The Unethical Supervisor

Luke Bullock, Tamar Horvitz, Aly Rasmussen, and Carmen Sepetka

Palo Alto University CLIN 610 Legal and Ethical Foundations
Federal
&

Case Study: Rationale for Topic: Ethical Decision-Making Model Applicable Codes & Laws State
Laws

A Practitioner's Guide to Ethical Decision Making Federal and State Laws

● According to a Authors: Holly Forester-Miller, Ph.D. & Thomas Davis, Ph.D.

18 US Code section 1035: False statements relating to health care matters – false, fictitious, or fraudulent statement or entry in connection with the delivery of or payment for health care benefits, items, or services, shall be fined
under this title or imprisoned not more than 5 years, or both.

California BPC § 4999.80: In order to carry out the provisions of this chapter, the board shall do all of the following: (a) Enforce laws designed to protect the public from incompetent, unethical, or unprofessional practitioners. (b)

Kathy, a student in the counseling program at Palo

Investigate complaints concerning the conduct of any licensed professional clinical counselor.

recent article A seven step EDM incorporating the work of Van Hoose and Paradise (1979), Kitchener (1984), Stadler (1986), California BPC § 4999.90: The board may suspend or revoke the license of any professional clinical counselor, if the applicant, licensee, or registrant has been guilty of unprofessional conduct, including (r) Any conduct in the
supervision of a registered associate, trainee, or applicant by any licensee that violates this chapter or any rules or regulations adopted by the board. (v) Failure to keep records consistent with sound clinical judgment, the standards of
the profession, and the nature of the services being rendered.
Haas and Malouf (1989), Forester-Miller and Rubenstein (1992), and Sileo and Kopala (1993)
Alto University was in the middle of her residency published by
2014 ACA Codes

A.1.a. Primary Responsibility: The primary responsibility of counselors is to respect the dignity and promote the welfare of clients.

The Ethical Decision-Making Model: A.1.b. Records and Documentation: Counselors create, safeguard, and maintain documentation necessary for rendering professional services.

when her supervisor asked her to do something American Step 1: Identify the Problem: this case exhibits an ethical and clinical problem. It also has the potential to
A.4.b. Avoiding Harm and Imposing No Harm: This code states that counselors have an ethical responsibility to avoid harming their clients and to not impose harm on them. Falsifying a diagnosis could potentially harm the client
by providing a diagnosis that does not accurately reflect their condition.

A.4.c. Professional Responsibility: This code requires counselors to uphold the highest standards of professionalism and follow ethical and legal standards. Falsifying a diagnosis is a violation of both ethical and legal standards.

become a legal problem.

Counseling
A.4.d. Respect for People's Rights and Dignity: This code emphasizes the importance of respecting clients' autonomy and treating them with dignity and respect. Falsifying a diagnosis could be seen as disrespectful to the client and
an infringement on their autonomy.

that made her feel uncomfortable. Her supervisor Step 2: Apply the ACA Code of Ethics: see adjacent section Applicable Codes and Laws.
B.6.a. Creating and Maintaining Records and Documentation: Counselors create and maintain records and documentation necessary for rendering professional services.

E.5.a. Proper Diagnosis: Counselors take special care to provide proper diagnosis of mental disorders. Assessment techniques (including personal interviews) used to determine client care (e.g., locus of treatment, type of treatment,

Association, “the Step 3: Determine the nature and dimensions of the dilemma: reflect on the values of autonomy, justice,
recommended follow-up) are carefully selected and appropriately used.

asked her to falsify a diagnosis for one of her

E.5.d. Refraining from Diagnosis: Counselors may refrain from making and/or reporting a diagnosis if they believe that it would cause harm to the client or others. Counselors carefully consider both the positive and negative
implications of a diagnosis.

most frequently
F.1.a. Client Welfare: Counseling supervisors monitor client welfare and supervisee performance and professional development.
beneficence, nonmaleficence, and fidelity. Conduct a literature review. Consult with peers and mentors. F.3.a. Supervisory Relationship—Extending Conventional: Supervisory Relationships Counseling supervisors clearly define and maintain ethical professional, personal, and social relationships with their supervisees.

clients so they would be covered by insurance. noted dilemma was

Step 4: Generate potential courses of action: consult with peers, mentors, and any other supervisors available.
If possible, speak with the supervisor directly. If necessary with HR present. File an official complaint with the
I.2.a. Informal Resolution: When counselors have reason to believe that another counselor is violating or has violated an ethical standard and substantial harm has not occurred, they attempt to first resolve the issue informally with
the other counselor if feasible, provided such action does not violate confidentiality rights that may be involved.

I.2.b. Reporting Ethical Violations: If an apparent violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution or is not resolved properly, counselors
take further action depending on the situation, such as referrals to state or national committees on professional ethics, voluntary national certification bodies, state licensing boards, or appropriate institutional authorities.

Kathy was shocked and confused. She couldn’t being directed to relevant board of behavioral sciences in your state if the issue is not resolved in an ethical manner.
I.2.c. Consultation: When uncertain about whether a particular situation or course of action may be in violation of the ACA Code of Ethics, counselors consult with other counselors who are knowledgeable about ethics and the ACA
Code of Ethics, with colleagues, or with appropriate authorities, such as the ACA Ethics and Professional Standards Department.

Step 5: Consider the potential consequences of all your options and determine a course of action: choose the
understand why her supervisor would ask her to do something by a least harmful option available to you. Resources For Practitioners:
do something unethical and illegal. She had supervisor or Step 6: Evaluate the selected course of action: Stadler (1986) suggests applying three tests: ● Consult with a trusted colleague or supervisor outside
1) test of justice: assess your own sense of fairness by determining whether you would treat others the same in of the situation to gain a different perspective and to
always believed that as a counselor, her primary administrator that this situation 2) the test of publicity: ask yourself whether you would want your behavior reported in the press 3) receive advice on how to proceed.
● Review the ethical guidelines and ACA to gain a
duty was to her clients and to help them in any the participant the test of universality: assess whether you could recommend the same course of action to another counselor in
the same situation.
better understanding of the expected standards and
how to handle ethical dilemmas.
deemed unethical”
way she could. She decided to talk to her Step 7: Implement the course of action: follow up and evaluate action efficacy after implementation. ● These agencies provide a range of resources,
(Burkholder et al., Note: Document all actions. including ethical guidelines, best practices,

supervisor about it and asked for an explanation. 2017).

research-based information, and consultation services.
Counselors can reach out to these agencies for

Her supervisor told her that the client in question Ways to Avoid This Dilemma: guidance, support, and advice on ethical and
professional issues.

was struggling financially and needed insurance ● Our group hoped

1. Seek clarification and understanding of the ethical guidelines and codes of conduct before starting the residency
to ensure that you understand the expected standards and how to handle ethical dilemmas that may arise.
1. American Counseling Association (ACA)
i. ACA Code of Ethics Resources
1. https://www.counseling.org/knowledge-cen
coverage to afford therapy. Kathy understood the to equip ourselves 2. Raise concerns or questions early and often with the supervisor or a trusted colleague. This can help to clarify
expectations and identify potential ethical issues before they become problematic.
ter/ethics/code-of-ethics-resources
2. National Board for Certified Counselors (NBCC)
reasoning but felt there might be better ways to with relevant 3. Discuss potential ethical issues during supervision meetings to gain guidance and support from a more
3. International Association of Marriage and Family
experienced counselor.
help the client than falsifying a diagnosis. What knowledge for our 4. Consider seeking a second opinion from a licensed counselor or mental health professional outside of the
Counselors (IAMFC)
4. American Psychological Association (APA)
residency program to get an unbiased perspective on the ethical dilemma.
should Kathy do? upcoming period of 5. Consider finding a diagnosis that applies accurately to the client, such as an other specified diagnosis.
5. National Institute of Mental Health (NIMH)
6. ACA Ethics Hotline
supervision. 6. Document any ethical concerns or issues that arise during the residency to maintain a record and provide
evidence of attempts to address the issue.
i. (800) 347 6647, ext 321

Literature Review & References

18 U.S. Code § 1035 - False statements relating to health care matters. (n.d.). LII / Legal Information Institute. Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev. ed.).
https://www.law.cornell.edu/uscode/text/18/1035 Retrieved from http://www.counseling.org/docs/default-source/ethics/practioner’s-guide-to
American Counseling Association. (2014). ACA code of ethics as approved by the ACA Governing Council. American Counseling ethical-decision-making.pdf
Association. https://www.counseling.org/knowledge-center/ethics Giovannetti, M., Sapp, T., & Jones, M. (2023). Supervision Tuneup: Ethical Considerations In Clinical
American Counseling Association. (2010). Procedures for processing complaints of ethical violations. Retrieved from Supervision. Counseling Today, 65, 22–24.
https://www.counseling.org/docs/default-source/center-resources/p_and_p_complaints_of_ethical_violations.pdf?sfvrsn=fe0c2 Governing Council. https://www.counseling.org/knowledge-center/ethics
92c_2
Publications, Inc. https://dx.doi.org/10.4135/9781071801154
Burkholder, J., Burkholder, D. B., & Gavin, M. (2020). The Role of Decision‐Making Models and Reflection in Navigating
Sheperis, D., Henning, S., & Kocet, M. (2016). Ethics and the Counseling Relationship. SAGE
Ethical Dilemmas. Counseling and Values, 65(1), 108–121. https://doi.org/10.1002/cvj.12125
Substance Abuse and Mental Health Services Administration (US). (2009). Chapter 1. Clinical
California Business and Professions Code. https://leginfo.legislature.ca.gov/
Supervision and Professional Development of the Substance Abuse Counselor - NCBI
Dahn, Vanessa. (2014). Unethical supervision practices and student vulnerability. Counseling
Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK64848/
Today. https://ct.counseling.org/2014/10/unethical-supervision-practices-and-student-vulnerability/