Ethical Guidelines Review: Compare/Contrast American Counseling Association (ACA) and American Art Therapy Association (AATA)

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Intro¶

In this paper, I will go through the major sections of the Ethical guidelines for the American Counseling Association (ACA) and the American Art Therapy Association (AATA). Why would I choose these 2 organizations? I came into therapy from my experience as a medic in the Air Force, and my education and passion for art. Thus, I am on the path to be an Art Therapist. However, every Art Therapist I know is dual licensed in some way in both art therapy and in counseling (either LMHC or LPCC). Eventually, I will move back to Kentucky; which is one of the fewest states that has an independent license in Art Therapy. However, it is still practically responsible for myself as a professional to be dual licensed in Counseling as well. Currently, I am a member of the New Mexico Mental Health Counseling Association, and I serve as webmaster on the board for the New Mexico Art Therapy Association. So ethics for both organizations mean a great deal to me and it behooves me now to be critical of both.

Review and Compare/Contrast

First off, the ACA has used the first section to talk about the Counseling Relationship. We have a duty and responsibility to foster the welfare and interest of the clients. Respect and trust are the cornerstone of the therapeutic relationship. Counselors attempt to understand the diverse background and cultures of their clients.  All of this wording has made me proud to go into the Counseling profession. I have spent a great deal of my time over the last year-and-a-half investing in the humanistic approach, and so far the tenets of the The Counseling Relationship outlined in Section A are seeing the client and respecting the client as human. Plus, the ACA has written on the counseling plan as it is imperative in the therapeutic relationship that both the counselor and the client are “on the same page.”

In the Ethical Principles for Art Therapists, the closest I can find to this description of the therapeutic relationship is: “At the outset of the client-therapist relationship, art therapists discuss and explain client rights, roles of both client and therapist, and expectations and limitations of the art therapy process.” While I do support that when a therapeutic relationship is established, it is ethically imperative to explain patient rights, expectations, and the roles of each person. However, AATA has not said anything about the client plan just as ACA has said that counselors and clients will regularly review the counseling plan. I do want to mention that in Section 13 of Referral and Acceptance Referral, it says that independent practitioners of art therapy design treatment plans to assist the client in attaining maintenance and quality of life appropriate for each individual.  I do want to stress that this is a nice statement but it still doesn’t say anything about making sure the counselor and client are reviewing said treatment plan.

Also, I want to spend some time talking about informed consent and confidentiality as these 2 things seem to be the two driving forces in majority of ethical situations. The ACA says that clients have the freedom to choose to go into a counseling treatment. Counselors should hold themselves responsible for informing clients both verbally and written. It is in A.2.b, the ACA is frank with saying that therapy services should be explicitly explained including the counselor’s qualifications, experience, and approach.  It also says that counselors should explain purposes, goals, and limitations of counseling. While we haven’t talked much about testing and diagnosis; clients should be adequately informed.

In the AATA’s Code of Ethics, the first instance of “consent” is the discussion if the client is a minor in 1.3. I might add that while this is important for Art Therapists that treat minors; certainly this document needs better formatting. Next, in the Confidentiality section, it states that clients will be treated in an environment that protects confidentiality and privacy. That’s a vague statement and maybe AATA needs to take a lesson from ACA. In both documents, it does state that both Counselors and Art Therapists need to get the informed consent of the client beforing seeking consultation or supervision, unless the client is in immediate danger.  I have to admit that I am naive in this part of informed consent as I assumed that therapists who have a more experienced supervisor should know of the less experienced counselor’s cases. Perhaps it is ethical to put that in writing in the initial paperwork when a counselor will seek advice on a particular case.

One large factor that has been brought up into ethical discussion is the concept of appropriate boundaries. As previously stated, it is imperative that the role of the counselor remain professional so that they can be objective. ACA talks about many different prohibited roles such as current and previous romantic relationships; as well as friends and family members. Also, it does talk about the risks and benefits if a counselor were to enter a therapeutic relationship with a former peer in an association or colleagues. Section A.6.a suggests that the counselor take extra precautions such as consultation, supervision, and informed consent in such scenario.  However, I would venture that if a counselor needs to spend extra time and energy to protect oneself for a potential “conflict of interest”; perhaps it is best to pass that client to a more appropriate counselor.

In the Ethical Principles for Art Therapists, in part 1 of Responsibility to Clients, it does have several subsections on the professional responsibility to avoid ambiguity in the therapeutic relationship. It is strongly discouraged for art therapists to refrain from multiple relationships as well. AATA does say that “Art therapists refrain from taking on a professional role when (1) personal, professional, legal, financial, or other interests and relationships could reasonably be expected to impair their competence.” Once again, AATA has left this as a general statement. ACA has made their principles for boundaries and roles clearer and explicit. Also, I want to add that ACA gives examples of role changes such as from evaluative to a therapeutic role; or from individual to family counseling. The idea here is that the counselor remains transparent; and the patient stays informed and agrees to any changes. I don’t see mention of this on the AATA Ethics guidelines.

Finally, I want to spend a great deal of time and space exploring multicultural and diversity considerations in ethics.  This means a lot to me as I am in an interracial marriage and as the old saying goes we should “treat clients like family” (ethically of course). I have spent several projects exploring how counselors can treat their clients respectfully and fairly no matter what culture they’re from. Most recently, I did a literature review on the best practices on counseling biracial clients. Needless to say, there needs to be more published research; and more education and experiences available for counselors.

In the ACA Code of Ethics, the word “Cultur” (this shows all parts of culture, cultural, and multicultural) appears 52 times in the 24 page document.  That fact alone tells me that ACA is doing everything possible to cover ethical considerations to remain respectful of all possible cultural scenarios. First and foremost, Counselors are to embrace and honor❡ a multicultural approach in support of a client’s dignity, worth, and uniqueness of their social contexts.  I’m glad to see this tenet set in the Preamble.

Next, as stated in Section A, it is imperative that Counselors strive to learn and engage in a client’s background to better understand them. Counselors should explore their own cultural identity as it can make a difference in knowing one’s own values. It can help with sharing the intimate space with someone else if the Counselor knows themselves first. Plus, the informed consent and the agreement between the Counselor and the client should be based on and understood by that client’s cultural milieu. If there is a lack of understanding, then the Counselor should provide an appropriate interpreter.  

As professionals, we should never discriminate against another person for any basis.  However, Counselors should maintain ongoing awareness of a client’s privacy within their culture. There should be ongoing competency regarding varying cultures in order to better understand that client and what they are going through. This is pertinent in order for a counselor to remain skilled in a continually diverse client population. Research has shown that clients have a better therapeutic relationship and outcome when placed with a Counselor that is more like them.  In that case, if it were me and perhaps therapy isn’t progressing with a certain client; then I would recommend certain clients to see a different Counselor that they would benefit from.

In the AATA document for Ethics, it of course states in 1.1 that Art therapists to do not discriminate against or refuse professional service of the basis of any identity. It’s sad that this has to be stated in either document but I wonder if a therapist has ever refused a client on religious purposes and then declared it a first amendment right. Perhaps that therapist or counselor should identify themselves as a Faith-based counselor.

Also, in section 6.1 of Multicultural/Diversity Competence, it has great detail of how an Art Therapist will remain respectful of a person’s culture, individual, and role differences. They are aware of their own values and beliefs and how they may affect cross-cultural therapy interventions. I found this part interesting that AATA added this part as an Art Therapist’s own background may impact the therapeutic setting; even on an unconscious level. From the Art Therapists that I have known, they spend a great deal of their time advocating for their clients but also working towards social justice. This requires a great deal of knowledge and ongoing experiences to be effective.

Conclusion

Finally, I want to reiterate the amount of detail and multiple scenarios that the ACA Code of Ethics explicitly stated throughout the 24-page document. I have been pleasantly surprised of how much is actually in this guideline and how it can be helpful in ethical dilemmas. I wish I could say the same for the AATA Ethics, but since I plan to be dual licensed – I will abide by both as best I can. Also, as we know there isn’t one right way to solve an ethical situation. It is nice that ACA released a white paper that is the “Practitioner’s Guide to Ethical Decision Making. It goes thru the foundational principles of justice, beneficence, nonmaleficence, and fidelity; while also explaining the Ethical Decision-Making Model recommended.  

References

 

American Counseling Association. (2014). ACA code of ethics. Alexandria,
VA: Author
American Art Therapy Association. (2013). AATA ethical principles for art therapists. Alexandria, VA: Author

 

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