-play,
cognitive behavioural techniques, relaxation exercises) to enhance the cli-
ent’s confidence. Clear and respectful communication also needs to be prac-
258 CHAPTER 14
consulting with knowledgeable colleagues or the CCPA Ethics Committee,
and examining the probable outcomes of various courses of action.)
• Beneficence – Rose must attend to what is in the best interest of her
client.
• Nonmaleficence – avoiding the main issue to preserve therapist
comfort level versus the clients’ healing; Rose must think about
what course of action would not hurt the client.
• Rose should consider consultation with counsellors who work with
faith-related issues and consultation with the Spirituality in Coun-
selling chapter of the CCPA could be helpful.
Step Four – How can the relevant ethical articles be applied in this
circumstance? – How might any conflict between ethical principles be re-
solved? – What are the potential risks and benefits of this application and
resolution?
• Based on Rose’s level of competence with faith-related issues and
her supervisor’s reluctance to attend to these issues in counselling,
Rose should consider providing a referral for Iris to work with a
counsellor who is more knowledgeable and comfortable in this area.
• In some cases, referral is not possible, in which case Rose should
discuss with her supervisor how to approach the situation or find a
different supervisor who will be able to help in this area.
• Ignoring the struggles with spirituality that Iris is bringing to coun-
selling would cause harm to Iris and would potentially be a waste
of her time (and money) if she is not able to work through her core
issues.
Step Five – What do my feelings and intuitions tell me to do in this sit-
uation? (See also Virtue-Based Ethical Decision-Making.)
To support the client in whatever concerns they are bringing and to
receive appropriate supervision to be able to help the client with their con-
cern which is outside of my boundary of competence or to refer the client to
someone who has more experience with these issues.
Step Six – What plan of action will be most helpful in this situation? –
Follow up to evaluate the appropriateness, adequacy, and effectiveness of
the course of action taken. Identify any adjustments necessary to optimize
the outcome.
• Receive supervision from an external supervisor who specializes in
faith-based discussions.
• Be open with the client that this is something Rose is less familiar
with.
260 CHAPTER 14
Key Issues:
The counsellor/social worker has discovered that another professional
(i.e., the CEO) in the same agency has been using other social workers/
counsellors’ professional designations while carrying out professional work.
There is a power imbalance between the CEO and the new employee,
despite the CEO having a baccalaureate degree and the counsellor having
a master’s degree. The CEO signs pay cheques, does employee evaluations,
and hires and fires staff.
The CEO has indicated that this practice has been checked out by a
lawyer and it is okay.
262 CHAPTER 14
right to just treatment. If the reports, or recommendations are safe-
guarded by having registered master’s degree level professional sign
them, then a person who is not registered should not be assuming
this role.
• Fidelity – Honouring commitments to clients and maintaining in-
tegrity in counselling relationships. Especially if the description of
services and counsellor credentials show that the counsellors are
Masters-level.
The CEO pushed back stating that she had authorization by the agen-
cy’s legal advisor. The counsellor is advised to document all interaction and
discussions with dates, who was present, issues, and outcomes. The next
step could be one more attempt to rectify the issue, where the counsellor/
therapist can cite A8 from the Code of Ethics and, if possible, take a col-
league or HR person with her.
And finally, if this is unsuccessful, call CCPA to request a consultation
before reporting the matter to the Board of Directors for the agency or the
appropriate regulatory body.
Instinctively it feels pretty clear that this behaviour is wrong; however,
the risk to employment or fear of “rocking the boat” may lead to a decision
to ignore the practice as others have reportedly been going along with it for
some time.
The solution requires not only a change in behaviour by the CEO but
more systemic changes with regard to oversight, policies and procedures,
and best practices. It is a challenging matter for a new employee as the
CEO’s behaviour is sanctionable and may lead to loss of employment.
I would also want to seek support from a qualified external supervisor
(CCC-S) as this kind of situation may cause discord within the workplace
and may also take some time to resolve.
264 CHAPTER 14
CHAPTER 5
Case 5.1
266 CHAPTER 14
Work Through B: Quick Check
In consideration of this dilemma, I will apply the quick check.
Publicity: Facilitating connections between your active clients and close
friends seems problematic on the surface. Although the support group and
corresponding WhatsApp group are seemingly separate from Sam’s for-fee
counselling services, if this group was publicized, it would likely draw criti-
cism in relation to (B8) Multiple Relationships. More importantly, whether
paid or not, the relationship formed by the support group is professional in
nature, and therapists are not to take on friends as clients.
Perhaps this concern was addressed within the consent process or this
particular group was structured to run more independently from Sam (i.e.,
her as a participant); however, from the information available, that doesn’t
seem to be the case. Sam did organize the group, and therefore is in the po-
sition of responsibility as well as in the role of professional therapist.
Universality: If every counsellor created support groups and WhatsApp
groups as Sam did, this could be potentially problematic. Beyond concerns
with multiple relationships, Sam’s close friends would be able to easily infer
that the other members of the support group are indeed Sam’s clients. This
could be interpreted as a violation of Confidentiality (B2). More would need
to be known about the specific rules of conduct from within the group and
the corresponding WhatsApp group to know if such issues may have been
addressed. However, even with clear rules, the blurring of lines between
personal and professional is problematic.
Justice: With the information available, Sam seems to have had the best
of intentions with this group. However, by mixing her close friends in with
clients, she seems to be blurring the boundaries between her personal and
professional settings. Even though she may not see herself as in the role
of “counsellor” within these groups, there still exists a power differential
between herself and her clients, and, ultimately, even if unpaid, she is in
her professional role as a therapist in this circumstance; the same power
differential doesn’t exist with her close personal friends. It’s unclear how
this power dynamic would influence the discussions and interactions within
the groups, and for this reason, this mix of clients and friends is not recom-
mended.
268 CHAPTER 14
• Justice – Respecting the dignity of all persons and honouring their
right to just treatment.
• Nonmaleficence – Refraining from actions that risk harm and not
willfully harming clients.
270 CHAPTER 14
B2 – Confidentiality - Exceptions include, as in this case, when a child
is in need of protection.
B10 – Consulting with Other Professionals – In this case, the counsellor
can not likely consult locally without unintentionally revealing the
identity of individuals involved; it may, therefore, be helpful to con-
sult with someone from the counsellor’s professional association,
to guide decision-making and documentation and to offer support
during what is likely to be a contentious situation at work.
The principles and relevant articles, combined, seem to make it very
clear that the counsellor will need to report the child’s revelation to the ap-
propriate authorities. Next, applying the seven sacred values, can help to
view this scenario from an Indigenous perspective.
Courage: It took courage for the Grade 4 student to tell his foster moth-
er what happened at school, especially since the person he was accusing,
the Principal, has the ultimate power and authority in the school. It will
also take courage for the counsellor to file a report that will put the leader of
the school under suspicion, especially when the counsellor knows that the
principal is a highly respected member of the community. The counsellor,
quite understandably, may fear being fired for not following the principal’s
policies.
Honesty: In reporting, the counsellor is not responsible to investigate
or determine guilt but, rather, to pass on, in a clear, honest, and transparent
way, the information that the student and his foster mother shared.
Humility: The counsellor is well aware that there can be many sides to
a story and, in this case, with humility, acknowledges not being in a posi-
tion to judge. That said, the student is a vulnerable child and needs to be
supported. Filing a report will inform those in a position to investigate, who
may have previous information about similar accusations.
Respect: The counsellor, up until the foster mother came in to report
what her foster son had said, had fully respected the Principal. Now, that re-
spect is in question, leaving the counsellor feeling unsure, perhaps deceived,
and on very shaky ground. The counsellor also respects the child and his
foster mother; for now, supporting them through the challenging process of
reporting and a likely subsequent investigation is the top priority.
Truth: Clearly, there are untruths in this scenario and, over time, the
whole story will surface. For now, the counsellor supports the child and his
foster mother for their courage and honesty in bringing the inappropriate
sexual touching to the counsellor’s attention and for their faith in the coun-
sellor to believe that truth and act on it.
Case 5.3
272 CHAPTER 14
(B5), Respecting Inclusivity, Diversity, Difference, and Intersectionality
(B9), and Referral (B16).
From a Quick Check perspective, the first consideration is what would I
be comfortable reading as headline news. The teen’s suicidality is a primary
consideration here – I would not want to read that my client had died by
suicide. Therefore, my decision-making is concerned primarily with safety
planning – how we, collaboratively, can best avoid that headline news story.
At the moment, despite the teen living at home, the parents do not seem
to be considered by the teen as supportive – the teen is begging me not to
involve them. Although I believe that, in the long term, building a strong re-
lationship between the parents and teen would be helpful, in the short term
I would assess the teen’s cognitive and emotional ability to give informed
consent to counselling – based on the teen’s age and apparent differentia-
tion from the parents’ beliefs, it is likely that “mature minor” status would
apply in this case. With informed consent from the teen in place, my next
priority will be to assess the level of suicide risk and, if it seems safe to allow
the teen to leave my office, to collaborate on developing a safety plan, with
clearly identified supportive people and resources that the teen can turn to.
I would be comfortable reading in headline news that the teen had found
life-enhancing support from a group supporting LGBTQIA+ youth, even if
I knew that might be upsetting to the parents.
Next, in the Quick Check model, I have to ask myself about Universal-
ity – would I make the same decision for everyone and if every counsellor/
therapist made this decision would it be a good thing? The challenge with
Universality is that no individuals are exactly the same, nor are the situa-
tions they find themselves in. However, yes, in the case of a mature minor,
expressing suicidal ideation, and begging me not to involve their parents, I
would make the same decision – to prioritize the teen’s immediate safety by
collaborating on a safety plan that involved other individuals the teen could
(and would) turn to for support.
The third component in the Quick Check model focusses on Justice – I
need to question whether everyone is being treated fairly by this decision.
This is where I need to face my own biases – as a parent myself, I am deeply
concerned about my children’s safety and wellbeing; I would not want to be
excluded from information about them as serious as suicidal ideation. That
said, I also recognize that sometimes I was not considered the best support
by my children as they grew into adulthood and differentiated their beliefs
and values from their parents’ and from how they were raised. Although
that’s a painful experience (on both sides), my priority as a parent remained
to keep my children alive and to help them to thrive. As a counsellor/ther-
apist, my hope is that this teen’s parents will eventually see this decision in
274 CHAPTER 14
collegial consultation or legal support. Set up a safety plan with cli-
ent, possibly voluntary or involuntary hospitalization.
B4. Client’s Rights and Informed Consent: Client must be able to give
consent voluntarily, knowingly, and intelligently.
B7. Access to Records: Parents or legal guardians have rights to access
their minor child’s records with a formal request, though these re-
cords are on a need-to-know basis only, so should be shared only if
in the best interest of the child.
B9. Respecting Inclusivity, Diversity, Difference, and Intersectionality:
It will be important for the counsellor to understand the ways in
which the client’s life experiences, values, beliefs, and prejudicial
attitudes are alike or different from their own. Keeping in mind the
client’s perspective will help to gain understanding and aid in the
client’s personal development.
B10. Consulting with Other Professionals: When sharing information
about a client it will be important not to divulge the client’s identity
unless such sharing has been approved with written consent from
the client. When in discussion with other professionals, counsellors
must remain accountable for the final decisions made.
276 CHAPTER 14
Case 5.4
278 CHAPTER 14
A counsellor should take all of the aforementioned points into consider-
ation before accepting this case. If the course is designed to help the parents
explore making decisions about their children or even feel comfortable with
a decision to allow blood transfusions in future and they agree to it willingly
without coercion, then the guidelines for this Code can be applied.
280 CHAPTER 14
implemented and the rationale for their selection, and results
and findings. Report conclusions and recommendations clear-
ly arise from the assessment results and findings. Reports are
written in an objective and professional tone, avoiding the use
of professional jargon in favour of language that can be under-
stood by a wide reading audience. (CCPA, 2020, p. 15)
Publicity: I have some hesitation about accepting the parents as clients
because of their tendency to sue everyone or to take issues to the press.
However, I need to make the clients (the parents in this case) my primary
concern - not protecting myself. The front-page news story that I’d hope to
see would be the parents speaking positively about the parenting course and
how it had been respectful and practical, and helped them better under-
stand how to care for their child within the various child protection systems.
Universality: Yes, agreeing to take on the parents as clients, to build a
therapeutic relationship with them, and within that relationship to explore
their concerns about the parenting course and the potential benefits that
could come from it, is a decision that I would make in other similar cases.
Justice: The case must be considered from a long-term perspective. The
child needs specialized care and the mother is a doctor. The parents have
the means to support the child’s ongoing medical care. The child loves the
foster mother and is settled in care; however, if the course and the therapy is
effective and the parents become less angry, the child living with her parents
is optimal. Forming a therapeutic alliance with the parents to explore their
concerns about the course seems respectful and just. Helping the parents to
understand the potential benefits of the course, not the least of which is the
potential to regain custody of their child, is most likely to happen within
such a therapeutic alliance. Justice for the child is, of course, of paramount
importance; ideally, within a safe therapeutic setting, the parents could
begin to see the other perspective and their duty to protect the child’s life
should a similar need arise in the future. Justice for the instructors and other
participants of the parenting course is another consideration. If, through
counselling, the parents see the value of attending the course and partici-
pate willingly and without causing a disruption or distraction, that would
contribute to justice for all involved in the course.
How can my values best show care for the client’s wellbeing?
My values tell me I should try to help in terrible situations – that bad
things happen when good people do nothing. I like understanding people,
discovering new perspectives, and solving tricky situations. I also like help-
ing the client navigate a system that they feel is entirely stacked against them,
or with people who they feel are judging them. I have a great deal of experi-
ence in this particular niche, so I potentially could be better at it than others.
On the other hand, I also value honesty and transparency, and I doubt that
I would be able to hide what I am thinking or feeling on this topic (even if
I did want to). If I would say what I really thought, I believe that would fur-
ther alienate the parents. If I was completely honest with them, there may be
a very small chance that they agree to talk with me – just because I am being
honest about where I stand on the issue, but that is likely not going to be the
case. In weighing values, I tend to default to honesty, because then people
know where I stand, and make their own decisions around that. Referring
to the CCPA (2020) Code of Ethics, reminding myself that my priority is the
client (B1), being really clear about the information provided in securing
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informed consent (B4), and upholding the principles of Nonmaleficence,
Autonomy, Fidelity, and Justice will be crucial.
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Based on that statement that there is a police investigation underway,
the counsellor would want to determine a) if there was indeed a formal po-
lice investigation underway and b) if counselling with the child at this time
may interfere in any investigation (i.e., if the child has not yet been formally
interviewed regarding the alleged abuse). If the mother does not provide
consent for the counsellor to confirm this information (CCPA, 2020, A10:
Release of Information), then the counsellor should only offer supportive,
objective counselling for the child, focused on things such as coping with
family change or managing specific symptoms, rather than initially treating
the child as a child who has been abused (B14: Multiple Helpers, in the case
that police interviewers may also become involved).
My emotions are influencing me in the way that I am afraid for the
child in the fact that nobody knows the seriousness of what has happened.
The father has been excluded and in a way is being condemned, so should
I not be playing a role in keeping the child safe from him? I feel a level of
responsibility to make sure that my client has the right to be in session safe
from the father having knowledge of the counselling because the mother has
given her consent and the parents are now separated. If counselling focuses
on abuse and the effects of having an abusive father, but the father, in fact,
was not abusive, then the child could suffer psychological harm, cognitive
dissonance, and attachment impairment. The child could also be influenced
by the tone of therapy and provide false information in any police investi-
gations.
My emotions are telling me that it is important for best practice for
continuity of seeing the child (B1: Primary Responsibility). My emotions
are also telling me that refusing to reach out to the father will escalate the
conflict and my fear would be that non-communication would be viewed by
the father as siding with the mother. I feel right in the fact that I have con-
sent from the mother in a separation situation and as such the father has no
right to know what is happening in therapy because the charges the mother
has brought forward scares me.
I want to be fair and equitable in this circumstance to all parties that I
am in contact with (CCPA, 2020, Principles: Justice, Fidelity). It is not really
being fair to the father if we don’t know his side of the story and whether
the abuse allegations are founded. Although in some provinces, only one
parent’s consent is required for counselling, it would be in the best interest
of the child if, now that the father is seeking information, that his request
be considered. This could look like the counsellor informing the mother of
the request and suggesting that the process be a) the counsellor reach out
to the father and set out boundaries regarding possible shared information
(e.g., attendance and progress); b) the counsellor discuss with the child her
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this case to have the added information that I truly need for best practice.
I might also contact the father’s lawyer in order to gain clarity about the
father’s rights and responsibilities as they stand currently in order to better
inform my own decision making. Reaching out for supervision or consulta-
tion on this matter is a great idea. This is a complex case with potential for
negative impact on the child client, the parents, and the counsellor.
The counsellor could contact the father, explaining the consent piece
given the current joint custody. If the father is not happy with this expla-
nation, the counsellor could suggest that the father have his lawyer contact
her and outline his current rights. Contacting the lawyer without the fa-
ther’s consent may only create further hostility in this situation, regardless
of whether the lawyer provides any information.
By looking at this case through the lens of the current status of joint cus-
tody as there has been no court order to state anything different, I have the
responsibility to follow the current consent requirement of joint custody,
and I should make sure that is the case in order to follow best practice and
support my decision one way or the other. Although the counsellor can see
the child with only the consent of one parent, she should set firm bound-
aries regarding the current focus of therapy and the father’s right to any
information about the following sessions (which he still may have via joint
custody). The therapist needs to determine if the child will be harmed (e.g.,
increase in anxiety) by the sharing of any information, even generic, with
the father. If there is no evidence that harm can come to the child by this
information sharing, and the counsellor does not share the information,
then the counsellor may risk being accused of supporting parental alien-
ation practices of the mother.
Phase Four: To best plan and take action by maintaining my own at-
titude of self-reflection, addressing balance and collaboration between all
parties involved in the case. Self-reflecting on why I feel the need to keep
the child safe from obtaining informed consent from the father. Am I afraid
of the mother? Losing the client if I don’t do what the mother asks? Why
am I afraid of finding out further information from the lawyer? Do I want
to keep things simple because I don’t know how to handle the complexity of
this case? Do I need to refer or obtain supervision or have added education
in high conflict situations in families?
If publicized, the best decision would be to: obtain supervision/expert
consultation, consider the facts of the situation, ensure beforehand that all
parental rights are confirmed, have a set plan to address any information
sharing related to counselling, and ensure that the child is not at risk for
harm if this plan is executed.
At this stage, the allegations of abuse against the father are just that,
allegations. Therefore, it would be important to determine the status of the
police investigation and the separation proceedings – i.e., is there an emer-
gency custody agreement and/or a no-contact, restraining, or protective or-
der in place? This would influence what the counsellor could or could not
do in relation to communicating or consulting with the father. In addition,
what was the nature of the “notice” received from the father – e.g., was it an
email or a formal letter from lawyer?
Step Three: Given there is an active investigation, it’s reasonable for the
counsellor to assume there is some credibility to those allegations. As such,
the key ethical principle in this circumstance seems to be Nonmaleficence
– refraining from taking actions that risk harm to the client (i.e., the child).
Allowing the alleged abuser into the client-counselling relationship might
indeed harm the client and compromise safety.
Step Four: In relation to providing services to children, Children and
Persons with Diminished Capacity (B5) describes the need for informed
consent from both the child and those who are legally entitled to offer con-
sent (e.g., parents). It doesn’t state that both parents/guardians need to con-
sent. As the mother has provided consent on behalf of the child and without
legal paperwork indicating otherwise, this should be sufficient to continue
the counselling relationship. If there are any additional legal restrictions to
the father’s parental rights (whether temporary or permanent), this would
strengthen the counsellor’s decision to continue without the father’s con-
sent. Regardless, it would be important to also ensure the child’s ongoing
assent as well.
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By not responding to the father and continuing to offer counselling ser-
vices, the counsellor might risk deepening the divide between child and par-
ent. However, given the ongoing investigation and the credibility/severity of
the allegations, this seems like a reasonable path forward. By responding to
the father, this might be viewed as compromising the client’s Confidentiality
(B2) – e.g., how does he know the child is seeing the counsellor if he doesn’t
have access to the child? It may be viable to ask the mother about the status
of the custody of the child.
Given the mother has indicated that she is restricting access to the al-
leged abuser, the child doesn’t seem in immediate danger so consequently
there isn’t an immediate Duty to Warn (B3); This, however, would likely
need to stay top of mind along with the possibility of the client’s records be-
ing subpoenaed – i.e., Access to Records (B7). It would be reasonable at this
point to review with the mother the counsellor’s ethical obligations in these
areas (even if this was noted within the informed consent documentation).
Step Five: Although the allegations haven’t yet been proven (and as-
suming the child hasn’t disclosed anything in therapy yet), given the police
investigation is moving forward, my intuition would tell me that the alle-
gations are credible. Although, I’m sad to see the family unit break, that
unit seems to be ineffective in providing a safe environment for the child. I
would feel protective of the child who is caught up in a potentially danger-
ous situation. However, given the proactive actions of the mother and the
support of the police, I’d be hopeful that early intervention/supports will
lead to more positive outcomes for the child. I might worry about the long-
term implications of this kind of trauma and the possibility about being
subpoenaed in the court battle between parents, whether or not the allega-
tions are substantiated. My intuition would tell me at this point to ensure the
mother understands my ethical obligations in these circumstances to she’s
not caught off guard should something change.
Step Six: Assuming no external legal requirements exist otherwise (e.g.,
documents from the court from the mother and/or father), in this situation,
it would be most helpful to continue to provide services to the child. The
need for ongoing consent from the mother and the child would be essential
in this circumstance as the situation might be fluid. This includes ensuring
understanding of the counsellor’s ethical obligations.
In addition, the counsellor might want to consult with another profes-
sional who has had more experience working with cases such as this (Con-
sulting With Other Professionals – B10). They might have some additional
tips, strategies, or cautions that could assist in moving forward ethically.
Step Seven: As part of the follow-up and evaluation process, I would
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CHAPTER 6
Case 6.1
292 CHAPTER 14
Justice
Societal Interest
(p. 14)
If the counsellor proceeds with this case, they should work with the
client to carefully identify counselling goals.
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Work Through B: Principle-Based
There are several issues that I must consider before I support HRT for
a transgender client, understanding that counsellors do not diagnose, and
therefore only can work to support the client. In considering a client’s tran-
sition, it is important to consider the wide variety of factors impacting their
psychological, emotional, mental, and social lives. Before proceeding, it is
important to consider both the health and legal aspects too. I have therefore
decided to use the Principle-Based Ethical Decision-Making Model, which
offers a structured approach that facilitates a thorough ethical analysis.
Step One – What are the key issues in this situation?
Client’s Age, Jurisdiction & Consent to Treatment Legislation: Since
my client is a 17-year-old individual, considered a minor in most provinces
in Canada, the first thing to consider is their age and how that age impacts
the autonomy they have over their health decisions. In BC a minor is any
person under 19 years old, although in other provinces and territories it is
different (e.g., in Newfoundland a minor is a person under 16; Government
of Canada, 2023). In terms of children’s consent to treatment, approach also
varies depending on jurisdictions. On the other hand, the term “mature mi-
nor” needs to be included too. Each jurisdiction has different considerations
on who can be considered as such.
Since I practice in BC, I must be clear on what age to consent to medical
treatment is considered appropriate in my province. The Infants Act states:
Children may consent to a medical treatment on their own as
long as the health care provider is sure that the treatment is
in the child’s best interest, and that the child understands the
details of the treatment, including risks and benefits. It is up to
the health care provider to assess and ensure the child’s under-
standing of the treatment... A child under the age of 19 is called
a “minor.” “Mature minor consent” is the consent a child gives to
receive or refuse health care after the child has been assessed
by a health care provider as having the necessary understand-
ing to give the consent. A child who is assessed by a health care
provider as being capable to give consent is called a “mature
minor” (…) A child who is a mature minor may make their own
health care decisions independent of their parents’ or guard-
ians’ wishes. In B.C. there is no set age when a child is consid-
ered capable to give consent. (HealthLink BC, 2022, 119)
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requiring substantial support, or Level 3 requiring very substantial support.
In this case, I and my client must reflect on their level of autism and each
of the challenges that impact their current desire to go through HRT and
soon move forward with top surgery. One of the challenges my client might
experience, which is common for autistic individuals, is time perception
and required support.
Time Experiencing Gender Nonconformity or Gender Dysphoria:
Considering the other factors and assuming that my client does have the
capacity to decide and has a level of ASD that allows them to move forward,
another factor that would have to be taken into account is the time they have
been experiencing Gender Nonconformity or Gender Dysphoria. DSM-
5-TR considers “gender dysphoria in children as a marked incongruence
between one’s experienced/expressed gender and assigned gender, lasting
at least 6 months” (National Library of Medicine, 2023). My client has iden-
tified as trans for less than 6 months, which would make me consider delay-
ing for a short period of time (another 6 months) to allow my client to bet-
ter prepare for this transition and work on the aspects of the non-standard
questions where they felt lost. The only reason that would make me ques-
tion waiting for some months is if my client is experiencing severe depres-
sion and waiting for this could become harmful and deteriorate my client’s
mental health. Again, I am keeping in mind that I as the counsellor would
not be diagnosing these conditions, and may need assistance in referring if
diagnosis is required to support.
Readiness assessment: After considering all of the above, a key issue as
a counsellor would be to explore the unrealistic expectations my client has
about HRT as well as the reaction they had when being asked non-standard
HRT questions. They seemed lost and this would have to be addressed, un-
derstanding if the way in which questions were framed was too unstructured
and their inability to answer was related to their autism or their actual ca-
pacity.
Additionally, I will need to work collaboratively with other profession-
als for proper diagnosis and to provide a holistic approach that considers my
client as a whole. According to Standards of Care for the Health of Transgen-
der and Gender Diverse People (Coleman et al., 2022), health care we should
provide to our trans clients is greater than the sum of its parts, and should
involve holistic inter- and multidisciplinary care between endocrinology,
surgery, voice and communication, primary care, reproductive health, sex-
ual health and mental (p. 57). Addressing with the client the level of stability
of their gender incongruence (e.g., how much time they have felt this way)
as well as their lived experience of “long-lasting and intense” dysphoria
would be extremely relevant.
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• Beneficence – I will proactively prioritize my client’s best interest.
Any course of action should ensure this principle is being protected
and promoted.
• Nonmaleficence – I will avoid actions that could harm my client.
• Autonomy – Although my main task in this case is to provide useful
information for my client on their current capacity to move forward
with gender affirming healthcare, my main duty is still to respect
their rights to self-determine what life decisions support their well-
being in the best possible way.
• Justice – My client, as any other client, deserves the right to search
for the resources and paths that allow them to live the life that they
want. Even though autism brings several barriers and there could
be some steps on the way that might look different than what they
envision, the approach that I will take will consider this as my main
goal.
Step Four: How can the relevant ethical articles be applied in this
circumstance? – How might any conflict between ethical principles be re-
solved? – What are the potential risks and benefits of this application and
resolution?
B1. Primary Responsibility (CCPA, 2020, p. 1). It is my main duty to
protect and respect my client’s welfare. I have been asked to partic-
ipate in a decision that will impact my client’s life. If, after assessing
their current situation it is considered that HRT or top surgery are
not ideal as of now due to factors such as time experiencing dyspho-
ria (less than 6 months), diminished capacity, or ability to weigh
the implications of their decision, I will work with my client on al-
ternative scenarios and solutions to make sure they are supported
towards their wellbeing and personal goals.
B5. Children and Persons with Diminished Capacity (CCPA, 2020, p.
10). As my client has ASD, I need to consider the level of capacity
they have for different decisions. Every decision requires a different
assessment because not all decisions have the same implications.
For example, my client could be fully capable of deciding what type
of job they want to do, which doesn’t necessarily mean they have the
capacity to understand the implications of the decision they have
made. I need to be mindful of this and support them in developing
the ability to understand this important decision’s implications and
be able to consider the specific barriers (and sometimes changes)
that my client’s autism brings.
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In this regard, I believe they would benefit from processing their decision
for a period of time. Additionally, I am aware that the anxiety associated
with a gender transition is high, and that my client is still developing coping
mechanisms to deal with life’s challenges, such as independence (e.g., they
still rely on their family for financial support). Typically, an autistic adult re-
quires some level of support throughout their life, but this does not prevent
them from making adult decisions or enjoying a fulfilling existence. To cre-
ate those layers of support, it may require them some additional time than
most in their same age group. Therefore, I would like my client to ensure
that they have all of the support networks they will need, as well as the skills
that will allow them to make a smooth transition.
Step Six: What plan of action will be most helpful in this situation? –
Follow up to evaluate the appropriateness, adequacy, and effectiveness of
the course of action taken. Identify any adjustments necessary to optimize
the outcome.
• Be clear about my role in this case. It is not for me to diagnose my
client, but to support them in making this life-changing decision.
• Understand laws in our jurisdiction (BC, in this case) regarding
HRT and child consent to treatment to ensure the recommenda-
tions are aligned to the law.
• Talk with the client about the ethical decision that is being analyzed
and the way in which I am proceeding, clarifying my priority to
proactively look for their best interest.
• Include the agreements and steps taken in the ongoing informed
consent.
• Evaluate the client’s capacity to consent to treatment understanding
benefits, risks, consequences, and life implications.
• Recommend a self-care plan to ensure the client’s wellbeing through-
out the process, whether the decision to move ahead with the HRT
and top surgery is made now or later. The recommendation should
include considerations of time frames for next steps.
• Consider and reflect on alternative scenarios and their pros and
cons (e.g., waiting longer for the surgery) both individually and
with the client.
• Connect with other professionals involved (e.g., physician, nurse)
to exchange perspectives, expand understanding, and provide a ho-
listic assessment of the client’s situation. Have the client’s consent
prior to do so.
• Make the final evidence-based recommendation for the client.
302 CHAPTER 14
Case 6.2
304 CHAPTER 14
to this diversity. This needs to also include working with the client
to locate resources and supports.
306 CHAPTER 14
would likely not be invited to attend the school if the results are released.
However, based on Mr. Thomas’ experience with Adrian’s motivation and
performance in school, his knowledge of other students who have been suc-
cessful in the vocational school, and the doctor’s support for the vocational
school option, Mr. Thomas is quite confident that the vocational school is
the right choice for Adrian and will open up the most future possibilities
for him. Mr. Thomas decides to recommend that the parents not agree to
share the assessment results for now. In collaboration with Adrian and his
parents, they decide that Mr. Thomas will speak to the school administra-
tors, asking them to temporarily admit Adrian based on recommendations
from the school and the medical doctor, with the option of conducting an
assessment after the first 3 months in the new school if it is deemed neces-
sary at that point.
308 CHAPTER 14
2. How can my values best show care for the client’s wellbeing?
My values in terms of the wellbeing of Adrian would have him remain in
the vocational school. If he encounters difficulty, the other school can still
be considered. Otherwise, I will feel like I have betrayed the trust the Adri-
an has placed in me (B1, C8).
310 CHAPTER 14
reports for each of the three clients the following day and
then, on the third day, before flying home, to provide the
assessment results in three 1.5-hour meetings (one for each
test-taker, to include the test-taker, family members, and at
least one elder from the community). Collin has never deliv-
ered assessment results to third parties before.
When raising concerns with the agency director, Collin
was told not to worry - they had been successfully using
this standard battery for years, mostly in the city but at least
twice before in this community, and the instructions in the
manual were really easy to follow.
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Work Through B: Wise Practices
Collin recognized the decision about whether or not to proceed with
the assessments as requested as an ethical dilemma – a dilemma that felt
quite overwhelming to sort through and scary because, given the employer’s
unwillingness to consider alternatives, it left Collin fearing being fired for
refusing to follow the boss’s instructions. Collin, a recent graduate, had large
student loans to pay back and it hadn’t been easy to find a job in the field.
The Wise Practices Lens (CCPA, 2020) seemed like a good approach
to use, given that it provided space to consider the dilemma from both In-
digenous and Western perspectives. From the recently completed Masters
program (which, although it embraced the values of equity, diversity, and
inclusion, and was beginning a process of Indigenizing the curriculum, still
very much comprised training from a Western perspective), Collin under-
stood that a solid working alliance is foundational to all aspects of counsel-
ling and that, within Indigenous communities, relationship is particularly
important (CCPA, 2020, Wise Practices Lens; I8). Therefore, upon reflec-
tion, Collin recognized that one of the key underlying areas of concern was
the expectation that the “tester” would fly in the night before, test the next
day, write up results without consultation, and then provide those results in
brief meetings that wouldn’t allow much time for questions or discussion. It
felt like testing was being done to rather than with the test-takers – and by a
complete stranger to the test-takers and the larger community.
From a Western perspective, consulting the CCPA (2020) Code of Eth-
ics, the process also felt wrong – raising concerns related to Articles A1-5,
A10, A12, B1, B4, B9, C1-8, C10, I1, and I6-9, especially given Collin’s very
limited competency with these types of assessments (A3, C3) and the ab-
sence of any option to customize the approach (C10), despite the significant
differences between the test-takers and the purposes for assessment.
Collin also considered the principles described in CCPA’s (2020) Code
of Ethics. It seemed clear that working outside Collin’s competency with in-
adequate supervision, having no room to appropriately customize the as-
sessment approach, and proceeding with the assessment process in the ab-
sence of a solid relational foundation, could result in the assessments doing
harm instead of good, could perpetuate injustice, and might not support
societal interest (in that decisions informed by inappropriate assessment re-
sults might be inappropriate).
As Collin also believed in the importance of consultation and super-
vision (A4) and felt quite vulnerable about arguing with a new employer,
reaching out to the assessment instructor from the counselling program also
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Case 6.4
316 CHAPTER 14
My values place the client’s needs above my own (B1). I also value ex-
cellence and continuous learning (A1). In my practicum, co-counselling
hours can count towards my total hours. Rather than referring the client to
another counsellor right away, I wonder if it might work (with the client’s
permission [B4]) to bring my supervisor into the next sessions to see if we
can make progress together towards the client’s goals (A4; B16)?
If co-counselling is a viable option, this would take additional time from
my site supervisor (but, perhaps, no more time than out-of-session super-
vision trying to turn this situation around or the time it might take to bring
in a new client and then move that client to someone else’s caseload once
my practicum has been completed). It might be perceived as unfair by other
practicum students, however. I’m confident, though, that my client would
be getting good support, which is important to me.
I would not feel good about publicizing that my client’s sessions were
abruptly terminated, nor would I feel good about word getting out that we
had continued to bring a client in for counselling with me despite evidence
that no progress was being made. I’d feel comfortable publicizing that we
engage our clients in Routine Outcome Monitoring (ROM) and respond to
what we find, collaborating with our clients in creating solutions that help
them to move forward.
From a place of cultural humility, I’m acutely aware that I still have so
much to learn. I’m grateful to have a site supervisor who wants to help me
learn and is willing to invest the time to co-counsel with me to help me
better understand how my client and I got stuck and how we can effectively
move towards the client’s goals together.
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Step Two: What ethical principles from the CCPA Code of Ethics are
relevant to this situation? Other policy, laws, regulations, and consultative
guidance:
• Policy, regulatory and guidance: Research Ethics board in the Uni-
versity, Graduate Supervisor, Peers, and CCPA Ethics Committee.
• D1 Researcher Responsibility (Parts of the Code of Ethics and Stan-
dards of Practice) might come into play.
• D8: Review of Scholarly Submissions: Counsellors/therapists who
review applications or manuscripts submitted for research, publi-
cation, or other scholarly purposes respect the confidentiality and
proprietary rights of those who submitted the materials (See also
A2, B2, I7).
Step Three: Which of the six ethical principles are of major importance
in this situation?
Justice and Societal Interest
Step Four: How can the relevant ethical articles be applied in this cir-
cumstance?
Research builds and advances knowledge. Expanding therapeutic per-
spective and modalities can help all people (i.e., clinicians, the general pop-
ulation, and people living with disordered eating) by reducing injustice,
increasing knowledge translation, and updating clinical practice.
Step Five: For this situation, my feelings and intuition tell me that it is
important to learn (generally and in different ways) and conduct research
(one specific form of knowledge), to update best practice and professional
practice over time. So, staying true to the alternative results and responding
to the review in general would be most in alignment with my intuitions.
Step Six: What plan of action will be most helpful in this situation?
Follow up for consultation with the graduate supervisor, peers, and
CCPA ethics codes and committee(s) first to get feedback and guidance for
Quincy to reflect on. Then consider how to respond to the review (and to
the editor) in order to stay true to the results of the research and speak to
the concerns of the reviewer. It may mean having to not get published in this
journal and seeking publication in another.
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Justice: Is everyone being treated fairly by my decision?
Yes, everyone is being treated fairly in this decision. The reviewer’s
opinions are being respected and the rationale for the approach used has
been strengthened. I am also treating myself fairly in this decision by trust-
ing the knowledge and expertise that I have and perhaps also opening the
eyes of the reviewer to emerging literature.
322 CHAPTER 14
ward if it is to be “research.” Otherwise, it is more of an evaluation, which
would still be benefitted by an ethics consultation to ensure principles like
beneficence and nonmaleficence are considered. Even evaluations need to
consider the ethical components to remain supported.
Justice: June’s clients have diminished capacity so informed consent
would likely involve both clients and parents. Further, if some of her clients
need a different approach, a hope would be that June would provide that or
refer her clients to someone who can provide the necessary care. The wel-
fare of her clients supersede her desire to gather data.
2. How can my values best show care for the client’s wellbeing?
By engaging in research, I would be able to validate my approach and
extend the body of literature. This would support my clients by providing an
approach supported by research – although I believe my approach is help-
ful, without specific evidence, I don’t know that for certain.
Although I haven’t planned any deception, coercion, or undue risk
within the study, I am working with a vulnerable population so need to en-
sure they feel informed and comfortable with the study. I would show I care
about my client’s well-being by making the research process as accessible,
enjoyable, and seamless as possible – a process which doesn’t infringe on
my clients’ rights or impede our work together. It could be helpful to have an
external body offer verification of that, especially as I’m working as a private
practitioner. Whether or not I have access to an ERB, I will be sure to fol-
low the Tri-Council Policy Statement: Ethical Conduct for Research Involving
324 CHAPTER 14
REFERENCES
Government of Canada (2022). Tri-Council Policy Statement: Ethical Con-
duct for Research Involving Humans. https://ethics.gc.ca/eng/docu-
ments/tcps2-2022-en.pdf
Case 7.3
Questions:
Does he have an independent practice or does he work for the military
(i.e., as the employer)? My responses are based on this counsellor being in
private practice.
Decisions:
1. He doesn’t require military approval for this research; he only needs
individual participant approval.
2. He has to uphold participant anonymity and privacy through a con-
sent process and maintain their confidentiality (D5 - right to confi-
dentiality; CCPA, 2020, p. 18).
3. Does he have a conflict of interest as a researcher and counsellor?
Multiple relationships are to be avoided (B8). As per Article D1, he
will need to gain approval for the research: “A person must seek in-
dependent ethical review and approval” (CCPA, 2020, p. 17).
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Work Through B: Principle-Based
Step One: What are the key issues in this situation?
The key issue in this case is potential conflict of interest if the military is
involved in each step of the research.
Step Two: What ethical articles from the CCPA Code of Ethics are rel-
evant to this situation? – Are there policies, case law, statutes, regulations,
bylaws or other related articles that are relevant to this situation?
D3 (voluntary participation)
D4 (informed consent of research participants)
D7 (research sponsors) – this article is key in this case, if Hassan works
with the support of the military, he would need to acknowledge this
and it may affect the interpretation of his results.
Step Three: Which of the six ethical principles are of major importance
in this situation? (This step also involves securing additional information,
consulting with knowledgeable colleagues or the CCPA Ethics Committee,
and examining the probable outcomes of various courses of action.)
• Beneficence – Attending to the best interests of my research par-
ticipants.
• Societal interest – In this case, what is in the best interest of society
is to be able to do research that might uncover the “truth”, this may
not be possible if the agenda of the military is to present the military
in a positive light and if the research might uncover some difficult
truths about PTSD in the military.
Step Four: How can the relevant ethical articles be applied in this
circumstance? – How might any conflict between ethical principles be re-
solved? – What are the potential risks and benefits of this application and
resolution?
In this case the ethical articles and the principles all align and point
to the same conclusion – to not partner with the military to conduct this
research.
The benefit of this is that it will be easier to protect participant’s iden-
tities so that they can share their true experiences without worrying about
repercussions with the military and this will lead to richer data/results.
The risk of this is that Hassan may be negatively impacting his relation-
ship with the military.
Step Five: What do my feelings and intuitions tell me to do in this situ-
ation? (See also Virtue-Based Ethical Decision-Making.)
328 CHAPTER 14
CHAPTER 8
Case 8.1
330 CHAPTER 14
discuss John’s need to quickly inform clients of the changes, or to ensure
that the centre has an immediate process for informing clients of the chang-
es and connecting them to new counsellors/resources.
332 CHAPTER 14
• CCPA Standards of Practice, B19.Termination of Counselling, p. 38
• CCPA Code of Ethics, p. 5:
“The “wise practices lens” model of decision-making (Wesley-Es-
quimaux & Snowball, 2010, p. 230) is a decision-making strategy
that practitioners may find helpful. The model uses teachings
from the seven sacred values that include courage, honesty,
humility, respect, truth, love, and wisdom (Baskin, 2007).”
REFERENCES
Marshall, A. (2004). Two-eyed seeing. http://www.integrativescience. ca/
Principles/TwoEyedSeeing/
Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, mental
illness and addiction through a Wise Practices Lens. International Jour-
nal of Mental Health and Addiction, 8(2), 390-407. 10.1007/s11469-
009-9265-6
334 CHAPTER 14
4. What decision would I feel bad about publicizing:
Telling a client about a potentially hurtful affair which may or may not
be true and may or may not be an issue to anyone but the counsellor could
result in diminished client confidence, termination of treatment (the main
purpose of the relationship), and defamation of another member of the
community which could be a legal offence depending on the jurisdiction
and further threaten the unity of a small community.
The clinical supervisor might start by discussing how the case related to
Western ethical principles. For example, the core of this issue is maintaining
a client’s Confidentiality (B2) – i.e., the client who is having the affair has
the right for that disclosure to stay with the counsellor. This is something
embedded into the informed consent process and is a foundation of the
practice. The supervisor might point to one notable exception for confiden-
tiality, Duty to Warn (B3) if the client was in immediate danger. This could
potentially be something to watch for; however, this case didn’t make note
of any suicidal ideation or threats of violence so this is likely not relevant.
The supervisor might reinforce for the counsellor that not sharing the dis-
closure isn’t an endorsement of the behaviour but rather a demonstration
of Primary Responsibility (B1) to the client. If the counsellor feels that they
aren’t able to maintain confidentiality, the supervisor would want to discuss
strategies for how to handle questions or concerns, perhaps engaging in role
play to practice those situations. If that didn’t feel like a satisfactory plan for
the counsellor, the supervisor might discuss appropriate referrals based on
a conflict of interest because of the Multiple Relationships (B8).
336 CHAPTER 14
to see the importance of respect towards all parties – herself, the husband,
and the wife.
Respecting the wife includes supporting her in her counselling goals
(e.g., is she happy in her marriage? Is she planning on building a family?
Does she know about this infidelity already? Does she suspect infidelity?).
There is also a respect for the boundaries of counselling – it’s not a counsel-
lor’s role to be a “truth teller” at all costs.
The supervisor might recognize the counsellor’s Love for their com-
munity in the fear about losing the police officer; however, the supervisor
might call on the counsellor’s Wisdom to balance a complex set of conflict-
ing demands. Perhaps the supervisor has case examples they might be able
to share with the counsellor – i.e., sharing their wisdom with the counsellor.
Circling back to Truth and Honesty, the supervisor should invite the
counsellor to engage in an ethical decision-making process themselves in-
cluding a reflection about the assumptions they are making in this case and
their capacity to maintain confidentiality. If the counsellor is being honest
with themselves and is unable to effectively manage this Multiple Relation-
ships (B8), the need for Referral (B16) should be considered. The supervi-
sor should also Respect the decision the counsellor makes as a professional
as well.
338 CHAPTER 14
clients I support through my private practice. I am aware of the conflict
of interest that accepting this offer would entail. Ideally, I would like to be
able to accept the offer and support them without this becoming a conflict
of interest. My intuition tells me that I could establish solid boundaries to
prevent this from happening, but my feelings tell me that it would not work,
and I would not be able to provide the best consultation services if this is on
my mind. I may be biased in my interventions, and the strategies I employ
may unintentionally be aimed at attracting clients to my company. It would
therefore be best to refer them to some other colleague who is not currently
engaged in private practice.
2. How can my values best show care for the client’s wellbeing?
In this instance, the primary clients I serve are the individuals in my
private practice. It is still necessary for me to be mindful of potential cli-
ents, including the social services association which is contacting me as a
potential client. Whatever the case, I am committed to conducting myself in
an honest and transparent manner. Furthermore, I believe that my actions
affect my clients directly (current and future). I also value professionalism
and taking this offer would dilute my attention in a way that could adversely
affect my ability to provide customized and detailed attention to my clients.
When making ethical decisions, I also adhere to the ethical principles
outlined in the CCPA Code of Ethics (2020, p. 2). When making ethical
decisions, I also strive to provide fair treatment to my clients by prioritizing
their best interests and preventing potential harm. There is a serious com-
mitment to my private practice, and I want to maintain integrity in all my
counselling relationships.
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A2. Respect for Rights: It will be important to keep in mind clients’ right
to withhold information that could be detrimental to them and their
safety (in this case, the client is an organization, so informed con-
sent should discuss the pros and cons of being forthright and also
could include the consultant signing a non-disclosure agreement).
A7. Responsibility to Counsellors/Therapists and Other Professionals:
The consultant must remain professional when in conversation
with other professionals, being diligent to act with honesty, accu-
racy, and integrity.
F - Consultation Services
F1. General Responsibility: Counsellors must only provide the level of
service that they are knowledgeable about and have been super-
vised in. They should also maintain an understanding with their
client, whether they be paying or not, that all discussions remain
confidential. Consultants must remain unbiased and not discrim-
inate in any fashion. All records are to be kept in a secure location
and are handled as the policies outline.
F3. Consultative Relationships: Counsellors in a consultation rela-
tionship must provide clearly documented informed consent that
outlines the boundaries of the relationship, the limitations of the
counsellor’s competence, as well as limits of liability and any fees
associated with the services. There needs to be discussion around
how any suggestions or recommendations that are put into action
are the legal responsibility of the receiving party.
F4. Conflict of Interest: Counsellors must be aware of any underlying
concerns which may present opportunities (or the appearance of
opportunities) for personal advancement from the consultation.
342 CHAPTER 14
Case 9.2
Step Three: Which of the six ethical principles are of major importance
in this situation? (This step also involves securing additional information,
consulting with knowledgeable colleagues or the CCPA Ethics Committee,
and examining the probable outcomes of various courses of action.)
• Beneficence – how can consulting in this way benefit clients?
• Nonmaleficence – will consulting cause harm to clients in any way?
• Societal Interest – will consulting uphold the best interests of so-
ciety?
344 CHAPTER 14
consider a possible headline of “Cancer agency spends X dollars hiring a
consultant with no previous experience to conduct a comprehensive review
based solely on her experience as a patient.” In that case, it readily becomes
crystal clear that the optics would not be great.
Universality: I tend not to like absolutes on the best of days. In this
case, as with others, I do not think that there should be a “blanket” answer.
As with most things, there are pros and cons. I think the key to answering
this question lies in how self-aware that counsellor is – not only in acknowl-
edging potential limitations or conflicts prior to accepting a contract, but
being able to identify them in the moment that something is going sideways
(e.g., being triggered or being out of her depth with lack of expertise). In
this case, I think it would be a good idea for Jazpreet to disclose to the cancer
agency that is requesting the consult, her exact level of experience with the
particular subject matter (e.g., personal and professional), as well as any po-
tential biases/difficulties she would be bringing to the table. Perhaps a more
personal “inside view” is what they were seeking? Or, perhaps they were
preferring an unbiased view? I’d wonder how the cancer agency would feel
about a headline being on the front page of a major newspaper.
Justice, in this scenario, is a fascinating concept. Is it about things be-
ing equal? Is it about things being equitable? What is justice? It would not
seem to be “fair” if the counsellor who had cancer and underwent treatment
didn’t get the job just because she could be perceived to have bias. Similar-
ly, it doesn’t seem “fair” that someone would not get the job, just because
they didn’t have cancer personally. The Cancer agency could justify hiring
or not hiring either counsellor to consult for the “right reasons.” On the
other hand, it would certainly be understandable to not hire someone that
doesn’t have the appropriate expertise or competency. Is that fair? I believe
most people would probably agree that an individual with no experience
or competency should not be hired to consult on something they do not
know anything about. In theory, “justice” to get (potentially) two different
perspectives might be to hire two experienced, competent people to consult
– one having gone through the experience of being treated for cancer, and
one not. It would then be the cancer agency’s decision as to which they find
more relevant or if they decide to incorporate both responses.
346 CHAPTER 14
nosed by medical professionals such as physicians, nurse practitioners, or
psychologists (National Eating Disorders Information Center, 2023). As a
result of discussing this key issue with their mentor (CCPA, 2020, B10. Con-
sulting with Other Professionals, p. 11), Alex determines they are not the
appropriate person to provide service to the attendee’s daughter.
Alex needs to approach the attendee in a way that represents their pro-
fessional qualifications properly (CCPA, 2020, A5. Representation of Pro-
fessional Qualifications, p. 6) while providing some guidance that does not
go beyond their current experience and training (CCPA, 2020, A3. Bound-
aries of Competence, p. 6; F1. General Responsibility, p. 24) or that it could
be considered as an opportunity to recruit clients (F5. Sponsorship and Re-
cruitment, p. 4).
Alex decided to suggest that the attendee discuss with the daughter the
possibility of consulting a psychologist who has the necessary experience
to conduct a proper assessment (B16. Referral). They feel good about this
answer and aware of feeling proud to have acted professionally (A1. General
Responsibility) and within their limits of competence (A3. Boundaries of
Competency, p. 6). Meanwhile, Alex is cognizant that the attendee has trust-
ed them after hearing the thesis presentation and that he deserves to receive
an answer that addresses his concerns. If this decision was to be announced
publicly, Alex feels calm and confident knowing they would be representing
the counselling/therapy profession in an ethical manner.
Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
It is the primary responsibility of counsellors/psychotherapists to en-
sure the client’s welfare is promoted in all professional contexts (CCPA,
2020, B1. Primary Responsibility Counsellors/therapists, p. 9), while main-
taining awareness of the unique and diverse circumstances for everyone
they interact with professionally (CCPA, 2020, B9. Respecting Inclusivity,
Diversity, Difference and Intersectionality, p. 11). Although the attendee is
not a counselling client, Alex is approaching him as a potential client who
trusts Alex as a professional. Alex understands that the information provid-
ed to the attendee should be accurate, ethical, and culturally sensitive – as
it would for any other client or professional. Although Alex is unaware of
any other information about the client, the ethical principles of beneficence,
nonmaleficence, and justice serve as a guide. It is necessary for the counsel-
lor/psychotherapist to obtain ongoing parental/guardian informed consent
as well as the client’s assent during counselling and throughout other pro-
fessional activities. In this case, the attendee is speaking about someone else.
As such, the counsellor should be aware of the potential dual relationship
in this interaction (CCPA, 2020 B5. Children and Persons with Diminished
348 CHAPTER 14
Step Three: Obviously, all six ethical principles are important. In this
scenario, if I am required to identify the most primary, they would be: non-
maleficence, beneficence, fidelity, and autonomy.
Step Four: In this case, to address the most obvious issue (degree of
competence), Alex would just have to make it clear that they are newly cer-
tified, and though eating disorders may be the subject of their thesis, they
(may) have limited practical experience counselling for that issue. Alex may
also want to disclose if they personally had an eating disorder – and be
forthcoming about any efforts that will be made to negate bias, triggering,
self-care, getting supervision, etc. Regarding the fact that the daughter is a
teenager, Alex would want to be very clear with ALL parties about responsi-
bilities when reporting any assessment results and limits to confidentiality,
as well as respecting the teen’s autonomy. The potential risks of this could
be that the parents might want to choose that their daughter see someone
more experienced; however, a potential benefit would be gaining rapport/
trust for being so candid, truthful, and upfront.
Step Five: In this situation, assuming that Alex is self-aware, and be-
lieves that they are competent to provide assistance to the client, then I
think it would be okay for them to proceed. Even newly certified people
need to get experience. Ideally, however, this would still be under supervi-
sion / consultation with other counsellors/therapists, given Alex’s newness
– and especially if they have personal triggers related to the subject matter.
Step Six: I think it would be most beneficial to have the first meeting
with all parties (the teen and the parents together), to set expectations re-
garding reporting, autonomy, and confidentiality, and to confirm “goals.”
Then, if they decide to proceed, to do occasional check-ins every couple
of sessions to confirm that all parties are still getting benefit from therapy
would be helpful. If it is not working, a referral should be made.
350 CHAPTER 14
Work Through A: Wise Practices
When considering ethical aspects of a case, I examine the actual Codes
of Ethics (and the accompanying Standards of Practice), using the deci-
sion-making processes to support decision-making regarding the applica-
tion of the Codes and Standards. The case, as presented, did not mention
our Code of Ethics.
In CCPA’s (2020) Code of Ethics and Standards of Practice (CCPA,
2021), Articles B4 and B5 outline the counsellor’s responsibilities regarding
consent for working with minor children (note: we are not provided with
the age of the child, but for these purposes it is assumed that child refers to
a minor.)
The counsellor should discuss the goals for counselling (within legal
parameters) with BOTH parents, (unless one has the legal parental deci-
sion-making rights). As a CCC with CCPA, David must take responsibility
for understanding the legal and ethical considerations around the use of
Conversion Therapy and consider seeking further consultation, in addition
to his current supervisor.
352 CHAPTER 14
tionships” section underscores the need for counsellors/thera-
pists to be mindful of their primarily obligation to help clients
(within legal and ethical parameters). Counsellors/therapists en-
ter into a collaborative dialogue with their clients to ensure un-
derstanding of counselling/therapy plans intended to address
goals that are part of their therapeutic alliance. Counsellors/
therapists inform their clients of the purpose and the nature
of any counselling/therapy, evaluation, training or education
service so that clients can exercise informed choice with respect
to participation. (CCPA, 2021, p. 14)
354 CHAPTER 14
a “mature minor” although that isn’t clear from the case description. David
also needs to clarify whether he is working with multiple clients (B13) and,
therefore, engaging in family therapy or if the child is his primary client,
in which cases the best interests of the child will be prioritized. David rec-
ognizes his boundaries of competence in this and will also offer a referral
(B16) to a program supporting youth who are questioning their sexual ori-
entation and/or gender identity.
1. Publicity: Would I want this ethical decision announced on the front
page of a major newspaper?
• What I would feel most comfortable announcing is engaging in a
discussion with the child on what they feel is best for them and
what they want. With the information provided, it’s unclear what
the preferences of the child are.
• I would also feel comfortable publicizing that I am looking further
into the laws surrounding consent with minors and try to give the
child as much autonomy as possible (e.g., could they be considered
a mature minor, B5). Additionally, this would include advocating
for the child and their needs and preferences, regardless of whether
the parent agrees. While doing this, I would try to see if there is a
way for the parents to see eye-to-eye with each other and with the
child to build connection amongst the parties impacted. I would
include the parents in conversations about conversion therapy and
the most recent research about it – it’s possible they aren’t aware of
the dangers.
2. Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
• As every counsellor should be making decisions based on available
research and laws, yes, if every counsellor made this decision, it
would be a good thing.
• I would also choose to support the child in their interests and ad-
vocate for them regardless of whether their parents agreed with the
child or with each other. I feel this would be important for all coun-
sellors to do as part of ethical practice.
3. Justice: Is everyone being treated fairly by my decision?
• In this case, the supervisor is being treated fairly by my decision to
incorporate his feedback and recommendations.
• The child is being treated fairly by being listened to and respected
and by being given agency over their own treatment.
• Both parents will be treated with the same respect as everyone else
Case 10.2
356 CHAPTER 14
ship regarding the lab. It seems unreasonable that similar processes and safe-
guards couldn’t be put in place regarding private practice as well. Therefore,
regarding the work in Dr. Janson’s private practice, there may be two ways
to proceed. One involves checking with Mimi to see if she is really okay with
the delay in her program, and perhaps assisting her in taking a leave from
the program for the period she will be working, if that is possible. Second,
the possibility of having another professor grade Mimi’s assignments could
be explored so that Mimi could complete the course with her cohort and not
delay her program.
2. How can my values best show care for the client’s wellbeing?
I would meet with Mimi to discuss her options and look at the costs and
benefits of her decision to take a year off to work for Dr. Janson. I would also
talk with both Dr. Janson and Mimi regarding the possibility of her attend-
ing Dr. Janson’s class with someone else grading her assignments. I would
also discuss processes for them both to consider if challenges arose in the
class, the lab, or the private practice employment situation.
358 CHAPTER 14
to ensure that Mimi is appropriately credited for any of her contributions to
Dr. Janson’s scholarly activities (G13).
There are other relevant articles throughout CCPA’s (2020) Code of Eth-
ics: Respect for Rights (A2), Supervision and Consultation (A4), Respon-
sibility to Counsellors/Therapists and Other Professionals (A7), Multiple
Relationships (B8), Acknowledging the Contributions of Others (D10), and
Conflict of Interest (F4). Taking all of these articles into account, assuming
that the multiple relationships benefit, rather than harm the vulnerable stu-
dent, and are carefully managed with integrity, they are likely to result in a
positive outcome for the student.
Step 3: Principles
Most of the principles seem relevant – Beneficence (being proactive in
promoting Mimi’s best interests as a student), Nonmaleficence (refraining
from delaying Mimi’s graduation or forcing her to give up a professional-
ly relevant job that fits with her school schedule), Autonomy (respecting
Mimi’s right to agency in choosing the work and school options that feel
like the best fit), Justice (honouring Mimi’s right to just treatment and not
punishing her for choosing work that is relevant to her career goals), and
even Societal Interest (by not delaying Mimi’s graduation when there are
long waitlists for qualified counsellors).
Step 4: Applying the Articles
I’d encourage Mimi and Dr. Janson to meet with a supervisor at the
university (e.g., the Program Coordinator, Department Head, or Dean, de-
pending on the reporting structure), with a clear plan in place for how they
could make it work for Mimi to take Dr. Janson’s course and graduate on
schedule. The plan would involve strategies for how to handle any conflicts
at work or in the class, protecting Mimi as the most vulnerable person in
this scenario. Options could include reporting to someone else within Dr.
Janson’s private practice or having a faculty supervisor in place for Mimi
to consult with should any issues come up in the university research lab or
the classroom. Arrangements could be made for another faculty member
to grade Mimi’s assignments or for Dr. Janson to grade the assignments but
with an option available for another instructor to regrade the assignments
in the case of an appeal. All of this would serve to clarify roles and respon-
sibilities and to set clear relational boundaries due to the multiple relation-
ships (G4, G6). There would also need to be clarity about how to discuss the
multiple relationships with other faculty and students, ensuring that Mimi
wasn’t perceived as being privileged in some way.
Step 5: Feelings and Intuitions
My feelings and intuitions tell me that this is a workable plan. Based on
Case 10.3
360 CHAPTER 14
Work Through A: Virtue-Based
What are the emotions expressed by each party and how do they
impact suggestions for solving the discomfort?
The student is frustrated by, and feels helpless about, the lack of feed-
back on assignments and expectations during the course. She also feels dis-
empowered, accusing the instructor of intentionally withholding feedback.
The instructor is also frustrated – by the student’s complaint and also
by what seems like an overwhelming workload. Upon receiving poor course
evaluations, she’s “appalled” – likely feeling anger, embarrassment, and a
lack of respect – perhaps mingled with some guilt and shame. She feels mis-
understood and unsupported, and disappointed that her work throughout
the course wasn’t well received.
These underlying emotions suggest that the students’ (including the
others in the class who submitted poor evaluations) concerns need to be
heard and validated. However, they also suggest that some earlier interven-
tion with the instructor might have been helpful. Dr. Rolland has a reputa-
tion as a “program gatekeeper” suggesting that this isn’t a new issue, which
raises the question, “Why now?” Had her previous evaluations been good
and suddenly this one wasn’t? Is there something unique about this cohort
of students? Is there something else going on for Dr. Rolland this term that
has created an unusually high backlog of marking? Or, is this a known and
ongoing pattern and is Dr. Rolland, at the program’s request, serving as the
gatekeeper? If so, are the course expectations clearly explained and is a grad-
ing rubric provided? Could the program support Dr. Rolland in re-aligning
assignments so that the first can be graded before the second is submitted,
and so on? Could Dr. Rolland be assigned a teaching assistant to help with
timely return of graded assignments?
362 CHAPTER 14
feedback on each assignment before submitting the next. I would like to be
known publicly as the instructor who supports student learning through a
mastery approach (rather than as the program gatekeeper), ensuring that
students who successfully complete my course are well-prepared for the rest
of the program. To avoid unexpected course evaluations at the end, I would
also build into the course design an opportunity for a midterm evaluation
of the course and my teaching and would set regular weekly office hours via
Zoom to invite students to ask questions and offer feedback throughout the
course.
364 CHAPTER 14
comes designed to develop students to become competent counsellors.
Justice: Is everyone being treated fairly by my decision?
Although the current student who is complaining to Dr. Janson might
not get a better grade, the student will have been respectfully heard, the
complaints documented, and there will be a tangible result from those com-
plaints in the form of a redesigned course. This is also fair to the many stu-
dents who did closely follow the grading criteria and successfully completed
the existing course, in that the goalposts weren’t moved for a student from
their class who chose to complain after the course had ended. Revising the
course will also be fair to Dr. Janson and future instructors, creating a course
that is more manageable to teach and grade.
366 CHAPTER 14
which students and other counsellors on staff share video segments of their
sessions and offer observations and feedback. I would ask the supervisor
if she believed that the student could successfully complete her practicum.
Hearing, “No,” I’d recommend that the student be pulled from the practicum
site and a remediation plan developed to address her “inability to connect
with clients.” If that goal was successfully achieved, the remediation plan
would also include finding a new practicum placement with a skilled and
supportive supervisor next term (E4: Welfare of Clients and Protection of
the Public; E5: Welfare of Supervisees; E10: Due Process and Remediation).
Publicity – This criterion asks me to reflect on whether I’d want to read
my decision as front-page news. I imagine the student might be angry with
me, but I’m having a hard time picturing a front-page news story from it
that would have any credibility. However, I would definitely want to avoid
front-page news that read, “Young mother died by suicide after incompetent
counselling at XYZ agency” if I knew that my student had been that coun-
sellor.
Universality – As this decision followed an ethical process and policies
within the program, it would apply to other students in a similar situation.
Promoting the wellbeing, respect, and safety of clients, colleagues, students,
and supervisors is a core value of all counselling activities. Consultation,
accepting feedback from supervisors, and following through with that feed-
back is expected in all clinical settings.
Justice – In this case, clear communication is key to everyone being
treated fairly. Not listening exclusively to, nor discounting, any single per-
spective is important. As the course instructor, I treated the student fair-
ly by investigating her concern, I treated the program fairly by consulting
with others who had more experience than me, and I treated the practicum
site and supervisor fairly by providing an opportunity for the supervisor to
share concerns and describe the process of giving feedback. Working with
practicum students, I also have a responsibility to protect the public – in
this case, the public was treated fairly by removing the risk of future clients
not being able to connect with their counsellor, as the therapeutic alliance
is fundamental to counselling success (Principles of Nonmaleficence, Jus-
tice, Societal Interest; E1: General Responsibility, E4: Welfare of Clients and
Protection of the Public).
2. How can my values best show care for the client’s wellbeing?
My values can show best by being even-handed in the situation, focus-
ing both on making sure the student is heard and respected and not avoid-
ing gate-keeping processes if they are needed (E5: Welfare of Supervisees;
E10: Due Process and Remediation; Principles: Justice, Societal Interest).
368 CHAPTER 14
CHAPTER 11
Case 11.1
Suzie has been a counsellor for 25 years. They have
been working at the same agency for their entire career,
and recently a new executive director has come on board.
The agency is looking to make changes and digitize busi-
ness processes. The executive director seems excited about
this switch as it will produce more clients locally and across
provinces as well as improve efficiencies in the administra-
tive, bookkeeping and client record processes. The execu-
tive director seems focused on increasing client volume, has
no background in ethical health management, and is focus-
ing on the financial aspect of the organization. Additional-
ly, the executive director wants to expand service provision
across provinces and internationally to gain more financial
resources for the agency. The executive director wants to
have a conversation with the counsellors in the agency to
understand the impact that these changes may have on
the counsellors, and to find ways to support them so they
may go through the changes rapidly and effectively. Suz-
ie is grateful for the upcoming meeting. However, Suzie is
unsure about the changes, feeling uncomfortable with be-
ing responsible for client booking, communications, record
keeping, and invoicing digitally since they were previously
only responsible for these processes in paper form. Suzie is
also unfamiliar with all the platforms associated with this
switch, such as social media pages, websites, and man-
agement systems. They are nervous about talking to their
employer about their discomfort and they don’t know their
responsibilities or how to approach the topic. Suzie is also
concerned about the timelines as these changes will occur
rather quickly. Suzie is aware that they are not the only one
concerned about these changes; other counsellors in the
agency have expressed concerns too. Suzie is afraid of los-
ing their job and feels entirely out of their depth.
370 CHAPTER 14
Work Through B: Wise Practices
As much as Suzie desires to continue at their current job and learn new
skills, adding a technology-based service is not within their current com-
petency. In addition, Suzie has a large number of Indigenous clients, which
adds to their concern about being able work with the new systems in place.
They fear that the new way of doing things will not be compatible with their
clients’ needs and realities.
In order to address this issue, they contact their supervisor, who has
more experience working with telehealth. It is important for them to navi-
gate this dilemma while ensuring that their practice is sensitive to the needs
of their clients and at the same time adapting to the changes at the agency.
Suzie’s supervisor refers to the Code of Ethics (CCPA, 2020), especially
attending to Section H: The Use of Electronic and Other Technologies that
was recently added (p. 28). Suzie, however, points to Section I: Indigenous
Peoples, Communities and Contexts and refers to new Wise Practices Lens
ethical decision-making model, embracing the concept of two-eyed seeing,
as well as the inclusion of the seven sacred values: courage, honesty, humil-
ity, respect, truth, love, and wisdom. In Suzie’s counselling practice, they
have been using this approach for the past few years under the guidance of
an Elder who has taught them how to incorporate it. In order to navigate
Suzie’s challenge, they both bring their perspectives to the table.
Courage, honesty, and humility: In reaching out to the supervisor, Su-
zie clearly shows these values. It was a humbling experience to acknowledge
the limits of their competence (CCPA, 2020, A3. Boundaries of Compe-
tence, p. 5) in this case and it took courage to admit their lack of compe-
tence to the supervisor (CCPA, 2020, A4. Supervision and Consultation, p.
5) who was known for expertise in this area. Suzie recognizes that the world
is changing and while they have a vast experience in counselling skills, they
lack the skills to adjust properly to the new ways in the agency. Suzie is un-
sure whether they will be ready by when these skills will be required. They
also want to be honest with their employer but fear losing their job.
Respect: After working as a counsellor for 25 years, Suzie has a great
deal of respect for the profession, their agency and their clients. With the
assistance of their family members, they have acquired some digital compe-
tencies for personal use. However, they realize that the decision being made
seems disrespectful to the counsellors, who have not had an opportunity
to develop digital literacy, as well as to the clients, who might feel uncom-
fortable with the changes taking place at the agency. Despite their desire to
adapt, they are unsure whether they will be able to do so or if they will fall
372 CHAPTER 14
Indigenous & Traditional Western Perspective
Perspective
- Indigenous communities and vul- - There is a need for mental health
nerable populations have histori- services to adapt to the current
cally been affected by colonizing trends and needs. Companies and
practices, forcing them to adapt to agencies were forced to respond to
Western views. Over time, many of the post-pandemic world by provid-
these changes have exacerbated the ing remote services and adjusting to
multibarrier realities they already technological advancements.
experience. The changes taking
place at the agency will require
cultural sensitivity and sensitivity - The use of technological services
towards vulnerable groups, includ- allows the agency to serve more
ing counsellors who are not com- people and provide mental health
puter literate. (CCPA, 2020, I1. support remotely, benefiting clients
Awareness of Historical and Con- in remote areas and clients with dis-
temporary Contexts, p. 30). abilities who are unable to travel.
374 CHAPTER 14
B7. Access to Records:
Counsellors/therapists understand that clients have a right of
access to their counselling/therapy records, and that disclosure
to others of information from these records only occurs with the
written consent of the client and/or when required by law. (See
also B4, H1; CCPA, 2020, p. 10)
376 CHAPTER 14
to honour client confidentiality, demonstrate respect for and
valuing of all individuals, and represent themselves with integri-
ty. (See also B2, G2; CCPA, 2020, p. 29)
Step Three: Ethical principles:
Beneficence: Taking proper (i.e., SOAP – Subjective, Objective, As-
sessment, Plan) progress notes as if they may be exposed at any time, not
divulging every last detail which reduces harm if progress notes were to be
exposed, and staying trained on the industry standards for use and protec-
tion of client data.
Nonmaleficence: Taking every available precaution electronically (e.g.,
VPNs, dual authentication, encrypted email) to reasonably secure the clini-
cal relationship with the client.
Justice: Taking necessary measures to deidentify personal information
on the web of these clients related to the timeframe of treatment.
Societal Interest: Taking measures to educate and eradicate such
threats across the field.
Step Four: (Please see Step Three) Also, contact the cloud service pro-
vider, seek legal advice, and alert clients of possible breach.
Step Five: What feelings say – Stay away from emotionally charged
public statements and focus on resolution for the sake of the clients.
Step Six: Plan of action most helpful – Consult with legal represen-
tative, contact cloud service provider, and advise clients of the potential
breach, while also advising of the actions that have been taken in order to
protect their information further. Focusing on preventative measures, shore
up well-defined and clearly stated consent statements before engaging in
therapy and stay current on associated training to improve protocols where
necessary to reflect contemporary standards.
378 CHAPTER 14
transpired. It will also be important to report the criminal activity to the
proper authorities for further investigation. As an added measure, Violet
will need to find an alternative secure location to hold her private files to
avoid any other possible incidence.
Publicity: If this case and decision were to be released publicly, I be-
lieve it takes into consideration the codes that cover the protection of client’s
confidentiality while also making an effort to rectify the possible leak of
information.
Universality: If the same decision were being made by other counsel-
lors, then we would see changes in the way important files were being stored
and secured. As there are multiple clients involved in this case, I would say
that I would make the same choice for each of them. Informing the clients
will show honesty and present an opportunity to once again establish open
discussion around how files are protected and changes that need to happen.
Justice: In this decision everyone has been treated fairly. All of the cli-
ents are at an equal risk level.
380 CHAPTER 14
Work Through A: Virtue-Based
In applying the virtue-based ethical decision-making process, the fol-
lowing questions help to conceptualize the dilemma and ethical next steps.
The responses will be written from the perspective of Mr. Xi, the school
counsellor.
2. How can my values best show care for the client’s wellbeing?
First and foremost, my duty is to my client – the student. To ensure
the student’s wellbeing, I need to assess whether the placement with Nao-
mi is indeed suitable and safe. I need to determine if there are any other
factors impacting the student which might be leading to this escalation in
behaviour. I’d need to offer empathy and understanding instead of discipline
or threats of punishment. It will be important to assess the student’s cultural
ties with the Indigenous community. I recognize my own limited experi-
ence in working with Indigenous students, so I’d like to consult with the
Elder-in-Residence at our school for support and guidance.
I also need to assess if Naomi’s feelings of frustration represent a true
incompatible placement or just a need for additional supports. I am not
aware of whether Naomi has had a foster placement before. I need to sup-
port Naomi to ensure we can collaborate on solutions.
Lastly, I need to find a way to deal with the inappropriate response by
the police. Ignoring it feels like being complicit and may serve to impair a
working, collaborative relationship between the student, the school, and
Naomi.
382 CHAPTER 14
reviewing additional supports, and discussing the police response and po-
tential avenues for action moving forward. I would also feel good about
involving our Elder-in-Residence in planning additional supports for our
student and in offering parenting strategies and community connections to
Naomi.
384 CHAPTER 14
on how to best support the student in an ethical way to ensure cul-
turally appropriate solutions for the student.
Step Three – Which of the six ethical principles are of major impor-
tance in this situation? (This step also involves securing additional informa-
tion, consulting with knowledgeable colleagues or the CCPA Ethics Com-
mittee, and examining the probable outcomes of various courses of action.)
• Beneficence: it is important to promote the best interest of the cli-
ent (i.e., the child), whether that be staying at the current foster
home or not.
• Fidelity: honouring the commitment to the client and remember-
ing who the client is in this case (the student).
• Consulting with colleagues who may know more about the foster
care system and the counsellor’s role in this would also be import-
ant at this point. For example, if it is determined that the placement
is not a good fit, what can a counsellor actually do in this situation
and does this mean referring to a different type of professional?
• Consulting with an Elder from the Indigenous community to learn
more about what supports and/or training might be available for the
child at school, for the foster mother, and for me as a counsellor.
Step Four – How can the relevant ethical articles be applied in this cir-
cumstance? How might any conflict between ethical principles be resolved?
What are the potential risks and benefits of this application and resolution?
• The ethical articles can be applied in this case by understanding the
cultural context of Naomi and the student as well as respecting the
rights of the student.
• There may be a conflict between ethical principles of beneficence
and societal interest in that if it is determined that the foster place-
ment is not a good fit for the student, honouring beneficence would
mean supporting the student in finding a better placement but this
may not be in the best interest of society in that finding a new place-
ment for the child will likely take up time and resources.
• In this case, the beneficence of the client should be prioritized. The
benefit of this is that the child and Naomi may feel better about their
situation, but the risk is that a better fit may not be found and that
the child will be moving to another home after having moved many
times in the last few months.
• In this case, it is not yet clear if the foster placement is a good fit
and this should be determined first as well as ways to minimize the
client’s behaviour of running away.
386 CHAPTER 14
nous community to gain more knowledge about how to effectively
support this child and others similar to him as this is an area in
which I have limited experience.
388 CHAPTER 14
good for them – their home needs to feel like a safe and respectful
place for them both.
• Respect for the child can be demonstrated by considering what
might need to change at school to make it feel like a safe space to
learn.
Truth— “our truth is not the only truth, there are many paths
to home, we are created equal, no matter how much we learn,
there is much we do not know” (Wesley-Esquimaux & Snowball,
2010, p. 396).
• Enacting this value requires remembering that the truth of the situ-
ation may be different for everyone involved (e.g., Naomi, her foster
son, the school counsellor, the bus driver, the police) and that no
one’s truth is the only truth. This also means being open to hearing
other people’s truths that may be different from your own – and to
speaking truths, even when they may be uncomfortable and diffi-
cult for others to hear.
Love— “unconditional acceptance of self and other; accepting
and embracing difference; allowing; and gracefully giving of ev-
erything we are” (Wesley-Esquimaux & Snowball, 2010, p. 396).
• To enact this, the counsellor could support both Naomi and her
foster child to fully accept themselves and each other, accepting and
celebrating their differences, and facilitating opportunities for each
to contribute their strengths. The counsellor could consider involv-
ing other stakeholders at the school (e.g., teachers, administrators,
student peer leaders) to examine how they could create a more wel-
coming and inclusive environment for the child, embracing his dif-
ferences, and meeting his needs in a spirit of love.
Wisdom— “providing an expansive and inclusive view of the
world” (Wesley-Esquimaux & Snowball, 2010, p. 396).
• In this context, the counsellor might work towards helping Naomi
and her foster child to better understand each other’s worlds and
realities and the options available to each of them.
• The counsellor might also meet with the teachers and administra-
tors to enhance their cultural competency in meeting the needs of
the student so that he is less likely to be triggered to run away.
• This could include allowing all involved to share their own lived
experiences and worldviews with each other and to share in each
other’s wisdom. This could also include providing opportunities
to share cultural wisdom and lessons with the others in order to
REFERENCES
Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, mental
illness and addiction through a Wise Practices Lens. International Jour-
nal of Mental Health and Addiction, 8(2), 390-407. 10.1007/s11469-
009-9265-6
Case 12.2
390 CHAPTER 14
supportive, but his father was angry. His father regularly
scoffs at James, saying he’s just using his Indigeneity as a
crutch to explain why he isn’t as successful as his siblings.
To make matters worse, James’ father is now sending him
Facebook memes about how Indigenous groups just com-
plain.
James comes to Georgina to try to work through this
family dynamic conflict. However, Georgina has very limit-
ed experience working with Indigenous clients in situations
like this.
392 CHAPTER 14
ence might provide a rich learning experience for Georgina and offer James
the support that he needs in the midst of the family conflict he is experienc-
ing, that upholds the ethical approach to build competence, maintaining
beneficence and nonmaleficence.
2. How can my values best show care for the client’s wellbeing?
I value the reunification of families and exploring one’s cultural iden-
tities so it’s important to support the client’s expressed desire to reconnect
with his biological parents. This value also pressures me to ensure the client
maintains a relationship with his adoptive parents.
Supporting James means supporting him to manage his relationship
with his adoptive father which may include challenging him.
394 CHAPTER 14
Case 12.3
Principles
Beneficence, Fidelity, Nonmaleficence, Autonomy, Justice, Societal In-
terest (all of them!). Of particular concern here is not hurting the client and
upholding the trust she has in the counsellor, without putting the client’s
child at risk.
Articles
A2 (Respect for Rights), A10 (Third Party Reporting), A12 (Diversity
Responsiveness), B1 (Primary Responsibility), B2 (Confidentiality – and,
in this case, informing the client about exceptions such as “when a child is
396 CHAPTER 14
Respect— “coming together and honouring each other’s place
and space, knowing that this is something you must give to get,
honouring the smallest to the oldest, walking in beauty” (Wes-
ley-Esquimaux & Snowball, 2010, p. 396).
• Levi respects Sonia as a mother, knowing that how she does things
may not be how he would choose to do them but that this does not
make them wrong. He refrains from judging the mother until he
learns more of her story.
• Respect also means respecting her child as deserving proper care.
• When thinking about equality and fairness, Levi asks: Would I
think the same thing if this were a child and parent of a different
race?
Truth— “our truth is not the only truth, there are many paths
to home, we are created equal, no matter how much we learn,
there is much we do not know” (Wesley-Esquimaux & Snowball,
2010, p. 396).
• Levi recognizes that there may be a lot he does not know about their
family life (e.g., current stressors for the child/Sonia, reasons the
child may be showing up like this, how common/normal this is for
this child or other children in general).
• “If truth is about the future, it is also about the First Nation, Métis
and Inuit youth that are growing up in circumstances that continue
to reflect colonial impacts and despair, as well as growing potential
for self-actualization and pride” (Wesley-Esquimaux & Snowball,
2010, p. 402). Levi ponders: What other things may the child be
experiencing? How are the child and mother experiencing colonial
impact and how might this affect the presentation of the child?
Love— “unconditional acceptance of self and other, accepting
and embracing difference, allowing, and gracefully giving of ev-
erything we are” (Wesley-Esquimaux & Snowball, 2010, p. 396).
• This includes unconditional acceptance of Sonia and her child, re-
gardless of whether or not there is neglect.
• “Establishing a sense of trust and unity in interpersonal relation-
ships and paying attention to the young people that require posi-
tive reinforcement” (Wesley-Esquimaux & Snowball, 2010, p. 403)
– This means establishing a relationship of trust with Sonia and her
child to explore the possibility of neglect.
Having applied two-eyed seeing, through using the principles and ar-
ticles from the Code of Ethics and also the seven sacred values as presented
in the Wise Practices Lens ethical decision-making model, Levi decides to
continue to monitor his concerns but, as the child seems alert and well-fed,
and is clearly attached to her mother, to not jump to conclusions about ne-
glect at this point. Instead, he will gently speak with Sonia about how she’s
doing and if she feels she may need any additional support in caring for her
child. Based on that conversation, and his ongoing observations, Levi will
remain open about how to proceed. However, for now, he does not consider
the child to be in an unsafe situation that would necessitate a report to any
authorities for further investigation.
REFERENCES
Wesley-Esquimaux, C. C., & Snowball, A. (2010). Viewing violence, mental
illness and addiction through a Wise Practices Lens. International Jour-
nal of Mental Health and Addiction, 8(2), 390-407. 10.1007/s11469-
009-9265-6
398 CHAPTER 14
Work Through B: Quick Check
Key issues:
• The most vulnerable individual in this situation is the child, even
though the child isn’t Levi’s client. If Levi perceives that the child
is in need of protection (CCPA, 2020, B2 iii), he will have a duty to
report that, even if that means breaching confidentiality.
• Although it is the counsellor’s primary duty to focus on the client’s
welfare (B1), having the client’s child in the sessions creates a con-
flict of interest and becomes implicitly a Multiple Relationship Issue
(B8). In the context of Multiple Relationships, now the counsellor
can’t ignore the presence of the child, so he cannot concentrate sole-
ly on Sonia, the client.
• A counsellor would not be exposed to the client’s child if the child
were not accompanying the mother to sessions. With the client’s
child present, extra information may emerge that the client is not
revealing, creating a dilemma of addressing the potential neglect
and moving away from the main responsibility, which is meeting
the client’s needs. Although it is not the child who is the client here,
but her mother, the counsellor may be torn between addressing the
potential risks for a child both hearing information that could af-
fect her and being exposed to her mother’s private conversations
during the session. Furthermore, the counsellor may be sensing in-
formation that could indicate a potential risk that he cannot avoid
assessing.
• Levi’s main responsibility as the counsellor is to support Sonia (the
client) in her current emotional state; however, this is supersed-
ed by the need to protect vulnerable children. It wouldn’t be as
challenging if Sonia attended sessions alone. This would mean the
counsellor wouldn’t even be aware of the care Sonia’s child is receiv-
ing and there would be no dilemma in addressing this issue if this
were the case.
• In bringing her child to sessions, Sonia shows that she lacks the
support she needs to take care of her personal needs (i.e., someone
to look after her child while she attends sessions) and that she cares
enough not to leave her child alone. The counsellor can use this in-
formation to learn about the client’s current situation and to ensure
that a safe space becomes a support for them.
• The counsellor’s main dilemma may be whether or not to express
concern about Sonia’s child. The client might feel judged and unsafe
400 CHAPTER 14
Grieving (losing her friend) and possibly re-traumatization (as a do-
mestic violence survivor) are two issues the client is experiencing. It is most
important that she finds a safe space to process both because she may be
feeling that “it could have been her.” The counsellor’s commitment to his pri-
mary responsibility and the fidelity to honor the client’s wellbeing, if made
public, would only demonstrate his fidelity to honour the client’s wellbeing.
If the counsellor later discovers that his intuition (but also potential
bias) about the child being neglected is true, he could feel guilty about not
addressing it earlier. Though this is possible, the counsellor’s feelings do
not take precedence over the client’s. Furthermore, the counsellor does not
have enough information to know that the child is in danger (B3) from the
current information he has (a disheveled child).
However, if the child is indeed in need of protection (B2 iii), and Levi
did not report his concerns, he would have breached his Code of Ethics and
also neglected his responsibilities as a citizen – he wouldn’t want that to be
the front-page news story!
2. Universality: Would I make the same decision for everyone? If every
counsellor/therapist made this decision, would it be a good thing?
First Scenario: As part of the therapeutic process, authenticity implies
addressing issues that arise in a sensitive and honest manner. The process
of sharing concerns throughout the process, and incorporating them into
an ongoing informed consent, would be done regardless of the client or
their context. In this case, the first scenario would allow the counsellor to
maintain an authentic level of interaction without feeling intimidated by the
client’s specific situation. If this is how the counsellor usually proceeds, it
would be ethical to be consistent in his standards of practice.
Second Scenario: An understanding of the level of crisis a client comes
into a therapeutic relationship with, as well as the gradual construction of
trust, is essential for a successful therapeutic relationship. Clients should be
respected and given the chance to address the issues that matter to them.
Listening, understanding, and getting to know your clients, as well as build-
ing trust, is always a good/ethical decision. The counsellor could find out
if his concern about Sonia’s child is biased or if there is a real neglect he
should address later by taking the time to investigate. Every client deserves
that the counsellor transcends his biases and does not let them guide his
decisions, instead taking the time to create a safe and trusting environment
before jumping to conclusions. In building this environment, the counsellor
should also attend to the limitations of the interventions and practices used
and use culturally appropriate practices (I7).
402 CHAPTER 1
WORKING THROUGH ETHICAL DILEMMAS 403
APPENDIX - A
Code of Ethics ( Excerpt)
APPENDIX - A 405
Code of Ethics (Excerpt)
________________________________________________
The articles (e.g., A1, C5, G2) contained within the Code of Ethics are
designed to function as an integrated set of principles. Cross-referencing
has been included in the document to assist readers in locating the most
commonly occurring combinations of articles to support informed ethical
practice. The Standards of Practice are also cross-referenced to the Code
of Ethics.
Preamble
The Code of Ethics for the Canadian Counselling and Psychotherapy Asso-
ciation is a living document. Between revisions to the Code, feedback from
members is accepted and compiled in preparation for reviews, updates,
additions, and amendments.
Context
The Task Group determined that one of the most important adjustments to
the Code
of Ethics in 2020 would be to include several new sections, one of which
was a section to draw attention to important concepts and contexts ad-
dressed by the Truth and Reconciliation Commission. The Group wished
406 APPENDIX A
to begin a process of development that could ensure that CCPA members
understood the ethical imperative to seek knowledge and understanding
and commit to self-reflection before engaging with Indigenous clients and
communities. The criticality of cultural humility and recognition of cultur-
al blindness were focal points in locating relevant research by Indigenous
scholars and experts to assist with the process. Consultation with Elders
and knowledge-keepers was prominent in the preferred update and review
process.
Within the mandate of development and revision, the Task Group chose to
strengthen existing and incorporate new articles of ethics that more clearly
addressed concerns related to:
Since the last revision of the CCPA Code of Ethics, there have been
major shifts in the use of technology in the counselling and psy-
chotherapy profession as well as changes in Canadian demograph-
ics and social, political, economic, and cultural awareness. There
is therefore a renewed focus on these elements in the revised Code
and those related to social justice, self-reflection, and diversityǂ.
Phases of Revision
The first step in the revision process involves the dissemination and re-
view of existing codes of ethics in counselling and psychotherapy related
professions from around the world. Scholarly articles and other research
focused on ethics and consultations with known experts or persons with
lived experience are sought out by individual Task Group members and are
considered by the full Task Group.
The second step in the revision process involves members of the Task
Group assembling in small groups to make recommendations pertaining to
additions, deletions, and adjustments to the Code of Ethics. The proposed
revisions are then distributed to the full Task Group.
APPENDIX - A 407
The third step in the revision process is a full group review of the work of
the sub-groups. The proposed revisions are reviewed with respect to style
and content. Style refers to semantic clarity and grammatical and syntac-
tical accuracy. Content review focuses on completeness and correctness
of concepts presented; analysis of potential omissions and overlap; and
alignment with CCPA bylaws and Canadian statutes.
Once the Task Group believes a first draft is ready for internal review by
CCPA Chapter Presidents, Chairs of CCPA-associated committees, and
National Office personnel,
the first phase of review is undertaken. The preliminary draft of the revised
Code is transmitted for feedback.
The feedback from the first phase of review is considered line by line by
the Task Group. Additions, deletions, amendments, and further research are
undertaken to address the needs identified in the first phase of feedback.
Once revisions have been approved by the Task Group and incorporated,
the next phase of review is undertaken.
In the third phase of review, the proposed Code of Ethics is presented to the
CCPA Board of Directors for its approval.
408 APPENDIX A
CCPA is also committed to the use of technology to enhance and further
develop the Code of Ethics and Standards of Practice. Electronic versions
of the documents contain hyperlinks to allow readers quick access to
cross-referenced components.
Introduction
This Code of Ethics expresses the ethical principles and values of the
Canadian Counselling and Psychotherapy Association and serves as a
guide to the professional conduct of all its members. It also informs the
public, which they serve, of the standards of ethical conduct that members
are responsible to uphold and for which they are held accountable. The
Code reflects such values as integrity, competence and responsibility with
an understanding of and respect for the cultural diversity, systemic issues,
and the social contexts in Canada. It is part of a social contract, based on
attitudes of mutual respect and trust, by which society supports the auton-
omy of the profession in return for the commitment of its members to act
ethically in the provision of professional services. The Code of Ethics is
designed to be used in combination with the Standards of Practice as well
as other sources of information such as recent literature and research, legal
statutes, cultural knowledge keepers, and other practice guidelines.
Members are accountable to both the public and their professional peers
and are therefore subject to the complaints and disciplinary procedures
of the Canadian Counselling and Psychotherapy Association. Violations
of this Code, however, do not automatically imply legal liability. Such a
determination can only be made by legal and judicial proceedings. This
peer review process is intended to enable the Association to advise and to
discipline its members in response to substantiated complaints originating
either with professional peers or the public.
APPENDIX - A 409
decision- making. Members increasingly confront challenging ethical de-
mands and dilemmas in
a complex and dynamic society to which a simple and direct application of
this code may not be possible. Also, reasonable differences of opinion can
and do exist among members with respect to how ethical principles and
values should be rank ordered when they are in conflict. Therefore, mem-
bers must develop the ability and the courage to exercise a high level of
ethical judgment. For these reasons, the Code includes a section on ethical
decision-making.
This Code is not a static document but will need revisions over time be-
cause of the continuing development of ethical knowledge and the emer-
gence of consensus on challenging ethical issues. Therefore, members and
others, including members of the public, are invited to submit comments
and suggestions at any time to CCPA by contacting the National Office at
https://www.ccpa-accp.ca/contact-us/.
Ethical Principles
The expectations for ethical conduct as expressed in this Code are based on
the following fundamental principles:
410 APPENDIX A
ing is provided to offer direction to counsellors/therapists when faced with
making ethical decisions and resolving ethical dilemmas.
APPENDIX - A 411
A virtue ethics approach is based on a belief that counsellors/therapists as
virtuous persons have the ability to make ethical decisions that are in-
formed
by their understanding of the interests of others, a capacity to subordinate
self-interest in the pursuit of just outcomes, an acceptance of complexity,
and a commitment to natural justice. Although there is no step-by-step
methodology for this approach, the following questions may help with the
process of context-specific, virtue-based ethical decision making:
2. How can my values best show care for the client’s wellbeing?
3. Quick Check
412 APPENDIX A
for the benefit of all.” (Marshall, A., 2004, http://www.integrativescience.
ca/Principles/TwoEyedSeeing/).
A. Professional Responsibility
APPENDIX - A 413
and research participants. (See also D1, D9, E1, Section I)
414 APPENDIX A
Counsellors/therapists demonstrate ethical conduct, integrity, and profes-
sionalism in interactions with counsellor/therapist colleagues and with
members of other professional disciplines. (See also Section I)
APPENDIX - A 415
not exclusive of texting, messaging, taking photos, making posts and com-
ments on websites, Twitter, or other platforms), gestures, unwanted sexual
images, or physical contacts of a sexual nature. (See also G11, G12)
416 APPENDIX A
B2. Confidentiality
APPENDIX - A 417
counsellors/ therapists conduct the informed consent process with those
who are legally entitled
to offer consent on the client’s behalf, typically parents or others appointed
as legal guardians. Counsellors/therapists also seek the client’s assent to the
proposed services or involvement, proportionate with the client’s capacity
to do so. Counsellors/therapists understand that the parental or guardian
right to consent on behalf of children diminishes commensurate with the
child’s growing capacity to provide informed consent. These dual processes
of obtaining parental/guardian informed consent and client assent apply to
assessment, counselling/therapy, research participation, and other profes-
sional activities. (See also B4, D4)
418 APPENDIX A
(See also B4, E7, F5, G4, G6, I5, I8, I9)
APPENDIX - A 419
such circumstances, clearly bear the burden to ensure that no such exploit-
ative influence
has occurred and seek documented consultationǂ for an objective determi-
nation of the client’s ability to freely enter a relationship or have sexual
contact without impediment. The consultationǂ must be with a professional
with no conflict of interest with the client or the counsellor/therapist. This
prohibition also applies to electronic interactions and relationships. (See
also A11, B12, G11, G12)
B16. Referral
420 APPENDIX A
tance to clients. They avoid initiating a counselling/therapy relationship or
refer an existing client for whom the counselling/therapy relationship does
not productively pursue the client’s goals. Counsellors/therapists suggest
appropriate alternatives, including making a referral, co-therapy, consul-
tationǂ, supervisionǂ, or additional resources. Should clients decline the
suggested referral, counsellors/therapists are not obligated to continue the
relationship. (See also G14)
APPENDIX - A 421
consent processes, confidentiality and third-party sharing of information,
boundaries of competence, and diversityǂ. When employing standardized
measures in formal assessment and evaluation, counsellors/therapists must
ensure that they are adequately trained to select and administer appropriate
measures, to interpret and report on the results, and to seek consultationǂ or
supervisionǂ
when unsure.
422 APPENDIX A
identity and/or membership, to ensure fair and valid assessment practice.
(See also A3, A4, D10, E5, E8)
APPENDIX - A 423
C9. Integrity of Instruments and Procedures
Counsellors/therapists ensure that they have provided for the security and
maintenance of evaluation and assessment results in their professional will
and client file directive.
424 APPENDIX A
using Ownership, Control, Access, and Possession (OCAP) principles for
Indigenous Peoples, and demonstrate ethical congruence as they engage
in research and share research findings in oral, written and visual formats.
(See also Section I)
APPENDIX - A 425
questions and to discontinue at anytime. (See also B4, B5, E3)
426 APPENDIX A
D10. Acknowledging the Contributions of Others
APPENDIX - A 427
C1, F1, G1, I8)
Clinical supervisors are conversant with ethical, legal, and regulatory issues
relevant to the practices of counselling/therapy and clinical supervisionǂ.
Clinical supervisors model and underscore the importance of ethical com-
mitment and accountability by involving supervisees in review and discus-
sion of the CCPA Code of Ethics and Standards of Practice (and any other
professionally relevant codes and standards). Clinical supervisors discuss
428 APPENDIX A
direct and vicarious liability with supervisees and employ risk management
strategies. (See also D4, F2, G1, G3, I8)
Client welfare and protection of the public are the primary considerations
in all decisions and actions of supervisees and clinical supervisors. Respon-
sibility for safeguarding extends beyond the immediate clients of supervis-
ees to protection of other members of the public who might be affected by
supervisees’ comportment and competence.
APPENDIX - A 429
Counsellors/therapists who conduct clinical supervisionǂ appraise their the-
oretical, conceptual, clinical/technical, diversityǂ, and ethical competencies
in both counselling/ therapy and clinical supervisionǂ from the standpoint of
suitability and sufficiency
for the counselling context of supervisees. They limit their involvement as
clinical supervisors to their verifiable (i.e., documented and demonstrable)
competencies and seek supervision of supervisionǂ or refer supervisees to
other appropriately qualified clinical supervisors when another area and/or
higher level of expertise is warranted. (See also A3, B9, C3, G2, I4)
E9. Fees
430 APPENDIX A
as part of the informed consent process. Supervisees are apprised of the
rates, payment schedule, method of payment, and collection processes (if
applicable).
E11. Self-Care
F. Consultation Services
APPENDIX - A 431
There are a number of contexts in which counsellors/therapists may offer
consultationǂ services. They may undertake a consultative role a) informal-
ly with colleagues or peers, b) formally with agencies or institutions, c) as a
private practice service, and d) informally or formally on an ad hoc and/or
pro bono basis. In all cases, despite counsellors/therapists are not engaging
in counselling/therapy in the consultative role, they are nonetheless respon-
sible for adhering to the professional Code of Ethics for counsellors/thera-
pists in the consultative role.
432 APPENDIX A
B8, B13)
APPENDIX - A 433
G4. Clarification of Roles and Responsibilities
G7. Confidentiality
434 APPENDIX A
ment and self-awareness of students and trainees to help promote ongoing
integration of personal insight with professional practice. (See also E11, I3,
I8)
APPENDIX - A 435
tion when concerns arise. (See also A11, B12, E7)
G13. Scholarship
436 APPENDIX A
H2. Permission for Technology Use
APPENDIX - A 437
Counsellor/therapist educators who use technology to provide or enhance
instruction in fully online or blended counselling/therapy programs have
demonstrated competency in this mode of delivery through their education,
training, and/or experience.
In their use of social media and related technology in their personal lives,
counsellors/ therapists monitor the style and content of their communica-
tion for ethical congruity and professionalism. They attend to privacy/secu-
rity features, continue to honour client confidentiality, demonstrate respect
for and valuing of all individuals, and represent themselves with integrity.
(See also B2, G2)
438 APPENDIX A
Peoples is critical to respectful and supportive work. Also of importance is
the mindfulness of counsellors/therapists in acknowledging the diversityǂ
of Indigenous Peoples, communities and contexts in Canada and the degree
to which clients may or may not have lived experience of their culture and
language. Counsellors/ therapists must also be attentive to clients who may
identify as Indigenous but are not from lands now known as Canada. All
counsellors/therapists acknowledge the unique historical trauma as well as
the resiliency and persistent cultural vibrancy of Indigenous Peoples and
communities. (See also A12, B9, B10, C6, Section D, E12)
APPENDIX - A 439
I5. Appropriate Participation in Traditional Practices
I8. Relationships
440 APPENDIX A
I10. Appropriate Use
Glossary of Terms
Clinical supervision
Consultation
APPENDIX - A 441
does not take on the legal responsibility or liability for decisions made by
the therapist. Consultation also may be undertaken as a formal arrangement
with fee requirements.
Diversity
Diversity refers to various differences which include but are not restricted
to: age and generation, sex, gender, biological heritage/genetic history,
ethnicity (includes culture; individual may identify multiple ethnic affilia-
tions), cultural background (shared beliefs, practices, traditions), geograph-
ic history, linguistic background, relational affiliation/ orientation, religion/
spirituality, educational status, occupational status, socioeconomic status,
mental health, physical health, physical (dis)ability, sensory impairment
and/or (dis)ability, learning differences and/or (dis)ability, intellectual (dis)
ability, historical issues of prejudice, discrimination, oppression, collective
trauma, etc., current issues of prejudice, discrimination, oppression, collec-
tive trauma.
Fiduciary Duty
A duty to act for someone else’s benefit, while subordinating one’s person-
al interests to that of the other person.” (Black’s Law Dictionary, https://
thelawdictionary.org)
Mandated Client
442 APPENDIX A