Author: Neukrug, Edward S
Date published: April 1, 2011
What is ethical counselor behavior one year may not be ethical the next, especially in light of the fact that ethical codes change as a function of changing values in society, new evidenced-based research, and the changing nature of professional associations (Ponton & Duba, 2009; Waiden, Herlihy, & Ashton, 2003). The latest revisions in the American Counseling Association (ACA; 2005) ethics code demonstrates how much a code can change. For instance, the ACA Code of Ethics replaces the terms "clear and eminent danger" (ACA, 1995, Standard B. Lc.) with "serious and foreseeable harm" (ACA, 2005, Standard B.2.a.; see Kaplan et al., 2009, p. 241), increases the restrictions on romantic and sexual relationships, softens the admissibility of dual relationships, includes a statement on end-of-life care for terminally ill clients, increases attention to social and cultural issues, allows counselors to refrain from making a diagnosis, highlights the importance of having a scientific basis for treatment modalities, requires counselors to have a transfer plan for clients, adds guidelines for how and when to use technology, and includes a statement about the right to confidentiality for deceased clients.
Making good ethical decisions is dependent on knowledge of one's code, familiarity with models of ethical decision making, the cognitive complexity of the counselor, and knowledge of problematic ethical situations (Corey, Corey, & Callanan, 201 1 ; Hill, 2004; Neukrug, Lovell, & Parker, 1 996). Relative to this last area, helping current and future counselors become more knowledgeable about problematic ethical situations has been accomplished in a number of ways. For instance, some have surveyed credentialing boards to assess the kinds of complaints and violations made against counselors (Neukrug, Milliken, & Waiden, 2001 ; Saunders, Barros-Bailey, Rudman, Dew, & Garcia, 2007). Second, ethics committees of professional associations have often provided extensive information regarding ethical concerns currently facing professionals (e.g., see American Psychological Association, 2008; Glosoff & Freeman, 2007; National Association of Social Workers, 2008). These committees tend to field questions about ethical dilemmas and respond to ethical complaints from their membership and from the public (Welfel, 20 1 0). Finally, some have surveyed counselors directly to identify those areas in which they may need additional training. For example, Gibson and Pope (1993) conducted a random sample of nationally certified counselors, asking them to rate 88 counselor behaviors. From the counselors' responses, the authors identified behaviors that seemed to cause the most confusion or difficulty for counselors.
The current research seeks to update and expand Gibson and Pope's (1993) work by administering a revised scale to counseling professionals. It is hoped that the results can guide educators in the training of students and counselors by highlighting which ethical situations are most distressing and confusing and also help guide the revision of future ethical codes of ACA.
Although few professionals are actually accused of unethical conduct during their careers, those who are can be devastated (Neukrug et al., 2001; Saunders et al., 2007), and clients affected by ethical violations can be traumatized. It is hoped that this research can aid in reducing ethical complaints and violations by providing important preventive information for students, counselors, and counselor educators (Chauvin &Remley, 1996).
On the basis of an analysis of the 88-item Gibson and Pope (1993) scale, a review of the 2005 ACA Code of Ethics, an examination of research on ethical complaints and violations made against counselors, and a review of "hot topics" discussed on professional electronic mailing lists and in the media, a new 94-item scale was devised. A poster session at the national convention of the Association for Counselor Education and Supervision (ACES) and a workshop at two of ACA's national conferences were used to gain feedback about the efficacy of the scale and seek suggestions for additional items. Furthermore, after examining the results of the Gibson and Pope study, as well as results from a similar study conducted with human services professionals (see Milliken & Neukrug, 2009), we eliminated a number of items endorsed as "ethical" or "unethical" by more than 95% of helping professionals from the survey. The final scale consisted of 77 items of which (a) approximately one third were nearly identical to those in the Gibson and Pope scale, (b) one third were somewhat related to those in the original scale (e.g., wording changed to modernize an item; additional items were added to expand on an original theme), and (c) about one third were new items.
Respondents were asked to identify each item as ethical or unethical (Scale 1) and rate how strongly they felt about their responses (1 = not very strongly to 10 = very strongly; Scale 2). Mean scores for items endorsed as unethical were converted to negative numbers to distinguish unethical from ethical group responses. Thus, scores of-10 through -1 were viewed as unethical, whereas scores of +1 through +10 were seen as ethical. The closer to -10 or +10, the stronger the respondents felt about their decision. Such scoring allowed for an analysis of strength of response. Thus, we were able to examine nominal data through Scale 1 and strength of response through Scale 2.
The instrument also solicited the following demographic information: gender, age, ethnicity, highest degrees held, counseling specialty area, current position held, professional memberships held in addition to ACA, and exposure to ethics education. The instrument was then transferred onto Inquisite Survey (see http://www.inquisite.com/), a web-based survey software program, and piloted by 48 students from two graduate-level courses of Introduction to Counseling. Suggested edits were made. For example, grammatical errors were corrected, and the item selection process was modified for ease in administration.
A copy of the survey and procedures for the study were approved by the college's human subjects committee. This approval, along with a summary of the study, was sent to ACA with a request for a random sample of 2,000 ACA members' e-mail addresses. After approving the study, ACA sent the requested e-mail membership list with a request for their usual fee.
An initial e-mail and four follow-up e-mails were sent over a 3 -month period. These e-mails included an explanation of the survey, an informed consent statement, and the survey's URL. Respondents were also informed that if they responded to the survey, they would be entered in a random drawing to win one of four $50 gift certificates to the ACA bookstore. Of the 2,000 e-mails originally sent, 205 were found to be nondeliverable.
Of the approximate 42,000 members of ACA (at the time of the survey), we hoped to obtain a response rate of approximately 500 to allow for a 95% confidence interval (CI) with a margin of error of 5% (Krejcie & Morgan, 1970; Smith, 2004). Of the 1,795 members contacted by e-mail, 535 (28%) responded to the survey (95% CI; margin of error of 4.2%). This rate is probably higher than the 28% because some e-mails remain "live" despite the fact that individuals no longer use their accounts (e.g., a counselor takes a job elsewhere, but his or her old e-mail is not turned off)· Response rates to e-mail surveys have been mixed and present some unique challenges (Jansen, Corely, & Jansen, 2007; Ye, 2007). The rate for this e-mailed survey was slightly higher than rates from educational, psychological, or sociological mailed surveys (Edwards et al., 2002). Demographic information from the respondents was similar to the national demographics from ACA, except that the sample appeared to have a larger percentage of students (22% vs. 12%) compared with data from ACA's population (ACA, 2009). The evidence suggests that this survey sample closely mimics ACA's population.
Of the respondents, most were female, were Caucasian, held a master's degree, and were fairly evenly split between the ages of 20 and 60 (see Table 1 ). A majority of respondents (53%) reported having a specialty in mental health counseling, with the remainder representing six other counseling specialty areas (see Table 1). Eighty percent were fairly evenly split between being full-time students, having a private practice, working in an agency, or working at some "other" setting; the remainder included counselor educators, school counselors, or college counselors. Almost all (97.8%) had been exposed to ethics education in a variety of ways in their training programs (see Table 1 ).
When asked to identify membership in a maximum of three associations other than ACA, 488 respondents identified 228 separate associations. Some of the more common responses were the American Psychological Association (6.4%), National Board for Certified Counselors (5.9%), American Mental Health Counselors Association (4.3%), American Association of Marriage and Family Therapists (4. 1%), ACES (3.7%), Chi Sigma Iota (3.7%), and American School Counselors Association (3.7%). Approximately half of the 288 associations were identified by one or two persons and included a large number of state counseling associations.
Item Response Agreement
Paralleling the Gibson and Pope ( 1 993) article, we agreed that if 90% of respondents deemed an item on Scale 1 as ethical or as unethical, the item would be viewed as having very strong agreement. Items 1-6 and Items 57-77 met this cutoff (see Table 2). Items 7-1 1 and Items 43-56 reflect agreement by 75% to 90% of respondents, thus indicating a fair amount of concordance. Items 12-42 reflect the most discord in that 25% to 50% of respondents differed regarding whether the item was ethical or unethical. Means and standard deviations based on Scale 2 are also listed in Table 2 and reflect the strength of the response for each item.
To highlight broad areas that reflect the most confusion, we independently placed responses in which 25% to 50% of participants disagreed (Items 12-42) into one of 16 categories developed after an extensive review of the ethics literature. Through an inductive reasoning process, we placed all items into six final categories: the counseling relationship, promoting the welfare of the client, social and cultural issues, relationship and boundary issues, informed consent and confidentiality, and professional/practice issues (see Table 3).
[TABLE 1 OMITTED]
Responses Based on Demographics
Using Scale 1 (items identified as either ethical or unethical), we performed chi-square tests on all items as a function of demographics. As with Gibson and Pope (1993), to control for Type I error, we set significance at ? < .001. Significance was examined for gender, age, specialty area, current position held, ethnicity, and degree.
Relative to gender, women saw the following items as slightly more unethical than men did: referring a client unhappy with his or her homosexuality for reparative therapy, trying to change your client's values, trying to persuade your client to not have an abortion even though she wants to, and not informing clients of their legal rights (see Table 4 for chisquare statistics, phi coefficient, and 95% mean CIs).
To determine trends in age differences, we dichotomized the group into those younger and older than age 40 years. Younger counselors viewed it as slightly more unethical than did older counselors to accept clients who are only male or only female, accept clients only from specific cultural groups, and keep clients' records in an unlocked file cabinet. Younger counselors viewed it as slightly more ethical to use the title "Ph.D. Candidate" in clinical practice while completing one's dissertation (see Table 4).
Relative to self-identified specialty area and current position held, four items consistently showed significance, with school counselor "types" (those who had a specialty area in school counseling or worked as a school counselor) being significantly different from other specialty areas or counseling positions on these same four items. Thus, to increase total sample size, we compared all school counselor "types" with a combined group of "other counselors." In the comparison, "other counselors" found it slightly more ethical than school counselor "types" to have clients address you by your first name, make a diagnosis based on the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders [4th ed., text rev.; American Psychiatric Association, 2000]), refrain from making a diagnosis to protect a client from a third party (e.g., an employer), and not report when you suspect that your client is being abused by his or her spouse (see Table 4).
Because the number of ethnic minority respondents was small, it was decided to compare those who identified as Caucasian with a combined group of all other ethnicities. The group that self-identified as Caucasian viewed it as slightly more ethical to encourage a client's autonomy and self-determination; self-disclose to a client; provide services to an undocumented worker; console a client by touching him or her; publicly advocate for a controversial cause; attend a client's wedding, graduation ceremony, or other formal ceremony; and barter for counseling services (see Table 4).
Finally, relative to degrees counselors held, all groups saw it as very unethical to view homosexuality as a pathology; however, those with doctoral degrees saw it as slightly less unethical than did those with bachelor's, master's, or educational specialist degrees (see Table 4).
There are inherent limitations to survey research such as this. First, although the sample was fairly large and mimicked ACA's demographics, there is a chance it may not be representative of ACA members in general. Of course, ACA members may not be indicative of all counselors. Relative to significant differences based on demographics, although differences were found, for the most part, they did not show practical differences and should be taken tentatively. Also, because of the nature of survey research, and particularly forced-choice research such as what was partially used here (terms ethical or unethical), results can be skewed. First, the context of many of the behaviors may be perceived differently by respondents. Also, forcing a respondent to make a choice as to whether a situation is ethical is not how most ethical dilemmas play themselves out, because they tend to be complex and need to be carefully thought through. Finally, although 3 1 items proved to show a large amount of disagreement, determining if such disagreement is positive or negative is difficult. For instance, disagreement could reflect the complexity of the issue, lack of training on the issue, differing opinions that do not reflect a right or wrong response, or differences in ethical codes. Given all of these possible limitations just cited, the following offers some thoughts on what was found.
[TABLE 2 OMITTED]
[TABLE 3 OMITTED]
Increase in Ethics Education
Whereas Gibson and Pope ( 1 993) surveyed nationally certified counselors, this study examined ACA members and conclusions should be tentative. However, given that 68% of those in the Gibson and Pope study were ACA members, and because demographics from their study mimic those from the current one, some conclusions can be drawn. One glaring change is the number of respondents who now indicate they have been exposed to ethics education. Whereas Gibson and Pope found 27% of their respondents had no ethics instruction in graduate school, this study found 97.8% of respondents had it. Also, whereas 29% of respondents in the earlier study reported taking a formal ethics course, this study found about 60% reported having taken one or more ethics courses and about the same number reported that ethics was infused throughout their program. Such dramatic changes demonstrate a major shift nationally. Clearly, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) is largely responsible for this shift, with its requirement that ethical standards be studied (CACREP, 2009; Urofsky & Sowa, 2004). It is also likely that knowledge of ethics has expanded as the result of licensing boards requiring continuing education in ethics (CEU-Hours.com, 2009), an increasingly litigious society that encourages up-to-date knowledge of ethics to avoid malpractice suits (Neukrug et al., 2001; Remley & Herlihy, 2010; Saunders et al., 2007), and an increase in scholarly works in ethics.
Differences as a Function of Demographics
This study found significant differences as a function of demographics on a number of items, although most showed little practical differences (see Table 4). This lack of practical differences is highlighted by the small differences in CIs on items found to be significant. In fact, when items on Scale 1 (ethical/not ethical) were found to be significant as a function of demographics and subsequently examined based on CIs from Scale 2 (- 1 0 through + 1 0), only 1 - or 2-point differences were found on almost every item, hardly powerful differences (see Table 4). This is also reinforced by the phi values; phi correlations show the strength of the relationship between variables and are an indication of effect size. In this study, they tended to hover between the . 1 and .2 range, which indicates a small effect size. Keeping in mind this lack of power, or limited real-world differences, the following offers some explanation of why these differences may have been found.
[TABLE 4 OMITTED]
With respect to gender differences, men were more likely to try and persuade clients to change in some manner (to not have an abortion, change clients' values, refer client unhappy with his or her homosexuality for reparative therapy). Similarly, men were more likely to not inform clients of their legal rights. These results suggest that gender differences in ethical decision making may be an area for elaboration and discussion in ethics education. Relative to age, younger counselors saw it as more unethical to see only male or female clients or clients from specific cultural groups. Perhaps Baby Boomers' ethic to fight for civil rights and acclaim differences is being challenged by the Generation Xers' and Millennials' increased comfort with diversity (Shallcross, 2009). Younger counselors were also more comfortable using the title "Ph.D. Candidate." Perhaps they are less concerned about the actual meaning of a title and thus more willing to use a title that could be confusing to some clients. Younger counselors also saw it as slightly more unethical than older counselors did to keep records in an unlocked file cabinet. Maybe younger counselors are more familiar with changes in the ACA code and in the laws that stress the importance of securing records (ACA, 2005; U.S. Department of Health and Human Services, 2003; see Table 4).
Those who self-identified as school counselors responded differently than did other counselors on a number of items (see Table 4). With school counselors generally not being trained in diagnoses (Bauer, Ingersoll, & Burns, 2004), "making a diagnosis based on DSM-IV-TR" was seen as more unethical for school counselors and showed one of the most powerful differences of all items (about 3 points on Scale 2). "Other counselors" saw it as slightly more ethical than school counselors to "refrain from making a diagnosis to protect a client from a third party," possibly because they are more likely to face this issue. With the emphasis on reporting abuse in the schools, it is understandable that "other counselors" deemed it slightly more ethical "to not report when you suspect that your client is being abused by his or her spouse." Finally, with the schools generally requiring students to address teachers and counselors by their last names, one can understand why "other counselors" were slightly more likely to endorse "having clients address you by your first name."
[TABLE 5 OMITTED]
Relative to ethnicity, members of the self-identified Caucasian group were slightly more likely to encourage a client's autonomy and to self-disclose to a client, which are both traditionally Western values (Richmond & Guindon, 2008; Sue et al., 1998; see Table 4). On all other items, the group composed of other ethnicities tended to be more conservative than the Caucasian group in that they were slightly less likely to console a client through touch; publicly advocate for a controversial cause; attend a client's wedding, graduation, or other formal ceremony; or barter for counseling services. Perhaps being a member of a minority group lends oneself to being more careful when in the mainstream. Knowledge of such differences can help all counselors examine how some decisions we make may be related to our ethnic background and helps us change future ethics codes to be more attuned to counselors from a variety of ethnic backgrounds (Henriksen & Trusty, 2005).
Finally, it was surprising that those who self-identified as doctoral students, compared with respondents with other degrees, were slightly more likely to treat homosexuality as pathology. This finding is perplexing but suggests our work is not done in informing doctoral students about the normalcy of homosexuality.
Items in Which a Large Number of Respondents Disagreed
Perhaps the most interesting and meaningful part of this study were those items in which 25% to 50% of respondents disagreed. These 3 1 items, which represented 40% of all items, may need to be addressed more thoroughly in ethics codes or discussed more intensely in courses and workshops. To highlight these difficult or confusing ethical areas, the current article distributed the 3 1 items into six categories (see Table 3). Relative to the category "counseling relationship," attention should be paid to "counseling a terminally ill client about end-of-life decisions" and "providing counseling over the Internet," because counselors might need guidance in understanding these relatively new ethical issues (Kaplan et al., 2009; Shaw & Shaw, 2006; Werth & Crow, 2009). Also, "using techniques that are not research based" can be an ongoing dilemma for counselors who are faced with upwards of 400 theories from which to choose techniques (Gabbard, 1995; "List of Psychotherapies," 2010). Finally, "pressuring a client to receive needed services" as well as "telling your client you are angry at him or her" probably should be discussed in ethics training in light of the powerful impact a counselor's use of language can have on clients (Dorre & Kinnier, 2006).
In the category "promoting the welfare of the client," the complexity of potentially breaking the law to protect clients' rights is evident in all three items from this category and provides fodder to any discussion on ethical decision making (see Table 3). The tension between protecting your client's welfare and committing a potential crime in doing so is a decision not lightly made and clearly has the potential for serious consequences. For instance, some states require mandatory reporting of child, spousal, and elder abuse, and in some circumstances, such reporting may not be deemed in the best interest of the client (Welfel, 2010; Welfel, Danzinger, & Santoro, 2000). Perhaps the fear of legal retribution has resulted in 45% of counselors saying it was unethical to refrain from making a diagnosis to protect a client from a third party, despite the ACA Code of Ethics explicitly stating "counselors may refrain from making and/or reporting a diagnosis if they believe it would cause harm to the client or others" (ACA, 2005, Standard E.5.d.; Kaplan et al., 2009).
In the category "social and cultural issues," counselors should probably be relieved that more than 94% of respondents believe homosexuality is not pathological. An increase from 86% in Gibson and Pope's (1993) study, these results reflect the continual erosion of the view that homosexuality is a disorder. It should be of no surprise, therefore, that the vast majority of counselors (96.6%) viewed "referring a client who is satisfied with his or her homosexuality for reparative therapy" as unethical. However, more than 38% of counselors believed it is ethical to refer a client who is unhappy with his or her homosexuality for reparative therapy. Maybe counselors believe a gay, lesbian, or bisexual client who is unhappy with his or her sexuality should be afforded all possible avenues for change. However, taking into account the potential harmful effects of such a referral, as well as the lack of empirical support for this approach, ACA strongly warns against it:
The ACA Ethics Committee strongly suggests that ethical professional counselors do not refer clients to someone who engages in conversion therapy or, if they do so, to proceed cautiously only when they are certain that the referral counselor fully informs clients of the unproven nature of the treatment and the potential risks and takes steps to minimize harm to clients. (Whitman, Glosoff, Kocet, & Tarvydas, 2006, Interpretation section, para. 10)
Also in the social and cultural issues category, it was found that providing services to only one ethnic group or one gender were controversial items. On the one hand, although it is not banned by the profession's ethics code, some counselors likely believe that a counselor should see any client who seeks help, as long as the counselor is reasonably competent in working with that client's issues. On the other hand, others might argue that one's best work is done when one can specialize.
As evidenced by this survey, issues around what kinds of relationships are permissible are still somewhat confusing to counselors and need to be addressed in course work and continuing education (see Table 3, "relationships and boundary issues"). In the revised version of the ACA Code of Ethics (ACA, 2005), the term dual relationships was removed because it is "nondescript and does not give good guidance to the profession or to clients who have an ethical concern or complaint" (Kaplan et al., 2009, p. 244). Instead, the ethical code distinguished three kinds of relationships in which boundary issues could become a factor: sexual and romantic relationships, nonprofessional relationships (e.g., attending a client's wedding), and professional role change relationships (e.g., changing from couples work to working with one member of a couple).
Issues related to informed consent and confidentiality are some of the more difficult and nuanced ethical concerns counselors face. Perhaps, then, it is not surprising that a number of items in this area showed a fair amount of disagreement. Three of these items were related to the ethics of counseling minors and informing parents of their child's involvement in counseling (e.g., Items 18, 25, and 42; see Table 3). State and federal laws vary on parents' right to access information about what their child is sharing in counseling, although most statutes have sided with the parents' right to gain such information (C. Borstein, personal communication, November 19, 2010; Remley & Herlihy, 2010). Meanwhile, in the ACA Code of Ethics (ACA, 2005), an attempt has been made to balance the rights of minors for confidentiality with the rights of parents to access information about their children's counseling sessions (Remley & Herlihy, 2010; Remley & Huey, 2002). Clearly, informing counselors of relevant laws and discussing related ethical issues in this area is critical and should be ongoing (Lehr, Lehr, & Sumarah, 2004). Two other controversial items in this category are "keeping records on computers" and "client rights to view their case notes" (Items 1 2 and 30, respectively; see Table 3). The ACA Code of Ethics highlights these issues in multiple places (e.g., Standards A. Lb. and B. 6.). In addition, the Family Education Rights and Privacy Act and the Health Insurance Portability and Accountability Act speak to clients' rights to access records, except for case notes under certain circumstances (Remley & Herlihy, 2010; U.S. Department of Health and Human Services, 2003). Understanding the ethical and legal implications related to these items are complex and should be discussed thoroughly during ethics education. Two other items in this category had to do with the limits of confidentially when conducting family counseling and group counseling (Items 21 and 33, respectively; see Table 3). Although the ACA Code of Ethics provides some guidance, counselors need to be clear that confidentiality cannot be guaranteed when conducting group or family work (Remley & Herlihy, 2010). Finally, two items focused on sharing information with nonclinical supervisors: sharing confidential information with an administrative supervisor and sharing confidential information with a colleague (Items 20 and 38, respectivley; see Table 3). Being clear about when to share information and informing clients about the limits of confidentiality are important ongoing issues in counseling and may need to be discussed more frequently in training and at workshops.
A number of professional and practice issues emerged in the last category where disagreement existed among counselors (see Table 3). For some items, their ethicalness is clearly debatable and probably contextual (e.g., "not being a member of a professional association in counseling," "not having malpractice coverage," "while completing one's dissertation, using the title 'Ph.D. Candidate' in clinical practice," and "engaging in a helping relationship with a client [e.g., individual counseling] while the client is in another helping relationship [e.g., family counseling] without contacting the other counselor"). Although these items are touched upon in the ACA Code of Ethics (ACA, 2005), how to address any one situation can vary and offering scenarios that address various permutations of these situations can help counselors make decisions about how they might address each of these areas. Other items in this category are sometimes unethical and illegal. For instance, "charging for individual counseling while seeing all members of a family" is not allowed by some agencies and insurance companies and can be medical fraud. Additionally, "reporting a colleague's unethical conduct without first consulting with the colleague" is generally frowned upon by the ACA Code of Ethics (see Standard H.2.b.). Clearly, increased discussion around these issues can help counselors develop nuanced yet appropriate ways of responding when faced with such dilemmas.
Throughout counselors' careers, ethics training should be ongoing. As was evidenced in this study, what is important during one year, or one decade, can dramatically change as the profession changes and societal values shift. Although surveys like the current one have implicit problems, such as possible population selection bias, potential problems with the lack of randomness of respondents, and sometimes difficulty with interpretation of results, they give counselors one additional view of the kinds of struggles they have when making difficult ethical decisions.
American Counseling Association. (1995). Code of ethics and standards of practice. Alexandria, VA: Author.
American Counseling Association. (2005). ACA code of ethics. Alexandria, VA: Author.
American Counseling Association. (2009, August 1). Membership report. Alexandria, VA: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
American Psychological Association. (2008). Report of the ethics committee, 2007. American Psychologist, 63, 452-459. doi:10.1037/0003-066X.63.5.452
Bauer, A. L., Ingersoll, E., & Burns, L. (2004). School counselors and psychotropic medication: Assessing training, experience, and school policy issues. Professional School Counseling, 7, 202-2 1 1 .
CEU-Hours.com. (2009). Online continuing education. Retrieved from http://www.ceu-hours.com/
Chauvin, J. C, & Remley, T. P. (1996). Responding to allegations of unethical conduct. Journal of Counseling & Development, 74, 563-568.
Corey, G., Corey, M. S., & Callanan, P. (2011). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.
Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 CACREP standards. Retrieved from http://67. 1 99. 1 26. 1 56/doc/2009%20Standards.pdf
Dorre, A., & Kinnier, R. T. (2006). The ethics of bias in counselor terminology. Counseling and Values, 51, 66-80.
Edwards, P., Roberts, I., Clarke, M., DiGuiseppi, C, Pratap, S., Wentz, R., & K. wan, 1. (2002). Increasing response rates to postal questionnaires: Systematic review. British Medical Journal, 324. 1 1 83-1 1 85.
Gabbard, G. O. (1995). Are all psychotherapies equally effective? The Menninger Letter, 3, 1-2.
Gibson, W. T., & Pope, K. S. (1993). The ethics of counseling: A national survey of certified counselors. Journal of Counseling & Development, 71. 330-336.
Glosoff, H. L., & Freeman, L. T. (2007). Report of the ACA ethics committee: 2005-2006. Journal of Counseling & Development, 85, 251-254.
Henriksen, R. C, & Trusty, J. (2005). Ethics and values as major factors related to multicultural aspects of counselor preparation. Counseling and Values, 49, 180-192.
Hill, A. L. (2004). Ethical analysis in counseling: A case for narrative ethics, moral visions, and virtue ethics. Counseling and Values, 48, 131-148.
Jansen, K. J., Corely, K. G., & Jansen, B. J. (2007). ?-survey methodology. In R. A. Reynolds, R. Woods, & J. D. Baker (Eds.), Handbook of research on electronic surveys and measurements (pp. 1-8). Hershey, PA: Idea Group Reference.
Kaplan, D. M., Kocet, M. M., Cottone, R. R., Glosoff, H. L., Miranti, J. G., Moll, E. C, . . . Tarvydas, V. M. (2009). New mandates and imperatives in the revised ACA Code of Ethics. Journal of Counseling & Development, 87, 241-256.
Krejcie, R. V, & Morgan, D. W. (1970). Determining sample size for research activities. Educational and Psychological Measurement, 30, 607-610.
Lehr, R., Lehr, ?., & Sumarah, J. (2004). Confidentiality and informed consent: School counsellors' perceptions of ethical practices. Canadian Journal of Counselling. 41. 16-30.
List of psychotherapies. (2010). In The Wikipedia free encyclopedia. Retrieved May 5, 2009, from http://en.wikipedia.org/wiki/ List_of_psychotherapies
Milliken, E., & Neukrug, E. (2009). Perceptions of ethical behaviors: A survey of human service professionals. Human Service Education, 29, 35^18.
National Association of Social Workers. (2008). NASW office of ethics and professional review. Retrieved from http://www.socialworkers.org/nasw/ethics/default.asp
Neukrug, E., Lovell, C, & Parker, R. J. (1996). Employing ethical codes and decision-making models: A developmental process. Counseling and Values, 40, 98-106.
Neukrug, E., Milliken, T, & Waiden, S. (2001). Ethical complaints made against credentialed counselors: An updated survey of state licensing boards. Counselor Education and Supervision, 41, 57-70.
Ponton, R. E, & Duba, J. D. (2009). The ACA Code of Ethics: Articulating counseling 's professional covenant. Journal of Counseling & Development, «7, 1 17-121.
Remley, T. P., & Herlihy, B. (2010). Ethical and professional issues in counseling (3rd ed.). Upper Saddle River, NJ: Merrill.
Remley, T. P., & Huey, W C. (2002). An ethics quiz for school counselors. Professional School Counseling, 6, 3-11.
Richmond, L. J., & Guindon, M. H. (2008). European Americans. In G. McAuliffe (Ed.), Culturally alert counseling: A comprehensive introduction (pp. 255-292). Thousand Oaks, CA: Sage.
Saunders, J. L., Barros-Bailey, M., Rudman, R., Dew, D. W, & Garcia, J. (2007). Ethical complaints and violations in rehabilitation counseling: An analysis of Commission on Rehabilitation Counselor Certification data. Rehabilitation Counseling Bulletin, 51, 7-13.doi:10.1177/00343552070510010301
Shallcross, L. (2009, November). From generation to generation. Counseling Today, 52, 38 - 4 1 .
Shaw, H. E., & Shaw, S. E (2006). Critical ethical issues in online counseling: Assessing current practices with an ethical intent checklist. Journal of Counseling & Development, 84, 41-53.
Smith, M. H. (2004). A sample/population size activity: Is it the sample size of the sample as a fraction of the population that matters? Journal of Statistics Education, 12(2). Retrieved from www.amstat.org/publications/jse/vl2n2/smith.html
Sue, D W, Carter, R. E, Casas, J. M., Fouad, N. ?., Ivey, A. E., Jensen, M., . . . Vazquez-Nutall, E. ( 1 998). Multicultural counseling competencies: individual and organizational development. Thousand Oaks, CA: Sage.
Urofsky, R" & Sowa, C. (2004). Ethics education in CACREPaccredited counselor education programs. Counseling and Values, 42, 37-47.
U.S. Department of Health and Human Services. (2003). Summary of the HlPPA privacy rule. Retrieved from http:// www.hhs.gov/ocr/privacy/hipaa/understanding/summary/ privacysummary.pdf
Waiden, S. L., Herlihy, B., & Ashton, L. (2003). The evolution of ethics: Personal perspectives of ACA ethics committee chairs. Journal of Counseling & Development, 81, 106-110.
Welfel, E. R. (2010). Ethics in counseling and psychotherapy (4th ed.). Belmont, CA: Brooks/Cole.
Welfel, E. R., Danzinger, P. R., & Santoro, S. (2000). Mandated reporting of abuse/maltreatment of older adults: A primer for counselors. Journal of Counseling & Development, 78, 284-292.
Werth, J. L., Jr., & Crow, L. (2009). End-of-life care: An overview for professional counselors. Journal of Counseling & Development, 87, 194-203.
Whitman, J. S., Glosoff, H. L., Kocet, M. M., & Tarvydas, V. (2006). ACA in the news: Ethical issues related to conversion or reparative therapy. Retrieved from http://www.counseling.org/ PressRoom/NewsReleases.aspx?AGuid=b68aba97-2f08-40c2a400-0630765f72f4
Ye, J. (2007). Overcoming challenges to conducting online surveys. In R. A. Reynolds, R. Woods, & J. D. Baker (Eds.), Handbookof research on electronic surveys and measurements (pp. 83-89). Hershey, PA: Idea Group Reference.
Edward S. Neukrug and Tammi Milliken, Department of Counseling and Human Services, Old Dominion University. Correspondence concerning this article should be addressed to Edward S. Neukrug, Counseling Program, Department of Counseling and Human Services, Old Dominion University, Room 110, Norfolk, VA 23529 (e-mail: email@example.com).
© 201 1 by the American Counseling Association. All rights reserved.