La. Admin. Code tit. 46 § LX-2103

Current through Register Vol. 50, No. 11, November 20, 2024

Section LX-2103 - Counseling Relationship

A. Licensees encourage client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy relationships. Licensees actively attempt to understand the diverse cultural backgrounds of the clients they serve. Licensees also explore their own cultural identities and how these affect their values and beliefs about the counseling process. Licensees are encouraged to contribute to society by devoting a portion of their professional activity to services for which there is little or no financial return (pro bono publico).

1. Welfare of Those Served by Licensees

a. Primary Responsibility. The primary responsibility of licensees is to respect the dignity and to promote the welfare of clients.

b. Records. Licensees maintain records necessary for rendering professional services to their clients and as required by laws (see Chapter 15, §1505 A), regulations, or agency or institution procedures. Licensees include sufficient and timely documentation in their client records to facilitate the delivery and continuity of needed services. Licensees take reasonable steps to ensure that documentation in records accurately reflects client progress and services provided. If errors are made in client records, licensees take steps to properly note the correction of such errors according to agency or institutional policies.

c. Counseling Plans. Licensees and their clients work jointly in devising integrated, counseling plans that offer reasonable promise of success and are consistent with abilities and circumstances of clients. Licensees and clients regularly review counseling plans to ensure their continued viability and effectiveness, respecting the freedom of choice of clients.

d. Support Network Involvement. Licensees recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent.

e. Employment Needs. Licensees work with their clients considering employment in jobs that are consistent with the overall abilities, vocational limitations, physical restrictions, general temperament, interest and aptitude patterns, social skills, education, general qualifications, and other relevant characteristics and needs of clients. When appropriate, licensees appropriately trained in career development will assist in the placement of clients in positions that are consistent with the interest, culture, and the welfare of clients, employers, and/or the public.

2. Informed Consent in the Counseling Relationship

a. Informed Consent. Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process, and the counselor. Licensees have an obligation to review, in writing and verbally with clients, the rights and responsibilities of both the licensee and the client. Informed consent is an ongoing part of the counseling process, and licensees appropriately document discussions of informed consent throughout the counseling relationship.

b. Types of Information Needed

i. Licensees explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following:

(a) the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services;

(b) the licensees qualifications, credentials, and relevant experience;

(c) continuation of services upon the incapacitation or death of a counselor; and

(d). other pertinent information.

ii. Licensees take steps to ensure that clients understand the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements.

iii. Clients have the right:

(a). to confidentiality and to be provided with an explanation of its limitations (including how supervisors, and/or treatment team professionals are involved);

(b). to obtain clear information about their records;

(c). to participate in the ongoing counseling plans; and

(d). to refuse any services or modality change and to be advised of the consequences of such refusal.

c. Development and Cultural Sensitivity. Licensees communicate information in ways that are both developmentally and culturally appropriate. Licensees use clear and understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language used by licensees, they provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, licensees consider cultural implications of informed consent procedures and, where possible, licensees adjust their practices accordingly.

d. Inability to Give Consent. When counseling minors or persons unable to give voluntary consent, licensees seek the assent of clients to services, and include them in decision making as appropriate. Licensees recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf.

3. Clients Served by Others. When licensees learn that their clients are in a professional relationship with another mental health professional, they request written release of information that the clients sign in order to communicate with other professionals and strive to establish positive and collaborative professional relationships.

4. Avoiding Harm and Imposing Values

a. Avoiding Harm. Licensees act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.

b. Personal Values. Licensees are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Licensees respect the diversity of clients, trainers, and research participants.

5. Roles and Relationships with Clients

a. Current Clients. Sexual or romantic licensee-client interaction or relationships with current clients, their romantic partners, or their family members are prohibited.

b. Former Clients. Sexual or romantic client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of five years following the last professional contact. Licensees, before engaging in sexual or romantic interactions or relationships with clients their romantic partners, or client family members after five years following the last professional contact, demonstrate forethought and document (in written form) whether the interactions or relationships can be viewed as exploitive in some way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering such an interaction or relationship.

c. Nonprofessional Interactions or Relationships (other than sexual or romantic interactions or relationships). Licensee-client nonprofessional relationships with clients, former clients, their romantic partners, or their family members should be avoided, except when the interaction is potentially beneficial to the client.

d. Potentially Beneficial Interactions. When a licensee-client nonprofessional interaction with a client or former client may be potentially beneficial to the client or former client, the licensee must document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. Such interactions should be initiated with appropriate client consent. Where unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, due to the non professional interaction, the licensee must show evidence of an attempt to remedy such harm. Examples of potentially beneficial interactions include, but are not limited to:

i. attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation);

ii. purchasing a service or product provided by a client or former client (excepting unrestricted bartering);

iii. hospital visits to an ill family member, mutual membership in a professional association, organization, or community.

e. Role Changes in the Professional Relationship. When a licensee changes a role from the original or most recent contracted relationship, he or she obtains informed consent from the client and explains the right of the client to refuse services related to the change. Examples of role changes include:

i. changing from individual to relationship or family counseling, or vice versa;

ii. changing from a nonforensic evaluative role to a therapeutic role, or vice versa;

iii. changing from a licensee to a researcher role (i.e., enlisting clients as research participants), or vice versa; and

iv. changing from a licensee to a mediator role, or vice versa.

(a) Clients must be fully informed of any anticipated consequences (e.g., financial, legal, personal, or therapeutic) of licensee role changes.

6. Roles and Relationships at Individual, Group, Institutional and Societal Levels

a. Advocacy. When appropriate, licensees advocate at individual, group, institutional, and societal levels to examine potential barriers and obstacles that inhibit access and/or the growth and development of clients.

b. Confidentiality and Advocacy. Licensees obtain client consent prior to engaging in advocacy efforts on behalf of an identifiable client to improve the provision of services and to work toward removal of systemic barriers or obstacles that inhibit client access, growth, and development.

7. Multiple Clients

a. When a licensee agrees to provide counseling services to two or more persons who have a relationship, the licensee clarifies at the outset which person or persons are clients and the nature of the relationships the licensee will have with each involved person. If it becomes apparent that the licensee may be called upon to perform potentially conflicting roles, the licensee will clarify, adjust, or withdraw from roles appropriately.

8. Group Work

a. Screening. Licensees screen prospective group counseling/therapy participants. To the extent possible, licensees select members whose needs and goals are compatible with goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience.

b. Protecting Clients. In a group setting, licensees take reasonable precautions to protect clients from physical, emotional, or psychological trauma.

9. End-of-Life Care for Terminally Ill Clients

a. Quality of Care. Licensees strive to take measures that enable clients:

i. to obtain high-quality end-of-life care for their physical, emotional, social, and spiritual needs;

ii. to exercise the highest degree of self-determination possible;

iii. to be given every opportunity possible to engage in informed decision making regarding their end-of-life care; and

iv. to receive complete and adequate assessment regarding their ability to make competent, rational decisions on their own behalf from a mental health professional who is experienced in end-of-life care practice.

b. Licensee Competence, Choice, and Referral. Recognizing the personal, moral, and competence issues related to end-of-life decisions, licensees may choose to work or not work with terminally ill clients who wish to explore their end-of-life options. Licensees provide appropriate referral information to ensure that clients receive the necessary help.

c. Confidentiality. Licensees who provide services to terminally ill individuals who are considering hastening their own deaths have the option of breaking or not breaking confidentiality, depending on applicable laws and the specific circumstances of the situation and after seeking consultation or supervision from appropriate professional and legal parties.

10. Fees and Bartering

a. Accepting Fees from Agency Clients. Licensees refuse a private fee or other remuneration for rendering services to persons who are entitled to such services through the licensees employing agency or institution. The policies of a particular agency may make explicit provisions for agency clients to receive counseling services from members of its staff in private practice. In such instances, the clients must be informed of other options open to them should they seek private counseling services.

b. Establishing Fees. In establishing fees for professional counseling services, licensees consider the financial status of clients and locality. In the event that the established fee structure is inappropriate for a client, licensees assist clients in attempting to find comparable services of acceptable cost.

c. Nonpayment of Fees. If licensees intend to use collection agencies or take legal measures to collect fees from clients who do not pay for services as agreed upon, they first inform clients of intended actions and offer clients the opportunity to make payment.

d. Bartering. Licensees may barter only if the relationship is not exploitive or harmful and does not place the licensee in an unfair advantage, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Licensees consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract.

e. Receiving Gifts. Licensees understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and showing gratitude. When determining whether or not to accept a gift from clients, licensees take into account the therapeutic relationship, the monetary value of the gift, a clients motivation for giving the gift, and the licensees motivation for wanting or declining the gift.

11. Termination and Referral

a. Abandonment Prohibited. Licensees do not abandon or neglect clients in counseling and inform clients of professional limitations. Licensees assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

b. Inability to Assist Clients. If licensees determine an inability to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Licensees are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, licensees should discontinue the relationship.

c. Appropriate Termination. Licensees terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling. Licensees may terminate counseling when in jeopardy of harm by the client, or another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Licensees provide pretermination counseling and recommend other service providers when necessary.

d. Appropriate Transfer of Services. When licensees transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed and open communication is maintained with both clients and practitioners.

12. Technology Applications

a. Benefits and Limitations. Licensees inform clients of the benefits and limitations of using information technology applications in the counseling process and in business/billing procedures. Such technologies include, but are not limited to:

i. computer hardware and software;

ii. telephones;

iii. the world wide web;

iv. the internet;

v. online assessment instruments; and

vi. other communication devices.

b. Technology-Assisted Services. When providing technology-assisted distance counseling services, licensees determine that clients are intellectually, emotionally, and physically capable of using the application and that the application is appropriate for the needs of clients.

c. Inappropriate Services. When technology-assisted distance counseling services are deemed inappropriate by the licensee or client, licensees consider delivering services face-to-face.

d. Access. Licensees provide reasonable access to computer applications when providing technology-assisted distance counseling services.

e. Laws and Statutes. Licensees ensure that the use of technology does not violate the laws of any local, state, national, or international entity and observe all relevant statutes.

f. Assistance. Licensees seek business, legal, and technical assistance when using technology applications, particularly when the use of such applications crosses state or national boundaries.

g. Technology and Informed Consent. As part of the process of establishing informed consent, licensees do the following:

i. address issues related to the difficulty of maintaining the confidentiality of electronically transmitted communications;

ii. inform clients of all colleagues, supervisors, and employees, such as informational technology (IT) administrators, who might have authorized or unauthorized access to electronic transmissions;

iii. urge clients to be aware of all authorized or unauthorized user,s including family members and fellow employees who have access to any technology clients may use in the counseling process;

iv. inform clients of pertinent legal rights and limitations governing the practice of a profession over state lines or international boundaries;

v. use encrypted websites and email communications to help ensure confidentiality when possible;

vi. when the use of encryption is not possible, licensees notify clients of this fact and limit electronic transmissions to general communications that are not client specific;

vii. inform clients if and for how long archival storage of transaction records are maintained;

viii. discuss the possibility of technology failure and alternate methods of service delivery;

ix. inform clients of emergency procedures, such as calling 911 or a local crisis hotline, when the licensee is not available;

x. discuss time zone differences, local customs, and cultural or language differences that might impact service delivery;

xi. inform clients when technology-assisted distance counseling services are not covered by insurance.

h. Sites on the World Wide Web. Licensees maintaining sites on the world wide web (the internet) do the following:

i. regularly check that electronic links are working and professionally appropriate;

ii. establish ways clients can contact the licensee in case of technology failure;

iii. provide electronic links to relevant state licensure and professional certification boards to protect consumer rights and facilitate addressing ethical concerns;

iv. establish a method for verifying client identity;

v. obtain the written consent of the legal guardian or other authorized legal representative prior to rendering services in the event the client is:

(a). a minor child;

(b). an adult who is legally incompetent; or

(c). an adult incapable of giving informed consent;

vi. strive to provide a site that is accessible to persons with disabilities;

vii. strive to provide translation capabilities for clients who have a different primary language while also addressing the imperfect nature of such translations;

viii. assist clients in determining the validity and reliability of information found on the world wide web and other technology applications.

La. Admin. Code tit. 46, § LX-2103

Promulgated by the Department of Health and Hospitals, Licensed Professional Counselors Board of Examiners, LR 15:622 (August 1989), amended LR 24:438 (March 1998), LR 29:142 (February 2003), LR 39:1792 (July 2013), LR 41725 (4/1/2015).

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1101-1123.