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Codes of Ethics on Termination in Psychotherapy and Counseling

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

This article is part of two online courses:
Termination: Ethical & Clinical Considerations and The Professional Will
 

This paper focuses on the sections of the Codes of Ethics of the major professional organizations that deal with confidentiality as it pertains to therapists' unexpected death or disability, or any other reason that therapists must close their practices. Additionally, it provides a summary of the codes stance on termination in psychotherapy and counseling.

The Following Codes Of Ethics Are Cited:

American Art Therapy Association, AATA
American Association of Marriage and Family Therapists, AAMFT
American Counseling Association, ACA
American Mental Health Counselors Association, AMHCA
American Psychiatric Association, ApA
American Psychological Association, APA
California Association of Marriage and Family Therapists, CAMFT
Canadian Psychological Association, CPA
National Association for Addiction Professionals, NAADAC
National Association of Social Workers, NASW
National Board for Certified Counselors, NBCC
United States Association for Body Psychotherapy, USABP
Summary Of Codes Of Ethics On Termination

American Art Therapy Association, AATA, 2013

4.0 CLIENT ARTWORK
4.1.b If termination occurs as a result of the death of the client, the original artwork is released to relatives if (a) the client signed a consent specifying to whom and under what circumstances the artwork should be released; (b) the client is a minor or under guardianship and the art therapist determines that the child's art work does not violate the confidentiality the child entrusted to the art therapist; (c) the art therapist received and documented clear verbal indications from the client that the client wanted part or all of the artwork released to family members; or (d) mandated by a court of law.

14.0 INITIAL AND ENDING PHASES IN ART THERAPY
14.3 Either the art therapist or the client may initiate termination. Art therapists and clients terminate art therapy services by attending to appropriate termination indications when it becomes reasonably clear that the client has attained stated goals and objectives, is not likely to continue services, is not likely to benefit, or is being harmed by continuing the service.

14.4 Art therapists communicate the termination of art therapy services to clients by engaging and involving the clients appropriately in the termination process.

14.5 Art therapists ensure, to the extent that it is possible, a termination process of sufficient duration so as to promote a smooth transition for the clients to another mental health practitioner or to independent functioning.

14.6 Art therapists remain especially attentive to clients’ behaviors when any danger of client regression or negative reaction to termination exists. Art therapists work to avert or assist in the management of such negative outcomes, to the extent possible, by use of appropriate therapeutic interventions and by taking steps to ensure continuity of care when appropriate.

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American Association for Marriage and Family Therapy Ethics Code, 2015
https://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/code_of_ethics.aspx

1.9 Relationship Beneficial to Client. Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship.

1.10 Referrals. Marriage and family therapists respectfully assist persons in obtaining appropriate therapeutic services if the therapist is unable or unwilling to provide professional help.

1.11 Non-Abandonment. Marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of treatment.

Standard II: Confidentiality
2.6 Preparation for Practice Changes. In preparation for moving a practice, closing a practice, or death, marriage and family therapists arrange for the storage, transfer, or disposal of client records in conformance with applicable laws and in ways that maintain confidentiality and safeguard the welfare of clients.

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American Counseling Association Code of Ethics and Standards of Practice, 2014
http://www.counseling.org/Resources/aca-code-of-ethics.pdf

A.2.b. Types of Information Needed
Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the incapacitation or death of the counselor; the role of technology; and other pertinent information. Counselors take steps to ensure that clients understand the implications of diagnosis and the intended use of tests and reports. Additionally, counselors inform clients about fees and billing arrangements, including procedures for nonpayment of fees. Clients have the right to confidentiality and to be provided with an explanation of its limits (including how supervisors and/or treatment or interdisciplinary team professionals are involved), to obtain clear information about their records, to participate in the ongoing counseling plans, and to refuse any services or modality changes and to be advised of the consequences of such refusal.

A.4. Avoiding Harm and Imposing Values
A.4.a. Avoiding Harm
Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.

A.11. Termination and Referral

A.11.a. Abandonment Prohibited
Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

A.11.b. Inability to Assist Clients
If counselors determine an inability to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors should discontinue the relationship.

A.11.c. Appropriate Termination
Counselors 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. Counselors 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. Counselors provide pretermination counseling and recommend other service providers when necessary.

A.11.d. Appropriate Transfer of Services
When counselors 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.

A.12. Abandonment and Client Neglect
Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

B.6.i. Reasonable Precautions
Counselors take reasonable precautions to protect client confidentiality in the event of the counselor’s termination of practice, incapacity, or death and appoint a records custodian when identified as appropriate.

C.2.h. Counselor Incapacitation, Death, Retirement, or Termination of Practice
Counselors prepare a plan for the transfer of clients and the dissemination of records to an identified colleague or records custodian in the case of the counselor’s incapacitation, death, retirement, or termination of practice.

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American Mental Health Counselors Association Code of Ethics 2015
https://amhca.site-ym.com/?page=codeofethics

C. Counselor Responsibility and Integrity
o. Develop a plan for termination of practice, death or incapacitation by assigning a colleague or records custodian to handle transfer of clients and files.

Section 5: Termination and Referral
Mental health counselors do not abandon or neglect their clients in counseling.

a) Assistance is given in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacation and following termination.

b) Mental health counselors terminate a counseling relationship when it is reasonably clear that the client is no longer benefiting, when services are no longer required, when counseling no longer serves the needs and/or interests of the client, or when agency or institution limits do not allow provision of further counseling services.

c) Mental health counselors may terminate a counseling relationship when clients do not pay fees charged or when insurance denies treatment. In such cases, appropriate referrals are offered to the clients.

d) If mental health counselors determine that services are not beneficial to the client, they avoid entering or terminate immediately the counseling relationship. In such situations, appropriate referrals are made. If clients decline the suggested referral, mental health counselors discontinue the relationship.

e) When mental health counselors refer clients to other professionals, they will be collaborative.

f) Mental health counselors take steps to secure a safety plan if clients are at risk of being harmed or are suicidal. If necessary, they refer to appropriate resources, and contact appropriate support.

Section 4: Exploitive Relationships
b) Mental health counselors are strongly discouraged from engaging in romantic or sexual relationships with former clients. Counselors may not enter into an intimate relationship until five years post termination or longer as specified by state regulations. Documentation of supervision or consultation for exploring the risk of exploitation is strongly encouraged.

c) Determining the risk of exploitive relationships includes but is not limited to factors such as duration of counseling, amount of time since counseling, termination circumstances the client's personal history and mental status, and the potential adverse impact on the former client.

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The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry 2013 Edition
http://www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards/PrinciplesofMedicalEthics.aspx

While termination is not specifically mentioned in the American Psychiatric Association Code of Ethics it has a number of standards that are relevant:

5. Psychiatric services, like all medical services, are dispensed in the context of a contractual arrangement between the patient and the physician. The provisions of the contractual arrangement, which are binding on the physician as well as on the patient, should be explicitly established.

One must assume that the issues of termination, access to the psychiatrist between sessions, and coverage arrangements during periods of unavailability must be included in the informed consent agreement to be able to uphold the standards of professionalism of the medical and psychiatric professions.

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American Psychological Association's Ethical Principles of Psychologists and Code of Conduct 2010
http://www.apa.org/ethics/code/principles.pdf

2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. (b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.

3.12 Interruption of Psychological Services
Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist's illness, death, unavailability, relocation, or retirement or by the client's/patient's relocation or financial limitations.

6. Record Keeping and Fees
(c) Psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists' withdrawal from positions or practice.

10.09 Interruption of Therapy
When entering into employment or contractual relationships, psychologists make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client/patient care in the event that the employment or contractual relationship ends, with paramount consideration given to the welfare of the client/patient. (See also Standard 3.12, Interruption of Psychological Services.)

10.10 Terminating Therapy
(a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.
(b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.
(c) Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

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California Association of Marriage and Family Therapists, CAMFT
http://www.camft.org/ias/images/PDFs/CodeOfEthics.pdf

1.3 TREATMENT DISRUPTION:
Marriage and family therapists are aware of their professional and clinical responsibilities to provide consistent care to patients and maintain practices and procedures that assure undisrupted care. Such practices and procedures may include, but are not limited to, providing contact information and specified procedures in case of emergency or therapist absence, conducting appropriate terminations, and providing for a professional will.

1.3.1 TERMINATION:
Marriage and family therapists use sound clinical judgment when terminating therapeutic relationships and do so in an appropriate manner. Reasons for termination may include, but are not limited to, the patient is not benefiting from treatment; continuing treatment is not clinically appropriate; the therapist is unable to provide treatment due to the therapist's incapacity or extended absence, or in order to avoid an ethical conflict or problem.

3.2 ABANDONMENT:
Marriage and family therapists do not abandon or neglect patients in treatment. If a therapist is unable or unwilling to continue to provide professional services, the therapist will assist the patient in making clinically appropriate arrangements for continuation of treatment.

1.3.4 NON-PAYMENT OF FEES:
Marriage and family therapists do not terminate patient relationships for non-payment of fees except when the termination is handled in a clinically appropriate manner.

1.2 DUAL RELATIONSHIPS-DEFINITION:
Marriage and family therapists are aware of their influential position with respect to patients, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationships with patients that are reasonably likely to impair professional judgment or lead to exploitation. A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship either simultaneously with the therapeutic relationship, or during a reasonable period of time following the termination of the therapeutic relationship. Not all dual relationships are unethical, and some dual relationships cannot be avoided. When a concurrent or subsequent dual relationship occurs, marriage and family therapists take appropriate professional precautions to ensure that judgment is not impaired and that no exploitation occurs.

1.2.2 SEXUAL CONTACT:
Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient's spouse or partner, or a patient's immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.

Should a marriage and family therapist engage in sexual intimacy with a former patient or a patient's spouse or partner, or a patient's immediate family member, following the two years after termination or last professional contact, the therapist shall consider the potential harm to or exploitation of the former patient or to the patient's family.

1.8 EMPLOYMENT AND CONTRACTUAL TERMINATIONS:
When terminating employment or contractual relationships, marriage and family therapists primarily consider the best interests of the patient when resolving issues of continued responsibility for patient care.

1.15 DOCUMENTING TREATMENT DECISIONS:
Marriage and family therapists are encouraged to carefully document in their records when significant decisions are made, e.g., determining reasonable suspicion of child, elder or dependent adult abuse, determining when a patient is a danger to self or others, when making major changes to a treatment plan, or when changing the unit being treated.

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Canadian Psychological Association: Canadian Code of Ethics For Psychologists (3rd Edition)
http://www.cpa.ca/docs/File/Ethics/cpa_code_2000_eng_jp_jan2014.pdf

I.41 Collect, store, handle, and transfer all private information, whether written or unwritten (e.g., communication during service provision, written records, email or fax communication, computer files, video-tapes), in a way that attends to the needs for privacy and security. This would include having adequate plans for records in circumstances of one's own serious illness, termination of employment, or death.

II.42 Be open to the concerns of others about perceptions of harm that they as a psychologist might be causing, stop activities that are causing harm, and not punish or seek punishment for those who raise such concerns in good faith.

Confidentiality
I.45 Share confidential information with others only with the informed consent of those involved, or in a manner that the persons involved cannot be identified, except as required or justified by law, or in circumstances of actual or possible serious physical harm or death. (Also see Standards II.39, IV.17, and IV.18.)

II.37 Terminate an activity when it is clear that the activity carries more than minimal risk of harm and is found to be more harmful than beneficial, or when the activity is no longer needed.

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National Association for Addiction Professionals (NAADAC) Code of Ethics, 2011
http://www.naadac.org/code-of-ethics

Standard 2: Client Self Determination
3. The addiction professional will terminate work with a client when services are no longer required or no longer serve the client’s best interest.
4. The addiction professional will take reasonable steps to avoid abandoning clients who are in need of services. Referral will be made only after careful consideration of all factors to minimize adverse effects.
5. The addiction professional recognizes that there are clients with whom he/she cannot work effectively. In such cases, arrangements for consultation, co-therapy or referral are made.
6. The addiction professional may terminate services to a client for nonpayment if the financial contractual arrangements have been made clear to the client and if the client does not pose an imminent danger to self or others. The addiction professional will document discussion of the consequences of nonpayment with the client.

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National Association of Social Workers Code of Ethics (revised 2008)
http://www.socialworkers.org/pubs/code/code.asp

1.07 Privacy and Confidentiality
(o) Social workers should take reasonable precautions to protect client confidentiality in the event of the social worker's termination of practice, incapacitation, or death.

1.15 Interruption of Services
Social workers should make reasonable efforts to ensure continuity of services in the event that services are interrupted by factors such as unavailability, relocation, illness, disability, or death.

1.16 Termination of Services
(a) Social workers should terminate services to clients and professional relationships with them when such services and relationships are no longer required or no longer serve the clients' needs or interests.

(b) Social workers should take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary.

(c) Social workers in fee-for-service settings may terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client.

(d) Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client.

(e) Social workers who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral, or continuation of services in relation to the clients' needs and preferences.

(f) Social workers who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.

3.04 Client Records
(d) Social workers should store records following the termination of services to ensure reasonable future access. Records should be maintained for the number of years required by state statutes or relevant contracts.

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National Board For Certified Counselors (NBCC) Code Of Ethics, 2012
http://www.nbcc.org/Assets/Ethics/nbcc-codeofethics.pdf

7. NCCs shall not engage in any form of sexual or romantic intimacy with clients or with former clients for two years from the date of counseling service termination.

62. NCCs shall not solicit testimonials from current clients or their families and close friends. Recognizing the possibility of future requests for services, NCCs shall not solicit testimonials from former clients within two years from the date of service termination.

76. NCCs shall discuss service termination with clients when there is a reasonable belief that the clients are no longer benefiting from or are unlikely to benefit from future services. NCCs shall not abruptly terminate counseling services without good cause or significant justification, and in such cases, shall provide appropriate referrals.

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Ethics Guidelines Of United States Association For Body Psychotherapy (USABP), 2007
http://usabp.org/about-us/usabp-code-of-ethics/

IV. AVOIDING HARM
3. Body psychotherapists do not engage in sexual intimacies with individuals they know to be the parents, guardians, spouses, partners, offspring, or siblings of current clients. Body psychotherapists do not terminate therapy to circumvent this rule.

6. Body psychotherapists make reasonable efforts to ensure continuity of treatment. When services must be terminated for a legitimate reason, the therapist makes every reasonable effort to insure that appropriate referrals are made for the ongoing needs of the client prior to termination and makes reasonable efforts to terminate the relationship satisfactorily.

7. Should a client desire to terminate the therapeutic relationship, body psychotherapists provide professional insights into the benefits and consequences of this course of action without explicit or implicit coercion to maintain the relationship against the client’s wishes. At all times they make clear the client’s right to terminate when he/she chooses.

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Summary Of Codes Of Ethics On Termination

These Codes of Ethics provide a detailed review of the principles and standards to be followed by mental health professionals in each of the professions indicated. Despite there being a broad range of professions (Counselors, Marriage and Family Therapists, Psychiatrists, Psychologists, Social Workers, and Body Psychotherapists) a great deal of agreement is seen in how each mental health profession view the clinician's responsibilities regarding termination. It is clear that each profession regards the informed consent process as essential for addressing termination and abandonment issues from the outset. Each mental health clinician must inform clients/patients how to contact him or her in between sessions should an emergency or crisis arise, each must make appropriate arrangements for coverage by a competent professional during periods of absence, and each must address the termination process as an essential phase of treatment.

While some of the Codes of Ethics provide a detailed review of the principles and standards to be followed in the event that a therapist abruptly dies or becomes disabled or must close their practice unexpectedly, other codes do not attend to such cases. Only the CAMFT Code of Ethics mentions the term "professional will."

For termination to be handled in a clinically effective and ethical manner discussions between clinician and client/patient should occur, when possible, in advance and be addressed in a thoughtful and sensitive manner in anticipation of it occurring. Clients/patients should not be abandoned and should treatment need to end and ongoing treatment needs remain, efforts must be made to assist clients/patients to obtain needed services through help with the referral process prior to ending the present therapeutic relationship. In fact, the Codes of Ethics of the mental health professions are consistent in requiring that clinicians assess each client's/patient's ongoing treatment needs prior to initiating termination. This is essential so that the clinician may ensure that any ongoing treatment needs are adequately addressed through the referral process.

Several Codes of Ethics make it very clear that mental health professionals do not terminate professional relationships for the purpose of pursuing a personal, social, business or sexual one. It is clear throughout the mental health professions that the focus is on the client's/patient's needs and not on the clinician's. Around the issues of termination, like with any other clinical concern, mental health professionals do not engage in exploitation or abuse of the power inherent in their role in the professional relationship. The Codes of Ethics make it clear that treatment termination motivated by gratification of the clinician's needs is a form of exploitation. Terminations of treatment should be determined by each patient's/client's clinical needs.

It is also acknowledged in several of these Codes of Ethics that at times mental health professionals may need to terminate the professional relationship without the opportunity for advanced notice. It is stated that this is done only in the most unusual circumstances such as "when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship" as stated in Psychologists' Ethics Code (see above). It is also made clear that mental health professionals terminate treatment services at times to promote the best interests of their clients/patients. Examples include when providing further treatment likely would prove harmful, when the client/patient is not benefiting from treatment, when the client's/patient's treatment needs no longer remain within the mental health professional's areas of professional competence, and when a multiple relationship that is either inappropriate or incompatible with on going treatment is discovered or initiated.

Regardless of whether the notion of therapists' abrupt disengagement from practice is mentioned in the code, it is clear that each professional code alludes to the fact that therapists must attend to such eventualities. One can easily argue that the injunction against harm by itself is a mandate to have a professional will so issues of continuity of care and appropriate handling of records are carried out in accordance with the codes of ethics and the law.

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