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Professional Organizations' Codes of Ethics On
Bartering in Psychotherapy, Counseling and Mental Health Services

Complete comparative list of different Codes of Ethics on a variety of topics

By Ofer Zur, Ph.D.
 

This article is part of an online course for CE credits on Bartering in Psychotherapy and Counseling.
It covers the aspects of bartering that are cited in the professional organizations' codes of ethics.

 

Table Of Contents

1. American Art Therapy Association (AATA) - (2013)
2. American Association of Marriage and Family Therapists (AAMFT) - (2015)
3. American Association of Pastoral Counselors (AAPC) - (2012)
4. American Board of Examiners in Clinical Social Work (ABE) - (2006)
5. American Counseling Association (ACA) - (2014)
6. American Mental Health Counselors Association (AMHCA) - (2015)
7. American Psychiatric Association (ApA) - (2013)
8. American Psychological Association (APA) - (2010)
9. Association of State And Provincial Psychology Boards (ASPPB) - (2005)
10. California Association of Marriage and Family Therapists (CAMFT) - (2011)
11. Canadian Counselling and Psychotherapy Association (CCPA) - (2007)
12. Canadian Psychological Association (CPA) - (2000)
13. Center for Clinical Social Work (CCSW)
14. National Association for Addiction Professionals (NAADAC) - (2011)
15. National Association of Social Workers (NASW) - (2008)
16. National Board for Certified Counselors (NBCC) - (2012)
17. Northamerica Association of Masters in Psychology (NAMP) - (2000)
18. United States Association for Body Psychotherapy (USABP) - (2007)

 

The Current Codes of Ethics, Verbatim
 

1. American Art Therapy Association (AATA) - (2013)

Section 11.0 "FINANCIAL ARRANGEMENTS," section 11.5 states:
Art therapists may barter only if it is (a) not clinically contraindicated, (b) not exploitative to the client, and (c) an acceptable community standard or practice where the client and art therapist reside. Bartering is an agreement entered by the client and the art therapist to exchange art therapy services for a type of non-monetary remuneration by the client, such as goods or services.

[Dr. Zur's comments: These are reasonable guidelines that are focused on the clinical context.]
 

2. American Association of Marriage and Family Therapists (AAMFT) - (2015)

STANDARD VIII Financial Arrangements states:
8.5 Bartering. Marriage and family therapists ordinarily refrain from accepting goods and services from clients in return for services rendered. Bartering for professional services may be conducted only if: (a) the supervisee or client requests it; (b) the relationship is not exploitative; (c) the professional relationship is not distorted; and (d) a clear written contract is established.

[Dr. Zur's comments: The AAMFT code seems to be very ambivalent in regard to bartering in therapy. On the one hand it states that MFTs should "ordinarily refrain" from bartering and on the other hand it states that it is permissible under certain conditions. It is hard to imagine why AAMFT would advise to "refrain" from activity such as bartering, which is as old as humankind. Claiming that a normal and healthy behavior, such as bartering, should "ordinarily be refrained" from does not make sense to me or to any reasonable experts who study human behavior. Bartering is a normal and healthy part of rural and agricultural communities. It is also common among artists, LGBT and minority communities in large metropolitan areas. Many clients in rural, agricultural, LGBT or Hispanic communities are too proud to have free therapy and would like to barter. A more extensive analysis of bartering in counseling]
 

3. American Association of Pastoral Counselors (AAPC) - (2012)

Fees and financial arrangements, as with all contractual matters, are always discussed without hesitation or equivocation at the onset and are established in a straightforward, professional manner.

[Dr. Zur's comments: These are reasonable and simple guidelines.]
 

4. American Board of Examiners in Clinical Social Work (ABE) - (2006)

This code of ethics does not mention the term barter
 

5. American Counseling Association (ACA) - (2014)

Section A.10.e. Bartering:
Counselors may barter only if the bartering does not result in exploitation or harm, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract.

[Dr. Zur's comments: The 2014 code, like the prior one, views bartering as a legitimate and ethical option and, appropriately, emphasizes the importance of cultural context within which the bartering relationship takes place. Still, in an unnecessarily strong language, it requires "a clear written contract", ignoring simple or other bartering situations where verbal, non-verbal, or implied consent will do.]
 

6. American Mental Health Counselors Association (AMHCA) - (2015)

Section E. Record-Keeping, Fee Arrangements, and Bartering
2b. Fee Arrangements, Bartering, and Gifts. Mental health counselors usually refrain from accepting goods or services from clients in return for counseling services because such arrangements may create the potential for conflicts, exploitation and distortion of the professional relationship. However, bartering may occur if the client requests it, there is no exploitation, and the cultural implications and other concerns of such practice are discussed with the client and agreed upon in writing.

[Dr. Zur's comments: Like the 2000 code, the revised 2015 AMHCA code could still use strong precautionary (discouraging) language while still allowing bartering when clinically and ethically appropriate. There seems to be no significant change between the 2000, 2010 and 2015 code. The AMHCA code seems to be ambivalent in regard to bartering in therapy. On the one hand it states that counselors should "usually refrain" from bartering and on the other hand it states that it is permissible under certain conditions. It is hard to imagine why AMHCA would advise to "refrain" from activity such as bartering, which is as old as humankind. Claiming that a normal and healthy behavior, such as bartering, should be "usually refrained" from does not make sense to me or to any reasonable experts who study human behavior. Bartering is a normal and healthy part of rural and agricultural communities. It is also common among artists, LGBT and minority communities in large metropolitan areas. Many clients in rural, agricultural or Hispanic communities are too proud to have free therapy and would like to barter. Also to mandate that bartering is acceptable if "the client requests it" is odd because it may mean that therapists or counselors cannot propose it or make the client aware of the possibility of bartering. A more extensive analysis of bartering in counseling]
 

7. American Psychiatric Association (ApA) - (2013)

This code of ethics does not mention the term barter.
 

8. American Psychological Association (APA) - (2010)

6.05 Barter With Clients/Patients: Barter is the acceptance of goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative.

[Dr. Zur's comments: The American Psychological Association (APA) Codes of Ethics have been evolving consistently over the last several decades in the direction of wider acceptance of bartering. The 1988 Ethics Code clearly denounced bartering as unethical. The 1992 Ethics Code section 1.18 Barter With Patients or Clients, states clearly: "Psychologists ordinarily refrain from accepting goods, services, or other non-monetary remuneration from patients or clients in return for psychological services..." and it even goes further in giving it a rational: "because such arrangements create inherent potential for conflicts, exploitation, and distortion of the professional relationship" (APA, 1992, Section 1.18 para.1). Then it defines the two conditions under which bartering might be acceptable: when it is not clinically contraindicated and when the relationship is not exploitative. However, the wording of the standard still implies that bartering is inherently unethical and should be avoided. The cautionary language of the 1992 Code has been deleted from the 2010 Ethics Code, which now states in section 6.05 Barter With Clients/Patients: "Barter is the acceptance of goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services". (APA, 2010, Section 6.05, para. 1). In providing a somewhat more liberal guideline, the new standard repeats the 1992 Code's two conditions under which bartering may be acceptable.]
 

9. Association Of State And Provincial Psychology Boards Report of Activities (ASPPB) - (2005)

Section H. Fees and Statements, section 2., states:
Reasonableness of fee. The psychologist shall not exploit the client or responsible payor by charging a fee that is excessive for the services performed or by entering into an exploitive bartering arrangement in lieu of a fee.

[Dr. Zur's comments: These are reasonable and simple guidelines.]
 

10. California Association of Marriage and Family Therapists (CAMFT) - (2011)

Section 9.5, Barter:
Marriage and family therapists ordinarily refrain from accepting goods, services, or other non-monetary remuneration from patients in return for professional services. Such arrangements often create conflicts and may lead to exploitation or distortion of the professional relationship.

Additionally, in the Unethical Dual Relationships section (1.2.1) it states: "Other acts that would result in unethical dual relationships include, but are not limited to, borrowing money from a patient, hiring a patient..."

[Dr. Zur's comments: The CAMFT Code presents one of the strictest codes of ethics on bartering arrangements. While APA (2010) and ACA (2014) revised their attitude towards bartering, CAMFT's 2008 code adheres to, in my opinion, an outdated ethics view on bartering. In my opinion, it is hard to imagine why CAMFT would impose such a highly bar in regarding to bartering, which is as old as humankind. Claiming that a normal and healthy behavior, such as bartering, should be "ordinarily refrained" from does not make sense to me or to any reasonable experts who study human behavior. The standard of care in many communities involves bartering. Bartering is a normal and healthy part of rural and agricultural communities. It is also common among artists, LGBT and minority communities in large metropolitan areas. Many clients in rural, agricultural, LGBT or Hispanic communities are too proud to accept free therapy and would like to barter. A more extensive analysis of bartering in counseling. With the explosion of IT and the Web we also see a surge in bartering online (more details). As the popularity of telehealth increases, such bartering practices will increase as well, leaving MFTs in California in economic, ethical and communal binds.]
 

11. Canadian Counselling and Psychotherapy Association (CCPA) - (2007)

This code of ethics does not mention the term barter.
 

12. Canadian Psychological Association (CPA) - (2000)

Section 1.15 states:
Establish fees that are fair in light of the time, energy, and knowledge of the psychologist and any associates or employees, and in light of the market value of the product or service.

[Dr. Zur's comments: These are reasonable guidelines.]
 

13. Center for Clinical Social Work (CCSW)

This code of ethics does not mention the term barter
 

14. National Association for Addiction Professionals (NAADAC) - (2011)

This code of ethics does not mention the term barter.
 

15. The National Association of Social Workers (NASW) - (2008)

Section 1.13, Payment for Services states:
Social workers should avoid accepting goods or services from clients as payment for professional services. Bartering arrangements, particularly involving services, create the potential for conflicts of interest, exploitation, and inappropriate boundaries in social workers' relationships with clients. Social workers should explore and may participate in bartering only in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community, considered to be essential for the provision of services, negotiated without coercion, and entered into at the client's initiative and with the client's informed consent. Social workers who accept goods or services from clients as payment for professional services assume the full burden of demonstrating that this arrangement will not be detrimental to the client or the professional relationship.

[Dr. Zur's comments: As was noted above, the idea that bartering should be avoided is unreasonable. Again, bartering is as old as the human race; it is a normal and healthy part of communal human behavior. A more extensive analysis of bartering in counseling. The NASW code gives a double message. On the one hand the code surprisingly forbids bartering and on the other it reluctantly allows it under specified circumstances. The above statement on bartering seems to be in direct contrast with the statement regarding section 1.05, Cultural Competence and Social Diversity, which states: "(a) Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures. (b) Social workers should have a knowledge base of their clients' cultures and be able to demonstrate competence in the provision of services that are sensitive to clients' culture and to differences among people and cultural groups" (NASW, 1999, Section 1.05 para. 1-4). The code reluctantly admits that bartering may be acceptable "in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community." Then it puts the burden of proof on the practitioner to justify such "deviant" behavior.

This discrepancy in the social workers' Code of Ethics, in regard to its stance on bartering, is surprising in respect of the commitment and history of social work, which is embedded in helping the poor and disenfranchised, and those of different cultures. It seems that in an attempt to emulate the strict guidelines of psychoanalysts or other mental health professionals, NASW Codes developed a firm and inflexible stance on bartering. One may wonder if such a rigid stance may be part of the social workers' attempts to gain professional legitimacy and parity by proving to be very strict on ethical matters.]
 

16. National Board for Certified Counselors (NBCC) - (2012)

This code of ethics does not mention the term barter.
 

17. Northamerica Association of Masters in Psychology (NAMP) - (2000)

This code of ethics does not mention the term barter.
 

18. United States Association for Body Psychotherapy (USABP) - (2007)

Section V. MULTIPLE RELATIONSHIPS states:
5. Barter is the acceptance of goods or services from clients in return for psychological services. Body Psychotherapists do not barter (including work exchange) unless the bartering arrangements are appropriate in the context of the therapeutic relationship, indicated by the needs of the client, and for the welfare of the client. Where bartering is used, the therapist and client make agreements in writing related to the exchange of goods or services to ensure that both understand the scope and limitations of the agreement. Body Psychotherapists consult or obtain supervision to ensure that the bartering arrangement is not harmful to the client, that the client is being given fair value in the exchange, and that no exploitation of and/or damage to the client is involved.

[Dr. Zur's comments: The United States Association for Body Psychotherapy (USABP) Ethical Guidelines of 2007 dropped its 2001 statement of "Body psychotherapists do not barter (including work exchange) for therapeutic services unless there is a compelling need to do so." The new statement regarding the importance of "context of therapeutic relationships" is highly relevant and equally appropriate. USABP has unnecessarily gone further to require that the agreement is in writing and consultation is obtained. These two requirements contradict the spirit of flexibility that was appropriately expressed in the first part of the paragraph that bartering must be appropriate in the context of therapy. While it may be appropriate in some contexts to have the agreement in writing, it may in inappropriate and counter-clinical in others. Lastly, the new code includes an impossible requirement that therapists "ensure that the bartering arrangement is not harmful to the client." Obviously, no one can ensure such a thing. Therapists can only do their best to avoid exploitation and harm. APA's Code of Ethics of 2010 states in section 3.04 of Avoiding Harm: "Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable."]

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