Ethics in Mental Health Practice: Guiding Principles and Professional Responsibilities

UPI Study › Courses › Abnormal Psychology › Free lessons › Lesson 24.5 Free with a free account

Ethics in Mental Health Practice: Guiding Principles and Professional Responsibilities

Abnormal Psychology · Chapter 24: Therapeutic Approaches in Mental Health PracticeSection 24.5 · lesson 94 of 9717 min · free with a free account

← Community-Based Mental Health Programs and Evaluating Therapeutic EffectivenessNext lesson: Psychological Evaluations in Legal Settings and Mental Health Law: Institutionalization and Duty to Protect →

Earn 3 college credits for Abnormal PsychologyRecommended for credit by NCCRS · Psychology 180 · self-paced · one payment, lifetime access
Enroll in Abnormal Psychology · $250 →Download the syllabus (PDF)

In this lesson

Principles that conflict - and a process that can be examined.

  • Describe the core ethical principles, and explain why they conflict
  • Apply an ethical decision-making process to a dilemma
  • Describe consent, confidentiality, and record keeping
  • Describe boundaries, competence, and duties to colleagues

Transcript

Everything said in the video, section by section (2,308 words). Read along, or search it.

Therapeutic Approaches in Mental Health Practice

Ethics in Mental Health Practice

This final section of chapter twenty-four turns to ethics in mental health practice. It describes the core ethical principles, and explains why they conflict. It applies a decision-making process to dilemmas. And it describes the principal professional responsibilities, including consent, confidentiality, records, boundaries, and competence.

Before You Begin

Obligations in General Terms

This material is educational, and describes professional obligations in general terms. Requirements differ by profession and by jurisdiction, and no professional body or code is named here. Practitioners must follow the code and the law that apply to them. The legal dimension of everything in this section is developed in chapter twenty-five.

Why Ethics Matters Here

4 Features That Raise the Stakes

Every profession has ethical obligations. Four features make them unusually consequential here. The first is power asymmetry. One person holds professional authority, controls the frame, and writes the record. The other has disclosed things they have told nobody. The second is vulnerability. People seek help when distressed, and distress reduces the capacity to object, to leave, or to judge whether something is normal practice. The third is privacy. The work happens with no observer. Almost nothing that occurs in a therapy room is ever seen by anyone else. And so, fourth, poor practice is hard to observe from outside. It is detected late, if at all, and usually through the person harmed. Together, these mean the field cannot rely on external correction. It relies on practitioners applying obligations to themselves. That is why what follows concerns process, rather than rules.

Ethics, Law, and Codes

3 Things That Don't Always Coincide

Three things are distinct. Ethics concerns what one ought to do. Law concerns what the jurisdiction requires or prohibits. And a professional code states the obligations a profession holds its members to. They do not always coincide. Something can be legal, and unethical. Permitted by the jurisdiction, and still a breach of what one owes a person. And something can be ethical, but prohibited. Defensible in principle, and forbidden by a code or law that a practitioner is bound by. Codes provide principles, not answers. That is not a deficiency. A genuine dilemma is a conflict between principles. A code that resolved every such conflict in advance would have replaced judgment with a rule. It would fail the first case it had not anticipated. What practitioners rely on instead is a process.

Table 24.5.1

The Core Principles - and Their Opponents

This table sets out the core principles. Read the last column. Each principle has a characteristic opponent, and knowing which lets a dilemma be named quickly. Beneficence means acting to benefit the person. It most often conflicts with autonomy, when the person declines what would help. Non-maleficence means avoiding harm, including harm done in the course of helping. It conflicts with beneficence, when the helpful option carries risk. Autonomy means respecting the person's right to decide for themselves. Consent, accepting a refusal, and supporting decision-making all follow from it. It conflicts with the first two, when a decision carries risk. Justice means treating people fairly, and distributing resources defensibly. And fidelity means keeping faith with the person, through honesty, reliability, and confidentiality. These two conflict with each other.

2 Worked Conflicts

Neither Principle Contains the Answer

Two worked conflicts show the pattern. A person declines a treatment likely to help them. Autonomy points one way, and beneficence the other, and neither principle contains the answer. Or a clinician has room for one more person, and two are waiting, one already known to them. Fidelity to that person, and justice between the two, point in different directions. In each case, the work is done by the process, rather than by identifying the correct principle.

Figure 24.5.2

A Process for Working a Dilemma

Here is a process for working a dilemma. Identify the problem. Identify the principles in tension. Identify who is affected, including people who are not in the room. And consult the relevant code and law. Then seek supervision or consultation. Generate and evaluate options, rather than choosing between two. Decide, act, and document the reasoning. And review the outcome. Look at the two marked boxes. Supervision is the step practitioners most often skip. Documenting the reasoning determines whether the decision can be defended afterwards. It is a process, not an algorithm. It does not produce the answer, and two practitioners working it carefully may reach different conclusions. What it produces is a decision that was made, rather than fallen into. And one that can be examined afterwards, by someone who was not there.

In the Clinic

Consultation Is the First Step, Not the Last Resort

The characteristic pattern in ethical difficulty is a practitioner deciding alone, late, and under pressure, and then seeking advice about a decision already made. Consultation works in the other direction. It brings a perspective not shaped by the relationship. It slows a decision that pressure is accelerating. And it turns a private judgment into one that someone else has seen. Supervision is not a trainee activity. It is a continuing obligation. A practitioner who only seeks it when something has gone wrong is using it as a remedy, rather than as practice.

Informed Consent

Knowing, Free, and Ongoing

Consent requires that the person knows what is being proposed, and agrees to it freely. What must be conveyed includes the nature of the treatment and what it involves, the likely benefits, and the material risks. It includes the alternatives, including no treatment, the limits of confidentiality, and the right to withdraw at any point. Consent is ongoing, rather than a single event. A person consents to a course of treatment at the start, and to what actually happens as it proceeds. If treatment turns out to be something other than what was described, the conversation must be had again.

Informed Consent

3 Complicating Situations

Three situations complicate consent. With children, parental consent and the child's own assent operate together, and capacity evolves, as section twenty-one point one described. Where capacity is impaired, capacity is presumed unless shown otherwise. It is specific to each decision. And supported decision-making comes before any conclusion that a person cannot decide. And under legal compulsion, consent and compulsion coexist uneasily. The legal dimension is in chapter twenty-five.

Table 24.5.3 - Confidentiality

Its Limits Are Stated at the Outset

Confidentiality exists because without it, people do not disclose. And without disclosure, the work cannot be done. It is not absolute, and its limits are communicated at the outset, rather than discovered. Read the last column. In every row, the person should have known this before disclosing anything. A limit revealed afterwards is a failure of consent, not of confidentiality. With consent, the person decides what is shared, and with whom. Some disclosures are required by law, and are not the clinician's to withhold. Where serious harm is in question, confidentiality has a limit. The clinician decides, ideally after consultation. This course describes that duty and its reasoning only, with no method or risk-assessment content. Protecting a child or vulnerable adult goes through safeguarding processes, which override confidentiality. A court order can require records. And the work is discussed in supervision.

Confidentiality With Multiple Clients

Settled Before It Arises

With couples, families, and groups, three questions arise. Whose confidentiality is held? How is information from individual contact handled? And what happens when members' goals conflict? These are settled by explicit agreement at the outset. Imagine a therapist who receives a disclosure from one family member, with a request not to tell the others. That is a problem that cannot be solved at the point it arises. The policy has to have been stated before.

Record Keeping

Written as if the Person Will Read It

Records exist to support continuity of care, to make reasoning available to others, and to let practice be examined. In most jurisdictions, the person has a right of access. So a record should be written on the assumption that the person will read it. The rule from section ten point two applies. Record observation separately from inference. Arrived twenty minutes late, and said the appointment letter went to an old address, is an observation. Poorly motivated is an inference, and one the next clinician will read as a finding. Both may belong in a record. Only one of them is a fact. A record that states only the decision can be defended only by its writer, and only while they remember. A record that states the alternatives, the considerations, who was consulted, and what would prompt a review can be understood by anyone. A decision that cannot be reviewed cannot be corrected.

Boundaries

Crossing or Violation?

The therapeutic frame is the ethical structure of the work. A boundary crossing is a departure from the usual frame, which may be benign, or even helpful. A boundary violation is a departure that serves the clinician's needs, is concealed, or exploits the relationship. It is harmful by definition. What places a given act is not the act itself, but three questions. Whose needs does it serve? Can it be discussed openly? And does it form a pattern? The slippery slope concern is that crossings accumulate. The evidence supports this as a pattern, not an inevitability. Most crossings do not escalate, but most violations were preceded by crossings. So not every crossing is dangerous. But a crossing that cannot be discussed in supervision is the one to attend to.

Relationships, and the One Absolute

Managed - With One Exception

Multiple relationships, being both clinician and something else to the same person, arise unavoidably in small communities, rural settings, and shared networks. A code that simply prohibited them would be unfollowable. So they are managed. Named at the outset, kept under review, discussed in supervision, and declined where the overlap would compromise either role. Gifts, self-disclosure, touch, and social contact are judgments, not rules, assessed by the same three questions. A small gift at the end of treatment and a substantial one mid-course are not the same act. Sexual boundary violations are the exception to the language of management and judgment. Sexual contact between a therapist and a current client is prohibited without exception. It causes serious documented harm, and it is the most serious violation in this area. Most codes extend the prohibition beyond the end of treatment, several without time limit. No qualification attaches to any part of that.

Digital and Remote Practice

Newer Than Most Codes

Digital and remote practice raises questions that are newer than most codes. That is worth saying, because practitioners often find no guidance, and improvise. They include privacy and data security in remote delivery, and what a person may reasonably expect in response to contact outside sessions. They include searching for information about clients online. That is easy, often uninformative, and rarely justified without a clinical reason and the person's knowledge. And they include the practitioner's own online presence. Clients can see it, and it forms part of the frame, whether or not it was meant to.

Competence, Culture, and Wellbeing

Continuing Duties

Competence means practicing within one's training and experience. It carries three obligations. To refer where a presentation is outside it. To maintain it as evidence changes. And to recognize the problem of working with a population one has not been trained for, which needs supervision rather than silence. Cultural competence is an ethical obligation, from section eight point three. But the term is contested, and many argue that cultural humility is the better framing. Competence implies knowledge about groups that can be acquired and then possessed. What is actually required is an ongoing stance. Recognizing the limits of one's own frame, asking rather than assuming, and treating the person as the authority on their own context. Practitioner wellbeing is an ethical matter, because impairment affects care. Burnout and vicarious traumatization both degrade judgment before they become visible. Fitness to practice is a continuing obligation. And a practitioner is poorly placed to assess their own impairment, which is another argument for supervision.

Colleagues, Research, and the Modalities

The Hardest Obligation

The hardest obligation in this section is what to do when a colleague's practice is impaired, or unethical. Codes require action. In practice, the evidence is often partial, the consequences for the colleague are serious, the relationships are close, and the cost of being wrong is high. Naming that difficulty is more useful than restating the rule. A practitioner who expects the decision to feel clear will conclude, when it does not, that the threshold has not been met. Research ethics from section two point three also apply. That includes consent where the condition affects capacity, and patients who may feel their service expects them to take part. And each modality has its own issues. In groups, confidentiality rests on members. In families, interests may diverge. In prescribing, the option of no medication is an ethical requirement. And in allocation, justice operates directly.

Historical Failures

Codes Exist Because of Specific Harms

Codes exist because of specific harms, not as abstractions. This course has documented several. Institutional abuses, and the conditions that made them possible. The classification of homosexuality as a disorder, and the practices that followed. Conversion and reparative efforts directed at sexual orientation and gender identity, which are ineffective, harmful, and widely prohibited. Coercive research conducted without meaningful consent. And the treatment of people given personality disorder diagnoses. The common feature is worth naming. In each case, the practice was defended at the time on clinical grounds, by competent people who did not think they were doing harm. That makes the history a live warning, not a set of curiosities. It is also why an examinable process matters more than confidence in one's own practice.

Table 24.5.5 - Chapter 24 Synthesis

The Ethical Frame Makes the Rest Safe

Here is chapter twenty-four in summary, as the obligations that attach to each kind of treatment. Individual therapy needs consent to what is actually proposed, a frame that is kept, and review when it is not working. Group and family work need stated confidentiality norms, and separate assessment before joint work. Medication needs shared decisions that include no medication, with monitoring as part of prescribing. Services need justice in allocation, and honest measurement, including of harm. And ethics itself needs consultation before deciding, documented reasoning, and boundaries that are managed rather than assumed. Treatment works, and the modalities differ less in outcome than their proponents suppose. What varies more is fit, delivery, and the conditions of the person's life. And every one of these treatments happens inside a relationship with a large power asymmetry, little outside observation, and a person poorly placed to object. That is why the ethical frame is not an addendum to this chapter. It is what makes the rest of it safe to practice.

About Abnormal Psychology at UPI Study

Abnormal Psychology (Psychology 180) is a self-paced online course of 97 video lessons in 25 chapters, from the main theoretical perspectives and clinical assessment to anxiety, mood, psychotic and personality disorders, treatment and the law. It carries a NCCRS credit recommendation for 3 semester credits.

Every lesson transcript is free on pages like this one, and the videos are free with a free UPI Study account. Enrolling adds a practice quiz after each lesson, the graded work and final exam that earn the credit, lifetime access, and an official transcript on completion. UPI Study has helped over 130,000 students with college credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Enroll now → Course details Download the syllabus All Psychology and social science courses Every course with PRO →

Why take it here

Why students take Abnormal Psychology with UPI Study

Understand mental health disordersAbnormal Psychology covers how psychological disorders are defined, assessed, explained and treated. It is a core course for psychology majors and useful for nursing, social work, counseling and criminal justice.
Credit at a fraction of the priceThe same 3 credits can cost $750 or more at a US college. Here it is one payment, self-paced, with lifetime access.
Finish your degree soonerTransfer credits reduce the courses you still owe, so you can graduate earlier or lighten a heavy semester.
Strengthen an applicationA completed college-level course on an official transcript shows admissions and scholarship committees you can do the work.
Study on your own scheduleNo start dates, no deadlines. Watch the lessons, practice, and take the final when you are ready.
130,000+students helped with college creditsACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Where the credit goes

Universities that work with NCCRS

Abnormal Psychology carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

Find my college → Not listed? Ask Athena in the corner of this page, or book a 15-minute call.

FAQ

Questions students ask us

About Ethics in Mental Health Practice: Guiding Principles and Professional Responsibilities

What are the core ethical principles in mental health practice?
The core principles are beneficence, acting to benefit the person; non-maleficence, avoiding harm; autonomy, respecting the person's right to decide; justice, treating people fairly and allocating resources defensibly; and fidelity, keeping faith through honesty, reliability and confidentiality. They often conflict, for example when a person declines helpful treatment. Codes supply principles rather than answers, so practitioners rely on a decision-making process that includes consultation and documented reasoning.
What is the difference between a boundary crossing and a boundary violation in therapy?
A boundary crossing is a departure from the usual therapeutic frame that may be benign or even helpful. A boundary violation serves the clinician's needs, is concealed, or exploits the relationship, and is harmful by definition. Three questions help place an act: whose needs does it serve, can it be discussed openly, and does it form a pattern? Most violations were preceded by crossings.
Can a therapist have another relationship with a client?
Multiple relationships, being both clinician and something else to the same person, are sometimes unavoidable in small or rural communities, so they are managed rather than simply banned: named at the outset, reviewed, discussed in supervision, and declined where they would compromise either role. Sexual contact with a current client is the exception, prohibited without exception, and most codes extend that prohibition beyond the end of treatment.
What is the difference between cultural competence and cultural humility?
Cultural competence suggests knowledge about groups that can be learned and then possessed, while cultural humility describes an ongoing stance. Many argue humility is the better framing: recognizing the limits of one's own cultural frame, asking rather than assuming, and treating the person as the authority on their own context. Either way, responding well to cultural difference is an ethical obligation, not an optional extra.

About the Abnormal Psychology course

How many college credits is Abnormal Psychology?
Abnormal Psychology (Psychology 180) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Abnormal Psychology cost and what is included?
$250, paid once, with lifetime access: all 97 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Abnormal Psychology take?
It is self-paced with no deadlines. The 97 lessons total about 24 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

Ready for the full course? Earn 3 credits in Abnormal Psychology.

97 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

Enroll in Abnormal Psychology →Download the syllabusEvery course with PRO →
Abnormal Psychology
3 credits · NCCRSEnroll →