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Two of the official BBS sample questions for California LPCC Law & Ethics are wrong

Two of the official BBS sample questions for California LPCC Law & Ethics are wrong

The "correct" responses for two of the official sample questions in the California LPCC Law & Ethics exam plan are not in line with guidance from the American Counseling Association's Code of Ethics.

When official sample questions are incorrect, the BBS and OPES lose some level of examinee and stakeholder confidence in the entire examination process. I've written to the BBS to ask that they address these questions, and take steps to ensure that their sample items for all exams accurately reflect current standards of practice.

Official sample question:

1. Which of the following situations would constitute an unethical dual relationship?

a. A current client begins to attend an AA meeting where the counselor serves as secretary
b. A current client and the counselor are both enrolled in the same art class at a local art studio
c. A counselor continues to receive services from a massage therapist who became a client after having provided services for the counselor
d. Two years following a client’s termination of therapy, the client and counselor meet each other on the street and decide to have lunch together

Listed correct answer: C.

Why this answer is not correct: Nothing in the current (2014) ACA Code of Ethics prohibits such a relationship or deems it inherently unethical. Counselors are prohibited from providing professional services to prior sexual or romantic partners (A.5.b), and with friends or family members with whom the counselor would not be able to remain objective (A.5.d). But counselors are not prohibited from counseling individuals from whom they have purchased (or even continue to purchase) other products and services. Here are the most relevant standards for the scenario described, copied in full (emphasis mine):

"A.6.a. Previous Relationships. Counselors consider the risks and benefits of accepting as clients those with whom they have had a previous relationship. These potential clients may include individuals with whom the counselor has had a casual, distant, or past relationship. Examples include mutual or past membership in a professional association, organization, or community. When counselors accept these clients, they take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs.

"A.6.b. Extending Counseling Boundaries. Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs."

In the scenario described, there is nothing to suggest a bartering relationship (which, even if present, would be allowed, as long as specific standards are met). It is not clear whether the two relationships are simultaneous (that is, whether the client is still actively a client at the time they are providing massage therapy, or whether they were first the counselor's massage therapist, then after that ended they were for a while a counseling client, then after the counseling ended, their massage therapist again). There is also nothing to suggest that the client is likely to be harmed by this relationship.

Even if the relationships are simultaneous, similar dual relationships occur every single day in rural areas and in more insular communities (such as specific ethnic or linguistic communities or LGBTQIA+ communities). In these communities, many clients prefer to see a clinician from within the community, and dual relationships necessarily result. As the ACA standards make clear, not all dual relationships are unethical or need to be avoided.

Whether the situation described in response C is in fact unethical would depend very much on the (unstated) circumstances of the case. Declaring option C to be unethical without the necessary contextual information to make such a determination is not only inaccurate, it would appear to demonstrate poor cultural competence.

It is possible here that the sample question was written to the prior (2005) ACA code of ethics, which did arguably suggest that option C would be a problem: "A.5.c [...] Counselor-client nonprofessional relationships with clients [...] should be avoided, except when the interaction is potentially beneficial to the client." However, this standard was changed in 2014 in part because of concerns related to cultural appropriateness. It is hard to believe that this has remained an official sample question for almost a decade after the 2014 code rendered it inaccurate.


Official sample question:

2. During an initial session, a client tells the counselor that she is currently seeing another counselor. She expresses angry feelings toward the other counselor and would like to get another perspective on her problems. What action should the counselor take?

a. Contract a set number of sessions with the client before sending her back to her current counselor
b. Inform the client that she needs to terminate her ongoing therapy before the counselor can provide treatment
c. See the client until she makes up her mind which counselor she wants to have for therapy
d. Call the current counselor to inform him about the client’s desire to change counselors

Listed correct answer: B.

Why this answer is not correct: Nothing in the current (2014) ACA Code of Ethics demands that a client discontinue treatment with one clinician prior to seeing another, even for the same clinical issue, or requires that counselors inform clients that they must do so. Quite the contrary; the ACA code's specific standard on concurrent treatment encourages counselors to contact fellow clinicians to develop positive working relationships.

Here's the full language of the ACA standard: "A.3. Clients Served by Others. When counselors learn that their clients are in a professional relationship with other mental health professionals, they request release [sic] from clients to inform the other professionals and strive to establish positive and collaborative professional relationships." This standard is unchanged from the 2005 ACA code. Section C.3 of the ACA code, which addresses solicitation of clients, also does not prohibit or even discourage concurrent care (and did not do so in 2005).

These standards, in place now for almost two decades, are in line with a more recent FTC ruling against ethical standards that could be seen as anti-competitive. The client, as a consumer with autonomy, is certainly entitled to seek a second opinion if they are frustrated with their current clinician. The counselor is free to provide it.

Obtaining a release from the client to speak to the current counselor, or simply agreeing to provide a different perspective as the client desires, would be more appropriate responses here, in keeping with the ACA code.

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