Abstract
The revised 2023 Commission on Rehabilitation Counselor Certification (CRCC) Code of Ethics, adopted in September 2022, addresses changes in ethical standards related to the counseling relationship. To promote awareness and understanding of these changes, this article reviews the purpose of Section A (The Counseling Relationship) of the CRCC Code of Ethics and provides a summary of the key revisions that have been made to Section A in the new revised Code and how the changes in these sub-sections of Section A impact counselors/practice.
The Code of Professional Ethics for certified rehabilitation counselors is designed to provide standards of practice for practitioners, trainees, recipients of services, and society on the ethical practice of certified rehabilitation counselors and Canadian certified rehabilitation counselors, henceforth referred to as CRCs/CCRCs. The Commission on Rehabilitation Counselor Certification (CRCC) provides national certification for individuals meeting rigorous educational requirements to provide specialized support for individuals with disabilities. The basic objectives of the Code are to (a) promote the public welfare by specifying ethical behavior; (b) establish principles that guide ethical behaviors; (c) serve as an ethical guide designed to assist in constructing a professional course of action; and (d) serve as the basis for the processing of alleged Code violations (Commission on Rehabilitation Counselor Certification [CRCC], 2017; 2023). In line with these objectives, several sections of the Code addresses rule of behaviors regarding some specific issues that CRCs/CCRCs are likely to encounter in their professional work. One key section of the CCRC Code of Professional Ethics is Section A: The Counseling Relationship.
Foundation of Section A: The Counseling Relationship
The foundation of Section A draws from the multiple influences that help define ethical behavior for rehabilitation counselors. A challenge the rehabilitation counseling profession encounters when defining ethical behavior is determining the source of expected practices and behaviors. As noted by Tarvydas et al. (2004), the profession “. . . has struggled with the balance between two traditions and sources of knowledge, skills, and attitudes: counseling and rehabilitation” (p. 234). In the development of Section A, a question remains if defining the counseling relationship is based on a generic consideration of counseling practice or based on a rehabilitation professional who used counseling as one of many tools.
The focus of Section A of the CRCC Code of Professional Ethics has been the relationship between CRCs/CCRCs and clients. Research has shown that one of the greatest predictors of success in counseling, including rehabilitation counseling, is the relationship between counselor and client (Lustig et al., 2002). In 1979, Bordin introduced the concept of the working alliance, which has three components: goals, tasks, and bonds. Goals involve collaboration between CRCs/CCRCs and clients to set appropriate, and achievable goals to be accomplished for the rehabilitation counseling process. Tasks involve the agreement between the CRC/CCRC and the client on the tasks that must be completed by each party to accomplish the agreed-upon goals. Bonds refer to the positive working relationship between CRCs/CCRCs and clients and it is this relationship that has an impact on goals and tasks (Bordin, 1979).
Lustig et al. (2002) conducted a study looking at the working alliance within the State-Federal Vocational Rehabilitation (VR) system. They found that a stronger working alliance between CRCs/CCRCs and clients positively impacted employment outcomes. The working alliance also contributed to the client’s perception of future employment possibilities and satisfaction with their current employment position. Therefore, these research findings suggest that it is vital that CRCs\CCRCs develop a positive working counseling relationship with the clients they serve to lead to successful outcomes.
This article will review the purpose of Section A of the CRCC Code of Professional Ethics, the revisions that have been made to this Section of the new 2023 Code, and how the changes in each sub-section of Section A impacts counselors/practice. The prevention of potential violations and concerns related to Section A, and practical recommendations for practitioners and implications for practice will also be discussed.
Purpose of Section A
It is fitting that the first section (A) of the revised code pertains to the counseling relationship. Certified rehabilitation counselors and Canadian certified rehabilitation counselors regularly face a multitude of ethical dilemmas in their work, and no ethical or legal issues have caused more controversy within the counseling profession than personal/professional boundary issues related to client interactions. For example, CRCs/CCRCs often struggle with the question of whether it is permissible to accept gifts from a current client or become involved in a friendly relationship with a former client (Remley & Herlihy, 2020). The purpose of Section A of the CRCC Code of Professional Ethics (hereafter referred to as the Code) is to help CRCs/CCRCs understand their responsibilities in a counseling relationship. Section A exists to help reduce the chance of crossing the line between personal and professional relationships.
Indeed, counseling often involves a great deal of emotional intimacy. Section A of the Code provides structure to the counseling relationship, creates a safe space for the client, and protects vulnerable clients from harm (Remley & Herlihy, 2020). Many experts have discussed the importance of counseling relationships in the rehabilitation counseling process (Herlihy & Corey, 2015; Hill et al., 2022; Kocet & Herlihy, 2014; Lustig et al., 2002; Pope & Keith-Spiegel, 2008; Roberts et al., 2002). Issues around dual relationships or multiple counseling relationships are often complex and ambiguous (Remley & Herlihy, 2020). However, some requirements regarding the counselor/client relationship are very clear. For example, CRCs/CCRCs are prohibited from having a sexual relationship with clients (past and present), trainees and research participants, their partners, or their family members for at least 5 years after the counseling relationship ends.
Section A of the Code serves a key purpose in the practice of rehabilitation counseling (past, present, and future). There is a need for conceptual clarity regarding when actual violations have occurred and for language that makes enforceability of the current Code viable thereby improving the ability of CRCs to resolve ethical dilemmas promptly, efficiently, and effectively. With all of this in mind, the overall goal of the 2023 CRCC Code is to: (a) improve conceptual clarity and (b) address current ethical challenges and projected ethical issues that we envisage may arise in the future. This review explains how those goals have been addressed concerning Section A of the Code.
Changes to Section A
Both minor and major changes were made across various sub-sections in Section A of the previous 2017 CRCC Code. Common minor but important changes included changing the word, “rehabilitation counselor” to “certified rehabilitation counselor”; expanding the word “electronic” to include “virtual,” “remote,” and “online” (see A.4.a, c, and d); and infusing the word “multiculturally competent” (see A.2.a), “client centered,” and “respecting client’s informed decision making” (see A.1.b). Because the old sub-section A.4: ‘avoiding value imposition’ in the 2017 CRCC code more closely aligns with Section D of the 2023 Code, it was moved to sub-section D.2.a in the new Code.
Consequently, the old sub-section A.5: “Roles and relationships with clients” was renumbered as A.4 with the word, “prohibited” added to the title. The new A. 4 sub-section title now reads “Prohibited roles and relationships with clients (see CRCC, 2023, p. 6 for details). In sub-section, A 5 “Multiple clients,” the word, “sibling” was added to the list of examples of persons that CRCs/CCRCs can agree to provide services (see CRCC, 2023, p. 7). These minor changes seek to address issues, such as confidentiality in social media, and cultural diversity that CRCs/CCRCs wanted to be addressed in future iterations of the Code (Hill et al., 2022). The expectation is that with increased clarity and understanding provided by these changes, CRCs /CCRCs would be more effective in the delivery of rehabilitation counseling services to their clients with a possible reduction in reported violations.
Section A.1. Welfare of Those Served
In the Employment Needs sub-section (A.1.c) of the new Code, pre-existing conditions, work history, and psychological characteristics were included as additional areas that CRCs/CCRCs need to pay attention to when working with their clients to determine appropriate employment. In line with the scope of practice (SOP) for rehabilitation counseling, CRCs/CCRCs facilitate the placement of clients in positions consistent with their culture, welfare, interests, and When assessing potential employment goals, CRCs/CCRCs consider the client’s overall abilities. Assessment of potential employment includes consideration of the client’s functional capabilities, interests and aptitudes, social skills, education, general qualifications, transferable skills, work history, psychological characteristics, geographic locations, and other relevant characteristics and needs of clients. CRCs/CCRCs facilitate the placement of clients in positions consistent with their interests, education/skills, culture, and welfare. CRCs/CCRCs assist clients in understanding potential barriers to employment and placement choices and mitigate barriers that could affect a successful employment outcome. Considerations include, but are not limited to legal history, substance use disorder, transportation, financial implications of work, skill level, and educational background. CRCs/CCRCs educate client’s on appropriate and accessible resources to address and resolve barriers. (CRCC, 2023, p. 4)
This is an important addition to the Code as it makes clients become self-aware and empowers them to become masters of their destinies. These values align with some of the underlying values in the professional scope of rehabilitation counseling concerning the independence and recognition of the importance of focusing on the assets of the client. Certified rehabilitation counselors and Canadian certified rehabilitation counselors must understand that it is necessary to educate themselves about these changes as they are ethically bound, both professionally and individually given that the Code serves as a basis for the processing of alleged Code violations. Similarly, in sub-section 1.A.d, besides CRCs working with clients to develop avocational and independent living goals, community integration (such as employment, return to work, and/or return to school) is also a goal of focus in the new Code.
Although the 2017 Code highlight the need of CRCs s/CCRCs to demonstrate respect for the cultural identity of clients in the development and implementation of rehabilitation and treatment plans, it stops short of explaining what these rehabilitation and treatment strategies should look like. The new Code now requires CRCs/CCRCs to develop and implement “culturally responsive” rehabilitation strategies. Sub-section A.2.a now reads thus: “CRCs/CCRCs demonstrate cultural humility and respect for the cultural identity of clients in developing and implementing culturally responsive rehabilitation strategies and treatment plans by providing and adapting interventions” (CRCC, 2023, p. 4).
A.3. Clients’ Rights
The language in all the sub-sections A.3.a to A.3.e was revised for clarity and brevity. For example, under the professional disclosure statement (A.3.a), in addition to CRCs/CCRCs reviewing with clients both orally and in writing, the rights of the counselor and clients, are now also required to document that the process has occurred. In addition, language was added to the informed consent sub-section (A.3.b) that requires CRCs/CCRCs to ensure that clients are advised of the benefits and/or consequences of their refusal of any services. Also, the new Code clarifies the need for CRCs/CCRCs to recognize that “informed consent is an ongoing process and needs to be reassessed throughout the rehabilitation counseling relationship, so that, clients are able to provide informed consent” (CRCC, 2023, p. 5). Furthermore, the title of Section A.3.c was changed also changed from “individualized approach to communication” to “developmentally and multiculturally appropriate communications” to effectively reflect the revised content in this sub-section. Section A.3.c—now reads thus: CRCs/CCRCs communicate information in ways that are both developmentally and multiculturally appropriate while taking into consideration the accessibility needs of the client. CRCs/CCRCs arrange for qualified interpreters, translators, or other necessary accommodations (e.g. captioning services) when needed to communicate effectively with clients. CRCs/CCRCs collaborate with clients and consider the multicultural implications of informed consent procedures and, adjust their practices accordingly. (CRCC, 2023, p. 5)
One of the issues that respondents in Hill and her colleague’s study stated that they would like to see in a new code is additional information addressing the issues of how to ethically engage with parents or guardians when working with minors. Consistent with findings from Hill and her colleague’s study, the language in the Inability to Give Consent (A.3.d) sub-section was revised to acknowledge the diversity of family systems, and the rights and responsibilities parents/guardians have regarding the welfare of their children/dependents. In the new Code, A.3.d now reads as follows: When counseling minors or persons who have limited capacity to give voluntary informed consent, CRCs/CCRCs seek the assent of clients and include clients in decision-making as appropriate. Parents and legal guardians are informed about the confidential nature of the counseling relationship. CRCs/CCRCs embrace the diversity of family systems, and the inherent rights and responsibilities parents/guardians have for the welfare of their children/dependents. CRCs/CCRCs recognize the need to balance the: (1) ethical rights of clients to make choices; (2) cognitive or legal capacity of clients to give consent or assent; and (3) legal rights and responsibilities of legal guardians to protect clients and make decisions on their behalf. (CRCC, 2023, p. 5). Hopefully, the revision in this section addressed this concern.
To avoid harmful multicultural service provision, sub-section A.4 (i.e., avoiding value imposition) in the existing 2017 Code was revised. It reads as: “CRCs/CCRCs recognize that personal values and dispositions (attitudes, beliefs, stereotypes, and behaviors) have the potential to impact interactions with diverse clients. CRCs/CCRCs do not impose their values and dispositions on their clients. CRCs/CCRCs recognize that prejudice is antithetical to the rehabilitation counseling philosophy and profession” (CRCC, 2023, p. 15). Given the relatedness of the content of this revised sub-section to contents in the newly created Section D: Multicultural Considerations) of the new Code, the revised A.4. was moved to Section D and renumbered as sub-section D.2.a, while the remaining sub-sections in Section A were renumbered accordingly.
A.4. Prohibited Roles and Relationships With Clients
In the new Code, sexual or romantic interactions between a rehabilitation counselor and a client (past or present), their romantic partners, or their immediate family member continue to be prohibited. Although the number of intervening years (i.e., 5 years after the last contact with the client) that must pass before a rehabilitation counselor could consider the possibility of entering into a romantic/sexual relationship with a former client did not change, a key addition to the code includes putting the sole responsibility on CRCs/CCRCs to demonstrate that neither coercion nor harm to the former client has transpired. Sub-section A.4.b. now reads: “CRCs/CCRCs are prohibited from engaging in any (e.g., electronic, virtual, online, and/or in-person) sexual or romantic interactions or relationships with former clients, their romantic partners, or their immediate family members for a period of five years following the last professional contact. Even after five years, CRCs/CCRCs carefully consider if a potential sexual or romantic relationship would be coercive or exploitative and/or cause harm to the former client. If CRCs/CCRCs choose to enter into such a relationship after five years, it is the responsibility of the CRCs/CCRCs (not the former client) to demonstrate that neither coercion nor harm to the former client has transpired. In cases of potential exploitation and/or harm, CRCs/CCRCs avoid entering into such interactions or relationships” (CRCC, 2023, p. 6). While this change is enforceable especially in urban areas, it may be challenging for CRCs/CCRCs working in rural areas to continue to provide emotional support without blurring the professional boundary, since CRCs/CCRCs are likely to have existing personal relationships with existing clients because of the unavailability of counselors in rural areas.
One area on which respondents in the Hill et al. (2022) study indicated they would like further clarification is how to deal with boundary issues in rural areas where a counselor is likely to have existing personal relationships with existing clients. While the new Code does not sufficiently address this concern especially when it is sexual, it does state that if CRCs/CCRCs choose to extend professional boundaries, they must seek informed consent, consultation, and/or supervision to ensure that exploitation or harm does not occur to the client. This is in addition to the current requirement of ensuring that their judgment is not impaired as already documented in the 2017 Code (see A.4.g). Despite these changes Section A of the new Code still falls short of guiding how CRCs/CCRCs in rural areas should act when a CRC/CCRC finds out that an individual that they are currently romantically involved with is a relative of a current or past client. Therefore, when faced with complex and difficult to resolve ethical dilemmas, such as this, CRCs are expected to engage in a carefully considered ethical decision-making process and must refer to Standard L of the new Code for general guidance.
In general, the new Code continues to recognize the harm that can impact clients when they are sexually intimate with their counselor. This point cannot be overemphasized given inappropriate sexual/romantic relationship is one of the top ethical violations often reported by CRCC and other professional associations and state boards of licensure (Ybanez-Liorente, 2019). Harm is inevitable whenever a romantic or sexual relationship occurs between a CRC and a client because of their power differential. Certified rehabilitation counselors and Canadian certified rehabilitation counselors need to recognize the harmful effect of being romantically involved with their clients and must therefore plan safe alternative options to meet their emotional and romantic needs (Kaplan et al., 2009).
Another important issue that was revised in the new Code, is, accepting gifts (A.4.j). Certified rehabilitation counselors and Canadian certified rehabilitation counselors are explicitly prohibited from accepting gifts from clients, except in cases when it is culturally appropriate or therapeutically relevant. Even in such cases, CRCs/CCRCs are in addition to being aware of and complying with their employer’s policies on accepting gifts, are also expected to seek consultation with their supervisors when necessary.) The revised language states: CRCs/CCRCs shall not accept gifts from clients except in cases when it is culturally appropriate or therapeutically relevant. CRCs/CCRCs understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept gifts from clients, CRCs/CCRCs take into account the cultural or community practice, therapeutic relationship, the monetary value of the gift(s), the client’s motivation for giving the gift(s), and the motivation of the CRCs/CCRCs for accepting or declining the gift(s). CRCs/CCRCs are aware of and comply with their employers’ policies on accepting gifts and seek consultation with their supervisor when necessary. (CRCC, 2023, p. 7)
Deciding to accept or decline a gift from a client may be uncomfortable, so that, it is important that CRCs consider the client’s motivation and are respectful of the cultural meaning of gifts to the client (e.g., showing gratitude and respect) in their decision-making process (Remley & Herlihy, 2020; Sue & Sue, 2012).
A.6. Group Work
In this sub-section, besides expanding on the meaning of “trauma” to include physical, emotional, or psychological trauma in A.6.b, the content in the “protecting clients” section remained the same as in the existing Code. The section now reads, “In a group setting, CRCs/CCRCs take reasonable precautions to protect clients from harm or physical, emotional, or psychological trauma” (CRCC, 2023, p. 7).
A.7. Termination and Referral
Another major change in the new Code is the addition of a new self-referral sub-section (A.7.e). This new sub-section specifically prohibits CRCs/CCRCs working in any settings/organizations from referring clients to their private practice unless the policies of such organizations provide clear guidance for self-referrals. In addition, if clients seek private rehabilitation counseling/forensic services, CRCs/CCRCs are required to inform the client of other options available to them. The new self-referral sub-section reads as follows: CRCs/CCRCs working in organizations (e.g., school, agency, institution) that provide rehabilitation counseling services do not refer clients to their private practice unless the policies of the organization make explicit provisions for self-referrals. In such instances, the client must be informed of other options available to them should they seek private rehabilitation counseling/forensic services (CRCC, 2023, p. 8).
A.8. Terminal Illness and End of Life Care
In addition, the revised CRCC Code added a key element to the end-of-life section of the 2017 Code; it focuses on the need for CRCs/CCRCs to be aware of their competency in seeking out information to assist their clients in making their own informed end-of-life decision. This new section is called End of Life Care (see Standard A.8.b). Given the specialized level of skills and knowledge needed among counselors providing palliative end-of-life care (Kaplan et al., 2009), CRCs/CCRCs who are not competent in the area of end-of-life options and planning, are required to make appropriate client referrals. Standard A.8.b reads as: CRCs/CCRCs are aware of their own competency as it relates to end-of-life decisions. When CRCs/CCRCs assess they are unable to work with clients on the exploration of end-of-life options, they make referrals to ensure clients receive appropriate assistance. (CRCC, 2023, p. 8)
The revisions in Section A of the Code impacts CRCs/CCRCs roles and responsibilities in their work with clients to achieve client goals and rehabilitation outcomes. The ensuing sections of the article illuminate these issues in greater detail.
Application of Revised Section A to Counselor Responsibilities
The introduction to Section A of the new Code (CRCC, 2023) states: CRCs/CCRCs work in cooperation with their clients to promote client growth, welfare, and support them in developing and progressing toward their goals. CRCs/CCRCs understand that trust is the cornerstone of the counseling relationship, and they have the responsibility to respect and safeguard the client’s right to privacy and confidentiality. CRCs/CCRCs respect the rights of clients to make their own decisions about matters that affect their own lives. CRCs/CCRCs make reasonable efforts to ensure clients make informed choices about every aspect of the rehabilitation counseling process. CRCs/CCRCs are expected to understand the diverse cultural backgrounds and identities of the clients they serve and do not discriminate in their provision of rehabilitation counseling services based on protected identities. CRCs/CCRCs also explore their own backgrounds, cultural identities, and experiences and how these affect their values and beliefs. (p. 4)
As CRCs/CCRCs, the primary responsibility is service provision for clients with disabilities. This service provision should be done for the dignity of the client and promoting the welfare of the client, as well as their freedom of choice. Certified rehabilitation counselors and Canadian certified rehabilitation counselors should “work with clients to develop avocational, independent living, and community integration goals consistent with their abilities, interests, culture, needs, and welfare” (CRCC, 2023, p. 4). Certified rehabilitation counselors and Canadian certified rehabilitation counselors should also empower clients to make their own decisions when possible, reinforcing client autonomy and cultural identity. Rehabilitation and treatment plans should be multiculturally relevant and created collaboratively. The support of others should be used and incorporated when appropriate and/or when requested by the client.
Relationships between CRCs/CCRCs and clients should always be professional and centered on the welfare of the client. This includes the prohibition of engaging in sexual or romantic relationships with current clients and refraining from engaging in virtual relationships, such as accepting friend or connection requests on social media, with current clients. Judgment should be used when engaging in these types of relationships with former clients and should never be engaged in with vulnerable former clients or those not capable of informed decision-making. If CRCs/CCRCs engage in boundary extensions, such as attending graduation or marriage ceremonies, they should carefully consider the risks and benefits of these activities and seek supervision or consultation as needed. Any boundary extensions should be documented appropriately. In the same vein, CRC/CCRC role changes should be carefully considered and documented. They should also obtain new informed consent from the client to reflect the new role.
When terminating the professional relationship with clients, the process should be explained thoroughly to clients. Termination should occur when the client’s goals have been met and the client no longer needs assistance, the client is no longer benefiting from services, or the client is being harmed by services. Termination should not occur because of personally held values on the part of the CRC/CCRC. Making referrals or transferring a client to another provider should also not occur because of a perceived values conflict on the part of the CRC/CCRC. Certified rehabilitation counselors and Canadian certified rehabilitation counselors have an ethical obligation to respect the diversity of clients and should seek out training or professional development related to areas in which they are at risk of imposing their values or beliefs onto clients, especially when the CRCs/CCRCs values or beliefs are discriminatory or in conflict with the goals set by the client.
Certified rehabilitation counselors and Canadian certified rehabilitation counselors have an ethical obligation to ensure that they have the skills and competencies necessary to build a quality relationship with clients. They must have: keen awareness and mastery of interpersonal communication skills that help facilitate relationship values that are fundamental to the counseling process. At the foundation of the counseling relationship are the principles of respect, warmth, understanding, genuineness, congruency, authenticity, and positive regard. (Stebnicki, 2018, p. 223)
When working with terminally ill and end-of-life clients, CRCs/CRCCs should always be aware of their competencies and make referrals to ensure clients receive appropriate assistance. Certified rehabilitation counselors and Canadian certified rehabilitation counselors should also develop skills to handle clients who may have difficult behaviors, are uncooperative, or dealing with trauma, as these skills go beyond the basic counseling skills. McCarthy (2014) found that clients had more successful outcomes when rehabilitation counselors used counseling micro skills, such as paraphrasing and confrontation, and when rehabilitation counselors used skills to handle difficult client behavior. Therefore, CRCs/CRCCs must develop, practice, and use basic counseling skills to build rapport and a positive counseling relationship with clients.
Preventing Violations and Issues Related to Section A
Certified rehabilitation counselors and Canadian certified rehabilitation counselors have a responsibility and obligation to read and understand the CRCC Code of Ethics and apply the guidance and standards in their everyday rehabilitation counseling practice, regardless of the setting in which they work. However, when it comes to working with real people in real situations, applying the Code can be difficult to navigate. Therefore, CRCC has provided resources to assist CRCs/CCRCs in navigating ethical dilemmas such as advisory opinions and grievances. For information related to ethical decision-making, please see the article in this special issue on this topic.
Cartwright and Hartley (2016) conducted a content analysis of 127 advisory opinions from 1996 to 2013. These advisory opinions referenced 470 citations to specific sections of the Code. Out of the 470 citations, 135 were references to Section A, making it the most referenced section. Within Section A, the most commonly cited standard had to do with informed consent and professional disclosure. Cartwright and Hartley (2016) stated that “these results are not surprising especially when one considers that the development of a therapeutic relationship and trust is critical to effective rehabilitation practice” (p. 90). Based on this information, CRCs/CCRCs must develop and provide clients with a thorough informed consent and professional disclosure statement and review this statement with clients to ensure understanding. This can be the first step in building rapport and establishing the working alliance between the CRC/CCRC and the client.
Serious ethical violations can occur related to Section A including inappropriate relationships with current or former clients. Regrettably, the problem of sexual violations is likely to continue. Certified rehabilitation counselors and Canadian certified rehabilitation counselors can and sometimes do have romantic feelings and fantasies toward their clients (Alpert & Steinberg, 2017). The goal is not to limit the feelings that some CRCs/CCRCs have toward their clients, but to prevent behavioral violations of ethical requirements regarding romantic and/or sexual relationships. Certified rehabilitation counselors and Canadian certified rehabilitation counselors should never engage in a romantic or sexual relationship with a current client or a vulnerable former client. If a CRC/CCRC begins developing sexual or romantic feelings toward a current client or a current client discloses sexual or romantic feelings toward a CRC, the CRC/CCRC should seek supervision and consultation as understanding and interpreting this transference/countertransference reaction can be extremely valuable. Consultation is needed to help the CRC/CCRC manage boundaries and to address the transference or countertransference within the therapeutic relationship. In a situation where the CRC/CCRC may conclude that this is not possible, the CRC/CCRC should consider transferring the client to another CRC/CCRC. For consideration of engaging in a romantic and/or sexual relationship with a former client, at least 5 years should have passed since the last professional-client contact, and careful consideration should be given to the potential for the relationship to be considered or perceived as coercive or exploitative. Regardless of the time elapsed, CRCs/CCRC should never enter a romantic or sexual relationship with a vulnerable former client, including those clients that have impaired decision-making capabilities. If CRCs/CCRCs choose to engage in this type of relationship with a vulnerable former client, this is cause for an ethical violation and the CRC’s/CCRC’s certification may be revoked if this relationship is reported to the CRCC Ethics Committee. Beyond the prohibition against working with clients determined to be vulnerable, CRCs/CCRC should always carefully consider the power dynamics and potential for ethical conflicts when engaging in a romantic and/or sexual relationship with a former client, even if the client is not considered to be compromised in their capacity to engage in such a relationship.
Recommendations/Implications for Practice
Sexual relationships with clients are undoubtedly harmful to the therapeutic counseling relationship. While the prohibition of any type of sexual intimacy with a current client is universally (Remley & Herlihy, 2020) accepted, the question of post-termination sexual relationship is still a subject of debate in the counseling profession. The CRCC Code of Ethics should be used as a resource and a source of training for counselors and trainees to engage in ethical practices, but with the understanding that the Code is limited in providing clear guidance to CRCs/CCRCs in rural settings. There is a need for education about boundaries, transference, the power differential, ethics, and self-care to be integrated into rehabilitation trainings/programs (Alpert & Steinberg, 2017). Given that previous ethical researchers have documented some benefits of dual relationships and the complex nature of dual relationships particularly in rural settings, we agree with Luse (2018) that training materials and supervision provided to counselors on how to avoid intimate relationships must be empirically validated and culturally appropriate for rural settings. A summary of specific professional and educational strategies is listed below:
Implications for Training and Practice
Professional Practice
Develop and provide clients with a thorough informed consent and professional disclosure statement and review this statement with clients to ensure understanding.
Deciding to accept or decline a gift from a client may be uncomfortable, so that, it is important that CRCs/CCRCs consider the client’s motivation and are respectful of the cultural meaning of gifts to the client (e.g., showing gratitude and respect) in their decision-making process.
If a CRC/CCRC begins developing sexual or romantic feelings toward a current client or a current client discloses sexual or romantic feelings toward a CRC/CCRC, the CRC/CCRC should seek supervision and consultation as understanding and interpreting this transference/countertransference can be extremely valuable. If this is not possible, the CRC/CCRC should consider transferring the client to another CRC/CCRC.
Education
There is a need for education about boundaries, transference, the power differential, ethics, and self-care to be integrated into rehabilitation trainings/programs and on-boarding programs in public VR.
Training materials and supervision provided to counselors on how to avoid intimate relationships must be empirically validated and culturally appropriate for rural settings.
The new CRCC Code of Ethics should be used as a resource and a source of training for counselors and trainees to engage in ethical practices.
Knowledge of how the requirements of the CRCC Code of Professional Ethics are being interpreted and implemented by CRCs/CCRCs should become part of the preservice training.
In summary, because ethical dilemmas vary with time (Tarvydas et al., 2010), it is important that CRCC continue to maintain the standard policy of revising existing CRCC Code of Professional Ethics after every 5 years, to meet the ever evolving|rehabilitation counseling practice needs.
Conclusion
Ethical standards related to the counseling relationship have changed and are documented in the revised CRCC (2023) Code of Ethics. Changes to Section A of the Code and related implications for practice are summarized. Virtual service delivery modalities may be considered in current and future rehabilitation counseling practice.
Footnotes
Acknowledgements
Commission on Rehabilitation Counselor Certification (CRCC), 1699 E. Woodfield Rd. #300 Schaumburg, IL 60173.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
