A regulatory board complaint may be filed against a counselor by a client, colleague, employer, and/or other regulatory agency, such as the Department of Health, or Department of Family and Children Services. Complaints are subsequently investigated by the regulatory board to ensure that licensed/certified counselors are practicing safely, professionally, and ethically. Regulatory board investigations can lead to outcomes ranging from no action against the counselor to revocation of the counselor’s license/certification to practice. This case study involves a Licensed Professional Counselor (LPC) who worked in a private practice setting.
Summary
In this matter, the insured counselor had been licensed as a Licensed Professional Counselor (LPC) for nearly 20 years. Through both the counselor’s private counseling practice and his nonprofit counseling practice, he specialized in treating clients who suffered from substance use disorders. The counselor also offered life coaching services to certain clients, although he was not certified by any entity and had no formal training as a life coach.
Through his nonprofit private practice, the counselor began treating a client, who was in his mid-20s, homeless, unemployed, with a criminal history and history of substance use disorders. The client was referred to the counselor by court order to complete 20 hours of substance abuse education as a condition of his parole. Through a psychosocial assessment, the counselor diagnosed the client with generalized anxiety disorder, substance induced depression, and antisocial personality disorder.
The client relied on his parents financially. The counselor recommended that the client’s parents have no direct contact with him and that all financial resources relating to the client be controlled by the counselor, who would also serve as the client’s life coach. At the request of the counselor, the client’s mother signed a “Client Financial Fee Contract”. The contract included provisions stating that the client would receive life coaching and counseling from the counselor. For these services, the counselor would be paid upfront and he would also be reimbursed for the client’s living expenses, including food, clothing, cell phone bill, and rent.
During the course of the client’s treatment, the counselor gave the client car rides on multiple occasions, purchased items for the client, and paid for the client’s rent. Every month, expenses were billed to the client’s parents. The counselor also hired the client to perform landscaping work at the counselor’s home, crediting the parents’ monthly bill for the landscaping services provided by the client.
The client’s parole officer eventually became aware of the fact that the client was both being treated by, and working for, the counselor. A complaint was soon filed against the counselor with the state Department of Professional Licensing, which referred the matter to the Board of Counseling (the “Board”). The Board opened an investigation into the matter.
Risk Management Comments
The state where the counselor practiced does not regulate life coaches, and life coaches are not subject to discipline under its Public Health Code. Therefore, the counselor’s conduct was evaluated solely by the Board. Pursuant to the Public Health Code, the Board is responsible for regulating the practice of counseling, including LPC licensure and disciplinary actions.
The Board retained an expert witness to review the counselor’s conduct and issue an opinion on this matter. The Board’s expert concluded that the counselor was negligent in treating this client, among others, and failed to conform to minimal standards of acceptable practice due to the following:
- First, the expert explained that life coaching is an approach that should only be used with clients who are free from acute psychological distress. The expert opined that the counselor failed to understand the difference between counseling and life coaching, as reflected in his decision to accept the client in this matter as a life coaching client notwithstanding his multiple mental health diagnoses.
- Further, the expert concluded that the counselor exceeded conventional counseling parameters and transcended ethical boundaries by bartering for services with his clients, occasionally purchasing items for them and giving them rides in his personal vehicle. The expert stated that this demonstrated a pattern of transcending professional boundaries with clients, which failed to conform to the American Counseling Association’s (ACA) Code of Ethics, requiring, in pertinent part, that “… counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs.”
During a conference with the Board, the counselor explained that when he engaged in bartering agreements with certain clients, he did so with their best interests in mind. However, the counselor also emphasized that he now recognized that his conduct was inappropriate. He further explained that his counseling work with clients confronting substance use disorders was very important to him and stated that he wanted to continue providing this valuable service to the community.
Resolution
Considering all facts of the matter at hand, as well as the counselor’s contrition and recognition that his actions were inappropriate, the Board decided to place the counselor on probation for 90 days and issue a $500 fine. The Board also ordered the counselor to complete at least eight hours of continuing education on ethics and professional boundaries.
This Board matter required nearly two and a half years to resolve, and the total incurred to defend the insured counselor in this matter exceeded
$5,200.
Risk Control Recommendations
- Know and understand the scope of practice for your specific professional designation, certification and/or licensure in your state and understand the standard of care to which you will be held. If multiple professional designations apply, you will be held legally accountable to the most stringent standard of care associated with the applicable license.
- Review the ACA Code of Ethics at least annually and participate in continuing education programs related to evolving ethical issues.
- Clarify expectations regarding roles and boundaries, including the counselor’s availability and method of contact, to ensure that counseling is therapeutic and client-centered. Document the discussion and the client’s agreement.
- Exercise professional judgment when extending counseling boundaries beyond conventional parameters in order to make appropriate decisions and to prevent harm to clients.
- Use caution when bartering with clients as this may be misconstrued as being self-serving. According to the ACA Code of Ethics (A.10.e.) 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.” Further, counselors should “document such agreements in a written contact.”
- Conduct a detailed informed consent discussion for every proposed boundary extension, and document all discussions in accordance with the ACA Code of Ethics. (A.6.c.),including, but not limited to, the counselor’s rationale for the interaction and the potential benefits and risks for the client.
- Document pertinent information for all client interactions contemporaneously and factually, as comprehensive documentation is a key component of the legal defense of a claim or Board action.
Disclaimers
These are illustrations of actual claims that were managed by the CNA insurance companies. However, every claim arises out of its own unique set of facts which must be considered within the context of applicable state and federal laws and regulations, as well as the specific terms, conditions and exclusions of each insurance policy, their forms, and optional coverages. The information contained herein is not intended to establish any standard of care, serve as professional advice or address the circumstances of any specific entity. These statements do not constitute a risk management directive from CNA. This material is for illustrative purposes and is not intended to constitute a contract. No organization or individual should act upon this information without appropriate professional advice, including advice of legal counsel, given after a thorough examination of the individual situation, encompassing a review of relevant facts, laws and regulations. CNA assumes no responsibility for the consequences of the use or nonuse of this information.
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